03 - Storytelling, narratives, metaphors

Event

• Single occurrence in which something happens

• There is no story until a second event is introduced

Story

• Two or more meaningful events happen in sequence

• “I got sick then I got better” = Event A à Event B

Narrative

• One particular rendering of a story

• Can be organized by many thematic and/or formal/ stylistic categories

• Not always written - Can be visual

thematic categories

• Non-fiction (autobiography, biography)

• Fictionalized account (anecdote, myth, legend)

• Fiction proper (short stories, novels, some poetry, drama)

whats the difference between story vs narrative

• Often used interchangeably, but need to differentiate

• Story

  • Irreducible substance of a story

  • The factual sequence of events

• Narrative

  • The way the story is related

  • How the story is framed or communicated

  • The form the story takes

Plot

• Plot and story are closely related

• Story:

  • Focuses on sequence of events

  • X → Y

  • The king died and then the queen died.

• Plot:

  • Gives a sense of causality

  • X → Y because Z

  • The king died and then the queen died of grief.

• The same story can allow for multiple plots

Character

• Representation of human identity

  • Fiction and non-fiction

• Characters guide readers through stories, helping us understand plots and broader theme

Character type:

• stands as a representative of a particular class or group of people (e.g., the depressed person, the cancer patient, the grief stricken lover)

epistemology

• how we know things

Point of view

both

• The way in which the story is narrated (e.g., first or third person)

• The worldview of the person or voice that tells the story

In other words...

• POV is either or both the perspective of the character or the ‘problem’ portrayed in the text

POV can look ___ or ___

outward

inward

what does it mean by POV can look outward

How does the character see things? First person, third person?

what does it mean by POV can look inward

How is the problem being framed? Humanities perspective? Biomedical perspective?

what does POV affect

POV affects how a story is told

As readers, we must be critical (aware of, sensitive to) POV

Allows us insights into the text

blind spots in POV

But also blindspots à what is not being seen/ said?

how can we be critical with POV

• To be critical is the capacity to detect how POV “reauthors” the story

  of some phenomenon (e.g., depression, cancer)

• And determine the strengths and weaknesses of the POV in terms of

  understanding the phenomenon

Enchantment

• Enchantment means bringing wonder, beauty, or meaning into something that might otherwise feel bleak or purely clinical

to imbue with meaning

why we distinguish between medical language (scientific, factual) and humanistic language (personal, emotional, story-based)

Because the humanistic terms do something to the illness experience

They enchant!

who coined the term Disenchantment

Term coined by sociologist Max Weber (1864-1920)

orgin of Disenchantment

Characteristic of modernity post-industrial revolution

Consequence of increased rationalization, bureaucratization secularization of Western society

Faith in systems and principles

Opposite of understanding reality through mystery and magic

Rationalization:

Explaining everything through science and reason

Bureaucratization:

Organizing life through rules and institutions

Secularization:

Moving away from religion and spiritual explanation

Disenchantment

As we subject the world to rationalization, we lose the sense of the mystical.

was webber saying we should go back to believing in superstition

NOT to say that we ought to understand the world through mystery and magic

Examples of Enchanted Worldviews

Flat earth, Curses

Disenchantment - pros

• Smart and defiant women aren’t witches! Yay!

• Birthmarks aren’t a sign of the devil! Sweet!

• Cancer isn’t a punishment for skipping class during undergrad! Phew

Disenchantment - cons

• A world without charm, without myth, without mystery...

• Antiseptic, boring, fearful and fearsome?

• Lose the ability to integrate the symbolic into everyday life

• We become illiterate to creativity, wonder

• Numb to possibility, potential, difference

Disenchantment in health

The loss of meaning, empathy, and humanity in medical practice due to overreliance on the biomedical paradigm (purely scientific, mechanical approach).

Health humanities as an “antidote” to disenchantment of health opposite of  biomedical paradigm

is Disenchantment common in health professions

• Burnout, compassion fatigue

• Empathetic aspect of relations reduced to mechanisms of institutionalization

• Stories (narratives) help to rehabilitate enchanted life and care

Disenchanted illness

is the body grown unworthy of the spirit, sinking into its own senses, especially the imperialism of pain, and disenchanted treatment reduces life to mechanics. (Frank)

Frank’s illness narratives

The “ill person’s story” is an ancient narrative genre

Often takes form of written autobiography or memoir

Three major types or patterns (as described by Frank)

• Restitution (cure)

• Chaos

• Quest

Restitution (cure) narrative

• Illness as a temporary detour; body is restorable

• Primary goal is permanent return to normal life and health; self is separate from illness experience

• Only outcome: getting well

Language of survival:

“Yesterday I was healthy, today I am sick, but

tomorrow I will be healthy again”

