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This essay offers two readings of its title. One takes the words understanding, narrative, and hermeneutics as nouns that stand for different though interrelated notions; the other proposes an understanding of hermeneutics as an approach to human reality in which narrative plays a crucial role. The first reading could be said to be concerned with three distinct notions and their overlap and interplay, being aware that each term is unfolded in a broader tradition of its own. There are, for example, more forms and practices of human understanding and meaning-making than those we call narrative; there is more to narrative than that it enacts processes of understanding; and hermeneutics is a field of inquiry that reaches beyond not only processes of narrative understanding but also beyond processes of understanding in general (acknowledging the border zones and limits of understanding).

It is with this in mind that we want to point out that, and show how, the hermeneutic approach explores interpretation [End Page 1] and understanding as central dimensions of language and, by extension, narrative. From this perspective, we propose viewing narrative as a hermeneutic practice in itself, a practice of meaning-making. This practice—or perhaps better, this plethora of practices—is of crucial significance for complex processes of interpretation that underlie, for instance, our ideas of self and identity. This view motivates the second reading of our title, the one without commas.

Combining these two readings, we outline the project of narrative hermeneutics by sketching some of the theoretical traditions on which it builds. In the first part of our discussion, we pay particular attention to its philosophical background, and in the second part we relate it to literature, delineating how fictional narratives have elaborated many key issues of narrative hermeneutics. If there is one point we consider essential for the hermeneutics of narrative, it is the way in which it brings together engagement with issues of storytelling in linguistic, discursive, and artistic contexts with the wider existential relevance of narrative practices for our (self-)understanding and being in the world. To further explain and unfold this argument we take a look, in the third and last part, at a new field that has become known as narrative medicine. In opening up to investigate the narrative fabric of health, illness, and care, narrative medicine represents an extraordinary theoretical and academic effort to overcome the divide between biomedical science on the one hand and the humanities and social sciences on the other. Moreover, it also is part of, and reflects, a lifeworld shaped in exemplary fashion by practices of narrative interpretation. We thus discuss literary fiction and narrative medicine, and the theoretical debates that draw on them, as exemplary fields of existential and hermeneutic reflection on narrative.

We want to stress right at the beginning an important difference with some former hermeneutic theories: in speaking of existential acts of meaning-making we do not assume universal features of human nature but refer to socioculturally very specific practices, as we explain in what follows. Our case is all but a universalist one; we argue that, particularly under complex and challenging conditions, our efforts to understand ourselves and the cultural world in which we live—we call this existential understanding—tend to take the form of narrative.

Yet the narrative dimension of understanding is only one side of the [End Page 2] coin. On the other side is the interpretive nature of narrative, so we also must address this side, that is, the fact that an interpretive process is at the heart of every process of narrative understanding.

The Project of Narrative Hermeneutics

The project of a narrative hermeneutics is closely associated with what has often been described as the narrative turn. Extending the study of storytelling beyond the fictive, literary, textual, and even linguistic domain, the shift toward narrative as ubiquitous practice of human communication and meaning-making has been driven by and catalytic to many debates. In the process, the scope of narrative theorizing has widened within and beyond the humanities. What is viewed as the spectrum of storytelling environments has also expanded, ranging from face-to-face interaction to textual genres, visual and performative media, and digital world-making. At the same time, narrative research has opened up to diverse cultural worlds, involving many new areas of inquiry in the social sciences, psychology, law, and health and medical sciences, to name but a few. The study of narrative and the narrative-based study of human reality have become multi-and transdisciplinary to a degree hardly imaginable a few decades ago. Finally, the narrative turn has not only been a theoretical discourse. Literature and other arts have actively tackled the relevance of storytelling for human existence, manifesting increasing narrative self-awareness (Meretoja 2014b).

Against the backdrop of this multifarious landscape of research, scholarship, old and new storytelling practices (especially, in the wake of the digital and artistic innovation), and forms of narrative self-awareness, we want to give a sharper profile to the hermeneutic approach. Although associated and intermingled with many of these developments, narrative hermeneutics is all but clearly localizable on this map, for it already is itself a transdisciplinary orientation, an approach to human life and understanding that has often been engrafted and specified within a number of different theoretical and empirical contexts. This might be one reason why it has not played a prominent role as a distinct approach in narrative studies. Another reason is that it is not easily combined with what for long was the most influential tradition of narrative studies: structuralist [End Page 3] narratology. This tradition has been part of the movement that sought to eliminate from the human sciences the sense-making subject and related notions such as intentionality, experience, and existence. Hermeneutically oriented narrative studies, in contrast, conceptualize narrative in terms of a subject who strives to give meaning to his or her experiences, while at the same time radically decentering—that is, socializing and historicizing—this subject.

More broadly, hermeneutics represents an intellectual tradition that has not merely been incompatible with structuralist, empiricist, and positivist philosophies of science and knowledge that have for a long time shaped much of the academic business, including the social sciences and humanities; from its very beginning, rather, the hermeneutic tradition in all its variants has radically challenged these philosophies, striving to elaborate an alternative view of the human mind, in fact, of human reality, by centering on our capacities of interpretive understanding, interacting, and meaning construction. From a hermeneutic perspective, different disciplines and theoretical approaches are based on different ways of interpreting reality, but none of them gives privileged access to “reality as such.” They produce different types of knowledge, because they ask different types of questions and use different vocabularies. As Gadamer (1966/1993: 226) puts it, “it is a hermeneutic fundamental phenomenon that there is no such contention that could not be understood as an answer to a question and that is not understandable only as such.”1

