Maria Giulia Marini - Languages of Care in Narrative Medicine: Words, Space and Time in the Healthcare Ecosystem

Cover illustration: Johannes Vermeer - Woman Holding a Balance, Date 1664. Courtesy: National Gallery of Art, Washington

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In the Language of Care , Maria Giulia Marini sets out both a theory and a method for applying narrative to foster health and healing. While this study has relevance to a variety of relationships, Marinis particular focus is on the clinical encounter, where gaps in knowledge, authority and experience tend to exacerbate stress and suffering.

Marini draws on her prior scholarship in the realm of the health humanities to argue that stories, told formally and informally, can build bridges to overcome these divisions with improved communication, insight and empathy. Using multiple examples, she demonstrates how Natural Semantic Metalanguage can be used as an accessible framework to facilitate the development and exchange of stories between the various constituents of the clinical encounter. Patients or providers may be unsure of where to start, or how to structure a narrative in such a way that it can be expressive not only of ones experience, but expressive to an audience; NSM functions as the template or script, which gives shape to thoughts and emotions for the benefit of both storyteller and interlocutor.

What makes Marinis argument in favour of this humanistic bridge so persuasive is the way in which the entire text is suffused with the humanities, applied as theory, rationale and demonstration. Marini employs varied examples from literature, art, music and popular culture, to first illustrate where healing is needed, and whyfrom the patient who is terrified of his illness to the physician whose efforts to provide care with limited resources have left him stressed and burned outand then to demonstrate how a structured sharing of narratives can facilitate healing: listening, exchanging, comprehending, empathising. Synthesising scholarly sources, interviews with health humanities practitioners, poetry, music, fiction and non-fiction, Marini demonstrates that the Language of Care is one that we all already knowand, with the guidance provided here, that we can apply to enrich our relationships in the clinic, the classroom and beyond.

Healthcare is a complex ecosystem comprising care providers, patients and their families, buildings and facilities, medical and communication technologies, competences, management, waiting times and performance times. Among such variables, we must recall the central position of a patient, a person who unwillingly sees his/her role within this ecosystem suddenly redefined by a disease and inevitably impacted by its internal variables.

Narrative medicine (NM) and narrative carewhich extends to all providers of clinical settingsconcerns the exploration of disease as experienced by the person who is ill (beyond the mechanistic view of the human body) and shaped by its sociological and cultural collocation. Apparently in contrast with evidence-based medicine (EBM), NM integrates the approach to disease and our current way of understanding and managing disease. Providing a new perspective, this new discipline (minimised to current of thought by some) enables us to look deeper into a disease and focus on its components, illness and sickness, and their role in the care of the disease.

EBM can be more effective and efficient by integrating narrative care, leading to less uncured patients, more satisfied patients and a better quality of life and satisfaction for all healthcare providers.

During these years, we witnessed the policies concerning healthcare narrative research by WHO. These policies rely on real, authentic narratives of all healthcare providers, from patients to carers and from administrative staff to citizens. These guidelines suggest a strong integration of EBM with the narratives originating from all stakeholders for an improvement in healthcare.

Following the WHO guidelines, this book focuses on the scientific approach to implement NM. It embodies the classic medical and health humanities, including literature, philosophy, ethics, history, spirituality, mythology, social sciences, anthropology and psychology, in addition to new insights from linguistics and the neurosciences.

I aim to provide a broad multiple approach to NM, which should be called narrative healthcare considering the complexity of the healthcare ecosystem.

The first new input comes from a linguistic point of view based on the concept of natural semantic metalanguage (NSM). According to this theory, all spoken languages across the globe share a core number of universal words, which stem from the ancestral development of perception and reaction to experiences common to all humankind. It can be viewed as our innermost and authentic language that allows individuals to reach out to others and connect beyond any cultural, social and historical upbringing and barriers. It is an important component of a human being and can play a central role where there are natural conditions of fragility in particular.