Narratives in reasoning

Narrative reasoning is quite a difficult topic to come to grips with. The term is often used inclusively to mean stories told by anyone ie. therapists, patients, carers, family. As a type of clinical reasoning, the relevant narratives are the ones that are in the head of the therapist. While searching for information on Blogs, I came across information about Cheryl Mattingly. I have copied it here as a summary of her contribution to occupational therapy. See the relevent blog.  The section in quotes illustrates the different types of narratives – those told by the patients and those understood by the therapist.

Cheryl Mattingly is a cultural and medical anthropologist who has studied professional practices, institutional cultures, and families in urban communities. She received her Ph.D. from MIT and also did a post doctorate at Harvard Medical School. Her interests include ethnography, the study of therapeutic processes, particularly the role of narrative in clinical reasoning, cultural diversity and health care, and the phenomenology of disability. In 2000, she won the Victor Turner Prize for her book Healing Dramas and Clinical Plots: the Narrative Structures of Experience, published by Cambridge University Press in 1998. Her essay entitled “In Search of the Good: Narrative Reasoning in Clinical Practice” was awarded Best Essay for Medical Anthropology in 1999, receiving the Polgar Prize from the Society For Medical Anthropology. She has received USC’s Phi Kappa Phi faculty recognition award and serves on the executive board of the Society for Medical Anthropology. Along with her colleague Mary Lawlor, she has received extensive research grants from the NIH, US Maternal and Child Health, and the US Department of Education. She is co-editor along with Linda Garrow of the well-received collection Narrative and Cultural Contributions of Illness and Healing, published by the University of California Press in 2000.

“With a joint appointment in occupational therapy and anthropology, I work at the juncture of two exciting fields. Anthropology as a study of culture focuses on people’s everyday lives and what makes those everyday lives meaningful. Occupational therapy as a clinical practice recognizes that the difficulty of pursuing everyday life with clinical conditions and disabilities powerfully influences peoples’ experience of their bodies. Occupational therapists ask how conditions and disabilities affect a person’s sense of self. That’s a salient question among medical anthropologists who have also come to recognize, in their research on disability, how important it is to understand illness and disability as an experience that changes lives, not just as a narrowly understood medical condition. As an anthropologist, a major area of my work has been the study of stories in health care. Interest in narrative has grown tremendously over the past several years in all the health professions, including among physicians. Stories can be especially relevant for occupational therapists because it is often through hearing stories that people learn what it is like for someone to live with disability. And the stories people tell also give many clues about what they care about, what matters most in their lives. This is important because when occupational therapy is most effective, it connects treatment interventions to those areas of deep concern to clients. A second area of my own work has been the study of how clients, families, and clinicians work together – or run into problems trying to work together – in the practice of rehabilitation. I have been particularly intrigued with how collaboration occurs across large cultural divides, that is when clients and therapists come from very different cultural worlds but must find some kind of common ground in order to work together toward goals. Finally, I have written extensively about clinical reasoning in occupational therapy, especially the role of narrative in the thinking of occupational therapists, the kinds of stories they tell about their clients and the influence of stories in helping therapists devise treatment approaches tailored to individual clients and their particular needs and strengths.”

The following link is to a book that Cheryl Mattingly wrote  with  Linda Garro.  It is called Narrative and the Cultural Constructions of Illness. The site allows you to read selected portions of the text.

DEBATES AROUND NARRATIVE REASONING

In the discussion forum there was a disucssion around narrative that I have questions about – the following is my response to one student:

“So, I think you are saying that the narrative that unfolds in the head of the therapist as he/she gains information from the client is ‘narrative reasoning’? That’s an interesting thought. As I understand Mattingly’s view – she generally talks about narrative reasoning as the stories told by the therapist ie. they need to be told orally to be stories. Is it still narrative reasoning when it has not been told?? I think I would see this accumulation of data as a way of developing our schema or knowledge networks – ie it is facts about the situation. Stories are different, they are told with embellishments (you might fill in gaps)and change with the particular audience that you are addressing eg. telling the tale to your friend or to a colleague.. in the telling of the story so your understanding of what happened also changes – otherwise, why would you tell it? It has been ’simmering’ away in your head for some time and you tell it in part to understand it better”

This got me thinking – when is a narrative, narrative reasoning? Is it only when its told to others? While its in your head is it just a collection of facts? Can you describe it as a narrative? I would have thought that it needs to be told – this brings it together in order to convey a story to someone for some purpose. So for instance, if as a lecturer I ask you to tell a story about an situation that you found to be particularly difficult – the telling of the story would help you to think it through and make sense of it.  You may tell a different story to different people but each time its told, it provides a better understanding of what was happening.