Shared woundedness enhances the effective practice of narrative medicine.

What is it about?

To teach physicians how to be better listeners of their patients, Rita Charon turned to literary criticism for categories and concepts that would focus physicians on the narrative structures of the stories their patients were telling them. That is, her premise was that there was more information that physicians could learn about their patients than what was put into charts or could be construed in medical terminology. Charon pointed doctors (and other clinicians) toward apprehending the meaning of their patients’ illnesses beyond that for which they were seeking treatment. She called this proposed enhancement of physicians’ skills narrative medicine. In the course of her studies of literary criticism she came across the hermeneutic phenomenology of the French philosopher, Paul Ricoeur. She found a parallel between three concepts she was using and three forms of mimesis Ricoeur had articulated in his three-volume work, Time and Narrative. Charon found conceptual support from Ricoeur. Even though she limited herself to those three mimeses of Ricoeur’s, she implicitly invited using other concepts from his writings on narrativity and identity. This is what I have done in this article. My claim is that using Ricoeur’s work more extensively deepens Charon’s claims for the practice of narrative medicine in ways that bring her closer to achieving her own aims and goals, which have to do with strengthening and personalizing the doctor/patient relationship. The turn I take is to reorient the “text” of the physician/patient conversation from the verbal narrative itself to what that narrative is about, i.e., the patient’s body. Once this is done, the hermeneutical circle “closes” when it also is that providing medical care has an impact upon the body of the physician. Ricoeur provides a conceptual framework for this understanding by recognizing that our “narrative identities” are “interwoven,” and we share a “fragility” that is “mutual.” This leads to my claim that the narrativity evident in doctor/patient relationship is in effect a storytelling of their mutual woundedness. Not all of that is evident in the medical records. However, Charon supplies two types of narratives that, together, tell the story of mutual woundedness. On the one hand, she speaks of physicians “bearing witness” to their patients’ narratives. On the other hand, she encourages physicians to practice “parallel charting” wherein they would record how aspects of their relationships with their patients are having an effect on themselves. The concluding claim of this collaboration between Ricoeur and Charon is that an appreciation of the processes of compassion is enhanced when the mutuality of the woundedness of both patients and their physicians is considered. In other words, the narratives of medicine becomes stories of compassion when their themes are about the mutual and shared woundedness of everyone involved.

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Photo by Manh LE on Unsplash

Photo by Manh LE on Unsplash

Why is it important?

At a time when the practice of medicine is often reduced to its technological capabilities, Rita Charon is advocating a "narrative medicine" focused on the stories patients (and families) tell their doctors. However, the interpretation of these stories is often constricted and distorted by the language of treatment and the time allotted for developing physician/patient relationships. Appreciating the interactive narrativity of clinical relationships restores a focus on compassion to medical practice. Paul Ricoeur's perspective enhances this aim.

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