The Standpoint of Storyteller - SAGE Journals - Sage Publications

QUALITATIVE Frank / STANDPOINT HEALTH OFRESEARCH STORYTELLER / May 2000

The Standpoint of Storyteller Arthur W. Frank

The legitimacy of an interest in illness narratives that is therapeutic, emancipatory, and preoccupied with ethics is defended in response to Atkinson’s critique of this interest as a blind alley. The value of storytelling as complementary to story analysis is argued, and the importance of recognizing one’s own standpoint is emphasized. The conclusion considers how qualitative methods can inform changing relationships between illness, health, medicine, and culture.

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riticism can present a welcome opportunity to clarify one’s project. Paul Atkinson’s (1997) “Narrative Turn or Blind Alley”—in which I am discussed as part of the blind alley—displays both a close reading of my work and his appre1 ciation for the importance of narrative. Unlike Atkinson, I believe there are many narrative turns, each being valuable with respect to its own purposes. My concern is not to refute Atkinson but to fill in what he leaves out: how my approach to narrative is consistent with a certain form of life (Wittgenstein, 1958) and, particularly, the ethics of that life. My own narrative turn can be summarized in five points. First, although I often use story and narrative interchangeably, people do not tell narratives, they tell stories; “let me tell you a narrative” sounds strange. The subtle semantics of narrative suggest a structure underpinning the story, and narrative analysis (narrativity in recent scholarship) locates structures that storytellers rely on but are not fully aware of. These structures are real and interesting, but exclusive focus on them risks leaving out what may be most important to the storytellers themselves. Second, people tell stories to reaffirm, possibly to create, and possibly to redirect the relationship within which the story is told. Put more strongly, stories as acts of telling are relationships. Although I write of storytellers and listeners, I should refer only to the storytelling relation. One person may be speaking, but stories are told with—not only to—listeners who are part of the storytelling. Storytelling is the recursive elaboration of the relationship between those sharing the story. Shared memories are made present, and shared futures are projected in the form of some day when stories. Stories reaffirm what people mean to each other and who they are with respect to each other. Third, when life is hard, stories can provide those in the storytelling relation with some distance from whatever threatens them. Atkinson (1997) is right to say AUTHOR’S NOTE: A version of this article was presented as a university lecture at the University of Alberta, sponsored by the International Institute for Qualitative Methodology, April 1999. Thanks to Susan Bell and Catherine Kohler Riessman for comments on an earlier draft, but the usual caveat of their nonresponsibility applies especially. QUALITATIVE HEALTH RESEARCH, Vol. 10 No. 3, May 2000 354-365 © 2000 Sage Publications, Inc.

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that for me stories have “a recuperative role” (p. 327). My own experience and research confirm Kleinman’s (1988) clinical observation that illness demoralizes (pp. 53-54; see also Tauber, 1999, p. 97). People use stories as part of their remoralization. Entering the relations of storytelling recuperates persons, relationships, and communities. Fourth, stories are thus more than “data” for analysis. However valuable analysis can be, analysts risk misunderstanding if they move too quickly outside the storytelling relation as they transform the story into a “text” for analysis. Returning to my first point above, the risk of reducing the story to a narrative is that of losing the purpose for which people engage in storytelling, which again is relationship building. The storytelling relation includes those who would analyze the story, and so I fully agree with Mishler’s statement: “My intent is to shift attention away from investigators’ problems . . . to respondents’ problems” (as quoted by Atkinson, 1997, p. 334), although Mishler and I may focus on different problems of respondents. The problem that most interests me is how storytellers sustain a relational self that is threatened by some crisis. A social scientist who engages the story shares this problem of how to sustain his or her part in the network of relationships created by the story. Finally, the most immediate problem of those who tell stories of illness is to be heard, to find others who will answer their story’s call for a relationship. Because the story is a call to enter relations of storytelling, I cannot accept the dichotomy underlying Atkinson’s (1997) criticism that Kleinman is “at heart a storyteller rather than a story analyst” (p. 335). I believe that any good story analyst has both an ethical and an intellectual responsibility to enter relations of storytelling; I have trouble conceiving listening outside of a relationship. When story analysis accepts its place in relations of storytelling, then it can model listening so as to expand the community called into being by the story. The above statements are mere abstractions until filled in by the stories themselves, for which readers must turn to the work that Atkinson (1997) criticizes, The Wounded Storyteller (Frank, 1995). Atkinson writes that he finds the work “often difficult to engage systematically” (p. 338). Maybe the point is not to engage it systematically but to engage it personally. Ill people do not seem to share Atkinson’s problem of engagement. The final story (Diamond, 1996) published in the series of first-person illness memoirs that I edited was written by a woman who contacted me after she read The Wounded Storyteller. She understood my intended terms of engagement: She entered the network of relationships by telling her own story in response to the stories I had told. Storytellers do not call for their narratives to be analyzed; they call for other stories in which experiences are shared, commonalties discovered, and relationships built. Atkinson (1997) is exactly right that my “standpoint is inspired more by ethical than by methodological preoccupations” (p. 338). Just as Levinas (1989) argues the primacy of ethics within philosophy, so I argue an ethics as first sociology. Social science needs methodology, but to afford priority to the methodological is to risk becoming one of the specialists without spirit whom Weber (1958) saw inhabiting the iron cage. Methodology must develop from a preoccupation with ethics lest it reinforce the iron cage with consequences most vividly demonstrated by Bauman (1989). My standpoint is, as Atkinson (1997) writes, “committed to the construction of narrative morality”; I commend “serious attention to illness narratives as the basis

