Narrative medicine and social dreaming interplay

I think we dream so we don’t have to be apart for so long. If we’re in each other’s dreams, we can be together all the time.”

– Alan Alexander Milne, Winnie-the-Pooh

Narrative medicine is the sharp capture of the experiences by written or verbal stories of the patients, physicians, nurses, caregivers and citizens as far as health and illness in their wholeness are concerned. More than this, through the narrative skills, people can develop coping strategies to handle factors which are unbalancing and destabilizing wellbeing. Thinking now at the COVID-19, every citizen all over the world have been impacted by the pandemic event, someones, tragically, with grief and loss, some others just through the lockdown, some others without lockdown but just facing this new risk factor, the virus, carrier of powerful emotional reactions, as fear, anxiety, terror, anger, or acceptation, and trust or, on the opposite, a denial reaction, as the virus does not exist. 

Narrative medicine is beneficial through the expression of the emotional and rational mind in soothing the weight of this new event, as well as of all other diseases: the telling is a cathartic agent, promotes affiliations among the constellations of carers and caring, fixes memories so that history doesn’t’ get lost and fosters creative solution to overcome these “troubled waters” up to “tsunami” events.  

A tsunami was a recurrent dream in many people during this pandemic: it was a symbol that our social unconscious expressed during our night time. At the very time in which I was reading an article in which there was a sort of evidence of “commonalities” in dreams, I was invited to take part in a group which practices “Social Dreaming” (we report the interview with Elisabetta Pasini and Cinzia Trimboli, the organizer of this activity). 

“Social Dreaming” is the name given to a method of working with dreams that are shared and associated with a gathering of people, coming together for expressing their dreams. Its immediate origins date back to the early 1980s, with the founder Gordon Lawrence who was on the scientific staff of the Tavistock Institute of Human Relations. The task of social dreaming was and is to transform thinking through exploring dreams, using the method of free association, amplification and systemic thinking, to make links and find connections to discover new thinking and thoughts. 

Why is this dreaming named “social”? It is like the composition of a “social mosaic”, through the listening in a group which is called Matrix (from Mater, Mother, the symbol of a generative approach), where anyone in the group is a provider of tiles, some similar, some different. Gordon Lawrence states: “each dream is a fractal of the other, for dreaming is revealed in pandemic patters; one dream is part of the whole sequence of dreams in a matrix. 

The conscious mind operates on the logical repeated patterns of thinking, the unconscious mind, which is unknown yet as a mechanism of functioning, tends to fuse and unite everything in an “oneness” that is limitless: “unconscious vision proved to be capable of gathering more information than conscious scrutiny lasting a hundred times longer; the un differential structures of unconscious vision display’s powers that are superior to conscious vision ( Ehrenzweig)” as the Yin and Yang united together.

Why there is the possibility to reach this “oneness” in instants of time? From a neuroscientific point of view, the brain cortex is configured by neural nets; when we are awake, these neural nets are connected very tightly and are very focused. When we are asleep, our neural nets during the Rapid Eye Movement phase (the REM phase) dissolve and become less tightly knit, with the connections becoming looser and broader.

Consciousness and unconsciousness are not two entirely distinct phenomena. Instead, they exist along a continuum, from the very conscious, to less and less aware, to twilight areas between the two and then on to the more and more deeply unconscious. Even though consciousness therefore typically blends into non-consciousness without a clear-cut boundary, neuroscientists have identified specific characteristics more closely associated with the non-conscious and others more associated with the conscious. Non-consciousness holds an almost unlimited amount of information, whereas consciousness is limited to only a few items at a time and is easily overwhelmed. As a result, the brain is designed to function without the intervention of consciousness most of the time (Posner and Rothbart, 1998). The vast majority of brain activity is non-conscious, with only a small percentage ever becoming conscious, therefore unconscious is not only related to night time but also to day time. 

Gordon Lawrence defined four kinds of thinking: thinking as being (it is a bit like white noise, the no stop of the mind), thinking as becoming (the strategic and generating thinking), feeling as dreaming (the REM phase), and unthought known (the daily unaware unconsciousness): they all four intermingle, and they all four are generative of new possibilities. 

The interplay among these thinking (a mixture of all of them, since the dreaming time probably unconsciously impact the daily life) is achieved through the narrative medicine practice and the creative, immense thinking provided by the dream. 

The neural patterns as somehow analogues when sharing a narrative of real-life awake time and when sharing a narrative of a dream: humans have a striking ability to infer meaning from even the sparsest and most abstract forms of narratives, both from awake time and from dream time. At the same time, flexibility in the form of a narrative is matched by inherent ambiguity in its interpretation. However, in our Western culture, we are quite prone to listen the real fact occurred during the days, less likely to investigate emotions behind -unless we don’t receive a literacy in emotional intelligence, – but we don’t accept the talking in an established setting about the personal dreams. This is today a taboo since no authority is given to the “dreamscape”. For many tribal cultures, sharing dreams was as central a part to community living as raising children and celebrating rites of passage. Possibly, our ancestors founded narrative medicine in Greece, in which in the day time the dreams of the ill persons were played in a dedicated theatre close to temples dedicated to Asclepios or Apollon, the Gods of Wellbeing and Health. And this happened probably even earlier than in the Greek culture. Therefore narrative medicine was woven in the dream thinking for millennia. 

Nowadays, the rediscovery of this practice could be extremely beneficial since the humankind, is very much upset by the what happened with the pandemic event and needs nourishment tools to medicate the wounds given by the current situation, both on the health state and the economic pattern, to rebuild the personal and social identity.

As Lawrence says “social dreaming directs attention to shared culture and knowledge and takes us beyond personal, selfish, ego-centric preoccupations.” In the social dreaming, the dream and not the dreamer is at the centre of the attention and provides a gain of knowledge of the environment and its culture. Books of pandemic dreaming are published already all over the world: however, one thing is being alone as a reader, and another one is belonging to a group- named Matrix- of relatives, friends, colleagues, health care providers, with a generation attitude, in which the central thinking is that one of becoming, since the Mater can generate new styles of life at home, outside, at school, at work, in the free time with the very self and with the others. This practice enriches our authentic real-life stories, since we are not separated individuals, in our day-night circadian rhythm.

Neurosciences are keeping on exploring the fascinating brain patterns during night and day: dreams are waves associated with quantum physics, some of them can be recalled and encoded into clear words, some other are beyond any spoken language, but maybe, arts could help in their capturing and meaning-making. Up to now, many of the old things that were living in the folklore as the beauty of the hugs, the importance of rituals, the damage of the loneliness were not evidence-based up to the development of neurosciences: now, the scientific society is changing its attitude towards these elements, because many of these tracts of cultural wisdom find scientific proofs in our contemporary world.

In one of my last nights, I dreamt of a chessboard tattooed on the back of one of the dearest persons in my life: I woke up, and the first free association was that we all have to play chess with Death as in the Seventh Seal by Ingmar Bergman. In this movie, only the artists save themselves from death, that is to say only a generating, out of the box thinking, can give a meaning to life. 

But this is just my free association, I would love to hear your opinion reader on this, and maybe, if you wish, you would like to break a contemporary society taboo and to share your dream, so to build together a dreamscape. 

Anyway, here it is a reading I would suggest for this summer period: Introduction to social dreaming- transforming thinking- Gordon Lawrence, Routledge, first published 2005.  

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."

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