story healing: part 1

 

I spent last week at a memoir writing retreat in Massachusetts with Nancy Aronie, author of "Memoir as Medicine."

I've taken this workshop with her several times over the years. I went back this time because I was looking forward to presenting my own twist on the healing power of storytelling this week at the annual Pennwriters Conference in Lancaster, so I wanted to soak up some of her inspiration, humor, and wisdom to tide me over. And I did. Unfortunately...I also picked up Covid while I was there. Meaning I had to cancel my debut presentation this week...

...after all that work.

So, instead, I decided to put it here for any one who is interested. The title is "Story Healing"…the idea that putting our personal stories into words and sharing them with others can play a role in healing…not just emotional and psychological healing…processing the pain, feeling better about ourselves, easing the symptoms of anxiety and depression…but real physical healing that we can observe and measure.

Seriously. This is good medicine.

It interests me because, for those of you who don’t know me, I’m a physician. I practiced family medicine for over thirty years…until I retired, because my other passion in life is writing…and I had a story in me that I really wanted to tell.

So…I want to talk about what we mean by Story Healing…the power of getting our stories down and sharing them with others. Is there really anything to it? How does it work? What happens between us when we share our personal stories, and why it’s so important that we do.

I'll also be talking a tiny bit about the science behind the process. I'm going to share my family's story because I think it illustrates some of the painful consequences of keeping our stories under lockdown. And, finally, I'm going to provide you with a prompt to encourage you to begin sharing your story.

By way of introduction, I live near Harrisburg. I have three grown children and three grandchildren. I’m an avid walker and meditator, and now that I’m retired, a wannabe writer. I post this blog which is loosely based on the practice of narrative medicine, almost weekly. But…enough about me.

I’m more interested in who you are and what drew you to this space. Are you a healthcare provider? A nurse? Doctor? Therapist? First Responder?

Are you a caretaker?

Do you have a personal story about an illness or injury? About abuse? Trauma? Fear? Shame?

Do you keep your story under lock and key even though you’ve been over it a million times in your mind…and it just won’t go away?

Of course you do. We all do.

The point is that we ALL have a story to tell. The problem is that most of us never get around to sharing it. Instead, we make up excuses. We tell ourselves we don’t have time to write. We don’t know where to begin, or how to put our story into words. We tell ourselves that what we have to say isn’t important. That no one will be interested in it. Sometimes shame silences us. We blame ourselves for what happened to us. We have been conditioned to keep secrets.

Or…perhaps it’s simply too painful, or sad, or maddening to revisit. We’d like to pretend it never happened. We’d like to forget it…but we can’t.

So…our stories go untold…and as such, I’m telling you…they wreak havoc on our bodies.

The anger we keep bottled up, the grief we can’t bear, the shame we keep under lock and key all take a toll on us. We know that they raise levels of stress hormones and inflammatory chemicals in our bodies, like cortisol and adrenaline because we can actually measure them. And we know that these substances raise the heart rate, elevate BP, and raise blood sugar levels. This can lead to all kinds of problems in adulthood--hypertension, heart disease, diabetes, and autoimmune problems like lupus and RA.

Not to mention anxiety and depression.

Unless we acknowledge and explore the source of the problem, nothing we do or say will touch the cause of our pain. The rape. The abuse. The loss. All the medication in the world will not solve the problem. Traditional therapy will barely scratch the surface.

Honestly, it might be wiser to try storytelling.

*

There is, in fact, some science to support the idea that telling our stories can help us heal, not only emotionally and psychologically, but physically, as well. We know that storytelling can lower levels of inflammatory hormones in the body, because we can measure them…and we can observe their effects on the body. In studies where subjects were asked to write about a painful episode they had experienced vs a neutral topic like the weather or a favorite food…heart rate, BP, and sugar levels fell in the first group as compared to the neutral group.

In another study, participants underwent a small skin biopsy that left a tiny open wound. They were then assigned to write about a painful experience or a neutral topic. The open wounds healed sooner in the cohort that wrote about their pain.

In other studies, functional MRI scans of the brain demonstrated synchronization in electrical activity between the storyteller and listener. Their brain waves actually changed.

The point is that telling our stories affects us in ways we can actually measure and observe.

