Classifying coronavirus COVID-19 approaches according to Narrative Medicine

While Northern Italy is trying to cope with the new outbreak of COVID-19, and politicians are attempting to make their best decisions on the basis of the experts’ opinion  who have a very few epidemiological data in comparison to the Chinese database,  we would like to practice on clustering of  the possible “readings and interpretation” according to the basic taxonomy that are currently used in narrative medicine and humanities for health.

In this article, the basic classification of Arthur Frank, Arthur Kleinmann, Mike Bury and John Launer. In addition, we will try to analyse the factual and symbolic language and we will apply the Plutchick wheel to evaluate dominant emotions[1]

Just few information of back grounds. The new coronavirus, now known as COVID-19, was first encountered in Wuhan, China, in December 2019. Like other coronaviruses, it originated in animals and then migrated to humans (this is the official version).  Many of those initially infected either worked or frequently shopped in the Huanan seafood wholesale market in the centre of the city, which also sold live and newly slaughtered animals. China’s national health commission has confirmed human-to-human transmission of the virus. The virus can cause pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. If people are admitted to hospital, they may get support for their lungs and other organs, as well as fluids. Recovery will depend on the strength of their immune system. Many of those who have died were already in poor health.[2] And epidemiological data shows that in Chinese people, around 95% of the population recovered or where even asymptomatic, 4 % requested intensive therapy and oxygen supply with a global mortality rate of 2%. Mortality can split into subranges showing an increased risk in elderly, immune depressed and affected by comorbidities people. Ro, that is the power of infecting others, is 2.5, that is for one person who is a carrier of the COVID, 2.5 others risk to get the infections.  The Italian data, since too uncertain,  are not for this article, unless saying that at the moment, since the discovery of the outbreak on Friday, February21,  we have the fourth – after China, South Korea, and Iran- worldwide highest number of people tested and diagnosed to be COVID-19 positive with a relative number of death toll related mainly to the elderly and immune depressed persons.

In Italy, in Lombardia and Veneto we are living in an isolation phase, with uncertainties about how long it will last: hospitals since used to have chronic diseases now have to face after many decades the reconversion and creation of new beds in intensive care. In the meanwhile, the more the days are  passing the more the cross countries exchanges are unwanted and penalized. With almost every country around the world,  as Italians, we are asked, especially to all people coming from Lombardia and Veneto not to come and/or to stay in isolation for at least fourteen days in the hosting countries.  Swiss do not allow Italian people to go back to their country and to return. Even inside our countries the Regions are very scattered in terms of policies; opening or closing of the schools, universities and travelling of people among the regions.[3]

The first classification, Arthur Frank:  Professor Frank classifies stories into three common story types: restitution, chaos and quest. Restitution narrative: this is the story most favoured by physicians and other medical professionals and poses the emphasis on restoring health. These narratives often have three moments: they start with physical misery and social default, continue with the remedy (what needs to be undertaken) and finish with the moment in which remedy is taken; moreover, the narrator describes how physical comfort and social duties are restored. These are often stories told about patients rather than by patients, also because they give little agency to the narrator: patients simply have to ‘take the medicine’ and get well. Chaos narrative, which is really a nonstory: there is little narrative drive or sequence, just a list of negative things that will never improve and by which the narrator is almost overwhelmed. The story signals a loss or lack of control, and medicine cannot do anything. Quest narrative: this is the teller’s story, where the teller is in control of things. Narrators tell how they met the illness ‘head on’ and sought to use it, to gain something from the experience; the story is a kind of journey, with a recognised departure, an initiation (the mental, physical and social suffering that people have experienced) and a return (the narrator is no longer ill but is still marked by the experience).

Illness narrative from an undiagnosed possible carrier, of COVID-19 living in Lombardia:

The washing machine

Arthur Frank helps me a lot with his division of the narrative illnesses into Chaos, Restitution and Quest. Here, Chaos is evident … the bad news, the invisible virus, the lurking enemy, here  the war of the worlds … the individual  is in Chaos, data are pulled out from a hat,  anyone is becoming an expert in virology and epidemiology, someone is saying CVID is a trivial flu someone is saying COVID is our contemporary plague, and they are arguing among each other. Total Chaos among individuals, scientists challenged from something ever happened in Europe after AIDS, and politicians.

