Narrative Medicine or Lyric Medicine?

Most of the medical Covid stories I read involve hospital work; here’s a different scene. My 100-year-old father used to get monthly B12 injections from his doctor. That ended in March when the physician shut his practice due to Covid. They’ve now reopened, but not the actual office. My father gets driven into a designated parking spot by his doctor’s building. His doctor then comes out, looking like what my father describes as a “spaceman” in protective gear, syringe in hand. He gives my father a shot through the car window, asks (through mask and visor) if there’s anything else, and retreats back to his office, presumably to shed the gear and suit up for his next patient. That’s a sort of story, but the narrative in such medicine is not between patient and physician.

I now make a big jump–or is it so big?–to Clive, which is the name that Philip Davis gives to a physician whom he writes about in Reading for Life, which was the topic of my previous blog post. Both Clive and Davis admire and are influenced by John Berger, especially his study of a rural physician, A Fortunate Man. Davis’s discussion of Clive is richly nuanced, including poems they read together. But let me focus on one moment, at risk of taking that out of context. Clive dislikes, or is suspicious of, what he understands as “narrative medicine”. What’s he mean by that? “He is referring,” Davis writes, “to the common belief that people must be able to have access to their own story, that they suffer without it, and that one way to realize it is by telling it to their physician who won’t otherwise recognize their individual depth” (144). Readers may want to take a deep breath, reread that, and ask how far it fits their previous ideas about what narrative medicine is. Clive’s sources for his understanding of narrative medicine are not specified.

My own reaction begins by noting that what Davis, maybe Clive, understands as a “common belief” has become common only fairly recently. Charles Taylor’s The Ethics of Authenticity is still the best genealogy of this belief that I’ve read, and the best critique of what’s inadequate about the idea of people having “their own” story. Taylor turns, as I do, to Mikhail Bakhtin to understand personal stories as never our own individually, but always dialogical, held between persons in relations of response. Davis doesn’t cite Bakhtin specifically, but Bakhtin’s dialogism is consistent with the process philosophy Davis aligns with. That limitation of how much a story can be anyone’s “own” is not, however, what Clive worries about. Clive actually listens to people, and what he hears disrupts the idea of what’s “narrative” in narrative medicine, or, what kind of story people are prepared to tell, or maybe what they are all too well prepared to tell.

What Clive hears, and what troubles him, are people “losing their initial insight, thinking it down into a more conventionally normalized and stereotyped account of their lives”. That’s the problem with the stories people tell in self-help groups on the AA model. One’s “own” story becomes a conventional narrative. Becoming a member consists in learning to tell your story that way, and the group enforces expectations for telling the story just that way. So let’s go back to what Clive means by “their initial insight”.

“I want the clue of the lyric glimpse,” Davis quotes Clive saying about his clinical practice; “the vestige or the fragment to begin from, not the self-conscious spelling out of an over-clear narrative.” Following Clive makes narrative medicine seem an odd name for what he’s perpetually looking for. There isn’t and won’t be and even shouldn’t be a narrative, in the sense of a sequential events connected by some sort of immanent logic of sequence (even if, in a particular sequence, time is out of joint). What there are instead, maybe, are moments of seeing through conventional, normalizing narratives to something beyond. Clive speaks of “the lyric glimpse”, so let’s call this beyond the lyric, which is momentary, a perceptual and affective instant, rather than the narrative, unfolding in longer durations. Clive, as I understand Davis’s understanding of him, wants what would be better called a lyric medicine. He wants people to stop at the moment of some initial insight and just stay there; don’t turn it into a narrative or a story.

I find much to recommend the idea of lyric medicine. There was a time, back in the late 1980s, when I would have aligned with the common idea (although then not so common) that people have a story and they suffer for the non-recognition of that story. That’s true, but maybe less so about personal illness experience; it may better fit collective stories, like the national identity stories that Charles Taylor was most interested in. For people whom illness makes feel radically alone, there’s not, I think, a story as much as a swirling confluence of narratives competing to direct how ill persons make sense of people and demands around them. Narratives appear and speak in fragments more than as wholes. These fragmented voices from narratives can be powerfully directive. Some are helpful, others not at all. What Davis, channeling Clive, calls the conventional normalizing narratives are often least helpful, and I think Clive is correct in suspecting that institutionalized storytelling, whether in dyads with professionals or in groups, often regresses to the conventional.

A serious problem for narrative medicine is whether it can survive not Covid, although that certainly presents challenges to clinical relationships. But more fundamentally, whether narrative medicine can survive what degree of institutional acceptance, with normalization being a price for support. Lyric medicine remains fugitive, practiced in small acts of affirmation such as repeating a phrase that the other person might want to hold onto, not to develop another narrative, but to find within the confluence of narratives something that can be called one’s own. Lyric medicine may be best practiced in significant pauses, moments of eye contact, shared silences: holding time in suspension, to allow what was said to resonate.