Being ill is demoralising, Franks argues, to both patient and to the system and institutions of ‘care’: a demoralisation involving moral and morale denudation: a sense of futility, disconnection, a sense that noone has a stake in one’s life and you have no stake in others’ lives.
The shared task is of remoralisation: one that involves the development of an ‘ecology of shared lives’, a renewed care for and restoration of the loss of, the patient’s personal dignity.
(A telling phrase comes from Tom Wolfe, who mentions the transit vans bringing in accused prisoners – to be digested by court system – being referred to as ‘bringing in the chow’. Although patients are not similarly named, the medical emphasis on metrics and performance process gives ‘throughput’ similar connotations: a language of metrics, a way of seeing individuals as ‘conditions’ with which Franks engages and battles in his 2004 book The Renewal of Generosity:illness, medicine and how to live.See also Arthur Kleinman The Illness Narratives: Suffering, Healing, and the Human Condition. )
This task is of remoralisation of the system is not, Arthur Frank said deprecatingly, good work for old men but they can cooperate in the shared task of helping those in the institutions re-moralise themselves and help those patients, administrators, clinicians who are held hostage to a system that will not change completely in their lifetime.
What is a task for even ‘old men’ is to tackle the question of narrative medicine texts not only for medical training and academics but to ask ‘What’s in it for the patient? In a sickness story for the sick?’
What that is to say, can be a ‘companion story’ for the sick, a companion story rather than a sickness memoir (brutally often called ‘misery memoirs’)?
There is a prevalent metaphor of shipwreck in Narrative Medicine: illness as resulting in narrative wreckage, the loss of access to an individual life story and thus a storied life.
There is no companion available in the Literature and Medicine corpora, no companions that make the sick feel less alone. What would be the stories that can help them re-moralise a condition that demoralises, that offer dignity in a state of indignity?
Two implications raised in questions:
Stories are in fact shared – any contact with folk lore and with dramatists’ use of same makes clear that identity is constructed from stories: nobody has his/her own story. But medicine and identity as well as narrative medicine theory is deeply imbued with the self as identified with a sense of having one’s own unique story.
Patients are demoralised by the sense that there is noone around – in some illnesses – who is willing to share their story: often patients find themselves in the care of people who don’t share their cultural and traditional stories and so can’t be involved in a co-construction.
NB Arthur Franks continues to be involved in an aspect of narrative therapy – of finding stories which are *dangerous* to one. For, stories lock down selves into narratives, they set boundaries, are culturally divisive, those create disconnections…