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Columbia University

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School of Continuing Education

Core Courses:

NMED K4020. Narrative Medicine: Giving and Receiving Accounts of Self. 4 pts. What are the clinical applications of literary knowledge? How are illnesses plotted represented? Does suffering belong to a genre? Can a medical history be co-narrated in order to redistribute ownership and authority? What does Geoffrey Hartman mean by the term "story cure?" The objectives of this course include advancing the instrumental value of literary practice in medical practice. At the center of this project are medical encounters in which one person gives an account of himself or herself and another person is expected to receive it. In examining the complexities of this exchange, to help clinicians to fulfill their "receiving" duties more effectively, we turn to narrative theory, performance theory, autobiographical theory, psychoanalytic theory, and the nexus of narrative/identity. Readings include works by, Henry James, W. G. Sebald, Kazuo Ishiguro, Judith Butler, Adriana Cavarero, Hannah Arendt, Arthur Frank, as well as illness narratives, trauma scholarship, and witnessing literature. The clinical component of the seminar take place in Dr. Charon's internal medicine practice at New York-Presbyterian Hospital, where graduate students will have the opportunity to function as witness, observing and representing what occurs in the office or on rounds as a way to help both patient and doctor to take full measure of what they do together.

NMED K4025. Illness Narratives: Embodiment, Community, Activism. 4 pts. Recent decades have witnessed the emergence of illness and disability autobiographies as a unique field of literary and sociological study. Autobiographies written by individuals experiencing illness bring to the fore issues of subjectivity and embodiment, while simultaneously reflecting larger social, political, and cultural realities. This course the field of illness and disability autobiography as well as prominent scholarship in this field. The primary goal of the course is to examine issues of embodiment and voice in illness narratives. The course will examine the relationship between illness and disability narratives and their familial, social, and institutional contexts. Finally, this course addresses the issue of “personal to political” narratives—illness and disability narratives as they relate to broader advocacy and activism. As narrative is both analytical and practical, this course combines theoretical articles with a variety of illness autobiographies and illness narratives. The course incorporates short weekly narratives based on a personal illness experience of a student’s own or that of a close family member or friend.

NMED K4100. The Self and Other in the Clinical Encounter. 4 pts. Who is the Other? What is the nature of the relationship between oneself and the Other—the intersubjective relationship? Is this relationship immediate or mediated? If mediated, by what? Can I ever truly know the Other? If so, how? What does “knowing” the Other mean? What is the role of language in the intersubjective relationship? This class explores “intersubjectivity” and the “Other” as terms central to the study of Narrative Medicine. Students examine various ways of conceptualizing these terms, from Cartesianism, Hegelianism, Phenomenology, Psychoanalysis, Feminism, and other traditions. Through this exploration of intersubjectivity and Otherness, the class challenges our assumptions about the nature of the clinical encounter, with a view toward better understanding the ways that Narrative Medicine might foster authentic intersubjective, empathetic relationships between clinicians and patients.

NMED K4110. Close Reading and Reflective Writing in the Clinical Context I (Seminar). 4 pts. The objectives of this course are to build close reading skills and to develop approaches to reflective writing in the clinical setting. Narrative training for interdisciplinary groups of health care professionals is a promising method for improving both the clinical care provided and the lived experiences of the professionals. Attention to how stories are told, where a story begins and ends, who’s included in the story, whether or not it runs along a familiar plot line, how the teller’s affect changes in the course of the telling are habits of mind for some people and acquired skills for others. A fundamental premise of this course is that literary interpretation is an ethical act that stresses the importance of the interpreter in the process of interpretation. It calls for a suspension, or recognition, of judgment so that observation can take place. From the classic “hermeneutic circle” (from part to whole) to Arthur Frank’s approach of “reading with” stories to Michael White’s theories of narrative-based therapy, the class examines different ways to effectively combine close reading with timed reflective writing exercises. As many students will be returning to medical institutions as narrative medicine administrators or facilitators, this course focuses on developing methods for teaching and facilitating discussion and on developing and responding to writing exercises with health care professionals. Literary texts offer a broad range of genres, voices, narrative strategies, and techniques, including short stories, prose poems, memoirs, novels, and a few films.

NMED K4111. Close Reading and Reflective Writing in the Clinical Context II (Practicum). 4 pts.Concurrently with the Close Reading and Reflective Writing in the Clinical Context I (seminar), students will be engaged in its partner activity, the “Practicum/Internship.” Each student enrolled in this Seminar is assigned to a teaching post in a clinically inflected writing workshop. The aim of the practicum is to give each student supervised responsibility for leading close reading discussions and coaching writing in the clinical setting. Each practicum site will be supervised by a faculty member in Narrative Medicine. The distinct goal of the practicum is to provide each student with field experience in setting up and directing a close reading and reflective writing workshop. It is expected that the students will use the skills developing in the seminar in their student-teaching. Opportunities will be provided at the meetings of the seminar and in the time slot following the seminar to debrief on and share experiences about the practicum experience. Flexible arrangements for these practicum meetings will be considered for particular students with permission of the faculty.

Topics Course:

NMED K4028. Bodies, Illness and Care: Perspectives from Phenomenology and Beyond. 4 pts. What is the meaning of embodiment? For most of us, it seems this is a question we only confront when our bodies “break down,” “fail,” or “betray” us. In truth, however, it is a question we are answering with every intentional movement, feeling, impulse and desire of our conscious life. In this course, we will explore various approaches to embodiment from contemporary thinkers. We will ask what these approaches might tell us about the experience of illness and how they might inform our understanding of care, both of ourselves and others.

