For this week’s responses, we provide you with the following prompts:
1. a. What constitutes good evidence (regardless of the academic discipline)?
1. b. How is the way we “see” influenced by the specific place in which we are doing the seeing?
2. What is the significance of storytelling for medicine and health?
There are many characteristics to a good evidence. With one quality in mind, good evidence can be something that tangible and visual. Visual evidence, like the human remain photo above, is universal. This tangible remnant communicates the message of human suffering and mortal vulnerability to all viewers. There is no language barriers to understand this message as long one can see and imagine. While seeing can be a powerful tool for acquiring evidence, it can also be misguiding when placed out of context. In this case, the viewer only unveils part of truth. I believe that seeing something on paper and seeing something in real life make a difference. Photographs require imagination to complete the story, whereas visiting the site is already more complete and holistic.
William James’ idea of “contracted life” captures the importance of humanities in medicine (Frank 17 par. 2). When sick, patients often forget that their lives were always more than just being ill. Joy is reduced, and the life becomes contracted with a ticking timer. Storytelling, which is fueled by the humanities, is important in medicine because it is an instrumental tool to battle diseases and again restore control of life. Diseases may take lives, but it never controls the attitude of how a person chooses to live his or her final moments. This greatly reminds me of ESPN anchorman who shared his story and this beautiful message: “When you die, it does not mean that you lose to cancer. You beat cancer by how you live, why you live, and in the manner in which you live.” Storytelling fosters solidarity through courage and with the message that we are facing these ailment battle alone.
I do agree with Lucy that we are conditioned to see good evidence as something tangible, something we can replicate in the laboratory (i.e. Koch’s postulates in biomedical research). But there are also other things we must consider, for instance research suggesting that meditation is beneficial to mental and physical health. We can see the changes manifest in these people; however, we know nothing of the mechanism. We must be able to consider that there is a broader world of evidence apart from the notion that seeing is believing; such as the evidence of a good story being its effect on our emotions or the effect of compassion on patients can truly help bolster their mental state and aid their treatment. The world of true and effective extends to visceral reactions and the establishment of connections that otherwise would not be possible, through all of our senses.
Storytelling and health is a very interesting combination to me, and for the longest time I could not make sense of it. As Frank puts it not only does he want to be able to tell a good story of the lives of the ill but also a good story for his doctor. Doctors frequently think that whats on their chart and the medical history is the entirety of the person that sits before them. Not only can the effective telling of the story of one’s life aid in the diagnostic process but it can serve as inspiration for others who may be going through similar situations or very simply preserve this person’s legacy apart from their illness. When reading through this chapter I also thought of Stuart Scott. A story reminds us and the patient that they are not their disease they are a complex individual who has led a full life. While it is not a solely biomedical example I cannot help but think of the story of Ann Frank, who’s diary reminds generations of schoolkids that she was not only a victim of the Nazi war machine but also a human being.
Good evidence is definitely debatable because the human experience is very vast and complex. For example, the idea of qualia or the “raw” sensation of something is hard to quantify as well as describe, mainly because what the color red means to me will differ from how the color red hurts for some people. Still, I agree that good evidence is tangible and intangible at times because physical reality is sometimes just as important as the internal reality. Good evidence is from both the external and internal worlds – whenever I think of any emotion, like fear or love, there is a physiology to the heart pumping and the butterflies someone can feel. Science has studied fear conditioning and analyzed neurocircuitry to examine how humans fear, flight and fight, but the way it’s described and experienced can vary by the state of mood someone is or the reality of someone’s intersectionality, or their identity. Thus, seeing is believing, but so is arguable feeling, acting, doing and moving. All these things contribute to a physical reality and an inner world of an individual. Seeing is also affected by our state of mind, our emotions, our past, our genetics, and a laundry list of what makes us who we are and who we are to become by looking at something. Therefore, although it’s a bit of puzzle to disentangle what the universal truth is from all these raw components, I think this is also why it’s so important because once we see the commonalities, trends, and feelings, we start to reach some good evidence.