When you give your story a title, describe how it unfolded, and name the characters in it, you may begin to understand why it still disturbs your peace after all these years. If someone you trust is listening, you may come away with an entirely different perspective on it.

Let’s say, for example, that you’ve been struggling with guilt after a friend committed suicide. You pick up a book like “The Ticking Is the Bomb” by Nick Flynn whose mother took her own life. His story looks at suicide differently. He explores the fact that it was inevitable given the course of his mother’s life. It wasn’t his fault. After reading it, you might see things a little differently, too. It wasn’t your fault your friend found life unbearable. Perhaps you didn’t miss the clues because there were none. A layer of guilt falls away. The aching in your chest subsides. This is healing.

Or maybe your friend has been diagnosed with cancer, and it doesn’t look good for her. You have no idea what to say or to do for her…no clue how to support her. No clue how to just be present for her. Then you pick up a novel like “Talk Before Sleep” by Elizabeth Berg, and you learn all the ways you can comfort and encourage her, and even bring a touch of humor to the situation. This is healing.

When you tell your own story, you may finally be able to forgive yourself…or the person who hurt you. You may be able to cast aside some of the things you’ve always imagined were wrong with you, but never were. And still aren't. Inflammatory hormone levels come down. Your BP and blood sugar levels normalize. Anxiety and depression improve.

This is definitely healing.

When I was in practice, I listened to patients’ stories all day long. Of course, we didn’t call them stories. We took the HPI, better known as the history of the present illness…better described as the story of the present illness. We explored the PMH, or past medical history...or story. The patient’s FH or family history...or story.

Nowadays…those stories have been replaced by a series of bulleted lists in the electronic medical record. (Don't get me started...) Details go missing. You overlook the fact that your patient’s headaches started the day she discovered the cigarette burn on the sleeve of the sweater her ten-year old wore to school that day. Or that she can’t sleep because of the pile of unpaid bills collecting dust on the kitchen counter. Or that your patient has heartburn because he’s headed for divorce...

…unless, of course, you invite him to tell you about it.

Rita Charon, MD, PhD, at Columbia University College of Medicine, pioneered the practice of "narrative medicine" over twenty years ago as a tool to help medical students uncover the missing piece in their patients' histories.

This is how she begins with each new patient: "Tell me what you think I should know about your situation." Then she listens to the patient without interrupting, clarifying, correcting, or taking notes. Instead, she focuses her attention on what is revealed and how it is communicated, noting the patient's posture and gestures, images and metaphors, facial expressions, and the characters who play a role in the story.

When we reach into our patients' cholesterol laden hearts to understand why they are poisoning themselves with food, we need to know more than what they are putting into their mouths. When we encourage a friend to talk, we may discover that the real reason for this one's fatigue, or that one's intractable headache is end-stage disappointment, or anger, or shame that has festered out of sight for years.

Only then can we help them heal.

Stories form the basis of every relationship. They are the foundation of all friendship. They are an integral part of healthcare. They reveal who we are. They help us process what happens to us. They embody our unspoken fears, our deepest sorrows, our greatest regrets…

…which is why we don’t tell them. It’s hard to put them into words.

I know this because it took me fifty years to get mine down.

The good news is, it’s never too late to get started. This is your chance. 

Remember:

"The work of your heart is your gift to the world."

Next week I'll share the story that my brother kept under lock and key as a child, how our family's life unfolded around it, and why it took fifty years to reveal itself. Story Healing: Part 2.

 jan

revisit. revise. recover.

 

"I write because

I don't know what I think

until I read what I say."

~Flannery O'Connor~

This observation by author Flannery O’Connor rings true to anyone who harbors a vague feeling of anxiety for no identifiable reason. 

Even though they are living in a comfortable rut—let’s say, they are financially secure, their health is good, their family is intact—they can’t deny the knot in their gut or the dull ache in their chest that suggests something is wrong. Or, maybe they wake up every day with a sense of dread, exhaustion, sadness, or isolation that screams “depression”, even though, as people like to remind them, they have nothing to be depressed about. After all, they have a steady job and a nice home, their children are doing well, and their bills are paid. They should be happy. Still, the feeling is always there…uncertainty, fear, emptiness, hopelessness. They just don’t know why.

