Illness Narratives - Positioned Identities
Illness Narratives - Positioned Identities
Illness Narratives - Positioned Identities
Department of Sociology
Boston College
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Narrative Inquiry: A critical overview
The personal narrative as an object of inquiry in social research has reached a level of
popularity few of us would have predicted twenty years ago, when we began analyzing
accounts for the popularity of the “personal”, and the “narrative” or story of experience?
“narrative turn” in the human sciences away from positivist modes of inquiry; 2) the
“memoir boom” in literature and popular culture; 3) the new “identity movements” —
emancipation efforts of people of color, women, gays and lesbians, and other
life in therapies of various kinds. I would add to Langellier’s list other post-World War
testimonies of survivors of state-sponsored violence and, in the post-Soviet era, the turn
away from class analysis, i.e. Marxian and other macro-structural theory which views
Embedded in the lives of the ordinary, the marginalized, and the muted, personal
of experience, claim identities, and ‘get a life’ by telling and writing their stories.”
attention over the last 15 years. The illness narrative—a form of case study—emerged in
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response to biomedicine’s focus on disease, and consequent neglect of patients’
embodied experience (Bell 1999, 2000; Langellier 2001b; Mishler 1984). Medical
sociologists distinguish between disease (the diagnostic entity) and illness (the way that
his study of written accounts of illness, Arthur Frank (1995) shows how the ill person
resists narrative surrender—the medical chart offers only the official voice. Building on
Mishler’s (1984) theory about the different (and often competing) voices in a medical
consultation, Hydén (1997:49) puts it well: “patients’ narratives give voice to suffering
Whatever the issues with personal narrative (and I will turn to these shortly),
physicians and other health practitioners are increasingly recognizing the value of
narrative for practice and teaching. Recent articles by physicians in the Annals of
Internal Medicine, one by Abraham Verghese (2001) and another by Rita Charon (2001),
articulate how knowledge emerges (otherwise unobtainable) when physicians think about
their patients narratively. Cheryl Mattingly (1998) shows how health professionals use
narrative thinking to re-vision a patient’s life after, for example, a stroke or spinal cord
injury. As practitioners are developing narratives about patients, so too are patients and
relatives of patients writing narratives about hospital stays (Rier 2000; Weitz 1999), and
and nursing research have experimented with “the story” as a mode of interrogating the
intersection of patients and practitioners in various health care settings (Hurwitz 2000;
Greenhalgh and Hurwitz 1998; Launer 2002; Edvardsson, Rasmussen and Riessman,
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forthcoming). The practical importance of the knowledge produced cannot be
describe in the two cases below, narratives of illness can provide a corrective to
biomedicine’s objectification of the body and, instead, embody a human subject with
Narrative approaches are not without their critics, however. Speaking as someone
who has been working in the field for many years, even I am becoming uncomfortable
with the popularity of the genre—the tyranny of the narrative, as I called it elsewhere
(Riessman 1997). To briefly identify some of the critiques: First, some sociologists
question the “naturalness” of the personal narrative as a form of meaning making. They
ask, in what contexts does personal narrative emerge? What are the social structures that
produce particular autobiographical narratives? Zussman (2000:6-7) argues that there are
“special” occasions, not part of everyday life, when “we are called on to reflect in
systematic and extended ways on who and what we are.” Of course, conversation
analysts and others who examine “naturally occurring” stories (told around the dinner
table, for example) would disagree—narrative forms are ubiquitous in everyday life, and
rules of turn-taking, gaze, and other communicative features have been studied in
everyday settings. But there is something different, as Zussman rightly believes, about
the extended reflections that have come to characterize modern notions of self-hood,
criminal investigations, and the Oprah Winfrey show! The narratives produced in
commercial and state-sponsored therapeutic settings are “broader in scope” and attempt
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to account for lives, not merely episodes or events. Certain social structures that involve
practitioner asks “what brings you here today?” or when a prospective employer
surveying a resume asks an applicant to “explain the gaps in your work history.” Under
conditions when institutional orders are most visible, extended stories are occasioned,
even required. There are additional contexts that mandate an extended account of “the
self,” and the talk produced takes particular narrative forms. Social movements (such as
gay liberation) and self-help organizations call forth particular kinds of stories, and the
way they are told has been studied by Ken Plummer (1995) and others. In Alcoholic
Anonymous groups, for example, the narrator can take few liberties with her story about
drinking and its consequences (Cain 1991). Social structures work on the
Besides lack of attention to social structure, narrative has been criticized for lack
personalize the personal narrative (Langellier 2001a). Paul Atkinson’s (1997) critique is
even stronger: Individual agency has been idealized, rooted in the Western Romantic
impulse and its assumptions about the interior self. We have reified the authenticity of
single in-depth interviews. As a narrative analyst, I would add that the narrative
produced is typically asked to “speak for itself”; language is viewed as a resource, not a
topic of inquiry. “Meaning” is assumed to be self-evident, that is, what any competent
user of language would find in a story. What the listener/reader brings to her encounter
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with a text—theoretical perspective, historical context, and biographical experience—is
typically unexamined.
