Unifying health narratives

Zénobie Cornille

The temple, a structure reserved to house religious and spiritual activities is commonly used in Western culture to represent the body. While the metaphor has largely been reduced to cliché, in its simplest form it describes the function the body must undertake to house the self. The self isn’t definable. It is not fixed. The body however, while under constant modification, is continuously physically present.

Throughout our lives we shape an alliance between the physicality that the body offers and the self, with the body as a vessel that enables navigation of oneself through space. 1 The feedback provided by the body is inherently connected to our physical survival and mental wellbeing. 2 The body assembles signals from the internal and external environment, prompting the mind. Our instinct, emotion and beliefs are embodied within this homeostatic loop.

Spirit, perspective and thought have no physical form of their own, so unwittingly, and often unwillingly the body becomes a symbol of identity, providing the self with a tangible existence and connection to the world. With the body as proxy for the self, illness that plagues the flesh often implies much more than just a physical disease process.

Throughout life we revel in the pleasures and strengths that the body offers. In exchange, as if a promise, we must endure the breakdown that comes with age, trauma and disease. No one seeks a doctor in victory. It is often the disruption of mind-body connectedness that generates the first manifestations of disease; signs of disarray, and perhaps a story to be uncovered. On the other hand, sensations are easily misinterpreted as evidence of perceived illness, often signifying an underlying mistrust of the body, conceivably accentuated by our rapid access to medical information and our increasing intolerance for discomfort. 3

The self is readily disregarded in the hospital while the body takes the forefront, mistaken as a total representative for the self. As a person transitions to the role of patient, we become primarily concerned with their physicality, forming a disease, rather than a person-centred narrative. We track inputs and outputs, assess organ function and pursue signs or anomalies that will direct us to the physical origin of a symptom. Our patient is no longer the rock that holds her family together, the lecturer, or the gardener, she is an amalgamation of lab results, medical imaging and an object of clinical examination.

The self also falls victim to the vulnerabilities of the doctor patient relationship where status and unfamiliarity fashion a reluctance for the self to vocalise sensibilities. The clinician asks a question of the body but often does not accommodate for the self when it answers. Whatsmore, as patients are passed between specialties, concerned each with an isolated organ system or disease process, the self is prone to dropping through the cracks.

An illness narrative that makes space for the self can be hard to shape. To successfully treat our patients we must be able to single out fact from the futile; and to do so we must embrace the self within its physicality. By doing this we are able to better direct the route of our clinical voyage. When the self is overlooked, we misread physical signs and symptoms and our path of enquiry is easily misdirected. For completeness, we must accommodate both the self and the body throughout our history, examination and treatment. Constructing a narrative that encompases the patient as a whole, permits both the physician and patient to recognise the insidious attributes of illness, and move forward in the healing process. No longer can we continue to treat the body alone, we must act to reconcile it with self and spirit.

  1. Charon, R. (2006). Narratives of Illness. Oxford: Oxford University Press.
  2. Beate M Herbert, O. P. (2012). The Body in the Mind: On the Relationship Between Interoception and Embodiment. Topics in Cognitive Science, 692–704.
  3. Warwick, H. M., & Salkovis, P. M. (1990). Hypochondriasis. Behaviour and Research Therapy, 105-117.

Zénobie Cornille is studying medicine at the University of Auckland.