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INNOVATIONS IN INTEGRATIVE HEALTHCARE EDUCATION

REGAINING OUR HUMANITY THROUGH STORY


Victor S. Sierpina, MD, and Mary Jo Kreitzer, RN, PhD, with
Elizabeth MacKenzie, PhD, and Michelle Sierpina, PhD

In this issue of Innovations in Integra- homes to just get their story, not a medical history.” This means that we coconstruct
tive Healthcare Education, we are de- history, as part of a required course on the with the patient the reality of the medical
parting from our usual format of spot- practice of medicine. Many students find encounter and the tone and timbre of the
lighting specific projects or programs in this immensely anxiety provoking, due to healing relationship. By bringing our own
lieu of presenting a more extended piece the lack of structure and familiar context. culture, beliefs, and values to the exam
by MacKenzie on relationship-centered However, ultimately they find an oppor- room and then allowing the patient to
care and narrative medicine. The impor- tunity to encounter a real person in a non- share theirs with us, we create a new kind
tance of these topics cannot be overesti- clinical setting. A scoring rubric based on of relationship-centered, patient-centered
mated in their role of humanizing the the construction and quality of a short care model. This allows the strength of the
healthcare encounter, improving self- story allows us to grade the students objec- linear standard medical history, chief
awareness of the practitioner, and creat- tively. However, a most interesting find-
complaint, history of present illness, past
ing a space in which the patient feels ing, which we expect to present at the Ot-
history, social/family history, review of
deeply listened to. A commentary by Dr tawa Conference in Australia next spring,
systems, etc, to be informed and enriched
Michelle Sierpina is also included in this is the process of personal transformation
by the nonlinear, perhaps circular, patient
special section to put into context the that such story writing has for students.
story. This story making further allows
power of narrative in medicine and in This is also reported by MacKenzie in her
patients’ lives. Her recent PhD focused article and in Sierpina’s accompanying deeper exploration of the patient’s life
on the power of life stories told by se- commentary. The importance of captur- goals as well as their medical goals.1 It cre-
niors; that research and training enables ing and understanding the patient’s story ates increased personalization of the pro-
her to provide a broad and scholarly re- is also a major focus in nurse practitioner vider-patient relationship and moves from
view of the power of story in relation to programs across the United States, where the “I-them” to Buber’s “I-thou.” Enjoy
MacKenzie’s article. the art of listening and the importance the article and the accompanying com-
In the medical school at University of of patient narratives have long been mentary and consider how to implement
Texas Medical Branch, we send out first- emphasized. this kind of care and mindfulness into the
year medical students in the first couple of In an integrative assessment of patients, education of health professional students
months of the first semester to patients’ we “make a history” rather than “take a and your practice.

s American healthcare experi- mensions. This deepened perspective will structed for the past three centuries or so.

A ences a paradigm shift away from


a purely biomedical perspective
of health and disease, it has be-
come obvious that the education of health
professions must respond appropriately. A
shape care in the future.”
—Pew-Fetzer Task Force on Ad-
vancing Psychosocial Health Edu-
cation3
Although this division has resulted in re-
markable advances in medical technology
(eg, gene therapy and organ transplanta-
tion), thus making biomedicine by far the
most dominant healthcare system, it has
key feature of this response is to amend As noted in the groundbreaking Insti- left conventional healthcare at a disadvan-
the healthcare curriculum so that it re- tute of Medicine4 report, “Improving tage with regard to the psychosocial di-
flects our understanding of the biopsycho- Medical Education,” “real medicine” has mensions of health and illness (eg, mind-
social determinants of health.2 for many years been defined only in terms body interactions, patient behavior,
of the biological sciences. One of the main physician-patient communication, socio-
reasons for this stems from age-long his- cultural dimensions to healthcare, inter-
TRAINING THE HEALTH torical trends (such as Cartesian dualism) personal dynamics, and health). At this
PROFESSIONALS OF THE FUTURE that biased the sciences toward a strong juncture, there is a great deal of interest
IN RELATIONSHIP-CENTERED preference for considering the physical among all concerned parties in reconfigur-
CARE body completely apart from other aspects ing how we train future health profession-
of the human being, such as the mind. als so that we can begin to address the
“Illness is an integral experience that can Mind-body dualism has been a basic enormous role played by psychosocial
only be artificially reflected into biological, premise upon which most of the Western and cultural processes in the maintenance
psychological, social, and spiritual di- (European) health sciences have been con- of health and the treatment of disease.5

