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Narrative Approaches to Wellbeing

Author: joe

Monday, 23 May, 2011 - 21:54

I have recently been holed up writing a paper to be delivered at a conference later in the year. It's felt like a good exercise to express in one concentrated piece a lot of the intellectual development I've covered in the process of doing my PhD, and even though I don't address the specific issues around bereavement that I'm examining in my doctoral research, this paper captures the main thrust of my thinking. It's been a really bad time to write the paper itself - dissertation marking, bill-paying and most importantly wanting to spend time giggling inanely with my baby girl; but hey, when is it a good time? Anyway, here's the paper. Feedback welcome - it's currently under review so any comments in advance of the final draft will be gratefully received.

Narrative Approaches to Wellbeing

The Self-Annalist

The Reverend Robert Shields of Dayton, Washington, died in 2007 at the age of 89, leaving tens of millions of words of self-narration behind him. Numerous news reports from the New York Times to Boing Boing noted his production of the world's longest diary, which he wrote in considerable detail, down to five minute intervals, pausing to sleep only for brief periods. The vast majority of his output remains obscure since he bequeathed his diary to Washington State University on terms that will restrict its publication until 50 years after his death. However a few pages of his writing found their way onto the Internet following an interview with the reverend about his diligent self-documentation which aired on NPR in the mid 90s. These pages, once digitised, were low-res but readable, and showed a few of the typed sheets listing the everyday events of 25 years of his life, from moments of metaphysical contemplation to frequent instances of bodily evacuation, as in this passage from the early morning of April 19th, 1994:

12.30 – 12.55 I squatted on the throne and purged a #2, a slurry and slush and partly a solid state, while I read from the Swedenborg Concordance entries under End (conclusion, purpose, intent). I meditated as I read. Everything in man and of man is directed by, controlled by and governed by the end of his intentions, and his end is the purpose of his life's love. All else is adventitous. Whether the end is heavenly or not depends on whether the purposes are directed toward the good of the Lord, his church, and the neighbor, or towards one's own gratification. I am earnestly examining myself in respect to my motivations. I honestly don't know what governs me. I don't know whether my goals are selfless or not. In any case, the self seems to be in them. Or is it? I struggle with my thoughts.

On the subject of his intentions, there are conflicting accounts. The recirculation at the time of his death of the few available diary extracts provoked speculation and comment: some parts of the press noted his completionist approach and wide vocabulary in describing urination; other parts of the web diagnosed him at best as an obsessive and at worst a candidate for "nutorama"; editorials warn us of the numbing mundanity of his diary; meanwhile he is included in a compendium of "eccentrics, visionaries, dreamers, believers". For his own part, he offers little in the way of explanation for his "self-annalising". In interview he confesses it to be an obsession, though he is not sure what he is trying to do. He puts it down to his "make-up", his "nature"; but also speculates that the diary with its encyclopedic detail and stuck-in nostril hairs may be of use to future historians and geneticists. He allows himself a certain pride in his endeavour, describing it as "uninhibited" and "spontaneous", "No restrictions. No holds barred". "I'm doing something that no one else has ever done in the history of the world' he asserts, even though he confesses when asked why he writes: "I don't know why any of us do anything. That's the truth."

The demands of archive maintenance have an impact on his life of course: he doesn't leave town because being away overnight would get him behind - even shopping in the nearest city 30 miles away forces him to take notes which he then has to spend a day catching up on. He has many achievements to his name - ghost-writing erotic stories, producing Civil War novels, as well as a career as a minister - but these appear to date from the period of life before he turned earnestly to diary-writing. Leaving aside the interesting meeting of eroticist and ecclesiast, one might wonder whether he hasn't sacrificed living in favour of recording; but not keeping the diary, he says, would be like "stopping ... turning off my life". "I don't think it has happened unless I've written it down."

Although the portrayals of Shields in the various news reports often invite us to consider his eccentricity as pathological - either sympathetically as unhealthily compulsive or more brutally as a sheer "nutcake" - I want to avoid casting him in this role here if I can. He illuminates for me an urge to self-document which I recognise to some extent in myself and a multitude of self-archivists whose traces are daily accreting on the web in gigabytes. He is at once a paragon of journal-writers, but an outlying anomaly offering an ambiguous warning and invitation. The self-chronicle functions as a technology of the self - a device and process whereby selfhood is grasped and established as a form of intentionality - yet it instils a fear of obsession, self-absorption and narcissism. So I want to use Robert Shields, as a foil, as a text - as a tool for thinking about the function of narrative in wellbeing. Reverend Shields materialises an example of life as narrative, in which a person becomes both the object and subject of their own existence, ambiguously triangulated by an indefinite other: playwright, actor and spectator; narrator, protagonist and narratee. These triple roles are, I will argue, crucial to a formulation of narrative as a tool for personal development and wellbeing. Throughout this paper the reverend thus sits on his sun-porch with his 91 boxes of journal manuscript, begging questions of the claims I make, but reserving judgment on their fitness.

