Literaturized clinical cases or clinical stories are a hybrid genre of clinical case and literary narration that have made a fortune in the field of mental health. Since they deal with a specialized topic, but adapted for dissemination to a wider audience, they should be considered a type of popular science literature. For this reason, they move away from the conventions of the more academic medical genres, where the presence of the narrators and the personality of the patients are blurred.
The tradition of clinical stories is rooted in the 19th century, with key figures such as Sigmund Freud, who composed narratives about the cases that he had encountered in his praxis. If medical genres and clinical cases in particular tend towards depersonalization, clinical stories offer an opportunity for the humanization of health.
Oliver Sacks and the neurology of identity
The best-known representative of contemporary medical writers, neurologist Oliver Sacks (1933-2015), author of several collections of clinical stories, among which stands out, is in this line. The man who mistook his wife for a hat. Sacks defends a medicine that is more focused on people and the individual experiences of illnesses and is committed to a neurology of identity, in which the central character is the subject, instead of the pathology.
In academic clinical cases, the presence of the health professional is blurred to the maximum, to the point that it can often seem to us that the tests are done alone and that the results are interpreted by themselves. It is not admissible for these professionals to openly express subjective opinions on personal issues of their patients.
Instead, Sacks is present as a first-person narrator and as a character always with a sympathetic, understanding and human face. He draws an image of himself as a sincere person with patients and, when he does not understand something that is happening to them, he does not hesitate to admit it to them. He also openly admits it when it is the patients themselves who help him discover some solution for his cases.
Allan Ropper and Brian David Burrell continue in the footsteps of Sacks. In Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain explore the complex relationship between the brain and mental and physical behavior. In a specialty such as neurology, highly dependent on technology, these authors are also in favor of person-centered medicine and not only in analyzing the results of the tests.
When Ropper mentors other early-career doctors, he often advises them to step away from the monitor, walk into the room, sit on the bed, talk to the patient, and thus examine the person rather than the pixels. .
Sometimes his arrogance is reminiscent of Dr. House from the well-known American television series. He is the boss with a team of residents behind him. During the analysis of the case, he asks them questions and criticizes the decisions they make, as if he knew all the answers from the beginning.
A psychiatrist perhaps too human
Irvin D. Yalom, Professor of Psychiatry at Stanford University, demonstrates to a general public the usefulness of psychotherapy in Love’s Executioner and Other Tales of Psychotherapy. As in Sacks’s book, the title presents us with a rather literary first part –Love’s Executioner (the executioner of love) – and a second with clinical reference –and Other Tales of Psychotherapy (and other psychotherapy stories)–.
In addition to recounting the problems his patients experience, Yalom shares his personal struggle to reconcile professional treatment as a psychiatrist with a more humane response. Dispelling the myth of the omnipotent and objective therapist is one of its purposes. It is essential that patients are comfortable in order to open up. But no matter how trained a psychotherapist is, he is still a person like any of us. Yalom tries to show us, perhaps with an exaggerated honesty, in order to break all idealization. Thus we see her aversion to an obese patient, whose body he finds so repulsive that he finds it hard to even look at her.
Stories from clinical psychological care
Randy Frost, Professor of Psychology at Smith College (Massachusetts), and Gail Steketee, Professor of Social Work at Boston University, were pioneers studying compulsive hoarding syndrome. They expected to find a few patients, but ended up treating hundreds of patients and discovered that this disease was much more present in society than previously thought (between 2% and 5%).
in his book Stuff: Compulsive Hoarding and the Meaning of Things They approach life and the dramas that these people and their families and friends must endure day after day. Contrary to the most widespread prejudices, they teach us that it is not a specific disorder of individuals who live with their backs to society, nor of unintelligent or uneducated people.
Humanization of the doctor and patients
The literaturization of clinical cases allows the authors to use strategies that would not be admissible in other medical genres. The patients are not treated, but the doctor treats them. The narrator does not hide. On the contrary, he stands out: it is the professional who explicitly accompanies us throughout the story. We can see in detail how he interacts with patients and sometimes also their opinions and emotions.
The authors review cases of specific patients, they try to set an example for future professionals, but above all they reflect on the current direction of health care. Unlike the canonical clinical texts, here the disease is not presented as a phenomenon alien to the individual who experiences it.
Individual cases can serve to illustrate the theories, vision or work of the authors and health professionals. But we also see the desire to demonstrate to readers the importance of listening to the patient first and then starting to do the relevant tests, always combining the two facets of healthcare praxis: the human and the technical. Each case – each person – can be unique and require personalized treatment.
Humans are complex beings. The rationality that gives rise to science coexists with emotions, an ancestral capacity that we share with other animals and that allows us to process large volumes of data and make quick and intuitive decisions – even wrong ones. Literary texts and artistic creation appeal to emotions more efficiently than documented reality. And that is one of its goals. Clinical stories, with the resources of literature, bring clinical cases closer to the general public and thus contribute to the humanization of mental health.