“…all of our literary tradition sees evil as having something to do with the inability to see outside ourselves, to see another human being as being real.” –Susan Neville, “Where’s Iago?”
A recent article in The New York Times gave me pause, as it reminded me that when it comes to health and healthcare, we live in troubled times. Penned by Brooklyn-based physician and writer, Rachel Bedard, “I Went to an Anti-Vaccine Conference. Medicine Is in Trouble” disrupted some of my thinking about the use and misuse of stories in healthcare.
Like many others, I could see the correlation of basic story structure mirroring a patient’s clinical experience. “The foundation of every story is a narrative arc with a beginning, middle and end. Illness also follows a similar pattern; however, its implications are more difficult to process” (Owate-Chujor). Mostly absent is the status quo or backstory, a person not yet thrust into the role of patient, still going about their daily life. The inciting incident becomes the health issue that brings that person, now a patient, into the clinical setting. Think of the doctor asking, “why are you here today?” Then comes the rising action, which might be comprised of various diagnostic activities, perhaps a consult with a specialist, a battery of tests, coping with symptoms, the ambiguity and uncertainty before a diagnosis, navigating the health system itself—think insurance, logistics, prior authorizations and such—and other activities that lead to the climax, or turning point. This climax might be a diagnosis and treatment, perhaps surgery, a crucial moment of decision. Then we have the denouement, the consequences of that turning point, action or inaction. Things unfold and resolve, perhaps recovery, the “new normal,” managing side effect from treatment, or navigating the hard revelation that the treatment didn’t work. The outcome is revealed. Perhaps loose ends are tied up. And often we are left only with what remains unresolved.
However, in reading Bedard’s Times piece, I was confronted by a form of storytelling that I’d come to think of only in evangelical Christian terms: testimony. Bedard related the experience of a father whose unvaccinated child died of measles to a friend, and that friend identified it as a form of testimony, “speaking the story of how you came to your truth, and how it helped you find your life’s purpose . . . It’s about achieving catharsis, community, and a calling all at once.” Attending the Children’s Health Defense conference to try to understand vaccine critics, Bedard encounters less science than story, and her piece sets out how the power of storytelling is impacting our approaches to health in ways that our current system of medicine is ill equipped to counter. As someone who works daily in the realm of story, who has applied storytelling to healthcare in both patient and provider contexts, this problem felt perplexing and terrifying to me. Bedard captures many of the nuances of how story works in her piece:
Suffering without meaning is very hard for most people to bear. Children’s Health Defense, like religion, helps people put their suffering in context. It offers people explanations that fuse spirituality and science.
. . . I can understand why traditional medicine—a secular, expert-centered, often impersonal culture—might feel alienating. This isn’t a matter of good science versus cultish belief. It’s a matter of what technocratic leadership can offer and what it can’t, and of people needing something more to tolerate grief and live with trauma in an uncertain world.
While I appreciated where Bedard was coming from, a place of compassion and seeking to understand, it also made me think about how story structure lends itself to the process of trust as well as mistrust, and how health professionals more skilled and versed in the nuances of story might improve clinical encounters so that fewer patients feel alienated.
Before we get into story structure itself, it’s useful to talk about viewpoint, the character through which the story is being told. In this case, the viewpoint character was a grieving father, a caregiver. In general, I’ll be talking about patients as viewpoint characters. We could just as easily talk about health providers as viewpoint characters, for instance, in a discussion of moral injury to healthcare workers, but that would merit its own piece of writing. The goal here is to illustrate how unpacking the way stories work can help equip health providers in an environment where a specific kind of story—testimony—is eroding trust in healthcare.