Narrative Therapy

The use of narrative is well-established in therapeutic situations. John McLeod offers a way of understanding the use of story as part of a psychotherapeutic process by contrasting narrative knowing with paradigmatic knowing. The latter emphasises abstract, propositional knowledge of the kind valued in scientific practices for its objectivity; the former by contrast emphasises the concrete knowledge of experience, context and significance. Paradigmatic knowledge strives for factuality, eliminating ambiguity and subjective evaluation and as such proves useful in systematic inquiry and instrumental endeavours, but less useful in providing the scaffolding necessary for people to understand their own lives. Narrative knowledge is precisely the kind of resource that makes it possible to contextualise facts into meaningful situations, and articulate the hazy significance that seems to surround human actions.

McLeod itemises a number of ways in which narrative knowing, and story-telling generally, are helpful in therapeutic situations: stories, he notes, give us our own personal myths, helping us to handle the multiplicity of our of selves; they offer ambiguity, allowing space for interpretive and imaginative acts, and as such they are liminal, offering "threshold" experiences which can be personally transformative or cathartic; they have sequentiality and thus impel events into an order, reducing apparent chaos, helping us to solve problems, and assimilate the exceptional; and they are shared experiences, opening windows into each others' lives, forging social bonds and implying a moral landscape where they emerge around sites of social conflict.

These tensions between selfhood and, on the one hand, the multiple selves we seem to be, and on the other, the community of social identities we live amongst, also feature in Celia Hunt's account of the therapeutic dimension of autobiographical writing. She draws on Hesse's notion of a "melody for two voices" and Bakhtin's concept of polyphony to explore the reflective acts necessary for comprehending what we might usefully call the self for-the-self, and the self for-others. For Hesse, the voices of the self both as self and as witness of the self are essential to breaking the unreflective absorption in life which breeds neurosis and peevishness. Hunt suggests that opening up and creating distance between the witnessed self and the witnessing self allows the narrative identity of each to be clarified. Meanwhile Bakhtin's celebration of the polyphony of novelistic discourse, in which a writer allows the many varied voices of the novel's world to stand on an equal footing with the author's own voice, depends on the "exotopic" self - the self who is able to experience an "outsideness", a protean ability to voice a "plurality of consciousnesses, with equal rights and each with its own world". The process of writing exotopically, notes Hunt, "demands a greater degree of psychic flexibility than would be usual in everyday life".

Thus the recognition of and intersubjective dialogue between multiple selves, both within the individual, and in a community of people, are crucial aspects of the therapeutic potential of narrative. The act of writing is a reflective tool permitting us to open and explore facets of selfhood and otherness: the sense of the unitariness of the self and its multiplicity as many-in-one, the oneness of the self and its constitution as one-among-many. But to state in this way the powerful scope for personal development that belongs to narrative opens further questions: does the capacity for nurturing wellbeing belong to all kinds of narrative experiences, or a particular kind? Are writers the beneficiaries of a healthy habit, and ought we all to write? Is the place of narrative in wellbeing reserved for the therapeutic situation, a tool to be applied in cases of illness and malaise, or is an engagement with narrative a more fundamental dimension of both being human and being well?

I don't intend to provide exhaustive answers to these ambitious questions, but to begin outlining some broad conceptions of narrative that might suggest ways that it is implicated in wellbeing. The use of narrative as therapeutic device which I've described could be seen as a way of considering some aspects of wellness which match the characteristics of story-telling. I propose to reverse the direction of this movement, and instead try to draw out some key aspects of narrative and search for ways in which they match conceptions of wellbeing. Meanwhile, I wonder whether the reverend listens to these suggestions and reflects on his own writing. His words suggest he grapples with a faceted sense of self: "I struggle with my thoughts." Are his goals selfless, and if he finds the self in them, what would it mean for the self to be absent? As for the story - does his stupendous diary function as a narrative at all, or does the exhaustive documentation of every feature of life diminish the capacity to establish the significance of events? When does a chronicle become a narrative, and must a narrative be selective in order to establish an order that is not merely factual and chronological?

The Aristotelian Narrative

Narrative theory has a long provenance - over 2000 years if we take Aristotle's Poetics as the first work of literary theory, as Richard Janko suggests in the introduction to his translation. The Poetics defines a number of ways of thinking about what a narrative ought to be, and thus offers a set of prescriptive criteria whereby the art of epic poetry or tragic drama might be perfected. Such instructions are intriguing of themselves, but I wish to draw out three features of Aristotle's analysis of tragedy which seem particularly relevant to the questions of selfhood and wellness. These are mimesis, the verisimilitude of stories to real life; anagnorisis, the recognition of an authentic identity; and catharsis, the famous emotional 'purging' which the experience of narrative should facilitate.

In an Aristotelian view, stories achieve their effect through their believable imitation of life, without which the suspension of disbelief would be impossible. Inviting us into the diegesis, the world of the story, compels the author to present a familiar world like our own, a world of things and laws and events and causes, and of people whom we can recognise as like ourselves or as we'd like to be. Recognition thus occurs at two levels, as we recognise the authenticity of the characters of the story, and those characters themselves discover either their own or each others' true nature - a key to Aristotle's understanding of tragedy. The moment of recognition is often key to the emotional welling which should be aroused in us, since it depends on the hamartia of the protagonists - their mistakes and errors of misrecognition. It is as witnesses to the ignorance and bloody-mindedness of our fictional counterparts whose misjudgements lead to their downfall that we experience pity for their lot and terror for our own.

