Rita Charon

A beautiful and inspiring collection of fifty-four photographic portraits, each paired with a brief response about self-image and the body from the woman depicted. This Is Who I Am presents a diverse group, with women of African, Asian, and Euro-American backgrounds, and autobiographical comments ranging from positive confidence to insecure unhappiness. Many different kinds of bodies are represented, from very thin to very fat, young to old, healthy to ill.

I found much here to identify with, much to admire, and am grateful to the friend who pointed it out to me. Many of the stories were very moving, from Gretchen, a breast-cancer survivor who always liked the strength of her body and chose not to have reconstructive surgery; to Reachel, a two-time rape victim who is determined not to "live timidly, to be afraid or ashamed." Some of the responses were quite humorous, as when eighty-year-old Constance confessed that she dealt with some of her more insufferable male colleagues over the years by imagining them pregnant; or seventy-four-year-old Dee, who wondered how much she'd weigh if she still had her tonsils, adenoids, appendix, uterus, one ovary, and the two inches of height she lost to osteoporosis.

Loti, one of the African-American women surveyed, said she thought that body-image problems were part of a more Eurocentric world-view; but many of the Asian woman in the collection reported that American ideals of feminine beauty were not as stringent as those from their mother cultures. Whatever its cultural origin(s) however, the unhappiness caused by unattainable ideals of feminine beauty quickly becomes clear to the reader, as almost every woman surveyed was in some fashion dissatisfied with her body, even the very thin ones. This is an effective and timely reminder that an image-based sense of self is NEVER a secure one, because the ideal to which we are all meant to aspire is an illusion.… (mehr)

Narrative medicine is the practice of incorporating an understanding of narrative into one's medical work and/or training, and also encapsulates the practice of training workers in medicine to incorporate an understanding of narrative into their work, as well as the study of how narrative can work to enrich and clarify one's experience as a patient or any professional working with ill individuals on any level. This training and enactment is heavy on writing (on the part of doctors, nurses, caregivers, etc.), and heavy on discussion/listening between professionals and patients. Ideally, training in narrative medicine incorporates basic training in close reading and narrative form(s) with medicinal training.

This is an excellent introduction to the discipline and enactment of narrative medicine within medical communities, outlining not only the goals of such ventures, but the eventual benefits and appearance of such a program. Charon goes out of her way to discuss the time element of incorporating narrative medicine into one's practice, and the longterm benefits, arguing that while it might take more time up front with any new patient, the time it eventually saves balances out that extra time. She also gives direct examples of gains and benefits (for patients, doctors, and the communities doctors and other professionals work within), allowing for anecdote to serve her argument as a continuous strength in the work. By describing what training looks like, what writing workshops, responses, and discussions look like, and how quickly benefits can mount for everyone from patients to doctors to medical students and all those surrounding them, Charon's argument makes her points all but irrefutable.

The one significant weakness is the fact that Charon's outlook is, undeniably, idealistic. While she briefly discusses the element of time, one gets the feeling that her discussion is so entrenched in her experience within a private practice that her points are less universally workable than she implies, at least until health professionals are less over-extended. And, while she also points out that some of her patients who take up so much of her extra time are the exceptions, and therefor worth the mentioning, she really fails to discuss how one can determine how much time a patient really requires in terms of narrative listening. Certainly, I'm willing to believe that this often takes care of itself because the patient does, as she says, reach a point where they've nothing left they feel the need to say. But, I also know very well that some folks would never stop speaking if given free rein, and that potentiality needs addressing.

Also connected to time is willingness. Charon makes the briefest of references to two doctors who worked with one of her relatives, and were uninterested in the benefits of listening to or understanding her cousin's (their patient's) narrative. And, this brings up the very real question: what about doctors and/or workers who are satisfied with their current level of relationships and understanding when it comes to patients and colleagues? What about those individuals who aren't interested in what benefits might be gained from narrative medicine? Whether Charon is suggesting that this training be compulsory or elective is unclear, but since she suggests that all institutions and professionals would benefit from such training and understanding, the question has to be addressed. Also, is this training to come from the medical school or the place one begins one's career? Finally, I also believe that some questions of legality and privacy are either overlooked or oversimplified. All of this leads me to the conclusion that, while this work does undoubtedly serve as an excellent introduction to the field and study and necessity of narrative medicine, I'm not sure whether it can in itself provide the full training and outline for such a program.

Charon's work here is an excellent introduction to narrative medicine, accessable to average readers (like myself) as well as those familiar with medicinal and hospital-based practices. And, truthfully, I think it probably ought to be required reading for doctors, and perhaps nurses, if they haven't received other similar training in person. True, for anyone, there are going to be some sections which give more information than necessary (medicinally related for folks like me, narrative related for folks without a degree in English or composition), but the full book is well-balanced and engaging enough throughout that this downfall occurrs far more irregularly than I might have guessed. I'd also say that this might be worth perusing for individuals with close family members dealing with a serious illness or elsewise entrenched in regular doctor/hospital visits, BUT, I only hesitate from making this step because I worry that the world and doctors pictured in the book might do more harm than good if the professionals those individuals are actually engaged with don't quite live up to expectations set forth in the book. Still, there is no doubt in my mind that health professionals should read the work, and perhaps many literature professors as well to remind us of the non-academic benefits of understanding narrative and literature more fully.

On a last note, I have one final doubt that does go entirely unaddressed, though I'm not sure Charon would see it as valid. As someone who has an unfortunate and impractical fear of hospitals, and doctors to a lesser extent, I simply can't imagine dealing with the situations health professionals face on a daily basis. I wouldn't be able to do it, facing illness and death every day. Charon suggests that each patient and each experience be understood more deeply, many of them reflected on at length so that the doctor can understand his or her patient's position. As a potential patient, I understand the innumerable benefits of this relationship. On the other hand, even from this vantage point, I can imagine how emotionally exhausting it would be for doctors. I can only relate my doubt to what can occur in method actors, who use their own memories and emotions to feed each of their character's developments. More often than not, if we look back to the amazing artists who've ended up self-destructing (from James Dean to Heath Ledger and too many others to count), they used a form of method acting to create and then become enmeshed in their characters, working more from emotion than academic study. I have to wonder whether a similar burn-out could endanger a healthcare worker who attempts to put himself in the place of dying or suffering patients on a daily basis. Perhaps this is an overdramatic comparison, but I have to wonder whether or not the lack of distance that Charon argues for is as much a danger for professionals as it is a boon for patients.

Regardless, Charon's work provides a strong and indepth view of a revolution that is being fought for in a significant number of health care institutions and departments,and, at the very least, sets up discussions that should equally engage doctors, nurses, social workers, caregivers, and anyone else involved in caring for individuals facing sicknes, disease, or new disabilities.

Recommended to all those with any interest in the subject or in contemporary healthcare.… (mehr)