Editors' Preface: Narrative Medicine, or a Sense of Story

And this our life, exempt from public haunt, Finds tongues in trees, books in the running brooks, Sermons in stones, and good in every thing.

Shakespeare, As You Like It, 2.1

Literature and medicine, as a field of inquiry and practice, has led to important changes in the lived experience of illness and the day-to-day enterprise of caring for those who seek health care. The clinical legacy of literature and medicine begins from a ground-floor recognition that experiencing and treating sickness are language-using events. From here, we move spirally toward original sightings of the deep events of illness, health, and care of the sick. As Bernard says in his final chapter of Virginia Woolf’s The Waves, “The trees, scattered, put on order; the thick green of the leaves thinned itself to a dancing light. I netted them under with a sudden phrase. I retrieved them from formlessness with words.”¹ Retrieving things from formlessness with words is what we on either side of the clinical relationship are training ourselves to do. Form holds things, makes them visible—psychoanalyst Hans Loewald says writing makes the immaterial material—and so gives power to the viewer and to the representer to approach and perhaps to comprehend or at least to face the real, that which happens, that which matters despite all the forces that collude to keep them invisible.²

Over the decades in which literature and medicine has opened up these trains of thought, it has spawned many offspring. Questions of the meanings of clinical discourse raised in medical rhetoric, for example, have been amplified by the attention of literary scholars to conversations. Both specialization and boundary-crossing have occurred, with sub-fields devoted to specific genres or time periods, on the one hand, and collaborative work with feminist theorists, oral historians, trauma theorists, psychoanalytic scholars, and aesthetic theorists on the other. Our initial interest in literary texts has widened to now animate a powerful commitment to learn and teach in creative writing, visual arts, and performative arts.

Some of these offspring have been primarily scholarly pursuits, and some have been primarily clinical pursuits. As those trained in fields of the humanities and qualitative social sciences who work in literature and medicine have come to appreciate, it is the very presence of their disciplines’ ways of thinking that alters what might go on in the clinical settings. Hence, the introduction of the arts, humanities, and qualitative social sciences into clinical realms has contributed deeply to such fields as disability studies, bibliotherapy, health literacy, and studies in pathography.

We have called this special issue of Literature and Medicine “Narrative Medicine” to highlight the local and global contributions made by a relative newcomer to literature and medicine. In 2000, when this work started at Columbia University, a multi-disciplinary group of scholars and clinicians conceptualized the field of narrative medicine as the “clinical cousin” of literature and medicine. Wanting to widen our concerns beyond literature and even beyond the humanities, we strove to include in our work all aspects of narrative—narratological theory, qualitative social sciences, communication studies, phenomenology, spoken discourse, visual and performative narratives, and the growing evidence from all these fields of the unifying realities of story-telling in human interactions. We were not so much committed to literary studies or even to the humanities as to the harnessing of narrative theories and practices to improve the care of the sick. By concentrating on specific missions that began within the wide universe of literature and medicine—the teaching of close reading, reflective writing, narrative seeing in clinical training—we hoped to fortify clinical practice with the peculiarly narrative capacities to make contact and to affiliate with patients, colleagues, students, and the people.

We now find ourselves seeking to strengthen clinicians’ and patients’ sense of story, that dimension of human experience that sustains the meaning-making efforts of our lives. We try to offer the meaning-making face of medicine to patients and clinicians as an alternative to the relentless, fact-using face of medicine. As we turn...