Narrative Based Medicine

Narrative Based Medicine (NBM) is a medical approach based on a new paradigm, aiming at integration with Evidence-Based Medicine (EBM) (Zaharias, 2018). In this perspective, the normal importance attributed to signs and symptoms goes along with patient’s own narration of his/her pathology to the physician. This perspective derives from the psychological field and was brought to medical practice thanks to the work of Rachel Naomi Remen and Rita Charon, with the objective of humanizing and optimizing the doctor-patient relationship (Testoni, 2020). Thanks to its holistic approach and to the active involvement of patients, NBM is able to make clinical-care decisions more personalized, and therefore effective.

Rita Charon divides the operative intervention in Narrative Medicine into three phases, or moments, of the therapeutic action (Charon, 2005). The first moment is Attention, hence the fundamental premise for any attempt at cure (Charon, 2008). The attention is rendered with the metaphor borrowed by Henry James of the “empty amphora”: that is, it is necessary to make a void of oneself, of one’s ego, in order to welcome the patient’s narration within oneself. “I sit and pay attention to what they say and how they say it: the forms, the metaphors, the gaps and silences. Where will be the beginning? How will symptoms intercalate with life events?” (Charon, 2005, p.264). This first moment already puts into action the transformative power of the narrative.

Strongly connected to the state of attention is the process of Representation (Charon, 2005). Representation is the direct consequence of attention, the process that takes place from what has been observed, experienced and felt in a relationship. It is about “giving aesthetic strength to the experience” (2008, p.152) through a means of communication (through words, images …). This is the peculiar moment when the innovative tool of the “parallel chart” is introduced. The parallel chart, firstly implemented by Charon, it is a private space in which clinicians are able to express themselves in a more holistic way than the usual hyper-technical and specific medical reports. In parallel chart, physicians can go beyond the data they are meant to fill in, as to freely express their emotions and thoughts toward their patients (Charon, 2001)

Thanks to the narration guaranteed by the parallel chart, physicians’ ability to be more present to themselves, to their experiences, and therefore more present to the patient, is enhanced. The body and the emotions enter the relationship, increasing the involvement and therefore the professionalism and the competence of the clinician. Thus, according to Charon, “a new type of connection between health professionals and patients, but also between colleagues” is established (2008, p.164). This special kind of renewed connection is the third column on which narrative medicine rests, what Charon defines as Affiliation.

“Finally, attention and representation, we believe, can enable us to know in earthy, rich detail that we are affiliated as humans, all of us humble in the face of time, ready to suffer our portion, and brave enough to help one another on our shared journeys.”

Without attention to the other, and forcing the representation of our experiences in folders full of data, affiliation between people will never be possible. It can therefore be said that attention and representation are the ways that enable us to affiliate as humans, “all of us humble in the face of time, ready to suffer our portion, and brave enough to help one another on our shared journeys” (Charon, 2005, p.269).

References

Zaharias, G. (2018). What is narrative-based medicine? Narrative-based medicine 1. Canadian Family Physician, 64(3), 176-180.

Charon, R. (2005). Narrative medicine: Attention, representation, affiliation. Narrative, 13(3), 261-270. 10.1353/nar.2005.0017

Charon, R. (2008). Narrative medicine: Honoring the stories of illness. Oxford University Press.

Testoni, I. (2020). Psicologia palliativa: Intorno all’ultimo compito evolutivo. [Palliative Psychology: Around the last evolutionary task]. Torino: Bollati Boringhieri.