Carol-Ann Farkas is Associated Professor in English and Director of Writing Programs at the Boston University Massachussets College of Pharmacy and Health Sciences (MCPHS). Her course “Literature and Medicine” wants to examine the disease experience not only from a clinical point of view, but also through narratives: a way to exercise active listening, reflection, comprehension, and to complete the training of future professionals that will have to learn to take care of people. Carol-Ann was “virtual” guest at the Applied Narrative Medicine Master of ISTUD Foundation: through a conducted dialogue after the showing of “The Elephant Man” by David Lynch, she gave an example of how to comprehend the human disease experience through filmography – without removing from actual socio-cultural contexts, on the contrary analyzing and interpreting them.
Q. What are Humanities for Health and Narrative Medicine now, in your opinion?
CA.F. Students preparing for careers in any area of Healthcare – future doctors, psychologists, researchers, nurses, technicians, pharmacists – need a strong foundational education in the Humanities, particularly Art, Culture, History, and Literature. In line with the major scholarship in the Medical Humanities of the last couple of decades, I agree that such study is broadly beneficial for improving students’ cultural knowledge and appreciation, critical thinking, communication skills, and empathy. These latter skills have, as we know, more specific clinical application – cultivating narrative competence, and teaching future health care providers how to engage with, and co-create, narrative in the clinical encounter can only improve understanding and respect between providers, patients, and care-givers. Additionally: I think a combined study of Health, Narrative, and the Humanities would be highly beneficial for undergraduate university students in any discipline. A course in Medicine and Narrative, for example (broader than Medicine and Literature, not clinically focused like narrative medicine) offers students the opportunity to confront questions of care, compassion, empathy, identity, affiliation versus alienation – all the important questions of humanistic study. At the same time, programs in the humanities often downplay education in Science, not to mention the Health Sciences, and yet attentiveness to interpersonal and ethical concerns surrounding illness and wellness are central to humanistic study as well.
Q. What do you think about making Narrative Medicine a specific academic subject? Do you think that it could be a radical change for the Narrative Medicine practice?
CA.F. Making Narrative Medicine a specific subject, as an interdisciplinary course for students in both Healthcare and the Humanities, as well as for more advanced professionals interested in the subject for both scholarly and pedagogical applications. But I’d be wary of creating just one course and adding it in with medical education programs. With my background in composition studies, I’m a strong advocate of Writing in the Disciplines – developing curricula for students where they both learn to write and write to learn across disciplines, and in genres specific to their chosen field of study. For this reason, I’d like to see Narrative Medicine integrated throughout medical education. When we create Humanities courses in health education, students tend to see that work as complementary at best, merely ancillary at worst – far more useful, I think, to apply the methods of narrative medicine in varied contexts.
Q. What could we read behind medical students’ narrative forms and expressions? Do you think that this approach could be important in the training of medical students, and how do they react to teaching Medical Humanities?
CA.F. Recent research has found that reading novels sparks the same neurological connections as “real” experience. We now have quantitative evidence that reading makes you a better human being! The more that Healthcare students engage in both critical and reflective reading and writing, the better. The practice requires them to become more thoughtful and aware about the range of human experience (whether directly to do with illness/wellness or more broadly), which must surely help them cope better with the demands of modern healthcare, and communicate more effectively and compassionately with their patients. Moreover, healthcare education is often very specifically, technically focused; as an inadvertent consequence, students often don’t learn enough about the larger psycho-social factors which affect health care – everything from politics and economics, to problems of gender, race, culture, and class. Courses in Narrative Medicine, and the Medical Humanities more generally, will help future health care providers develop a meaningful context for their work. Ideally, they’ll be inspired not only to treat their patients, but to advocate for broader social reforms.
Q. Could we think about moving from Narrative Medicine to a more “holistic” form of comprehension of illness, body-states, and health, so to come to Narrative Healthcare or Narrative Health Competence?
CA.F. Absolutely! It’s possible that the evolution of the Medical Humanities represents an evolution in how we think of illness/health and healthcare – a movement to care for the whole person through a biopsychosocial model, rather than the biomedical model. There’s certainly evidence in health and behavioral psychology, as well as from projects in Narrative Medicine such as those undertaken by ISTUD, that helping both lay people and health experts to think of individual and group health in a more holistic context really makes a positive difference!
Q. Medical Humanities are often considered “a nice to have”: do you think that through them it is possible to save costs for the Healthcare System?
CA.F. Absolutely! In my own research, and as the ISTUD project on Narrative Medicine and fibromyalgia has demonstrated – patients with medically-unexplained symptoms, or hard-to-diagnose conditions like fibromyalgia or chronic fatigue syndrome, are very intensive consumers of health care. Frightened by their symptoms, and frustrated by their treatment by the healthcare symptom, they return again and again for tests, treatments, and reassurance, often with poor results. Their physical symptoms continue, and their distress increases, because they have little certainty and, too often, little sympathy from the people they trust as health care experts. Instead, when providers and patients can engage in a practice of shared, reflective reading and writing they can improve their understanding of their own, and one another’s situation. With more specific communication AND more empathy, providers and patients can work together more efficiently, and cost-effectively.