Journey of Hearts

Introduction
At the most basic level "Telling the Story" is a means of transmitting ideas from one person to another. [1] Storytelling is a part of life, intrinsic to most cultures. They help people make sense of the world--life’s experiences, dilemmas and hardships. Stories can educate, inspire and build rapport. They are a means of communicating, recreating, and helping preserve cultures [2] by translating memories into a more concrete manner that can be handed down verbally or in written form. Telling the story can provide the opportunity to gain a deeper understanding of one’s experiences and oneself.

Each person has a unique story, unlike any other. These stories are constantly changing and being rewritten, reconstructed, even discarded from the moment we are born until we die. [3] Stories help make sense of the insensible. Stories can help people explore other ways of doing, feeling, thinking and behaving. [4] Forming a story about one’s life experiences improves physical and mental health. [5] Storytelling can be regarded as one of the oldest healing arts; it has been used for centuries as a universal, useful way for the grieving person to cope with loss. [6]

An experience of loss--a loved one’s death or a major life-changing event--can disrupt the a person’s world causing most to re-evaluate their life priorities. When a loss or significant life change occurs people need to adapt their life story to include the loss. [6] Many have an inherent desire to understand and recover from a loss; this may be accomplished by creating an account or a story to find meaning in the loss and put pieces of a shattered life back together. To assimilate a major loss the grieving person needs to create a private personal story and then confide that story to others. [7] Developing a narrative allows a person to weave together their life changes into a new more cohesive story. [5]

We are a society that in general denies grief, avoids the emotion whenever possible, and expects those grieving to quickly "deal with it" and "get over the loss." Listening to stories of loss is difficult. It requires taking time to slow down and "be" with the painful emotions. [8] We are unsure what to say, how to act, what to do. In our fast-paced, efficiency-focused society, people often do not recognize the benefit of telling or listening to the story.

Table 1 summarizes some of the various ways that stories can utilized.
 

Definitions
A Storyteller is "a teller of stories," "a relater of anecdotes," or one who recites or writes stories. [9] Telling the Story focuses on the act of relating anecdotes and telling healing stories; this can be accomplished via several methods--verbal or written narratives, tape or video recordings. Stories can also be expressed in song, poetry, film, theater, or artwork.

Account Making is used by Harvey synonymously with Storytelling. Accounts involve interpretive comments, descriptions and other components found in most stories. Many cope with a major loss by forming accounts or telling stories about the loss to aid in grieving and adapting to the loss. [7, 10]

Most people on receiving bad news such as a death or a new diagnosis try to make sense of what happened by talking with family and friends. Meaning Making is the process by which people construct the meaning of a death or loss and set the tone for the grieving process. Storytelling is the most common strategy utilized in meaning making. [11]

Using Stories in the Practice of Medicine
Although storytelling is a fundamental part of clinical practice [12] the technique is perhaps more fully appreciated by other professions--nursing [2, 13], psychology [5, 8, 10, 11], and by physicians in other countries [1,3, 12, 14, 15] than by physicians in the United States. Acknowledged or unacknowledged, telling the story is central to the practice of medicine. Patients tell their illness story to the physician who translates their story into a disease story. [1] Stories allow physicians and patients to communicate, look for meaning in their illness, and discover ways of coping. [1,12]

During my medical training, I felt a strong obligation to "Tell the Story." My storytelling forte is examining the emotional reactions to traumatic or disturbing events encountered during the practice of medicine. Writing allowed me to turn intense experiences or disturbing topics into educational articles as a way of making sense of difficult training situations. The articles are on areas generally not considered part of traditional medical education--death, loss, and the grief response, etc.[16-20]

Loss is the disappearance or sudden deprivation of someone or something cherished. Physicians are often the bearers of painful news to patients--telling of death, illnesses, or tragic events. Sharing stories of loss can help those grieving overcome the existential crisis that frequently occurs after experiencing illness or loss, by under-standing the new identity and accommodating to the life change. [7, 14] Research has demonstrated that writing about emotionally traumatic experiences has beneficial effects on lessening illness symptom reports and improving physical and mental health. [5, 21]

For many patients telling or writing their story is what helps them to heal, [3] by enhancing their coping with the disease [14, 15] or trauma or improving their symptoms [16]. Swiss writer Walter Diggelmann regarded stories as his weapon against cancer. [15] Telling a life story can be particularly beneficial at the end-of-life for the person dying, the family and the survivors. [8, 13, 22] Physicians may be unable to take away the pain and grief that patients, family members and friends experience following a loss, however we can listen to their stories of illness or grief.

