The importance of Story for health and wellbeing

I have always loved listening to and telling stories.

 

At my place of work, a Kindergarten in Elwood, Victoria, I perform an oral story twice a week, making it an embodied experience for my audience of little people. There I witness the phenomenon of transference visible in the children's expressions of surprise, enlightenment, trance, concern or joy.

 

I attend regular storytelling sessions facilitated by Storytelling Victoria Australia, in an active and passive role, at a community garden in Brighton. This experience renders a powerful feeling of catharsis; I feel ‘human’ again and accepted for my vulnerability, especially when sharing a personal story involving a degree of suffering or pain.

 

I have completed workshops on the art of writing, ‘Narrative Therapy’ and Storytelling techniques, and have recently completed a Major in Creative Writing at Monash University. I have set up two book clubs, a writing group and I coach creative writing to Middle school children.

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So, fundamentally, I am not only an active proponent for stories, it is somewhat of a truism that I live and breathe them. I have learnt a few narrative skills along my path and I claim knowledge of stories’ affective powers.

 

Every time I tell a story – whether that is a fictional or personal story, I can tell it in a different way, adding or subtracting details or framing it differently, but the way I choose to tell the story shapes me and redefines my identity each time. Borrowing a term from Arthur Frank, my very self is “perpetually recreated in stories” (2013:53). And so, I fully appreciate Frank’s sentiment in The Wounded Storyteller when he says, “Stories do not simply describe the self; they are the self’s medium of being” (p53).

 

In other words, stories are, what Tumarkin calls the “pipes of the self, not just the water in the pipes” (2014:10). This kind of metaphoric language serves as an example of how narrative discourse is “as much performative as it is constantive” (White, 1991, pp149-150).

 

White, commenting on philosopher Paul Ricoeur’s seminal work, Time and Narrative, says, “narrative discourse does not simply reflect or passively register a world already made”; rather it “works up the material given in perception and reflection, fashions it, and creates something new, in precisely the same way that human agents by their action fashion distinctive forms of historical life out of the world they inherit as their past” (1991, pp149-150).

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Connecting with other people through stories seems to be a basic human need. Stories are something we apparently need to tell ourselves ‘in order to live’ (Didion, 1979, p11).  Judging by the plethora of literature about suffering and illness of various kinds and the coping thereof, texts on illness narrative theory and concepts such as ‘Narrative Medicine’ (Charon, 2006), ‘Narrative Therapy’ and ‘Storytelling Therapy’ (Billington, 2016), one can deduct that stories have a special status for our wellbeing.

 

Some go as far as claiming, “An unnarrated life is not worth living” (Kearney in Tumarkin, 2016, p2) and then there is Muriel Rukeyser’s poetic line, “The universe is made of stories, not of atoms”. But what accounts for the contemporary fascination with stories? And is there no limit to what stories can or cannot do for us? In this essay I examine the way in which narratives shape us individually, how they function in society and - in particular - what stories mean for health sociology.

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Not only do we socially and culturally construct our individual selves with our very own narratives, the concept of social constructionism is now considered a crucial perspective within the sociology of health and illness (Bury, Lupton, Conrad and Barker, in Nettleton, 2013, p15). Nettleton (2013, p13) suggests, disease refers to the “pathological changes within the body which find expression in various physical signs and symptoms” and illness refers to the “individual’s subjective interpretation and response to these signs and symptoms.”

 

Nettleton argues, not only is our personal experience of health and illness historically and culturally variant, even “medical knowledge is socially constructed” (2013, p13). “Nettleton also makes the point that the social construction of health is not simply a reflection of historical and cultural variation or a matter of knowledge or power but also shaped by politics and economy” (Davis, 2017, p3). 

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Narratives and stories have an important function in society whereby they help us understand who we are and help us interpret our life experiences. Dutta (2008) says, “Narratives refer to a mode of reasoning through which cultural participants make sense of the world; they constitute the processes through which these stories are shared.”

 

On a very basic level, Andrews et al (2004, p3), define narrative as a ‘sequence of events’ ordered chronologically or what Labov (in Polletta et al, 2011, p111) describes as “an account of a sequence of events in the order in which they occurred to make a point.” In other words, a narrative is a meaning-making construction of a thing in motion.