626 EXPLORE November/December 2007, Vol. 3, No. 6 Education


Many believe that an important step in ing patient care. The authors outline the vack et al18 suggest ways in which personal
reaching this goal is to reorient healthcare components of the art of medicine and growth, self-awareness, and well-being can
education so that students are (1) pre- define physician personal awareness as be taught in medical school, whereas
sented with information on psychosocial “insight into how one’s life experiences Wear and Castellani29 describe an ideal
aspects of health and (2) given the skills and emotional makeup affect one’s inter- medical curriculum that teaches profes-
necessary to create healing relationships actions with patients, families, and other sionalism and humanism through the
with their patients.3 professionals.” They present examples of integration of biopsychosocial interdisci-
activities designed to increase self-aware- plinary content that emphasizes compas-
ness and show that “through enhancing sion, communication, mindfulness, re-
HUMANISM, PROFESSIONALISM, personal awareness physicians can im- spectfulness, and social responsibility.
AND RELATIONSHIP-CENTERED prove their clinical care and increase satis- The authors underscore the notion that
CARE faction with work, relationships and them- “professionalism” is “an on-going, self-re-
selves.” A study of 53 medical residents flective process involving habits of think-
“From my perspective, medical students suggests that training in self-awareness en- ing, feeling, and acting.” A qualitative
need to master the art of listening to and hances the ability to conduct patient-cen- study of 32 physicians found that power-
communicating with their patients just as tered interviews.11 A number of studies ful experiences, helping relationships, and
much as they need to learn the fundamen- and reviews have suggested that increased introspection were the antecedents to the
tals of human biology.” self-awareness can help prevent and man- personal growth necessary to the develop-
—C. Everett Koop, MD, ScD6 age stress and “burnout,” and increase em- ment of such attributes as wisdom, com-
pathy.10,12-16 Finally, Borrell-Carrio and passion, and integrity.30 These kinds of
An important next step in achieving the Epstein17 propose a teaching strategy that educational activities support the training
goals of professionalism and humanism uses emotional self-awareness and per- of physician-healers and can ultimately
already defined by academic medicine is sonal insight to help the physician func- provide the best context for relationship-
to expose students to the concepts of rela- tion better, thereby reducing clinical er- centered care.
tionship-centered care.7 The Accredita- rors.
tion Council for Graduate Medical Edu-
cation defines professionalism as “a NARRATIVE MEDICINE: WRITING,
commitment to carrying out professional STORYTELLING, AND THE
THE DEVELOPMENT OF
responsibilities, adherence to ethical prin- CULTIVATION OF HUMANISM
PHYSICIAN-HEALERS
ciples, and sensitivity to a diverse patient
population.”8 The American Academy of
“The need for the health professions to be- “Simply put, we must create an intellec-
Pediatrics identified eight key compo-
come more reflective or contemplative dis- tual climate that encourages our educators
nents of professionalism: honesty (integ- to help students bridge boundaries be-
rity), reliability (responsibility), respect for ciplines calls, therefore, for a profound
change in professional education, from a tween academic disciplines and make con-
others, compassion (empathy), self-im- nections that produce deeper insights. Our
curriculum dominated by abstractions
provement, and intellectual analysis to one balanced scholars and, therefore, our students must
self-awareness (knowledge of limits), com- between intellectual analysis and the be skilled at synthesis as well as analysis.”
munication (collaboration), and altruism depths of human experience.” —Vartan Gregorian31
(advocacy).8 Relationship-centered care —Pew-Fetzer Task Force on Ad-
highlights the human relationships that vancing Psychosocial Health Edu- We often hear that human beings can
form the basis of all healthcare. Such care cation3 be distinguished from animals by our abil-
gives primacy to the healing relationship ity to make and use tools; in other words,
and places the patient and his or her expe- There has been a growing interest in the that it is our technology that sets us apart.
rience at the center of the care paradigm, training of physician-healers.18-21 An emer- However, some have argued that a far
thus providing more focus on the psycho- gent body of literature explores how to more definitive trait is language and the
social while simultaneously increasing the train physicians in the art of medicine reflective exploration of meaning. Perhaps
probability that the care will be effective, through the teaching of mindfulness and the essence of our humanity has less to do
humane, ethical, compassionate, cultur- contemplation.21-27 Among the tech- with how we manipulate our environment
ally competent, and more satisfying for niques used to enhance healing presence and more to do with how we find meaning
both patient and provider.9 One of the are mindfulness meditation, reflective in our lives.32 Narrative in any form helps
most important skills needed to create re- writing, and a greater appreciation for the to connect us with our own and others’
lationship-centered care is increased self- connections among body, mind, and humanity. To tell a story is to be human,
awareness. A number of publications have spirit with regard to our lived (or subjec- in some sense, for we are storytelling ani-
called for increased attention to humanis- tive) experience. In a similar vein, Aung28 mals. Story is the way we define ourselves,
tic dimensions of medical education. For suggests that loving kindness (or metta), a make sense of our world, learn about our-
example, an article published in the Jour- concept from Buddhism, can be culti- selves, share our experiences, and form
nal of the American Medical Association by vated through meditation and applied in group identities. It is this aspect of human
Novack et al10 reviewed the importance of the clinical setting for the purposes of knowledge that the health sciences so of-
physicians’ personal awareness in provid- practicing a more humane medicine. No- ten discount. The admissible data tends to

