Article Text
Abstract
This article draws on VM’s doctoral research into the narratives of illness and surgery, and their impact on conceptions of self and life story. This article was the result of conference presentations held during June/July 2005 in Belfast (Arts-Based Educational Research) and Truro (Association of Medical Humanities), UK. The aim of this article is to explore the topic of “dialogue” in the research relationship. This is done primarily through a story, Shoes, butterflies and devils, which is intended to evoke a sense of the relationship between Patricia and VM, through which the connections between the autobiographical roots of her research and Patricia’s experience of kidney failure, dialysis, transplant and heart failure are portrayed. The story is preceded by a brief introduction and account of her methodology, followed by a discussion of some of the conceptual aspects of dialogue that she has tried to highlight in the story.
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When I started writing this article my intention was to focus on a theoretical discussion of the topic of dialogue, based on my research conversations with Patricia. I planned to quote from the authoritative voices of my theoretical background—from the work of philosopher Martin Buber, and that of the originator of person-centred therapy, Carl Rogers—because their ideas and values are close to my heart, and also because of the status and authority of academic, theoretical and conceptual knowledge. However, I came to feel that conceptual analysis alone would not capture a sense of the relationship between Patricia and myself, the dialogic and dynamic nature of the research process, the feel of its impact on the stories Patricia tells or its affect on my own stories. I wanted to create a resonant text, which would represent something of the immediacy and particularities of Pat’s experience as she expressed it in relationship with me. Therefore, I decided to write a story, Shoes, butterflies and devils, based on our research conversations, which would invite affective engagement and resonance, and follow that with a separate and more theoretical perspective. This distinction between a paradigmatic mode of knowing and a narrative mode is one that Jerome Bruner makes. He writes that each provides “distinctive ways of ordering experience, of constructing reality”.1 Although the paradigmatic mode represents categories, concepts and propositional knowledge, and “seeks to transcend the particular by higher and higher reaching for abstraction”, narrative knowing focuses on “the particulars of experience located in time and place” (Bruner,1 p 13). I wish to approach my research material from both modes of thought. For, as Bruner argues, we need both narrative and paradigmatic “modes of thinking” in order to make sense of the world and our lives in it.
The tales told by Oliver Sacks2–4 and those by Irvin Yalom5 work, I believe, because they are compelling stories, beautifully told, which invite us into the lives of others; tales which arouse our curiosities, but which above all engage our sympathies; tales in which we come to care about the people and through which they matter.
UNTOLD STORIES
When I read Into the silent land, neuropsychologist Paul Broks’ account of his work, the people he encounters and his personal reflections, I found resonance in his metaphor of “the silent land”.6 I thought of stories which go untold: for all sorts of reasons; because they are paradoxical or contradictory; because of dominant discourses; because they are just too painful to tell or to hear; or because, as Heather Leach7 argues in a challenge to the “relentless forward linearity of narrative”, “experience may be outside narrative” and “that what surrounds, what threatens the path of the life, is fearful, chaotic, confusing”. There is simply too much to tell. White and Epston8 state, “persons are rich in lived experience” and “only a fraction of this experience can be storied and expressed at any one time”. As Patricia put it: “As I’m talking to you, I’m reliving some of it in my head. I’m telling you bits of it but in my mind I can see the whole scenario playing out…and the emotions. I’m telling you part of it but in my mind the rest of it is happening.”
In the story, I draw particularly on Patricia’s experience as a patient with renal failure and also as a nurse. I draw, too, in an oblique sort of way, on my own experience of illness and neurosurgery, as well as on my background as a person-centred counsellor. In trying to portray something of the dialogic nature of the story-telling process in the research relationship, I hope to convey a sense of the chaos of experience; to invite the reader to dwell in “uncertainties, mysteries, doubts, without any irritable reaching after fact and reason”,9 as well as—paradoxically—to demonstrate how our own stories inform and order that chaos. Thus, I also invite dialogue between what are inevitably my representations of Patricia’s stories and whatever the reader may bring to them: in Arthur Frank’s10 words, to “listen with” her stories, to feel their power, uniqueness and difference, as well as to allow resonance with one’s own experience.
