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Narrative Medicine: The Use of History and Story in the Healing Process (Anglais) Broché – 11 juin 2007

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from Chapter 3

The Maps That Define Our Reality

I remember thinking once that everything could be figured out, that formulas would be discovered to explain it all, that there were pristine and independent truths that transcended all cultures and stories. The person discovering those truths would certainly win prizes. Historically, in medicine, we have been driving toward certainty like Hannibal through the Alps or Patton into Italy, waging war with the darkness of ignorance, believing we can triumph. But what if health is a matter of equilibrium? What if disease and misfortune are related to disharmony? What if nature is pliable and plastic and molds to our intent and wishes? What if intent really does change material processes? What if it is all just story, and some stories no longer fit as well as they once did?

Narrative medicine helps us understand that everything we assume to be true about the world is just a story. The idea is simple--that it’s all story and that we, as a culture, create our stories. This is not in a negative sense, as in lying or confabulation, but in the most positive sense as a creative act of meaning-making in which we produce a story or map that makes sense of our world and, to the extent it matches our environment, allows us to survive in that world. It even allows us to alter our world and even our physiology. What’s different about the story of the person who is diagnosed with schizophrenia, for example, is the mismatch of his story with the environment. We can evaluate stories on the basis of how well they fit their context and environment.

Narrative medicine argues against the natural history of disease concept with its narrow focus on biological cause and effect. It claims instead that disease is embedded in a person, family, locality, and culture, and can only be understood through the many stories told that include the person and the illness. We cannot see an illness independent of the stories we tell about it. We cannot treat an illness without telling a story. We cannot position ourselves as healers or as experts, without telling stories. We cannot explain anything without telling stories.

For example, a mother brought her five-week-old daughter to the family medicine clinic for an urgent visit. Over the past two weeks she had already been seen several times in the office and once in pediatric emergency. The child had been without bowel movements for the past ten days, was sleeping poorly, and was fussy and irritable. She vomited after nursing. For the past 36 hours she had had projectile vomiting.

Most of us with conventional medical training would approach this child similarly because we share a certain story about health and disease. Our story focuses upon the mechanical things that can go wrong and become life threatening. After the x-ray, ultrasound, and blood and urine tests all came back normal, I made the intuitive leap that this mother and child could benefit from a simple prescription for chamomile and peppermint tea. I told the mother the story of Peter Rabbit and how his mother had given him chamomile and peppermint to calm his stomach and make him sleep after his antics in Mr. Macgregor’s garden. “If it worked for Peter Rabbit, it will probably work for your child,” I said, with some humor. She smiled and agreed with a nod. Then we discussed how to prepare and administer the tea. I asked her to return the next day in case my story wasn’t as good a map for this territory as I had hoped.

When they returned, mom stated with pleasure that the tea “had worked.” The baby’s bowels moved, the vomiting stopped, the child slept for six hours straight, and the irritation and fussiness resolved. Was it the tea or was it the story tied to the tea, or both? Was it, perhaps, the relaxation of the mother that was added to this brew when she was reassured that nothing terrible was happening? Did we heal the mother sufficiently for her to heal her child? We don’t know.

Mainstream medicine teaches physicians to be skeptical about evidence that cannot be explained by a physical process. A key notion behind the narrative approach is that we need to create a guiding story, a map that works and is pleasing, even as we recognize that the map is not the territory. Consider this story John Briggs told in a lecture at Massey University in New Zealand. During World War II, a platoon of soldiers was lost in the Alps. They had no idea where to go. Their lieutenant found a map in the bottom of his pack. The soldiers examined the map, compared it to their terrain, and struck out in a verified direction, heading for safety. When they arrived, their Captain looked at the map. Without knowing it, they had a map of the Pyrenees Mountains in Spain--nowhere near their position in France. Nevertheless, the map had worked. It had helped them find their way back. Maps do not have to be correct to work.

The story shows that we need a map, regardless of its accuracy or point-to-point correspondence with our surroundings. We need structure to orient our perception or we are lost in what has been called pre-narrative awareness, or pure sensation without interpretation. This kind of experience presents as the confusion of psychosis, when the map has vanished and experience is overwhelming. The map interprets our experience in such a way that we can take action. The soldiers took the action of walking out of their position, following the map. Regardless of the accuracy of the map, it led them to take action, without which they would have surely died. It gave them the needed certainty to act.