Thus, it is also why I appreciate and honor storytelling in medicine and health. The human story is a powerful tool. Lucky raises a good point that sometimes, if we narrow down too much and reduce ourselves to an illness or a moment, we rob ourselves of our own humanity. Matthew also articulates very well how we reduce people down to charts or medications. It’s easier said than done not to rob someone of who they are or their story, but I think creating a story that reinforces who we are while also being open to changing what the story’s main themes are, where our story goes and ultimately, where it might end, is powerful. We can learn so much from the right choice of words collected in profound, delicate thoughts spoken to the world. I’d like to believe that medical professionals see how challenging, but rewarding medicine is because it is scientific and progressive, but at the same time, it’s human like they are. Medicine is at the boundary and forefront of the human condition, like the humanities so the relationship is inevitable, but important. A story is a tool that can tell us so much and fill in the gaps that we sometimes miss, because with a story, we can understand so much better and help them so much more than we may have thought.
1.) a. Good evidence should be relevant, clear, and verifiable. For an individual doing the observing, the evidence loses its significance if it has no bearing on what the individual is looking to explain. For example, you cannot identify the chemicals involved in the mummification process seen in the catacombs of Palermo if you are examining the ash of Pompeii! Additionally, evidence should be something one can understand, and replicate, as Matthew stated. Finally, evidence should be verifiable. If multiple people state that a piece of evidence is accountable, then other people feel that that piece of evidence is dependable.
Courtni brings up an interesting point of discussion: the line between the external and internal world. Many academic disciplines operate on physical evidence, something tangible, as Lucky stated. However, the images we viewed of Pompeii and Palarmo evoked a similar internal sensory experience for each viewer in our classroom. Almost everyone could say that the images brought them awe, fear, sadness, or curiosity (to name a few).
1.) b. I think the environment definitely affects our view of a specific place. Being in the place adds to the experience because it allows people to use their own senses to come to their own conclusions. For example, our view of the deceased individuals in the catacombs of Palermo might be influenced by the hushed voices of the other observers who walk past. The whispers and quiet atmosphere might inspire a certain amount of reverence or fear (depending on how you look at it; in class, it was said that some people could not even bear to look at the deceased).
2.) Storytelling for medicine and health is, as my peers have mentioned, key to reminding patients that they are more than their affliction. Storytelling is used in every culture to simultaneously entertain and inform about the human experience. In that sense, storytelling overcomes boundaries and allows people to connect on the human level. I thought Arthur Frank put it in a nice way: patients can take control of their lives by rewriting their stories. A healthcare provider can help encourage this by sharing their own anecdotes. Stories help providers empathize with their patients, and patients remind their providers (and themselves) that they have homes, families, and lives beyond their illness. It is an act of reciprocation and a reminder of support.
There are many aspects that combine to create good evidence. The most obvious evidence is that which is visible through sight. As the saying goes “Seeing is believing”. However, as my colleagues have indicated, what is visibly evident does not always provide complete evidence. For example, by simply looking at the photograph of the mummy above, one cannot obtain a full understanding of it. By going to see the mummy in person, it is possible to gather a much broader and detailed idea about the mummy. Seeing something in context, learning its history, and experiencing its surroundings enable the observer to create a more accurate picture. As previously stated in the comments, knowing more about the mummy and the context in which it came from allows us to connect on a more personal and emotional level with what we are observing.
Storytelling holds a lot of power when it comes to healing and health. I still remember when I was younger and my Mom would tell me stories when I was sick as a way to help me relax, laugh, and forget how awful the illness made me feel. Lucky’s point that patients need storytelling to remind them that their lives mean more than their illnesses is a very accurate one. Through recounting fond memories and joyful times, people are able to remember just how wonderful their lives really are and why they are worth fighting for. Instead of the disease or illness deteriorating and controlling a person’s life, that person is able to turn the tables and regain control over their health and well-being. As Matthew brought up with his example of Anne Frank and her diary, storytelling reminds people that illnesses do not have to be defining. By telling stories, patients are no longer sufferers of disease but human beings who are engaged in a tough battle for their health.
