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2. Narrative Medicine
- Johns Hopkins University Press
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18 chapter two Narrative Medicine Many in psychiatry may fear that a turn to narrative will risk alienating their hard-nosed medical cousins. They may think to themselves, “With the recent decade of the brain, the growth in ‘hard’ science research, and the explosion of pharmacological interventions, we are finally starting to get some respect from our medical colleagues.We are no longer a‘soft’ specialty, one that is not‘really medicine.’ We can hold our heads high, wear white coats, and monitor blood pressures and body mass index without seeming silly. If we take a narrative turn, won’t we once again be seen by our medical colleagues as a pseudodiscipline—out of touch with the tough-minded realities of the brain and science?” As anxiety provoking as that thought may be for psychiatrists, there is a good chance that a narrative turn for psychiatry would have just the opposite effect, that it would increase psychiatry’s reputation rather than diminish it. Why? Because psychiatry’s wholehearted embrace of neuroscience and pharmaceutical treatments has become a single-minded obsession that can make psychiatry look absurd, even a little mad, in the eyes of many of its peers. And, more important, the leading edge of medicine has already taken a narrative turn. Yes, we are in a paradoxical moment when medicine is more open than psychiatry to the human and the storied aspects of clinical work. As counterintuitive as it may seem, by taking the narrative turn, psychiatry does not risk “getting away” from medicine as much as it gains the possibility of “catching up” to medicine.1 A Brief History of Medicine To understand the recent narrative turn in medicine, I shall tell a story that puts it in context and helps us understand the felt need for narrative work in today’s medical practice. This story (like all stories) could be told Narrative Medicine 19 with many beginnings, middles, and ends. The way I tell it starts not with Hippocrates or the many medical luminaries to follow him (such as Galen and Osler) but with Abraham Flexner—a former schoolmaster with no background in medicine. It goes something like this. In 1908 the Carnegie Foundation for the Advancement of Teaching chose Flexner to head up a commission to assess U.S. medical education. At the time, most American medical schools were two-year “proprietary” schools owned by local doctors and unaffiliated with universities. Teaching varied enormously, and the scientific standards were not a high priority. Flexner was picked to report on these medical schools on the strength of his connections; his brother was director of the Rockefeller Institute for Medical Research—an institution with much to gain from the commission ’s eventual findings (Hiatt 1999). Flexner began his investigation by setting a benchmark for medical education based on the then current practices in Germany and the few U.S. schools that followed these practices . The German approach placed priority on university education and scientific research, which for Flexner was the cutting edge of medical progress. Using this model as a guide, Flexner eventually concluded that U.S. medical training needed a wholesale overhaul. In the process of his report, Flexner narrowly defined the proper goals of medicine as the “attempt to fight the battle against disease” (Flexner 1910, 23). He argued that the future of pathology, therapeutics, and medicine depends on those trained in the methods of natural science. Clinicians must, in short, be“impregnated with the fundamental truths of biology ” (1910, 25). As Flexner reasoned, “The human body belongs to the animal world. It is put together of tissues and organs, in their structure, origin, and development not essentially unlike what the biologist is otherwise familiar.”Humans, like animals, are“liable to attack by hostile physical and biological agencies; now struck by a weapon, again ravaged by parasites” (1910, 25). Flexner’s analogy between humans and animals meant to him that the biological sciences provided the core content for all medical education. Consequently, he argued for medical student admission requirements, what we now call“pre-med,”that concentrated on chemistry, biology, and physics . Flexner’s first-year curriculum for medical school itself included anatomy , histology, embryology, physiology, and biochemistry, and the second year consisted of pharmacology, pathology, bacteriology, and physical [3.234.177.119] Project MUSE (2024-03-29 02:03 GMT) 20 Narrative Psychiatry diagnosis. Flexner’s third and fourth years took the student to the hospital setting for clinical experience in the use of the...