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QUALITATIVE HEALTH RESEARCH / May 2000

for clinical understanding and as the foundation for practical ethics” (p. 338). Within what form of life do such commitments take priority?

WHAT’S IN A STANDPOINT? Atkinson’s (1997) reference to my standpoint, quoted above, may not afford the same importance to that word as I give it. Interpreting the practice exemplified by Smith (1987), I understand a standpoint as a political and ethical act of self-reflection: To take a standpoint means to privilege certain aspects of what your biography shares with others. These biographical selections constitute whom you want to be, including what work your biography best suits you to do. Taking a standpoint requires self-consciousness about how the fate and choices in your life have positioned you in the world and with whom you have been positioned. One side of this positioning is internal, expressed in Foucault’s (1985) “attempt to transform oneself into the ethical subject of one’s behavior” (p. 27). The complementary external side involves taking responsibility for the ethical effects of your behavior and seeking to affect the world through that behavior. A standpoint both reflects one’s own unique experience and asserts membership in a community of those who understand shared experiences in mutually supportive ways. Smith (1987) writes of distinct personal experiences such as being a single parent while finishing graduate study in a male-dominated department, and her “standpoint of women” (pp. 106-107) suggests a community of those who do not share exactly those experiences—”It does not universalize a particular experience” (p. 107)—but who share a commonality of experience that provides a mutual understanding. Standpoints are both individual and communal because biographies are singular and yet can only develop within communities. The individual and communal aspects of a standpoint each recursively calls the other into being. The individual uniqueness of standpoints does not imply that they are beyond critique. The point of a standpoint is not “I can be no other”; self-reflection suggests I could be many others. Out of all my various experiences that could have made me into a different person, I became who I am by choosing to give precedence to some and not others. This choice is an ethical act, calling others into some degree of mutual identification and answerable to their response to this call. As Taylor (1991) argues about authenticity, there is a danger of sliding “toward an affirmation of choice itself” (p. 37). The ethical answerability of a standpoint requires “taking into account the actual nature of [the particular] experience and life” (p. 38). This taking into account entails recognizing that choices made for the self necessarily invoke values outside the self: “The ideal of self-choice supposes that there are other issues of significance beyond self-choice” (p. 39). Two final points. First, standpoints are never static: One aspect of my responsibility for my standpoint is that it continues to change as experiences and communities change. Second, standpoints are not optional; the only difference is whether or not they are acknowledged. No one can opt out of having a standpoint. To suggest how a standpoint shapes the form of one’s work, I will write something about my own. Just as I have learned from Smith how to think about my own standpoint, readers can learn from my standpoint how to become self-conscious of their own. I hope my own biography demonstrates one further complexity: What I


