by Dr. Talia Marcheggiani, ND | Oct 10, 2021 | Alcohol, Anxiety, Balance, Book Review, Depression, Emotional Wellness, Emotions, Happiness, Healing Stories, Health, Meditation, Mental Health, Mind Body Medicine, Mindfulness, Psychedelics, Psychology, Self-care
It was a crappy week and I was chatting with a friend online. He said something that triggered me… it just hit some sort of nerve. I backed away from my computer, feeling heavy. I went to the kitchen to pour myself a glass of water and collapsed, elbows on the counter, head in my hands, my body shaking and wracking with deep, guttural sobs.
A few seconds later, I’m not sure how long exactly, I stood up. Tears and snot streaming down my face, I wiped them off with a tissue. I felt lighter, clearer. I was still heavy and sad, but there was a part of me that had opened. I went back to my computer and relayed some of this to my friend, “what you said triggered me, but it’s ok, it just hit a personal nerve. I’m ok now though, I know you didn’t mean any harm”. I typed to him.
Joan Rosenberg, PhD in her book 90 Seconds to a Life You Love, would have said that, in that moment, I had been open to feeling the moment-to-moment experience of my emotions and bodily sensations. I felt the waves of emotions run through my body, and let them flow for a total of up to 90 seconds. And, in so welcoming that experience and allowing it to happen rather than blocking it, fighting it, projecting it (onto my friend or others), I was able to release it and let it go.
For many of us, avoidance is our number one strategy when it comes to our emotions. We don’t like to feel uncomfortable. We don’t like unpleasant sensations, thoughts and feelings and, most of all, we don’t like feeling out of control. Emotions can be painful. In order to avoid these unpleasant experiences, we distract ourselves. We try to numb our bodies and minds to prevent these waves of emotion and bodily sensation from welling up inside of us. We cut ourselves off.
The problem, however is that we can’t just cut off one half of our emotional experience. When we cut off from the negative emotions, we dampen the positive ones as well.
This can result in something that Dr. Rosenberg titles, “soulful depression”, the result of being disconnected from your own personal experience, which includes your thoughts, emotions and body sensations.
Soulful depression is characterized by an internal numbness, or a feeling of emptiness. Over time it can transform into isolation, alienation and hopelessness–perhaps true depression.
Anxiety in many ways is a result of cutting ourselves off from emotional experience as well. It is a coping mechanism: a way that we distract ourselves from the unpleasant emotions we try to disconnect from.
When we worry or feel anxious our experience is often very mental. We might articulate that we are worried about a specific outcome. However, it’s not so much the outcome we are worried about but a fear and desire to avoid the unpleasant emotions that might result from the undesired outcome–the thing we are worrying about. In a sense, anxiety is a way that we distract from the experience of our emotions, and transmute them into more superficial thoughts or worries.
When you are feeling anxious, what are you really feeling?
Dr. Rosenberg writes that there are eight unpleasant feelings:
- sadness
- shame
- helplessness
- anger
- embarrassment
- disappointment
- frustration
- vulnerability
Often when we are feeling anxious we are actually feeling vulnerable, which is an awareness that we can get hurt (and often requires a willingness to put ourselves out there, despite this very real possibility).
When we are able to stay open to, identify and allow these emotions to come through us, Dr. Rosenberg assures us that we will be able to develop confidence, resilience, and a feeling of emotional strength. We will be more likely to speak to our truth, combat procrastination, and bypass negative self-talk.
She writes, “Your sense of feeling capable in the world is directly tied to your ability to experience and move through the eight difficult feelings”.
Like surfing a big wave, when we ride the waves of the eight difficult emotions we realize that we can handle anything, as the rivers of life are more able to flow through us and we feel more present to our experience: both negative and positive.
One of the important skills involved in “riding the waves” of difficult feelings is to learn to tolerate the body sensations that they produce. For many people, these sensations will feel very intense–especially if you haven’t practice turning towards them, but the important thing to remember is that they will eventually subside, in the majority of cases in under 90 seconds.
Therefore, the key is to stay open to the flow of the energy from these emotions and body sensations, breathe through them and watch them crescendo and dissipate.
This idea reminds me of the poem by Rumi, The Guest House:
This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.
Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.
The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.
Be grateful for whoever comes,
because each has been sent
as a guide from beyond.
One of the reasons I was so drawn to Dr. Rosenberg’s book is this idea of the emotional waves lasting no more than 90 seconds. We are so daunted by these waves because they require our surrender. It is very difficult however, if you suffer from anxiety to let go of control. To gives these emotional waves a timeframe can help us stick it out. 90 seconds is the length of a short song! We can tolerate almost anything for 90 seconds. I found this knowledge provided me with a sense of freedom.
The 90 seconds thing comes from Dr. Jill Bolt Taylor who wrote the famous book My Stroke of Insight (watch her amazing Ted Talk by the same name). When an emotion is triggered, she states, chemicals from the brain are released into the bloodstream and surge through the body, causing body sensations.
Much like a wave washing through us, the initial sensation is a rush of the chemicals that flood our tissues, followed by a flush as they leave. The rush can occur as blushing, heat, heaviness, tingling, is over within 90 seconds after which the chemicals have completely been flushed out of the bloodstream.
Dr. Rosenberg created a method she calls the “Rosenberg Reset”, which involves three steps:
- Stay aware of your moment-to-moment experience. Fully feel your feelings, thoughts, bodily sensations. Choose to be aware of and not avoid your experience.
- Experience and move through the eight difficult feelings when they occur. These are: sadness, shame, helplessness, anger, embarrassment, disappointment, frustration, vulnerability.
- Ride one or more 90 second waves of bodily sensations that these emotions produce.
Many therapeutic techniques such as mindfulness, Dialectical Behaviour Therapy, somatic therapy, and so on utilize these principles. When we expand our window of tolerance and remain open to our physical and emotional experience we allow energy to move through us more gracefully. We move through our stuckness.
Oftentimes though, we can get stuck underwater, or hung up on the crest of a wave. Rumination and high levels of cortisol, our stress hormone can prolong the waves of unpleasant emotion. We may be more susceptible to this if we have a narrow window of tolerance due to trauma.
However, many of us can get stuck in the mind, and when we ruminate on an emotionally triggering memory over and over again, perhaps in an effort to solve it or to make sense of it, we continue to activate the chemicals in our body that produce the emotional sensation.
Therefore, it’s the mind that can keep us stuck, not the emotions themselves. Harsh self-criticism can also cause feelings to linger.
I have found that stories and memories, grief, terror and rage can become stuck in our bodies. Books like The Body Keeps the Score speak to this–when we block the waves, or when the waves are too big we can build up walls around them. We compartmentalize them, we shut them away and these little 90 second waves start to build up, creating energetic and emotional blockages.
In Vipassana they were referred to as sankharas, heaps of clinging from mental activity and formations that eventually solidify and get lodged in the physical body, but can be transformed and healed.
Perhaps this is why a lot of trauma work involves large emotional purges. Breathwork, plant medicines such as Ayahuasca, and other energetic healing modalities often encourage a type of purging to clear this “sludge” that tends to accumulate in our bodies.
My friend was commenting on the idea that her daughter, about two years old, rarely gets sick. “She’ll have random vomiting spells,” my friend remarked, “and then, when she’s finished, she recovers and plays again”.
“It reminds me of a mini Ayahuasca ceremony”, I remarked, jokingly, “maybe babies are always in some sort of Ayahuasca ceremony.”
This ability to cry, to purge, to excrete from the body is likely key to emotional healing. I was listening to a guest on the Aubrey Marcus podcast, Blu, describe this: when a story gets stuck in a person it often requires love and a permission to move it, so that it may be purged and released.
Fevers, food poisoning, deep fitful spells of sobbing may all be important for clearing up the backlog of old emotional baggage and sludge so that we can free up our bodies to ride these 90 second emotional waves in our moment-to-moment experience.
Grief is one of these primary sources of sludge in my opinion. Perhaps because we live in a culture that doesn’t quite know how to handle grief–that time-stamps it, limits it, compartmentalizes it, commercializes it, and medicates it–many of us suffer from an accumulation of suppressed grief sankharas that has become lodged in our bodies.
Frances Weller puts it this way,
“Depression isn’t depression, it’s oppression–the accumulated weight of decades of untouched losses that have turned into sediment, an oppressive weight on the soul. Processing loss is how the majority of therapies work, by touching sorrow upon sorry that was never honoured or given it’s rightful attention.”
Like a suppressed bowel movement, feelings can be covered up, distracted from. However, when we start to turn our attention to them we might find ourselves running to the nearest restroom. Perhaps in these moments it’s important to get in touch with someone to work with, a shaman of sorts, or a spiritual doula, someone who can help you process these large surges of energy that your body is asking you to purge.
However, it is possible to set our dial to physiological neutral to, with courage turn towards our experience, our emotions and body sensations. And to know that we can surf them, and even if we wipe out from time to time, we might end up coming out the other side, kicking out, as Rumi says, “laughing”.
The only way out is through.
As Jon Kabat Zinn says, “you can’t stop the waves, but you can learn to surf”.
by Dr. Talia Marcheggiani, ND | Jan 7, 2016 | Asian Medicine, Book, Book Review, Diet, Docere, Education, Evidence Based Medicine, Exams, Healing Stories, Health, Medicine, Narrative Therapy, Naturopathic Philosophy, Naturopathic Principles, Philosophy
A singular narrative is told and retold regarding medicine in the west. The story goes roughly like this: the brightest students are accepted into medical schools where they learn—mainly through memorization—anatomy, physiology, pathology, diagnostics, microbiology, and the other “ologies” to do with the human physique. They then become doctors. These doctors then choose a specialty, often associated with a specific organ system (dermatology) or group of people (pediatrics), who they will concentrate their knowledge on. The majority of the study that these doctors undergo concerns itself with establishing a diagnosis, i.e.: producing a label, for the patient’s condition. Once a diagnosis has been established, selecting a treatment becomes standardized, outlined often in a cookbook-like approach through guidelines that have been established by fellow doctors and pharmaceutical research.
The treatment that conventional doctors prescribe has its own single story line involving substances, “drugs”, that powerfully over-ride the natural physiology of the body. These substances alter the body’s processes to make them “behave” in acceptable ways: is the body sending pain signals? Shut them down. Acid from the stomach creeping into the esophagus? Turn off the acid. The effectiveness of such drugs are tested against identified variables, such as placebo, to establish a cause and effect relationship between the drug and the result it produces in people. Oftentimes the drug doesn’t work and then a new one must be tried. Sometimes several drugs are tried at once. Some people get better. Some do not. When the list is exhausted, or a diagnosis cannot be established, people are chucked from the system. This is often where the story ends. Oftentimes the ending is not a happy one.
On July 1st, naturopathic doctors moved under the Regulated Health Professionals Act in the province of Ontario. We received the right to put “doctor” on our websites and to order labs without a physician signing off on them. However, we lost the right to inject, prescribe vitamin D over 1000 IU and other mainstay therapies we’d been trained in and been practicing safely for years, without submitting to a prescribing exam by the Canadian Pharmacists Association. Naturopathic doctors could not sit at the table with the other regulated health professions in the province until we proved we could reproduce the dominant story of western medicine—this test would ensure we had.
Never mind that this dominant story wasn’t a story about our lives or the medicine we practice—nowhere in the pages of the texts we were to read was the word “heal” mentioned. Nowhere in those pages was there an acknowledgement about the philosophy of our own medicine, a respect towards the body’s own self-healing mechanisms and the role nature has to play in facilitating that healing process. It was irrelevant that the vast majority of this story left out our years of clinical experience. The fact that we already knew a large part of the dominant story, as do the majority of the public, was set aside as well. We were to take a prescribing course and learn how primary care doctors (general practitioners, family doctors and pediatricians), prescribe drugs. We were to read accounts of the “ineffectiveness” of our own therapies in the pages of this narrative. This would heavy-handedly dismiss the experience of the millions of people around the world who turn to alternative medicine every year and experience success.