"Worrying is like walking around
with an umbrella
waiting for it to rain."
~Wiz Kalifa~

This is where storytelling comes in. Writing enables us to seek out and sort through memories, and to locate them in time and space. It encourages us to name the gremlins that stalk us, to label our fears, acknowledge our wounds, and reimagine our lives. We are no longer the victims of some obscure fear or unacknowledged sorrow. We can claim it and conquer it.

"The act of putting pen to paper
encourages pause for thought.
This, in turn, makes us think
more deeply about life…"
~Norbet Platt~

Physicians do this for every illness—from diabetes to heart disease to cancer. We ask about symptoms. We search for causes and encourage our patients to do what they can to avoid or eliminate them. We name the disease and suggest a course of treatment. If we have done our work well, we alter the course of the illness. We take control of it. We change the patient’s narrative.

"Revision is the heart of writing."
~Patricia Reilly Giff~

This is storytelling at its finest. It is also the goal in both clinical practice and in narrative medicine. When we write about illness, we revisit the initial injury. Perhaps it was a childhood rape, or a tragic accident, or the loss of a friend or family member we couldn’t face. By naming it, we confront it. The road to recovery leads us to a new perspective or understanding of it. Then, when we read what we’ve written, we finally know what we think.

Storytelling is the very process by which we revisit, revise, and recover.

~Revisit. Revise. Recover.~

jan

 

illness, inside and out

 

Illness has to be understood in terms of its effects on the patient, both inside and out.

Within, it interrupts normal physiology and function. It alters anatomy. It causes pain. Traditionally, this has been the domain of the healer: diagnosing and treating the illness or injury by asking about symptoms, examining the patient, ordering diagnostic tests, and formulating a plan of treatment. It can all be done at the bedside.

But illness also triggers a cascade of cognitive, emotional, and psychological responses. It affects the patient’s relationships, his capabilities, his expectations, and his role in the family and community. Positive mental and emotional changes have been shown to support the ability to heal. On the other hand, negativity is believed to impede recovery. Unless we take into account the patient’s sense of self when tending to his illness or injury, we may neglect one of the most important determinants of his ability to heal.

"It may take a doctor to diagnose
someone's illness, bit it takes a friend
to recognize someone's suffering."
~author unknown~

For example, when the family's breadwinner is laid off because of illness, he loses wages. It’s possible he will lose his job, so he worries how he will support his family. Fear and uncertainty aggravate the illness. His self-respect and confidence take a punch to the gut. That’s the thing that really hurts, but he won’t tell you about it unless you ask.

"To me the ideal doctor

would be a man endowed with 

profound knowledge of life and of the soul,

intuitively divining any suffering or disorder

of whatever kind,

and restoring peace by his mere presence."

~Henri Amiel~

Or perhaps your patient is a mother with young children at home. Who will take care of them while she is in the hospital? She worries about them. She feels guilty because she can’t be there for them. She may actually lie to you in hopes of being discharged from the hospital sooner, denying the pain she still has, or pretending to be stronger than she actually feels. Her narrative is misleading.

The patient’s story extends beyond the bedside. It embraces more than his illness. One person will be crippled by it while another is healed.

We can’t understand a patient’s illness unless we understand how it affects everything and everyone around him—his family and friends. His hopes, dreams, and plans for the future. We can’t hope to heal the patient until we hear his whole story.

“The doctor may learn more about the illness
from the way the patient tells the story
than from the story itself.”
~James B. Herrick~

jan

words of wisdom for writers who sometimes waver

 

In anticipation of my presentation on the healing power of sharing our stories at the 2024 Pennwriters Conference next month, I would like to share inspiration and wisdom from some really awesome writers and teachers:

~Words of Wisdom for Writers Who Sometimes Waver~

"There is no greater agony than bearing an untold story inside of you."
~Maya Angelou~

"The healing that can grow out of the simple act of telling our stories is often quite remarkable."
 ~Susan Wittig Albert~
 
“One of the most valuable things we can do to heal one another is listen to each other’s stories.”
~Rebecca Falls~
 
"Telling our story does not merely document who we are. It helps make us who we are."
~Rita Charon~
 
"Writing is medicine. It is an appropriate antidote to injury. It is an appropriate companion for any difficult change."
~Julia Cameron~
 
