Story Telling: A Journey to Better Health?

Dr. Jonathan Adler OF Olin College of Engineering studies the science of people’s stories. research supports that humans need a coherent story of who they are to support their wellbeing.

One of the most powerful aspects of the fellowship program at Stanford’s d.school is the strong sense of trust and family that develops among the cohorts. Whenever I’m asked what the best thing about the program was, I don’t hesitate. It’s the people – and the relationships formed. I developed a love and trust of my fellow fellows within weeks rather than the months and years it often takes to build a trusting bond. I’ve been thinking about that bond lately as I come to learn more about the nature of narrative identity, and the importance of story in each of our lives.

Why? One of the cornerstones of the Fellows program is the Backstory Dinner – a weekly dinner in a private setting held over the course of the first couple of months of the program in which each week one fellow shares his or her personal story. That story can be told in whatever form the fellow chooses. There are no fixed guidelines.

The stories are often powerful and emotional. It’s implicit in the exercise that each is a deliberately edited product of each fellow’s “backstory” as he or she wants to be seen by the group, but that makes it no less authentic. I remember from my fellows’ narratives a marriage video, artifacts from a challenging childhood, family photos and news covers; a wall of sports trophies displayed by proud parents; stories of creativity born of isolation. One fellow spoke with no notes or artifacts at all, like sharing around a campfire. Others presented Power Points standing, more comfortable and familiar perhaps from years of leadership. I shared excerpts of audio interviews with my aging parents and a sibling, hoping to better understand myself who I was from the perspectives of others.

Was this narrative inventory part of the powerful culture of trust and wellbeing that developed within our cohort? Without a doubt. I left the dinners feeling closer to each fellow who shared their story, a fierce advocate for the story teller – grateful and privileged by the confidence shared.

At The Better Lab at UCSF, we interview both medical professionals and patients for our projects, and the process has encouraged us to consider more deeply the importance of story in a healthcare setting. Is story more than the way we string together words to engage, instruct and entertain? Could story be fundamental to health? There’s a solid body of research that says yes.

 Dr. Jonathan Adler of Olin College of Engineering

Dr. Jonathan Adler of Olin College of Engineering

One person who understands this well is Dr. Jonathan Adler, a professor of psychology at the prestigious Olin College of Engineering in Needham, Massachusetts. Olin is unique among engineering programs not just because of its size – it has just 335 students enrolled, representing 37 states and 13 countries – but because of the way the school positions itself. Heavily influenced by the work of the Stanford d.school and IDEO, the mission of Olin is to do engineering in a different way – starting and ending with people and their desire for a better world. Human-centered design is a governing approach.

Adler’s work centers on narrative identity – the science of people’s stories. He’s particularly interested in the ways personal story relates to mental health and psychological wellbeing.

“Humans tell stories,” Adler says. “This is how we distinguish ourselves from others and navigate the complexities of our lives.”

Adler says the biggest question we each face in our lives is “Who are you?” The answer to that question is the foundation of our mental health.

Research shows just how important the stories answering that question can be – and the structure of that narrative can have profound implications for health. For example, people who have incoherent stories about their lives have poor mental health. Humans, it seems, need a coherent story of who they are to support their mental wellbeing – linked to our relationships and everything we do in the world.

But our stories are fluid, changing over time as we travel the course of our lives. Traumatic events pose a narrative challenge, making it an increasingly hard task to weave a coherent story.

“Certain kinds of populations such as those with violent lives have highly fragmented stories,” Adler says. “A hard story to put together to make sense of it.”

Working in a trauma hospital such as Zuckerberg San Francisco General we encounter patients like that daily – victims of gun shot wounds, stabbings, car accidents and other tragedies that can cleave one’s sense of order in the world. Healthcare by its very nature is isolating and fragmenting, Adler says, and violence can intensify that.

Can story help? Adler believes so.

“When something happens to your body it’s there all the time and you need to grapple with the plot.”

 

“You can help these patients by helping them frame a story that makes sense,” he says. Illness is a “biographical disruption that calls people’s identities into question.

“When you develop a chronic illness your body is different than the story you’ve been telling yourself your whole life. It’s a moment when people recreate themselves. When something happens to your body it’s there all the time and you need to grapple with the plot,” Adler says.

 Studies have shown that finding positive meaning in such negative events is linked to a more complex sense of self and greater life satisfaction. Sickness or violence in our lives can be framed in a way that can strengthen our narrative identity. Life stories that emphasize redemption in the face of challenge are associated with higher wellbeing.

While those with mood problems can have many good memories, these scenes are usually marred by a negative detail. On the other hand, “generative adults”— those who score highly on tests measuring civic-mindedness, and who are likely to be “energetic and involved” — see the events of their lives as linked by themes of redemption.

In his research, Adler has noticed two themes in people’s stories that tend to correlate with better wellbeing: agency, or feeling like you are in control of your life, and communion, or feeling like you have good relationships.

Helping people frame their stories in a way that promotes a sense of control and coherence ­can aid the journey to better health.

All of this brought to mind my own experience with my d.school Fellows cohort. This was a group of highly accomplished, deeply empathetic people – “generative adults” by every measure. In retrospect, I can see that the stories they had framed for themselves included the themes of redemption and the qualities of agency and communion central to Adler’s research on positive narrative identity: the dismissive and destructive comment of an early teacher became a story of overcoming; a parent’s painful mistakes provided the opportunity for deeper meaning and wisdom in life; death and isolation led to the creation of something new that had the ability to inspire others. And, sharing these stories deepened and engendered a sense of communion that – imagined or not – seemed to enhance the wellbeing of the group.

“Our experience as a species takes place in a highly rich, complex dynamic social ecosystem,” Adler says. “Our brain needs a medium for working this out – and that medium is story telling.”

Adler says there’s a vital need in the healthcare system for the kind of integrating that story telling provides. Is there a way to bring this learning into the healthcare environment and the patients we meet? We’ll be exploring this at The Better Lab in the months ahead.

Learn more about narrative identity and the role of story telling in healthcare:

Health Story Collaborative

Living into the story: agency and coherence in a longitudinal study of narrative identity development and mental health over the course of psychotherapy, Jonathan M. Adler

Variation in Narrative Identity is Associated with Trajectories of Mental Health over Several Years, Jonathan M. Adler, et al.

The Is Your Life (and How You Tell It), The New York Times

Life’s Stories, The Atlantic