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have called a standpoint is better understood as a shifting intersection of multiple standpoints, involving multiple communities. I first studied the social sciences in the United States during the late 1960s and early 1970s at the height of university-based protests and cynicism about collusions between academic research and what many students perceived as centers of power. Positivist claims to methodological neutrality were understood as political acts. Against these claims, I joined those who valued Becker’s (1967) question, “Whose side are we on?” as presuppositional to any sociological investigation. Habermas’s (1971) phrase, “emancipatory interest,” seemed to express all that social science could and ought to be and who we—I and my fellow graduate students—wanted to be as responsible social scientists. Thus Atkinson’s (1997) claims that “purposes of advocacy” are “illegitimate extrapolations” and that “principled investigations” need to exclude advocacy (p. 325) are foreign to my standpoint. What makes an investigation principled is its advocacy. What counts, given my standpoint, is not to describe the experiences of the ill but to provide resources for the ill to experience their situations differently. My standpoint was also formed by the interest in family therapy I had since the 2 late 1960s and by working as a therapist during the early 1980s. My work in applied clinical sociology was disrupted (I would now say, reoriented) during the mid1980s by several critical illnesses, which I then described in my own illness memoir (Frank, 1991). This book and the academic work that has followed exemplify my belief that storytelling can be therapeutic, both in the clinical sense intended by Kleinman (1988, p. 9) and in a broader humanistic sense (Nussbaum, 1994; see also Kleinman’s later work, e.g., 1995). This therapeutic effect requires a clinician or social scientist who has cultivated a moral imagination that allows listening without the imposition of analytic categories.3 Reading medical sociology after my illnesses, I experienced my own version of Smith’s (1987) “line of fault”: My lived experience of illness did not match the descriptions of illness experience offered by academic sociology and bioethics. My sense of this line of fault was sharpened from 1994 to 1996 when I edited the “Case Stories” series of the journal Second Opinion directed to the medical and faith communities. Each segment consisted of a first-person narrative of illness followed by one or more commentaries by clinical and ethics professionals. The illness stories were easy to come by and often required little editorial suggestion. The professional commentaries were more difficult: Few professionals, I quickly learned, were able to write a sustained response to the uninterrupted voice of ill people describing their experience according to their own relevances. These professionals were skilled at responding to patients as medical subjects, but many revealed their discomfort and inability to respond to ill persons, a crucial distinction for me that Atkinson either fails to notice or that his standpoint excludes, as I will discuss below. My 1995 book, The Wounded Storyteller, is not only about narrative recuperation; it also is a narrative in which my own recuperation is performed by aligning myself with the stories I retell. My own recuperation is my stake in these stories. Again I follow Kleinman’s (1988) understanding that illness demoralizes and that the ill person’s need, both therapeutic and emancipatory, is for remoralization (pp. 53-54). For me, this remoralization includes attempting to write across the line of fault that separates lived experiences of illness from academic and professional analyses of these experiences.

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Writing across lines of fault involves a kind of academic bricolage (Levi-Strauss, 1966): gathering concepts and ideas as needed to make the case, or tell the story, at hand. Although Atkinson (1997) situates his argument firmly in “contemporary sociology and anthropology” (p. 325; see also p. 342), I cultivate hybrid discourses such as medical humanities. Medical humanities is sufficiently institutionalized to have a name (and journals, academic departments, and grant categories) but not yet 4 to have boundaries that anyone seems committed to policing. It shades into another hybrid discourse, bioethics, comprising discourses of medicine, law, philosophy, theology, and sometimes sociology as well as literature. The more significant hybridity of medical humanities and bioethics lies, however, not in the multiple discourses they draw on but in their multiple audiences. Hybrid discourses seek to address academics, practicing clinicians, policy makers, and ill people, sometimes alternatively and sometimes simultaneously. Simultaneous forms of address can be academically messy, but they can also cross the lines of fault that too frequently divide these groups from each other. Again, methodology follows ethical commitment. The standpoint summarized above is both my unique biographical experience and an intersection of historically specific local communities (student protesters, therapists, illness survivors, and social theorists among others). This standpoint selects and interprets certain experiences as having led me to define my work as I do. The point of rehearsing my standpoint is to ask readers what your standpoint is: What has shaped you for the work you choose? As I wrote above, standpoints are not optional; they are only more or less reflected upon. What I have just presented as a standpoint is certainly readable as what Atkinson (1997) calls “a vehicle for a construction of the social actor” (p. 330). My own autobiographical sketch exemplifies what he criticizes: “The narrative unfolding of the self and a life’s history may thus be represented as a potentially unique site of authenticity” (p. 330). In telling my story as I have, “The speaking subject reappears under the auspice of storytelling” (p. 330). I observe that in Atkinson’s article the speaking subject reappears under the auspice of methodological critique, but for Atkinson that may not count as a refutation since methodology privileges certain forms of speech over others. Without wishing to denigrate the values of methodology, I want to defend the authenticity of stories told by speaking subjects. Taylor (1991) provides the exemplary defense of authenticity while never minimizing the potential abuses of what can be claimed in its name (for an elaboration, see Frank, 1998b). Taylor (1991) makes it clear that authenticity is not a matter of what Atkinson (1997) objects to as an “interior self” (e.g., Atkinson, 1997, p. 327) that is supposedly revealed when subjects speak in interviews and narratives; I would join Atkinson in his objection if that were the issue. Neither authenticity nor stories are about interior selves, although Taylor traces the history of that idea. The authentic subject speaks not from her or his own supposed interior self but rather as one imbued with the speech of others (Taylor, 1991, pp. 32-33; see also Bakhtin, 1981; Gardiner, 1992; Holquist, 1990). Even written memoirs of illness are dialogical since dialogue is an ethical stance of recognizing that one’s life takes place not only among others, but also with responsibilities toward those others. The ethical preoccupation that informs The Wounded Storyteller (1995) is how to live and tell stories for the other (see Frank, 1995, pp. 35, 49): “Ill people’s storytelling . . . represents one way of living for the other. . . . Storytelling is for an other just as much as it is for oneself” (Frank, 1995,