Good evidence involves an appropriate level of collaboration between quantifiable data and qualifiable observations. In this sense it is a multifaceted entity. Quantifiable evidence, such as data, allows us to compare current numbers with standard measurements and thereby conclude if what we are looking at fits the expected mold. Additionally since researchers spend a great deal of time transcribing evidence it is important that any written accord include descriptions of physical features of what it is we are observing. Only with a cohesive set of data involving both numbers and creative descriptions do we stand the chance of being able to piece together everything that we are presented with. Neither data nor descriptions can stand independent of one another – both are imperative to fully appreciate any body of evidence. However while written descriptions are an imperative part of good evidence I agree with Lucky’s assertion that seeing can be misleading. The way we see is often influenced by our surroundings and personal biases. Pictures inherently require the individual to draw upon personal experiences and individualized ideals that may not be consistent with the image in question. This furthers the point made in class that we cannot study anything completely independent of its relationships to the surroundings. We must take into consideration the context of the situation that we are seeing; for example the picture used for the week one voice thread is nearly impossible to accurately analyze if one is not aware that the body was rooted from Pompeii. The eruption of the volcano and the resulting events play a large role in why the bodies appear as they do – when given the context one is likely to be able to draw the conclusion that the position the bodies are in reflects a state of suffering. However when given this image outside of its historical context it is difficult to infer the emotional state of the body at the time of death.
Story telling is especially important for medicine and health. Patients are often able to offer their physicians invaluable information regarding their condition that would be missed through routine examination procedures. By allowing a patient to tell his personal story the doctor bestows upon the patient the greatest gift at all – the ability to remain human. One of the major drawbacks of the current American medical system is the overriding tendency of doctors to prefer treatment over lack of treatment. Doctors often use strong medications and invasive procedures as a means of further investigating what is wrong with a patient. They perform these procedures without sufficient knowledge of whether or not the intervention will be effective. By listening to the personal story of patients doctors can gain better insight into the person’s medical condition; an individual’s story consists of so much more than simply the symptoms and signs that caused his physical distress.
Matthew states that doctors often see patient’s medical history as what is listed on chart. I believe this is an interesting point and an accurate description of the tendency of medical professionals to see patients as cases instead of people. Doctors routinely do not take the time to fully listen to the story of their patients. They often overlook seemingly trivial symptoms in patients that could ultimately lead to a cure. Hence if we are able to improve the medical system and the quality of care for those involved it is imperative that physicians take the time to listen to the stories of their patients and see them not as a client but as an assistant in the healing process.
For something to be classified as “good evidence”, it must have a relevant incorporation of the senses for different people- all while having the potential to lead to a similar result for each of those individuals. What we see, smell, hear, and feel can all be used as evidence. However, when many different people experience the same result towards the same stimulus or experience, it can be considered as good evidence. This is seen in science labs when replicating experiments and looking for similar results, as well as in the arts when individuals are not only looking at tangible evidence, but emotional and spiritual evidence as well.
How we see evidence definitely is impacted by where we are. As many of my peers have said above, being in front of an artifact or seeing an experiment happen in front of you will have a different level of intensity for the senses compared to looking at an image online or reading about the experiment. Along with that, our personal cultures and experiences we bring to the table when looking at something changes how we may interpret it. If the evidence we see is relevant to one place or culture and not to others, this may influence how we see and experience that evidence.
I believe storytelling is a necessary part of health for the patient and the health care providers. As my peers mentioned above, storytelling is a crucial part of the patient’s experience. Not only is there the cathartic aspect of telling your story of recovery and strength, it can help others who are in a similar position to know they are not alone and there are others who understand their situation from experience. I agree with my peers above regarding the importance of storytelling for doctors and for them to get a better understanding of the patient’s experience outside of their illness. In a field where the science and medicine are so critical in saving lives, it’s important to also remember that patient’s aren’t just their illness, but people whose lives are affected daily by health issues; looking to have a fulfilling life despite their illness. However, an important part of storytelling for the doctors that I feel often goes overlooked is the cathartic experience it may have for the doctors with their colleagues. While very personal information about patients may not be discussed, I believe storytelling among health care professionals may help them deal with situations out of their control. A physician may do everything in their power to save a patient, and that patient still might die. This can be something that is very hard to come to terms with; especially in the beginning of someone’s career. Talking with other physicians about this experience and how it made them feel may be very helpful; especially considering the other physicians may have experienced the same thing.
