Narrative Medicine: Relationships, Stories, and Healing

A medical doctor trained at Stanford University School of Medicine, Lewis Mehl-Madrona has pioneered the conscious integration of Native American approaches to healing with 21st-century health care. He is the author of Coyote Medicine, Coyote Healing, and Coyote Wisdom, a trilogy of books on what Native American culture has to offer the modern world. In this excerpt from Narrative Medicine: The Use of History and Story in the Healing Process, he discusses how relationships and the sharing of our personal stories can be tools for combating disease.

The Power of Large Groups in Shaping Identity

A few people have a bed for the night
For a night the wind is kept from them
The snow meant for them falls on the roadway
But it won’t change the world
It won’t improve relations among men
It will not shorten the age of exploitation.

—Bertolt Brecht

Imagine a ceremony in a rural area near Duncan, British Columbia, on Vancouver Island. In the longhouse, a youth is being initiated. Two hundred people are singing. The rhythm of multiple drums and rattles sets the pace. The youth is lying flat. He is lifted up and carried on the shoulders of eight men. He remains this way for four days after which time he is returned to the vertical. The collected energy is awe-inspiring. Even the trees outside are vibrating in the thick fog.

Western culture has forgotten the power of large groups. Modern culture’s closest version is the sports spectacle, which has a very different intent from ceremony and ritual. Religious services provide us with some sense of group power, but modern religion has vitiated the power of its ceremonies so greatly that it is hard to feel. (Notable exceptions to this generalization exist, including in some Roman Catholic masses, evangelical revival meetings, and Gospel churches.) While we can still go to ceremony in areas rich in aboriginal culture, it has vanished for much of the urban world.

In my teachings about ceremony and ritual, I like to show people how easy it is for a group of strangers to come together, create shared ceremony that is inclusive of elements of all their cultures, and then enact it. Whenever people gather with the same intent, coherence occurs. Coherence implies connectivity. In essence, we hook up. Hearing stories is healing. It requires a group setting to produce those stories and to hear other people’s stories. Within the group, we can hear the story and consider its source. Others are present to corroborate the story, thereby demystifying it. We have a diversity of sources supporting a common story. As people have become more and more isolated, however, such group experiences have become progressively less common in modern life. Lost along with the sense of community group experiences engender, is the opportunity to take a storied approach to health care through a process of group re-authoring. Groups that can provide this do still exist, and include Alcoholics Anonymous, the Native American church, and others in which people give testimony and the group reshapes the story, in a sense “re-authoring” a new story in a collaborative framework.

Life is storied and narrative is the mode in which meaning and values are stored. This allows for multiple techniques for transformation. We are not limited to one set of local practices and values, regardless of how successful they are in that locale. They may not generalize. As one elder told me, “When you think you know what you’re doing, you don’t. When you think you know what’s going on, you’re wrong.” That’s an important perspective to keep. We can talk about what we think we’re doing and what we think is going on as we work collaboratively with others, but in the spirit of remembering that we’re probably wrong and we’re only making gross approximations anyway. Transformative practices and results spontaneously emerge in large groups when people gather with the same intention, defying rational explanation.

In medicine, we doctors are faced with the difficulty that most of us don’t know that we have a story. We think everything we do is the factual truth. We forget that history really means “his story” or “her story.” When we talk to someone about her illness, we are actually helping her tell her story, how she came to be where she is. Having other family members and friends present results in a much richer story than would emerge with just the individual there. Health care is supposed to build on the story with each contact, but if we don’t know the story, each contact becomes a closed episode of its own, disconnected from every other episode. Fragmentation results as the outcome of a nonstoried approach to health care.

Disease Is Found Within Relationships

In the view of conventional medicine, disease is found within organs. Autopsies with microscopic confirmation are the ultimate form of diagnosis. When we look for disease, we look for structural and enzymatic changes within individual organs. Aboriginal elders tell me that what we are seeking is only the footprint of the disease. Looking as we do, we only find the tracks and traces of disease, which, they say, is long gone by the time a person dies. Look for the disease within the relationships, they say. That is where it is found. The rest is consequences and effects of the disease. This leads us to a consideration of the logic behind spiritual healing, for it addresses what lies between people, or between people and spirits, or people and earth energies.

Is some of the potential value of conventional medicine that it offers a break from being accountable for our own health as people? If it’s all random and biological and genetic, then it’s best left up to the experts. We can relax. We don’t have to change anything. We’re not responsible. We can just do what the experts tell us and let the chips fall where they may. For Europeans, modern medicine also broke the tightfisted hold of the church. In that context, illness had been seen as punishment from God. Illness was not supposed to be cured because doing so interfered with God’s divine will to punish. Healers were burned at the stake in thirteenth-century France and Spain. Conventional medicine freed Europeans from this terrible burden, from this belief that illness was justified punishment. If it was merely random and genetic, and people weren’t responsible, then the Church had to stop vilifying the sick. Clearly this was a step forward.

What must be pointed out, however, is that indigenous cultures didn’t need this liberation. While the conventional medical story may have liberated Europeans who had been held captive by the Roman Catholic Church, it was not so beneficial to aboriginal people who did not have the same need for liberation. An Assinboine elder put it bluntly:

From the treaty, they took everything away, the diet, the way of life; all that was put on the earth by the Great Spirit. The new diet made the people weaker. It was too much change, too quickly … [The old people] say that they brought sickness over from across the water; sickness like typhoid fever. And after they got rid of the Indian medicine and the people had to take white medicine, and some of it made us real sick. They kind of damaged our bodies through pills and their side effects. They were experimenting on us. It was the tame food, too. We were used to eating wild game. That’s why they figured our bodies lacked the strength they had before.

Thus, narrative medicine represents a search for a storied understanding of health and disease that works for all the world’s peoples, and not just Europeans. It is as compatible with indigenous knowledge and healing as it is with European-derived approaches. It is not compatible with a position, like that taken by much of medicine, which restricts truth to only one story—that of biology and genetics. Conventional medicine has served people by freeing them from the bondage of Old World religions and giving them permission to not heal, address change, or restore balance and harmony—to just relax and be passive. Some need this, and we can be thankful that it is available for them. But not everyone wants this approach, which is why we need diversity and a more narrative approach to medicine.

Those of us who attempt to bridge the Native world and the world of conventional medicine are trying to conceptualize and integrate the wisdom of indigenous cultures with biological medicine. We believe that current medical explanations for health and disease are culturally driven, and that we cannot separate biology from culture.