Numero 1

Mi accingo a scrivere questo editoriale con un misto di soddisfazione e di timore. Soddisfazione perché si concretizzano fatiche che chi ha avuto esperienze editoriali conosce bene, timore perché avverto l’importanza di questo momento e non vorrei deludere le aspettative che inevitabilmente si creano di fronte a quello che dovrebbe essere un vero e proprio atto di nascita di una creatura. Un altro timore è poi rappresentato dal rischio di essere banale o retorico, o entrambi. Come uscirne?

Forse la maniera più facile e anche quella a me più congeniale è di scrivere semplicemente poche parole sul perché di questa iniziativa ed esprimere un augurio.

Medicina Narrativa nasce per essere un momento concreto di aggregazione per tutti quelli che hanno scoperto ( o riscoperto ) questo modo di fare Medicina per renderlo da una parte sempre più diffuso e condiviso, dall’altra sempre più scientificamente approfondito e accreditato. L’obiettivo è volutamente lasciato aperto perché è mio desiderio che la sua struttura non sia rigida , ma si arricchisca dei suggerimenti che spero arrivino nel tempo prendendo la forma che gli Autori vorranno dare. In tal senso va letto Il rapporto con la altrettanto giovane Società Italiana di Medicina Narrativa: non solo voce della Società, ma sua vera e propria anima e ragione di essere.

L’augurio è quello che non manchino i contributi, quelli “scientifici”, senza i quali non ci può essere confronto oggettivo, e quelli “narrativi”, ad evitare che proprio in queste pagine si riproponga la mortificazione delle emozioni del paziente e di chi gli vive accanto. Manca ancora un auspicio, forse il più importante per fare crescere questa iniziativa: che non si spenga quell’entusiasmo di tutti i componenti della Redazione, senza il quale questo primo numero non sarebbe nato.

Antonio Virzì

A. Virzì, O. Bianchini, S. Dipasquale,

M. Genovese, G. Previti , M. S. Signorelli

Summary
Every day we use our narrative capacity to tell us to others, at the same way the patient tells the doctor their "history of illness", and this is the description more true and complete of their illness.

From these considerations born the concept of narrative medicine, a way to deal the disease and understaind the overall meaning in context,

systemic, comprehensive and respectful of the person assisted. The story mode is a flexible and targeted communication, which goes from time to time adapted to the patient and the real situation. No two stories are equal, even when made from the same person.

It is therefore obvious that the narrative medicine requires the use of methods of study to analyze the projects and to draw conclusions with scientific criteria. By the physician is required to communication training, using multiple tools such as literature. Ultimately narrative medicine is a good opportunity for medicine to get out of the vision of technical and scientific evidence and close us to the lived of the patients.

V. Masini *, C. Lencioni **

*Dir. Prepos S.A., Libera Università del Counseling, Lucca

**Dip. Endocrinologia e Malattie del Metabolismo, Univ. Pisa

Summary
The analisys of stories about eating disorders lead to a new vision of the relationship with food that produces the concept of confidence. For confidence we mean the relationship with food in terms of ability to recognize subjective taste and satiety but also objective complexity of the food.

The concept of confidence has been derived from the research on intuitive eating and on the dimension of satiety/hunger that overlap with the psychological dimensions of the processes of addiction/denial systems connecting them to taste/distaste. When this dynamicintuitive adjustment leaps, then takes place the emotional and symbolic value of food that is considered the core of the eating disorders The lack of confidence can be tranlated in “disconfidece” (mistrust), “pseudoconfidence” and “badconfidence” as generative systems of anorexia nervosa, bulimia (and binge eating  disorder) and orthorexia. They may in fact be represented as an expression of excess dynamic projection (anorexia), overemotional exchange (bulimia and binge eating disorder), excessive symbolic distrust (orthorexia).

If we ask ourselves about the reasons for which we like and dislike a food, in our history we can find the experiences that led to the initiation of taste/distaste, acceptance/rejection. This process is functional and physiological in the progressive opening up to multiple types of foods. The more our individual food experience has been extended without trauma, the more we are open to different flavours: if the recognition of taste is not possible, eating disorders can be triggered.

G. Bert

Istituto CHANGE di Counselling Sistemico, Torino

A story is a series of events woven into a plot. The narrator may choose to arrange events in chronological order or to move back and onward on the time axis. The story may begin in the present moment or move in the past (flashback), and even in the future (flash forward). More often, especially in daily practice and training, the story can be reported such as a "daisy" as it can start from a central event and then grow in all directions, like petals of a flower. For these reasons, the story often becomes difficult to understand because of the narrator builds a chaotic "narrative frame”.

