The ‘Dialectic at the Heart of Healing’

By Jacob Molyneux, senior editor

Here are the opening paragraphs of the short intro I wrote for our special December edition of the Reflections column. Since the illustrations are an important part of this column’s presentation, I’d suggest clicking through to the PDF versions of the articles linked to below:

“There is a dialectic at the heart of healing that brings the care giver into the uncertain, fearful world of pain and disability and that reciprocally introduces patient and family into the equally uncertain world of therapeutic actions.” —Arthur Kleinman, The Illness Narratives: Suffering, Healing, and the Human Condition

In recent years, the role of narrative in medicine and nursing has gained (or perhaps regained?) a certain amount of respect.

Some advocates value the stories of patients and practitioners because they bring us in from the cold, reminding us of the human side of an increasingly technology-driven field. Others argue for narrative as a crucial source of knowledge about disease processes and best practices, yet another form of evidence in the constant quest to improve outcomes. Others focus on the therapeutic aspect of such writing, our deep need to make sense of encounters shaped by loss, pain, and suffering, whether witnessed or experienced.

The Reflections column has been appearing monthly, with rare gaps, since 1983, when AJN debuted this and other new columns (as well as its editorial board). Reflections essays exist to give a voice to those who have a story to tell about health care, whether they be nurses, patients, physicians, or family members of patients.

I’ve been editing Reflections for a number of years now. The authors include people who have never published before and people who are well-known authors, nurses, scholars. Some situations repeat: it’s hard to forget the death of a child, a loving spouse saying goodbye to a partner of 50-plus years, a clinical challenge that changes the way we practice, an act of great cruelty or kindness in a coworker, a loneliness assuaged, the discovery of a hidden strength in ourselves just when we seem to have lost our way. But each author’s voice and perspective is different.

This month, we’ve decided to highlight this column, publishing a group of three new Reflections essays, each very different in tone and subject matter from the next. In “The Brat,” a woman recalls the nurse who helped her angry adolescent self through the first stages of a long recovery from a life-altering accident. In “A Mind in Search of Its Moorings,” a nurse and judge adroitly sketches out her experience as a patient suffering postsurgical delirium. In “Hiding a Tender Soul,” a nurse who works with homeless people in Boston describes a surprising and moving reversal of roles between caregiver and patient.

This intro and the three essays are all free. We hope you’ll have a look. In the intro, I also give some info about how to submit an essay for consideration for this column. We depend mostly on unsolicited submissions, so if you have a story to tell . . .