The International Journal of Narrative Practice - 2009 - Vol1

Spring 2009 Vol (1) 1 ISSN 2041‐2207

IJNP Spring 2009 Vol (1) 1 1

International Journal of Narrative Practice (IJNP)

Introduction

This new journal is an eclectic publication that draws on different uses of narratives in research,
education and practice. As such, it is not confined to any one area or discipline. Submissions from
practitioners and academics in any discipline are encouraged and it is planned to have guest editors
and single theme issues. The publication will come out four times a year (Spring, Summer, Autumn
and Winter) and the first and second issues will be devoted to presentations and papers from the
2nd. International Narrative practitioner Conference, held at Glyndŵr University in June 2008.

The journal will initially be published as an online journal but it is planned to develop it as an
academic journal, published in hard copy.

Vision

Much of human life is conducted through narrative accounts of events and
experiences. Many of our social institutions are comprised almost entirely of
opportunities for telling and re‐telling stories, for sharing the narratives that
constitute our lives. We have all had experience of relating to and living
vicariously inside the stories that are told by others, whether they are stories
about their own lives or stories of the kind that we encounter in literature and
film, that writers create, using elements of their experience. Narratives,
therefore offer a method of teaching and communicating with one another
about professional matters.

The aims of the journal are:

To engage participants in a multidisciplinary dialogue around the use of narratives in research
education and practice

To facilitate ongoing collaboration in the development of narrative communities

Editorial Board

Chief Executive Editor

Alexander Carson, Glyndŵr University

Donald Polkinghorne, University of California, Los Angeles

Tom Janisse, Permanente Journal

Michael Murray, Keele University

Gavin Fairbairn, Leeds Met University

John Given, University of Northumbria

Ronald Stoetaert, University of Ghent

Vera Kalitzkus, University of Witten/Herdecke

Marjorie Lloyd, Glyndŵr University

Nikki Lloyd Jones, Glyndŵr University

Karen D. Roscoe, Glyndŵr University

Christine Savvidou, University of Nicosia

Andre Mottart, University of Ghent

Editorial assistant Graphic Illustrator
Rachel Parsonage Karen D. Roscoe
Journal Format
The Journal will accept both empirical/research based and theoretical articles
Journal Timings
The journal will be issued quarterly
Much of life is conducted through narrative accounts and
experiences.
Contents

Welcome and Introduction ................................................................................................................. 4
The Narrative Practitioner: Theory and Practice. Alexander M. Carson ................................... 5
Critical Social Work Practice: A Narrative Approach. Karen D. Roscoe and Iolo Madoc
Jones ........................................................................................................................................................ 9
Telling stories: Writing narrative. Marjorie Lloyd ........................................................................ 19
Telling stories and making sense of cancer. Michael Murray.................................................... 25
Fictions of Solidity in The Time Machine. Stephen C. Kenyon ................................................... 37
‘Moving beyond the limits of language’ Autobiographical narrative in animation shorts.
Yvonne Eckersley ................................................................................................................................. 45
Narrative Based Medicine: Potential, Pitfalls, and Practice Vera Kalitzkus, PhD / Prof. Dr.
Peter F. Matthiessen, MD.................................................................................................................. 56
Notes For Contributors ...................................................................................................................... 65


The International Journal of Narrative Practice (IJNP)

Welcome and Introduction

I want to welcome you to the first issue of our new journal, The International Journal of Narrative
Practice (IJNP). The journal is for anyone, in any context, who uses narratives in any way. We
welcome narratives from fields as diverse as the Arts, Humanities, Social Sciences, Philosophy and
Ethics as well as from professionals in any area. The first issue is the beginning of an ongoing
conversation, which we hope you will join with. The journal will come out four times a year
corresponding to Spring, Summer, Autumn and Winter issues (see Notes for contributors).

This issue comes out just as the 3rd.International Conference takes place at Keele University, UK. It
promises to be a very exciting event with a variety of workshops, art exhibitions, performances,
presentations, music and storytelling. Next year’s conference will take place in North Wales at
Glyndŵr University in June 2010. We hope you will join us (www.thenarrativepractitioner.co.uk.).

There are a variety of interesting ways of using narratives and this is reflected in this issue. Papers in
this issue were presented at the 2nd. International Conference on Narratives at Glyndŵr University in
June 2008. I hope you enjoy this first issue and that it motivates you to engage with the community
of narrative practitioners.

Alex Carson (Chief Executive Editor)

The 4th International Narrative Practitioner
Conference
Glyndwr University, Wales, UK

June 21‐23 2010
Speakers include Arthur Frank, Alex Carson and others
to be announced

For more details visit the website

http://www.thenarrativepractitioner.co.uk


The Narrative Practitioner: Theory and Practice. Alexander
M. Carson
Glyndwr University Wrexham North Wales

Science is rooted in conversations. (Heisenberg)

Abstract
This paper outlines a method that shows how narratives can be used to bridge the ‘gap’ between
theory and practice. The paper begins by showing that every narrative is a claim to see what is going
on in any situation. The narrative practitioner is the person, in this paper, who wants to question this
claim by engaging in a critical conversation with the narrative. The narrative practitioner’s
motivation to engage in this conversation is her assumption that the narrative is not the only
possible claim and that other, better possibilities may be available. The conversation is designed to
reveal the assumptions underlying the original narrative and to present other possible narratives.
This conversation, while bound within the original narrative, is a joint search for meaning and self
understanding. The paper illustrates the use of this method as either an empirical interaction or that
soundless conversation we call thinking. The paper concludes by showing how this conversation can
bring theory and practice together.

Key Words: Narrative, narrative practitioner, conversation, theory‐practice gap

Introduction
This is the first paper in our new journal and it is intended to show the way that narratives can bring
theory and practice closer together. I say this cautiously as I know that many readers might assume
that I am neglecting the ‘reflexive turn’ inherent in any talk of distinctions between theory and
practice. Narratives provide an anchor for both theory and practice since they are always
theoretically driven practices. However, there is a difference between what a narrative claims to do
and what it actually will do; the difference between what it proposes or claims for itself and what it
actually is. Each narrative, in my view, can be considered as a practice. But it is also a theoretical
proposal about a good way to live or practice. A narrative advances a claim about itself as a good
solution to some problem and therefore can be measured in terms of its own claim. Empirically, the
narrative is held together by a number of theoretical concepts or ‘background understandings’.
Narratives provide an opportunity for a conversation between these conceptual assumptions and
the practice that the narrative is. The aim is to develop a clearer understanding of what the practice
or narrative might actually do. It is in this space between theory and practice that my version of the
narrative practitioner is located.

This is the basic assumption of the narrative practitioner and of our journal. The narrative
practitioner is the person who works within the narrative to say more about what the narrative is
and tries to develop the narrative in better ways. The narrative, as one possible interpretation
among many other possibilities, could always be other than what it is. The narrative practitioner
knows this but welcomes the opportunity to develop the narrative. While there are many ways to
‘do’ narratives, all practitioners who use narratives share this need to learn: to develop themselves.
In this paper I want to outline a particular method for using narratives to develop oneself. There is a

plurality of methods for using narratives and this paper does not insist that the method outlined in
this paper is the only possible approach to narratives. However, it does present a narrative practice
that does not rely on complex techniques or education and takes its orientation from the Socratic
practice of engaging people in conversations. As Heisenberg notes, any firm convictions that we do
have begin in these conversations that we have with each other.

Science and Conversations
However, science has used these conversations to try and discover a reality behind them; to get
beyond these conversations. At best, these conversations became adjuncts to more ‘serious’ work.
Part of the problem goes back to the Enlightenment and the rise of rational empiricism and the
natural scientific method. The Enlightenment, as its name suggests, promised to shed light on the
true nature of reality; to get behind the appearance of things to their real nature. Appearances, as
we all know, can be partial, fuzzy, untrue and the like. Conversations were seen as ‘anecdotal’, tied
to the appearance of things. The Enlightenment project was intended to build a more secure basis
for our knowledge of the world, as it really was. The scientific method, as it was developed by
Newton, Copernicus, Galileo and many others, was designed to see behind the appearances; the
appearance of things being seen as a distraction from a true knowledge of the world. The world of
appearances, the way things ‘seem’ to us, was relegated to impressions and as such was seen as
unreliable. The new sciences aimed at a more reliable view of the world as it really was and rational
methods sought to rule out our impressions as unstable and subject to error.

Of course, the natural science model of rationality has had great successes in the development of
our knowledge of the stars and the material and physical world. Medicine, for example, developed
as a rational profession, has had many successes in curing illnesses and increasing our morbidity and
mortality. It has had less success in either explaining ourselves to ourselves or of making us more
rational than we were previously. This is despite attempts to explain ourselves as rational animals
and other such terms. At heart we are not consistent, stable nor rational. On the other hand, if you
already believe that we are rational animals or selfish genes or whatever; your life’s work will be
engaging in a search for a proof of your theory. This kind of approach fails because it has already
explained us to ourselves and that self‐understanding forms a basic assumption of much of modern
science. If we take the example of the modern conversation between science and religion, it
sometimes seems that those in the scientific tradition would like to measure religion by scientific
standards. This is not a real conversation but simply a scientific monologue. Richard Dawkins is a
good example of someone who has simply substituted one modern scientific theory (evolution) and
judges it to be better than religious explanations but this judgement is based on scientific
(theoretical ) criteria; this is not a conversation but a monologue (Dawkins, 2004). What are missing
from this approach are common grounds, where religious and scientific narratives can conduct a
proper conversation.

Romanticism and Hermeneutics grew up in opposition to this implicit assumption. Experience and
observation had shown that not only were we not particularly rational but that scientific or natural
science approaches to understanding ourselves had these in‐built limits. Romanticism developed
different methods for understanding ourselves. Hermeneutics and Interpretive methods grew from
seeing the limits of science in human affairs. Here the goal became a search for self‐understanding
through an attempt to understand the other (narratives, biblical texts etc). Gadamer’s great work,
Truth and Method (1989), outlines the development of the relationship between self and other in
this search for self understanding. In the rest of this paper, I want illustrate one particular method
for developing this relationship between self and other in a search for self‐understanding; a
conversational approach.

Narrative and Self Reflection

The self‐reflective method that I am outlining aims at developing our self‐understandings. Here, the
idea is that the narrative reflects on the difference between what it is and what it could be. It does
not import external criteria, borrowed from another narrative or grand narrative, to make
judgements on the value of the narrative. It stays close to the narrative, working with what the
narrative offers for interpretation. The stories we tell and listen to are products of our imagination;
images and concepts that are tied to a particular context. The conversational method that I am
proposing tries to develop itself as a relationship between concepts and contexts; between the
general and the particular. In a way, it is neither quantitative, where the aim is to develop general
rules, or qualitative, where contextual matters have primacy. The narrative method I use starts with
the context (narrative) so it is grounded in the practice, but it tries to develop a closer relationship to
the concepts and theoretical pre‐suppositions that support the narrative but are not an explicit part
of the narrative. By making these underlying assumptions explicit and visible, the method has the
beginnings of a conversation as what appears (the narrative) can engage with its own assumptions
and concepts. In this paper, I am using conversation in at least two different ways but they have the
common aim of developing our self‐understandings. I want to say a little bit about how both these
ways of re‐searching could be used.

One method could be seen in the context of empirical research. This conversation would require the
narrative practitioner to collect various narratives around a chosen topic or idea such as decision
making or empowerment. The narrative practitioner collects narratives such as interviews, journal
articles or any literature around the chosen topic. Viewing each, no matter its socially sanctioned
status, as aiming at some good, the narrative practitioner tries to show the good or standard that
the narrative implicitly orients to. The standards are the underlying assumptions that drive the
narrative. The narrative practitioner develops a critical conversation between these narratives and
their underlying assumptions. The chosen topic is able to reflect on itself as each version or narrative
provides another interlocutor in the ongoing conversation. In this way, the narrative practitioner
‘reviews, re‐collects and re‐formulates’ the narratives as a way of seeing more in the narratives and
saying more about the topic under discussion (Blum & McHugh 1986). This method helps in
developing ourselves and bringing theory (saying) and practice (seeing) closer to each other. The
aim, as already stated, is not to say it all but to develop the best available formulation of the topic.

In a similar way, this method can be used as a metaphor for thinking or having a silent conversation
with oneself. The aim is to convince or persuade oneself of the rightness of the narrative and its
ability to provide a justification for itself. This is the space between the narrative as a practice and its
theoretical assumptions. These theoretical assumptions are used to engage with the narrative in a
conversation about both the narrative’s possibility as good practice and a reflection on its grounds
or justification for itself. The narrative reflects back on its ability to do what it says it will do. This
brings theory and practice into a more engaged relationship.

Unlike more positivistic assumptions, the failure of any particular narrative to capture the whole of
any particular situation or to say it all is an impetus for further conversations. Whether this
conversation is a dialogue between an agent and other agents, objects, texts or the soundless
dialogue that we conduct with ourselves and that we call thinking, they all aim at self understanding.
The fact that narratives cannot say it all leaves room for us to develop our self understanding. We
talk to each other or ourselves through metaphors that unite the intangible or invisible to the
everyday appearances. Thinking or talking both requires these everyday appearances and narratives
represent this concreteness as a search for meaning. In Platonic terms, this search was known as
love. So the method that I am discussing requires that we enter any conversation in a genuine and
sincere attempt to understand and empathise with the other.

The narrative practitioner, as I am outlining, is the person who can genuinely engage in these
reflective conversations. They enable us to catch a glimpse of ourselves and our way of seeing things

as we listen and engage in these conversations. They do not end in definite answers or knowledge
but they do help us to understand ourselves and others a little better and this can make a difference.
Narrative provides structure and discipline to these conversations. They prevent conversations
straying too far from the topic and they provide a ‘disciplined empathy’ for participants in the
conversation. I use this term to show the difference between an empathy that claims, rhetorically, to
stand in the place of the other and a ‘disciplined empathy’ that is genuinely guided by the other. The
narrative has to validate any empathy that participants claim as it grounds and measures what could
count as empathy. For example, a nurse may claim that she empathises with a client who suffers
from a disabling condition. How does this work? Imagination is what is usually called for. But in many
cases, this imagination is nothing more than an agent constructing what she imagines to be the case
with the other without having any means of validating this imagining/constructing. However,
listening seriously to a client’s story provides a framework and measure of the nurse’s imagination
or empathy. Empathy can be misplaced and imaginations can be wrong. Sharing narrative through
engaging in conversations can help to evaluate the empathy expressed by the nurse if she is willing
to share her particular take on things with her clients. What can emerge from these conversations
are both client and nurse learning more than each could simply imagine if they kept things to
themselves. Narratives are always socially orientated and provide a particular viewpoint, which can
always be wrong. Engaging in conversation, sharing stories with each other, can help us to tell right
from wrong and is always an ethical practice.

Conclusion
In this paper I have tried to say something about a particular use of narratives. The method I have
outlined might be called a ‘critical conversation’ method where views about a particular situation or
topic are engaged with other ways of seeing the same topic/ situation. It is conducted through
metaphors, imagination and concepts: tools that hold the narrative together. This conversation can
be silent or spoken. It is not a cognitive but a social process where all can join in. No special skills or
education is required as it is something that all do every day. Unlike everyday conversations it tries
to bring out the best or most persuasive point of view and provides a critique of other perspectives.
It produces no definite conclusions but provides opportunities for reflection on any particular point
of view or narrative.

The human sciences have tried, historically, to model their methods of inquiry on natural science
methods as a way of finding out what is really going on behind our backs. Here the aspiration is for
the establishment of general or universal rules equally true of all human beings. In this search for a
general theory of human action, particular stories and particular agents have generally been
‘reduced’ to themes or categories. While this may have some limited value it loses more by losing its
sensitivity to any particular agent or situation. The return to narratives as a way of helping to
understand ourselves restores this sensitivity by taking narratives seriously. The narrative
practitioner does not want to reduce a narrative or subsume it under a general category but wants
to work with the narrative to develop a better sense of its own possibility. Two possible ways of
analysing narratives have been suggested but both have the aim of developing a clearer
understanding of ourselves. They provide opportunities to work in the space between what we do
and what we say and can help us to be clearer about what we do and who we are.

References
Arendt H (1989) The Life of the Mind Harcourt Brace & Company, New York
Blum A & McHugh P (1986) Self Reflection in the Arts and Sciences
Dawkins R (2004) The Ancestor’s Tale Phoenix, London
Gadamer H‐G. (1989) Truth and Method Continuum, London


Critical Social Work Practice: A Narrative Approach. Karen
D. Roscoe and Iolo Madoc Jones
Abstract:
This paper outlines the theory and approach of narrative therapy and applies this specifically to the
context of contemporary practice in social work. This paper explores the use of externalising
conversations to assist service users to re‐author their lives. The problems inherent in adopting
narrative approaches in Care Management is explored arguing that critical practice in social work
requires a need to develop a language for practice which provides for recognition of the skilful
activity of the work that social workers do.
The social work endeavour, to promote change, problem solve and with the emphasis on
empowerment of people is outlined in the definition of social work in the International Federation of
Social Workers (2000).
Social work is a profession that promotes social change, problem‐solving in human relationships and
the empowerment and liberation of people to enhance well‐being (International Federation of Social
workers, 2000, p. 1).
This was also reflected in the Barclay Report (1982) when social workers were reconceptualised as
‘Care Managers’. The report highlighted that whilst social workers were to assess needs and
commission the provision of social care, the second activity was to provide
‘face to face communication between clients and social workers, in which social workers are helping
service users to tolerate, or to change, some aspect of themselves or of the world in which they are
living’ (p.33‐34)
Stepney (2008) argues however, that the broader vision of change and empowerment in social work
‘calls for social workers to be innovative, creative and preventative’ (p. 1302). Whilst social work has
a long history of the prevention of risk and resource management with vulnerable people, the
authors argue that it is possible to be creative and adopt critical practice in the current climate of
social work. This may be considered difficult in contemporary social work as Howe (1992, 1996)
argues that the profession has become proceduralised with interventions functional almost to the
exclusion of any creativity or skill. This exclusion of creativity is understood by many as a
consequence of the more authoritarian elements of social work practice under ‘Community Care’
policy because of its emphasis on managerial outcomes. Ife (1997) suggests that the ‘traditional’
social work role, termed by Harris (2008) as the ‘therapeutic enterprise’ has eroded because of social
works relationship and location with the welfare state. Ife (1997) understands this as managerialism,
which adopts a realist view of the world and a deep respect for positivist quantitative approaches to
describing and measuring outcomes.
According to Dominelli and Hoogvelt (1996) the fragmentation and routinisation of complex
professional tasks in assessment and Care Management privilege managerial over professional
values and objectives. In this concentrated role as assessor, Ellis (1999) points out that social
workers are less able to engage in long term work and the notion of the ‘brief’ case work has
become the favoured method for practice. Milner (2001) argues however that brief case work is
considered to be influenced by the ‘forensic gaze’ of psychology, seen as resulting in categorising
and homogenising service users. As a result, creative and critical practices which adopt narrative
approaches and challenge dominate ways of viewing service users ‘problems’ is often less heard of
in the climate of Care Management. Reissman (2005), for example, points out that the contribution
of narrative approaches in social work practice is scarce in contrast to narrative therapy developed
By White and Epston (1996) in the Dulwich Centre in Australia.


Narrative Approaches and Social Work.
Narrative approaches emerged in the 1980’s with the social constructionist movement and other
relativist approaches to social sciences (Gergen, in Kazdim, 2000). Narrative approaches have
primarily been located in the relativist ontological position. From this position, nothing is deemed to
exist outside language and events, occurrences or even the boundaries between perceived objects
exist only in language. Practice from this perspective is concerned with understanding how
individuals identify, order and come to put meaning onto events and how the individual shapes
themselves through the stories they create about themselves, others and the world around them.
For White & Epston (1990) problems can be created because of the ‘stories’ people draw on or
create. White (1986, 1988/89, 1991) refers to this as ‘problem saturated’ stories. Over time it is
understood that a ‘dominant plot’ (Morgan, 2000) may emerge that can create and sustain problems
for the individual or, at the very least, can serve to restrict individuals in analysing their story
critically. Freedman and Combs (1996) suggest that the aim of narrative social work practitioners is
to work with people to bring forth alternative stories or to thicken contradictions to the problems
saturated story so that they do not support or sustain problems. White’s (1986, 1988/89, 1991)
methodology, involves externalising social and behavioural difficulties (Jessup and Rogerson, 1999)
that enable service users’ to reconstruct the dominant problem saturated story/plot.

