Narrative imperative

Some time ago I wrote about the assumption that I, as a patient, always want to tell you, my doctor, my story. I pleaded for my right not to talk. Yesterday, I was reminded of it. And in this post I want to write about the narrative imperative, the requirement to tell a story.I was reminded by the tweets from a conference on “narrative of health and illness” (you can find them at #narrathealth16). As I was reading them, I tweeted this:

I keep asking myself, what if I don’t want to have ‘a narrative’. Is it OK say: leave me alone? I’m tired of the ‘narrative imperative’

That’s my first reaction to what quickly was translated into the (academic) suspicion that narrative medicine has changed its paradigm. I think (tentatively) that ‘narrative medicine’ might have shifted its focus from describing ‘narratives’ to prescribing them. Narrative is what is required by medicine and there are two aspects of this.

The first is about stressing the word ‘narrative’. Consider that the conference title is: “International conference on narratives of health and illness”.  I had never given it much thought, but this time it struck me that the conference was on the ‘narrative’. What exactly does it mean? Does it mean that the conference only focuses on stories which have a beginning, middle and end? Or as, for example, Todorov would say, start with equilibrium (normality), go to disequilibrium (disruption) and reach a new equilibrium (yes, I know that narratives do not have to be defined by speaking in a structured way – see below)?  So, is it OK to focus on just ‘talking about illness’? Or is it not fancy enough?

There is no answer to this question (the question might not even have been posed at the conference). However, a recent article by Angela Woods on limits of narrative, suggesting that focusing on a specific kind talking or ‘speech genre’ might be unhelpful (thanks to Jonathon Tomlinson for pointing the article out to me), might also indicate the ‘narrative’ in the title refers to ‘structured talking’. And indeed, this is how I read the conference and the tweets. They all asked me, a simple patient, to have a ‘story’, a narrative, a structured way in which I will tell the doctor about my experience. And so giving me the space to talk changed to the requirement to ‘talk in a particular way’.

I reject this ‘narrative imperative’, the imperative to tell you a story, however unrounded. This is because you change my space to talk, the opportunity to share my experience with you into a form that suits you. And, quite frankly, I do not want to tell you or anyone else ‘a story’. So, please, leave me be.

But here comes the second issue. It’s the issue of understanding narrative as resulting from the contract to tell you something. Narrative here is not understood as having a particular structure, but is simply focusing on me fulfilling the tellership contract. The narrative imperative means that I must tell you something.

There is no need to repeat what I wrote in the post I quoted above. However, let me just add one other dimension (I draw upon my current condition again).  Every time I had to tell the same ‘story’ (and it probably was a structured story), I was getting more sick and tired of it. I mean – really sick and tired of it. So, let’s consider it: what happens when you need to repeat the same thing over and over, and over again?

I think such a situation suggests two things. One is that the channel of communication is closed or faulty. In other words, your interlocutor cannot hear you, much like on the phone with a bad line. Obviously, in an interaction in the doctor’s surgery this is hardly the case. And so, we are faced with option two: the doctor’s not listening, and if s/he is listening, then s/he ignores what you say. Basically, this is a breakdown of communication – your interlocutor does not cooperate (communication, as we know from Paul Grice, is underpinned by communicators’ cooperation).

And so, as I told ‘my story’, I don’t know how many times, I am really not in the mood to re-tell it. It might still be tellable, but my tellership has expired. The only thing that I want to tell you, doctor, cannot be repeated in a public academic blog. Let me put it differently, every time you ask me for ‘my story’ again, you also show me that you don’t listen, you ignore me. Every time I have to tell you ‘my story’ again, I am positioning myself as someone ignored and unlistened to.

And this is why I also reject the ‘narrative imperative’. I am tired both of the constructed need to talk in a particular way and I am tired of the assumption that I should talk in the first place. Yes, talking is probably in my best interest, but let’s not assume that if you ‘open the space’ for me, it’s this wondrous time in which I shall flourish as I tell you ‘my story’. No, in fact, I don’t want to tell you anything, sometimes, I don’t even want to talk to you at all. And, frankly, I’d rather you did the tests and be done with it.

And so, here is an irritated linguist-patient’s take on the ‘narrative of health and illness’. As I am pulled into this beautiful world of ‘narratives’, I just want to scream that sometimes ‘Mmm’ in response to your question is the grand narrative you should be grateful for. And as you focus on absorbing my language (as one of the tweets had it):

Advice to health researchers: absorb the incidental, accept language is imprecise and loaded with resonance/meaning.

I, in turn, wonder whether you will listen to me at all or whether you will ignore me in the name of the ‘evidence’ you choose to focus on, as if I were not speaking to you. So, please, at least spare me the ‘resonance/meaning’, as there is a limit to which I can tolerate being patronised.


  1. This. All of this.

    And it’s not just an imperative made by clinicians, the whole fecking NHS seems to be riddled with narrative-itis!

    I’m currently 6 months into a 30-day NHS Complaint process which has gone from bad to beyond bloody ridiculous. It currently feels as though the Complaint Team has inexplicably passed my correspondence over to the Amateur Dramatics Team for the purpose of re-enacting my original complaint, which was about precisely about the problem of feeling unheard/ignored.

    Six months of obtuse emails, two “final” response letters, and I am just now being asked to attend a meeting to clarify what it is that I would like to be investigated…

    I know I’m not actually the one that is going mad, because I have copies of the eleventy times I have already re-hashed the same problem in writing. But the way I keep being invited to clarify my story, I feel as though my head might explode sometime very soon. I clearly haven’t yet told a story that anyone wants to hear.

    I think that what most of us hope for when we first share our narrative of any given illness, is that we will be working towards the the kind of catharsis you get from a Three-Act Play. Of course, life and illness are not always so clear cut, but too often lately I’ve felt as though I’ve been drafted in to serve as unpaid scriptwriter for yet another episode of an endless soap opera.

  2. In my practice as a clinician and trainer of GPs and medical students, the narrative imperative is an imperative upon the clinician to listen more deeply to what is being said (by patients and others)

    1. Dariusz Galasinski

      Yes, but look at it from my, the patient’s, point of view. The more you want to listen, the more I must say something. What if there is nothing to say?

  3. Thanks for this Dariusz. One of the ways I try to address these legitimate concerns is by trying to use the verb (narrating) rather than the noun (narrative). I hope this allows for forms of narrating that need not have any structure, can be fragmentary or silent, or include dissent. I still regard narrative medicine as an advance on more paternalistic approaches including “biopsychosocial medicine” (ugh) “patient-centred care” (yuk) or unexamined ones with no principles or landmarks to guide ethical conduct. John Launer

    1. Dariusz Galasinski

      John, thank you for your comment. You raise an interesting issue of narrative medicine moving away from the more paternalistic approaches. I agree with you on the whole and focusing on what I do (narrating), rather than the product (narrative) is probably a way forward. I suppose I wanted to suggest that also narrative medicine is ‘unfinished’, so to say.

Comments are closed.

Loading ...