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Anders Juhl Rasmussen, Anne-Marie Mai and Helle Ploug Hansen (eds.), Narrative Medicine in Education, Practice, and Interventions, London and New York: Anthem, 2023, 194 p.

ISBN: 978-1-83998-816-5
Christina Dokou

Texte intégral

1Ever since its groundbreaking introduction in 2000 by Columbia Professor Rita Charon, Narrative Medicine (NM) has had a drastic impact in medical education and practice, as well as the Humanities and the Arts within the broader context of the intersecting epistemic area known as “Medical Humanities.” Combining literary analysis and medical ethics, the practice of NM aims at combating the dehumanization of HMO-driven commercialized healthcare by honing clinicians’ (self-)diagnostic and bedside skills through the guided narratological analysis of literary texts. Charon´s method consists in workshop-style seminars where medical practitioners or students of all specialties and levels are initially prompted to collectively produce what is known in literature as a “close reading” of a very short literary text (or video, or painting). They are directed to pay attention to the narratological features like syntax, word choice and frequency, and narrator idiolecton in order to derive underlying meanings – without privileging any interpretation over others – from that short piece of “information,” in the same way they would have to mine information from their all-too-brief interviews with their patients. The aim, therefore, is to use what literary analysis has been doing all along to hone and enrich the doctor-patient interaction for maximum diagnostic effect and establishment of empathy, seeing literary criticism and textual explication methods as a form of “diagnosing” literature. Seminar participants then take a few minutes to create a small piece of writing that reflects on an aspect of the text, thus honing their own expressive skills and often releasing the tension related to their stressful profession. They are encouraged to read those pieces aloud to the group, which then discusses it among themselves, developing further their analytical, diagnostic and empathic sensitivities.

2Success in practice has led health professionals along with literature scholars and artists to establish NM workshops, and even entire programs in institutions of higher learning and research, always in collaboration with professors or professionals from the Humanities (at Columbia University but also at the Hershey Medical Center in Pennsylvania, the Ohio State University Humanities Program, or at the Lewis Katz School of Medicine, to name but a few), which soon, through the efforts of Charon and her associates, expanded into a “Narrative Medicine International” program that now involves both workshops and program offshoots in Europe (like Denmark, Germany and Italy’s ISTUD Health Care program) and Asia (China, Japan, Malaysia). Further variations of NM were established, such as the family-oriented “Narrative-based Medicine” by physician and English literature degree-holder John Launer in the UK, or interventions initiatives (see below). The practice inevitably led to the creation of a robust corpus of NM scholarship comprising both theoretical texts and textbooks/practice guides, following Charon’s collectively authored and edited anthology, the much-translated The Principles and Practice of Narrative Medicine (Oxford UP, 2016) and Launer’s How Not to Be a Doctor: And Other Essays (Duckworth, 2019). Yet NM, and the spread of Medical Humanities, has also reciprocally affected the way literature is read and analyzed, encouraging a turn towards “Illness Studies” and body-related literary criticism—as heralded by Susan Bordo’s 1993 Unbearable Weight, Susan Sontag’s 2003 Regarding the Pain of Others, or C. Robert Bennett, Nadia Shive and Heather Coats’s 2020 “What Mattered Then, Now, and Always: Illness Narratives from Persons of Color” (Journal of Hospice & Palliative Nursing 22.5, pp.392-400). It has also fed, and reciprocally fed on, the creation of literature broaching (taboo) health issues, such as the so-called “cancer theatre” dramatizing – often autobiographical – cancer narratives, as exemplified by Bryony Kimmings’s 2016 musical A Pacifist’s Guide to the War on Cancer, or Margaret Edson’s Pulitzer-winning 1995 Wit.

3Within this context, the present anthology by Rasmussen, Mai and Hansen falls on the practical side as a set of analytical case studies that can be a “how-to” manual for NM scholars/practitioners. The contributors’ qualifications combine two or more specializations in (comparative) literature, ethics, sociology, anthropology, philosophy, IT, medicine and other aspects of health sciences and/or practice. Such breadth of scholarly viewpoints is one of the main advantages of the anthology, reflecting the hybrid nature of NM and also highlighting how each approach contributes uniquely to the sensitization of medical practitioners. It also offers a welcome variety of tone, with the more conversational humanities pieces alleviating the more cut-and-dried medical ones.

4The volume is forewarded by Charon herself; she highlights its internationality and transdisciplinarity as paradigmatic of the next phase in NM, which “has evolved into a systems narrative medicine since it is increasingly influenced by and influencing global and social processes far afield from actual clinical settings” (7). In enunciating the challenge of navigating a complex global field, but also in recognizing the systems’ properties of autopoiesis and emergence, Charon offers a definition of systems thinking that is akin to appreciating a poem, “closely observing, interpreting, and interacting with the unpredictable and beautiful unity” (8).

