Scientists have the stereotype of brainy figures with a penchant for abstraction.
Medical researchers study microscopic processes that require special tools and powers of deduction—abstract stuff for anyone. Science is, after all, an unbiased search for truth, a world of abstraction, proofs, and testing. In lab work, scientists seek to identify how the world works, piece by piece.
Pretty dry stuff, eh? No, not really.
In fact, the best researchers often rely on stories to understand the complexities of their research. By understanding their petri dishes as great stages, with dramas that unfold the suspense of a thriller, they can better explore the phenomena of the world.
Every experiment provides dramas with vivid characters with goals, conflicts, and setbacks. And groundbreaking research creates the kind of cliffhangers and surprises that would make Agatha Christie or Alfred Hitchcock proud.
Years ago, I talked with medical researchers at New York University’s Langone Medical Center. My goal was to learn about the power of narrative in research. Here’s what I found out.
Machines, Parts and Wholes
For Rodolfo Llinas, it’s impossible to understand the intricacies of the human body without remembering old stories and constructing new stories.
Dr. Llinas, , the Thomas and Suzanne Murphy Professor of Neuroscience and chairman of NYU’s Department of Physiology and Neuroscience, remembers the time, as a child, visiting his grandfather at his psychiatry practice. Young Rodolfo witnessed a patient having a seizure. “I thought he was going to die,” Dr. Llinas said.
“There’s something wrong with the man’s brain,” his grandfather told him. That statement posed questions that Llinas has investigated his whole career. Is the brain separate from our being? Or is the brain, in essence, the whole self? How do we understand how the brain operates?
As a boy, then, Dr. Llinas discovered an approach to problem-solving that would help him understand the brain. He began thinking of the brain–and all of life itself–as a complex machine that can be understood by taking it apart and putting it together again. Soon he disassembled the family’s Victrola and reassembled it. “All of these parts by themselves had no property,” he recalled. “But as a whole, they would make music.”
Rebuilding the machine helped Llinas appreciate its “elegance.” Simple outside, it was complex inside. “Once you understand something at that level,” he explains, “it’s yours.” The Victrola gave the aspiring scientist confidence—and a metaphor for research.
“The universe is understandable,” he says. “There are some unknowns, but it’s not mysterious.”
Metaphor and Suspense
Like Llinas, other researchers also turn to metaphors and stories to find answers amid mountains of data. In their quest for groundbreaking knowledge, researchers often find insight in the ordinary. They seek out surprises and evidence against their arguments. And while digging deep in their own specialties, they also look for ways to connect their work with other scientific puzzles.
Llinas’s colleague Gordon Fishell also makes sense of data by comparing it to other things and putting it in a drama. “At the end of the day, the scientist is a storyteller,” he says. “In prehistoric times, cave dwellers didn’t have a hell of a lot to do but tell stories. Whoever holds the big stick gets to talk. You get to hold it as long as you hold the audience.”
Research, he says, creates a similar kind of suspense. Researchers ask tough questions and develop a collection of answers—some right and some wrong. In their labs, at conferences, and in their writing, they “iterate stories.” In this process, the wrong answers are just as important as the right ones, for they force you to think harder.
Surprise–Or Not
At conferences, Fishell makes a practice of guessing what speakers are going to say. “If people go through details and I know where the story’s going, I’m bored. I’m more interested when they say, ‘We did this, but didn’t get the result.’”
The willingness to make mistakes—countless ones—is what enables researchers to reach. “Whether you’re Spike Lee or Ingmar Bergman or a scientist, it’s all the same,” says Fishell. “Creative people create.” Suspense drew Susan Schwab, assistant professor of pathology at NYU, from one field to another.
Schwab avoided biology because she considered it little more than “memorizing names and pathways.” But as a graduate student in environmental science at the University of California at Berkeley, she could not understand the aerodynamics of fine particulates as a cause of childhood asthma. So she took an undergraduate biology class “it was basically the coolest thing I ever experienced.” The professor, Nalabh Shastri, made the mystery of learning his touchstone.
“His biology was one of how do we know what we know,” Schwab says. Stories are only as good as their surprises, Fishell and Schwab said. At conferences, Fishell says, he makes a practice of guessing what speakers are going to say. “There’s a rhythm to it,” he said. “People are going through details, and I know where story’s going. But I’m bored if that’s what they do. I’m more interested when they say, ‘We did this but didn’t get the result.’”
The suspense starts before experimentation begins. “There’s suspense about whether you’re going to get the right tools to ask the question–whether you’re going to be able to do the right experiment.” As a staffer at the Natural Resources Defense Council, Schwab sought to show that the organization’s policy stances were right. Now she seeks to disprove her own ideas.
Proving–and Disproving–Hypotheses
“It’s very important that you are always working to disprove your hypothesis,” she says. “It helps to have a nice neat picture or story and hope you’re always working to disprove it.”
Evgeny Nudler, a biochemistry professor at NYU, says hypotheses are best considered steps toward finding something else. “You start researching on thing, you get a result that you can’t explain, and you have two choices—either pursue or forget about it. The unexpected result is the most interesting thing in the end.” At its best, one narrative spins off new narratives, says Nudler.
