Emotions and narrative medicine – by John Launer

John Launer is lead for educational innovation in primary care for Health Education England in London, honorary associate clinical professor of primary care at University College London, honorary lifetime consultant at the Tavistock Clinic, associate editor of the Postgraduate Medical Journal, faculty member at ISTUD Business School in Milan and founding president of the Association of Narrative Practice in Healthcare. Professor Launer was the originator, with Caroline Lindsey, of Conversations Inviting Change (CIC). His most recent books are Reflective Practice in Medicine and Multiprofessional Healthcare (2022), Narrative-Based Practice in Health and Social Care: Conversations Inviting Change (2018), How Not To Be A Doctor: And Other Essays (2018).

My first encounter with narrative ideas didn’t come through my medical training. It began when I did additional training as a family therapist in the 1990s. Some therapists at the time were beginning to talk about ways of people ‘re-story’ their lives. This meant listening to them attentively and asking them to consider how their experiences might be looked at in different ways, hence altering the nature of the experiences themselves. This style of thinking was a shift away from how family therapists had worked previously, which largely depended on looking at how people within family systems affected each other. The approach was also very different from forms of psychological therapy rooted in psychoanalysis, where the emphasis was on emotions rather than either systems or stories.  

At the Tavistock Clinic in London, where I worked, there was a strong tradition of teaching doctors like me to approach their clinical work by applying the ideas of the psychoanalyst Michael Balint. That approach involved careful scrutiny of the emotions being transferred between patient and doctor. It therefore seemed very radical when a colleague and I set up seminars there that drew on a narrative framework instead: approaching the stories that patients told like texts that could be gently and respectfully questioned, providing opportunities for them to be retold in different ways. The emergence of narrative medicine around the year 2000 gave us more confidence and we began to identify ourselves as part of that movement..

Twenty-five years on, our work has developed a great deal and so has the work of others who took on narrative ways of thinking. The different varieties of narrative medicine, including academic ones like the approach at Columbia University, and clinical ones like our own, are learning from each other.  There has also been cross-fertilisation between narrative and psychoanalytic approaches. All the same, I am still sometimes asked questions like: “Isn’t narrative medicine rather detached? Doesn’t it place too much emphasis on words and not enough on emotions?” 

I like to answer these questions, as you might expect, with stories. Here is one such story, without specific details of the person or place involved.

Some years ago, I was demonstrating how to use the ideas and skills of narrative medicine by interviewing a young professional on a residential course. I was doing so in front of some of her colleagues and faculty. She was telling me a story about difficulties she was experiencing at work. I began asking her the kind of questions that I usually do: to tell me the story of how she came to do that job, an account of what her work involved, and to describe the different members of her team and how they each supported her. 

Following my usual preferences as a narrative practitioner, I don’t think I asked her questions like “how did you feel about that?”, I avoided making any interpretations, or reflecting back what she said by using my own words. This neutral approach often surprises people, and it is what sometimes leads to the impression that this way of working is “unemotional.”

Suddenly, and quite unexpectedly, the young woman I broke down in tears. A question I had asked had evidently triggered very strong emotion in her. I was taken aback. For a moment. I had no idea what to say. All I could think of was to ask “Would it be appropriate to offer you a hug?” “Yes please,” she answered, so we hugged. I then asked if she wanted to stop the conversation. She said no, absolutely not. She explained that my questions had helped to release a lot of feelings that needed to come out. She wanted me to ask more questions and to carry on exploring her difficulties so that she could imagine ways of resolving them. 

When our conversation finished, I suggested she might go for a walk outside in the open air with someone else in the group. While she did so, I confessed to the people observing us that I felt unsettled and possibly a little ashamed. Had it been fair, I asked them, to provoke such raw emotions in her, even unintentionally, leading her to expose these openly? 

The observers – both the young woman’s peers and their educators – took the opposite view. The conversation, in their judgement, had shown the power of narrative inquiry. It had also helped her to feel what she needed to feel, to give words to these feelings that would help her to gain mastery of them, and possibly to transform them.

This story, I hope, is self-explanatory. There is a circularity between the words we speak and the emotions we feel. Emotions may be wordless responses to what happens to us (or what we fear may happen). However, when we are invited to contextualise them with words, descriptions and stories, the emotions may alter as we do so. They may even burst out with surprising power, which then subsides in a way that brings forth new words and more tolerable emotions. 

Every narrative, if approached with love and curiosity, has its own momentum for change and, in doing so, to heal the feelings of the narrator. 

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