The cathartic effect which Aristotelian narrative aims for thus depends on the sharing of feeling - empathy for the plight of the tragic characters which manifests itself as a vicarious experience of the same emotions. The exact means by which catharsis functions has been the object of debate. Aristotle borrows the term from medicine where it refers to purification by purgation - the cleansing of the body of excesses. Interpreting it in this way encourages us to understand the role of the vicarious experiences provoked by narrative as releasing extraneous emotions which will presumably become dangerous if they are allowed to stagnate. Janko points out that this conception of catharsis suggests its purpose is best served by an audience of people who are disturbed and unbalanced, and its function is to ensure that their pent-up arousal doesn't escalate into hysteria. Meanwhile, Janko's own proposition is that catharsis instead is a device for learning to feel the "correct emotion toward the right object, at the right time, to the proper degree"; narrative is then a rehearsal space in which we should be habituated into the correct responses towards people and actions, thereby becoming "tractable for education".

Both of these interpretations of catharsis entail an understanding of narrative which is normative - whether it is through prevention of hysteria or socialisation into the correct emotional composure. The normative drive in Aristotelian theatre can be detected in the theatrical conventions that arose as the prescriptions of the Poetics were naturalised. The protagonist ought to be someone 'above the common level', such that the events of their life are of no little consequence; tragedy should befall characters not as punishment for vice but as the consequence of human frailty; the unfolding of the drama should express unity of time, place and action thus maintaining the imitative mode. The spectators of such dramas are often provided with an omniscient view of the helpless players, increasing the poignancy of dramatic irony, highlighting the catastrophe of inescapable fate and affirming the inevitability of the tragic outcome for the pawns in the world of the master author. Goethe and Schiller at the end of the 18th century reinforce this sweeping surge of emotional vicarity and epic scope, writing that the spectator of this theatre must remain in "constant sensuous exertion, is not allowed to elevate himself to reflection, he must passionately follow, his imagination is completely reduced to silence, one is allowed to make no claim upon it, and even what is narrated, must be as if it were graphically brought before one's eyes".

It is precisely this immersion into passion, this tide of predestination and its concomitant silencing of imagination, that Bertolt Brecht later reacted against so strongly in his conception of a non-Aristotelian theatre. Brecht famously argued in favour of the Verfremdungseffekt: alienation, distantiation and estrangement are all short-falling translations of this German term. These negative renderings themselves hint at the pervasive triumph of cathartic absorption that Brecht so disliked. Suzanne Langer's description of the misery of experiencing the shattering of the immersive illusion of a story captures all that was Brecht thought was wrong with the old bombastic theatre:

I ... remember vividly to this day the terrible shock of such a recall to actuality; as a young child I saw Maude Adams in Peter Pan. It was my first visit to the theater, and the illusion was absolute and overwhelming, like something supernatural. At the highest point of the action (Tinkerbell had drunk Peter's poisoned medicine to save him from doing so, and was dying) Peter turned to the spectators and asked them to attest their belief in fairies. Instantly the illusion was gone; there were hundreds of children, sitting in rows, clapping and even calling, while Miss Adams, dressed up as Peter Pan, spoke to us like a teacher coaching us into a play in which she was taking the title role. I did not understand, of course, what had happened; but an acute misery obliterated the rest of the scene, and was not entirely dispelled until the curtain rose on a new set.

Misery and obliteration: Brecht notes that indignant reactions are the correct response to the broken diegesis of a traditional narrative. Such a story presents itself as a self-contained, hermetically sealed world, outside which we must leave our imaginations when we enter; it presents a world of unchanging destiny, where disproportionate tragedy befalls people for their weakness or their hubris, rather than as a just punishment for their evil; and it is an ordered world of beginnings, middles and ends, in which the protagonists are powerless to escape their inevitable fates, since it is a world that is completely determinate, rational, explicable, inexorable. No wonder that we should, as Aristotle puts it, "thrill with fear and melt to pity at what takes place" - and no wonder, too, that, when the integrity of this spectacle disintegrates, we should, like Langer, crash to earth with misery and incomprehension.

I interpret Langer's misery at the rupture of her immersion into the storyworld as a direct analogy to the "unhomeliness" that Heidegger notes arises when our own world of being is disrupted by the obtrusiveness and obstinacy of things that seem not to belong - indeed the fracturing of the coherence of our world by traumatic events and exceptional circumstances is a key aspect of our experience of anxiety and illness. The order of our life and any sense of its providence descend into inexplicability and doubt. The "letting-be" that Heidegger suggests consists in an authentic sense of being at home in the world is lost to a sense of estrangement and unbelonging. The unity of life, events and actions no longer coheres.

9.00 - 9.05 I had to take a nitroglycerine tablet
9.05 - 9.45 I sat on the fixture voiding urine and reading Swedenborg on End, England, other subjects. I wish I knew something. Anything would do.

The Estranged Narrative

Brecht's alienation effect aimed at a different sort of defamiliarisation. Martin Esslin notes in his study of Brecht that he thought the Aristotelian theatre was a fraud. Instead he "demanded a theatre of calm contemplation and detachment, a theatre of critical thoughtfulness", where audiences should think for themselves, rather then be swept away in emotion. In his essay celebrating Chinese theatre, Brecht himself talks of a distance not only between the spectator and the world of the play, but between the actor and the role in which he is cast. This distance ensures that the performance is not imitative, but an artistic rendering of character; the actor clearly knows he is a part of a performance, and the spectators do not surrender themselves to empathy, but instead enter a reflective mode and adopt a "watchful attitude". The alienation at work here, then, does not strive to drive a wedge between the world of the spectator and the world of the performance; rather the remoteness between audience and actor is reduced, while the storyworld they are experiencing, either as observers or as players, is pushed far enough away for it to become the object of their shared contemplation.