Revue de presse

"What makes this Narrative Medicine important and exciting, at least to me, is that we have a board certified medical doctor challenging the more tradition modalities of Western medicine; not by ridiculing them, or even dismissing them, but rather offering narrative medicine as both a complement and a way to systemically treat the whole person. . . . shows us the importance of our own story in our own healing process. Throughout the book there are case histories which we can draw upon to both understand how the process works and to make personal application." (Frank A. Mills, Co/Create Ideas Matter, March 2010)

"Lewis Mehl-Madrona is an extraordinarily gifted physician and healer. I saw him transform the lives of profoundly affected patients. Mostly, he was sitting next to them, listening carefully and telling them stories. I was amazed." (David Servan-Schreiber, M.D., Ph.D., Clinical Professor of Psychiatry, University of Pittsburgh, aut)

“Some people say that we are made of molecules and cells, but Lewis Mehl-Madrona insists that we are made of stories. Stories involve a whole person in a historical context and in a whole environment. This more expansive view of ourselves is more true-to-life and real. Dr. Mehl-Madrona teaches us to learn our own story and to use it to heal ourselves and to appreciate our own soul’s path.” (Dana Ullman, MPH, author of The Homeopathic Revolution and coauthor of Everybody’s Guide to Ho)

“Dr. Mehl-Madrona’s work with Narrative Medicine is both powerful and exciting. He meets each patient as a unique individual instead of a diagnosis. He provides story after story of successes that are not within the normal spectrum of modern medicine, and breaks down narrative medicine into components so we may catch a glimpse of how it achieves its success. He brings the reader back to listening and compassion, the two human aspects of medicine that are crucial to the doctor-patient relationship. His view of medicine and healing expands how one looks at the illness, health, and community.” (Ann Marie Chiasson, M.D., MPH, CCFP, Clinical Assistant Professor of Medicine, University of Arizona)

“It is clear from Lewis Mehl-Madrona’s work that healing is far too complex a process to entrust to the western medical profession. And in opening the door to indigenous voices from outside these professional doors, the present volume is both illuminating and invaluable. My hope is that this book will serve as a beacon and an inspiration for the broadest collaboration in defining and enriching our orientations to health, illness, and cure.” (Kenneth J. Gergen, Mustin Professor of Psychology, Swarthmore College)

“Stanford Medical School trained Mehl-Madrona invokes the philosophy of his Cherokee and Lakota ancestors to remind us that the path to redemption for today’s health care world is to honor the patient’s life story with all of its elements of culture, community, family, health beliefs, spirituality, and individuality. Mehl-Madrona’s narrative contribution is possibly the most inclusive philosophy ever proposed in medicine. “After reading Narrative Medicine, when we come face-to-face with that terrible question, ‘Doc, how long have I got to live?’ we will know that the answer cannot be found in a statistic or the natural history of a disease, but depends upon your unique story--the one told up until this point and especially the one authored from this point onward.” (Farrell Silverberg, Ph.D., author of Make the Leap: A Practical Guide to Breaking the Patterns That)

“Our stories bring us comfort and help us become acquainted with our unanticipated dreams and fears. Narrative Medicine helps us connect to this personal taproot enhancing our understanding of how we can find our way back to wellness in crisis.” (Roberta Lee, Continuum Center for Health and Healing, Beth Israel Medical Center, New York)

"Addressing shamanism, quantum physics, critical theory, and more, this book will appeal to a wide variety of readers, including healing practitioners . . ." (Blanche Angelo, Library Journal Xpress Reviews, July 2007)

"The author writes very well, weaving examples throughout, as well as stories from a variety of cultures, showing how he uses stories in his practice with actual patients." (D. Tigermoon, The Pagan Review, Nov 2007)

"Dr. Lewis Mehl-Madrona presents us with a sincere and well-researched case for a new approach to mental and physical health. . . . as well as cutting-edge sociological developments in transformational studies." (David Paulsen, New Age Retailer, Jan 2008)

"It is quite refreshing to read the perspective of a health-care practitioner who can draw on his own cultural experience and articulate his interventions scientifically. Yet, at the same time he does not alienate the reader by romanticizing his uniqueness." (PsycCritiques of the American Psychological Association, Mar 2008)

"Dr. Mehl-Madrona treats each of his patients as a unique individual with a history and a story rather than simply a diagnosis. As well as listening with compassion, he offers a traditional story to help a patient gain insight into their illness and path to wellness. Most of the stories he shares come from North American Native culture as that is Dr. Mehl-Madrona's heritage." (Ann Moore, Synergy Magazine, Vol. 6, Issue 2, Mar/Apr 2009)

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24 internautes sur 25 ont trouvé ce commentaire utile 
Not a "tool" like narrative therapy: this is a new way of seeing. 7 avril 2008
Par Nancy L. Howe - Publié sur Amazon.com
Format: Broché
Narrative Medicine is a radical critique of conventional medicine in which Mehl-Madrona, M.D., Ph.D. challenges the knowledge system that physicians, especially psychiatrists, use to diagnose illness and direct treatment. Mehl-Madrona's writing style is straight-forward and concrete, enlivened with his skillful use of patient stories and historical examples drawn from his years in practice and as a professor of medicine, currently at University of Saskatchewan and before that, University of Arizona. He traces the philosophical roots of western medicine's fundamental axioms that disease can be understood with a mechanistic, biological model alone, and that valid medical solutions must generalize to a large population. Mehl-Madrona uses clinical experiences, recent research in physics, and advances in post-modern philosophy to underscore how these medical truths are, in themselves, a story. "Narrative therapy," as described by more than 200 Amazon authors, is promoted as an effective tool to be added to the physician's standard repertoire. Narrative medicine, by contrast, is not a tool; it is a way of seeing. In Mehl-Madrona's experience, storytelling is transformative, capable of promoting healing as a consequence of the interplay between teller and listeners.

