Psychology for Lawyers



understanding ourselves (and our work)
stories and narrative medicine

 

Preface

"Narrative medicine is growing in popularity in academic medical centers and healthcare settings. Developed over the past decade by physician and literary scholar Rita Charon and colleagues at Columbia University, narrative medicine (as defined by Charon), “fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness.” There are textbooks on narrative medicine, workshops, undergraduate courses, and masters degree programs in narrative medicine, and even the venerable Modern Language Association is considering establishing a new forum related to narrative medicine (to be called Medical Humanities and Health Studies)."

—The Problem(s) With Narrative Medicine, Medical Margins, Josephine Ensign blog

"A scientifically competent medicine along cannot help a patient grapple with the loss of health or find meaning in suffering. Along with scientific ability, physicians need the ability to listen to the narratives of the patient, grasp and honor their meanings, and be moved to act on the patient's behalf. This is narrative competence, that is, the competence that human beings use to absorb, interpret, and respond to stories. [Narrative competence] enables the physician to practice medicine with empathy, resflection, professionalism, and trustworthiness. Such a medicine can be called narrative medicine."

—Rita Charon, Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust, 286 (15) JAMA (J. Amer. Med. Assoc.) 1897 (2001)

"[B]oth modalities [psychoanalysis and narrative medicine] encourage the patient to share his or her own st ory as an integral part of the healing process."

—Peter L. Rudnytsky, "Introduction," to Peter L. Rudnytsky & Rita Charon (eds.) Psychoanalysis and Narrative Medicine 1-19, at 11 (Albany, New York: State University of New York Press, 2008)

Readings

Rita Charon, Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust, 286 (15) JAMA (J. Amer. Med. Assoc.) 1897 (2001) [online text]

Debra Malina, Book Review [Rita Charon, Narrative Medicine: Honoring the Stories of Illness (NY: Oxford University Press, 2006)], 355 (20) N. Engl. J. Med. 2160 (2006) [online text]

Melanie Thernstrom, The Writing Cure, New York Times Magazine, April 18, 2004 [online text]

Kelly Gross, Storytelling, Illness and Carl Jung's Active Imagination: A Conversation with Rita Charon of the Narrative Medicine Program, Intima: A Journal of Narrative Medicine, 2017 [online text]

Class Videos

Class Video 1: Honoring the Stories of Illness: Dr. Rita Charon [18:16 mins.]

Class Video 2: Colloquium Presentation [1:21:12 mins.] [Charon speaking at Adventist University of Health Sciences, 2015] [addressing the theme of integrity] [in class presentation begins at 28:14 mins.; ends at 41:26 mins.]

Notes on Narrative and Narrative Medicine

Rita Charon, Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust, 286 (15) JAMA (J. Amer. Med. Assoc.) 1897 (2001):

▪ "Not only medicine but also nursing, law, history, philosophy, anthropology, sociology, religious studies, and government have recently realize the importance of narrative knowledge. Narrative knowledge is what ne uses to understand the meaning and significance of stories through cognitive, symbolic, and affective means. This kind of knowledge provides a rich, resonant comprehension of a singular person's situation as it unfolds in time, whether in such texts as novels, newspaper stories, movies, and scripture or in such life settings as courtrooms, battlefields, marriages, and illness." [1898]

▪ "As in psychoanalysis, in all of medical practice the narratiing of the patient's story is a therapeutically central act, because to find the words to contain the disorder and its attendant worries gives shape to and control over the chaos of illness." [1898]

▪ "Not unlike acts of reading literature, acts of diagnostic listening enlist the listener's interior resources--memories, associations, curiosities, creativity, interpretative powers, allusions to other stories told by this teller and others--to identify meaning. Only then can the physician hear--and then attempt to face, if not to answer fully--the patient's narrative quetions: 'What is wrong with me?' 'Why did this happen to me?' and 'What will become of me?'" [1899]

▪ "[I]t may be that the physician's most poetent therapeutic instrument is the self, which is attuned to the patient through engagement, on the side of the pation through compassion, and available to the patient through reflection." [1899]

Rita Charon, Narrative and Medicine, 350 (9) N. Engl. J. Med. 862 (2004):

▪ "[Narrative competence can be defined] as the set of skills required to recognize, absorb, interpret, and be moved by the stories one hears or reads. This competence requires a combination of textual skills (identify a story's structure, adopting its multiple perspectives, recognizing metaphors and allusions), creative skills (imaging many interpretations, building curiosity, inventing multiple endings), and affective skills (tolerating uncertainty as a story unforlds, entering the story's mood). Together, these capacities endow a reader or listener with the wherewithal to get the news from stories and to begin to understand their meanings." [862]

Rita Charon, Narrative Medicine: Attention, Representation, Affiliation, 13 (3) Narrtive 261 (2005):

▪ "The teller of an illness needs a listener. How can one develop the state of attention required to fulfill the duties incurred by virtue of having heard accounts of illness? . . . . How does one empty the self or at least suspend the self so as to beocme a receptive vessel for the language and experience of another? This imaginative, active, receptive, aesthetic experience of donatng the self toward the meaning-making of the other is a dramatic, daring, transformative move." [263]

Reference (Rita Charon & Narrative Medicine)

Rita Charon: Narrative Methods of Building Effective Health Care Teams
[51:23 mins.]