One of the effects Brecht hoped to produce with this reorganisation of story, player and spectator was to historicise the drama. The Aristotelian theatre emphasised the unchanging universality of events, while Brecht's epic theatre emphasised their particularity. Aristotelian theatre proceeded inexorably toward endings, while Brecht's performers could "freely range forward and backward in time". Aristotelian theatre showed people at the mercy of fate, while Brecht's theatre invited the viewer to consider how things might have been otherwise. Aristotelian theatre thrilled the audience into submission, while Brechtian theatre strove to stimulate them into reflection. The challenge Brecht presented was to say that narrative was not there for us to learn the way of the world, but to provoke us into changing it. Injustice is not merely a doom that befalls hapless victims at the hands of fate, but is something that is carried out by oppressors in ways that can be contested.

In direct contrast to the normative tendency of the Aristotelian theatre, Brecht's theatre is avowedly political and aligned with the Marxist effort to disrupt dominant ideologies. However, the function of narrative in this conception is aimed at restoring the dignity of the individual not only through the wholesale restructuring of the social order, but through the transformation of the individual's consciousness. The Brazilian playwright Augusto Boal identified himself with the Brechtian tradition in his book Theatre of the Oppressed, by critiquing what he called the "coercive" nature of Aristotle's system of tragedy, claiming that "spectator" is a bad word, since the "spectator is less than a man, and it is necessary to humanise him". Boal conceives of the division of spectators from actors as an enclosing intervention by the ruling classes in the history of theatre. He writes: "First they divided the people, separating actors from spectators; people who act and people who watch— the party is over! Secondly, among the actors, they separated the protagonists from the mass. The coercive indoctrination began! " Philip Auslander helps to clarify Boal's aims here, by placing his work in the context of Marx's concern for what is human:

For Marx, alienation is pernicious primarily because it is dehumanizing: human beings, who are supposed to be autonomous, free subjects, endow things outside of themselves, whether another class, a deity, or the products of their own labor (commodities), with power over themselves and become slaves to those things. As I have suggested, Boal’s use of the basic categories of Marxism in his analysis of the body in performance suggests that, like Marx, Boal wants to overcome alienation and restore basic autonomy by eliminating actor and spectator in favor of the spect-actor, thus undoing the traditional division of theatrical labor and overcoming alienation (the audience’s surrendering of its autonomy to performers who act in its stead) and returning the "protagonistic function" [...] to the audience from which it was taken ...

It is precisely the tendency to delegate human agency to things outside ourselves which Marx, Brecht and Boal aim to challenge. Fetishism in both Marxism and in Freudian analysis refers to the way that potency is attributed to objects instead of human action. Thus it is that thrill-seeking audiences surrender their emotional lives to the characters in Aristotelian tragedy, no less than they accept that they are just as powerless to intervene in their own fate as that of the tragic characters themselves. Meanwhile the purpose of Brecht's Lehrstücke, experimental dramatic pieces in which the distinction between audience and actor is dissolved, and of Boal's 'forum theatre', in which audiences can intervene in an iterative unfolding of dramatic situations, is to restore autonomy to the individual human and remind them of their own radical empowerment. After all, if we devolve our autonomy to objects and players to act and feel on our behalf, whether they are fetishes, actors, institutions or leaders, we have deferred both our ability and our responsibility to determine our own lives.

From 'The Spokesman Review', 14th December 1995:

He says the diary doesn't control him. He says he could quit. But he won't, even though a minor stroke a few years ago slowed his typing speed. [...]
"Some people would say 'Well, he's a nut,"' said Shields, seemingly unfazed by the prospect. "Maybe I am." He'd rather be called an eccentric.
Asked if he worries about a fire or another stroke, Shields smiled like someone about to reveal a secret. "I don't worry about anything," he said. "Everything is in the hands of God."

Pasts and Futures

The tension between determinism and agency that is at the heart of the contrast between the dramatic tragedy of Aristotle and the epic theatre of Brecht, is implicated in the structure of narrative itself, and as I intend to argue, provides a way to understand how narrative is involved in a sense of wellbeing. The self is in a tension between its future and its past, its intentions and its history, its destination and its provenance - and this is a tension at the heart of every narrative which is bounded by the role of the author. Just as the author determines the intelligibility of the events of a story, so the self strives for authorship over its lifeworld, and the freedom of self-direction. This freedom apparently entails a paradox, however: the same paradox that is inherent in an author devolving free will to a character, yet maintaining the integrity of that character's world.

To help us understand the directedness of narrative, we can turn to Tvetan Todorov, the bulgarian philosopher, who proposed a very influential but essentially simple definition of narrative, which, he argues, is constituted by the progression from one state of equilibrium to another, through a stage of disequilibrium. Todorov examines a story from Bocaccio's Decameron, arguing that the presentation of a cast of characters living in Naples is not enough to qualify as narrative - it is only when Bocaccio begins to transform the states of affairs and the attitudes of the characters that we can understand his tale as a narrative. This transformation is an "unfolding of an action, change, difference", and leads Todorov to the insight that narratives have two principles: succession and transformation. Elements of stories are related to each other both by succession (following on from one another) and transformation (embodying change).

