Last updated: October 23, 2005

Narrative Psychology Search

  


[Narrative Psychology]


 Narrative in Other Disciplines

  Medicine, Nursing, & Health Care

 

              
          Background  ||  Internet  ||  Bibliographical  ||  Theorists

 


Background Issues

Focus of this page: Narrative as it relates to human illness, health, and healing processes. This includes medicine, nursing, physical and occupational therapy, and allied health professions. Also, the educational processes associated with the healing professions such as medical or nursing school falls within the focus of this subpage.

Overview. The experience of illness -- of the body's impairment, deterioriation or recovery, and, ultimately, its mortality -- concerns a broad set of persons: ill persons themselves, their families and caregivers, their healers (be they physicians, nurses, and therapists of all sorts), and a host of publics who administer, finance, counsel, profit from, or otherwise serve as partners in health care systems regionally, nationally, and internationally. All of these parties have some need to make sense of what is happening to those persons experiencing illness and how they are being treated. For patients, there is often a profound need to understand how illness has changed their worlds as well as themselves, whether in threatening eventual death or in altering the possibilities of life on a daily basis. For health providers--physicians and their allies in health care--the need to understand the integrity of a patient's life course may be central to understanding or diagnosing the illness itself or in seeking amelioration by treatment plans of ambitious or conservative design. Equally, as health providers encounter pain, defigurement, death, and fragmentation across the individual lives of their patients, their own realities as compassionate and competent human beings on course toward a common mortality come into question. Further, problems of ethical as well as psycholological challenge necessarily accompany the practice of healing arts.

All of these issues find expression or response in some fashion by narrative means. For patients, narratives can be the source of information about their illnesses and its course while also suggesting alternative means of treatment. For health care providers, narrative resources offer an appreciation of the nuances and vagaries of illness at levels which may not be apparent in many clinical or consultative venues. Physicians and their colleagues can find themselves challenged to practice better or more authentic forms of clinical caring as they encounter the storied insights of other professionals or patients. Families and caregivers whose relationship entails close support of patients can themselves find support through understanding the course of illness as well as the often unspoken needs of those who rely on them through narratives. The resources below address these and a host of other issues in respect to health care and practice.


Theorists*Key Figures

Patricia Benner
Howard Brody
Rita Charon
Nancy Diekelmann
Arthur W. Frank
Anne Hunsaker Hawkins
K. M. Hunter
Arthur Kleinman
Elliott Mishler
Michael Murray (Memorial University of Newfoundland, Canada)
James W. Pennebaker


Internet Resouces

PubMed [National Library of Medicine] MEDLINE searching for free on the net.

Medical Humanities [NYU] Resources including

Program in Narrative Medicine [College of Physicians and Surgeons, Columbia University]

Nancy Diekelmann PhD, RN, FAAN Homepage [School of Nursing, University of Wisconsin-Madison]

Syllabi from her courses

<NARRATIVE-HEALTH-RESEARCH> electronic discussion list

Narratives

Arthur W. Frank Homepage (Sociology, U Calgary)

James W. Pennebaker Homepage (U Texas)

Google: Society > Issues > Health > Mental Health > Personal Stories

[Documentary Resources]

[Radio Icon]   I Remember When (CBC Outfront; 14:27 min.). In hope and sadness, Gloria Troyer describes her life since suffering significant memory loss due to encephalitis. She takes a train to Ottawa from Guelph, Ontario and she remembers nothing about doing so many times before. First broadcast in March, 2003. Link.

[Radio Icon]   My So-Called Lungs (Joe Richman/Radio Diaries, Inc.; 21:52 min.). Brown University student, Laura Rothenberg, created a very direct and frank audio diary of her life with cystic fibrosis over the previous two years -- both inside and outside the hospital. She and her parents talk about what it is like to grow up and live with this chronic and ultimately fatal illness. She describes the processes awaiting, receiving, and struggling afterwards with a lung transplant.. Laura died on March 22, 2003 at age 22 following chronic rejection of her transplant complicated by an infection. First broadcast on NPR on 5 August 2002. Direct link to RA file which is also available at NPR. Transcript online. Written before her transplant, her memoir, Breathing for a Living, is scheduled for July, 2003 publication.