As Dr. Labrecque broke down in class, “evidence” often relies on sight, stemming from the root word “vid” meaning to see. Therefore, “good” evidence clearly shows verifiable and relevant information. As many of my colleagues articulated, our studies, especially the sciences, condition us to consider only tangible products as evidence. For example, a chemical reaction produced in a laboratory demonstrates the interaction between two chemical substances. However, the constitution of “good” evidence depends upon the context in which the information is being examined, for context, such as cultural differences, can influence perception. For instance, the culture in a laboratory shaped by education and training would cause one to consider levels of parasitemia as evidence of infection but not a testimony as a court of law would perhaps use. Furthermore, culture, with regard to different countries, affects the perception of evidence as well. For example, physicians in Germany and physicians in the United States received the same results of an EKG as “evidence” of a heart problem. The physicians in Germany who obsess with conditions of the heart reported forty percent abnormal readings, and the doctors in the United States only reported five percent abnormal results (Payer, 1990). Thus, a culture’s mentality influences the interpretation of evidence, which could result in a bias towards the evidence.
Moreover, individuals can influence storytelling as well. As our reading states, “People need models on which to tell their stories, and here we encounter a significant paradox: stories are very much one person’s own, but any person’s story is also a more or less (often less) creative mixture of previously heard stories,” (Jones, Wear, & Friedman, 2014). Thus, people can shape another individual’s personal narrative. For instance, I grew up listening to my mother tell my physicians that our family suffers from an allergy to a specific medication. As a result, once I began visiting appointments alone, I adopted the story and retold it as my own. Since I did not actually suffer from the allergy, I compromised my treatment. Thus, storytelling in medicine can harm an individual’s health. On the other hand, however, storytelling can improve certain situations in the health field. For example, through an elaboration of one’s story, a patient could reveal more information about his or her condition, which could aid a physician in diagnosis. For instance, one of the readings described a scenario in which the patient’s description of her experience during the Great Depression enabled the health care workers to better understand her condition (Jones, Wear, & Friedman, 2014). Furthermore, with the idea of evidence, an individual may visit a doctor complaining of an earache. However, after examination, the physician does not see any evidence of an ear infection. Therefore, the doctor can not make a diagnosis. However, if the space allows the patient to describe his recent travels on an airplane, then the physician can determine other causes for the ear pain. Thus, science, or medicine, does not always rely on tangible evidence. Moreover, as Matthew explained, a disease or an illness does not define an individual. In addition to the patient’s story, a physician’s narrative could benefit certain situations in the health field as well. For example, if a patient is experiencing anxiety about a certain procedure or diagnosis, then the physician could share a personal story from his or her past to ease the patient’s nerves to better prepare him or her for the situation. Thus, although detrimental in some situations, storytelling seems to improve the experience for individuals in a health context.
Jones, T., Wear, D., & Friedman, L. (2014). Health humanities reader. Rutgers University Press.
Payer, L. (1990). Borderline cases. The Sciences, 38-42.
In Thursday’s class, we learned about ‘evidence’ and its root, which means ‘to see’. Evidence can be observed, and provides a balance of quantitative and qualitative data. Evidence can be sighted like Lucky, Kristine, and others mention. Good evidence can be visual, heard, and read. However, sometimes it may be difficult to determine truth in evidence, even when data can be repeated and reproduced. How many times does a question need a similar answer in order for the result to be deemed as true evidence How does the background of the observer affect what constitutes as good evidence? In asking these questions, I create a parallel between true evidence and good evidence to reflect the ethics of research and humanities in health (Jones, Wear, and Friedman, 4). Additionally, who has the authority to claim what evidence is good and what is not? Consulting a number of sources, and recognizing a multidisciplinary approach is necessary to determine good evidence.
Just as Arthur Frank writes in his article, “Being a Good Story,” we learn about the importance of context in what we see. Combating pain is easier said than done when we are healthy. With this in mind, we as readers may disregard the intensity and immobilizing of the pain felt by patients because we are not in their position (Frank, 13). Acknowledging where we are, while we observe, leads to differences in our results. For example, if we were observe a work of art that was initially intended to be in a church, instead in a museum, how much truth in our observations do we lose? When we determine someone else’s pain and experiences using our own perspectives and reference points, we miss details which are crucial in determining good evidence.
