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May/June 2008 Alternative Health
Narrative Medicine: The Story of Asthma

by Lewis Mehl-Madrona

Narrative medicine helps us understand that everything we assume to be true about the world is just a story.

The idea is simple -- that it's all story and that we, as a culture, create our stories. This is not in a negative sense, as in lying, but in the most positive sense as a creative act of meaning-making in which we produce a story or map that makes sense of our world and, to the extent it matches our environment, allows us to survive in that world. It even allows us to alter our world and even our physiology. What's different about the story of the person who is diagnosed with schizophrenia, for example, is the mismatch of his story with the environment. We can evaluate stories on the basis of how well they fit their context and environment.

Mainstream medicine teaches physicians to be skeptical about treatments that are not purely material or for which a palpable physical process cannot be invoked. Most of us are unwilling to consider that some of our beliefs might be inaccurate. We can only express doubt from within the shared beliefs of our peers. Narrative medicine helps us to understand that all is story, that we can believe everything and nothing, in the sense that we can work with those stories that seem helpful at the time without pledging allegiance to them for all time.

Within a narrative framework, we are free to seek other stories about science and medicine to support our work. We can use these stories as bridges to indigenous medicines, which are based upon stories similar to those of the new physics that emphasize connectivity and the interrelatedness of all things.

Talking with Asthma

Asthma has a well-established conventional story. In this story, genetic factors influence the interaction of the membranes of the respiratory tree with the environment, which leads to excess mucus production, inflammation, constriction and spasm of the smooth muscles. In this story, how the person lives, influences of family stress and relationships, and personal and cultural beliefs all are irrelevant to asthma, which appears because of genetic mutations that lead the immune system to respond in "asthmatic ways." Pulmonologists rarely care about the story of the person's life. This is unimportant to their conceptualization of the disease.

Asthma can be conceptualized as one thread that runs through a life, just as multiple themes may run through a novel. Asthma wants to be recognized, for it is not just a theme. It is also a character. It has a life. It has its own story. It has its own spirit. Small miracles can occur when it is recognized. It rejoices when recognized. Asthma is a kind of person who wants to be encountered. This is not the daily fare of physicians, who work with signs and symptoms, much as historians work with documents. In the context both of medicine and history, the voices behind the signs, symptoms and documents are silent.

Here is an example. Karen had long suffered from asthma (as well as Crohn's disease, hypothyroidism and arthritis). She was only in her mid-30s and felt her body was betraying her, as all the men in her life had done. She said she had "tried everything" for her asthma, and all had failed.

We began with a dialogue with the spirit of her asthma. These dialogues emerge as part of a guided imagery process in which we enter a relaxed state of mind and then slowly allow a scene to appear in which the spirit of the illness wishes to present itself. For Karen, it appeared as a huge spider that was eating her bronchial tubes. The spider said it had been there since her birth and that it fed on shame. It thrived on humiliation, which had been a major issue for her parents and their parents as well.

We learn from the aboriginal healers not to try to generalize this into any principles about asthma. This is Karen's story and only Karen's story. Nothing more. Her story tells us nothing about what the next person will tell us. Next we looked for a helper spirit. It happened to be Gauguin. Was it really the historical person? Does it matter? Gauguin told Karen the story of his frustrated life as a banker in Paris and how he overthrew it and ran off to Tahiti to become a painter. He told her to do the same.

Now we could shift the focus of the dialogue to wonder what form her escape might take. We began to plan a "jail break." I suggested we contact several "future selves" to inquire how each of them had handled the transition to wellness. We found beings with whom to talk. One had moved to San Francisco and opened up a gallery. Another version of her future self moved her social work practice to a low-key job with an agency. All involved her starting to paint again, with a dramatic increase in her exposure to light and space. I playfully invoked Max Tegmark's parallel universe story as a rationale for our journeys.

Within this new story, even dietary changes and micronutrients could take on new meaning and new effectiveness. As Karen made these changes, she began to improve. The biomedical story cannot explain Karen's changes, except to say that they were random, which dismisses the personality of her asthma and the richness of her narrative about what happened.

Ceremony was pivotal in Karen's healing journey. Healing ceremonies like Karen's require focused, concentrated effort -- more human consciousness than can be attained in ordinary life. In Karen's context, this was accomplished through guided imagery, visualization and other dialogue.

Excerpted from Lewis Mehl-Madrona's Narrative Medicine. Lewis Mehl-Madrona, M.D., Ph.D, is an associate professor of family medicine and psychiatry at the University of Saskatchewan and is the author of the bestselling book Coyote Medicine. Visit www.mehlmadrona.mysite.com.