Thinking OT

Thoughts from Harrison Training and the occupational therapy world

What Is Narrative Medicine?

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As I was reviewing the Mayo Clinic’s various social media channels (see my earlier blog post here) I came across this blog post by former patient/client Jillayn Hey.

Click through on the picture to read the blog in full

That in turn led me to this interview of Lewis Mehl-Madrona and his thoughts on Narrative Medicine.

The article suggests that “Narrative Medicine…asserts the importance of an individual’s whole life story to the person’s health-not just the medical history, but a story that includes ancestors and friends, interests and spiritual orientation.”

Given that the subtitle to this blog is “Thoughts, observations and provocations from the occupational therapy world” I thought this would make for good debate.

To what extent do we agree the premise?

The narrative movement can be seen in many disciplines other than medicine.  Another example can be found in narrative mediation, for example, as a dispute resolution process.

Allow me to break out of the OT silo for a moment, and look over to see what they do there.

Within narrative mediation the conflict that disputants find themselves in is held up as being a story that they are involved in.  Referring to the dispute, or, here, the question of illness or wellbeing, as a story is not intended to diminish how real that situation is.

The “Story” label, however, allows mediators, or maybe practitioners, to deconstruct the story.

  • Who are the players in this story? 
  • Who else is effected by it?
  • What is the plot? 
  • Crucially, what is the outcome?
  • How are we using language to tell this story?
  • How else might we re-tell the story, perhaps to a different audience?

A powerful part of narrative mediation, and I can see no reason why it would not have an impact here, is to set up the problem – the dispute or illness – as an entity within the story.  that in turn enables us to ask questions such as

  • How did this thing called conflict lead you to feel or react?
  • When conflict was around, did you notice anything different?
  • How did the pain invite you to respond to others?

That line of questioning can be developed further

  • What was your relationship like before conflict arrived on the scene?
  • How did you imagine your career progressing before the illness?
  • Can you think of a time when the illness didn’t have stop you from doing something?

and further still by asking

  • Am I right in thinking that you would rather this conflict was not ongoing, that you would like to see an end to it?
  • If so, what other ways might you react when conflict appears? What might you do differently?

and so on.

As the dialogue is developed, conflict, or illness, is first recognised as having an impact on our lives and behaviour.  We then go further and look at how we can explicitly recognise the grasp that it has upon us and how we can start to loosen its grip. 

In the words of Winslade and Monk, authors of Narrative Mediation, we then allow room for alternative, newly created and more helpful narratives, or stories to be constructed by ourselves and retold to others. 

In the words of Jillayn Hey herself “Through telling our personal stories of illness and disease, we assist in creating a new story of wellness that facilitates healing and in turn directs a person towards recovery.”  Note how Jillayn explicitly speaks of her new wellness.  In doing so she brings her new symptoms of being well to the foreground.  If she had not done so, then the grasp, or the narrative, that her former condition had on her own expectations of what it is to live day to day might have continued and therefore limited her activities and perceptions.

What are your thoughts?

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