Using Narrative Medicine to Explore the Social Roots of Illness

Andrew Herxheimer and Ann McPherson, clinical pharmacologist and general physician, respectively, initiated the DIPEx Project– a database of individual experiences from patients that received a hospital treatment. The database is divided into module names including accounts particular to each module. For example, some of the modules included chronic pain, breast screening, ovarian cancer, people with dementia and their fears. The experiences shared on DIPEx originated from interviews conducted orally as is custom in medical sociology (Lawton, 2003) where the participant was encouraged to share their story without being interrupted. (Herxheimer & Ziebland 2004)

This means of using narrative to explore illness ties into Harvard Psychiatrist, Kleinman’s argument that differentiating between “illness experience” and “disease experience” allows us to separate experiences of symptoms and suffering from physiological changes. While both aspects are crucial to understanding the full extent of the ailment, disease experience alone does not allow us to diagnose ailments efficiently (Kleinman, 1988). Paul Farmer, in his book, goes into the social roots of illness. He claims that the largest epidemic we face is poverty. Poverty is what forces people to live in small unsanitary places with low ventilation. Poverty forces increased crime rates because people steal resources because they are unaffordable, but necessary for survival. Increased crime results in unsafe living spaces. Poverty dictates our food choices, which come back to affect overall health.

Figure 1. Kleinman’s book, The Illness Narratives

Kleinman picks it up and reveals that the causes for pain and suffering are the same institutions that distort the accounts of pain that are expressed. Pain is a manifestation of a much larger idea, that we experience pain through our surroundings and the influences of day to day life greatly impact our well beings. There is violence in all aspects of our life and this constant violence influences how well our bodies function. Violence can come from images, daily stress, and fear/hatred. This can cause pain and suffering to our bodies, leaving us ill and weak. (Kleinman, 2000)

Citations:

Farmer, P. (2001). Infections and inequalities: The modern plagues. Univ of California Press.

Herxheimer, A., & Ziebland, S. (2004). The DIPEx project: collecting personal experiences of illness and health care. Narrative research in health and illness, 115-131.

Kleinman, A. (1988). The illness narratives: Suffering, healing, and the human condition. Basic books.

Kleinman, A. (2000). The violences of everyday life. Violence and subjectivity, 226-241.

Julia, L. (2003). Lay experiences of health and illness: past research and future agendas. Sociology of health & illness, 25(3), 23-40.