[Radio Icon]   Stories in Medicine (NPR Morning Edition, October 28, 2003; 8:49 min.). Dr. Rita Charon (Columbia University College for Physicians and Surgeons) and her students discuss/illustrate narrative medicine in the context of medical education with NPR correspondent, Margot Adler.

[Radio Icon]   Doctors Stories (NPR All Things Considered, July 15, 2003; 12:41 min.). Dr. Danielle Ofri, author of Singular Intimacies: Becoming a Doctor at Bellevue (2003; Beacon Press), talks with NPR correspondent, Melissa Block, about encountering patients and listening to their stories as she treats them and teaches young doctors her speciality of internal medicine. Bellevue Hospital is the oldest public hospital in the United States.

 

Bibliographical Resources

Theory and Research

Adler, H. M. (1997). The history of the present illness as treatment: Who's listening, and why does it matter? Journal of the American Board of Family Practice, 10, 28-35.

Andre, J. (1998). Learning from nursing. Medical Humanities Report, 19 (2). Available online from the Center for Ethics and Humanities in the Life Sciences at Michigan State University: http://www.bioethics.msu.edu/mhr/w98nursing.htm

Judith Andre provides a reflection on how the experiences of nursing can contribute to the study of ethical development and places the role of storytelling by nurses at the center of such a contribution.

Ayres, L. (2000). Narratives of family caregiving: Four story types. Research in Nursing & Health, 23, 359-371.

Ayres, L. (2000). Narratives of family caregiving: The process of making meaning. Research in Nursing & Health, 23, 424-434.

Baker, C. & Diekelmann, N. (1994). Connecting conversations of caring: Recalling the narrative to clinical practice. Nursing Outlook, 42, 65-70.

Benner, P. (1994). The tradition and skill of interpretive phenomenology in studying health, illness, and caring practices. In P. Benner (Ed.), Interpretive phenomenology: Embodiment, caring, and ethics in health and illness. Thousand Oaks, CA: Sage Publications.

Borkan, J. M., Quirk, M., & Sullivan, M. (1991). Finding meaning after the fall: Injury narratives from elderly hip fracture patients. Social Science & Medicine, 33, 947-57.

Borkan, J., Shvartzman, P., Reis, S., & Morris, A. G. (1993). Stories from the sealed rooms: Patient interviews during the Gulf war. Family Practice, 10, 188-92.

Narrative analyses of open-ended interviews with 60 Israeli primary-care patients about their experiences during the Gulf War

Boyd, K. M. (2000). Disease, illness, sickness, health, healing and wholeness: Exploring some elusive concepts. Journal of Medical Ethics, 26, 9-17.

The six terms which comprise the opening of Boyd's title are words whose meaning can be understood in diverse ways. He examines this "elusiveness" with reference both to science and religion as perspectives which both employ these terms.

Brody, H. (1994). "My story is broken; can you help me fix it?" Medical ethics and the joint construction of narrative. Literture and Medicine, 13(1), 79-92.

Brody, H. (1994). The four principles and narrative ethics. In R. Gillon (Ed.), Principles of health care ethics (pp. 207-215). New York: Wiley.

Brody, H. (1997). Who gets to tell the story? Narrative in postmodern bioethics. In H. L. Nelson (Ed.), Stories and their limits: Narrative approaches to bioethics (pp. 18-30). New York: Routledge.

Brody, H. (2003). Stories of sickness (2nd ed.). New York: Oxford University Press.

Examining stories drawn both from literature and nonfictional sources, Brody explores the meaning of illness in this classic work (originally published in 1987) which has been updated to include issues of disability and the emerging field of narrative ethics.

Charon, R. (1986). To render the lives of patients. Literature and Medicine, 5, 58-74

Charon, R. (1989). Doctor-patient/reader-writer: Learning to read the text. Soundings: An Interdisciplinary Journal, 72, 1101-1116.

Charon, R. (1993). Medical interpretation: Implications of literary theory of narrative for clinical work. Journal of Narrative and Life History, 3, 79-97.

Charon sees patients as writers or tellers and doctors as readers or listeners and the field of clinical medicine as highly imbued with narrative activities.

