Narrative
The word narrative seems omnipresent in our contemporary world, having escaped from an obscure corner of literary studies to accrue power in social sciences, in popular culture, in politics, and throughout the humanities. One early definition of the word is Barbara Herrnstein Smith’s: narrative is “someone telling someone else that something happened” (B. Smith 1981, 228). Narrative has become a health humanities keyword because central events of health care occur when a person or group gives an account of ill or good health to another person or group, whether in a private conversation in a clinical encounter or a virally spreading social media story of trauma or illness. Such health-care fields as narrative medicine and reflective practice propose that the telling of a patient’s or community’s situation begins not only the factual report of a health matter but the discovery of the matter itself (Charon et al. 2017).
Such narrative acts as close reading, radical/critical listening, and advocacy allow the health humanities to approach many of its commitments: to improve clinician-patient relationships, to critique assumptions of bioscience, to unite with patient communities in activism, and to interrogate the power/economic/ethical dynamics of structural health care (Gilligan 2015). Dimensions of power and privilege along race, class, gender, and ideology positions are enacted in scenes of telling and listening, placing narrative at the core of efforts toward bias-free health-care justice.
Beginning at least forty-four thousand years ago with Neanderthal cave paintings, the story of narrative winds through origin tales of Gilgamesh and Homer and through Plato’s and Aristotle’s studies of poetics and rhetoric. Much of the sentinel works of modern literary criticism, from Henry James’s The Art of Fiction to James Baldwin’s Collected Essays, shows how narrative accounts bridge the gulf between emitter and receiver, in effect asking, “How do stories work?” The field of narratology (i.e., the study of narrative) itself emerged in the late nineteenth century, when Russian literary scholars Vladimir Propp and Viktor Shklovsky studied the structures of Russian folktales to catalog the functions of the tales’ characters and plots and to distinguish between the fabula, the events being represented, and the syuzjet, the narrative account produced (Propp [1928] 1968; Shklovsky [1917] 1965). The early twentieth-century rise of the fields of linguistics and semiotics added to narrative theory’s conceptual foundations. Later twentieth-century literary theorists furthered the intellectual paradigms of narrative with close attention to time, space, poetics, metaphor, and voice (Genette 1980; Todorov 1977; Ricoeur 1984–88; de Certeau 1984). Among his many contributions, Gerard Genette introduced a third dimension to the story/narrative dyad—narrating—to complete the impersonal and abstract process of fabula/syuzjet with the flesh-and-blood action of the teller: “The narrative can only be such to the extent that it tells a story... and to the extent that it is uttered by someone” (Genette 1980, 29).
By the early 1980s, narrative escaped the sectors of literary study and linguistics to show up in far-flung disciplines—history, phenomenology, cinema studies, psychoanalysis, sociology, psychology, and law (Kreiswirth 1992). Those who were early drawn to narrative in these fields overturned the conventions of their own disciplines to uncover the paradoxes, biased perspectives, storied uncertainties, and untestable grounds upon which many of the convictions of their fields were based.
Whether one examines Toni Morrison’s Beloved, a Bach fugue, or the transactions of a death-row exoneration trial, the receiving listener/viewer/reader enters a contract with the teller, inheriting ethical duties toward the one whose messages are communicated (Miller 1987). Although one can recuse oneself from the contract by choosing not to read the book, leaving the concert hall, or ignoring public wrongdoing, the demands placed upon the receiver by the presence of the Other—that is, a person other than oneself—cannot be negated (Butler 2005; Levinas 1979).
Among the scholars and artists early attracted to narrative ways of knowing were clinicians and bioscientists who recognized the salience of narrative in health care. I remember sitting in narrative theory graduate seminars in Columbia’s English Department realizing that what I learned about narrative process was fundamentally changing how I practiced my internal medicine. Shocking realizations about my science and about my patients’ situations emerged from the shadows cast by professional training. How complex were these accounts I heard and witnessed from my patients and their families once I could hear/see with my newfound narrative skills. Many of us in the early days of literature and medicine—Joanne Trautmann Banks, Kathryn Montgomery Hunter, Anne Hudson Jones—discovered how actionable were the connections between literary studies and clinical practice. The more recent works of Lisa Diedrich, Catherine Belling, Ann Jurecic, and Rebecca Garden, among many others, expand health humanities’ commitment to narrative into areas of critical health studies, disability studies, illness autobiographies, and activism.
Narrative skill allows health humanities practitioners not only to examine their own clinical work in health care but also to powerfully read the records of the past to recognize how current injustices got baked into what has been passed down as knowledge and practice (Metzl 2009; Matthew 2015). Using the affordances of narrative ethics and qualitative and archival research methods, clinicians and humanities professionals trained in narrative can elicit or exhume persons’ accounts of their own health situations. These accounts spell out individual lived experiences of embodied and socioeconomic conditions, producing convincing evidence of otherwise unseen forces that influence health (Charon et al. 2021). Narrative skills equip clinicians to challenge the hierarchies of the health professions and to equalize power across members of a health-care team. Advocacy efforts join health humanities practitioners with community groups for shared efforts toward health-care justice—identifying local social determinants of health, revealing underlying mechanisms of a community’s health disparities, and exerting collective force to alter them.
The complexity of stories requires attention to the hazards as well as the dividends of using them. Corporate name branding, polarizing and misleading political utterances, and public access story slams oversimplify or exploit the complex phenomena of narrative. Some narrative scholars warn that casual sharing of private stories with an unknown public may endanger tellers and listeners with invasion of privacy, commitment of voyeurism, psychic dangers of unlicensed psychotherapy, and being lied to (Mäkelä et al. 2021). If the human processes of narrative require not just attention to words but attention to the relationships that cull meaning from those words, then narrative acts themselves unite us story-using creatures and require ethical attention to networks of power and domination.
Taking into account both its risks and its benefits, a narrativized medicine contributes demonstrably to health-care quality, humanistic clinical education, and social justice in health (Remein et al. 2020). Beyond clinical settings, expanding intellectual foundations of narrative studies now address such conceptual and practical health humanities concerns as posthumanism, ecocriticism, digital storytelling, cognitive literary studies, rhetorical narratology, and the vast media transformations of how we see ourselves, represent ourselves, and place ourselves in the widening cosmos (Lanser and Rimmon-Kenan 2019; M. Ryan 2017; Zunshine 2020; Phelan 2010). I can already see—both at Columbia and beyond—the forward contributions of a narrative medicine to health humanities in increasingly rigorous methods of assessing the consequences of humanities interventions in health care, tested pedagogic methods to deepen self-awareness and collaborative practice among clinicians, partnerships with community-based organizations in facing health disparities, and literary/visual scholarship exposing means of comprehending one another’s perspectives.
All these narrative concepts and practices further display why narrative has become both an increasingly complex and an increasingly necessary concept in health and health care. As a bonus, the concept of narrative has constructed bridges among otherwise seemingly unrelated endeavors, intimating that there may be some possibility of uniting our fractured human experiences. Together, perhaps, literary scholars, anthropologists, clinicians, philosophers, rhetoricians, historians, archeologists, painters, and players of Bach can overlay our varied concepts of narrative to emerge with a transcending mosaiclike understanding of human lived experience while, at the same time, the local uses of narrative concepts are practical tools for each field.
Roland Barthes wrote in 1966, “International, transhistorical, transcultural, narrative is there, like life” (1988, 95). Maybe he was right.