Narrative, Embodiment, and Health

Sharing Stories

Stories have always been a part of human well-being. They connect us to others, help us process our own lived experiences, and facilitate the creation of collective values. Sharing stories is a way to connect to others, to adopt a vulnerability that allows us to see and be seen more clearly. Because of this emotional vulnerability, stories can be dangerous, too. We take a risk when we open the narratives of our lives up to others, but not doing so can be even more devastating, leading to isolation, loneliness, and the loss of a sense of community or belonging. Today, narrative-based practices of medicine aim to provide practitioners with tools from narratology and related disciplines for enacting stronger ethics-oriented and patient-centered care during clinical encounters.^1,2,3 Critical to these undertakings is the admission that the importance and value of patients’ stories have not been sufficiently recognized as central to medicine.

Stories’ Evolutionary Importance

In many Indigenous cultures, stories have long been recognized as medicinal for their capacity to impact how we feel and to become linked to ritual, interpretation, and belief.^4,5,6 While narrative medicine and writing therapies have explored the healing powers of storytelling over the past few decades, the root of stories’ role in human health has origins deep in our evolutionary past.

Many of the purported benefits of narrative-based medicine (such as increased reflection, divergent thinking for problem solving, and empathy^7,8,9,10,11) parallel evolutionary theories about why humans became storytellers in the first place. Proposals for the emergence of storytelling include that it developed as an adaptation for counterfactual thinking to help people work through possible scenarios in order to better respond to them in real life.¹² Others have posited that storytelling likely evolved as a form of cognitive play that helped to expand our ancestors’ cognitive abilities.^13,14 A crucial aspect is thought to have been the ways in which storytelling—and listening—provides a space for people to safely navigate emotions, both their own and those of others (real and imaginary).^12,13

From an evolutionary perspective, stories are tools for expanding a theory of mind about others’ interiority, for developing our own emotional maturity, and for promoting group cohesion through shared meaning-making.¹⁵ Stories evolved because they are beneficial at individual, interpersonal, and sociocultural levels. Good stories—those that offer the potential for a healing encounter—reach back through evolutionary time to connect listener and teller alike to our shared human history. The healing capacity of stories lies in our embodied experience and in our exchange of them, and the impact that stories can have on both storytellers and listeners reveals that good stories have always been good medicine.

Embodied Meaning and Health Care

Our emotional responses to stories—and their neurological underpinnings—are a reminder that our experiences of narratives are inherently felt and embodied. Our experience of the world is filtered through our emotions, and because our responses to stories are aesthetic, inherently connected to our emotional reactions, stories cannot help but constitute a meaningful part of our world.

Emotions are a form of meaning that give rise to core values; stories are, in effect, tools for the creation of shared emotional experiences and thus shared moral values because they teach us how to act in a social world.^16,17 As Gottschall writes: “the human mind was shaped for story, so that it could be shaped by story.”¹⁸ And we are shaped not only by the stories we hear but also by the stories we tell.

Pull Quotation: Good stories—those that offer the potential for a healing encounter—reach back through evolutionary time to connect listener and teller alike to our shared human history.

People experience the world through narrative, and so to heal and to be healed requires narrative understanding. Charon writes: “The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.”¹⁹ Charon goes on to assert that narrative competence crucially enables physicians to practice medicine with greater empathy, reflection, professionalism, and trustworthiness.¹⁹ “Medicine is a narrative art,” writes Pollock, as “physicians have always practiced the craft of narrative as a central feature of professional practice.”²⁰ Narrative medicine arose as a patient-centered model of care that recognizes the importance of narrative knowledge. Narrative knowledge is of course embodied knowledge, as the narratives of our lives are tied to our physical experiences. Varela et al explain: “knowledge depends on being in a world that is inseparable from our bodies, our language, and our social history—in short, from our embodiment.”²¹ A basic premise of narrative medicine is that stories can be therapeutic, affecting our bodies, minds, and experiences.

Stories Influence Health

How and in what contexts stories can be healing has become an increasingly studied topic in medical research. Although more research is needed, studies show that creative writing exercises confer a wide range of benefits to both medical professionals and patients. For health professionals, exposure to writing has been found to increase empathy, emotional awareness, emotional intelligence, reflection, and divergent thinking.^7,8,9,10,11 For patients, narrative writing has been found to create a space for self-reflection and to distract from symptom burden, leading to reduction in fear, sadness, anger, worry, and fatigue and to the promotion of empathy and resiliency.^{22,23,24,25,26,27}

Ultimately, narrative-based clinical practices aim to enhance connection and understanding among everyone involved. Charon writes: “narrative medicine focuses on our capacity to join one another as we suffer illness, bear the burdens of our clinical powerlessness, or simply, together, bravely contemplate our mortal limits on earth.”²⁸ It is this bridging of individuality, Charon asserts, that we all desire and which is “the ultimate goal of narrative medicine: affiliation.”²⁸ Research has shown that patients’ stories can be powerful instruments, not only within their own clinical encounters but also for helping other patients with similar illnesses and experiences.²⁹ While narrative approaches are not a panacea for clinical encounters, they are a reminder that consultations with patients are pivotal opportunities for generating shared empathy and medical knowledge.³⁰

Today, narrative medicine and therapies incorporating writing, art, and other narrative techniques are bringing traditional, Indigenous understandings of stories as medicine into modern health care settings. Many see this development as a corrective for the de-professionalization of medicine that has resulted in a reduction in time spent with patients, whereby every interaction is a data point and health professionals feel they are treated more like mechanics than healers.

Embodied Stories

Narrative medicine and narrative therapies are a reminder that we all have stories, and stories are powerful. Stories remind us that others matter, that their struggles are just as real as our own, and that by sharing stories we share what is important to us. Sharing stories is a way to create shared values through empathy and understanding. Humans evolved with and through stories, as stories shaped and transformed our perceptions and values. Stories matter because they have always mattered.

In health care, we need to make more time and more space for the sharing of stories. If we wish to heal the people who need help the most, we need, more than ever, to listen to them tell their stories (and, with their permission, share their stories, too). Stories help us with understanding because we are made of stories—stories told in ribonucleic acid, stories shared in seasonal cycles, stories told over generations. Our world is built of stories, stories we embody every day. If we pause to look back far enough, we can see that to live is to enact a story, and to live together is to recognize how deeply all our stories are entangled.