©2007 Maine Humanities Council Literature & Medicine Humanities at the Heart of Health Care® Synapse ::: Spring 2007 :::
Volume 3, Number 1 Literature & Medicine:
From the Inside Out Interview with Rita Charon :::
bio, by Lizz Sinclair :::
In Narrative Medicine: Honoring the Stories of Illness, Rita Charon defines narrative medicine as “medicine practiced with… narrative skills of recognition, absorbing, interpreting, and being moved by the stories of illness.” (p.4) As she explains in her writings, it is about listening to another’s stories skillfully and carefully—bearing witness and being present to both another’s experience and one’s own.
Because this is not as easy as it may seem, Charon and her colleagues share their approaches to teaching and developing narrative skills such as close reading, reflective writing and bearing witness in her book, classes and workshops. It was at one of her Narrative Medicine workshops that I had the great privilege to meet Dr. Charon and learn about narrative medicine first hand.
Nourishing Ourselves and Bearing Witness
An Interview with Rita Charon
LS: In your book you write that narrative medicine provides hope that our health care system can become more effective by “recognizing and respecting those afflicted [by disease] and in nourishing those who care for the sick.” Would you elaborate on this?
RC: This is the hope of the entire discipline—that by equipping health care professionals and patients and family care-givers with the wherewithal to meet in discourse, to recognize one another and oneself as one goes through illness, and to be open to one another’s lived experience, we can bridge the divides now separating us and get down to the challenge of either healing or living with illness. It is a far-flung hope that there be, eventually, some sort of equivalence or commonality among us all, sick and well; that we become partners and wayfarers together. See what I mean by positing recognition as the central event? The recognition has to pierce through the differences that currently segregate us away from real contact.
LS: An essay of yours mentioned that by writing narratives, health care professionals can better imagine not only what their patients might be experiencing, but also understand “what they themselves endure in the care of the sick.” I was struck by that sentence. Would you talk a little about how writing can help health care professionals in this way, and how it can (as you say in your recent book), nourish them?
RC: Writing is one of the easiest and most cost-effective methods of exposing the “unthought known,” a brilliant phrase from the work of psychoanalyst Christopher Bollas. We know things that we don’t know we know. We need specialized methods—psychoanalysis, dreaming, and, I suggest, writing—in order to rescue this known from falling prey to boredom, fear, censure, or simply being overlooked. Invariably, when doctors and nurses and social workers write about their patients, they have “aha” moments—“oh, I didn’t know I was afraid of his disease,” or “I want to be like her when I’m dying.” These insights accumulate in the course of sustained writing about practice to let the writer understand the complexity of this interior life as a clinician, to appreciate the bonds formed between us and our patients, and to simply take stock of the magnitude of what it is we do. This is, I think, nourishing, whereas practice without reflection becomes automatic and not unlike starvation.
LS: I was surprised at the willingness of people at the narrative medicine workshop I attended to write about their experiences—do you find that this is generally the case? It seems that writing could be pretty intimidating to those who are not in the habit of writing regularly, especially when writing about one’s feelings and experiences with patients.
RC: When clinicians do this kind of writing in groups and near spontaneously (take out some paper and write, right now, about a patient in your practice whose suffering moves you), writing becomes not a chore or a test but a far more “owned” act. There need not be private stage fright (yes, many persons get anxious with the blank page) when done this way without premeditation and postponement and the like. Something comforting happens when heads bow around a table, and a characteristic silence of plenitude drops upon us. I think we derive some kind of momentum by watching others scribbling away, and no one expects anything polished and finished if you simply dash it off right here. These factors help to explain some of the ease that we typically see in these writing workshops. The other part of the ease is the urge to tell of these meaningful and grave clinical situations that build up inside us, plucking at the sleeves of our attention, queued up to be brooded about.
LS: Are these writings ever shared with colleagues?
RC: We typically ask persons to read aloud what they have written. In our writing seminars that continue over time, many will submit things they have written to various clinical journals and the like. I don’t think the power of the writing exists in the publishing of them, myself, but rather in the doing of them. I have found myself sharing things I or my colleagues write about my patients with either other clinicians caring for that patient or with the patient himself or herself. I think there are vast therapeutic potentials for these texts that we have yet to conceptualize and test.
LS: You sometimes suggest that health care professionals write about an experience from the imagined perspective of a particular patient. How do you know if you’ve gotten it right? What if what you imagined is not the patient’s experience? Do you or any of your students share these with the patients?
RC: The imagining is hypothesis-generating, not hypothesis-testing. That is to say, the act of imagining from a patient’s perspective is done not to find answers, heavens, but to find questions. The next time you see that patient, you will approach him or her with a fresh set of curiosities, hypotheses, ideas about what might have been behind some behavior or comment. And so you will ask. You will enter perhaps a more complex and sustained conversation with the patient than you would have without having imagined and written. I would never think that what I made up was actually true! Oh, dear, no, simply that imagining another is a way of nearing that other.
LS: In your writing and workshops you talk a lot about the importance of bearing witness. Would you explain what you mean by this, and why this is important for health care professionals?
RC: Bearing witness means letting another’s suffering register on you. You recognize the suffering not, right now, for instrumental reasons of fixing it or doing something yourself in response to it. This will come, perhaps, but the fixer or the doer thereby becomes the agent while the sufferer becomes the passive recipient of the fixing or the doing. In bearing witness, we invite the sufferer to be the active agent while we, simply, behold that active one. Our witness does not diminish or replace the active one. Our witness, instead, recognizes the magnitude of what the patient does and lives through. Our witness takes account of the gravity of that other person’s lived experience. I don’t mean to sound mystical, but it is indeed a matter of some awe in the presence of profound human experience. This is important for the health care professional because the posture conveys to the patient that the doctor or nurse grasps the gravity of the patient’s situation and respects the magnitude of his or her plight.
LS: Time is such a commodity for those involved in health care—it takes time to listen attentively to people’s stories. Can this really be done in a busy clinical setting?
RC: We have no choice. We will simply have to learn how to do these things more efficiently and we will have to change office routines to guarantee that the time for these essential parts of health care get done.
LS: Is there anything that you would like to add in closing?
RC: There is so much to do. Thanks for your very thoughtful questions.
LS: Thank you very much for your time, Dr. Charon, and for the important work that you are doing. We are very excited to have you speak and lead a workshop in narrative medicine at our upcoming conference!