In a nutshell, the basic claim of all modern hermeneutics is that human understanding is mediated. It is mediated through sociocultural circumstances, history, and signs—particularly, language. Directly related to this claim is the interpretive imperative. The assumption of the interpretive nature of human understanding is inseparable from its linguistic, social, and cultural mediatedness or, to again use Gadamer’s (1960/2004) term, its historicity (Geschichtlichkeit). We always encounter the present moment within the horizon of experience shaped by our past experiences and by the cultural traditions and forms of life in which we have become who we are. All our understanding takes place within such a historical matrix. Because this matrix is always in flux, every act of understanding is singular. As we never step into the same river [End Page 4] twice, there are, strictly speaking, no two processes of understanding alike. This alone defies every cognitive or intellectual universalism. For Gadamer (1985/1993: 8), the real challenge is to accept and comprehend that the inherent structure of all understanding is “Immer-Anders-Verstehen,” “always-understanding-differently.” As a consequence, all our interpretations are reinterpretations, interpretations of previous interpretations to which they add, from a different point of view in time (and often also in space), new versions, as minimally distinct from each other they might be. In this way, another layer of historicity is bestowed upon the hermeneutics of understanding, one that qualifies historicity in terms of instability, openness, and limited predictability. Contingency is another term, suggested by Rorty (1989), to capture this twofold hermeneutic condition—historicity as presupposition and inherent feature—of our strategies of understanding.

This helps explain another much-debated hermeneutic argument, according to which interpretations are not just views or cognitive representations but have real, material, world-constituting implications. Rather than just reflecting subjective opinions or evaluations of human reality, they are part and parcel of it, integral to the historical fabric of our lives and our existence. Interpretations not only have a bearing on how we act and interact, constituting frameworks of intelligibility and action—with new interpretations creating new possibilities of action; they also are actions themselves, interventions that change the very world in which we live.

Building on these premises of contemporary hermeneutics on the one hand and on narrative theory in its multi-and interdisciplinary ramifications on the other, narrative hermeneutics offers a perspective of narrative as a crucial form and practice of interpretive understanding. Complementing this perspective, it simultaneously considers interpretive understanding—especially, if it is concerned with the temporal complexities of the human being in the world—as taking on a narrative form.

An essential element of this vision has already been mentioned, though not yet considered in the light of the narrative extrapolation of the hermeneutic project that we propose: meaning-making is not just about cognition, knowledge, consciousness, or the mind, but about living a life in a cultural world. It is about the human condition itself. In [End Page 5] this sense we can say, drawing on a distinction by Heidegger (1927), that narrative hermeneutics goes beyond the meaning of language and texts—the main subject of hermeneutic reflection before Heidegger—and grapples with ontological issues; that is, it deals with the human being in the world as a historical, social, and cultural condition, rather than only with epistemological issues of knowledge, thought, and cognition (Meretoja 2013).

What, more precisely, does it mean to view understanding as entwined with living a life? How can understanding be an existential stance, a form of life, a way of being in the world? According to twentieth-century hermeneutics, humans do not take their existence for granted but are continuously engaged in making sense of it; telling and retelling their experiences and identities as well those of others, they give shape to them, or question such shape and try out different interpretations. Humans, as Charles Taylor (1985) puts it, are “self-interpreting animals”; interpreting themselves and the world they inhabit is inherent to their cultural way of being. From the point of view of a narrative hermeneutics, this is not to say that these processes of interpretation necessarily lead to a coherent story, much less to one story. If we look, for instance, at processes of narrative identity, we face more often than not messy and puzzling configurations of story fragments, of hypothetical or speculative versions, try-outs, and question marks (cf. Hyvärinen et al. 2010; Georgakopoulou 2007). Understanding does not necessarily mean successful or harmonious understanding; nor is it realized in a single act of comprehension. Subject to dialogue, conflict, and contest, it is a process carried out through revisions and reinterpretations that are, in principle, endless.

On this account, to live a life is to establish, together with others, a world of sense and meaning that constantly entangles us in efforts of constituting significance, of interpretive “acts of meaning,” as Jerome Bruner (1990) has it. Narrative plays a pivotal role in this process—as an activity not only of self-reflection and self-resolution but also of social interconnection, linking people to others and to their storytelling activities. Bruner therefore saw the emergence of narrative psychology as one facet of the narrative turn that he localized within what Rabinow and Sullivan (1988) described as the interpretive turn in the social [End Page 6] sciences (see also Hiley, Bohman, and Shusterman 1991; Brockmeier 1996). Relating to these and like-minded interpretive undertakings, the project of narrative hermeneutics is to explore how and to what degree acts of meaning are realized by narrative practices and how individuals, through these practices, bind themselves into their cultural worlds while binding the cultural world into their minds.

This dynamic is particularly manifest when we seek to understand complex human affairs, which we distinguish, even though only gradually, from the countless processes of everyday understanding that we typically realize in passing, mostly without noticing. When we are asked, say, what time it is or what is our address, the interpretive charge mostly goes without being noticed. This is not to maintain that everyday interactions and “small stories” do not have a wider, existential significance. In fact they do have, not least in the same fashion as understanding a remark like “Since the first spring days have arrived I feel more confident and hopeful” is not only about seasons, moods, and mental states. It presupposes an entire cultural system of knowledge, thought, and linguistic practices. It is not difficult to see that acting in cultural worlds is awash with challenges from personal conflicts, illnesses, and crises to social tensions, political and economic contradictions, not to mention the intricacies of self-resolution and identity formation that are bound up with all of this. To put the matter more pointedly, whenever processes of interpretive understanding and sense-making reach a certain level of complexity—in particular, when they deal with temporal processes and multi-temporal scenarios (as in most life and identity stories)—it comes to narrative.