At the heart of stories, then, are transformations: upsettings and degradations, restorations and reversals. Narratives which only tell part of this transformation (which perhaps only have the degradation without the restoration), are only "half a cycle". To fulfil a complete cycle, a narrative must unfold and present succession; it requires transformation, and moves towards endings and resolutions - thus, narrative points at an implied future. Perhaps for this reason, Todorov says that death has an "exceptional narrative status": it is a reversal which cannot be restored other than in exceptional narratives - the logic of the non-exceptional narrative implies a future which death exceptionally negates.

Todorov pushes us towards a notion of a narrative as something that resolves, and that completes cycles. The structures of these transformations are implicit in their designation as "restoration" or "reversal", and in the exceptionality of death. He notes, "the passage from A to non-A is in a way the paradigm for all change" and thus sets up a dialectic between the successive elements of stories such that they are co-defined. The nature of the state of disequilibrium, which narrative demands must follow an initial equilibrium, is therefore derived from that initial state of affairs and the nature of its disturbance. Just as every action has an equal and opposite reaction, so narrative sequences must be articulated with each other. From this causal structure, future states of affairs are also defined. Many narratives may gain their appeal from striving to obfuscate what the nature of that implied future might be, but in Todorov's scheme, that implied future is limited to new states of equilibrium which are configured by the preceding succession of events.

Jean-Paul Sartre provides a sense of the importance of this implied future. He offers a powerful phenomenological insight into what it is like to realise the freedom of self-direction in his novel Nausea, whose name has already told us much about the experience. His protagonist's realisation that the freedom of self-determination comes at the price of absurdity throws him into an anguish in which he feels crushed. I cannot have both a sense that I have had a meaningful life journey leading to the present moment, and have a completely open future in which I can direct my actions in any way I like. To have had a meaningful trajectory to the present, I must have a purpose whose imperative limits my freedom if I am to remain faithful to that purpose; to have complete self-determination renders whatever actions I take absurd - literally, meaningless. The existential dilemma is that one can choose one or the other - purpose or freedom - but never both.

... for the most commonplace event to become an adventure, you must - and this is all that is necessary - start recounting it [...] a man is always a teller of tales, he lives surrounded by his stories and the stories of others, he sees everything that happens to him through them; and he tries to live his life as if he were recounting it. But you have to choose: to live or recount [...] When you are living, nothing happens.

We find ourselves doubly caught here - if we wish to make sense of our lives, we find ourselves turning between the future-headed path to which our life-narrative directs us, and the retrospective sense we must make of our journey on that path in order to give our future a shape; or if we wish for total autonomy, we will be suspended between the vertiginous, nauseating experience of infinite possibility, and the denial of any purpose to the events which have led us to the here and now. Meaning is oppressive; freedom is absurd. To free ourselves into an indeterminate future, we must sacrifice any sense of articulation in the succession of events in our lives, or, if we follow Todorov, recast our narrative as mere description.

2.05 – 2.10 I was at the keyboard of the IBM Wheelwriter making entries for the diary.
2.10 – 2.25 I rested on the couch.
2.25 – 2.35 I checked on whether our county tax payment had been received. It had. We were shuttling back and forth between the ledger, the study and the telephone.
2.35 – 3.00 I rested on the couch.
3.00 – 3.25 I read the Walla Walla Union-Bulletin. Matthew F[...] tried to take a baby from Walla Walla General Hospital. He assaulted four of the nursing staff, who held him for the police. He was charged with custodial interference and with assaulting the nursing staff. Boise Cascade’s loss of $421 million over the last 13 quarters has "embarrassed" the chairman of the board and Chief Executive Officer, but he will not quit.
3.25 – 3.35 I was at the keyboard of the IBM Wheelwriter making entries for the diary. I drank two cups of orange juice.
3.35 – 4.30 I prepared a 10-ounce tin of Campbell’s vegetable soup and ate it with saltines as I read Mr. Lincoln’s Army by Bruce Catton. I washed out the soup pan and a frozen food tray left by Cornelia.
4.30 – 4.35 I was at the keyboard of the IBM Wheelwriter making entries for the diary.

Annalist and Analyst

Contrary to Todorov's assertion that description alone does not qualify as narrative, a strand of thought that I will trace through Louis Mink, Arthur Danto and Paul Ricoeur suggests that there is no substantial difference between history and narrative; thus there is no chronological account of events that does not impose narrative order onto them, no description of events that is not "always already" structured by narrative. And if this is the case, then the existential autonomy which Sartre describes is unobtainable, and in any case, it doesn't play a helpful role in a conception of wellbeing which is grounded in sense-making, belonging or self-direction.

In debates about the value of narrative in the discipline of history, Louis Mink has argued that narrative is a primary cognitive form, rather than a derivative one. Hence, instead of thinking of narrative as a device by which a historian might present events of the past, he asserts that when historians present histories, the entire processes of research, selection, comprehension and dissemination are structured by narrative. Thus, events "are not the raw material out of which narratives are constructed; rather, an event is an abstraction from a narrative". To speak of a "narrative of events" is a tautology, since it is the narrative form of understanding that defines and constructs an event as such: its commencement, its closure, its causal connectedness and its transformative significance - these are the narrative criteria by which it can be construed as an event at all.

