Type of Course: Community

Depression Quest

This is a choose-your-own adventure game that aims to illustrate what having depression is like, specifically for those who have not experienced or have not been diagnosed with depression. The creators stress on the opening page that the game is not representative of everyone’s experience with depression, but is an amalgamation of different or shared experiences from people with depression. Each “level” has a different description of what the character, you, do or can do throughout the day. You then have the opportunity to choose between a few options that lead to different results or storylines. Some of the options are portrayed as beneficial while others are harmful. Some levels, specifically when the character’s depression is particularly extreme, show answers that are red-lined and unavailable to us, although we can read them. There are many different endings that appear depending on what choices you make throughout the game, meaning that everyone in the class who plays could have a different outcome or experience, which can lead to an opportunity for discussion.

The creators end the game with this message : “Instead of a tidy ending, we want to just provide a series of outlooks to take moving forward. After all, that’s all we can really do with depression – just keep moving forward. And at the end of the day it’s our outlook, and support from people just like you, that makes all the difference in the world.”

This narrative experience could be used to discuss themes such as immersive and experiential learning, including controversial learning models such as disability simulations It can also be used to discuss what we value in narratives: does the ability to act as the character immerse us more? Do we feel distanced without an author to connect with? The game play could be supplemented with other reading materials to compare and contrast different uses of narrative. When the game was released, it was also caught up in the “gamer-gate controversy” (described in a New Yorker feature article: https://www.newyorker.com/tech/annals-of-technology/zoe-quinns-depression-quest). This larger context for the game could prompt discussion about stigma associated with depression, and the appropriateness of using a “game” to educate in this way.

Users have the option to “play for free” or “pay what you want.”

Lost and Found Narrative Medicine workshop outline

This is an outline for a workshop I led for the Northwest Narrative Medicine Collaborative Community of Practice, May 26, 2020. Although this workshop occurred on zoom during the pandemic, it could be modified to address other time periods or other kinds of shared experience of loss. At the time it was offered, we gave the workshop the following description:

This pandemic has produced so many losses—some devastating, others disruptive or disappointing. This workshop will provide a space to name our losses, both large and small, and also to name and articulate what we may be finding. In the spirit of narrative medicine, we will use reading, writing, and listening to acknowledge, absorb, interpret, and act on our own and others’ stories of what we have lost and found.

The audience for the workshop included Health Care Professionals, Patients, Caregivers, Artists, Scholars, and Students (15 to 25 people) and no previous preparation was expected of them. The outline provides time-markers for a 90-minute session.

Accessible Narrative Medicine digital library

The Accessible Narrative Medicine digital library includes outlines for narrative medicine workshops, as well as “third objects” (poems, short essays, stories, images, items that can be the catalyst for conversation, reflection, and writing).

The goal of the site is to encourage the practice of narrative medicine in a wide range of community settings by making available detailed workshop outlines and resources that can be adapted by community workshop facilitators for their particular audience and setting. The developers of the site believe that “narrative medicine workshops should be led by trusted members of a community. In order to create an inclusive safe space, the content and leadership of a workshop should reflect the lived experience of those attending.” The outlines and materials focus on the health narratives of BIPOC, LGBTQ+, and persons living with disability.

Registration is required to access the materials; once registered, site users can find workshops on core narrative medicine ideals, including attention, witness, and re-presentation. The library of third objects is searchable by topic and genre and includes not only written works but also images and art. The site has secured permission for use of narratives and many of the third objects include a bio for the author/artist, as well as a downloadable PDF of the object.

Health Humanities syllabus repository

The Health Humanities Consortium’s Syllabus Repository is a searchable database of syllabi from academic, professional development, and public education programs with a connection to health humanities. Not all of the syllabi are focused on health narratives, but many are, and many of the syllabi on broader health humanities-related topics include narrative readings, assignments, and other material. For example, a search for the topic, “narrative,” brought up numerous results, including courses on narrative medicine, illness stories, medicine and literature, autobiography, media, writing, social history, and gender and race.

The site is searchable by course topic, discipline, level of course, and modality. Users are also invited to share their own syllabi.

Worlds Apart Facilitator’s Guide

This is a thorough facilitator’s guide on how to facilitate class discussions on the cross-cultural healthcare documentary Worlds Apart (a detailed summary can be found in the Search for Stories tab). In brief, Worlds Apart is a documentary split into four 10-15 minute sections that each focus on a different cross-cultural health experience, including a Muslim man’s journey with stomach cancer, a Lao woman with a hole in her heart, a Black man waiting for a kidney transplant, and a Puerto Rican woman with diabetes, hypertension, asthma and depression. This documentary showcases narratives that illuminate the limits of Western medicine and expand our ideas of how the American medical system can grow to be more inclusive, equitable, and sensitive.

