What exactly is narrative medicine, and how is it different from the work of humanities scholars who investigate medical topics? With this problem in mind, I set out to explore the roots of narrative medicine–not in academic medical schools, but in North American indigenous practices of healing through ritual storytelling.
In our moment, narrative medicine has become a bona fide subspeciality of the medical arts. Practitioners describe it as “an interdisciplinary field that aims to enhance healthcare through effective communication between caregivers, doctors, nurses, family members, and patients”; in Rita Charon’s terms, narrative medicine is “practiced with these skills of recognizing, absorbing, interpreting, and being moved by the stories of illness” (4). This formalized, academic version of narrative medicine asks the practitioner to attend with sensitivity to the stories of the patient; the patient, in turn, uses rhetorical devices and tools to express the truths of their body. The doctor’s attunement to the nuances of patient storytelling is a radical update to what might otherwise be a dispassionate, instrumental doctor-patient discourse. Meanwhile, using rhetorical techniques in communicating pain is rife with danger for patients (as Susan Sontag famously describes in Illness as Metaphor). In this piece, however, I’d like to consider another strand of narrative medicine–North American indigenous “medicine stories,” which offer a rich tradition of therapeutic narrative-making that is very different from Western conventions of both doctor-patient relations, and rhetorical and narrative norms.
What makes storytelling medicinal? In Ceremony (1977), one of the most widely taught Native American novels, Leslie Marmon Silko, a Laguna writer, describes stories as “all we have, you see, all we have to fight off illness and death. You don’t have anything if you don’t have the stories” (Silko 2). As the book’s title suggests, storytelling in its healing capacity in inextricably linked with ritual, a poetic component of a multigeneric ceremony designed to bring about bodily change through the power of language. The Laguna/Sioux writer Paula Gunn Allen describes such “medicine stories” as “ceremonial narratives that produce ‘mythic’ (metaphysical) states of consciousness and/or conditions” (qtd. in Harris 101). Betty Booth Donohue, a Cherokee writer, confirms this continuity between bodily and spiritual states: in the ritual practices of many native traditions, medicine “is sometimes a healing potion,” but its true significance lies well beyond the material realm, since “psychologically it can be curative for any human problem that is out of balance with the universe.” For all these writers, language itself is the origin of power in ritual healing practices: “Native words have creative energy,” and “medicine is literary power” (Donohue).
In North American indigenous narrative medicine, textual poetics are deeply tied to the practice of medical ritual, and both depend on the essential idea that “all living things are interconnected and that the mind, body, and spirit of humans are not to be treated separately” (Schwing, abstract). This notion of continuity among individuals, community, and environment is sometimes symbolized across different Native traditions through circular motifs, including the “web of life,” the sacred hoop, or the medicine wheel. Chief Seattle, the 19th-century Suquamish leader, is said to have remarked:
“Whatever befalls the earth befalls the sons and daughters of the earth. We did not weave a web of life; we are merely a strand in it. Whatever we do to the web, we do to ourselves.” (Qtd. in Morris 104)
In this and similar formulations, illness is the consequence of a loss of “balance and integrity.” It results in a “severed web” between the individual and the environment, whose strands can be re-woven through narrative-making (Morris 100).
The medicine stories that bridge physical and spiritual realms display recurrent, distinctive generic features. In contrast to narratives from other cultural traditions, medicine stories are “specifically designed” to bring about healing (Marilou Awiatka, qtd. in Morris 106). This sense of intention is helped by the indigenous oral tradition’s inherent “flexibility of form,” which allows traditional stories to be reshaped according to personal circumstances (Morris 98). These stories also demand the ill person’s participation in narrative-making by preferring the rhetorical device of allegory over description. Roma J. Heillig Morris writes that listeners “are urged to experience answers available through stories and oral tradition […] Asking ‘why’ is thought to limit the quality and experience of the mystery,” since the interpretation of allegorical narrative elements is central to the experience of healing (97). Some of the most popular medicine stories, then, are trickster tales featuring Coyote, Spider, Rabbit, Whiskey Jack, or Raven (depending on their culture of origin), which are “humorous, easily remembered, and thematically consistent” (Donohue). The ambiguous role of the protagonist in a trickster tale is “purposely designed to arouse laughter and provoke thought,” and thereby elicits the participation of listeners in allegorical interpretation (Donohue).
