the difference between practicing medicine and narrative medicine

RMNP

It's one thing to be able to put a name to your illness. To say, "I have cancer," or "I'm in heart failure," or "I have arthritis." It's another thing to describe all the ways it affects you. All the ways it makes you feel...physically, psychologically, and emotionally. This defines the difference between medicine and narrative medicine.

"Science tells you when and how you are ill;

your particular culture, or subculture tells you

when and how you are sick."

~Ken Wilbur~

It isn't enough to know that you have a disease. You want to know why you have it. You want to attach some sort of meaning to this illness. What did you do to deserve it? What can you expect? How will it affect the people in your life? These issues describe your sickness, and they have everything to do with the culture that surrounds you and the stories it tells. Those stories reach into your family, your environment, your experience, your expectations, and your longings.

"There's a phenomenology of being sick,

one that depends on temperament, personal history,

and the culture we live in."

~ Siri Hustvedt~

Oh, you have lung cancer? Why did you smoke? Why didn't you quit? Who will miss you when you're gone?

You have diabetes? What did you expect? Your mother and father were both diabetic...and overweight, just like you.

Cancer? When no one else in your family ever had it? That's so sad.

The culture you live in can create an entire narrative around your illness.

"Patients tell stories to describe illness.

Doctors tell stories to understand it. 

Science tells its own story to explain diseases."

~Siddhartha Mukherjee~

In some cases, your narrative is fueled by speculation, judgement, ignorance, and blame. Not a healing thought among them. The patient's pain is intensified by guilt. Weakness is compounded by shame. Fear morphs into despair. The patient feels sicker and sicker.

In other cases, illness is met with concern, compassion, and care. 

Your confused or agitated grandmother is treated patiently and gently. The abject beggar is bathed, clothed, and fed. The smoker with lung cancer, the obese diabetic, and the middle-aged banker with the STI are all cared for without speculation, judgement, or antipathy.

The stage is set for healing.

When we are ill, the diagnosis is just that: the name we give the disease. The sickness is the story that surrounds it.

"It is more important to know

what sort of person has a disease

than to know what sort of disease a person has."

~Hippoctares~

jan