‘Stories, narratives, scenarios in Medicine’

by Jan Parker

©Emma Barnard @PatientAsPaper

in Representing Trauma; Honouring Broken Narratives Special Issue 

Introduction

There are occasions when ‘literary’ academic writing abuts and can profitably engage with other disciplines and other professional practices. Life-writing, archaeological and land- and sound-scape writing and many other ‘New Humanities’ tackle the possibilities and practicalities of making Humanities narratives – meaning-making, significance-highlighting accounts – out of their subject matter.

None more urgent than Narrative Medicine; like life-writing to [auto]biography, literary geography to both literature and topography and material culture to both fine art and historiography, Narrative Medicine is charged with exploring, interrogating and challenging the received wisdom in and about the ethical and epistemological processes of both its disciplines.

For Medicine, based as it is in traditions of case study and pathography, Narrative Medicine stresses the hermeneutics of patients’ accounts, of attending to the silences and silenced as well as what is said. And the ethics, problematics and effect of mediating the experience and condition of those who, perhaps disenvoiced by that very condition, are unable to speak for themselves: the affordances of constructing ‘Broken Narratives’.

For literary narrative studies, patients’ narratives demand scrupulous attention to the ethics and responsibility of interpretation: to the effect of ‘applying’ analytical critical tools to an individual’s particular life story, life experience, pain.

For both there is the ethical challenge of constructing a narrative at all: of creating an ordered account with claims of ‘before and after’; ‘cause and effect’; and perhaps attributing or denying culpability.

Theatre directors talk about the contract they set up between stage and audience: about the structures of the world that the audience is entering, about the shape and affect of the experience. Literary critics are practised in analysing the contract between text and reader but have been accused of practising ‘cultural hygiene’: of developing, and teaching students to ‘apply’, techniques to distance the text.

For practitioners of medicine, this perhaps has two important implications: to be aware that they ‘stage’ the clinical encounter onto which they demand or invite the patient to ‘present’; and second, that they create, or better co-create, a narrative when they turn observations, vital signs and ‘data’ into an ordered account. That created narrative has to use the constructions that the discipline offers: about the role of medicine, its discriminating processes (of health from sickness and between diseases and treatments). And, in complex ways, those narratives are illuminated by as they illuminate non specialist models of health and sickness.

Together, the two fields, with such different ethical demands on them but with common or overlapping knowledge-making processes, can round out and explore the meta questions that both need to take for granted in day to day practice. As interrupted life stories (the narratives that patients develop in response to medical or other crises) reveal the unformulated expectations that are now challenged by illness, so the patient entering the consulting room ‘presents’ an account that reveals much about conceptions of health and illness, minds and bodies but also potentially about constructions of identity, integrity, moral worth, formation of character, guilt, shame … and finally, the human condition.

So, given that health and illness narratives are constructions:

• How can particular narratives be best ‘co-created’ between clinician and patient?
• What are the ethics and proper processes for turning [medical/psychiatric] ‘cases’ into ‘material’?
• What is it, and how best, to give that material its due?
• What is it to give an account of that material?
• What are the ethics and impact of ‘accounting for’, of [necessarily] interpreting, of giving one’s account when others’ accounts may be differently located?
• What is the effect of being so ‘accounted for’?
• What is the effect of exposing oneself to another’s narration?
• What is the effect of re-telling, re-presenting a traumatic event?
• How does one give a meaningful, significance-highlighting account of the material without appropriating it, alienating it from the teller, rendering it closed to other and others’ narratives?
• What are the ethics of electing and re-presenting ‘test’ cases?
• [As raised in the later articles in this issue] What are the ethics of electing and re-presenting test cases not in narrative but as ‘scenarios’?

This Special Issue is interested in narrative practices around medical, psychiatric and trauma care and in what it is to first hear and then to give an account of complex, psychological and ‘psychosomatic’ conditions.

For medical and clinical practitioners, it asks what it is to listen to, attend to, be co-present with a ‘patient’: what are the power relations and ethics of re-presenting and re-narrating someone whose narrative is broken – by illness, trauma, psychosis or a ‘condition’.

In so doing, they each raise questions about that accounted for and the ethics of the accounting: in both senses.

First, the Issue explores ‘Broken narratives and the lived body’; narratives of self harm as embodied expressions of pain; the psychiatrist experiencing, witnessing and co-constructing meaning while ‘weathering a violent storm together’ with her patient and the problematics of the ‘narrative work’ involved in ‘honouring a life’.

Then in a section about trauma narratives in/and art, we turn to narratives of ‘emotional breakup, suffering and wilfulness’, to visual and textual dialogues in a photo essay of mental illness, to music and post-traumatic discourse and finally in this section to visual media and intergenerational transmission of violence.