Stories Inside Healthcare

My new lifeWhen people get sick we think of two sorts of illness. It’s either an acute problem where the person will get better in a short time or that it’s a chronic condition, one where the problem exists for a long time. However it’s common for medical communication to talk about these two different disease experiences in the same way.   Medical communication and goals for treatment focus on the disease or conditions but not the patient as a whole. At this larger level we are missing some points that might help improve both short-term and long-term ways people experience disease. I want to make the case for understanding both the patient journey at a medical level and understanding the patients life story or narrative as it relates to disease as an equal part of therapy planning.

We treat acute and chronic conditions in the same way. Our aim is to get the person back to normal. That sounds intuitive and without question but when we look a little closer this may not be the only way. Each of us has a life story or narrative that guides us. Think of it as the way we make decisions relative to our personal story and it’s the way we authenticate ourselves. This narrative is made up from the stories we tell ourselves about the past and the future we expect for ourselves. Our health is very much part of this narrative.

When someone gets acutely sick our outlook on life changes. We wish to return to the “normal us” in line with the stories we have about what we used to do and what we want to do in the future. Most acute episodes allow us to return after a period back to the normal narrative. The problem comes in chronic conditions, which are permanent deviations from our expected narrative path. Over a time a new narrative forms, incorporating the new and often-limited possibilities the chronic condition allows. This period of adaptation is part of the coping mechanisms we use to live within sickness.

While this process looks logical and familiar,  it may offer new possibilities in caring for people with chronic conditions. The use of storytelling as part of therapy may help both the goals of treatment and the path of therapy to be tailored better to the person. This thought comes from idea that healthcare should be more about personal wellbeing than focused just on the sickness aspects of illness. In acute cases this wellbeing is often in the form of comfort and with comfort the person is often closer to the normal narrative. The speed of resolution of the condition equals the speed of returning to the normal narrative. As long as there are not frequent acute episodes there is little long-lasting disruption to the normal narrative.

In chronic conditions there is a different dilemma. The normal narrative is under threat and more often than not permanent changes are made in a person’s life. For example diabetes requires a permanent change of diet and arthritis often limits activity. In each of these cases the normal narrative is adapted and eventually leading to a new narrative.

So the way we approach wellbeing must be seen through the narrative we are aiming to support. In most acute cases it’s a return to the normal narrative. In chronic conditions it’s an adaptation to a new narrative. We most also recognize that in many conditions people are transitioning to hybrid people. These people are incorporating new tools like wheelchairs, pacemakers and crutches into their lives and narratives. These become part of their identity and they incorporated into the person’s personal story.

The use of story in healthcare allows us to think more holistically about illness and move the goals of wellbeing within illness to goals of recovery and existence in the future. Given the right story goals we may adapt to illness within wellbeing. This phenomenological approach attempts to align the goals of pharmacological therapy with types of therapy like psychological or even philosophical in the attempt to create the best new normal narrative for people living with disease. If the goals of therapy do not match the new narrative forming in people’s minds, the outcomes of treatment will always feel sub-optimal. If we are always expecting and communicating the outcome of treatment will return people to the normal narrative and do not help to build the new narrative (the one which is achievable for the person to live with illness within wellbeing) we are likely to fail to make the best outcomes. One result of this misaligned story is poor adherence to medical advice like taking pills, dieting, improving exercise. It’s possible that people fail to adhere to medical advice as they have not accepted the role of the medical advice as part of the new narrative towards wellbeing.

So to make sure we are supporting this way of thinking we should spend more time thinking and understanding people´s personal story and the way it may need to adapt in the face of chronic illness.

This post was inspired by the writing of Illness- The Art of Living by Havi Carel and of and Atul Gwande’s (Reith Lectures)

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“Myth is the public dream and the dream is the private myth. J Campbell


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Its funny History is hiSTORY. Some would say the future is a story we tell about tomorrow. History is a tale we  tell about yesterday. Reality only exists now, the rest is just a story. So we live all our lives in a perpetual story.

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“Metaphor is both a detour and a destination”.

James Geary

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April 5, 2014 · 10:32 pm

Stories from the Edge

Man at the EdgeIn Lovemarks, Kevin Roberts said ” I want to be as close to the edge as I can without going over. Out on the edge you see all kinds of things you can’t see from the centre”. It’s a great quote and has me looking for stories from the edge. Especially when creating pharma brands the centre is the norm. There are not many of us at the edge yet.

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Emotion and Reason in Marketing-Choosing Your Brand Story

“The essential difference between emotion and reason is that emotion leads to action while reason leads to conclusions.”

Donald Calne

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Choice, Freedom and Happiness Stories

Blue Man MatrixIn the last edition of MISC magazine I read the article by Paul Isakson on “ Truth, Beauty and Transformation” as the central themes for brand stories.  I agree with Paul that these are essential elements of story but I gravitate to three components of story that could be even closer to the center of every story. My three forces in story center around Choice, Freedom and Happiness. These themes seem to reoccur across culture and continental boarders.

Choice stories
Wherever you look you see stories of choice or the lack of choice. As with each of my three there are positive and negative stories to be  told. A brand may use these stories as part of positioning urging the consumer to advocate for change. Counties use these stories to define and maintain society norms reinforcing the way counties and society choose to live. Choice or the lack of it is the literary equivalent of tension. Without tension there is no story worth telling or listening to and here choice becomes the tension.

Freedom stories
These have been told everywhere as part of our ambition and drive for life. Freedom is split into two aspects. Freedom to and freedom from. This is well explained in the great book by SHEENA IYENGAR in “THE ART OF CHOOSING”. So essential are these that few stories do not have some aspect of freedom woven into the meaning of the story. From Mandela to the Olympics (especially Para Olympics)  or the Landrover brand. Freedom is a central theme. Countries also use these stories as part of their culture. It’s central like choice because of our humans aspiration to improve and advance.

Happiness Stories
Finally there are stories of happiness. Building on the other two story themes we seem to be programmed to seek happiness. Maybe this is based on long-term happiness subthemes like love, family, wealth and security or the type of enlightened happiness that come from doing good and all that stems from giving. Happiness stories could equally come from shorter-term subtopics like sports, food and films.  Call it fulfillment or Maslovian self actualization but many of our actions play this story willing us to seek out these forms of happiness.

Of the three themes there appears to be a hierarchy with choice leading to freedom and freedom leading to happiness. For brands these are essential customer experiences that need to be understood by marketers, advertisers and consumers alike.

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