Storytelling, a type of observational evidence, allows patients to become more than a disease, and engage with others an experience of their illness. It’s a coping mechanism, and a way for patients to reflect on what they are going through, how they feel about it, and what they wish their treatment and care options to look like. Illness narratives and other stories from patients tell medical professionals a lot about family, culture, history, and experiences. Stories serve as a window to understanding the complex interpretations of health (Jones, Wear, and Friedman, 5). While story telling is beneficial, Arthur Frank also notes the importance of asking follow up questions. These can be casual and can include topics like daily habits, lives, grooming, and clothes; these questions act as a gateway “to more fundamental concerns” (Frank, 21). Regardless of what one’s story is, everyone wants a chance to be heard. Silence is debilitating, especially or those who are suffering. For those who cannot share their stories, it is difficult to maintain one’s autonomy and motivation. Silence is not an opportunity for caregivers or physicians to assume that things are well or not well. In these cases, well-intended observations, evidences, and inferences, are vital to maintaining patient dignity (Frank, 24).
Good evidence seems to entail various examples or situations not only to validate the main argument presented, but also to create a wider understanding of why the original argument was made. I personally feel that when someone makes a claim even in everyday conversation that I either don’t agree with or don’t know much about, I ask them to back it up or look it up myself. I feel that humans are naturally curious and thus want any evidence to show the truth. We aren’t simply satisfied with any response, but what is “real”. I feel that since caveman times, we relied heavily on sight and our other senses because that was how we distinguished things, the real and the fake, the safe and the dangerous, and many other binaries vital for survival.
There is a common saying that “seeing isn’t always believing, but believing is seeing”. I think that holds significant value because its based on the idea that we think influences what we see, even if what we see is completely different. With those preconceived notions associated with one’s belief, there becomes multiple perspectives and understanding of the same one thing by many people. Therefore the sight is very personal. I liked that when we discussed the casts of Pompeii and the cemetery of Palermo, my classmates had different feelings associated with it, as well as the many visitors of the world. Some may view it as an amazing experience to view the past, while others may be uncomfortable with “objectifying” death in that way. Others still may not even wish to enter because of how they choose to respect death. With our actions so intertwined with our emotions and beliefs, there is truly no way to see the same thing as someone else. Which adds many dimensions to the particular object.
I think the connection between storytelling and medicine and health is necessary. After reading the chapter and what my classmates have touched upon, it makes me notice how needed it is, or like others have said, we lose our humanity and uniqueness. Many survivors of mental and physical illnesses tend to use storytelling to better heal themselves, and send out testimonies of hope to others who may be struggling as well. For example, cancer survivors may go to support groups and seminars and hear similar situations like theirs. Alcohol and substance abusers go to group therapy sessions and similar setups to not only remind themselves of why they cleaned up, but also as a supportive resource for others. Without storytelling, we lose the idea of ourselves, and I think how it can be used in medicine and healthcare is good.
As Dr. Labreque mentioned in class, the root words for “evidence” literally mean to draw out of and see. Thus, good evidence can be anything you can extrapolate from an experience or experiment. Good evidence means different things for different people based on our own upbringing and personal worldviews. For instance, some people can be presented with mounds of scientific evidence “disproving” God’s existence and it will mean nothing to them. Yet, at the same time, an atheist may be given a series of inexplicable, miraculous events that, for some, prove the existence of God, but the atheist views them as pure coincidence and poor evidence. Our acceptance of evidence as good or bad is shaped by our culture, values, and background. Furthermore, the type of evidence needed to support a theory or idea is often driven by the nature of what is being tested. One can use visual evidence to identify chemicals in a flame or identify the types of brush strokes used to paint the picture of Lazarus we viewed in class. Yet, you cannot rely on visual evidence alone to understand the significance of the painting. Likewise, you cannot simply observe the bodies in the cemetery at Palermo and understand why they are there or know that once natural preservation stopped, the monks began using various minerals to continue preserving bodies. Many things require testing. Others require subjective opinion. Good evidence is completely subjective, open to interpretation, and varies across every field. For many, good evidence must be quantifiable, testable, and replicable and in many cases it is required. Yet, in many instances such as meditation, faith, and human nature one experience can be the only evidence necessary.