The Existential Turn of Hermeneutics

That the offers of hermeneutics have often been ignored in recent discussions on narrative and storytelling is all the more incomprehensible when we bring to mind that the history of hermeneutic thought is marked by a turn likewise fundamental as the narrative turn. This “existential turn” or “ontological turn” of hermeneutics (Gadamer 1960/2004: 259–64), which took place more or less half a century before the interpretive turn in the social sciences, has brought to the fore precisely [End Page 7] the existential aspects of our processes of sense-making, which we have just outlined. This focus is closely associated with the work of Heidegger. It was prepared by Husserl’s (1931/1982) view that even simple sense perceptions have the structure of interpretation (we always see “something as something”) and that human life itself shows a hermeneutic structure because it is laid out for its own interpretation. Already a generation before Husserl, the later Dilthey had reformulated Hegel’s idea that life itself has a hermeneutic dimension that is only extended and reflected by philosophy and the humanities. This idea broke with Dilthey’s earlier, more instrumental view of hermeneutics as the specific interpretive methodology of Geisteswissenschaften (humanities). But Heidegger’s existential radicalization went farther; it fundamentally changed the subject, scope, and status of hermeneutics.

As it was Dilthey’s thought that paved the way for Heidegger’s existential turn, the implications of Heidegger’s shift were further elaborated by Gadamer and Ricoeur: by Gadamer in shifting the accent from Heidegger’s Weltverstehen (world-understanding) to the process of linguistic communication in which all understanding of the world is embedded, and by Ricoeur in treating narrative as an important form of such communication, especially with respect to our understanding of human time. Yet the selective affinities between the two intellectual orientations of hermeneutics and narrative theory are even closer. Whereas the narrative turn redefined storytelling in a twofold sense—as a mode and practice of meaning-making inherent to many forms of life, and as an act of interpretation—Heidegger’s version of hermeneutics placed the emphasis on something else: on the human condition as incorporating the ongoing need for understanding and self-resolution.

Heidegger’s (1927) Dasein (being-in-the-world) is a way to conceive of human life as posing permanently open questions. He calls them Existenzialien (existentials). They reflect aspects of human reality traditionally discussed in philosophy, such as the spatiotemporal conditions of our experience; they also address the subjective and cultural frames of meanings underlying our experiences that are defined by our corporeality or bodyhood and the way we sense the world and our being in it mediated through mood, attunement, and feelings. A likewise fundamental [End Page 8] frame of experience is constituted by humans’ social and societal nature, by our mode of “being with others” that colors whatever we think and feel and however we decide to live our lives. For Heidegger, there is no doubt that becoming aware of these dimensions of our historical condition and, in fact, just living them is inextricably intermingled with the use of language and the sociocultural matrix of interpretation to which it belongs and which it evokes.

As far as the forms and practices of language that are unfolded by narrative in particular, Heidegger did not further examine them. For him, it apparently was the language of poetry—even if he understood poetry in the broad sense of early German Romantics—that more than any other linguistic forms appealed to the philosophical reflection of the human condition. It was Ricoeur (1983/1984, 1984/1985, 1985/1988) who, in the wake of Heidegger’s existential hermeneutics of temporality and historicity, studied the intrinsic relationship between time and narrative (see Kaul 2003; Ritivoi 2006). Nevertheless, Heidegger had prepared the ground for this with his views on the fundamental temporality of our being in the world. Moreover, he called for reinterpreting the past so as to open up new possibilities of being in the present. These ideas, not least, led to Ricoeur’s (1986/1991: 86) conceptualization of narrative fiction as a form of art that opens up new possibilities of being, acting, and thinking.

Viewing this scenario at large, we can observe how, akin to the shift in narrative theorizing from fictional, textual, and linguistic structures to general forms and practices of human action and interaction, hermeneutics changed: it transformed from understanding textual and linguistic meaning (the dominant endeavor in nineteenth-century hermeneutics) to a notion of understanding as a basic concern of human life, as an intrinsic component of our forms of life. To characterize the subjective, affective, and intentional dimension of this, Heidegger also applies the term Sorge (concern, preoccupation, care).

We have used the phrase “forms of life” to describe this concern through a further, different, though in several respects similar philosophical lens, that of Wittgenstein’s later philosophy (1953/2009). At the same time, we suggest extending (as well as specifying) this view of self-and world-understanding as a basic human concern by exploring the [End Page 9] role that narrative, as a particular form and practice of language and understanding, plays in it.

The Significance of Language

The view of narrative as action and interaction, rather than simply as representation, combines two lines of argument that both substantiate the case of narrative hermeneutics. One has been outlined by Wittgenstein and Wittgensteinian pragmatists like Rorty (1991); the other has taken shape in the hermeneutic tradition of investigating human understanding. The latter tradition draws on Heidegger’s reconceptualization of understanding as an activity that is not just cognitive, affective, and aesthetic, as in the reading of texts, but a fundamental structure of human existence. To make this point using a different vocabulary, one could say that the human search for meaning is not an intellectual exercise but part of humans’ cultural nature as it has historically developed in many diverse traditions (Brockmeier 2012). In the twentieth century, this line of hermeneutic inquiry has been advanced not only by philosophers such as Gadamer, Ricoeur, Taylor, and Derrida but also by anthropologists and psychologists such as Geertz (1973, 1983) and Bruner (1986, 1990), who outlined notions of human life and subjectivity that radically repudiated empiricist and positivist models of scientificity. They all reject the assumption that there is a pre-semiotic and pre-cultural layer of unmediated raw experience—which then might or might not be represented, reflected, and interpreted through language—and emphasize, instead, the intrinsic interpretative and cultural nature of all experience. Conversely, arguments against the interpretative, culturally mediated nature of experience and narrative build on the problematic ontological assumption that only what is given in immediate experience is truly real, whether or not this assumption is explicit and reflected (Meretoja 2013, 2014a).