An objection to Mink's line might be that since narrative knowing, as it has been developed by McLeod, is attuned to the ambiguity and significance of events, it cannot therefore get at the facts of the matter. Narrative processes are partial and selective, rather than objective and comprehensive. An ideal history in this conception would precisely be a "non-narrative" - a pure record of everything. Arthur Danto imagines this ideal history, in the shape of the "Ideal Chronicler" (I.C.), who is a godlike figure with the powers of omniscience and instantaneous transcription, recording every action and event, every thought and motive: "everything that happens across the forward rim of the Past is set down by him, as it happens, the way it happens." We might imagine the mortal historian is now redundant, since the work of recording a faithful history of the past is taken care of. Alternatively we may ascribe to the fallen historian a new role, whose task it is to use the I.C as evidence as though it were an eye-witness account. The point, Danto urges, is that even though all of history is laid before us, it will still not tell us everything we wish to know about events. Even a complete account of the past is not enough. "The truth concerning an event can only be known after, and sometimes only long after the event has taken place," he tells us, and crucially: "What we neglected to equip the Ideal Chronicler with was knowledge of the future."

I take Danto's argument to be that just as the significance of past events changes as the catalogue of new events is enlarged in the passage of time, so readings of history are shaped by an anticipation of the future. "Our knowledge of the past [...] is limited by our knowledge (or ignorance) of the future." And just as much as we are able to make claims about the past, just so much are we also making claims about the future. The horizon of our interpretive action moves forward and backward in time, like the estranged Brechtian performer whose character's destiny resists being fixed. Our intentions for the future shape how we view our past, while what sense we draw from our journey into the present shapes our future purpose.

I find the figure of the "last historian" helpful here: succeeding in bringing to light the truth of history will also be to succeed in predicting the shape and significance of the future. Danto compares this striving with prophecy itself - to see the present as though from the future. The last historian must see the past from the perspective of the end of time - the last, exceptional narrative event of history. It is in this sense that we all strive to be the last historians of our own life-narratives. To assimilate the past and future into an articulate form, we interpret the past from an imagined future, and the future from an always re-imagined past.

Paul Ricoeur borrows terminology from Mink to express this double mode of narrative apprehension:

The art of narrating, as well as the corresponding art of following a story, therefore require that we are able to extract a configuration from a succession [...] every narrative can be conceived in terms of the competition between its episodic dimension and its configurational dimension, between sequence and figure [...] to narrate and to follow a story is already to 'reflect upon' events with the aim of encompassing them in successive totalities.

It is in the movement of configuration that we may see narrative implicated as an existential aspect of wellbeing. The extent to which we are able to apprehend the totality of a life from its discrete episodes, including those phases of it which have not yet occurred, ensures that we are able to feel both purpose and self-direction - indeed they become the one and the same. Ricoeur's own approach to expressing and resolving the tension between the discreteness and continuity of self that is captured in a single figure of many parts is to consider the duality implied in the word "identity" itself. Using the terms "idem-identity" and "ipse-identity", Ricoeur draws attention to identity as both sameness and selfhood. The idem-identity is that which is recognisable as the same, unchanging self, and asserts itself as the recurring identity that is and will be continuous through all the moments of a life. The ipse-identity is that which is present at any given moment - the one who voices the words, "Here I am!" It is in what Ricouer calls a "narrative identity" that the idem and the ipse meet, since it is only through access to the experience of self-sameness (idem) that the self (ipse) is able to answer the question "Who am I?"

To conclude, I wish to take these understandings from the writers and thinkers I have touched on. As much as I am willing to absolve myself of my autonomy by permitting others to define and direct me, just so much I become a spectator of my own life rather than its protagonist, living through vicarious emotions and fearing the dispersal of an illusion over which I have little control. Yet, if I am able to apprehend my life as meaningful, in even the merest details, then I begin to be the creator of my own life-story. Without access to the dimension of the self with a "history and a mortal future", my self is no self at all. The self which emerges for me at their intersection is justified in feeling that my life-narrative is coherent: the many episodes of my life are articulated into a unified whole, and the self-authorship of this "configuration" offers me a sense of self-determination. A pure freedom, which detaches itself from my past, is desirable only in so far as I am willing to forgo a sense of historical identity and personal heritage; but a directedness to a future which is faithful to my journey to the present is what gives my life purpose.

Coda

The Reverend Shields' diary is exhaustive, but if our guides have been right, there is no chronicle that is not a narrative, and therefore no diary which does not aim to configure events and episodes into a totality. In Washington State University are tens of millions of his words, of which we have read only a miniscule extract. Many of them inventively describe urination, and attract our prurient attention. Some of them elicit pathos, and provoke curiosity. A few might even seem mundane, but as Mink notes, annals are "fascinating to the teller, whose recollections they are, and boring to the listener, who has only the pointless story without the vividness of recollected content." But some of them invite us to see a glimpse of the self of their author on the page, and his apprehension of his own life. The reverend is reading from the The Swedenborg Concordance, a reference work which accompanies the theological writings of Emmanuel Swedenborg, a philosopher, scientist, theologian and, in the latter part of his life before his death in 1772, a mystic. He is claimed to have predicted the date of this own death. He refers often to the "proprium" – an archaism referring to properties that belong to something – what is its "own". His concordance tells us that the flesh is the "proprium of man, thus the evil of the love of self", and the "voluntary proprium of man, which in itself is nothing but evil ... Fully ill."