Importance of Listening
Experts consider sharing the story of loss and finding someone to attentively and empathetically listen to be integral in the recovery process. [7] Listening requires maintaining an active presence, empathy and openness to hear the person telling the story--something difficult to do in our fast-paced culture.

The medical profession receives little training on how to deal with patient’s grief, therefore, physicians may unknowingly erect barriers to a patient telling the story of loss, trauma or illness. Many physicians may feel untrained in dealing with their patients’ grief. However, if physicians do not ask, the patients may never tell their stories and unknowingly withhold information that could help in finding a proper diagnosis. Researchers have discovered that if the sharing experience is difficult for the storyteller, it may impede the healing process of adapting to the stressor or the loss. [7]

Health care professionals are starting to recognize the impact of listening to patient’s stories. By listening to the  story of loss, illness or disease the physician gives the patient a chance to express his/her concerns. It is also important to listen for what is not being said--the subtle clues that the patient may want to say something more--perhaps a slight pause in the conversation, a cough, shifting nervously. Dr. Victoria Maizes provides a poignant narrative that underscores the importance of listening to patients. She shares a real case example of an exchange with a patient and then re-writes the story in three different scenarios in which the physician listens empathetically and engages the patient. [23] It is known that a healing, nurturing relationship develops between storyteller (patient) and the listener (health care provider). [4] Listening with empathy to the patient’s stories of loss, illness or disease is invaluable to their integration and/or recovery process; [15] this is central to grief support.

The Healing Effect of Telling the Story
In the last decade of the 20th century, the traditional views of grief have changed. The current idea is that people do not "get over" major losses, rather those losses become incorporated into who they are as part of their life; the story is rewritten to assimilate the loss. A central process in grieving is meaning making--discovering the implications of a loss on the person’s sense of identity. Account making helps the grieving understand their new role in a world forever changed. [5, 7] Recovery from loss begins with "Telling the Story," as the grieving person is able voice his/her tale of grief verbally or in writing. Many find solace in sharing their experiences with others, knowing they are not alone in their feelings of grief. [6]

On the Journey of Hearts website we have observed a pervasive need for people to "Tell the Story." Visitors privately send their experiences as long e-mail narratives of their grief stories or publicly post their stories or suggestions for coping in the guestbook. [6] Typing and sending an email message appears to be helpful for many people in their grieving process, giving them a chance to express deep emotions and make some meaning of the loss; the online writing supports the hypothesis that translating physical or emotional distress into words aids in assimilating the loss and allows the person to move beyond the experience. [5]

Survivors of traumatic loss are one of the groups most likely to benefit from telling the story. For those who have experienced a loss it is critical that the loss become real. This can be difficult when a loved one is presumed dead, the body is never recovered from an accident or in a variety of other situations in which hope remains for finding survivors. Grieving individuals should be encouraged to tell their story of grief as often as needed as part of the healing and recovery process. Each time the story is repeated, the reality of the loss becomes more undeniable and more real. [6] Initially the story may be long including many small details, as a way of remembering the loss. Over time the story shortens, becoming more cohesive, as a way of incorporating the loss. [5,7]

A Recent Example of Telling the Story
Those who may wonder about the healing effect of stories need only look at the recent, powerful demonstration of the importance of Telling the Story following the traumatic events of September 11, 2001. In the days and weeks following this tragic event people have been "Telling their Story." The survivors of the incident, friends and family members, police, fire and emergency personnel, medical responders, and others have told and shared their stories--again and again. This tragedy has left us with stories that will be indelibly etched into our personal and our national psyche.

These personal stories inspired a nation in grief and helped provide moments of light during one of the darkest times in our history. Hearing, viewing and reading the courageous stories of firefighters, police officers, paramedics and ordinary people put faces and names to the event. Stories of courage and bravery provided hope reminding us that even in the face of evil, the human spirit prevails.

Conclusion
Following a loss or a life-changing event many people have a strong desire to understand how the events fit into their life. Life stories need to be rewritten to make sense of and find meaning in the loss, reassemble shattered lives and incorporate the change or loss. Telling (or writing) the story about one’s experiences in life has been shown to have beneficial effects on illness symptoms and is associated with improved physical and mental health.

As presented in this article there are many benefits for health care providers and patients in telling the story. Physicians may be unable to take away the pain and grief experienced following a loss, however we can listen. Listening to a patient’s story of loss or of illness, if even for just a few moments, can be beneficial in integrating, healing and recovering from the loss. Table 2 summarizes many of the benefits presented in this paper.
 
 

References
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