Psychology for Lawyers

understanding ourselves
stories & 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, reflection, 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 & narrative medicine] encourage the patient to share his or her own story 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

Debra Malina, Book Review [Rita Charon, Narrative Medicine: Honoring the Stories of Illness (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]

Rita Charon, "Close Reading: The Signature Method of Narrative Medicine," in Rita Charon, et.al., The Principles and Practice of Narrative Medicine 157-179 (New York: Oxford University Press, 2017) [online text]

Class Videos

Class Video 1: Dr Oliver Sacks on Narrative and Medicine and the Importance of the Case History [40:59 mins.] [begin class presentation at 2:06 mins., end at 8:00 mins.]

Class Video 2: Stories in Our Lives [59:41 mins.] [Rachel Naomi Remen, an early pioneer in the mind/body holistic health movement] [begin presentation at 0:38 mins.; end at 6:03 mins.] [Remen goes on, in this video to talk about the "art of living" and much else]

Class Video 3: Honoring the Stories of Illness: Dr. Rita Charon [18:16 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 one 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 narrating 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 questions: '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 potent therapeutic instrument is the self, which is attuned to the patient through engagement, on the side of the patient 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 become 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]

Bibliographical Reference & Articles

Peter L. Rudnytsky & Rita Charon (eds.), Psychoanalysis and Narrative Medicine (Albany, New York: State University of New York Press, 2008). A number of papers that appear in Psychoanalysis and Narrative Medicine were presented at the Psychoanalysis and Narrative Medicine Conference, University of Florida, 2004:

"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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