A Medical School for the Soul

The following is a reframe of the Narrative Healthcare Certificate Program as a medical school for the soul, unifying scholarship from science and literature. This is not a renaming but a re-envisioning with greater depth. Overview, implementation, research, and readings are provided.

The Call for a Medical School for the Soul

Modern medical education was defined by a junior-high-school teacher named Leo Flexner in 1910. Why he was selected remains a quiet mystery, but his influence and thinking documented in The Flexner Report shut down more than half of the medical education programs in the U.S., unfortunately many of which were specifically for Black students. Flexner is neither shiny knight nor entirely villainous. Many ideas in his report supported a humanistic medicine while other ideas bear the prejudice of his time. The essentials of his report required medical schools be housed in universities; doctors should focus solely on pathology; and a medical degree required standardized, rigorous study. 

Dr. Arthur Kleinman, a psychiatrist, identifies in The Illness Narrative, a cornerstone text of Narrative Medicine, three aspects of unwellness. There is the disease or ailment, which is diagnosed using differential diagnostics and empirical evidence. This aspect requires the familiar, modern methods of science. The next aspect, illness, is the patient’s experience of the disease or ailment. This aspect cannot be addressed by science. Science, nonetheless, has pointed to what can address it, and that is Storytelling. Storytelling also resolves the third aspect, sickness, which Kleinman defines as the cultural perspective of illness and disease. Storytelling serves this aspect as well. 

A new kind of medical school is necessary if we are to embrace and apply the extraordinary findings these fields generate. In the past two decades, the field for how we define healing has expanded remarkably since Expressive Writing, Narrative Medicine, and Neuroscience started paying attention to creativity. Yet, one piece to the puzzle of well-being is missing from integrative, alternative, and clinical practice education: storytelling in its various, archaic forms.

Storytelling is our natural medicine. It is a function of autopoiesis, the capacity within all living organisms to heal from within through a process of self-reorganization. Through the devaluation of storytelling, the modern world has left this feature of our physiology, our very nature, behind. Over the course of the past century, Medical Humanities programs sought to fill in what Flexner left out: the humanness of the patients and of the doctors. These programs were often located across campuses from the medical schools, though, and the medical curriculum left little room for a full semester of Humanities courses. Dr. Rita Charon, MD PhD found a solution in the English Department when she attained her Doctorate. 

The dual practice of close-reading and reflective writing to a prompt provided the solution. When third-year medical students spent 45-minutes a week over the course of six weeks close-reading literature and writing reflectively to a prompt, their empathy remained intact. The discovery cast light upon the healing properties of stories and poems. Between 1998 and 2022, 843 studies proved as much and more. For all of these, the mechanism of how writing and storytelling heal remains suspended in conjecture—oxytocin, mirror neurons, neuroplasticity, to name a few. 

The natural medicine inside our stories is natural intelligence. Noted in biology as the vehicle for autopoiesis, natural intelligence in humans is seldom, if ever, discussed. It has been renamed as creative imagination and devalued until the current Neuroscience reframe. By cross-referencing Neuroscientific findings on creativity with Narrative Medicine and Expressive Writing findings on the same, this kind of intelligence holds both cognitive and physiological benefits. This latter feature calls attention to all we have nearly forgotten. It is this: until 1790 doctors and poets were both storytellers, one of the body, one of the soul. We needed both. Health is the continuum of one to the other and back again. 

That’s the ouroboros of medicine: we can heal ourselves by knowing our stories so well that we can reorganize ourselves beyond emotional pain and, in some cases such as chronic illness symptoms, beyond sickness. One without the other, though, leaves us in either despair or endless pain. Reaching again back into the pre-modern world, we find Alchemy is not and was never primarily about turning lead into gold. It was embraced globally as fermentation of the self into a soul through storytelling and creativity. This fermentation is the promise of renewal. It occurs at every level of life as autopoiesis. According to the lore, it is the life-process of the universe as much as it is the life-process of the flea, and we are a part of it. Storytelling is its engine. 

The creative process of alchemy was the creative process of becoming whole people by establishing and maintain a steady shifting between matter and mind. The matter of the brain with its synapses firing gets heated and confused. The mind as what we now call “gut brain”  cools it down with reflection and intuition, hence Victor Frankl’s illumination of “the pause” in Man’s Search for Meaning. The pause allows us deeper consideration. It tethers us to actual reality and prevents us from flying off into our sparkling fictions and destructive obsessions. It humbles us. It modifies our thought. It doses us with conscience, compassion, and care. We of the West have let this function vanish in favor of external means of acquiring knowledge. Even Empiricism, though, is expanding to accommodate the linguistic feature of consciousness and what we have termed reality. Physics, Neuroscience, and Medicine have all turned toward Poetics in a mysterious migration. 

The tether binding us to nature is language, the Word even. It reveals itself when we are telling stories and composing poems. Sharon Olds illustrates a poet’s relationship with alterity in her poem, “Improv,” 

. . . I know she is the locus of a gift—
and I am too, a spiral of energy, a genie, a dust-devil,
I was born with it, a life force,
it does not belong to me, or to anyone else,
I’m the container of it, the guardian.
And I love to let it out toward people—
nectary nosegay gusts of it.