5In the introduction that follows, the anthology editors identify its singularity in that the majority of its contributors are affiliated with the University of Southern Denmark (USD) with its innovative combination of programs in Culture, Literature and Medical Humanities (20). Rasmussen, Mai, and Hansen emphasize the systemic social and practical orientation of the volume towards “developing a health system that recognizes each person as an individual with social relations in the context of diagnosis, treatment, nursing, and care” (13). They outline the anthology, review the history, goals and scholarly research done in recent years in NM, and conclude by focusing on the Nordic tradition in Medical Humanities and their scholarly efforts to establish NM as a seminal part of Denmark’s medical education.

6The first section of the anthology, “Narratives in Medicine,” begins with a chapter by Rutgers English professor Ann Jurecic, who asks “Is Teaching Empathy Possible?” For Jurecic, empathy is difficult to define, teach, and more so, measure via short-term, formulaic or standardized methods (27), since it “refers to social and emotional practices that are learned… over years and decades” and “draws on many different habits of the mind, including attention, curiosity, openness, flexibility, imagination, and self-reflection” (30). Recalling personal experiences as a Humanities teacher of medical students, Jurecic advocates for a radical restructuring of medical teaching in favor of slow learning “that reinforces the habits of mind that support empathy, including attention, curiosity, reflection, and an acceptance of both ambiguity and complexity in human lives and relationships” (36).

7Chapter 2, “The Role of Narrative Structures and Discursive Genres in Healthcare Education and Practice” by Medical Humanities professor Ronald Schleifer offers a practical “how to” diagnostic guide. It emphasizes the importance of discerning the “six elements” of narrative structures for understanding patients’ stories, especially that information that remains unspoken/repressed, yet often is vital in understanding the nature of the complaint. Combining those structures with Schleifer and Jerry Vannatta’s three “orders of cognition” in -patient-doctor interactions – “biomedical understanding,” “the patient’s understanding,” and “affective engagement” (45) – allows the physician to shift the focus of the medical history interview from the “chief complaint” (the medical problem) to the “chief concern” (a patient’s understanding of, investment on, and expectation regarding, their situation).

8The emphasis on the role of storytelling in the diagnostic-healing process continues with “Vulnerable Reading: Stories as Good Companions” by Sociology professor Arthur W. Frank. He advocates offering up cases of vulnerable individuals from literature as “companions” for ailing people to identify with, and thus alleviate some of the stress, solitude and sense of despair their illness inevitably engenders (53) – in a sense, what literature has been doing all along. The advantage of vulnerable reading, according to Frank, is that it transcends the “subject/object split” (54) between clinicians (who are trained in NM) and patients (their objects), since it makes ill people the acting agents of their own story, offering a sense of empowerment.

9Chapter 4 inaugurates the second Section of the anthology, “Narrative Medicine in Healthcare Education” with an article by NM professor Anders Rasmussen and medical professor Morten Sodemann, titled “Prescribing Stories before Medicine. Narrative Medicine in the Teaching of Medical Students and Physicians.” It is a foundational article in the volume, a comprehensive overview of NM showcasing the obligatory course in NM at the USD as the impetus for the anthology. The article offers a detailed description of the program components situated within a broader overview of the NM discipline, laying particular emphasis on empathy and structure-making: “The healing power of a story is often linked with the narrative’s potential to create a plot to ascribe meaning to experience and to inscribe events into a context that makes cultural and personal sense” (74). At the same time, for clinicians, NM works as a “parallel chart” where they monitor their own emotional states/symptoms, allowing them to recognize and alleviate the stress of their environment.

10Similarly, Chapter 5, “Connecting Classwork to Clinic: Narrative Medicine for Healthcare Professionals and Students” by Cindie Aaen Maagaard, Helen Schultz, and Anita Wohlmann focuses also on the NM program at the USD with a detailed overview of its elective Master’s course. They present the two narratological approaches covered in the course, the “instrumental close reading” for “understanding concepts through a literary text” (91) and the “exploratory close reading” of affective and intellectual interaction with a text (94), with the benefits and challenges of each during clinical practice. The chapter actually is a meticulous and complete course blueprint, very useful for anyone wishing to implement their own NM course.

11The next section, “Narratives of Healthcare Practice” opens up with a psychiatry professor Anette Søgaard Nielsen and psychologist Jakob Emiliussen’s “What’s with the Drinking? Narratives about Alcohol Abuse.” Drawing from their own research experience on substance abuse, the two detail the “five master narratives” (107) of how people become alcoholics. The invocation of the appropriate master narrative through NM methods is instrumental in complementing diagnostic criteria, which often overlook the cultural and non-biological meanings of drinking, while avoiding the (re-)conferral of social stigma upon the patients (112).

