Spoken paper for BMA Conference on Narrative Research in Health and Illness, Thursday 9th Sept, 2004
FROM NARRATIVE TO NARRATION – THE POWER
OF LIVING, RESPONSIVE EXPRESSION
John Shotter
Department of Communication
University of New Hampshire
and
Arlene M. Katz
Department of Social Medicine
Harvard Medical School
Let us begin with a brief comment about time and the temporal flow of living activities or processes that grow and develop and unfold in time.
Given our interests in communicative interactions, as we see it, among the many distinctive characteristics of such living movement, three features stand out:
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$ 1) One is, that as living embodied beings, we cannot not be spontaneously responsive, bodily, to events occurring around us.
$ 2) The next is, that the others around us can find our embodied responsiveness expressive of our unique relations to both to them and to other aspects of our circumstances.
$ 3) The third is, there is always a kind of developmental continuity involved in the unfolding of all living movement because all living bodies, i.e., organic forms, change internally [from within a social interaction] by growth and differentiation into more complex forms, while still retaining their identity as the unique individuals they are, Thus, the earlier phases of a living activity are indicative of at least the style of what is next to come.
[Slide one]
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In other words, we do not experience ourselves as living and acting in a neutral space of simply physical objects, but, as living, embodied beings, we can, at each moment in our interactions with the others and othernesses around us, ‘go out to meet them’, so to speak, with the appropriate anticipations and expectations at the ready. Thus, we can have an evaluative and anticipatory sense of ‘where’ we are with them, and of ‘where next’ we might go with them – a shaped and vectored sense of the “intentionalities” (Merleau-Ponty, 1962) we experience in what we might call the momentary landscape of our meetings.
We emphasize these features of the present moment, because we want in our presentation to focus on certain special events that can occur in people’s meetings with each other, if – instead of dwelling on patterns of already spoken words, on completed patterns that can be set out as static forms in space – we focus our attention on the power of words in the moment of their speaking. For such unfinished forms of unique expression, still unfolding in time, can still, nonetheless, to ‘move’ us in uniquely significant ways. Indeed, considering both the spontaneous responsiveness and the indicative nature of all living activity – in both ‘pointing’ to our current relations to the others and othernesses in our surroundings, and toward what possibly is next to come in the activity – the three characteristics we outlined a moment ago – we want to suggest that all such ongoing, living activity bears meaning within itself, so to speak. Meaning is intrinsic to it.
Under the pressure of theoretical thinking, however – influenced by what Bakhtin (1993) calls theoreticism – we can still easily be tempted to conceive of each present moment as being like a separate bead on a string.
Once we adopt this view of time, however, rather than living movements bearing their meaning within themselves, they need meaning imposing upon them. To an extent, we see the current interest in narrative theory as an expression of this need – the need to bring meaning back in when the intrinsic meanings that emerge when living beings meet with or engage with the others and otherness in their surroundings, have been lost, or forgotten, or ignored.
However, that need can, we feel, be satisfied in another way – by attention to what elsewhere we have called “living,” “arresting,” or “moving” moments (Katz and Shotter, 1996; Shotter and Katz, 1998). We emphasize these moments, for we see them as openings, not only into the unique ‘inner lives’ of the unique people before us, but also as opening up new, unique possibilities for making sense of the events they recount.
On events occurring within “living moments:” hearing the patient’s world speak
In an effort to bring alive what can be at stake here – in social, cultural, ethical, and professional realms – we would like to present a case fragment which not only strikes us now as of significance, but which was in fact striking to those who directly participated in the event at the time.
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Site – a primary care clinic serving a multi-immigrant, multicultural community.
Dr. M is a young doctor in training who, with the agreement of her patient, has invited AMK into the consultation as, so to speak, an “ethnographic resource,” to aid her in becoming more reflectively aware of what is at stake for her immigrant patients.
Dr. M introduces AMK to Ms. J, a middle aged woman from E. Africa who has been living in the USA for 2 years. On this 2nd visit with Dr. M, she enters and immediately sits down, faces Dr. M and is ready to begin. She has clearly come in with a purpose:
Ms J: You are my Dr. I will tell you everything. I tell you the truth so you can help me.
(She talks about menopause and her concern and discomfort with hot flashes that wake her up in the night)
Dr.M: ... there are meds I could give you to help with these symptoms.
Ms J: [pause] ... No, I don’t think so. There are those who think you should not go against nature; it leads to bad results.
[Slide two]
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AMK reflections: As I listened to this interchange, I was struck by her opening words:“You are my Dr. I will tell you everything. I tell you the truth so you can help me.” This was a woman who had something on her mind.
I was taken by her words, ‘you should not go against nature’ and wondered what other words were in these words… if this phrase could speak, would it say? ... I wondered about how ‘going against nature’ was seen and treated ‘back home’ in East Africa... Has she been in conversation with anyone about this? Who would hear her voice, and ‘see her’ and what mattered to her? ... But I kept silent and the resident continued.
