August 6, 2012
Multi-storied lives matter in medicine as well as in literature


The article that goes with this abstract focuses on the importance of doctors listening to the stories that people want to tell as well as the more narrow and technical stories that standard medical education teaches doctors to gather, document, and focus their work around. For my taste, this is better than many narrative medicine articles because it emphasizes how doctors should listen rather that focusing on the doctor’s empathy and humaneness while taking the spotlight off the “patient.”

I posted a link to the video by Chimamanda Adichie yesterday.

Commentary: Narrative Lessons From a Nigerian Novelist: Implications for Medical Education and Care
Joseph Zarconi, MD

In her TED Talk entitled “The danger of a single story,” Nigerian novelist Chimamanda Adichie shares stories about her life that illustrate the natural human tendency to interpret the lives of others in the context of what she describes as narrowly constructed and often stereotypical “single stories.” These single-story views often portray others as wholly different from those constructing the stories, thereby diminishing the possibilities for genuine human connection. Referencing Adichie’s talk, the author describes the narrative dissonance that so often distances patients from their physicians. He illustrates the dangers to patients that can result from single-story caregiving by physicians, sharing an example from his own experience in which unnecessary harm came to his patient because of his own single-story thinking. The author argues that these single-story dangers must be openly and consciously addressed in the training of doctors to counteract the tendency for their clinical and educational experiences to inculcate single stories by which physicians come to interpret their patients. He offers suggestions as to why single-story thinking arises in clinical practice and how to mitigate these forces in medical education. The author concludes by contending that the education of physicians, and caring for the sick, should be aimed at preserving the dignity of those being served, and he argues for an “equal humanity” model of the patient– physician relationship that engages patients in all dimensions of their multiple stories.

Acad Med. 2012;87:1005–1007.
doi: 10.1097/ACM.0b013e31825ce727


August 3, 2012
Cheryl Mattingly on generosity as an underground practice in medicine


Cheryl Mattingly is an anthropologist who has spent her career studying the culture of occupational therapists who work in large inner city hospitals. This is “exoticizing the domestic” rather than the more traditional cultural anthropology which “domesticates the exotic.” She has a lot to say about the culture of hospitals in general, the politics of class and race in urban hospitals, and the poetics of encounters between professionals and patients. Reading her work gives me hope for the future of medicine. She sees “clinical encounters” as dramas in which each participant is actively and collaboratively making up the lived story of the meaning of what has come before and of what’s possible in the next moment. I am moved by this long paragraph from her book Healing dramas and clinical plots. She is talking about what she has learned in the course of her studies.

“There was more generosity than I was prepared for. I saw small kindnesses rather than life-saving interventions. These went almost unnoticed by the therapists themselves. Generosity and small attentions are not the stuff of the medical chart. Even when something more dramatic (trying to help a despairing person find a reason to stay alive), there is no place to formally record these actions. They are undocumented exchanges, not part of the official purview of the occupational therapist. Therapists personally valued their own kindness and their imaginative capacity to link their interventions to the lives of their patients, but because there is almost no language within biomedical discourse for recognizing and examining exchanges which address the illness experience and because this is not a “reimbursable” part of treatment, the phenomenological aspects of treatment are quite neglected, carried out almost furtively. these attentions to the illness experience constitute an “underground practice” in occupational therapy and doubtless many other health professions. Taking careful note of the narrative structure of clinical interventions reveals “hidden values” within biomedical practice which run counter to the dominant metaphor of body as machine that holds such persuasive force in Western medicine. Put differently, it reveals how some health professionals, some of the time, recognize a physiological body which is inextricable from the imagined and lived body, the body which carries a person through social space and time.”

-Mattingly, Cheryl (1998) Healing dramas and clinical plots: The narrative structure of experience. p 22. Cambridge University Press, New York.

July 24, 2012
"The best way to dehumanize someone while claiming you’re not is to believe you are just the same. You erase their experiences and perspective, their struggles and obstacles, their unique way of having to deal with those things in a world that also erases them. With the words, ‘but humans are humans’ or the bullshit dramatics of ‘we all bleed red’ normal people can simply pretend that if we all did things the way they did, then everything would work out okay. But, yes, we all bleed red but you don’t treat a papercut the same way you treat a gash, you don’t treat an infected wound the same way you treat one that isn’t, you don’t treat a wound to the leg the same way you treat a wound to the gut. You are not acknowledging someone’s personhood when you ignore the very things that make their lives different than yours, and when you refuse to understand that their circumstances have given them their own perspective that is just as valid as yours. More valid in fact – their perspective about their experiences that you haven’t been through is far more valid than anything you could ever think about it."

The danger of worldviews (Speaking when the world sleeps)

(Source: kiriamaya, via shrinkrants)

July 22, 2012


I love Harlene Anderson.

Thanks to Christopher Kinman and Rhizome Network for making and sharing this excellently crafted video of Harlene explaining in clear, plain language one of the foundational principles of Collaborative Language Systems Therapy. In Narrative Therapy, we come at this same territory when we emphasize the importance of noticing (whenever possible) our assumptions and questioning them. We spend more time and effort in trying to unpack and understand the historical, social, cultural influences that support particular assumptions, but both not knowing and questioning our assumptions are stances that have the intention of supporting a non-impositional, client-centered, present-to-future kind of psychotherapy.

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