BETWEEN THE LINES: EXPLORING THE STRAIN OF NARRATIVE
MEDICINE THROUGH LITERARY THEORY
Dr. R. Pavithra,
Assistant Professor of English,
Sona College of Arts and Science, Salem.
Abstract:
Can
Narrative Medicine take the Strain? This paper looks at how narrative-based
approachesin medicine can help improve doctor-patient communication and
healthcare outcomes. It usesideas from literary theory, including the works of
Vladimir Propp, Claude Lévi-Strauss, andpost-structuralist thinkers, to show
how storytelling in medicine is similar to storytelling inliterature, shaping
the way doctors and patients interact. The paper focuses on the gapbetween the
personal stories of patients and the medical stories created by
healthcareprofessionals, stressing the importance of listening carefully and
showing empathy. Bycomparing the certainty of medical language with the
uncertainty often in patients'experiences, it calls for a more compassionate
approach to medical practice. Finally, thepaper suggests that narrative-based
medicine should be part of medical training to improvecommunication, empathy,
and understanding, especially when it comes to the emotional andpsychological
aspects of health and illness.
Keywords:
Narrative Medicine, Literary Theory, Doctor-Patient Relationship,
MedicalHumanities, Post-Structuralism, Empathy in Healthcare.
The Story or
narrative is shaped by its historical, cultural, and social context, which
determines how the relationship between the storyteller, the listener, and the
story itself is structured. In ancient societies, like Greece, oral
storytelling was highly organized. Storytellers relied on memory, and audiences
understood familiar structures and characters, with some room for improvisation.
This approach is similar to the way medical cases are presented in a structured
format.
However, novelists
and poets explore a wider range of narrative styles, much like the varied
presentations seen in medical settings, such as in GP surgeries or emergency
rooms. For example, in Moby Dick, Herman Melville immediately grabs the
reader's attention with the simple and striking opening sentence: “Call me
Ishmael.” This creates an instant, intimate connection with the reader, drawing
them into the story. Similarly, how does your doctor greet you?
In Cutting for Stone, the idea of
“narrating” comes from the Latin word for telling a story or giving an account.
The Russian scholar Vladimir Propp studied folk tales and found that they often
follow a similar structure, with common themes like heroes and villains. Later
thinkers, like Claude Levi-Strauss, suggested that language shapes how we
think, and that cultures use a common set of rules to tell stories.
However,
experimental writers like James Joyce and William Faulkner challenged
traditional storytelling, breaking the usual rules of plot. Post-structuralism
thinkers, like Lyotard, argue that rather than finding universal rules for
stories, we should focus on the unique, small stories that exist in different
cultures and contexts. This shift in thinking helps us see that the way people
talk about health and illness can be very different from the specialized
language doctors use. This gap in language can lead to misunderstandings
between doctors and patients.
Kathryn Montgomery
Hunter, who studied “doctors’ stories,” emphasized that medicine isn’t just a
science but a practice based on narrative. Doctors turn patients’ stories into
medical cases, which often follow a detective-style structure, looking for
clues to solve the problem. But there is often a gap between the patient’s
story and the doctor’s medical story. While this disparity can help doctors
work at a technical level, it can also lead to misinterpretations and
objectifying the patient.
Doctors must learn
to read patients like texts, paying close attention to both what is said and
what is not said. This is not something that is always formally taught in
medical schools, but it’s an important skill. It requires doctors to listen
carefully during consultations and understand the patient’s experience, not
just their symptoms.
In a clinical
setting, the doctor and patient exchange stories. The patient presents their
symptoms, and the doctor asks questions to take a history. But the power
dynamic is often in favour of the doctor, and the doctor tends to lead the
conversation. Medical schools don’t always teach students to understand the
psychological side of patient stories, especially in general practice or
psychiatry. Additionally, many stories are told by others, such as parents
telling the doctor about their children’s health, or patients with cognitive
challenges whose stories are told in a different way.
The main takeaway
is that medicine involves listening to and translating the stories of patients
into medical language, while being careful not to lose the true meaning or
humanity of the patient’s experience.The
different ways stories are told in medicine—the patient’s story, the doctor's
response during the appointment, and the doctor’s summary of the case—have all
been studied as examples of traditional storytelling. This have been widely
studied in terms of embodying aspects of the traditional forms of narrative
described by the formalists and structuralists, like characters, plot, and
style. Style here refers to how language is used, such as with rhetorical devices
(like metaphors or figures of speech), genres, and ways of representing ideas.
James Joyce’s Finnegans
Wake, though known for its complex language and experimental structure,
actually follows a simple circular narrative. The novel’s ending loops back to its
beginning, creating a timeless cycle. The text begins with the line “riverrun,
past Eve and Adam’s,” which refers to a place near Dublin, but in a way that
feels timeless. Joyce's structure mirrors the idea of an eternal return, where
the narrative comes full circle.