Then there is the Restitution, we wash our hands every five minutes, the washing machine is keeping on moving, the furniture is losing its colors by dint of being bleached (on the other hand it bleaches) and we try to eat healthy, fruit, vegetables , vitamins, and then breathing gymnastics to keep the airways active.  And then foulard since the mask are not available anymore. Waiting to go through. Things have to get back as they were, and that we are restored to health as if nothing had happened. But you may go to the third level, the Quest, the research … Why all this? What does it mean? And how do I live with this situation? What meaning can I give to a forced staying at home? To all canceled events? To canceled tours? To a life no longer programmable?

Here it is entering this third sphere, which is that of the hero’s journey. We realize how much a painful aesthetic is there in giving priority to other things, to prune between Business (it’s crazy that the economy follow the number of plague victims … that is to say the more deaths there are, the higher the financial spread: the inhumanity related  to the financial trends instead of providing solidarity funds),  and the Affections, one’s passions  other talents to cultivate in its own small perimeter which, however, with the technology of communications becomes planetary.  I think we will write a lot, and maybe at the end of this story we will not be stronger, as in the Restitution model … but we will be freer to do and spend our time with the people and things we really love to do. A little slowing down the pace in a hyper-accelerated society speeds up the thinking and the small and future choices. Model Quest. Well now let’s go and run the next washing machine…

The second classification, Arthur Kleinmann: , The concept trilogy of ‘illness’, ‘disease’ and ‘sickness’ has been used to capture different aspects of ill health. Disease is defined as a condition that is diagnosed by a physician or other medical expert, and it is considered as alterations or dysfunction in biological and/or psychological process, a deviation from the recognised ‘normal’ state, an isolated malfunction of a body part; ideally, this would include a specific diagnosis according to standardised and systematic diagnostic codes. This also means that the clinical specific condition has a known biomedical cause and often known treatments and cures. On the other hand, illness is defined as the ill health the person identifies themselves with, often based on self-reported mental or physical symptoms. It refers to the lived experience, to how the ill person and the members of the family or wider social network perceive, live with and respond to symptoms and disability; it is something being lived through the body and can have many types of meanings, in different contexts, to different people. Lastly, Kleinman introduces a third term, sickness. Sickness describes a disorder in a generic sense as applied to a population or group. It is related to a different phenomenon, namely, the social role a person with illness or sickness takes or is given in society, in different arenas of life, often used to measure social consequences for the person of ill health.

Metanarrative of the facts running in Italy

Sickness is pandemic, more than epidemic

As concerning with the biomedical model, the Disease imperative mode is tackling which the kind of symptoms and signs the body refers, and how they might be cured. There is a huge dilemma on the label to give to this disease, whether this is a FLU (something easy to take care of) or a Viral Respiratory Disease (more severe). On the disease, scientists and clinicians were arguing (now less since the severity) between both the positions, trying to understand how the COVID-19 works, how does infects the people, and which best therapeutic strategies are there.

The oddity is that, in our contemporary times of Chronic Diseases, where the word “Healed” is almost disappeared, here the language has brought back this word. The rate has changed: it is not, as in diabetes, or cardiovascular disease just the  number of deaths on prevalent cases (mortality rate), but we assist to something quite new for us of our XXI century after the Spanish flu epidemy between 1918-20 , the number of healed cases on prevalence. This disease is like an earthquake, – one hundred years after the worse flu of the XX century, to which our Western world is not used anymore and found us not prepared with very few beds dedicated to intensive care and infections and the majority of health care facilities dedicated to chronic patients.  After the HIV infections (which was much more under control in terms of infections), we learnt that one could live with the HIV virus a normal life using antiviral therapies. However, it is not possible to get rid of HIV infection, it is possible to control it.  Here, with COVOD-19 healing sounds quite an esoteric word nowadays, apart from children diseases.

