Narrative in Medicine

Recent years have seen an increase in the interest for the use of literature in the medical context with different objectives. First of all, its use as a pedagogical tool for medicine students made it possible to improve necessary professional competencies that were difficult to achieve with traditional biologist education. Secondly, patients’ accounts have become very interesting to understand how they live their disease. Finally, the usefulness of literary works as an enhancing tool in order to improve the quality of life of patients is starting to be recognised. In conclusion, literature constitutes an element with great formative interest that can improve the relationship with patients because it allows a better understanding of their disease.

The Sea Inside as a Tool in Medical Education 3 See Hojat et al. and Spatoula et al. to know more about the decrease of empathy in medical education. Also see Neumann et al. to find information about its decrease during residency. 2 See Wilkinson et al. 1 See the introduction to Esquerda et al. Consider also examining their bibliography to directly learn more about the research studies that have been done to examine patient outcomes from empathic physicians. Lehrburger 2 educators interested in fostering empathy during medical school have studied its decline in medical professionals with the intention of identifying methods for restoring its presence in and beyond medical education to simultaneously generate more empathic care providers, foster better care provision, and reduce physician burnout. In a recent meta-analysis interested in comparing current investigations focused on improving empathy scores in medical education programs, investigators successfully described training student doctors via role-play scenarios to maintain eye contact, sit at eye-level and within touching distance of patients' bedsides and to use physical touch in order to exhibit compassionate listening skills and empathetic care provision. 4 However, in returning to the definition of empathy as mentioned above, none of these practices directly involve "sharing," "understanding," or "responding with care" to the emotional state of others. Rather, this exemplifies the spreading of a misinformed understanding of empathy, one rooted in practiced performances rather than built upon from a foundation in emotional intelligence for knowing one's own body and understanding the experience of others. This misinterpreted definition of empathy endangers the future of thoughtful care provision. The core of the issue is likely engendered during medical education, where students learn to become doctors. Rather than pushing student doctors to understand their own emotional reactions as well as to ponder those of their patients, medicine maintains a tendency to strive towards the now outdated model of how a provider should act-stoic, domineering, calculating, cold-rather than as the true human that lies beneath every white coat and set of scrubs. There remains a pattern of overlooking the ways interpersonal and emotional skills play into caring for others, pushing such practices to "the fringes of medical education," forgotten about and rarely "treated as central to the heart of medicine" (Shapiro 7). Promoting a more authentic practice of empathy-one that can be fostered and incorporated into care provision-calls for returning to 4 See Patel et al. for details of the findings of this study. Lehrburger 3 our emotions and establishing a new model for how the modern-day medical provider interacts with their patients. Narrative Medicine: A Starting Point A recently pervasive practice for inviting more compassionate care has been through the interdisciplinary involvement of the humanities in medicine. Medical programs in the U.S. have sought to intersect subjects of the humanities into their curriculum since the 1960s, including practices such as creative writing, poetry, music, art, literature, and film. 5 Narrative medicine (NM) is a humanities-based philosophy towards medical practice that incorporates narrative training into the art of healing. In her work Narrative Medicine: Honoring the Stories of Illness (2001), Rita Charon, the executive director and founder of the Narrative Medicine Program at Columbia University in New York, argues that narrative competence, i.e., conceptualizing the role that stories play in everyday aspects of our lives, strengthens the relationships formed between provider and patient by allowing physicians to "recognize, absorb, interpret, and be moved by the stories of illness" (vii). Narrative competence is strengthened through the study and involvement of stories into the medical classroom, leading to more thoughtful care provision and empathy, which develops seemingly naturally through this practice. Narrative medicine proposes that health professionals, as a matter of routine… competently and naturally absorb, recognize, interpret, and comprehend the value of all that patients tell. Through training in reading, in writing, in reflecting… health professionals can readily become dutiful and powerful readers of their patients' illness narrative… They can then, with deep empathy, name the suffering they see, offer 5 See Baños and Guardiola. Lehrburger 4 themselves humbly as one who recognizes, who listens, and who cares. (105; emphasis added) Charon argues that narrative competence, which is strengthened through reading, writing, and reflecting, grows physicians that metaphorically read their patients like a book-examining them between their pages, palpating their spines, listening closely to their tales-so as to hear the heart of each patient's story. To her, empathy appears to develop as somewhat of a byproduct of reading literature; a "routine" and "natural" skill that comes second hand to an avid reader. In the

