How should healthcare narratives address the tension between hope and realism?

The New Thought Movement in the nineteenth century emphasised the interconnectedness of the mind and body, and revolutionised medical perspectives on healthcare [1]. Previously, healthcare saw the body as something that could be “repaired” through medical intervention only. The New Thought Movement believed that better mental health would improve physical health and promote faster recovery from illness. Since then, more comprehensive, patient-centred therapies that encompass mental health have become increasingly integrated into modern medical treatment practices. This includes the use of healthcare narratives.

 

At present, healthcare narratives are popularly employed for patient empowerment. These stories are usually personal accounts of an individual’s struggle with a particular ailment, but can also encompass fictional and artistic expression. In this essay, I will explore both the triumphs of healthcare narratives in fostering hope, as well as how overly-positive narratives can lead to worsened despair – and thus overall health – in patients. Finally, I will share my insights on how to use storytelling to balance hope and realism through the analysis of different narratives, to help patients navigate their health journeys with heightened resilience and ultimately create a more transparent and authentic healthcare system. 

 

We all enjoy stories, and it is they which help us make sense of the world and our experiences [2]. When their power is effectively harnessed, successful recovery stories can act as a beacon of light for patients, especially those with chronic illnesses such as cancer. These narratives serve as powerful reminders that healing is possible, even in the face of daunting health setbacks, thereby injecting a strong dose of hope into their hearts and fuelling them through their darkest hours. Moreover, personal accounts not only offer a much-needed firsthand lens on the lived experiences of illness, treatment and recovery, but also validate its emotional turmoil, providing a sense of community and reducing feelings of loneliness and isolation. A meta-analysis published in 2011 has indicated that, although the effects may be small, higher levels of emotional wellbeing correlate to higher recovery and survival rates of patients [3]. Healthcare narratives provide both physical and psychological benefits for patients.

 

While hope is a vital component of healthcare, an overemphasis on optimistic outcomes can often lead to unintended consequences. When overly-positive healthcare narratives generate unrealistic expectations of success, patients can be left feeling discouraged from their setbacks or treatment failures. This tension between hope and realism is particularly salient in recounting patient stories, as many narratives fail to acknowledge the unique health circumstances of each individual [4]. Consider the example of acne treatment. As someone who has and still struggles with hormonal acne, I was constantly exposed to Accutane success stories and “miracle cures” on social media and personal blogs. However, despite completing a full course of the drug and enduring its taxing side-effects, I still suffer from persistent and recurring acne breakouts, which exacerbated feelings of dismay and hopelessness, because I could not achieve the promised results others have proclaimed. My skin struggles pale significantly compared to the life-and-death situations unfortunately confronted by patients battling chronic illnesses, and I can only try to imagine their emotions.  Nonetheless, it demonstrates how unrealistic success stories can adversely impact a patient’s wellbeing.

 

Therefore, I believe it is crucial for healthcare narratives to strike a balance between hope and realism. This can be achieved through a strategic choice of language and structure to convey hope without making false promises or unrealistic claims regarding treatment outcomes. 

 

Rather than solely making direct statements of treatment success, healthcare narratives should prioritise patient experiences, focusing on their resilience and strength whilst acknowledging their challenges and difficulties. Personal accounts should reference patients as “fighting” or “battling” their illness, which implies their agency and purpose amidst adversity. For example, one patient’s story published by the Mayo Clinic Website titled “Never Stop Fighting. Never Give Up” stated that following her challenging diagnosis of glomerulonerphritis, Stacy Neumayer and her family “remained strong in their belief that she would persevere and lead the life she always wanted”, and that “they were going to fight this”. She added that her philosophy for survival was to be determined and to advocate for herself [5]. This frames her illness as a struggle instead of a guaranteed victory or passive acceptance of fate, but nonetheless a struggle which she could eventually prevail in.

 

The balance between hope and realism ultimately lies in presenting authentic and realistic stories to showcase the mental fortitude of patients who persevere through their health challenges, and to inspire the same in others. These narratives should avoid sugarcoating tales or giving false outcomes as that would only serve to diminish hope and worsen despair in the end. In this way, healthcare narratives can give a proper balance between hope and realism and act as a pillar of strength to empower patients through their health journeys.

 

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References

[1] Andrade G. The ethics of positive thinking in healthcare. J Med Ethics Hist Med. 2019 Dec 21 \[cited 2024 Aug 5\]; 12:18. Available from [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166246/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166246/). doi:10.18502/jmehm.v12i18.2148

 

[2] Kalitzkus V, Matthiessen P. Narrative-Based Medicine: Potential, Pitfalls, and Practice. The Permanente Journal. 2009 Dec 1 \[cited 2024 Aug 5\];13(1). Available from [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034473/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034473/). doi: 10.7812/tpp/08-043

 

[3] Lamers SMA, Bolier L, Westerhof GJ, Smit F, Bohlmeijer ET. The impact of emotional well-being on long-term recovery and survival in physical illness: a meta-analysis. Journal of Behavioral Medicine. 2011 Sep 15 \[cited 2024 Aug 5\];35(5):538–47. Available from [https://pubmed.ncbi.nlm.nih.gov/21918889/.doi: 10.1007/s10865-011-9379-8](https://pubmed.ncbi.nlm.nih.gov/21918889/.doi:%2010.1007/s10865-011-9379-8) 

 

[4] Woods A. The Limits of Narrative: Provocations for the Medical Humanities. Medical Humanities \[Internet\]. 2011 Oct 28 \[cited 2024 Aug 5\];37(2):73–8. Available from [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281385/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281385/). doi: 10.1136/medhum-2011-010045

 

[5] Mayo Clinic News Network \[Internet\]. 2016 Nov 20 \[cited 2024 Aug 5\]. Sharing Mayo Clinic: “Never Stop Fighting. Never Give Up”. Available from [https://newsnetwork.mayoclinic.org/discussion/sharing-mayo-clinic-never-stop-fighting-never-give-up/](https://newsnetwork.mayoclinic.org/discussion/sharing-mayo-clinic-never-stop-fighting-never-give-up/)