"Dancing, singing, storytelling, and silence are the four healing salves."
~Gabrielle Roth~
 
"The greatest story commandment is: make me care."
~Andrew Stanton~
 
"One day you will tell the story of how you overcame what you went through
and it will be someone else's survival guide."
~Brene Brown~
 
"The most important part of a story is the piece of it you don't know."
~Barbara Kingsolver~
 
"If we are artists...it is our job, our responsibility, perhaps even our sacred calling to take whatever life has given us and make something new, something that wouldn't have existed if not for the fire, the genetic mutation, the sick baby, the accident."
~Dani Shapiro~"
 
There isn't a stronger connection between people than storytelling."
~Jimmy Neil Smith~
 
"Because right now there is someone out there with a wound in the exact shape of your words."
~Sean Thomas Dougherty~
 
"You'd be surprised what lengths people will go to not to face what's real and painful inside them."
~unknown~
 
“Good writing is not about good grammar. Good writing is about truth.”
~Nancy Slonim Aronie~
 
"Everything you need to know about life can be learned from a genuine and ongoing attempt to write."
~Dani Shapiro~
 
"Write about what disturbs you, what you fear, what you have not been willing to speak about. Be willing to be split open."
~Natalie Goldberg~
 
“Stories are not material to be analyzed; they are relationships to be entered.”
~AW Frank~
 
“Can you tell me about a moment that was big for you…an instant when you saw things differently from then on? Not a sensational moment—you won ten-thousand dollars in the lottery, you were lost in the woods alone with no food—but a quiet moment when your whole awareness shifted?”
~Natalie Goldberg~
 
"Tell your story with your whole heart."
~Brene Brown~
 
"We read to learn about the world. We write to change the world."
~Lori Jamison Rog~
 
"Write hard and clear about what hurts."
~Ernest Hemingway~
 
"Share your story with someone. You never know how one sentence of your life story could inspire someone to rewrite their own."
~Demi Lovato~
 
"Everybody walks past a thousand story ideas every day. The good writers are the ones who see five or six of them. Most people don't see any."
~Orson Scott Card~
 
"If a story is in you, it has got to come out."
~William Faulkner~
 
"The truth is, in order to heal we need to tell our stories and have them witnessed."
~Sue Monk Kidd~
 
“The degree to which you can tell your story is the degree to which you can heal.”
~Stasi Eldredge~
 
“Your body’s ability to heal is greater than anyone has permitted you to believe.”
~unknown~
 
“Instructions for a long life: Pay attention. Be astonished. Write about it.”
~Mary Oliver~
 
“People start to heal the moment they feel heard.”
~Cheryl Richardson~
 
“Tell your story, because your story will heal you and it will heal someone else.”
~Iyanla Vanzant~
 
“We write out of revenge against reality.”
~Francine du Plessix Gray~
 
“It may be that when we no longer know what to do, we have come to our real work, and when we no longer know which way to go, we have begun our real journey.”
~Wendell Berry~
 
“At some point you are going to want to give up. Consider this a reminder:
don’t you dare.”
~Karen Salmansohn~

*

I could go on...

jan

what to do when you can't write, or you don't want to

If you have a story that keeps playing itself out just when you're dozing off at night, or after you've  been driving for a while, or when you're walking in the woods or on the beach...when your mind is free to wander and you were hoping for some peace and quiet...it may be begging you to share it with the rest of us. It may be time to put it into words on the page.

"If a story is in you, 

it has got to come out."

~William Faulkner~

The problem is that life hands us all kinds of interruptions and distractions. Some are happy events like the birth of a baby, a wedding, or an overdue vacation. We celebrate them with the people we love, and we enjoy doing it even when it puts our work on hold.

Unfortunately, some are unhappy occasions--a death in the family, the loss of a job, or an illness. Because there is so much to think about and so much to do, writing has to take a back seat for a while. People need our attention and our care. We may not be able to shake off our own sadness, or pain, or fear. It can be a challenge to put two consecutive thoughts together in proper order.

Still, when life gets in the way, we can't simply ignore it in the battle to make our word count for the day. We can't just sneak away when no one is looking to hang out with our manuscript.

In fact, we may not want to.

So what will you do when you can't write, or don't want to write? When you don't have the time, or the energy, or the motivation to line up perfect little sentences one after the other for someone else to judge?