Education EXPLORE November/December 2007, Vol. 3, No. 6 627


be quantitative: lab values, blood counts, narratives), medical students are able to luted, official, important-sounding aca-
MRIs, graphs, and charts—anything that reconnect with the human dimension of demic style can be coaxed to communi-
can be conveyed in numbers. Of course, clinical care. Ultimately, this serves to re- cate clearly when composing a narrative.
numbers do have their own story to tell, mind health professionals in training that Second, writing an illness or healing nar-
and quantitative inquiry is crucial to all the real purpose of medical technology is rative helps to ground students in their
the sciences. However, in medicine, the to achieve humanistic goals. In this way, own bodies, their own experiences, their
quantitative is never the whole story. narrative medicine plays an important role own subjectivity. This in itself can be a
Quantitative inquiry can never shed much in efforts to redress the tendency of mak- healing experience for students inured to
light on pain, or pleasure, or meaning, or ing the human subordinate to the techni- an educational system that teaches us to
suffering—important pieces of each pa- cal in training and practice of health pro- devalue the personal and subjective while
tient’s story. It is in narrative that we redis- fessions. appreciating the impersonal and objec-
cover our humanity. We cannot commu- tive. I ask each student to include some
nicate humanistic concepts in numbers; it kind of generalization or learning that
is not possible. Language, words, and sto- HEALING NARRATIVES grew out of the experience and to commu-
ries are the currency of the humanities— nicate this in one sentence at the close of
they are fundamental to the human expe- “As the practice of medicine evolves and the essay. In this way, they learn to write
rience. changes, it is clear that people recruited proposition statements, opinions they can
When Rita Charon, MD, PhD,33 and selected to be the physicians of the fu- expand upon in essays throughout the
sought a way to reconnect the practice of ture must be superior in both the cognitive- course. It also makes transparent the pro-
medicine to its moorings as a service to academic and the affective-humanistic cess by which our experiences become
realms.”
humanity, she turned her attention to the opinions or positions. It helps students ask
—L.S. Linn et al36
telling and hearing of illness narratives, themselves, What did I learn from that?
and in the process, created the field of nar- Why do I believe what I do? What do I
At the University of Pennsylvania,
rative medicine. The basic idea is to elicit think about this? Sometimes a student ex-
where approximately 40% of incoming
illness narratives from students, who then periences a revelation about their experi-
freshmen intend to become prehealth ma-
reflect upon the subjective meaning of the ence during the process of writing, peer
jors, I teach an undergraduate writing sem-
experience; this process helps them de- review, and revision. For example, one of
inar called Healing Narratives, partially in-
velop the capacity for empathic listening, my students wrote about how she had lost
spired by the field of narrative medicine.
helps to strengthen the patient’s voice in her formerly daredevil approach to life af-
The aim of the course is twofold: (1) to
the clinical encounter, and reorients the teach writing skills to undergraduates and ter she suffered a head injury while at a