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p. 17).5 Again, the relevant self is not interior but dialogical. The speaking subject does return (if it ever left), and what is spoken is a relationship. From my standpoint, one cannot analyze this relationship without entering it, which means putting ethics before methodology.

ILL PERSON OR PATIENT? I had not realized how fundamental the distinction between patient and ill person is to my standpoint until Atkinson (1997) tried to describe my work without this distinction. What I learned from being ill, and what I have subsequently read and heard from many other ill people, is that the time I spent being a patient—entering a clinic to be treated by medical professionals—was only one part of a life in which illness remained present but medicine played a role that diminished to periods of being irrelevant. For the hospitalized person, being a patient can wholly subsume being an ill person, yet someone chronically ill may remain an ill person during long periods—perhaps years—of not being a patient. The traditional concern of medical sociology has been patients; my interest has always been ill people. The part of my life I spent in hospitals and clinics was by no means the most important part of my life as an ill person. The contrast between Atkinson’s (1997) project and mine represents a genuine alternative. He writes that the stories I tell “seem to float in a social vacuum. The voices echo in an otherwise empty world” (p. 339). For me there is no vacuum: Ill people’s stories speak to other ill people, and I read the stories from within that relationship. Because Atkinson hears the storytellers only as patients, he perceives the absence of medical staff responding to their patients. Atkinson’s project is to study illness experience within “a sociology or anthropology of the domain of medical and health work” (p. 342), and my project is to show the richness of what ill people experience outside this domain. What for Atkinson is a crucial shortcoming is for me a tactical necessity: “The narratives of medical work are given minimal attention” (p. 339). Atkinson’s (1997) specification of the elements of illness narratives includes only what is relevant to medicine: “The attributions of disease and the accounting of medical treatment, the medical history, and the prognosis may also be enacted through narrative performances. As I [Atkinson] have suggested, the modern clinic is a densely narrated environment” (p. 340). Atkinson’s work enhances our understanding of how the clinic is densely narrated, but he omits the ill person’s narrations outside the clinic. As closely as Atkinson reads me, he cannot appreciate why anyone would choose to proceed as I do. My work becomes a deficient version of his project. His culminating criticism may be that “Frank eschews any methodological principle of symmetry in his treatment of narratives while reversing the polarity of credibility that normally distinguishes lay from professional knowledge” (p. 339). Physician and philosopher Howard Brody understands me better. Brody (1997) writes that I “consciously ignore” offering “lessons for medicine” because I am “much more concerned to establish the responsibility of patients individually, and the community of patients jointly, for telling their stories and hence assigning meaning to their suffering” (p. 26). Brody then addresses Atkinson’s (1997) criticism that I “eschew . . . symmetry.” “He knows,” Brody writes of me, “that each diversion into

