- The Paradox of Hope: Journeys through a Clinical Borderland by Cheryl Mattingly
Cheryl Mattingly's The Paradox of Hope: Journeys Through a Clinical Borderland makes a major contribution to the study of narrative in health care. Mattingly has long worked at the borders of health care, anthropology, literary theory, phenomenology, and critical studies. Because she draws from and combines such diverse sources, her work has already added a great deal to understanding how narrative is central to experiences of illness and healing, not something imposed [End Page 361] after the fact. In an earlier book, Healing Dramas and Clinical Plots, for example, she analyzed the ways in which ordinary clinical encounters in occupational therapy are transformed into what anthropological studies of narrative and ritual categorize as dramatic healing rituals. In The Paradox of Hope, Mattingly builds on her previous work, this time focusing on the urban hospital and exploring why and how dramatic healing rituals occur or break down at cultural divides—at the borderlands of identity, power, and difference. The core of this book is Mattingly's groundbreaking approach to hope as a complex narrative practice, which has profound social and political implications in the border zone of the urban hospital. Hope has never been so illuminated in its full contemporary significance, so rooted in life and history, so far removed from sentimentalism.
Mattingly's linked concepts of the clinic-as-borderland and hope as a narrative practice are grounded in a thirteen-year ethnographic study of African American families, specifically parents who care for children with severe chronic illness or disability, as well as the health professionals who take care of these families. The clinic is a borderland not because it is politically defined as such, but because it is a space "defined by practices that bind people together who otherwise wouldn't belong together" (7). Mattingly's innovative approach to the borderland concept resonates with the best of postcolonial and transnational feminist thought, in which the political space of the borderland has been used as a tool to assess racist and patriarchal categories of national knowledge production or subject formation. Her use of the concept has similar decolonizing, anti-racist aims, and it is dazzlingly subtle and original when applied to the contemporary urban hospital. This book excels at mapping and theorizing the very real but invisible borders that create "Others," often along lines of race and class, in the daily interactions of contemporary health care.
The most significant practice in a border zone, Mattingly argues, is hope. Her discussion of hope is a notable departure from scholarship on hope as a feeling or cultural construct. Instead, Mattingly locates hope as central to the problem of creating trust between families and clinicians across categories of difference. Her meditations on hope as a paradox are insightful and devastatingly grounded in life. For example, she writes: "cultivating a hopeful stance . . . involves an ongoing conversation with embittered despair. To hope is to be reminded of what is not and what might never be" (3). She also notes that, when trust breaks, it disturbs the fragile balance between hope and despair. Despair, always nearby, floods in, and the possibility for hope can be irrevocably lost. [End Page 362]
Recognizing hope as a paradoxical stance also allows Mattingly to map a constellation of the many social, political, cultural, and intimately singular ways in which hope can be narratively practiced. She shows, for instance, that the experiences of navigating chronic illness and disability in the border zone are structured by the realities of contemporary health care. This drives the core questions of the book: "How to cultivate a practice of hope that is bearable, despite its elusive promises, its retreating horizons, those darkest times when the suffering is so excruciating that any advent, any salvation, is already too late? How to find a way to hope that will be supported by clinicians and in clinical settings where expensive or even adequate care may be denied—both realities of contemporary health care for...