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“The Languages of Care in Narrative Medicine”: a review by Reverend Professor June Boyce Tillman

We gladly publish the review of The Languages of Care in Narrative Medicine by Maria Giulia Marini, written by Reverend Professor June Boyce Tillman, MBE, PhD, MA, LRAM, FRSA, FHEA, Professor of Applied Music and Artistic Convenor for the Centre for the Arts as Wellbeing at the University of Winchester, Extraordinary Professor at North-West University, Potchefstroom (South Africa).

This is an important book adding a new dimension to the contemporary literature on health. The contemporary obsession with Evidence-Based Medicine is here balanced by the need to listen to patients’ voices. This is carefully supported by a rich bank of evidence. Behind it is the language which enables the narratives to be collected. This way of collecting narratives allows them to be compared and analysed with greater ease than the free interview technique.

Although Narrative Medicine strives for a less technological approach to humanity, this book shows how technology can serve its purposes, relying on semantic mapping software which analyses words, synonyms, expressions, and metaphors. This software permits the organization and analysis of the non-numerical or unstructured data of patients’ stories to obtain metrics. This semantic alignment allows for iterative co-construction with the patient. It is a tool that can reduce ambiguities in patient-physician relationships. This alignment allows the understanding and sharing of identities—following a process of listening, accepting the non-linearity of patients’ thinking, and the feeling of otherness. The book shows how it makes shared sense of the active listening to, writing of, reflection on and interpretation of the patient’s story.

The evidence of the interviews that underpin this book is that doctors and nurses start their interviews from the diagnostic manuals rather than the patient’s experience. This, it is claimed, skews that diagnostic process and leads to a diagnosis that may not reflect the patients experience accurately. This requires doctors and nurses to learn new techniques particularly those of listening. I like the discussion of time, based on ancient Greek ideas especially the contrast between Chronos and Kairos and how these relate to the standard way that the appointments are organised. The claim is that the embracing of a more intuitive Kairos time (close to concepts of flow) will not take more time.

The analysis of the problems with time and rest in current Western culture is beautifully analysed with a call to return to a more cyclical time – more in tune with the circling of the seasons (including the change of relationship between light and dark) and the rhythms of the natural world. There are critiques of the absence of convalescence in contemporary recovery practices and the subjugation of wellbeing to increased productivity.

These are but a few of the areas of contemporary medicine that are problematised in this significant volume which I recommend warmly to all who are uneasy about the progress of the mainstream of contemporary European medicine and wish to interrogate them from the perspective of the patient. It supports an evidence-based approach but one starting from patient experience. This has the potential to illuminate current practice extensively.

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