home. Stories of illness, in particular, have been stripped of their class and historical
bearings. Alan Radley (1989:243) puts it eloquently: “becoming chronically ill does not
remove one from society; if anything it amplifies one’s position in it, so that what people
adjust with is as important a matter as what people attempt to adjust to.” Social class and
gender, in addition to nationality and race, are the primary determinants of physical and
mental health, as medical sociologists have documented for decades. Locating the social
How can narrative researchers deal with these criticisms? As a beginning we can
circumstances. As C. Wright Mills (1959) said long ago, what we call “personal
troubles” (e.g. illness) are located in particular times and places. Individuals’ narratives
about their troubles are works of history as much as they are about individuals, the social
spaces they inhabit, and the societies they live in. We can also locate narratives in the
social relations of production, that is, in their class, institutional, and interactional
contexts. We can include and interrogate our positions as interviewers and investigators
—the audiences for the narrative — using the insights of reader-response theory (Iser,
Ph.D. student, Makiko Duguchi, raised a question that pushed me to think beyond verbal
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communication. Speaking from her position as a Japanese-American, she asked how she
could include in her transcript of an audiotaped interview (an assignment I gave) her
observations about gesture, silence, and the displays of deference her Japanese-American
subjects used to communicate with her. She observed that Americans seem to put all
their faith in the spoken word. Since the seminar, she has taught me about ishin denshin,
occurs, but never spoken. Japanese people do not trust the spoken word: “somehow
profound feelings and emotions are more authentic if not said…There is a lot of
genuine, because words never capture the ‘true’ essence” (Deguchi 2003). Radley and
Chamberlain (2001) recently articulated the same issue for health research: we need to
attend to the presentational features through which illness experiences are reflected, the
“displays” of identity, illness and health that can be observed, but are not verbalized in a
formal illness narrative. As I look back on narrative research over the past 20 years, I
sense we have relied too much on our “holy transcripts.” Mishler (1999:19) says “we
speak our identities,” but much remains unspoken, inferred, shown and performed in
gesture and association, and in action. What narrators show, without language,
(1984) and Mike Bury (1982), about biographical disruption. Illness (and other life
events, such as divorce or infertility), interrupts lives that many individuals assume will
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be continuous, ordered, sequential. The interruption of life by a chronic illness must be
accounted for, placed in context of the life before and after, at least by Westerners
theory and gender research to my re-interpretive work on the illness narrative, and it is to
examples that I now turn (see Riessman [2003] for extended analysis).
Narrative (re)vision
I examine two narratives developed in conversations with two men with multiple
gender and the divorcing process) as part of a new research project on narrative identities.
Returning to data one collected in the past with new questions in mind is common in
medical research when new knowledge about a disease process emerges. It is less
Analysis shifts from “the told” —the events to which language refers—to “the telling”
(Mishler 1995), specifically the narrator’s strategic choices in illness narrative about
positioning of characters, audience, and self, and to the listener/reader’s response. I ask,
why was the tale told that way? In what kind of a story did the narrator place himself?
How did he strategically make identity claims through his narrative performance? What
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was the response of the audience, how did she influence the development of the illness
narrative, and interpretation of it? How might it be interpreted differently with historicity
To illustrate what this angle of analytic vision offers, I analyze and compare two
illness narratives. 1 Each man carries a diagnosis of multiple sclerosis, and each performs
a version of masculinity that is agentic and positive. Beyond these similarities, the two
men could not be more different. An obvious difference I will not dwell on here is stage
of the disease.
