Narrative Medicine

The search for medical care leads to the need for interaction between the patient and the doctor, in which there is a meeting of narratives. The patient's narrative is an important base of work for the physician who will diagnose and care, however, its interpretation and communication, in the therapeutic sense, will obey ethical and moral commitments. This relationship of dependence is part of the medical narrative formulation whose ultimate contribution will be a therapeutic response recognized and accepted by the patient.
Keywords: Narrative; Ethics; Moral; Medicine; Therapy

An introduction to the blind-spot in medicine: human existence is systematically left out of healthcare. Two stories are told that introduce this blind-spot. The first is that of Kurt Goldstein, the WWI German neuropsychiatrist who describes a crisis in modern medicine. The second is that of Médard Boss, a WWII Swiss neuropsychiatrist that finds that medicine has trained him poorly to treat problems of meaning and existence. Time is spent differentiating existential health psychology from health psychology and complementary or alternative medical models.

This essay frames the autoethnographic show, I Got Your Back: A One(ish) Person Show Exploring Pain, Empathy, and Performance within scholarly conversations around pain, performance, medicine, and crafting. We operationalize empathy as an action through which the relations between performance and medicine/ care, subjectivity and witnessing, and pain and embodiment are made manifest under the inadequate U.S. healthcare model. Through a descriptive analysis of our work as co-writers, coperformers, friends, and director and performer, we propose what we call crafting empathy as a methodological and aesthetic performance practice with aspirations toward the tradition of coperformative witnessing.

This article considers nineteenth-century Scottish author Robert Louis Stevenson’s portrayal of pediatric illness in his renowned collection of poetry, 'A Child’s Garden of Verses' (1885). Stevenson, who suffered frequently from poor health, drew upon his own experience to give voice to youthful narrators whose resilience is due in part to their ability to conceptualise and interact with generative spaces beyond the physical limitations of illness-induced isolation. For these children, the enactment of therapeutic adventuring into imaginative realms leads to vibrant engagement with the world beyond their immediate settings and, ultimately, to a more hopeful outlook.

A z orvoslással, orvostudományi kutatásokkal és biotechnológiával kapcsolatos etikai megfontolások az 1970-es évektôl új lendületet kaptak. Ebben az idôben jelent meg és vált világszerte népszerûvé a bioetika kifejezés. A bioetika felfogható az orvosi etika több ezer éves, Hippokratészig visszanyúló hagyományának szerves folytatásaként, ugyanakkor fontos látnunk, hogy a bioetika saját megközelítését és céljait jórészt az orvosi etikával szemben határozza meg. A hagyományos orvosi etika és a modern bioetika között több lényegi különbség is van. Az egyik, hogy a bioetika inkább a legújabb orvosi lehetôségekre, tudományos felismerésekre és technológiai áttörésekre összpontosít, érdeklôdésén belül a napi klinikai gyakorlatban megszokott etikai helyzeteknél nagyobb figyelmet kapnak például a szervátültetés, génmódosítás, ôssejtkutatás, klónozás vagy az idegtudomány jövôbeli kilátásaiból eredô etikai és társadalmi problémák.

This case study is an example of narrative medicine applied
to promote self-awareness and develop humanistic
contents in medical education. The impact and the human
appeal of the narrative lie in the maturity and empathy shown
by a student when reporting his dramatic experience during
the care given to a newborn (with Patau syndrome and multiple
malformations diagnosed at birth) and to her mother.
The narrative approach helped the student to be successful
in bringing out the meaning behind the story and to position
himself from the mother’s and newborn’s perspective. The
student’s introspection changed a seemingly scary interaction
into a positive experience, overcoming many initial
negative emotions, such as fear, disappointment, horror,
hopelessness, and insecurity in the face of the unexpected.
It is uplifting how the student was strengthened by the power
of maternal love to the point of overcoming any remaining
feelings of eugenics or rejection. Other important lessons
emerging from the case study were the art of listening and
the value of silence. This narrative shows how the development
of narrative competence can help establish a good
physician-patient relationship, because the physician or the
student with such competence usually confirms the patient’s
value and demonstrates concern for them, focusing on what
they say and allowing genuine contact to be established,
which is necessary for effective therapeutic alliance. The
student’s interpretations of the meaning of love and value
of life inspired him on his reframing process of a medical
practice marked by vicarious suffering.

