Skip to content

Thursday Review: “Performing Narrative Medicine”

I was initially interested in Kristin M. Langellier’s article because of the idea of performance. The main project of my work in medical storytelling has been to take the ideas bound up in Narrative Medicine and apply them to face-to-face interaction. With Narrative Medicine, my concern has always been that narrative skills are often parallel to, and not a part of, clinical practice.

Writing in the Journal of Applied Communication Research, Langellier writes that although attention to narrative performance is never absent from [Rita Charon’s 2006 book] Narrative Medicine, it is sometimes overshadowed and obscured by textualization. Humans learned to speak before we learned to write. Text, then, is formalized and recorded speech, and Langellier writes that all of the textual skills which Charon advocates depend on performance, and I wholeheartedly agree.

The bulk of the paper is spent relating some of Charon’s ideas with aspects of performance theory. The author is likely intending this article for other critical and communication theorists, so the language is dense with terminology. Langellier tends to alternate back and forth between discussions of Charon’s work and theoretical underpinnings.

Among the discussion is the confirmation from various sources that narrative in general and the act of speaking in particular1 can teach us things we know but didn’t know we knew.2 This act in and of itself makes talking to one another important, especially in a medical context. In addition, there is a discussion about the “intersubjectivity” of communication. Words are not spoken in a vacuum; in very real ways, we co-create narratives and stories when we speak to someone else.

In the discussion of Charon’s “close reading”, Langellier framed the discussion in a way I hadn’t considered before: stories allow us to do two contradictory things. Stories let us both summarize information and not summarize it. In other words, stories let us listen closely, with subtlety, and let us hear what’s truly going on when things get messy.

The summarizing aspect of stories is a cornerstone of my work. From a high level, stories and narrative let us hear who is doing something, the activity they are doing, and why they are doing it. A lot of my work in story is about helping professionals understand the structure of stories. In other words, that stories are another way of helping people communicate 1) Why? 2) How? then 3) What? when our everyday way of communicating is usually 1) What? 2) How? 3) Why?3

This way of perceiving stories is important, among many reasons because it helps broadly understand the cause-and-effect relationships of what we’re talking about. Another aspect of stories, however, is that they help us not to summarize. There is a time in human interaction when a listener that skims, skips, and scavenges for information won’t do. We are complex people, and our narratives are complex relations. We need to understand one another not simply, but richly, with subtlety and with texture. Our complex nature that spills over into our stories means that sometimes an understanding of complexities, contradictions, and secrets is required, and I’m sure health care providers can’t practice for very long before even an average person’s contradictions and secrets surface.

This is a useful aspect to talk about in medical storytelling: that listening for information and content is good, but sometimes, listening for understanding requires something deeper. This listening requires the professional to bring the whole [story] close to themselves.4

There is still, though, the question of how Narrative Medicine makes medicine better. Langellier provides a wonderful quote on the nature of narrative competency in a professional environment:

Narrative skills are practical arts of embodied knowledge—of knowing how to do something as well as knowing that something.

The author continues, and focuses on medicine specifically:

Narrative competence is based on performance as the gestures of hands and posture, glances and gazes, inflections of voice which are the bodily techniques of speaking and listening to reveal or conceal, empathize or avoid, come close or stay apart. These matters of style, habits of the body, and “second natures” of routinized response come out of the repertoire or sensibilities of people involved in institutional and interpersonal relations. Participants’ spontaneity, like that of the artist of improvisation, emerges from repeated practice. It is these routines that narrative medicine wants to undo and redo as new bodily habits of telling and listening, reading and writing.

I find this both comforting and frustrating. Comforting in the sense that the ideas of Narrative Medicine infuse themselves into everything a healthcare professional does, and that it makes a difference in their practice. At the same time, the answer to the question “What does Narrative Medicine look like in practice?” seems to lie somewhere between “It’s complicated.” and “It’s subtle.” That seems frustrating: that healthcare providers who want to make their practice more human, more caring, and more humane find no concrete and immediate answers about what they can do when they see their next patient in an hour.

As if anticipating my frustration, Langellier closes her article by asking questions which, broadly speaking, are the ones I’ve raised: What is our desire—as professors and researchers, as physicians and patients—in performing narrative? What world do we create in this desire for the pleasure and power of storytelling? What is our investment in storytelling? Are we storytelling to save lives? To save ourselves?

As if wanting to add to my frustration, Langellier doesn’t answer them.


The article reviewed: Langellier, Kristin M. “Performing Narrative Medicine.” Journal of Applied Communication Research 37, no. 2 (2009): 151–58.

1 Merleau-Ponty, Maurice. The Primacy of Perception. Edited by James Edie. Translated by William Cobb. Evanston, Illinois: Northwestern University Press, 1964.

2 Charon, Rita. Narrative Medicine: Honoring the Stories of Illness. Oxford, UK: Oxford University Press, 2006. xii.

3 Sinek, Simon. Start with Why: How Great Leaders Inspire Everyone to Take Action. New York, NY: Portfolio, 2009.

4 Bacon, Wallace. The Art of Interpretation. New York, NY: Holt, Rinehart and Winston, 1966. 19.

Featured Image: Detail of Ether Day, or The First Operation Under Ether, by Robert C. Hinckley (1853 – 1941). The painting is in the public domain. The original is in the Francis A. Countway Library of Medicine at Harvard University.