The Guggenheim Grotto Philosophia

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The Guggenheim Grotto Philosophia

• When were young we set our hearts upon some
  beautiful idea?Maybe something from a holy book
  or French philosophia?Upon the thoughts of better
  men than us we swear by and decree a?Perfect way
  to end the war of ways the only way to be a??Work
  of art, oh to be a work of art??But in time a
  thought comes tugging on the sleeve edge of our
  minds?Perhaps no perfect way exists at all, just
  many different kinds?Oh but if its just a thing
  of taste then everything unwinds?For without an
  absolute how can the absolute defineA work of
  art, oh to be a work of art

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Narrative Prompts in the Clinic

• Susan M. Barone
• MHS 205 Medicine and Literature
• February 12, 2008

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My Research

• Examines the extent to which providers prompt
  patients illness narratives.
• Falls within framework of Institutional Talk
• Uses Method of Discourse Analysis
• Works under assumptions that medical
  interactions- are interactional (Schegloff,
  Goffman)- assist us in creating
  narratives/parallel narratives- are
  co-constructed (Garfinkel)- are asymmetrical
  (Foucault)

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This talk is based primarilyon the works of

• Heritage, Maynard and RobinsonSociolinguistics,
  Conversation AnalystsRecent Publication
  Communication in Medical Care Interaction
  between primary care physicians and patients.
• Ochs and CappsLinguist and Psychologist,
  Discourse AnalystsKey Publications
  Constructing Panic, Living Narrative

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Talk and Storytelling

• When we have the capacity, we use talk and
  storytelling to make sense of the world
• Stories characteristically emerge in every
  social interaction (Sacks)
• A medical interaction is simultaneously social
  and medical.

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Medical Discourse Analysis

• The Case
• Make notations of any and all observations of
  this medical interaction in the second column.
• In the third column, make any additional
  notations based on what you hear throughout this
  talk.

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Medical Interaction Video
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An assumption

• If given opportunity, a patient will reveal
• how they see who they are in the world identity
  
• and what the problem to be solved is why they
  seek medical attention.

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Person to Patient Identity Reformation

• Accommodation (Zola)
• Validity and Doctorability

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Two Types of Talk

• Mundane talk
• Everyday speech
• Well researched
• Institutional talk
• Interaction where the participants institutional
  or professional identities are somehow made
  relevant to the work activities in which they are
  engaged.

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Mundane Talk and Personal Narrative

• Personal Narrative is

• the recounting of
• unexpected turn of events,
• - or is in response to inquiry
• but it is usually in the realm of what is
• acceptable to tell.

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Narrative Dimensions

• Telling and Tellership
• Moral Stance Barriers
• Credibility and Verifiability

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Telling and Tellership

• Storytelling relies on
• Memory
• Mental development
• Emotional capacities
• Linguistic capabilities

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Moral Stance

• Tellers strive to
• Represent themselves as decent, ethical
  individuals
• Who pursue the moral high road
• at times, in contrast to certain others in
  their narratives.

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Credibility and Verifiability

• Reportable events are almost by definition
  unusual.
• Inherently less credible than non-reportable
  events. The more reportable an
  event is, the less credible it
  is.
• Yet credibility is as essential as reportability
  for the success of a narrative. They are threaded
  with subjective events such as thinking, knowing,
  intending, and feeling.

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Context

• Each interaction is doubly contextual
• context shaped by what just occurred,
• context renewing - every utterance creates a
  framework for some next action in the sequence.

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Co-constructors/Co-tellers

• Listeners, or interlocutors, typically use -
  common sense, - personal background knowledge,
  - and the narrative up to this point - to
  anticipate the intentions, emotions,
  physiological states, and/or actions that the
  event is likely to offer.
• Co-construction emphasizes both parties.

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Co-construction

• Especially in mundane talk, it is common
• for co-tellers to contribute psychological
  responses that show sympathy and otherwise align
  with anothers point of view on the recounted
  events.

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Application

• Provider has to determine
• How much certain capacities are intact - memory
• The state of development- mental - emotional -
  linguistic

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Analysis

• Take a look at the Case
• What is your analysis now?

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Consider

• Remedying interactional problems is not simply a
  matter of being careful with terminology. Nor
  does it mean knowing how to confront the
  sometimes overeducated but naïve understandings
  patients bring to the interview.
• Becoming aware of the inexplicit methods by which
  patients approach providers on various topics,
  and the taken-for granted ways by which providers
  deploy their specialized knowledge.

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Other Considerations

• Be wary of the appearance of shared
  understanding.
• Rita Charons definition of Narrative
  Medicinethe patient has a narrative, and it is
  up to providers to both offer the necessary
  prompts and space for the narrative to be told
  by the patients and to hear the narrative.
• Provider must be present and mindful yet
• Balance involvement and detachment.

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Final Consideration

• As providers who repeatedly participate in
  stories that, in turn, shape your identities and
  world views, these moments of listening and
  contributing to storytellings with recurrent
  emotional themes and formats create critical
  socializing experiences.
• Think about the extent to which what we say and
  how we say it affect interactions and shape one
  anothers narratives.