Abstract: The paper offers analysis of the book entitled “The Wounded Storyteller” by Arthur Frank. As the title suggest, the book uncovers some insightful information related to the sociology and psychology of illness tales. The book challenges healthcare personnel to realize that there different personalities depicted by patients. The findings from the analysis can be applied by healthcare staff in planning for management of the patient. It can also be enforced by caregivers in improving the caregiving exercise. The findings can help the healthcare stakeholders and caregivers come up with better intervention measures that can improve conditions of the patient and compliance.
Keywords: disciplined body, the mirroring body, the dominating body, communicating body, narrative identity, sick role, chaos model, Quest model, manifesto, automythology and restitution
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Introduction
The book The Wounded Storyteller intends to shed some insights on how patients behave when facing different disease. It is important to note that the relationship between physician and patient is imperative. Consequently, the physician should interpret patient's storytelling processes so that they can intervene in the best way possible. The book explores different narratives given by patients and how they relate to their suffering and feeling. It also examines four ideal-typical bodies and the three distinct narrative technique used by patients to explain their conditions. Understanding such narrative techniques and the types of bodies can help physicians and caregivers come up with better intervention measures that can improve conditions of the patient and compliance. For example, if physician establishes that the patient is dominating, he or she can devise a strategy that can be used to facilitate compliance of such patient to the regimes. As we shall learn, sick people tell stories to make sense of their lives and use this process to cope with suffering.
The Four Ideal-Typical Bodies
Disciplined body
The Frank (2013) reveals that the way the body act can generate four ideal-typical bodies. These include the disciplined body, the mirroring body, the dominating body and the communicative body. The disciplined body, according to Frank (2013), is characterized by self-regimentation. Individuals who fall under disciplined body are easy to manage. The physician can just give them instructions, and they will follow. The disciplined body act by control. The level of self-control under the disciplined body is high and that its worst experience is when there is a loss of control. It follows the set regimens. It does not yield to desires. The reason why the disciplined body comply with regimens is that it understands the negative consequences of non-compliance. Consequently, disciplined bodies, according to Frank (2013), can make "real patient."
Mirroring body
The second ideal typical body is a mirroring body. Mirroring body, according to Frank (2013) defines itself in acts of consumption. Individuals associated with this type of body are fond of feeding, clothing, grooming and curing their bodies. They attempt to recreate the body in the images of other bodies. They try to make their bodies more stylish and healthier. That is why they tend to eat a particular food, wear certain clothes, and take certain medications. Like the disciplined body, the mirroring body seeks predictability because it fears contingency. The only different between this body and other bodies is the type of emergencies they face. For example, the mirroring body fears disfigurement, whereas the disciplined body fears contingencies that might disrupt work routines.
Dominating body
Dominating body, according to Frank (2013), defines itself in force. This kind of body is associated with sick individuals. Such individuals assume the contingency of disease but never accepts it. They can do anything to justify that they are not going to die. The book gives an example of Dick, a patient diagnosed with Leukemia. The book reveals that Dick went crazy and claimed that he was afraid not of death but the wait. Interestingly, dominating body displaces rage against contingency onto other people. For example, the case reveals that Dick could not control illness following the discovery that he was suffering from Leukemia. Unable to manage the situation, he opted to control Carole. Such bodies see everything as meaningless and would want to dominate and dictate others and influence them because they feel they are alone. The aggression of this turning against others may reflect the bitterness of the dominating body's loss of desire.
Communicative body
The communicative body is another type of an ideal body. This kind of body is not only an ideal type but also an idealized type. The communicative body accepts its contingency as part of the fundamental contingency of life. When bodies sense themselves in alignment with others, words make sense in the context of that alignment. Consequently, when adjustment is lacking, even the best semantic content risks misinterpretation. Citing the assertion made by Broyard, the book reveals that ill person personifies illness and "own" it rather than allow it to be the unknown disease that medicine depicts. It should be noted that most people do not achieve communicative body easily. The study by Atkinson, & Young, (2008) reveals that these bodies are perhaps the least common, as very few people can develop the empathic body orientation and self-awareness required for engaging in communicating body performance.
