Arushi Dogra JE ‘24
Tired of the endless doctors visits, Anne Doge was quickly losing hope. Since the age of twenty, she had experienced fierce nausea and gut pain anytime she ate, often to the point of vomiting. Once her physician’s antacid prescription failed, her psychiatrist landed on the diagnosis of bulimia nervosa, a psychological disorder associated with harmful cycles of binge-eating and purging. Anne’s life was soon consumed by a series of health consultations with orthopedists, endocrinologists, immunologists, and more. She took antidepressants and underwent therapy. Her internist suggested she force herself to consume at least 3,000 calories daily, but her physical condition continued to depreciate. Her bones weakened, her immunity dwindled, and her weight dropped. When she insisted that she was eating, her protests fell on deaf ears; her doctors assumed she was lying. After over thirty physician consultations, Anne finally met Dr. Myron Falchuck, an acclaimed gastroenterologist. When she walked into his office, her eyes were drawn to the tall stack of her medical records on his desk, a pile that she had watched grow taller over the last fifteen years. But to her surprise, Dr. Falchuck pushed it aside, pulled out a blank sheet, and said, “Before we talk about why you are here today, let’s go back to the beginning. Tell me about when you first didn’t feel good.” Then he listened and observed, and it made all the difference.
Dan McAdams and Kate McLean, professors of psychology at Western Washington and Northwestern Universities, respectively, explain that narrative identity is the “internalized and evolving story a person invents to explain how he or she has become the person he or she is becoming.” Narratives are the expression of a message through a character over time. In his book The Literary Mind: The Origins of Thought and Language, cognitive scientist Mark Turner suggests that this is what makes the human mind unique: its ability to draw meaning from stories. Additionally, a number of studies have found a positive correlation between reading literature and demonstrating higher emotional intelligence. By placing the reader directly into the mind of the character, narratives can “disarm readers of some of the protective layers of cautious reasoning that may inhibit empathy in the real world.” As a result, the importance of narratives and storytelling in modern society has become an area of interest for many industries, including medicine.
Narrative medicine centers around the idea that narrative competency in physicians enhances their “ability to acknowledge, absorb, interpret, and act on the stories and plights” of patients, as explained by Dr. Rita Charon, a pioneer of the field. It integrates work from the 1960s and ’70s that led to the realization of the importance of physician-patient communication with more modern research proving a connection between storytelling and empathy. Combining these findings, narrative medicine has become one of the most acclaimed models for practicing effective and humane medical care.
Charon explains that the benefits of a robust narrative education for physicians can be best explained in the context of three different “narrative situations” or relationships. One is the relationship between physicians and the public. Physicians hold a lot of power; people turn to them during the most vulnerable moments of their lives, instances of illness and uncertainty. It’s critical for the public to trust in the fact that physicians will prioritize what’s best for their patients, and a method for ensuring this trust is through honest narrative-sharing. Narrative competence also benefits physicians themselves, particularly in relation to mental health. In the 1960s, sociologists observed that medical practitioners conducted their work with “detached concern,” likely in order to reduce the emotional toll of the job. The catharsis of storytelling can assist with processing, instead of repressing, these emotions, and it can also alleviate burnout.
The most integral (and conspicuous) narrative relationship exists between the physician and the patient. In fact, every physician-patient relationship begins with a narrative – the narrative of the patient’s symptoms and circumstances. The patient conveys important information via several avenues: their words, tone, gestures, body language, physical wellbeing, mental state, relationship with loved ones, recent events of note, fears, hopes, dreams, and infinite other nuances. All of these pieces work together to inform the correct conclusion. In the words of William Osler, known by some as the father of modern medicine: “Listen to your patient. He is telling you the diagnosis.” The physician must be able to empathize with their patients, and narrative experiences allow doctors to read and analyze them the way one would “close-read” a literary work. This is exactly what Dr. Myron Falchuck practiced with Anne Doge, and what a number of physician-writers have preached as a pillar of ideal medical practice. In Anne’s case, as with many patients, she finally felt heard, rather than dismissed as a liar or psychologized for the sake of convenience. When Dr. Falchuck empathetically listened to what she was telling him, not just with her words, but also her tone and her body language—the tremor of fear in her voice and the way she was physically closing into herself—he was able to pick up on something every other physician that had seen her missed, diagnosing her correctly with celiac disease and consequently saving her life.
The strong link between narrative-sharing and the development of empathy is especially critical during the COVID-19 crisis, as well as the devastating social, political, and economic turmoil the pandemic has precipitated. Patient-centered medical practice is crucial, now more than ever. The necessary increase in telemedicine means that doctors have had to rely more heavily on their patients’ narrations. However, even beyond the realm of medicine, what people need right now is support. In a world of chaos, storytelling has helped people find meaning and community; educators across the country are awed at the solidarity that’s developed between members of their school communities, with one observing that even a 17-year-old child and a 60-year-old senior saw parts of themselves reflected in the other. In this period of hate and division, only empathy can bring us together. As Martha Nussbaum, Professor of Law and Ethics at the University of Chicago, poignantly put it: “You can’t really change the heart without telling a story.”