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Let’s Play a Game: Imagination in a Narrative Medicine Workshop

Avril Tynan //

In 2010, Martha C. Nussbaum published Not for Profit: Why Democracy Needs the Humanities, a manifesto on the importance of arts and humanities education for social and political life. The role of critical thinking in global education policies is being undermined, she argues, by an emphasis on rote learning and the promotion of studies transparently related to economic production (122—143). Yet it is the humanities and liberal arts, she writes, that cultivate the life skills that global democratic societies hold so dear: “freedom of speech, respect for difference, and understanding of others” (141).

At the heart of Nussbaum’s manifesto is a call for greater imaginative training, cultivated through literature and the arts, that will teach students not about facts and functions but how to interpret, assess, and appreciate information. Although Nussbaum’s work has been criticized for the assumption that literature can “teach” us anything at all (Keen 2007), and for oversimplifying a supposed connection between literature, imagination and the cultivation of an “innate” capacity for empathy (Jurecic 2011; Pedwell 2014; Whitehead 2017), her ideas have a central role to play in the development of global humanities education and research. Indeed, the development and integration of “intensive narrative training” (Charon 2006, viii) in clinical medical education aims precisely to promote “more humane, more ethical, and perhaps more effective care” (vii).

It is for these reasons that, when recently asked to deliver a creative workshop on narrative medicine, I turned to the role of imagination as a means of nurturing our approaches to caregiving in complex interpersonal situations. The workshop was organized by RéCITS, an international and transdisciplinary network on care hosted by the Universities of Montréal (Canada) and Bordeaux Montaigne (France) that aims to bring together literary, medical, artistic and cultural perspectives to animate new and creative discourses on care and caregiving. In this workshop, I challenged overly simplistic notions of narrative imagination that subsume the unique subjectivity of the Other. At the same time, I aimed to show how one’s own understanding of, and orientation in, the world can be transformed by the actions and reactions of others.

The focus of my workshop was to draw attention to, and potentially alleviate, some of the problems associated with understanding and writing about Alzheimer’s disease, a degenerative condition notoriously associated with lapses in memory, language and the construction of narrative identity. Yet one of the most overlooked aspects of this disease is, in my opinion, the ways in which Alzheimer’s is projected onto the patient through stigmatizing social and cultural narratives of dehumanization, infantilization and loss. The lived experience of the disease is in fact constituted in the crosshairs of complex and overlapping narratives between the external perspective of others and the internal perspective of the patient. Without clumsily stepping into the ethically dangerous and uncomfortable grounds of an attempt to think what it might be like to suffer from Alzheimer’s disease, I approached the possibilities of imagination in a narrative medicine workshop to think instead what it might be like to be confronted by a situation in which the subject remains seemingly unchanged but the world around suddenly becomes unfamiliar, unfriendly and unsettling.

Image credit: Book cover, On n’est pas là pour disparaître (Paris: Gallimard).

Inspired by Olivia Rosenthal’s We’re not here to Disappear (2015; On n’est pas là pour disparaître 2007), in which the narrator directly challenges the reader to imagine uncomfortable and even undesirable situations, I aimed to create a scenario in which the participants would become strangers to themselves, subjects of a derisive external gaze, and yet essentially unchanged. Crucially, I would not impose a pathology or diagnosis. In Rosenthal’s text, which she qualifies as a fiction that reinvents and reimagines the lives and experiences of real people (2007, 235), the narrator recounts the surprising turn of events in which Monsieur T. has been found in the garden of his neighbors’ house after stabbing his wife. Ricocheting between first-, second-, and third-person narrative voices that interweave dialogues with Monsieur T., the perspectives of his wife and caregivers, and the autofictional narrator herself, the text blurs the boundaries between fiction and reality, self and other, present and possible future. On several occasions, the narrator makes a direct address to the reader to assimilate the experience of Alzheimer’s disease into everyday realities and brings us face to face with the potential alterity of the self:

Do an exercise.

