The self-telling body

This essay will examine some of the narrative practices emerging in the health care professions — medicine, nursing, social work, and psychotherapy. We have always, of course, understood that the most fertile and clinically salient information we derive about patients comes from listening to them talking about their illnesses. Nonetheless, medicine’s recent past is marked by not so much a suspicion of as a dismissal of word in diagnosing and treating disease. Of late, medicine (and because I am a doctor, I will limit myself to thinking about medicine in the essay) has found sustenance from such fields as trauma studies, oral history, and testimony work. Finally, we are coming around to understanding that our tasks include the duty to bear witness as others tell of trauma and loss.The narrative practice of medicine — or, as I have come to say, the practice of narrative medicine — unites a host of neighboring concerns and approaches. Historically, medicine came into the narrative realms through qualitative social science, especially sociolinguistics, as a means to represent and comprehend the conversations that take place between doctors and patients. Such scholars as Elliot Mishler, Richard Frankel, Catherine Riessman, and Candice West really altered medical practice by making medical discourse amenable to inspection and then analysis. Around the same time, we also turned to literary texts and ways of thinking that help us to enter the worlds of patients, see others’ experience from their perspectives, greet the metaphorical as well as the factual power of words, and be moved by what we hear. Oddly, then, medical practice became a bridge between the qualitative social sciences and literary theory, letting us, from the inside, see how very similar are the efforts of the sociologist examining discourse and the novelist creating it.We doctors feel great good fortune in having the ultimate objective correlative — what might be captivating but ethereal theorizing becomes as practical and concrete and earthy as can be by virtue of being about somebody’s body — particularly somebody’s ailing body. What extreme pleasure that my thinking complicated thoughts and being attuned to the complex ways of language can translate into control of my patients’ blood sugar or relief of their migraines or diagnosis of their coronary artery disease. Narrative medicine becomes, in the end, a heady, brainy, compassionate, corporeal practice that can heal the patient and nourish the doctor at the same time — by virtue of the talk.