Charon, R. (1996). The narrative road to empathy. In H. M. Spiro, M. G. M. Cumen, E. Peschel, & D. St. James (Eds.), Empathy and the practice of medicine: Beyond pills and the scalpel (pp. 147-159). New Haven, CT: Yale University Press.

Charon, R. (2001). Narrative medicine: Form, function, and ethics. Annals of Internal Medicine, 135(10), 929-930.

Charon, R. (2001, October 17). The patient-physician relationship: Narrative medicine: A model for empathy, reflection, profession, and trust. JAMA, 286(15), 1897-1902. (Follow up comments & discussion of this article in JAMA [2002, Jan 23-30] vol. 287 (issue 4), pp. 447-448.)

This important article (widely disseminated by reason of its publication venue) provides both a valuable introduction to narrative medicine as an emerging field and an extensive reference list of essential readings. The abstract of this article is available online.

Charon, R., Brody, H., Clark, M. W., Davis, D., Martinez, R., & Nelson, R. M. (1996). Literature and ethical medicine: Five cases from common practice. Journal of Medicine and Philosophy, 21, 243-265.

Charon, R., & Montello, M. (Eds.). (2002). Stories matter: The role of narrative in medical ethics. New York: Routledge.

Church, K. (1995). Forbidden narratives: Critical autobiography as social science. Toronto, Ontario: University of Toronto Press.

Clark, J. A., & Mishler, E. G. (1992). Attending to patients' stories: Reframing the clinical task. Sociology of Health and Illness, 14, 344-372.

Coughlin, L. D., & Patel, V. L. (1987). Processing of critical information by physicians and medical students. Journal of Medical Education, 62, 818-28.

Couser, G. T. (1997). Recovering bodies: Illness, disability, and life writing. Madison, WI: University of Wisconsin Press. (Annotation at NYU Medical Humanities database)

Crabtree, B. F., & Miller, W. L. (Eds.). (1992). Doing qualitative research. Newbury Park, CA: Sage Publications. [R853.S64 D65 1992]

Focus in this volume is techniques useful for primary health care & family medicine.

Crossley, M.L. (2003). 'Let me explain': Narrative emplotment and one patient's experience of oral cancer. Social Science and Medicine, 53, 439-448.

Daniel, S. L. (1986). The patient as text: A model of clinical hermeneutics. Theoretical Medicine, 7, 195-210.

Diekelmann, N. (1991). The emancipatory power of the narrative. In Curriculum revolution: Community building and activism (pp. 41-62). New York: The National League for Nursing Press.

Compiled from the Seventh National Conference on Nursing Education held in 1990 in Scottsdale, AZ.

Diekelmann, N., & Diekelmann, J. (2000). Learning ethics in nursing and genetics: Narrative pedagogy and the grounding of values. Journal of Pediatric Nursing, 15, 226-231.

Diekelmann, N. (2001). Narrative Pedagogy: Heideggerian hermeneutical analyses of lived experiences of students, teachers, and clinicians. Advances in Nursing Science, 23, 53-71

Doolittle, N. D. (1994). A clinical ethnography of stroke recovery. In P. Benner (Ed.), Interpretive phenomenology: Embodiment, caring, and ethics in health and illness. Thousand Oaks, CA: Sage Publications.

Ekman, I, Skott, C, & Norberg, A. (2001). A place of one's own: The meaning of lived experience as narrated by an elderly woman with severe chronic heart failure. A case study. Scandinavian Journal of Caring Sciences, 15, 60-65.

Frank, A. W. (1995). The wounded storyteller: Body, illness, and ethics. Chicago, IL: University of Chicago Press.

A foundational text in the analysis of illness narratives. Arthur W. Frank here provides an analysis of three forms of narrative: restitution, chaos, and quest and discusses how the stories of the wounded -- fundamentally quest narratives -- serve ethical purposes as testimony by their sufferers to the moral implications of their experiences. Essential.

Frank, A. W. (2003). Survivorship as craft and conviction: Reflections on research in progress. Qualitative Health Research, 13(2), 247-255.

Fredriksson, L, & Eriksson, K. (2001). The patient's narrative of suffering: A path to health? An interpretative research synthesis on narrative understanding. Scandinavian Journal of Caring Sciences, 15, 3-11.

