“The art of medicine consists in amusing the patient while nature cures the disease” Voltaire (1694 – 1778)
Narrative medicine is not something you’ll easily find on the ‘net and if you do, information is sparse. But would it surprise you to know that the techniques employed by both Western allopathic medicine and African traditional healers (such as sangoma and inyanga) make extensive use of narrative techniques? And that most practitioners are unaware that much of their work is based in storytelling?
Narrative medicine refers to an eclectic combination of art and science used to heal the mind/body complex using storytelling. No practitioner does it quite the same way and because narrative medicine skills are not formally taught, they are learned intuitively and through emulation to the extent that many healing practitioners use narrative medicine without realizing it. Narrative medicine engages skills related to listening to stories, transforming the stories and re-telling stories the narrative medicine patterns identified are similar in African traditional healers in the South Sotho and Zulu traditions as well as among Western-trained doctors.
It’s also important to deconstruct the term narrative, particularly in the sense of “personal narrative”. Personal narrative refers to the stories, visions and ideas that we create continuously about ourselves and the world around us. The narratives are normally about relationships, situations that have happened and may happen in the future. The personal narrative has two distinct components; the stories we tell to ourselves in our own minds (sometimes referred to as “thinking”) and the stories we tell to others, which is described as talking, conversation or storytelling. The public and private nature of our personal narratives form a duality and may be highly compartmentalized and distinct from each other; in other words, we may not always say out loud the things we think.
To better understand the narrative medicine process, let’s look at a typical interaction between 2 characters playing the roles of ‘Patient’ and ‘Healer/Dr’ in both the western allopathic and an African traditional paradigm.
Here is a typical scenario: Tim wakes up one morning. He’s feeling grim, nauseous and sweaty. He’s never felt this way before and he starts imagining the worst of scenarios. “What could it be?” he wonders.” Last night’s curry? That new Avian ‘Flu he read about on the ‘net? Maybe malaria, the symptoms are similar to a documentary he saw on TV. Or perhaps a cancer of some kind? The rusty nail he stepped on a month ago in the garden – was it Tetanus? Why didn’t he get a jab just after it happened?” All are exciting, fear engendering, ego obliterating story lines that heighten Tim’s anxiety levels. Tim’s own storytelling, not having a name for what he feels, is making him feel sicker.
With groaning, stiff joints, he goes to see both Dr. Brian (MD University of Cape Town) and TDr. Zekhile (Traditional Doctor trained in the Southern Sotho tradition). Tim is normally cautious and wants a second opinion. First he sees Dr Brian:
SCENE 1 – Dr. Brian’s reception: Tim checks in with the receptionist and sits down after filling in a form. He waits a while then is called into Dr. Brian’s surgery. Tim enters and smells rubbing alcohol and ether, triggering memories of visiting hospitals doctors as a child. He sees medical certificates framed on the wall. A calendar from a pharmaceutical company sits on Dr. Brian’s desk and posters on the walls advertising various drugs with pictures of happy, smiling and healthy people. Dr. Brian has a computer on which he is typing. “Probably my case file”, thinks Tim as he sits down in front of the Dr. who makes a little small talk.
“So how are you today?” asks Dr. Brian, leaning back with a confident grin.
“I’m awful – woke up with nausea and sweating and headache – I’ve never felt like this before.”
“Whereabouts does it hurt?” asks Dr. Brian with eyebrows slightly furrowed displaying concern.
“My head hurts, my stomach aches and I also feel dizzy when I stand up,” says Tim.
“Did you eat anything unusual over the past few days? Anyone around you sick?” asks Dr. Brian.
“Nothing I can think about.”
Dr. Brian examines Tim’s throat, tongue and ears with his special scope while making umming sounds.
“Please cough” he asks and listens to Tim’s chest with a stethoscope and then goes over to his desk and takes out his prescription pad.