It’s important to understand testimony as a form, but it’s not the only form of story that happens as a result of a clinical encounter: “As a rule, it [testimony] is a thoughtfully constructed narration of a person’s path to conversion. And for a skilled believer, a particular biblical event plays a crucial role in the story” (Liutkevičius, 43). In a health setting, we might swap the term “biblical event” for “medical event” or encounter. Since testimonies are usually the result of searching for explanations for turning points in the converted person’s life, we can see medical testimony—if I might coin the phrase here in a story sense (not to be confused with expert testimony of a medical nature for a court of law)—of the kind used by Children’s Health Defense work as stories of personal transformation much like conversion stories do in a religious context. These testimonies necessarily require the patient to be the viewpoint character, and they fit neatly within Vivian Gornick’s situation and story framework for personal narratives. “Every work of literature has both a situation and a story,” she writes. “The situation is the context or circumstance, sometimes the plot; the story is the emotional experience that preoccupies the writer: the insight, the wisdom, the thing one has come to say” (13).
For the patient as viewpoint character, the inciting incident is that moment of coming into the clinic with a specific issue or need. For a provider, such a physician, this is just part of everyday work. The physician may encounter many of these moments throughout the day, and for the most part, each individual encounter is neither different nor unusual. It’s not an inciting incident in their story. Another way of thinking about this in Gornick terms is to say that, for the doctor, a patient encounter is typically all “situation.” Layered on that situation are the demands doctors face from insurance providers, as well as metrics for performance. These tend to prevent the encounter from moving beyond situation and into story.
For the patient, however, this encounter may represent the inciting incident, that vulnerable moment right before everything changes. It sets in motion the plot “built of significant events in a given story—significant because they have important consequences” (Dibell, 5). The plot is very much centered on the patient, for whom the stakes, that is, something to gain or to lose, are acute and potentially life changing.
For something to be “at stake” in a story there must be opposing forces. This supposes a villain, an opponent, a set of conflicting circumstances. This can be another character, a feature of the environment or landscape, or even internal forces clashing within a character, such as fear versus need. In medical testimony, however, the medical establishment is the oppositional force, a foil to the valiant patient or patient stand-in, such as a caregiver, as in the Bedard piece. Doctors, in particular, may be cast as a stand-in for the entire medical establishment, including systems they themselves often oppose, such as the corporatization of healthcare and the growing authority of insurance companies over physicians in determining medical care. A doctor in a white coat is a powerful symbol, and for a subset of patients, they represent the inequities of all the interrelated systems we call healthcare. As a patient moves through the clinical encounter, through diagnostic activities, treatment plans, and so on, the oppositional forces acting on their autonomy can trigger a conversion-like event.
The writer Louise DeSalvo takes on the subject of writing and healing, and it can be instructive to consider how her approach can either help heal or be used to validate stories that might impede healing. “We are all the accumulation of the stories we tell ourselves about who we are” she writes (11), and she maintains that the act of writing—and I would extend that to the act of orally telling stories—allows us to change our personal histories. While this can help us overcome trauma and obstacles, we can see through Bedard’s experience, how it can also be manipulated by unscrupulous people, targeting those who feel alienated by the medical establishment. It’s DeSalvo’s stance that those who confront stories of traumatic experiences should also receive the support and guidance of trained professionals, which might mitigate the kind of situations perpetuated by organizations like Children’s Health Defense. That this organization was once headed by now Health and Human Resources Secretary Robert F. Kennedy, Jr., does not help the situation and may have the chilling effect of legitimizing the testimonial aspects of stories used against accepted medical practices like vaccination.
DeSalvo’s asserts that in times of struggle, disease, pain, and trauma, stories can validate those experiences and allow us to process them in personally powerful ways. She writes in Writing as a Way of Healing:
We receive a shock or blow or experience a trauma in our lives. In exploring it, examining it, and putting it into words, we stop seeing it as a random, unexplained event. We begin to understand the order behind the appearances.
Expressing it in language robs the event of its power to hurt us; it also assuages our pain. And by expressing ourselves in language, by examining these shocks, we paradoxically experience delight—pleasure even—which comes from the discoveries we make as we write, as we create from seeming randomness or chaos (43).
