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.
Contents
|
List of Tables and Figures |
|
|
Abbreviations |
|
|
Introduction |
|
|
Section
I: Voices from the Margin: Health Providers and Healers |
|
One |
Moral
narratives and biomedical critiques in the accounts of bone doctors and their
clients |
27 |
Two |
“No one
medicine is enough”: Accounts of complementary therapy practitioners in Delhi |
46 |
Three |
Outcaste
women, cast-out birth knowledge |
75 |
Four |
Narratives
of Tulu-speaking healers in Karnataka |
94 |
Five |
“Numerical
narratives”: Accounts of lay health workers in Odisha |
121 |
|
Section
II: “Doing” Health: Stories of Health and Illness |
|
Six |
Where
there is no doctor: Narratives on biomedical healthcare practitioners in
Chennai, South India |
143 |
seven |
Health
and sex work: Structures as narrative nodes |
173 |
eight |
Living
with diabetes: Accounts of South Asian |
|
|
migrants
in the United Kingdom |
193 |
nine |
“We
were never sick in our time”: Social change, |
|
|
food and
identity in Uttarakhand |
218 |
ten |
Fertility
narrative: A Proppian approach |
239 |
|
Section
III: Narrative Approach to Mental Health: Two Contrasting Case Studies |
|
Eleven |
Silent
voices: Narratives in child mental health |
269 |
Twelve |
Are
narratives a legitimate tool of diagnosis? |
290 |
appendix |
Facing
a catastrophic illness: Lessons from a personal encounter |
304 |
|
Notes on Contributors |
|
|
Index |
|
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.
Contents
|
List of Tables and Figures |
|
|
Abbreviations |
|
|
Introduction |
|
|
Section
I: Voices from the Margin: Health Providers and Healers |
|
One |
Moral
narratives and biomedical critiques in the accounts of bone doctors and their
clients |
27 |
Two |
“No one
medicine is enough”: Accounts of complementary therapy practitioners in Delhi |
46 |
Three |
Outcaste
women, cast-out birth knowledge |
75 |
Four |
Narratives
of Tulu-speaking healers in Karnataka |
94 |
Five |
“Numerical
narratives”: Accounts of lay health workers in Odisha |
121 |
|
Section
II: “Doing” Health: Stories of Health and Illness |
|
Six |
Where
there is no doctor: Narratives on biomedical healthcare practitioners in
Chennai, South India |
143 |
seven |
Health
and sex work: Structures as narrative nodes |
173 |
eight |
Living
with diabetes: Accounts of South Asian |
|
|
migrants
in the United Kingdom |
193 |
nine |
“We
were never sick in our time”: Social change, |
|
|
food and
identity in Uttarakhand |
218 |
ten |
Fertility
narrative: A Proppian approach |
239 |
|
Section
III: Narrative Approach to Mental Health: Two Contrasting Case Studies |
|
Eleven |
Silent
voices: Narratives in child mental health |
269 |
Twelve |
Are
narratives a legitimate tool of diagnosis? |
290 |
appendix |
Facing
a catastrophic illness: Lessons from a personal encounter |
304 |
|
Notes on Contributors |
|
|
Index |
|