Most hermeneutic theorists agree on the pivotal role of language for our self-and world-understanding. But there are many notions of language. Which one is relevant here? Rorty, for example, has critiqued a view of language as a medium of representation or expression that assumes “that there are nonlinguistic things called ‘meanings’ which it is [End Page 10] the task of language to express, as well as . . . that there are nonlinguistic things called ‘facts’ which it is the task of language to represent” (1989: 13). In debates in narrative and linguistic theory in the social sciences and psychology about how to define narrative it is commonly taken for granted that language is representation. By contrast, the idea of understanding as a hermeneutic process of interpretive meaning-making is grounded in a notion of language as a form of action. As Gadamer (1960/2004: 457) puts it, following Heidegger, language is not an instrument for pointing to pre-given things but an articulation of intelligibility, a medium in which “the order and structure of our experience itself is originally formed and constantly changed” and which exists only through a continuous conversation. Conceiving of narrative as a form of action and interaction does not necessarily exclude the idea of representation; but it provides a different focus, one that allows us to recognize narrative as a form of life in Wittgenstein’s sense or as integral to historical worlds in the hermeneutic sense. It thus also permits us to examine many aspects of narrative that are often neglected and ignored. One is the intimate relation between narrative and human agency, a crucial notion in many critical debates on human subjectivity.

Consider, for example, processes of narrative understanding salient in autobiographical discourse, life stories, and other forms of life writing that can be captured only in a reduced way if described in terms of cognitive acts following the empiricist view of knowledge dominant in traditional psychology and cognitive science. Instead of “facts,” “events,” or “data” to be represented by language, or perception-based cognitions to be transformed into concepts and theories, the stuff of narrative understanding appears as an ongoing flow of interpretive and self-interpretive acts: a stream of attempts to figure out what one’s and others’ experiences, intentions, emotions, beliefs, desires, and anxieties could possibly mean (Brockmeier 2013). Theorists like Heidegger and Arendt have employed the Greek term poíēsis (which stems from the Greek verb poiéō, “to make”) to describe this process of configuring and negotiating of meaning-making. Localizing it more explicitly in the context of narrative, Mark Freeman argues that poiesis captures “that sort of constructive, imaginative activity that is involved in our various [End Page 11] efforts to make sense of the world, both outer and inner” (2010: 43; see also Ricoeur 1983/1984: 48).

Narrative hermeneutics holds the promise of shedding new light on this kind of meaning-oriented, creative, imaginative, and in principle ever-open process of understanding, because it is narrative that plays a pivotal role in it. At the same time, it affords us the possibility to view the process of narrative understanding as a potentially never-ending interpretation, as something that is part and parcel of human life. Various theorists have pointed out that such interpretive processes cannot be understood as self-centered monologues or expressions of “inner life,” although they often have been perceived and described in this manner. In contrast, they have brought to bear several hermeneutic traditions of dialogical, relational, and conversational thinking—whether in Gadamer’s and Rorty’s proposals to conceive of all human investigation, both in everyday life and the academic world, as a conversation; in Derrida’s model of (inter)textuality and dissonant understanding; in Bakhtin’s notion of dialogical and multi-voiced language; in Habermas’s theory of communicative action; and in other conceptions of discursive and intersubjective interaction. All this has given center stage to interaction and the dialogical sphere of the social, suggesting a picture of mutual (which does not mean consensual) understanding as the primal model, the ur-scene of narrative interpretation.

Living and Telling

The existential significance of narrative sense-making practices and the relation between living and telling are issues debated not only in theoretical discourse but also in narrative fiction. In the wake of the crisis of “realist” storytelling in literary modernism and in postwar experimental fiction, many fictional narratives of the last few decades have engaged in an intense exploration of both the relation between narrative and experience and the intertwining of living and telling. Literature has developed, challenged, and scrutinized ideas on the ethical, cognitive, and existential significance of narrative for human existence, often in dialogue with or even in advance of the theoretical articulation of these ideas. While in theoretical debates the question of the relation between narrative and experience [End Page 12] is frequently put in rather dichotomous terms—for example, in terms of whether we “live” or “tell” narratives, whether they are imposed on our existence or found in life itself, or whether they are “good” or “bad” for us—narrative fiction can help us think beyond these dichotomies. As an approach to literature, narrative hermeneutics fosters awareness of this complexity and aspires to bring narrative theory and the study of narrative forms in literary history into a more productive relationship. It analyses different forms of narrative as historically changing modes through which humans interpret their being in the world.2