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The concept of social constructionism in health sociology and the constructionsim of our individual selves through stories is an extension of the concept proposed by Anthony Giddens on self-identity (1991).

 

It can be argued what sets us apart from the animal world is that humans are self-reflexive. Giddens (pp52-53) says, self-identity is “something that has to be routinely created and sustained in the reflexive activities of the individual” and is “not a distinctive trait, or even a collection of traits, possessed by the individual.”

 

Quoting Judith Zaruches, Frank (2013, p1) says that we identify with a certain self-constructed ‘destination and map’ to our lives. The seriously ill person, whose biography and worldview is disrupted by illness, then needs to shape a new ‘map’ to a new ‘destination’.

 

This kind of disruption creates, what Giddens calls, ‘ontological insecurity’ (p53). Laing (in Giddens, p53) points out, “the ontologically insecure individual lacks a consistent feeling of biographical continuity” and “an individual may fail to achieve an enduring conception of her aliveness.”

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Giddens’ idea of self-identity, which presumes continuity across time and space, seems synonymous with the concept of ‘inertia’ in physics (OED):

 

A property of matter by which it continues in its existing state of rest or uniform motion in a straight line, unless that state is changed by an external force.

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Applied to self-identity, property would be ‘identity’, the existing state ‘personhood’, the uniform motion ‘linear temporal trajectory’ and the external force ‘illness’.

 

Hydén and Brockmeier (2008, p2) assert, “Narrative helps us to make sense of the new life that now has to accommodate an ‘uninvited guest’” – being the external force and biographical threat which disrupts our ‘sense of continuity, identity, and autobiographical coherence’ (Hydén and Brockmeier, 2008, p4).

 

Giddens (p53) further states, “Time may be comprehended as a series of discrete moments, each of which severs prior experiences from subsequent ones in such a way that no continuous ‘narrative’ can be sustained.” By reflecting and plotting a new life trajectory we can create our new identity, shape our new ‘map’, with the help of storytelling.

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Illness narratives can be both, oral or written, accounts of sick people’s experience of illness and its effect on their lives or the effect on people’s lives around them (Hydén, 2007). Davis (2017) points out that “narrative is a long-standing aspect of health sociology”.

 

However, forms and functions of illness narratives have expanded rapidly during the last few decades (Hydén, 2007), which is due to what Frank (2013, p11) suggests as a need in late modernity of the ill person to have their “suffering recognized in its individual particularity”.

 

In other words, rather than having illness reduced to medicine’s general view, the postmodern human ‘reclaims’ (Frank, p11) her or his own suffering by way of storytelling. Cultural historian Maria Tumarkin (2014, p2) suggests what is happening with storytelling now and what stories can do for us has to do with “the way stories are being pressed into the service of some yet-to-be-fully-glimpsed zeitgeistian thing.”

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To put it more succinctly and to expand Frank’s postmodernist argument on illness narratives, Polletta et al (2011, p110) suggest one of the reasons for the increase in personal stories, in general, is its symbolical alignment with common sense rather than science, making them “seem engaging and concrete rather than abstract” and “appealingly authentic.”

 

However, David Intrator (2016) has found that authenticity is not always enough to tell a ‘good’ story. Recently witnessing the stories of several victims of child abuse, he argues that one must ‘craft’ authenticity - he could ‘sympathize’, but not ‘empathize’ with some stories due to their poor construction or delivery.

 

I agree that in order to be a good storyteller one must have good narrative skills and that 'crafting' a story is one of the most important aspects of good storytelling. However, I take departure from Intrator’s claim that authenticity is not enough when telling stories about pain and suffering.

 

It is enough because what we do when telling our story is not just a form of entertainment; it is also a form of transformation and healing. I agree with Tumarkin (2014, p9), when it comes to storytelling about pain and suffering, preference should not be afforded to “pathos over tragedy.”

 

As Tumarkin (p10) says, the essence of what happens between humans in the act of communication is not ‘just’ telling a story, it is a lot stronger than that. It is something along the lines of our self having a ‘narrative structure’ – something “unified and continuous with the past, present and future”, which is why “we string ourselves through the stories” (Broks in Tumarkin, p10).

