Meaning in Suffering: Caring Practices in the Health Professions

4: Narrative Phenomenology: Exploring Stories of Grief and Dying

4 Narrative Phenomenology Exploring Stories of Grief and Dying craig m. klugman As a way of putting the death of a loved family member or friend into perspective, people tell stories. They discuss who the deceased person was in life, how the person died, and what their own life has been like since the death. During the conduct of a needs assessment study that inquired about the resources people needed to assist them with grieving and to able to die “well,” I became intrigued with the stories people told me. Wondering why people were telling me such stories and what function the stories served, I concluded that telling one’s story seemed to be a way of bringing order out of the chaos that ensues from a loss (Becker, 1997). Reflecting on the stories that emerged from clinical practice, I noted that narratives enabled a patient to share an experience with another who did not have direct access to the experience. Through stories clinicians learn not only about symptoms and perceived causes but also about the meaning that these things hold for the patient (Good, 1994). Since stories enable healthcare professionals to gain an understanding of their patients’ lived experiences and enable empathy and diverse human engagement, stories offer clinicians a way of enriching their practice. Narrative Theory The telling of narratives—whether through oral storytelling or through published books—is a fundamental human activity that allows 144 conversations and experiences to be shared among people and, often, across cultures (White, 1981). Humans use narrative to structure experience , order memory, connect to other people, and build a life history (Bruner, 1987). Narrative humanizes time and action so that people can comprehend events and deal with their emotions (Richardson, 1990). Anthropologist Byron Good (1994) calls this process of constructing a story narrativizing, “a process of locating suffering in history, of placing events in a meaningful order in time” (p. 128). In healthcare practice it is evident that patients use narrative to make sense of their illness and to integrate its experience into their life (Good, 1994; Kleinman, 1988). Healthcare providers employ narrative to learn about a patient’s illness through empathy, to recognize their own personal medical stories, to connect with other healthcare professionals, and to talk with patients about healthcare (Charon, 2001). Broadly conceived, narrative is a series of interpreted events connected through time, within which one or more characters change or react to change (Ricoeur, 1981a). A narrative is a text that attempts to make sense of the lived reality of certain characters as they progress temporally from one event to another. Narratives are “kinds of discourse organized around the passage of time in some ‘world’” (Polanyi, 1985, p. 10). Norman Denzin (1989) defines narrative as “a story, having a plot and existence separate from [the] life of [the] teller” (p. 48). Philosopher Paul Ricoeur (1981a) explains that a narrative should be “self sufficient,” complete without additional explanation or comment. Donald Polkinghorne (1996) defines narrative as “a storied linguistic production of a person’s emplotted configuration of life events into episodes or a whole life” (p. 78). According to the Oxford English Dictionary Online (2001), narrative derives from the Latin narrare, which means “to relate, recount , give an account of.” Although some narratives may be told in order to entertain, others are presented for a specific purpose, such as to comment on the world or an experience (White, 1981). “Stories are told to make a point, to transmit a message—often some sort of moral evaluation or implied critical judgment—about the world the teller shares with other people” (Polanyi, 1985, p. 12). For example, a narrative may be told to educate, to complain , to motivate, to inform, to sway, or to elicit sympathy and hope. Humans use narrative to transmit ideas, thoughts, knowledge, culture, opinion , and experience, both personal and social. Narrative Phenomenology 145 146 craig m. klugman Ricoeur has had a strong influence on the development of anthropological narrative theory. His writing attempted to create a philosophical anthropology that combined phenomenological description with hermeneutic interpretation. From his foundations social scientists have further developed his work to create the richness of narrative theory. Narrative has been widely used in qualitative research as a method for knowing the experience of another. Anthropologists such as Byron Good, Clifford Geertz, Arthur Kleinman, Sharon Kaufman, and Barbara Myerhoff have interviewed their participants to...