Forgiveness, narratives and listening

Frank

“Forgive is a verb, not a noun. Every day I try to forgive and hopefully move a little further down the road”

Marian Partington has been on that road for a long time. In 1973 her younger sister Lucy disappeared. She wasn’t found until 1994, when her dismembered and decapitated remains were discovered in the basement of Fred and Rosemary West’s house. It was another year until Marian and Lucy were reunited because her remains were needed during that time as an exhibit at the West’s trial. When at last they were together, Marian cradled Lucy’s beautiful skull in a brown blanket and kissed her forehead, just as she had cradled and kissed her own children.

That same year, Marian went on a silent retreat trying to get to the roots of her own forgiveness. The first thing she experienced when she arrived home was not serenity or acceptance, but “murderous rage”. At that moment, she realised that this was an emotion that she shared with her sister’s murderers and this meant that she was not so unlike them. This was almost too much to bear. Not only does forgiveness not come easily, but it forces us to confront our own darkness, our desire for violent retribution, our own homicidal potential . In order to forgive we have to accept this darkness as our own without denying it or projecting it onto others. This is perhaps the hardest part of forgiveness. One reason it is so hard is because it is not a phase we go through just once, but one we have to return to time and again.

Marian describes forgiveness as a healing narrative.  When I listened to her a few days ago, it brought home for me more than ever before, the importance of not just listening to my patients, but of listening to their stories and learning from them. She is a ‘wounded storyteller’.

Healing narratives

The Restitution Narrative

Medical Sociologist Arthur Frank, who has done more than most to illuminate the stories our patients tell, proposes three basic types of narratives told by those who are suffering. In the restitution story, the healthy person is struck down with illness, treated and restored to health. The main players are the heroic clinicians, and disease is the enemy, to be conquered. This is the preferred narrative of TV dramas and medical journals with their triumphant optimism. It is also the preferred narrative of the recently diagnosed. In terms of forgiveness the desire for restitution is powerful. When Marian returned from her silent retreat she had decided that restitution, through forgiving the Wests, was what she wanted, but she was confronted with murderous rage. After ten years of reflection and spiritual practice, much of it on silent retreats, she wrote a letter to Rosemary West. It was another four years before she felt ready, because she was sure she had reached a position of unconditional compassion, with no expectation of response and she sent the letter. She received a reply from the prison security, ‘Ms West wishes you to be informed that she does not wish to receive any further correspondence from you’. When she tells this story, as I heard it, there is a pause, an awful silence, filled with the brutal reality that the desire for restitution can never truly be overcome, and that it has just been dealt a near mortal blow. You can watch Marian tell this story in the Forgiveness project video below. It is a ‘groundhog day’ moment, no matter how many times I have watched it, I hope upon hope that there will be some reciprocity, a glimmer of hope, the next time.

The Chaos Narrative

The second narrative Frank describes is the ‘chaos narrative’. When Marion first heard that Lucy’s remains had been found at the West’s house she “vowed to try to bring something positive out of this meaningless trauma”. The chaos narrative is meaningless trauma, deepest suffering and unremitting pain. According to Frank, ‘people live chaos, but chaos cannot in its purest form be told’. Marian described the 23 years between Lucy’s disappearance and her discovery as ‘frozen stillness’, a time when her story could not be told, a time of silence. The chaos narrative presents the greatest difficulties for those of us whose job it is to listen. These stories make us listeners feel helpless, but ‘paradoxically then, the chaos story that can be told is no longer total chaos, and in that paradox lies a therapeutic opening. The clinical problem is not to push toward this opening prematurely. The chaos narrative is already populated with others telling the ill person that “it can’t be that bad”, “there’s always someone worse off”, “don’t give up hope”; and other statements that ill people often hear as allowing those who have nothing to offer feel as if they have offered something”.’

“To deny the living truth of the chaos narrative is to intensify the suffering of whoever lives this narrative. The problem is how to honor the telling of chaos while leaving open a possibility of change; to accept the reality of what is told without accepting its fatalism.”

My role as a doctor is to listen, deeply and compassionately, to ‘be with’ the other person in their suffering. In my experience it is impossible to do this without sharing in the other person’s suffering.  The lessons I attempted to articulate in my recent post, Love, Hate and Commitment are about the great efforts and risks we take when we do this.