Greenhalgh, T. & Hurwitz, B. (Eds.). (1998). Narrative based medicine: Dialogue and discourse in clinical practice. London, UK: BMJ Books.

Gogel, E. L., & Terry, J. S. (1987). Medicine as interpretation: The uses of literary metaphors and methods. Journal of Medicine and Philosophy, 12, 205-217.

Gordon, S. (1997). Life support: Three nurses on the front lines. Boston: Little, Brown & Co.

Suzanne Gordon's compelling narrative account of the experiences of three nurses at Boston's Beth Israel Hospital challenges its readers with the question whether real care is being lost in the new world of "managed care". Unsettling.

Greenhalgh T., & Hurwitz B. (Eds.). (1998). Narrative Based Medicine. London: BMJ Books.

These editors assemble both patient narratives and the commentaries of medical professionals in coming to an understanding of how narrative can complement the practice of evidence-based medicine.

Greenhalgh T., & Hurwitz B. (1999). Narrative based medicine: Why study narrative. British Medical Journal, 318, 48-50. [Available for download from the BJM site: http://www.bmj.com/cgi/content/full/318/7175/48]

Hawkins, A. H. (1984). Two pathographies: A study in illness and literature. Journal of Medicine and Philosophy, 9(3), 231-252.

Hawkins, A. H. (1986). A. R. Luria and the art of clinical biography. Literature and Medicine, 5, 1-15.

Hawkins, A. H. (1990). A change of heart: The paradigm of regeneration in medical and religious narrative. Perspectives in Biology and Medicine, 33, 547-559.

Hawkins, A. H. (1991). Constructing death: Three pathographies about dying. Omega, 22, 301-317.

Hawkins, A. H. (1999, August). Pathographies: Patient narratives of illness. Western Journal of Medicine, 171, 127-129.

Hawkins, A. H. (1999). Reconstructing illness: Studies in pathography (2nd ed.). West Lafayette, IN: Purdue University Press.

Seminal study of pathography, the genre of autobiographical writing focusing upon the illness of the author, which Hawkins originally published in 1993 and is here updated in a second edition. Essential.

Hensel, W. A., & Rasco, T. L. (1992). Storytelling as a method for teaching values and attitudes. Academic Medicine, 67, 500-504.

+Hunter, K. M. (1991). Doctors' stories: The narrative structure of medical knowledge. Princeton, NJ: Princeton University Press.

Important study of the ways in which physicians use and the medical arts reflect narrative ways of knowing at many levels of training and practice. The process of translating a patient's story into the "scientific" structures of medical knowledge receives extensive review. Essential.

Karp, D. A. (1996). Speaking of sadness: Depression, disconnection, and the meanings of illness. New York: Oxford University Press.

Fifty depressed people are interviewed in order to gain an understanding of what depression feels like from its sufferers and their family members. Karp, a sociologist at BC, bemoans biological reductionism in recent psychiatry and emphasizes cultural factors at work in the lives of these seriously depressed subjects.

Kleinman, A. (1988). The illness narratives: Suffering, healing, and the human condition. New York: Basic Books.

Kleinman, A. (1996). Writing at the margin: Discourse between anthroplogy and medicine. Berkeley, CA: University of California Press.

A collection of seven essays written by Kleinman alone or in collaboration with new introductory and closing summary chapters; centered on the general topic of medical anthropology.

Leder, D. (1990). Clinical interpretation: the hermeneutics of medicine [see comments]. Theoretical Medicine, 11, 9-24.

Lee, C. S. (2001). The use of narrative in understanding how cancer affects development: The stories of one cancer survivor. Journal of Health Psychology, 6, 283-293.

Mathews, H. F., Lannin, D. R., & Mitchell, J. P. (1994). Coming to terms with advanced breast cancer: Black women's narratives from Eastern North Carolina. Special Issue: Narrative representations of illness and healing. Social Science and Medicine, 38, 789-800.

Mattingly, C. (1991). The narrative nature of clinical reasoning. American Journal of Occupational Therapy, 45, 998-1005.

Mattingly, C. (1994). The concept of therapeutic "emplotment." Special Issue: Narrative representations of illness and healing. Social Science and Medicine, 38, 811-822.