More and more seems to be necessary to find new ways of communication between medical doctors and bioethicists in order to build a shared vocabulary and to prevent conflicts: many bioethical problems seem to be caused by the lack of dialogue between them, which both seem to speak two different languages. Improving this dialogue means searching new languages and innovative forms of communication: the narration could be a really effective tool to enhance the physicians' and bioethicist's moral conscience, since it facilitates reasoning on someone's particular experience, and, ultimately, on our experience. Starting from the results of a questionnaire administered to a group of students of the Faculty of Medicine and Surgery of the University Campus Bio-Medico we present a theoretical discussion about the need for more dialogue and for a shared vocabulary in medical experiences. In this regard, we suggest as a possible solution to the conflicts among medical doctors and bio...

begin with a story of my own, about how I came to understand my own professional journey. I am a pediatrician, and for the last ten years, I have been on the faculty at the USC Keck School of Medicine, where I direct the Introduction to Clinical Medicine (ICM) program. Before going to medical school, I was a pre-med English major in the days when such a concentration was frowned upon by advisors and admissions committees alike. My passion for literature, though, has always been about the power of stories to reveal meaning and to expand my understanding of the world beyond my own life's experiences. At the same time, the stories of my patients and their families (as well as those of the patients who share their lives with the Year I and II medical students whom I supervise in ICM) have sustained my passion for medicine. When I had the opportunity to hear Rita Charon speak at a meeting several years ago, she was a practicing internist who was finishing her dissertation in English Literature at Columbia University. In the course of her remarks at a conference on Spirituality and Health, she referenced some of my favorite recent novels-Pat Barker's Regeneration trilogy and Michael Ondaatje's The English Patient-and I had one of those life-changing moments. Besides the kind of life change that goes along with a decision to return to school at the age of forty-something (taking the GRE subject test in English Literature some 25 years after reading Beowulf, doing MY homework with my kids at the dining room table, getting paged by the clinic while in graduate seminars), my real epiphany was the understanding that my relationship to stories was what fueled my

Embodiment theory shows up in several fields of (clinical) medicine, it has been applied in studying various diseases, conditions, and treatments. The aim of this short review - due to its extent limitation - is to provide some insight into the diversity of interpretation and application of the embodiment paradigm within medicine.The question of embodiment was often discussed regarding diseases and conditions with physical modifications or lesions, as well as in case of those with notable changes in perception (e.gpregnancy, cancer or organ transplantation). However, studies were also performed in seemingly distant areas such as psychiatry (schizophrenia, dementia, depression, anorexia), pulmonology (asthma and COPD), or endocrinology (perimenopause). Meanwhile embodiment was most frequently explored in connection with the lived experience of femininity-masculinity, physical symptoms, movement limitations, altered body sensations, some of these articles discussed more general concer...

More and more seems to be necessary to find new ways of communication between medical doctors and bioethicists in order to build a shared vocabulary and to prevent conflicts: many bioethical problems seem to be caused by the lack of dialogue between them, which both seem to speak two different languages. Improving this dialogue means searching new languages and innovative forms of communication: the narration could be a really effective tool to enhance the physicians' and bioethicist's moral conscience, since it facilitates reasoning on someone's particular experience, and, ultimately, on our experience. Starting from the results of a questionnaire administered to a group of students of the Faculty of Medicine and Surgery of the University Campus Bio-Medico we present a theoretical discussion about the need for more dialogue and for a shared vocabulary in medical experiences. In this regard, we suggest as a possible solution to the conflicts among medical doctors and bio...

At the heart of narrative medicine as conceived and practiced at the Columbia University Program in Narrative Medicine lies the desire to maintain contact, the move toward intersubjective encounter, reader and writer, doctor and patient, colleague and colleague. Whereas narrative medicine is most commonly described as arming medical professionals with narrative tools to develop more effective relationships in health care, the human consequences and ethical implications for literature scholars in this interdisciplinary practice are equally profound.  “Ethics” can be an unfashionable word in contemporary literary circles. Today’s scientific community, by contrast, regularly tackles issues of empathy and “meaning.” Contact, engagement, and affiliation are at the heart of both the literary and the medical act, and by extension, the ethical act. Post-workshop reflections from the Aristotle University Thessaloniki School of English narrative medicine seminar “Understanding Illness and Tra...

Al centro del volume è la narrazione intesa quale straordinario strumento per indagare i modi in cui la memoria collettiva ha elaborato il tema dei conflitti sociali e personali, della malattia e delle alterazioni del corpo, quest’ultimo inteso sia nella sua accezione generale – la società, la comunità, le città – che in quella particolare dell’individuo.
La maggior parte dei saggi è incentrata sugli eventi che hanno determinato una rottura degli equilibri collettivi e individuali nella società moderna e contemporanea, quando l’insorgere di patologie – sociali, economiche, mediche – hanno sconvolto il tempo storico e hanno costretto a ricercare rimedi e soluzioni.  Un ordito complesso, metodologicamente fondato su di un approccio multidisciplinare e su di un quadro delle fonti che ha riunito quelle prodotte dalle istituzioni con quelle provenienti dalla diaristica, dalle corrispondenze, dai carteggi, dalla letteratura, dalle scienze umane, nel fine ultimo di ritrovare l’individuo dietro il linguaggio delle istituzioni perché se la malattia avviene nella vita ed è espressione delle contraddizioni della realtà, allora è quest’ultima che si deve ricercare anche nelle sue testimonianze più intime.