As a cancer researcher, I found that Narrative Medicine held the key to understanding interviews I conducted with ovarian cancer survivors. I had asked these women to tell me how they learned of their diagnosis. What they told me were stories of how their illness had changed their self-understanding. For most, their interactions with the medical community had been frustrating and fragmented. They described being shuttled back and forth among a variety of experts (e.g., nephrologists, internists, and GI specialists), few of whom had the time or patience to listen when the women attempted to describe how their symptoms had unfolded. For all of them, the diagnostic process was frightening and disheartening.

My colleague found that Mehl-Madrona's analysis of bi-polar disorder and the current predominance of the biochemical explanation mirrored her experience. As a "non-responder" to standard medications, her hopes for relief had been undermined by the prevailing view that bi-polar disorder is a life-long biochemical imbalance for which drugs are the only effective treatment. "What I do now to help myself includes many of the approaches contained in the healing stories in Narrative Medicine," she told me. "Like Mehl-Madrona says, my solution is particular and works for me; other people in my support group find that their stories spur them to actions that are very different from mine, but equally helpful. Narrative Medicine gave me a new understanding of why that might be."

For a single text --- and a paperback at that! --- to accomplish both these tasks is testimony to the breadth of application available to the reader who is open to Narrative Medicine's premise.
8 internautes sur 8 ont trouvé ce commentaire utile 
Not as good as "Coyote Medicine" 27 juillet 2009
Par Stuart Dole - Publié sur Amazon.com
Format: Broché Achat vérifié
The overall tone of this book is plodding and academic, compared to Mehl-Madrona's "Coyote Medicine". Either he changed editors or didn't use one. Not much new material. But this may appeal more to academic types. I much preferred the dynamic personal narrative of the earlier book.
7 internautes sur 7 ont trouvé ce commentaire utile 
A major contribution 3 septembre 2009
Par Olivier Clerc - Publié sur Amazon.com
Format: Broché
This book goes way beyond giving us a new understanding of medicine and the power of story in healing. It provides us with incredible insight into this too often untapped (or unconsciously tapped) power to create stories out of what we live, what we perceive, to give meaning to our lives.
There are major parallels to draw between Dr Mehl-Madrona's books and Viktor Frankl's work, and his "logotherapy". Frankl helped his patients find meaning (logos) in their lives, and so does Lewis Mehl-MAdrona, but by using a different approach.
As compared to previous books, "Narrative Medicine" allows readers to have a much deeper understanding of the workings of this medicine. It gets to the very principles of the power of stories.
It is not always an easy book, but it is undoubtedly a major one, a reference book, to be read, re-read and considered : there is much to me learned from it !
5 internautes sur 5 ont trouvé ce commentaire utile 
Narrative Medicine is filled with deep wisdom and insight. 4 septembre 2009
Par Christine Cameron - Publié sur Amazon.com
Format: Broché
I am so grateful to have serendipitously stumbled upon Dr. Lewis Mehl-Madrona's work. Narrative Medicine is filled with deep wisdom and insight into the process of healing. He brings heart and soul to a profession which has become largely cold and clinical. Witnessing my Mother's health decline and then finally her diagnosis and cancer treatment truly opened my eyes to the heartlessness of our Western system. Reading Narrative Medicine made me feel less alone in my belief that health and wholeness is more rich and complex than diagnosing and medicating. I have been blessed with personally meeting and witnessing Dr. Mehl-Madrona at work. As a result, my view of illness and disease will never be the same. I highly recommend this book!
4 internautes sur 4 ont trouvé ce commentaire utile 
One of my favorite books, let alone textbooks. 27 août 2009
Par J. D. - Publié sur Amazon.com
Format: Broché
In this book, Dr. Mehl-Madrona provides a thoughtful critique of modern medicine. While he acknowledges many of the positive things that modern medicine has done for society (like making it possible to attribute disease to more than just people's religious and moral failings), he also proves how the discipline misses many aspects of health and wellness.

In the first few chapters of the book, Dr. Mehl-Madrona references a wide range of topics, from traditional stories to recent research on quantum physics. These chapters help to provide a foundation for understanding how narrative medicine can be conceived and employed in practice. Dr. Mehl-Madrona has a writing style that is very relaxed and inviting to the reader. Through his writing, he creates a dialectic in the truest sense: instead of trying to discredit all of modern medicine, or attempting to integrate narrative medicine into previously established theories of modern medicine, Dr. Mehl-Madrona provides a vital approach to medicine and health.

This book was used as part of a senior Psychology class. However, I would recommend it to anyone who is interested in learning about the field of medicine, about how doctors today treat physical and mental illnesses, and how narrative medicine can be used to help people.
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