Barrett Dorko
01-01-2007, 04:13 PM
I’ve been listening lately to podcasts from the American Writer’s web site, specifically on creative writing ( http://www.americanwriters.com/). Yesterday I learned the difference between narrative and story: Story – the entire set of events that are accounted for in your tale, not just what you write but also what you imply. Narrative – specifically the things you mention and nothing more.
On this first day of 2007 I thought I’d write a bit about what this might mean about our profession and, beyond that, what it means to the profession’s center – clinical life.
Last week while getting my haircut I was seated next to some guy and his barber while they discussed their dogs’ sleeping habits. This began before I sat down and went on beyond my leaving the chair (this guy has a lot more hair than I do) and it had a profound effect upon me – it drove me to distraction. Specifically, it revealed my ever decreasing tolerance for small talk and meaningless conversation; that sort of talk full of repetition and points so obvious anybody can see them coming. For me, it is characterized primarily by a lack of respect for the listener’s understanding.
Though I appreciate the patient’s need to impart information via story, I also appreciate how seductive and literally false stories may prove to be. Full of modifiers and inflection, the patient’s story draws the therapist into the world seen from the patient’s perspective – and guess who the hero is? There’s also this; the patient probably has no idea that their story has strayed far from the truth and does not contain the elements essential for the therapist’s understanding. This was discussed in depth in the thread about confabulation (http://www.somasimple.com/forums/showthread.php?t=3045) a few weeks back. In there I said this:
When people begin to talk too much I have a look that cuts them off. I think I got it from my mother, a wonderful nurse.
In the Feb. 10 2005 issue of The New York Review of Books there is an essay about a new collection of Sherlock Holmes stories. The author speaks of Conan Doyle being trained by a physician named Joe Bell, a legendary diagnostician in London. Not only were his observational skills and interpretive abilities acute, he attended to the patient's story in an unusual way:
"To succeed as a narrative diagnostician...you needed the feeling for story, both for the 'history' to be inferred from the signs and symptoms and for the way that story could be reconstructed, in therapeutic terms, for the good of the patient. Bell treated his patients, in part, by telling them their own stories, as if threading a coherent narrative were itself a kind of therapy."
Here I can see that the author had a wonderful understanding for the difference between narrative and story; how both contained therapeutic elements but that the narrative finally constructed by the therapist reduced the confusion and irrelevance stories commonly contain. I think it’s important to remember how important the patient’s story is to them. In fact, in German there’s a word for this; Lebensluge. It means “the lie that makes life bearable.”
So, I’d conclude that an effective diagnostician turns the patient’s story into narrative and then repeats it back to them in a fashion that satisfies the needs of everyone involved – not always an easy thing to do – and the therapist needs to do this at the proper moment and at the proper pace as well.
Now, back to the barber shop. My intolerance for repetition and mundane speech doesn’t help me here, but at least I can acknowledge that and work to change it. In fact, I’ve created an evaluative form ( http://www.somasimple.com/forums/showthread.php?t=2404) that minimizes my exposure to it.
I’m wondering; how do others separate story from narrative? How important an issue is this in the clinic? How has modern practice affected all of this?
On this first day of 2007 I thought I’d write a bit about what this might mean about our profession and, beyond that, what it means to the profession’s center – clinical life.
Last week while getting my haircut I was seated next to some guy and his barber while they discussed their dogs’ sleeping habits. This began before I sat down and went on beyond my leaving the chair (this guy has a lot more hair than I do) and it had a profound effect upon me – it drove me to distraction. Specifically, it revealed my ever decreasing tolerance for small talk and meaningless conversation; that sort of talk full of repetition and points so obvious anybody can see them coming. For me, it is characterized primarily by a lack of respect for the listener’s understanding.
Though I appreciate the patient’s need to impart information via story, I also appreciate how seductive and literally false stories may prove to be. Full of modifiers and inflection, the patient’s story draws the therapist into the world seen from the patient’s perspective – and guess who the hero is? There’s also this; the patient probably has no idea that their story has strayed far from the truth and does not contain the elements essential for the therapist’s understanding. This was discussed in depth in the thread about confabulation (http://www.somasimple.com/forums/showthread.php?t=3045) a few weeks back. In there I said this:
When people begin to talk too much I have a look that cuts them off. I think I got it from my mother, a wonderful nurse.
In the Feb. 10 2005 issue of The New York Review of Books there is an essay about a new collection of Sherlock Holmes stories. The author speaks of Conan Doyle being trained by a physician named Joe Bell, a legendary diagnostician in London. Not only were his observational skills and interpretive abilities acute, he attended to the patient's story in an unusual way:
"To succeed as a narrative diagnostician...you needed the feeling for story, both for the 'history' to be inferred from the signs and symptoms and for the way that story could be reconstructed, in therapeutic terms, for the good of the patient. Bell treated his patients, in part, by telling them their own stories, as if threading a coherent narrative were itself a kind of therapy."
Here I can see that the author had a wonderful understanding for the difference between narrative and story; how both contained therapeutic elements but that the narrative finally constructed by the therapist reduced the confusion and irrelevance stories commonly contain. I think it’s important to remember how important the patient’s story is to them. In fact, in German there’s a word for this; Lebensluge. It means “the lie that makes life bearable.”
So, I’d conclude that an effective diagnostician turns the patient’s story into narrative and then repeats it back to them in a fashion that satisfies the needs of everyone involved – not always an easy thing to do – and the therapist needs to do this at the proper moment and at the proper pace as well.
Now, back to the barber shop. My intolerance for repetition and mundane speech doesn’t help me here, but at least I can acknowledge that and work to change it. In fact, I’ve created an evaluative form ( http://www.somasimple.com/forums/showthread.php?t=2404) that minimizes my exposure to it.
I’m wondering; how do others separate story from narrative? How important an issue is this in the clinic? How has modern practice affected all of this?