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offering advice for professionals is one more distraction that could undermine his message of the responsibility of the sick for their own fate” (pp. 26-27). Brody then takes the most sensible approach: “It is up to us [physicians and bioethicists] to elaborate upon some of the lessons from his thinking” (p. 27). The Wounded Storyteller excludes medical voices not because physicians lack stories that deserve attention (in my current writing, I do deal with these stories) but because the topic of the book was how the ill narrate their own experiences. Medical voices relegate ill people to patienthood and render their stories into fragments of a larger medical story; that is their work but not my topic. Precisely because medical voices are privileged by what Atkinson (1997) usefully calls the normal “polarity of credibility,” they tend to silence “lay” experience by reducing it to medical relevances, i.e., the accounts of treatment, history, and prognosis of the disease that Atkinson expects to hear in an illness narrative (p. 340, as quoted above). Making the ill hearable requires the deconstructive move (Derrida, 1981, p. 41) of a provisional reversal of this normal priority: How would the world look different if seen from the perspective of the other, the disempowered, the too-often silenced one? As Smith (1987) writes of the standpoint of women, It is rather a method that, at the outset of inquiry, creates the space for an absent subject, and an absent experience that is to be filled with the presence and spoken experiences of actual women [for me, ill persons]. (p. 107)

Atkinson (1997) represents many clinical and academic professionals who cannot accept this reversal: “He [Kleinman] wants us to believe that the narrative selfknowledge and narrative self-revelation of the patient are inherently more valid and more authentic modes of knowing or experiencing than other modes of interpretation” (p. 333). Speaking, as always, for myself and not for Kleinman, what I find curious is Atkinson’s use of more. I do claim that ill people have their own narrative self-knowledge and even moments of self-revelation but only to say that this knowledge is valid, full stop. More enters in only as what I take to be the unexceptional claim that anyone’s self-knowledge is more authentic for that person, including medical workers’ self-knowledge as being more authentic for themselves. But this position is not without its own dilemmas, which I will turn to now.

THE STORYTELLER’S WORK My methodological quandary has been and remains the limits of what can be said about anyone else’s story. At issue is the role of the intellectual (including physicians and medical sociologists) and contemporary suspicions of those who claim to be able to speak the truth of others’ stories better than those others can for themselves (Lemert, 1997; Said, 1994; Smith, 1987). This suspicion was expressed in the politics of Foucault’s Groupe d’Information sur les Prisons (GIP), who wrote that they proposed not “to speak in the name of the prisoners in various prisons” but rather “to provide [prisoners] with the possibility of speaking themselves and telling what goes on in prisons” (as quoted in Eribon, 1991, p. 227). The GIP positioned themselves as storytellers and, through those stories, as advocates, not as story analysts.


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But Foucault’s storytelling advocacy had its complementary form of analysis; there is no contradiction between the two forms. In Foucault’s analytical study of prisons, Discipline and Punish (1979), an actual prisoner speaks—on my reading—only once, and then briefly. But Discipline and Punish is not about the experience of living in prison; its topic is the overlapping of discourses that draw society into an increasing panopticism. Analysis has its legitimate sphere, but there is also a clear imperative for the analyst to step back from first-person testimony and allow those who testify to speak for themselves. The analyst claims, inevitably and often effectively, to be the master of the underlying code that makes some phenomenon intelligible. That code may be a set of stages that define an experience; it may be described in neutral terms, like the sick role, the negotiated order, discourse, and narrativity, or in more evaluative terms, such as the medical gaze, medical nemesis, or adaptive upgrading. Foucault’s (1979) use of surveillance and panopticism is such a code, as much as he would resist that description. Analysts who identify the code underlying some social order unavoidably present themselves as the masters of that order. The auspice of this knowingas-mastery is often called methodology. The method both guarantees the claim to knowledge and neutralizes the analyst’s interest in how that knowledge is insinuated in relations of power. I could hardly object to work that identifies these codes since I do such work myself. Each code describes some aspect of social life and is useful in its own way. But too often analysts who present these codes do not want to be descriptive in their own way. Their analysis claims privilege over other codes. This claim is an academic version of truth. What, by contrast, does a storyteller claim? I return to the idea with which I began: People I call storytellers tell stories to remind those who share their form of life what it is they share; people’s sense of being together is enriched within the storytelling relation. Storytellers also offer those who do not share their form of life a glimpse of what it means to live informed by such values, meanings, relationships, and commitments. Others can witness what lives within the storyteller’s community actually look, feel, and sound like. Storytellers tell stories because the texture of any form of life is so dense that no one can describe this form of life; the storyteller can only invite someone to come inside for the duration of the story. Those who accept an invitation into the storytelling relation open themselves to seeing (and feeling and hearing) life differently than they normally do. Listening is not so much a willing suspension of disbelief as a willing acceptance of different beliefs and of lives in which these beliefs make sense. Whether or how a story makes sense seems not so much an analytical question as an experiential one: Did the story draw others into its world far enough so that people’s actions in that world seem reasonable in that world? Those who have accepted the invitation to the story may not choose to remain in the world of the story, but if the story works, then life in their worlds will seem different after they return there. Stories address the problem of how we can live different forms of life within the same social world. Stories deriving from different forms of life are like gestalt drawings: The same lines depict two different images simultaneously. And more than that, one person cannot teach another how to see the other image in the drawing (the first image is usually seen immediately). The only way to see that other image is to keep looking until, suddenly, the other way of seeing is there: The duck becomes a rabbit, the young woman turns into the old crone, or the vase becomes two profiles.