At the time of our interview, Randy2 was a 38-year-old white academic, who had
received his diagnosis 3 years earlier (see Appendix for edited version3 ). The news of his
disease slipped out during a conversation about his divorce. Mid-way into a long
meditative response, developed to answer my question about the reasons for his
separation, Randy mentioned “the other thing.” After several false starts, he said simply,
“I have MS myself.” I was jolted by the revelation. He had no symptoms I could discern.
He was vigorous and fit. He described how “it’s kind of a funny disease, the diagnosis
goes from possible to probable to certain, so there’s a period of finding out.” The lengthy
to evaluate his life and what he wanted out of it. He decided he didn’t have “time to dally
around about things…putting off things for 5 or 10 years like many people do.” He and
his wife had discussed separating before he began having symptoms (things in the
relationship had “gone flat”). After the diagnosis his mantra became “do it now.” He
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initiated change in many areas of his life: he and his wife agreed to separate and begin
other relationships, while maintaining their friendship; he decided not to pursue tenure in
a teaching university and he began a research career; he traveled to Asia and spent time
hiking in remote areas. Traveling to “exotic” regions of the world, “just the experience
of traveling alone, it was kind of discovering that I could do it alone…I just feel stronger
as a person that I’ve been able to do those things.” As he reasoned, it was all “part of the
MS thing, doing things now.” Discovering “strength” by redefining challenge, and the
I now wonder whether Randy performs a classic masculine tale. As all narrators
do, Randy draws on cultural stories to form his personal one, and the “lone hero on the
move” is a familiar Western storyline. As Nigel Edley (2002:16) says, the lone hero on
the move has many referents in popular culture; it is a “widely available resource for the
imaging of masculine selves. ” Randy is not quite Clint Eastwood riding off from human
suggest, such leisure activities “vivify breaking away from the confines of domesticity
variant of the classic epic: mortal man endowed with god-like courage, choosing risk in
are muted, even marginalized in Randy’s account. He says “I particularly love traveling
alone…I can spend 4 weeks alone and enjoy my own company.” But he turns to
company with others in the next breath: “you meet people when you travel alone very
easily, rather [than] traveling as a couple.” The wandering hero with intermittent ties,
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unencumbered by the constraints of family: a romantic image, I think, that finds its way
into the identities of many an ancient and modern man—independent, self-sufficient and
determining. But the paradox is palpable: Randy and I both know how fleeting his
Odysseus after the fall of Troy, for example. But contemporary women do have cultural
motifs of travel they can draw on to compose their story lines—remember the film
I can imagine myself enacting his tale; its form may be familiar to women and men who
face adversity, refuse to give in, and go on a journey to find strength. “Do it now” is a
shared mantra that draws on Western modernist notions of the “self.” And how might
one think about Randy’s pull away from committed relationships: Is it one version of
with illness and (most likely) a premature death? Interpretive questions a health
activity since his divorce, especially the discovery that he was “attractive to members of
the opposite sex.” He adds: “I guess I feel more masculine.” I ask, “What do you mean
by being more masculine?” He responds with a list of “things that come to mind”: sexual
performance, abilities in bed, and attractiveness to women at parties. I get it, and think
classic guy stuff. Then Randy says “I’ve also become more comfortable…with my
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femininity,” saying he feels freer to do things that are feminine than he would have been
when his “masculinity felt more tenuous.” I am totally confused: “What do you mean?
The feminine side?” He explains: he feels free to talk personally to others. Again, I think
I get it—sex role stuff. Randy then adds “I think I have a component of bi-sexuality to
my sexuality…which hasn’t happened yet.” But he says, “sooner or later it will happen”
because he’s more “comfortable.” In the past, he says, his “masculinity was threatened
ago I was probably totally confused. I moved quickly to the next question.
