Salus Forum: May 2025

Bill B

Yes, and what narrative do they listen to? Among other things, Joe is treating the traumatic injuries that come with playing professional football. Joe can share all the collected information about that. Does that change things or does it take a specific story? For instance, there is an extraordinarily tight end for the New England Patriots who suffered major brain injury. He ends up with a very muddled brain. He kills someone and ends up in prison, eventually committing suicide. Or one recalled a young man, Junior Seau, in San Diego, who similarly had a muddled brain and got in trouble. So, those are stories. They’re not as “valid” as all the statistics. But there’s something about the story of an individual and what happens to them that seems to be very compelling. Those are proximal stories.

Gay, you can talk about all the people (67%) who’ve had this form of trauma will end up experiencing depression. That’s nice to know. But as you begin to get into their signs of depression and what it’s like to be depressed, there’s something more than just the 67% in the stories they tell. This is called a qualitative or ideographic perspective.

In the behavioral sciences, there’s a strong pull between nomothetic, with a large sample size. By contrast, an ideographic perspective requires that we focus on the individual. So, for instance, Erik Erikson is one of the psychologists who has had a huge impact in the area of adult development. Eric Erickson told stories. He wrote a great book about Martin Luther and one about Gandhi. Erikson influenced the field of adult development through individual stories.

Jeremy

Bill B, part of what you’ve presented concerns proximal narratives. Part of what has happened is the technological explosion that now brings all of those proximal narratives to whoever wants to read them. So, their influence now appears to be outweighing objective, fact-based evidence. This nomothetic objectivism is that to which most of us in the professions are committed. We’ve become enamored with the objectivism model. There is a truth, there are facts.

We have a rationalistic argument regarding why we ought to do one thing or another. But then we’re a bit baffled because most of the data I’m aware of is ignored by our patients. They only follow about half of the things we suggest. Maybe half the prescriptions we write actually get filled. So, there’s a narrative of which we’ve kind of ignored or been baffled by. We must assume that these patients are not just “non-compliant.” We used to use this terminology which is rather pejorative suggesting that they’re non-compliant. Now we call them “non-adherent.” There’s a lot of that “non-adherence” going on, perhaps because there are narratives that they’re hearing from their family or others.

And so, as we have previously discussed, the whole decision-making process has become socio-emotional. And we’ve seen the horrible distortions that come with pure use of narrative. The whole notion that Bill G, brought up last time, concerns this socio-emotional dynamic operating in the decisions that patients make. “My cousin took this thing and, by God, their headaches went away or they could sleep a full night. Okay, then I’ll just follow their advice and ignore what the physician has to say.”  Obviously, what’s going on in U.S. government now is that we end up having these individual distorted narratives determining public policy and leading to the death of people.