Mishler, E. G. (1984). The discourse of medicine: Dialectics of medical interviews. Norwood, NJ: Ablex Publishing Corp. [RC65.M57 1984]

Mischer, E. G., Clark, J. A., Ingelfinger, J., & Simon, M. P. (1989). The language of attentive patient care: A comparison of two medical interviews. Journal of General Internal Medicine, 4, 325-335.

Morris, D. B. (1991). The culture of pain. Berkeley, CA: University of California Press.

Morris, D. B. (1998). Illness and culture in the postmodern age. Berkeley, CA: University of California Press.

Morris, D. B. (1999). Sociocultural and religious meanings of pain. In R. J. Gatchel & D. C. Turk (Eds.), Psychosocial factors in pain: Critical perspectives (pp. 118-131). New York: Guilford Press.

Morris, D. B. (2000, Nov-Dec). How to speak postmodern: Medicine, illness, and cultural change. Hastings Center Report, 30(6), 7-16.

Morse, J. M. & Field, P. A. (1995). Qualitative research methods for health professionals. Thousand Oaks, CA: Sage Publications.

Murray, M. (2000). Levels of narrative analysis in health psychology. Journal of Health Psychology, 5, 337-347.

Murray, M., & Chamberlain, K. (Eds.). (1999). Qualitative health psychology: Theories and methods. London, UK: Sage Publications, Ltd.

Nehls, N. (1995). Narrative pedagogy: Rethinking nursing education. Journal of Nursing Education, 34, 204-210.

Nochi, M. (1998). "Loss of self" in the narratives of people with traumatic brain injuries: A qualitative analysis. Social Science & Medicine, 46, 869-878. (a)

Nochi, M. (1998). Struggling with the labeled self: People with traumatic brain injuries in social settings. Qualitative Health Research, 8, 665-681. (b)

Nochi, M. (2000). Reconstructing self-narratives in coping with traumatic brain injury. Social Science & Medicine, 51, 1795-1804.

The three references above from Masahiro Nochi draw upon the results of his 1998 dissertation in health and social psychology at Syracuse University undertaken among 10 persons with traumatic brain injuries (TBI). Nochi examines various aspects of the loss and recovery of self following injury in a review of narrative data gained from his participants. He details active processes of interpretation that TBI patients utilize as they attempt to make sense of their post-injury situation within wider social contexts.

Pennebaker, J.W. (1997). Opening up: The healing power of expressing emotions (revised ed.). New York: Guilford Press.

Pennebaker, J.W. (2000). Telling stories: The health benefits of narrative. Literature and Medicine, 19, 3-18.

Pennebaker, J.W. & Seagal, J. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55, 1243-1254.

Phillips, S. S., & Benner, P. (Eds.). (1996). The crisis of care: Affirming and restoring caring practrices within the helping professions. Washington, DC: Georgetown University Press.

Phillips and Benner have assembled a broad array of essays which examine reflectively how the helping professions have been estranged from genuine forms of care by the ethics of technological bravado, bureaucratic caution, and purely instrumental intentionalities. Multiple narratives of care are used by these authors to reorient the notion of care itself and to challenge readers to develop a deeper and broader moral imagination of what care ought to be about. Deeply humanistic and, at times, explicitly spiritual voices from a Christian perspective characterize many of these essays. An enthralling compendium.

Porter, R., & Bynum, W. F. (Eds.). (1994). Companion encyclopedia of the history of medicine. London: Routledge.

+Ray, E. B. (1993). Case studies in health communication. Communication textbook series: Applied communication. Hillsdale, NJ: L. Erlbaum. [R118.C37 1993]

Riessman, C. K. (1990). Strategic uses of narrative in the presentation of self and illness: A research note. Social Science and Medicine, 30(11), 1195-1200.

Rimmon-Kenan, S. (2002). The story of 'I': Illness and narrative identity. Narrative, 10, 9-27.

Sandelowski, M. (1991). Telling stories: Narrative approaches to qualitative research. Image: Journal of Nursing Scholarship, 23, 161-166.

Sandelowski, M., & Jones, L. C. (1996). 'Healing fictions': Stories of choosing in the aftermath of the detection of fetal anamolies. Social Science & Medicine, 42(3), 353-361.

