Table Of ContentDeveloping a Narrative Approach
to Healthcare Research
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Developing a
Narrative Approach
to Healthcare
Research
VIV MARTIN
PhD
Foreword by
Karen Forbes
Radcliffe Publishing
Oxford (cid:129) New York
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CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2011 by Viv Martin
CRC Press is an imprint of Taylor & Francis Group, an Informa business
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Version Date: 20160525
International Standard Book Number-13: 978-1-138-03150-0 (eBook - PDF)
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Contents
Foreword vii
Preface ix
About the author xviii
Acknowledgements xix
Part I: Introduction 1
1 An autoethnographic introduction 3
2 Pat’s story 29
3 Jan’s story 47
4 Jim’s story 65
5 Yasmin’s story 85
Part II: Introduction 101
6 Imagery 103
7 Issues 120
Part III: Introduction 133
8 Narrative ideas: a rationale 135
9 From rationale to method: relationships, ethics and accountability 149
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10 Representation 164
11 Implications and spaces 175
12 Evolution and refl ection 187
Index 199
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Foreword
I fi rst met Viv Martin while sitting in a narrative workshop in the Graduate School of
Education at the University of Bristol. My admiration for her grew as I learnt of her
story and was, in small ways, involved in the unfolding of the journey that brings
her to the publication of this book—and me to the honour of being asked to write
the foreword for it. I am a consultant in palliative medicine involved in medical
education and interested in narrative both as a way of hearing my students’ stories
and as a tool to explore their experiences of learning to look after people who are
very ill and dying. I have cared for many people during their journeys through ill-
ness. Viv has been there; she is a remarkable lady.
Many, faced with life-threatening illness, surgery that could kill or severely dis-
able, and the ongoing spectre of further problems, would awaken each morning,
pinch themselves and be glad merely to be alive. Not Viv. Once she could write,
having had to learn to do so with her non-dominant hand, she wrote—fascinated
by the way in which writing and storytelling helped her to understand the person
she had been before her surgery, the process she had been through and the person
that thinking about, telling and writing her story had helped her to become. She
published her fi rst book, Out of my Head, an account of her journey through neu-
rosurgery and her meaning-making during that journey in 1997. Her realisation of
the importance of narrative and story in fi nding her new place in the world led her
to explore whether narrative and story had been as pivotal for others. The result was
her doctoral thesis and now this book.
In this book, Viv gathers together the stories of four very different people who
have faced disability, illness and surgery: Pat, an experienced dialysis nurse facing
kidney failure; Jan, facing the spectre of ever more surgery for congenital hip prob-
lems; Jim, experiencing sudden, unexpected heart disease and surgery; and Yasmin,
undergoing the roller coaster of remissions and exacerbations of severe infl am-
matory bowel disease. But this book is not just about telling stories, it is also a
celebration of the individuals telling those stories and of storytelling: of the power
of stories to shape and heal lives, to make and regain identity and to assert the
uniqueness and personhood of the story teller. Viv then goes on to tell and examine
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viii FOREWORD
the story of her research process, the ethics of asking people to tell their stories and
of presenting them to others, the responsibility of representation and the implica-
tions of it, weaving throughout rich diverse narrative literature. Her reason for doing
so is clear:
A nurse who read one of my contributors’ stories commented, “This should be
read by the nurses on the ward – they tend to forget that this is a person with a
life.” When I asked my contributors what message they particularly wanted to get
across, everyone indicated the importance of being recognised as a person.
She suggests:
The relational dimension of narrative encompasses both our singularity and our
shared humanity. I would add that if we learn to tend our own stories, and to
acknowledge our own vulnerabilities, then we are more likely to attend to and bear
witness to the stories of others.
Viv’s contributors wanted to be recognised as people; she has certainly recog-
nised them as such, tending and attending to their stories with great care; they are
nurtured and shaped to powerful effect. But for whom? Who should read this book?
Anyone interested in narrative as method, but I hope that healthcare professionals
will also read it. Medical students, for instance, become increasingly ‘professional-
ised’ during their training. They learn to adopt professional distance so that they do
not become enmeshed in—and disabled by—the emotional impact of the situa-
tions they encounter. Some are so good at this they lose sight of the person behind
the diagnosis. Jim’s story, for instance, is ‘ordinary’: a heart attack, coronary artery
bypass grafting ... it happens every day to countless people. But this book shows
us the man behind the diagnosis, the impact of what has happened to him on his
identity, on him as a unique individual. Viv does this so well; I fi nd some of her
deft, small touches—the green doors, the red shoes—unbelievably moving.
I will recommend this book to my students; I hope other healthcare profession-
als will do the same and that some, like me, will go on to explore how narrative and
story can be harnessed to both explore experience and to teach within healthcare.
Karen Forbes
Consultant and Macmillan Professorial Teaching Fellow in Palliative Medicine
University Hospitals Bristol NHS Foundation Trust and University of Bristol
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Preface
INTRODUCTION
Stories form the basis of this book. At its heart are the illness stories told to me in
narrative research conversations with Pat, Jan, Jim and Yasmin, as well as an account
of my own illness; these were the basis for a narrative inquiry into the experience of
illness and its impact on the identities of fi ve people.
Stories have long had their place in medicine—traditionally in the form of the
‘case study’, a form of professional narrative that focuses on a single ‘case’. If nar-
rative is a re-presentation of events over time told to a particular audience, then
the ‘case’ fulfi ls these criteria: it involves the selection and shaping of a sequence
of relevant events and the presentation of these events to a prospective audience.
As a representation and medical interpretation of facts and events, the case report
will usually be written in the third person to remove any suggestion of subjectivity
or expression of emotion. However, those same events told by a patient to a friend
will be conveyed from a different perspective to a different audience; the portrayal
of events will be subjective and convey feelings, values and interpretations that give
meaning to the events within a particular life in relation to a personal or social
context. Similarly, a doctor’s account of her/his day at work as told to a partner will
express experiential knowledge from a particular personal perspective in a particular
relational context.
What researchers bring to their task, in terms of both personal and profes-
sional knowledge, often connects with their own life stories, and my interest in this
research originated in my own experience of illness. With a professional background
in teaching and counselling, and following major disruption to my life through
serious illness and neurosurgery, I ventured into autobiographical writing. Together
with an emerging interest in narrative ideas and practices, this led me to undertake
a PhD at the University of Bristol. My doctorate was a narrative inquiry in which
I worked with four people who had experienced major health problems; I examined
the impact of health diffi culties on their lives and identities. In a sense, this book is
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