Healing Through Stories: A Special Issue on Narrative Medicine

Keywords:

• Doctor-Patient Interaction
• Health Communication
• Narrative

If sickness calls forth stories, then healing calls forth a benevolent willingness to be subject to them, subjects of them, and subjected to their transformative power. (Charon, 2006, p. 216)

The field of communication boasts a rich history of narrative theory and practice (Bochner, 2002; Fisher, 1984; Rawlins, 2009), and communication scholars have contributed significantly to the narrative turn in health contexts (e.g., Ellingson, 2005; Geist-Martin, Berlin Ray, & Sharf, 2002; Harter, Japp, & Beck, 2005; Sharf & Vanderford, 2003). In this issue,1 we invite an interdisciplinary conversation that focuses on the value of narrative sensibilities for understanding and performing health and healing. As assumptions of scientific methods prove limiting in understanding the human condition, scholars across disciplines have turned to narrative as an organizing framework for studying and showing how meaning is performed and negotiated (e.g., Bochner, 1997, 2002; Bruner, 1986; Ellis, 2004; Frank, 1995; White, 1987). Healthcare providers are realizing how narrative capabilities such as imagining and plotting offer advantages in diagnostic and treatment processes, and in bearing witness to the suffering of others (e.g., Charon, 2006; Greenhalgh & Hurwitz, 1998; Montgomery, 2006). When exercising clinical judgment, providers remain poised between the singularity of lived experience and the generalities of a science-using practice and, thus, must rely on their own interpretive capacities to determine courses of action in inevitably ambiguous moments charged with emotionality, vulnerability, and uncertainty.

The Vice-Presidential Plenary Lecture delivered by Dr. Rita Charon at the 2007 National Communication Association (NCA) Convention serves as a point of departure for this special issue. In dialogic fashion, several scholars engage Dr. Charon's work and the broader interdisciplinary conversation, and delve into the storied nature of health and healing. Barbara Sharf, Lynn Harter, Kristin Langellier, Art Bochner, Bill Rawlins, Richard Zaner, and Teri Thompson offer renderings of pressing issues and inequities in health care, and identify therapeutic possibilities opened up when health care providers and patients alike engage narratives as primary resources in performing health care. By invoking narrative practices, narrative ethics, and narrative theory to enlarge healing practices, these authors offer images of how to live well in the midst of the inescapable suffering, trauma, and disability associated with the lived experience of illness. The essays illustrate the inextricable connection between narrative and healing, the ways unexpected life experiences call forth stories, and how narrative provides the hindsight to make meaning of the past and move toward a more hopeful future.

On Friday, November 16, 2007, over two hundred convention attendees gathered at the Chicago Hilton, Boulevard C in anticipation of the keynote to be delivered by Dr. Charon, Narrative Medicine as Witness to the Self-Telling Body. Charon is a Professor of Clinical Medicine and Director of the Program in Narrative Medicine at Columbia University. She is a pioneer and national authority in the field of narrative medicine, and has written extensively on provider–patient relationships, medical ethics, and empathy in medical practice. Guided by her leadership, Columbia University became the first medical school to establish a program in narrative competence. Few, if any, attendees had met Charon in person prior to NCA. Even so, many individuals knew her through her writing—a distant yet kindred spirit who inspired them to imagine the possibilities of narrative medicine. Most attendees remained past the close of the session riveted by the possibilities and anxieties that accompany moments when someone challenges you to stretch boundaries and reconsider realities you've come to know as true. “You see,” argued Charon, “The routine, obvious, and heretofore unproblematic ways of being in health care suppress rationalities, narrative ways of knowing, that are essential for fuller and richer relationships. Narrative and medicine are deeply about human troubles and expectations gone awry.”

Viewed aesthetically, the mandate of storytelling is what Burke (1931) described as “the element of self-expression in all human activities” (p. 52). We are all poets, narrators who symbolically give meaningful form to experiences, and in so doing craft and perform our sense of self and our worlds. We engage in narrative activity to identify and divide, cooperate and compete, perform and motivate action in poetry and fiction, news and bits of gossip, in courtrooms and boardrooms, and clinical settings and online support groups. “For health care providers,” emphasized Charon, “narrative training develops their capacities for attention, representation, and affiliation, all of which are needed to act on behalf of patients.” Drawing from her recent text (2006), Narrative Medicine: Honoring the Stories of Illness, Charon wove between the narratively inflected enterprise of diagnostic encounters and the plottedness of life itself, composed as it is of events befalling characters amidst a vortex of corporeal, cultural, relational, economic, artistic, and institutional forces. Charon expanded the narrowing gaze and impulses of biomedicine and offered a hopeful vision of healing in which providers recognize the physiological and relational ruptures of patients’ lives, ever attentive to the plights of those for whom they are summoned to act.