Shafer, A., & Fish, M. P. (1994). A call for narrative: The patient's story and anesthesia training. Literature & Medicine, 13, 124-42.

SmithBattle, L. (1994). Beyond normalizing: The role of narrative in understanding teenage mothers' transition to mothering. In P. Benner (Ed.), Interpretive phenomenology: Embodiment, caring, and ethics in health and illness. Thousand Oaks, CA: Sage Publications.

Smyth, J., True, N., & Souto, J. (2001). Effects of writing about traumatic experiences: The necessity for narrative structuring. Journal of Social and Clinical Psychology, 20, 161-172.

Stuhlmiller, C. M. (1994). Narrative methodology in disaster studies: Rescuers of Cyrpress. In P. Benner (Ed.), Interpretive phenomenology: Embodiment, caring, and ethics in health and illness. Thousand Oaks, CA: Sage Publications.

Uden, G., Norberg, A., Lindseth, A., & Marhaug, V. (1992). Ethical reasoning in nurses' and physicians' stories about care episodes. Journal of Advanced Nursing, 17, 1028-34.

Ventres, W. B. (1994). Hearing the patient's story: Exploring physician-patient communication using narrative case reports. Family Practice Research Journal, 14, 139-47.

Medical Narratives: Selected Examples by Care Givers, Patients, and Survivors

(Note: This section requires a great deal of work. It will be augmented gradually.)

Bauby, J.-D. (1997). The diving bell and the butterfly. New York: Vintage Books.

"Locked-in" syndrome following a stroke as experienced by the patient. Reviewed sensitively by Prashant Tamaskar in the Yale Journal for Humanities in Medicine. Also, reviewed at the NYU Medical Humanities site.

Didion, J. (2005). The year of magical thinking. New York: Knopf.

"Life changes fast...Life changes in the instant...You sit down to dinner and life as you know it ends." The writer Joan Didion explores the year following the sudden death by heart attack of her husband of 40 years, the novelist John Gregory Dunne, and the simultaneous critical care hospitalizations of their only child, Quintana (who died soon after publication of this book). In harrowingly-honest and direct reflections on her interior conversations, memories, and daily encounters with places and persons from her life, Didion tells the story of the experience of grief and mourning in a remarkably powerful way. Her recollections of the preemptory style of the many physicians and health care professionals she confronted in hospitals in both New York and Los Angeles provide a striking sense of what surviving family members cope with in the midst of their fear and confusion. Her spare and beautiful prose which so artfully invites the reader to a place of intimate listening cannot obliterate her devastating sense of loss.

Luria, A. R. (1987). The man with a shattered world. Cambridge, MA: Harvard University Press.

The compelling clinical memoirs of Zasetsky, the brain-injured World War II veteran, who wrote to survive and find meaning in his universe of physically shattered perceptions.

Ofri, D. (2003). Singular intimacies: Becoming a doctor at Bellevue. New York: Beacon Press.

Osborn, C. L. (1998). Over my head: A doctor's own story of head injury from the inside looking out. Kansas City, MO.: Andrews McMeel Pub.

Quinn, D. A. (1998). Conquering the darkness: One woman's story of recovering from a brain injury. St. Paul, MN: Paragon House.

Rothenberg, L. (2003). Breating for a living: A memoir. New York: Hyperion Books.

Sacks, O. W. (1983). Awakenings. New York: Dutton.

Sacks, O. W. (1984). A leg to stand on. New York: Summit Books.

Sacks, O. W. (1985). The man who mistook his wife for a hat and other clinical tales. New York: Summit Books.

Sacks, O. W. (1995). An anthropologist on Mars: Seven paradoxical tales. New York: Knopf.

 

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When citing this document, you may wish to consider this form for the reference (derived from APA Style [5th ed.])

Hevern, V. W. (2005, October). Medicine, Nursing, and Health Care. Narrative psychology: Internet and resource guide. Retrieved [enter date] from the Le Moyne College Web site:
http://web.lemoyne.edu/~hevern/nr-med.html

     Narrative Psychology: Internet and Resource Guide
is copyright © 1996-2005 by Vincent W. Hevern, SJ, all rights reserved.

No portion of this guide may be reproduced or used for commercial or other purposes without the express written consent of the author.