Narrative Identity
Narrative identity, as postulated by Paul Ricoeur, is common in illness story. Narrative identity is often not clear at the start of the story. Paul Ricoeur believes that because the narrative identity is concealed, the quality and morality of the story is high. A story whose narrative identity is hidden is not associated with ego, self-centeredness or avaricious.
Paul Ricoeur asserts that narrative identity is the liberation from this narcissism of being a narrator who believes he already knows who he is. William Mays echo the similar concept. Narrative identity is associated with objectivity and truth. The people describing an illness become "good stories" because they are narrating without knowing the subject matter. They are telling what happens and how they feel. They cannot hide anything.
Talcott Parson’s Concept of Sick Role
Parson's observation reveals that a core social expectation of being sick is surrendering oneself to the care of a physician. The idea where the ill person surrenders to the doctor is considered as the pivotal moment in modernist illness experience. Consequently, such person not only agrees to follow physical regimens that are prescribed but also accept to tell her story in medical terms. Person coins "sick role" as a term used to describes behavior that the sick person expects from others and what they expect from him. Such expectations are validated by social norms and are internalized, meaning that individuals regard their expectations around sickness as normal and natural. There are some assumptions related to "sick role." First, illness is not to be seen as the ill person's fault or an indicator of moral failure. Second, the sick person is exempt from normal responsibilities. Ill persons expect this exemption. Third, the sick person should be under social control to avoid him or her getting abused.
Sick people play a useful social role. They reveal their problems openly and try to fit well in the society. They are genuine about their state. Society should emulate such ethical life because ill individuals accept their situation, face it directly and are flexible to comply with any recommendations. That is why Talcott reveals that compliance with "doctor's orders" is fundamental to the social control aspect of the sick role.
Contingency and Predictability during Illness
Contingency is life's uncertainties and emergencies that can cause sickness or illnesses. Some of the contingencies occur unexpectedly. That is why most of the sick people cannot put up appropriate measures to curb such contingencies. They have limited predictability as far as contingency is concerned. Consequently, contingency juxtaposes predictability. That is why Frank (2013) reveals that contingency is not exactly accepted; rather, it is taken as inevitable.
Concept of Body Restitution
Restitution is one of the formats or styles used by people to narrate about their illnesses. Restitution treats health as a normal condition that people ought to have restored. A sick person who believes in restitution expect to be treated and get well just as may people have passed through the same processes. The plot of the restitution, according to Frank (2013), has the basic storyline: “Yesterday I was healthy today I'm sick, but tomorrow I'll be healthy again.” This perspective gives people hopes to face disease hoping that they will be healthy again after undergoing treatment. Some researchers have supported the idea of having hope during sickness. Mattingly (2010) describes hope as a crucial requirement that can help patients recover easily.
Restitution is associated with both strengths and weakness. One of the strengths of destitution is that it gives the patient hopes and energy to focus on imagined healthy future life. As a result, the patient may not get stressed easily. When there is no stress, the chances of such patient facing psychological problems which can affect the overall quality of the situation. The only limitation is that destitution is a plausible argument of a necessary self-delusion. The reason why destitution is a plausible argument of a necessary self-deception is that it makes a person imagine that recovering from an illness is guaranteed, yet in reality, some conditions or illnesses are fatal. Marini (2016) challenges the validity and reliability of restitution. Marini (2016) argues that restitution stories reveal themselves to be told by self but not about that self. In such stories, ill people meticulously describe the visits they have undergone, the lab tests, the drugs were taken, and “getting better phase.”
Chaos Narrative Approach
Chaos narrative is another way in which storytellers and listeners use to structure and interpret stories. Chaos approach is normally applied in situations characterized by unpleasant expectations. For example, a patient who initially thought that he or she is suffering from a minor illness may have to change the narrative upon the realization that his or her disease is fatal. Frank (2013) gave an example of a patient who, initially, was optimistic that his condition would improve. His restitution narrative is characterized by hopes. However, the patient had to change his narrative when he discovered that his rapidly progressing testicular cancer was misdiagnosed, first as a sports injury, and then as an unknown disease, probably, but not certainly, cancer. The patient had to switch from restitution narrative to chaos narrative to reveal that something was not going on well. He states that the chaos was in the disconnection between the increasing pain that was sending his life off the rails and his physicians' frustrated insistence that nothing serious was wrong. The patient was faced with a challenge of confronting others’ inability to see what he so clearly felt.