[Slide three]
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Ms. J talked of her concern about her headaches, which she has had since her accident one year ago. She wondered if they could still be from the accident. Dr. M looked at her chart and reassured her that they found no damage at the time.
AMK reflections: I had the sense that this was nonetheless, still a concern for her... and later on, following what mattered to her, I talked with her about her worry that it’s ‘something terribly wrong’.
Ms J: Perhaps it is my fault partly because I drink sherry when I am depressed about the hot flashes, and partly because I don’t feel good.
Dr.M: What’s in the depression?
Ms J: I don’t feel good!
Dr. M: Or is it that you miss your family?
Ms J: Partly it’s missing my family, and it’s changed circumstances which get me to worry.
[Slide four]
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AMK reflections: I wondered what kind of change ‘changed circumstances’ meant… and who she was talking with about them. The words ‘connection and disconnection’ were reverberating for me… As she ‘spoke’ to me [in my inner dialogue]… I had images of her family in E. Africa… what kind of conversations and ‘meetings’ went on there – and was she a part of them? How did she carry them with her, here in this ‘world’? Were they aware of what she was going through, and if so what advice might they offer.
[Slide five]
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Later we reflected on the changes she had hinted at when she spoke of "changed circumstances". And she said it had to do with being "redundant". When aske what this meant to her, she said, "idle". And she continued and talked about how used she is to being busy and productive. And further she is here to make money so that her children might go to university.
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Dr. M began to pursue Ms J’s drinking, invoking the CAGE [ Cut down; Annoyed by critical others; Guilty; Eye-opener] questions
Ms J: Yes, I get concerned sometimes; I do cut down.
Dr.M: Do you do things you might regret?
Ms J: Yes I even called my children in Africa once.
[Slide six]
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AMK reflections: And I began to wonder what was in "drinking sherry" for Ms. J? what did it mean 'back home'? How much was it more part of the social fabric, a way to connect with others – in times of celebration and in times of stress.
I was cautious about pathologizing her "drinking" too quickly. I mused that the categorical, whilst a resource, can pursue a narrative of fixity, rather than listening to the 'calls' of this particular person, and what is at stake for her.
[Slide seven]
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Dr. M began pursuing the ‘medical narrative’ of alcoholism with its own ‘internal logic’ and coherence; its prescribed questions and best practice-suggestions for treatment. And in pursuing it, she asked Ms. J whether she thought she was an alcoholic, whether she would attend an AA meeting or consider talking with a counselor, but at every step, Ms J. pulled further and further back. Rather, she went on to mention that in her culture, alcohol was part of enjoyment, something people did together at times of gathering – during celebrations.
As Dr. M. did her internal exam I was struck by the multiple threads that were juxtaposed, or perhaps woven, in this meeting. Dr M. focusing on the biomedical and psychiatric narratives with a primary concern with alcoholism, while Ms J spoke of what was at stake for her – living betwixt and between (at least) two different ‘cultures’ – each making their pulls on her: How drinking sherry was an act of connection – a form of meeting, a reminder of ‘gatherings’ in her home country… I was struck by the possibilities illuminated in the way we talked: what was visible, or not; what could become a resource… whether the social and cultural context is such that alcohol has a very different meaning for Ms. J.
The question was: ‘How do you proceed in a way that follows what matters most to Ms. J, without prematurely seeking a medical narrative [medicalizing Ms.J’s concerns]?’ When I spoke briefly to Dr. M, and she asked me what I thought, we talked about “the timing of the alcoholism piece” and wondered about ways to enter into Ms. J’s world… be in dialogue…how could you work with her…to acknowledge her concerns and yours…
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Reflections of AMK out loud to Ms J:
AMK: I was struck by how much has happened – I think what you referred to as “changed circumstances” – being made 'redundant', moving here, looking for a job, relationships; your concerns about headaches... And I thought of what you said about the importance of comfort and how you try in different ways to bring comfort: drinking sherry, and going to church. I had the idea that it reminded you of how you would drink together with others in your culture – it was seen differently. And now perhaps you’re looking for other ways to be connected.
Ms J: The alcohol is not new, its been a long time in my culture.
AMK: It is a way to connect.
Ms J: Yes.
AMK: I wonder if there would be other ways to connect in addition.
Ms J: The church.
AMK: Perhaps we could come up with other ways to be connected.
Ms J: Yes, that would be helpful. She then thought and said, I think what’s most important is for me to be doing more.
AMK: I had the sense that you are a person with a lot of energy, who needs something to be occupied with.
Ms J: Oh yes! But they all require money.
AMK: If money were not an issue, which one thing would you want to do?
Ms J: I am an accountant. I would like to take a computer course so I could get a job.