“There’s a virus going around and it looks like you’ve got it,” says Dr. Brian, picking up his pen. “I’m going to give you a prescription to take to the pharmacy and then you should go back to bed and rest. Remember to take plenty of fluids. Today you may still feel grim but in 3 days max you’ll feel better again.”
Dr. Brian scribbles on his pad and hands Tim his prescription, stands up and escorts him back to the reception.
“There’s nothing to worry about, but if you’re still not well by Thursday, give me a call and I’ll take another look” says Dr. Brian with a reassuring smile.
Tim visits the pharmacy to fill out the prescription. He gets a packet with two bottles of medicine; one containing a red liquid and another containing pills. Each medicine comes with a large multi-folded package insert with tiny printing. Time tries to read the package inserts but soon gives up because he can’t understand most of the big words used. On the way home, Tim visits the offices of TDr. Zekhile.
“You are unwell and it is good that you have come to see me today” says TDr. Zwekhile. “Where are you feeling the pain?” she asks
“I’m awful – woke up with nausea and sweating and headache – I’ve never felt like this before. “My head hurts, my stomach aches and I also feel dizzy when I stand up,” says Tim.
TDr. Zwekhele sits humming softly for few minutes, rocking backwards and forward. “The ancestors are displeased and have made you sick,” says TDr. Zwekhile. “When you go home, you must do the following things to please the ancestors – you must not eat for the rest of the day and you must burn Mpepo in your bedroom before you go to sleep and make a tea from the Mpepo that you must drink a whole pot of. The ancestors say that tonight you will be healed but you must remember your dreams and remember your ancestors, then you will get better.”
Healing Language Patterns
In both cases of interaction between Dr. and Patient and TDr. and patient, similar pattern emerges. The healer, regardless of which of the two traditions they come from, listens to the patient’s story. The patient’s responses, gait, gestures, words, tone of voice plus myriad other variables may be assessed – it is different for every healer. In some cases, traditional healers may show the patient ‘their power’ by telling the patient why they have come to see them. In either case, a story is shared by the patient and at a certain point in the proceedings, the health professional will interrupt the patients’ narrative flow replacing it with the healer’s own version of the story and its course going forward.
What happens in the process is that the patient’s narrative flow is interrupted and given a different ending by Healer. The original narrative wasn’t useful and engendered a sense of fear and Illness “I don’t know what’s wrong with me”. The new narrative provides a name, a label and a reason for the dis-ease. The patient, in both cases, is also provided with a ritual to perform – take these pills or drink this tea three times a day. And the end of the story inspires hope – “In 3 days’ time, you’ll be better.”
Researchers are continuously uncovering links between on-going anxiety and manifestations of disease symptoms. Anxiety is associated with stress hormones, increased inflammation and a compromised immune system. We know that the nervous system, the endocrine system and the immune systems in the body communicate with each other via polypeptides (chemical messengers) where a change in one system informs change in the other systems and so on. So Eunoia (a very rarely-used English language word for “beautiful thinking”) stimulates a decrease in anxiety, inflammation, and pain and activates the immune system. Good storytelling keeps us well, bad narrative that stimulates anxiety and fear, can kill us.
Characteristics Of Successful Healers
So what are the characteristics of successful healers? The following attributes are vital tools of all healing practitioners. The key attributes are Power, Authority, Vision, Performance Skills and Charisma.
- Power – The healer needs to be experienced as powerful by the patient. This is conveyed through visual cues (medical degrees, animal skins, stethoscopes, white coats etc.), smells, sounds, gestures, use of voice, technical jargon and stories. It also includes the power to tell a convincing story, one that will be believed by the patient because it is more empowering than the story constructed by the patient.
- Authority – In this context, Authority refers to the ability to Author the story. The healer temporarily enters into the patient’s power to author/create story. The distressing story is transformed into a hopeful, liberating story, it is told in an empowering way and given back to the patient along with a ritual to perform, “You’ll be better soon. Here, take these pills 3 times a day, drink this tea, suck that root etc.”
