Narratives in Medicine

'Doctor's  Stories' from a linguistic point of  view

The relevance of storytelling to medicine has been discussed inside and outside the discipline with emphasis on the observation that medicine is a science of individuals and therefore its knowledge not just expertise, i.e. relevant biological and pathological information, but more often than not orally presented evidence that, since based on individual experience, forms a coherent discourse, a story. In the course of diagnosis and treatment this story becomes a case, to be represented in a variety of genres. Some of these, most notably medical case reports, preserve a kind of natural, “degree-zero” narrativity although professional medical discourse, just as most other sciences, has historically undergone a process of de-narrativisation. In other contexts and media, in particular in the new media, proper illness narratives are produced by both patients and doctors, not only due to the event-based structure of the experience of illness, but also because there seems to be a need for storytelling with potential and positive health effects.

Analyzed against the linguistic background of natural, conversational storytelling, these medical narratives yield insights into the variability and ubiquity of narrative discourse structure. Finding out when and why it is abandoned sheds light on processes such as condensation, impersonalization, and conventionalization, typical of written, specialized discourse, but not at all to the same extent in this domain. Ultimately, only “solved” maladies allow for naming, i.e. non-narrative form, while the new, unexpected and inexplicable element in illness is likely to preserve narrative presentation even in a professional domain. Vice versa, when patients gradually become experts in their illness across time, their discourses also tend towards a mixing of experience and expertise. What is left for narrative presentation in such cases increases our understanding of storytelling, medicine, as well as doctor-patient roles and relationships; at the same time it offers key explanations of grammatical phenomena such as nominalization, embedding, or narrative and evaluative syntax and is therefore a prime case of the interaction between grammar and discourse.