By Ricky Shear, HI Graduate Research Assistant
Dr. David Ring, Associate Dean for Comprehensive Care, professor of surgery and perioperative care, and courtesy professor of psychiatry at the Dell Medical School, led the first Spring 2019 meeting of the University of Texas Humanities Institute’s Faculty Fellows Seminar. In keeping with the FFS’s theme, “Narrative Across the Disciplines,” Dr. Ring suggested that attending to and understanding personal narratives is essential to providing comprehensive healthcare. When Ring meets with patients he not only considers how best to treat their broken hands or sore shoulders but also strives to understand the narrative they have constructed about themselves and their health in response to injury or illness. Is the patient a musician who sees her broken hand as having the potential to bring a tragic and irreversible end to her passion and career? Or is he a high school swimmer who views his sore shoulder as a painful obstacle that should be fixed as quickly as possible? A proponent of the “biopsychosocial paradigm of medicine,” Ring believes that “thoughts, emotions, behaviors, and context are as important as or more important than pathophysiology (when the body is not working as designed)” to getting and staying healthy. Therefore, attending to patient narratives like those outlined above enables him to understand how care may influence or be influenced by patients’ narratives and their associated contexts, thoughts, and emotions. This helps clinicians provide treatment that guides patients to construct narratives that enhance resiliency.
In his article (co-written with Dr. Claiborne Johnston, Dean of the Dell Medical School), “Your Best Life: Resiliency and the Art of Medicine,” Ring cites several studies which suggest that patients’ resiliency (defined by Ring as “the underlying ability to respond positively to adversity such as that brought about by disease”) can positively influence the intensity and magnitude of their symptoms (the reduction of the intensity and frequency of chronic arthritis pain, for example). Ring argues that patients can develop and deploy resiliency by constructing certain kinds of narratives, and that doctors invested in comprehensive care can provide patients with tools to restructure their narratives and develop their resiliency. According to Ring,constructing healthy narratives is the essence of disciplines such as cognitive behavioral therapy with health benefits that are strongly supported by scientific evidence. Ring points out that lines of evidence, including those related to the placebo effect (when people feel better and can do more even when interventions are inert), emphasize the importance of establishing personal connections between doctors and patients, and he writes that having a “trusting and compassionate patient-doctor relationship, where the physician encourages the patient to be involved in their own care” is one of the “core elements of a comprehensive approach to healthcare.”
A number of seminar participants responded to Ring’s take on narrative and comprehensive care by reflecting on the role(s) that narrative has played or could play in their own health and medical experiences or those of their friends and family. That it felt natural to make connections between personal experiences and Ring’s discussion of the importance of narrative to health and comprehensive care suggested that the discussion struck many as potentially impactful in their day-to-day experiences with illness and injury as both patients and caretakers. These reflections on personal experiences related to health, healthcare, and narrative also led seminar participants to interrogate the group’s use of the word “narrative” and pose a pair of questions that will likely pervade seminar meetings going forward: how do we define narrative and what counts as narrative and what doesn’t? Puzzling over and making connections between faculty fellows’ various answers to these questions will likely be an exciting and thought-provoking component of future seminar meetings. Ring’s own answer is that human identity itself counts as a narrative. It is “the story we tell about ourselves,” the kind of story that needs to be sought out and heard by healthcare providers, because stories we tell about ourselves as resilient, vulnerable, inadequate, etc. may impact our health in ways too significant to be ignored.