Showing 41 - 43 of 43 annotations contributed by Carter, III, Albert Howard
This is an ambitious and far-ranging book, the result of years of thinking, teaching, and working with patients. An internist at the College of Physicians and Surgeons at Columbia University, Charon sees a wide range of patients in an urban setting. Also a Ph.D. in English literature, Charon has devised a "Parallel Chart" and other means for caregivers to write personally about the dynamics between healer and patient, to read texts--narratives in particular--and, as a result, to listen better to patients, thus improving the delivery of medical care.
Charon defines narrative medicine as "medicine practiced with these skills of recognizing, absorbing, interpreting, and being moved by the stories of illness" (4). She calls this a "new frame" for medicine, believing that it can improve many of the defects of our current means of providing (or not) medical care. Caregivers who possess "narrative competence" are able to bridge the "divides" of their relation to mortality, the contexts of illness, beliefs about disease causality, and emotions of shame, blame, and fear.
Charon finds that medical care and literature share five narrative features; she argues that careful reading of narratives builds skills that improve medical care, including intersubjectivity between caregiver and patient, and ethicality. Beyond the theory, there are powerful and persuasive examples of interactions between caregiver and patient, many from Charon's own practice. A mother of a sick daughter experiences stress that makes her ill; when she sees a narrative connection, she begins to heal.
Charon sees wider applications. As caregivers understand better concepts of attention, representation, and affiliation, they become more ethical, more community minded, and better healers to their patients. Patient interviews will be different: instead of following a grid of questions, physicians will converse with patients in an open-ended way. What is most important will emerge and emerge in ways that are most beneficial to the patient. Yes, this method will take more time but it will be more efficient in the long run. Bioethics, Charon argues, has been limited by legal approaches and philosophical principles. For her, narrative bioethics offers more human values in how people feel, experience reality, and relate to each other. Finally, there are implications for social justice: why are the poor underserved in this country and in many others?
One of the most exciting and radical formulations comes late in the book: ". . . practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument" (p. 215). This notion links up fruitfully with concepts of energy medicine (v1377v), therapeutic touch (Tiffany Field), and intentionality (Wayne W. Dyer).
This densely packed book follows Oschman's Energy Medicine: The Scientific Basis (2000, see annotation) with applications to medical treatment and--very briefly--human performance (athletics, dance, music). Oschman, a cell biologist, shows how electroencephalograms, electrocardiograms, and pulsing electromagnetic fields (which can heal broken bones) are accepted medical technologies, while theoretically related Healing Touch, Therapeutic Touch, Qi Gong, Reiki, Reflexology, massage, etc. are widely used and effective but generally (and inaccurately) considered to be alternative medicine.
According to Oschman, contributions from quantum physics explain that the energies of the body are subtle, instantaneous, and highly efficient in regulation and healing at the cellular level. The body is best understood as a living crystal, which can semiconduct energy, translate physical energy (such as touch) to piezoelectricity, and maintain coherence and continuity. Given our evolutionary heritage, we can sense from healers their intention, empathy, and healing energy. Our bodies heal themselves with energy provided by both standard and nonstandard medicine.
Moller is a sociologist who takes us into the world of the urban poor; he focuses on half a dozen individuals, giving intimate and moving portraits of them. An opening character is called Cowboy (a pseudonym); he lives under a bridge with his dog Cowgirl and dies a slow death of lung cancer. In an Epilogue (pp. 163-184) Moller calls him "an urban Thoreau." This respect for the dying poor pervades the book.
Besides descriptions of the characters, there is much dialogue, including extended quotations, but also some 100 small photographs, usually close-ups, inserted into the text. One photo shows a man in his coffin. Clearly Moller gets close to his characters, and so does the reader.
Moller argues that the dominant society--to its shame--neither supplies adequate care for this sector of society nor even recognition that such people exist. He calls the dying poor "an invisible world." It's a disturbing world, with the pain and neglect, but also an inspiring one, because of the caregivers such as social workers and nurses and the heroism and dignity of the patients presented.