How do you balance the intentions of maintaining the necessary privacy and safety of providers while also pushing the envelope to tell stories about a stigmatized subject in order to undo that very stigma?
I will be exploring this question in a series of articles, highlighting individuals and organizations that use Narrative Medicine to de-stigmatize experiences in reproductive health care.
Narrative Medicine is a powerful tool for community building, with applicability to health care teams, educators and colleagues in academic environments, and activists working in social justice movements and community organizing. Narrative Medicine is a meeting place where people gather to explore how storytelling functions in relation to health and social issues.
In an article, “Narrative Medicine Isn’t the Same Old Story,” the author describes it in terms of how the field relates to medical humanities and greater criticisms of medical systems,
At first glance, narrative medicine might appear to be a slight encroachment of the “soft” sciences upon steadfast medical empiricism – or, dare I say it, “some New Age shit.” But those involved in the field – students, teachers and allies – are proving that narrative medicine poses both a credible threat and a powerful alternative to the medical-industrial complex, which began with the corporate takeover of US health care in the late 1980s and early 1990s, and has only become more institutionalized since.”
One of the most important aspects of Narrative Medicine, especially in how it relates to reproductive health, is the assertion of Narrative Humility.
Dr. Sayantani DasGupta, professor in the Program in Narrative Medicine at Columbia University and the graduate program in Health Advocacy at Sarah Lawrence College, flipped Cultural Competency on its head: Narrative Humility implies an internal focus, i.e. what are my beliefs, assumptions, prejudices, and fears, and how do they contribute to my interactions with others? Humility, in this context, means we know we are very limited in our knowing of any Other.
This is a stance from which to witness stories, based in the recognition that:
- Each person’s story belongs to them
- We cannot claim to know the totality of another or their story
- The primordial ethical act is to answer the call of another
As Dr. Sayantani DasGupta puts it,
“Narrative humility means understanding that stories are not merely receptacles of facts, but that every story holds some element of the unknowable. It simultaneously reminds us that there are larger sociopolitical power structures that marginalize certain sorts of stories and privilege others. Narrative humility suggests an inward orientation, requiring not only that we learn about others, but that we begin by learning about ourselves—how our past cadre of life stories has built our prejudices and preferences, and how by the very act of listening, we ourselves are always changed into different kinds of listeners.”
Narrative Medicine, and the concept of narrative humility in particular, asserts the importance of storytelling and maintains an ethical stance as it examines the way in which stories get told — who has the right to tell a story, whose stories get listened to, whose stories are ignored, and so on. Stories are shaped by multiple layers of social, situational, cultural and political factors.
When we apply this concept to reproductive health, we see stories as tools for change. What happens when many people share their stories? When patients tell their stories about getting an abortion or early pregnancy loss? When residents tell their stories of trying to incorporate comprehensive reproductive health services into their practice post graduation? When providers, from physicians to advanced practice clinicians, tell stories about how people react when they find out their profession?
I will continue to explore these questions in future installments, highlighting how a handful of powerful individuals and organizations are working to create space for more stories to be told.
– Elsa Asher
Elsa is a writer, full spectrum reproductive health advocate, and Narrative Medicine educator. She holds an MS in Narrative Medicine from Columbia University and is a current TEACH intern. www.elsaasher.com