According to the psychologist Jerome Bruner,

“… the culturally shaped cognitive and linguistic processes that guide the self-telling of life narratives achieve the power to structure perceptual experience, to organize memory, to segment and purpose-build the very ‘events’ of a life. In the end, we become the autobiographical narratives by which we ‘tell about’ our lives.”

We may, of course, baulk at such a radical-sounding view of the role of narrative. The philosopher Marya Schechtman has outlined a range of views that narrative can play in our everyday lives. In terms of the kinds of narrative, they can vary from a simple report of a sequence of events, to a story with a “unifying theme and direction” (Schechtman 2007 p.160). Our awareness of our own narrative can also vary, from something we need have no awareness of at all, to something we “must actively and consciously undertake” (ibid.). On a third spectrum, Schechtman identifies a scale of benefits of having a life narrative, from narrative playing an essential role for any sort of functioning, to narrative only being necessary for more complex “person-specific” (ibid.) behaviour, such as moral and prudential reasoning.

Using Schechtman’s topography, we can formulate a more moderate view of life narrative than the one Bruner envisages, yet preserve the transformational aspect of his account. We think of ourselves as holding particular views and beliefs, hopes and aspirations, and all of these elements will, under normal circumstances, contribute to our plans for the future, as well as the way we understand the events of our past. We need not, as Schechtman points out, explicitly consider any of these things when we plan for the future, or reflect on the past; the influence of our beliefs, hopes, and so on can, in a sense, operate automatically. However, we can, if we so choose, try and identify the drivers and motivations for our planned and past actions, and by doing so, we can not only give ourselves the opportunity to re-evaluate and change those motivations, but also re-evaluate how we think of ourselves. To put things more colloquially, we can change our story.

Narrative comes into contact with medicine from a slightly different direction. The physician and medical humanities scholar Rita Charon, coming from a point of view not dissimilar to Bruner’s, has argued that understanding and emotionally engaging with patients’ “stories of illness” (Charon 2006 p.vii) allows clinicians to “singularize the care of patients” and “bring about healing relationships” with them (Charon 2006 p.viii). Both aspects: treating the patient as an individual with a unique life story, rather than simply as a cluster of symptoms to be fitted into a diagnosis, and seeing each contact with the patient as part of an ongoing relationship, are clearly incredibly important, even if they are not always realised in the clinical encounter. And, I suggest, it is when the clinical encounter lacks these things that the more philosophical considerations of Bruner and Schechtman come into their own, because it is then that as patients we have to rely to a greater degree on our own resources, along with the help and support of those around us.

The experience of being a student, with the pressures of work and creating and maintaining a new social network, can be stressful enough to cause substantial mental distress (e.g. https://www.bbc.co.uk/news/uk-england-45824598 ). It can also be difficult, away from family and friends of home – in many cases for the first time – to reach out for help and support. Even those who do can lack the mental space and distance to contextualise their difficulties in a way that allows them to take the best advantage of any help that is available.

Even those who do can lack the mental space and distance to contextualise their difficulties in a way that allows them to take the best advantage of any help that is available.

An IATL Pedagogic Intervention grant funded a workshop (in December 2018) to begin the process of examining the ways in which narrative could be used to help students understand difficult experiences they and their peers are having, and to help staff and students cope with those experiences. The workshop consisted of three talks on different aspects of narrative (narrative and transgender identity, narrative and the arts, and narrative approaches to understanding the self), interleaved with opportunities for questions and discussion. Participants – who, though smaller in numbers than anticipated, included students and staff – also completed a questionnaire on understanding and communicating difficult experiences. Some of the key responses to the questionnaire are:

• Having access to accounts of the difficult experiences of others, including those in public life – and how they have coped – would help to reduce the alienation people might feel;
• Using multiple methods (e.g. talking, writing, drawing, using pictures) to construct narratives or expressions/responses to difficult experiences;
• Not being judged for having those experiences.

Looking forward, the aim is to trial a combination of pictures, written accounts of difficult experiences and writing and drawing materials with students on the undergraduate IATL module Navigating Psychopathology (a ‘toolkit’) as part of an exercise in expressing, contextualising and describing difficult experiences. This will be used alongside the more theoretical material from Bruner, Schechtman and others to develop a student-led strand to a prospective module on narrative and medicine.