Rilke speaks of our loss of this tether in his Sonnet to Orpheus 24, (italics mine)

I, 24 (Sollen wir unsere uralte Freundschaft, die großen)

Will we retain our old friendship with the great gods,

That fail to woo us, our harsh steel raised so sternly,

Knowing them not, rejecting them now, or suddenly

Being forced to search them out on our ancient maps?

Those formidable friends, who bear the dead from us,

Without touching our turning wheels, at any point?

Our banquets are distanced from them, our bathing

Removed, and their messengers now far too slow,

Whom we always overtake. Alone now, wholly

Dependent upon, yet not knowing each other,

We no longer treat the paths as lovely meanders,

But like flights of steps. In the furnace the old fire burns,

There alone, while the hammers are raised in the steam,

Ever larger. While we, like swimmers, lose strength.

 Trans. A. S. Kline

Natural intelligence is how humans naturally experience our world and come to understand our place within it. It is navigation through discernment using Pierce’s “triadic logic,” a systemic knowledge engaging multiple fields. We experience life with a mix of head and heart, linear reason and associative reason, step by incremental step— as opposed to steamrolling ahead without knowing what we are doing. Story cultivates and instills this slower but more meaningful way of being. Evidence shows that this way is better for our health. When we know our stories, we know who we are, what we like, what we hope for and can live toward purpose. Narrative Medicine is folk medicine. We are returning to our nature. 

In 1637 Renée Descartes famously stated “I think, therefore I am.” He revised the thought four years later, removing “I think” and replacing it with “I exist.” Four more years later, another philosopher, Antoine Leonard Thomas, changed the statement to “I doubt, therefore I think, therefore I am.” Linear rationality was figuring itself out through philosophy. How does one rid oneself of the problems of emotion and the lore of imagination and superstition but to doubt one’s own self and leave to someone else the work of explaining who we are? 

So it began, the dimming of the “secret fire” of imagination in favor of a universal light that shines when we have conquered our passions and clearly see the world as it is by way of The Divine Light of Reason. Science promised this reality. Empiricism, the root meaning experience, promised we could find it using our five senses and abolishing any other form of knowing. This edict made its way to Medicine two hundred years later. Without Narrative Medicine Research, natural intelligence would remain in the shadows of the neglected Liberal Arts Education. In the spirit of autopoiesis on the macro scale, the research is calling our attention to it, and it is in our best interest to listen and cultivate individuals’ openness to it in creative practice. 

As CBD dispensaries prepare for the imminent legalization of marijuana, so can a Creative Writing program with a Narrative Healthcare track prepare for the imminent adoption of Social Prescribing. Blue Cross Blue Shield’s partnership with Blue Ridge Parkway Foundation, Kids in Parks, which originated here is now a national initiative embraced by the American Academy of Pediatrics. Today, Asheville is a hot spot for healthcare. It is also a hot spot for non-scientific healing practices. Former chiropractic clinics now brand as Wellness Centers offering massage, meditation, nutrition, psychotherapy, and other therapeutic practices, some approved by the American Medical Association and others not. Until Social Prescribing becomes standard operating practice, graduates can still draw on the data to locate themselves in the healthcare field, charging clients for guidance at similar rates to massage and other integrative practices. The difference is that exploring our stories is no longer classified as integrative or alternative. Creative Writing/Storytelling is Medicine, and this is a Medical School.

A Pedagogy of Natural Intelligence engages the medical research, Depth Psychology, books on Gaelic culture and Druidry, sacred texts including the Tibetan Book of the Dead and Gnostic Gospels, Quantum Physics articles on Triadic Logic, Polyvagal Theory, Alchemy, and the archaic techniques of Storytelling and Poetry. These final two hold the real value for us. These hold our subjectivity, our means of establishing meaning as well as our means of self-reorganization through creativity. Without these practices, we are adrift. Storytelling and Poetry are our means of drawing natural intelligence with its healing properties from Nature. 

Hospitals and clinics address only the first of three aspects of Kleinman’s framework of unwellness. Patients have been given a treatment plan, a prescription, and scheduled, physical protocols. Blue Cross Blue Shield is exploring Social Prescribing that addresses the other two. Social Prescribing covers art classes, writing workshops, walks in the forest, and more emerging, evidence-based yet non-empirical strategies. While Social Prescribing is currently pilot-program initiative, based on studies from Europe and Britain where Social Prescribing is common practice, soon it will be so in the United States. Social Prescribing USA gathers data and builds partnerships with high and low-profile institutions sharing the goal of expansion. Data declare the (in some cases superior) healing capacity of stories for chronic illness, PTSD, loneliness, depression, side-effects of chemotherapy, arthritis, asthma, and more. Yet, there are few opportunities for patients to access the kind of Storytelling that helps us heal. 

As Humanists, I feel we have a responsibility to help Medicine understand the depth and the wonder they have just opened the door into. In Percy Bysshe Shelley’s “Defense of Poetry,” the poet outlines the utilitarian purpose of poetry as a “natural intelligence” humans require for moral development and without which he predicts the world we are in today where money calls the shots. This is what heals us. It is what has intentionally been concealed first by Constantine and again by Newton and Locke for reasons I cannot fathom as other than politically motivation. It is the greater part of our humanity and the source of dignity, grace, and confidence that we are okay as we are, that as long as we know our story we know we belong. When we have found our stories again, we reboot empathy, the core of our humanity, in the West and the restore a natural order to the world.