Patients with hypermobile Ehlers-Danlos syndrome, an hereditary disorder of the connective tissue, often face a long and difficult diagnostic odyssey in pursuit of a name for their condition. Clinicians may dismiss subjective symptoms of chronic pain, thus prolonging patients' odysseys and worsening their care and satisfaction and creating antagonisms in the patient-provider relationship. A greater understanding of patient experiences is necessary in order to decrease burdens of this relationship and to improve care. To that end, we conducted 22 in-depth, semistructured interviews with individuals who had undergone this diagnostic odyssey. We focused on the impact that the odyssey had on their lives, both inside and outside the clinic. Through

As part of our family medicine clerkship seminar on the patient-physician relationship, third-year students write about an illness episode within their own families. Using a grounded research approach, we examined 260 student narratives to extract the most significant meanings. Significant themes that emerged include the role of family members in illness episodes, specific influences resulting from the family's ethnicity or religion, experiences with socially unacceptable illnesses, experiences with death, appreciation of the moral trajectory of illness, and situations that display the fallibility and limitations of medicine. Writing exercises can help students recognize the centrality of narrative and of cultural values in medicine so they are better able to understand their patients and provide more patient-centered medical care.

Disability and anti-poverty activist A. J. Withers' recent book, Disability Politics & Theory, is an open denunciation of what Withers call the "medical-industrial complex," which includes "doctors, medical researchers, pharmaceutical corporations, insurance corporations, hospitals and others involved in the medical industry" (31). This book rejects the medical model of disability, in favour of what Withers call the radical model: an inclusive recognition of a community based on solidarity and openness. (Instead of working on assumptions and in respect

Uno studio intorno allo sguardo in medicina: sguardo non romanticamente inteso ma sistemicamente ricondotto a questioni inerenti il ragionamento clinico e lo studio della complessità.
Una domanda riflessiva intorno alle competenze riflessive di chi cura.

, een reuzenluipaard, de sluipwesp en de onzichtbare fee Mmotia uit het oerwoud gehaald. Als beloning mag hij nu de doos gevuld met verhalen ophalen in de hemel. De God van de hemel, Nyama, geeft hem met pijn in het hart weg. Maar ja, een man een man, een woord een woord. Dat was toch een van de eerste lessen die hij de mens had geleerd. Dan kun je als God niet opeens terugkrabbelen. Daar word je ongeloofwaardig van. Als God van de hemel kun je je van alles permitteren, maar dat nou net niet. Terug op aarde roept Anansi alle dorpelingen bijeen om het openen van de doos bij te wonen. Anansi doet dit in de opwinding te enthousiast, waardoor de verhalen ontsnappen. De mens moet vanaf dat moment op zoek naar zijn verhaal. (Bohlmeier & Westerhof, 2010) 3

Susan Sontag’s Illness as Metaphor and AIDS and Its Metaphors critiqued the use of metaphoric language, particularly military metaphors of invasion and battle, to describe illness experiences. Metaphors generate explanatory narratives, just as stories often use a resonant metaphor as shorthand for theme. Metaphors and narratives can suggest reductive or stereotypical ways of imagining illness, disability, and other experiences of embodiment. Rather than an end to metaphoric framing of illness, however, the agency to make metaphors needs to be conferred to a larger constituency that always includes the patient. The author’s first-person ovarian cancer narrative illustrates that not having the capacity to make metaphors for one’s embodied experiences can mean late diagnosis; the dearth of effective public metaphors for imagining some internal organs, such as the ovaries, contributes to the problem. Metaphors can be reductive, but they can also generate a wide range of relationships between illness and the person experiencing it, as illustrated by examples including Margaret Atwood’s short story “Hairball.” Simile in particular, which expresses similarity but not equivalence and thus does not erase difference, can generate a healthy way of imagining illness. Some recent literature has suggested that doctors use metaphor to communicate with patients; this gives doctors the power to determine which metaphors will frame the illness and direct its narrative. The lessons of narrative medicine, which advocate that patients and doctors use narrative collaboratively to generate a more effective understanding and treatment of illness, need to be extended to include metaphor.

