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PubMed2001

Accommodation, resistance and transcendence: three narratives of autism.

This paper presents a narrative analysis of autism. It follows much of the literature on illness and narrative by emphasising the moral quality of illness narratives and the role it plays in creating coherence out of the disordering effects of autism on family life. In particular, the significance of narratives as "moralizing antidotes" to the experience of marginality and their linkages to the cultural "master narratives" of science, politics and faith are stressed. The three narratives presented display both conformity and non-conformity with the official narrative of autism offered by the autistic treatment centre where the research was based. Accordingly, they are described as narratives of accommodation, resistance and transcendence.

Adaptation, Psychological↗
PubMed1999

Illness narratives: discursive constructions of self in pediatric oncology.

Narratives from adolescents in treatment for cancer were examined for the variety of ways in which self is constructed in discourse. Narratives were elicited by the second author (Bearison) from 75 children ranging in age from 3 to 19 years and at various stages of treatment for cancer. The present study examined a subset of these data. According to discourse theory, narratives are a means of constructing and understanding the self, particularly during unsettling life events that perturb the self-system. Adolescents who have cancer strive to make sense of the threatening and uncertain consequences of treatment, and their narratives reflect this struggle and their attempt to resolve it. The present study identified three narrative domains of self (biomedical, social, and personal) and considered variations among them according to the following features: (1) degree of otherness (i.e., to what extent and in what manner are other people, family, peers, and medical staff brought into the discourse), (2) expression of self as agent versus object, and (3) a series of linguistic markers denoting the narrative voice: understatement, exaggeration, reassurance, passive voice, and the use of personal and impersonal pronouns. In addition, expressions of denial and control were identified as central issues of self in narrative. Findings indicated that there were patterns of co-occurrence of discourse features that constituted different narrative styles by which participants gave voice to their struggle to redefine the self.

Adaptation, Psychological↗
PubMed1998

Theoretical perspectives on narrative inquiry.

Narrative inquiry is gaining momentum in the field of nursing. As a research approach it does not have any single heritage of methodology and its practitioners draw upon diverse sources of influence. Central to all narrative inquiry however, is attention to the potential of stories to give meaning to people's lives, and the treatment of data as stories. This is the first of two papers on the topic and addresses the theoretical influences upon a particular narrative inquiry into nursing scholars and scholarship. The second paper, Conducting a narrative analysis, describes the actual narrative analysis as it was conducted in this same study. Together, the papers provide sufficient detail for others wishing to pursue a similar approach to do so, or to develop the ideas and procedures according to their own way of thinking. Within this first theoretical paper, perspectives from Jerome Bruner (1987) and Wade Roof (1993) are outlined. These relate especially to the notion of stories as 'imaginative constructions' and as 'cultural narratives' and as such, highlight the profound importance of stories as being individually and culturally meaningful. As well, perspectives on narrative inquiry from nursing literature are highlighted. Narrative inquiry in this instance lies within the broader context of phenomenology.

Attitude to Health↗
PubMed2001

Dynamics of inclusion and exclusion: comparing mental illness narratives of Haredi male patients and their rabbis.

By comparing versions of mental illness narratives - told by Haredi (Utraorthodox Jews) male patients of a mental health clinic in Israel and by their rabbis - this paper relates to two distinct, yet interrelated, theoretical questions: the place and agency of narrators, and the tension between experience and representation. A pair of narratives exemplifies a pattern in which the patients (Talmudic students) tell a narrative of a sudden breakdown related to a dramatic meeting with a non-human figure (often, a woman) or force. Their rabbis, by contrast, tell a narrative that emphasizes their students' mundane symptoms, "abnormal" and "immoral" behavior, and use a local adaptation of a Western psychological explanatory model. A dynamic of inclusion and exclusion emerges as students are seeking legitimization and avoidance of stigma, while their rabbis are silencing themes that challenge social and cultural orders. The different narratives are further interpreted in the context of the micropolitics of the interviews and of identity politics between the Haredim and secular Israelis. This social dynamics shows how differently placed social actors-narrators-interpreters construct differently contested and diverse cultural narratives of a seemingly shared reality.

Clergy↗
PubMed2000

Listeners as co-narrators.

A collaborative theory of narrative story-telling was tested in two experiments that examined what listeners do and their effect on the narrator. In 63 unacquainted dyads (81 women and 45 men), a narrator told his or her own close-call story. The listeners made 2 different kinds of listener responses: Generic responses included nodding and vocalizations such as "mhm." Specific responses, such as wincing or exclaiming, were tightly connected to (and served to illustrate) what the narrator was saying at the moment. In experimental conditions that distracted listeners from the narrative content, listeners made fewer responses, especially specific ones, and the narrators also told their stories significantly less well, particularly at what should have been the dramatic ending. Thus, listeners were co-narrators both through their own specific responses, which helped illustrate the story, and in their apparent effect on the narrator's performance. The results demonstrate the importance of moment-by-moment collaboration in face-to-face dialogue.