- Performance Skills – going to see a healer of any kind is a form of ritual for both patient and healer. So whatever healing modality you’re participating in as a patient, you will see symbols, hear unfamiliar words, experience odors and sensations that are all characteristic of a ritual space. So the healer has to “hold the space” using storytelling and ritual performance designed to lead to the moment where the old story is replaced with the new story and the ritual ended.
- Vision – The healer needs to see and experience the patient as someone who has the potential for getting better and who is getting better. Stories like “This is the first time I’ve ever seen anything like this!” won’t inspire confidence.
- Charisma – From the Greek word meaning literally ‘given by god’ – Charisma is a rather ineffable quality exuded by the healer. It creates the impression that the healer is somehow connected to a ‘higher authority’ such as the “medical establishment” or “the ancestors” for whom the healer is a conduit / high priest.
Functions Of Healing Stories
Healing stories serve to provide clarity and reduce patient anxiety. They also provide meaning, a reason for the illness, a vision of the future and rituals to perform. Healing stories give a new way of thinking about the dis-order. The problem is named, it has a label.
Characteristics Of Healing Stories
So what are some key characteristics of healing stories? We suggest that they include the following elements:
- Healing Stories are Patient centered – healing stories are focused on and are about the patient, their experience, feelings and symptoms. Research has shown that simply listening to someone can help them feel better. It’s unfortunate that in this age many people need to pay a professional to hear them out.
- Healing Stories provide an ending to a Dilemma Tale – effectively the patient is providing the healer with a dilemma tale – in African traditions, the dilemma tale is a story without an ending. In this case, the ending is a story created by the healer and answers the question “What’s going to happen to me?”
- Healing Stories Provide Meaning and Reason – healing stories may communicate meaning to the patient answering the question “why am I sick?”
- Healing stories provide a label – Applying a “label” to a disease, especially a chronic disorder has been known to have a profound impact on a patient and perhaps even alter the course of a disease. The label provides a shorthand way of referring to the condition and answers the question “What do I have?”
- Healing Stories provide context and a hopeful future – This part of the story is about telling the patient what can be expected to happen next, how they will feel, what they will experience etc. Many of these language patterns such as “You’ll wake up tomorrow and feel right as rain” are well known and decode-able using techniques from NLP and Ericksonian hypnosis. The patient feels better because there is a story that makes sense of his experience answering the question “When will I get better and what can I expect?”
- Healing Stories engage the patient in ritual performance – It is said that ritual suspends the rational mind. The purpose of ritual is to engage the patient in activity such as taking medication at a particular hour, praying etc. These rituals reinforce the new story through physical, whole body engagement – what learning practitioners may refer to as a blended learning experience. Each time the ritual is performed, it reminds the patient that he has a role in the process and is responsible for get better.
- Healing Stories are told in a ritual space – the space in which the consultation occurs (whether a surgery, studio or a sangomas’ grass hut) is designed for ritual and is embedded with information that is communicated to the patient. The setting removes patient away from day-to-day reality and makes them available to accept a new story that guides future experience.
- Healing Stories inspire a sense of confidence and hope – the patient leaves with a new story to explain their experience. The story provides a framework within which symptoms can be interpreted and engaged. The problem has been contained and you’re getting better. As a Nigerian proverb says “Hope is the pillar of the world” and an Old Hungarian proverb maintains “Hope dies last”
- Healing Stories are supported with media and memory devices – memory devices are objects that serve as reminders of the healing journey. They are multi-media containers including bottles of pills, package inserts, décor, posters, prescription pads, smells, sounds, shapes and colors.
You don't get better 'till you have a new storyThe stories provided a frame of mind that reduced anxiety. Tim’s sickness wouldn’t kill him after all – Dr. Brian and TDr. Zwekhile were both confident and didn’t look worried about him in the least. Tim started to think about things other than his symptoms and then, on the third day as was foretold, Tim suddenly realized that he’d forgotten that he was sick. Which meant that he was well.
First Published in https://storytelling.co.za/healing-change-storytelling/