Celtic Spirituality

Renames Celtic Spirituality, formerly "Health Spirituality." We aim to encourage and develop awareness of the many benefits of a healthy faith with many innsights from a Celtic perspective. We explore the Mind-Body-Spirit connections. See also Paschal's home faith community at the website of Celtic Christian Chruch. Inspiration: Ps 23, Luke 1: "My sould magnifies the Lord...", & follwing 15 vv., and the words of Amazing grace. Noblesse Oblige.

Tuesday, February 17, 2009

Narrative Medicine by Rev. Canon Whitmer, Wayne Oates Inst.

I am privileged to post this part of an online course on the Healing Power of Stories by Rev Canon Marlin Whitmer, sponsored by the Wayne Oates Institute of Louisville, Ky. Fruther attributions and references at the end. Paschal, Feb. 17

Narrative Medical
I (marlin speaking) have revised this medical section. Exciting narrative insights have been
taking place in the disciplines of literature and medicine. I have followed the development for 25 years in the Journal of Literature and Medicine.

The first edition in 1982 is subtitled: Toward a New Discipline. For the sake ofbrevity I can not begin to track the complete history.
The editor’s first column serves as a good source of quotes to give us an
idea of what this journal has been about. She starts her opening paragraph
with an orientation metaphor, “possibilize.” “In Paterson, William Carlos
Williams speaks of divorce as “the sign of knowledge in our time.” Yet the
counter theme of that poem is marriage, a conjunction of seeming
incompatibilities. It is to help “possibilize” (to borrow James Joyce’s term)
such a conjunction that this journal has come into being.” (Rabuzzi, page
vii)
Later in her introduction she describes the focus of an essay by Larry and
Sandra Churchill “the stories patients tell, emphasizes patient’s needs to
engage in the act of telling.” (Rabuzzi, page viii) I have been “possibilizing”
my agenda envisioned by Fred Kuether and actualized by the Befrienders
for some years now. We have a unifying factor with all of humanity,
regardless of disciplines. Mavoreen as a volunteer with the Auxiliary made
the same observation as the Churchill's. Human beings tell and listen to
stories.
Scientific medicine is beginning to team up with the humanities to recover
this unity. Many of us in Pastoral Care are already aware of our role on the
team by “being a part but not a part” to use Paul Tillich’s expression in
“Courage to Be.”
Dr. Rita Charon’s book Narrative Medicine: Honoring the Stories of Illness
can be called an outcome of the Literature and Medicine Journal. The book
will also give you a thorough history of this approach. She is a medical
doctor with a PhD in Literature who can speak with authority in seeing unity
in narrative and medical practice. (Arthur Frank’s Review)
Clinicians are challenged to “become fluent in the tongues of the body and
the tongues of the self, aware that the body and the self keep secrets from
one another, can misread one another and can be incomprehensible to one
another without a skilled and deft translator.” (Charon, 107) I have used the
word “translator” to describe pastoral care as we move from Scripture to
everyday life. My hope for this seminar is to improve our translator skills.
She also differentiates a number of influences on our work. “Unlike
communication theory or interpersonal relations theory, a reading theory of
the clinic encompasses the dynamics of the relationship between two
people, the teller and the listener, but also conceptualizes the narrative
itself as a dynamic partner in their intercourse, able of its own to alter what
happens between them.” (Charon, 108) The conversation with Mr.
Geibelstein altered what happened between us as he moved words from
others to tell his story. I see this a different from a psychological view
although that is not deleted. I had a spokesperson for this perspective talk
to chaplains when we met in Boston during the 80s. A number walked out,
unable to see the place of metaphor in the framing of the story. A few years can make a difference.

She also affirms the perspective I will be working from. The primacy of
metaphorical thinking appears not only literary acts but in all our acts of
thinking and living. (Charon, 119)
Part 3 of her book has three chapters which covers “Developing Narrative
Competence.” I see her title as a metonymy for “story listening skills” from
both a medical and literary perspective. In some ways her book parallels
pastoral care using different words although her approach is from a
medical/literary direction. Her first section in Part 3 discusses “A Close
Reading” where she approaches listening in the way you read a book. All
the elements apply: frame, form, time, plot, and desire.
The narrative features of medicine are identified --- “temporality, singularity,
causality/contingency, intersubjectivity, and ethicality.” (Charon, 114) In a
few pages we will see her list has features similar to the 9 metaphors
identified by Rachel Stanworth in her research with dying patients at St.
Christopher’s in London.

Her chapter 7 on “Attention, Representation, and Affiliation” has even more
connections with pastoral care. Attention is primary for Stanworth as well.
Charon means, “a state of focused attention that requires the clinician to
actively mute the inner distractions to concentrate full power of presence on
the patient.” (Charon, 132) By so doing the physician gives voice to what
the patient can not articulate. At the same time she admits, “This
suspension of the self is poorly understood, certainly by medical
doctors.” (Charon, 133) We will look at this again, several times or more, in
this presentation as well. The self emptying will be addressed under the
Pastoral and the Biblical.