In social work, and from a purely social constructionist perspective, this practice would be located
within a ‘seekers after meaning’ paradigm in Howe’s (1980) taxonomy of social work theories. The
social worker here is concerned with how the social world is understood subjectively. Stories
however, constitute aspects of people’s identity and provide a background context that gives
coherence to their lives (Monk et al, 1997). Therefore, narrative is not only a linguistic matter; it is a
powerful and early‐acquired way an individual interprets his/her identity and that of other people
(Bruner, 1986, 1991; Sarbin, 1986). From this social constructionist perspective, we speak ourselves
into existence within the stories available to us.

The ways we speak and the things we speak about are part of our cultural heritage; they are handed
down to us, and they are our tools for making sense” (Monk et al, 1997, p. 34).

The assumption from which the narrative approach is developed is that people make meaning and
meaning is not made for us (White, 1990). Such stories may be formed from discourses which
Foucault identified and described as ‘practices that systematically form the objects of which they
speak’ (Foucault 1972, p.49). In this sense, a discourse is a

group of statements which provide a language for talking about ‐ a way of representing the
knowledge about ‐ a particular topic at a particular historical moment (Hall, 2001, p.72).

For simplicity’s sake, discourses can be understood here as ideas that exist in linguistic or
behavioural forms e.g. sexism exists as a discourse arising from the use of words and the sentences,
and as a behavioural practice. Such discourses can be identified in the context of service users’ lives
and ‘problems’; for example, ‘depression’ ‘stress’, and ‘alcoholic.’ These terms provide a language
for talking about; a way of representing what an ‘alcoholic’ might look like. Such descriptions
produce a set of expectations that positions the person within an available discourse. For example,
wife or mother; these reflect a particular positioning in relation to others. However, it is possible to
hold positions in several discourses at the same time (Monk et al, 1997). For example, a wife may
also be feminist. For White, the extensive use of Foucault’s notion of discourse is emphasised in the
context of removing relatively fixed qualities which are ascribed to persons, specifically in the
context of identity (Jessup and Rogerson, 1999). Thus, in our narratives, we outline our perceptions
of self and which assumes that identity is not stable or a fixed singular entity. Moreover, people do
not just choose a discourse from an available menu but rather can create, reinforce and sustain

dominant discourses. As a result, they may draw upon and ‘frame’ (Goffman, 1986) stories or
discourses in specific ways. Stories can become patterns of behaviour, ways of seeing the world
which colour perception and interpretation and become problematic in service users lives.

In practice, the authors understand that people’s narratives are shaped and influenced but not
determined solely by dominant discourses. Therefore, the social worker here works with the service
user to develop and encourage alternative constructions which make it possible to work in an
empowering and anti‐oppressive way by developing potential, rather than focusing upon problems.
Stories, drawing on Whites ideas are primarily based in a social constructionist approach. However,
this approach can be criticised for ignoring the material inequalities that give rise to the
constructions that people draw. According to Payne (1997) ‘social constructionism stresses the social
aspects of knowing and the influence of cultural, historical, political and economic conditions’ (p.
31). Therefore, in order for the social worker to commit to anti‐oppressive practice, acknowledging
the wider structural inequalities that are sewn into western society is encouraged. Failure to do this
can result in pathologising service users’ and drawing on discourses that are inherited by western
ideas of individualism and diagnostic ‘treatment’ (Milner, 2001). Normalised ways of viewing
service users ‘problem’s does not promote critical practice, empowerment and change as it
effectively ignores the power of discourse upon the subjective. Therefore, the authors in this paper
argue that narrative ideas in social work practice require not only an understanding of social
constructionist ideas, but the application of a narrative model through the lens of critical realism in
order to develop critical practice successfully. As Reissman (2005) highlights, narrative approaches
can be understood from a variety of perspectives.

Narrative enquiry in the human sciences is a 20th – century development; the field has ‘realist’,
‘postmodern’ and constructionist strands and scholars disagree on its origins and precise definitions
(Reissman, 2005, p. 393).

For critical realists, the effects of structure and the possibility of the construing agent (human
agency) are particularly important. They argue that the material world is not simply received but
perceived and whilst the ways in which people can understand themselves are structured both by
the available discourses in their social milieu and the material conditions in which they find
themselves, these contexts ‘offer a range of possible ways of being’ (Sarantakos 2005, p.107). This
perspective enables the social work practitioner to view human beings as part of the natural world
and also to identify the possibility that their ‘self’ and subjectivity is altered by ‘deliberately
engineered environments’ that constrain each persons construction of ‘self’ (Ward and Marshall,
2007). King (2004) argues that although structure has power over individuals, the structure is only
reproduced by the individual.

“Since individuals are conscious agents, they are able to re‐interpret their situation and consider
new forms of actions” (King, 2004, p.71).

As Bhasker (1979) notes, ‘people, in their conscious activity, for the most part unconsciously
reproduce (and occasionally transform) the structures governing their substantive activities of
production’ (p. 44). This perspective enables the social worker to recognise the material conditions
(social structures) that give rise to constructions that people draw upon and the role of human
agency in challenging these discourses. This enables the practitioner to challenge dominant
discourses in order to influence a re‐authoring process in collaboration with service users. The model
proposed in this article is based upon three key stages, engagement and rapport, critical questioning
and re‐authoring conversations. The following diagram illustrates this process.


Engagement and Rapport.
Engagement and rapport skills remain of vital importance in social work practice. However as Scott
(2006) points out, its central importance is often unappreciated at times. It is therefore worth re‐
emphasising that in any article that offers models for practice, literature on what works in therapy
consistently highlights that it is the quality of the relationship a service user develops with a worker
that stands out as being most important determinant of the perceived success of an approach to
practice (Lambert, 1992). Practitioners eager to work to or, like ourselves, document working
models for practice, do well to keep this in mind.

Rapport refers to key concepts such as empathy, collaboration, trust and loyalty (Patton 2001;
Springwood and King, 2001). Without these components, the social workers ability to adopt
narrative approaches would be problematic. Humanistic qualities of unconditional positive regard
and empathy remind social workers that it is important in any narrative analysis to hear the service
user’s story fully before considering whether a narrative approach would be purposeful. Without
this, the social worker will not be able to progress to the later stages of this approach, that is,
listening to the service user’s problem saturated story and gently exploring this is the context of
dominant discourses.

Deconstruction and Critical Questioning Techniques

A key part of narrative approaches is that of deconstructing problem saturated stories. According to
Winslade and Monk, (2000) exploring stories which may be problem generating involve the process
of questioning taken for granted assumptions. Viewing things from a different perspective enables
gaps or inconsistencies in a story to be identified. In this sense, we attempt to make the familiar,
dominant story strange rather than simple.

The deconstruction process involves the use of externalising conversations. The aim of externalising
conversations is to encourage service users to conceptualise themselves and their problem as
separate and not the same thing. This is achieved through asking questions in which the adjectives
that people use to describe themselves are changed into nouns. Hence instead of “how long have

you been stressed,” we ask ‘How long has the stress influenced you?’ (Carey and Russell, 2002).
There are four general questions that we use:

 How has {the problem} affected your life?
 How long has {the problem} affected your relationships?
 How has {the problem} affected your view of yourself?
 Are these {affects/influences} helpful or unhelpful?

White and Epston (2005) argue that externalising a problem can undermine the sense of failure that
often develops from problems. Equally that it helps form a therapeutic alliance in that the service
users conceives of themselves as uniting with the worker against the problem. Once problems have
been externalised they can be examined and critiqued. Through linguistic analysis, it is possible to
explore and expose dominant discourses such as gender, poverty, sexuality. In discussion we open
up the possibility for service users to re‐think whole social categories (Jessup and Rogerson, 1999).

Empathic responding, according to Jessup and Rogerson (1999), is a post‐structural approach in a
narrative context as this involves critical questioning techniques.

Poststructuralists are concerned to move away from notions of ‘essential’ meanings of beliefs in a
fixed, singular, logical order’ (Featherstone and Fawcett, 1995, p. 27).

Skills in interpersonal communication processes are inquiries into knowledge formations which
enable taken for granted assumptions to be explored and surfaced. Jessup and Rogerson (1999)
argue that questioning skills in this context help the interviewee identify what it is about their own
idea’s that enables them to sustain the problem.

In this sense, they are not only surviving’, but themselves re/producing a political structure which
both disciplines them and punishes; which constructs their own prison (Jessup and Rogerson, 1999,
p. 174).

Re‐authoring
Re‐authoring conversations is an invitation to individuals to do what they usually do, that is, to link
events of their lives in sequences through time according to alternative perspectives on events.
Alternative narratives can be founded in unique outcomes. A unique outcome, as defined by White
(1989) an aspect of a person’s lived experience that lies outside the dominant story. White (1989)
suggests practitioners listen with a view to identifying “unique outcomes” and exploring them
because they can act as a bridge between a dominant narrative (problem saturated story) and the
re‐authored alternative story. In any narrative, there will be instances where the problem was less
influential and these instances may stand out in contrast to the dominant story. Unique outcomes
however can go unnoticed without careful listening from the social worker as people can place less
significance on events that do not support the ‘problem saturated story’. Themes or patterns of
‘unique outcomes’ can emerge which in turn can provide a type of scaffolding to re‐author an
alternative story/plot. Unique outcomes also provide a conduit for exploring identity. White (1989)
suggests they open the doorway to exploring what the unique outcome means in terms of the
person’s desires, intentions, preferences and beliefs.

Case Example.

A 35 year old female was referred to social services on the grounds that another social worker had
visited her parents and identified that from the age of 16, this service user had rarely left the house
following her formal education. The service user was had Spina Bifida and was dependent upon a
wheelchair for mobility. There were significant caring responsibilities within the household, as her

father had ‘middle stages’ of dementia and her older mother took the primary caring role within the
household. The prevailing narratives that surrounded the service user, from the family and her, were
saturated with stories of illnesses and disability. What became clear was that the service user’s
narrative centred upon her disability and underpinned her reasoning for why she had rarely left the
house following her formal education. For example, ‘it is because of my disability that I cant…’ These
statements were confirmed and reinforced by mum, who was reluctant for her daughter to have
support from others to enable her to go out. As a result, the service user was socially excluded and
had fixed ways of viewing disability that constrained her quality of life and opportunities. The social
worker gained an agreement from the service user to explore her story further by utilising a
narrative approach.

The worker in this case used externalising conversations with the primary objective to situate the
problem (disability) away from the person, by asking the service users questions such as

 What has the disability tried to talk you into about going out and trying new things?
 How has the disability convinced you to remain at home?
 How does the disability link to your ideas about yourself?
 How has the disability been influencing your ideas about going to college?

These externalising questions avoided reinforcing the problem and locating disability in the context
of identity. Questions which ran the risk of doing this were avoided, so questions such as the
following were not used:

 Is your disability why you decide not to go out?
 Do you think your disability affects yours ability to undertake a college course?
 Do you think your disability makes your situation worse?

The questioning techniques employed by the social work begin to explore how cultural and social
expectations about disability impact upon the service users construction of self. In narrative
approaches, this is often referred to ‘mapping the effects of the problem’ (White, 2007) through
deconstruction. This involved the worker asking questions such as:

 Tell me how the disability has convinced you that it is not a good idea to go out.
 How do these ideas impact upon your current situation?
 In what ways does the disability convince you that you are unable to do or achieve certain
things in your life?

In response to how these ideas impact upon the current situation, the service user recounts how she
has occasionally went out with her Aunty to social activities. A ‘unique outcome’, contradiction to
the narrative emerged, thus the worker used externalising questions to explore how the service user
overcame feelings of the disability affecting her ability to go out. These can be identified as
‘landscape of action’ and the ‘landscape of identity’ questions (White, 2007). Landscape of identity
questions are framed to capture the persons desires, wishes and preferences (Morgan 2000) and
landscape of action questions facilitate further exploration of an identified unique outcome.
Questions asked can be based around events or actions that led to the unique outcome, or
events/actions that occurred after, as well as the distant past that can be linked to the unique
outcome (Morgan 2000). In the context of the case study the landscape of action questions were
framed in this way.

 How did you prepare yourself to go out this particular day without the disability talking you
into staying in?

 What did your Aunty say about this when you told them that you had decided to go out with
her?
 What were the steps leading up the decision to go out?

Whilst the landscape of identity questions were framed in the following way:
 When you agreed to meet up with your Aunty, what do you think this says about what you
want for your life?
 What personal values is this course of action based upon?
 When you took the step to go out, what were you intending for your life?

Mapping and identifying unique outcomes that encourage a re‐authoring conversation are ways in
which to thicken an alternative plot, as opposed to the dominant plot which sustains the problem.
Landscape of action and identity questions encourage service users to identify a specific event which
can then be built into a sequence which then unfolds according to a valued theme (White, 2007) This
process involved the service user and social worker collaboratively re‐authoring an alternative story
that contradicted the dominant storyline of disability.

By employing these questioning strategies, the re‐authoring of the service users dominant story
evolved. She did accept some project work support to go out and realised how her own story,
saturated by taken for granted assumptions surrounding disability, impacted upon her own quality
of life and opportunities. The social worker continued to support the service user returning to
externalising questioning techniques when glimpses of the problem saturated story were potentially
emerging.

The model for practice proposed in this article however offers practitioners a way to apply
therapeutic processes within contemporary practice. Equally it offers not only a method of
intervention which can sit comfortably with Care Management, but a useful tool in assessment for
understanding constraints in service users lives. This requires the social worker to engage in ‘critical
practice’.

Critical Practice
Being constructively critical and challenging accepted wisdom and practice theories/methods
requires the social worker to adopt the stance of ‘critical practice’. For Fook (2002), ’critical social
work is primarily concerned with practising in ways which challenge domination, exploitation and
oppression’ (p. 18). Therefore, ‘critical’ in this paper is understood in the context of the sociological
sense, that is, of ‘critique’ (Ferguson, 2003).
Critical social work practice emerged in the 1990’s, influenced by a wide range of critical
perspectives. These included feminism, racism, post‐modernism and post‐structuralism. According
to Ferguson (2003), this influenced a paradigm of practice that seeks to reconstruct the idealised
theoretical prescriptions of social work. In order words, a profession that seeks to challenge
oppressive practices which consist of a variety of fixed ideas of service users problems which can
sustain and reinforce oppressive practices.
In order to reconstruct some of the idealised theoretical prescriptions that are available in social
work, for example, ‘Care Management’; this paper has explored a model for practice that challenges
social structures which produce and sustain oppressive practices. Through the application and use of
a narrative model for social work practice, challenging oppressive social structures is applied in the
socio‐political and ideological context where meanings are influenced by material conditions (social
structures), but considered to be socially constructed and sustained by the individual (Ferguson,
2003).

For Stepney (2008), the hallmark of critical practice in social work requires the social worker to
respond to structural oppression in ways that are preventative. This opens up the possibility for
change, recognising the importance of context and agency and the social worker here is required to
develop skills that effectively challenge dominant discourses (Stepney 2008).
Conclusion
Butler et al (2007) argue that ‘we are aware that currently social workers have the power through
statute, language and perspective, to define the experiences of others’ (p.287).

When social workers enter helping relationships, they enter with their own biases and prejudices. It
is these biases and prejudices that can, and often do, affect how they listen to the problems of
service users and, ultimately, how they proceed to address them (Sakamoto and O. Pitner, 2005, p.
442).

The social worker in the context of the case study may use terms such as low self‐esteem or
depression which reinforce and add to the problem saturated story. Whilst it can be acknowledged
that procedural models of assessment in social work tend to lean towards a ‘problem’ focus, the
practitioner here is encouraged to gently brush over the landscape of the service user to identify and
determine the discourses that sustain service users problems, but have material consequences.
However, it is also worthy to note that when social workers automatically ‘frame’ problems in terms
of sexism or racism for example, the service user may not define their problems in the same way
(Sakamoto and O.Pitner, 2005).

In utilising narrative approaches in the model proposed in this paper, the social worker can position
themselves as ‘raisers of consciousness’ in Howe’s (1980) taxonomy of social work theories. Pre‐
determined structures of people with disabilities definitely had ‘power over agent’ in the case study
presented, as the service user engaged in conscious activity of maintaining a role consistent to her
constructions of disability, yet unconsciously reproduced this reality. The practitioner here works
with the service user to identify how dominant discourses of disability have influenced the service
user’s ideas, feelings and thoughts and how re‐interpreting her narrative provides an opportunity for
re‐construction, change and action. The social worker sees beyond phenomenology and social
constructionism by looking at social structures which lie behind individual action and understanding
as Joseph (2002) concludes, ‘no human activity can exist outside the medium of social structures’ (p.
9).

In short, such linguistic analysis discloses ideas, beliefs, norms, behaviours, which produce
normalisations – in effect, expression of and [re]production of prevailing power structures around
race, class, gender, poverty, sexuality and so on. As social workers, we can collude with this or
attempt to shift discourses and their outcomes for individuals’ (Pease and Fook, 1999, p. 171).

Critical practice in social work requires a need to develop a language for practice which provides for
recognition of the skilful activity of their work. Rees (1991) argues that such practice is ‘empowering’
for both the recipient and the practitioner (in Pease and Fook, 1999). The skills used in critical
questioning challenge social works problem‐saturated view of a profession that is dominated by
Care Management and managerialist outcomes. They offer reconceptualisations of methodologies
that work with people in innovative and creative ways and adhere to the value base of anti‐
oppressive practice.

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Telling stories: Writing narrative. Marjorie Lloyd

Abstract
Narrative research is about helping people to tell their stories but it is only when these stories are
crafted together do they become narratives (Frank 2008). This paper will discuss the creation of
narrative from the stories of individuals who have experienced the mental health care system in the
UK. Their stories highlight a number of issues that are often unheard or dismissed as being too
subjective to be of value for (objective) evidenced based practice. This paper will discuss how using
traditional data collection methods, stories from “hard to reach” participants can be woven together
to form strong narratives. Narrative methods are used to analyse the stories in a way that will
authentically support evidence based practice that at the same time respects and values the
subjective collective voice.

It is only when stories are collected together into some form of cohesive order e.g. that together
with this …….. can we develop narratives ( Frank 2008). Narratives are therefore something that is
built upon and developed rather than reduced. Neither do they induce something from nothing as
there will always be a story to build upon whether that is in the here and now or in the “history” of
an event. However this is not always as straightforward as it sounds and there are often times when
we do not pay attention to the history of the service we provide in any great detail and may even,
during periods of change, totally ignore the experience and advice of others.

One often advises rulers, statesmen and people to learn from the experience of history. But what
experience and history teaches is that peoples and governments have never yet learnt from history,
let alone acted according to its lessons. Hegel 1837 (1953:8)

Historically, literary criticism provides many narratives in the form of novel or prose to examine the
meaning behind the story and what messages the author is trying to communicate through the
actions and behaviours of the characters (Trilling 1971, Frank 2008). However Arendt (1958) in her
study of The Human Condition identified the interrelatedness of action between people as a way of
connecting with and supporting each other. This connection provides a powerful force of people
who share a common goal or purpose, sometimes with devastating results such as the holocaust but
also as a critical mass such as mental health survivor movements and pressure groups which has led
to the call for more involvement in their own care. Arendt (1958) was able to argue respectively
that people who followed such commands were under the influence of this powerful force. Taylor
(1991) suggests that this approach towards solidarity looses the individual identity of the person so
that they no longer know why they act in a particular way but are following some sort of rational
objective without question. More recently he suggests that a focus on narcissistic individualism
encouraged by the liberal movement has led to a lack of social cohesion and the destruction of
cultural norms which tips the balance in the opposite direction. An equal balance is therefore
required between society and the individual that incorporates an objective account of the subjective
experience. Story and the use of narrative methods in research can begin to bridge the gap between
the hard ground of research and the soft life experiences of everyday people
However we all need to learn rules to help us interpret the moral world and in such circumstances
we need some sort of categorisation or ideology. Althusser (1971) suggests that a moral ideology is a
set of rules that is taught from a very young age so that by time we are adults they are part of our
natural view on life. Problems can occur however, when subjectivity as an allegiance to a particular

society or culture prevents us from experiencing individual personhood or authenticity. Taylor
(1991:65) suggests that wholeness is different from the achievement of morality … it engages us
totally in a way that morality cannot. Althusser (1971) describes the categorisation or ideology of
morality as an “imaginary law” which we recognise but is not written down. He provides an example
of the waving of one person across the street as “hailing” them to take notice and respond. This
hailing can result in an automatic response that follows without thinking and is termed
“interpellation” which changes beings into subjects who respond in a certain way according to their
culture. In particular situations we need to think about how this happens in everyday life and
examine in more detail the taken for granted rituals that we perform without question. Service user
involvement has become one of those situations in many areas of practice which is accepted but
never really questioned. And yet when asked service users and carers may give a totally different
version of events of a story to the one experienced by the practitioner. Church (1995:126) in her
study of service user involvement in Canada entitled Forbidden Narratives, identifies with the taken
for granted assumptions that are made around service user involvement that are not spoken but
expected. These assumptions can cause many problems and distress for people who are involved in
service development as they struggle between “patienthood and personhood”. She goes on to argue
for a need to explore “the white spaces” on the page. That which is not said can sometimes mean
more than that which is. Her own health suffered during the process and she recognised that

My experience alone suggests that professional deconstruction / reconstruction is an anguished
passage in which emotional bending, stretching and (sometimes) breaking is unavoidable (p127).