The way we see is shaped by our environment in many ways. The setting in which we see or learn something directly influences our perception of it. The feelings ignited within when we read about the Civil Rights Movement are different than when we watch Selma which provides yet a different experience than that of those who were there (I may or may not have just watched Selma). The way we interpret events are very reliant on the climate and condition in which we experience them. I am certain that my understanding of the cemetery at Palermo would be very different had I seen it in person rather than in a classroom setting.
As Farida and others have mentioned, storytelling allows us to engage with the past in an interactive and tangible way. It allows us to connect to those around us. It makes the woman dying of cancer in a hospital bed more than just another patient. It defines us and sets each individual apart while bringing us all together into one common thread: humanity. Both written and oral storytelling have the ability to transcend time and engage medical and ethical issues of the past as they currently apply to us. They enable us to cope with sickness and empathize with those around us. Furthermore, firsthand storytelling can alleviate stress and create bonds between the patient and physician. Storytelling, although often overlooked, is an important aspect of how we relate to others. The presence or lack thereof can directly influence our health.
Good evidence begins with what can be verified and seen. However, if we solely rely on what we see, many contextual clues may be left behind. So, by using all of our senses and incorporating contextual clues from our surroundings (or others), we can have a better chance of believing that our evidence is “good”. One example of why good evidence cannot solely be comprised of what can be seen is in a photograph of a crying woman. Imagine that the picture is zoomed in on her face. From what it looks like, one would guess that she is sad. Another person might believe she is in pain. However, when the picture is zoomed out, the viewer can see that with more contextual clues, the woman was actually happy! The image shows a man (boyfriend or husband) down on his knee proposing to her.
If we were present at the time that the photo was taken, we would have better understood the context in which the picture was taken. The photograph itself is evidence of the event happening. Depending on where you are when you see the evidence, you may be influenced differently. For example, the photograph will bring about a certain emotional response to the woman when she looks back at that memory in the photograph years down the road. The photographer will also have a certain set of emotions when viewing the picture as it is happening. My peers have mentioned that depending on who you are and what your background is, you will have a different understanding of the evidence.
When I think of how storytelling plays into medicine and health, the TV show “House M.D.” immediately comes to mind. The main character is a callous doctor who only believes in the evidence that can be tested or seen. Because of this, he refuses to talk to his patients, believing that all people lie. As brilliant as he is, he makes an incorrect diagnosis in the beginning of each episode. Only after he talks with the patient does he reach the correct diagnosis. This is just one example showing how important storytelling and communication is in medicine. Without storytelling and talking to patients, key clues are missed. Each patient needs to have their situation taken into its own context to have the best possibility to figure out the underlying cause of the problem. As my peers have mentioned, there are other uses for storytelling in medicine and health. One of the most helpful ways storytelling can be used in health is to motivate and encourage others. Whether a survivor reaches out to patients suffering from a similar condition or a person speaks to a group of individuals trying to make lifestyle changes in order to improve their health, it is important for those seeking better health to know that there are always others on their side. Everyone needs a cheerleader.
As Kayleigh mentioned above, good evidence is different for different people. For scientist per say, good evidence consist of proven facts or a series of experiments that coincide. It must be physically and visibly there for it to be considered “good” evidence. For a religious person “good” evidence is not so much about physically seeing something as it is feeling it. If a person feels the presence of God or a higher being it is “good” evidence that it is existent. As one of my classmates mentioned above, the way we see things varies with the place we are in. There is a big difference between seeing pictures of an event and actually witnessing it. When a person only looks at pictures there is no emotional connection being done with the place the only sense that is being practiced is sight. When a person is physically there all senses are being practiced. They can smell the atmosphere, touch the surroundings, hear noises associated with the place, and “feel” the energy throughout the place.
The significance of story telling is great for medicine and health. This is because for a long time the way in which we communicated was through storytelling. As many of my classmates have said before now a days storytelling is the way in which me make a person become more than just a number. By telling medics about a person there is more of an emotional tie made and the “want” to help becomes present. Many times medics and health providers break those ties because it becomes easier to “let go” of someone who they have no knowledge of. What that brings in question though, is whether this is an ethical approach. Because when there is an emotional tie a person will do everything in their capability to make sure they survive, while when there is non the person is not as incentivized to “give it their all”. Then their task becomes more of a routine and the inspiration is in a way lost or misguided.
