The roses blossomed in ways she had never seen before. They opened in a manner that exposed their inner complexity, the bees furrowing in their pollen and the wind disturbing their exchange; yet, the rose’s simplicity was still astounding. To Alice, “it was a far too gorgeous a day for tragedy.” (2000, para. 1)  Yet, the bleak tinge of the doctor’s words still rung through her ears. Despite its beauty, this sunny day in July was the day that Alice Hoffman was told the lump in her breast wasn’t benign, when good fortune was no longer in her vocabulary, and “I’m sorry” fervently replaced it.  However, soon her illness found a way to replace the beauty of a passing rose; it became beauty itself.

∙∙∙

There is nothing quite like a story. With the capacity to incite feeling that goes beyond the tactile and the tangible, the act of storytelling reaches into your bones and makes them tremble. The beauty of storytelling rests in its ability not only to uncover knowledge from the past, but also the progression of consciousness. Stories not only evolve in content, but in how they are shared, whispers and screams alike. Stories allow us to peer into another’s conscience, often with personal fervor. Understanding is therefore at the heart of storytelling. The perspective of the teller breeds self-awareness, yet their devotion reflects the desire to delve into the mind of another. Stories are rooted in empathy; it is here that healthcare finds its swerving path into the world of words.

For Alice Hoffman, the outer shell of her suffering self soon began to wither away as the duration of her illness progressed. This existential shedding, however, was not eliminatory but instead, enlightening. Her breast cancer and ensuing depression permitted her most passionate self to manifest, “as if the once excess was stripped away [and] only the truest core of [herself] remained.” (2000 para. 6) Hoffman questioned: “who was I at the bottom of my soul, beneath blood, skin and bones?” (2000 para. 7) She yearned for a self that she could once again call her own. Miraculously, Alice emerged as a writer. She transformed the dismal facts of her life into a beautiful story in her fiction; the possibility of her gorgeous, rose-filled day was revived. The bump in Alice’s physiology would not present an obstacle in the road that lay before her, instead it became the catalyst to transform her life into a fictional madhouse.

At times Alice was too sick to stand, but that did not stop her language wheels from turning. She “moved a futon in my office and went from desk to bed, back and forth until the line between dreaming and writing was nothing more than a translucent thread.” (2000, para. 8) The fervor of language soon became the means to heal for Hoffman, her writing taking the role as the therapeutic agent, giving significance to her weakened physical state. She found herself in a world where wounding was cherished rather than feared. The beauty of illness became wrapped in words, for they sustained that which had been divested of hope.

In Judith Harris’s Signifying Pain, Alice’s story is unpacked so that it highlights the notio
n of storytelling as it pertains to health. Harris suggests that writing moves the individual beyond the limits of the suffering body, unlocking a novel and beautiful realm that lay within the confines of health. Stories emerge as antibodies against illness as their words absorb a certain level of pain. As a result, stories and poems bear more hardships than their authors. They enable pain to be suppressed and celebrated at the same moment. Their beauty lies in the ability to comfortably evoke pain.

Health, both its sustenance and its study, depend on a story. Despite attempts to bring storytelling and a piece of the liberal arts into the medical profession, its presence is still lacking. Often times, the role modeling of senior, and cut-and-dried, physicians are proven to have greater influence on the student than lecture might. It is therefore within the starkly bleak walls of the operating room that scientific knowledge is favored at the expense of the affective nature of illness. Patient centered care soon becomes disease centered care and the soul of the patient—what makes him tick—is lost.

While this concept is often lost in the treatment of physical illnesses, within the realm of mental health, the story takes more of a central role in treatment. Frequently, however, this “other side” to mental health creates an imbalanced perception of what mental health truly entails. The general population gets lost distinguishing the social or environmental factors that influence mental health and its biological foundation. Michael White and David Epston in Narrative Means to Therapeutic Ends, suggest that in a purely scientific perspective, “the particulars of experience are eliminated in favor of reified constructs, classes of events, systems of classification and diagnoses.” (1990, 80)  They go on to depict a narrative mode in contrast to the scientific, however, in its core, the narrative mode inherently fits within the context of mental health, potentially more so than physical health. The “narrative mode of thought privileges the particulars of a lived experience”, making the patient’s story the epicenter of care. (1990, 80)As a result, “links between aspects of lived experience [become] the generators of meaning” and culminate in an overall synthesis of a patient’s story. (1990, 80)