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Illouz (in Polletta et al, p110) claims the rise of personal storytelling “as coterminous with the union of Freudian self psychology and self-help in an enterprise that made performances of the self the route to happiness and success.”

 

Kristeva (in Alford, 2008, p226) argues against the claim that traumatic experiences are ‘unrepresentable’, and claims “we have a bodily need to communicate”, which we are able to do through symbolic language.

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When a patient shares their illness narrative with their physician it becomes a dialogue, rather than a monologue, wherein lies its ‘transformative potential’ (Greenhalgh, 2006, p28). This, however, is only possible if the physician has the appropriate narrative skills to interpret the narrative.

 

“The patient is a ‘text’ to be ‘read like a book’ and ‘physicians are like literary critics’” (Montgomery in Tanner, 1999, p157). Mishler (in West, 1986, p445) argues there is a discrepancy between ‘two structures of meaning’ - the ‘voice of medicine’ (medical professional voice) and the ‘voice of the life world’ (ill person’s voice).

 

Mishler (in West, 1986, p445) argues “that the realization of clinical practice through this type of discourse “seriously impairs and distorts essential requirements for mutual dialogue and human interaction.”

 

It has therefore become a virtual imperative that physicians have all the narrative skills necessary to ‘read’ their patient’s stories. Charon (2006, p4) stresses the importance of practicing medicine with the “narrative skills of recognizing, absorbing, interpreting, and being moved by the stories of illness”. In order to do this, doctors must do the following (Charon, p4):

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Listen expertly and attentively to extraordinarily complicated narratives-told in words, gestures, silences, tracings, images, laboratory test results, and change in the body-and to cohere all these stories into something that makes provisional sense, enough sense, that is, on which to act.

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What Charon (p9) calls ‘narrative knowledge’ – “requiring the doctor to use empathy and to enter the worlds of their patients, if only imaginatively, and to see and interpret these worlds from the patient’s point of view” is also a concept within anthropology.

 

Charon (p11) extends this by asserting, a ‘narrative shift’ has taken place across many fields of human learning, “challenging scholars and practitioners from religious studies to psychoanalysis to police work to concentrate on not just the facts but the situations in which these facts are told.” This is echoed by Tanner (1999, p169): “Works on illness narrative such as Frank’s The Wounded Storyteller do not only demonstrate the presence of ‘narrative imperative’, they also make it ‘imperative that we understand the structures and functions of narrative’.”

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Frank (2013) identifies three main illness narrative storylines or plot models: narratives of ‘restitution’, ‘chaos’, and ‘quest’.

 

Restitution narratives depict illness of a temporary nature and once health is restored, the person’s life will go back to ‘normal’, with unaltered identity. Restitution narratives have an Aristotelian plot structure of a Beginning, Middle and End.

 

Chaos narratives are almost the opposite of restitution narratives as they lack plot structure, the life of the severely ill person is radically disrupted and the future or end point is unpredictable. Tanner (1999, p161) calls the chaos story an ‘anti-narrative’ because “the putative speaker is overcome by feelings of loss, despair, and the ineffable; in its purest form it cannot be told.”

 

The quest narrative resembles a journey where the ill person is fundamentally changed, having learnt something valuable along the way, which can be passed onto others, and readily accepts a new identity. The quest narrative may incorporate both, chaos and restitution elements, but it is “distinguished by an intrepid confrontation with illness and the transformation of suffering into healing insight” (Tanner, p161). The quest narrative takes the form of a heroic journey, which Joseph Campbell (in Tanner, p161) describes as “contemplative and instructive, a ‘pedagogy of suffering’ that acknowledges loss and lack while reaffirming desire for life and commitment to others.”

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In this essay I have shown the use and importance of stories for the individual and what they mean for health sociology. Hydén (2007) asserts, “narratives can be used as a means of transforming individual experience into collective experience” and that by removing an illness experience from the private sphere it “becomes a part of an all-encompassing political and social narrative and context.”

 

By making it a part of the collective experience we also have an obligation to do it ethically. Frank (p158) warns about the ‘moral imperative’ about being self-reflexive when shaping our stories, “entailing the requirement to change that self-story if the wrong self is being shaped.” Thus awareness of the general type of narrative one is telling or responding to – restitution, chaos, or quest – is a useful beginning.

 

 

 

References

 

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