Adult↗
PubMed2002

A randomized survey of the preference of gastroenterologists for a Cochrane review versus a traditional narrative review.

BACKGROUND: Clinicians often rely on review material rather than analysis of primary research to guide therapy. Systematic reviews use methods to insure thoroughness and to minimize bias, but many clinicians are not familiar with systematic reviews and continue to rely on narrative reviews. OBJECTIVES: To determine whether a traditional narrative review or a systematic review is perceived to be more useful. METHODS: A clinical scenario (patient with chronic Crohn's disease considered for azathioprine therapy) was circulated to gastroenterologists, along with a narrative review of therapy (including azathioprine) for inflammatory bowel disease written by an acknowledged expert, or with a systematic Cochrane review of the use of azathioprine for this disease. Whether knowledge of authorship and journal source influences the perception of usefulness of a narrative review was investigated. RESULTS: The Cochrane review was rated significantly more highly than the narrative review on a 100 mm visual analogue scale (21.3 mm; 95% CI 14.5 to 28 mm). The proportion of respondents who considered the review to be a useful guide was also higher in the group that received the Cochrane review (91%) than in the group that received the narrative review, with author and journal concealed (62%) or identified (70%) (P<0.001 for both comparisons). Ratings from the two groups that received the narrative review were not significantly different. CONCLUSIONS: The focused systematic review was perceived to be more useful than a traditional broad narrative review as a guide to making a decision concerning the use of specific therapy. The possible strengths of systematic reviews should be more fully investigated. If there is additional evidence supporting their greater value to clinicians, they should be made more widely available to clinicians and their strengths should be publicized.

Aged↗
PubMed2003

Dialogical relationships in impoverished narratives: from theory to clinical practice.

Individuals are guided in their actions in the world by a set of narratives portraying them in their relations with others. The narratives contain representations of self, of the world, of the various characters with which individuals interact and of the forms of relationship that they foresee establishing. Within the narratives the various characters, each from the position of an independent author, negotiate the meaning of events. A narrative can be altered either as regards its contents or its form. In this article, we describe impoverished narratives. These are lacking in various elements-descriptions of a narrator's inner state, of others' points of view, of the action scenario and of what goes on between the characters-and concentrate repetitively on only one or a few themes. With such features, individuals are hampered in their actions in the world. A therapist listening to a patient relating impoverished narratives finds it difficult to grasp what the problems are and what steps need to be taken. As a result, it takes longer or is not possible for each to become attuned with the other and to put together an agreed treatment programme. We illustrate this narrative deficit with a psychotherapy case study and hypothesize about the way a therapist ought to operate in order to tackle the deficit.

Adolescent↗
PubMed2001

The limits of narratives in understanding teacher thinking.

Researchers have argued that narrative provides insight into teachers' thinking and a model for the storage of knowledge about teaching. Concurrently, however, there are numerous cautions about using narratives as data sources. The present study addresses two problems: the limits of narrative as a data source and the feasibility of productively analyzing narratives. It also addresses the question of whether teachers actually store information as narratives. For the study, 23 deaf or hearing teachers of the Deaf participating in a project on integrating technology into teaching were interviewed about their experiences as teachers in general and in using technology in the classroom in particular. They rarely generated stories spontaneously. Rather, responses were related to the nature of the stimulus question. For example, when asked about their "worst class," teachers did not provide complete narratives but instead gave responses containing problems without resolutions. The study results suggest that teachers do not store information about teaching as narratives, but nonetheless can expertly construct narratives when given the right opportunity.

Deafness↗
PubMed2001

The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust.

The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. Adopting methods such as close reading of literature and reflective writing allows narrative medicine to examine and illuminate 4 of medicine's central narrative situations: physician and patient, physician and self, physician and colleagues, and physicians and society. With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care.

Communication↗
PubMed2006

Story recall and narrative coherence of high-functioning children with autism spectrum disorders.

Previous research has found few quantitative differences between children with high-functioning autism spectrum disorders (ASDs) and well-matched controls in the length, complexity, and structure of their narratives. Researchers have noted, however, that narratives of children with ASDs have an unusual and idiosyncratic nature. This study provides an analysis of narratives in 17 children with high-functioning ASDs and 17 typically developing children matched on age, gender, language abilities, and cognitive abilities. We examined story recall and narrative coherence. The study revealed no group differences in story length or syntactic complexity. Children with ASDs also did not differ from controls in their use of the gist of a story to aid recall, or in their sensitivity to the importance of story events. Children with ASDs did, however, produce narratives that were significantly less coherent than the narratives of controls. Children with ASDs appeared less likely to use the gist of the story to organize their narratives coherently. These findings are discussed with regard to their relationship to other cognitive and linguistic difficulties of children with ASDs.

