The year is 1973, the setting Stanford University School of Medicine. “Life is a relentless progression toward death, disease, and decay,” asserts a professor. “The physician’s job is to slow the rate of decline.” A student takes issue.
Perceiving a need for a parallel path to biomedicine, the young man finds a Cherokee healer with whom to study. He continues learning from indigenous elders as he makes his way through Stanford, the Psychological Studies Institute in Palo Alto, and Massey University in New Zealand. Today, Lewis Mehl-Madrona is a champion of narrative medicine, which 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.
As a doctor, Mehl-Madrona helps patients discover their own stories of illness and create ones of healing that pull them forward toward recovery. These stories help create hope and a path to wellness—features often lacking in the “story” that patients get from mainstream medicine based on statistics and life expectancy tables.
Mehl-Madrona’s efforts to bring narrative medicine into mainstream practice seem to be making headway. This fall, Columbia University’s College of Physicians and Surgeons began offering a master’s degree in narrative medicine. Mehl-Madrona is currently an associate professor of psychology at Argosy University in Hawaii.
What do you mean by “narrative medicine”?
Narrative medicine is the encompassing of our awareness of health and disease into a storied structure. We embed the illness into the life story of the person in such a way that we discover meaning and purpose in both the illness and the experience of recovery.
It’s hard, sometimes, to give a simple definition, but in a diagnostic sense, the label of “sickness” becomes secondary to the life of the person who has a particular sickness. In order for a person to get well, there has to be a story, one that everyone believes, that leads the individual back to health.
Beliefs about illness have actually been shown to make a difference in patients’ outcomes.
Clearly, the character of the person who has a disease is important. That seems like such a no-brainer. But it can be a huge leap for my colleagues to realize that the person is as important to the outcome as the histology of a biopsy in the laboratory, maybe more important.
A study done in London suggests that acupuncture works better for Chinese people born in China than it does for Chinese people born in London. People who grew up with the practice respond to it and rely on it the most. They believe in the treatment.
The placebo effect should be called the faith response; you heal because you believe. As Jesus said, with faith, you can move mountains. To say that in a scientific way: Whatever you do to get well, it has to fit into the story you have about how people get sick and get well.
Given that many of us have grown up with a Western medical belief system, how do we open to believing that a different way of healing will work?
First I would work with people to be really clear about what their story is—what sickness means to them. Once we’re aware of their story, then probably I would use guided imagery or hypnosis to begin to explore how we might plant the seeds of other plausible stories.
I don’t know if the person would change, but that’s how I would begin the exploration. I might also have a meeting of everyone that person knows, to explore the range of possible stories in the community. You can’t change your story too far from what people around you believe.
What do you do if family and friends are not into alternative ways of healing?
I would have a talking circle with everyone, exploring what we can negotiate as possible and acceptable, in hopes that there is middle ground. If nobody will buy into the story of an alternate healing method, it’s going to be difficult. Sometimes people go to an alternative practitioner in order to say to some loved one, “See, I went.” But, of course, going in with that attitude, it won’t work.
I don’t imagine a mainstream doctor is going to adopt a story approach any time soon.
Western medicine has been involved in constructing stories, too, from the beginning of time. We have theories, which are stories about how people get sick and get well. We’re arrogant enough to believe that today’s story is the truth. But in Western science the story changes every few years.
For me the first shift needed is to respect the story of the people who are sick. People who survive against all odds—according to Western medicine—show that the doctor’s story sometimes is not right, and the patient’s story sometimes is.
You say that the process of telling one’s story is, in itself, a rich and valuable process.
At the end of life we all like to feel like we had meaning and purpose. It’s easier to die then. Much of what goes on around people who are dying is the preparation of story, to allow everyone to agree that the person’s life had meaning—with the funeral being the culmination. It’s so much more valuable to do that when people are alive.
Sometimes when people come for the magical cure, which I can’t give them, I end up doing this other work, which is incredibly valuable and important. The beauty of the narrative approach is in people getting to tell their story, to speak their life and make sense of it.
Lorrie Klosterman is the health and wellness editor of Chronogram, a monthly magazine that nourishes and supports the creative, cultural, and economic life of New York’s Hudson Valley. This interview is excerpted from the May 2009 issue. www.chronogram.com