Monday, November 2, 2009

Narrative Based Medicine: Potential, Pitfalls, and Practice

International Journal of Narrative Practice Spring 2009 Vol1 ISSN 2041-2207


This new journal is an eclectic publication that draws on different uses of narratives in research, education and practice. As such, it is not confined to any one area or discipline. but welcomes narratives from fields as diverse as the Arts, Humanities, Social Sciences, Philosophy and Ethics as well as from professionals in any area. The publication will come out four times a year (Spring, Summer, Autumn and Winter) and the first and second issues will be devoted to presentations and papers from the 2nd. International Narrative practitioner Conference, held at Glynd┼Ár University in June 2008.


Two articles hold particular interest for me:

Narrative Based Medicine: Potential, Pitfalls, and Practice by Vera Kalitzkus, PhD / Prof. Dr. Peter F. Matthiessen, MD, Chair in Medical Theory and Complementary Medicine, University of Witten/Herdecke, Germany


According to the authors narratives have always been a vital part of medicine. Stories about patients, their recovery from illness, as well as the experience of caring for them have always been shared. With the rise of “modern” medicine, narratives were increasingly neglected in favour of “facts and findings” regarded as more objective and scientific. Yet, in the recent years the medical narrative is changing again – patient narratives and the unfolding story between health care professionals and patients are both gaining momentum.


In due course this led to the formation of Narrative‐based Medicine (NbM). The term was coined deliberately to mark its distinction from Evidence‐based Medicine (EbM), with NbM propagated to counteract the shortcomings of EbM (Greenhalgh 1998; Charon/Whyer 2008). But what does this term actually contain? Is it a specific therapeutic tool, a special form of doctor‐patient communication, a qualitative research tool, or does it just signify a particular attitude towards patients and doctoring? It can be all of the above, but depending on the field of application, a different form of narrative or practical approach is called for.


This article gives a systematic overview of NbM: a short historic background; the various narrative genres; and an analysis of how genres can be effectively applied in theory, research, and practice in the medical field, with a focus on possibilities and limitations of a narrative approach.


In medical practice, three different, although overlapping, areas can be distinguished:

1. Learning about the patient and carers’ perspective for research and training. For this area we will offer a classification of the various narratives.

2. The narrative approach in actual medical practice, through understanding the narrative structure of medical knowledge, and narrative‐oriented, doctor‐patient relations.

3. Narratives as evidence – narratives from social science research and narratives derived from medical practice and patient encounters are a source of knowledge for evidence, beyond the gold standard of randomized controlled trials of evidence‐based medicine.


For the full article go to:

http://thenarrativepractitioner.co.uk/journalsIJNPNarrativeBasedMedicinePotentialPitfallsAndPractice_VKalitzkusProfDrPFMatthiessen.pdf


Telling stories and making sense of cancer by Michael Murray, Keele University Staffordshire England.


According to Murray storytelling is not just the domain of the professional writer. “Rather, we are all natural storytellers – we construct and reconstruct our worlds through the stories we exchange (Murray, 1997, 1999). These stories are not simply spun out of fantasy but engage with the social and material world in which we live. In this paper I want to explore the role of narrative for everyday making sense of cancer.


The advent of serious illness is a crucial turning point in our lives that causes us to reflect upon our materiality and the transitory nature of our lives. According to narrative psychology the person begins to grasp the meaning of a crisis by creating a story about it (e.g. Bruner, 1987). A central belief in Western society is that our lives have a form of linearity and continuity (Becker, 1997). A challenge to our expected organized storyline can lead to disorientation. The experience of illness represents a crisis for the patient and for their families. On initial diagnosis the individual can experience substantial existential dislocation. It is through narratives that sick people can define themselves and clarify their relationship with their bodies and with society. In this paper the author discusses how narrative shapes our understanding of cancer in everyday life.


For the full article go to:

http://thenarrativepractitioner.co.uk/journals/IJNPTellingStoriesAndMakingSenseOfCancer_MMurray.pdf


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