AIMS
I aim to approach the stories of those with whom I work in a way that is respectful of their experiences, and of their particular meanings and interpretations, and yet, I am aware that I also want to represent my research with a critical edge, which will enhance its representational power and analytical force. In the story Shoes, butterflies and devils, I set out to focus on the dialogical nature of the narrative process and, using our actual words, to select the detail from several research conversations. I try to capture something of the feel of the relationship between Patricia and me, while also representing something of the substance and content of Patricia’s experience of renal failure. I aim to do this in a way that invites affective engagement and resonance alongside conceptualisation, which in Clough’s11 words “calls for a methodology which can deal [with] analytical justice at the same time as experiential truth”.
METHOD
In writing the story, I tried to create images of characters and events in a manner (at least in aspiration) similar to that of novelists, with the hope of transporting the reader of the text as Patricia and I co-research the stories and meanings of illness and surgery, and the impact of these on identity. I have increasingly come to view aspects of my research as a form of literary analysis: one which owes more to the strategies and techniques of the non-fiction12,13 or biographical novel, which, according to literary theorist David Lodge,14 “… takes a real person and their real history as the subject matter for imaginative exploration, using the novel’s techniques for representing subjectivity rather than the objective evidence-based discourse of biography”. In an article on the non-fiction novel, Lodge15 discusses the contribution of the new journalism of Tom Wolfe, and demonstrates how Wolfe used novelistic techniques such as dialogue, creation of scenes and rich description to “generate an excitement, intensity and emotive power”.
This form of creative non-fiction has developed out of my own experience of writing,16–18 and is an approach that I am increasingly using as one means of representing my research. I wrote the story, which follows, by selecting extracts from three research conversations, and gave them a narrative structure by weaving them into an account of a visit told in the first person from my perspective as a researcher and coparticipant. I then sent it to Patricia for her comments, and the subsequent version has her permission and blessing. In accordance with her wishes, her identity has been anonymised as far as possible.
Shoes, butterflies and devils
Three lanes of traffic enclose Bluebell Island. Eleven in the morning, locked in by cars, lorries and vans, squeezed by buses and towering concrete mixers; crushed and barely moving, I think, I hate this road. I turn up the volume as Neil Young sings;
‘Somewhere on a desert highway
She rides a Harley Davidson …’19
Eventually, the knot of traffic untangles, and I find my way to Patricia’s house. As I pull on to her drive, I think of her words when I saw her last:
‘It’s changed me; I look at my body—it makes you less of a woman, you know. I’d been quite a feminine woman. I liked my high heels, my stockings … but I can’t wear them any more. You look at yourself and you think, ee, there’s a big blob in the mirror.’
She opens the door and greets me, ‘Hi Viv. Cup of tea?’
‘Cheers. That’d be great,’
While she makes the tea, I set up the tape, check the microphone is working.
We settle with our mugs of tea.
‘I guess this is stirring up quite a lot for you ….’ I begin.
‘Yeah, it is; you know, I was thinking about it—we’re going to a party next week and I thought, why can’t I wear my high heels? So I went out and bought a really high pair of sexy shoes!’
She laughs uproariously—and so do I.
‘Oh, wow, fantastic!’ I exclaim.
‘I thought well, I’ll wear them and if my feet start swelling up, I’ll have another pair in the car—because you make too many excuses don’t you? I thought, I’m just gonna walk in there, in me shoes.’
We talk of death. I say, ‘A couple of weeks back, you said I’ll be lucky if I get to 50, and I wondered how you feel about that and how you see it? You’ve mentioned it a couple of times. And I’ve said similar for me—it’s something I’ve done too—it’s how it is to live with a heightened sense of your own mortality, isn’t it?’
‘It is. And I get really panicky … John has never had anything wrong with him, his mam’s 93 and he doesn’t see. I see death more clearly than he does … he’ll take things for granted and I can’t, because I don’t have that luxury anymore’.
‘Yes,’ I reply, ‘and it is a luxury isn’t it—you can’t take it for granted—not anymore.’
‘You can’t—it’s a fact of life.’ The surgeon said to me, ’I’ll lay it on the line-you’ve got a 50:50 chance—you might make it and you might not—that’s when it really hit me that I could die.’
