When I cracked my head on the floor, words leaked out as quickly as blood from the wound in my scalp. Yet the damage from my brain contusion was as much internal as it was external. Blood seeped into my frontal lobe as I lay, head throbbing, in a hospital bed, ravaged by pain and fear of what had truly been broken in my injury. It was the kind of accident where neurologists arrive to question your cognitive capabilities, take brain scans to point out the splotches of damage where intellectual fortitude and self were maimed.
My sense of identity also splintered after my accident—suddenly I was the girl with the brain injury and anosmia, blood pooling in the very part of my brain where personality was modulated. The doctors seeded doubt about my ability to perform in school, my writing capabilities, my emotional range, and my character traits. I couldn’t help but think of Phineas Gage, an invisible rail lanced through my head. All of the elements of my identity that I’d taken for granted, all of my aspirations and long-term goals were called into question; brain injuries are nothing less than an existential crisis waiting to happen. And yet I was given no recourse for healing, no therapy to help my physical injury or my wounded psyche, just the negative language that had been used to describe my status as a patient.
Hurt does this to people. We take for granted our tenuous health and the ease with which words come to articulate such a whole and vivacious existence unmarred by illness or tragedy. It is only once the simple narrative we’ve constructed for ourselves is shaken, unsettled and begins to splinter under the weight of disease or trauma that we are forced to reorient ourselves in the world, reconsider our identities, and utilize the power of language to reconcile the inconsistencies and contingencies of reality into a new story. As Joan Didion quipped, “We tell ourselves stories in order to live” (1979, 11), just as we reconstitute and change these stories in order to survive when our health is otherwise compromised. As we cobble together fragments into a larger narrative, we begin to make sense of our worlds, our bodies, and ourselves through the stories that we create, so that even though scar tissue may form, we can again achieve a sense of wholeness.
Anthropologists, sociologists, and psychologists have long been interested in the palliative health effects of narrative. In instances of illness, we need narrative as much as we depend upon medicine and health care. Wrought by pain, disease or trauma, our bodies and minds crave stories to make sense of the disruption, a cohesive narrative that gives meaning to the suffering of sickness and the disturbance of identity often generated by illness. In the West particularly, we tend to think of our lives as chronological biographies composed of a continuous sense of self. Yet “In illness we have the breaking through into consciousness of non-narrative, inchoate experience that resists narrative smoothing and containment” (Kirmayer 2000, 169). If the selfing process— as McAdams (1996, 2011) describes it—evolves out of storytelling, and narratives are a version of reality and theory of events that help to assemble our sense of identity (Ochs and Capps 1996), then it makes sense that healing may also incorporate an adjustment of these narratives and an attention to the role language can play in our mental and physical well-being. Contemporary understandings of illness, therefore, have come to incorporate not only a more holistic perspective, but one that also attends to the therapeutics of narrative.
Bereft of any clinical or therapeutic options after my brain injury, and struggling to find some option to feel better, I turned to poetry.
Metaphor may play an enormous role in either the efficacy or failure of narrative in healing. To draw upon a common anthropological aphorism, metaphors are good to think with. They help us re-organize and reconceptualize the world around us and, subsequently, our space within that reality. This mechanism of metaphor is explored in depth in Claude Levi-Strauss’s ground-breaking essay “The Effectiveness of Symbols” (1963). Calling upon Rimbaud’s premonition that metaphors can change the world, Levi-Strauss illustrates how a Cuna shaman’s role in a difficult pregnancy is as much about framing pain through culturally salient metaphors as it is about physical interventions upon a laboring mother’s body. Metaphors therefore provide models for habitation within our bodies and possess the potential to alter our consciousness, a connection between the mind and the body that medical practitioners are beginning to come to terms with.