Adolescent↗
PubMed2006

Structural development of the fictional narratives of African American preschoolers.

PURPOSE: This study examined the structural development of African American preschoolers' narratives. It also investigated the effect of background variables (e.g., gender, maternal education, stimulation and responsiveness of the home environment, and whether or not the child lived in poverty) on the children's narratives. METHOD: Sixty-five children completed a story-retelling task at age 4 and again at kindergarten entry. Narratives were then coded for story grammar elements. RESULTS: Four-year-olds narrated some attempts to solve the problem and some elements of the story ending. At kindergarten entry, children had higher total narrative scores and included more of every type of story grammar element except relationship. Overall, narratives were not related to background variables. CLINICAL IMPLICATIONS: The Bus Story Language Test (C. Renfrew, 1991) appears to be an assessment tool that is sensitive to structural growth in African American children's narratives from 4 years to kindergarten entry.

Black or African American↗
PubMed2006

Life is never the same: childhood cancer narratives.

No longer considered an inevitably fatal disease, childhood cancer nonetheless presents many challenges for children and families. Developing an understanding of the impact that childhood cancer has on the lives of children and their families is essential to being able to provide comprehensive and sensitive care to them. Hence, a longitudinal qualitative study guided by the philosophy of interpretive interactionism was conducted to arrive at an understanding of what it was like to experience childhood cancer and its symptom course from the perspectives of children and their families. Thirty-nine children with a variety of cancer diagnoses and their families participated. Data collection methods included formal and informal interviewing and participant observation. As part of the data analysis process, narratives of the children's and families' experiences were created that provided direction in comprehending how childhood cancer and its symptoms affected children and their families. The narratives helped to illuminate the reality of the children's and families' experiences. This paper focuses on describing the core narrative lived by the children and their families. The core narrative, 'life is never the same', represents the extent to which cancer truly affected the children's and their families' life stories. Three narratives embedded in the core narrative are also described: (1) losses: shared and unique; (2) moving forward, moving on; and (3) it is never over with . . . always a waiting game. The narratives in this paper are valuable to those healthcare professionals who seek to develop a greater understanding of how childhood cancer and its symptoms impacts on children's and families' ways of being in the world.

Adaptation, Psychological↗
PubMed2005

Narrative ethics in nursing for persons with intellectual disabilities.

Both in The Netherlands and in Britain, practices of 'life story work' have emerged in nursing for persons with intellectual disabilities. The narrative approach to care and support may at the same time be considered as an attempt to compensate for the 'disabled authorship' of many persons with intellectual disabilities and as a sign of controversy with standard practices of diagnosis and treatment that tend to neglect the personal identities of both clients and care givers, their particular historical and relational contexts and their spiritual needs. This paper argues that narrative ethics not only offers an appropriate moral framework for practices of life story work, but that these practices are a narrative ethics in action. Starting with an account of the concept of 'life story work' as it has been introduced in nursing practices in the field of intellectual disability, the paper explains its relationship with key characteristics of narrative ethics. The teleological dimension in narrative ethics and in practices of life story work sparks off a dialectic process of understanding of the client and self-understanding of the care giver. It also invites a respect for life in its openness toward the future and presupposes an openness toward other possible versions of the life narrative. The phenomenological and hermeneutic-interpretative methodologies in narrative ethics aim at a 'sudden moment of intimacy' in relationships of nurses and clients. The 'epiphany' of this essential moment of recognition, insight and engagement cannot, however, be brought about by methodology.

Attitude of Health Personnel↗
PubMed2006

Narrative identity processing of difficult life experiences: pathways of personality development and positive self-transformation in adulthood.

Difficult life experiences in adulthood constitute a challenge to the narrative construction of identity. Individual differences in how adults respond to this challenge were conceptualized in terms of two dimensions of narrative identity processing: exploratory narrative processing and coherent positive resolution. These dimensions, coded from narratives of difficult experiences reported by the women of the Mills Longitudinal Study (Helson, 1967) at age 52, were expected to be related to personality traits and to have implications for pathways of personality development and physical health. First, the exploratory narrative processing of difficult experiences mediated the relationship between the trait of coping openness in young adulthood (age 21) and the outcome of maturity in late midlife (age 61). Second, coherent positive resolution predicted increasing ego-resiliency between young adulthood and midlife (age 52), and this pattern of increasing ego-resiliency, in turn, mediated the relationship between coherent positive resolution and life satisfaction in late midlife. Finally, the integration of exploratory narrative processing and coherent positive resolution predicted positive self-transformation within narratives of difficult experiences. In turn, positive self-transformation uniquely predicted optimal development (composite of maturity and life satisfaction) and physical health.