focus to the shared humanity of both pa- (2) to introduce prehealth majors to the track meet. As she contemplated and
tient and provider.34 In essence, narrative concept of humanistic medicine. There wrote about the event, she realized that
medicine uses reflective writing to evoke are parallels between teaching and healing. the reason she had become so fearful after
empathy.35 In addition to the program in Both activities seek to bring out that this, was that she had lost consciousness
narrative medicine that she created at Co- which is whole in a person, both seek to for a moment, and she associated this loss
lumbia University, numerous other empower others, and both endeavor to of consciousness with the Alzheimer’s
courses and programs have been estab- guide persons to their own integrity. Cre- that runs in her family. After making this
lished at medical schools throughout the ating safety in the classroom is paramount. connection, she was able to better under-
United States. What these curricula have As a writing teacher, I see my primary role stand her fears and to take a good look at
in common is the use of personal illness as someone who can help young people the underlying anxiety surrounding de-
narratives to ensure that the humanity of find their own authentic voices in an aca- mentia that existed below her conscious
both provider and patient remains central demic context. This process is more about thought. By writing, revising, reflecting,
in the clinical encounter. paring away that which is inauthentic, un- and sharing her narrative with her peers,
A scientifically competent medicine necessary, in error, or confused than it is she was able to gain a new perspective that
alone cannot help a patient grapple with about adding more knowledge. At the end led her to a significant insight.
the loss of health or find meaning in suf- of it, I hope to introduce students to their Later in the semester, I ask students to
fering. Along with scientific ability, physi- inner writer, a mature voice that is uniquely collect an illness narrative from another
cians need the ability to listen to the nar- and confidently their own. In practice, and to write this up. To prepare for the
ratives of the patient, grasp and honor what this means is that the first graded interview, we do an exercise in active lis-
their meanings, and be moved to act on writing exercise I give students is to com- tening, where students take turns telling
the patient’s behalf. This is narrative com- pose a short personal experience narrative one another a simple narrative (eg, “what I
petence, that is, the competence that hu- about illness or healing. I do this for the did so far today”), and the listeners prac-
man beings use to absorb, interpret, and following reasons. First, everyone knows tice listening actively (once) and then “lis-
respond to stories.33 how to tell a story. Stories have a begin- ten” while focusing their attention on
Narrative medicine is rapidly making its ning, middle, and end, so this sets the something other than the speaker. After-
mark on medical education at the gradu- groundwork for handling structure with ward, we discuss how the two interviews
ate level; by communicating stories about assurance. Young adults who have learned compare. This in-class experience teaches
themselves and their patients (eg, illness to get good grades by writing in a convo- them the importance of active listening in