The irreducible tension between narrative and life was powerfully articulated by literary modernism. Virginia Woolf (1925: 188–89) famously asserts that literature aspiring to “likeness to life” should abandon “plot” and focus on the flux of consciousness as the mind “receives a myriad impressions.” Robert Musil’s Der Mann ohne Eigenschaften (1930–43, The Man without Qualities), in turn, reflects on the tension between “the overwhelmingly manifold nature of things” and the human need to believe that the “thread of the story” reflects the “thread of life itself ” and that our lives have a direction and a “course” (Musil 1930–43/1997: 159, 708–9). Jean-Paul Sartre’s (1938/1965: 61) Roquentin suggests that we have a natural inclination to storytelling but that there is something false and dishonest in this tendency: “You have to choose: to live or tell.” Partly in response to the experience of World War II, the nouveau roman further radicalized this critique of storytelling, drawing a sharp opposition between reality that resists human meaning-giving and narratives that try to impose meaningful order onto the chaotic flux of the real. By focusing on the description of disparate sense-perceptions here and now, nouveaux romanciers like Alain Robbe-Grillet and Claude Simon wanted to show how the world refuses human aspirations to narrative sense-making: “The world is neither significant nor absurd. It is, quite simply” (Robbe-Grillet 1963/1989: 19). Their novels emphasize that history is not “what the schoolbooks would like to make us believe” but consists of the insignificant, the fragmentary, and the everyday, such as the “dull existence of an old lady” (Simon 1958: 35–36). The suspicion of narrative as explored and developed by these postwar French writers found theoretical articulation in the work of a range of thinkers from Levinas (1948/1989) and Barthes (1953) to Kristeva (1969) and [End Page 13] other poststructuralists, who criticized narrative first and foremost for presenting a certain historical, contingent, human-made order as natural and inevitable.

Since then, literature has questioned in manifold ways the idea that narratives necessarily impose some kind of order on the disorder of the real. First of all, there are different forms of storytelling, and not all narratives attempt to mask their own cultural makeup. They can have the opposite aspiration and increase our awareness of the ways in which our relation to the world, to ourselves, and to others is mediated by cultural webs of narratives. Moreover, narratives can be highly critical of the norm of a coherent, linear plot and the idea of a single life-story; in fact, they can actively extend the limits of narrative and reflect on the tensional relation between narrative and experience. Even more importantly, after the strongest wave of postwar antinarrativism (which was most powerful in France), hermeneutically oriented writers (and, a little later, theorists such as Ricoeur) questioned the assumption, underlying most antinarrativist positions, that there are immediate raw experiences on which narrative interpretations are supposed to externally impose order. In contrast, they laid emphasis on the cultural mediatedness of human reality. As Georges Perec (1992: 88–89) puts it, “We live in a world of speech, language, narratives.” Likewise, Michel Tournier’s novels foreground the ways in which cultural narratives affect both how we retrospectively interpret our experiences and how we experience things in the first place. They show how individuals are entangled in narrative practices and construct their own storyworlds and narrative identities in a dialogical relation to cultural narratives, using cultural stories as material for assembling “a culture of their own” (see Tournier 1970: 18–19; 1994: 167–68)—a process visualized in Les météores (1975, Gemini, 1998):

All the boys had made the insides of their desk lids into miniature picture galleries of their dreams, memories, heroes, and private myths. So you would see family snapshots next to pages out of sport magazines and portraits of music-hall singers side by side with comic strips.

In Tournier’s novels, the cultural models of narrative sense-making do not determine what the characters become like; instead, they set a [End Page 14] framework for their projects of narrative self-interpretation. Their lives unfold as processes in time in which they have to constantly revise their expectations and their self-understanding. This corresponds to how hermeneutic approaches to narrative emphasize that we are always already in dialogic webs of interlocution, reinterpreting our experiences in relation to cultural narratives in a process that Ricoeur (1983/1984) characterizes as refiguration. In this process, narratives are “never ethically neutral” (Ricoeur 1985/1988: 249), but—as Tournier’s novels demonstrate by showing how, for example, the Nazi mythology and colonialism are linked to problematic strategies of myth-making—narrative form itself does not make narratives either ethical or unethical: everything depends on how it is interpreted and put into practice in intersubjective contexts of action.

Many contemporary novels offer variations of such metanarrative reflections on the nature and role of narrative vis-à-vis human existence. A recent example that deals with the intertwining of living and telling and with how narratives always already pervade our very experience is Julian Barnes’s The Sense of an Ending (2011). It unfolds not only the retrospective process of narrative self-interpretation but also how story models affect how we orient ourselves to the future—as when the young experience and plan their lives in relation to the books they have read. Narrative fiction shapes both their hopes and their fears, their desires and anxieties: “This was another of our fears: that Life wouldn’t turn out to be like Literature” (15).

Barnes’s novel oscillates between the perspective of the I-narrator, an old man looking back at his life, and the perspective of the experiencing self, living in the midst of events, which renders a sense of how the I experienced things at earlier stages of his life:

I remember a period in late adolescence when my mind would make itself drunk with images of adventurousness. This is how it will be when I grow up. I shall go there, do this, discover that, love her, and then her and her and her. I shall live as people in novels live and have lived.

(2011: 93)

Yet the time of telling and the time of experiencing do not remain neatly separate. The narrator first clearly indicates that he is reminiscing about his past, but in the second sentence the use of free indirect speech and [End Page 15] the shift to the present tense make the past experiencing self present. This past experiencing self, however, is also presented as an interpretation, oriented by the temporal horizon of the narrating I.3 The novel foregrounds how the autobiographical process makes past experiences present and how telling is always a matter of interpreting: “This is my reading now of what happened then. Or rather, my memory now of my reading then of what was happening at the time” (2011: 41). The novel investigates how we are always interpreting our previous interpretations: our lives unfold as such processes of constant reinterpretation of past interpretations. There is no reason to think of this process as mere distortion, as such critics of narrativity as Galen Strawson (2004) and Crispin Sartwell (2000) have suggested. In fact, what is most real is not necessarily given in immediate experience. Rather, often temporal—and that is, interpretive—distance is a means of sharper and more complex insight; it can help us see reality more clearly (Freeman 2010).