‘Yes; death—it is a fact of life—there’s no getting away from it, is there … I don’t know if this rings any bells for you but I remember—in the days leading up to my own surgery—looking at my children and knowing that there was quite a strong chance that I wouldn’t see them grow up, and that was the most indescribably painful thing—and for you…you presumably had similar moments when …’
Both slightly tearful. ‘I think it’s, erm …’ She swallowed. ‘It’s erm leaving them behind actually, it’s … my son only visited me a couple of times in hospital and I thought he didn’t care … and afterwards he said to me, ‘I couldn’t bear it, mam …’
‘As you were talking, I remember a time when things looked pretty grim and it did look like I might well not… and my son couldn’t look at me—I could see the pain on his face and I remember feeling so helpless—I wanted to take that pain away and I couldn’t—and he just knew; it was one of the saddest things I’ve ever experienced in my life.’
‘Yeah’ … she pauses … ‘That’s when you think there’s no-one for him to go to—it’s like when you’re driving along and you think, oh god, if we had an accident, he’d be on his own’ …
There is stillness in the room. Traffic hums in the distance but in the room there is sadness you could touch.
Patricia’s kidney transplant was followed by major complications and ultimately heart surgery. I wanted to find a means of representation which would take you into her experience, and convey something of the essence of it, and so I have used her words but selected and ‘distilled’ them into poetic form.
PATRICIA’S WORDS ARE ON THE LEFT—MINE ARE IN ITALICS
50:50
The next morning
They came for me
They came very early
I was quite calm
In a way
When you’re faced like that
I dunno about you
But I’d made my peace
With the world
Or whichever god you believe in
You are at peace
Aren’t you
Yeah I remember
Seeing other
patients
Wheeled down to
theatre
And thinking
One day that will
be me
And how am I
gonna feel?
And when it was
me
I was as ready to
face that
As I’ve ever been
To face anything in
my life
I knew
That I might
Not be coming back
But I just felt
I would be with Caroline
That there would be someone
There for me
And so
you had a sense of
connection with her
A sense
that you were close
to her
whatever
whether you came
through
or you didn’t.
Is that right?
Yeah
cos it took the fear away
It just took the fear away
I felt I’d made my peace
But, as Barone writes, “Good stories rattle commonplace assumptions and disturb taken-for-granted beliefs”.20
And then when I woke up I was quite angry!
Cos I felt cheated!
We laugh
Almost like you’d prepared
yourself for one thing
Yeah-it was like a rebirth!
It was such a shock!
So you woke up
And you were almost
shocked to be—I’m still here
Yeah—its all over
and you don’t expect
to be
alive!
You wake up and you are
Alive … What!!
What’s going on here??!!
Yeah … what’s this!?
Much laughter
And then soon as I was awake,
I was awake…
I remember
Feeling very uncomfortable
With the intubating tube
And I couldn’t move very well
And I remember
My hand was here
And I got to the end
And the nurse thought
‘She’s gonna pull her tube out’
And it was down again
John said ‘I knew you were going to be all right
cos you were being naughty again’
Roars of laughter!
You know the probe
they put on your
finger, the oxygen
thing. I remember
playing
And flicking it
And it stopped
beeping
And I got told off
So I did it again!
It was just that little
Devilment
Mischief
Reasserting yourself
Yet more laughter!
She talks of the changes that illness brings;
‘I mean, you just get on with it, don’t you, you have to … but when you look back…. sometimes it’s too much … I mean- like with dialysis … you dream of simple things—like coffee, or tomato soup—just silly things. There have always been restraints throughout my life; if it’s not dietary, it’s something … and that idealistic person gets knocked out—a chain thrown here, a chain thrown there, and if it’s not racism, it’s sexism; they’re all chains, and they pin you and bind you. So you can’t be a butterfly and flutter here and there.’ She pauses; ‘I want to be alive,’ and connects with an image; ‘When I was nursing—on a geriatric ward—this old lady had died, and they found a poem in her locker. The gist of it was; “you’ve seen me here, all wrinkled and old, but do you know my hopes and my dreams when I was young”. The world sees her as a little old lady, but inside she’s still that vital woman.’
I feel and I say, ‘that’s the sense that I get of you—that you feel that your body has changed on the outside; but inside you’re still that vital woman … and I recognise the butterfly too—it’s funny, but when I was driving here, I was listening to a Neil Young song and it’s a story about this girl who rides a Harley Davidson with her hair flying in the wind … so when you said that, the song just came into my mind …’
She sighs; ‘I mean there’s a friend of mine, and he has a sports car, and the car represents who he is.’