Narrative medicine is an approach to medicine which seeks to combine with and enhance conventional evidence-based medicine by adding perspectives and experience in medical humanities. The chapter expounds on the importance of effective communication with patients and in particular on the importance of having some structured protocols (scripts, interview prompts, and the like) to encourage more comprehensive and effective patient narratives and to allow for increased comparability between them. It tells the story of an emerging collaboration with Minimal English and an international pilot study applying Minimal English to such protocols.

Stigma against fat people permeates every level of healthcare, yet most attempts to reduce weight stigma among healthcare providers have shown only marginal results. Fat studies, a field that rigorously interrogates negative assumptions about fatness, can help social psychologists understand weight stigma by centering the pathologization of fatness as a major contributor to weight stigma at the structural and interpersonal level. A fat studies approach also reorients the normative goal of weight stigma interventions from reducing stigma to eradicating stigma and calls for methods that reject weight stigma’s roots in medicine and medical discourse. Even nuanced and sympathetic models of “obesity” cannot combat stigma that is structurally based in medical authority. We applied these principles to develop a new method of weight stigma intervention: direct contact structured through narrative medicine. In a qualitative pilot study, four medical students and two fat activist community members met for five 2-hour narrative medicine workshops over five weeks. All participants completed focus group interviews about the experience. Interview transcript analysis revealed that these workshops provided a space for depathologizing, humanizing, empathy-inducing, and power-leveling interactions between medical students and fat people, where members of both groups reported benefiting from the experience. We conclude that non-pathologizing approaches to eradicating weight stigma are not only feasible, but both ethically and methodologically necessary.

European Union’s statistics show that comparative recent data on life expectancy position Romania by the end of the hierarchy of European countries. 2005-2014 collected data in Europe show that only 48 percent of Romanian men reach 75 years of age, compared to 67 percent of all 28 member states data related to men, and 71 percent Romanian women reach same age, compared to 81 percent of European women. Romania stands for a vast majority of cardiovascular issues causing death both in men and women (Eurostat, 2013). World Health Organisation has listed in 2016 three major categories on aggravating factors in cardiovascular diseases in population – social and economic environment, physical environment and individual lifestyle. Addressing the latter, narrative medicine approach could impact the way the patient acknowledges the lifestyle changes one has to make in order to prevent, manage or cure cardiovascular disease. Analysing the way medical practitioners explain, participate and involve the cardiovascular patient in becoming aware of the risk and avoiding it, is part of the patient-centred care, focused on communication between the patient and his/her doctor. Through narrative approach medical practitioners not only address patient’s complaint, his obvious physical problems arising from anamnesis (Schleifer, Vannatta, 2013) but his concern about his health, described as how the patient feels about being ill and how he envisions him becoming healthy again. The study will present a qualitative analysis of interviews with cardiovascular patients and the impact of narrative medicine approach in doctor-patient communication. How important in the behavioural change of a cardiovascular patient is the way his doctor addressed his concerns, not only his illness? How the improved patient-doctor communication contributes to the concept of cardiovascular revolution? The concept (Vallin, Mesle, 2004) is one considering the decrease in mortality from cardiovascular diseases in Europe due to several factors, who include both general conditions and country-specific contexts. The cardiovascular revolution presents itself in different speeds – more accelerated in Western Europe, less in other countries, due to fundamental changes in behavioural risk factors, but also medical technology and disease prevention. Studying the narrative of patient-doctor relationship in cardiovascular filed might bring some additional valuable information to tackle the current situation.

