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October 10: Illness Narratives and the Body in Medicine and Medical Anthropology

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York University
ANTH 3330
Christianne Stephens

Illness Narratives and the Body in Medicine and Medical Anthropology • Narrative: a discourse featuring human adventures and suffering connecting motives, acts, and consequences in causal chains • Illness narratives: expressing feelings and recalling actions around a particular illness • There is a fundamental difference that occurs bw the term "illness" and "disease" • illness: referes to the experience of symptoms and suffering (lived experience) ◦ Illness involves the patient's appraisal of their symptoms ◦ I.e. is it serious? should I seek medical attention? • Illness includes: ◦ the categorization and explanation of the distress caused by the symptoms in a "common-sense way accessible to all lay persons in a social group" ◦ a patient's judgements as to how to deal with the impact that symptoms have on their daily lives • All illness experience is culturally and socially shaped ◦ it doesn't evolve or manifest in a vacuum ◦ there are certain ways to be normally in a society ◦ illness is always distinctive (unique individual biographies) ▪ how you should act during your illness episode • Illness Complaint: are what are brought to practitioner • Disease: is what the practitioners creates in the recasting of illness in terms of theories of disorder; disease is what practitioners are trained to see • To a practitioner DISEASE is the problem ◦ The interpretation of a health problem in a particular nomenclature "disease nosology" which create an "it" (disease) to diagnose ◦ Practitioner often don't consider other factors in a person's life; they direct their focus on the biological aspects of the condition • Sickness: "Is the understanding of a disorder in its generic sense across a population" ◦ epidemiologists • Illness has multiple meanings: Illness is polysemic or multivocal ◦ within a relationship it belongs to the sick person's spouse, child, friend, etc, and the patient themselves ◦ dialogues and illness narratives are always evolving: a work in progress • Illness narratives: interpreted by medical anthropologists as "a common way by which people organize, display, and work through experience" ◦ into a logical, coherent structure, display of information, words used to describe it ◦ failure of language to actually capture pain • A way that humans make sense of their experience of illness ◦ how does it become meaningful to you? Arthur Kleinman • very influential in the study of illness narratives • The Illness Narratives: Suffering, Healing, and the Human Condition (1988) • connection between health, culture, and society • talks about illness in a specific way • Doctors and patients often navigate different meanings of symptoms and semantics networks ◦ can result in misunderstanding and poor quality of medical care ◦ some cultures can mention the dead (if they have to talk about previous people in their family who have died of a certain disease/illness) ◦ in some cultures healthcare is sex-segregated ◦ cultural competency • I The Illness Narratives Kleinman explored the tension and gap between advances in medical technology and quality of care and illness as experienced by patients ◦ one of the first medical doctors who was able to effectively let doctors know that when people talk about their illness narratives they need to listen to; there's a lot of important information that's being communicated ◦ it's not the discourse of an uneducated person; it shapes your professional opinion of the situation • He recommended the use of an explanatory model, a method developed to improve doctor-patients exchange ◦ Employed to help doctors understand their patient's experience of illness through narratives ◦ improve communication • good step towards patient-practioner relationship, but there were some issues • Scheper-Hughes (1990-) argued that there's still a power-relation, and they still want to shape the experience into what the doctor views as the issue • Singer critiqued that the power relations between doctors and patients could never be resolved because of class, gender, and racial conflicts within society; doctors are highly educated and make lots of money and there are tensions that result from that as well ◦ power and political economy dynamics Arthur Frank • Canadian sociologist who developed the concept of the illness narrative in his influential book The Wounded Storyteller: Body, Illness, and Ethics (1995) • has referred to his own cancer and recovery as inspiration to his research ◦ other interviews with subjects that made up his study • Emphasizes that "ill people learn by hearing themselves tell their stories, absorbing others' reactions and experiences their stories being shared" ◦ not just a description, but also the social relations that make up this illness event ◦ creative process behind making illness narrative ◦ "work in progress" ◦ talking about that narrative aspect of the story and how people depend on other's reactions to how they tell the story ◦ constant reconstitution of that narrative • he incorporated the social context, interactive experience that the person enters into • describes a framework or plot line that the ill person uses first to understand and then explain their illness - typology of narratives ◦ Restitution narrative: talks about this being the most common, familiar, socially condoned or accepted, and is the narrative that a person shares where they describe their desire to be restored to good health; positive, optimistic narrative ▪ people talking about the restitution of their body, back to its former image before the illness ▪ mechanistic metaphors used by people using restitutions narratives: ▪ the illness can be managed, the body is broken down and is being restored ▪ I.e. organ transplants, broken bones ◦ Chaos narrative: is a narrative t
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