Looking back at the interview segment now, there are several ways to think about
1987). The abrupt change of topics at the end, perhaps, reflects my discomfort at the
time with the open discussion of bi-sexuality with a male interviewee, a peer who was
nearly my age, also divorced. During the 1980s there was questioning in some
communities about sexuality and gender identity (the Stonewall protest in New York had
occurred 10 years earlier), but my perspective at the time reflected the dominant
discourse—gender and sexuality were binary. 5 Although I moved away from Randy
suggesting otherwise, I did hear his strategic choice in the first line of his response about
how to organize his experience (“rank order”). With this opening, he positions me as an
academic peer; he performs with a specific audience in mind. He does identity work with
me, as I do meaning work in my repeated probes (‘what do you mean by…”). The
between narrator and audience has influenced the account we produce together.
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Trying now to re-interpret Randy’s statements about masculinity and bring to bear
historical context, there are (at least) three ways to think about the performance of
masculinity in the excerpt. 6 Perhaps Randy was voicing the sex and gender practices of a
unnoticed by academics, until gender theory and queer studies named it in the 1990s.
(although his language about it certainly isn’t), and how current theory can illuminate it.
male category—shows that this aspect of identity develops early in life, but is not
(Fausto-Sterling 2000; Foucault 1980; Kessler 1998). Randy goes even further by
emphasizing both sides of his gender. In the current historical context, he would have
postmodernists and social movements on his side, but then—20 years ago when
did not understand. Randy was not embedded in a set of relationships or community
familiar to me—I could not position him—and consequently the illness narrative we
Looking back, I now speculate about the meaning of masculinity and sexuality in
the life of a 38-year-old man who is 3 years into an illness career. I wonder: Has medical
uncertainty about the probable course of his disease opened up uncertainty about other
aspects of his persona, including gender identity and sexuality? Does he wonder how
long his body will be able to perform heterosexually? Randy resists the idea of a
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continuous essential self, performing instead a multiplicity of selves, a stance that
universal in its stages (Mishler 1999). Randy speaks of components of identity shifting.
consistent self, and resist the uncertainty Randy performs, the mantra with which he
began his meditation on “the MS thing” provides a key—“do it now”: divorce, travel,
The second man, Burt, was 43 years old when I interviewed him. He was white,
had a high school education, and advanced MS. I went to Burt’s home to interview him
about his divorce, having obtained his name from court records, and I was surprised when
an aging man in a wheelchair answered the door. I wrote in my field notes, “He looked
much older than 43 years.” He asked for my help at several points to handle activities of
daily living (for example, he could not easily reach his urinal from the wheelchair). I
conducted the usual interview, but Burt redirected the conversation at every opportunity
to the topic most salient to him: how MS over the previous 8 years had altered his life.
Taking charge of the interview early on, he told story after story, each recounting a time
since the diagnosis when he had been a responsible husband, father, or worker—a
representation of ‘self’ that was the basis of a case study I published many years ago
claimed the status of hero, against all odds—a reading I now view as incomplete.
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Similar to other white working-class men, the job had provided a secure
masculine identity. Burt had been the breadwinner in a traditional marriage that lasted 21
years. As the disease advanced, his wife left him for another man. Burt had worked for a
large well-known company for 20 years. When he got sick, he said with pride “they got
me an electric wheelchair”; they also gave him a desk job. He continued to work until
he “couldn’t sit for too long in a wheelchair.” Within the first five minutes of the
interview he told me he was “planning on going back to work part time.” Sitting across
from him, it was hard to imagine. He said he had gone to see his boss several weeks
earlier but had been told “things were kind of slow…there was nothing open right
now…they would get in touch with [him].” I now wonder if they were putting him off.
(I learned after our interview that the plant was downsizing; within a year, another
acquired the company, and the plant closed. Thousands of line semi-skilled workers
were let go. Unlike executives, these were local people who couldn’t move elsewhere).
