Benedetta D’Astolto: What prompted the idea for a book on nonviolent communication and narrative medicine to promote sustainable health?
Maria Gulia Marini: The idea was born in a sunny August of 2022. Several experts and lovers of narrative medicine had asked me for a new book that would talk less about the known issues on narrative medicine, thus close reading, hermeneutics of narratives, and literature related to stories of illness. In the meantime Examples of violent communication had happened in my professional life; I was witnessing testimonies from doctors and nurses and patients who said that after the covid they had turned on each other. All this had happened in recent months. I was in Milan alone with covid, high fever, and a sore throat that I had never experienced before. I could not swallow drink eat talk: my resource was writing. And so I say that this book partly wrote itself.
Benedetta D’Astolto: Let’s review what are the pivotal concepts of nonviolent communication and how do they intersect with narrative medicine?
Maria Giulia Marini: nonviolent communication tells us that in order to come to the aid of others we must first of all observe and listen to the facts and check them, secondly give space to the feelings and emotions of others, recognizing even our own but not allowing our own to overwhelm those of others, to invite others to the explications of their needs, needs I emphasize not demands, and the fourth point to help them in the verbalization of requests. Narrative medicine from an initial narrative, or rather a beginning of narrative in which the patient or caregiver wants to express some considerations and experiences about the process of care; then according to narrative medicine we have to accommodate our own and others’ emotions; then and precisely because of trust building that narrative can go on explicating needs, turning the unsaid into said, to end with a new narrative. Here I see a very great possibility of a meeting between these two methods, two approaches, both of which are generators of health and well-being.
Benedetta D’Astolto: How is the book structured?
Maria Giulia Marini: The book unfolds in 10 chapters, it is a journey for the reader from violence to peace. The mythological meaning of the word violence is interesting: in Greek she was called Bia, she was a minor goddess and she was the sister of nike, the winged victory. Therefore, there can be no victory triumph without violence. Latin was also associated with the word opulent wealth however also with the word vis, force; in short for our Mediterranean matrix a certain coexistence with violence was the norm. And in fact it is in that our brain in the most archaic part as I explain in the book has situations in which it generates violence when it feels dissatisfied and threatened. Can we conquer peace? Once again mythology and etymology help us: peace was a spring goddess Irene according to Greek culture and she came after the long and violent winter and reigned together with justice and harmony. Pax is the Latin word for peace: the Sanskrit root of the word peace indicates the ability to know how to lose, how to let go, a skill that will be transformed by the ancient Romans into the great Roman pax or negotiations. No peace is possible without the art the losing, as Elizabeth Bishop teaches us in her poem The art of losing. Violence and thus associated with power, with dogma, with role with impassable rules and unknowingly with dysfunctions in the health care system: the too short times for visits that do not allow for that generative listening, the automatism of defense behind prescriptive protocols, the shutting down of any conversation patients want to open about their lives so that the conversation with the doctor takes place only ON THE SICK BODY. These are forms of behavioral violence and the of language. The use of the imperative mode in health care is excessive: you must, you must not et, do these tests … sometimes ridiculous: take care be well commands the caregiver. Sometimes there can be a micro placebo effect but most of the time this is not the case indeed when faced with an order often the body rebels against the will of the other because one cannot make room for one’s own will to one’s own attitudes to one’s own values. This book wishes to be a training manual on respect, boundaries, and how words can be carefully chosen and selected. In short, taking a cue from Aòice in Wonderland, Alice will be able to step through the looking glass and no longer fear the Red Queen when she learns the meaning of words and therefore how to speak.
Benedetta D’Astolto: With respect to the age of the human being, how does the book unfold?
Maria Gulia Marini: it deals with youth’, the age of passions in the post covid era, with immense thanks to the kids who sacrificed a year of their existence for us, and who are still paying for the trauma of that 2020: talks about old age, and tries to figure out how remarriage homes can be made kinder and more comfortable with examples of narrative medicine, and then talks about death, a chapter is devoted to the “violence of nature” the limitation placed on human beings: and how the subtraction of time from mourning and rituals are acts of violence toward what remains.
Benedetta D’Astolto: the two key messages you want to leave us with?
Maria Giulia Marini: the first is that of Slow violence, a term borrowed from environmentalists: day after day with almost imperceptible violence we continue to do damage to the planet and local populations. I have included this term in health care because Slow violence itself happens every day in clinics, in places of care, and is partly dictated by excessive bureaucracy and partly dictated by unsatisfactory and biased humanities training to future physicians and future caregivers. Evidence-based medicine is sometimes In opposition to what are the best choices for the patient. This happens unconsciously but imperceptibly.
The second message is in the final chapter, where I mention the importance of intersecting narrative medicine and nonviolent communication with multiple intelligences: the challenge is to be able to benefit in even a short time from the other intelligences, not only the logical-rational, and the linguistic and the dimensional intelligences: there is the body intelligence to understand the nonverbal language of the person we are caring for, the intrapersonal intelligence to understand our own emotions, the interpersonal intelligence, to understand the emotions of the other, the natural intelligence to understand what life cycle the person we are caring for is in, and the existential intelligence that rests on the foundational values of the other. We therefore bring peace and ward off violence by introjecting ethical concepts of respect for the beliefs of the person in front of us. Only by not prevaricating with our protocols and certainties can we make room for nonviolent communication that will lead to a viable ecosystem with less conflict is greater well-being.
Benedetta D’Astolto: There are also literary quotes and moments of practice, would you like to tell us about them?
Maria Giulia Marini: I took up the epilogue of Shakespeare’s The Tempest to explain what nonviolent communication is, a few poems by Emily Dickinson to describe the hikikomori syndrome, Sophocles’ Antigone to describe the brutality of stolen and denied rituals, Alice in Wonderland to talk about power and language, Isaac Asimov with I Robot to talk about artificial intelligence in this last case: I think that literature is extraordinarily evocative and can be balanced is integrated with authentic narratives of care and illness precisely the moments of practice are just as fundamental as reading the other parts: I want memory to be exercised, as well as reflection that only happens by asking questions about what has been read and how we operate on a daily basis with respect to the issue of violence and peace in our professional organizations. There are many questions where I open the scenarios to what I could have done differently, what could have happened if… This is a conditional reflection that does not wish to be judgmental but is meant to be an invitation to creative intelligence so that other possibilities and parallel worlds that are more sustainable, more vital, and more serene may emerge. Analogically, it will then be the readers who will bring back into our lives what they have learned from the other thought worlds they have created.