Picture the opening move of almost every appointment: so, tell me what has been happening. For most people it is an invitation. For someone whose memory, language and sense of sequence have changed, it can be a trapdoor. The account may arrive out of order, or as an image that makes no literal sense, or not at all, and in that silence the clinical conversation quietly reassigns itself to the daughter in the next chair. Nothing cruel has happened. A whole professional habit has just done exactly what it was trained to do.
That habit is what Erin Gentry Lamb and Anita Wohlmann take apart in an essay published on September 18, 2025 in the Hastings Center Report, at pages S57 to S63 of the special report "Living with Dementia: Learning from Cultural Narratives of Aging Societies," edited by Nancy Berlinger, Lamb, Kate de Medeiros and Liz Bowen. It is worth being clear about what kind of document this is: an argument essay in bioethics, not a study, with no participants, no measurements and no follow-up period. Its claim is that the use of narrative in medicine, when applied uncritically, risks further disenfranchising people who are already marginalised, and that dementia (a term covering multiple conditions, with Alzheimer disease the most prevalent) is the clearest place to see it. The authors propose two guiding principles for how narrative is used in medicine and medical education: "inclusivity and opportunity."
Their description of current practice is unsentimental. In the United States, the authors write, narrative usually enters the curriculum through some version of narrative medicine, teaching students to elicit, interpret and act on patients' stories. Students apply the tools of literary analysis, close attention to perspective, form, voice, mood and motion, to short literary texts, on the explicit premise that this transfers into better reading of patients, then write to a prompt and share the result in a small group. The teaching is often left to whichever faculty sit in medical or health humanities or social medicine, if a school has them at all, and the essay notes there is no guarantee narrative appears in the curriculum beyond an uncritical emphasis on the patient's narrative. The unexamined assumption inside all of it is that a patient is a narrator: someone with a plot, a voice, a first person. Cultural narratives about dementia, the authors argue, cast people living with it as unreliable narrators, or in advanced stages as unable to narrate at all, which makes the assumption quietly exclusionary rather than merely incomplete.
What they offer instead is not a softer version of the same lesson but a wider definition of narrative, drawn from literary studies, narrative gerontology and the health humanities. One strand is metaphor: reading a statement that is false as fact but true as figure, a tradition the essay traces through Paul Ricoeur's work on metaphor, through Wohlmann's own book on metaphor in illness writing, and through Aagje Swinnen's reading of the documentary Mum by Adelheid Roosen, which the authors cite as an example of interpreting the expressions of a person with dementia as metaphors rather than errors. The second strand is embodied selfhood, and here the essay leans on Pia Kontos's ethnographic work, in which the body is "a fundamental source of selfhood" that does not take its agency from cognitive knowledge, expressed through appearance, social etiquette, caring, gesture and dancing. Kontos's own conclusion, as the essay reports it, was that attending to embodied selfhood could support a new ethic of care. The third strand is critical: teaching students to notice the frames they themselves bring, a discipline the essay associates with the idea of narrative humility.
For a family, the practical meaning of this is narrow and real. It is not a technique to try at home, and it is certainly not a claim about what any one person understands or can still do. It is an argument aimed at curriculum committees: that the clinician sitting opposite your father might be trained to treat a hand reaching for a coat, a repeated phrase about going home, or a sentence that is geographically impossible as communication to be interpreted rather than noise to be corrected. A companion essay in the same special report by Kate de Medeiros, at pages S29 to S33, presses the neighbouring point that people living with dementia are more reliable narrators of their own experience than the culture assumes. Neither essay claims to have shown that any of this improves care. That is the next question, and it is an empirical one.