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Attention, Representation, Affiliation
Sick persons and those who care for them become obligatory story-tellers and story-listeners. Hippocrates knew this, Chekhov knew this, Freud knew this, and yet knowledge of the centrality of storytelling was obscured in medicine throughout much of the last century. With the rise of interest in the humanities in general and literary studies in particular among medical educators and practitioners, today's medicine is being fortified by a rigorous understanding of narrative theory, appreciation of narrative practice, and deepening respect for what great literary texts can contribute to the professional development of physicians and the care of the individual patient (Hawkins and McEntyre; Anderson and MacCurdy). This rise of the power of storytelling in medicine helps me to conceptualize what has been evolving in my own practice of internal medicine and in the emerging field of narrative medicine.
You'd think that doctors, nurses, and social workers know of the centrality and privilege of storytelling in their practice. What else do we think we are doing when we ask someone in pain about their situation? Even the junior medical student who says, "What brought you to the clinic today?" and is met with the answer, "The M104 bus" knows that he or she is in search of a story. And yet, there has been an odd diminishment of the status of storytelling in medicine ever since we decided we knew enough about the body by virtue of reducing it to its parts that we did not need to hear out its inhabitant. [End Page 261]
As a general internist and literary critic, I have been brooding about the place of narrative in medicine for a long time. Our Program in Narrative Medicine at Columbia University has developed an agenda in research, teaching, and scholarship devoted to examining and studying the relations of narrative thinking and practice to being sick or taking care of sick people. Indeed, the field of literature-and-medicine or medical humanities has for decades been excavating the relationships between literature and medicine, both in terms of literary texts and literary theory (see Hunter; Gilman). Narrative medicine is a more evidently clinical cousin of this intellectual discipline. I define it as medicine practiced with the narrative competencies to recognize, absorb, interpret, and be moved by the stories of illness (Charon). Not unlike nuclear medicine or internal medicine, you can practice narrative medicine and still be a doctor!
It became clearer and clearer to my colleagues and me that doctors, nurses, and social workers need rigorous and disciplined training in reading and writing for the sake of their practice. I am by no means the only one to have observed that being a close reader equips one to perform some of the most difficult tasks of the health care professionals: attentive listening, simultaneously being transported by a text while analyzing it most meticulously and critically (Keats would call this negative capability and psychiatrists might call it splitting), adopting alien perspectives, following the narrative thread of the story of another, being curious about other people's motives and experiences, and tolerating the uncertainty of stories (Holt).
More recently, many of us within medicine and within literary studies have realized the critical importance that writing—autobiography, memoir, pathography, fiction, personal essay—has developed within health care.1 Patients and their families are giving voice to their suffering, finding ways to write of illness and to articulate—and therefore comprehend—what they endure in sickness.2 The therapeutic potential of narrative medicine expands when we encourage patients to join us in writing their own medical charts, for patients are, or should be, the co-authors and curators of whatever records are kept about them. Health professionals, too, are writing reflective essays about their practice for medical journals or the trade press (Bolton). By telling of what we undergo in illness or in the care of the sick, we are coming to recognize the layered consequences of illness and to acknowledge the fear and hope and love exposed in sickness.
In examining the...