More and more seems to be necessary to find new ways of communication between medical doctors and bioethicists in order to build a shared vocabulary and to prevent conflicts: many bioethical problems seem to be caused by the lack of dialogue between them, which both seem to speak two different languages. Improving this dialogue means searching new languages and innovative forms of communication: the narration could be a really effective tool to enhance the physicians' and bioethicist's moral conscience, since it facilitates reasoning on someone's particular experience, and, ultimately, on our experience. Starting from the results of a questionnaire administered to a group of students of the Faculty of Medicine and Surgery of the University Campus Bio-Medico we present a theoretical discussion about the need for more dialogue and for a shared vocabulary in medical experiences. In this regard, we suggest as a possible solution to the conflicts among medical doctors and bioethicists, an educational strategy, i.e., humanities courses for medical students, which may help them to deeply describe their practical present (and future) experience. RESUMEN: Cada vez más parece ser necesario encontrar nuevas formas de comunicación entre los médicos y los bioeticistas con el fin de construir un vocabulario común para evitar conflictos: muchos problemas bioéticos se deben a la falta de diálogo entre ellos, ya que ambos parecen hablar idiomas diferentes. Mejorar este diálogo significa buscar nuevos lenguajes y formas innovadoras de comunicación: la narración podría constituir un instrumento muy eficaz para mejorar la conciencia moral de los médicos y de los bioeticistas,

Workshop to take place in Barcelona, 17-18 November 2016:

The locked-in syndrome (LIS), in which persons are conscious but almost entirely paralyzed and voiceless, is one of the most dramatic states a human being can find himself or herself in. This interdisciplinary international workshop will bring together cognitive neuroscientists, care and neuro-rehabilitation professionals, brain-computer interface experts, individuals involved in LIS patients associations, philosophers, bioethicists, medical anthropologists and sociologists, and historians of the brain/mind sciences to discuss the impact this unique condition has on ways of understanding personhood at the theoretical and practical levels. While the philosophy of personhood in the Western tradition since the late 17th century has emphasized cognitive capacities and self-consciousness, the experience of LIS contributes to open new ground for understanding how relationality, emotion, communication and phenomenal consciousness (the feeling of what it is like to be in a certain state) are constitutive of personal identity and the sense of self.

Background: Efforts to "rehumanize" medical education through curriculum reform and program development have been numerous and ongoing in recent years. One particularly intriguing contribution has come from the area of narrative studies. It is now common to use literature in general, and physician-patient narratives in particular, both to expand students' understanding of the clinical encounter and to sensitize them to the humanistic aspects of medicine. Description: In this article, we describe the process by which we have introduced key insights from and elements of narrative theory into our 1st-year clinical skills program. Rather than limiting our efforts to the use of literature and to the description of individual narrative encounters, however, we have framed our entire course as an exercise in narrative construction. We refer to this process as "narrative structuring." Evaluation: A combination of short essays on topics related to the various literary materials utilized in the course, written reports on ethical aspects of the clinical cases presented in the clinical skills sessions, and student journaling are integral components of the evaluation of this course. Conclusion: Characterizing our course in terms of narrative structuring serves both to integrate the various elements of our complex curriculum around a common theme and to remind both students and faculty alike of the privileges and responsibilities we share as we participate in the writing of one another's stories.

Az utóbbi években látványosan megszaporodtak az olyan könyvek, filmek és egyéb művészi vagy "laikus" beszámolók, amelyek egyéni betegségtörténeteket mutatnak be. Ezekben rákos, vagy más halálos kórral diagnosztizált, életük végével közvetlenül szembesülő betegek, súlyos balesetet átélt, fogyatékkal élő, neurológiai, pszichiátriai vagy pszichológiai problémákkal, függőséggel küszködő személyek vagy közvetlen hozzátartozóik számolnak be a betegség által meghatározott emberi létállapotról. Knapp 2015) írnak saját vagy hozzátartozóik betegségtapasztalatairól. A betegség-narratíva viszonylag új műfaj. Az, hogy a legnépszerűbb könyv-vagy filmpiaci újdonságok között a betegségtapasztalatok ábrázolása ennyire feltűnő módon előtérbe kerül, még újabb fejlemény. A betegség, fogyatékosság és halál kimeríthetetlen, örök témák, már csak azért is, mert végső soron minden embernek saját magának kell megtapasztalnia testi sebezhetőségét és élete végességét. Önmagában ez még nem magyarázza ezt az újabb tendenciát. Ennek megértéséhez a tágabb társadalmi-kulturális környezet bizonyos sajátosságainak megértése is szükséges.