Kleinman (1988) in his book The Illness Narratives suggests that this is true of what we understand
of taken for granted words such as illness and disease. The former being an interpretation of the
lived experience of symptoms and disability while the latter is a professional interpretation that is
reduced to a treatable cause.
When chest pain can be reduced to treatable acute lobar pneumonia, this biological reductionism is
an enormous success. (Kleinman 1988:5)

Indeed (Frank 1997:32) is exploring his own experiences was not really aware of this lack of
personhood until his own physical health was threatened with heart disease and then cancer

Then I began to realise that despite my cancer centres' claims to treat the “whole person” any sense
that was going to be made of my experience was going to have to come from me

This embodiment or illness and indeed any experience is often ignored or dismissed as being too
subjective and not objective enough to be of any concern. Yet Coffey (1999: 59) argues that the body
is negotiated in everyday life, serving as an agent of cultural reproduction and as a site of cultural
representation. This paper argues that the subjective embodiment of service users and carers and
how they interpret their experiences must be taken into account for their involvement to be
effective and meaningful for all involved. This requires further exploration of their stories to create a
narrative that embodies the subjective experience and does not assume that as professionals we
know or can assume knowledge from objective observation. Garfinkel (1984:50) takes this stance
using the work of Schultz in describing that

…. for the conduct of his everyday affairs the person assumes, assumes the other person assumes as
well, and assumes that as he assumes it of the other person, the other person assumes it of him, that
a relationship of undoubted correspondence is the sanctioned relationship between the actual
appearances of an object and the intended object that appears in a particular way.

Ethnomethodological approaches can help us to explore the collective subjective experience of
groups of people and their cultural approaches to everyday events. This approach analyses the taken

for granted assumptions that we make about one another in everyday practices or interpellation as
suggested by Althusser (1971) and in this situation the involvement of service users and their carers
in mental health services.

An Ethnomethodological approach to narrative research
Garfinkel and Sacks (1970:339) were perhaps the first to talk about the categorisation and
interpellation of subjective experiences into a cultural norm as “indexical expression”. This term
depicts the language and behaviour used to account for everyday action that is common amongst
cultural groups. This action of language together with bodily expression can be analysed to identify
individual and social rules that are authentic to personhood (Taylor 1991) or who we are at any
given moment. Garfinkel and Sacks (1970) suggest that ethnomethodology does not take the same
route of analysis as constructivists who attempt to “repair” social theory through model building,
cost benefit analysis, statistical analysis, experimental design or metaphor building. Instead
ethnomethodology focuses upon the indexical properties that are ordered and are found regularly in
everyday action of language and behaviour that is consistent within historical and cultural moral
boundaries. Individuals who take part in everyday activities become members of a group who
develop methods or rituals to express themselves. These methods once identified are then analysed
by exploring the language and behaviour used to describe the methods.

Analysis therefore takes the role of reflexivity as a way of uncovering hidden meanings and
observations that may be unnoticed during everyday interaction. In ethnomethodology, reflexivity is
taken to mean the self study of an account of an event to explore the phenomenon in much greater
detail (Ten Have 2004). For example Althusser’s (1971) interpellation of the waving hand across the
street could be explored in greater detail using reflective practices to help us understand the many
meanings that it might have and which of those are accepted in everyday practice. This form of
reflexivity therefore considers not only meaning but the history of an event in order to capture the
cultural horizon within which it lies (Taylor 1991). Authentic explanations of an event can therefore
only be found within the reflexive analysis of meaning and horizon upon which it is based (history).
This form of analysis links back to Hegel’s (1837) work on Reason in History who uses the term
horizon to depict all that has gone before the event and how it has helped to shape the event. Hegel
(1837) argues that we cannot ignore past history because it is that that will shape the future.
However history is often too quickly ignored or even forgotten. In mental health services oppressive
practices are not that long ago as to be forgotten but sometimes they are ignored as being an
inherent part of a person’s history in the mental health services. Thornicroft ( 2006) in his book
Shunned identifies many ways in which people who suffer from a mental illness are still
discriminated against and do not access services either because they have to wait too long or the
treatment options and not favourable. He also identifies media coverage as a negative affect upon
service users becoming more involved in their own care and the service that provides it. In this
study it was important therefore to use an approach that could capture the whole person on how
they see themselves becoming more involved. It was not enough to simply provide the opportunity
to become more involved if some of the above issues around involvement are not addressed. Using
an ethnomethodological approach, culture and history is captured and retained rather than
discarded or ignored in a person’s account of an event such as involvement. Hegel (1807) provides
an example of this search for meaning as
When we want to see an oak with all its vigour of trunk, its spreading branches, and mass of foliage,
we are not satisfied to be shown an acorn instead (p76).

One way of reflecting upon everyday practice is by using narrative methods. Narratives provide us
with stories or accounts of everyday events that are often taken for granted. This particular research
project aimed to explore the taken for granted assumption of service user and carer involvement in
mental health services, from individual care to service planning.


Narrative methods
In narrative practice we are not looking to find out if the story is true, although it would make our
job a lot easier in some areas of practice ( for example the police or forensic science) but how it is
embodied by what it means to the individual and / or group. A story is however re‐crafted with other
stories to make a narrative which is a much stronger argument than an individual story alone (Frank
2008, Kleinman 1988 and Taylor 1991).

Analytical formula
There are different formulas that can be followed when analysing stories and that can be of some
guidance to those who wish to use this method of research. This formula created by Labov and
Waletsky (1967 cited in Elliot 2005) closely aligns itself to grounded theory and to ethno
methodology but instead of creating a totally new concept from practice, works with what is already
there and crafts it. The essence of the data therefore remains intact but the reflexivity that occurs
following a period of intense reflection and clarification (analysis) of the data provides a rich
narrative of events.
Nelson (1997) suggests that there are five ways of using narratives in research and bioethics. Stories
can be used to be listened to, to be told about history and events, to compare with others and for
analysis. Finally stories may be invoked using some or all of the above to discover meaning. In this
paper one story will be used as an example of invoking an everyday event in a service user’s life.
Analysis of the story can be carried out using the narrative method developed by Labov and
Waletsky (1967 cited in Elliot 2005) which explores the following areas of the story.

An Abstract provides a summary of the whole story from which orientation is identified in order to
set the scene. The complicating action is identified as the significant event and a brief evaluation of
the event takes place. Following evaluation a resolution is given as to how the story ended and a
code (or coda) is provided that summarises the results of the analysis.

Example – A Carer’s story

We were given a form to fill in, about health and medical conditions, (abstract) to join a walking
group (orientation) and he said he didn’t want to put down that he was ill, he said I’m so fed up of
years of being schizophrenic, I just don’t want to put it on. And I thought well you don’t have to, not
to go walking about ……. (Event) But he said it with feeling (evaluation), I’m not going to put that
down because its such an emotive word isn’t it? (Resolution) Theme ‐ Diversity ‐ Stigma (Coda)

The service user narrative
The above story was taken from research that was carried out with service users and carers on their
taken for granted assumptions about involvement in mental health services. 30 people and their
stories were involved in the research which mainly took place in focus groups. The data gathered
was taped and transcribed verbatim so that analysis of the data could be coded and later themed.
This was intended to give the data structure and identify meaning from taken for granted
assumptions and no data was excluded from this process. Analysis was originally carried out using a
constant comparative method to identify codes and consequently themes. This method of constant
comparison allows the researcher to build or craft stories together into a narrative of events that
leads to a horizon or history of service user involvement for this particular group of people. The data
therefore was historical in that is was based upon the experience of people with many years in the
service who were able to identify what had been influential in them becoming involved and what
had not. From the reflexive analysis of the stories three themes were identified as Universality,
Recovery and Diversity.


Universality reflected the need for goals to be shared when service users and carers were invited to
get involved. These goals needed to be explicit and relevant to both service users and service
providers. There seemed little point in attending meetings for the sake of it or for providing
feedback on consultation documents that would never be acted upon. Universality therefore
required recognition of the needs for recovery and diversity of the service user by regaining skills
and confidence through participation and in the process, helping to improve services by making
them more user friendly. In the participants story participation in a walking group would help him to
recover but he was afraid that stigma might prevent him if he disclosed his disease.

Diversity was identified as being able to recognise different needs within different individuals and
groups and not treating all service users and carers as the same. This may be an obvious observation
to some but still many service users and carers are assumed to have access to the internet and a
computer, transport to attend meetings and resources to get them their either in a car or skills in
using public transport. These are all things that are expected from professionals but cannot be
assumed to be accessible by service users. The service user in the above story did not want to be
known by his illness but as a participant with individual needs.

Recovery is a more familiar term in mental health settings with most people having a general
understanding as meaning an improvement in mental health symptoms. However it is also assumed
that people need to get involved with professionals to do this and that other forms of support are
not effective. The importance of supportive relationships was identified as significant in mental
illness that will provide reassurance and encouragement to return to a level of functioning and
quality of life. Recovery therefore of the individual and the service becomes evident as dependency
decreases and daily functioning improves taking a whole person approach (Kleinman 1988 Frank
1997). In the above story the service user wishes to move on from being “a schizophrenic” to
becoming a person who is supported in increasing his own independence.

Conclusion
In creating a narrative the above story was coded as a story about how stigma affected the way in
which people with mental health problems presented their own personhood. The white spaces
(Church 1995) identified that this was important to him. The above service user had decided that his
subjectivity was not just about being schizophrenic. Although as Frank (2008, 1997) and Kleinman
(1998) suggests, the illness was embodied within him he was also capable of other actions that did
not involve his disease. He recognized that informing others of his disease would risk losing his
history as a person (Hegel 1807, Taylor 1991) by becoming categorised (Althusser 1971) as a subject
within a group of people who suffer from mental illness. The service user narrative indicates that
there is more to being mentally ill than the symptoms (Taylor 1991) although these can be all
consuming when acutely ill. In the meantime they need to live as ordinary lives as possible that will
promote their recovery (Coffey 1999). The themes identified above indicate that there should be
plans in place to address some of the needs of service users and carers to become more involved.
These include shared goals or visions, recognition of individual needs and a focus upon recovery.
These methods or actions when in place could facilitate involvement and consequent recovery for
the individual and mental health services that reduces dependence and increases recovery of the
whole person.

References
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Telling stories and making sense of cancer. Michael Murray
Keele University Staffordshire England.
Narrative psychology

Storytelling is not just the domain of the professional writer. Rather, we are all natural
storytellers – we construct and reconstruct our worlds through the stories we exchange (Murray,
1997, 1999). These stories are not simply spun out of fantasy but engage with the social and
material world in which we live. In this paper I want to explore the role of narrative for everyday
making sense of cancer.
The advent of serious illness is a crucial turning point in our lives that causes us to reflect
upon our materiality and the transitory nature of our lives. According to narrative psychology the
person begins to grasp the meaning of a crisis by creating a story about it (e.g. Bruner, 1987). A
central belief in Western society is that our lives have a form of linearity and continuity (Becker,
1997). A challenge to our expected organized storyline can lead to disorientation. The experience of
illness represents a crisis for the patient and for their families. On initial diagnosis the individual can
experience substantial existential dislocation. It is through narratives that sick people can define
themselves and clarify their relationship with their bodies and with society. In this paper I want to
discuss how narrative shapes our understanding of cancer in everyday life.

Cancer is one of the most common diseases in modern society about which much has been written
by both the scientist and the layperson. The literary critic Anatole Broyard (1992) detailed his early
response to the diagnosis of cancer:

“My initial experience of illness was as a series of disconnected shocks, and my first instinct was to
try to bring it under control by turning it into a narrative. Always in emergencies we invent
narratives. We describe what is happening as if to confine the catastrophe. Storytelling seems to be
a natural reaction to illness. People bleed stories and I’ve become a blood bank of them” (p. 21).

However, not everyone finds storytelling as easy. For example, in one study we conducted on
women’s choice of treatment for breast cancer (Dicks & Murray, 2000) we found that most of the
women we interviewed reported that they felt numb, agitated and distressed when informed of the
diagnosis. Indeed, when asked to recall details of the subsequent conversation with their physician
most of the women could recall little. When the surgeons were later interviewed they reported that
they always provided details of the different treatment to all their patients. However, the women
did not recall any of these details. Instead they recalled what could be described as incidental
details such as the colour of their shoes or what dress they were wearing. It was these images that
they recalled. It would seem that the more traumatic the episode the more difficult it is to create a
narrative account about it (cf. Kraft, 2003).

At the initial stage of diagnosis it is difficult for the patient to develop a narrative account. However,
over time the patient begins to develop a personal narrative. Arthur Frank (1995) has argued that
the desire to develop such a narrative by the patient is a symptom of the postmodern era in which
the more standard biomedical narrative is being challenged. It is not just the standard medical
narrative that is being challenged by the stories constructed by patients but other popular myths
about particular illnesses and diseases. In this paper I consider this and other characteristics of

illness narratives through consideration of a selection of narrative accounts provided by women who
had breast cancer.

Cancer stories: Narrative character and structure

Breast cancer is one of the most feared diseases for women striking as it often does at relatively
early periods of the adult life cycle (Murray and McMillan, 1993). Despite substantial advances in
the treatment of the disease it still has a high mortality rate for those women who are diagnosed at
a late stage. Further, the medical and surgical treatment of the disease can lead physical
disfigurement. There has been much research into how women cope with breast cancer but what
does it mean in terms of their identity and their social relationships.
In a recent study I conducted, women who had had surgery for breast cancer at least one year
previous were invited to discuss the experience. In general, the women were very keen to provide
detailed narrative accounts. Indeed, the interviewer had merely to introduce the topic and then
played a minimal role in the unfolding conversation. There was an obvious desire to tell their
stories. Indeed, many of the women mentioned that they had had little opportunity to talk about
their cancer experiences since their family and friends wanted, as it were, to return to normal as
rapidly as possible.

Narrative analysis

Through their stories people define both themselves and their experience. In analyzing the
narratives the aim is not to break them down into parts but to try to consider their integrative
features (Murray, 2008. Such features include who is telling the story, how is the story structured,
and what is the story trying to do. Further, the particular features of the various narratives gain
their potency through connection with previous personal emotional experiences, interpersonal
episodes, and their meshing with broader cultural narratives. Each of these features will be
introduced later in this paper.

Narrative character
The narrative account revolves around a certain character or characters who are, in turn, defined by
the narrative. Bruner (1987) places the character or cast of characters at the centre of the
psychological narrative. We tell stories about someone. Central aspects of character are the extent
to which they are defined as action centres in the sense that they are responsible for their actions
and the nature of their beliefs and values. For example, to what extent is the character in control of
their own destinies or victims of fate. The character connects with the actions – he or she is an
action centre. As the writer Henry James argued: “What is character but the determination of
incident? What is incident but the illustration of character?’
Besides describing the characters through their actions and their beliefs, we also define the
characters through their relationships with others. The characters in the narrative do not exist in
themselves but in relation to others. For example, we can define a character as powerful by
portraying other characters as weak or vice versa (see Jacobs, 2000).

The study of the narrative character is a central feature of narrative analysis. However, the
character identified is not something fixed but emerges out of the engagement between the
narrative and the analyst. The character does not simply reside in the story but also in the very
analysis. It is through the analysis that the analyst identifies certain consistencies that form the basis
of the inferred narrative character. Even when the individual attempts to diminish his distinctiveness
the perceiver constructs a certain character. This does not mean that the analyst invents the
character, but through careful exploration identifies consistencies in the narrative actions and
relationships (Abbott, 2002).

It is through exploring these narrative features that we can begin to understand the character of sick
individuals and, more specifically, how they react to disease. In this paper, I consider three
character dimensions: womanhood, perceived control, and outlook on life in general.

Womanhood: Mater versus Materia
The central character in the breast cancer narratives is the woman telling the story. In Western
society, representations of women vary along two primary dimensions defined by Nead (1992) as
‘mater’ (mother) and ‘materia’ (matter). In everyday life these two dimensions vary in their
importance for women. Many of the women with breast cancer interviewed felt that motherhood
was the central part of their identity. They defined themselves in reference to family life, children
and their role in childcare. Consider the case of Nina. In many ways she was not a traditional
mother, nor had she experienced traditional family life. But it was these very differences or
absences that drew attention to the centrality of motherhood. She was a fifty‐year‐old single
mother. She described her upbringing as difficult. Her mother died when she was two and she and
her siblings were sent to different orphanages. There they were very badly treated by the guardians.
On leaving the orphanage Nina trained to be a nurse. She found it difficult to establish a secure
relationship but wanted to have children. She had three children by different partners but never
married. Two of the children had grown up and left home. The third was aged twelve years. She
had not held a full‐time job for many years. About ten years ago she had been diagnosed with
breast cancer and had undergone surgery. She described her life as difficult and the diagnosis of
cancer was considered to be devastating.
It was not marriage and being a wife that Nina desired but rather motherhood and having children.
At one stage she said:

“So then when I had my children it was like, still no commitment. I just wanted a child and I got a
child … And I went out and got another child because that’s what I wanted and you know, so that’s
the way I did it.” She did not want a husband: “don’t ever want to think of it, and just wants my kids
and you know.”

Her experience of not having a mother when she was growing up and her desire to be a ‘good’
mother meant that she had to give up her job as a nurse when she had children since “my kids were
more important and I didn’t want them to be raised by somebody else like I was raised by somebody
else”. When she was receiving chemotherapy after having had surgery the main disruption was to
her childcare, viz. “I had to get up, go have chemo and come home and look after three children and
it was like wicked, wicked.”

For Nina the actual experience and consequence of having breast cancer was patterned through this
characterization of herself as a mother. The physical exhaustion following her chemotherapy was
accentuated because of her childcare responsibilities. While the prospect of death was fearful she
could handle it if she had the opportunity to fulfil her responsibilities as a mother.

Contrary to Nina, Jane played down the motherhood dimension. Jane was a 47 year old married
woman with one young child whom she had adopted five years ago after finding she could not
conceive because of fertility problems. Although she had one child, motherhood was not the
defining characteristic of her identity. At on stage she said: “I figured I wasn’t going to use my
breasts per se (laughs) … I’ve never had a child. We couldn’t have one, so that was really sort of
wasn’t on the cards.” Instead, Jane defined herself more in terms of her job as a senior executive. It
was not surprising that she recalled that: “for some reason or another, the thing that worried me or
worries me was the possible loss of the use of my arm”. It was her arm and her hands, not her
breasts that she identified as the essential parts of her body. Those were the bodily parts that she
required to fulfill her working life.

The women referred less frequently to ‘materia’ or their bodies. This was an aspect that
they preferred not to dwell upon. They would refer to the absence of a breast in an off‐hand
manner. This emphasis on ‘mater’ and not on ‘materia’ reflected the age profile of the women
interviewed. They were mostly in their 40s and 50s. The youngest woman named Lucy was only in
her 30s. She felt a greater sense of physical loss. She recalled:

“I got it [breast] off and instantly I felt like a little girl again. I really did because you don’t have your
breasts. I was like … I felt like a little girl. … You even look at yourself different. You look like a little
girl.”

Then she added: “but that passes, that goes. It doesn’t bother me not to have breasts.” Initially she
was more conscious of her bodily change: “I guess I just had more time to just focus on me. I was
like … I’d look in the mirror and go ‐‘yuck’ ”.

Being a woman meant different things to these individuals. For most it meant being a mother and
the horror of breast cancer centred on this threat to their motherhood. For the younger women,
being a woman had more sexual connotations. For these women, the removal of their breasts
threatened that aspect of their identity.