I now wonder if Burt wanted to return to work for status, and for human
research materials with historical context in mind, I sense Burt’s extreme isolation in a
time when the disability rights movement had not yet secured wheelchair access in
communities—disability had not yet become politicized. Burt said that “being alone”
was his greatest difficulty. A personal care attendant, who helps him with
With the attendant’s aid, he is able to get out of the house several times a month only, to
movement can accomplish much more, but as I think about Burt’s illness narrative now, I
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can imagine how his mobility, at least, might have been greater. Burt’s illness narrative
(and experience of MS) would have been different in the context of current policies in
longs for companionship and pines for his former wife: he continues to carry her picture
in his wallet and shortly before we talked he had sent her a Mother’s Day card, “but she
something like that. She was always here Saturday night watching it with
me. I sit here and I see these things and I feel depressed. Sometimes I
Other sources of companionship, tied to the marriage, have been lost. Contacts with in-
laws have “gone down the drain”: “they don’t call and they don’t even write,” and his
adult son and daughter have moved out. It is unclear what led to estrangements,
especially the relationships with children. Whatever the reasons, the limited possibilities
for a public life, and the loneliness of the private sphere, are grimly apparent to me now
isolation need not accompany polio or multiple sclerosis, except as social arrangements
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companionship. Musing in the interview about how the younger generation has changed,
he reaches out to me—his audience—in a kind of plea for understanding. It was the first
Kids today are a lot different than they were in our time. I don’t know—I
am— I don’t know how old you are. In your early forties, too? (I nod).
We used to take the kids to the drive-in, something like that, but today-
forget it, everything has changed. Now they have to go down to the Cape
and spend the weekend down there. You are saying to yourself, “what is
There is a hint of intimacy, even sexuality here—topics Burt returns to many times in our
conversation. He describes “growing fond” of a nurse who took care of him during a
recent hospitalization:
I wish I could have some kind of real close relation with her, but she is
married and has five children. That just about throws everything down the
drain. I like the girl very much, she is more my age and I wish I could
have some sort of relation with her. I feel something like that. That’s
He continues:
You know what I mean, you used to sleep with a woman for 21 years and
now I’m sleeping in my own bed and there’s no one beside me to keep
warm, let me put it that way. Nights are cold- something like that.
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Burt wants “someone to talk to, you know, someone to love.” Perhaps the research
relationship offered a fleeting “woman companion,” someone who listened, gave support,
and expressed interest in his life world. Re-examining the transcript now, I see how Burt
B: Never
question, this time about income. I learned he had no pension, and was living on meager
Social Security disability payments. Burt, resisting the constraints once again of the
fixed interview format, inserts a long story that recounts his last day at work several years
previously—an association that suggests the huge significance of employment for his
masculine identity. In the story he positions himself as the central character in a heroic
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drama, with his boss and several doctors as supporting characters. He positions me, his
INTERVIEW EXCERPT
I had told my boss ahead of time that I was goin' to see him [the doctor]. SCENE 1
And he said "well, let us know, you know, as soon as you find out so we can get your
wheelchair all, you
know, charged up and fixed up and everything."
So I had seen him [doctor] on a Friday
and I'd called soon as I got back Friday told him [boss] I'd be in that following Monday.
And he said, "oh, it's goin' to be so good to have you back, you've been out of work so
long."
When I get home I figured well maybe it's because I'm nervous SCENE 3
coming back to work the first day on the job.
So I get home (p) I still couldn't go.
So I called my doctor, Dr George
and he said "well, can you get up to [name of hospital]?"
I said, "well, I'm in my pajamas."
He said, "well, I'll send an ambulance."
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And he put a catheter on me
soon as he put that on I think I must have let out maybe two pints.
Everything just went shhhhh.
You know, I felt so relieved.
And he said "well, I'm goin' to keep you in," he says
"I want, I want this uh (p) urinologist to take a look at you."
So it was Dr Lavini
I don't know if you know Dr Lavini he’s one of the best around.
He looked at it and said, "we're going to have to operate."
Everything just blocked up.
They had to make the opening larger
so the urine would come out, you know, freely.
So I was in [name of hospital]-
This poignant narrative about the failure of the masculine body is a classic story in a
formal sense. 8 It moves us: me—the original listener—and you, listeners and readers,
perhaps. Looking beyond the events to which the narrative refers, how does the process
of storytelling so engage us? Burt claims an identity through the narrative devices of
setting, plot, and characters (including dialogue between them); they draw us into his
temporally through the fateful events that transpired on his last day at work. His
representation includes discrete scenes: the Friday before (scene 1), Monday, the
beginning of the workweek (2), that evening (3), and the final hospital scene. There is
characterization: he gives speaking roles to his boss, the two doctors, and himself. Burt
positions himself in a moral story about what it means to be a virtuous man. As the
“selves” he had suggested earlier (e.g. lonely man wanting a woman to love). He sustains
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As I muse now about the identity Burt performs in the closing narrative, I am
Death of a Salesman, telling off his corporate employer when he is fired. A salesman for
34 years who was tired and aging, he too wanted to be known as a workingman. The
employer, who extracted Willy’s labor for 34 years, took his work identity away. Burt’s
corporate employer is not portrayed so harshly, but he also used up the able-bodied man.
