Here’s a plenary paper I gave this weekend at the annual meeting of the International Association for Human Caring. I may have played the history a little loose to make the point to a non-curriculum audience, but I think the larger argument stands: medicine IS doing a better job than we are of focusing on the role of individual stories in caregiving, and the “black leather jacket” boys remain in full sway. Looking forward to some discussion of this one from my colleagues among their ranks. Enjoy your summer!
Good morning. It is a pleasure to be with you today, though I am a stranger in a strange land. I believe I am the only educator attending this conference who is primarily concerned with K-12 school settings. Although I have spent many years in healthcare settings, my caring context is the school, not the hospital. Nonetheless, the extraordinary nurses I share the dais with today have helped me understand the textures of practice in my world, as I have theirs. We have so much to say to each other.
Today I would like to open our time together by trying for the first time to explain the ways I think the practice of narrative lets the worlds of education and healthcare inform each other.
First, I’ll tell you a story from my discipline about how we have decided what matters most in caring educational practice, and how I think we got it wrong. Then I’ll explain how the use of narrative in healthcare settings has given what education had lost back to me. And finally I’ll suggest what this evolving nexus means for both of our practices.
I’ll start with a story of internecine conflict. Sayre’s Law dictates that the reason academic battles are so fierce is because the stakes are so appallingly low. But I feel the stakes were very high in this fight, dealing as it did with the very core of why we do what we do in school. So let me sing you the song of my people. I think you will recognize the tune.
Almost fifty years ago, one of our most audacious curriculum dreamers, Joseph Schwab, pronounced the field of curriculum studies “moribund.” Stasis was attributed to unquestioned applications of single-perspective theories to education. To revitalize our work – to make ourselves more than simple doers of curriculum prepared for us and assessors of whether or not we had met established objectives – Schwab called for renewed interest in “the practical,” by which he meant a deliberative, interdisciplinary process that was attentive to reality: situated, relevant, responsive to experience.
In the wake of this call, curriculum studies was “reconceptualized” as a site to critically engage the values and practices that describe school in our culture. Two main strands of reconceptualization emerged: first, a materialist critique, which embraced neomarxist understandings of the role of power in education as underlying the observed tendency of institutions to replicate the existing social order. And second, a phenomenological, autobiographical, and psychological critique, which sought to understand curriculum as currere, a “course run” by successive retrenchings in one’s own experience and projection of that experience into future action.
Currere understands curriculum as chronological, situated, a constant reinterpretation of past experiences that reorients us toward what is not yet the case. These two forces struggled for a few years for ideological and epistemological dominance of the newly reborn field, and finally the materialist critique ascended. Gradually, critical curriculum work became synonymous with neomarxist analysis of power, while the more reflective work of currere paced the field’s edges through its own journals and conferences.
I trained in the currere tradition, and so confess to having personal skin in this game. But what most interests me for this audience is why things went the way they did – and that “why” might ring some bells. Because the materialist critique was outward-focused: concerned with structures (even through post-structuralist lenses), with social justice and the end to hegemonic maintenance of existing power relations as its clear goal. It was a muscular critique, and tended to be masculinist and even sexy in its rhetoric: a memorable skirmish caricatured its practitioners as “the marxists, who identified autobiography with bourgeois idealism, a retreat to interiority by those unwilling to don their leather jackets and storm the barricades, or at least picket General Dynamics.”
Currere, on the other hand, suffered dismissal as not only bourgeois, but navel-gazing, irrelevant, esoteric. To stake a claim for the role of individual experience and dyadic connection in curriculum was to be consigned to the basement with the other misfit toys: to be the shadow. Camille Paglia drew the dichotomy beautifully in Sexual Personae between “apollonic” and “chthonic” impulses in literature: the first clean, visible, attainable, the other hidden, murky, imprecise.