Continuing Unending Conversations

In this special issue, several scholars of narrative inquiry join Charon, resurrecting subjugated voices, breaking the grip and closure of cultural scripts, and offering into circulation alternative storylines for medical encounters. Narratives are productions (and repressions). Through narrative activity, we structure perceptions of events, identify protagonists and victims, accentuate details, redress dilemmas, and legitimate and discount social orders. By adopting narrative sensibilities, authors reveal processes through which the creation of a sense of the natural, necessary, and appropriate takes shape and gains traction. Woven together, these essays disrupt the dominant narrative of surrender in which patients’ voices and bodies are subsumed by the authority of the biomedical script (see critiques by Frank, 1995).

Sharf calls for a multisensorial approach as a necessary corrective to the linguistic determinism dominating narrative theory and practice. Similarly, Harter positions narratives as aesthetic accomplishments, and cautions that an overreliance on linguistic form can obscure that which remains unspoken, inferred, shown, and performed in gesture, association, and action. Although storytelling relies on words uttered and heard, it also depicts images and deciphers gestures. Once closely aligned with the written and spoken word, narrative studies can stretch to include a wealth of other expressive media including song, dance, photography, and painting. Langellier binds narrative theory with performance studies to illustrate the embodied nature of performing narrative medicine—a craft that is at once metaphoric and material. Langellier offers a vision of listening out loud. Sharf directs us to the work of alternative practitioners of care, and Harter features the creative practices of Dr. Pete, a pediatric oncologist at the University of Texas M. D. Anderson Cancer Clinic. Collectively, these authors materialize horizons of possibility and hope.

Bochner presents a decidedly relational view of narrative medicine. Even as we ask providers to acknowledge patients as more than localized sets of symptoms, patients, too, must grasp how ordinary living is achievable only through narrative acts. From this perspective, provider–patient relations unfold as the coconstruction of narrative knowledge, interactions that both parties use to comprehend their own and each other's plight. For Rawlins, practicing narrative medicine requires an ethos of friendship—an answerability to each other's singularity, needs, and commitments in light of providers’ and patients’ common concerns. The vulnerability stressed by Bochner's notion of “heartful medicine” ensues when the truth of how much doctors don't know is acknowledged and revealed, allowing a fuller and more vivid presence in which the doctor may allow herself to be examined by the patient. Zaner depicts the moral dilemmas arising amidst the rhythms of asking and answering, feeling and thinking, giving and receiving. Thompson joins the conversation, and asks us to consider Bob, an archetypal doctor who may be incapable of realizing or fostering the dialogic potential of authenticity described by Bochner, the civic friendship envisioned by Rawlins, and the ethical decision-making portrayed by Zaner.

Institutional norms offer particular identity dilemmas and afford a range of acceptable behaviors and resources for resolving them. The veracity of the biomedical model attests to the tenacity of social scripts and rigidity of roles often assumed by characters like “Bob.” Social structures work their way into personal performances and sensemaking, and institutional orders are reinvented in the process. Meanwhile, tensions ensue when providers and patients alike live out alternative scripts. In her rejoinder essay, Charon points to the difficulty of enlarging healthcare performances without shifts in material circumstances (e.g., the reorganization of clinical spaces, time constraints imposed by third party payers, legal liabilities). At the same time, she concludes this issue with hopeful optimism and unwavering faith in providers’ and patients’ abilities to help each other live well in the midst of strenuous life circumstances.

In Closing

When our life story is interrupted by the inevitability of illness, we are summoned to wrestle with the purpose and meaning of life and death. Narrative rationalities are by no means a panacea for life's difficulties, but they do acknowledge suffering in ways that lie beyond the traditional prowess of biomedicine. Inspired by the work of Dr. Charon, this collection of essays appraises and challenges entrenched habits composing healthcare settings that too often diminish rather than dignify the human spirit. Like narrative itself, the ideas embodied in these essays are not finalized or finalizable. We invite you, our readers, to continue the conversation in journals, classrooms, medical schools, and in your own encounters with healthcare practitioners. We express our gratitude for the edification we have received from our colleagues and collaborators and our hope that you will be gratified by the space that is opened by this dialogue. We thank Laura Stafford, Editor of the Journal of Applied Communication Research, for granting us this opportunity to spark future communication theory and practice on narrative medicine.

Additional information

Notes on contributors

Lynn M. Harter

Lynn M. Harter is the Steven and Barbara Schoonover Professor of Health Communication in the School of Communication Studies at Ohio University

Arthur P. Bochner

Arthur P. Bochner is Distinguished University Professor in the Department of Communication at the University of South Florida and President of the National Communication Association

Notes

¹Editor's Note: This essay introduces a special issue of the Journal of Applied Communication Research on “Health as Narrtive,” volume 37, issue 2.