Perceived control: Fate versus free‐will
Perceived control or personal self‐efficacy is a central concept in models of personal identity (e.g.
Bandura, 1996). In narratives, the central character often veers between being in control and being
controlled by circumstances. General self‐efficacy also overlaps with perceived control of disease.
Some women with breast cancer that we interviewed had achieved much success in their lives but
still were very self‐deprecating and emphasised the role of luck or good fortune in their lives.
Consider again the case of Jane. Life held many challenges for her but with hard work and good
fortune it had been possible to overcome these. She held a senior position in government and at the
time of diagnosis she was experiencing marital difficulties and was considering separation. These
difficulties had increased after her husband lost his job. Jane had been diagnosed with breast cancer
about five years ago. She had undergone surgery and after a short period of sick leave she had
returned to work.

Throughout her account Jane discussed her job in which she had been very successful. However, she
was reluctant to attribute her successes to herself but rather frequently referred to her good
fortune. This good fortune extended from her educational achievement through to her success in
gaining her position. However, she did couple this repeated reference to good fortune with the
admission that it also involved hard work. This image of the hard working but fortunate person was
the character that pervaded the account. The fact that her husband had lost his job while she was
achieving successes was disconcerting. To take all the credit for her own success would be in
someway to blame him for his failings – it was better to consider her success as due to luck.

In terms of health Jane again emphasized her general good fortune: "I've been very lucky, I had
good health”. Finding the cancer was in some ways good fortune too. She had gone to her
physician after she had stubbed her toe. The physican thought that since she saw her so rarely she
might as well do a complete physical and found the lump. When she was diagnosed as having breast
cancer Jane was shocked but took it in her stride. She initially had a lumpectomy followed a year
later by another lumpectomy. However, on further investigation the surgeon decided to do a full
mastectomy. Jane described this decision in very moderate tones. She felt having cancer was a
matter of chance. It was something that happened and which with the help of good medicine and
determination on her part she would recover.


She said at one stage: “People have described me as being … not getting too excited over things, and
I think I handle stress reasonably well. And when I do get to the stage where it gets to me, I can
have a bit of a short temper but I hide it in most places.” The characterization of self as a lucky
character but one who handled life crises in a matter‐of‐fact manner permeated this narrative. In
many ways, life was a job that had to be worked at. She was a good worker and destiny had
generally been good to her.
The role of fate and chance in people’s lives pervaded many of the narrative accounts. It
contributed to a certain acceptance not only of good fortune but also of adversity. Cancer was
something that happened – it was the way of the world. There was no need for an extended search
for meaning. It did not mean that you relented when faced with adversity, rather you attempted to
combat the challenge.

Outlook on life: Optimism versus pessimism
Within the literature on psychosocial oncology perhaps on e of the most researched psychological
dimensions has been that of perceived optimism (e.g. Murray and McMillan, 1993). Several of the
women with breast cancer referred specifically to the general positive attitude they had to life’s
challenges. Thus while they may have experienced various adversities, they felt that they had
overcome these partly through adopting a positive attitude. Consider the case of Bonnie, a 52 years
old woman. She had two siblings and felt that her childhood had been happy: “We’re from a very
united family. We were all very close … We were always a close, happy family”. Bonnie trained as a
nurse but after she had children she became a full‐time mother. She had two children who she
described as “happy, healthy children.” Her husband was a surgeon. Not surprisingly, she
frequently used medical language in her description of cancer. At one stage she stressed her belief
in the power of medicine, although even then she qualified this by referring to the need to adopt a
positive attitude: “I suppose I have faith in medicine anyway. There’s so many people out there
doing research that everyday there’s new drugs … new treatments that we have to be optimistic.”
Throughout her narrative she emphasized the positive outlook that pervaded her life. She
contrasted her stance with the frequently depressing events that occur in everyday life:

“I’m very positive about life. I’m a positive person anyway. I tend to look on the bright side and
hope for the best. I try to see the best in everything really. It’s the only way. Otherwise, like I’ve
said earlier, there’s lots of doom and gloom out there. Try not to look at it, focus on the positive.”

When she was diagnosed with breast cancer this outlook came into play: “I always feel that it is
important to have a positive outlook. So that’s how I faced breast cancer. I’m going to do the best I
can and be positive.” This positive attitude extended to how she conveyed her reaction to cancer to
her family and friends. She felt that despite shock and fear she had to convey an upbeat image:

“I know that the day I was diagnosed when I came home my sister‐in‐law called and when I gave her
the news, of course, she was so upset she started to cry and I became very emotional but I thought I
can’t talk now, I can’t cry because my son was writing an exam that night and I didn’t want to let him
know.”

Looking back, she adopted a bravado attitude. Cancer was something that had happened but now
she must move on with her life. She said: “it happened and I’m doing OK. It was rough but I made it
through.”

Implicit in this general positive attitude was the belief that other people had a more negative
attitude but because of her family responsibilities she had to keep going. She could not let the
cancer adversely affect her family life. Other women also articulated this viewpoint that
circumstances meant that they had to be optimistic. Consider the case of Lucy. She was pregnant

with her first child when she was diagnosed with breast cancer and had a radical mastectomy before
the child was born. She recalled:

“when I was going through it I was too busy to think about anything negative because like I said I
was taking care of, trying to take care of, myself and a brand new baby. … I just had that mindset
that I’m going to be OK because I have to be now that I’m a mother.”

These three character dimensions were pervasive in the women’s narrative accounts. In many ways
they were complementary. While the women might feel that they were the objects of fate they
could manage by having a positive attitude. Thus rather than struggling with the ‘why me?’
question, many women adopted an acceptance of the disease. This orientation in their narrative
accounts was developed after the event. The women frequently reported that initially they were
shocked but then they began to develop a more integrative narrative.
The narrative accounts are developed looking back on the event. It is through adopting this
perspective that the women can actually begin to transform the experience narratively. As Hilda
said about her life after cancer:

“Well, I see the value of it more. I mean when you are staring in the face of life and death you
realize how precious life is and you go for it. Like, I’m lucky. I’m lucky I’ve got everything I’ve got.
And I realize that. Whereas before you’d take a lot for granted but I know … you know … I’m very
lucky. And I love it [life] more because of that.”

This attitude provided a sense of closure to the narrative and enabled the woman to put the cancer
behind her.

Narrative structure or Genre
While analysis of these character dimensions provide insight into the experience of having breast
cancer they are in turn bounded by the structure of the narrative. The genre refers to the overall
structure of the narrative. There have been many attempts to describe the basic structure of
narratives. A popular formulation is that developed by the literary critic Frye (1957) who argued
that the four basic genres underlying Western literature were the tragedy, the romance, the comedy
and the satire. In the tragedy, the hero struggles against adversity but ultimately fails. Conversely,
in the romance the hero initially encounters resistance to achieving certain goals but through
persistence eventually succeeds. In the comedy, the hero engages in an ongoing sequence of
change. Finally, in the satire, the hero is considered from a position of detachment as an almost
comic figure and victim of circumstance.
This classification is a useful heuristic device for organizing literary works but its application to
everyday narratives must be considered with caution. In everyday narratives the genre can shift
from one form to another and back again. This shift can characterize certain crises or turning points
in the narrative. As Jacobs (2000: 29) has argued: “crisis gets its dramatic power from the tension
between competing genres”.
Again, the structure is not something that simply resides in the narrative but rather is a strategy
used by the analyst to systematize the detail of the plot. Indeed, in some ways it is similar to Paul
Ricoeur’s (1987) definition of narrative: it is a means of bringing order to disorder.

Genre I: Comedy
The structure of Jane’s narrative was more of a comedy. She had described her past as a mixture of
hard work and good fortune. The emphasis on good fortune is typical of the central character in the
comedy. She had had difficulties but had overcome these, partly through good fortune. Life was a
series of challenges and successes. If you worked hard you could succeed. So far, she had achieved

a lot and did not expect cancer would end it. Instead she put cancer behind her and got on with
dealing with new challenges. “It happened. There is no sense in crying over spilt milk”.
The central part of her narrative account was the diagnosis and treatment of the cancer. Admittedly
this caused some considerable disruption, but as with the many challenges she faced at work these
could be overcome. As she stated: “There’s been so much advancement, particularly in this type of
cancer, that I really feel even if, even something else was found it could be handled”.
Now that she had been successfully treated for cancer she could move on with her life. This sense of
control over the disease was reflected in the absence of a dramatic turn in the narrative account.
Despite this Jane was cautious about the future. As she said:

“I think that you … at least me anyway … I’m almost at my most vulnerable when I think I’m through
something. It’s like I’ve done it. I’ve made it but I don’t think you feel you’ve got the reserve to
handle anything else.”

In this sense the narrative was ended but there was no sense of closure. There was always the
possibility of the cancer returning.

Genre II: Romance
Lucy’s narrative account was similar to Frye’s romance. Although cancer was a major challenge she
had transformed this into an opportunity for growth. In some ways, her narrative was one of
liberation. The very experience of disease had strengthened her. At one stage she said:

"I think I’ve grown up a lot. Things that I placed a lot of importance on before, you know … looks and
… I don’t know … not so much material things because its not like I’m Rockefeller or anything … but
it’s just a whole focus of, you know … I know someday … like I’m not immortal or anything. I’m going
to pass on some day. I know that and I can deal with it. I’m not afraid. That changed. I came to
that realization. And, like I said, just how you perceive yourself. Like you don’t need breasts to be a
woman. I’ve matured that way, I guess … just my whole outlook on life, you know. You go for life,
you don’t go for the other way. There’s no point. So I’m just happy. I’m a happy person.”

This turn in the narrative account could also be associated with a form or awakening or an epiphany
by which is meant that the patient reflects broadly on life. However, for many women with breast
cancer there was no sudden epiphany but rather a gradual reassessment of life’s chances. This
gradual reassessment is similar to Frank’s (1995) concept of cumulative epiphanies. For example, in
the case of Jane, it was only after the treatment had finished that she began to reflect on her life:

“You start to think about the meaning of life and why you’re here and … you know … is there some
reason and what are you going to leave behind you … I think about how life is evolving. Are humans
getting any better than they used to be or are they getting worse … or …those things are more
prominent in my thoughts than they had been before, I guess.”

It is the prospect of death that encourages this reassessment of life. This reassessment through
narrative has been termed a ‘resurrective’ practice (Seale, 2000). It is a means of re‐imposing life
where there has been the prospect of death. This practice is central to the everyday work of
narrative.

Genre III: Tragedy
In terms of narrative structure or genre Nina's story contains the movement from romance to
tragedy. Her whole life had been difficult but she had managed to overcome many challenges and
to find personal fulfillment through having children. This was a major achievement of which she was
proud. However, the diagnosis of cancer seemed to turn this right around. Life has been an ongoing

struggle. Initially she met with some successes but now she was uncertain about what the future
held. This turn from one form of narrative to another highlighted the impact of cancer.
This narrative can be divided into three clear phases. The first phase had the classic romantic
characteristics. It began with a period of difficulty followed by struggle and limited transcendence as
she freed herself from her early childhood difficulties and began to define herself as an independent
woman. The middle phase was the diagnosis and treatment of cancer. The actual detail of the
cancer diagnosis and treatment was described as happening very quickly:

“She sent me to Dr. Smith and Dr. Smith said this is what it is, right. And before I knew it, like I say, I
was in hospital and the next day was the operation and the next day I was awake and somebody was
saying now we’re going to start chemo. And, you know, it was happening just so quick, you know.”

This speed of occurrence accentuated the crisis: “like it really flipped me right out … I cried for three
weeks”.

The third phase had many of the elements of tragedy. After so many hopes and limited successes
there beckoned a period of decline. However, she was able to limit this decline by highlighting the
success. Now that her children were getting older Nina was less concerned about the cancer. She
had fulfilled her duty as a good mother: “if it happens again I would sort of say well I got my children
raised and they’re going to do good; they learned a lot from me – that sort of thing.” However,
that’s in a few years time: “if it happens tomorrow and he’s only twelve I will flip, I will really go
crazy … because what’s going to happen to him … welfare would come and take him, always worry
about all that kind of stuff.” So she was balancing on the edge of tragedy. The threat of the
recurrence of cancer was a constant fear in her life.

Work of narrative

Normalizing events
Narrative is not simply concerned with describing an event or series of events. A primary function is
to give meaning to events through organization and systematization. It is through this process that
events can be grasped and understood and integrated into everyday experience. There are two
primary processes in this rhetoric of narrative: the linking together of events into a causal chain and
the normalizing of events (Abbott, 2002).
The identification of a causal chain helps restore order to a world that has been disrupted. However,
the onset of a disease such as cancer can sometimes evade the identification of a single cause.
Indeed, the person can feel that it is undeserved morally in the sense that they had led a good life
(see Murray, 1997). For example, consider the case of Bonnie. She felt that she was basically a good
person: “I was always aware of the feelings of others. I always tried to please people. I didn’t go
out of my way to cause trouble.” As such she did not deserve and did not expect the diagnosis: “I
never really thought about having any health problems. So it’s a kind of shock … when you’re
diagnosed”.
This sense of shock is often followed by attempts to integrate and normalize the news rather than to
continue with the causal search. For example, Bonnie recalled: “I think you accept it and try to deal
with it the best you can because what else can you do?” Other women referred specifically to the
limited initial causal search or even to self‐blame.
This process of integration and acceptance continues throughout the treatment of the disease.
Afterwards, some felt that they could put it behind them. As Bonnie said:

“I was really positive when it was over that I was getting on. It’s all over. I was putting it in
the past but unfortunately the opposite effect happened and I became depressed.”


However, she continued to work against the disease, in her words: “Its sort of been an up and down
battle since chemo but I’m happy to say that things have finally straightened themselves out.” Now
she can say: “But anyway, it happened and I’m doing OK now. It was rough but I made it through.”
The process of normalization and acceptance can be difficult not least because other people are
often unaware of what the survivor has been through. In Goffman’s (1964) terms, the disease is
concealable and thus the woman can pass. Bonnie referred to this problem: “I think, well when
people who see someone who looks so perfectly well and whatnot they can’t imagine that you
actually have breast cancer.”

For some patients, particularly those with chronic or life‐threatening diseases, the process of
normalization however is never fully finished or successful. The patients are changed by the disease
and, in the case of cancer, there is always the prospect of recurrence. As Bonnie said: “You don’t
look six years down the road or two years down the road. You tend to take life for the present and
hope that you’re going to be a lucky person and live a full life.”

These narrative accounts do not have closure in the sense that they can be forgotten about. Indeed,
the attempt to narratively put cancer behind them is sometimes challenged by the identification of
new symptoms or news about a friend or a colleague.

Biographical work
The narratives reflect the different experiences of the women and their efforts to integrate the
cancer experience into their broader life story. This process has been termed biographical work
(Bury, 1982). For Nina her life story was one of woe and one of the few achievements was her
children to whom she was devoted. The onset of cancer was a major threat to her role as a mother
and reinforced the negative life story. For Jane life was a series of hurdles that she could overcome.
The advent of cancer was portrayed as yet another hurdle ‐ with persistence and medical assistance
she could proceed to the next hurdle.

A feature of this and other studies was the eagerness of the women to tell their stories. A prime
reason why women with breast cancer join support groups is that it provides them with an
opportunity for biographical work through sharing their stories (Yaskowich and Stam, 2003).
Through discussion with their peers they are able to sort out their changed identity. This
opportunity for biographical work is often restricted with their family members who have
themselves been burdened with the crisis surrounding the disease and want to ‘move on’. In the
interviews, this lack of opportunity for biographical work was a common issue raised by the women
and, indeed, was one of the reasons why they found the research interview in many ways
therapeutic.

Arthur Frank (1995) began his discussion of storytelling by sick people with the phrase “The stories
that ill people tell come out of their bodies”. They come out of bodies that have undergone
substantial change due to the very fact that they have had or still have disease and may have
undergone major surgery that has changed the physical appearance of their bodies. It is through
publicly narrating their story about that disease and the surgery that the sick person can begin to
redefine herself as a new person. For many survivors this can be a very difficult and challenging task.
A particular challenge is the very choice of words and the sympathetic audience. For example, Jane
stated: “I’m not very good with words when it comes to describing how you feel. I was fine when I
was with a doctor. I had a hard time telling anybody else.” Thus the opportunity for the public
narration of their changed identity is an essential part of redefining themselves but it is an
opportunity that many sick individuals find difficult to obtain. When talking with a physician the
women who had breast cancer could comfortably use medical discourse. But this dispassionate
scientific language did not enable them to convey their changed identity. The language needed to

describe their new identity was not accessible and instead many of the women found that when
they could not tell their stories they were confined to silence.

Narrative context
Narratives are told within a particular context the character of which needs to be considered to
explore further their meanings. There are different ways of considering the context (see Murray,
2000). Here, I consider the personal, the interpersonal and the societal contexts.

Personal context
During our socialization we learn to attach emotional value to different events and experiences.
One way of exploring the personal context of narrative accounts is by considering their emotional
bases (cf. Hollway and Jefferson, 2000). In the case of Nina the experience of growing up in an
orphanage added particular emotional associations to the presence and absence of family life. She
and her siblings had made substantial effort to re‐establish those family relationships that they had
lost when they were separated in childhood, “we’re always calling each other and sending each
other a card and so on and so forth”. She lost her mother when she was young. She did not want
this to happen to her own children. Her fear of cancer was intertwined with this fear of history
repeating itself for her children.

In the case of Jane, life was a series of good fortunes and she felt that she should enjoy these.
Indeed, she made explicit reference to the advice her father gave her: “That was one of the things
my father said to me one day. He said, ‘life is meant to be enjoyed, not endured’ and it’s really stuck
with me because I think it hit a cord with me. Something I really believe myself.” The diagnosis of
cancer should not be perceived as a threat to this basic optimistic framework. Rather with
determination and good treatment it could be overcome.

Interpersonal context
The narrative is told to someone else – there is always either a listener or an assumed listener. In
telling her story, the narrator selects certain events to focus on and ignores or underplays others.
This occurs in the interview as much as in everyday social interaction. For example, Jane was very
successful in business. Despite this she felt uncomfortable talking about her successes. At one stage
Jane said: "I must say I find it difficult talking about myself. Umm … I don't know what to say." By
emphasizing her good luck she is reducing any power imbalance between her and the interviewer.
In addition, this constant reference to luck was a way for this woman to deal with success in a male
dominated world (cf. Deaux & Emswiller, 1974). She had been promoted ahead of her male
colleagues but felt that she "couldn't understand this." Also, she had survived cancer and returned
to work speedily. She preferred to underestimate her own role in the recovery. Breast cancer was
just some misfortune; it was nothing special. She had been able to overcome it with luck,
persistence and the assistance of medical science.

Societal context
Finally, the personal narrative accounts mesh with the broader social narratives or myths about
particular diseases. Mary‐Jane Paris Spink (1999) has argued that making sense of illness events is “a
process that integrates two levels of socially constructed contents: the collective level associated
with the circulation of ideas and socially instituted practices , and the inter‐subjective level of
dialogic interchanges in of daily life”.

Here, I consider three social narratives about cancer:

1. the recovery myth: this is the belief that breast cancer is just another event in a woman’s life
that with a certain amount of willpower she should be able to get over and move on.
Although Bonnie had great faith in the power of medicine she was still somewhat

apprehensive about the future: “When you know you’ve had any type of major illness
you’re thankful for good health, so you tend to … well I do anyway. I take one day at a time.
And I try to be very happy that I’m healthy.” Cancer was not something that could easily be
left behind. Rather the prospect of it recurring was something that the women still carried
with them. In that sense their narrative accounts were often open‐ended and the source of
recurrent anxiety. Despite this fear of recurrence the women felt they had to continue as
normal. The widespread prevalence of the recovery myth led many women to conceal their
anxiety. It was not something that they felt comfortable continuing to talk about. After a
certain period had passed they were expected to continue but this did not mean that the
fear of cancer was gone.
2. the hero myth: the belief that’s those who survive adversity are implicitly heroes. Jane’s
narrative account deliberately tried to subvert this myth by emphasizing the everyday
mundane storyline of her recovery. Indeed, none of the women we interviewed accepted
such an overtly heroic storyline. Rather they preferred what could be described as the
unassuming or quiet hero image. In many ways they were proud of themselves but it was
not something they wanted to boast about. Cancer was an unwelcome visitor and whilst it
had been vanquished, the women felt that to boast about it may attract retaliation. They
were cancer survivors, not victors and there was always the possibility of its recurrence.
3. The victim myth: the converse of the hero myth is that a survivor of cancer is a person who
has lost so much that they are in a constant state of misery. Many of the women resented
this viewpoint. For example Lucy said: “I’m right into the swing of things again. I feel
fantastic about it all. So for me it wasn’t a terrible thing. You know. All of it. It wasn’t a
terrible thing. I’m not making light of it but in my opinion I have no choice but to look on the
up side. Look towards life because there is no other side. That’s just the way I looked at it
and that’s the way I still look at it. So I’m … you know … I mean I have people say to me “Oh
my god, you poor thing. You’ve been through so much. I’m praying for you. . I’m like, you
know, I’m OK. Until they tell me I’m not, I’m OK.” So women felt tossed between these
competing myths. On the one hand they were expected to get over it and on the other they
were expected to be broken and changed. In their everyday social interaction the women
were aware of these different expectations and could adjust their narrative accounts
accordingly.

