John A. Carranza There has been much criticism about the time that physicians spend with patients in an average visit. Physicians simply do not have enough time to fully interact with their patients. Couple this with the rising demand for doctors to enter patient information and complaints into databases, and the patient suffers. While this may not change any time soon it is important to remember the human aspect of medicine. One question that I pose is: How might history and its methods be used to better the physician-patient interaction? I propose one possibility involves the consideration of the past as informing the present social and cultural context of the patient and the physician-patient relationship. Secondly, using oral history as a framework not just for interviewing, but for understanding that much of what the patient conveys to the doctor is their own perception of how they view and experience their health and illness.
The sociologist and oral historian, Paul Thompson, reminds us that history has served a social purpose. In all cultures, memories of the past and cultural mores are passed down orally and in writing, and have, in large part, been produced as a component of a larger historical context. This historical context includes aspects such as: systems of oppression pervasive in a community’s past, governmental institutions that pass laws regulating human interaction, religious influences on a community, concepts of health and wellness, and many other cultural attributes that effect decision making.[1]
Orally conveying the past has been a critical component of health in some cultures. Naomi Adelson, an anthropologist, found that the Whapmagoostui Cree Nation’s concept of “health,” which Adelson translates as “being alive well,” was rooted in the specific context of colonial and neo-colonial relations in Canada. The meaning of being Cree is rooted in how members recall their past through a “chronology of events, lives, and seasons of travel.”[2] For the Cree, retelling stories was an essential part of their identity as hunters who had a close relation to the land. The Cree concept of “being alive well” was frequently influenced by oral histories of the importance of the land tied with the context of outsiders disrupting hunting norms and polluting water sources. The act of storytelling reinforced the sense of community and identity, but more importantly, it conveyed the sense of importance of land in the Cree understanding of “being alive well.”[3]
Naikan therapy in Japan is another example of the importance of oral history and cultural context in health and healing. Chikako Ozawa-de Silva found that while Naikan is meant to be a practice in individual (and solitary) reflection, with clients sitting behind screens, it is in fact a community effort. Clients reflect on their relation to someone important in their life and apply three themes: what the client has received from that important person, what was returned to the important person by the client, and what trouble the client has caused the important person.[4] Telling the story of one’s life blurs the lines between individual and social memory because Naikan is one’s perception of their experiences shaped by the world around them. A person’s memories are hardly objective, but are subjective and may change over time. Memory, and its ability to change over time, is essential for understanding patients and treating them because concepts of health and well-being can change over time. This should not be understood as having a fickle patient, but provides for the possibility that what may be chronic may come to influence what the patient communicates to their physician over time.[5]
How does the Cree understanding of “being alive well” and the practice of introspection found in Naikan therapy fit into United States-based understandings of medical practice? The answer rests in the diverse ways in which patients speak about their illnesses and their perceptions of their health. Physicians, as arbiters of medical knowledge and healing, should remember that their patients are living in ever-shifting cultural contexts that influence their health. The Cree concept of “being alive well” and Naikan therapy are just two examples to consider the multiplicity of ways in which health is considered. The act of speaking about symptoms, for example, reveals various meanings of what a symptom might or might not be to some people.
Oral history can add dimension to how physicians carry out gathering medical histories from their patients. Physicians might increase the information obtained from a patient by establishing rapport and ensuring the patient that he or she is the ultimate authority in their own body and the symptoms expressed. The physician, as listener, should allow the patient to digress slightly from their narrative in the event that the patient reveals more about the context in which they became ill or hurt. Watching for nonverbal cues and listening for distress are also key to learning more about the patient. Is someone else (parent or caregiver, for example) in the room that makes a patient hesitant to reveal more of their past? While most oral historians have the benefit of recording their interviews and listening to or watching them again later, physicians do not get that luxury. As a result, they must try to read and listen to their patient as close as possible.[6]
Our specific cultural context is complicated to say the least, but the skills and practices associated with oral history and memory can be critical for the medical community when working with their patients. At the very least, it should be remembered that medicine is a social endeavor with human actors. History serves a social purpose. By learning the methods of the discipline, the physician would be equipped to help their patients and community by learning of the past that influences the present.
[1] Paul Thompson, “The Voice of the Past: Oral History,” in The Oral History Reader: Third Edition, eds. Robert Perks and Alistair Thomson (New York: Routledge, 2016), 33.
[2] Naomi Adelson, ‘Being Alive Well’: Health and the Politics of Cree Well-Being (Toronto: University of Toronto Press: 2000), 27.
[3] Adelson, 9, 61, 80-85.
[4] Chikako Ozawa-de Silva, Psychotherapy and Religion in Japan: The Japanese Introspection Practice of Naikan (New York: Routledge, 2006), 6
[5] Ozawa-de Silva, 87-88, 98.
[6] Valerie Yow, “Interviewing Techniques and Strategies,” in The Oral History Reader: Third Edition, eds. Robert Perks and Alistair Thomson (New York: Routledge, 2016), 157-158, 164-165
