This chapter discusses how narrative medicine, which emphasizes the uniqueness of each patient's voice, complements scientific knowledge to transform healthcare. Using theater as a prism, the study reflects on the specificity of narrative as an in vivo relationship in a clinical situation. Observations at the Portuguese Oncology Institute Lisbon reveal clinical dialog as an intersubjective lived experience that highlights interiorization processes through which individuals experience the other in their alterity. At a time when virtual health training and practice are prevalent, the study emphasizes the need to rescue the foundational inter-human relationship of the clinic in terms of dialog, attentive listening, corporality, and socio-relational dynamics. We examine the theatrical model's potential to perceive different bodily narratives in communicating experiences, fears, ideas, and intentions. Finally, the pioneer “Theatre and Representation” unit at a School of Medicine is presented as a case of this approach in action.
“To help the doctor reach the patient, and to help the patient reach the doctor, the hospital ought to be less like a laboratory and more like a theatre.” – Anatole Broyard, Intoxicated by my Illness and Other Writings on Life and Death (1992).
TopContext And Concepts
The role that literature plays today in training within the health field is unquestionable, and especially in narrative medicine. It is an approach based on the transforming/training (and restorative) value of a story – the one that is expressed and the one that is embraced; what is read and what is recreated. Rita Charon, physician, and professor at Columbia University (New York) is the main mentor of this emerging disciplinary area and a prominent figure whose book, Narrative Medicine: Honoring the Stories of Illness (Charon, 2006), has already become a classic. This work sees Charon return to a definition, now complete and fully substantiated, which had first been given in 2001: “Narrative Medicine [is] medicine practiced with the narrative competency to recognize, interpret, and be moved to action by the predicament of others” (Charon, 2001, p. 83).
In her academic and professional career, Charon has combined training both as a doctor and a professor in the field of medicine, as well as training in the humanities and, more specifically, literature1. She has transposed the same interweaving between scientific and epidemiological knowledge and narrative knowledge to health training and the doctor-patient relationship which, as already understood, is the mainstay of the narrative medicine model:
As a living thing, narrative has many dimensions and powers. The novelist values its creative force; the historian relies on its ordering impulses; the autobiographer redeems its link to identity. . . . What is clear is that narrative does things for us, perhaps things that cannot be done otherwise. Narrative structures, such as novels, newspaper articles, and letters to friends enable us to recount events, to depict characters, to suggest causes for events, to represent the passage of time, to use metaphor to convey meanings otherwise elusive. As an instrument for self-knowledge and communion, narrative is irreplaceable (Charon, 2006, pp. 39-40).
Behind this narrative model, which has progressively spread not only in North America, but also in various European medical schools, there are individual characteristics that make it possible to comprehend the uniqueness of the disease situation:
Unlike scientific knowledge or epidemiological knowledge, which try to discover things about the natural world that are universally true or at least appear true to any observer, narrative knowledge enables one individual to understand particular events befalling another individual; not as an instance of something that is universally true, but as a singular and meaningful situation. (Charon, 2006, p. 9)
Heir to the New Criticism tradition (the dominant current of Anglo-Saxon literary criticism between the 1920s and 1960s), as regards didactic-pedagogical terms, Charon appropriated the “close reading” method and transferred it to the clinical field, expanding it to what she called “attentive listening” – an availability and attention that facilitates the understanding of the patient's case history. The American doctor and professor blends medical and literary knowledge that contributes to developing the “work of the imagination”, crucial in clinical decision-making (Charon, 2017, p. 127). Charon insists on repeating and emphasizing the importance of literary training, comparable to any other type of technical training: