OET Listening Teil C: The Role of Narratives in Medicine

Hello, my name's Anthony Gibbons.

I'm a clinical psychiatrist and published author.

I'd like to talk about something that's relevant to all medical professionals,

the use of narratives in medicine.

Let me begin with a case study sent to me by a colleague who shares my interest in the subject.

The study featured a 30-year-old man who was hospitalized for severe panic attacks.

He was treated with narcoanalysis but, feeling no relief,

turned to alcohol and endured years of depression and social isolation.

Four decades later, he was back in the psychiatric system,

but for the first time he was prescribed the antidepressant Zoloft.

Six weeks later, he was discharged because the panic attacks and depression had disappeared.

He lived a full life until his death 19 years later.

If the narrative was striking, it was even more so for its inclusion in a medical journal.

Repeatedly, I've been surprised by the impact that even lightly sketched case histories can have on readers.

In my first book, I wrote about personality and how it might change on medication.

My second was concerned with theories of intimacy.

Readers, however, often use the books for a different purpose, identifying depression.

Regularly, I received and still receive phone calls,

people saying, my husband's just like X, one figure from a clinical example.

Other readers wrote to say that they'd recognised themselves.

Seeing that they weren't alone gave them hope.

Encouragement is another benefit of case description.

Familiar to us in an age when everyone's writing their biography.

But this isn't to say that stories are a panacea to issues inherent in treating patients,

and there can be disadvantages.

Consider my experience prescribing Prozac.

When certain patients reported feeling better than well after receiving it,

I presented these examples first in essays for psychiatrists and then in my book.

Where I surrounded the narrative material with accounts of research.

In time, my loosely supported descriptions led others to do controlled trials that confirmed the phenomenon.

But doctors hadn't waited for those controlled trials.

In advance, the better-than-well hypothesis had served as a tentative fact.

Treating depression, colleagues looked out for personality change even aimed for it,

even though this wasn't my intended outcome.

This brings me to my next point.

Often, the knowledge that informs clinical decisions emerges when you stand back from it,

like an impressionist painting.

What initially seems like randomly scattered information begins to come together,

and what you see is the bigger picture.

That's where the true worth of anecdote lies.

Beyond its role as illustration, hypothesis builder, and low-level guidance for practice,

storytelling can act as a modest counterbalance to a narrow focus on data.

If we rely solely on evidence,

we risk moving toward a monoculture,

whereby patients and their afflictions become reduced to inanimate objects.

A result I'd consider unfortunate,

since there are many ways to influence preople for the better.

It's been my hope that while we wait for conclusive science,

stories will preserve diversity in our theories of mind.

My recent reading of outcome trials of antidepressants has strengthened my suspicion

that the line between research and storytelling can be fuzzy.

In medicine, randomized trials are rarely large enough to provide guidance on their own.

Statisticians amalgamate many studies through a technique called meta-analysis.

The first step of the process, deciding which data to include, colours the findings.

Effectively, the numbers are narrative.

Put simply, evidence-based medicine is judgement-based medicine,

in which randomised trials are carefully assessed and given their due.

I don't think we need to be embarrassed about this.

Our substantial formal findings require integration.

The danger is in pretending otherwise.

I've long felt isolated in embracing the use of narratives in medicine,

which is why I warmed to the likelihood of narratives being used to inform future medical judgments.

It would be unfortunate if medicine moved fully to squeeze the art out of its science by marginalising the narrative.

Stories aren't just better at capturing the bigger picture, but the smaller picture too.

I'm thinking of the article about the depressed man given the drug Zoloft.

The degree of transformation in the patient was just as impressive as the length of observation.

No formal research can offer a 40-year lead-in or a 19-year follow-up.

Few studies report on both symptoms and social progress.

Research reduces information about many people.

Narratives retain the texture of life in all its forms.

We need storytelling.

Which is why I'll keep harping on about it until the message gets through.