Chaos occurs when the physician, who is entrusted with the responsibility for proper diagnosis and proper treatment, fails. This failure means that the patient will continue to suffer. The chaos approach of storytelling is common to people with a chronic illness characterized by diagnostic uncertainty. The chaos can be addressed when physician validates how much is wrong, even if the diagnostic news is devastating. Some patients may experience multiple misfortunes. For example, the disease may lead to job loss, which creates a housing crisis, and then some other family members get sick.
During chaos crisis, the level of desperation is high and most patients are left with nothing to say. Most of them opt to remain silent because chaos imposes silence. Those living in chaos are least able to tell a story because they lack any sense of viable future. That is why Frank (2013) asserts that chaos is anti-narrative. People copes with chaos theory by accepting the situation and expecting anything that may happen. Most of them will leave things to fate. Others may opt to remain silent. Some may decide to craft a new life and forget about their illnesses. As a result, they will adopt another form of narrative called quest narrative. They develop a more intimate level of connection with others and forge a new way of life where the issue of illness or pain can be suppressed.
Facets of Quest
Quest narrative is common among individuals who have been diagnosed with the serious fatal disease. Frank (2013) reveals that every seriously ill person needs to develop a style for his illness. Such individuals may discover new ways of going through the situation amicably. They find ways to avoid feeling that their lives are diminished by illness. The range of quest narrative, according to Frank (2013), is broad enough to make a further specification. The facets stories can be classified into three facets, which include memoir, manifesto, and automythology.
A memoir is a form of quest that combines telling the illness story with telling other events in the narrator's life. It is also called an interrupted autobiography. Sick narrators may opt to memoir as a way of letting people know that despite the fact that the sickness may overwhelm them, they have so far achieved some of their objectives. Memoir, in most cases, is used to squelch other rumors and to paint the image of the sick in a positive angle. Memoirs are also useful for postmodern purposes. Events included in memoirs are not chronological. This is because the narrator is sick and his or her memory determines the quality of narration. The illness constantly interrupts the telling of the past. Memoir captures key instances in narrator’s past that are important to the narrator.
Manifesto is another facet of quest stories. As far as manifestos are concerned, the sick opts to narrate the story about their experiences, not for their sake, but as a way of helping others who may go through such experience. Such stories often carry demands for social action. In most cases, society often suppresses truths about a certain form of suffering. However, narrators who opt to narrate about manifesto often tries to uncover the truth. They want to use the suffering to move others forward with them. The narrator gave an example of Audre Lorde who demands that she begin wearing a breast prosthesis after her mastectomy.
The third facet of the quest is automythology. It entails self-reinvention following massive trauma or catastrophic illness. According to Frank (2013), those patients who survive and revive after traumatic illnesses such as cancer are more likely to reconstruct, tap new power and appropriate patterns that help define a new existence. Automythology depicts narrator as a reborn survivor. Like the manifesto, the automythology reaches out, but its language is more personal than political. In emphasizing individual change and not social reform, Frank (2013) depicts himself as an exemplar of change.
Narrative Ethics as proposed by Rita Charon
Rita Charon acknowledges the fact that the pedagogy of suffering is taught in the testimony of illness stories. Charon’s aim is to explore how such stories should affect lives. Should the listeners believe such stories and act accordingly? Charon suggests how the study of illness stories can contribute to improving “trustworthiness of medical ethics.” Charon also intends to demonstrate whether physicians should rely on illness narratives and possibly, identify “multiple tellers of the patient’s story as well as the interpretive community responsible for understanding it.
According to Charon, the value of “narrative contributions” lies in physicians’ ability to enhance medical caregivers’ recognition of the complexity of treatment decisions. Charon asserts that narrative should lead physicians to recognize the moral dimension in every medical encounter and helps to ground difficult medical decisions in the concreteness and specificity of each patient’s life. Consequently, narrative ethics entails approaches of determining how “narrative contributions” should influence decision-making.
