Dr. Iro Filippaki // The Covid-19 pandemic has illuminated the fact that medical culture and practice belongs to a complex system of ethics, signification, capitalist market, and political representation. This article considers how one of the pandemic’s legacies for narrative medicine might be to provide medical students with the theoretical and conceptual tools to deal with the interconnected nature of the medical profession. Examples of medical staff who are asked to behave like Foucauldian docile bodies, simultaneously hailed as heroes while being left unprotected, have left not only the public, but also medical students, in disbelief. How can narrative medicine deal with the changing nature of medical work under this pandemic?
As a teacher of narrative medicine, I have realized that our moment of crisis in the Covid-19 pandemic affords us an opportunity to rethink parts of narrative medicine’s mission statement. Here are some verbs used to describe the role of narrative medicine: fortifies, utilizes, improves, facilitates. It is a model, it is valuable. It has immediate impact, can be measured, can be carried out in a neat sequence of sessions and talks. But the words of Nobelist author Olga Tokarczuk haunt me: “constellation, not sequencing, carries the truth.” My own exploration of narrative medicine echoes the analyses of critics of medical humanities more broadly: over the past few years, scholars such as Angela Woods, Anne Whitehead, and most recently Travis Lau (in a recent Synapsis piece) have voiced concerns about how even as medical humanities gains institutional support, the leading scholarship of the field risks falling, in various ways, into conventionalism.
One incipient tendency of narrative medicine, I would argue, is habitualization—in other words, the discipline runs the risk of being eroded by what has been called the ‘business-like’ ethos and corporate medical culture of US medical practice. Looking back on my own narrative medicine syllabuses, compiled from classic narrative medicine texts, I’ve come to wonder why they seem too tame for the current crisis. As I teach narrative medicine in the midst of Covid-19, I’ve come to realize that to address urgency, which is a constant in the work of healthcare teams, we need to teach texts that re-create a sense of urgency in the classroom. Although it has been argued that exposure to narrative medicine and storytelling in particular improves working conditions, teaches empathy, and ultimately makes “better doctors,” recent events show clearly that perhaps we also need to ask what kind of text would enable physicians and nurses to better understand and work within increasingly illiberal surroundings.
In short: what do we have to gain by convincing medical schools to shelve William Carlos Williams’ collected works, and instead teach (distinctly non-medical) texts like Melville’s “Bartleby the Scrivener”?
Narrative and educational research would suggest a great deal. It is worth remembering the Shakespearean trope of placing British problems on exotic lands: the thinking was that, in seeing these issues as far away as possible, British audiences would understand what was wrong with their land. This is an example of defamiliarization, a key concept that has since been used by educators and creative authors in their teaching. Defamiliarization’s oft-quoted definition by its creator, Victor Shklovsky, is perhaps in order here:
Habitualization devours objects, clothes, furniture, one’s wife, and the fear of war. If all the complex lives of many people go on unconsciously, then such lives are as if they had never been. Art exists to help us recover the sensation of life; it exists to make us feel things, to make the stone stony. The end of art is to give a sensation of the object seen, not as recognized. The technique of art is to make things ‘unfamiliar,’ to make forms obscure (Art as Device, 1917).
Not only can we view the lack of empathy and physician burnout as a form of habitualization to a physically and emotionally draining timetable, but in the current critical climate we can discern a cultural habitualization towards medical vocation, supported by the dominant view of the medic’s duty to heal under any circumstances. The necessity that lies at the core of the medical vocation can be detrimental to criticality, because, as Shklovsky wrote, it “reconstructs things in its own way, transforming a person into seventy kilograms of human meat, regard[ing] the old thing simply as material” (2016, 154). The defamiliarized events of the past weeks have resulted in urgently seeing how healthcare is influenced by every single choice that is made in each country. Can this effect be simulated in the classroom by teaching texts that defamiliarize medical students, taking them out of the medical “comfort zone,” and placing them in a state of social urgency?
In the classroom, defamiliarization (or estrangement) is a powerful tool for achieving this vital effect. In the medical context especially, it might offer certain affordances:
- The deeply political issues that inhere in the design and practice of medicine, such as inequalities sustained by hegemony and existing power structures, could be safely addressed
- Narrative theory fields and concepts, such as critical race and gender theory and the ideology behind empathy, and narrative tropes, such as metaphor, synecdoche, or hyperbole— may enable medics understand how they contribute to these power structures simply by going into work every day
- Lastly, narrative medicine would not gloss over concepts that originated and developed in literary and cultural studies, such as the concept of biopolitics, in remedial, utilitarian “how to human” sessions
Teaching narrative medicine (and pitching its importance to medical faculty, as many of us do) is already hard work. But we need to question whether the sparse hours of narrative medicine decenter or change a “commodified health care system that places corporate and bureaucratic concerns over the needs of the patient.” As problems more structural and systemic than the relationship between physician and patient loom ahead, we can turn narrative medicine into something less benign and more critical of the systems that have produced and enabled the practice of medicine as we currently know it. Approaching medicine through a defamiliarized lens would mean that we recognize that empathy cannot be taught in an hour, that we resist viewing literature-reading in the medical context as a box-ticking exercise, and that we really see the common element between narrative studies and medical practice: critical thinking.
Iro Filippaki is a postdoctoral fellow at the Center for Medical Humanities and Social Medicine, Johns Hopkins University. She writes and teaches on narrative, trauma, and embodiment.
Cover Image: Origin of life. Credit: Odra Noel. Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)