We were assured that there were no direct biases or conflict of interests (no one was directly being paid by the companies who manufacture these drugs). However, we forget that to have one story is to be inherently and dangerously biased. Whatever the dominant story is, it strongly implies that there is one “truth” that it is known and that it is possessed by the people who tell and retell it. Other stories are silenced. (Author Chimamanda Ngozi Adichie describes this phenomenon in her compelling TED Talk, “The Danger of a Single Story”).
Despite the time and money it cost me, taking the prescribing course afforded me an opportunity to step outside of the discouraging, dominant story of the standard medical model and thicken the subordinate stories that permeate the natural and alternative healing modalities. These stories began thousands of years ago, in India and in China, at the very root of medicine itself. They have formed native ancestral traditions and kept entire populations and societies alive and thriving for millennia. Because our stories are not being told as often, or told in the context of “second options” or “last resorts”, when the dominant narratives seem to fail us, the people who tell them run the risk of being marginalized or labeled “pseudoscientific.” These dismissals, however, tell us less about The Truth and more about the rigid simplicity of the singular story of the medical model.
It is frightening to fathom that our body, a product of nature itself, encompasses mysteries that are possibly beyond the realm of our capacity for understanding. It’s horrifying to stand in a place of acknowledgement of our own lack of power against nature, at the inevitability of our own mortality. However, if we refuse to acknowledge these truths, we close ourselves off to entire systems that can teach us to truly heal ourselves, to work with the body’s wisdom and to embrace the forces of nature that surround us. The stories that follow are not capital T truths, however, they can enrich the singular story that we in the west have perpetuated for so long surrounding healing.
The body cannot be separated into systems. Rather than separating depression and diarrhea into psychiatry and gastroenterology, respectively, natural medicine acknowledges the interconnectivity between the body’s systems, none of which exist in a vacuum. When one system is artificially manipulated, others are affected. Likewise, an illness in one system may result in symptoms in another. There have been years of documentation about the gut-brain connection, which the medical model has largely ignored when it comes to treatment. The body’s processes are intricately woven together; tug on one loose thread and the rest either tightens or unravels.
We, as products of nature, may never achieve dominion over it. Pharmaceutical drugs powerfully alter the body’s natural physiology, often overriding it. Since these drugs are largely manmade, isolated from whole plants or synthesized in a lab, they are not compounds found naturally. Despite massive advances in science, there are oceans of what we don’t know. Many of these things fit into the realm of “we don’t know what we don’t know”—we lack the knowledge sufficient to even ask the right questions. Perhaps we are too complex to ever truly understand how we are made. Ian Stewart once wrote, “If our brains were simple enough for us to understand them, then we’d be so simple that we couldn’t.” And yet, accepting this fact, we synthesize chemicals that alter single neurotransmitters, disrupting our brain chemistry, based on our assumption that some people are born in need of “correcting” and we have knowledge of how to go about this corrective process. Such is the arrogance of the medical model.
There are always more than two variables in stories of disease and yet the best studies, the studies that dictate our knowledge, are done with two variables: the drug and its measured outcome. Does acetaminophen decrease pain in patients with arthritis when compared to placebo? A criticism of studies involving natural medicine is that there are too many variables—more than one substance is prescribed, the therapeutic relationship and lifestyle changes exert other effects, a population of patients who value their health are different than those who do not, the clinical experience is more attentive, and so on. With so many things going on, how can we ever know what is producing the effect? However, medicine is limited in effect if we restrict ourselves to the prescription of just one thing. This true in herbalism, where synergy in whole plants offers a greater effect than the sum of their isolated parts. By isolating a single compound from a plant, science shows us that we may miss out on powerful healing effects. Like us, plants have evolved to survive and thrive in nature; their DNA contains wisdom of its own. Stripping the plant down to one chemical is like diluting all of humanity down to a kidney. There is a complexity to nature that we may never understand with our single-minded blinders on.
