Storytelling in Medical Arenas: The Art of Self-Determination

Abstract

^Storytelling in Medical Arenas: The Art of Self-Determination Larry R. Churchill and Sandra VV. Churchill Hospitals are the settings for major life transitions: birth, death, and critical incidents in between. The stories that emerge are significant and revelatory, not only for the patients who tell them, but also for general understanding of the human condition. Ironically, these stories are not always heard. The reasons have to do not only with the large and impersonal nature of hospitals, or the customs and structures of medical practice that place physicians at a distance from the lives of their patients. Although these factors are significant, the stories told in hospitals and medical clinics are lost to us because of a more general devaluation of the act of narration, or storytelling, as a mode of selfknowledge . I. The Human Importance of Storytelling Human beings understand their experiences in and through the telling and hearing of stories. Narration is the forward movement of description of actions and events that makes possible the backward action of self-understanding. It is essentially a juncture, or seam, in the fabric of forward living in which interpretations are offered. As such, narration constitutes a threshold phenomenon, and the narrator occupies a liminal place from which the pre-liminary events of the past are given order and coherence and post-liminary possibilities are discovered. When stories are told about ourselves, about our lives, narration becomes a way of taking up again our own past and also pondering, ordering, or interpreting the meaning of what may come. Unlike the careful factual description of history, narrative asserts the human meaning of events, creating, often metaphorically, the categories for interpreting those Literature and Medicine 1 (Rev. ed., 1992) 74-81 © 1992 by The Johns Hopkins University Press Larry R. Churchill and Sandra W. Churchill 75 events. So, one may review past events through narration and say, "Oh, now I see," as if for the first time. Storytelling, whether it takes the form of history, autobiography, myth, folklore, or novel, is a mode of coming to know ourselves and others. Stories are devices that bind agents and events into some intelligible pattern. They weld actors to their actions and doers to their deeds. Both distance and intimacy characterize storytelling. To tell our own story is to recount events and actions from a reflective posture, as an observer, looking in from the outside. The temporal gap between one's actions and the telUng allows the narrator to assume a distance about his or her actions as narrated in the story, which creates a space for recognizing actions as "good" or "bad," "better" or "worse." This space provides the reflective ground for change. Storytelling is also marked by intimacy, especially when it takes the form of autobiography. This is true because of the personal stake we have in the actions we describe. The events and happenings are not merely actions or events in general, but actions and events that are "mine." The "I" that tells reviews intimately the story in which he or she is the hero. The dialectic of distance and intimacy is what makes storyteUing distinctive as a mode of self-knowledge. Distance without intimacy would be sheer factual reporting from the viewpoint of a disinterested observer. Intimacy without distance would be purely private. Intimacy alone forecloses on the possibility of reinterpretation and assessment of one's story by oneself and others. New connections within one's story would be impossible if stories remained within the province of one's own opinion, unacknowledged and unconfirmed in the broader social world. Storytelling is one way persons cross the threshold from individual interpretation of the actions and events of their lives to make contact with a larger range of common experience. We are moved to tell stories because we assume connections between our own story and the common experiential story (social, political, mythic) in which we—as both teller and hearer—know ourselves. Telling stories is not merely, or even primarily, an individual feat of selfrevelation . Because stories manifest trust in the possibility of making connections through the telling, they move persons to tell and retell to reestablish connections with the common experience of the...