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Since the start 2012 the Centre For Culture and Health has created new areas of contact through various activities and events – both within the university and vis-á-vis the general public.
At the end of 2016 the centre co-hosted a work-shop on narrative medicine at Kungälv Hospital. Below we re-publish an article on the work-shop from GU Journalen.

Physician as fellow human and artist

Health is silent. But diseases carry a story.
– By being observant and curious in the best sense, health care staff can discover the patient's story. Doing this is literally an art form, Rita Charon explained during a workshop at Kungälv Hospital at the end of November.
She is the initiator of the program Narrative Medicine at the University of Columbia in New York City.

Among the participants in the workshop on 25–26 November were Ola Sigurdson, professor of systematic theology as well as director of the Centre for Culture and Health at the University of Gothenburg. He explained what narrative medicine is by using himself as an example.

– At the moment I probably have an unusually high pulse. But what does this say about me? Not very much; it is only when the pulse is put in its context, namely that I as a humanist feel rather nervous about lecturing before a group of health care professionals, that it becomes comprehensible.

Ola Sigurdson

Narrative medicine is however no alternative to evidence-based medicine. Instead it is about ethics in a wider sense and about recognising the human being as something much more than a biological system, Ola Sigurdson explained.

– According to Aristotle, a story consists of a beginning, a middle and an ending. But also of a peripety, a turning point. And disease may mean precisely such a change that causes everything to be different.

One way of practising one's emphatic fantasy is to read literature.

– Good stories train our ability to reason around what might have been, practice emotions such as fear, sorrow, compassion and love. The medical diagnosis is intimately connected to a story that creates context. But there is always more to bring forth.

Founder of a research field

The keynote speaker at the workshop was Rita Charon, professor of clinical medicine but also doctor of English with a literary orientation.

– Nobody can be anything but grateful for the enormous progress that medical science has made over the past one hundred years. But it has also meant objectification of the patient that actually leads to worse care. This was something I observed during my early days as a physician when I was working in one of New York City's more vulnerable areas. My patients were to quickly account for their chest or stomach pains, then I would make a diagnosis. At the same time, I kept bumping into other health care staff, such as nurses or occupational therapists, who provided completely different stories, such as a patient having lost their job or having trouble paying the rent. And I discovered that I quite simply wasn't well-educated enough to manage this. So I decided to learn more about stories and started studying English literature. I found that literary analysis could also be used within health care.

Rita Charon

In the year 2000, she started the programme for narrative medicine at Columbia University. It entails health care professionals studying literary theory, philosophy, comparative religion and meeting various sorts of artists.

– What is exciting is that everyone is so enthusiastic. The health care staff realise that they can use so much more of their knowledge when they discover the proximity of the profession to art and philosophy. And for example the artists we work with become inspired by the medical images of among other how the brain works.

Focus on the patient's story

Rita Charon's thoughts have been disseminated to various parts of the world, among other to Kungälv Hospital, which since 2010 works with the project Andra ronden (The Second Round).

– It is the most successful example I have encountered of how narrative medicine can function. Patients often meet several kinds of health care professionals, such as physicians, nurses and maybe a psychologist or a counselor. Every time the patient must repeat their story anew. In Kungälv they do the opposite. Here they have created a special room where all staff that are to take care of a patient are gathered to listen when she or he describes the circumstances around their illness. This not only leads to better health care for the patient, but also facilitates the cooperation between staff members.

Listening to a patient is an art, says Rita Charon, which can be compared to making music, painting or writing a poem.

– It is about letting yourself be absorbed by the patient's story in the same way that you can be consumed by a Mark Rothko painting or a string quartet by Sjostakovitj. In order to be able to do this, you must be both attentive, curious and respectful.

Those who listen thereby become part of the story, Rita Charon points out.

– What is paradoxical about being a health care professional is of course that while you are being surrounded by pain and death, you still experience yourself as immune to bodily suffering. It is of course a way of protecting yourself and being able to preserve your professional role. But emotions are not as dangerous as many believe, the physician or the nurse is allowed to be moved. The patient may become a witness to the human being's conditions here on Earth, which may be important to take stock of. For even though it may be hard to become engaged, it is also extremely enriching.

Broadened perspectives

For one aspect of working with narrative medicine is also that staff shall experience their work as more meaningful, Rita Charon points out.

– I teach my students, aside from the ordinary journal, to also write a more personal journal of their individual experiences. When the staff express in words that which they have experienced, they discover that they know surprisingly much. In this way, writing becomes liberating.
Many physicians and nurses would probably say that they would love to listen more to their patients, but that they quite simply do not have the time.

– And this is the way it is, Rita Charon admits. In the United States a patient has 18 seconds on average to give an account of their illness. So in the short-term perspective, it is of course time-consuming to listen concentratedely to a patient. But in the long run, the health care system benefits from acquiring the whole picture at once, since one can provide so much better care and avoid misconceptions and hasty conclusions.

At the moment Rita Charon is working on putting together an online course in narrative medicine. But she would really like to create a much broader course on the significance of storytelling within all public sector activity, for example school, social services and not least within politics.

– Many ask themselves how the Americans could elect a person such as Donald Trump to be president. But similar movements, against that which is seen as the establishment, has of course also started to sprout in Europe. In the United States there are people who lost everything during the financial crisis of 2008 and who then are only viewed as stupid losers. Naturally they are angry and disappointed. Maybe we have to start listening to them as well, intensely and with curiosity.

Footnote: Andra ronden (The Second Round) is a project at Kungälv Hospital that started in 2010. One of the initiators is the chief physician Valdemar Erling, who also participated in the workshop. The project means that the hospital has created a particular room where staff and patient meet to talk about the treatment. All involved in the care process meet, get the same information and thereby become participative in the patient's story. Valdemar Erling is also chairperson of the newly-launched Swedish Society for Narrative Medicine. Vice-chairperson is Lars Midböe, the Swedish Association of Local Authorities and Regions. More information at: narrativmedicin.se.

[The article was published in GU Journalen number 6 2016. Text: Eva Lundgren, foto: Johan Wingborg]

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