Narrative Medicine: Honoring the Stories of Illness (review)

More than a few years ago, in a hospital far from where my colleague and I each lived, we had reached the point in the session with the medical residents when the whining begins. The young physicians had listened respectfully while I had spoken from the patient’s perspective about what kind of doctor could best heal, rather than simply provide treatments. Now I was listening respectfully while they told me how The Realities of Medicine (including any possibility of their having future careers) made it impossible—much as they would like to—for them to practice that way. My colleague had been sitting unobtrusive and quiet; some of them might even have forgotten she was there. Suddenly, she unfurled her colors and her professional self. Coming in low and fast with the sun behind her, she blasted them with her message: Don’t tell me you can’t; here’s how you can, exactly how. To see Rita Charon in full teaching mode is to behold a force of nature. I cannot know how long her effect on those residents lasted. But now, for teaching programs everywhere that cannot experience the force herself, live and in person, this book is the next best thing.

I open with this anecdote in part to underscore that this review is anything but disinterested. Charon has traveled about so much, given so many lectures and workshops, edited this very journal for so long, that finding a reviewer who does not know her would require searching dark regions. To call this book long awaited is an understatement. Charon, despite her many articles and chapters, and her edited works, has waited a long time to produce a book of her own. The finished product reflects the time spent sifting and refining, hearing every objection, assessing what made clinical successes possible. Narrative Medicine is anything but a cobbling together of Charon’s previous shorter writing—something it would have been all too easy for her to do. Instead, it is a finely structured work, integrating a range of medical and literary source material, as well as clinical experience and observation. In Charon’s writing as in her personal presence, she effects the inseparability of the practical and theoretical, the clinical and the humanistic. Her consistently unified authorial voice brings multiple audiences and reader needs into dialogue with each other. She leaves no doubt that practicing narrative medicine is possible.

Narrative Medicine is both what Charon calls a “primer for this new field of narrative medicine” and a “manual for teachers of reading and writing in the medical context” (x). I would add that it is also a manifesto, a moral plea for how medicine can continue to be a profession in the changing times of this new century. Charon offers physicians—and, to a lesser extent, other health professionals—a compelling image of how they can become and remain true healers to their patients. More by indirection, she offers those patients a vision of the medicine they need and deserve. I fantasize how readily this book could be revised as a manual for patients to teach their physicians how to be more attentive, empathic, and effective doctors.

What, then, is Charon’s vision of narrative medicine? The core elements are what I would summarize as moral generosity (my phrase), coupled with what Charon calls the skills of close reading (her phrase). Narrative medicine begins in Charon’s dialogical conception of being human: “We [in this usage, we humans] get to know ourselves as a result of the vision of others, and we [shifting, on my reading, to we physicians] are able to donate ourselves as instruments of others’ learning” (10). Charon writes later in the book of “the courage to relinquish one’s own coherent experience of the world for another’s unexplored, unplumbed, potentially volatile viewpoint” (112). With these clinical acts of donating and relinquishing one generously waives one’s own immediate purposes to be “at...