I wonder; ‘What do you think would represent you?’
‘A big walrus at the moment,’ she laughs.
‘And the butterfly?’ I ask, ‘the you that wants to fly?’
‘Well … Yes … I mean—like these shoes—yeah, they’re ridiculous! And I think, that is me … it’s just that sometimes, you just want to be that person, don’t you—you want to be who you are inside—you want to be that outside, as well. And I can’t get into the clothes that I’d really like to wear, but I can get into these shoes … it’s just a little bit of rebellion, I suppose …’
She pauses, ‘Like my friend—we went to a tattoo parlour not so long ago. I had a fantastic time in there—I was enthralled … they were like ZZ Top, the blokes; biker blokes—they looked so fierce, and they were really nice … it’s like they represented freedom; on their bikes, doing what they wanted. She’s 57, my friend and she had a little devil put on her shoulder … I suppose it’s an expression of yourself … she sees herself as a little devil … and she’s bigger than I am … but she’s still got that rebellion in her’.
‘And you have it in you, haven’t you,’ I venture.
‘So have you!’ she counters. She roars with laughter, and I do too.
As I pack away my tapes and prepare to leave, Patricia says, ‘just a minute’, and goes upstairs. She returns with a pair of shoes; red suede, elegant, and vital.
‘Look, they’ve got 3 ½ inch heels!’ she exclaims.
‘Oh wow—they’re gorgeous! And very sexy!’
As I drive home, I wonder about meaning, purpose and identity. I wonder about the ethics of finding my own meaning and purpose in researching and writing about the illness experience of others. For I know that my movement into writing and research is rooted in my own loss. My musical self, which had found expression in the piano, the guitar and the saxophone, was thrown into complete disarray by my illness and subsequent left-side disability. That self, with its associations of independence, freedom and voice, seemed to disintegrate when I could no longer play those instruments. My writing has been a site for creating meaning and also for developing a new voice and a new sense of self.
I accelerate onto the motorway. As I join the traffic streaming south, the ‘Angel of the North’ watches over. Neil Young sings, ‘She gets the faraway look in her eyes’. I think of beautiful shoes and my saxophone in its case under my bed. It lies there, its golden sound unvoiced; for now that I can no longer play it, I can hardly bear to look at it.
DIALOGUE: “THINKING WITH” STORIES
Arthur Frank writes of “thinking with” stories as something we do when we enter into another’s story and allow our “own thoughts to adopt the story’s immanent logic of causality, its temporality and its narrative tensions” (Frank,10 p 18). Frank argues that “listening with” stories is a “fundamental moral act” (p 25). I would add that representing another’s stories is a similar moral act, a responsibility to represent experience in a way which is evocative, and which “touches your heart”, a kind of ethics of aesthetics. I have tried to resist what Raymond Williams21 refers to as the “immediate and regular conversion of experience into finished products”, where “relationships, institutions, formations in which we are still actively involved are converted into, … formed wholes rather than forming and formative processes”.
I am aware of the tensions and difficulties in writing a story where I am trying to convey the complexity of experience, and the danger of creating caricatures rather than characters. I am further aware, as I develop the theoretical aspects of “dialogue”, that I am writing for myself and through my academic voice, and for a particular academic audience; I feel very conscious of not wanting to eclipse Patricia’s stories, with this paradigmatic way of knowing.
However, I will briefly summarise the aspects of dialogue, which I have tried to highlight in the story. I will do this from the perspectives of Martin Buber and Mikhail Bakhtin, and with regard to certain sites of dialogue: within the research relationship, within the research process, within the individual, between the text and the reader.