There are few issues more emotional and divisive than what has become known as “the right to die.” One camp advocates the “death with dignity” approach, according to which the patient is an autonomous being who can form his or her own judgment on the timing and process of dying. The other camp advocates the sanctity of life approach, in which life is intrinsically valuable and should be sustained as long as possible. Is
there a right answer?
    In The Right to Die With Dignity, Raphael Cohen-Almagor takes a balanced approach in analyzing this emotionally charged debate, viewing the dispute uniquely from public policy and international perspectives. This book offers an interdisciplinary, compelling study in medicine, law, religion and ethics. It is, arguably, the most comprehensive book yet to be written on the fascinating question of whether physician-assisted suicide should be allowed. Cohen-Almagor delineates the distinctions between active and passive euthanasia and discusses some of the legal measures that have been invoked in the United States and abroad. He outlines the reasons non-blood relatives should be given a role in deciding a patients’ last wishes. He examines euthanasia policies in the Netherlands and the 1994 Oregon Death with Dignity Act, suggesting improvements to each. Finally, he makes a circumscribed plea for voluntary physician-assisted suicide.

The paper departs from the assumption that while the analysis of the systematic effect that popular cinema (genres like melodrama, horror or action movies) has on its spectators has been largely discussed by film theorists, little has been written on the affective dimensions of arthouse cinema. The lasting effect of visually compelling films on the individual spectator's emotions has been addressed only sporadically by cognitive film theory, film phenomenology and aesthetics. Therefore, the author proposes to bring together terms and concepts from different discourses (film and literary theory, intermediality studies and empirical psychological research of the literary effect) in order to elucidate how intermedial, painterly references in midcult and arthouse films mobilize the associative dimensions of film viewing and may have an impact on spectatorial selfreflexion and emotional growth. Moreover, films that rely on the associative power of still(ed) images, painterly references bring into play the personal and cultural experiences of the viewer. As such, they can be effectively used in professional and cultural sensitivization.

The interactive fields of philosophy of psychiatry, philosophy of mind and psychiatric ethics have proved excellent frameworks in which to examine conceptual changes in our understanding of the human being during the last two centuries. Comparatively little has been written in the field of moral philosophy about these insights into the nature of moral agency, subjectivity and other fundamental concepts that enrich our understanding of mental health. The aim of this chapter is to develop Iris Murdoch’s work on moral perception in this novel direction. In doing so, it speaks to recent philosophical and empirical work on therapeutic understanding through literary expressions and illness biographies, which I use to explain why narrative self-creation is central to the recovery process. My new argument of narrative understanding in psychiatry explores the wider implications of relational moral agency for psychiatric ethics. This deliberate move away from an overly individualistic conception of the moral self to an intersubjective one creates opportunities for self-cultivation in concept application and the normative grounding of concepts.

Autobiographical narratives of illness and disability are influential in popular and medical discourses of illness and disability, in part because these narratives represent illness and disability within a sociocultural context, intersecting with other categories of difference. Clinicians can benefit patients through a critical understanding of the formal and social conventions that shape illness and disability narratives and the effect these conventions can have on the lived experience of illness and disability. I analyze the 2003 edition of Lucy Grealy's Autobiography of a Face to illustrate these socio-narrative conventions, especially in light of an afterword that significantly revises the ending to Grealy's narrative. I explore the parallels between narrative conventions-such as the "recovery narrative"-and caregivers' expectations that shape the role of the "good patient," as well as the resistance to conventions of closure, represented by the "renegotiated ending."