628 EXPLORE November/December 2007, Vol. 3, No. 6 Education


communication and builds a foundation vulnerability that will provide the best listen to you. The main thing I learned
for collecting the interviews in the field. basis for a career in the health profes- from this class was the focus of my final
Learning to collect and write up these sto- sions. This gives students the permission essay, which discussed the need to distin-
ries is also a simple way to introduce them to take all of themselves on their journey guish between curing the body and heal-
to the concept of qualitative research. For toward competence, even the painful ing the soul. So often, the two ideas are
students who will spend much of their un- parts of their lives. Reclaiming the hurt, lumped together, or one aspect is com-
dergraduate years studying math and sci- weak, or embarrassing dimensions of pletely ignored. This class pointed out the
ence, this exposure to narrative and to ourselves is an important part of becom- importance of acknowledging illness and
writing is extremely valuable. ing more whole, and as Carol Donley so dealing with it, rather than trying to shove
Writing is different from talking or famously phrased it, “It takes a whole it to the back of your mind where it will
thinking; it can have a far deeper reflective doctor to treat a whole patient.” What only get worse. This was helpful for me in
and educative function. Writing enables better way is there to reclaim our whole- coming to college this year because now,
the writer to express and clarify experi- ness—to connect with our own and oth- having been in remission from Hodgkin’s
ences, thoughts, and ideas that are prob- ers’ humanity—than by listening to and Lymphoma for over a year, it is surpris-
lematic, troublesome, hard to grasp, or telling stories? ingly easy to forget about the illness that
hard to share with another. Writing also And what evidence do I have that the basically took over my life for six months.
enables writers to discover and explore is- course has any impact at all? We have not This class helped me acknowledge its pres-
sues, memories, feelings, and thoughts yet implemented a formal evaluation of ence and understand that it will never be a
they hadn’t acknowledged.37 the course beyond the standard student part of who I am. Once the illness resur-
It is no accident that the academic fields evaluations. However, I ask students to do faced with this class, I was much more eas-
known collectively as the humanities are a self-assessment at the end of the semes- ily able to talk about it with my new
those areas of study for which writing is ter, and they often comment on their per- friends here at Penn, which is a difficult
central. The act of writing (including col- sonal growth or mention a new under- thing to trust new people with.”
laborating, critiquing, revising, and so standing regarding health and healing. ”In addition to developing as a writer, I
forth) helps the student go beyond gather- Here are some of their words: discovered a lot about myself as a person,
ing and broadcasting information to syn- and what I believe. I can relate the confi-
thesizing and communicating meaning. dence that I gained as a writer to my con-
Writing grounds prehealth education in fidence in myself, my thoughts, and my
STUDENT ASSESSMENTS
humanism, it emphasizes the humanistic beliefs.”
“On a personal level, I found Healing Nar-
goals of healthcare, and forces students to ratives to be an extremely interesting “Just this week, I have realized how
grapple with meaning. course—particularly as I am premed. Al- important this class has been to me per-
Taking students on this journey helps though I did initially believe compassion sonally. If I had not enrolled in this
them to reflect on their own wounds and to be an important aspect of healing and I course and read about the effects
helps them begin to find ways to heal, to knew (albeit vaguely) about the healing journaling can have on someone, and
become whole. Raising awareness of suf- benefits of writing, sharing, and listening, had I not been assigned to write journals
fering and the transcending of suffering this course greatly increased my awareness based on our readings, I probably would
assists them to become healed healers. of their importance. I thought our read- not have resorted to journaling as a heal-
This will help them to retain a connection ings were extremely interesting— but what ing aid after my traumatic experience
to their humanity as they advance through I found to be the most significant aspect of last week. This course has opened my
their health professions training. them was that many of the stories were eyes to the deeper and different mean-
Everyone alive has suffered. It is the moving. In fact, the story ‘Grace’ by ings of health and healing, as well as the
wisdom gained from our wounds and Rachel Naomi Remen . . . had such an benefits expressive writing has on the
from our own experiences of suffering impact on me that I printed it, and it now immune system. My new understanding
that makes us able to heal. Becoming sits on my bulletin board above my desk . will definitely remain with me through-
expert has turned out to be less impor- . . . Years from now, I might not remember out my medical training in the future as
tant than remembering and trusting the how to do integration, or what the next well as when I hopefully go into practice
wholeness in myself and everyone else. step in the citric acid cycle is, but perhaps as a physician.”
Expertise cures, but wounded people in the corner on my wall, there will still be “Imagine yourself a freshman nursing
can best be healed by other wounded a piece of paper with the word ‘Grace,’ and student at the University of Pennsylvania.
people. Only other wounded people can a story that will remind me that healing is Over the summer, you thought deeply
understand what is needed, for the heal- not black and white.” about which course you would take to ful-
ing of suffering is compassion, not ex- “Personally, learning about the way fill your writing requirement. Though you
pertise.—Rachel Naomi Remen32 doctors and patients interact was very in- are very interested in healthcare, you have
So, rather than approach their trans- teresting because I have spent a lot of time always had a love of exploring ideas
formation into health professionals as at the doctor’s office. I loved learning through writing. You longed to combine
invincible experts, I introduce them to about the different ways in which people these two passions in an interesting critical
the idea that it is the fact of their human- learn to work through illness, from writing writing seminar. To your delight, you dis-
ity that makes them strong, and it is their a narrative to just having someone there to covered the class ‘Healing Narratives,’ a

