Narrative Medicine Across Languages and Cultures: Using Minimal English for Increased Comparability of Patients’ Narratives

Abstract

Narrative medicine is an approach to medicine which seeks to combine with and enhance conventional evidence-based medicine by adding perspectives and experience in medical humanities. The chapter expounds on the importance of effective communication with patients and in particular on the importance of having some structured protocols (scripts, interview prompts, and the like) to encourage more comprehensive and effective patient narratives and to allow for increased comparability between them. It tells the story of an emerging collaboration with Minimal English and an international pilot study applying Minimal English to such protocols.

Appendices

Appendix A: The New Narrative Medicine Storyline , Written in Minimal Italian/English

Appendix B: Text of the Letter Sent to Narrative Medicine Scholars, Inviting Them to Take Part in the Pilot Study

Dear X,

Since May 2016, a team effort involving Bert Peeters, honorary associate professor in the School of Literature, Languages and Linguistics at the Australian National University in Canberra and adjunct associate professor in the School of Humanities, Languages and Social Science at Griffith University, Brisbane, on the one hand, and Maria Giulia Marini, professor of narrative medicine at the Fondazione ISTUD and at Hunimed University, Milan, on the other hand, has been underway aimed at evaluating the benefits of using the Natural Semantic Metalanguage (NSM) in narrative medicine.

NSM is based on a lexicon of semantic primes, that is, simple concepts or building blocks that can be used for analysis of complex concepts, which are broken down into simpler concepts via reductive paraphrase. Research in the NSM approach deals extensively with language and culture. The declared NSM primes have stabilized as a list of irreducible meanings, typically coded as English words with specific senses, but expressible also in any other language. Indeed, the primes are hypothesized to be language universals, with most of them having been tested across a wide variety of languages without encountering disconfirmation. Each prime has its own universal combinatorial properties, which guarantee that any allowable sequence of semantic primes can be translated into any other language.

In narrative medicine, there are many possibilities to collect patients’ narratives: it can be a free practice with no given script, or it can be according to a more structured process, known as an illness script. The story could be written according to a linear time development which follows the occurrence of a particular illness: before the illness, the falling ill phase, the being ill phase, and the getting better or getting worse phase. With this plot, given some micro-prompts, narratives can be told and written by patients and caregivers.At the Fondazione ISTUD, a linear script is used that tries to follow this concept of “memory” of the illness, together with an evaluation of the present situation.

Looking at previous versions of the script, it turned out that some of the micro-prompts corresponded to NSM sequences of semantic primes. This was the starting point of the collaborative process between the Fondazione ISTUD and the Australian National University in Canberra and Griffith University in Brisbane, referred to above. Bert Peeters and Maria Giulia Marini have been working out an illness script written in the so-called minimal English, which is a by-product of the Natural Semantic Metalanguage, transformed from a purely linguistic tool into a tool with concrete applications (such as narrative medicine) in mind.

Our aim was fourfold:

• Make it possible for the illness script to be translated into other languages without too much distortion.

• Make the script easier to understand for patients from a variety of cultural backgrounds.

• Through the use of simple language (Minimal English), get patients to tell their story using relatively simple language as well—the idea here is to apply findings coming out of the field of social psychology, particularly accommodation theory.

• Verify the hypothesis that, when an illness occurs and times get rough, patients may fall back on a greater number of semantic primes in their discourse, since the primes are more natural, less artificial, and universally embedded in humankind.

The draft script is now ready and we would like to test it in a number of languages for which there are stable NSM versions, as well as in our network: Italy, the UK, Australia, France, Portugal, Germany, and Israel.

The test would involve the collection, either verbally or in a written fashion, of a number of narratives (at least ten) from each country. The aim is to ascertain whether the effort of harmonization of illness scripts across languages is worthwhile.

We are strongly committed, together with Prof. Anna Wierzbicka (ANU) and Prof. Cliff Goddard (Griffith University), the main promoters of the NSM approach, to developing a universal illness script, respectful of contextual differences, which can be a vehicle for transferring knowledge on a worldwide base.

English and Italian versions of the draft script are attached for your feedback. Your opinion about this new field of investigation, resulting from the application of the Natural Semantic Metalanguage approach to the field of narrative medicine, matters a lot to us, and we would really like to know your thoughts.

As far as testing the script is concerned, please let us know whether you wish to join us in this pilot study. We sincerely hope you will be interested in our joint venture and look forward to hearing back from you at your earliest convenience.

With all best wishes,

Bert Peeters Maria Giulia Marini

PS—For more information on the Natural Semantic Metalanguage (NSM) approach, see https://www.griffith.edu.au/humanities-languages/school-humanities-languages-social-science/research/natural-semantic-metalanguage-homepage [short URL: http://bit.ly/1XUoRRV]