The Quest Narrative

The final narrative that Frank describes is ‘The Quest’. Through suffering we learn things that we might never otherwise have learned. To be clear, there is nothing intrinsically good about suffering, but it can nevertheless lead to a ‘wisdom that can only come from such harshness.’ This wisdom is a matter of being exactly where one is, yet grateful for that’. This came across very powerfully and clearly when I listened to Marion. She has a gift for language, and she has used words and stories to discover, through her suffering, what forgiveness means.

Anatole Broyard, when he was dying of prostate cancer, wrote that his “first instinct was to try to bring [cancer] under control by turning it into a narrative.” He describes stories as “antibodies against illness and pain”

‘Quest stories carry the unavoidable message that the restitution narrative will, one day, prove inadequate. Quest stories are about being forced to accept life unconditionally; finding a grateful life in conditions that the previously healthy self would have considered unacceptable.’

There is a need to testify, and ultimately the quest narrative is testimony. Marian’s testimony is through her book, her public speaking and her work with The Forgiveness Project and groups of prisoners.

The quest for forgiveness is a search for understanding and meaning and is very suited to spiritual practice and poetry. It is a journey with direction but without end, a struggle and an aspiration rather than a place of rest or something we leave behind. It is important to realise that the quest is a journey, not a destination, “The quest story fears being heard as a triumph over chaos; part of the lesson of deep illness is that victories are always provisional”.

In 2007 in the sermon at my wedding, the recently retired Rector of Hackney, John Pridmore told us about a series of books called ‘Great Journeys’, our marriage was an event in the great journeys of our lives. He joked that there would never be a series of books called, ‘Great Arrivals’, although there are those who believed in ‘great arrivals’, they are fundamentalists; finders, not seekers.

More than just listening.

I was struck, as I listened to Marian, that she is on a great journey, telling the story she needs to tell with elements of restitution, chaos and quest. In listening to her I realised that I was learning that as a doctor I need to listen much more carefully to my patient’s stories. I must be able to honour suffering without imposing my own desire for a restitution narrative. ‘Honouring suffering shapes the spirit of helping. The helper who honours suffering can accept the ‘dark night of the soul’ but also offers the immediate, practical help others need.’ To listen to a patient’s story involves a conscious repression of the desire to take a medical history, an un-learning of what we have practiced all our professional lives. This puts us in an uneasy position, are we (as professionals) fulfilling a different role if we listen to stories instead of taking histories?

The dichotomy between listener as professional or friend is one from which Frank wishes to ‘rescue clinicians’. The experience of suffering is often one in which old friends disappear, in which others may be lost for words or uncomfortable hearing about sickness. Some of my sickest patients tell me that they have become isolated and alone because their illnesses have become so overwhelming that they have nothing left to talk about and they don’t want to burden their friends, ‘who have troubles enough of their own’. Friends may be poor listeners because ‘they want to steer the person back to being the person they were before’ rather than the new person they become, transformed through suffering’. As a doctor to patients who have lost their friends, I need to be able to play the role of a friend if I am to listen seriously.

The second lesson is that listening has a nurturing role, and part of that nurturing is to help the person telling the story to hear exactly what story they are telling. Although one type of narrative may dominate, through shared reflection it may be possible to show that a story already contains elements of other narratives in the background. We need the patience to accept that our patients may struggle to articulate their stories time and again before they find a narrative. In the pressure of a ten minute consultation it is extraordinarily difficult, but not impossible – especially if we take narrative seriously.

When I first wrote this blog, I realised that I was being taught an extraordinary lesson about forgiveness, which I have summarised below, but I now know that even more profoundly, she has taught me a lesson about listening.

Forgiveness

We cannot wait for tragedy before we practice forgiveness
We need to think about forgiveness every day, what it means to us personally, professionally and culturally.
Denial, rage and the desire for retribution are natural stages in a cycle that can, if we choose, lead towards forgiveness
In order to be able to forgive we need to be accept our own vulnerability, our shame and our capacity for violence
We need to be able to share our stories and we need to be able to listen

Forgiveness is a quest, in which the desire for restitution is overwhelming and chaos a state to which we have to return from time to time.