This is where the language doctors, nurses and clinicians use has consequence. I was told that I would be “cognitively compromised”; neurologists puzzled over the severity of my injury without ever realizing how internalizing this narrative only hurt me more. To think of myself as damaged goods was not responsible or therapeutically helpful, and it only worsened my conception of self and personal capabilities. So in order to regain a sense of wholeness, confidence and calm, I rewrote these clinical stories, fiddled with the idea of brokenness and creativity, and imagined vignettes in which I was wounded but capable of repair, resilient through these new narratives about the world which slowly drew me out of my desperation and sadness. The medical community may not yet fully understand the placebo or nocebo effect, but an individual’s subjective understanding of his or her health can have demonstrable health consequences.
Medically trained anthropologists like Arthur Kleinman emphasize the importance of empathic listening during clinical encounters and advocate for clinical ethnographies—the health stories of patients. This literary turn in the medical field encompasses an attention to authorship for patients, providing them with the space and materials necessary to craft their own narratives of health, similarly providing new opportunities to story their process toward recovery. This can be an empowering process for both doctors and patients. Professor Lauren Small and Doctor Benjamin Oldfield instituted “AfterWards”, an art and narrative therapy workshop for doctors, nurses, therapists and social workers at Johns Hopkins Hospital. Workshops are held monthly to hone storytelling muscles and remind participants how to use stories as a part of their caregiving responsibilities. Participants read Franz Kafka’s “A Country Doctor” or William Carlos Williams’ The Doctor Stories to reflect upon and strengthen relationships with their patients. Small and Oldfield indicated in an interview that the workshops are intended to facilitate resilience among practitioners and build an egalitarian community across different professional approaches to care. What does it mean to hold space for the stories you hear amongst the people you help and what are the metaphors you use to understand your own clinical practice?
Bereft of any clinical or therapeutic options after my brain injury, and struggling to find some option to feel better, I turned to poetry. Initially, I was terrified that my injury may have crippled my ability to write. But I found the form and style of poetry liberating as it enabled me to evoke all the pain, fear and hurt that had nested within my body and give voice to it, name it for what it was, and somehow strip the injury of its power over me. By the time I had a follow-up appointment to determine the amount of scar tissue that had accumulated on my brain, I’d written a chapbook titled On the Mend. Each poem dealt with the idea of brokenness and resiliency by telling and retelling a similar story from different perspectives, narrators and discursive cadences. I physically sewed the pages together with black string, the book itself both fragile and forever marked by the sutures that had brought it together. Yet I also learned to find a beauty in this damage; it was particularly empowering to put the collection on display, so that I became the author of my own representation and trauma. If, in addition to other health interventions, narratives are necessary to heal an ailing world, then medical practitioners must be there, ready to facilitate and attend to those stories. ●
Didion, Joan. The White Album. New York: Harper Collins, 1979.
Kirmayer, Laurence J. “Broken Narratives: Clinical Encounters and the Poetics of Illness Experience.” In Narrative and the Cultural Construction of Illness and Healing, edited by Linda C. Garro and Cheryl Mattingly, 153-180. Berkeley: University of California Press, 2000.
Kleinman, Arthur. Writing at the Margin: Discourse between Anthropology and Medicine. Berkeley: University of California Press, 1997.
Levi-Strauss, Claude. “The Effectiveness of Symbols.” In Structural Anthropology, Volume1, 186-205. Harper Torchbooks, 1963.
McAdams, Dan P. “Personality, Modernity, and the Storied Self.” Psychological Inquiry 7 (1996): 295-321.
McGranahan, Carole. “Anthropology as Theoretical Storytelling.” Savage Minds, 2015. http://savageminds.org/2015/10/19/anthropology-as-theoretical-storytelling
Ochs, Elinor and Capps, Lisa. “Narrating The Self.” Annual Review of Anthropology 25 (1996): 19-43.
Emma Louise Backe is currently pursuing a master’s in medical anthropology at George Washington University. She serves as an editor and contributor on The Geek Anthropologist.
Stephanie Hofmann is a self taught illustrator and surface designer based in London. She has a love of the surreal and gothic and is inspired by most things. You can see more of her work at www.stephaniehofmann.co.uk
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