Illness as Literature
Malady studies

Summary

Monika Ładoń’s book refers to and disputes a famous essay Illness as metaphor by Susan Sontag. The authoress recognizes the potential of Sontag’s consideration and the fact that the American writer’s views were marked very strongly in the malady discourse. To this day, they are cited by literary scholars, culture experts, sociologists and doctors, which proves that the written in 1978 text is still very relevant. Yet Sontag’s essay evokes discussions and questions whether the suggested struggle with metaphors (especially the ones of tuberculosis and cancer) is a radical endeavor, which precludes understanding. Although Sontag’s book is a background of modern concepts of research on illness, the literature and the cultural understanding of it prove that the baggage of allegedly harmful metaphors is an irremovable element of the illness narrative.
The researcher proves in her book that an illness is a fact (as Sontag writes), but also the effects she unveils which are connected with giving sense and meaning and changing the fact into a sign or interpretation. This attitude results from the twentieth-century understanding of metaphor, which expanded its meaning. It is no longer only a stylistic or rhetorical device, but also a mechanism of understanding. This book is trying to grasp the condition of increased interest in illness over the last years, which is methodolical and unsystemic one. It uses various exploratory languages and inspirations.
Despite the polemics with Sontag’s concepts, the authoress finds her essays thought-provoking. It can be seen in the title of the book, in the phrase: Illness as... The creative Sontag’s influence can also be found in the structure of the book. The three chapters recreate her thinking about similarities and differences amongst tuberculosis, cancer and infarction. She discusses here a few of her theses: firstly, about a depleting of a romantic figure of a consumptive; secondly, the imperviousness of cancer to aestheticization; thirdly, the belief that an infarction is just a mechanical failure without any metaphorical form.
The first chapter is devoted to tuberculosis and it presents interpretations of some classic texts by Thomas Mann, Franz Kafka and Zbigniew Uniłowski and also two less known ones by a Scottish poet, William Soutar and a contemporary American writer, Edmund White. The clash of the canon and the margin proves the persistence of tubercular imagery and an inspiring power of consumption, which is present in the form of stylization even in the texts written in the twenty-first century.Tuberculosis, which has been used as a form to give the illness and death a positive meaning, is becoming a historical costume and an equivalent of another disease – AIDS.
The second chapter deals with malignant diseases and the gathered interpretations are built in an order allowing to understand the specificity of expression of women’s cancers. It is devoted to records of the disease by Maria Pawlikowska-Jasnorzewska, Anna Kowalska and Krystyna Kofta. These writers deal with their physiology, but also ask questions concerning the woman’s identity changing during the disease. Their diaries prove their need of autotherapy due to creating a figure of the wounded storyteller. These authoress analyzes the cultural and linguistic approaches of cancer narratives, possibilities of using the metaphor and aestheticization of the disease, which, above all, hurts the body. She also asks whether it is possible to find  differences in  male and female diseases.
The third chapter focuses on the texts written by men an infarction. Miron Białoszewski and Jan Kott spin their stories (autobiographical novels, poems, letters, diaries, essays) about mechanical failures of their hearts, which they are not able to do without the cultural meaning of the organ and the use of symbols. An infarction is becoming a challenge for the personality and a starting point for their further work and the language and theme renewal. A heart attack like any other disease brings us closer to death, makes us get used to the fears connected with it, but on the other hand forces us to create a postinfarction life.
In the last chapter the authoress analyzes the narratives by Maria Dąbrowska, Jerzy Pilch and Grażyna Jagielska. In contrast to the previous chapters, there is no common disease, but a specific attitude towards illnesses, which seem to be like chatting their health up. The interpretations presented in this chapter of the book do not focus on the name of the disease, but on the struggle for the writer’s own subjectivity within its limits. The analyzed texts are becoming the evidence of disagreement with disease, a heroic struggle for health and a slow process of accepting the new identity.