Studies are conducted over the periods of weeks and, rarely, months, but very rarely are studies done over years or lifetimes. Therefore, we often look for fast results more than signs of healing. This is unfortunate because, just as it takes time to get sick, it takes time to heal. I repeat the previous sentence like a mantra so patients who have been indoctrinated into a medical system that produces rapid results can reset expectations about how soon they will see changes. Sometimes a Band-Aid is an acceptable therapy; few of us can take long, hard looks at our lives and begin an often painful journey in uncovering what hidden thought process or lifestyle choices may be contributing to the symptoms we’re experiencing. However, the option of real healing should be offered to those who are ready and willing.
When we study large masses of people, we forget about individuality. When we start at the grassroots level working with patients on the individual level, we familiarize ourselves with their stories, what healing means to them. In science, large studies are favoured over small ones. However, in studies of thousands of people, singular voices and experiences are drowned out. We lose the eccentric individualities of each person, their genetic variability, their personalities, their preferences and their past experiences. We realize that not everyone fits into a diagnostic category and yet still suffers. We realize that not everyone gets better with the standard treatments and the standard dosages. Starting at the level of the individual enables a clinician to search for methods and treatments and protocols that benefit each patient, rather than fitting individuals into a top-down approach that leaves many people left out of the system to suffer in silence.
It is important to ask the question, “why is this happening?” The root cause of disease, which naturopathic medicine claims to treat is not always evident and sometimes not always treatable. However, the willingness to ask the question and manipulate the circumstances that led to illness in the first place is the first step to true and lasting healing; everything else is merely a band-aid solution, potentially weakening the body’s vitality over time. No drug or medical intervention is a worthy substitute for clean air, fresh abundant water, nutritious food, fulfilling work and social relationships, a connection to a higher purpose, power or philosophy and, of course, good old regular movement. The framework for good health must be established before anything else can hope to have an effect.
The system of naturopathic medicine parallels in many ways the system of conventional pharmaceutical-based medicine. We both value science, we both strive to understand what we can about the body and we value knowledge unpolluted by confusing variables or half-truths. However, there are stark differences in the healing philosophies that can’t be compared. These differences strengthen us and provide patients with choice, rather than threatening the establishment. The time spent with patients, the principles of aiming for healing the root cause and working with individuals, rather than large groups, offer a complement to a system that often leaves people out.
There are as many stories of healing and medicine as there are patients. Anyone who has ever consulted a healthcare practitioner, taken a medicine or soothed a cold with lemon and honey, has experienced some kind of healing and has begun to form a narrative about their experience. Anyone with a body has an experience of illness, healing or having been healed. Those of us who practice medicine have our own experience about what works, what heals and what science and tradition can offer us in the practice of our work. Medicine contains in its vessel millions of stories: stories of doubt, hopelessness, healing, practitioner burnout, cruises paid for my pharmaceutical companies, scientific studies, bias, miracle cures, promise, hope and, most of all, a desire to enrich knowledge and uncover truth. Through collecting these stories and honouring each one of them as little truth droplets in the greater ocean of understanding, we will be able to deepen our appreciation for the mystery of the bodies we inhabit, learn how to thrive within them and understand how to help those who suffer inside of them, preferably not in silence.
by Dr. Talia Marcheggiani, ND | Apr 8, 2013 | Art, Art Therapy, Book Review, Canadian College of Naturopathic Medicine, Creativity, Empathy, Healing Stories, Listening, Naturopathic Philosophy, Naturopathic Principles, Philosophy, Psychology, Student, Writing
A classmate recently lent me a book that introduced me to the intriguing field of “narrative medicine.” The book is called Narrative Medicine: Honoring the Stories of Illness, written by Rita Charon, MD, an internist practicing in New York City. Narrative medicine combines the practice of medicine with simultaneously learning to recognize, absorb, interpret, and be moved by the stories of illness.
