Narrative Medicine

Professors and peers constantly reassure arts and humanities students like myself that the arts and humanities are worthwhile studies because studying them will result in transferable skills. Unfortunately, such reassurance often stops short when it comes to pinpointing clear examples of how and where these skills transfer.  After spending three intensive days studying narrative medicine at a Columbia University workshop, however, I finally have one clear answer: medicine.1

The phrase “narrative medicine” is often met with perplexed faces by the uninitiated, as though the idea of humanities and science merging is the ultimate paradox. Yet these same faces are ones that have undoubtedly sat in a doctor’s offices sharing their stories of illness and health. In a medical world so focused on the STEM side of health care, we seem to have forgotten that what ultimately connects the health care practitioner to the patient’s illness is not medical biology or technology, but medical stories. Thus, by recognizing this, narrative medicine can “fortif[y] clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness.”2

Rita Charon, founder of the program in narrative medicine at Columbia University and an award-winning physician with a Ph.D. in English Literature, hypothesizes that “what medicine lacks today—in singularity, humility, accountability, empathy—can, in part, be provided through intensive narrative training. Literary studies and narrative theory, on the other hand, seek practical ways to transduce their conceptual knowledge into palpable influence in the world, and a connection with health care can do that.”3

Columbia University - Maryam Golafshani
Columbia University – Maryam Golafshani

This weekend reaffirmed for me that the theory, literary/artistic analysis, and creative writing us humanities students so regularly practice and engage with have significant implications in disciplines beyond our own. Imagine two doctors, one trained in narrative medicine and the other not, listening to the same story by the same patient. The doctor with traditional medical training will likely only absorb the patient’s story at the superficial level of content, whereas the doctor trained in narrative medicine can potentially distinguish when the narrating agent (the patient) differs from the focalizer (the narrative’s perspective), understand why the patient chose to alter the chronology and speed of event time in his/her narrative, unravel the meaning of the patient’s metaphors, appreciate the patient’s singularity, recognize pertinent themes, and much more. As such, this doctor will undoubtedly produce significantly more meaning from the same story, establish a stronger relationship with the patient, and likely identify a better diagnosis and treatment plan. And how do you instil such skills in a health care practitioner? By doing exactly what we do in arts and humanities classrooms. At the workshop, several hours of each day were dedicated to close readings of literary texts ranging from a short story by J.D. Salinger to a film by Yojiro Takita. Rita Charon recognizes, as us humanities students can attest to, that close reading and narrative competence “takes practice, skill, and long experience with many texts,” but yields “replenishing dividends of creativity, self-knowledge, understanding of others, and deep aesthetic pleasures.”4

Along with acquiring these analytical skills, narrative medicine relies heavily on reflective writing practices. Several times daily in small seminar groups we would be presented with prompts and a mere five minutes to respond in words. We would then listen to the author read his/her words aloud to the group, just as a health care practitioner listens to patient’s story. By engaging in a literary analysis of the text, not the author, we were able to provide the space necessary to productively reflect on the work without attempting to mimic the role of a therapist. In her plenary talk on “The Skills of Bearing Witness to the Suffering of Others”, Kristen Slesar powerfully stated that “narrative medicine is not therapy, but it is therapeutic.” During these reflective writing seminars, we were often surprised by what we revealed through our writing, how quickly we opened up to each other, and how strong, empathetic relationships were established in a mere three days. Rita Charon highlights how “writing unlocks reservoirs of thought or knowledge otherwise inaccessible to the writer,”5 something we quickly learned first-hand at the workshop. For those working in health care, encounters with illness and death undoubtedly take their toll, and thus, reflective writing is also a powerful tool to come to terms with these often traumatic experiences. Marian M. MacCurdy reveals how reflective writing through personal essays can allow the authors to “become both owners of their moments and witnesses for others” as the personal essay begins the author’s “journey into themselves, but the journey will take them ultimately out of themselves and back to a community which can re-establish our common humanity.”6 The inter-subjective nature of engaging the texts, whether its works of literature or someone’s piece of reflective writing, fosters empathetic affiliations where one can effectively recognize and act upon the ethical duties incurred by bearing witness to someone’s story.

Narrative Medicine Workshop - Maryam Golafshani
Narrative Medicine Workshop – Maryam Golafshani

It was refreshing, to say the least, to be in an environment outside the faculty of Arts and Humanities where what we do as humanists is genuinely valued and the positive outcomes of engaging with our practices are made real. While narrative medicine does, to a certain extent, produce a clear answer to the question of why a humanities education matters, there still exists a matter of importance that can’t be specifically pinpointed — something that you fumble to describe, something that you just know in your core. Yet, I believe it is precisely this elusive quality of why a humanities education matters that ultimately makes what we do so powerful; it reveals how what a humanities education offers is unlimited, excessive, insidious, and permeates our lives and actions so deeply and thoroughly that we can’t even put “our finger on it.” And this ability to live with the excess and unknown is a crucial lesson that humanities students learn everyday in class, but is also remarkably valuable for everyone since human lives are inevitably full of excess and the unknown.

Narrative Medicine: Honoring the Stories of Illness by Rita Charon (Oxford University Press, 2006). viii.
Narrative Medicine: Honoring the Stories of Illness by Rita Charon (Oxford University Press, 2006). ix.
Charon, Rita and Hermann Nellie (2012) “A Sense of Story, or Why Teach Reflective Writing?”
Academic Medicine 87(1): 5-7.
MacCurdy, Marian (2000) “From Trauma to Writing: A Theoretical Model for Practical Use.” Writing & Healing: Toward an Informed Practice, Edited by Charles M. Anderson and Marian M. MacCurdy.
National Council of Teachers, 2000. 158-200.

2 comments Add yours
  1. Maryam,
    Your blog was very well written and I enjoyed reading it. I was there at the workshop with you, but I don’t think we met. May I post your piece to my Facebook page, as it explains narrative medicine well? Many people ask me what it is and your piece will help. I too am working towards my BA, a life long dream. Right now I am enrolled in a Prior Learning Assessment program which enables you to write for credits using your life experiences. It is an insightful, challenging and empowering experience so far. Currently, I am working with OHSU (Oregon Health and Sciences University) in Portland, Oregon with a goal of hosting the first ever NW Narrative Medicine Conference! We are at the very beginning stages of planning and we are hoping to collaborate with CU. We are very excited! I am interested in hearing about the events you hosted titled “Stories of Illness and Health.” Would you be willing to share with me?
    Thank you,
    April Brenneman

    1. Hello April!

      Apologies for the delay in response, the Blog has been going through management turn-over and it seems your comment had slipped through our notifications. We’d be happy to share this material with you if you are still interested! Thank you!

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