The COVID-19 disease is risky not only for elderly people and persons with multiple comorbidities, but also for many physicians and nurses facing this new condition. The research and enrolment of doctors and nurses now is hiring retired staff and young health care providers; in Italy, the health care service is public and infective diseases are related to social medicine. Will Italy, already a country in economic regression, be able to face the sustainability of caring of all these people and defeating this disease?  And, with few beds available, when facing the ethic choice to cure between elderly people and adult people with comorbidities, who has to be taken care of?

As fas as Illness, when you come to know that you are positive fear might decrease: these from some collected narratives (n.d.r)- It’s more the fear of uncertainty, the impossibility to plan that knowing that it might happen: the fact that the percentage show the high number of healed people, is positive and more powerful in terms of energy that the anxiety generated from the unknown. Ill people with very few symptoms as low fever, cough and sore throat are told to stay home, and live separately from the rest of the family and the world- the same rules for healthy people as well.  Working and school activities are suspended, worries are when things will get back to normality. The being ill in hospital, as told by the doctors, tells about very kind and trustful patients as ever seen before. No claiming, no panic, no hysteric symptoms, in the hospital silence and the Patient becomes a Patient in the etymological meaning.

Sickness: no other diseases, no mental illness, mental retard, skin disorder can be compared to how the sickness of COVID-19 here lives on a Mega scale.  A healed person remains a person with a stigma, a brand on his/her skin at least for the next month’s coming. He/she risks to lose human relationship. To be elder is to be sick: some voices of the young generation, angry for what’s happening, wants to sacrifice the elderly since they had lived enough. Doctors and health care providers are seen as possible source of contagion so left isolated. Sickness concerns all Italian in the rest of the world since we are blamed to have infected fourteen or even more other countries. Italian people have been beaten for this abroad, as before the Chinese people. From the press, the COVID-19 people in the world speak about “that travel to Northern Italy”, cursing “that travel”. If patients stay calm in silence, the population is angry and wishes to have an escape goat.  Sickness is pandemic, more than epidemic.

The third classification, Mike Bury: This type of classification foresees that analysis must consider three types of narrative forms: contingent, moral and core narratives. Under the heading of contingent narratives, narrative analysis is concerned with those aspects of the patient’s story that deal with beliefs and knowledge about factors that influence the start of disorder. If this kind of narratives describes events, their proximate causes and their unfolding effects in relation to the performative of everyday life, moral narratives provide accounts of changes between the person, the illness and social identity and help to (re)establish the moral status of the individual or help maintain social distance, introducing an evaluative dimension into the links between the personal and the social. Core narratives reveal connections between the person’s experiences and deeper cultural levels of meaning linked to suffering and illness.

Illness narrative from an undiagnosed possible carrier, of COVID-19 living in Lombardia

In this spring will see more blossoms than ever

Mike Bury helps in analysing our thinking attitude in accordance to the external requests and stimuli. It is very much related to evaluate the kind of communication with the other people. First level, Contingent style: “dear Miss Jane Austin, I’m quite confident that you read about our Northern Italy situation on COVID-19. At the moment we have to avoid possible interaction as stated by your Prime Minister Boris Johnson, who asked to Italian people to spend fourteen days in isolation when coming to UK. British Airways and Easy Jet flights are cancelled.  As it stands for now, I see the impossibility to come and work on the seminar with you. I’m sure you can understand, I’ll keep you informed about the evolution of the rules and laws. Best regards, signature”.

Moving on, to “Moral style, keeping the fiction (it’s a faction– a mixture or real facts and fiction), the letter could be like this: “Dear Miss Jane Austin, I’m sure we have read the news about COVID-19 spreading in Northern Italy. We don’t’ know how this could happen in this small town close to Milan: there was a great incompetence, and the doctors in that hospital are to be blamed for all what’s happened. Scientists are fighting on a daily basis for who is right or wrong: in my opinion, they all should be fired. It seems that the new mutation of COVID-19 could be a danger for elderly people. But should I care for elderly people? Are they productive? No, they are just a huge cost in retired funds for us. And in the mean time they are the cause for interrupting our life, which is made of programs. And the politicians, what the heck are they doing? Arguing among each other: your Boris Johnson has closed the borders and Norther Italian people cannot come, as I was intended to do:  are they serious?  On one had they reopen here, the bar but the schools are still closed… Well, I don’t see any sense in this decision. I’m so angry, the culprits should be found and executed. And who cares for the people who live in the Wuhan of Italy, yes, they call like this Codogno. The people who put us in this difficult economic situation should pay. You know, Miss Jane Austin, and I can go on criticising for hours, people don’t’ wash their hands properly, the trains are so dirty, that this beast of Coronavirus is weighing more and more on the day by day. What the heck are they doing instead of blocking not our circulation but the bat-virus circulation? I hate Chinese people, yes, they were the cause of all our torment. Mrs. Jane Austin, one day the story will be over and we will discover what’s happened. I’m quite sure that it might have been Trump, using a viral weapon to block Chinese economy: you know conspiracies are always behind the doors.

