The overall aim of this article is to extend the traditional remit of narrative medicine beyond the confines of bedside manner and the individual level of medical practice, which have historically defined its role, by demonstrating its potential to enhance medical knowledge translation. Knowledge translation, often associated with the more empirical, scientific dimension of medicine, seeks to bridge the gap between medical research and its practical application, thus resolving the tension between science and culture in favour of the evidence-based paradigm. Narrative medicine, on the other hand, has typically emphasized the humanistic and cultural dimensions of healthcare, largely focusing on the individual patient’s experience within their specific cultural and narrative context. Its main focus has been on the singular experience of the patient and clinician and on the individual act of storytelling rather than the narrative underpinnings of medical practice as a whole. This has often created a perception of narrative medicine as the ‘art’ side of medical practice, set in opposition to the rigorous scientific methodologies of evidence-based medicine.
By contesting the dichotomy of art versus science that sets narrative medicine in opposition to knowledge translation, I demonstrate that Rita Charon’s (2017) concepts of attention, representation, and affiliation—understood as the hallmark of narrative medicine—can be evoked to demonstrate a supplementary relation between translational and narrative medicine. Following Derrida, the supplement is understood as being at the same time an addition from the outside to something natural and original and a compensation for an insufficiency inscribed within the natural origin. My analysis shows that the narrative, relational, and interpretive domains are integral to translational medicine, defining what makes it truly “translational”. Beyond the immediate clinical encounter, every step of the translational chain involves narrative elements, though these may be less visible than in patient interactions.
Goyal et al. (2008) propose “narrative evidence-based medicine” as an elaboration of the translational medicine approach and suggest that it can effectively bridge gaps in the translational chain by fostering and enriching transformative bidirectional relationships. They further note that most descriptions of the translational research pipeline focus on the transition from basic research to clinical research (T1) and from clinical research to clinical practice (T2), but often neglect the critical role of individual patient decisions. Without incorporating the essential interactions between patients and informed healthcare professionals (termed T3 in their extended model), which are crucial for ensuring patient adherence and benefiting from healthcare recommendations, the translational research model remains incomplete.
While Goyal et al.’s (2008) proposed addition to the translational chain (T3) and their overall approach represent a valuable enhancement to translational research, confining the relevance of narrative interactions to a specific step in the translational chain also narrows its scope. This limitation restricts the processes of attention, representation, and affiliation that are central to the practice of narrative medicine to the clinical encounter—that is, to the direct relationship between clinician and patient. I explore how the conceptual framework derived from narrative medicine—specifically the concepts of attention, representation, and affiliation—can enhance our understanding of translational processes beyond mere clinical interactions. I apply and extend these concepts to analyze a study by Dela Cruz et al. (2023) that investigates how mice can model the reproductive effects of puberty suppression with puberty blockers followed by testosterone, a common treatment for transmasculine youths during puberty. In this research, young female mice were used to simulate the hormone treatments typically administered to transgender males during their transition. Drawing on the concepts of attention, representation, and affiliation, I argue that the translational steps involved should be viewed as complex acts of meaning-making rather than a straightforward process of logical inference.
Attention—including a critical examination of the narratives involved, focusing on their probability and fidelity—can expose the duality of the narrative and potential conflict in values. In the context of the study on puberty blockers discussed here, this includes the dissonance between promoting disparate sets of values, for instance, the value of individual freedom and the right of children and young adults to choose their identity, which the experiment supports by making it possible for young transgender individuals to exercise such rights, and the value of extending the same freedom and rights to the animals involved in the experiment.
In the context of knowledge translation, representation involves a complex process of renarration that includes prefiguration to shape perceptions and guide interpretation, configuration to weave disparate events into a coherent narrative, and refiguration to integrate this narrative back into our life world. This process necessarily involves selective appropriation, including decisions on what to include or exclude and what to emphasize or downplay within the narrative. Understanding this complex process can lead to the recognition of alternative narratives that can be constructed based on the same set of events. For example, in the study on puberty blockers, a different pattern of selective appropriation might emphasize details about the treatment and reactions of the animals involved, hence giving more weight to the justification for their sacrifice.
Finally, what Charon identifies as affiliation is essential to any process of knowledge translation. It involves not only establishing new and credible pathways of connection, such as bridging the gap between mice and humans, but also catalyzing diverse interests and investments, intentionally or otherwise. Examples of such dynamics include the pharmaceutical industry’s promotion of puberty blockers and the subsequent political critiques of its interventions.
The article ultimately suggests translational narrative medicine as a more nuanced lens for analyzing what specific evidence can be utilized for what purpose in which context. By recognizing that different epistemic cultures—here represented by a story of mice and a story of humans—are narratives shaped by distinct protagonists and rationalities, each reflecting unique systems of values, we can foster a more ethically grounded translational practice. This approach moves beyond reliance on scientific rationality and logical inference alone, embracing a broader, value-sensitive narrative rationality.
