Con l’intervista a John Launer, Associate Dean for Faculty Development for Health Education England, inauguriamo la pubblicazione, sul nostro blog, di una serie di interviste a esperti riconosciuti nel campo della Medicina Narrativa e delle Medical Humanities. Siamo certi che la qualità e il valore di questi contributi possa ampliare e approfondire il dialogo circa la riflessione della Narrative Medicine.
John Launer è medico, terapeuta familiare, educatore e scrittore pluri-premiato. Le sue principali aree di interesse includono la Medicina Narrativa, la supervisione clinica per i medici, e la psicologia evolutiva. Launer è consulente onorario a vita alla Tavistock Clinic, senior lecturer onorario alla Queen Mary University of London, e decano associato alla Health Education England.
Q. What is Narrative Medicine now, in 2014, in your opinion?
J.L. I don’t think there is one thing called narrative medicine. In my view, the term represents a range of many different activities, from studying literary texts concerning illness, to practical trainings for heath professionals to help them become more attentive to people’s stories. However I think all the forms of narrative medicine have two things in common: a concern to engage with accounts of lived experience, and a counterbalance to evidence-based medicine and the influence of technology. I also like Rita Charon’s concept of “narrative competence” which also links the various kinds of narrative medicine.
Q. Do you think that Narrative Medicine practice it’s important?
J.L. My primary interest has always been in clinical applications. I admire people who take a research approach to narrative medicine, but my own career has been based on applying narrative skills and ideas to medical interactions: particularly the patient consultation and clinical supervision.
Q. Is there an epistemological shift is necessary to move from Evidence Based Medicine to Narrative Medicine?
J.L. For some people an epistemological shift is necessary, and I have even heard this described as a spiritual awakening. Other people have a natural epistemological inclination towards narrative and are relieved to find this affirmed. A few feel intuitively comfortable in both worlds – or acquire this attitude over time.
Q. Why should patients tell about their illnesses? Must we believe that stories are always true? And how should we behave with patients’ narratives?
J.L. Patients tell us about their illnesses because they know it will help us make a diagnosis and offer treatment, but also because they expect us as fellow human beings to be interested in their experiences – to witness them, to offer sympathy, and to show curiosity. Almost all the stories we hear from patients are true in so far as they represent the experiences as people genuinely recall them at that moment although the stories and memories may change over time, which is also human. A few people tell us intentional lies, usually because they think we have the power to provide something they feel that they need.
Q. Do you think that Narrative Medicine could be a competence to learn already at the University?
J.L. Yes, although there is so much technical information to learn at the university that it might be distracting. My personal preference has always been to work with established professionals, as a kind of “remedial therapy” for them.
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?
J.L. I think people’s attitudes are more important than the terminology. I have met people who have never heard the word “narrative” used in a medical context, but instinctively possess a kind of holistic understanding of illness. I have also taught people on narrative medicine courses who loved the theory but were hopeless at putting it into practice. I expect that narrative medicine will give way eventually to some other term: that doesn’t worry me, so long as it captures the same spirit.
