Breaking Down Communication: Narrative Medicine and its Distinctions.

In “Communication Breakdown: Probing the Limits of Narrative Medicine and its Discontents” (2019), David J. Leichter engages practical experience teaching medical ethics in the college classroom to explore opportunities—and limits—of narrative engagement within medical ethics and clinical practice. Leichter raises concerns regarding potential epistemic harms, both testimonial and hermeneutical, when individuals, or their pain, cannot be adequately recognized through expressive modes traditionally understood as “narrative.” While I largely agree with Leichter’s worries about narrative authority and limits, I challenge his characterization of “narrative medicine.” In response, I suggest that “narrative medicine” is more than merely narrative engagement in medicine. As theorized by Rita Charon (2001, 2006), “narrative medicine” involves an inclusive approach to what narrative is, and more than mere mastery of “narrative competency.” I argue that at least one way to conceptualize “narrative medicine” is as a technical term, which refers to the process of attention, representation, and affiliation Charon develops as the achievement of narrative medicine. When understood in this technical way, narrative medicine can both resist and respond to the kinds of epistemic harms about which Leichter is rightfully worried.