Global Journal of Human-Social Science, A: Arts and Humanities, Volume 22 Issue 7

through both mental and social processes and culturally and historically conditioned. During the narrative process, both the narrator and the listener are affected, through a process that allows for reflections, understanding and explanations related to the narrated events. When narrating the process of becoming ill, the patient justifies and provides meaning to their suffering, integrating representations, knowledge, practices, their own experiences and those of their families and social groups, reconstructing reality within a context. By transforming the fact into an experience, it is externalized through verbal and non-verbal language 14, 21 . From the mid-twentieth century, illness narratives start being applied in the teaching of health professionals as a tool that encourages active listening, empathy, bonding, and the humanization of the health professional-patient relationship. Unlike the anamnesis (standardized interview scripts used by different health professionals), the narratives seek to stimulate the students' narrative competence, working on skills such as recognizing, absorbing, interpreting and being moved by the story of the other, combining textual, creative and affective skills 14, 22 . The textual skills refer to identifying the structure of the story, perceiving its multiple perspectives and recognizing metaphors, creative skills stimulate the imagination and develop curiosity and, lastly, the affective skills include the respect for diversity, otherness and uncertainty. Together, these three contribute to the understanding of the story and its meanings, thus allowing a look beyond the biological mechanisms that produce diseases, focusing more on the language, representations, emotions and relationships that permeate daily practices in the health area 14, 21, 22 . In the medical field, the usage of illness narratives extends from the beginning of graduation 13, 23 all throughout the professional’s education 22 and their professional life. Several ways of stimulating such narrative competence can be studied and implemented, such as the reading of classic works of literature or photographic essays and the analysis of cinematographic or artistic texts. This research made use of illness stories written by the students themselves and the collection of narratives from sick people 14, 24 , examples where real people were interviewed by the undergraduates, without the need to resort to anamnesis scripts specific to each profession. Regardless of the form, narratives are considered as transforming care practices, promoting empathy, approximating the student to the ailing person and forming a bond. By encouraging active listening, they favor the expansion of the view regarding the entire process of becoming ill 21 . In Brazil, there are reports of its use in the training of doctors, nurses and psychologists, both at undergraduate and graduate levels 25 . As already mentioned, in the literature, there are no prior mentions concerning the use of narratives in the graduation of physiotherapists and nutritionists in the country, which was done in this research. The narratives would break with the technicity of the curriculum, incorporating popular knowledge and allowing a look beyond the biological, while contextualizing the illness as a complex, multifaceted, non-reducible phenomenon carried out by those who suffer. Health professionals enter people's lives at moments of significant fragility, with the narratives bringing out the subjectivity and uniqueness of such moments. Due to these characteristics, they are able to provide the necessary life experiences and reflections that allow the shifting of the standards of health education from the traditional hospital setting to a more humanized primary care 26 . When working with narratives, listening is a priority. Being recognized as one of the foundations for the effectiveness of the care proposed by the Expanded and Shared Clinic, a strategy included in the Humanize SUS policy, which prioritizes the expanded understanding of the health-disease process, the shared construction of diagnoses and therapies, the expansion of the work object, the transformation of means and work instruments and the support for health professionals 25, 27 . As has been already mentioned, the health professional is very early trained, primarily, to listen to people through a common script, called anamnesis. This script, permeated by a technical approach, completes, cleans and standardizes people's narrations in order to reach the ailment, however, in the process, it devalues the knowledge that the patients have about themselves. In this process of “selective deafness” 24: 54 , the sick individual becomes an object, a vessel, with the highlight being on the disease. The health professionals think they are listening to the suffering person, but the social representations constructed and reproduced by the Flexner model prevent such an active listening. During this process, the disease is treated as a universality, equally applicable to everyone, due to the removal of the psychic, cultural and social issues related particularly to the person seeking treatment. This creates a distance that prevents the formation of bonds. The Flexner model, by prioritizing only traditional scientific knowledge and technical skills, removes compassion, empathy, attitudes and relationships 28 . These points appear in the subsequent reflections made by the students, who are surprised by the discovery of the subject beyond only diseases, an experience that permeates the entire corpus of the research and is highlighted in several of their speeches. It is a discovery that arouses a multiplicity of emotions in these undergraduates, who start to reflect on aspects not previously perceived by them. In the whole corpus , it is noted how much these students, from a more © 2022 Global Journals Volume XXII Issue VII Version I 7 ( ) Global Journal of Human Social Science - Year 2022 A The Use of Illness Narratives in Undergraduate Physiotherapy, Medicine, and Nutrition: Innovative Experiences at a University in São Paulo