Languages of Care in Narrative Medicine (Review)

In this post, Autumn Marie Chilcote reviews Languages of Care in Narrative Medicine: Words, Space and Time in the Healthcare Ecosystem (New York: Springer International, 2018), authored by Maria Giulia Marini.

Narrative Medicine, a relational movement in Western healthcare, aims to disrupt the transactive experience of patient-provider relations while improving health and well-being assessment, intervention, and outcomes.  Through reflection and meaning-making of personal experiences of illness and wellness, healthcare professionals are tasked to facilitate dialogue with the patient, where strengths, symptoms, and systems influencing wellbeing are explored in detail toward a comprehensive care strategy.  Narrative Medicine is a growing field in Western medicine, legitimized by programs at King’s College and Columbia University, but with a long tradition in the global South as social medicine encompassing the holistic phenomenology of well-being (Birn & Muntaner 2018).   The Western history of Narrative Medicine has been well-documented by Rita Charon (2006), who developed a definition and methodology of deep-listening in medicine that has since been adopted by a number of university and college medical programs in Europe, the United States, and Canada. One of the primary conflicts within Western Narrative Medicine continues to be the role of language in healthcare, with controversy over centering linguistics at the “existential crisis” of physical, emotional, and community health (Murphy 2015: 94).  Maria Giulia Marini, disregarding the linguistic controversy, enters the conversation highlighting the work of Fondazione ISTUD in using English reflective writing and verbal testimony to determine 60 “universal health and illness terms” to support competent care in narrative medicine (Marini 2018: 155).

In her ambitious tome Languages of Care in Narrative Medicine: Words, Space and Time in the Healthcare Ecosystem, Marini begins with a history of Narrative Medicine, making a strong but predictable argument on the importance of patient narrative to supplement more quantitatively objective applications of evidenced-based practice.  She then situates her text in the Western linguistic tradition of evolutionary ethnography by offering a brief history of oral and written communication from 30,000 BC homo sapiens. What Languages of Care contributes to this oft-repeated history is a collection of chapters – imaginative, sometimes scholarly –  exploring the origin of language, complex meanings of linguistic categories for health and wellness, and a creative interplay between linguistic myth and possibilities of narrative truth in medicine. Integrating evolutionary concepts of linguistic theories with organizational and health psychologies throughout, Marini recounts various strategies for amplifying the use of narrative in evidence-based healthcare practice through case presentations from ISTUD.  Each chapter explicates this position, with most including a brief description of quasi-experimental or qualitative-descriptive research conducted by the ISTUD team and (previously published) interviews with specialists in health research or the arts. At the close of each chapter the author has invited critical thinking “Practice Time” with brief questions such as “What do you think about the border between medical humanities and narrative medicine?” (Marini 2018: 55) and “How do your patients or their family members refer to their healthcare providers?” (96).

In her introduction, Marini admits that she used chaos as a model for writing the book, and in this she has succeeded. The first three chapters aim to describe the theoretical approach to narrative medicine – closely mirroring Rita Charon’s highly-influential Narrative Medicine: Honoring the Stories of Illness (2006). The following seven chapters lack coherence and parsimony, making it difficult at times to determine whether she has developed a sound strategy for application of Narrative Medicine, or indeed enhanced evidence-based practice, the primary argument of the text.  This is not to say that the stories of hope, spirituality, emotional knowledge, and myth found do not have value – indeed, these chapters detail rich experiences of patients at ISTUD.  The dilemma for the reader is in parsing mixed metaphors and multiple sources in order to connect to Marini’s thesis.  For example, the dense chapter exploring trauma begins with the usefulness of symbolism in narrating coping and suffering.  What follows are complicated jumps from patient to care-provider storying, a symbolic minotaur, a labyrinth (sometimes described as a maze),  Beauty and the Beast, Odysseus, a sprinkling of the neurobiology of trauma, Latin etiology, and an embedded interview with a family doctor discussing suicide rates of physicians in the United States.  If this sounds complicated and difficult to follow, that is because it is.  Indeed, care and intentionality is required to enter the assemblage of stories that Marini has compiled.

Languages of Care continues the tradition of language-first healthcare, and Marini presents an extensive, if somewhat incoherent, account of her experiences with narrative medicine at ISTUD. She has offered interesting chapters on the translation process of her team while working with immigrants and refugees in Italy, included interviews with authorities in the fields of healthcare research and consultation, and offers critical thinking questions and case presentations as exemplars. She uses literary, spiritual, and mythological metaphor to exemplify application of Narrative Medicine. Her definition of Narrative Medicine and evidence-based practice has been well-established by previous authors, as has the argument for the necessity for Narrative Medicine to supplement evidence-based practice. If anything, this work continues to demand critique of the “instinct of language” that she and others perpetuate (Pinker and Plutchik, for instance, referenced in her text), and the questions of problematic universals of Western medicine. Whether the addition of the 60-plus “cultural universal” terms that Languages of Care suggests improve healthcare outcomes or supplement other approaches to medicine remains to be seen and indeed cautiously .

About the reviewer:

Autumn Marie Chilcote specializes in relational neuropsychology practice and education, most recently leading research in cognitive rehabilitation and creative therapies after language loss. She is the author of Adaptable Interventions for Counseling Concerns (Routledge, 2017).

References:
Birn, Anne-Emanuelle & Carles Muntaner. 2018.  “Latin American Social Medicine Across Borders.” Global Public Health. Doi: 10.1080/17441692.2018.1439517

Charon, Rita. 2006. Narrative Medicine: Honoring the Stories of Illness. New York, Oxford Press, 2006.

Murphy, John W. 2015. “Primary Health Care and Narrative Medicine.” The Permanente Journal 19(4): 90-94.