At the odd intersection of narratology and clinical medicine can be found some fresh postings of old questions about the consequences of representational acts for tellers and listeners. The simple practice of guiding health care professionals to write in non-technical language about what they witness patients to go through and what they themselves undergo in caring for the sick has led us contemplate the acts of attention and representation in primal and primary ways. We see the intersubjective affiliation born of narrative transactions, as it were, unadorned, right there in front of us as doctors, nurses, and social workers discover, through acts of writing, what on earth they know and how what they know connects them to their patients. Like arboreal and nocturnal tarsiers in the Malay Archipelago with their enormous eyes, we are open collecting retinae for the impressions and the assault of that which might be seen. The seer attends—absorbs, composes, puts himself or herself in the way of things to be seen. The simultaneous act of representation expresses, with muscular force, the value of what is seen as if expressing juice from a lemon or, more saliently for my writers, milk from a nipple or secretions from a gland. My conceptual examination of clinical representations rely on Henry James’s theoretical and formal practices that suggest that the self (or consciousness) is constituted by, and not simply made visible by, acts of attention and representation. If indeed the self is the most powerful therapeutic instrument, we need intensive means whereby doctors and nurses, who owe sick people authentic attention and care, can constitute and inhabit that self. Narrative training can expose these fundamental aspects of self to health care professionals, if only so that they can use that self on behalf of the ill. June 2006: Rita Charon, M.D., Ph.D. is Professor of Clinical Medicine and Director of the Program in Narrative Medicine at the College of Physicians and Surgeons of Columbia University. Dr. Charon graduated from Harvard Medical School in 1978, trained in internal medicine at the Residency Program in Social Medicine at Montefiore Hospital in New York, completed a fellowship in general internal medicine at the College of Physicians and Surgeons of Columbia University in 1982, and has practiced general internal medicine since 1981 at Columbia. She completed the Ph.D. in English at Columbia University in 1999, having written her dissertation on the use of literary methods in understanding the texts and the work of medicine.Dr. Charon is currently Editor-in-Chief of the journal Literature and Medicine. She has written and lectured extensively on literature’s salience to medical practice as well as on the doctor-patient relationship, empathy in medicine, narrative competence, narrative ethics, and the late novels of Henry James. Dr. Charon’s research has focused on communication between doctors and patients, seeking ways to improve the ability of doctors to understand what their patients go through. She inaugurated the Program in Narrative Medicine at Columbia in 1996 to increase Columbia’s effectiveness in teaching the narrative skills of clinical imagination, empathy, and ethical discernment to health professionals and trainees. She has designed and directed medical education programs at Columbia in medical interviewing and medical humanities and conducts outcomes research to document the effectiveness of training programs in narrative aspects of medicine. Dr. Charon has been honored with a Guggenheim Fellowship, a Rockefeller Foundation Bellagio residence, and achievement awards from the Association of American Medical Colleges, the American College of Physicians, the Society for Health and Human Values, and the Society of General Internal Medicine. She is co-editor of Stories Matter: The Role of Narrative in Medical Ethics (Routledge, 2002) and is currently working on a book called Narrative Medicine: Honoring the Stories of Illness to be published by Oxford University Press in March 2006. |
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