Dr Ayesha Ahmad, Global Health Humanities Correspondent, has been travelling in Afghanistan and Nepal and meeting women who’s lived experience is a conflict of chronic gender-based violence. Her initiatives are to integrate storytelling into mental health trauma interventions globally in contexts of war, oppression of women’s speech, violence towards women and girls, and writing against the backdrop of rich story-telling traditions.
Often I reflect on the stories I have listened to. At these times, I collect the way I have experienced their stories; the gazes and the silences and the image of when someone looks me in the eye and speaks. These stories come from doctors, students, patients, and from people unknown to the world because of the suffering they carry. I bring these stories together in my mind. I wonder whether practicing medicine has limits; can medicine find all of humanity? I believe medicine can, and does. I always remember some feedback I received from a lecture I once gave on conflict and health; I was told I know how to tell a story. To this day, this remains a source of strength for me. This is the humanity of medicine, of the treatment of suffering whether from the clinic or the academy; the telling of and listening of stories.
I am one of countless individuals indebted to Professor Rita Charon who is working in some context of the clinic and feels at home with the concept of narrative as foundational for medical practice. My work focuses on the written narratives in mental health trauma related to gender based violence. Alongside, Charon’s pioneering research, during my PhD I saturated myself with Jacques Derrida’s notions of discourse and the signs and symbols of how we interpret and understand our experiences. To write the phrase ‘medical practice’ begs reflection; what does practicing medicine mean? Medicine places the unknown existentialisms of our human condition into a sphere of turning narratives; we find structures among these, creating universalities of being human wherever the world tilts; our births, living, suffering, dying, and death, and then the spirit, where medical practice halts and understands that spirits cannot be treated, and are only for healing. Spirits, then, are an equaliser; whilst medical practice is the handling of humanity, a spirit solidifies the existence of the story.
In my field of global health, I bear witness to the narratives of healing from the depths of all languages; the narratives of different authenticities that speak from a truth that I have perceived in the eyes of people who I am recollecting now, one by one. As Charon describes, I am honouring their stories. Their truths are speaking.
In all the stories that I have received, though, I have held disclosures yet at the same time I face distances of darkness, spaces of unfilled voices and visibilities that remain silent and unseen. This is the tragedy I am writing about. The truths that are unspoken, yet lived.
I question my role as an academic researching, lecturing, discussing ethics consultations, writing, presenting in international conferences, collaborating with non-governmental organizations, providing medical education for students and trainee doctors, and trying to find ways to free the tightly-rolled narratives of the marginalized. Medical practice provides a mode of examination for the way our stories make us ill; the somatised symptoms of a suffering that our societies suppress; because we fear bearing witness to suffering, and the telling of a story requires justice. But when the perpetrators are our protectors then what is the role of medicine? Can medicine practice justice?
I have heard the truths of doctors who witness other doctors committing abuse and violence towards patients in countries that are born from structural poverty, colonialization and chronic humanitarian crises; I have held in my hands the transcripts of traumas from the land as well as the body from asylum seekers and refugees; I have seen the pains that languages cannot speak. In all of these the truth has spoken; these are the discourses of medicine; the signs and symbols of our suffering of humanity and the patients for the practice of medicine.
Some of our greatest contemporary writers, Elif Shafak and Adiche, warn against the reduction of our identity into a single narrative. Truth also follows a similar path; symptoms of suffering are not reducible to a single narrative, not of the body, not of the mind, not of the spirit. The narratives of a narrative-based medicine are embodied, encompassing, and excite the diversity of different discourses.
We do not need to speak every language or interpret every sign or symbol to practice medicine; rather, to honour humanity, we need to have space for the truth to speak—that is, for our voice and our visibility to be present, that is the practice of medicine.