Imagine yourself in the place of the one whose life story has been swallowed up.

Imagine yourself at the dinner table, unaware of what you’re eating, of where you are, of the objects around you, of the strangers chatting to you like friends. (2007, 156)[1]

Despite the implication that the reader is being asked to imagine a future in which they are affected by Alzheimer’s disease, Rosenthal wisely avoids asserting such an ethically questionable task and instead choses to focus on the ways in which it is possible to imagine oneself in the midst of a world that has suddenly and inexplicably become hostile and unheimlich.

Do an exercise.

Imagine for a moment that on returning home and in front of your door, or rather in its place, you find yourself in front of a hole; either there was a fire, or, due to a very strong earthquake, the foundations gave way.

1. Would you lean over the hole?

2. Would you plunge into the hole?

3. Would you stand motionless in front of the hole? (2007, 74)

Inspired by this exercise, my own creative proposition for the workshop drew out the ways in which subjective experience could be radically transformed by Others:

One day, on returning home, you put your key in the front door. It doesn’t turn. Nothing serious, you think, this happens sometimes. Knowing that your partner is already home, you ring the bell. The door opens and a stranger appears. She doesn’t know you. She tells you that she has lived in this house for the last five years. You don’t live here. Neither does your partner. This is not your home. This is not your family. You are dumbstruck. What do you do? How do you feel?

As in Rosenthal’s imaginative exercises, I wanted to avoid the assumption that the scenario was the result of a disease, and more specifically of Alzheimer’s disease, but still provoke a disorientating and disquieting sense of alienation in an otherwise familiar space. The exercise does not ask that we imagine the situation of another, but rather that we imagine what it might be like to have our own everyday worlds suddenly and inexplicably turned upside down and inside out.

With only fifteen minutes, participants created incredible short responses to this complex, frustrating and fear-inducing scenario that brings into sharp focus the ways in which our agency is contingent upon others. There is always a risk that imagination might be instrumentalized in ethically dangerous and irresponsible ways; particularly when we assume that we can simply think ourselves into the world of another we undermine the difference and diversity of experience. Yet exercises in imagination, like those I discussed here, may help us to look out for, and even to understand, the multiple ways in which experience is constituted intersubjectively and lived differently. In situations of care and caregiving, imagining these sorts of disparities may help us to think more carefully about our responsibilities towards others, helping us to map the limits and edges of our own experiences and understandings.

I would like to acknowledge the support of the Institut Français de Finlande, the Embassy of France in Finland, the French Ministry of Education, Higher Education and Research, the Finnish Academy for Science and Letters and the Finnish Society of Sciences and Letters for funding a research visit to the Universities of Bordeaux and Bordeaux Montaigne in February 2022. The workshop and this subsequent post would not have been possible without this support.

Works cited

Charon, Rita (2006). Narrative Medicine: Honoring the Stories of Illness. Oxford and New York: Oxford UP.

Jurecic, Ann (2011). “Empathy and the Critic.” College English 74.1: 10–27.

Keen, Suzanne (2007). Empathy and the Novel. Oxford and New York: Oxford UP.

Nussbaum, Martha C. (2010). Not for Profit: Why Democracy Needs the Humanities. Princeton, NJ: Princeton UP.

Pedwell, Carolyn (2014). Affective Relations: The Transnational Politics of Emotion. Basingstoke: Palgrave Macmillan.

Rosenthal, Olivia. (2007). On n’est pas là pour disparaître. Paris: Gallimard.

— (2015). We’re not here to Disappear. Trans. B. Mousli. Los Angeles, CA: Otis Books.

Whitehead, Anne (2017). Medicine and Empathy in Contemporary British Fiction: An Intervention in Medical Humanities. Edinburgh: Edinburgh UP.


[1] All translations from the original French my own unless specified.

Image credit

Dementia by Nick Youngson CC BY-SA 3.0 Alpha Stock Images

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