So the critical day in education was won by what was observable and measurable: psychologic, phenomenologic, and autobiographical perspectives were abjected. To work in education meant either joining a mainstream educational milieu that was as concerned with setting objectives and measuring their attainment as ever, or an equally well-boundaried critical stance that tried to dismantle it through analysis of the observable workings of class and power. By disposition and training mine became the voice of a minority report, and my work the writing of an unread amicus brief.
You know: of course this is how things played out. Common sense always feels better dealing with the observable. The high modern notion of care, in education and health, values noting what is observable and making coherent, replicable responses to it.
And here’s where your story crosses mine. Healthcare strives to manage quality outcomes through measurement, and its critics tend to focus on observable structural impediments to quality care, both administrative (cost and waste management, handwashing checklists) and social (race and ethnicity, language barriers, “cultural competence” efforts, etc). Medicine – the most scientific of caring practices – is way out front on observing and responding to the objective data. Stories are secondary, nice-to-have not have-to-have.
But when I joined the faculty of a medical school for five years and went searching for other caring practitioners who shared my conviction that interiority and self-reading were essential parts of sustainable practice, I was amazed to find that medicine also fostered a rich subculture of story-telling and story-listening in the name of compassionate practice.
I found the literature and medicine movement, most notably Rita Charon’s articulate and passionate argument for a concept of caring practice as requiring “narrative competence.” Also the Maine Humanities Council’s “Humanities at the Heart of Healthcare” movement, which supported reading groups of physicians, nurses and other providers that allowed them to read together stories of human suffering and caring and thereby find voice to share their own. I was amazed to find that the doctors and the nurses knew as much about honoring stories as my people did – and more. To be sure, the narrative impulse in health care haunted the dominant version as well. But it was a much hardier ghost, and getting stronger by the day.
The contours of my field’s twinned stories are limned in Arthur Frank’s The Wounded Storyteller. You probably know that Frank advanced three modes of understanding suffering: the “chaos” narrative, with its obliterative “no-time” of endless suffering; the “restitution” narrative, which seeks to remedy suffering by overwhelming chaos with order, managing experience according to scientifically-verified algorithms that identify clear problems, then regulate and solve them. And finally, Frank’s critique of the “restitution” narrative’s tendency to do violence to the selfness of the sufferer, abandoning her at the moment her symptoms do not match the algorithms or her suffering is not healed by their fixes. He offers the “quest narrative” as an articulation of a caring practice dedicated to hearing and witnessing the unique qualities of individual suffering; as a way to walk the path of illness with the sufferer.
Here was the deepest hope of currere as I longed to practice it in my own work, and to see it practiced in the work of my students. Aspiration for communion in care that heals both parties by letting their stories meet each other out on the field beyond right and wrong. And I had to come to medicine to see it articulated with a passion my own field had disavowed. It was both an acknowledgment of the co-creative nature of healing communion, and a way to articulate education work as also healing, as a site of care.
The fruits of this narrative nexus between healthcare and education are only beginning to flower; my colleagues will share some of the insights emerging from our shared inquiry over the last three years. In closing, I’ll preview three of the most striking.
1. Institutions are not external to us; institutions are us. I mourn for our culture’s wounding institutions: schools, hospitals, and prisons, each with their own fiendish Procrustean beds of regulation that create habitus of self-control. These are all sites of trauma, but school most tragically, as emotional, mental, and intellectual damage is unthinkingly wrought upon students even in apparently benign classroom settings (to say nothing of egregious physical and sexual wounds, all too commonplace as well). I think healthcare is working harder than education right now to name the ways, in Ivan Illyich’s words, that “the functions of a profession are not necessarily those of the institutional structures that house it:” that the regulating, impersonal, measure-it-to-manage-it way of being in hospitals is maleficent as surely as the rising tide of outcomes-based assessment was in schools.
And the solution to both, it seemed, has to do with a recommitment to finding the individual story in the data; to shaping institutional life to the present need of the patient or student by being that kind of caregiver. Foregrounding narrative gives us permission in our own practice to “talk back” to dominant versions of how we are to be and upon what index the value of our efforts are to be reckoned. The ways that medicine taught me to use narrative – and my grasp of the stakes if I don’t – have shaped the way I practice education.
