From Close Reading to Ostranenie: The Historical and Methodological Foundations of Narrative Medicine

The subject of this study is the technique of “close reading” in Rita Charon’s narrative medicine, considered as one of the ways of operationalizing narrative medicine in contemporary clinical practice. The focus is on the epistemic status of this technique, as well as on its significance for overcoming the limitations of evidence-based and biomedical models of medicine in cases where not only the biological parameters of disease but also changes affecting the patient’s lifeworld become clinically significant. These include disruptions of everyday practices, transformations of social roles, changes in relationships with loved ones, difficulties in articulating illness experience, and challenges in decision-making. The article examines in greater detail how this technique makes it possible to connect clinical knowledge with the patient’s personal experience. The methodological basis of the study consists of philosophical-epistemological and historical-genealogical analysis: on the one hand, it reconstructs Charon’s model of “close reading” as a reproducible professional practice; on the other hand, it traces its foundations in New Criticism and compares them with Russian Formalism. The scientific novelty of the article lies in interpreting close reading not only as a disciplined practice of listening to and interpreting the patient’s narrative, but also as an epistemic framework that can be substantially enriched through the Formalist concept of ostranenie. It is shown that turning to ostranenie makes it possible to move beyond a narrowly text-centered understanding of narrative and to consider it as a form of de-automatization of perception, significant both for the patient, who experiences a crisis of everyday life in the context of chronic illness, and for the physician, who seeks to perceive illness in its biographical and social context. The article concludes that narrative in medicine performs not only a representational but also a performative function: it participates in the objectification of illness experience, in sustaining adherence to treatment, in decision-making, and in shaping a richer intersubjectivity between physician and patient.