Multiple Voices and Stories (Narratives of Health and Illness)

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About the Book

In the field of medical sociology/ anthropology, narratives of patients are widely used as an approach to understand social reality and lived experiences. As a theoretical and methodological entry point, they contribute towards defining the scope of the discipline, point out the limitations of the ‘positivist language’ of biomedicine, and highlight the role of culture and society in understanding health, illness and suffering in everyday lives.

Inspired by the ‘possibilities of narratives’, Multiple Voices and Stories is a collection of essays on the narratives of health which goes beyond the patients and their immediate families to include midwives, traditional healers, complementary and alternative medical practitioners, health workers, to name a few.

The essays are arranged thematically. The first section captures the voices of the care-providers and healers in different settings. The second section narrates the voices of the self in providing accounts of doing health-whether curing an illness episode, living with a chronic illness or engaging in everyday practices of health. The third section goes further by offering two contrasting examples on mental health narratives by showing where and why a narrative approach to medicine works or does not work.

The volume also raises important questions like: What functions do these narratives perform? Do they generate evidence? If yes, what kind of evidence? How does such evidence provide an ‘alternative’ to the evidence in biomedicine? Where do narratives stand in the practices of evidence-based medicine and public health?

Bringing together essays by well-known scholars, this volume is an indispensable read for students and scholars of medical sociology/anthropology, sociology / anthropology of health and illness, public health, narrative theory, social work and nursing studies.

About the Author

Arima Mishra is Associate Professor, Health, Nutrition and Development Initiative, Azim Premji University, Bengaluru, India.

Suhita Chopra Chatterjee is Professor of Sociology, Department of Humanities and Social Sciences, Indian Institute of Technology, Kharagpur, West Bengal, India.

Introduction

Narrative is widely used as a method and approach to understand social reality and lived experiences in many disciplines within humanities, social sciences and, more recently, within health sciences, including nursing and pharmacy research (Bissell et al. 2006; Ryan et al. 2007; Hayter 2006; Haidet et al. 2006). Narratives, more specifically illness narratives, occupy a central place in the field of medical Sociology and anthropology. As a theoretical and methodological entry point, these narratives contribute to defining the scope of these sub-disciplines. To begin with, illness narratives point out the limitations of the positivist language of biomedicine and highlight the role of culture and society in understanding health, illness and suffering in everyday lives. Medical anthropology, not surprisingly, witnesses a rich stream of literature on illness narratives that reflect accounts of the ill people themselves. Why, then, this volume on narratives of illness and health? Following Mattingly and Garro (2000), this volume is inspired by the “possibilities of narratives” -narratives from a range of human actors that go beyond the patients and immediate family members. This volume, then, is conceived to expand the scope of the narrative literature in medical anthropology and sociology in the following three directions.

‘Patients’ Narratives and Beyond

The “narrative turn” in medical anthropology can be traced directly indirectly to a range of theoretical and methodological concerns address issues of health and illness within the sub-discipline. At the et, such a turn draws on the early distinctions between disease (a logical dysfunction of the physical body) and illness (lived human experiences of the physiological state and beyond). Good (1994: 5), for instance, defines “illness as a syndrome of experiences, a set of words, experiences and feelings which typically run together for members of a society”. This distinction provided medical anthropology an “object of study and program of research” (ibid.). It accompanies a critique of the positivist approach of biomedicine that universalises notions of body and disease. Such an approach, Good argues, relegates alternative notions of body, illness and care as “beliefs” contrasted with scientific knowledge characterising biomedical knowledge. Anthropologists hence opt for an interpretive approach to the study of understanding the body, health, illness and medicine in cross-cultural contexts. It examines how medicine and clinical reality itself are culturally constituted.

It is this focus on the lived experiences of illness and the centrality of meaning through an interpretive approach that has led anthropologists to turn to narrative practices. It is through such practices (and modes of storytelling) that patients, their families and others participate in sharing the accounts of pain and suffering following the onset of illness. As Mattingly and Garro (2000: 1) write, “narrative is a fundamental way of giving meaning to experience. In both telling and interpreting experiences, narrative mediates between an inner world of thought -feeling and an outer word of observable actions and states of affairs”. Narratives, then, become a means to understand meanings and representations of health, illness and suffering in the social and cultural contexts we live in.

The significance of patients’ narratives emerged from an anxiety stemming from changes in the clinical consultation process. Shorter (1985) traces the history of doctor-patient relationships to understand the deteriorating and debilitating nature of clinical consultations that lead to increasing mistrust between doctors and patients. He charts three phases in the doctor-patient relationship, that is, traditional, modern and postmodern. Looking into the nature of the consultation process, he finds distinct changes in these phases. If one takes into account case history-taking as a component of consultation (Shorter discusses other components like diagnosis, prognosis and treatment), Shorter argues that traditional consultation did fairly well in history-taking although it omitted any kind of clinical investigation, in the sense of observing and examining the patient. The modern phase did fairly well in taking the case history; however, the anatomical-clinical method attached great importance to the chart and the course of the illness. The postmodern phase is limited to an impatient and abbreviated style of history-taking and pays cursory attention to the physical examination while giving painstaking attention to laboratory data and diagnostic imaging. The disease-trained doctors, he argues, by focusing on the “chief complaint” ignore the psychosomatic or psychoneurotic problems. The postmodern doctor-patient relationship has stripped medicine of its intrinsic healing properties. Mishler (1985) writes how the suppression of patients’ voices (suppression of the voice of the life world by the voice of biomedicine) in clinical encounters results in the provision of inhumane and ineffective medical care.

The need to pay attention to patients’ voices has led anthropologists to take recourse to the narrative method to allow the sufferers to speak about their own illness experiences. As Mattingly (2006: 568) notes: “An interest in narrative within the clinical world has been linked to concern with ethics-with how to provide a more humane, a more human-centered’ approach to healthcare.’ By narrating illness experiences, the patients do not merely share their experiences with others; they also speak about what it means to them and what it does to them while narrating it. In other words, anthropologists are concerned not merely about allowing an agency to the patients to narrate but discuss functions of narratives as well. In this context, there are several accounts to show how illness sufferers mobilise narratives of personal experience as therapeutic and meaning-making resources (Capps Ochs 1995; Frank 1995; Garro 2003; Good 1994; Hyden 1997; mman 1988; Mattingly and Garro 2000; Radley and Blig 1996; an 1990; Shohet 2007). More specifically, studies have illustrated narratives as rhetorical accounts that may be designed to elicit a particular interpretation of the illness condition (Charmaz 2002; Good Hyden 1995), restore the moral position of the teller and assert a positive identity (Frank 1995; Kleinrnan 1988; Riessman 1990) or narrate other pressing concerns and suffering in lives and hence illness may not be central to illness narratives (Buchbinder 2010; Wikan 2000). patients accounts of illness through narratives are a dominant theme in another stream of writing too-qualitative sociological research on chronic illness that furthers our understanding of the dynamics of body self and society (Bury 1982; Charmaz 1983; Gerhardt 1990; Lawton 2003; Riessman 1990; Robinson 1990; Scambler and Hopkins 1990; Williams 1984.

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