Modes of Narration during Illness
The three models of narration include restitution, chaos, and quest models. The prevailing situations determine whether a patient will use destitution, chaos or Quest models. Those individuals whose conditions are uncertain may prefer chaos model. Those individuals whose conditions are fatal may prefer the quest model.
Restitution is helpful to those who are just ill and are optimistic and certain that their illness is normal and natural. As stated earlier, the plot of the restitution, according to Frank (2013), has the basic storyline: "Yesterday I was healthy today I'm sick, but tomorrow I'll be healthy again." This perspective gives people hopes to face disease hoping that they will be healthy again after undergoing treatment. Restitution is a source of hopes to the patient. By believing that he will get well, the patient can wade off unnecessary complications that could have arisen due to psychological stress.
Hope is very important to the patient. Hope is a source of faith and can facilitate what is called faith healing. Fazzalaro (2016) reveals that faith healing can be practiced by all different types of people and is not limited to the believers of a particular religion. It is believed that a channel of energy released in an individual with strong faith in his or her professed beliefs is very powerful and can heal. Faith healing is done through prayer, spiritual insights, and mental practices.
Compelling illness experience story from the book
Of the many stories offered, I can relate most to the story by Audre Lorde about breast-cancer survivor. There is a point where Lorde retorts "My silence had not protected me, your silence will not protect you." This statement carries a lot of weight and message not only to the patients but also to the physicians and policy makers. Health care is an evolving field. New ideas generated should be used to improve the quality of health care. Lorde reports about the significance of manifesto. From Lorde story, we learn about a patient who, after undergoing mastectomy demands that she begin wearing a breast prosthesis.
The narrative is so compelling to be because it shows that patient's narrative can be a source of the idea that can change the quality of health care services. The narrative reveals that patient's stories, especially manifestos should be taken seriously and if possible, their stories should be channeled to appropriate consumers such as policy makers and healthcare administrators. Such stories can be used as the basis for future research ( Hurwitz, et al., 2004). Such illness narratives, according to Schell & Schell (2008), should be used to show causal relationships between health, disease, illness, impairment and individual meaning of living a life affected by illness.
Reflection
A critical look at the book reveals that most people ignore their healthy status. They only realize that being healthy is good when they become sick. That is why most people opens up and even reveals their hidden secrets when they are sick. Hot, sexy do need medical services. Hot and sexy falls into mirroring body. They are cautious about disfigurement and would do anything to restore a particular “model state.” They are even willing to buy expensive medication in trying to lead a particular way of life and health. Circumstances force people who are sick to determine how sick, what they can live with and without. Those suffering from deadly disease, for example, are forced to behave in a particular manner. Those diagnosed with cancer are obliged to accept the situation and “forget” it. A patient who initially thought that he or she is suffering from a minor illness may have to change the narrative upon the realization that his or her disease is fatal. They develop a more intimate level of connection with others and forge a new way of life where the issue of illness or pain can be suppressed.
References
Atkinson, M., & Young, K.: 2008, Deviance and social control in Sport , Champaign, IL: Human Kinetics.
Fazzalaro, C.: 2016, Healing Through Christian Faith, Digital Revolution Media
Frank, A. W.: 2013, The wounded storyteller: Body, illness, and ethics, Chicago: The University of Chicago Press.
Hurwitz, B., Greenhalgh, T., Skultans, V., & Wiley InterScience (Online service).: 2004, Narrative research in health and illness . Malden, Mass: BMJ Books.
Marini, M. G.: 2016, Narrative Medicine: Bridging the gap between evidence-based care and medical humanities , Cham: Springer
Mattingly, C.: 2010, The Paradox of Hope: Journeys through a Clinical Borderland , Berkeley: University of California Press.
Oyebode, F., & Royal College of Psychiatrists.: 2009, Mindreading: Literature and Psychiatry , London: RCPsych Publications.
Schell, B. A. B., & Schell, J. W.: 2008, Clinical and professional reasoning in occupational therapy , Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