Forgiveness is as hard as it is important.

These are my thoughts, still fresh in my mind from this listening to Marian on Sunday. I’m worried I’ve done her a disservice by attempting to summarise forgiveness in a list like this, so I will start reading her book, If You Sit Very Still, and strongly recommend you read it too.

You can read more about Marian, restorative justice and The Forgiveness Project here: http://theforgivenessproject.com/stories/marian-partington-england/

Quotations from Arthur Frank taken from Just Listening: Narrative and Deep Illness.

11 responses to “Forgiveness, narratives and listening

  1. Very detailed and engrossing…

  2. I recently had the best consultation of my life. I have been very ill for 23 years – many, many, many consultations have been had! Admittedly it was an allergy clinic so they had more time to give me – BUT, the Doctor spent well over an hour with me.

    She listened. She asked questions relevant to every aspect of my life – physical, medical, environmental, social, family, care, relationships, support network, home situation – everything. She explained medical things to me which no other doctor had ever done. When I sobbed because she was so kind, she put her arm round me and stayed with me in silence. All others have turned their back, glued themselves to their computer screen and ignored me, relying on the nurse to hand me a tissue – the supposed cure-all for distress!

    She acknowledged how very hard my life was. She treated me with respect and as an equal. She did not make the fundamental error so many medics seem to make of thinking that because I am very ill I cannot possibly be intelligent. She treated me like a human being.

    She could not offer me any cure, solution or treatment.

    But, I came out elated. My spirit’s lifted, my faith restored, and told everyone I met that I’d had the best consultation, for weeks afterwards.

    Oh, what did she give you? What treatment did she offer? What’s she doing to fix things? were the common responses. I even asked myself that after a while.

    It didn’t matter that she couldn’t treat me. ( I am used to that anyway). What mattered was that for that short time she saw ME, as a whole person, not just a diagnosis or the next file on the desk. Her kindness has stayed with me for months and probably will for years. Far more beneficial than any pill she could have given me

    She shared her knowledge. She heard me. She reached out to me.

    She held my suffering.

  3. This blog was absolutely brilliant.

    It resonated with me both as a doctor dealing with the meas of peoples lives but also as a failed and failing Christian…

    Not sure if you have any faith, but bless you anyway.

    Take care

    Sam

  4. Love to read your thoughtful, articulate blogs. Your words resonate with me; as I work in hospital, providing nursing care to many people who need someone to listen to them even more than they need our professional expertise. Thanks for reminding me that caring is more important than charting….

  5. A great blog. I have often felt that non judgmental listening is as much about validation of a persons experience as anything else. It makes a statement that that persons experience as they remember it is valid and important. I also believe that allowing someone to articulate their story helps them sort it out, place it the correct place in their mind and their memory, and sometimes helps them make judgements about it.

  6. Wow! Thank you! I continuously needed to write on my site something
    like that. Can I implement a fragment of your post to my site?

  7. I was an RN (qualified nurse, in the US) until my immune system failed, then documented Java software until I developed CRPS, a complex and brutally painful disease which leads, eventually, to brain damage and autonomic dysfunction; a tricky business, because many of the meds have the same effects.

    That was almost 15 years ago. The changes in science have been amazing in one direction, while the changes to the clinical environment in the US and UK have been amazing in the other.

    The international network of people with such diseases is a lifesaver — literally. The internet gives us, not only each other, not only access to the science that makes our disease understandable and slightly more treatable, but it gives us gems like these to take into our doctors and say, as kindly as possible, “I know you’re struggling, and you feel bad because your struggle is scarcely a fraction of one percent of mine but you still can’t bear it. Here. Take a clue. It’s not an answer, but it could help. You aren’t alone, either.”

    • Thanks for sharing your experience Isy. I’ve discovered that the potential for social media to bring together those forced apart by illness, especially those illnesses that are stigmatised and exhausting, is amazing. By listening to what people have to the confidence to say about themselves and their experiences of care, amongst trusted peers is really changing my perceptions of patients, even though I listen to my patients every day. Thanks again, Jonathon

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