Chaos narrative

• Illness as a permanent state of disaster

• Will get worse with no redeeming virtues

• Anxiety-provoking

• Ill person is not in control of illness

• Strong personal and cultural dislike of such stories

Quest narrative

Illness is an opportunity to transform oneself or one’s relationship to disease

Characterised by three typical events

departure 

initation 

return 

departure - quest narative

the “call of the symptom”

initiation - quest narrative

determining extent of illness, often through a “road of trials”

return - quest narative

the ill person no longer in crisis but remains marked by illness

what does frank say abpout quest narative 

Quest stories tell of searching for alternative ways of being ill. As the ill person gradually realizes a sense of purpose, the idea that illness has been a journey emerges. (Frank)

how is Quest narrative diff from the other two

• Fundamentally different from restitution and chaos narratives

• Can be therapeutic

• “I’m not alone”

• Ways to work with illness in ways that enrich their lives

• New understanding of illness emerges

• Illness as something other than something to cure or dread

• Jar the reader into a creative relationship with illness

Language (basis of expression and communication) comes in two main forms:

literal and figurative language

literal language

• Refers to the use of words in their primary and non-figurative sense

• An exact rendering

• What is actually written, as opposed to what is implied

figurative language

• Language with uses figures of speech (e.g., metaphor, simile, alliteration)

• Distinguished from literal language

Contemporary literary theory

argues that all language is fundamentally figurative

Much “literal” language consists of figures whose nature has been forgotten (or overlooked)

• Can you see the logic here?

• Can you grasp this concept?

Defining poetics

How a text’s many elements synthesize to produce certain effects on the reader

• “The attempt to account for literary effects by describing the conventions and reading operations that make them possible” (Culler 1997)

Alliteration

• The repetition of a consonant

• "Ride the rocket"

Apostrophe

• Addressing something that is not a regular listener

• “Be still, my heart!”; “O, Canada!”

Assonance

• The repetition of a vowel sound

• “hot shot”; “barren peaks and winding creeks”

Significant figures of speech

Simile and metaphor

Both help us understand “one kind of thing in terms of another”

SIMILE

• Implied or qualified association between two things or ideas

• “Life is like a journey”

METAPHOR

• Strong association drawn between two dissimilar things

• “Life is a journey”

• Not limited to poetry

• Everyday language is full of metaphor

• Helps us understand the world around us

Metaphors are composed of two parts:

Tenor and Vehicle

Tenor in metaphor

The subject to which attributes are ascribed or given

Vehicle in metaphor

The object whose attributes are borrowed to make the comparison

what is the tenor and vehicle in “Life is a journey”

• Attributes of journey are borrowed to describe life

• Tenor = life

• Vehicle = journey

what is the tenor and vehicle in “All the world’s a stage”

• Tenor = world

• Vehicle = stage

Metaphors and illness

Both disease and experience of illness are often described using metaphor

what metaphors are common in health feild

Military metaphors (i.e., pertaining to war, battle, invasion, combat) are especially prevalent in health care

examples of Military metaphors

• Influenza attacks the body’s immune system

• White blood cells fight off disease

Why military metaphors?

• Socio-culturally ubiquitous (“wars” on… drugs… terrorism… poverty)

• Have recognizable tenor (illness/ disease/ sickness) and vehicle (war)

• There is an enemy (the illness or disease)

• There is a combatant/ fighter (the patient)

• There are allies (the health care team)

• There is weaponry (technologies of treatment)

• Connotes seriousness of purpose

• Provides strong counter-message to feelings of powerlessness/ passivity associated with serious illness

Why military metaphors? For health care providers...

Metaphors provide effective, efficient language to help patients understand complex biomedical processes

This chemotherapy is a weapon against the cancer in your body

Why military metaphors? For patients...

Metaphors impose order on a suddenly disordered world, helping the understand and (symbolically) control their illness

I’ve decided to fight this disease, and win

Why military metaphors? In terms of therapy..

Metaphor can serve as the basis of shared understandings of the clinical realities of treatment

You have a long battle ahead, but I know we can win this together

what provides building blocks for larger narratives of healh and illness

Figurative language provides building blocks for larger narratives of health and illness • E.g., language of “battling” illness often associated with restitution (cure) narratives

The language we use—similes, metaphors, other figures of speech— provides a ____

powerful frame for understanding relationships to disease and illness • E.g., patient-professional relationship as form of combat or military engagement

Figures of speech can be a way of _____ disease, but with consequences…

enchanting

consequences of enchanting disease

• May distort or not fit with individual experience (e.g., illness as fight or battle)

• May become overused, thus reducing experience of illness to cliché (i.e., disenchantment)