I am cheating this week and multi-tasking through this blog post. I am simultaneously digesting feedback I got this week from an anonymous (academic) reviewer about my book proposal (“It’s just anecdote”), and a commentary I am giving tomorrow at a narrative ethics symposium in response to philosopher Hilde Lindemann’s paper entitled “Five Ways to Use Stories.” It is the Rabinowitz Symposium “Telling Stories, Revealing Narratives: Perspectives on Illness and Care” by the Program on Values in Society at the University of Washington. Lofty. Oh yes, and I am also talking with my 176 students about the use and misuse of anecdote in health policy.
Academese and anecdotes don’t mix. I suppose that anecdotes could be written in academese, but most seem written in laypersons’ ‘common’ language. They are more comprehensible and sharable that way. We don’t have to be pretentious or pedantic with anecdotes—they are akin to parables. So I am glad my book is being labeled anecdote and not academic.
Anecdotes for narrative advocacy can be powerful motivators for policy change. As academics, we like to believe that facts—scientific evidence alone will sway people towards certain actions, but people’s world views/values are much more important. Stories can be used and misused in health policy—as can any ‘evidence.’
Anecdote is secret, shadow history. It appeals to emotions. It cannot be used as scientific evidence. It is not to be trusted. Tricky things, anecdotes.
The paper I am commenting on has to do with narrative ethics, as opposed to traditional biomedical ethics, which Craig Irvine calls spaceship ethics, since it emphasizes detachment and the Grand Judge (terribly paraphrased here). Irvine describes narrative ethics as the moral coherence of stories—what stories can do and teach us about how to relate to others. As a somewhat down-to-earth health care provider who was trained in ‘classical’ bioethical grand principles, this all seems way too fuzzy.
I start to get a somewhat clearer picture about how narrative ethics could actually work in the real world by reading a short essay called “The art of medicine: narrative humility” by Sayantani DasGupta in the Lancet, 2008. Paralleling problems with the term “cultural competency”—we can know all about how to treat a patient from Mexico by having a list of Mexican cultural beliefs—is the problem with the term “narrative competency”—we can know all about our patients from the illness narratives they tell us. In contrast, cultural humility/narrative humility is a bit like Donald Schon’s reflection-in-action at a more spiritual level. DasGupta writes: “Narrative humility acknowledges that our patients’ stories are not objects that we can comprehend or master, but rather dynamic entities that we can approach and engage with, while simultaneously remaining open to their ambiguity and contradiction, and engaging in constant self-evaluation and self-critique about issues such as our own role in the story, our expectations of the story, our responsibilities to the story, and our identifications with the story—how the story attracts or repels us because it reminds us of any number of personal stories.” That’s a crazy-long sentence but I get what she’s saying. Plus, she comes up with even more than five things to do with stories. I am up to my eyeballs in anecdotes and narratives, and what I really want is a good bedtime story…