Now moving to the Core style: “Dear Jane, I’m quite confident you came to know the news of the situation in Northern Italy caused by the outbreak of COVID-19. I am, as many other people, deeply shocked by what’s happened. I know I should have been coming to visit you for our wonderful seminar run four hands and two souls together, however I’m sorry to say that the situation forces me to say no, even if your Prime Minister would have been saying yes, Northern Italian People are welcome. You know very well my core values, and first is health at all costs, and second is service, which can endure me. However, I ‘m happy to do for the people I love, my cherished families, friends and people with whom I work. Don’t’ think here that the situation is tragic: I’m in smart working, having video conferences, talking to the phone: it looks like I’m more connected than before… Thanks to the beauty and miracle of technology, now we can work from remote…if this things would have happened twenty years ago, probably we would have felt much more isolated and lonely. When the weather is good, I walk alone outside to take fresh air, I love it, and since the gym is closed, I have started a home-based program. I am grateful to all the doctors, nurses and volunteers who are dedicating their full time, with a no stop rhythm to overcome this emergency.  They are like angels and I keep them in my heart and bringing with me in my time. Jane, my dearest, yes, I’m little bit scared but not by the virus, well even if I’m trying to follow all our safety rules, but by the future time. You know how much I’m an extrovert person, and I believe in the value of human touch: hugs, kisses are banished in these days. The new season will come on March 21, and I hope that we will be out on this sometime nightmare. In this spring will see more blossoms than ever.”

The fourth classification, John Launer: Classification of illness narrative according to John Launer Stories can be divided into three types: progressive, regressive and stable one. Progressive narratives move towards the personally valued goals; regressive narratives move away from such valued goals; and stable narratives sustain the same position in relation to the valued goals throughout the narrative sequence. This last kind of narrative could be seen as less engaging than others, because it tends to relate a sequence of events without great drama—a form of storytelling that goes under the heading of the so-called contingent narratives. The use of a progressive, regressive and stable framework allows an analysis that safeguards against over-interpreting the range reserved of meanings conveyed by patients’ accounts. It is important to underline that whatever narrative form may be identified in analysis, many accounts move from one to another, for example, from regressive to stable. Consistency in narrative accounts may be achieved or sought by patients, but it may not: much depends on the context in which narratives are constructed and presented and on the intentional acts which they help to constitute. This classification is very useful to focus on the coping strategies acted by patients: if regressive or stable narrative may show no positive engagement and if narratives are progressive, this may represent an evolving positively situation.

Illness narrative from an undiagnosed possible carrier, of COVID-19 living in Lombardia

There is no place for fear, and there is much to do

If I follow the John Launer’s principle of reading stories, starting from the worst case scenario, that of regression, the narrative is like this: “few days ago I knew that here in my homeland there is an outbreak of Coronavirus, and I’m keeping on reading the news on the social, watching TV, to understand… All I know is that I had a life before, and now everything is worsened. Before, I was free to move everywhere across the world, yes, I was a little bit scaring of travelling so much, but now I’m frozen by fear. I’m stuck at home, cleaning obsessively my furniture, rubbing my hands 300 hundred times a day, I don’t’ go to the supermarket, I buy food through Amazon, I’m sleeping on the couch while my partner sleeps in the bed. I fear it will get worse. I fear that we will not have money enough to live a serene life, since most likely in the future they will cut my salary. My partner who is a free-lance is paying already a huge toll, since he is involved with entrepreneurship and nobody wants to launce any business now. All dreams collapsed. If it goes on like this, I will die of panic attack.  Or I might suicide myself. I’m already starting to think of it. It’s better to suicide than to wait this fucking virus to come and kill me. “