Quoting James Baldwin:

"One writes out of only one thing--

one's own experience. 

Everything depends on how relentlessly

one forces from this experience

the last drop, sweet or bitter, it can possibly give."

~James Baldwin~

Whether your experience is sweet or bitter, savor it. Submit to every moment. Don't waste a drop. This is what will inform your writing when you do take up your work again. Anticipation, joy, and kinship, deeply felt, have the power to uplift the reader. Likewise, tribulation, well written, connects the reader with his own reality and tempers his own sorrow.

"Share your story with someone.
You never know

how one sentence of your life story

could inspire someone to rewrite their own."

~Demi Lovato~

Is it hard for you to maintain your writing practice? What is preventing you from writing? When will you begin?

"There's a secret that real writers know

that wannabe writers don't,

and the secret is this: 

It's not the writing part that's hard. 

What's hard is sitting down to write."

~Steven Pressfield~

The secret is to sit. Stay. Write. Remember that to get started:

"All you have to do is write one true sentence.

Write the truest sentence that you know."

~Ernest Hemingway~

jan

compassion, surrender, and equanimity

 

This past week was difficult, not so much for me individually, but for people I know and love. It can be described in two words: helplessness, which is what I felt, and hopelessness, which was the rock bottom truth.

It started with someone close to my heart who took ill, and required hospitalization for both evaluation and treatment. It turns out the management part of the story will require long, complicated surgery. That happens tomorrow, followed by that treacherous period when we have to wait for results, and hope for healing, while trying to keep everyone's spirits up. The trouble is I can't be there. Not that I would play any role in his surgery or treatment, but I believe in the healing grace of presence. So, I feel totally helpless.

"When you love someone,

the best thing you can offer

is your presence."

~Thich Nhat Hanh~

Then I received word that a friend's husband passed away unexpectedly over the weekend...while they were travelling out West with their two dogs in their brand-spanking new RV...leaving her alone somewhere in Texas to find her way home. Without him. Without hope. Which leaves those of us who love her fraught with worry and sorrow, unable to be there for her. Unable to help at all.

"At some point

you are going to want to give up.

Consider this a reminder:

don't you dare."

~Karen Salmansohn~

Not only my little speck of the world, but the entire planet appears to be blanketed with fear, pain, dread, and sorrow. Punctuated by cruelty, indifference, hatred, and greed. Littered with broken bodies, broken hearts, and broken lives. With no end in sight. It has frustrated us by making us feel helpless. It has discouraged us with loss of hope. 

But make no mistake about it. Both the suffering we witness around us and the pain we experience in our own lives are wellsprings of deep compassion. They invite us to come together and to remain present for one another. They train us to acknowledge what is real and true in our lives, and by doing so, to embrace equanimity:

"EQUANIMITY:

mental calmness, composure, and

evenness of temper,

especially in a difficult situation."

~multiple attributions~

Compassion, surrender, and equanimity are the three healing forces that teach us what is precious and tender about this life we share. They train us to feel deeply. They teach us what we need to do in order to heal.

"It is both a blessing

and a curse

to feel everything so very deeply."

~David Jones~

jan

why stories go untold

 

When we refer to the healing power of storytelling, what do we mean? Is there anything to it? How does it work? What happens between us when we share our personal stories, and why is it important that we do?

This interests me because I’m a family physician. I practiced medicine for over thirty years…until I retired because my other passion in life is writing…and, you know, sometimes you have to make tough choices.

Plus…I had a story in me that I really wanted to tell. 

"Tell your story

with your whole heart."

~Brene Brown~

The point is that we ALL have a story to tell, but most of us ever get around to sharing it. Instead, we make up excuses. We tell ourselves we don’t have time to write. We don’t know where to begin, or how to put it into words. We tell ourselves that what we have to say isn’t important. That no one will care. Sometimes shame silences us. We blame ourselves for what happened to us. We have been conditioned to keep secrets. It’s too painful, or sad, or maddening to put into words.

