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Illness Narratives

Illness Narratives. EH Lecture 3 31-10-2002. Relevance of Illness Narratives. IN are social action and bring about change Psychoanalysis uses IN common pattern of IN: not individual experience, but what the individual tells us is important, experience is presented in IN

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Illness Narratives

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  1. Illness Narratives EH Lecture 331-10-2002

  2. Relevance of Illness Narratives • IN are social action and bring about change • Psychoanalysis uses IN • common pattern of IN: not individual experience, but what the individual tells us is important, experience is presented in IN • listener is important, subjunctive mode (dependend, joint) • “the real thing” happens the “story” is the tale. • N are not only verbal accounts • Mattingly 1998: EMPLOTMENT: IN give a meaning, have therapeutic effect • Bruner 1991: 10 points of IN, all 10 features of IN have a plot

  3. How did Illness Narratives enter Medical Anthropology? • IN was introduced by A. Kleinmann, Harvard Medical School, 1980 who used IN in his psychiatry practice ( limited focus, IN served his needs) • Young and Frankenberg: sociologist view: criticised interview culture, focused on non-spoken aspects that seem to be more important. IN good for Western context. Can it be used in the East?( eg. Husbands answer for wives in Muslim cultures)Despite critiques IN have a lot of potential and have been used in MA in many ways. • Bryan Good: IN on epilepsy in Turkey, offers a good structure • Skultan 1997: IN of Latvian women with neurasthenia in search for identity after deportation • Goodman 2001: Self and Collectivity

  4. Suggested Literature (see reading list) • Goffmann 1963: focuses in STIGMA • Wikan 2000 and Atkinson 1997: critique on IN, focus on the unspoken • Austin 1962: How to do things with words:We cannot take statements literary for the force they take illucutionary force of words “ it rains “ (give me the umbrella) ILLOCUTION and PERLUCOTION (EH comment: Austin changes his view even within the same book) • Hunter K and Montgomery 1991:Doctor’s Stories • Sinclair 1997: Making Doctors: gives comments on medical culture • Adams 1998 and Guiseppe 2002: reading will create more sensibility about biomedicine being culture mediated, macrocosmic relations • Hunt 2000: IN allow reflection ( Roberto remains a “good son” through cancer) • Murphy 1987: IN address anger and marital problems • IN turns suffering into a form of empowerment ( getting cancer to avoid encounter with husband) • Steffen 1997: AA self help groups are empowering. AA needs a narrator ( I am AA) and an announcer ( you are AA) ( close to witchcraft, which also needs an announcer ( you are bewitched)

  5. Biomedical case history • Depersonalisation • Omission of the agent (passive voice) • Medical technology as the agent (the CT scan shows....”) • Marker for subjective view of the patient: “Mr. Mentions that....” • Experience is channeled along clear lines • physical examinations, prescribed series of diagnostics

  6. Opposite poles in medicine • Doctor’s experience in clinic _________ knowledge • oral culture______________ written culture of knowing • case history__________general biomedical knowledge • history presenting physical examination_________ rigid sequence of aetiology • collective experience ________ myth • case story __________ myth, timeless, general

  7. Scholarly medical traditions • Are the traditions derived from Galen, Chinese medicine, Tibetan and Ayurvedic traditions • E: Hsu studied 25 case histories of the 4th century BC in Han Dynasty ( 200BC-200 AD), Chinese case stories from patients belonging to the Nobility: • Symptoms were not introduced by marked labels • cause of illness was not related to illness • signs of illness were related to the names of illness • The doctor criticised the nobility by mentioning as causes of disease alcoholism and sexual intercourse. List of illness is very detailed, causes remain the same. • Conclusion: EM models do not apply to all systems!

  8. Illness labels • Chinese history: labels are related to colour, pulse, chi, atmosphere • later: label relates to treatment • 19th century: Chinese view is fitted to Western biomedical EM • BUT: Reasoning about the case still follows Chinese medical thought, only the documentation form is Westernised • see FARQUAR 1994, and Christopher Cullen • Chinese EM: • quality • Label

  9. The woman beneath the skin • Barbara Duden 1991 • was criticised of being too GALENIC in her presentation ( Hsu does not agree)

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