We see this as a key concern of narrative hermeneutics: to show that experience itself involves constant interpretation and that our narrative self-interpretations and the cultural frameworks in which we are entangled affect how we experience things in the first place. If cultural narratives already mediate experience as it is lived and we keep reinterpreting our experiences, as new experiences and points of view alter and challenge our former interpretations, and new stories we encounter prompt us to refigure our narrative identities, there is no need to view narrative as a matter of imposing order from without. Rather, from the very beginning, narrative is woven into the fabric of life in a variety of ways. It is not found, nor is it imposed, nor is it the result of a representation; rather it is created through practices of meaning construction. These narrative practices also take part in constituting our sense of who we are as individuals and as communities (with their specific cultural memory).

In this sense, literary narratives, too, have real, world-creating effects. Differently put, they have not merely cognitive but also existential and ontological significance, as they contribute to both the understanding of our historical world and our ways of being in this world. To be sure, literature has its peculiar means of doing this. Involving the full realm of the imaginary and experimentation with unconventional narrative forms, it can question our taken-for-granted storytelling practices [End Page 16] and open new possibilities of being, acting, experiencing, and thinking. Narrative hermeneutics conceives of literature and the other arts as forms of cultural self-understanding that have existential relevance, exploring most fundamental issues of our existence. It examines what makes artistic forms of narrative so uniquely appropriate to expand and, indeed, transcend the horizon of our understanding and imagination.

Understanding Health and Illness

In the last section we were mainly concerned with literary fiction. But, as noted at the beginning of this essay, the narrative approach to human existence and the hermeneutic approach to the narrative fabric of this existence have extended to a number of non-literary and non-artistic fields. These fields include the study of everyday narrative and discursive practices as well as scientific and applied disciplines, disciplines where human understanding, interacting, and social self-reflection are crucial. Striking examples are medical and health sciences, areas that only a few decades ago were hardly associated with narrative and hermeneutic thought.

Yet as a steadily expanding research literature documents, the significance of narrative practices of meaning-making has become recognized in various medical and clinical domains. They have been identified to play a role within scientific research practices and their overarching conceptual and philosophical framing; as intertwined with clinical activities of examining, healing, and caring; as integral to the teaching and training of novices in the field; and as central to the ways people reflect on and cope with the extraordinary challenges and experiences of illness and suffering. In the first place, these are, of course, persons who are immediately affected in their bodily and mental life and identity, but also individuals who care for them as care professionals, family members, and friends. Finally, there is the experience of falling ill, which often coincides with the experience of falling into the machinery of the medical apparatus. Both experiences have been articulated in myriad literary and journalistic works written in many different genres from report, memoir, and autobiographical essay to all forms of fiction and semi-fiction.

According to many medical and health-care scholars, what is [End Page 17] involved—or, from a more critical point of view, what needs to be involved—in all these areas and practices is what is called narrative competence. Narrative abilities are claimed to be pivotal, because the complexity of interactions among patients, their families, doctors and other health practitioners, and the public sphere demands an advanced ability to tell, understand, and interpret stories: stories of and about others and oneself struggling with the challenges of illness and death.4 In this light, the view has been advanced that understanding the complexities of life—specifically in the face of serious illness, its examination, recognitions, treatment, and the often ensuing existential earthquakes—is interpretive in nature. Such a hermeneutic view radically breaks with the empiricist and positivist philosophies that have often dominated the interpretation of modern sciences, including biomedical sciences. Even in this respect, medical scholars, health-care researchers, and bioethicists have increasingly adopted anti-positivist and hermeneutic orientations, further extending the narrative and hermeneutic turn that we outlined.

The stakes are high, be it in ethical terms or in terms of efficient health care and policies. Again, at a certain level of complexity, understanding of humans’ social, cultural, and corporeal life tends to take the shape of narrative. As Ricoeur (1991) had it, life manifests itself merely as a biological phenomenon as long as it has not been interpreted, and he saw this process of interpretation as ultimately depending on the form of narrative. That said, we should keep in mind that narrative experience is not the only form of human experience, even if it is true that the form of narrative, as Ricoeur emphasized, is inherent to humans’ specific “living experience of acting and suffering” (1991: 28).

This can help us explain why, as we have argued, the narrative dimension of this experience cuts across traditional borderlines between fiction and nonfiction, literary and everyday narrative, linguistic and nonlinguistic semiotic environments. All of this makes narrative medicine—a term that we use as a shorthand for the wider field of narrative studies of health, illness, and health care—a case in point for our exploration of narrative hermeneutics. With the emergence of narrative (or narrative-based) medicine, the hermeneutic orientation toward interpretive understanding has been meandering into a realm where healthcare practitioners and theorists have increasingly come to understand [End Page 18] health and illness (including injury, disability, atypical development, and other existential challenges) in narrative terms. It is to this hermeneutic orientation of narrative medicine that we want to draw attention.

It would be hard to claim that there has been a cogent intellectual genealogy leading from mainly European philosophy to mainly Anglo-Saxon theorizing on the narrative dimension of medicine. Yet there are obvious conceptual continuities represented by influential theorists familiar with both traditions, such as Taylor, Rorty, and Ricoeur. In a medical reading of Ricoeur, James D. Lock notes:

To suggest that hermeneutics on the Ricoeurian model has a role in medicine is to make some rather broad assumptions. The first of these is that medicine is subject to the same kinds of limits that other human knowledge and activities are subject to—namely, that understanding, describing, and carrying out the activities of medicine are mediated by language. In Ricoeurian hermeneutics this mediation is thoroughgoing, allowing no privileged access by either the science or art of medicine.