1a. What constitutes good evidence (regardless of the academic discipline)?
I do agree with the majority of my classmates on the point that seeing alone does not provide good, or even complete evidence. And although technology can help us measure and “see” almost everything nowadays, I still believe that good evidence is based on good intuition. We all have intuition, but few of us choose to develop it. It’s easy to dismiss it, but yet I think it is that “gut feeling” which we use to make important decisions in our lives. Can technology tell us why people fall in love? Perhaps some chemistry behind it, yes, but does every couple take a blood test or MRI to make sure they’re compatible and no conflicts arise in procreation? Can we measure how long a relationship can last or if it is even worth pursuing? Can we know, right now, who we will spend the rest of our lives with? Why is it that we’ve chosen one line of work to fulfill us rather than another? How do we know that? How can we know that? Most of it’s a mystery, but still, people know whom to choose, whom to love, whom to befriend, because… they. just. know. They know without really knowing, without really “seeing” by conventional standards. They use their intuition. On a related note, perhaps our reliance on science and technology has not at all contributed to good evidence, because it cannot substitute that which is most important for us to see. I’m also afraid that an excessive reliance on technology may cloud the ability to see success in small ways. Evidence in my point of view is not something that is easy and straightforward. Technology may make it somewhat easier, but it’s going to take our courage to get good evidence. It will take courage for us to reach out to others in a meaningful way. I tend to consider we are collectors of evidence for life. So on this point, I have to say is it fair to ask ourselves how we measure our lives? Do we measure it by the pounds we’ve gained or lost over the years? By the wrinkles around our eyes or the state of our health? Do we measure it by people around us who have died or those who’ve lived and made an impact on our lives? Perhaps we measure life in stories…yes, the way I see it, I think we are collectors of stories. They are our evidence. Stories we know about ourselves, those that we tell ourselves, those we know about and pass on about others. We are made of stories, you and I ☺ For some reason, when we were studying the icon depicting Lazarus’s Resurrection as a class last Thursday, the man clothed in white standing next to Jesus fascinated me. We did not know who he was – a relative, an Angel, perhaps? Jesus alone could have been presence enough. Why was this man included in the icon? He was a witness and his seeing what was prophesized; his ability to retell the story is significant. In our lives, we all need witnesses. The more I live in the world, the more I realize we are here for the sake of one another. We need someone to be there to see us, to testify, in some way, just like the Angel, that we were really here and we really lived; someone to witness our wounds, and pain, and trials, and joys; someone to ultimately believe in our worth and remind us of it. Also, I can’t help but remember to think that our ability to see (“videre”) almost implies a choice of how we see a certain person or a certain situation. Because we see, we perceive and we have the ability to construct our reality. We have the choice to see something or someone as positive or negative, good or bad, beautiful or ugly, well or ill. This thought relates to my earlier questions about pain – which verb is it related to – the verb “to have” or the verb “to be?” Pain or a disease or a social condition most certainly does not define a person. I learned that after spending some time with the homeless in Atlanta. People are not homeless; they are merely experiencing homelessness. There is no need to degrade their humanity and their wholeness. Besides, experiencing homelessness is not their entire life. They are someone’s mother, brother, uncle, sister, friend. They have relationships and they are whole, intelligent, creative human beings with much potential. There is so much more to being human. Humanity is holy, and what we really need in this world is to develop our senses to see it and acknowledge it in one another.
1b. How is the way we “see” influenced by the specific place in which we are doing the seeing?
Absolutely. I think that one’s position can influence the way one sees and perceives something. In a healthcare setting, the doctor can be (and is often) seen as all-powerful, and in some parts of the world even regarded as a god. There are certainly examples in my own life and in the lives of those around me when doctors suffered from the “Bathsheba syndrome,” alluding to the story of King David and Bathsheba from the Old Testament. The story ultimately is a warning that even people with a highly developed moral sense can make grave mistakes. David’s fast rise to power, wealth, success led him to become complacent and comfortable, and inflated his beliefs in his own power and ability to manipulate outcomes. King David saw himself as great, so much so, that he ignored God and committed sin – lying with Uriel’s wife, Bathsheba, and ordering that Uriel be killed in battle. In the same way, doctors can overestimate their ability to find solutions, to cure, to be all- knowing because they are in a place of power and people seeking help have almost always no other choice but to seek their consultation.
