Title: What are narrative medicine and medical humanities and why are we here?
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Permanent Link: http://ufdc.ufl.edu/UF00095026/00001
 Material Information
Title: What are narrative medicine and medical humanities and why are we here?
Physical Description: Book
Language: English
Publisher: College of Medicine
Place of Publication: Gainesville, FL
Publication Date: 2009
Copyright Date: 2009
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Bibliographic ID: UF00095026
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.


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My initial experience of illness was as a series of disconnected shocks, and my
first instinct was to try to bring it under control by turning it into a narrative.
Always in emergencies we invent narratives... Storytelling seems to be a natural
reaction to illness... Stories are antibodies against illness and pain..." Anatole
Broyard. "Toward a Literature of Illness."

What are narrative medicine and medical humanities
and why are we here?
The modern practice of medicine is often seen- by health care practitioners and
patients- as being too focused on technology and treatment of acute ailments.
Both practitioners and patients can feel that the system is intensely stressful,
impersonal, and lacking in empathic connection. This situation can lead to sub-
standard care- missed diagnoses, lack of follow up, and medical mistakes. It
also can be profoundly unsatisfying for both.

Use of medical humanities in medical education is one way of meeting the
challenge to reform the art of medical practice and to improve the
physician/patient relationship.

What are medical humanities?
We define the term "medical humanities" broadly to include an interdisciplinary
field of humanities (literature, philosophy, ethics, history and religion), social
science (anthropology, cultural studies, psychology, sociology), and the arts
(literature, theater, film, and visual arts) and their application to medical
education and practice. The humanities and arts provide insight into the human
condition, suffering, personhood, our responsibility to each other, and offer a
historical perspective on medical practice. http://medhum.med.nyu.edu/

How can medical humanities help to develop all of these skills and

Different aspects of humanities and narrative medicine address basic clinical
skills, such as visual observation and listening skills. These include art criticism
and the study of visual arts, oral history interviewing and narrative medicine.

Other aspects- writing, journaling, as well as all forms of creative expression, and
music, help to develop positive and constructive means of processing stress
and emotionally challenging experiences.

Many humanities- history, medical anthropology, sociology, and literature- help to
enlarge understanding of the human experience and human cultures, including
how cultures understand and deal with death, health and disease- and how
cultural beliefs, biases, and needs are reflected in the structure of medical

Humanities, including theater, narrative medicine1 and literature and medicine,
also help to develop empathy and compassion for patients.

In all of these approaches, the basic component is storytelling, for the physician
listening to and understanding, and for the patient telling the story. Increased
ability to listen increases diagnostic accuracy, and strengthens bonds between
patient and practitioner. If physicians also understand stories and storytelling
they are better able to see when a story is missing a critical component. They
can look for the story within the story. For patients, also, telling the story and
knowing someone is truly, closely, and carefully listening can be healing in and of
itself. Thus, the creation of narrative medicine in order to focus on the story and
the process of storytelling and listening.

Classic must-reads for narrative medicine, medical humanities
and the art of medical practice:

Jean-Dominique Bauby. The Diving Bell and the Butterfly. The story of a man
who suffers a massive stroke resulting in locked in syndrome. Unable to move
any muscle consciously except for the one eyelid, he tells his own story by
blinking his eye. Well written and compelling.

Anatole Broyard. Intoxicated by my Illness. An example of a patient who defeats
death by telling his own story.

Joan Didion. The Year of Magical Thinking. Extraordinarily well written account
of a wife's response to the sudden death of her husband while their daughter is
very ill. It chronicles, with great clarity, one woman's process of grieving.

Anne Fadiman. The Spirit Catches You and You Fall Down. This book explores
the difficulty of communicating across cultures about health and health care,
especially when physician and patient have, without each other knowing it,
different definitions of disease and in particular the disease in question.

Tracy Kidder. Mountains beyond Mountains: The Quest of Dr. Paul Farmer, A
Man Who Would Cure the World. In this book, Kidder describes the life and work
of Paul Farmer, a physician who has devoted his life to overcoming health care
disparities in the developing world.

Reynolds Price. A Whole New Life. A story of what the patient experience can
be like by a patient who clearly is articulate and has high expectations for the

1What is narrative medicine? Narrative Medicine fortifies clinical practice with the narrative competence to recognize,
absorb, metabolize, interpret, and be moved by the stories of illness. Through narrative training, Narrative Medicine
helps medical students- and all health care workers- to improve the effectiveness of care by developing the capacity for
attention, reflection, representation, and affiliation with patients and colleagues.

way in which he should be treated. Perhaps not a typical patient, and an
excellent spokesperson for patients generally.