1.05 - 1.10 I lip-read Psalm 97
1.10 - 1.30 I affirmed my conviction in the faith of the heavens: 1) The Lord reigns; 2) The Lord is the life of all; 3) All salvation is of mercy; and 4) The proprium is evil. Then I reviewed the things I want most before this life is over: 1) To write Thunder in Heaven or Up With the Star or both; 2) to endow the University so as to perpetuate the preservation of my papers; 3) to use the annuity to help six people and six causes. But I conceived of a way to do that. I would give the whole of the WSU annuity to the American Bible Society and use the annuity from the ABS to help the six people and the causes. I would save a bundle in taxes, both immediate and deferred, by doing this, and would bestow an immense benefit on the American Bible Society which is dear to my heart. I give credit for this intention to the Divine Providence. I realize that the achievement of any of those goals is the Lord's doing; it is marvelous in our eyes.

Bibliography

Auslander, P., 1997, From Acting to Performance : Essays in Modernism and Postmodernism, London: Routledge
Bakhtin, M., 1984, Problems of Dostoevsky's Poetics. Edited and trans. by Caryl Emerson, Minnieapolis: University of Minnesota Press
Boal, A., 1993, Theater of the Oppressed, New York: Theatre Communications Group
Brecht, B., 'On Chinese Acting' in Martin, C., 1999, Brecht Sourcebook, Florence, KY: Routledge
Danto, A., 1965, Analytical Philosophy of History, Cambridge: Cambridge University Press
Esslin, M., 1969, Brecht, a choice of evils, London: Heinemann
Frauenfelder, M., 2006, Pages of obsessive diarist, BoingBoing, 5 Dec. Available from: http://www.boingboing.net/2006/12/05/pages-of-obsessive-d.html
Geranios, N., 1996, Dear Diary: Every Second, Every Minute, Every Hour, Every Day, The Oregonian, 3 Mar
Goethe, W., & Schiller, F., 1827, On Epic and Dramatic Poetry. Available from: http://www.schillerinstitute.org/transl/schil_epic_dram.html
Heidegger, M., 2008. Being and Time, Oxford: Blackwell
Hunt, C., 2000, Therapeutic Dimensions of Autobiography in Creative Writing, London: JKP
Isay, D., 1997, Holding On: Dreamers, Visionaries, Eccentrics, and Other American Heroes, London: Norton
Janko, R., 'Introduction' in Aristotle, 1987, Poetics, Indianapolis: Hackett Publishing
Langer, S., in Ryan, M., 2001, Narrative as Virtual Reality: Immersion and Interactivity in Literature and Electronic Media, Baltimore: John Hopkins University
MailOnline, 2007, Discovered: The world's longest diary - all 3.75 million words of it, 30 Oct. Available from: http://www.dailymail.co.uk/news/article-490674/Discovered-The-worlds-longest-diary--3-75-million-words-it.html
Martin, D., 2007, Robert Shields Wordy Diarist, Dies at 89, The New York Times, 29 Oct. Available from: http://www.nytimes.com/2007/10/29/us/29shields.html
McLeod, J., 1997, Narrative and Psychotherapy, London: Sage
Mink, L., 'Everyman His or Her Own Annalist' in Critical Inquiry, Vol. 7, No. 4 (Summer, 1981), pp. 777-783
Mink, L., 'Narrative Form as a Cognitive Instrument' in Roberts, G., (ed) 2001, The History and Narrative Reader, London: Routledge
Neatorama, 2006, World's Longest Diary, 5 Dec. Available from: http://www.neatorama.com/2006/12/05/worlds-longest-diary/
Potts, J., (ed) 1888, The Swedenborg Concordance, London: London Swedenborg Society. Available from: http://openlibrary.org/books/OL23412205M/The_Swedenborg_concordance.
Ricouer, P., 'The Narrative Function' in Thompson, J., (ed) 1981, Paul Ricouer : Hermeneutics and the Human Sciences, Cambridge: Cambridge University Press
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The Cincinnati Post, 1996, Dear diary: You fill 81 boxes on my porch. Journal obsession keeps author busy, 22 Mar
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Categories: narrative, therapy, wellbeing, agency, sense-making,
Comments: 1

Placebo prozac

Author: joe

Sunday, 09 March, 2008 - 17:29

SSRIs are no better than placebo at treating depression in the majority of cases. It's been a couple of weeks since this story broke, but it was infinitely fascinating, and for a while I was amazed that no-one seemed to be examining the weird reflexive problem that breaking the story itself seemed to present. Placebo (in my limited understanding) works because patients believe they are being treated - and presumably the improvement in the psychological state of the patient has physiological benefits. But then if the national media tells everyone that even though the pills they take are actual 'medicines' as defined by NICE and the pharma-industry (rather than sugar-pills), actually the benefit they're getting is really only a placebo, doesn't that mean that you remove the efficacy of even the placebo (because now everyone knows their benefits are 'only' psychological)?

As the author of the report, (and by the way, isn't the PLOS open access peer-review journal an awesome thing), Irving Kirsch, stated on the Channel 4 News coverage:

one of the core characteristics of depression is a sense of hopelessness, and anything that combats that, and instils a sense of hope is going to help people feel better.