[Slide eight]
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Later, Dr. M. mentioned that she indeed did go back to Ms. J, and said that after the exam: “I think I moved too quickly into talking about alcoholism, and instead, I asked her would she mind bringing in more information the next time, e.g., keeping track of when she herself was concerned about her drinking.” And she went on to talk with me about how attuned she was to issues of alcoholism, particularly after being on the alcoholism wards, where there was a set way to proceed – perhaps she herself prematurely focused on it, making an automatic assumption of alcoholism early on. And we talked further about social, economic and cultural factors at stake for an immigrant in the US.
We find here, then, as the medical interview unfolded, in AMK’s spontaneously responsive reactions to Ms. J’s voiced expressions of her concerns, not so much the fitting in of Ms. J’s words into already existing general frames of reference, but the beginnings, the opening, of uniquely new, possible lines of understanding.– about what mattered most to her – which otherwise could be elided in pursuit of professional narratives…parallel with ethnographic research…
Outcome:
$ Ms. J came in next time holding her diploma... a bit tired, perhaps, but having just received a 98% on her final exam...
$ But also to refer her sister to both of us, wanting the same treatment for her... .
Spontaneous understandings of 1st-person expressions
To contrast the kind of inter-active kind of dialogic understanding occurring in this episode with the more passive kind of “representational-referential” understanding well known to us in our conscious reflections as intellectual and academic individuals, we can call it, following Bakhtin (1986), a “relationally-responsive” form of understanding.
As he puts it: “When the listener perceives and understands the meaning of speech..., he simultaneously takes an active, responsive attitude toward it. He either agrees or disagrees with it..., augments it, applies it, prepares for its execution, and so on... Any understanding is imbued with response and necessarily elicits it in one form or another: the listener becomes the speaker... Of course, an utterance is not always followed immediately by an articulated response... [But] sooner or later what is heard and actively understood will find its response in the subsequent speech or behavior of the listener... And the speaker himself is oriented precisely toward such an actively responsive understanding. He does not expect passive understanding that, so to speak, only duplicates his or her own idea in someone else’s mind... Rather, the speaker talks with an expectation of a response, agreement, sympathy, objection, execution, and so forth...” (pp.68-69, our emphasis).
It is not only Bakhtin’s (1986) insistence on the active presence of an other as a part of the process of understanding that makes his whole approach unique, but much more than this. For a start: 1) Listeners can be influenced in their thinking by another’s utterances – as we will say in a moment, rather than thinking about what was said by another, another’s utterance is something they can think with. They can keep repeating it to themselves to call out within themselves, the kind of responsive understandings of which Bakhtin speaks. But also: 2) In the moment of speaking, a listeners’ responsiveness can act back on speakers to shape their speech.
It is such features as these that makes Bakhtin’s (1981, 1986) dialogic approach to our understanding of speech and the activity of speaking, quite different from other previous linguistic approaches to the study of language.
But even more than this: As Bakhtin (1981) points out, among the other features of such responsive talk, is its continual orientation toward the future:
“Every word is directed toward an answer and cannot escape the profound influence of the answering word that it anticipates. The word in living conversation is directly, blatantly, oriented toward a future answer-word... and structures itself in the answer’s direction. Forming itself in an atmosphere of the already spoken, the word is at the same time determined by that which has not yet been said but which is needed and in fact anticipated by the answering word” (p.280).
In other words, rather than giving outward expression to already existing mental states hidden within individuals, by indicating possible future actions, such anticipatory talk can work to help people inter-relate their activities with those of others. But – to emphasize our central point here – it is only from within those of our ongoing living involvements with our surroundings over or through time, that this kind of meaningful, responsive understanding of people’s next possible actions becomes spontaneously available to us.
Indeed, to go further: Irrespective of whether people’s expressions are accurately linked to a mysterious inner realm or not, what their spontaneous 1st-person expressions can tell us, is what their anticipations and expectations ‘are’; that is, they can tell us how we should or could ‘go on’ with them, how we should respond to them, or treat them as being. In other words, from within our ongoing living involvements with them over or through time, we can in fact get a sense of their ‘inner lives’, their thoughts and feelings. And we can do this, not because we talk with them in accordance with a pre-determined form or pattern of talk, whether of a narrative or of any other special pre-arranged pattern of talk, but because we adopt a certain style of relation in our talk – a dialogical rather than a monological style – a style of talk with them that allows such mutual expressive-responsiveness to occur spontaneously.
Conclusions: from narrative to narration, from ‘aboutness’ to ‘withness’ talk/writing/thinking
What we have presented here, then, is not so much a 3rd-person narrative report on a finished and completed piece of research that occurred some time ago, but a 1st-person telling, a narrating.... of a remembered incident. 3rd-person reports of research, represent important regularities and de-contextualized universals about events occurring between people that can be observed by outsiders to the events. 1st-person tellings work in a different way. They are related to the experiences of insiders to those events, and they work in their telling to ‘move’ listeners into paying attention to previously unnoticed particularities within the ‘world’ of those insiders.