There are other doctors who are approach story from a different angle.
Herbert Benson does so from a “Remembered Wellness” approach.
Placebo is redefined as "remembered wellness" (Benson, p. 20-1). When
people tell their story they can move from sad times to good times and in
so doing they engage in self care from a health standpoint.
The placebo effect yields beneficial clinical results in 60-90% of diseases
that include angina pectoris, bronchial asthma, herpes simplex, and
duodenal ulcer. Three components bring forth the placebo effect: (a)
positive beliefs and expectations on the part of the patient; (b) positive
beliefs and expectations on the part of the physician or health care
professional; and (c) a good relationship between the two parties. (Benson
and Friedman, p. 193)
Because of the heavily negative connotations of the very words "placebo
effect," he hopes "remembered wellness" will replace it. Remembered
wellness has been one of medicines most potential assets and it should not be belittled or ridiculed. Unlike most other treatments, it is safe and
inexpensive and has withstood the test of time. (Benson and Friedman, p.
193)

One of my stories with "remembered wellness" came shortly after I bought
Dr. Benson's book on Timeless Healing. We had stopped in Las Vegas to
visit my Aunt residing in a nursing home. At one of the meals I sat next to
an elderly lady who after preliminary remarks began to tell me about the
death of her husband. Tears streamed down her cheeks. She continued
with different parts of her story. Then she began to tell me about the birth of
her younger sister in the family home. It was in the middle of the night when
she was awakened. When she reached the hallway an older sister chased
her back into her room. She began to laugh. Her sadness was gone the
remainder of the meal. I was a witness to what I had been reading about,
"remembered wellness." The telling of her experiences gave witness to the
placebo effect.
I would include the peace experience of patients part of the "remembered
wellness" effect and the same components can be manifest in the
relationship any person has with another. Lay people, then, become new
clinicians on the front lines of the pastoral/spiritual/health care delivery
system facilitating this phenomenon since health care is out in the
communities in a variety of settings. I may write an article on Narrative
Caregiving to include the stories heard out in the community.

REFERENCES

References:
Herbert Benson; Timeless Healing: The Power and Biology of Belief;
Scribner, New York; 1996; 350 pages

Herbert Benson, MD, and Eileen M. Stuart, RN, C, MS; The Wellness
Book: The comprehensive Guide to Maintaining Health and Treating
Stress-Related Illness; A Fireside Book, New York; 1992.
Herbert Benson, MD, and Richard Friedman, PhD; “Harnessing the Power
of the Placebo Effect and Renaming It "Remembered Wellness’”; Annual
Reviews of Medicine; vol. 47; pages 193-199;
Rita Charon, MD; Narrative Medicine: Honoring the Stories of Illness;
Oxford University Press; 2006; 266 pages
Arthur Frank, PhD; Review of Narrative Medicine; Literature ad Medicine
26, no.2 (Fall 2007), pages 408-412
Bible with the Apocrypha, New Revised Standard Version, Oxford
University Press, 1991, 432 pages.
Davidson, Stuart. (1996, November/December). Tomorrow's medicine:
Placebos and nacebos,Healthcare Forum Journal, p. 48-50.
Esther de Waal; Every Earthly Blessing: Celebrating a Spirituality of
Creation; Servant Publications, Ann Arbor, Michigan; 1991; 148 pages.
Esther de Waal; The Celtic Vision: from the CARMINA GADELICA --- Orally
Collected in the Highlands and Islands of Scotland by Alexander
Carmichael; St. Bede’s Publications, Petersham, Mass; 263 pages.
Susan K. Hedahl, Listening Ministry, Fortress, 2001, 123 pages.
George G. Hunter III, The Celtic Way of Evangelism, Abingdon, 2000
Levine, Carol, and Murray, Thomas H., Ed.; The Cultures of Caregiving;
Johns Hopkins University Press; 2004; 187 pages
Pennebaker, James. (2000, Spring). Telling stories: The health benefits of
narrative,Literature and Medicine, Vol 19, No 1, p. 3-18.
Pennebaker, James, and Francis, Martha. (nd). Linguistic inquiry and word
count, University of Texas at Austin; Published by Lawrence Erlbaum
Associates, Software and Alternative Media, Inc.
Pennebaker, James (web site search name: James W. Pennebaker)
http://homepage.psy.utexas.edu/homepage/faculty/pennebaker/Home2000/
JWPhome.htm
Smyth J.M., Stone A.A., Hurewitz A., Kaell A. (1999, April 14). Effects of
writing about stressful experiences on symptom reduction in patients with
asthmatic or rheumatoid arthritis: a randomized trial, Journal of the
American Medical Association, 281:1304-1309.
Spiegel, David. (1999, April 14). Healing words: Emotional expression and
disease outcome,Journal of the American Medical Association, 281:1328-9.
Stanworth, Rachel; entitled originally 'Spirituality, language and depth of
reality" ; is reprinted from the International Journal of Palliative Nursing, Vol
3 No. 1, Jan-Feb 1997
Stanworth, Rachel; Recognizing spiritual needs in people who are dying;
Oxford University Press, 2003, 255 pages
K. B. Thomas; “The Placebo in General Practice’; Lancet; Vol 344; October
15, 1994; pages 1066-7
VanderCreek, Larry; “Tragic Events and the Benefits of "Cognative
Processing’ and "Finding "Meaning’.” The APC News, Nov/Dec 2002, page
15
Vaisrub, Samuel, Medicine's metaphors: Messages and menaces.Oradell,
NJ: Medical Economics Co., 1977, 124 pages.
footnote: Iʼll be sending a separate e-mail to explain