Despite the fortifying meaning, which emerges from this narrative mode of treatment, there still exists an unforeseen emphasis on the scientific. In Shefali Luthra’s article from NPR, Doctors Often Fail to Treat Depression Like a Chronic Illness, there is an explicit divide noted between the treatment of chronic physical illness and mental illness. While both of them are forms of a chronic and enduring condition, one is more explicit in its scientific treatment. The article suggests, however, that mental health should be treated in accordance with any other physical illness where the symptoms are noted, a treatment is suggested, and follow ups are set in place to ensure the patient is improving.  Dr. Harold Pincus, vice chair of psychiatry at Columbia University’s College of Physicians and Surgeons, suggests that “the approach to depression should be like that of other chronic illnesses” – namely physical illnesses such as heart disease or high blood pressure. (2016, para. 3)  The article is quick to believe that “if we actually treat depression as a chronic illness and use the level of tools we’re using for diabetes, then we’ll be able to better treat patients — and help them live healthier lives and more productive lives.” (Luthra, 2016, para. 12)  In their analysis as to why the divide in treatment exists, no real factor is pinpointed except for “time pressures” which hinder the ability of doctors to sufficiently diagnose patients with depression. What if, however, we look at another option, one that places the improper care in the hands of physical illness instead of mental illness?

Katrina Brown in Narrative Therapy: Making Meaning, Making Lives, suggests that we make sense of our lives through stories. In her book, she cites physiatrist Michael White who argues that one’s story should be told, retold and rewritten. This narrative approach to the exploration of one’s health draws similarities between the “physical treatment” outlined in the NPR article, however the dynamic component of the equation is not a clear cut symptom, but rather a conglomerate and expressive story. Here, medicine enters the world of the particular, for no two stories can ever be the same.

While potentially revolutionary in this idea and how it pertains to medicine, the act of storytelling is something that has survived for millions of years. Human beings inherently want to be a part of a shared history, fueling the preservation of oral tradition over time. Storytelling affords the opportunity to partake in something bigger than the individual, enabling the jump into discerning what it means to be human. Mental health is a direct articulation of one’s experience in the world and how individuals make sense of it all. One’s story affords us with the ability to delve into the consciousness of another and make sense of the way another human being thinks, acts, and breathes. Empathy is to inhabit, to make a home in another; the power of a story to bring about change comes not from the story itself but from the reactions that it creates in the minds of the listeners. In the darkest of times, life can be stripped of one’s soul. Tellers and listeners revive. Words become a catalyst to recovery and as a result, the person is placed at the center of care, not the symptoms.

It is possible that stories hold such fervor and compassion in therapy because they are told in the same way your childhood nurseries were whispered as you fell to sleep. Mother is sitting in the chaise lounge tucked in the corner of your yellow, childhood bedroom, rocking and reading. Now, the psychologist sits in the plush chair across from yours, adjacent to a table adorned with a clock, a box of tissues and a tall glass of water. In this setting, the willingness of the patient to be exposed and vulnerable directly allows for a personal narrative to unfold. You get to tell your own story this time; you become the protagonist, but also the narrator, articulating the story of your soul. This conversation with yourself, yet also with the guidance of a medical professional, therefore inherently embodies the very idea that there must be a confluence of conversation and medical jargon. Certainly a patient has symptoms, the content of the story per se, but a diagnosis rests in the way the story is told, the perspective. Mental health therefore becomes a branch of storytelling itself, one with a setting, a plot, and most importantly a particular point of view. The ways in which patients divulge themselves reveal their potential illnesses, and over time, their progress. I argue that this should be the way in which we conduct all health assessments, mental and physical alike. Doesn’t everyone deserve to share his or her own story?


REFERENCES

  1. Brown, C., & Augusta-Scott, T. (2007). Narrative therapy: Making meaning, making lives. Thousand Oaks, CA: Sage.
  2. Coles, R. (1989). The call of stories: Teaching and the moral imagination. Boston, MA: Houghton.
  3. Harris, J. (2003). Signifying pain: Constructing healing the self through writing. Albany, NY: State U of New York.
  4. Hoffman, A. (2000, August 13). Sustained by fiction while facing life’s facts. New York Times, Books. Retrieved from http://www.nytimes.com/2000/08/14/books/writers-on-writing-sustained-by-fiction-while-facing-life-s-facts.html?_r=0
  5. Luthra, S. (2016, March 7). Doctors often fail to treat depression like a chronic illness. Retrieved October 3, 2016, from NPR website: http://www.npr.org/sections/health-shots/2016/03/07/469504900/doctors-often-fail-to-treat-depression-like-a-chronic-illness
  6. White, M., & Coles, R. (1990). Narrative means to therapeutic ends. New York, NY: Norton.

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