Illness Narratives and the Construction of Self and Healing
I remember a news story about a female pilot being shot down by Iraqi forces during the Gulf War of 1990-91. She was being interviewed about her experience whereby she tells the story of how she was shot down and finds herself in the company of several Iraqi soldiers. She tells her story in a calm and clearly conversational tone of how she removes her flight helmet and with her hair falls down revealing to the soldiers that she is woman and not a man. After their initial shock, the soldier's reaction is to grab her and commence to rape her. What I found fascinating about her story is that while she tells it she never loses her composure, and in a calm and clinical manner explains how she remembered the moment as, "Oh my God! Here I am shot down, bloodied and injured and these guys (Iraqi soldiers) want to rape me, how absurd." Rather than play the victim and perpetuate the trauma over and over again—remembering and reliving the horror each time, instead, framing her story as "that was then and this is now", her narrative illustrated a clear separation of this traumatic event as past, reframing it as an incurred war injury. Her construction of the "current self" appeared healthy and recovered, not fragmented, victimized and linked to past trauma. Her account left me pondering about notions of how the self is defined, constructed, deconstructed and reconstructed over time either in unhealthy and healthy ways.
In the context of chronic suffering, this week's reading by Emily Mendenhall (2012), the notion of "speech acts" as performative acts by which individuals can construct meanings to their illnesses and define who they are within their domain, thus creating an interconnected matrix of the soma, psyche and social meanings (Mendenhall 2012:35). Domenga's and Rosie's narratives show how story-telling is a therapeutic process by which individuals can make sense of their past experiences and construct a concept of "the self" that is predicated on time and context (Mendenhall 2012:36). Furthermore, these narratives illustrate the embodiment of a current "self" and that their stories not only demonstrate a biographical trajectory over time, but also exemplifies a subjectivity that makes sense and has a purpose. Thus, story-telling narratives reveal the current construction of the subject's "self" as coping or worsening—healing or deteriorating—healthy or unhealthy. Lastly, story-telling and retelling stories serves not only to make sense and meaning of one's illnesses, but also reconfigures their identities in relation to their illnesses and past traumatic experiences in manner that is both empowering and healing.
Domenga's and Rosie's narratives illustrate how they constructed a resilient self capable of shouldering the stresses of everyday life and resolve to trudge forward and continue "going on with life again" (Mendenhall 2012:42). Their stories highlight their ability to strategically use their illness and traumatic experiences to make sense of things and reorganize aspects of their biographies as "strategic suffering", both as a social tool for reconfiguring self, and to make meaning of ongoing current physical and psychological stresses (Mendenhall 2012:36). Lastly, Mendenhall shows how story-telling and narrative analysis can reveal the interconnectedness of "structural, social, interpersonal, psychological, and metabolic factors" contributing to women's health and well being (Mendenhall 2012:50).
Merav Shohet (2007) in her article, Narrating Anorexia: "Full" and "Struggling" Genres of Recovery, shows how story-telling is a therapeutic medium and a resource for confronting illness and that narrative analysis illuminates that healing and recovery is possible when "the self" is reconstructed with a temporal disjuncture between the past and present self-identity coupled with a logical empowering narrative that has a clear beginning, turning point and successful, societal sanctioned ending (Shohet 2007:344). Shohet (2007) highlights two genres: 1) "Full recovery" whereby the reframing of the illness redefines "the self" in two distinct aspects where there is a "past sick self" and a complete and distinct break from the former self to a "current and transformed self" capable of coping and handling life's vicissitudes (Shohet 2007:346). The other "struggling to recover" genre posits a "self" that is continuous and conflicted with a past, present and imagined future self that fluctuates between agent and patient, ambivalent about one's status (Shohet 2007:346). Illness narratives in addictive disorders does not generally follow a linear temporal trajectory, but rather recovery is reconfigured contingent on the coconstruction and adoption of healing stories which are constructed through interactions with caregivers and other patients. Encounters with the healing dramas of others, patients begin to call forth new "self" possibilities worth achieving (Shohet 2007:346). These interactions occur with some frequency in Twelve Step recovery meetings where stories are told in a context of what the alcoholic used to be like, what happened and what they are like now" (Alcoholics Anonymous 2001:58). Shohet posits that narrators are pulled in one of two directions: 1) a tight storyline with a clear beginning and end (coherent) versus a trajectory narrative of what happened (authentic) (Shohet 2007:347). Full recovery narratives embrace a strong epistemology of empowerment that highlights a temporal linearity—a step-by-step progression with a complete understanding and affiliation with an authoritative clinical description of the addiction disorder and contrasted with a clear demarcated line between past and present self (Shohet 2007:348). Struggling to recover narratives in contrast to full recovery storylines, have a varied certainty, endemic ambivalence and indeterminate self that progress through time with an uncertain future of multiple possibilities (Shohet 2007:349).
In a continuous encounter with reality, illness narratives help to tease out strategies of how "the self" is constructed in its quest of how to be and how to exist in the world. The process of telling and retelling one's illness narrative and its framing seems critical for healthier recovery. Mendenhall is clear to point out that Domenga's and Rosie's stories are not those of victims but rather narratives of endurance of two people who have survived life's adversities. By reframing one's illness and hardships of life into an empowerment narrative—highlighting a clear beginning, turning points and successful outcomes coupled with consistent affiliation and adoption of institutional master narratives seems to have a stabilizing effect. Whereas, struggling to recover narratives, reinforce an ambivalent, unstable myriad of future possibilities the perpetuates a cyclical life recurrent illness that eludes permanent recovery.
Mendenhall, Emily. 2012. Syndemic Suffering: Social Distress, Depression, and Diabetes among Mexican Immigrant Women. Left Coast Press, Inc. California, USA.
Shohet, Merav. 2007. Narrating Anorexia: "Full" and "Struggling" Genres of Recovery. Ethos. Vol. 35, Issue 3. pp. 344-382.