As chief resident on the arduous Osler service at Johns Hopkins in the 1960s, Thomas P. Duffy, M.D., was asked to verify the suicide of a young nursing student.
Alone, he entered her room and found the student upright in bed, dressed in lace, stained with vomit, dead from an overdose of sedatives. A supervisor soon joined him and asked Duffy to fill out death forms and search the room for anything embarrassing. He found a risqué snapshot of a happy young man wearing only combat boots.
Minutes later, Duffy hurried to grand rounds. Determined to maintain equanimity, he chose not to discuss or even think further about the young woman’s death or his role in sanitizing it.
Years later, as a professor of medicine at Yale, Duffy sat down to write an article for the journal The Pharos about his Hopkins years. As he thought back, the memory of this incident returned full force. For the first time, he mentally revisited the young woman’s deathbed, and he included her story in the article. His failure to acknowledge the young woman’s death had been callous, he wrote, while his need to put it out of his mind illustrated a system that was unaware of the emotional disruption that encounters with tragedy could trigger in young doctors. The program’s pyramid system winnowed half of each residency class annually while demanding what Duffy wrote was an “almost superhuman effort” and a “conspiracy of silence” about traumatic experiences. For the house staff, he wrote, this training amounted to “self-torture.”
Duffy believes it is important to share such experiences. “If one does not address moments like that, at some point in the future one pays the toll,” he said. “It comes back to haunt you.”
Denial and machismo hardly make for healthy souls. Yet studies of interventions for post-traumatic stress disorder (PTSD) show that recounting a traumatic incident right away can sometimes mean worse stress symptoms later, too. Stories that bring healing and insight can take time to assemble from the raw material of the memory. Decades, even.
Narrative underlies most, if not all, of our attempts to make sense of the world. Yet the links between memory and stories are many and complex. Memory is less like a set of index cards and more like a set of systems that direct decisions, many unconscious, about how to reconstruct and interpret events in the past. From such decisions, stories arise. How these processes take place, how they heal or harm, how faithfully they affect reality, are by no means straightforward questions.
To create compelling stories aimed at other readers, fiction writers draw upon their own experiences. But too much reliance on memory can paradoxically weaken prose, according to novelist Bret Anthony Johnston, who urges his writing students to buck the advice “Write what you know.” By all means, he writes in a 2011 essay for The Atlantic, set stories in a familiar setting and festoon them with details from memories. But then route the plot away from memory. Let characters do things you’ve never done. Fiction’s narrative and emotional integrity can and should trump the literal truth of what happened.
“Stories aren’t about actions. Stories are, unto themselves, actions,” Johnston writes.
Medical professionals who want to write accounts of their patients are faced with a practical and ethical concern: how to conceal patients’ identities and protect their privacy. Anna B. Reisman, M.D., associate professor of medicine and co-director of a writing workshop for residents, recommends that residents (and any health care professional writing about patients) either remove enough detail to hide patients’ identities or ask their permission, which is also fraught with ethical issues. Ideally, one does both; another option is to go beyond simple de-identification. Write a story, she advised in The Atlantic in February, free from dependence on the facts of what happened. To Reisman, fictionalizing a medical history not only is the more clearly ethical option, but it can also yield truths independent of literal accuracy. “Sometimes, the truth can emerge more clearly‒and more kindly‒through the prism of fiction,” she writes.
The mind seems to think so, too, as memory routinely obliges the present by rewriting the past. Eyewitness testimony is so malleable, its underlying memories so subject to suggestion and prone to distortion, that it can wrongly convict a defendant. The 1980s recovered-memory movement sent many innocents to prison after their accusers came to believe that they had been abused as children, often encouraged by well-meaning therapists to tell stories of rape or Satan worship. Researchers now understand that false memories can be implanted by storytelling.
In everyday life, too, simply recalling and retelling memories can alter them. The act of retrieving and reconsolidating a memory seems to render it susceptible to change, as if we could reread only while highlighting and crossing out. This effect is so strong that researchers are looking to tweak it for better PTSD treatments.
“In order to incorporate [memories] into the story, what was vague has to become concretized. So no question, we polish them,” Duffy said. “[Knowing] how it all played out, now the memories are refracted through a different prism.”
Stories can heal, a truth well-known to Annita P. Sawyer, Ph.D. ’81, assistant clinical professor of psychiatry and a practicing psychotherapist. In 1960, as an adolescent traumatized by family abuse, Sawyer was misdiagnosed with schizophrenia, hospitalized, and subjected to shock treatments that erased much of her memory. She built a successful life, keeping the hospitalization a secret. But in 2001, she decided to read her own medical records from that long-ago time.
Disturbing memories rushed back, shaking her deeply. Clinical experience told her that she must have had PTSD back then, not schizophrenia. Compelled to rethink her own identity, she realized she had a story to tell.
During the decade that followed, as Sawyer read, remembered, and wrote, an ingrained feeling of disconnection from daily life gradually disappeared. So did her lifelong shyness. Her life story retold lost its frightening energy, and she felt whole. She published Smoking Cigarettes, Eating Glass: A Psychologist’s Memoir last spring.
Whether in therapy or in memoir, Sawyer says, constructing a true story allows another person to hold your experience, helping transform “inchoate, churning” memories into something orderly and coherent. (Her patients’ lives are so much like novels, she says, that she has no trouble remembering all the characters from their stories.) Even if this story doesn’t perfectly correspond to reality, even if it’s filled with the kind of ugliness her book’s title suggests, a story based on truth can restore a fragmented sense of self.
“People don’t have to have prettiness,” Sawyer said. “People don’t need a story to be pretty; they need it to make sense.”