Les essais réunis dans ce volume interrogent aussi bien le temps des œuvres que le temps à l’œuvre, c’est-à-dire sa formulation narrative mais également son pouvoir d’érosion et de genèse qui affecte les hommes, les livres qu’ils écrivent ou qu’ils lisent et les genres littéraires qu’ils pratiquent. Si l’on veut explorer l’œuvre du temps, on ne peut s’en tenir à l’hypothèse que les intrigues se contentent de mettre en ordre l’histoire et de la doter d’un sens, il nous faut à l’inverse définir les fondements d’une poétique de la discordance narrative qui permette de suivre le glissement du sens dans le temps. Cette réflexion sur le temps soulève une question subsidiaire mais non moins essentielle : « D’où vient le récit et où va-t-il ? » Tenter de répondre à cette question exige de sortir de l’emprisonnement textualiste pour penser la manière dont la narration émerge de la vie et retourne à elle. Il s’agit aussi de marquer la différence qui existe entre les récits qui visent à clarifier le passé, ceux qui veulent en témoigner fidèlement, et ceux enfin qui mettent en scène des histoires inachevées, tournées vers un avenir à vivre ou à lire. Face à la crise que connaissent aujourd’hui les études littéraires et à l’inquiétude que génèrent les usages médiatiques, politiques ou économiques du storytelling, il s’agit de rappeler que la théorie narrative permet de reconnaître dans la littérature le plus fascinant des laboratoires du récit. Si l’homme n’est pas autre chose qu’un faisceau d’histoires, alors l’analyse narratologique des œuvres littéraires demeure la voie royale pour accéder à son humanité.

The purpose of this research is to explore the applicability of a womanist narrative medicine. The research builds upon the work of Rita Charon. It argues that the close reading of Meridian informs medical students of the epistemological privileges of the oppressed. The research poses the following questions. What are the parameters of a womanist narrative medicine? What is peculiar about the structure and content of Alice Walker’s novel Meridian and its importance in the training of medical professionals? It concludes by arguing that the rigorous study of Meridian can encourage culturally competent, compassionate, and attentive care.

RESUMEN:
En el presente texto se revisan las principales intervenciones basadas en el paradigma narrativo en el contexto del modelo sistémico. En primer lugar recapitulamos de forma somera, aún a riesgo de resultar excesivamente simplistas, la evolución del modelo sistémico para describir la manera en que este proceso acompaña el desarrollo de la óptica narrativa. En segundo lugar, nos centramos en la descripción del modelo de terapia narrativa de Michael White y el procedimiento de externalización, deteniéndonos en los principales pasos del proceso terapéutico e ilustrando cada fase con ejemplos clínicos con el objeto de dar al lector una visión detallada de las intervenciones narrativas al uso. Un último apartado está dedicado a reseñar la afinidad entre la teoría de constructos personales y las intervenciones narrativas destacando su relevancia para el futuro desarrollo del modelo sistémico.

Palabras clave: terapia familiar, terapia narrativa, externalización, constructos personales, integración en psicoterapia

ABSTRACT
In this article we review the main interventions based on the narrative paradigm in the context of the systemic model. Firstly, we briefly recapitulate, at the risk of being overly simplistic, the evolution of family therapy describing how this process accompanies the development of narrative practice. Second, we focus on the description of Michael White’s narrative therapy and his externalization procedure detailing every stage of the therapeutic process with clinical examples in order to give the reader a detailed view of common narrative interventions. A final section is allocated to describe the affinity between personal construct theory and narrative therapy highlighting its fruitfulness for the evolution of the systemic model.

