Notes on:  Sharf, B. F., & Vanderford, M. L. (2003).  Illness narratives and the social construction of reality. In T. L. Thompson, A. M. Dorsey, K. I. Miller, & R. Parrott (Eds.), Handbook of Health Communication, 9-34. Mahwah, NJ: Lawrence Erlbaum.

Note: These notes are intended to act as a guide as you read the above chapter, which can be found in the library. The material in brackets refers to places when I added my own phrasing or explanation. . .

This chapter illustrates how matters of health and illness are socially constructed; that is, how bodily and psychological states of being are perceived and imbued with social and cultural meaning. The chapter discusses a social constructionist perspective to health illness narratives and the five functions of health illness narratives.

Rhetoric is epistemic, a way of knowing. Berger and Luckman defined a social constructionist perspective as a dialectic between social reality and individual existence. [In other words, what how we talk about something influences (or determines?) our experience of it. Thus, reality is perceived and shaped by how we talk about it. What we commonly perceive as "truth" or "common knowledge" is created through the process of communication. . .]  Narratives are a particular type of social construction. Walter Fisher theorized that narrative is the defining paradigm of human communication. Fisher named our species as “Homo narrans” due to our unique ability to tell stories.

The social construction of health is a reaction to biomedical perspective which assumes that the scientific method is the only one route to knowledge.  A purely biomedical perspective represents the “voice of medicine” whereby health and illness is regarded in purely organic terms. In contrast, the “voice of the lifeworld” represents a biopsychosocial perspective (i.e. the impact of a medical condition on a person’s social, emotional, and intellectual life.) Use of narratives is a specific method to examine the voice of the lifeworld.

Health communication scholars have approached illness narratives as psychosocial maps, revealing the storytellers’ emotional and cognitive journeys. Thus, they challenge the voice of medicine as the primary means of understanding health and disease.

[Narratives are stories.] Illness narratives are stories about illness as defined in the next paragraph. Illness narratives make use of familiar elements which shape our perceptions of the world. Such elements include: Characters, the people who enact the events of the story (e.g., heroes, villains, victims, innocent bystanders), scenes, the setting in which key events occur (e.g., hospital, home, the workplace); motives, the thoughts, emotions and circumstances that impel characters to take certain actions (e.g., fear, concern, anger, accommodation); chronologies or time frames (which emphasize past, present or future); plots or dramas, the meaning that emerges from how key events and characters actions are configured in relation to one another.

Attention to personal narratives first emerged in health communication with the development of a conceptual distinction between “disease” and “illness.” Disease was defined as organic malfunctions and pathological processes whose signs and symptoms typically can be observed and quantitatively assessed. However, illness was defined as a person’s experience of disease or ill health.

Clinical medicine does collect some form of narratives in the form of case reports, chart notations, and clinical rounds. However, narratives are increasingly used in health research in the form of patient accounts of their illnesses, patient writings, and ethnographies. [As the trend toward patient-centered health care continues, health narratives may become more prominent.]

The five basic functions of health narratives are:

1. To make sense of health and disease: Narratives function to create meaning and giver order to the health experience. Voicing becomes an act of healing. Stories may take different forms: those of rebirth and promise of cure, those of battle and journey, those of dying, and those of health beyond medicine (i.e., alternative modes of healing). Moreover, there are stories or restitution or recovery, stories of chaos or illness with no hope of recovery, and stories of question or journey in which the suffering engendered by illness leads to larger purposes or understandings.

2. Assert control in the midst of physical and psychological losses: Illness may result in loss of financial resources, inability to work, etc. Stories can provide patients with a way to take control of their experience and assert themselves. Examples are discussions of advanced directives.

3. Transform the identities and social roles as a result of altered health and disease: Illness may serve to redefine the self or shape a new identity. Chronic illness may often disrupt a person’s previously established self-image. Stories are a way to know ourselves and will reflect and influences changes in roles, relationships, social circles, and activities. Thus, the process of narrating an illness can reveal a person’s essential character through the struggles to adapt, persist, and thrive. Illness can take a person on “an odyssey of the self.” [Examples may be: I went from X kind of person to X kind of person as a result of my illness; I can no longer do X like I used to; or I appreciate life in a way I didn't before my illness because. . .]

4. Make decisions about health: Narratives reveal the storyteller’s reasons for actions, including routine activities as well as those involved in medical decision making. They may justify decisions already made and determine future decisions. Understanding a patient’s story is key to understanding his or her decisions [e.g., why did someone accept/refuse a particular treatment?]

5. To solidify health-based communities with common visions and social agendas: Multiple individuals or organized groups are attracted to and build upon stories in a form that Ernest Bormann calls “fantasy themes” which are the development of rhetorical visions as stories build from one another. Face-to-face or online support groups share a socially constructed reality shaped by commonly expressed interests, rules or operation, and vocabulary. These communities enable members to have wide access to information and give attention to socioemotional needs and coping skills, help in decision making, activist events, etc.

This website is maintained by Marceline Thompson Hayes, mhayes@astate.edu

This page last updated August 21, 2007

Arkansas State University