Moving to Stuck Stories, or stable narratives, the narrative style could be like this:  “few days ago I knew that here in my homeland there is an outbreak of Coronavirus, and I’m keeping on reading the news on the social, watching TV, to understand…I was shocked when I read the news, I could not believe it, I did not want to believe it, and now I’m still frozen in panic. All my activities are blocked, I don’t’ know what to do of my time, I’m wasting such a lot of time watching the social media, trying to understand who is right or wrong. It’s a mess and I’m in a messy situation. My partner is trying to get appointments for his business but everything is blocked. He is an expert in entrepreneurship, but nobody wants to invent a new start up now. I don’t know what to do: I simply fill my time with washing my hands, days are no more a Monday, a Tuesday, or Thanks’ God it’s Friday, since tomorrow I will not work. The weekend is forgotten, every day is rhythmed by the news of the number of healed and dead people. Life is just now in a prisoner time”.

A progressive narrative could be like this: “few days ago I knew that here in my homeland there is an outbreak of Coronavirus, and I’m keeping on reading the news on the social, watching TV, to understand…I was shocked when I read the news, but now anxiety and fears is gone and I’m trying to enjoy even this undesired arrest. All appointments to me and my partner are cancelled at the moment, but I’m intended to follow an on line course to become a good on line teacher, and my partner is thinking about a new app for safety and security, with a recall system for giving good hygienic rules to the people: he is projecting it in many languages, since this outbreak might reach many parts of this planet. We want to be engaged in creating a better and safer world: deep in my heart I think that humanity, after this shock, will be more attentive to climate changes and respect of the Earth. There is no place for fear, and there is much to do.”

The fifth classification, factual language and symbolic language

Factual language: digits, facts, visits, number of healed people, contaminated people, of deaths. Mechanism of action by the COVID-19. Rules, countries, decisions made, who visited whom, who was the patient 0, people seen by patient 1, dates of the outbreak, age by mortality rate, gender by mortality rate, immune children, number of available beds by Region, days of isolations- 14 and/or longer, number of potential contaminated people by one asymptomatic carrier, number of masks available, number of ambulances in the streets, spread and fall of the stock market value, number of closed activities, number of online new services, number of days spent in home working, volumes of purrell sold, potential time to vaccines,  and so on….

Metaphoric language: try just to see on the screen shot the numbers of healed and deaths and contaminated as they are in the Frankfurt, Paris, New York London stock-exchange market by analogy.

Contribute of Professor Carol-Ann Farkas, Professor of Humanities for Health at the Massachussett College of Health Care and Life Sciences

Nothing is more punitive than to give a disease a meaning – that meaning being invariably a moralistic one. Any important disease whose causality is murky, and for which treatment is ineffectual, tends to be awash in significance. First the subjects of deepest dread (corruption, decay, pollution, anomie, weakness) are identified with the disease. The disease itself becomes a metaphor Then, in the name of the disease, that horror is imposed on other things. The disease becomes adjectival.

 – Susan Sontag, “Illness as Metaphor and AIDS and Its Metaphors” (1989)