Ongoing narrative discussions
The rapid growth of narrative research provides an opportunity for a more detailed understanding of
the illness experience. Analysis of narrative accounts attempts to consider the whole structure
rather than breaking it down into parts. In this paper I have considered some central features of
narrative accounts: the character of the narrator, the narrative structure, the work of narrative and
the context of the narrative account. Each of these provides additional insight into the experience of
illness.

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Fictions of Solidity in The Time Machine. Stephen C. Kenyon

This paper will examine the specific peculiarities of narrative technique present in HG Wells original
novella, what has been termed the ‘fudge and tell’ elements of the narrative form itself. The focus
here is the examination of conflicting elements between reality, and if not an ‘un’‐ reality, then an
alternative construction which relies upon the unusual practice of presenting "precision in the
unessential and vagueness in the essential." (Bergonzi, 1961. 43) This textual interrogation will then
be applied to the divergent interpretations contained in this fiction focusing upon George Pal’s
(1960) adaptation, and illustrate how specific technical elements may transfer, or evolve, within this
variation of the text.

H.G Wells ‘The Time Machine’ is an often explored and popular work, both in a curricular and non‐
curricular sense. It appears in classrooms, and lecture theatres throughout the world, interrogated,
analysed, enjoyed and perused in many different formats, and through a variety of academic
disciplines, The Time machine can be viewed as a meta‐text constantly available for further
ponderings. For Science Fiction studies, Wells is acknowledged as one of the central progenitors of
the form, introducing and popularising many key Sci‐Fi themes; journeys into space, the future
metropolis, and invisibility, are all explored in his writing. Here, time travel, the very principle of the
novel, provokes significant fascination for the reader. Raising endless possibilities, conjuring
countless imagined vistas, we can literally go anywhere and do anything, and provides the greatest
‘What if?’ (which may be seen as a broad defining basis of Science Fiction) of them all. Within a
historical context, it is a work that harnesses Darwinian and Marxist thought, projecting in its fiction
a view of a ‘split’ Humanity aeons hence, the cattle‐like Eloi, and the dreaded Morlocks, those above,
and those below. Wells also ventures further in the novella, raising the concerns and anxieties of
evolution, degeneration and class, thus providing within its nature as a ‘fantastic’ vehicle a reflection
of the age in which it was written. Aside from its intellectual angst and social concern, the novel’s
popularity also stems from the manner in which it is written. It is a tremendously exhilarating literary
ride. We race through futurity with the Traveller, arriving at the end seemingly before we have even
begun, which is a fitting paradox given the novella’s premise. Eight hundred thousand years and
more flash past in the blink of an eye.

Wells use of the ‘lone traveller’ motif also provides clues as to the antecedents of Wells’ fiction. The
Time Machine has more than a passing similarity with what has been termed ‘nineteenth century
adventure fictions’, tales in which men are men and the new world is there to be conquered. The
text owes much to writers such as Haggard, R.L.Stevenson and Kipling. These are fictions where the
dreams of Empire, the myth of Nineteenth Century Imperialism combine with the energetic rush of
the masculine. Expansive areas where our lone adventurer is thrust into a world in which he has
sparse or limited knowledge, where he experiences great trials and tribulations, gradually
overcoming diversity, peril, danger and fear. The Time Traveller, firmly ensconced into the year
802,701 acknowledges that:

“…the problems of the world had to be mastered…”
(Wells 1895. 254)

This grand space, this new world, can be seen at times as great ‘gymnasium’, to test oneself and
overcome the odds. Wells’ Traveller is not wholly a carbon copy of Haggard’s Allan Quartermain, he
is a scientist first, not an adventurer, however Wells posits this character in many situations where
his ‘sense’ of self is thrown into confusion, and torn asunder. The balance between rational thought
and primitive action was a contentious subject for nineteenth century thinkers, again at its heart was
the presence of Darwinism, the acknowledgement of the animal in man. However, on more than one

occasion the delight and lust for slaughter appears in our journeyman, viscerally described, he recalls
a:

… kind of frenzy. I remember running violently in and out among the moonlit bushes all around the
sphinx…I remember…beating the bushes with my clenched fists until my knuckles were gashed and
bleeding from the broken twigs…sobbing and raving in my anguish of mind…I began bawling and
raving like an angry child…
(Wells 1895. 254)

Our man of Science visualises flinging the Eloi around “like ninepins." (Wells 1895. 229) The Time
Traveller himself is a paradox, not only caught between past and future forms, but possessing a
conflict between reason or assurity versus primal acts. In the violent actions stated above, and in his
desire for ‘meat’ upon his return, he resembles the embodiment of appetite. The temporal gap of
around 800, 000 years between his present form, and the beastly Morlocks does not seem so very
distant.

It is this dichotic state that assists in rendering psychological and psychoanalytical readings of the
text. By presenting a central character as an embodiment of conflict, who manufactures a method of
situational escape, and is met only by further clashes, it may be surmised that the Traveller himself
embodies the very future situation he resolves to make sense of. Whereby each element of the text
simply serves as a psychological narrative, where there is no real journey, save into the mind of its
creator. The possibility is raised that each character is a ‘type’ or archetype (notably, hardly anyone
has a name: they are doctor, Psychologist, Journalist, Traveller, Eloi / Morlock, etc.) and represent a
reflection of the societal constraints, and anxieties pressed upon the ‘creator’ of the text, or
machine. Each event is merely a symbol, a contrivance to be worked through, and perhaps
understood. The Sphinx is the obvious image that lends itself to this form of analysis, the very
elements of the creatures creation, a "winged lion with a maiden's face and a serpents tale" (Evslin.
1975) reinforce a conflict of opposites and confusion inherent in the text. Mythically, the Sphinx
devoured every traveller who could not answer her riddle and Wells' Sphinx is no different to
Oedipus. He must get past her, or be caught like a beast in a trap, as his machine, his great invention
waits on the other side of a vast, and impenetrable door. It is surely beyond mere coincidence that
Robert Louis Stevenson’s most famous work, The Strange Case of Dr Jekyll and Mr Hyde, begins its
tale with a chapter entitled ‘The Story of the Door.’ This work may resonate within the Wellsian text,
its many secrets, doors (accessed metaphysically, and physically), ‘hyding’ places, mysteries and
formulas; functions through its interconnected strands not just through mystery, crime, or thriller
narratives, but as a psychological map of the divided self.

Therefore, in one sense, we are back at the start, if this is merely an ‘Invention’, a manifestation of
the imagination, then it could be argued that we were told right from the very beginning, the
subtitle of The Time Machine was ‘An Invention.’ This is also contradictory, presupposing the
imaginary, insubstantial nature of the tale, and the seemingly very real time machine itself, and it is
this purposeful inconsistency between solid and insubstantial which predicts the manner in which
the tale will be told.

Treat my assertion of its truth as a mere stroke of art to enhance its interest. And taking it as
a story, what do you think of it?
(Wells 1895. 202)

This enigmatic response or challenge, may provide the reader with the impetus of the story, whilst
centring on a reading of the text; yet it also provides an indication as to how it is written. The Time
Machine has been described as the "perfect vehicle for (Wells') intellectual, artistic and personal
obsessions." (McConnell. 1985. 88) Thematically, the nature of hope and despair, progress and

degeneration, the promise of civilisation and its seemingly inevitably bleak end are all presented in a
dichotic, near schizophrenic literary vision. However the use of the term ‘vehicle’ may be particularly
apt, as there are a number of such constructions operating within the text, primarily in the format of
the narrative, and the construction of the time machine itself. The two are not mutually exclusive.

Structurally, the text possesses a frame narrative, we begin and end seated with other distinguished
guests at the dinner party, whilst in the main body of the text we have the fantastic nature of Time
Travel, the violence of the Morlocks, and the end of time itself. Frame narratives provide a
somewhat safe reading environment, particularly for tales of the fantastic. They provide grounding,
a safe place to enter and exit whilst we are told various weird tales. Led with welcoming hand into
this creation, we sit by and listen in a lulling sense of forgetfulness, existing in an ageless space of
after dinner sleep, our growing surmise gradually floating towards the unsettling paradoxes of the
storyteller. We are present in the fireside glow of comfortable narration, being "embraced and
caressed" by our surroundings. We are not in ordinary company here; our fellow journeymen consist
of pillars of the community: Provincial Mayor, Editor, Journalist, Medical Man and Psychologist to
name but a few. They are the 'new' professional men of the emerging world, overseers of our
people, authors of current times, explorers of the mind and body. Entirely male, our compatriots
form not only the realistic, scientific and sceptical backbone of the tale, but also embody new
middle‐class social 'types' emerging at the end of the nineteenth century. However, our welcome
into this group comes not with the words of the traveller, but with the beckoning hand of a 'barrier'
narrative voice.

In writing it down I feel with only too much keenness the inadequacy of pen and ink ‐ and
above all, my own inadequacy ‐ to express its quality. You read I will suppose, attentively enough; but
you cannot see the speaker's white, sincere face in the bright circle of the little lamp, nor hear the
intonation of his voice. You cannot know how his expression followed the turns of this story!
(Wells 1895. 219)

The 'invention' that is relayed to us begins in an optimistic, and ends here in a disclamatory tone. A
firm division between what can be described and its unconscious effect is presented, a separation of
literary distance between real and unreal events. The journalistic tone is reinforced to assure
distance, but its inadequacies in relation to the visualisation of events on the page are clearly
recognised. The repetitions of “You cannot” resound with emotional force, rendering helpless the
writers art and the historians’ knowledge, indicating that we are already beyond time, past certainty
and reason. We are forced to immediately face an uncertainty of perspective that will amplify as we
move towards the inevitable future. Our entrance into the Wellsian narrative machine is not quite so
comfortable or safe as our surrounding would have it appear, as it is revealed that we:

“…shall have to controvert one or two ideas that are almost universally accepted. The geometry, for
instance, they taught you at school is founded on a misconception.”
(Wells 1895. 313)

Mistaken beliefs, deception, and delusion are all necessary parts of the narrative, present within
both its method, and impetus of events. The question asked upon the Traveller’s return may prove
particularly apt:

“A man couldn’t cover himself with dust by rolling in a paradox, could he?”
(Wells 1895. 219)

For the Traveller, and Wells himself, illusory constructions allow this grand fraud to take place, and
in answer to the query above, is an enigmatic, yes.


The word “trick” is repeated numerous times throughout the early chapters. It is clear that the
Traveller is not to be trusted; he is viewed as a fraud, a charlatan, as something akin to mesmerists,
hypnotists and purveyors of Animal Magnetism popular throughout the Century. Wells conjures for
us a scene that lends itself well to such connections, as before the full‐size Time Machine is revealed
its miniature arrives by way of an experiment to prove a hypothesis. Table coverings quiver, there is
a breath of wind, candles are blown out and astonishment is easily provided. The Time Machine
itself appears as a literary enigma, " an eddy of faintly glittering brass and ivory… “ (Wells 1895. 210‐
213) Representing both absence and presence, a dream, a whisper, seen as an incandescent light in
lilies of silver, appearing briefly, and then is gone forever. The machine operates as an allegory of the
techniques present within the tale, and dually as a narrative device, a Hitchcockian ‘MacGuffin’, or
deus ex machina. A personification of the confusion of physical form, the machine illustrates further
embodiments of paradox, as the only possible way that the Traveller can ‘exist’ away from the scorn
of his contemporaries. His creation serving only as an isolation machine, flinging him into the future
and providing no conclusions or solidity, existing as a fashioned and constructed dream which will
allow only nightmare visions to stem from its iridescent inception.

All of these elements assist with a Historical, psychological or archetypal reading of the text, feeding
into; doubt, psychological complexity, dreamscapes and social anxieties. The themes raised,
together with the writing technique, assist in creating a literary hinterland, purposely confused,
vigilantly disguised, with knowledge tucked adeptly away behind doors that remain resolutely shut.
Joseph Conrad’s proclamation of Wells, as the 'realist of the fantastic, ' assists in verbally solidifying
the narrative stylistic present. Yet, how can such an intrinsic element of the original text, the
technique of showing just enough, but never giving away the whole story, be contained within a
visual medium?

George Pal’s 1960 version follows a format roughly equivalent to the original text. However the film
re‐focuses its intentions, with humanity gradually destroying itself through war, a prevalent issue in
the Cold War environment of the 1960’s. Perhaps the most memorable episode of the film – (and
the element it won an award for) is the time‐lapse photography that allows us visual transport into
the future. We see seasons change, windows crack, walls collapse, all in the blink of an eye. His
constant companion throughout these successive ages is a mannequin.

“I began to grow very fond of that mannequin, maybe because like me, she didn’t age”
(Pal. 1960)
The viewpoint is crucial here; the position of the Traveller remains constant. He possesses only a
limited perspective, and must deduce current events from that which is shown to him, just as the
original Traveller in the novella sees only dimly through “columns of hail” and must reconfigure his
vision accordingly, conjecture upon the nature of the world around him.

This image of woman as passive object would seem to be more than a nod to his future compatriot
Weena, in the film she is represented by Yvette Mimieux. It is through the Weena subplot in Pal’s
film, that the element of romance is extended, but not invented, however it is the difference in the
representational vision that is crucial. Mimieux was a sixties sex symbol and as such the emphasis
(for the viewer, and the Traveller) is shifted. Her very presence (in a divergence from the original
text), acts as the prompt for the Time Traveller’s return to the future, to save his beloved, refocusing
the narrative core. (There was a sequel planned, where further events in the future could be
explored.) Weena in Wells novella is a little different, childlike, needy and intellectually barren she
appears as utterly passive. In comparison to Mimieux, she is asexual, rather than sexual, a
mannequin demonstrating companionship with no interaction, a helpless worn out creature,
shackled to the ground and begging for the adventurers return. In the original text, at the moment
the Traveller ‘loses’ his Eloi companion, the failure seems temporary and insubstantial:


I felt the intensest wretchedness for the horrible death of little Weena. It seemed an overwhelming
calamity. Now, in this old familiar room, it is more like the sorrow of a dream than an actual loss.
(Wells 1895. 299)

The sexual themes in the novella concerning Weena and the Morlocks underground lair are a rife
subject for critical analyses and meta‐disciplinary approaches, Feminist and gender‐based,
Psychoanalytic, Freudian, Jungian and Lacanian areas of attack are often utilised to interrogate the
inward nature of the text itself. The danger of such an inward view however, is that the text itself
disappears, and we are left only with a mirror which reflects the critics’ own area of study.

“The critic necessarily conspires in the text’s imaginings: the act of reading is a process of mutual
seduction; whereby the reader and the read arouse each others fantasies, expose each others
dreams.”
(Ellman. 1994. 11)
That is not to dismiss what is a fruitful area of examination, but rather to exercise caution in the
application, for fear of finding archetypes, psychoanalytic answers, and Oedipal trajectories
wherever you may look. As Cynthia Chase observes “…Oedipus is the one person in History without
an Oedipus complex…” (Chase 1979. 58) However, the relationship between the traveller and his
companion, his isolation (in the future and the ‘present’), and the enigmatic frustration mentioned
earlier, does itself lend to this form of reading. Maud Ellman’s comment regarding Oedipus applies
here in a very real and familiar context.

“… the hero’s wishes have gone underground, and we discern them only in the deeds he cannot do,
rather than the deeds he does…”
(Ellman. 1994. 16)

Inaction, hesitation and doubt have been a feature of the narrative format, and central to the
characteristics of our central protagonist. The phrasing here in particular “…the deeds he cannot
do…” may need to be re‐expressed, as his search is for that which is hidden, or refused to be
recognised. The unutterable truth that he seeks waits within the Morlocks underground lair, and is
manifested within his temporal isolation apparatus, the time machine.

The air was full of the throb‐and‐hum of machinery pumping air down the shaft……the walls fell away
from me, and I came to a large open space…I had entered a vast arched cavern, which stretched into
utter darkness beyond the range of my light. The view I had of it was as much as one could see in the
burning of a match…Great shapes like big machines rose out of the dimness, and cast grotesque
black shadows, in which dim spectral Morlocks sheltered form the glare. The place…was very stuffy
and oppressive, and the faint halitus of freshly‐shed blood was in the air. Some way down the central
vistas was a little table of white metal, laid with what seemed to be a meal. The Morlocks at any rate
were carnivorous…It was all very indistinct: the heavy smell, the big unmeaning shapes, the obscene
figures lurking in the shadows, and only waiting for the darkness to come at me again! Then the
match burnt down, and stung my fingers, and fell, a wriggling spot in the blackness.
(Wells 1895. 269)

What remains is the image of a solitary creature only dimly aware of the calamity of his situation
surroundings, desperately trying to strike the match so he may see more clearly, that the brief flame
may linger and protect from an immense oblivion. Elaine Showalter suggests that this environment
occupies a place of specialised masculinity, the traveller effectively leaving the feminine space of the
Eloi and entering not just a male space, but the male body itself. Wells’ own pun within the novel,
revolving around ‘the possibility of wells still existing’ also lends to this view. Showalter continues in
supplying an enhanced reason for the traveller's early escape:


“…these men's novels are about the flight from marriage…the racial and sexual anxieties displayed in
these stories…mask the desire to evade heterosexuality altogether….”
(Showalter. 1992. 72)

The masculine ‘in‐group’ presented earlier is where the real threat lies, the escape from past into
futurity, is a further attempt to evade the self. Even the mechanism used to travel to this
destination is but one more manifestation of masculinity, a great ‘bachelor machine’ that exists in a:

“…closed, self‐sufficient system…frictionless, sometimes perpetual motion, an ideal theme of the
magical possibilities of its reversal…electrification, voyeurism and masturbatory eroticism.”

Determinedly male, these are:

“…anthropomorphised machines to represent the relation of the body to the social, the relation of
the sexes to each other, the structure of the psyche, or the workings of history. “

The extension of the masculinisation of the machine is insightful, yet the gender structure of the
Morlocks residence demands closer inspection. The ‘wells’ used to traverse these lower levels are
seen as phallic in origin; the smell of blood and the cannibalism identified as undeniably male traits;
lastly, in the use of mechanism, it is claimed that “…all complicated machinery and apparatus
concurring in dreams stands for the genitals, and as a rule the male ones….” (Showalter. 1992. 75)
However, the machinery directly referred to here is ‘complicated’ but what is seen throughout, from
the construction of the text, the summoning of an environment, through to the manifestation of
character identity and make‐up of the great machine, is that there are no ‘complications’ or highly
detailed objects present. The minutiae so important to this analysis simply do not exist. If the wishes
he seeks are indeed underground, then this abysmal environment is just as unreal, just as hazily
recollected as the preceding events.

In this psychological landscape, the environment he has returned to, in a sense that he has made,
occupies two distinct realms. The Arcadian world of the Eloi, and the purgatorio of the Morlocks.
Stylistically, as Showalter states, they would seem to embody the opposite gender, Eloi ‐ Feminine,
gentle, fair, passive. Morlock ‐ dark, mechanistic, organised, carnivorous. If the supposition is correct
then, that The Time Machine occupies a created space of imaginary self‐enclosure, a maternal
womb, or tomb, as it turns, then by definition that imaginary, creative space, the land of displaced
night, must also occupy a maternal or creational realm. Rather than a cave, this lair seems to re‐
enact what is female body. What transpires is not the displacement of the masculine self, or even
the mystery of the sexual feminine, but the unification of these themes within an individual facing
inaction and obliteration. The ‘wells’ moved down towards the centre of this realm the very tubes of
creation, leading toward an unimaginable blackness, a grand belly of night that keeps the traveller
from his 'bachelor machine'. The dislocation of this masculine edifice, and its indefinite form may
signify an element of loss, of castration, a severance of a further defining factor from its host. “the
deeds he cannot do” are deeds requiring recognition and acceptance of his own need for flight, the
desire to enter a hyper‐realised existence. All such attempts to create a solidified identity have been
rendered ineffective and insubstantial as dream. Cast helpless and alone, the Traveller can only
wander amid the self‐created space that has emerged as a nightmare of inaction and conflict. There
is no escape here from the blood, the indefinable, the constant frustration. Stuck in the very mystery
of womb, the homogenised elements have collapsed and travelled inward to this paradoxical
creation. Existing as dream, his wishes have reversed, and instead of conquering and finding an
answer to the Sphinx' riddle, he is left with only the resounding echo of an unutterable question,
resonating in the deep dark.