Keywords: family therapy, narrative therapy, externalization, personal constructs, integration in psychotherapy"

Does anyone intentionally tell something that we could call a master narrative? How much resistance or diversion do counter narratives embody? Can we always divide competing narratives into two groups: master and counter narratives? In answering such questions, this article explores the conceptual ambiguities attached to the terms of counter and master narrative, and sets out to investigate their different ontological statuses as well as potential uses in narrative research. The distinctive point of departure in this article is Jerome Bruner's narrative theory. Building on it, I take distance from the metonymic heritage of the Lyotardian " Grand narratives " , which, to closer analysis, seldom pass as proper narratives. Nevertheless, the role of master narratives is studied here as a form of narrative conventionality and power. After outlining my Brunerian theory of master and counter narratives, I test its uses by reading a doctor's story column " Vaikea tapaus " [Difficult case], published in a Finnish weekly journal for medical professions. In particular since the publication of Considering Counter-Narratives (Michael Bamberg and Molly Andrews, eds. 2004) discussion on counter and master narratives has been lively from psychology to politics and organizational studies. Patricia Ewick and Susan S. Silbey (1995) had earlier suggested the contest between " hegemonic tales " and " subversive stories. " Donileen Loseke (2008), in turn, writes about " formula stories " that strongly resemble the " master narratives " Bamberg and Andrews discussed. Recent studies have provided many proposals about master narratives but not much by way of shared, solid theoretical grounding. This chapter maps some of the different proposals and their mutual connection and before all, connection to the narrative theory and positioning. The perspective of master and counter narratives is relevant at least for three reasons. Firstly, it is one of the most promising ideas of introducing the notions of societal power, resistance and conventionality into narrative studies. Secondly, while the methodological work on small stories (Georgakopoulou 2015) and narrative positioning (Deppermann 2015) is vibrant, new analytic perspectives are needed in the study of larger narratives. As Lundholt et al. (2017, 421) notice, " counternarratives play a role in storytellers positioning themselves against, or critiquing, the themes and ideologies of master narratives. " Thirdly, the theorization of larger narratives has often been founded on the analysis of individual, isolated materials, whereas the counter narrative approach immediately positions the stories within a larger narrative contest.

H ealth care institutions and medical educators assert that empathy is essential to optimum patient care, yet medical education and the practice of medicine often neglect empathy in favor of biomedical approaches to disease and injury. This essay discusses the development in medical literature of the concept of "clinical empathy"-which attempts to reorient a biomedical, disease-centered approach to treating illness by accounting for an increasing fluency within the interpersonal relations between physician and patient-and examines arguments for supplementing medical training with the study of literature and the practice of reflective writing as a means of developing empathy in physicians. In order to interrogate the problems as well as the possibilities of clinical empathy, I turn to theories of sympathy produced in the eighteenth century, when innovations in medical technology and knowledge had only begun to create separate categories that would ultimately untwine the body from mind and culture. The eighteenth century was also a time when philosophy and literature, rather than being compartmentalized from medicine as distinct disciplines, informed medical understandings before medicine became specialized as a "science." A critical approach to the theory and literature of the eighteenth century can help to formulate a productive critique of clinical empathy in contemporary medicine and to suggest possibilities for a reconfigured and strengthened understanding of empathy within the larger social context of institutions, systems, and access to care.

RIASSUNTO Negli ultimi trent'anni anche nell'ambito della Storia della medicina si è accentuato un approccio narrativo, soprattutto nei Paesi anglosassoni. L'attenzione viene centrata sull'essere umano, sulle relazioni interpersonali, sulla storia individuale piuttosto che su quella collettiva. Tale prospettiva si avvale del contributo privilegiato della scrittura (il ro-manzo, la poesia, il teatro, le favole, i diari, gli epistolari) e di quello evocativo dell'arte. In primo piano l'esperienza di vita di medici e malati, ma anche di familiari, colta attraverso il processo empatico che l'opera suscita nel lettore/osservatore. La malattia è quindi vista come condizione esistenziale. Lo storico Roy Porter definisce questa pro-spettiva " the history from below " e ritiene possa essere utile nel ricostruire gli aspetti antropologici della malattia " from the patients' point of view ". Lo studente di medicina " immergendosi " nelle storie di medici e malati del passa-to acquisisce la capacità di capire non solo la malattia ma di sentire l'esperienza del malato (empatia). Le storie aiu-tano a focalizzare ciò che manca o è andato perduto nella pratica medica, stimolano l'introspezione personale perché spingono a riflettere non sulle abilità pratiche (competenza tecnica) ma su se stessi, sulle proprie emozioni. Il linguag-gio denotativo non esaurisce tutta la realtà umana perché «la medicina è contemporaneamente scienza naturale e scienza umanistica. Il chiarire e il comprendere sono necessari allo stesso modo» (D. Von Engelhardt).