For a literary author the ability to keep the player within its “narrative frame” is obviously a test of storytelling. In the case of a professional interview, this behavior is instead a serious obstacle to an effective and useful intervention. The listening skills of a professional should not allow him to remain trapped in that frame, however trying to stay close to the needs of the patient.

The intervention of care based on narrative consists is aimed at allow people trapped in its chaotic “narrative frame” to deconstruct this

narrative world rigid and static, keeping in mind that caution is needed in facilitating the emergence of the new elements, while respecting the needs and timing of the patient.

M. Gangemi*, F. Zanetto **

*Pediatri di famiglia Verona, Associazione Culturale Pediatri

**Pediatri di famiglia, Milano, Associazione Culturale Pediatri

A difficult diagnosis, the birth of a child with a serious disease, symptoms that make fearor suspect a health problem: allowing and leading the narration by the parents and, when it’s possible, by the child, and plaiting his own allows the paediatrician to define and buildin the consultation a common and shared space, a means of knowledge and care, achance that helps in making clear some sides of a complicated reality, in which the paediatrician enter, willing or not.

S. Dipasquale, O. Bianchini, G. Previti,

M. S. Signorelli, A. Virzì.

Azienda Ospedaliero- universitaria PoliclinicoVittorio Emanuele P.O. Gaspare Rodolico

U.O.P.I. Psichiatria, Università di Catania

The objective of this study is the analysis of cinematic depictions of physicians to determinate common attributes of movie doctors, major themes and whether portrayals have changed over the time. The results showed that in the 125 selected films, physicians were generally portrayed in a positive way before 1960’s, then they are depicted as greedy, egoistical and uncaring until 1980’s, while in the two past decades medical movies have explored critical issues surrounding medical ethics and managed care, focusing attention on the doctor-patient relationship. So these recent movies should suggest the importance of a new doctorpatient relationship, based on respect, dialogue, comprehension and empathy.

F. Pirracchio

How does the medical profession appear in the world of fiction? Literature has always dealt with the manysided character of the doctor. However nobody could ever describe this profession better than a doctor, and this was the mission of Archibald Joseph Cronin, British physician and writer.

We have chosen two books by Cronin: his masterpiece The Citadel (1937) and one of his last novels, Doctor Finlay of Tannochbrae (1978). Through the analysis of some paragraphs from these novels we will compare the imaginary figure of the doctor with the real one. We will compare the exciting world of medicine, as it appears in fiction, with the harsh reality of medicine which physicians

and patients experience every day. Cronin’s characters aren’t remote abstract figures, on the contrary Doctor Manson and Doctor Finlay completely live the problems and the challenges of their historical period.

Consequently a look at the historical background of Cronin’s novels, the nineteenth century and the twentieth century, will arouse new interesting questions: how has the medical profession changed in these years? And has the patient’s attitude changed as well?

The historical reflection on these themes makes us think that the progress of medicine is always driven by a main thread, made of hardships and hopes, that leads the way and, especially at present, both questions and encourages us to go on.

Coordinatore S. Polvani

S. Polvani, A. Zuppiroli, A. Sarti, F. Biondi, I. Sarmiento, F. Trentanove.

"Medicina basata sulla narrazione in cardiologia"

A. E. Gentile, I. luzi, M. De Santis, D. Taruscio

"Medicina Narrativa e malattie rare: l'esperienza del Centro Nazionale Malattie

Rare"

G. Natalucci

"La comunicazione con il paziente all'interno del sistema delle cure"

S. Marcadelli

"Narrative based medicine e la medicina di genere"

A. Virzì, O. Bianchini, S. Dipasquale, G. Previti, M. S. Signorelli

"Storie di medici e pazienti"

S. Spinsanti

"L'ascolto che guarisce"

"La vita che torna" di Laura Prete

Edizioni: Feltrinelli , 1997

Recensione a cura di O. Bianchini

Lettera di Giulia Masini, medico infettivologo in Congo per missione umanitaria, al padre Vincenzo Masini.

R. Manfredi

Dipartimento di Medicina Interna, dell’Invecchiamento, e Malattie Nefrologiche, “Alma Mater Studiorum” Università degli Studi di Bologna, Policlinico S. OrsolaMalpighi, Bologna

The present role, space, task, mission, function, and outcome of University Medicine in Italy are briefly examined, taking as a pure and trivial pretext the actual professional activity of single, representative physician who changed his role at the same specialistic Department of the same University Hospital, by covering an University role in the past five years, after working at the same facility as an Hospital affiliated specialist in charge of the same Medical Division during the previous 14 years. The lights and shadows of assistential and academic Medicine organization and integration in Italy are the starting point of our preliminary observations, which may be potentially extended to the University Medicine as a whole, from an organizative, functional, and especially ergonomic point of view.