Thus it is that we have tried in our presentation of the case of Dr. M and Ms. J, to talk of it in an expressive manner, to express our attitudes and evaluative judgments, thus, to try to arouse in you a shaped and vectored [living] sense of the landscape of involvement…what is at stake for each participant – Dr.M, Ms, J, and AMK – shaped their actions, their talk.
And it is in this way, in making the unnoticed noticeable, that, although the case described above might seem to be utterly unique and particular, it can give rise in its telling – if we can make use of the utterances of the participants to think with, in the sense already mentioned above – to a kind of (relationally-responsive) understanding that can be of use practical use later.
But continually throughout our presentation, we have said that this can be done, that it is a possibility only if we change the whole relational style of our inquiry towards the others and othernesses that puzzle us, if we change from a monological to a dialogical style of inquiry.
We would like to end this presentation by characterizing AMK’s adoption of this very different style of relation in her inquiries, by putting it in terms of a distinction between ‘withness-‘ and ‘aboutness-thinking/talking/writing’:
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1) Aboutness (monologic)-thinking, however, is unresponsive to another’s expressions; it works simply in terms of a thinker’s ‘theoretical pictures’ – but, even when we ‘get the picture’, we still have to interpret it, and to decide, intellectually, on a right course of action. Thus, in aboutness-thinking, “(in its extreme pure form) another person remains wholly and merely an object of consciousness, and not another consciousness... Monologue is finalized and deaf to the other’s response, does not expect it and does not acknowledge in it any decisive force” (Bakhtin, 1984, p.293).
2) Withness (dialogic)-thinking is a form of reflective interaction that involves coming into living contact with an other’s living being, with their utterances, their bodily expressions, their words, their ‘works’. It is a meeting of outsides, of surfaces, of ‘skins’ or of two kinds of ‘flesh’ (Merleau-Ponty), such that they come into ‘touch’ with each other. They both touch and are touched, and in the relations between their outgoing touching and resultant incoming, responsive touches of the other, the sense of a ‘touching-’ or a ‘moving-difference’ emerges. In the interplay of living movements intertwining with each other, new possibilities of relation are engendered, new interconnections are made, new ‘shapes’ of experience can emerge. This reflective encounter is thus not simply a ‘seeing’, for what is sensed is invisible; nor is it an interpretation (a representation), for it arises directly and immediately in one’s living encounter with an other’s expressions; neither is it merely a feeling, for carries with it as it unfolds a quite unique, ‘shaped’ and ‘vectored’ sense of our moment-by-moment changing placement within our current surroundings – engendering in us both: 1) a unique evaluation of our placement, i.e., to anticipations as to what-next might happen to us, 2) along with, so to speak, ‘action-guiding advisories’ as to what-next we might do.
[Slide nine]
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About writing, we might be tempted to say that the very activity of writing has an inherent tendency towards decontextualization and generalization, while only the spoken word – the ‘living word’ – can be inherently unique and specific, and anchored in the practical. But this might be too hasty a conclusion.
The point, we think, is this: it is when the words used are not responsively related to the practical context within which they occurred that their meaning becomes, so to speak, ‘theoretical’ – that is, their meaning must be derived from some other source than the actual practical context in which they occur. By absorbing each such moment into the coherency of a well formed, after-the-fact narrative, we can rob ourselves of the authentic experience of the specific but inexhaustible range of possibilities open to us in each moment.
In contrast, a language game which takes place within the very same practical situation to which that language game refers, can possess – as a result of the very interplay between the actors use of words and the practical circumstances – a kind of specificity of which a language game ‘out of context’ is not capable.
It is in being able to ‘move’ us, to elicit from us, creatively, responses not previously expressed, that ‘withness’ styles or forms of talk/writing can do what ‘aboutness’ styles cannot. They can work to illuminate what would otherwise pass by unnoticed and they can do this by guiding us toward eliminating previously unnoticed misleading tendencies, and by directing our attention toward ones of a more enhancing kind.
Their force in practice, is that they can bring previously unnoticed, alternative, intrinsic possibilities to our attention. In short, the voices of others can do for us what we cannot do for ourselves. It is that their “‘otherness’ which enters into us,” says Steiner (1989), that “makes us other” (p.188) – they, in arousing dialogically-structured responses in us, can create possibilities for change within us that we cannot create within ourselves alone.
AMK’s final reflections:
Redundant
not just merely ‘laid off’
[or other such cultural euphemisms]
but a shift from ‘Subject’ to object,
productive to idle;
easily replaced,
no longer unique,
with something to contribute.
Infinite repetition,
a key stroke run amok…
Redundant