I also want to bring in a sculpture that is one of my favorites that can perhaps explain how we see and how we could see. Paige Bradley created one of the most striking sculptures I’ve ever seen. Her masterpiece, entitled “Expansion,” is a beautiful woman seeking inner peace but fractured and bleeding with light. “From the moment we are born, the world tends to have a container already built for us to fit inside: a social security number, a gender, a race, a profession,” says Bradley. “I ponder if we are more defined by the container we are in than what we are inside. Would we recognize ourselves if we could expand beyond our bodies?”
2. What is the significance of storytelling for medicine and health?
I think that storytelling is very important to medicine, because it allows for an acknowledgement of humanity. However, I think storytelling is a tool that not only helps the patient – the one receiving care – to provide important background information and express his or her feelings (which greatly ease the tension often felt in a healthcare setting), but it also helps the one administering care to stay humble. From my own experiences as a CNA, working in a post-acute care facility, I grew to appreciate the stories of my residents. What stands out in my memory is a woman who came in every morning at 6 am to feed her ninety-year-old mother although the mother could not recognize who she was. The mother had severe Alzheimer’s, yet her daughter told me, little by little, every morning, with every spoonful of breakfast oatmeal, about her mother’s life before it, describing a strong woman that had embraced so many challenges, and had the most wonderful laugh you could ever hear. She also described how the onset of Alzheimer’s shook their family and how her siblings had made the difficult decision to place her into managed care. There she was, this woman, a witness for her mother’s life, her mother’s glorious humanity. She is one of the people for whom I have much respect. If not for the daughter, I would have known that the woman she was feeding merely had Alzheimer’s – and otherwise I would have known nothing more than that fact – I could not have imagined the implications the disease had on their family and would certainly not know the many extraordinary things she told me about her mother’s life. Storytelling to me is allowing space for emotion, for one’s own definition of something; it’s a place of power, because it holds important knowledge about our holiness, about our humanity. Doctors and other healthcare professionals are often expected to listen, but I think they should be free to contribute to the stories and feelings of patients with their own life experiences. As a little girl, when I got a bruise, I remember that always asking my mom to tell me if she had a bruise like that once. It would comfort me when she shared that yes, she too, had been hurt before and that it would be okay. It would help me feel that I am not alone and someone had gone through the same pain before. Therefore, I think that storytelling is significant in general, but for medicine because (at the very least!) it is healthy for both the caretaker and the one who is receiving care.
1. a. What constitutes good evidence (regardless of the academic discipline)?
1. b. How is the way we “see” influenced by the specific place in which we are doing the seeing?
Good evidence makes you feel something. I agree with people who said something visual and tangible is good evidence. Just publishing statistics on a disease hardly does enough to catalyze change in someone, but seeing the realized effects of something like AIDS, maternal mortality, war, etc. can have a lasting impact on one’s psyche.
The place in which we see something is important as well. Completely off topic but the “I Can’t Breathe” movement by many NBA players recently comes to mind. Some normal middle aged white guy watching a basketball will typically have no deep knowledge of the anti police brutality movements taking place across the country, and this is no fault of his own, he is a product of his environment and the mainstream news sort of glosses over the movements. However, if he is constantly seeing guys like Lebron James, Kobe Bryant, and Derrick Rose wearing these shirts he is going to start thinking about the issue more. So while random it is telling of what disrupting the conscience can do to one’s thinking, and this is the point of protest. Therefore, place and time is very important for seeing.
2. What is the significance of storytelling for medicine and health?
Health is a narrative in and of itself. In mental health much of one’s current psychological state is determined by all the events that have occurred in one’s life. The connection between these events and it is important for one to realize that. Health in general is a result of all the events that have occurred in one’s life. Where you were born and who you were born to, where you went to school, your friends, your relationships, your gender, your sexuality, your race, etc. These all tell the story of your health, and it is important for health providers to recognize this.