(1990: 42)

Against this backdrop, we want to further advance our argument by considering some of the assumptions, values, and practices that Rita Charon describes as the core of narrative medicine. Charon has distinctively contributed to the theoretical elaboration (and institutional establishment) of narrative medicine at many medical schools, not only in the United States. We want to use the pointed outline of the project she gives in Narrative Medicine: Honoring the Stories of Illness (2006) to foreground some of the specifically hermeneutic underpinnings of narrative medicine (which Charon and many of her colleagues conceive of as a new theoretical frame for clinical work and health care in general, rather than only a medical specialty).

In the literature there are two different strategies of advancing the vision of narrative competence in medicine. Both consider the present state of health care as highly problematic; in fact, for many it is deplorable, mainly because of the dominance of biomedical and technology-based approaches, the influence of the medical and pharmaceutical-industrial complex, and the excessive commodification of health care in the wake of neoliberal policies. In view of this situation, one line of [End Page 19] argument puts forward alternative visions of better health care implementing more humane (or humanistic) and ethically responsible principles of medicine—narrative medicine, that is. The other line is committed to the same mission but chooses to bring to the fore how much even the present clinical system—indeed, every kind of health care—necessarily implies narrative modes and practices of understanding and care, with the implication that clinicians should become aware of them, further developing them proactively. This second line is that of Charon.

In her view, there is little in the practice of medicine that does not have narrative features; in fact, “medicine is a more narratively inflected enterprise than it realizes” (2006: 39). Clinicians aim at understanding a wide range of diverse phenomena that happen in the field of human experience of health and illness, and to act on the basis of this understanding. Narrative sense-making is a challenge not only for the sick and suffering but also for those who care for them, do research, learn, teach, and theorize medicine and health care. In Charon’s analysis, all these practices are “indelibly stamped with the telling or receiving or creating of stories” (2006: vii).

If we look at this portrait of medicine from the perspective presented earlier, it appears to be suffused with hermeneutic practices: with activities of understanding and interpretation of the stories of patients and their family members, of charts and accounts, of bodies (and their interpretation by those who embody them), and with strong emotions, including the emotions of caregivers themselves. Charon describes typical encounters with patients in her clinic room at New York’s Presbyterian Hospital. Most of them are poor, elderly, and sick women of color from the Dominican Republic or Puerto Rico, living in rundown New York neighborhoods. Over the years, she slowly comes to see her task as an internist as one to realize that “what my patients paid me to do was to listen expertly and attentively to extraordinarily complicated narratives—told in words, gestures, silences, tracings, images, laboratory test results, and changes in the body” (2006: 4).

What additionally complicates things is that the physician’s interpretive task is supposed to be goal-oriented: she has to cohere all these stories into something that she can act on. Very diverse narrative genres, often suggesting only story fragments, have to be boiled down [End Page 20] to an intervention-enabling, helpful story line. And there is more than just one teller. There is, of course, the patient, yet often there also are family members and friends; there are reports by employers, school authorities, social workers, and police; there are nurses who tell what happened in the emergency room, interns dictating hospital discharge summaries, therapists and other doctors who are also involved and have written in the medical chart. “What I was listening for and reading for,” Charon remarks, “were diagnostic clues to help identify a biological or emotional source of the patient’s symptoms, autobiographical background to help me understand who it was who bore these symptoms, and grounds for personal connections between the two of us sitting in that little room” (2006: 4).

How can one carry out all these tasks? And what happens if one indeed manages to carry them out, in a way that lives up to medical standards and is helpful and respectful to the patient? This is Charon’s answer:

In order to do all these things at once, I had to do what all doctors—ideally—do, whether they realize it or not. I had to follow the patient’s narrative thread, identify the metaphors or images used in the telling, tolerate ambiguity and uncertainty as the story unfolded, identify the unspoken subtexts, and hear one story in light of others. . . . Like the reader of a novel or the witness of a drama—who naturally do all these things seamlessly—I also had to be aware of my own response to what I heard, allowing myself to be personally moved to action on behalf of the patient. I was the interpreter of these accounts of events of illness that are, by definition, unruly and elusive.

(2006: 4)

In drawing a portrait of the medical and clinical world as a narrative world, Charon pays particular attention to a number of features that have also been pointed out as essential to the hermeneutic structure of human understanding by Heidegger, Gadamer, Ricoeur, and others, as we sketched in the first parts of this essay. This is not to say that Charon or any other theorist of narrative medicine takes philosophical considerations as his or her point of departure. Charon draws mainly on clinical realities, based on her long-standing experience as an general internist who has become more and more aware of the role of stories as “membranes of care” (Charon 2012). But if we take a closer look [End Page 21] through the lens of hermeneutic theorizing at this doctor’s descriptions and the stories she tells about her clinical encounters, we discover an amazing presence of hermeneutic gestalts. In particular, narrative medicine appears to be saturated with attention to the following elements:

  • • the understanding of meaning—of acts of meaning and meaning-making—rather than prepositions or information or “facts”

  • • the existential charge of the human condition in the clinical border zones between life and death, where many of the events at stake have far-ranging consequences of enormous gravity

  • • the understanding of singularity, of always unique human individuals with singular diseases, treatments, and predicaments

  • • the recognition and understanding of otherness, of other persons and other physical and psychological ways of being in the world, especially with respect to patients and their family members, but also to colleagues and co-workers

  • • the interpretive, hermeneutic imperative—that is, the need to grasp illness events and the plights of the individual human beings afflicted by them through, in principle, open-ended processes of interpretation