Education EXPLORE November/December 2007, Vol. 3, No. 6 629


course advocating a humanistic approach nition of the singularity of their relation- equation; the other half is to understand
to medicine. Throughout this class you ship. . . . This does not mean that the roles our own stories and what has drawn us to
explored complex ideas relating to the are the same but rather that power and the the health professions. Relationship-
state of healthcare, narrative medicine, sense of limitation, irritability and excite- centered care of any kind (medicine,
and the meaning of healing. You ex- ment, fear and self-mastery, despair and
compassion, sadness and joy, and all the nursing, social work, psychology, chiro-
pressed your thoughtful opinions through practic, etc) requires that we bring as
other landmarks of healing flow in both
a variety of essays. This is precisely where I directions.” much of ourselves as possible to the
am at this point in my journey in writing —Saki Santorelli, EdD38 practitioner-patient encounter. To put it
and in my understanding of some very another way, to care authentically for
profound issues. . . . I feel that my ideas To the degree that all training for others, we must be able to stand in our
drastically changed as a result of this health professions has become “sur- own authenticity. Being authentic re-
course. I explored some very profound is- feited by science,”39 all curricula could quires us to know who and where we are
sues in my writing, including the defini- benefit from an infusion of humanism. in our lives. Without understanding our
tion of healing, the source of worth in a The dominance of the bioscientific is own stories, we cannot truly know our-
person, facing the unknown, and the im- most obvious in medicine, but nursing, selves. According to George et al,40
portance of patient input. I feel that I truly clinical social work, psychology, other “Your life story provides the context for
gained a lot of knowledge from reading all allied health professions, and even com- your experiences, and through it, you
of the articles and books we were assigned plementary and alternative medicine
in this class. I experienced tremendous can make an impact on the world.” Re-
training programs are not immune to the flecting deeply on these narratives lets us
growth from these readings and I feel that lure of trending away from the human-
I learned some very important lessons that see ourselves by the light of self-aware-
istic to the scientific. Techniques of nar- ness and gives our actions the power of
will not only help me in my future profes- rative medicine are already being widely
sion as a nurse, but also help me in my integrity. Authentic healing relation-
used in nursing schools,37 and social
journey as a human being. I would even go ships can only occur between persons
workers are exploring how to use this
as far as to say my learning was life chang- who have some awareness of their life
approach in clinical practice (N. St
ing because I now see that the worth of a stories, of where they are along the tra-
Louis, personal communication, 2006).
human being is not determined by the jectory of their personal narrative. When
There are even business leadership appli-
things he or she is capable of, but simply both practitioner and patient know
cations to narrative.40 Like mindfulness
that value comes from the fact that he or meditation training, the technique of “where they are,” they can inhabit the
she is a human being. I feel that this is one writing our stories to reconnect with our same “space” and engage in meaningful
of the most important lessons in life and humanity can be helpful in a myriad of communication. Exclusively relying on
the fact that I was able to grasp such pro- settings. Any person whose job centers professional degrees, technical knowl-
found meaning from this course demon- on addressing the needs of people who edge, titles, and training will only take us
strates that I involved myself in the read- are in pain is in need of tools to help him so far. At some point, each of us must
ings and used writing as a means of or her cope with the seemingly endless find a deeper core strength that is rooted
understanding my own thoughts. In a stream of human suffering. One option, in our experience of being human. Once
way, I feel that I was healed by narrative of course, is to become numb to the pain we make this connection, we can create
medicine.” we both experience and witness, and healing relationships that not only ben-
Not all students are as deeply affected most of us do this to some degree. How- efit our patients (and clients and stu-
by the course, but the fact that some are ever, anesthetizing ourselves not only re- dents), but also serve to help us become
compels me to continue to think of ways sults in interpersonal barriers but also whole.
to reach the rest. In a higher education paves the way for professional burnout. Thanks to Valerie Ross, PhD, director of
landscape characterized by competition, Why is narrative an effective antidote to the Critical Writing Program at the Univer-
perfectionism, objectivity, standardiza- isolation, callousness, and numbness? sity of Pennsylvania, for her contribution to
tion, and technology, providing students Because it serves as a lifeline to experi- portions of an earlier iteration of this manu-
with the opportunity to share, reflect, con- encing our own humanity, as well as a
template, and feel compassion for them- script and for introducing me to the art of
bridge that connects us to others, break- teaching writing. I would also like to ac-
selves and others is a strongly humanistic ing through barriers built by profes-
stance and an important way in which we knowledge the students who have generously
sional roles, judgments, biases, assump- allowed me to quote from their self-assess-
can help them prepare to deliver high tions, stress, and time pressures. At the
quality, relationship-centered care. ments and who did such excellent work in the
most fundamental level, hearing the life
course. Ute Arnold, creator of Unergi, taught
stories of others reminds us that people
me about healing in her body-psychotherapy
THE WHOLE STORY: are not things. Health professionals are
training program. This article is based on a
TRANSDISCIPLINARY not “omniscient automatons,” as one of
presentation I made at The Patient: A
APPLICATIONS my students phrased it, and patients are
Symposium, Bucknell University, in May
not problems to be solved.
Understanding clients’ and patients’ 2006.
“Perhaps the most fundamental work of
practitioner and patient lies in the recog- stories in a profound way is only half the —Elizabeth MacKenzie, PhD