The question is met in Pal’s film version via direct conflict. Indeed, the film has war as its narrative
focus, it is the device which drives people ‘underground’ (Rather perversely, it may be seen that a
relative of Philby, 800,000 years hence, may end up chewing on what might have been the Time
Traveller.) The film can be viewed as an anti‐war parable moving through several historical, and non‐
historical conflicts. Our Traveller (as H.George Wells) moves through the Boer War, WWI & II and in
1966 (the fictional evolution of the Cold War), which is the first ‘leap beyond’ its own time the film
makes. Yet perhaps appropriately enough, as it is a version of a contradictory Wellesian tale, war
forms the narrative, and resolves it. Wells Traveller surmises that “We are kept keen on the
grindstone of pain and necessity” (Wells. 1895. 241) and as if to prove this point, Pal’s George Wells
seeks to rouse the Eloi from their domestic slumber, urging them to fight back against the Morlocks.
Thus by travelling to the future he has re‐awakened those animal urges long‐forgotten and by doing
so condemns Mankind to another cycle of struggle, and warfare. HG Wells himself stated that
“Human history becomes more and more a race between education and catastrophe.” Encased
within a paradox, Pal’s Traveller may end up causing both.

Pal’s film diverts from the original text in an additional notable manner, in precisely how the Eloi are
called to ‘market’. It is via an air‐raid siren, which instantly causes waking paralysis, the Eloi
venturing to the Sphinx’s doors unaware of their impending doom. This scene has been predicted,
with Filby anxiously attempting to drag the Traveller into an underground shelter and awaiting the
‘all‐clear’. The siren may serve an alternative purpose, that of a broadcast, so that this section may
also be seen in a more current context, that of the perils of mass communication with media
broadcasting transforming its listeners into somnambulistic puppets. Themes of Hypnotism and
‘trick’ play a key role in Wells novella, and perform major functions here. The first is by the use of
visual trickery, the film justifiably won an award for its special effects, most notably in the time‐lapse
mannequin sequence earlier mentioned. The narrative loci of the film is that of a different kind of
trickery involving the terms ‘All‐Clear’. In a study of global media corporatisation and its effect on
mass culture, Wheeler Winston Dixon (2003) examines the contention that the majority of media
experiences, in this case with regard to film, enforce a ‘juvenilization’ of cinema, and its audience.
This simplification will bring: “Global cultural meltdown… all… values of the past… replaced by…
greed, hunger for sensation… desire for useless novelty without risk…” (Dixon. 2003. 2) This is not
simply a comment upon a Jamesian existence, but upon the effect such creations have, of producing
submission, acceptance and the desire to endlessly consume a recycled culture. Whilst paralleling
the Sphinx as a ‘Multiplex of doom’ may be beyond Pal’s intentions, the mindless regurgitation of
message, and the desire to follow it, may not.

This paper, centring upon specific textual constructions and narrative techniques, contains some of
the multiplicity of interpretations of H.G. Wells’ The Time Machine. From its continual engagement
with an avid readership; its basis in a historical context; as an object for scrutiny across divergent
academic schools, and its altering treatments by differing film Directors, the novella possesses a
mutable core around which varying understandings are constructed. The axis of interpretation here
was upon the manner of construction itself, and how it may create a resonant meaning within the
narrative, shifting by degrees from a lucid vagueness to a fiction of apparent solidity.

References
Pal, George. (Director) (1960). The Time Machine. (DVD). Warner Home Video.
Wells, Simon. (Director) (2002) The Time Machine. (DVD) Warner Home Video.
Wells. H.G. (1983) H.G The War of the Worlds / The Time Machine. 1898 / 1895. London: Chancellor
Press


Bergonzi., Bernard. (1961) The Early H.G.Wells ‐ A Study of the Scientific Romances. Manchester
University Press.
Chase, Cynthia. (1979) Diacritics. Vol 9, No 1. The Topology of Freud. Johns Hopkins University Press.
Accessed via Jstor. URL http:/www.jstor.orgstable/46700
Ellman, Maud. (1994) Psychoanalytic Literary Criticism. London: Longman, 1994
Evslin, Bernard (1975) Gods, Demigods, and Demons. New York: Scholastic Book Services.
McConnell, Frank. (1981) The Science Fiction of H.G.Wells. New York: Oxford University Press.
Showalter, Elaine.(1992)The Apocalyptic Fables of H.G.Wells in Fin de Siecle / Fin du Globe ‐ Fears
and Fantasies of the Late Nineteenth Century. Macmillan


‘Moving beyond the limits of language’ Autobiographical
narrative in animation shorts. Yvonne Eckersley

I intend to examine how selected animators have interpreted autobiographical themes through the
medium of animation. For the purpose of this paper I will be looking at five animated shorts by
different artists, which vary in length from four to fifteen minutes. They are largely ‘labours of love’,
(indeed one is a student degree film), having brought little financial reward for the artists who made
them and whose main audience is that of the animation festival plus occasional airings on TV.

The main areas under analysis will be autobiographical themes, narrative structures, visualisation as
well as the motivation of each artist in making their film. I am particularly interested in whether
therapeutic benefit to the artist might provide a motivation, both in terms of the animation
production process and thedesire to communicate a personal truth.

Autobiographical themes
The main themes in animation autobiography relate either to observation and the everyday or
involve some aspect of memory. More often than not the memories are associated with powerful
emotional events, such as childbirth or trauma.
I will look at animators whose films have been triggered by episodic memories and consider how a
personal trauma or extreme emotion can be the starting point for a film.

Narrative structure
The animation artist is in the fortunate position of having an almost infinite array of narrative
strategies at their disposal. The whole of the vocabulary of film language and editing devices
available to the live action filmmaker also apply to animation, however the animator has many
others that the live‐action filmmaker does not. In his book ‘Understanding Animation’, Paul Wells
describes how metamorphosis and the dynamics of dialogue or musicality can form the basis of a
narrative structure for an animated film. He explains how the soundtrack plays a vital role in a film,
tempering the mood and atmosphere and offering the audience the vocabulary to decode and draw
meaning from the film.
Moreover, Wells derives his own terms, for example fabrication and penetration to describe
approaches the animator can take to express a narrative.
He sums up this potential:

‘Animation is, after all a distinctive film form which offers to the adaptation process a unique
vocabulary of expression unavailable to the live‐action filmmaker’( Wells P. 1999, p199 )
Visualisation
I will analyse how colour and graphic style relate to the theme and serve to fulfil the intention of the
artist.

Motivation
I will analyse the artists motivation in making their autobiographical animations and how a desire to
communicate and inform mingles with elements of personal therapy.

The’ Uncanniness of the familiar’

The inspiration of the everyday as a theme seems to have emerged in avant‐garde film of the 1950’s
and 60’s. Avant‐garde film shares a lot with independent animation, being largely in the format of
the short and may even be constructed on a frame by frame level.

In his paper Avant‐Gardens – Scott MacDonald looks at the work of avant‐garde women‐film makers
during the 1960’s. Though these autobiographical films were shot in live action the filmmakers like
Marie Menken, Marjorie Keller and Carolee Schneemann experimented with editing and painted the
filmstrip, etched into the emulsion with a razor blade and a toothbrush, bleached portions and
batiked it in order to evoke the psychological meaning behind their films, which related directly to
their everyday lives and experiences. Gardens and intimate relationships provided the raw material
for their films.

In Marjorie Keller’s ‘The Answering Furrow’ ‘Keller evokes ancient European spiritual and aesthetic
traditions and is centred around her father’s vegetable garden in York‐town Heights, New York .

‘Most obviously all the films I’ve discussed are defiantly unpretentious, and part of their
defiance involves the film makers’ choices to honour domestic spaces and aspects of
domestic dailiness considered too mundane or too ‘personal’ for big‐budget melodrama and
even for most documentary and avant‐garde cinema
(MacDonald S. 2005,)

Because of their mode of construction, (frame by frame) certainly many of the above films could fall
in to the category of animation and their themes have been followed up by animators.

‘Growing’ – Alison Hempstock – 1994 Running time 5”

Theme
Gardening, and cycles of nature form the theme for Alison Hempstock’s animation, ‘Growing’.
It represents a year in the cultivation of a garden. The artist takes us on a close‐up journey in which
we see in detail the growth of plants. The images are derived from the animators close observation
of her garden and the processes of gardening. This gives the subject matter a drama and intensity,
which is not normally associated with gardening.

Narrative Structure
There is great beauty in the simple structure of this film. It begins with the gardener (Hempstock’s
partner) preparing the soil. We focus on his repetitive actions, raking, digging, planting and finally
watering the seeds. We then focus in to extreme close‐up on the actual growth of the plants. This is
sped up and accompanied by the exaggerated sounds of seedlings pushing up through the soil and
leaves unfurling. This cacophony of growth culminates in the dramatic bursting forth of flower heads
of every description. The pace returns to normal with the appearance of the gardener’s hands and
his discovery of the vegetables, ripe for harvesting. We see them being collected and a ceremonial
handing over of a large marrow, (presumably to the filmmaker). The final sequence shows the
gardener once more preparing the soil ready for the next season of growth.
This film demonstrates how effective animation can be at condensing time. A whole year’s growth
takes place in the space of five minutes. There is no dialogue or music. The beautifully simple

soundtrack is made up of the natural sounds of a town garden and exaggerated Foley sound for the
growth sequences.

Visualisation
The close focus observation, coupled with the technique, each image (12 per second) hand coloured
with oil pastel crayons give this film an intimacy and intensity rarely seen. The film grew out of oil
pastel observations of the artist’s garden in a sketchbook. An observational sketchbook has been the
starting point for many personal animated films. This kind of direct observation from life can draw
the audience’s attention to the subtlety in colour, texture and movement in an environment
engaging them on a subliminal, emotional level.

Motivation
‘Growing’ was commissioned by Channel 4, following an artist’s residency at the museum of the
moving image. The film draws the audience’s attention to the inherent beauty and abstraction,
colour and composition of everyday locations and activities.
After this film Alison continued with her observational autobiographic theme with ‘Bath’, which also
features her partner. The subtle beauty in the colours and movement of the water, contrast with
skin‐tones and are abstracted by the artists eye.

‘films about the everyday allow us to see what psychological significance might lie in
apparently innocuous behaviour such as folding clothes, enabling us to experience what
Cavell has labelled in other contexts as the’ uncanniness of the familiar’ (Klevan A.2000, p62)

‘Daddy’s little bit of Dresden China’ – Karen Watson 1988 Running time 15”

‘The stories told with the full richness of a life, and are seen as making sense and giving
meaning to deeply disturbing experiences’
(Plummer,2006, p244)

Theme
Karen Watson really stretches the potential of the animated form to communicate the deeply
distressing emotions associated with child molestation.

In this brave autobiographical short Watson represents herself by a feather puppet with a small vase
for a head. The metaphor continues with her mother being constructed from model food and
kitchen utensils and her father of sharp metal with scalpel like scraps or razor‐blades for a mouth.
Photographic collage and drawn sequences convey the disturbing narrative. In a cruel irony
Watson’s experience is narrated in the form of a fairy story.

Watson narrates the film herself in a haunting voiceover, ‘It happens in so many families, and no‐one
ever talks about it.’

Narrative Structure
This film incorporates a number of different narrative structures. Symbolism and metaphor combine
with fabrication. Fabrication is a term used by Paul Wells to describe how inanimate objects and
components can be brought to life through the process of animation. An audience can engage with a
3D model animated puppet on a more fundamental and emotional level than they would if
presented with the people they represent. We are not distracted by a need to make value
judgements on appearance and the true nature of the character can be revealed by the choice of
materials and their construction. Hence we see the vulnerability of the figure representing the child
in her construction of feathers with a small vase for a head. In all her figures Watson has dispensed

with eyes, usually seen as a vital feature for expressing character, yet this doesn’t detract from their
believability. The soundtrack provides the dominant narrative strategy with the artist’s narration
holding together the story, which might otherwise appear disjointed due to the variety of techniques
employed.

Visualisation
Model animation, simplified drawn animation, collage and photograph all combine to give this film
it’s bold aesthetic. This combining of techniques is evident in the work of a number of animators of
this period and this eclectic approach has been described by some as inherently feminist.
The late 1970s and 1980s saw the emergence of a number of women animators in the UK and North
America producing work, which reflected their lives and the lives of women in general. This included
the overtly feminist work of The Leeds Animation Workshop angered by the tradition of sexist
imagery in much animation and Vera Neubauer’s experimental, mixed media animation. Later work
has taken feminism for granted and focussed more on subjective experience often allied to personal
autobiography.

‘As novelist Jeanette Winterson has commented, for women with a talent for art and an
interest in film, animation offers both a challenge and a safe place’. A challenge for because
of the unlimited potential for expression (and self expression), and a safe place because it
can offer a private place in which to experiment.’ (Pilling J. 1992, p6)

Rather than feel restricted to traditional cel animation women developed the confidence to explore
the moving image in unconventional media such as collage, cut‐out and object animation which
meant that they could produce their vision single‐handedly in the same spirit that Lotte Reinegar
produced the first ever animated feature, ‘The Adventures of Prince Achmed’ from cut‐out
silhouette puppets.

‘Women… care more about variety than men and variety connects to fragmentation and to
the autobiographical aspect (of their work), too, as a sort of defiance.’ (Lippard L. p67)

Films described as feminist, dealing specifically with what it means to be a woman became almost a
genre of their own in the 1980s and 90s and from a sociological point of view form what could be
described as a collective consciousness of women’s experience. As mentioned above such films are
characterised by a greater experiment with visual language and modes of expression than the
mainstream of the time.

‘Many women deal more openly with feelings, with their own and with others, and as a
movement, feminist art tends to be more humanistic than formal.’ Pilling Reader p73

Motivation
This was made as a student Degree film.
‘For me, ‘Daddy’s Little Bit of Dresden china’ acted as a form of therapy, enabling me to
express feelings I could not have expressed otherwise. Feelings I didn’t have words for, and
forbidden feelings such as anger. The process of making the film helped me to come to terms
in some ways with what had happened to me as a child and locate certain patterns of
behaviour in my adult life that were destructive.
The final image is of the shattered china vase. It is the child who is damaged and broken
through such an experience and this can only be stopped when society offers encouragement
and support to people who have to live in silence because of the ignorance of others. Sexual
abuse is a political, as well as a personal issue.’ Karen Watson
(Pilling J. 1992, p97)


Karen Watson went on to make another animated film about anorexia, which was also
autobiographical.

‘The Runt’ – Andreas Hykade 2006 running time 10”

Theme
“Alright, I give you the runt. But you take care of it, and you kill it in one year”, This was the bargain
made between the young Andreas and his uncle. Initially an act of compassion to save the tiny rabbit
from suffocation, as the time of the rabbit’s demise draws near the small boy is forced to turn his
thoughts to the terrible act he must perform.
The Runt is the last of a trilogy of films by Hykade, which begins with ‘We Lived in Grass’, a film,
which though not strictly autobiographical is based on childhood observations in his home‐town in
Bavaria. All three films in his trilogy deal with the way young boys in the area are inducted into a
sexist creed by their fathers.
‘I’ve been brought up with a very anti‐feminine point of view. I mean Women’s Lib was there, but not
in Bavaria.’
This oppressive upbringing might well be responsible for the high suicide rate in this ‘right‐wing,
conservative, depressing area.’

The film chronicles a sort of rites of passage for the young boy in which he is stripped of his
compassion and brutalised into killing. Whilst the child is given no choice or opportunity to opt out
of killing, his father also seems uneasy with the situation. The uncle character is clearly portrayed as
the villain of the piece and is drawn differently to the small and slightly built Andreas and his father,
being huge with a large square head. His father is portrayed as a sympathetic character, sharing in
the boys marvel at the birth of the rabbits at the start of the film and is seen tending to the rabbits
needs whereas the uncle only seems interested in killing them.
The stylised characters, with simplified, uncluttered backgrounds in a limited colour palette help us
to focus on the very essence of the memory.
The vast bullying form of the uncle first looms into view as the father and son watch with wonder
the birth of the rabbits.
The placing of the rabbit skin on the boy’s head at the end of the film is a clear sign that the
gruesome right of passage is completed.
It is not surprising that this traumatic memory should form the basis of an animated film in Hykade’s
adulthood.
The dialogue gives us a clear narration of the story and is explicit. I do however feel that the images
are so clear and symbolic and the visual narrative so powerful that they would work without the
words.

Is this film evidence of an animator using the medium as a form of self‐help therapy or is it merely a
case of drawing on past experience as interesting subject matter with which to engage an audience?
Narrative Structure
The narrative structure is refreshingly simple and follows chronologically. An acoustic guitar and
percussion track are accompanied with natural sounds of the countryside to provide the soundtrack.
The only voices are those of the boy and the uncle. Time is condensed in the sequence where we see
the boy playing with his rabbit and each time we return to him the rabbit has grown. This sequence
serves to cement the bond between the boy and his pet.

Visualisation
Like a persons perceptual experience of the present environment, recollective experience of
past events can at best be only an incomplete and stylised model of the apprehended reality.
(Tulving E. 1985)

The hand drawn black outlined and simplified, stylised figures ensure we are not distracted by
unnecessary detail. The environments are similarly simplified. Even the table and stools on which the
characters sit have been reduced to simple lines.
This economy is also reflected in the animation, with the twitching of the rabbits noses making them
appear more alive than the people in some scenes.
The colour palette is restricted mainly to warm yellows and browns and has the rich texture of oil
pastel. The boy’s rabbit provides a counterpoint of vivid blue.
It’s wonderful the way his memory has stripped the image bare of all unnecessary detail.

Motivation
‘In 2001 I did a drawing of myself watching my uncle killing rabbits – an image I remembered
from my childhood. A few years later I went through my sketchbooks, discovered the image
again and it really hit me inside. At the same time the subject connected to the past. The idea
of killing rabbits to eat them seemed to be centuries old. I felt the subject connected a
personal story to a collective myth.’ (Hykade from an interview with Chris Robinson)

At the 2006 Bradford animation festival Hykade discussed his attempts to understand the sadistic
behaviour of his uncle and how talking to him recently he seemed to have mellowed and had this to
say about his fervour for killing animals, ‘It’s not the same anymore, there is no pleasure in it for me
now.’
While there is little doubt that the experience was traumatic for Hykade as a child there is also a
need to make sense of his uncle’s sadistic behaviour.

‘Small Treasures’ – Sarah Watt 1995 Running time 15 minutes

Theme
Although much of her work has its origin in autobiography and personal experience Sarah Watt
prides herself on her research and uses this to make her work more universal and meaningful by
referring to the shared experience.

‘Our first baby died during birth, which was, you know, pretty traumatic.
Small Treasures is about a pregnancy, written in diary form, sort of, follows a pregnancy
through, and it’s about a baby that dies, doesn’t make it through the birth, which is a fairly
common thing, horribly common still, that women go through and I, made it sort of,
autobiographical in a way, but I kind of universalised it. I’ve looked at a whole lot of stories of
women that have been through, or, you know, people that have been through the same
thing and made a hybrid story, cause at the time I really felt it was unspoken about and
although things had improved, it was still something a bit under the bed, you know, shove
your emotions under the bed and get back out and have another baby and it’s a lot harder
than that, it’s a lot harder on relationships. It’s a real death and I wanted to make a film
about that, yeah, but not a depressing one, I hope.’
Sarah Watt

Narrative Structure
The film structure is in some ways influenced by live‐action film.
We begin with a first person narrative of a woman walking on a beach reminiscing about how she
first found out she was pregnant when she was at the beach. This scene is inter‐cut with a series of
flashbacks to different memories from her pregnancy and the birth of her baby who was stillborn.
Sarah Watts has made about eight animated films and in 2006 produced ‘Look both ways’ a live
action feature with animated inserts.

Although much of the films structure is reminiscent of live‐action, animation comes into its own
through the rich colour and beautiful painterly texture.
Metamorphosis is applied as an editing device, moving us creatively from one scene to another for
example where a gull is transformed into the image of the woman on a hospital bed. Moreover a
montage of nightmarish images, morph into each other in the sequence leading up to the moment
when the woman learns that her baby has died.

Visualisation
The film is visualised in painted backgrounds with paint and crayon on cel. There is a beauty and
richness to the choice of colours and textures, which may well have been inspired by the strong
Australian light. Recognisable images move in and out of abstraction. A painterly quality is
maintained throughout and there is a refreshing absence of the strong black outline which
characterises much mainstream animation.
There is a seductive quality to this feast of colour and texture, which draws and engages the
audience in this moving narrative.