The facilitator’s guide provides background on the filmmakers and their intentions. It includes suggestions for facilitators such as setting ground rules for discussion and asking students to jot down notes during the documentary. The four-part narrative-driven documentary is summarized, and then each section is broken down in great detail, so even someone who did not watch the film could understand the exact circumstances of each family and individual being featured. After each synopsis we also receive medical background information and a variety of discussion questions specifically tailored to different issues discussed in the stories. Each section has a separate “focus” also outlined, ranging from language barriers to explanatory modules to informed consent to racial/ethnic healthcare disparities to non-adherence to medications. This guide was created “to give health care professionals an engaging experience through which to explore ideas about cross-cultural issues in health care and to learn from the actual experiences of both patients and clinicians,” but could also easily be adapted to a university classroom setting to guide student discussions. The guide does not include any assignments, but any of the issues headlining the discussion topics could work well as research essay prompts.

He was not the first dead man I X-rayed

The author had this to say about the poem: “I have X-rayed thousands of people over thirty years, but this one still come backs to me. It’s the story I tell when people ask me for ‘hospital stories,’ so it’s no surprise that I eventually wrote the story in a poem. I can still so vividly see him and me alone in that cold room.”

” Content warning : Gun violence, some graphic descriptions of bodily harm

This is a short poem written from the perspective of the author as a X-ray technologist. It describes one particular experience he had caring for a man with a gunshot wound who dies during the treatment and the poem. Provides an opportunity to talk about death and the impact experiencing death may have on healthcare providers. The brevity and personal quality of this piece leaves room for students to interpret and discuss their own thoughts and reactions.

There is a complex story in a brief poem, with lots to unpack, accessible to all audiences.

(Not so) golden years

Daughter describes the stress of caring for her aging parent from geographically distant place. Details many issues that created burnout in her caregiver role, including feeling isolated and embarrassed about her struggle until she found out all of the problems she faced were very common for caregivers in her position. Useful to discuss how difficult it is to care for elderly parents, especially from a distance, and caregiver burnout.

Bullet journaling to save a life

An African American woman at a predominantly white institution is diagnosed with bipolar disorder. Along with therapy, she works through her struggles with various mindfulness strategies, including a method described by Ryder Carroll as “bullet journaling.” Her story encourages consideration of writing as a mental health practice, describes the author’s adaptations of the bullet journal technique, and contains links to a TED talk and a book that go into more detail about this particular approach to intentionality. Useful starting point for talking about therapeutic (and general mental health maintenance) uses of writing. Glances of POC experiences in PWI’s, though not much detail.

La historia de Bill

This CDC-based cautionary tale about the dangers of smoking involves a Michigan man who was diagnosed with diabetes as a child. It stresses how angry Bill is to have accepted the first cigarette as a teenager, given the complications for diabetes caused by smoking. At 37, he lost sight in his left eye and later had kidney failure. Two years later his leg was amputated due to poor circulation, which motivated him to quit smoking. He nonetheless died of cardiac disease at age 42. A 5-7 minute read for intermediate level Spanish speakers – written in simple past tenses – it leans heavily into the cautionary tale of not smoking. It also gives vivid details of how much worse smoking is for diabetics, giving a starting point for discussion of both smoking and diabetes. Usable in mid-level medical Spanish courses, composition or conversation; stylistically might not be very compelling as a health narrative.

The CDC website where this written narrative is posted also offers an English translation and biography of Bill.

Listening to Patient Narratives Exercise: Anju’s Breast Cancer story

This is an outline for a class exercise utilizing a video from the Look Now Project. The short documentary tells Ajnu’s story of treatment for breast cancer.

The class exercise is part of a one-hour session entitled “Between the Lines,” part of a training by the Northwest Narrative Medicine Collaborative in collaboration with Lewis & Clark College, which brought together undergraduate students, medical students, and medical professionals for a one-day workshop. In the “Between the Lines” session, we examined how clinical interactions are framed by medical scripts and encourage changing these frames to make room for patient stories. Then we engage in practicing listening closely to patient stories for what is said, how it is said, what is not said, and how our own experiences and identities shape what we hear.