- Terminology and Praxis: Clarifying the Scope of Narrative in Medicine
Until about thirty years ago, narrative and narrative theory were the province of those disciplines that have traditionally formed the accepted core of the humanities: literary, cultural, religious, and, to a lesser extent, philosophical studies. Researchers in these fields—whether hardcore narratologists or narrative ethicists—tend not to produce narratives, but to receive them. Their work involves commenting analytically on that reception, looking at the determinants, operations, and semantics of individual narratives or of narrative as a genus. Narrative theory now populates new and rather different territories—those fields that support narrative production as well as consumption, including history and historiography, ethnography, law, therapy, and of course, medicine.1
Our interest lies specifically in the theoretical and practical uses of narrative in the medical field, and we began with a review of the relevant literature that generated some surprising results. We expected the influence of narrative in medicine, which had captured the interest of physicians and scholars, to be legible in medical and humanities publications. Moreover, we had observed the ways in which popular culture reflected that interest in media, ranging from print publications such as The Atlantic Monthly and The New York Times to television series such as House, M.D.2 We were nonetheless surprised by the sheer volume of articles, essays, and editorials we discovered when we conducted a search in medical and humanities journals using the keywords “narrative and medicine.” Our search returned no fewer than 7,000 related writings, raising the question of precisely how narrative was being employed by its various proponents, for the remarkable quantity of this research alone does not give one a sense of the range [End Page 246] of approaches, methodologies, assumptions, and goals that the phrase “narrative medicine” has come to encompass (A more recent search in September 2011 using the same search terms but limited to the years 2009–2011 led to an additional 3,000 papers, though addressing the same array of issues as noted in the previous search). Many medical schools, for instance, have not only introduced the analysis of narratives—both fictive and non-fictive—but also the creation of narratives. Within the last twenty years, the study and teaching of medicine has, in short, embraced the entire realm of narrative theory and practice, as both consumers and producers.3
As Martin Kreiswirth puts it,
[at] every linguistic register, inside or outside academic or specialized discourse, in the marketplace, . . . [physician’s] office, or courthouse, narrative is inherently double; it points either to a kind of discursive performance—a telling, an ongoing method of organizing data (“x is a narrative, not an argument”; “the first words of his narrative fell flat . . .”)—or to that which has been performed—what has been told, a product, a conceptualized or reified content (“x is the most important narrative for that culture”)—or to both, indiscriminately. And the same holds true for the words story, tale, or account. Narrative by its very signification and cultural use is both presentation and presented; the narratological problematic, the basic formal relationship between the what and the how, is thus contained within the term itself and infects, to some degree, any attempt to define, legitimize, or criticize it.4
As well, for something to be labeled a narrative, it must stress sequence, causality, and even teleology. Through whatever media—linguistic, visual (static or dynamic)—narrative must place the represented phenomenon in a serially linked, temporally ordered chain, whose culminating end point is in a position to control what came before it.
The explosion of interest and the resulting proliferation of publications on medicine and narrative have not always concerned themselves with such definitional issues. Indeed the sheer range of such studies has, perhaps inevitably, led to a diffusion of concepts and terminologies—terminologies that are slippery enough in individual [End Page 247] disciplines, let alone in a cross-disciplinary context. For example, in The Routledge Companion to Historical Studies, published in 2000, the entry on Narrative cites forty-three works for “further reading.” Not one author among...