As powerful as these stories can be for healing, they can also be methods of creating illusions that, if they don’t exactly heal, offer some approximation of that pleasure by making “sense” of randomness and chaos. In both cases, the story creator transforms themselves from victim to survivor. The difference is that, unlike other more healthy stories, the medical testimonials like those identified above, are built not on an act of self-discovery (which can often be painful) but on a self-protective, delusory act of avoidance (which dulls the pain). In the proposed context, this can allow a patient to recover a sense of agency and autonomy in the face of difficult health challenges. Once such a transformation occurs, it will not be easily undone.
If we follow the typical story structure, the falling action and dénouement of the clinical story can lead to a form of restitution. It would be foolhardy to put a shiny gloss on stories, however. In the stories shared at Children’s Health defense, and those shared in other instances of medical denialism, the storytellers are reinforced by accolades of bravery and heralded as truth-tellers. Bedard respects the impact of the storytelling she heard, even as it unsettles her. The oppositional forces that create the tension and stakes of these stories cannot be denied:
Medical culture . . . tends to approach preventable tragedies as teachable moments. This is a mistake. Crises are opportunities to show people what you can do for them, not ask them to change their minds. Prevention is about risk mitigation; providing people with care and options when they disregard your best advice reduces harm. Effective public health policy should aspire to do both things well.
It isn’t the role of health policymakers or even individual doctors to make meaning for people; the local health department is not supposed to be a source of spiritual succor. But I am thinking hard, after attending this conference, about where spiritual succor is supposed to come from in a technocratic world.
What strikes me in Bedard’s mediation is that she both acknowledges the patient as the viewpoint character of clinical encounters, while also not denying her own status as the viewpoint character at the conference. It’s less about whose story it is than seeing the root of the oppositional forces at play.
When I think about story structure and oppositional forces, I often refer to an essay by one of my early creative writing instructors, Susan Neville. She was given unsolicited advice on how to “fix” her novel by Kurt Vonnegut, who tells her to “find Iago,” a reference to the antagonist in Shakespeare’s play Othello. As Neville explains, Iago is “the character that bounces all the other characters around” (124). He creates dramatic tensions, therefore ensuring the story has stakes. He uses illusion to make conflict real. He’s self-interested with a vengeance, appears to have the viewpoint character’s (in the play, Othello) best interest at heart, making that viewpoint character vulnerable to him. Of course, Neville uses Iago as the stand-in for the opposing force in any story: “Iago is inevitable because every human system contains the roots of its disorder, every order the contains the seeds of its disintegration” (Neville, 128).
We can see this both within the stories from the clinic, but also in the stories about the clinic. In the medical testimony, the medical establishment proclaims to help but ultimately hurts patients, and in the response, we see a member of that establishment wrestling with scientific truth (in this case, Bedard), witnessing the power of storytelling to systematically refute that truth. Refutation which Bedard sees as patients feeling a spiritual breech, becomes something that story then fills, however disconnected from scientific fact. Bedard resists using the term, “evil,” but certainly there have been instances, both inferred and explicit, in which “evil” has been invoked. And here, too, it is instructive to see how the concept of evil works within story: “If evil slips in when illusion is created, as our literature suggests, or if evil is the elevation of our self-interest over the whole, or if it is the inability to see anyone outside ourselves, if human culture is only a system of signs referring to one another with nothing at the ground of things, not even an identity to mask, then we may be living in a particularly dangerous time” (Neville, 134). It’s perhaps important to note that Neville wrote those words in 2007, not 2025.
Yet here we are.
When I read the Times article, I paused to consider deeply what I know about stories and their structures, and how these tools can be used and manipulated. But as I also consider the attack on medical science and expertise, contemplating our current time as one of post-meaning, I also see where understanding stories in a deeper, less superficial way is going to become more and more important to health professionals, in general, and physicians, in particular. Rather than being the oppositional force, they need to reconsider their roles in the stories patients tell themselves about their clinical encounters as supporting characters. Here is the opportunity to listen to patients who are scared, even when they bring forward ideas that don’t align with science and medicine, resulting in better conditions to offer gentle corrections. Rather than defend medical knowledge in a combative way, providers can create the conditions for patients to absorb it into their own stories. But to do so requires a knowledge of how stories work, and how the patient as viewpoint character will view their doctors and other health providers.
