Tuesday, July 03, 2007

Getting out of the way (and the illness narratives)

One of the first things we try and teach our new chaplains is not to say, "I understand exactly what you are saying, let me tell you when the same thing happened to me . . ." and then going on to tell the patient their own story.

Students really have trouble understanding this -- "don't we want to establish common ground with our patients," they ask? "Doesn't this establish rapport?"

The problem is that we're jumping to conclusions when we do this. We're assuming we understand what the patient is going through before we even have the slightest conception of his or her experience. We're taking the focus off the patient and putting it on us. We're telling our story by preventing the patients from telling theirs.

My supervisor shared with me an excellent short article by a San Francisco doctor that explains this problem wonderfully by talking about the "Illness Narratives". The Illness Narratives (Restitution, Chaos and Quest) were described by sociologist Arthur W. Frank (see his The Wounded Storyteller: Body, Illness, and Ethics; for a brief, but excellent, description of these three narratives, see the short article, above).

The author of the article takes a great quote from Frank's book that well describes much of my understanding of how pastoral care can heal:

"Serious illness is a loss of the destination and map that had previously guided the ill person's life: ill people have to learn to think differently. They learn by hearing themselves tell their stories, absorbing others' reactions and experiencing their stories being shared".

This is what we try and train our student chaplains to do instead of sharing their own stories with patients -- inquire into the patient's experience. Get out of the way and let them to tell their story. Don't try and fix their problem. Instead, try and understand their experience. . . and open the door for the suffering person to take the next step: the step to the learning and self-transformation that has the potential to make them into a person who has regained control over their life, even if they have tragically lost any control over what their body is doing.


By the way: Speaking of people who miss the patient's story by telling their own (in a ill-conceived effort to establish rapport), the Archives of Internal Medicine recently published a study saying many doctors are doing just that. The New York Times headlined its story about the study: Study Says Chatty Doctors Forget Patients

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