DIALOGUE WITHIN THE RESEARCH RELATIONSHIP
My research methodology has developed as a result of my training and experience as a person-centred counsellor, and out of my experience of writing of my own illness. The person-centred approach to therapy was developed by psychologist Carl Rogers during the 1960s and until his death in 1987, and rests on a view of the person as in the process of “becoming”. This “actualising tendency”, as Rogers terms it, regards the individual as moving towards fulfilment of his or her potentialities.22 The person-centred approach, which emphasises the relational qualities of empathy, congruence and unconditional positive regard, is fundamentally based on the values of equality and dialogue in relationship, and is closely related to the ideas of Martin Buber. As a counsellor, I know how effectively this way of relating can create a climate where someone can explore and express meanings and understandings, and therefore my approach to research is informed and influenced by its values and qualities. Indeed, Mearns and McLeod23 have convincingly argued that the emphasis on the quality of relationship in the person-centred approach can also be applied to the relationships between researchers and participants, and they also view this as a valid means of inductive social research. My experience of the storytelling process—of writing my own story and of hearing the stories of others—is that it is, or can be, reciprocal, connective and life affirming: it flows from what Buber terms the “a priori of relation”.24 Buber views what it is to be human as relational; that we gain a sense of our own identity and authenticity through relationships. He distinguishes two primary attitudes which characterise our existence in the world; he differentiates the monologic “I-It” way of being from the dialogic “I-Thou”.
The “I-It” way of being is one in which we relate to others as objects, in which “man stands before things but not over against them in the flow of mutual action. Now, with the magnifying glass of peering observation, he bends over particulars and objectifies them, or with the field-glass of remote inspection he objectifies them and arranges them as scenery.” (Buber,24 p 46).
The dialogic, I-Thou attitude, on the other hand, is when we relate to others as persons and risk something of ourselves. It means, as Buber says, “confirming the other” and “accepting the whole potentiality of the other”. This acceptance is very similar to Rogers’ concept of “unconditional positive regard”. Indeed, in conversation with Buber, Rogers speaks of a “real, experiential meeting of persons in which each of us is changed”.25 Although both acknowledge that there are differences, they agree that it is when we meet as people that we are most fully human. Buber describes the I-Thou relationship in spiritual terms:
‘Spirit is not in the I, but between I and Thou. It is not like the blood that circulates in you, but like the air in which you breathe. Man lives in the spirit if he is able to respond to his Thou. He is able to, if he enters into relation with his whole being’. (Buber,24 p 57–p 8).
This dialogic relation, according to Buber,26 is “inclusive” and has three forms: the first is abstract and relates to “man as a spiritual person”; the second is a recognition of “the wholly concrete spirit” of this other person; my understanding of this is of the recognition and valuing of a different subjectivity, differently embodied; the third form of dialogue is “based on a concrete and mutual experience of inclusion. It is the true inclusion of one another by human souls.” This recognition of shared humanity alongside a valuing of difference is fundamental to the person-centred approach. Rogers writes of respect and commitment to each other thus: “rightfully separate persons, with separate realities” would mean that “The natural human tendency to care for another would no longer be ‘I care for you because you are the same as I’ but instead “I prize and treasure you because you are different from me.” (Rogers,22 p 105).
I will give an example from “the story” of my growing awareness of the implications of relating as a person within the research relationship. My training as a person-centred counsellor emphasised “bracketing” in the sense derived from Husserl’s phenomenology; it views reality as perceived, as subjectively experienced, and sees therapeutic change as associated with understanding another person’s worldview or “frame of reference” as fully and empathically as possible; our worldview then is socially and culturally informed, shaped by dominant discourses to do with gender, sexuality and class, and is shaped by our family and personal history. This means that, as a counsellor, I need to be as much as aware as I can be of the ways in which my own “frame of reference” can obscure a clear appreciation of another person’s subjective reality, and then to “bracket” this off. Therefore I would be very cautious about self-disclosure, not wanting to make assumptions about another’s frame of reference, nor to shift attention from client to counsellor, or from participant to researcher. However, during the second conversation with Patricia, I dimly realised, and, on listening to the tape, became more strongly aware, that I was “bracketing” in a way that was unhelpful, which was not dialogic but was effectively keeping me “safe” and also not enabling further exploration of, in particular, the experience of mortality; it was necessary to engage more fully and more genuinely, or “congruently”, in Rogers’ terms. As a counsellor, I would ask myself the question—“does this move the therapeutic process on?” In research, the question is, “does this open up further areas for exploration/co-construction and thus move the research on?” (in a way that will be helpful—not harmful to the participant). The question for me here is, can I carry out these research aims with integrity and with respect for the integrity of the other person? Am I willing and able to “be” in relation?