Adult↗
PubMed2004

Emergency medicine narratives: a systematic discussion of definition and utility.

A substantial number of emergency medicine providers are publishing stories and other creative expressions related to their medical experiences. This is a systematic review of such publications, introduces the term "emergency medicine narratives" to describe such pieces, and proposes a framework to classify the various forms of expression. Specifically, six genres of emergency medicine narratives are discussed: medical autobiography, clinical narratives, creative narratives, out-of-hospital narratives, lay exposition, and photojournalism. This review explores the utility of these narratives and the role they play within the field of emergency medicine, provides a bibliography of emergency narratives, and suggests future questions that might be addressed regarding this growing phenomenon in the field of emergency medicine.

Emergency Medicine↗
PubMed2005

Narrative means to humanistic ends.

BACKGROUND: Efforts to "rehumanize" medical education through curriculum reform and program development have been numerous and ongoing in recent years. One particularly intriguing contribution has come from the area of narrative studies. It is now common to use literature in general, and physician--patient narratives in particular, both to expand students' understanding of the clinical encounter and to sensitize them to the humanistic aspects of medicine. DESCRIPTION: In this article, we describe the process by which we have introduced key insights from and elements of narrative theory into our 1st-year clinical skills program. Rather than limiting our efforts to the use of literature and to the description of individual narrative encounters, however, we have framed our entire course as an exercise in narrative construction. We refer to this process as "narrative structuring." EVALUATION: A combination of short essays on topics related to the various literary materials utilized in the course, written reports on ethical aspects of the clinical cases presented in the clinical skills sessions, and student journaling are integral components of the evaluation of this course. CONCLUSION: Characterizing our course in terms of narrative structuring serves both to integrate the various elements of our complex curriculum around a common theme and to remind both students and faculty alike of the privileges and responsibilities we share as we participate in the writing of one another's stories.

Altruism↗
PubMed2005

Narrative possibilities: using mindfulness in clinical practice.

Narrative is ever present in medicine and is an integral aspect of the doctor and patient relationship. Although theoretical discussions of narrative medicine and narrative ethics are important, they may serve to reify the patient's story, to make it a specific entity. In practice, the patient's story unfolds in the moment of communication depending on the individuals and the circumstances; the story is not an "object." Patients' narratives heard in clinical settings are often limited by physician behaviors, especially the tendency of physicians to control the interaction with the patient. To develop individual narratives effectively and competently, physicians must be able to help the patient tell the story that is most important, meaningful, and descriptive of the situation. If the patient's narrative is not heard fully, the possibility of diagnostic and therapeutic error increases, the likelihood of personal connections resulting from a shared experience diminishes, empathic opportunities are missed, and patients may not feel understood or cared for. The practice of mindfulness--moment-to-moment, nonjudgmental awareness--opens a doorway into the patient's story as it unfolds. Such mindful practice develops the physician's focus of attention and offers the possibility for a meaningful and important narrative to arise between patient and physician.

Attitude of Health Personnel↗
PubMed2004

Narrative discourse in bilingual children: language and task effects.

PURPOSE: This study investigated the effect of language on Spanish-English bilingual children's production of narrative samples elicited in two ways. METHOD: Twelve bilingual (Spanish-English-speaking) children ranging in age from 4;0 (years;months) to 6;11 who were fluent speakers of English as a second language produced two narratives--one elicited by using a wordless picture book and another by using a static picture. The children produced stories for each task in each language, for a total of four stories. For the book task, the story complexities were compared across both languages. Stories were scored for complexity of story grammar and the inclusion of specific narrative elements. Both stories in each language were further analyzed for productivity (total words, number of C-units, and mean length of C-unit). The grammaticality (proportion of grammatically acceptable C-units) and the proportion of utterances influenced by the nontarget language was compared across each language and story task. RESULTS: Children produced narratives of equal complexity for the book task regardless of language. However, children used more attempts and initiating events in Spanish, while producing more consequences in English. The picture task yielded mixed results, and these were not compared quantitatively. There were differences in the two task conditions with respect to the children's use of Spanish-influenced English and English-influenced Spanish. Although children were equally productive in both languages, they used proportionally more Spanish-influenced utterances in the book task. CLINICAL IMPLICATIONS: The results demonstrate the importance of considering the test language when eliciting narratives from bilingual children and the type of the narrative task for eliciting a productive and complex narrative.

Child↗