Nor does Burt confront corporate power, as Willy did: “You can’t eat the orange and
throw away the peel [he says]… A man isn’t a piece of fruit.” Thinking now about Burt’s
lack of a pension after 21 years with the same employer, learning about downsizing and
subsequent closure, I see a vivid instance of how market capitalism and job loss have
ravaged American workers. People in management and upper levels of the plant were
given employment opportunities and generous benefit packages. Line workers were not.
The post-industrial wasteland of the entire Northeastern US, produced in the 1980s by
acquisitions and mergers, capital flight and the search for corporate profits, eclipsed the
factory labor.
There are many ways to compare the two illness narratives and I develop several
elsewhere (Riessman 2003). Viewed from a biomedical perspective, the men are at
contrasting points on an uncertain illness trajectory. Each man resists being a “case” in
biomedical terms alone. Each negotiates the balance of healthy and ill aspects of his life.
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resisting disease designations. Each positions himself in a narrative account as a man
with agency and choice, even as there was no choice in getting the disease. Randy and
Burt are exemplars of men with a disease that has a downward trajectory, yet they “do”
illness experiences. Randy hints that illness offers an opportunity for personal growth.
Illness narrative as a discursive form allows each man to connect strands of his
existence: health, illness, self-identity, and the life world. For each, “the illness is
articulated and positioned in time and space, and within the framework of a personal
biography” (Hydén 1997:56). 9 But there are critical differences between the two. Burt’s
illness narrative pivots on the breakdown of the physical body and, more fundamentally,
the breakdown of a social world. He does not reconfigure his thinking as he confronts
the biographical disruption of chronic illness (Bury 1982), but engages in a form of
segment reinforces prior components of identity (working man) that connect him to a
collectivity (other factory workers). “By arranging the illness symptoms and events [on
the last day of work] in temporal order and relating them to other events in [his life], a
coherence, to be sure, but self-positioning in the closing narrative shores up the identity
of working man, momentarily eclipsing other “selves” Burt performs in the broader
has called into question his constructed identities as husband and academic, including the
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associated life project: getting tenure. The illness narrative allows him to re-imagine
identity and a life world, regenerating both. By interpreting illness narratively, he can
re-establish a relationship between the “self”, the world, and his body. Illness is cast as
an epiphany, a kind of wake up call, which allows him to re-order everyday life. Illness
Not only do the men “do” illness differently, they also “do” gender in vastly
narratives. As gender theorists now argue, we need to speak about masculinities and
femininities, rather than assuming singular notions about gender (Connell, 1995; Berger,
Wallis, and Watson 1995; Edley and Wetherell 1997). Contrary to gender stereotypes
about men and relationships, there is variation here: Burt craves connection, whereas
Randy keeps enduring emotional ties at bay. Both men emphasize action—doing—but
differently. Each is trying to stay active in the face of the disease, Burt with his dogged
attempts to return to work and Randy with his trekking. But the centrality of doing paid
work for self-identity distinguishes them. Remember, Randy had left his academic job,
research. I did not sense any grand plans for work, but instead a “balanced” life filled
with some work, lots of travel to “exotic” lands, new friendships and sexual exploration,
until disability hits. In contrast, Burt’s life, which had been structured by a traditional
marriage and working class job before MS stopped him in his tracks, had lost both
marriage and job. He did not have the resources to begin a new life, nor perhaps the
inclination, and there was little community support at the time for a person with his level
of disability. Burt could have narrated about new hobbies, the achievements of his adult
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children, and other topics, but he didn’t. The closing narrative segment he constructs
about going to work does not break the frame that structured life before the disease—the
centrality of paid work for self-identity. The narrative represents a protagonist who tries
to push ahead, doing the things he’s always done, retaining a past identity; when he can’t,
Randy, in contrast, narrates about breaking the frame of a previous life (and that
life is already more “bendable” because he has role flexibility that Burt lacks). His
activity involves shifting the set, freeing his mind of the constraints of the past, and
affirms his physical health with trekking. In the context of an encroaching illness, he
constructs a “supernormal” social identity (Charmaz 1991). Burt performs the man that
are storied into being through illness narrative. Both tell familiar American cultural tales
from the early 1980s—pursue pleasure, do it now (on the one hand) and get to work (on
the other). Hanging out in the piazza drinking espresso and talking politics with other
Why do the men “do” gender and illness so differently? There are character
differences that probably distinguish them, and stage of the disease is clearly important.