Metaphors are not mere language. In “Illness as Metaphor and AIDS and Its Metaphors” Susan Sontag’s purpose was “to calm the imagination, not to incite it. Not to confer meaning…but to deprive something of meaning.” In these essays, Sontag warns us that when we describe illness with figurative comparison – almost always originating in fear, stigma, and prejudice – we distort its meaning in ways that harm rather than heal: “illness is not a metaphor…the most truthful was of regarding illness – and the healthiest way of being ill – is one most purified of, most resistant to metaphoric thinking.” Think of the comparisons we use, reflexively, unthinkingly, in western culture: disease is an invader, against which we wage a war that has victims and victors; contagion is infiltration, attack, impurity, and pollution, which must be cleansed, suppressed, eradicated. Such language, Sontag argues, obscures illness within dramatic narratives, meant to rouse and inspire…through vigilance and alarm. The problem with stories, of course, is that the action only unfolds through the choices and responses of characters – that is, us – which in turn evokes assumptions about moral values and responsibility…about blame.If the disease wins the battle – does that mean the physician didn’t fight hard enough? that the patient didn’t have enough will to victory? or that, perhaps, the patient might even have inadvertently sabotaged her own defences, through insufficient vigilance, or morally lax behaviour? And if contagion spreads, infecting, corrupting…whose unclean habits are to blame? who is the source of the pollution? Sontag makes the connections: our metaphors of illness tell stories of passive weakness, of malicious vice, of threat and danger, which we then use against one another. Never mind this pathogen, that imbalance of brain chemistry, this insufficiency of antibodies, that excess of cellular activity: we have others to blame (and “they” are always “other), others who can be the target of our shame, helplessness, fear, hatred. It might be a natural, human, impulse to use stories to give shape and meaning to otherwise arbitrary, uncontrollable phenomena; the danger is that the metaphorical thinking that we use to build those stories for our individual comfort then takes on a life of its own. The metaphors are especially vulnerable to ideological use, not at the level of the individual body, but of the body politic – the metaphors of invasion, pollution, sickness are used to justify the marginalization and separation of whole populations: Jews in 1930s Germany; gay men in 1980s America; immigrants, refugees, “aliens” (and their children) who threaten us with the infection of difference

In addition, I wish to add a widely used metaphor which is the plague and plague spreaders. The cancer metaphor of the society has quietly faded away: now the new words are “infodemia”, “the viral decisions of politicians”.

Simply, my thought goes to Albert Camus and its novel, the plague: the story of a plague sweeping the French Algeriancity of Oran. It asks a number of questions relating to the nature of destiny and the human condition. The characters in the book, ranging from doctors to vacationers to fugitives, all help to show the effects the plague has on a populace. From the novel:

“Flagella, indeed, are a common thing, but flagella are hardly believed to be when they fall upon your head. In the world there have been, in equal numbers, plagues and wars; and yet plagues and wars catch men always unprepared. (…) Stupidity always insists, we would notice if we didn’t always think of ourselves. In this regard, our fellow citizens were like everyone else, they thought of themselves, the scourge is not commensurate with man, we are therefore told that the scourge is unreal, it is a bad dream that will pass.”

The sixth classification, Plutchik emotions: Plutchik proposed that eight ‘basic’ emotions are biologically primitive joy, fear, anger, disgust, sadness, (the same as Inside Out) plus trust, surprise and anticipation. Plutchik argued for the primacy of these emotions by showing each to be the trigger of behaviour with high survival value, such as the way fear inspires the fight-or-flight response. Plutchik’s psychoevolutionary theory of basic emotions has these main postulates: 1. The concept of emotion is applicable to all evolutionary levels and applies to all animals, including humans. 2. Emotions have an evolutionary history and have evolved various forms of expression in different species. 3. There are a small number of basic, primary or prototype emotions. 4. All other emotions are mixed or derivative states; that is, they occur as combinations, mixtures or compounds of the primary emotions. 5. Each emotion can exist in varying degrees of intensity or levels of arousal. Plutchik first suggested eight primary bipolar emotions: joy versus sadness, anger versus fear, trust versus disgust and surprise versus anticipation.

Illness narrative from an undiagnosed possible carrier, of COVID-19 living in Lombardia

Fear is like a poisoned rain

Awe, it was that Friday morning, February 21, before the meeting with my manager, that I read that there was a man, aged 38, in intensive care, at 40 km from Milan, in this Codogno, a town hardly ever before. Surprise, to read also that his family was infected but then denial. No fear, just anxiety for the meeting I was preparing for… I had worked hard for that moment, I had collected all the figures, economics, endorsements, publications; the meeting was tough but very constructive. Lunch together that Friday was a joy: I was relieved. That man in Intensive care, now I know even his name, Mattia, was so far away from the morning memory.

