Narrative Inquiry - Volume 16, Issue 1, 2006

The turn to performance re-situates narrative as an object of study: narrative is both a making and a doing. The performance turn emphasizes narrative embodied in communication practices, constrained by situational and material conditions, embedded in fields of discourse, and strategically distributed to reproduce and critique existing relations of power and knowledge.

Ethnopoetics is a form of narrative analysis designed, initially, for the analysis of folk stories and based on an ethnographic performance-based understanding of narrative emphasizing that meaning is an effect of performance. It offers opportunities for analyzing ‘voice’. The ways in which speakers themselves organize stories along indexical patterns of emphasis, focus, super- and subordination and so on. As such, it is a potentially very useful tool for tracking ‘local’ patterns of meaning-making in narrative. I argue that ethnopoetics could be productively applied to data in which different systems of meaning-making meet — a condition that defines many important service-providing systems in globalizing contexts. Asylum applications in Western Europe are a case in point, and examples will be used from that domain, but the potential usefulness of such an applied ethnopoetics stretches into many other types of service encounters in which crosscultural storytelling is crucial.

This essay will examine some of the narrative practices emerging in the health care professions — medicine, nursing, social work, and psychotherapy. We have always, of course, understood that the most fertile and clinically salient information we derive about patients comes from listening to them talking about their illnesses. Nonetheless, medicine’s recent past is marked by not so much a suspicion of as a dismissal of word in diagnosing and treating disease. Of late, medicine (and because I am a doctor, I will limit myself to thinking about medicine in the essay) has found sustenance from such fields as trauma studies, oral history, and testimony work. Finally, we are coming around to understanding that our tasks include the duty to bear witness as others tell of trauma and loss.The narrative practice of medicine — or, as I have come to say, the practice of narrative medicine — unites a host of neighboring concerns and approaches. Historically, medicine came into the narrative realms through qualitative social science, especially sociolinguistics, as a means to represent and comprehend the conversations that take place between doctors and patients. Such scholars as Elliot Mishler, Richard Frankel, Catherine Riessman, and Candice West really altered medical practice by making medical discourse amenable to inspection and then analysis. Around the same time, we also turned to literary texts and ways of thinking that help us to enter the worlds of patients, see others’ experience from their perspectives, greet the metaphorical as well as the factual power of words, and be moved by what we hear. Oddly, then, medical practice became a bridge between the qualitative social sciences and literary theory, letting us, from the inside, see how very similar are the efforts of the sociologist examining discourse and the novelist creating it.We doctors feel great good fortune in having the ultimate objective correlative — what might be captivating but ethereal theorizing becomes as practical and concrete and earthy as can be by virtue of being about somebody’s body — particularly somebody’s ailing body. What extreme pleasure that my thinking complicated thoughts and being attuned to the complex ways of language can translate into control of my patients’ blood sugar or relief of their migraines or diagnosis of their coronary artery disease. Narrative medicine becomes, in the end, a heady, brainy, compassionate, corporeal practice that can heal the patient and nourish the doctor at the same time — by virtue of the talk.

The growing emergence of an appreciation of the significance of narrative, within philosophy, the social sciences and the humanities, has had a significant impact on theory and practice within the field of counseling and psychotherapy. The influence of narrative thinking has been felt in two main ways. First, concepts of narrative have been assimilated into established forms of practice. For example, within psychoanalysis and psychodynamic therapy, it is now accepted that attention to narrative structures within the discourse of therapy can be used to generate a fuller understanding of the operation of well-known phenomena such as transference. The primary intention of this area of work has been to utilise narrative concepts to permit a deeper understanding of existing ideas about therapeutic processes and procedures. Second, a quite separate set of developments has seen the construction of an approach to therapy which begins from an acknowledgement of the central role of narrative and storytelling in lives and relationships. This alternative approach, generally described as “narrative therapy”, can be characterised as the formation of a postpsychological approach to therapy, which focuses on issues surrounding the performance of narratives within relationships, community and culture, rather than on inner psychological processes within individuals. It is argued that postpsychological narrative therapies have the potential to address key contemporary personal and social dilemmas in ways that are not possible within individualist models of therapy.

There is a culturally-held belief that good narratives are associated with good mental or physical health. Scores of studies have demonstrated that writing about emotional upheavals can have salutary health effects. Despite the writing-health relationship, there is scant evidence that expressive writing samples that are judged to be good narratives are themselves linked to health change. Across multiple studies, linguistic features of essays have been empirically linked to health changes. For example, use of positive emotions, increasing use of causal and other cognitive words, and shifts in pronoun use are correlated with fewer physician visits. These language markers, however, are not strongly related to the quality of narrative. Whereas most research has been conducted with English-speaking samples, new analytic methods suggest that many of the language findings can be exported to other languages and cultures. Implications for our understanding narrative, language, and culture within the context of new language analytic methods are discussed.

Knowledge is composed of stories — primarily the stories we experience, and much less the stories we are told. We have difficulty remembering what others tell us, but schools are designed to teach by telling. Story Centered Curricula place learners in stories that mirror the real life world of working professionals, enabling them to learn through experience, and to remember the stories they have lived.