Motivation
‘I probably make films that are autobiographical more because I think they make better
stories because they’re real and therefore more likely to, sort of touch other people and pull
other people into the story and into the drama, that it would help me as some kind of
therapy. When I go and see films or look at paintings, I want to be moved and touched and
usually its coming from something personal in the artist so that’s probably why I raid my own
life to make films.’ Sarah Watt

I can identify a lot with Sarah Watt’s motivation for making ‘Small Treasures’.
I also wanted to express something more universal about childbirth and in 1995 made an animation,
‘Birthday’ It features three births, two are those of my own children the third is based on a
storyboard of my animator friend Strinda Davies. Happily all three resulted in live births. Even
though the outcome was positive I wanted to show the births exclusively from the mother’s point of
view. I was often irritated by live action‐films, which seemed to objectify and control the woman
giving birth rather than acknowledge her role as birth giver. I wanted to celebrate this role even
when the woman had issues with the way the birth was handled.

My motivation for making this film was in some ways similar to Sarah’s in that I felt that the whole
experience of birth was shrouded in secrecy or reduced to cliché rather than being seen for the rich
area of human experience and endeavour that it is.

‘Brush the teddy’s toes’ – Yvonne Eckersley 2003 Running time 4”
Theme
This film tells the story of Louis, a boy with developmental difficulties and follows his family’s search
to find help for him. The title comes from a comment made by a paediatrician trying to assess his
level of understanding. It seemed that by asking such a bizarre question he was already being
assigned an identity outside normality. This was emphasised by his sister who commented, ‘but you
usually brush hair, not toes’.

Narrative Structure
With ‘Brush the teddy’s toes’, I wanted to achieve what Paul Wells, in his book ‘Understanding
Animation’, describes as penetration.

‘One of the outstanding advantages of the animated film is its power of penetration. The
internal workings of an organism can easily be shown in this medium. The depth of a man’s

soul is more than a phrase to the animator: it can also be a picture.’ – Halas and Batchelor,
1949 (Wells P. 1998, p122)

The soundtrack is structural to the piece. The beginning is deliberately disorientating and
fragmented mirroring the visuals and is distorted to try to convey the feeling of senses not tuned in
to the brain. The film progresses, the images becoming more readable and the soundtrack more
conventional, reflecting the improvements in the boy’s ability to make more sense of his
environment. Metamorphosis is used as a structural device to transist from one scene to another.

Visualisation
The technique involved two levels of animation, pen on paper and food colouring on watercolour
paper, layered together in Première.
Some of Louis’ drawings were used as inspiration and combine with the animators drawn
observations from life.
A simple colour palette of largely warm colours, oranges, reds, and warm greens, is used to convey
an optimistic mood with purple applied in scenes where sadness dominates.
The line drawings are slightly mis‐registered creating an individual aesthetic which seems to fit the
theme of discord.

Motivation
Making this film was certainly therapeutic for the animator. It helped to take stock of the family’s
efforts to both come to terms with their son’s disability and their status as a disabled family. It also
acknowledges the struggle to find useful therapies and the strain the repetitive nature such
programmes can put on the family. The intended audience was other families struggling with similar
circumstances so it was a surprise when S4C saw that it had a wider appeal and funded the film.
The animator finds the creative production processes inherently therapeutic in themselves.

Autobiographical themes in independent animation

Autobiography makes trouble: it is difficult to define as a distinct genre, on the borderline
between fact and fiction, the personal and the social, the popular and the academic, the
everyday and the literary (Marcus 1994). This kind of disruptive interdisciplinarity, the
challenging of traditional boundaries and definitions, has also been central to the feminist
project, especially as articulated in Women’s Studies, and autobiography provides a meeting
place for many different kinds of feminist approach.
(Tess Cosslett 2000)

The films discussed are, I believe, intentionally or not inherently feminist and many of the terms
above used by Cosslett in linking autobiography to feminism might also be applied to them and in a
wider sense to independent animation. They are interdisciplinary, bringing together sound and a
variety of media and techniques, challenge traditional boundaries whilst providing a meeting place
for many different kinds of feminist approach. The use of sound or music without voice to convey
narrative has been seen as a more feminist approach than more traditional forms of script or
narration.

Scott McDonald has this to say in defence of personal autobiographic and domestic themes, as
legitimate subject matter for film:
‘We cannot live outside a domestic sphere and that therefore, given the inevitability of the
domestic, surely it is progressive to model ways of cinematically exploring and revealing the
domestic without reducing it to sterile metaphors in the service of either patriarchy or
justifiable feminist fury. (Scott MacDonald, 2005, p233)

Narrative structures in the films discussed.

An animated film can condense material so that an image can operate simultaneously as a
retrieval of image forms, as a deployment of (sometimes highly personal) symbolism and
metaphor, and can provide incidence of penetration.’ (Wells P. 1999, P201)

The films discussed each employ several of the forms mentioned in the above quote by Paul Wells
and each gives us a very individual, highly personal point of view. Although the overall narrative
strategies vary from film to film they all provide some degree of penetration, and invite the audience
to enter their internal world and share their perceived experience.

Visualisation
The highly visual and individual aesthetics of the films are refreshingly different from each other and
give just some examples of the wealth of media and visual codes that are available to the animator.
They are free to evolve and adapt their imagery from an unlimited variety of sources such as
painting techniques or found objects and apply them to express their ‘inner necessity’.

‘For the truth claim that animation visualises the essence of truth, other than filming a
truthful event. It is similar to the difference between a caricature and a photograph. …While
photography can be distractive or misleading, drawn images tend to focussed on topic. This
is also connected to the economic nature of drawn images such as in characatures: it does
not require many words to describe what it is about’. Hee Holmen, Aalborg University
Esbjerg

The therapeutic potential of producing animated autobiography

In ‘Documents of Life 2 Ken Plummer describes how in the Social Sciences there has been
considerable interest in life stories and their therapeutic role.

One of the striking new turns in the uses of life histories and narratives has been their
development within medicine and therapy. Of course, ever since Freud and earlier, the focus
upon understanding the dynamics of an individual case or life has always been a prime
concern.’ Plummer

From many angles – illness narratives, trauma and abuse narratives, coming out narratives,
aging and reminiscence narratives – the power of the story to hold together a potentially
fragile life starts to be seen’ (Plummer K. 2006, p243)

Karen Watson and Sarah Watt both recognise the therapeutic potential of producing
autobiographical animation. Sarah describes the type of person she believes is more likely to want to
express them‐selves through animation as
‘a weird mix of being very creative and very dull and able to embrace routine’

The animation process consists of numerous different tasks requiring differing levels of
concentration.


‘Small Treasures is 15 minutes long and is 12 drawings per second so it was an incredible
amount of work but I love it with animation because you have days when you’re really
creative and you really want to paint something gorgeous and so you can paint a
background or you can get the feeling of movement and then you have days when you just
want to sit there and do really boring work like just the craft f it. It’s like knitting, you know,
you just colour in and listen to story tapes and music, its great. Sarah Watt

All of the films I have selected set out to engage an audience and reveal a personal truth. This might
be simply to draw attention to the miraculous nature of the everyday, as in ‘Growing’. More often
than not this truth is not just a personal one but relates to a collective truth as in the other films.
Theatre pioneer, Augusto Boal has expressed how the opportunity to tell ones own truth is in itself
therapeutic to the individual.

‘The political potential of a personal story is grounded not in particular subject matter but
rather in storytelling’s capacity to position even the least powerful individual in the proactive,
subject position, For personal story draws on the authority of experience; everyone is an
expert on his or her own life.’ (Jan Cohen‐Cruz, 2006, p103)

In 2006 Melanie Hani, animation lecturer at Sunderland University worked on an animation project
with a group of adults and children who had been recently bereaved. This project formed the basis
of her Masters Degree in Animation. In her publication “Made with love’ she draws some interesting
conclusions regarding the therapeutic potential of animation as a process. The participants clearly
benefited from the opportunity to share their stories of loss with each other as well as
communicating them to a wider audience via an exhibition featuring the animated shorts they
produced.
On a neurological level Hani believes that the processes involved in producing animation effectively
stimulate the frontal lobes, believed ‘to play an important role in the mediation of depression’ and
who’s main function appears to be ‘thought and concentration on problems’, (Austin T.A. 2006)
Hani lists the functions of the frontal lobes, including motor function, problem solving, spontaneity,
memory, language, initiation, judgement, and maps these quite convincingly onto the various
processes involved in the animation produced by the group.

Although it falls into the related field of experimental film and not animation it is worth mentioning
here American artist’s Anne Robertson’s ‘’Five Year Diary’. For over 20 years, Robertson chronicled
her experience of bi‐polar depression and covered frequent stays in hospital.

‘Filmmaking ‘has been not only the central activity of her life, but one of her most effective
means for managing the ravages of her disability: filming, editing and showing her films has
become a celluloid lifeline, providing coherence and continuity amidst the demands of the
sometimes self‐destructive voices she hears’. (McDonald S. 2005 P224)

As a form of therapy animated autobiography is in its early days and we have a lot to discover about
its possible benefits to the individual. Moreover it is unclear to what extent the desire to
communicate and share our personal truth with an audience contributes to the therapeutic process
as a whole. It seems reasonable to assume however, that animation, with it’s interdisciplinarity and
many eclectic approaches is particularly well placed to evoke deep emotions and plum different
levels of consciousness, making it an exceptional medium for expressing autobiographical narrative.

References
‘Adaptations, from text to screen,screen to text’(Thou art translated – analysing animated
adaptation’, Paul Wells), Eds Debora Cartmell and Imelda Whelehan,1999, Routledge,ISBN 0‐415‐
16738‐8

‘Women and Experimental Film making (Avant‐Gardens’ Scott MacDonald)’
Eds Jean Petrolle and Virginia Wright Wexman, University of Illionois Press 2005, ISBN 0‐252‐07251‐0

‘Disclosure of the everyday – undramatic achievement in narrative film’ by Andrew Klevan, 2000,
Trowbridge, Wiltshire: Flicks
‘Elements of Episodic Memory’ by Endel Tulving, 1985, Oxford University Press ISBN 0‐19‐852125‐1
‘Documents of life 2’’, Ken Plummer, 2006, SAGE, ISBN 13: 978‐0‐7619‐6132‐1
‘Women and Animation, a compendium’ , Ed Jayne Pilling, BFI,1992,
ISBN 0 85170 377 1
‘A Reader in animation studies’, ed Jayne Pilling, 1997, John Libbey,ISBN 1 86462 000 5
‘Feminism and autobiography’, Tess Cosslett, 2000, Routledge
‘A Boal Companion, Dialogues on theatre and cultural politics’ (‘Redifining the private, from personal
storytelling to political act’, Jan Cohen‐Cruz)’, Eds Jan Cohen‐Cruz and Maddy Schutzman, 2006,
Routledge
‘Understanding Animation’, Paul Wells, 1998, Routledge, ISBN 0‐415‐11597‐3
‘Made with Love’, Melanie Hani, 2006, University of Sunderland,
ISBN 1 873757 11 5
Life in Norway, an interactive animated documentary CD‐ROM, Hee Holmen
Aalborg University Esbjerg hee@cs.aue.auc.dk
Interview with Sarah Watt, http://www.abc.net.au/austory/content/2005/s139856.htm


Narrative Based Medicine: Potential, Pitfalls, and Practice1
Vera Kalitzkus, PhD / Prof. Dr. Peter F. Matthiessen, MD

Chair in Medical Theory and Complementary Medicine
University of Witten/Herdecke, Germany

Introduction
Narratives have always been a vital part of medicine. Stories about patients, their recovery from
illness, as well as the experience of caring for them have always been shared. With the rise of
“modern” medicine, narratives were increasingly neglected in favour of “facts and findings”
regarded as more objective and scientific. Yet, in the recent years the medical narrative is changing
again – patient narratives and the unfolding story between health care professionals and patients
are both gaining momentum.
In due course this led to the formation of Narrative‐based Medicine (NbM). The term was coined
deliberately to mark its distinction from Evidence‐based Medicine (EbM), with NbM propagated to
counteract the shortcomings of EbM (Greenhalgh 1998; Charon/Whyer 2008). But what does this
term actually contain? Is it a specific therapeutic tool, a special form of doctor‐patient
communication, a qualitative research tool, or does it just signify a particular attitude towards
patients and doctoring? It can be all of the above, but depending on the field of application, a
different form of narrative or practical approach is called for.
In this article we will give a systematic overview of NbM: a short historic background; the various
narrative genres; and an analysis of how genres can be effectively applied in theory, research, and
practice in the medical field, with a focus on possibilities and limitations of a narrative approach.
In medical practice, three different, although overlapping, areas can be distinguished:
1. Learning about the patient and carers’ perspective for research and training. For this area
we will offer a classification of the various narratives.
2. The narrative approach in actual medical practice, through understanding the narrative
structure of medical knowledge, and narrative‐oriented, doctor‐patient relations.
3. Narratives as evidence – narratives from social science research and narratives derived from
medical practice and patient encounters are a source of knowledge for evidence, beyond the
gold standard of randomized controlled trials of evidence‐based medicine.

Background
Medical narrative is undergoing a change: a movement from the doctor’s narrative to that of the
patient. In modernism, the dominant medical narrative has been the doctor’s narrative in the form
of the classical objective biomedical scientific report. The medical narrative nowadays, David Morris
points out, increasingly recounts the patient narrative (Morris 2000). In the late 1980s, Polkinghorne
and others spoke about a “narrative turn” in the medical field ‐‐ narratives are now seen as a useful
resource for understanding the individual, patient‐specific meaning of an illness. Narratives ‐‐
especially patient narratives ‐‐ incorporate the question of causality and thus foster an
understanding of the patient’s illness perception. In the words of Greenhalgh and Hurwitz:
1
This paper has also been published by the Permanente Journal (Vol. 13, No 1, Winter,
December, 2008). We thank the publisher/editors for their consent.

“Narrative provides meaning, context, perspective for the patient’s predicament. It defines
how, why, and what way he or she is ill. It offers, in short, a possibility of understanding which
cannot be arrived at by any other means.” (Greenhalgh/Hurwitz 1998: 6)
This understanding, we believe, is also true for stories about being a medical professional and caring
for the sick in times of growing economic, as well as institutional constraints and an increasing
dominant economic narrative.

Narrative Structure of Medical Knowledge
The development of NbM has to be understood in the context of patient‐centred approaches ‐‐
bringing the patient as a subject back into medicine. This has been central to the work of Viktor von
Weizsäcker and psychosomatic medicine (Ten Have 2000: 22ff; Uexküll 1997). He demanded
inclusion of the patients’ experience into the medical endeavour. An illness narrative tells us not
only about a specific medical case, but about the intensive, ultimate and most authentic reality of
life or death of a person. According to von Weizsäcker, the illness narrative is not only a description
of something pathological that is happening objectively, but the description of the involvement of
life itself in that illness of that specific individual human being (von Weizsäcker, acc. to Konnitzer
2005: 126). This subjective approach can also be found in patient‐oriented, doctor‐patient‐
communication and relations extending back to Carl Rogers (Wood 2000) or Michael Balint (1986
[1968]). In 1998, Greenhalgh and Hurwitz point out that, especially in Balint groups, the meaning of
narratives in the doctor‐patient interaction become apparent (Greenhalgh/Hurzwitz 1998).
Kathryn Montgomery Hunter was one of the first to point out the narrative structure of medical
knowledge:
”Narrative is the ultimate device of casuistry in medicine (as in theology and law), which
enables practitioners who share its diagnostic and therapeutic worldview to fit general
principles to the single case and to achieve a degree of generalization that is both practicable
and open to change.“ (Hunter 1991: 46f)
In that sense narratives can be understood as the bridge between the evidence of large scale
randomized controlled studies and the medical art of applying this knowledge to a single case. EbM
and NbM thus have to be understood in complementary terms, Peter. F. Mathiessen points out: In
medical practice, both aspects, the search for laws of cause and effect and the description of the
specific, unique and singular cannot be pursued separately; they are inextricably intertwined. In the
process of turning medicine towards a natural science the effort to reach ever more objective
findings led to a neglect of the subjective dimensions of medical practice. Matthiessen argues that
an incorporation of the subjective areas (for example in single case studies) would result in a higher
objectivity within medicine. According to Matthiessen a narrative culture in medicine would
highlight the interpretative and judgemental character of diagnostic statements. It would further
clarify the intrinsic contextuality of knowledge. He concludes that objectivity in that sense would be
the methodological inclusion of the subjectivity of all perception and knowledge (Matthiessen 2006).
The latest development in the field has led to the endeavour to integrate the approaches of EbM
and NbM in a program called “narrative evidence based medicine” (NEBM) that, according to one of
its founders Rita Charon, “recognises the narrative features of all data and the evidentiary status of
all clinical text” (Charon 2008).

The different Genres of Narratives
Narratives about being ill and caring for the ill, provide insight of the respective experience and so
could foster mutual understanding – not only from the medical side for their patients, but also from
patients for their caregivers. Narratives also give further insight into the cultural and sociohistoric
context of medicine and being ill. Four genres of narrative can be distinguished:
1. Patient Stories ‐‐ classical illness narratives
Patient stories allow: making sense of their suffering; how it feels from the inside; offer biographical
and social context of the illness experience; and suggest coping strategies and potential for personal
development. An annotated bibliography of about 270 books on pathographies and

autopathographies has been compiled by Jeffrey K Aronson
(http://www.clinpharm.ox.ac.uk/JKA/patientstale; acc. July 31 2008. See also Aronson 2000).
2. Doctors’ stories
Autobiographical accounts about delivering care for the sick and life as a doctor also have a
long history ‐‐ one prominent example being the writing by Anton Chekov (Coope 1998).
Doctors’ stories can also contribute to a re‐humanisation of medicine in the same way as the
acknowledgement of patient narratives (Verghese 2001). After all, it is humans that deliver
medical care. A special genre constitute stories about doctors as patients. Reflections on
doctors own vulnerability are not very prominent, and even less so in public; however, these
accounts show how doctors’ illness experience changed their understanding of their
professional role and their relation to their patients. DasGupta and Charon tried to foster that
kind of reflexivity ‐‐ that is taking on a reflexive stance towards their own experience ‐‐ in
medical students, asking them to write about a time of experienced bodily vulnerability or
suffering. This means of reflection helps doctors to develop empathy and understanding for
the situation of their patients. DasGupta and Charon conclude: “The personal illness narrative
allows the reader‐writer to more fully enter the reality of the patient world by recognizing,
describing, and integrating the similarities in her own personal experiences and those of, the
patient.” It can also counteract the neglect of their embodiment that is intrinsic unfortunately,
to the medical system (DasGupta/Charon 2004: 355).
3. Narratives about doctor‐patient encounters
Illness, and the process of being ill, is formed and articulated in the doctor‐patient‐encounter.
The patients’ experience of symptoms is interpreted by doctors’ medical knowledge,
eventually leading to a diagnosis and respective therapeutic intervention. This in turn then
changes patients’ narratives about what they experience. As they “make sense” of their
sensations, the medical perspective on them plays a vital part. There is an ongoing debate
about the degree of doctor’s influence in creating the patient’s story (Brody 1994; Rabin et al.
2004: 20; Eggly 2002) and we will suggest a way to look at it in the next section of this paper.
Nevertheless, doctors have the potential to take on an important supportive role in the
creation of the illness narrative: that is to bring to life and formulate new stories, as family
physician John Launer (2006) points out, and thus help patients in their coping process and
even contributing to their personal growth. The illness narrative has to be understood and
seen as being part of a patient’s life story. Of course an inverse effect is possible in that
patients feel devalued by medical judgement of their existence, especially if it is a strictly
pathological judgment without account of the still healthy and valuable aspects a person has
even in severe illness or when the whole person story is truncated merely to the illness
narrative.
4. Grand stories ‐‐ Metanarratives
In the background of individual narratives there are always grand narratives of socio‐cultural
understandings of the body in health and illness. They are described in studies of medical
history or the history of the body (Turner 2000 ‐‐ such as “The culture of pain” by David B.
Morris (1991) or “Fragments for a history of the human body” by Michael Feher and others
(1989), and the dominant medical discourse in particular as has been analysed by, for
example, Michel Foucault (1973). This influences both the caregivers’ and the patients’ view
on illness and the sick body (Mattingly/Garro 2000).

