The Art of Medicine

Narrative Medicine

Speaking of fascinating developments in medical training, did you know that Columbia University offers a Master’s degree in Narrative Medicine?  The program was created by Dr. Rita Charon, a doctor who went back to school and got a PhD in literature after she realized how important story-telling was to her job. 

Narrative medicine asks doctors to consider not just the chemistry and biology of disease, but also the person coming to the doctor’s appointment, how they describe their experience, how they contextualize health and illness, how they relate to their body or to their doctors, what values, ethics and life circumstances underlie their own goals for treatment.  People trained in narrative medicine are trained to listen to people’s stories and take them seriously, and also to help people formulate their experience into a more cohesive and meaningful story.  The intent is to provide treatment that is more humane and better suited to the person; to give patients back their place and voice at the center of their own experience; to recognize the narratives that are underlying the doctor’s and patient’s experience and expectations; and tap into the power of story to connect, support, create insight and, yes, even healing.

That’s a lot packed into a little story-telling!  And narrative medicine is a broad-ranging field, combining disciplines of anthropology, sociology, psychology, philosophy, literature and more.  Here’s the listing of core courses in the program at Colombia:

NMED K4020. Foundations in Narrative Medicine. 4 pts.
NMED K4025. Illness Narratives: Embodiment, Community, Activism. 4 pts.
NMED K4100. The Self and Other in the Clinical Encounter. 4 pts.
NMED K4110. Methods in Narrative Medicine. 6 pts.
NMED K4990. Applied Writing in the Narrative Medicine Context and Beyond. 4 pts.
Topics in Narrative Medicine
NMED K4028. Bodies, Illness and Care: Perspectives from Phenomenology and Beyond. 4 pts.
NMED K4040. The Literature of Art. 4 pts.
NMED K4220. Narrative, Health, and Social Justice. 4 pts.
NMED K4250. Co-constructing Narratives. 4 pts.
NMED K4290. Narratives of Death, Living & Caring at the End of Life. 4 pts.
NMED K4300. Research Methods in Narrative Medicine. 4 pts.

Why is narrative important for medicine?  The idea is to see beyond the narrow model that measures health and disease as something purely objective, located within the cells and tissues.  As an article in Huffington Post explains, narrative medicine “teaches physicians to be more comfortable asking such questions as: How do you feel about your illness? What are your religious beliefs? How has the pain changed your life?”  In the more traditional scientific model, how a patient feels about being sick isn’t relevant to how medicines work — but more and more research is showing that positive attitudes, feeling supported, feeling some degree of control can all aid in healing.  People will tolerate and even welcome pain if they feel there is some value or “gain” to it, while seemingly senseless pain can create chronic cycles of dysfunction.  And placebos work because we believe in them — they match our story of how illness is recognized, created, and treated, and provide a satisfying conclusion.

Listening to and telling stories can also help doctors and patients connect and understand each other.  Our brains are wired for stories.  They hook our attention, draw us in.  They make it easy to remember details, and are the most powerful way to change opinions and unite people.  If a patient feels that the doctor really listened and understood their concerns, they will feel calmer, trust the doctor more, and be more likely to follow the treatment.  A doctor who is trained in soliciting stories can gain more information from the patient about what is going on, what is important to them, what their goals for treatment are — and tailor treatment more effectively.  And together, doctor and patient can examine the narratives they bring in with them, and see where they could be refashioned to be more accurate, more empowering, and more aligned.  For example, in her wonderful book The Pain Chronicles, Melanie Thernstrom describes visiting a doctor for her chronic neck pain.  After evaluating her, the doctor explained her condition to her, pointing out features on a model skeleton.  The narrative of bone atrophy and vertebral displacement was familiar and clear to him, but to her the skeleton bore no relation to how she saw herself or wanted to be seen, and instead seemed like a chilling indictment of her pain.  She couldn’t listen to what he was saying, never came back or did the exercises he prescribed, and lived in pain for many more years before venturing any more treatment.

Thernstrom found this kind of disconnect to be common among the doctors and patients she observed.  Doctors felt confident in their knowledge and treatment plans, and patients felt that the doctor had not understood them and not addressed their concerns.  The important stories were not heard and shared.  In contrast, Dr. Charon, the founder of narrative medicine, explains the power of connection, and how powerful it can be to have a companion in illness, rather than just a medical exam.  I’ll give her the last word:

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  1. quite interesting, heard it before but still interesting.

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