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When perception switches back to seeing the initial image, the other configuration remains as a background possibility, not presently seen but now an immanent possibility in what is seen. How much of this process can be “analyzed” without first having the experience is questionable. Any analysis seems to depend on an experience that is prior to and always somewhat outside the analysis. Rarely do different forms of life intersect so intimately as in clinical settings. As Toombs (1993) has meticulously demonstrated, physicians and patients live in different “lifeworlds”: Their fundamental structures of meaning and relevance are different. Each needs to hear the other’s stories to make sense of why the other is as he or she is: why physicians seem patronizing or patients seem noncompliant. Until these stories are heard, clinics will remain tense places. The drawing that is the other’s life will remain an unintelligible squiggle or be configured as a shape that makes sense in the viewer’s life but is not the shape that the other understands his or her life to be. Only when the storytelling relation is entered can the duck become a rabbit; only then can each see the shape of the other’s life as the other experiences it. This view of stories, illness, and medicine grounds a broader work for qualitative methods than either storytelling or story analysis, although these activities remain the core that reminds me of what is easily forgotten: the experiences, meanings, problems, and everyday work of being ill and of caring for the ill. I propose to qualitative researchers that illness experience is increasingly less determined by clinical medicine than by a medicalized culture (Morris, 1998) that progressively exceeds the profession of medicine. On one side, the clinic in an age of managed care offers less physician contact and shorter hospital stays (Schneider, 1998, pp. 64-69, 186-195). On the other side, and only beginning to be studied, the mediascape—the proliferation of images, sounds, messages, and information reaching further into people’s lives than the old mass media ever came close to doing—offers quantities of medical (and “alternative” medical) information and contact with fellow ill people that were unthinkable a decade ago (Annas, 1995; McLellan, 1997). If both sides together represent a trend toward downgrading the centrality of professionals, this should not surprise us. Historically, the 20th-century period of professional dominance is probably the aberration. As medical technologies proliferate and become more expensive and as culture becomes increasingly global and electronically mediated, the increasing corporate rationalization of medicine seems inevitable. Radley, Lupton, and Ritter (1997) express the complexity of the new relationship emerging between the cultural category of health and medicine: Paradoxically, just as health matters appear from one perspective to escape the confines of medicine, to become an issue for lay persons to deal with either collectively or as individuals, so these issues reflect back upon medicine in ways that not only challenge it, but open up new avenues for its expertise. (p. 9)

I suggest the same of illness: It is gradually but perceptibly escaping the confines of medicine and becoming an issue that lay people are dealing with, individually and collectively. The ways that ill people are dealing with illness—including face-toface, print, and electronic narratives, each of which affects the others—are both challenging medicine and opening new avenues of medical expertise. My recent experiences with medical groups make me optimistic that one new expertise is listening to patients’ stories about their lives, not only about their diseases. But just as