12Next, Anette Grønning and Anne-Marie Mai combine their expertise in Communication technologies and Literature to address a feature of 21st century healthcare in “E-mail Consultation in General Practice: Reflective Writing and Co-created Narratives.” The article extends the narratological practices of NM to patient emails of illness narratives in the context of the “Digital Consultation” program by the USD (121). Gleaning material from patient and doctor interviews, as well as from Nordic literature, the article illustrates how close-reading competence in digital/asynchronous consultation offers clinicians a valuable diagnostic skill, especially since today, “E-cons” comprise 1/5th of Denmark’s annual medical consultations and “are set to remain a permanent and ever more challenging part of the GP’s everyday life” (133).

13The final part of the anthology, “Narrative Medicine in Interventions,” begins with “Creative Writing as Rehabilitation” by Sara Seerup Laursen, Tine Riis Andersen, and Helle Ploug Hansen. The three NM scholars chronicle in detail a workshop for rehabilitating chronically ill patients through creative writing. “Writing as a form of therapy” is well-established in literary history; but now the hypothesis is entertained from a medical perspective with “measurable” positive results for “rehabilitation, health promotion, palliative care, and treatment” (138). The researchers admit that “Illness can cause chaotic thoughts, loss of the language needed to express oneself to those around you…” (139); nevertheless, they stand by CW as improving communication, enabling self-expression, and alleviating illness conditions.

14Chapter 9, “Poetry Prescribed for Loneliness: Shared Reading for Men Near Retirement” by Marie-Elisabeth Lei Holm, Peter Simonsen, Mette Marie Kristensen, and Anna Paldam Folker, a group also coming to NM with joint Humanities specializations, takes occasion from a review by the World Health Organization (WHO) “who has singled out art and culture as important resources that can be integrated into various forms of health initiatives” (153). The article details the elements and results of their USD-affiliated project, “Read, Man!” aimed at retired men, a group “vulnerable in terms of experiencing loss of meaning and loneliness when they are no longer working” (155). It concludes that literature, whose universal character offers more widespread potential for recognition (identification, catharsis, empathy), “does seem to have the potential to promote enhanced health when read, used, and shared among different groups of people” (164).

15The final Chapter of the anthology, Jeanette Bresson Ladegaard Knox’s “Socrates and Sickness: On Philosophizing through Narrative,” takes basic NM from narratology to philosophy. Knox, a professor of Medical Ethics and Philosophy, delineates through an actual session example how oral narratives of personal stories by cancer patients, when dialogically processed through Socrates’ “midwifery” method, lead patients to “think chorally” (168) about their own experiences and thus achieve a philosophically palliative perspective on their ailments. It can also “help doctors to refine their interpretation of patients’ perceptions of their own illness, make nurses better at safeguarding their own values and those of others, and improve patients’ ability to cope with the uncertainty of their situation” (179).

16The volume closes with an afterword by Rishi Goyal, Head of the MA program in Medical Humanities at Columbia, who recalls encountering chasms in patient-doctor communication as a young doctor-in-training since, “Simply put, we had not been trained in the imagination” (183). This led to the realization that healthcare is always-already embedded in larger social and cultural structures of “biopolitics and biopower” (185), such as the changes from a paternalistic to a patient-interactive clinical model and the effects of increasing “migrancy, race, or poverty” (185) on the quality of healthcare. Goyal concludes that “Biological existence is reflected in political existence” (186), echoing Charon’s original impetus for the institution of NM as offering practical justice on matters as vital as life, health, and death. Thus, the transplantation of the American-born NM ideal worldwide concludes appropriately by acknowledging the challenge of global migrancies on the future of that ideal and its practices. Following that logic, one can note that the volume, though useful as a case log and rich in a transdisciplinary way, would probably have benefitted from including paradigms from other notable NM programs across Europe, thus increasing its applicability reach by taking into account cultural, economic, geographic and social variables among EU countries. It is nevertheless useful for two groups of people: on the one hand, professors and medical professionals who wish to explore step-by-step working paradigms of NM workshops in higher education and social outreach programs as a step towards implementing their own; and, on the other hand, Humanities teachers who can cite tried-and-true examples to contest the devaluation of their field in a global market oriented towards science skills and business qualifications and affirm the diachronic and irreplaceable benefit of reading and teaching literature.

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Christina Dokou, « Anders Juhl Rasmussen, Anne-Marie Mai and Helle Ploug Hansen (eds.), Narrative Medicine in Education, Practice, and Interventions, London and New York: Anthem, 2023, 194 p. »Revue LISA/LISA e-journal [En ligne], vol 22. n°57 | 2024, mis en ligne le 15 février 2024, consulté le 20 juillet 2024. URL : http://0-journals-openedition-org.catalogue.libraries.london.ac.uk/lisa/15880 ; DOI : https://0-doi-org.catalogue.libraries.london.ac.uk/10.4000/lisa.15880

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Christina Dokou

Department of English Language and Literature, The National and Kapodistrian University of Athens, Greece

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