The Potential of Narratives in Communication
Published narratives tend to be told in reflected and elaborated ways. But narratives are also shared
in and created by communication ‐‐ that is narratives as a kind of speech act. They constitute a
specific form of text genre with a specific linguistic text structure that is distinct from other forms,
for example an argumentation or a report. These nucleus narratives can also emerge in a doctor‐

patient‐consultation. There are five characteristics of narratives in a speech act that are important
for medical practice. These:
1. Consist of distinctive and recognisable phases: orientation, complication (an incident that is
problematic or out of the ordinary, i.e. the part of the story that makes it worth telling),
evaluation, coda2;
2. Always have a specific addressee (and thus can never be told in the same way twice);
3. Always are about an individual and what s/he experiences/feels;
4. Contain information not an essential part of the story ‐‐ the content is the narrator’s choice
of what s/he regards as relevant for the story and thus is an act of meaning creation
5. Have the potential to “draw us in” and thus, in the words of Greenhalgh/Hurwitz (1998)
enable the experience of “living through” and not only “knowledge about”” (emotionality)
Narratives on the level of a communication act follow an intrinsic drive for completion: to give
relevant context information and to bear in mind the social rules of interaction ‐‐ that is, reaching a
conclusion of the story within a reasonable time frame. This is especially important for medical
professionals as they act under severe time constraints and fear of being overwhelmed by their
patients’ narrative, if they open that Pandora’s box. This nucleus form of a narrative can emerge in a
doctor‐patient‐interaction and gives the doctor the specific insights as mentioned above. They can
form also an element of the larger narrative evolving in the doctor‐patient‐encounter.

Co‐creation of Illness Narratives
Concerning the co‐creation of the patient’s illness narrative we agree in that her/his illness narrative
is formed and changed by the medical encounter (co‐creation) and that this accounts for its
therapeutic potential. Nevertheless, this process of co‐creation in the encounter does not lead to a
more or less stable narrative shared by both and recounted as such by the patient. Instead, his/her
illness narrative is in the process of forming/changing through time and will be a separate form of
narrative ‐‐ distinct from the doctor’s and the encounter’s narrative, although influenced by it.
Likewise the doctor’s story of that patient’s illness is changed by the encounter and, in consequence,
can inform the doctor’s understanding of that disease ‐‐ the above mentioned narrative structure of
medical knowledge.3 The patient‐, doctor‐ and the encounter narrative each signify a specific type or
aspect of an illness narrative, their mutual influence always given.
Medical professionals are trained in medical history‐taking with the goal of eliciting the relevant
medical facts from patients without too much supposedly “useless” information. However, allowing
a narrative flow in the consultation does not necessarily require a lot of time. A study about
spontaneous talking time of patients in general practice points out that two minutes of listening
from the doctors side is enough for 80% of the patients to recount the concern that they brought
into practice. From 335 patients only seven needed more than five minutes. The doctors of the study
were trained in “active listening”, and the study cohort consisted of many “difficult” patients with
complex medical histories (Langewitz et al. 2002). “One of the most difficult tasks in health care,”
John Launer (2006) states, “may to be manage each consultation so that it continually meets both
narrative and normative requirements.” Illness narratives provide context for physiological
symptoms and results of diagnostic texts ‐‐but an illness has meaning in the biographical context of a
patient. This meaning, however, has to be decoded.

The Analysis of Meaning
Medicine has no respective theory or methods for analysis of meaning. It draws on the knowledge
from interpretive sciences, such as humanities or social sciences. This is less a problem in research,
where respective disciplines could be part of the research team, or for reading published accounts of
illness, where the story is “processed” in order to convey its meaning to the reader. However, it
2
Based on Labov’s elaborate distinction of six elements. Labov (1972).
3
The development of this thought was triggered by an email-conversation with Celia Engel
Bandman, who understands the narrative of the doctor-patient- relation as a narrative with two voices.

becomes crucial in the context of medical practice ‐‐ the actual doctor‐patient‐encounter. Rita
Charon points out that “literature and medicine” classes for medical students and professionals can
be a means to develop a respective sensitivity towards meaning‐creating processes. But it might also
be necessary to reflect on actual daily practice to get a feel for “narrative in action”, for example by
analysing video or tape recorded consultations together in a peer group. We tested that in a
research project with General Practitioners. In a monthly quality circle (peer review group), and
additional workshops, the participants were trained in analytical methods derived from the social
sciences, and then used these skills and methods to discuss recorded consultations from their own
practice (Bahrs et al. 2003). This training helped them to identify areas of strength and weakness in
their relations with their patients. In addition, it had the effect of self reflection with regard to daily
practice, and during daily practice, and helped to overcome established, hindering habits. After two
years they reported a higher sensitivity for biographical context, subjective illness categories, and
meaning‐creating processes by the patient. It became apparent, however, that a narrative approach
cannot be learned in a short course conveying a tool box of narrative techniques. Changing from a
conventional form of practice towards a narrative oriented one asks for perseverance, vigilance
against old routines and constant (self) reflection ‐‐ ideally in a peer group with regular video
documented case discussions.
Understanding the quite often complicated and contradictory stories of suffering is not easy or self
explaining. As Rita Charon (2005) explains: “Pain, suffering, worry, anguish, the sense of something
just not being right: these are very hard to nail down in words, and so patients have very demanding
‘telling’ tasks while doctors have very demanding ‘listening’ tasks.” Apart from analytical skills to
understand the implicit meaning in narratives, listening skills are therefore vital for narrative
practice. The necessary listening skills go beyond specific techniques. What is needed is a particular
mindset of “inner involvement” or, as Arthur Kleinman calls it, a stance of “empathetic witnessing”
(Kleinman 1998: 54) and an all‐encompassing attention: “Attention may be the most urgent goal in
our work”, Rita Charon (2005) concludes, “to attend gravely, silently, absorbing oceanically that
which the other says, connotes, displays, performs, and means.”

The Healing Potential of Narratives
“[I]llness is terrible but, with some luck, it can also be full of wonders”, Arthur W. Frank is convinced.
“The terrors assault us at once; the wonders take longer to become visible. Stories help us gain some
distance from the terrors and learn to perceive the wonders […] In telling all kinds of stories, we find
healing.” (Frank 2007) Thus, narratives can have a healing effect ‐‐ both in listening to others’ as well
as telling one’s own story (Coulehan 1991). Concrete evidence for this has been given especially in
writing about illness and traumatic events (Conolly Baker/Mazza 2004; Sakalys 2003). Hatem/Rider
(2004), for example, cite a clinical studies that show significant changes in physiological parameters,
such as improvement of lung functions in asthma patients or decline of disease activity in patients
with rheumatic arthritis due to writing about personal stressful experiences. Another study gives
evidence about an increased immune response in Hepatitis B vaccinations in a group of medical
students that wrote about traumatic experience shortly before it (Keith/Petry 1995). But also talking
about once experience has the potential to heal, as Pennebaker (2000) makes clear, as the expression of
emotion can have a cathartic effect
(Pennebaker 1997). And it ultimately helps all parties involved in developing
their human potential: “narrative based medicine is about helping people to tell stories that have to
be told if all of us are to remain fully human.” Arthur W. Frank (2002: 1) concludes.

Narrative in Medical Practice
A narrative approach in medicine will only succeed if ultimately it has a positive effect on daily
practice rather than just adding to the already existing pressure. For this it is helpful to point out
that complex illness narratives as published in biographies or collected by social scientists are
useful for knowledge generation and also for training medical professionals. But in that
complexity narratives are neither applicable nor necessary in daily medical practice (Launer

2002). A narrative approach in daily medical encounters consists mainly of a specific stance
towards patients and practicing medicine as well as so called “narrative skills”:
 Sensitivity for the context of the illness experience and the patient‐centred perspective
 To establish a diagnosis in an individual context, rather than merely in the context of a
systematic description of the disease and its etiology
 Narrative communication skills, such as exploring difference and connections,
hypothesising, circular questioning (a technique originally from systemic family therapy
aiming hat a differentiated view on a specific topic; it can include questions that are
ranking, speculative, relational or contextualising), strategising, sharing power, reflection
and active listening (Launer 2002: 39‐41).
 Self‐reflection.
To use the potential of narratives for self‐reflection and professional development, Gillie Bolton
proposes reflective writing courses, where practitioners put their experience in words ‐‐ even poetry
‐‐ and reflect on them in a facilitated and mentored peer group (Bolton 2007, 2001).
As the “language” and “lifeworld” of patients and doctors can be so far apart it might be helpful to
have an intermediary. Celia Engel Bandman encapsulates this position in her concept of a facilitator
between the doctor’s and the patient’s world that she calls a ‘Medical Humanist‘. The term is
derived from the philosophical tradition and world view of humanism and not to be confused with
the field of the medical humanities. A published writer herself, her role as a Medical Humanist in a
Cancer Center in Vermont, USA, is one to create a bridge between doctor and patient:
“By recognizing that the language of medicine and the language of the patient’s world
transformed by illness are not the same, the medical humanist creates a communication
bridge. And in so doing, provides support to both doctor and patient as they face uncertainty.”
(Bandman 2004: 108)
She does so, for example, in helping patients to find words for their experience and to include them
in the medical record: “The ‘Medical Humanist’s Note’ documented the patient’s story in their own
words and was filed alongside the clinical record which made for the whole story.” (Bandman 2008)

Pitfalls of Narrative based Medicine
Finally, some warning remarks might be appropriate. Narrative based medicine is not all beer and
skittles. It takes time and effort as “significant technical and attitudinal change that is necessary does
not come quickly.” (Launer 2002: 180) At the beginning, embarking on the narrative adventure can
lead through a phase of destabilization and doubt about once own approach to medical practice. It
can also lead to a phase of getting carried away by it. “The biggest challenge in taking a narrative
approach is knowing when to stop. Disease, disability, deprivation and death are not stories. They
are facts. Professionals, who get carried away by narrative ideas to the point where they forget this,
are not safe” (Launer 2002: 6). Narrative is not the only thing that counts in medicine: by no means
is it meant to devalue medical knowledge. Also there are patients who are not interested in telling
their story or sharing their innermost feelings, and not every topic raised in a consultation calls for
detailed narrative exploration.
The insight into the potential of narratives is not new, but it is necessary to re‐enliven it: to find ways
and forms to share stories and the personal experience of being ill and caring for the ill, and thus
make a contribution to humanising health care as well as encouraging individual personal growth,
for the patients and the caregivers and the people who are still healthy.

Acknowledgements
We thank Celia Engel Bandman and Jon Airdrie for valuable comments on an earlier draft of this
paper.

References
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Notes For Contributors
GENERAL
The IJNP is an international journal that publishes articles about the use of narratives in a wide
variety of contexts. It is specifically multi‐disciplinary and will accept articles from all disciplines
including health, social science, education, the arts and humanities. Original papers are sought which
are empirically grounded and reflect the use of narratives in research, education or practice. The
journal publishes:
 Original research papers in all areas
 Theoretical/Conceptual papers on narratives
 Book reviews
 Special issues
 Letters and Comments
ETHICAL GUIDELINES
Authorship and Acknowledgements
Authorship: All named authors must have made an active contribution to the conception and design
and/or analysis and interpretation of the data and/or the drafting of the paper and ALL must have
critically reviewed its content and have approved the final version submitted for publication.
Participation solely in the acquisition of funding or the collection of data does not justify authorship
and, except in the case of complex large‐scale or multi‐centre research, the number of authors
should not exceed six.
It is a requirement that all authors have been accredited as appropriate upon submission of the
manuscript. Contributors who do not qualify as authors should be mentioned under
Acknowledgements.

Acknowledgements: These should be brief and must include reference to sources of financial and
logistical support. Author(s) should clear the copyright of material they wish to reproduce from
other sources and this should be acknowledged. Under Acknowledgements please specify
contributors to the article other than the authors accredited. Suppliers of materials should be named
and their location (town, state/county, country) included.

Conflict of Interest and Source of Funding
Conflict of Interest: Authors are required to disclose any possible conflict of interest. These include
financial interests (for example patent, ownership, stock ownership, consultancies, speaker's fee).
If the author does not include a conflict of interest statement in the manuscript then the
following statement will be included by default: 'No conflicts of interest have been declared'.

Source of Funding: Authors are required to specify the source of funding for their research when
submitting a paper. Suppliers of materials should be named and their location (town, state/county,
country) included. The information will be disclosed in the published article.
Appeal of Decision
The decision on a paper is final and cannot be appealed.

Permissions
If all or parts of previously published illustrations are used, permission must be obtained from the
copyright holder concerned. It is the author's responsibility to obtain these in writing and provide

copies to the publisher.

Copyright Assignment
Authors submitting a paper do so on the understanding that the work and its essential substance
have not been published before and is not being considered for publication elsewhere. The
submission of the manuscript by the authors means that the authors automatically agree to assign
all copyright if and when the manuscript is accepted for publication. The work shall not be published
elsewhere in any language without the written consent of the Publisher. The articles published in
this journal are protected by copyright, which covers translation rights and the exclusive right to
reproduce and distribute all of the articles printed in the journal. No material published in the
journal may be stored on microfilm or videocassettes, in electronic databases and the like, or
reproduced photographically without the prior written permission of the publisher.
Correspondence to the journal is accepted on the understanding that the contributing author
assigns the full copyright to the publisher to publish the letter as part of the journal or separately
from it, in the exercise of any subsidiary rights relating to the journal and its contents.
Upon acceptance of a paper, authors are required to assign the full copyright to publish their
paper. Assignment of the full copyright is a condition of publication and papers will not be passed to
the publisher for production unless full copyright has been assigned. (Papers subject to government
or Crown copyright are exempt from this requirement; however, the form still has to be signed).
SUBMISSION OF MANUSCRIPTS
Manuscripts should be submitted electronically via the online submission site
www.thenarrativepractitioner.co.uk.
The use of an online submission and peer review site enables immediate distribution of manuscripts
and consequentially speeds up the review process. Complete instructions for submitting papers are
available online and below. Further assistance can be obtained from the
www.thenarrativepractitioner.co.uk.
Manuscript Files Accepted
Manuscripts should be uploaded as Word (.doc) or Rich Text Format (.rtf) files (not write‐protected)
plus separate figure files. GIF, JPEG, PICT or Bitmap files are acceptable for submission, but only
high‐resolution TIF or EPS files are suitable for printing. The files will be automatically converted to
HTML and PDF on upload and will be used for the review process. The text file must contain the
entire manuscript including title page, abstract, text, references, tables, and figure legends, but no
embedded figures. Figure tags should be included in the file. Manuscripts should be formatted as
described in the Author Guidelines below.
Please note that any manuscripts uploaded as Word 2007 (.docx) will be automatically rejected.
Please save any .docx file as .doc before uploading.

Blinded Review
All manuscripts will be reviewed by two experts in the field. The names of the reviewers will thus not
be disclosed to the author submitting a paper and the name(s) of the author(s) will not be disclosed
to the reviewers. To allow double‐blinded review, please submit (upload) your main manuscript and
title page as separate files.
All documents uploaded under the file designation 'title page' will not be viewable in the HTML and
PDF format you are asked to review at the end of the submission process. The files viewable in the
HTML and PDF format are the files available to the reviewer in the review process.

E‐mail Confirmation of Submission

After submission you will receive an e‐mail to confirm receipt of your manuscript. If you do not
receive the confirmation e‐mail after 24 hours, please check your e‐mail address carefully in the
system. If the e‐mail address is correct please contact your IT department. The error may be caused
by spam filtering software on your e‐mail server.
Manuscript Status
You should expect to wait no longer than 8 weeks for a decision to publish or not. The journal will
inform you by e‐mail once a decision has been made.

Submission of Revised Manuscripts
Revised manuscripts must be uploaded within three months of authors being notified of conditional
acceptance pending satisfactory revision. Please remember to delete any old files uploaded when
you upload your revised manuscript. Please also remember to upload your manuscript document
separate from your title page.
MANUSCRIPT FORMAT AND STRUCTURE
Style
Authors should remember that they are writing for an international multidisciplinary audience. A
covering letter must be submitted as part of the online submission process, stating on behalf of all
the authors that the work has not been published and is not being considered for publication
elsewhere. The Editors will decide on the time of publication and retain the right to modify the style
of a contribution; major changes will be agreed with the author(s) before production of proofs.

Papers should be between 3000 and 5000 words in length, typed using double spacing and a wide
margin on each side of the text. The numbers of words used, excluding abstract and references,
should be specified. Details of sources of research funding, other support, and acknowledgements
should be included. Contributions to the manuscript should be indicated, by initials, at the end.

The top sheet should display the manuscript title and a shortened version of the title. Please ensure
that manuscripts are completely anonymous, by removing author details and acknowledgements
from the text. Author details will be requested separately during online submission. No identifying
details of the authors or their institutions should appear within the main text of the submitted
manuscript.

Format
Language: The language of publication is English. Authors for whom English is a second language
must have their manuscript professionally edited by an English speaking person before submission
to make sure the English is of high quality.
Structure
All manuscripts submitted to IJNP should include: title page, abstract, text, references, tables and
figure legends, but no embedded figures.

Title Page: This should contain a concise title of the article, names and qualifications of authors, their
affiliations and the full postal address, email and telephone number of an author to whom
correspondence can be addressed.

Abstract: This should be clear and concise and should not exceed 300 words. No particular format or
structure is essential when constructing the abstract. The Abstract should be followed by up to six
key words.


Main Text: Where possible authors should avoid using abbreviations and footnotes. The use of non‐
discriminatory language is encouraged and spellings should conform to that used in the Concise
Oxford Dictionary of Current English.

5.4. References
These should be in the Harvard style. In the text the authors' names should be cited followed by the
date of publication, e.g., Lloyd & Carson (2005). Where there are three or more authors, the first
author's name followed by et al. should be written in the text, e.g. Welstand et al. (2009). The
reference list should be listed in alphabetical order. The references should list authors' surnames
and initials, date of publication, title of article, name of journal or book, volume number or edition,
editors, publisher and place of publication. In the case of an article, page numbers should be
included routinely, page numbers from books need only be included when referencing direct quotes
or paraphrases. Unpublished work should be cited in the text only. Only references to articles
genuinely in press should be included in the reference list.

5.5. Tables, Figures and Figure Legends
Tables: These should be clearly titled, follow a consistent layout, and be referenced within the text.
Wherever possible, they should be self‐contained avoiding the need for a reader to cross‐reference
the text to understand a table. Tables should be submitted one per page, numbered in the same way
as figures and listed on a separate page at the back of the manuscript.

Figures: These should be referred to in the text as figures using Arabic numbers e.g., Fig. 1, Fig. 2,
etc., in order of appearance.

Figure Legends: Each figure should have a legend clearly describing it. The legends should be
grouped on a separate page at the end of the manuscript. In the full‐text online edition of the
journal, figure legends may be truncated in abbreviated links to the full screen version. Therefore,
the first 100 characters of any legend should inform the reader of key aspects of the figure.

Preparation of Electronic Figures for Publication: Although low quality images are adequate for
review purposes, print publication requires high quality images to prevent the final product being
blurred or fuzzy. Submit EPS (line art) or TIFF (halftone/photographs) files only. Microsoft
PowerPoint and Word Graphics are unsuitable for printed pictures. Do not use pixel‐oriented
programs. Scans (TIFF only) should have a resolution of at least 300 dpi (halftone) or 600‐1200 dpi
(line drawings) in relation to the reproduction size (see below). Please submit the data for figures in
black and white or submit a Colour Work Agreement Form (see Colour Charges below). EPS files
should be saved with fonts embedded (and with a TIFF preview if possible).
For scanned images, the scanning resolution (at final image size) should be as follows to ensure
good reproduction: line art: >600 dpi; halftones (including gel photographs): >300 dpi; figures
containing both halftone and line images: >600 dpi.

Corrections Policy
The version of an article which is published online is considered the final and complete version. Once
published, we will not make alterations to an article itself except where legally required to.
In the case of an article where there is a major error, or one that could prove dangerous, we will
attach an electronic erratum sheet detailing the correction to the online version of the article. In the
print version of the journal we will print an erratum.
Where an author’s name has been misspelled, we will provide a duplicate bibliographic record on
the online version of the journal, so that readers searching for the article will be able to find it using
either spelling.



The International Journal of Narrative Practice - 2009 - Vol1

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Spring 2009 Vol (1) 1 ISSN 2041‐2207

Telling stories: Writing narrative. Marjorie Lloyd ........................................................................ 19

Fictions of Solidity in The Time Machine. Stephen C. Kenyon ................................................... 37

Yvonne Eckersley ................................................................................................................................. 45

Notes For Contributors ...................................................................................................................... 65

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