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physicians are learning (anew) how to listen to the ill, ill people’s ways of dealing with illness reflect both liberation from medicine and a sense of abandonment by medicine. We live at a paradoxical moment when people fear both that managed care will prevent them for receiving the medical care they need and that they risk becoming prisoners of more medical treatments than they want (one motivation for the rightto-die movement). Only the nuanced interpretations of qualitative methods may be able to disentangle the strains of dependence on medicine and resistance to medicine that pervade not only illness experiences, but the newly differentiated “health” experiences—the self-consciousness of the tenuousness of one’s health and of what one must do to sustain that health against ever-present risks (Frank, 1997). As society confronts these issues, more knowledge may be less important than a clearer sense of value. During the Clinton impeachment hearings, a reporter remarked that the facts of the case were not in much dispute; the differences concerned what values those who judged Clinton were to invoke in making sense of those facts. This shift seems paradigmatic of our times—from needing more knowledge to needing values that allow us to take a stand with respect to what we know. Put another way, the old faith was that more facts and better theories would render ethical dilemmas moot; the new realization is that knowledge only increases the density of ethical dilemmas. The existence of bioethics reflects this predicament, whether the issue is genetic engineering or the needs of the medically underserved. Deciding what to do about what we know requires having an ethical standpoint. The challenge for intellectuals is to help people make policy, clinical, corporate, and personal decisions in a milieu of profound dislocation. The dislocations we face include but are hardly limited to new medical technologies, new diseases, new problems of resource allocation, and new issues of how ill people can best live prolonged lives. The ill and their families, physicians, nurses, and administrators struggle with the disappearance and fragmentation of what recently were taken-for-granted values. Social scientists may not be formulators of emergent ethics, but they can facilitate this emergence by circulating stories, finding commonalties in those stories, and confronting people with the “inconvenient facts” (to adopt Weber’s [1972] phrase) of stories that have been unheard. Creating a space for absent subjects—who may increasingly be medical workers as well as ill people—and filling that space with those subjects’ presence and spoken experience is a form of ethical work. This brave new world of illness and health requires many works and multiple narrative turns. My work, deriving from the standpoint where choice and chance have left me, is to listen to the ill: to attempt to give their stories greater currency and to help other ill people and those who are not yet ill to hear the wisdom in illness narratives. Wisdom is not an analytical category; it is a normative judgment with all the hazards of such judgments. Yet without such judgments, analysis will be empty, 6 inapplicable to human life. I claim a place for my work, but I would be dismayed if too many others took it up. I need colleagues doing different work to fill in other parts of the picture. When I become lost in multiple dislocations, I return to Audre Lorde’s (1980) expression of her survivorship: “I am a post-mastectomy woman who believes our feelings need voice in order to be recognized, respected, and of use” (p. 9). Against Atkinson’s (1997) good, social scientific advice (p. 341), I am seduced by this voice. I hear too much of my own fears and struggles in it not to be. And if nothing can

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seduce me, then I would lack conviction in anything. If my seduction disqualifies me from doing one kind of analysis of Lorde’s discourse, it opens me to an understanding of where her voice comes from and who it speaks to. My seduction grounds my standpoint, my sense of value, my origin of judgment, and my usefulness. Lorde (1980) wrote, “Because I am woman, because I am black, because I am lesbian, because I am myself, a black woman warrior poet doing my work come to ask you, are you doing yours?” (p. 21). The only identity I share with her is survivorship, but that is enough for me to embrace her question, to ask who I am and what work I am doing. As each of us chooses how we will live and what we will say about how others live, we can be well served by Lorde’s question with its exultation of difference and responsibility.

NOTES 1. Atkinson (1997) also criticizes the work of Arthur Kleinman and Elliot Mishler, and these criticisms are repeated in Atkinson and Silverman (1997). In this response, I speak for myself only, although because Atkinson argues that my work “displays some of the same underlying assumptions” (p. 335) as Kleinman and Mishler, I sometimes respond to points made with reference to their work. 2. I am fortunate to have a current clinical affiliation with the Family Nursing Unit at the University of Calgary and to address audiences of clinicians frequently. 3. For a more clinically relevant discussion of the framework of illness stories presented in The Wounded Storyteller and discussed by Atkinson (1997, pp. 337-338), see Frank (1998a). 4. For how my work can be applied in medical humanities, see Wear, Jones, and Nixon (1999). 5. Atkinson (1997) understands stories differently, “in terms of a kind of economy in which the stories of medical work are the tokens” (p. 329). In this account, the storyteller’s problem is to enhance his or her “social worth” (p. 329). I accept that as part of what goes on in storytelling. We are all like the proverbial blind men grasping at the elephant, and thus, we need multiple narrative turns. 6. As Brubaker (1984) writes with respect to Weber, The truly human life is one that is guided by reason. To live a life informed by reason, an individual must become a personality. To become a personality, he must commit himself to certain fundamental values . . . [but] there is no rational way of deciding among the plurality of conflicting possible value commitments. Every rational life . . . is founded on a non-rational choice.” (p. 98) Nonrational choices can and must be answerable; their nonrationality is hardly relativism.

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Arthur Frank is professor of sociology at the University of Calgary. He is author of At the Will of the Body (1991) and The Wounded Storyteller: Body, Illness, and Ethics (1995). His recent and forthcoming articles appear in Body & Society, Health, Qualitative Sociology, and Families, Systems & Health.