Stories of Sickness (review)

Howard Brody first published Stories of Sickness in 1987. Innovative and provocative at that time, Brody's text challenged medicine and medical ethics to take notice of a deeply rich and compelling line of thought and experience that acknowledged the implications and value of a narrative approach that could be integrated into clinical practice and ethical discourse.

The present volume, the second edition, is fuller and richer than the first. By my rough estimate, the first is composed of 86,000 words while the second extends to perhaps 147,000. Brody explains in the new introduction that he "extensively revised each chapter to try to bring the text up to date" (p. vi), and I found this claim to be true. Much of the prior text remains recognizable, especially the choices of literary stories and his interpretive discussions, but these pieces are classics, and we expect them to remain. What is new is Brody's view and summary of the last fifteen years of scholarship, during which new words and concepts, such as pathography and narrative ethics, have been explored, studied, and debated, and real-life experiences have confirmed that pursuing the narrative path in both fiction and nonfiction is important (as Brody and others thought in the 1980s). Through his analysis, the nature of stories of sickness and the field of narrative, including narrative ethics, are described clearly, and he documents the growth of the field from a conceptual, philosophical, theoretical basis to a more mature, well-defined, practical, and compassionate approach.

During the early years of the academic exploration of stories and narrative in medicine, I (in my role as a physician) asked myself on several occasions, "What is all this excitement and debate over stories about?" Naïve as I was at the time, I assumed that all physicians understood the importance of the many aspects of the patient's story, including the patient's story as medical history and its relationship to the accuracy of diagnosis, the telling of the story as a healing activity for the patient, as an opportunity to be heard or witnessed, and so on. My naïveté is gone after twenty years of teaching in a medical school. I know wholeheartedly now that ongoing exploration of the story is important as a discipline. First, many practicing physicians and trainees do not recognize or understand the power of the patient's story, and they may do harm to patients as a result. Second, the theoretical framework that has evolved now allows physicians, educators, and patients, if they wish, to climb into the confusion, suffering, pain, and joy of the experience of sickness and attempt to understand it from intellectual, experiential, inside-out, and deconstructed perspectives. Stories are an intimate as well as an essential aspect of medicine and offer an entrance into the world of possibility and healing relationships.

Through philosophical reflections and historical analysis, Brody brings us to this point of awareness, and he offers a full account of the progression of our understanding of "stories of sickness" to the present day. His aims, articulated in the preface, reveal that he has learned much during the last decade of this interdisciplinary discussion about narrative, with its focus on stories of health care providers, patients, and family members. He looks to narrative to help us understand what it means to be sick, for ethical guidance, and for improving health care and professional education.

What else is different about the second edition? This text is organized into two parts. The first ten chapters focus on "narrative in health care." Many of the chapter titles are familiar; however, as I noted earlier, much of the text has been revised. The groundwork for the volume is laid out in Chapter One, as Brody inquires into the "relationships between storytelling and healing—how the practice of medicine can be seen in part as a storytelling...