2. The personal is not merely personal. Professional empathy is not the same thing as personal empathy: to practice as a caring professional is to be “in role,” and to accept the essentially divided nature of our professional attention. As Terry Holt notes,
As I lean against the wall, tears are coursing down my face. I am being very quiet about it, but in a very quiet way I am sobbing as freely as I know how. And meanwhile I am thinking: If this is over by twelve-thirty, I’ve got a chance of getting lunch before I replace the art line in twenty-four. The tears are streaming down my face, and I am utterly sad, haunted by memories of my father’s nearly identical death ten years before. But somewhere a voice is also thinking: Maybe today I can sign out by three.
This splitting of attention is not abandoning our patients in their need; rather, it is enabling us to actually give the best to care to all who are in our charge. This insight has deep consequences for the role of empathy in our preparation of caring professionals. In the New Yorker last week, Paul Bloom noted that natural empathetic responses might cloud our professional judgment about where the greatest need lies. Wondering at the warehouse filled with unrequested plush animals that stands in Newtown, Connecticut today, the millions of dollars that rolled into that affluent community, while twenty million American children go to bed hungry each night, he reached for a similarly professional deployment of empathy:
Our best hope for the future is not to get people to think of all humanity as family – that’s impossible. It lies, instead, in an appreciation of the fact that, even if we don’t empathize with distant strangers, their lives have the same values of those we love. That’s not a call for a world without empathy…the problem with those who are devoid of empathy is that, although they may recognize what’s right, they have no motivation to act upon it. Some spark of fellow feeling needed to convert intelligence into action. But a spark may be all that’s needed.
Story-making and story-witnessing is where we stay in touch with that spark, and cultivate our capacity to catch fire. We need a more complex notion of empathy that both meets the world’s bottomless needs and gives us a structure within which to make complex prioritization decisions.
3. Self-care is other-care. To ably hear another’s story – to be capable of leaning-in to witness and hold another’s experience in your attending – requires commensurate self-care. In our institution’s Honors seminar on “Narrative and the Caring Professions,” we bring together future teachers, nurses, physicians, dentists, veterinarians, and allied health students in a joint exploration of stories of caring and professional formation. As we discuss their perceptions of the nature of the professions that await them, so many of them equate their capacity to care with their tolerance for self-denial: “I won’t have time to eat or go to the bathroom until 1:00;” “I’m not in it for the money, anyway”; “I’m just there to love those kids up.” Each of these statements echoes with the way that status is assigned and taken away in our culture to caring professionals, and they reveal a tendency among students to set themselves up as the unfailing source of energy and nurture: a tendency we know predispose young professionals to burnout. How best to support these students in treasuring the impulse to give and love that brings them to this work, while also exercising the self-protection and self-care that will guard them against exhaustion, exploitation, and compassion fatigue?
We start with the sharing of stories of others who have walked their path. Body of Work by Christine Montross and Educating Esme are two autobiographical narratives of professional formation – the first through a year-long gross anatomy class, the second through a first year of teaching. What vivid stories these authors tell of the importance of self-care and the consequences when it’s not practiced! And as we discuss their stories, we see the uncanny capacity of discussing someone else’s story to draw out one’s own. Students are amazed, then grateful, to see how their own profession’s deepest values can be better articulated by a member of another. Interdisciplinarity becomes the gateway to a deeper understanding of sustainable compassion as a human practice, not merely a professional one.
So, thank you, colleagues in caring, for teaching me my own work better than my own field could; for helping me reconceive an energetic narrative practice that embraces the ambiguous and the subjective as the engines of practice, not their obstacles. I am in your debt, and will work to strengthen the connections across our fields that our small collaboration has begun – to the good of both, and most of all for the students who place in us their confidence that we will train them up in the way they should go. Thank you.