It is a mistake to treat case and story as if they exist only in their own universe. But it is tempting to do so. The patient reduces world to ego, centering experience on body and self. Pain, fear, and anxiety drive this isolationist move. The patient not only is dependent but becomes a dependent, and welcomes it. Institutionally, we encourage the patient toward this constricted self, as can be observed in the admissions office, examining room, or hospital room. The typical hospital visit is brief. Conversation, such as it is, is conventional and desultory. This is reinforced by the instruction to keep things pleasant (i.e., don’t intrude). Institutional routines become a way of life for the patient. Sickness, thus acknowledged, ends in retreat from the world and disconnection from others. Consequently, recovery and recuperation are as much a return to the world as a biomedical outcome.
The clinician is also tempted toward isolation, the loss of the story on one side and the reduction of the world to the practice community on the other. Of course, context persists. But, like the patient, the clinician resists context as intruder. The clinical situation becomes a closed-away world.
The move from story to case serves to break into isolation. Located in the practice community, the case connects as well to other practice communities, that is, appears at the intersections of law, business, religion, and so on. The case attaches to other cases, becomes a genre. Together,