  • • the understanding of persons and their diseases and ordeals, and imagining of their experiences (Charon speaks of “clinical imagination”), from their points of view; in fact, from multiple points of view

  • • a multitude of often contradictory sources of authority that have to be recognized, paid heed to, critically interpreted, and applied to the specific situation of an individual

  • • the significance of language—in the form of writing, reading (sometimes even “close reading” akin to narrative analysis in literary contexts), and interpreting of texts, conversations, charts, statements, laboratory reports, narratives, life stories, and case histories

  • • the need to bring one’s own thoughts, sensations, and perceptions to the level of language, in this way bringing them to one’s consciousness

  • • an attitude that permits one to expand one’s horizon and to let it [End Page 22] be challenged by others, entering into relations of dialogue and trying to empathically understand their physical and psychological situation in their life-world

  • • the interplay between the whole and the particular (the “hermeneutic circle”) that emerges from the fact that “patients and their caregivers enter whole—with their bodies, lives, families, beliefs, values, histories, hopes for the future—into sickness and healing,” which is to say that their “efforts to get better or to help others get better cannot be fragmented away from the deepest parts of their lives” (12–13)

Many of these hermeneutic gestalts and practices also underlie other descriptions and accounts of narrative medicine.5 To add some concluding remarks to the last point—the patient’s sense of wholeness vis-à-vis its threat—we want to stress the significance of the narrative dimension of these practices in light of the narrative hermeneutics explored in this essay. For Charon, it is exactly this sense of wholeness that is reflected, if not created or evoked, by the stories of the patients—stories that themselves are rarely whole but typically fragmented, broken, and enigmatic—whether they are told in medical interviews, late-night emergency telephone calls, hasty personal remarks to a nurse, or the wordless rituals of the physical exam.

Without narrative acts, the patient cannot convey to anyone else what he or she is going through. More radically and perhaps equally true, without narrative acts, the patient cannot himself or herself grasp what the events of illness mean. And without telling about or writing about the care of a patient in a complex narrative form, the caregiver might not see the patient’s illness in its full, textured, emotionally powerful, consequential narrative form.

(2006: 13)

It is in this sense that we have argued for a notion of the hermeneutics of narrative that is not limited to storytelling in linguistic, discursive, and literary contexts, but rather one that conceives of narrative practices as forms of life in a broader sense. Narrative practices in any social and semiotic environment—our examples ranged from everyday storytelling to literary texts and the lifeworlds of health and illness—realize [End Page 23] what we have called existential acts of meaning. We have described these acts as interpretative and dialogical mediations of our relations to the world, including our relations to ourselves and to others. This is not to neglect the important differences among various categories of narrative practices; it rather is to provide an overall framework for studying their differences, similarities, and interrelations. Narrative hermeneutics, on this view, offers an interpretive approach not just to storytelling but to the human being in the world at large, and combines this with a perspective of narrative as a hermeneutic practice in itself.

Jens Brockmeier

jens brockmeier is a professor at The American University of Paris. He has a background in philosophy, psychology, and language studies, and his interests include human identity, mind, and narrative, which he has examined in a variety of cultural contexts and under conditions of health and illness. He also is a visiting professor at the University of Manitoba and a Senior Visiting Member of the Centre for Narrative Research at the University of East London.

Hanna Meretoja

hanna meretoja is professor of comparative literature at the University of Tampere and adjunct professor and research fellow at the University of Turku (Finland). She is the director of Narrare: Centre for Interdisciplinary Narrative Studies and the research leader of the interdisciplinary project “Ethics of Storytelling and the Experience of History in Contemporary Arts” (2013–15, funded by the Emil Aaltonen Foundation). Her research interests include narrative theory, hermeneutics, and the interrelations between literature, philosophy, and history. In The Narrative Turn in Fiction and Theory (Palgrave Macmillan, 2014) and several articles, she explores the philosophical and historical underpinnings of different conceptions of narrative.

Notes

1. Here and elsewhere in this article, when the references are not to existing translations, the translations are our own.

2. For a more detailed account of narrative hermeneutics as an approach to the study of literature, particularly in relation to the crisis and return of storytelling and to their philosophical and historical underpinnings, see Meretoja (2014b).

3. Narratology traditionally separates the frames of experiencing and telling, and the experiencing I and the narrating I, but narrative fiction frequently destabilizes such dichotomies by oscillating between the past, experiencing self and the present, interpreting self and by showing how the different dimensions of time impregnate one another in lived experience.

4. We want to mention only a few exemplary publications from an extensive research literature that have especially informed our argument: Charon (2006, 2012); Frank (1995); Gunaratnam and Oliviere (2009); Hurwitz, Greenhalgh, and Skultans (2004); Hurwitz and Tansey (2015); Hydén and Brockmeier (2008); Mattingly (1998); Hunter (1991). In the discussions on the relations between narrative and medical knowledge a major role has been played by the journal Literature and Medicine.

5. The term underlying denotes an implicit use. Keep in mind that for long there was no explicit reference to, or awareness of, hermeneutic thoughts or attitudes in the emerging field of narrative medicine. In her pathbreaking book Doctors’ Stories: The Narrative Structure of Medical Knowledge, Montgomery Hunter (1991) pointed out that medically efficient encounters between doctors and patients rely heavily on narrative interactions, which is quite different a scenario from the common practice to “translate” the patient’s story into a medical shorthand account called diagnosis. However, as Hunter (2013) reports, the reviewers and editors of her book insisted on her deleting the word hermeneutics from the manuscript, which was considered too alien to the nature of medical knowledge. [End Page 24]

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