Buber accepts that both modes of relating are necessary. He states “without It a man cannot live. But he who lives with It alone is not a man.” (Buber,24 p 52). Clearly, in research, there is a purpose, an objective; so arguably there is an “objectification of the person, and thus an “I-It” dimension, but I would still contend that there can be fleeting I-Thou” moments in which there is a shift from “communication to communion” (Buber,26 p 6), which can therefore be transforming for both the researcher and the participant. As Carl Rogers writes: “Such a deep and mutual personal encounter doesn’t happen often, but I am convinced that unless it happens occasionally, we are not living fully as human beings”21 (p 19). I think that where there is a commitment to relating equally, in a dialogic way, and a willingness to engage fully, there is no reason why we cannot be open to such moments in the research relationship. Indeed, Arthur Frank27 has published a paper in which he advocates dialogical research and contends that it is both empirical, in the sense that research relationships are “interactive and reactive”, and also “ethically desirable”.
Etherington,28 a strong advocate of reflexivity in research, echoes similar values and concerns and reminds us that ethical research “requires us to come from behind the protective barriers of objectivity and invite others to join with us in our exploration of being a researcher and remaining human”.29
DIALOGUE WITHIN THE RESEARCH PROCESS
The second site of dialogue I want to consider is within the research process itself: our conversations impact on that which is being researched, and also on ourselves, in a way that is dynamic and transformative. Peter Martin expresses this eloquently: he writes of “the existential meaning of doing research for me. I catch a moment in the lives of others. I ponder on it and respond to it. Meanwhile, their lives have moved on in a thousand different ways. Yet for me the fleeting moment has become a kind of aeon, I am changed in some way” (Etherington,28 p 230). To offer a more prosaic but no less significant example, Patricia bought her new shoes following our previous conversation in which she had said she was no longer able to wear high shoes. (Following these conversations, I went out and bought a pair of high boots!) So, the story-telling process can have a transformative effect on the sense of self of both the participant and the researcher. Arthur Frank writes, “The struggle for most ill people seems to be keeping multiple selves available to themselves” (Frank,10 p 66). I have hoped to show here how those selves can be created through telling stories.
A further aspect of dialogue within the research process is highlighted by Etherington,28 who discusses some of the power issues involved in research and stresses the importance of “our awareness of the need to recognise and talk about the potential dilemmas raised by the research” and our willingness to be transparent and to engage in dialogue. I have learnt a lot from asking my early research participants about what is helpful to them in the research process, and this has influenced my sense of self as a researcher, such as in the development of my confidence and sensitivity in knowing when or how to disclose aspects of my own experience. For example, when I asked Patricia about the occasions when I had referred to my own illness, she said, “I feel it was important as it showed you were involved; otherwise you would have had all the power and the relationship would have been unequal and uneven”, and felt that this was something I should disclose with other participants.
DIALOGUE WITHIN THE INDIVIDUAL
The third site of dialogue I want to highlight is that within each of us—the “internal dialogue” between different aspects of ourselves, as well as the dialogues each of us carries between others present or absent from the text (partners, children, medical professionals and so on); I want to consider this from the perspective of literary theorist Mikhail Bakhtin’s conceptualisation of “dialogism”, with particular reference to ambiguity and intersubjectivity.
In The problems of Dostoevsky’s poetics, Bakhtin30 describes Dostoevsky’s predisposition to dialogism:
In every voice he could hear two contending voices, in every expression a crack, and the readiness to go over immediately to another contradictory expression; in every gesture he detected confidence and lack of confidence simultaneously; he perceived the profound ambiguity, even multiple ambiguity, of every phenomenon.