Still an echo was ringing in my mind, anticipating my internal alarm; I called a physician who works at Sacco Hospital, the main centre for infective disease of Northern Italy: he was at a congress in Naples, did not know anything  about that case and told me that at the hospital, they were waiting for this outbreak to start already one month earlier: his voice was serene, calm and looking as he knew what they all were doing. I trusted him. Completely, with no doubts. On that Friday evening, things boosted, I had an argument with a relative of mine who was looking, in my perception,  “somewhat happy” that the virus could have been brought to Italy by a rich manager and not by poor African migrants. I got angry, furious, lives of our old parents were in danger and, for me, it was damned stupid to take a political position on this delicate matter.

On the same evening I saw the cautious, sad face of my son who said laconically to me “University closed”, I replied with sadness in my heart,” well it was the best things to do”. I organized an on line meditation group, inviting many of my contacts; some nice people have left, I was a little bit annoyed, but I respected them. A dozen people stayed and we fixed an appointment every evening from 9 pm to meditate for ourselves, the people around us, the careers, the patients, and expand this meditation to all what we wanted. It brought and it still brings serenity and we are keeping it on doing, and sharing emotions at the end.

Anger was eating and devastating me in the last days: all my plans of travelling and teaching were cancelled, I was full of rage: I knew I had to submit to restrictions for the safety not only of myself but of the others, but I was devastated: the meeting with that manager had been so successful, that I could not accept to slow down, I could not stand this blocking situation.  I cooled myself down, as I started to work on line, trying to convert all the lessons I could in a digital fashion.

I felt even contempt for the people who continued to say that this story was like a simple flu, that they were travelling as nothing happened: while me and many more other people were trying to do their very bests from home, avoiding not to get sick or to produce sick people since our hospitals are full as ever before, “the others”  were still and are gathering together in offices, acting as if nothing happened? I cancelled journeys abroad, it was a sad sacrifice, but then I was proud of doing it before putting the other in embarrassment, since very likely they would having asking me to do it.

Fear is there, it is like a poisoned rain that enters in your skin: fear is in any time opening the news, reading the numbers, and in meeting in a different way the people in your family with no hugs, no kisses. The utmost fear is reading the fear in my mother’s eyes. She wants a reassurance that I cannot give, she gives me the number of an opinionist – an influencer, by the way, – who covered the Covid thing as dust under the carpet.  “well, I don’t know, history will bring light on what’s happening”. I’m not lying, because we are tackling a huge uncertain thing.  No way, from the seen data, she is at risk of dying. Well, after having found a difficult person for so many years, today I discover that I love her and I have to try to prepare myself.  Optimism is there, I tell her a true fact, “come on, we are facing spring, today is March 1,  on Tuesday sunshine is forecasted, you can go out for a nice  stroll, the air in Milan has never been so clean,  and all the viruses disappear in spring and summer”.

[1] Marini MG, The languages of care in Narrative Medicine, Springer 2019

[2] The Guardian, January 2020

[3] Daily press releases, February 21- February 28



Maria Giulia Marini

Epidemiologist and counselor in transactional analysis, thirty years of professional life in health care. I have a classic humanistic background, including the knowledge of Ancient Greek and Latin, which opened me to study languages and arts, becoming an Art Coach. I followed afterward scientific academic studies, in clinical pharmacology with an academic specialization in Epidemiology (University of Milan and Pavia). Past international experiences at the Harvard Medical School and in a pharma company at Mainz in Germany. Currently Director of Innovation in the Health Care Area of Fondazione ISTUD a center for educational and social and health care research. I'm serving as president of EUNAMES- European Narrative Medicine Society, on the board of Italian Society of Narrative Medicine, a tenured professor of Narrative Medicine at La Sapienza, Roma, and teaching narrative medicine in other universities and institutions at a national and international level. In 2016 I was a referee for the World Health Organization- Europen for “Narrative Method of Research in Public Health.” Writer of the books; “Narrative medicine: Bridging the gap between Evidence-Based care and Medical Humanities,” and "Languages of care in Narrative Medicine" edited with Springer, and since 2021 main editor for Springer of the new series "New Paradigms in Health Care."

This Post Has 10 Comments

  1. Mona El Sherbini

    The experience of COVID 19 in Italy was indeed important to unravel all its underpinned humanistic aspects . I am glad the author cleverly referred to some narrative accounts of suspected patients who expressed a range of emotional issues that denotes how stressful the situation was in all aspects.

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