Colleagues sometimes criticize him for “a lack of focus,” Nudler says. But intellectual wandering lead the lab in new directions and inform the continuing work of old projects.
One spinoff project involved the transcription process that controls blood pressure and erections—and contributed to the development of Viagra. “I’m interested in hardcore biochemistry,” Nudler says. However elaborate and far-reaching the narratives of their work, Fishell and Schwab say, scientists ultimately need to follow their subjects’ leads.
The Challenge of Observation
“There’s a quote I read somewhere, we can never do an experiment, we can only hope through careful observation that nature will reveal its secrets,” Fishell says. But only to acute observers. “It really matters who’s doing the experiments,” Schwab said. “Things are pretty subtle. The best experiments are always viewing and looking at each stage until you notice things. Even if you use genetically identical mice, there’s always going to be variation, and so having somebody who can watch carefully” is essential.
The drama never ends. “You’re getting clues all the time,” Schwab says.
Narrative Medicine: A Growing Movement
If you take the 1, 2, or 3 trains to Morningside Heights, you’ll see this narrative approach not just in research, but also in the care of patients. Rita Charon, a doctor at Columbia University, developed the practice of “narrative medicine” when she struggled to understand a difficult patient.
Dr. Charon remembers the moment when she became the doctor she was meant to be. Early in her career, Charon did not always take the time to understand her patients’ lives and problems. Then along came a patient named Luz. When Luz complained about headaches, Dr. Charon prescribed acetaminophen. Later Luz asked Dr. Charen to fill out paperwork for disability benefits. Rushing to an appointment, Dr. Charon signed the forms.
But she wondered about Luz’s plans. She imagined that Luz might be abusing the system. Dr. Charon felt guilty about her brusque treatment of Luz. So she asked Luz to come in for a visit.
Luz then explained her real reasons for seeking disability benefits. The oldest of five girls, who lived with her father and uncle in Yonkers, Luz had suffered sexual abuse since she was twelve years old. Now that she was twenty-one, she wanted to rent an apartment in Manhattan and care for her sisters. She wanted to spare them the abuse she had experienced.
After learning Luz’s real story, Dr. Charon enlisted social workers, emergency shelters, and support groups to work with Luz. She helped Luz find a Manhattan apartment and also cared for her dying father. Oh, yes: Dr. Charon also continued to be Luz’s physician.
That experience, Rita Charon says, convinced her of the need for doctors to make storytelling a part of their care for patients. It’s not enough, she decided, to isolate symptoms and disease for treatment. It’s also not enough to analyze patterns of behavior, like diet, exercise, and relationships.
To provide care, doctors need to understand their patients’ stories. Doctors need to know how their patients got from Point X to Point Y before they can help them go to Point Z. And so Dr. Charon has become a leading figure in “narrative medicine,” a movement to get doctors to write and tell stories about their experiences. Telling stories can transform the way we care for people.
We live in an age when people’s unique stories get lost in the maw of bureaucracy and technology. Professionals in all fields—medicine, law, business, and education—follow complex rules and procedures but do not always understand the people they work with. Administrators, meanwhile, swim in an ocean of statistics and procedures, isolated from the larger dramas of life.
But when you engage people in stories, you give them something to grasp to make sense of their situations. Stories offer all of us—not just doctors and patients, but all of us—an approach to create richer lives for ourselves. Stories make us human; they make us whole. Stories might not make all things possible. But they give all possible things a chance to come true.
A Dangerous Backlash Against Medical Narrative
Peter Kramer, the author of Listening to Prozac and other popular medical works, writes passionately in The New York Times about the power of stories to guide medical care. Despite the rise of narrative medicine, Kramer says, the medical profession has in recent years rejected storytelling as unscientific, irrelevant, and even dangerous.
“In the past 20 years, clinical vignettes have lost their standing,” he says. “For a variety of reasons, including a heightened awareness of medical error and a focus on cost-cutting, we have entered an era in which a narrow, demanding version of evidence-based medicine prevails. As a writer who likes to tell stories, I’ve been made painfully aware of the shift. The inclusion of a single anecdote in a research overview can lead to a reprimand, for reliance on storytelling.”
But stories often clarify issues better than screens of chi-square, regression, and other data.
Kramer tells the story of a man who, in 1954, was hospitalized for panic attacks. Treatments failed. He slipped into decades of substance abuse and depression. Then in 1995, at age 70, the man sought psychiatric treatment when he became suicidal. The doctor treated him with Zoloft. After six weeks, his suffering faded. He lived 19 more years–happily.
So what does this story prove? Nothing, at least definitively. But it does suggest something about the possibilities of treatment, the dangers of mistreatment, and the need to care for each patient on his own terms.
Stories, more than statistics, can touch the deepest part of people’s being. When people read case studies, they see themselves. So they can feel less alone, more hopeful. They can redouble their resolve to find answers.
In a sense, stories are part and parcel of statistics. A single story represents just a single data point, so in that sense it’s insignificant. But a collection of stories is a sample, properly organized, becomes data. With data, we can work toward scientific knowledge. We need more than one story–or two, five, ten, 20, or 100 stories–to draw definitive conclusions. But stories do offer a start–for conversation, questioning, theorizing, and understanding. We dismiss the power of stories at our own peril.
