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Interview to Antonio Virzì

virziAntonio Virzì, specialized in Neurology, Psychiatry and Psychology, is professor director of Psychiatry U.O.C.of Ragusa – Vittoria. Author of more than 300 publications, he conducted research at the University Clinic of the University of Catania, with attention to clinical, rehabilitative and psycho-social area. During the last years, his interest has focalized on medical didactic themes, with in-depth analysis about doctor-patient relationship and Narrative Medicine. President in charge of the Narrative Medicine Italian Society, he’s also a component of the Executive Committee.

Q. What is Narrative Medicine now, in your opinion?

A.V. Nothing is more difficult than enclosing in a definition that little cultural revolution represented, today, by Narrative Medicine. In fact, “cultural revolution” is a definition, and not so far from my way of interpreting Narrative Medicine. N.B.M. is a cultural attitude which involves a different way to think what is to be a doctor and the whole health management. It is evident that this definition is a general one, and it could seem superficial. If you want something more exhaustive, I would refer to the Consensus Conference that took place in Rome last year, by the Superior Institute of Health, about this theme. I would not underestimate the range of a more simple definition, because this could permit a more accessible use of Narrative Medicine, even without a deep preparation. I would like to point out that these are essential premises for a widespread use. Now, I would be satisfied just by a new attention to the patients’ stories, by a willingness to listen to. We must not forget that, for centuries, listening to patient and the attention to his illness narrative (not separated from his life narrative) were the doctor’s principal tools, and it doesn’t seem to me that the physician’s credibility and authority suffered for it. And on, the whole health system. The focus is the attention to the person’s story: this is could be the summary. Alerting to the importance of personal narratives is a smallest, but very important objective, because it could concern all medical practice. There’s a parallel discourse, about narrative skill, of attention to narrative… We are specializing in this direction, with a final “pole”, that one of psychotherapy. We are on a continuum, from a pole represented by a capability that everyone must have, to another one in psychiatric field – and this, according to me, is not Narrative Medicine.

Q. Do you think that is important to practice Narrative Medicine?

A.V. If for “to practice” we intend a better capability to listen to people stories, if we intend the assumption of that cultural tendency I was speaking about, surely. If we intend an alternative practice, a new alternative medicine, that one “à la mode”, I think it could be extremely dangerous, with the risk to create a new “specialist” who – in reality – will be the umpteenth physician searching for an identity more useful for his business activity than for the patient.

Q. Is there an epistemological shift necessary to move from Evidence Based Medicine to Narrative Medicine?

A.V. Two different worlds that must be considered complementary, that must learn to coexist, to criticize themselves, to know their limits, to define areas of interest, to recognize themselves as different, but with one purpose: human well-being. It’s clear that Narrative Medicine has major difficulties, because it has to get back lost positions, old and new prejudices – but it must not use the EBM same paradigms. NBM and EBM are two different situations, and they often must remain separated. We need EBM, with its strict and scientific methodology, that could respect therapies. But if we apply EBM rules to Narrative Medicine, we kill it. Paying attention to single stories, as if they were scientific realities, is even more dangerous. For example, Stamina case, but it’s valid also for certain anticancer therapies, for certain “trends” that are exclusively based on single narratives, it’s evident we can’t consider personal experiences as objective truths.

Q. Why should patients tell about their illnesses? Must we believe that stories are always true? And how should we behave with patients’ narratives?

A.V. A patient’s narrative is never “real”: it’s his/her narrative, the story he/she lives and is told us. Just personal data could be real (except of clear cases of bad faith). Patient’s narrative is always subjective: we must take it as the patient narrates, and as we understand it. Is the patient’s life that matters, and it’s very different from the objective fact, if it exists. We always must believe that is the reality the patient is living. It’s necessary to understand how that type of reality can be compared with that one of other subjects. One of the principal Narrative Medicine value is the recognizing of the necessity to get different points of view. The same story can be narrated in several ways: by the patients, by his/her familiars… There’s no true or false, only points of view.

Q. Do you think that Narrative Medicine could be a competence to learn already at the University?

A.V. It must be taught at University! However, we have to understand how needs go against traditions that very often are position and (next to never legitimate) interest defences. When a competence becomes a subject, the risk is that of an inconceivable distortion, and this risk is stronger in the case of new subjects. We are capable to plan even 20 hours for a Heart-Surgery that no one will ever apply, and we don’t plan any hour to analyse more “humanistic” competences. Even in this case, we must find new ways to grow that sensibility to narratives, to escape the difficulties of the actually organization of our Universities.

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?

A.V. Probably I’m not directly answering to this question, but I take the opportunity to tell one last important thing – and the question gives me the idea for a “narrative exercise”. Personally, I specialized in Psychiatry, then in Psychology and in Neurology. This, maybe searching for bringing together that mind and that body presented as absolutely separated, through the acquisition of further competences. From my own experience, I don’t think this will be the fairer way, and when I listen to similar questions, I relive all the controversies, all the conflicts of those psychiatry “militancy” years. I wouldn’t discuss again on the mind-body dichotomy. When I listen to this kind of discourses, I have the impression that we are in an already travelled, continuously travelled road. I make a provocation: what if, instead of discussing about the mind-body relationship, we listen to both of them?

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2 thoughts on “Interview to Antonio Virzì

  1. In Ragusa till 21st March 2015 ..that is now. I went to Ibla today. I am on a short holiday with my wife.

    I am a psychiatrist aged 60.

    I am a medical educator, very interested in clinical human factors and psychology and mental health law.

    I am in the clinical human factors group…see Martin Bromiley about his first wife’s death in “just a routine operation ” on u tube.

    The clinical human factors group has a web site. I am one of the trustees.

    My spoken italian is “stanco” but I read italian. I am keen t make links with such an organisation.
    Personalised medicine as genetics needs narrative based techniques more than ever.

    See play by Antonio Checkov re Ivanov.

    There is a lot more to story than words

    Have you heard of the work of Frederick Bartlett in the 1930s on memory and stories?? I agree psychiatry is behind in all of this ..more therapies than stories

    Patient stories are a big way of changing medical education, doctor patient relationships, patient empowerment and focusing original answers on problems faced by individual patients.
    I work as a consultant in the NHS, Mental Health Review Tribual Wales as a medical member and for Health Indpectorate Wales as Lead second Opinion Appointed Doctor.
    I work in Haverdfordwest, Wales ( Galles).
    Matthew Sargeant

  2. Medicinal Narrative e multimportanti a causa di ” personalised medicine” svilupparsi da medicina dientro alleanza terapeutico sono rotti isolamento dentro gente et ideas. La realita da successo e di fare una futuro insieme.
    L’arte di medicina existe dientro una sistema sociotechnica.

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