My understanding of Bakhtin’s reference to “voices” is of the multiplicity of voices within each of us and within the text—the complexity, contradiction and ambiguity of those voices, as well as the way our language is infused with the voices of others. For example, we hear Patricia preparing herself for the possibility of dying: “I’d made my peace”, followed by the angry self who feels “cheated” when she wakes up and finds that she is alive, the rebel who challenges the orthodoxy of “I’m lucky to be alive” and subverts the passivity of patienthood. We hear the mischievous playful self, the agentic patient who plays with the intubating tube, alongside the self who is in chains which “pin” and “bind” and for whom “sometimes it’s too much”. There is ambiguity in the raucous laughter and tears—a reminder of how humour often results from heightened emotions and incongruity. Or we may hear inner contradictions: the “absent but implicit” of the word “peace” with its undercurrent of turbulence. I hear my own voices: my voice of “hope” with its implications of uncertainty and fear. I hear Patricia as she speaks, “I want to be alive”; I note her use of the present tense. I ponder the meanings of alive. I hear the echoes of the voices of those who said to me, “Well at least you’re alive”, and my internal response to that. If we listen carefully, we can hear the whisper of “well, actually, there were times when I wished I had died”. As Bakhtin31 writes, “Our practical everyday speech is full of other people’s words: with some of them, we completely merge our own voice.”
The intersubjective nature of reality is such that meanings are continually shifting, continually negotiated, in the moment and within the context of a particular set of relationships. If we look again at the conversation between Patricia and me, we can see how it is socially and culturally informed and located: the story implicitly embodies the discourse of popular culture and the voices therein—for example, when Patricia uses the phrase, the “idea-image” (Bakhtin,30 p 91) of “biker blokes” and the cultural reference to the band ZZ Top, I immediately have some sense of what I assume to be the picture she intends to convey, an image which is “out there” in western culture in the late 20th or early 21st century. Another instance is the “idea-image” of the “girl” on her Harley; all these draw on a particular cultural repertoire. The story also includes medical discourse in, for example, Patricia’s reference to the 50:50 chance, the quantifying of medical risk, and her sense that such quantifying of risk would have meaning for someone of a certain age within a certain culture.
DIALOGUE BETWEEN THE TEXT AND THE READER
My overall intention, in my representations of my research, is to participate in the creation of evocative and resonant texts, which are dialogic and offer personal understandings, intentions and meanings that challenge the polarised positioning of sick and well, patient and doctor, client and counsellor, participant and researcher. Rita Charon32 powerfully argues for intersubjective approaches to healthcare ethics, which “seek congress among human beings limited by mortality, identified by culture, revealed in language, and marked by suffering”. With this in mind, the final site of the dialogic that I want to highlight is that between storyteller and audience or readers of the text. Stories are performative: through them we initiate, suggest and call for responses. As Leach writes, “It is the connection, the shared exchange that activates the story: interactivity that creates meaning that is more than the self.” (Leach,7 p 19). Singer-songwriter Jackson Browne33 says, “The song is working if people think it’s about them … if the song is really doing its job then they’re not imagining you in the song. They’re imagining themselves in it.” Each one of us will read or hear stories differently, through the filter of our own consciousness, our particular frame of reference, our ways of construing the world. Therefore, I want to invite some personal reflection on the text, in terms of its resonance, the questions it raises and the stories it may evoke in the reader.
CONCLUSION
Bakhtin, in words reminiscent of Buber’s I-It relationship, describes Devushkin, a character in one of Dostoevsky’s stories who was “outraged that he had been “spied upon” that his entire life had been analyzed and described, that he had been defined once and for all, that he had been left with no other prospects” (Bakhtin,30 p 58). As I work with my participants’ stories and try to find means of representation that does justice to experience, at the same time as speaking to academic or professional audiences, as I negotiate the intersubjectivities and the tensions between voices, signature and audience (Clandinin and Connelly34), I am reminded that when we presume to research people’s lives, that when we analyse and describe, we risk defining and thereby reducing and limiting. Frank’s concept of “thinking with” stories seems to me to be close to the dialogic “way of being” advocated by Rogers and Buber, which involves a genuine interest in and engagement with others, which embodies acceptance and empathy alongside an openness and willingness to respond, as researchers, as healthcare practitioners, as readers of a text, and above all as fellow human beings.
Footnotes
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VM’s professional background was originally in teaching. She has worked in primary and secondary education in England and taught English in Zambia. She moved into the area of counselling in 1991. She was a bereavement counsellor for Cruse, UK, and has experience as a counsellor in further and higher education. Following neurosurgery in 1994, she wrote a book about the experience, Out of my Head (1997), and an article for the journal, Auto/Biography (2000). She worked in Adult Education as a counsellor trainer from 1996, and is currently undertaking doctoral research at Bristol University on the effects of illness and major surgery on conceptions of self and life story.
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Competing interests: None declared.