According to the book, the practice of narrative medicine builds empathy and compassion for patients by giving meaning to their experience through stories. It allows doctors to bear witness to the patients and their suffering and to enable those who are suffering to be heard, thus making their care more effective and, by virtue of the doctor’s presence and ability to testify to the patient’s pain, the pain is lessened somewhat.
The Need for Narrative in Modern and Natural Medicine
Rita writes, “the medical impulse toward replicability and universality has muted doctors’ realization of the singularity and creativity of their acts of observation and description.” In medical school we come to learn that, when asked to choose between a) b) c) d) or e), all of the above, there can only be one right answer. Through these educative measures, we are led to believe that there is no room for creativity or individuality in medicine. Narrative medicine, however, begins to challenge that belief. According to Dr. Charon, there is a struggle in medicine to balance the need to properly observe the phenomenon of the individual patient and his or her particular clinical presentation before us, with the need to fit people into diagnostic categories. Oftentimes, the scale tips to the latter, simply by nature of patient volume or ease of the encounter. When we fit people into categories we can ease the anxiety that comes with uncertainty. We are soothed by the security of being right, the same way we are soothed by correctly choosing c) on a multiple choice exam. Patients, however, have come to resent this aspect of modern medicine. Rita writes, “patients complain that doctors or hospitals treat them like numbers or like items on an assembly line. They lament that their singularity is not valued and that they have been reduced to that level at which they repeat other human bodies.” In Rita Charon’s eyes, however, we are beginning to see a new emergence of both doctors and patients taking back the right to patient individuality in medical care. We naturopathic doctors hear this often, when asking why a patient decided to come to see us in lieu of a medical doctor, and hearing that they were driven by the need to be treated “like a person”, not just a disease.
Our bodies and our health are integral parts of the narratives of our lives. And so a personal medical history that, in the case of a medical school exam, takes about 8-10 minutes to complete, actually carries in it the patient’s life story. Everything that the body have been through the self has also been through and whatever has happened to the body remains ingrained in the self and forms a part of the patient’s narrative. Kathryn Montgomery, a colleague of Rita Charon’s once said, “you can accomplish an entire medical interview by simply asking a patient, “tell me about your scars.'”
Dr. Rita Charon writes, “without doubt, the teller and the listener in the clinical setting work together to discover or create the plot of their concerns. The better equipped clinicians are to listen for or read for a plot, the more accurately will they entertain likely diagnoses and be alert for unlikely but possible ones. To have developed methods of searching for plot or even imagining what the plot might be equips clinicians to wait, patiently, for a diagnosis to declare itself, confident that eventually the fog will rise and the contours of meaning will become clear.” Narrative, we learn, is essential for understanding illness.
Receiving a Patient History
Sir Richard Bayliss, another colleague of Charon’s, writes, “not only must the physician hear what is said but with a trained ear he or she must listen to the exact words that the patient uses and the sequence in which they are uttered. Histories must be received, not taken.”
Rita Charon’s current method of “receiving” a patient history is described eloquently in her book. It differs so much from the style we are taught in medical school, that I feel it is worth sharing. She writes that, when she first meets a patient, she begins by saying, “tell me what you think I should know about your situation.” She then makes the commitment to listen, without speaking or writing anything down. In medical school we are taught to organize a chart by history of presenting illness, past medical history, family history, etc. However, Charon realized that, by allowing the patient to direct his or her own clinical interview, the information all comes out eventually. She believes it is crucial to allow the patients to narrate their own history, allowing the information to take its own order, to formulate itself into not just a coherent plot but also a literary form, so that the entire story becomes apparent, and free from her own bias and internal or external editing. While the patient tells his or her story, Dr. Charon listens as intently as she can, registering diction, form, images and the pace of speech emitted from the patient’s mouth. She tries not to interrupt or confer signs of encouragement, pleasure or disapproval. She refrains from asking questions. And, she takes the time to absorb the metaphors, idioms, accompanying gestures, plot and characters involved in the patient’s narrative.
Once her patient has finished with his or her telling, Dr. Charon proceeds to the physical exam portion of the clinical visit. She tries to capture what has been said by writing the story down in her chart while the patient changes into his or her gown and readies for the physical examination.