In a similar way,
doctors might view medicine as a cycle, seeing patients with familiar symptoms
over and over. The doctor might treat the patient as just another “type” based
on past experiences or patterns, much like how Joyce loops back to the same
place. But what’s not visible is the doctor’s thought process and the
complexity behind their clinical reasoning, which often remains hidden from the
patient. The patient, of course, is unaware of the medical “Finnegans Wake” in
the doctor’s mind.
In a
clinical setting, a radiologist might present a diagnosis in a straightforward,
formalized way, using the subjunctive mood to create narrative tension. For
example, when reading an X-ray showing a double-contrast barium enema with an
“apple core lesion,” the radiologist might say, “There is an area of narrowing
in the sigmoid. The undercut edges give an apple core appearance. This is
colonic carcinoma.” The language used here is very direct and certain, focusing
only on the symptom and leaving no room for ambiguity. The subjunctive mood
subtly introduces a sense of uncertainty or possibility, yet the overall tone
leaves little space for doubt. In this clinical context, the patient isn't
mentioned by name; they are reduced to a mere description of their condition,
stripping away the individuality and humanity behind the diagnosis.
In contrast,
William Carlos Williams, a poet and doctor, wrote a simple but deeply evocative
poem titled The Red Wheelbarrow:
so
much depends
upon
a red wheel
barrow
glazed with rain
water
beside the white
chickens. (79)
Although the poem
seems simple, the line “so much depends” makes us wonder what depends on the
wheelbarrow. This uncertainty makes the reader think more deeply and reflect on
the poem.
The key difference
between the radiologist’s description and Williams’s poem is how they handle
certainty. The radiologist uses clear, factual language, leaving no room for
interpretation. But Williams’s poem uses language that embraces uncertainty, inviting
the reader to imagine different meanings and possibilities. This uncertainty
creates tension and makes the poem more interesting.
In medicine,
there’s often a preference for clear answers, which means doctors tend to speak
in a way that leaves little room for doubt. This can make it harder to listen
to patients, whose stories are often filled with uncertainty. For example, a
patient might say, “I'm not sure what will happen,” while the doctor might say,
“You have ovarian cancer,” which is a definite diagnosis. Patients’ stories are
often full of unknowns, and they may express themselves using words like
“maybe” or “possibly,” which leave room for uncertainty. But in medicine, this
kind of language is often overlooked in favour of more direct, certain
language.
As
doctors faced more public distrust and lawsuits over poor communication, there
was a push to reconnect with patients by listening to their stories. This led
to a focus on medical ethics and using literature to teach these values. The
emphasis shifted to “taking a history” from patients, which became important in
medical humanities. Narrative-based medicine emerged, focusing on the personal
meaning of illness rather than just statistics. It also highlighted the
importance of language in doctor-patient communication. However, medicine often
avoids dealing with uncertainty, which can lead to misdiagnosis and reinforce
hierarchies. Ludmerer argued that medicine must learn to share its uncertainty
with patients. Particularly how medical language avoids terms that express
uncertainty, like “maybe” or “could.” This focus on
certainty can be a problem because it makes it harder to truly understand and
connect with the patient’s story. It also means that medical students might
learn to focus too much on facts and diagnoses, instead of understanding the
emotional and uncertain aspects of people’s experiences.
In conclusion, narrative medicine can greatly improve the
way doctors connect with patients by recognizing the importance of storytelling
in healthcare. Just like in literature, where uncertainty and emotion create
depth, doctors can learn to understand patients' stories beyond just symptoms
and diagnoses. When patients are reduced to mere medical terms, their
individuality and emotions are lost, which can lead to misunderstandings. By
embracing uncertainty and focusing on the personal experience of illness,
doctors can form a stronger connection with patients. Incorporating
narrative-based medicine into medical practice and education helps doctors listen
more attentively and respond with greater empathy. This approach allows
patients to be seen as whole individuals rather than just cases. By doing so,
healthcare becomes more human-centered, creating better understandding and
care.
Works Cited
Hunter, K.M.
“Toward the Cultural Interpretation of Medicine”. Literature and
Medicine, 1991 (Vol 10): 1–17.
Joyce, J. Finnegan’s Wake. London:
Faber & Faber, 1939.
Ludmerer, K.M. (1999) Time to Heal:
American Medical Education from the Turnof the Century to the Era of Managed
Care. Oxford: Oxford University Press, 1999.
Lyotard, F.
The Postmodern Condition. Manchester: University ofManchester
Press, 1984.
Verghese, A. Cutting for Stone. London:
Chatto&Windus, 2009.
Williams, William Carlos. “The Red
Wheelbarrow.” The Collected Poems of William Carlos Williams, edited by
A. Walton Litz, New Directions, 1986, p. 79.