ABSTRACT In the last thirty years a narrative approach has become more noticeable even in the field of the History of Medicine, above all in English speaking countries. Attention is concentrated on the human being, on interpersonal relations, on the history of the individual rather than on the collective body. This narrative approach privileges the individual as a person, rather than the group, a methodology that uses the contributions of literature (the novel, poetry, theatre, fables , diaries, letters) as well as the evocative approach of the arts. In the foreground are the life experiences of doctors and patients, also of close relatives, evinced by the empathic process that a work of art fuels in the reader or observer. Sickness is viewed as an existential condition. The historian, Roy Porter, defines this perspective as 'the history from below' and maintains that it can be useful in reconstructing the anthropological aspects of sickness from the patient's point of view. By emerging himself in the stories of doctors and patients of the past, the medical student acquires the ability to understand not only the sickness but to feel the experience of the patient (empathy). Medical stories help to focalize what is missing or has been lost in medical practice, stimulating personal introspection, because these stories urge reflection not on technical competence but on themselves and on their own emotions. The denotati-ve language does not diminish all human reality because «medicine is contemporaneously natural and humanistic science. Clarifying and understanding are both necessary in the same way» (D. Von Engelhardt).

Parole chiave: storia della medicina, narrativa, etica, antropologia.

Siamo abituati a considerare le parole, le immagini, i suoni come strumenti espressivi dell uomo e della sua cultura. Uno strumento è tale perché è un mezzo per raggiungere un fine, è subordinato a una meta, a qualcosa che va oltre lo strumento stesso. Anche nella nostra esistenza siamo abituati a subordinare il viaggio alla meta, il percorso alla stazione di arrivo, la gara al suo esito. E corretta o è limitata, riduttiva o sbagliata questa abitudine di pensiero e di vita? Credo che non tenga conto che le parole, le immagini, i suoni hanno un loro valore intrinseco così come il viaggio, il percorso, la gara sono momenti vitali in sé indipendentemente dalla meta prefissa. Spesso impieghiamo molto più tempo a viaggiare, a percorrere una strada che a fruire della meta, del traguardo, che possiamo, come a volte capita, anche non raggiungere. Le parole, le immagini, i suoni non sono semplici strumenti, ma sono avvenimenti essi stessi con un loro valore intrinseco. A un rabbi fu chiesto di raccontare una storia. «Una storia», disse il rabbi, «va raccontata in modo che sia essa stessa un aiuto». E raccontò: «Mio nonno era storpio. Una volta gli chiesero di raccontare una storia del suo maestro. Allora raccontò come il santo Baalshem solesse saltellare e danzare mentre pregava. Mio nonno si alzò e raccontò, il racconto lo trasportò tanto che ebbe bisogno di mostrare saltellando e danzando come facesse il maestro. Da quel momento guarì. Così vanno raccontate le storie», riferisce Martin Buber ne I racconti di Chassidim.

Cet article analyse les autobiographies des malades atteints du cancer dans la double perspective de témoignages et de moyen d'inscription de la maladie grave dans un parcours de transformation de l'identité.
Mots-clés : Cancer, autobiographie, autopathographie, littérature et maladie, humanités médicales, médecine narrative.

This article analyses autobiographies of cancer patients as both testimonies and ways to understand their critical illness within a process of redefining their identity.
Key words: Cancer, autobiography, autopathography, illness-related literature, medical humanities, narrative medicine.