 "You'd be surprised

what lengths people will go to
not to face what's real and painful inside them."
~attribution unknown~

So…our stories go untold…and as such, I’m telling you…they wreak havoc on our bodies. The anger we keep bottled up, the sorrow we can't express, the shame we keep under lock and key all take a toll on us. They increase levels of stress hormones and inflammatory chemicals in our bodies that raise the heart rate, elevate BP, and raise blood sugar levels. This can lead to all kinds of problems in adulthood--hypertension, heart disease, diabetes, and autoimmune problems like lupus and RA. Not to mention anxiety and depression.

There is, in fact, some science to support the idea that telling our stories can help us heal. We know that storytelling can lower levels of inflammatory hormones in the body, because we can measure them. In studies where subjects were asked to write about a traumatic episode they experienced vs a neutral topic like the weather or a favorite food…heart rate, BP, and sugar levels fell in the first group as compared to the neutral group. In another study, participants underwent a small skin biopsy. They were then assigned to write about a traumatic episode or a neutral topic. The open wounds healed faster in the cohort that wrote about trauma.

When the listener is engaged with the story the teller is sharing, functional MRI scans of their brains demonstrate synchronization in electrical activity between the storyteller and listener. EEGs demonstrate the ways their brain waves change. 

Think of it. If we had a pill that could lower our blood pressure, control our blood sugar levels, and elevate our mood, we would all be buying stock in that company. So…why not invest in storytelling?

"Because right now
there is someone out there 
with a wound in the exact shape of your words."
~Sean Thomas Dougherty~

Unless we explore the anger, or despair, or confusion that is at the root of our pain, nothing anyone says or does will touch the cause of suffering. All the medication in the world will not solve the problem.

The point is that telling our stories affects us in ways we can actually measure and observe. When you give your story a title, describe how it unfolded, and name the characters that populate it, you may begin to understand why it still disturbs your peace so many years later. If someone you trust is listening, you may come away with an entirely fresh perspective on it. You may finally be able to forgive yourself or the person who hurt you. You may be able to cast aside some of the things you’ve always imagined were wrong with you, but never were. Your BP and sugar levels may come down. Anxiety and depression may improve. All pathways to healing.

As a physician, I listened to patients’ stories all day long. The history, or story, of the present illness. The past medical history, or story. The patient’s family history, or story. But that was back in the days when I could scan my schedule for the day and envision every patient, I knew them that well. With a quick glance at the schedule, I knew who was getting ready to start chemo, who had just welcomed their first grandchild into the world, whose mother was recently transferred to the dementia unit. I knew because I had asked about it, the patient told me the story, and I made a note of it in the chart.

Nowadays, rather than dictating a note about the clinical encounter (a.k.a. narrating the patient’s story), you open an electronic medical record (EMR) that presents you with a confusing array of bulleted items, complicated charts, and abbreviated details. You can easily pick out a list of symptoms that were problematic at the patient’s last visit, when they started, how often they occurred, and how long they lasted. You know what tests you ordered and how you treated him, but you might not remember anything else about the patient because nothing else is recorded there. He looks like any other older patient with diabetes, or heart failure, or COPD…because you missed the fact that he’s a decorated Vietnam veteran. You can’t understand why your pregnant patient is so anxious because you failed to ask about her sister who had three miscarriages in a row. You don’t know because you didn’t get that part of the story. 

"The most important part of a story
is the piece of it you don't know."
~Barbara Kingsolver~

If you’re a healthcare provider, it’s easy to understand how missing details can make it hard to come up with the right diagnosis. You miss the fact that your patient’s headaches started the day she discovered the cigarette burn on the sleeve of the sweater her ten-year old wore to school that day. You have no way of knowing that the patient’s heartburn and indigestion have been a problem because of the pile of unpaid bills that are collecting on the kitchen counter. Or that your patient has insomnia because he is headed for divorce...

…unless, of course, you ask about it.

"There isn't
a stronger connection between people
than storytelling."
~Jimmy Neil Smith~

Sharing our stories helps us heal. It is built into healthcare. It can’t be ignored. The stories we share in the back of an ambulance, or in the examination room, or at the bedside describe who we are. They help us process what happens to us. They embody our unspoken fears, our deepest sorrows, and our greatest regrets…

…which is why we don’t tell them. It’s hard to put them into words.

 It took me fifty years to get mine down.

 Now is your chance to get started on yours.

"Write about what disturbs you, what you fear,
what you have not been willing
to speak about.
Be willing to be split open."
~Natalie Goldberg~

 jan