But even if the health professional’s role in the story changes, the fact remains that in many clinical encounters, there’s a profound and lingering sense of ambiguity. Endings may be cloudy, especially with the rise of chronic conditions, and grief at the loss of a loved one can be a long and unclear process. Afsheen Farhadi writes about ambiguous endings with a surprising amount of clarity, given the subject. He writes, “Often the most complex emotional moment of a story comes at the end. And it can come in the form of the most divisive moves in any work of fiction: the ambiguous ending. . . . To deal with ambiguity is to work with a tenuous and volatile balance.” Even those stories in which an ambiguous ending works, it can be difficult to articulate why that writing pays off, just as it’s difficult to voice ambiguity in our lived experiences. Ironically, the physician-writer Anton Chekhov often employed such endings, leaving us with more questions than answers. Those who study Chekhov will remind us that he famously called that the writer’s job. In responding to students who struggle with ambiguity, Farhadi says, “I tell them that the story avoids easy answers and absolute conclusions, reminding us we are dealing with matters of the heart.” The heart is not always rational, not always aware of its own motives, and it also allows for more than one outcome to coexist. Farhadi sees this as a potent aspect of the ambiguous ending: “What I try to impart to my students is that fiction is meant to convey complex emotional states and sentiments that can’t be handled straightforwardly, by simple recounting.”
Medical science is not fiction, and the stories that come in and out of the clinic are happening to real people. What we don’t know about the complexities of the human body is still vastly more than what we do know, despite the strides biomedicine has made. Human beings often enter the clinic in complex emotional states, and a great way to understand and, eventually, probe their stories is to examine stories, in general, both fictional and not. This medical training can focus on understanding the writer-reader relationship, which in the clinic becomes the teller-listener relationship. We are continually opening spaces for stories to happen, but this often happens as a circumstance or byproduct, not by design. I don’t believe the clinic was envisioned as a space for stories, but it is such a place. The oppositional forces know this well and will, like Iago, use it in their own self-interest. What the rest of us choose to do with this knowledge may help or hinder their progress, and it may help buoy that relationship between patient and physician, our culture and healthcare, or at least the slice of it that is still about human health and prosperity.
Works Cited:
Bedard, Rachael. “I Went to an Anti-Vaccine Conference. Medicine Is in Trouble.” The New York Times, 25 Nov. 2025.
DeSalvo, Louise. Writing as a Way of Healing: How Telling Our Stories Transforms Our Lives. Beacon Press, 1999.
Dibell, Ansen. Plot. Writer’s Digest Books, 1988.
Farhadi, Afsheen. “How Ambiguous Endings Lure Us In.” Catapult, 25 Nov. 2025, magazine.catapult.co/dont-write-alone/stories/how-ambiguous-endings-lure-us-in-craft-essay-by-afsheen-farhadi.
Gornick, Vivian. The Situation and the Story: The Art of Personal Narrative. Farrar, Straus and Giroux, 2001.
Liutkevičius, Eugenijus. “Evangelical Transformation: Learning the Three‐dimensional Perception of Reality.” Anthropology of Consciousness, vol. 35, no. 1, Mar. 2024, pp. 42–57, doi:10.1111/anoc.12215.
Neville, Susan. “Where’s Iago?” Sailing the Inland Sea: On Writing, Literature, and Land, Quarry Books, 2007, pp. 122-135.
Owate-Chujor, Obarianasemi. “Storytelling: Finding Meaning Within Illness.” The Brown Journal of Hospital Medicine, vol. 2, no. 1, 19 Dec. 2022, doi:10.56305/001c.57592.