January 30, 2013, by Teaching at Nottingham

Using stories to encourage student empathy

Charley Baker: “The theoretical and pedagogic background to using literature, narratives, stories, autobiographies and fiction (and other humanities) in the education of clinical professionals is the subject of a growing body of research, with accompanying fierce debate about its educational utility. Tischler (2010, p. 2) suggests that current clinical curriculums “don’t nurture the student’s whole being as they are trained”, and that adding humanities-based elements of medical curricula can aid in developing clinical students as holistic practitioners. Much of the theoretical research and teaching guides produced on using literature, or stories, in clinical teaching refers to the education of medics (Tischler 2010; Beveridge 2003; Evans 2003; Oyebode, 2009). Beveridge (2003, p. 385) suggests that the enriching educational benefits of reading fiction for psychiatrists include the suggestions that literature offers a deeper existential understanding of illnesses than that found in clinical textbooks, and that it can aid in the development of empathic skills. There are of course critics of this type of addition to clinical curriculum, who suggest disadvantages include the fact that the arts are irrelevant to clinical practice, and that reading literature on mental health is not “a substitute for experience’ (Beveridge 2003, p. 386). Others have questioned the notion of whether teaching the humanities to clinicians necessarily produces humane clinicians (Stempsey 1999). However, there is a developing recognition of the value that literary-based elements to clinical education may have for other health professionals such as nurses (Crawford and Baker 2009; McKie and Gass 2001).

“My starting point using narratives and stories in my teaching is that the educational principles around using literature for medical education are both relevant and adaptable for nursing students. Crucially, this type of “soft” material may enable students to gain an idea of how it may feel to experience a range of particular psychiatric symptoms, whereas clinical textbooks tend to rely on describing the form of such symptoms (Crawford and Baker 2009; Tischler 2010, p. 3). Using first person narratives in mental health nurse education perhaps marks a move away from traditions in mental health where other narratives or versions of a narrative (those of the doctor, nurse, GP, carer, psychiatrist) were (and still are in some settings) valued and privileged over that of the person themselves. The subjective accounting of mental distress has not been seen as important terms of the more “objectively” based symptom-diagnosis-treatment paradigm in psychiatry – as Oyebode (2009 p. viii) suggests: “What the arts and humanities can do for psychiatry is to reinforce the importance of the subjective”. Who knows better how it feels to experience a particular emotion, experience, illness, state of mind or thought process than someone who has been there themselves?

“Virtually all of the theoretical research around using literature and humanities in clinical education emphasises the need to value, listen to and acknowledge the subjective reporting (whether verbal, written or through a different humanities-based medium such as painting) of the individual’s experience of illness. Stories, autobiographical material, fiction and even poetry, for me, enables students to immerse themselves in a practice-congruent, “real life” experience, while simultaneously considering the theoretical principles we teach them in other areas. When I have used stories directly in my teaching, they have produced lively debate around the conditions and experiences described in the material, often contrasting the student’s previous clinically-contextual reading and how this differs from our own (because we all have our own stories) personal stories – highlighting the gap between personal and professional knowledge. The students have also been able to independently link different parts of the narratives to other sessions that they have had as part of their learning on mental health and recovery, demonstrating cross-lesson applicability.

“Myself and colleagues (Paul Crawford, Brian Brown, Maurice Lipsedge and Ronald Carter) recently co-founded the Madness and Literature Network (www.madnessandliterature.org) – providing repository of a range of different types of stories relating to mental health. This has been very successful, demonstrating the value (pedagogic, personal and professional) of mental health stories. Working in mental health essentially entails valuing, listening, hearing, respecting and responding to people’s own experiences, emotions, relationships and thoughts. Learning this is the classroom via the “safe” medium of literature is, for me, a vital part of clinical education.”

Charley Baker
Lecturer in Mental Health,
School of Nursing, Midwifery and Physiotherapy

References
Beveridge, A. 2003. “Should psychiatrists read fiction?” British Journal of Psychiatry 182: 385-387.
Crawford, P., & Baker, C. 2009. “Literature and Madness: A survey of fiction for students and professionals” Journal of Medical Humanities 30: 237-251.
Evans, M. 2003. “Roles for literature in medical education.” Advances in Psychiatric Treatment 9: 380-386.
McKie, A. and Gass, J. P. 2001. “Understanding mental health through reading selected literature sources: an evaluation” Nurse Education Today 21: 201-208.
Oyebode, F. (ed). 2009. Mindreadings: Literature and Psychiatry. London: Royal College of Psychiatry.
Stempsey, W. E. 1999. “The quarantine of philosophy in medical education: Why teaching the humanities may not produce humane physicians” Medicine, Health Care and Philosophy 2: 3-9.
Tischler, V. (ed.). 2010. Mental Health, Psychiatry and The Arts: A Teaching Handbook. (Oxon: Radcliffe Publishing).

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