Rachel Naomi Remen. Kitchen Table Wisdom: Stories that Heal. Rachel Naomi
Remen is an excellent story teller who discusses how the act of story telling can
be healing. "The style of this collection is gentle, low-key and totally unapologetic for its journeys into
the mystical and scientifically inexplicable elements of healing. Remen uses her insights as a wounded
healer to demonstrate, through stories, the kaleidoscope of possibilities in human response to a failing body.
This is, among other things, another demonstration of the power of listening and the value of the personal
narrative in the practice of medicine." http://litmed.med.nyu.edu/Annotation?action=view&annid=1158

Richard Seizer. The Doctor Stories.

Oliver Sacks. The Man Who Mistook His Wife for a Hat. Oliver Sacks tells of
patients and their neurological conditions with great compassion and
understanding- he shows how such conditions can close certain windows of
perception and comprehension while at the same time opening others.

William Styron. Darkness Visible. Another very well written account by a writer,
this time about a bout of debilitating depression. In a very eloquent and
persuasive manner, Styron shows the reader the mind of someone in a
depression, illuminating the world of an illness that is all to often misunderstood
and dismissed.

Abraham Verghese. My Own Country. In this description of Verghese's work
with AIDS patients in eastern Tennessee right at the start of the HIV/AIDS
epidemic, Verghese shows tremendous compassion and empathy for his patients
while he chronicles the varying responses of the community to a new, sexually
transmitted disease, and to homosexuals who were facing discrimination in this
rural part of Tennessee.

Short Stories
Leo Tolstoy. The Death of Ivan Ilyich.

Poets and Poetry collections

Physician poets:
Rafael Campo
William Carlos Williams
C. Dale Young

Poets writing on illness, life, and death:
Emily Dickinson
Sylvia Plath
Dylan Thomas- Do Not Go Gentle; Death Shall Have no Dominion

Reference works

Schon DA. Educating the reflective practitioner: toward a new design for teaching
and learning in the professions. San Francisco: Jossey-Bass, 1987.

Reference works, specific topics:
Jerome J. Bylebyl. Teaching the History of Medicine at a Medical Center.
This resource calls itself a "how-to" manual in the teaching and study of the
history of medicine. Its contents are the proceedings from a 1980 symposium at
Johns Hopkins Medical School. Presentations included: the History of Health and
Disease for the Health Professionals; The History of Medicine in a Medical
Context; Pharmaceutical History for the Pharmacy Student; and Antecedents to
Contemporary Health Issues: History, Politics, and the Policy of Health.

Literature and medicine
Couser, G. Thomas. Recovering Bodies: Illness, Disability, and Life Writing.

Anne Hunsaker Hawkins and Marilyn Chandler McEntyre, eds. Teaching
Literature and Medicine.

Thaut, Michael. Rhythm, Music, and the Brain: Scientific Foundations and
Clinical Applications (Studies on New Music Research).

Narrative medicine
Charon, Rita. Narrative Medicine Honoring the Stories of Illness. 2006

Verghese, Abraham. "The Physician as Storyteller".

Campo, Rafael. The Healing Art: A Doctor's Black Bag of Poetry. 2003

Jill MacDougall. Contaminating Theatre: Intersections of Theatre, Therapy, and
Public Health.

Visual arts
Powley E, Higson R. The arts in medical education: a practical guide. Oxford:
Radcliffe Publishing, 2005.

Kay Mohanna. Education for life-teaching medicine using art and humanities

Important web resources

NYU Medical Humanities database

Why read and write about illness?

Physicians may not ultimately "defeat" death- at least, their patients may die.
And if they live their lives seeing every death as a failure, then they can quickly
face compassion burnout and disillusionment. The metaphors of conquering
cancer, defeating death feed this sense of failure. But everyone ultimately dies,
and the ultimate triumph is not so much in defeating death but in living graciously
and dying gracefully. Understanding this, physicians can help to facilitate that
transition. And writings about illness can help to show us the way:

"When Anatole learned that he was ill, he responded by talking and then
by writing about his situation. Anatole was a superb storyteller, and at this most
difficult time of his life he concentrated his talents in a way that enabled him to
hope and believe that he could outwit his cancer by constructing an alternative
narrative that would wither and erase the shadow of death.
He did not conquer his cancer, but he triumphed in the way he lived and
wrote about it. In a talk he gave six months before he died he said, "dying is the
end of illness. It is the further shore of illness. There's a wonderful book called
the Wilder Shores of Love. Well, dying is the wilder shore of illness."
From the introduction to "Intoxicated by my Illness," by Alexandra Broyard

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