630 EXPLORE November/December 2007, Vol. 3, No. 6 Education


A COMMENTARY ON REGAINING OUR HUMANITY THROUGH STORY
In “Regaining Our Humanity through Story,” MacKenzie skillfully illustrates the application of theory into practice. The work of theorists in healthcare
education, humanism, and narrative medicine provides a foundation for understanding the important learning that occurs in the Healing Narratives
course at the University of Pennsylvania. Benefit is multidimensional for learners during the course and later equally multifaceted for them and their
patients long into the future. The examples from learners, described in their own words, powerfully illustrate the educational outcomes achieved and
demonstrate the transformation that can occur. This careful progression enhances the reader’s understanding of how the course equips University of
Pennsylvania students to recognize, value, and practice relationship-centered care throughout their professional lives.
Like those cited in this article, geriatrician Gene Cohen41 highlighted the value of personal narrative, citing an “autobiographical urge” in late life.
Cohen theorized that the brain regions in the older adult are primed for life review, a process of summing up the life that he believed, is “a bit like
chocolate to the brain in late life—a sumptuous activity.” Healthcare professionals of tomorrow trained in MacKenzie’s approach will be well prepared
to honor these late life narratives.
Robert Atkinson, another proponent of personal narrative, has long endorsed genuine self-reflection in sharing one’s story:
Telling our story, and sharing the meaning we find in our life, also helps to connect more to the human community. By sharing our story, we find
that we have a lot more in common with others than we might have thought. This sharing of stories creates a bond between people who may not
even have known each other before. After sharing, or listening to, a life story, a connection is established that remains even if we don’t see the other
person again.42(p15)
He added, “We discover in the process of telling our life stories that we are more sacred beings than we are human beings. A life story is really
a story of the soul of a person.”42(p4) Like MacKenzie, he emphasized the transformative power of authenticity in the telling.
In one study, those with chronic diseases, such as rheumatoid arthritis and asthma, who wrote about stressful experiences, reported measurable
health improvement.43 One reviewer noted, “Were the authors to have provided similar outcome evidence about a new drug, it likely would be in
widespread use within a short time.”44 In other research, writing about personal experiences for only 15 minutes a day for three days demonstrated
improvements in both physical and mental health of study subjects.45 In that study, those who used more positive-emotion words gained most benefit.
Evidence mounts that, whether writing about positive or negative experiences, there is increased well-being from participating in story writing and
sharing. The Healing Narratives course and others like it give healthcare professionals of the future the awareness of the value of sharing personal
narratives and the opportunity to experience their own self-reflective narrative writing and sharing.
Mastel-Smith et al46 recently found that writing and sharing authentic, deeply personal life story narratives diminished depressive symptoms both
in those who recognized they were depressed and also in those for whom depression was undiagnosed. Our own research sought to capture the voice
of individuals as they spoke of the meaning derived from sharing personal narratives with others. In the words of one coresearcher, knowing someone
will listen to the illness narrative makes one “finally feel free to reach down inside themselves and pull that out and confront it, not tell us about it,
but pull it out so they can look at it and say, ‘This is what happened.’”47
The Healing Narratives course at the University of Pennsylvania allows healthcare professionals in training to reach down inside themselves for their
own story, then prepares them to create a safe space for their patients to do the same. Healthcare educators and practitioners alike would benefit
from more complete descriptions of the course and further documentation of its value.
—Michelle Sierpina, PhD

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