Dr. Charon writes that it has taken her a while to perfect this form of receiving a patient history. As unorthodox as it may seem, she writes that she has come to thoroughly enjoy the individuality and humanity of the stories that come from each person, each one so different from any other and each belonging to a singular person and body. It has helped her understand her patients, maintain empathy for them and provide them with what she believes is more effective care.
The Parallel Chart
Rita Charon believes that, not only is the use of narrative helpful for the doctor-patient relationship, it can be used to help physicians and other healthcare practitioners digest their experience as well. In one of her years as a clinical supervisor, she developed a practice called the Parallel Chart. As medical students and doctors, we are required to write our patient’s stories in the form of medical charts, following a specific format, creating what can be viewed as an entire literary genre used solely among medical professionals. Medical students and doctors alike are expected to learn to write and maintain a coherent medical chart, according to the standards of this genre.
However, as a clinical supervisor, Rita Charon also has her young precepts write a Parallel Chart, one that will not be filed for reference but that is just for the benefit of the practitioner, written in plain language, about one of his or her patients. She tells her students, “every day you write in the hospital chart about each of your patients. You know exactly what to write there and the form in which to write it. You write about your patient’s current complaints, the results of the physical exam, laboratory findings, opinions of consultants, and the plan. If your patient dying of prostate cancer reminds you of your grandfather, who died of that disease last summer, and each time you go into the patient’s room, you weep for your grandfather, you cannot write that in the hospital chart. We will not let you. And yet it has to be written somewhere. You write it in the Parallel Chart.”
After giving her students these instructions, Rita Charon meets with them in a group once a month and gives everyone the chance to read a Parallel Chart entry of their choice out loud. After the reading, she proceeds to comment on the genre, temporality, metaphors, structure and style of the text that has been written, using her literary background as a guide. The other students then have a chance to respond to the text, creating a dialogue surrounding their clinical experiences.
She reflects that her students in the past have written about their deep attachment to patients, their feelings of helplessness in the clinical encounter in their role as mere medical students, the rage, shame and humiliation they experience in the face of disease as well as their awe at patients’ courage. Dr. Rita Charon claims that the students who undertake the task of keeping a Parallel Chart have found that they are more in touch with their own emotions during the clinical encounter, feel deeper empathy for their patients and fellow colleagues and are able to understand their patients more fully. Research is even being conducted at Columbia University to evaluate the effectiveness of Parallel Charting, finding that physicians who engage in this practice are more proficient and effective at conducting medical interviews, performing medical procedures and developing doctor-patient relationships with patients.
In many ways, naturopathic medicine already acknowledges the importance of patient story-telling when it comes to healing from disease. We treat people as individuals and look for the root cause of illness, taking into account the story behind each of our patient’s “scars”. However, as our school curriculum becomes more medicalized and primary care-focused, I believe that our need to conduct efficient medical interviews and develop effective treatment plans is in danger of displacing our inherent philosophies. Taking the time to read Rita Charon’s book opened my eyes to the importance of patient individuality and respect for patient narrative. To understand illness, it is essential to integrate narrative into the framework of the clinical encounter by giving patients the space to tell, while also giving ourselves, the practitioners, the space for our own telling with the intention of becoming better, more empathetic doctors.
by Dr. Talia Marcheggiani, ND | Jul 30, 2012 | Balance, Book, Book Review, Creativity, Education, Emotions, Finding yourself, Ideal You, Mental Health, Philosophy, Psychology, Self-esteem, Self-reflection, Writing
I have a confession to make. Sometimes when I see someone I know in a public place, usually at the end of a long day, I am often guilty of lowering my head and pretending I don’t notice them, regardless of how good a hair day I’ve been having.
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by Dr. Talia Marcheggiani, ND | May 24, 2012 | Art, Book, Book Review, Naturopathic Philosophy, Summer, Sunshine, Travel Stories
While suffering through the damp, dark remaining months of 2nd year of naturopathic medical school, camped out in middle-of-nowhere North York, I began to have intense emotional cravings for summer. (more…)
