Narrative Medicine: Honouring the Stories of Illness
Oxford: Oxford University Press, 2006, 259 pp
Charon's book focuses on the practise of narrative medicine as a way of providing humane and empathic health care. Though the concept of narrative medicine is relatively new, the practise of narrative medicine has been around for quite a long time. Narrative medicine may be defined as a practise that develops a physician's narrative skills, such as recognizing, absorbing,interpreting and being moved by a patient's stories of illness. Narrative medicine has developed gradually from the humanities and medicine, primary care medicine, and a study of effective physician-patient relationships. There is very little in the practise of medicine that does not have narrative content because clinical practise is stamped with the telling and receiving of stories from patients and their lives.
A scientifically competent medicine alone cannot help a patient grapple with the loss of health and to find meaning in illness and dying. Physicians need the expertise to listen attentively to their patients, to understand as best as they can to the ordeals that their patients experience as a result of their illness, and to honour the meanings of their patients' narratives of illness It is only when physicians understand what the patient is going through can medical care proceed with humility, trustworthiness, and respect. Narrative medicine offers the hope that our health care system can become more humane and empathic than it has been in treating disease by recognizing and respecting those afflicted with illness. Narrative medicine has come to understand that patients and caregivers enter into sickness and healing, and that their efforts to get better or to help others get better cannot be fragmented away from the personal stories of their illness.
Medical practise is a much more narratively inflected enterprise than it realizes since there are intersubjective and ethical elements of healing from any illness, be it chronic or terminal. Narratives teach us where we come from and where we are going, allowing us to understand the meanings of our own lives. Medicine is making room and allowing for a type of humane and singular patient care that is unique to each patient. The patient's fear of an illness is almost as painful as the reality of having it. Narrative medicine always joins one human being with another. One key benefit of narrative medicine is altruism and empathy. The altruistic listener listens attentively to the authentic patient so that after a while the authentic speaker will understand what is said. The listener need not be a passive receptacle but instead is shaping, questioning, asking, probing, forming potheses, delving into possible interpretations, looking for clues everywhere, and listening for the patient's authentic voice. These narrative acts celebrate the self and the other, and mark the meeting between physician and patient as a mutual creation of identity.
The healing process begins when patients tell physicians their symptoms or even fears of illness. These narratives demonstrate how important is the process of a patient's sharing his/her pain and suffering. This process enables patients to give voice to what they endure and to frame the illness in terms that they understand. Without these narrative acts of telling and being heard, the patient cannot convey to the physician what (s)he is going through. Without these narratives, the patient cannot him/herself grasp what the event of illness really means. The unrehearsed, spontaneous sharing of sensations and feelings begins all the time in the doctor's office; however, usually this process is only allowed to proceed for less than a minute.Sadly, physicians are not equipped to listen to such telling of the self with a diagnostic and interpretive ear. Relative strangers share their deepest fears and aspirations about their health with the physician. It falls to physicians to actively listen to their patients' stories.
Through a physician's powers of reflection and clinical imagination, (s)he can recognize the plights of patients sometimes more clearly than the patients themselves. Physicians can, with deep empathy, name the suffering that they see, offer themselves humbly as one who recognizes, listens, and care about the patient's predicament. Different health care professionals will find themselves doing narrative medicine differently by virtue of their different interests, gifts and talents. Some physicians are better listeners or more empathic than their colleagues. This is perfectly acceptable. By being effective listeners, physicians are bearing witness to a patient's illness and suffering which helps physicians to overcome some of an illness pernicious divides. Recognizing, hearing out, receiving, and honouring the stories of illness may give physicians new tools with which to make contact with patients and to ease the psychological and physical suffering that is related to a particular disease.
Charon's book has been a joy to read because it develops a method of humane health care that will help patients feel more at ease talking about their illness and how it affects their lives. What is especially exciting is that Columbia University has just recently designed an intensive one year Certificate Program in Narrative Medicine ( www.narrativemedicine.org) for physicians and medical staff and is planning to offer short workshops throughout the year to develop narrative skills in health care. This is a demonstration of how narrative medicine can open doors toward the search for meaning in routine medical practise. Narratively informed health care can revise the goals of medicine to embrace a zeal for health as well as for unity. Narrative practise is by no means a cure for all of medical care's deficiencies. However, narrative medicine presupposes a set of skills and methods that can be applied to all aspects of medical practise. Its methods can be especially beneficial to cross boundaries, inhabit one another's perspectives, and build toward effective health care for all.
Irene Sonia Switankowsky, University of Wales, Lampeter