The Narrative Medicine Program at Columbia University School of Medicine
[48:55 mins.]

To Behold in Practice
[28:23 mins.] [2014]

Bodies, Stories, and Selves: How Narrative Saves Lives
[1:26:29 mins.] [2015] [presentation begins at 11:48 mins.]

Narrative Methods of Building Effective Health Care Teams
[51:23 mins.]

Story as Evidence: Communicating Science
[49:42 mins.]

On Narrative Medicine
[1:01:52 mins.]

Transforming Our Vision of Illness, Deepening Our Resolve to Care
[41:54 mins.] [2009] [presentation begins at 2:13 mins.]

Telling and Listening to Stories of Self
[50:40 mins.] [audio]

Conversation with Magdalene Brandeis
[1:20:21 mins.] [poor quality video]

Rita Charon at New York Society for Ethical Culture
[48:55 mins.] [poor quality audio]

Rita Charon
[47:47 mins.] [poor quality audio]

Narrative Medicine (Videos)

Narrative Medicine: A Pill for Medical Jargon?
[3:14 mins.] [Ben Schwartz, a New Yorker cartoonist and physician]

Narrative Medicine Helps Heal Mind and Body
[3:04 mins.] [University of Kentucky Markey Cancer Center]

Why Medicine Needs Literature
[10:48 mins.] [Maryam Golafshani] [TED Talk]

Story Specialists: Doctors Who Write
[6:37 mins.] [NPR, audio]

Doctors' Stories: For a Bellevue Physician, Listening--and Writing--Are Key
[12:44 mins.] [NPR, Melissa Block, audio]

Dr Oliver Sacks on Narrative and Medicine and the Importance of the Case History
[40:59 mins.]

Oliver Sacks on Humans and Myth-making
[6:34 mins.]

Every Patient Tells a Story
[1:01:04 mins.] [Lisa Sanders is a professor of medicine, at the Yale University School of Medicine and author of Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis] [presentation begins at 5:06 mins.] Meet Author Dr. Lisa Sanders [51:30 mins.]

Brian Hurwitz Interview on the Narrative Future for Medicine
[4:40 mins.]

Stephen Ludwig Interview on the Use of Narrative in Medical Education
[3:36 mins.]

Narrative Medicine and the Humanities
[31:24 mins.]

Medicine & the Humanities (Videos)

Dr. Edmund Pellegrino Talks about Medical Humanities
[7:06 mins.]

Best Practices in Medical Humanities Education
[54:08 mins.] [Suzanne Garfinkle] [audio with slides]

Narrative Medicine (Web Resources)

Stories in Medicine: Doctors-in-Training/A Different Type of Patient History
[NPR, Margot Adler, audio]

The Healing Power of Stories

The Living Handbook of Narratology: Narration in Medicine

Doctor as Story-Listener and Storyteller

Stories for Life: Introduction to Narrative Medicine
[Miriam Divinsky]

Interpreting People as They Interpret Themselves: Narrative in Medical Anthropology and Family Medicine

From Narrative Wreckage to Islands of Clarity: Stories of Recovery from Psychosis

An Extraordinary Moment: The Healing Power of Stories

Literature and Medicine: Exploring Margaret Atwood’s Short Story “Death by Landscape”

A Series of Articles on Narrative Medicine
[LitSite Alaska, a website devoted to "Inspiring learning and building community through narrative"]

Bibliographical Reference & Articles

Peter L. Rudnytsky & Rita Charon (eds.), Psychoanalysis and Narrative Medicine (Albany, New York: State University of New York Press, 2008)

Psychoanalysis and Narrative Medicine Conference, University of Florida, 2004.

Narrative Medicine, Negative Capability, and Me
[The published version of Terrence E. Holt's paper, titled "Narrative medicine and Negative Capability," appears in Psychoanalysis and Narrative Medicine, at pp. 83-96]

Reading, Listening, and Other Beleaguered Practices in General Psychiatry
[The published version of Neil Scheurich's paper appears in Psychoanalysis and Narrative Medicine, at pp. 247-260]

“What Story Am I In?” Times Two: Narrative as a Foundation for Active Patient Participation

The Narrative Link: Stories in Medicine, Psychoanalysis, and Creative Writing

 


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