In his plenary at a recent conference on narratives of health and illness, Jonathon Tomlinson said that narrative is evidence. He said it a number of times. As much as I agree with him (if I may), in this blog I want to consider what it might mean for a person who deals with people’s stories.Some time ago I actually wrote about the use of ‘evidence’ by a doctor. I wrote about the expression:
So, the evidence is….
which inevitably referred to ‘objective’ evidence such as blood tests, at the same time completely blanking the ‘narrative evidence’, in other words, what I said. Of course, I do realise that I am not a doctor and I am not in a position to offer ‘advice’ on what you, the all-powerful, omniscient medic should consider, but I would have wanted at least some acknowledgement of what I said.
And that’s the first point I want make. If you seriously think about ‘narrative evidence’, consider the stories you have not heard, you have ignored. As I still don’t feel healthy, I can tell you what they are for me:
I have not exercised for about 4.5 months – this is the longest period without exercising for me for about 25 years.
I have put on weight (due to lack of exercise), which you criticise me for, as I apparently don’t take care of myself. It seriously angers me.
My mood has been going haywire, the consequences of stopping cold a very significant regimen of exercise went well beyond my expectations
I have not felt so unfit for about 25 years and it is seriously depressing.
I could continue, but you get the picture. I despair when I think about how many aspects of my ‘illness narrative’ you have completely ignored. So, yes, the biopsychosocial model I keep hearing about, with the more progressive of you, doctors, stressing the social and psychological, is reduced to the ‘bio’, while the psychological factors are limited to the unsavoury accusations of me being on the verge of delusions.
(To be honest, I am also sick and tired of hearing how dangerous and unnecessary antibiotics are, especially getting them 6-8 weeks later than needed without a word of apology. Please stop using me to further your ideological agenda. I am too old, too ill and too intelligent not to notice it. But that’s for another blog perhaps).
From the point of view of a linguist narrative evidence is not the ‘evidence of the stories you happen to like because they fit in with your ‘objective’ evidence’. How to do it is, of course, a matter for medicine and not linguistics, but if ‘Narrative is evidence.’ is to make sense, it must, in my view, cover the whole of my narrative account. Including the fact that I dream of putting my running shoes on and going for a run. It might be trivial for you, it’s far from trivial for me. Basically, al that you are completely uninterested in, doctor.
Now, as much as I think the above points are important to make, they have not yet left the realm of what is fairly obvious and written about in the social sciences of medicine. So here is something which is perhaps less obvious. If narrative is evidence, what about the narrative form? In other words, if medicine is to take the narrative as evidence, it cannot simply take the contents of the narrative on board and pretend it does not have a form.
Let me give you an example. When I interviewed men in depression, it struck me that despite the fact that most of them voluntarily attended an outpatient clinic at a hospital, they never actually said they had depression. Whenever they talked about their depression, they distanced themselves from it. For example, they would talk about ‘someone/one/a man having depression’, never directly. They positioned themselves away from the illness, they rejected the illness-like status of their depression. In the book, I raised the problem of insight into depression.
And so, here is a problem. It’s fairly obvious for a linguist to take the narrative form on board, but should you, doctor? Well, if narrative is evidence, then the answer is yes, no doubt about it. The problem, of course, is how – and I don’t have an answer to such a question. I am not a medic. But this doesn’t meant that the question is unimportant, actually.
This blog is about implications of saying ‘Narrative is evidence’. So far, I have talked about the ‘unheard narratives’ and the form of the narrative. There is, however, one more thing. If you actually do want to focus on the narrative, you need to start making doctors sensitive to the narrative. Not only to the fact that a patient must be able to tell her/his story. However strange it might seem, this is the easy bit. The difficult bit is to actually make sense of it. And this means not only just listen to what is said, but also to how it is said. And this opens a whole new world of medical training.
Do you still want my story, doctor?