Doesn't the coverage of this report tell those patients that their hope is illusory? I know that about 10 years ago I enquired about a stop-smoking trial. The researcher taking applications said that the trial would use a placebo, and that half of the participants would be given a glucose sweet, while the other half would be given a 'placebo'. I mentioned that I had heard that glucose sweets helped to combat the physical symptoms of nicotine withdrawal because they mitigated the drop in blood sugar levels, and had tried it before (with obviously limited success). At this point, of course, the researcher said I couldn't take part because, since I had used glucose sweets before, I would be able to tell whether I was being given the sweets or the placebo, rendering my participation in the trial meaningless.

In fact, this is precisely the point of double-blind trials which use placebos: the researchers don't know who is getting the medicine and who the placebo; and equally, the patients don't know either. Ethically-speaking, they have to know there is a chance, because I think the procedural codes of these trials require that participants are told that some of them will receive placebo.

Of course, all of this acknowledges the fact that a patient's psychological state, their expectation, hope and optimism, has an important and measurable effect on the likelihood that their prognosis improves.

So it was interesting to see Ben Goldacre look at the topic in his unfailingly interesting column Bad Science:

Do drugs stop working if you know they are little better than a sugar pill? And do cultural factors, like our collective faith in a treatment, have a measurable effect on the benefits? On this, there has been a only tiny amount of highly tenuous research.


And in the little research that has been done on the subject, while some reports might imply that declining 'belief' in a medicine reduces its efficacy, there is also evidence that even when patients are told explicitly that they are being given a placebo, nevertheless, the treatment has a beneficial effect.

This, I suppose, gets the media off the hook for telling millions of people that their medicine is no better than sugar pills, and perhaps we'll see more in the coming years as to whether the use and efficacy of these SSRIs change. And of course, exposing the the cravenness of the pharma-industry can never be a bad thing. But it does still leave the question, what exactly is it about the change in expectation that using a placebo encourages, that works therapeutically, even when people know it is just a placebo? And, indeed, why can't I just heal my head, by believing it will be healed?

Categories: medicine, placebo, therapy, depression, pharmaceutical,
Comments: 0

Health fiction

Author: joe

Monday, 12 November, 2007 - 18:45

I considered going to the hospital carrying a copy of 'Narrative Based Medicine' by Greenhalgh and Hurwitz. My experience has become so reflexively, regressively contingent that I thought I might as well go the whole hog, and encourage the consultants and nurses, by noticing the book, to become radically self-aware of the experience they were creating around me.

Earlier in the year I registered for my PhD, which I intend to focus on the therapeutic uses of creative activity. There is evidence that people who keep journals during their treatment for serious illnesses such as cancer have a statistically significantly improved prognosis. Why might this be? Is it the case that our experiences of serious illness are such chaotic, disempowering transactions with the machine of healthcare, that the productive act of creating our own purposeful, narrativised story out of the bare, brute facts of therapy and treatment actually improves our bodies' ability to survive?

My father was diagnosed with cancer 7 years ago and died six months later. He said the process of pin-balling between consultants and treatments was frustrating precisely because doctors want to tell you as little as possible. Perhaps for good reason. Perhaps euphemism ('growths' rather than 'tumours') helps to minimise the psychological trauma. Perhaps a gradual induction into the language of primary and secondary, benign and malignant, potassium levels, morphine and death spray is a therapeutically beneficial approach, and ignorance is convalescent bliss. Perhaps knowing little, and trusting in the authority of the medicinal apparatus improves the prognosis.

"How is your hearing?" one nurse asked him. "Pardon?" he replied.

And so, as I have had constant headaches since February of this year, which usually recede only after the self-medication of Nurofen, I have been witnessing at first hand the efficiencies of the British healthcare system. And rather like a media studies student who is suddenly noticing how adverts are constructed, I can't not examine the story of illness (or lack of narrative) the actors in my performance are creating. My consultant informed first, not me, but his dictaphone, of my almost certainly necessary surgery. What surgery, I am still only able to speculate. It is sinusitis, an infection, pus in the ethmoid. Today's MRI scan of my head was olympically efficient - I arrived 15 mins early and had left the hospital by the time my appointment was supposed to take place. I, rather unnecessarily, slowed things down by asking the nurse what happened next. "Your scans go to the consultant now, and then he will contact you soon. Just turn left out of the doors."

Of course I have the problem of Einstein's observer, watching trains travelling in different directions at the speed of light. I'm in the train, and can't get out of it to look. I can't experience medicine without thinking about the experience of medicine, and I can't think about the experience without picking out the moments that are self-selected to illustrate the competing narratives that constitute the phenomenon of medical treatment.

I also can't help but think there is a certain kind of guilt associated with querying the treatment that our noble welfare-state doctors and nurses provide. One is supposed to say "mustn't grumble...", adopt the Blitz spirit, "there are people worse off than me..", "oh it's just a touch of sinusitis..." How self-indulgent to expect a consultant to spend an extra few minutes explaining the diagnosis and how the treatment will pan out, when he must dash off to start someone's heart any second now. "Remember that the appointment that you cannot attend is very valuable to someone in pain or distress" the leaflet says. Unusual, fatal, healing, fictions.

Categories: medicine, hospital, treatment, therapy, narrative, phd,
Comments: 0