Recent years have the seen the call for a melding of the humanities with biomedicine in the quasi-discipline of the medical humanities. The forging of such partnerships offers authority, status and utility for disciplines like creative writing. We will argue, however, for caution. We identify two different strands within the medical humanities: the critical and the paramedical. The first strand requires disciplinary autonomy to carry out its task effectively. The second strand, however, often becomes subservient to biomedicine, asset-stripped for what is useful. We describe two case studies in the paramedical humanities where this process has occurred: the ‘Creative Writing and General Practitioner Wellbeing’ project, which used reflective writing to augment professional medical training and practice, with a view to enhancing GP wellbeing; and a description of a literature workshop facilitated by a medical practitioner for a medical humanities retreat in the United Kingdom. We argue that the problems identified are inherent to the paramedical humanities, a product, no less, of the history of biomedicine. Finally, we conclude that biomedicine needs the humanities, but not the medical humanities. Creative writing and other humanities disciplines should maintain their autonomy and, therefore, their integrity.
Keywords: Medical humanities; creative writing; narrative therapy

Based on the distinction between living body and lived body, we describe the disease-subject as representing the impact of disease on the existential life-project of the subject. Traditionally, an individual's subjectivity experiences disorders of the body and describes ensuing pain, discomfort and unpleasantness. The idea of a disease-subject goes further, representing the lived body suffering existential disruption and the possible limitations that disease most probably will impose. In this limit situation, the disease-subject will have to elaborate a new life-story, a new character or wayof-being-in-the-world, it will become a different subject.

Until about thirty years ago, narrative and narrative theory were the province of those disciplines that have traditionally formed the accepted core of the humanities: literary, cultural, religious, and, to a lesser extent, philosophical studies. researchers in these fields-whether hardcore narratologists or narrative ethicists-tend not to produce narratives, but to receive them. Their work involves commenting analytically on that reception, looking at the determinants, operations, and semantics of individual narratives or of narrative as a genus. narrative theory now populates new and rather different territories-those fields that support narrative production as well as consumption, including history and historiography, ethnography, law, therapy, and of course, medicine. 1 our interest lies specifically in the theoretical and practical uses of narrative in the medical field, and we began with a review of the relevant literature that generated some surprising results. We expected the influence of narrative in medicine, which had captured the interest of physicians and scholars, to be legible in medical and humanities publications. moreover, we had observed the ways in which popular culture reflected that interest in media, ranging from print publications such as The Atlantic Monthly and The New York Times to television series such as House, M.D. 2 We were nonetheless surprised by the sheer volume of articles, essays, and editorials we discovered when we conducted a search in medical and humanities journals using the keywords "narrative and medicine." our search returned no fewer than 7,000 related writings, raising the question of precisely how narrative was being employed by its various proponents, for the remarkable quantity of this research alone does not give one a sense of the range

Nagy örömet okozott, amikor egy kis könyvesboltban (kihalóban lévő faj) rábukkantam Kovács Gusztáv A páciens neve: Doktor House című könyvére. A felfedezés örömét csak az a gondolat árnyékolta be, hogy lévén egyrészt bioetikával foglalkozom, másrészt különös figyelemmel kísérem a könyvpiaci fejleményeket, az a tény, hogy egy több mint egy éve napvilágot látott bioetikai könyv híre elkerült, valószínűleg azt is jelenti, hogy a kötet terjesztése nem sikerült maradéktalanul. A kiadó célja feltehetőleg nem az volt, hogy eltitkolja vagy elrejtse az érdeklődő olvasók elől a könyvet, inkább csak a piaci lehetőségek nem megfelelő kihasználásáról lehetett szó. A könyv kapcsán mindenesetre rögtön levonható egy tanulság: továbbra is érdemes eldugott kis könyvesboltokban, a nagyobb terjesztők kínálatán kívül is kutakodni. Az épp csak bontakozó hazai bioetikai élet számára különösen fontos, hogy legyenek könyvek, olvasnivalók hazai szerzőktől, ezek eljussanak a szakemberekhez, a hallgatókhoz és a szélesebb olvasóközönséghez, ezekről és a bennük megjelenő témákról tudjunk, beszéljünk, vitatkozzunk. Jelen recenzió is részben azzal a céllal született, hogy felhívjam a figyelmet a magyar bioetikai élet ezen új és jelentős fejleményére -no meg persze hogy megfogalmazzak néhány véleményt az abban megjelenő nézetekkel kapcsolatban.