More important, social structures are deeply embedded in each illness narrative. The
contrasting way men bear illness is realized through the body. Drawing on Radley
(1989) for insight here, I would say that the men used their bodies in distinctive way in
the course of their working lives. Working-class men, like Burt, earn a living by bodily
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labor, a body that is “fit for work” displays health. A particular work ethic runs through
Burt’s identity performance; his vigorous attempts to return to work (and to the topic of
work in our interview) serve to minimize illness and embody the value of a man in his
economic world. As Radley says, “There is every reason to return to heavy work (in
spite of ‘more informed’ expectations) if, in the labour of one’s body, one can recover the
forms of relationship which give meaning to one’s place in the social structure” (Radley
1989:244). Physical identity for Randy, in contrast, is not tied to work but, rather, to self-
cultivate the body’s expressive use. In contemporary times, the bodily practices of
middle-class, academic men revolve around the gym, not the job. Randy goes further and
steps off the treadmill of his university—moving off the tenure track—preferring instead
to minimize paid work in his life, and maximize pleasure and self-discovery. He wants
distance from instrumental roles, in contrast to Burt who wants to perform tasks that are
central to masculinity in his class context. Because the two men are embodied so
differently in social class position, their illness narratives take different forms. Social
practices and “styles” of response distinguish the two men’s identity performances that,
in turn, are located in discourses about the body and the self (Radley 1989). Material
conditions and power over space shape the freedom of each man, a comparison that
25
Conclusion
To return to the ideas with which I began, narrative research has been criticized
for “over-personalizing” the person narrative, for lack of attention to historical context,
the social structures that occasion extended accounts of the “self”, for bleaching research
of class relations, and for relying too much on the spoken word, to the neglect of
illness narratives, how one narrative researcher has taken these critiques seriously, even
and use of photography and videotaping (Bell 2001; Mattingly and Lawlor 2001; Radley
I have argued that gender, class, and historical context matter in the construction
and interpretation of illness narratives. The two men’s engagement in the economic world
and the resources at the disposal of each made important differences in the scope of lives,
and in possibilities for narrating them. Historical context shaped topics that could be
introduced into each narrative (e.g. sexuality), audience response, and assumptions about
illness itself (e.g. disability inevitably brings social isolation). At the global level, Randy
can be the “lone hero on the move” exploring the developing world, while Burt cannot
move around his own community without a paid attendant, because of structural
26
Through the examples, I provide a glimpse into my current project— “looking
back” and re-working narratives I collected long ago, in light of contemporary critiques
gender, disability, and the discursive construction of illness identity, which informed my
re-readings. I introduce the idea of a “performative self”, which contrasts with the
are missed with static conceptions of identity, and by essentializing theories that assume
the unity of an inner self. Because narrators control the terms of storytelling, they occupy
“privileged positions in story worlds of their own creation” (Patterson 2002: 3); the
2000:9). Individuals negotiate how they want to be known by the stories they develop
collaboratively with their audiences, and by their performance of health and illness in
social interaction. When ill, individuals do not reveal an essential self as much as they
perform a preferred one, selected from the multiplicity of selves or persona that we all
switch between as we go about our lives (Harre and van Langenhove 1999:17).
beyond Goffman, structures of power work their way into what appears to be “simply”
talk about lives affected by illness (Sarangi and Roberts 1999). 10 To emphasize the
performative is not to suggest that identities are inauthentic, but only that they are
27
constitute appeals to an audience, they are “performances-for others” (Young 2000:109).
Hence the response of the listener (and ultimately the reader) is implicated in the art of
narrative (Iser 1978; 1998 ). I positioned myself as a figure in the illness narratives (as
interviewer and audience, and as a current voice asking new questions of them). In all
studies of lives.
