Content area
Full text
Narrative in the field of medicine: six uses, five debates, seven dangers
The role of narrative in medicine, and its importance both to clinical practice and to understanding the illness experience, has expanded considerably in recent years. Across clinical disciplines, as well as in the medical humanities, medical sociology and anthropology, narrative is called upon to fulfil an increasingly wide range of functions. First and foremost, narrative is understood to provide privileged access to the subjective experience of illness, and is frequently promoted as the primary vehicle through which the ill person can express her changing sense of self and identity, explore new social roles and gain membership of new communities. 1-3 Here, narrative is regarded as not merely expressive but as transformative and even therapeutic. 4-6 Turning from patient to practitioner, narrative has long been valued for the insights it offers into the experience of all those who care for the sick, 7-10 but more recently, and more radically, 'narrative competence' has come to be seen as an essential skill in clinical diagnosis and treatment. 11-13 In the sphere of health research, narrative offers new methodologies for qualitative and quantitative studies of the illness experience, 14-17 and at the societal level, narrative is seen by some to challenge the hegemony of naturalistic and biomedical approaches to illness and so provide the foundation for a new ethics and politics of healthcare. 3
The difficulty of giving precise definitions of narrative (see p 1 in Hutto 18 )-and the reluctance of many to do so-further complicates the ways we can see it in operation in the field of medicine. Some have argued that the concept of narrative adds little but academic pretention to the experience-near and 'probably universal' concept of 'story'. As Unni Wikan puts it: "people bleed stories, but academics gather narratives" (p 217 in Wikan 19 ). Others reserve the term 'story' to denote a sequence of events which are then discursively rendered in 'narratives', or argue that 'stories' belong to the realm of the individual while 'narratives' refer to the organising culturally-variable frameworks through which stories are told (see p 12 in Garro 20 ). The concept of 'narrativity'-the thick or thin, minimal or rich, quality of being narrative-raises further complications for plotting...