The courage of introducing narrative competences in clinics and science. A review of “Narrative Medicine. Honouring the stories of illness” by Rita Charon

The book Narrative Medicine. Honouring the Stories of Illness, by Rita Charon, has been recently published into Italian by the Raffaello Cortina Publishing, in a magnificent translation by Cristian De Lorenzo and Micaela Castiglioni.

More than ten years have passed since the English edition, addressed to all the enthusiasts and future experts in Medical Humanities. Many of us trained on this book, which we considered sacred: here, we learned how much space Charon gave to the narrative skills that care professionals must possess.

Narrative competences open up to listening, overcoming the technicalities of decision-making algorithms, and allow to create an affiliation relationship between the healthcare team, patients and family members. On the other hand, the passion for non-medical literature and art is an item in the Jefferson Empathy Scale, used in the healthcare context: the lower is the score, the higher the gap from the patient.

In this masterpiece, Charon teaches us to honour patients’ stories: an upstream message in an Evidence-Based Medicine world that has often marginalized these narratives. Charon delves into the animated writing of clinical cases, started by Oliver Sacks and named by her parallel chart: it became an educational tool for students of Medicine and other faculties, as well as for senior teams. Charon incites to write narratively since university; she teaches how to read masterpieces, and to write.

For Charon, literary tools are precious and indispensable for everyday clinical practice. Like a gymnastics, Charon brings to the wards the close reading: it is a meticulous text analysis that observes how single elements related to larger groups, without neglecting the text’s composition, themes and literary schemes – all skills we learned at school.

Now, we wonder why we Europeans and Italians have not been able to enhance our classical, cultural and artistic heritage and make it entering medical and scientific disciplines.

We experienced schools that taught us poetry as a pleasure and reflection, classical literature and theatre, Dante, Shakespeare and his sonnets, Manzoni and the description of the seventeenth-century plague. We experienced school outings and trips in art galleries, museums, churches, temples, and cities that are essential for our cultural and historical imaginary. History, indeed, and philosophy still transversely characterize our study paths. Art courses have expanded their boundaries, starting from the “greats”, such as Antonello da Messina, Leonardo, and Caravaggio, and coming to include Warhol, Rothko, Lichtenstein, Basquiat, Frida Kahlo. By studying Latin and ancient Greek, we learned to make “dead” languages alive again. Above all, our schools taught us critical sense and curiosity.

The fact that we must learn from Columbia University, as well as other US universities, reveals that the immense heritage learnt at school – considered as a “cultural background” in Italy and most of Europe – remained at a standstill, especially in scientific disciplines. Who undertakes medical and scientific studies, for example, writes almost nothing until the dissertation.

In her courses at Columbia University, Charon “inherits” students who are used to more informal and colloquial lessons, and often do not have an in-depth knowledge of the humanistic, historical, and artistic field. Moreover, as noted by Carol-Ann Farkas, Associate Professor at Massachusetts College of Pharmacy and Health Sciences (MCPHS) in Boston, the education quality is strongly influenced by social inequalities. Disparities separate who have access to more resources (including textbooks, museum visits, art programs) and those not. Rightly, Charon requires his student to learn to read the great literary classics easily: she quotes Faulkner among the US writer, but also fundamental texts of European tradition, such as Shakespeare, Tolstoy, and Chekhov, are included.

It is therefore difficult to understand why we fail to enhance not only our cultural heritage but also the richness and depth it brings to our critical sense, our relationships, how we narrate ourselves and the world around us. Also, lastly, how much we fought for this heritage to be for everyone.

We do not even give value to our National Health Service. Charon writes a perfect book which fits well in the high school educational background, and also in the US healthcare economic context. In this private healthcare model, insurances play an essential part, and doctors must establish a proper care relationship with the patient, who is inevitably tied to an economic return. So, Charon’s message is even stronger since she teaches care professionals that patients come before every possible profit.

Let us wonder how it is possible that, although our models primarily based on the public and an essential humanistic tradition, we give more importance to an “imported” paradigm, rather than to our specificities and reflections closer to us, even if different between each other.

The perspective of recognizing ourselves does not imply opposition to the solicitations coming from the rest of the world. After all, several books by non-European authors, researches and academics have frequently opened relevant scenarios; we may quote Stigma, by the Canadian Erving Goffman, to remain in the Humanities field.

In Italy, Narrative Medicine is flourishing. There is a scientific society, and there are university and institutional Masters. A course in Narrative Medicine was included at La Sapienza University (Rome), while Hunimed (Humanitas) has a program for future doctors and nurses that also includes narrative, ethical and philosophical skills.

Undoubtedly, Charon has the greatness of enhancing what we, on the contrary, have forgotten for long.

Almost like when Great Britain took the Parthenon metopes, left in a dire state of neglect: even today, it is debated whether or not these should be returned to Greece, and meanwhile, we continue to see them exhibited at the British Museum. What may we think about it?

With a warm invitation to read an essential book to reflect on the importance of storytelling in the care field and humanistic skills in the education of health professionals.

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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