Trickster tales are not merely designed for “moral instruction” (though that is one of their functions), but also to provide models for encountering and surmounting challenges in the process of healing. Lewis Mehl-Madrona’s Narrative Medicine: The Use of History and Story in the Healing Process (2007) reveals how trickster stories can be used productively in a discursive medical practice that bridges Western medicine with Native traditions. A Cherokee/Lakota writer, Mehl-Madrona is a medical doctor working closely with First Nations groups in Saskatchewan. In many of his own cases, he introduces trickster stories and creation myths from Diné (Navajo) to Haida and even Hawai’ian contexts, often according to the cultural background of the patient. The tales, which he reprints alongside his narrative account of each case history, have helped his patients re-plot their own narratives of cancer, mental illness, diabetes, asthma, and other conditions–often with very positive clinical results. These trickster tales evoke the tension between Western allopathic medicine and indigenous traditional medicine, Mehl-Madrona writes, and they help to model the mutual recognition and reconciliation of both practices.
Practicing indigenous narrative medicine is not without challenges. With narrative medicine originating in pre-contact oral cultures, there are problems of transcription and translation. As Donohue documents, whole rituals have disappeared, leaving partial texts in English that are “fairly accurate replications but are devoid of animation […] at best we can say we have impressions of how Native poetic expressions may have been rendered.” And translating medicine stories into settler languages raises the specter of cultural appropriation. “The attraction of non-indigenous people to Native American traditions,” including narrative medicine, “stirs resentment and controversy,” says Morris; instead, we should “create our own metaphors” about health within our distinct cultural traditions (108-109). In his practice, Mehl-Madrona addresses this problem by drawing on the myth and ritual from each patient’s own culture: for instance, he uses local creation myths in developing therapy exercises for a family of native Hawai’ians. For him, the mindset of narrative medicine–its emphasis on ritual storytelling, allegory, and community–is portable across cultures, but myths particular to certain Nations may be less therapeutically effective out of context.
What, then, does North American indigenous narrative medicine have to teach us–whether we are physicians practicing narrative medicine, or scholars working in the medical and health humanities? Otherwise comprehensive texts in academic narrative medicine (for instance, Rita Charon’s Narrative Medicine: Honoring the Stories of Illness (2006) and Principles and Practice of Narrative Medicine (2017)) reveal an important gap: these books do not detail how Native storytelling practices, both traditional and modern, relate to the narrative medicine taught to medical students in the university or the hospital. Mining this gap helps us see how indigenous narrative medicine reveals something new: it calls for a change in the practitioner’s philosophy. More than simply a newfound attention to the patient’s story, the practice of narrative medicine must change the doctor’s story too:
What we lack in medicine is a context from which to make sense of human suffering, of people getting sick, getting well, staying sick, being born, and dying. Literature does much better than we do; hence, the proliferation of Literature and Medicine courses. But beyond this understanding of the contexts of patients, we physicians need to realize that our treatments are also contained in stories and are presented in story fashion. If we really want to change suffering and illness, we must renegotiate the stories within which we all work and live. (Mehl-Madrona 158)
“More a philosophy than a set of practices,” narrative medicine asks health professionals as well as patients to rewrite their stories of illness (175). By changing the plot of the therapeutic encounter, we can open up new potential for healing through language.
The image above is a Finger Mask for Storytelling. Yup’ik, Alaska, c. 1880. De Young Museum.
Charon, Rita. Narrative Medicine: Honoring the Stories of Illness. Oxford: Oxford University Press, 2006.
—, et al. Principles and Practices of Narrative Medicine. Oxford: Oxford University Press, 2017.
Donohue,Betty Booth. “Remembering Muskrat: Native Poetics and the American Indian Oral Tradition.” The Cambridge History of American Poetry. Ed. Alfred Bendixen, Stephen Burt. Cambridge: Cambridge University Press, 2014.
Mehl-Madrona, Lewis. Narrative Medicine: The Use of History and Story in the Healing Process. Rochester, VA: Bear & Co., 2007.
Morris, Roma J. Heillig. “The Whole Story: Nature, Healing, and Narrative in the Native American Wisdom Tradition.” Literature and Medicine 15, 1 (Spring 1996): 94-111.
Schwing, Laurie J. “Native American Healing: A Return to Our Past.” Journal of Consumer Health on the Internet 12, 1 (2008): 71-78.
Silko, Leslie Marmon. Ceremony. 1977. New York: Penguin Books, 2006.
Sontag, Susan. Illness as Metaphor and AIDS and Its Metaphors. 1978. New York: Penguin, 2013.