NMED K4220. Narrative, Health, and Social Justice. 4 pts. Description Narrative medicine, its practice and scholarship, is necessarily concerned with issues of trauma, body, memory, voice, and inter-subjectivity. However, to grapple with these issues, we must locate them in their social, cultural, political, and historical contexts. Narrative understanding helps unpack the complex power relations between North and South, state and worker, disabled body and able body, bread-earner and child-bearer, as well as self and the other (or, even, selves and others). If disease, violence, terror, war, poverty, and oppression manifest themselves narratively, then resistance, justice, healing, activism, and collectivity can equally be products of a narrative-based approach to ourselves and the world. This course explores the connections between narrative, health, and social justice. In doing so, it broadens the mandate of narrative medicine, challenging each of us to bring a critical, self-reflective eye to our scholarship, teaching, practice, and organizing. How are the stories we tell, and are told, manifestations of social injustice? How can we transform such stories into narratives of justice, health, and change?

NMED K4250. Co-constructing Narratives. 4 pts. This course is an in-depth exploration of the way in which narratives are co-constructed, negotiated, and performed. The reciprocal relationship between storytelling and listening is an additional focus of the course. Students apply current and previous experience to the presentation of a co-constructed narrative. The course is structured in three interrelated phases: The first phase addresses theoretical foundations and philosophical issues of narrative approaches, dialogue, and negotiation; the second phase focuses on practical components, including creating safe spaces for storytelling, uncovering the obstacles to listening, and elucidating the basic elements of storytelling; and the final phase includes the presentation and in-depth analyses of student co-constructed narratives. To facilitate the application of knowledge accrued about the co-construction of narratives, students examine and analyze a series of illustrative examples over the course of the semester, including documentary films, published articles, and live performances.

NMED K4290. Narratives of Death, Living & Caring at the End of Life. 4 pts. Death and dying, like birth and birthing, are medical events in modern society. Most of us end life as we began it—in the hospital, with “strangers at the bedside,” as David Rothman writes, and often as cyborgs imbedded with machinery that externalizes even as it embodies life itself. Is it indeed possible to be part of this medicalization process and yet understand and connect with dying and death from within the experience of the person? The intention of the course is to bring students to a deeper understanding of their own connection to death and dying, to a stronger connection to the experience of dying for dying people, and to a more caring sensitivity to those who care for others at the end of life. While we live we are the subject: our lives unfold in stories and are connected to others through narrative. By using narrative to better understand our own feelings toward death and dying, as well as connecting to the experience of others, we become better clinicians and more effective caregivers. The course explores the meaning of death and its cultural construction in western and non-western societies; the definitions of death and the place of the individual at the intersection of physiological, technological, legal, and philosophical interpretations; and the experience of death in the personal and in the public spheres. We use narratives by patients, families, caregivers, and clinicians in different media to explore these dimensions, as well as using secondary sources built on narrative and narrative analysis.

NMED K4225. Organ(ic) Bodies: Medicine, Technology and the Question of the Human. 4 pts. The rapid proliferation, over the last fifteen years, of technologies that aim at the preservation of life at the edges of illness has created a conceptual, intellectual, and political fissure in the ways in which life and death can be fixed with any degree of certainty. This is true as much in chronic cases, such as the various neurodegenerative diseases, as in acute cases managed in the ICU, where life is being preserved through mechanical intervention. Are these mechanical interventions (ventilators, stomas, monitors) prosthetics that become part of the human body or do they remain within the space of signification of the extracorporeal? These questions become pressing when they inform the decision-making process of patients, families, physicians, providers, and/or the State. Cases such as Terry Schiavo’s belie the deep anxieties that appear when medical interventions are in the process of becoming naturalized and normalized. This course will examine the conceptual spaces that are being created in the crevices of the fixity of life, death, and the human/non-human being by looking at concerns that have been voiced by various thinkers: Donna Haraway, Nicholas Rose, Barbara Maria Stafford, Michel Foucault, Elizabeth Grosz, Rosi Braidotti, and Melinda Cooper.

NMED K4300. Research Methods in Narrative Medicine. 4 pts. As students create and implement narrative programs, research methods become essential tools in assessing their impact. The nature of most narrative work - group process around writing, sharing and responding to text - lends itself to descriptive study. Thus, this course will focus primarily on qualitative methods of inquiry and analysis, including participant observation, interviews and focus groups, with a brief foray into commonly used, basic quantitative tools that serve to supplement qualitative data. Students will read and discuss examples of qualitative studies, learn the methods in class, engage in fieldwork in order to practice the methods, and analyze the data collected in the field.

NMED K4990. Why We Write/How We Write: Applied Writing in the Narrative Medicine Context and Beyond. 4 pts. In this class we will explore the act of writing: how it is done, what it is for, how it works on our minds and bodies, and how it can be used to engender meaningful change in the clinical context. What really happens to one in the act and wake of writing? We will examine this question through the explorations of writers and thinkers as well as through our own practice and close study of the craft. At the end of the course students should have, in addition to a better understanding of their own strengths, weaknesses, and instincts as writers, a working knowledge of how and why to write with others in a clinical context.