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33
APPENDIX: RANDY’S ACCOUNT
The text is edited from four pages of interview transcript. I tried to observe the structure of the account,
which is organized into a rank ordering of benefits, in the selection of utterances to delete (marked “…”).
Where substantial deletions occur I summarize content (marked “[ ]”). Other transcription
conventions: “-“ is a break-off in an utterance; speakers are identified by my initials (CR) and the
informant’s pseudonym.
CR: What are the greatest benefits that have resulted from your separation?
Randy: Getting close to lots of people…I feel this need to put them [benefits] in rank
order…Getting close to lots of people and I started to travel places alone…Discovering
that I had the resources to do things … [describes traveling to several ‘exotic’ places]…
This was part of the MS thing, doing things now…[describes enjoyment of traveling
alone]-
CR: Tell me more about that, what is that- discovering that you ‘have the resources to
do things’ alone?
Randy: Oh- To me there’s some kind of, oh, strength…[describes trekking in Asia]. I
just feel stronger as a person that I’ve been able to do those things…I can spend 4 weeks
alone and enjoy my own company and meet people, because you always meet people
when you travel alone, you meet people when you travel alone very easily rather than
traveling as a couple...I guess competencies. The last one is- something about the
benefits of separation- is becoming somewhat more outgoing in terms of meeting people,
somewhat more comfortable with myself. So what I have mentioned, I've mentioned
close friendships, travel in terms of personal growth…I feel I’ve learned more about
things—relationships, people…I certainly find that a benefit-
Randy: Well, the obvious- I’m still with that thing of rank order…Things that come first
to mind are sexual performance, abilities in bed and attractiveness, just in a sense of
being at a party and other women relating to you as someone sexually attractive. I’ve also
become more comfortable- I guess this has to follow- with my femininity. So I feel
34
freer now to do things that are feminine or to joke about things like that than I would
have when my masculinity- I guess I felt- was more tenuous.
Randy: I’m certainly freer about talking- that’s funny, that’s not really femininity- but
the first thing I was going to say- I’m freer about talking to people- close people- about
that I think I have a component to bi-sexuality to my sexuality and that sooner or later- I
haven’t- but sooner or later it will happen. I’m not sure though why, if it’s there, it
hasn’t happened yet. But at least I’m freer about talking about it, because I’m more
comfortable perhaps with that. My masculinity was threatened by homosexuality
[describes loving to cook dinners, expressive movement]. And those are consequences, I
guess, of some more tangible sense of masculinity. There are probably others.
NOTES
1
I use an expanded definition of illness narrative here, to include speech during the interviews (discrete
narrative segments, or stories, and other utterances related to illness and its effects), and unspoken
“displays” of illness and health. The definition of illness narrative is the subject of considerable debate, as
is the definition of narrative itself (Riessman 2002b).
2
“Randy” and “Burt” are pseudonyms.
3
It is questionable whether the text in the Appendix meets even minimal criteria of personal narrative,
although there may be brief embedded narrative segments. The response is told primarily in the present
tense, not the past, and consequently not organized temporally. As a unit of discourse it has a structure,
organized as an elaborated listing of “benefits” (prompted by my initial question) that Randy—the
academic—repeatedly tries to “rank order” for me, another academic, who repeatedly interrupts with
questions about “meaning.” There is an abstractness to our conversation—two academic talking—that
defies easy categorization. As I suggest, my discomfort with (and confusion about) Randy’s sexuality
probably affected the “narrative.”
4
Films about women on the road exist, but generally do not represent woman as solo traveler. Relational
ties are dominant in the genre when women travelers are represented, and in some cases when men are as
well (“Easy Rider.”).
5
I thank Susan E. Bell for helpful comments here.
6
I thank Lars-Christer Hydén for helpful comments here.
7
See Riessman (2003) for more on interview with Randy.
8
For more on the “classic” uninterrupted bounded story, see Labov (1982), Riessman (1993).
9
Good (1994) argues that illness narratives are, by definition, incomplete and ambiguous because the
ending is missing, and unknowable: how much deterioration will there be? Will the illness lead to death?
10
See Riessman (2003) for development of a structural re-reading.
35