February 16, 2013 · 1:49 am

Catalyzing Change With Narrative

Standing before us were four individuals: a public health professor, a director, an actor, an artist. But each of these individuals held so much more than just one profession; they each dabbled into a variety of other realms, but they were all here for one reason. Today, they were here to promote the power of narrative.

Tell Me A Story: Designing Narratives for Health Behavior Change was an extraordinarily compelling and fascinating symposium organized by the School of Public Health.

Tell Me A Story

With three prominent guest speakers each contributing their insight about a different facet of the narrative, this symposium explored essence of the narrative and the potential potency of its role in instigating change.

To begin with, Monte Montgomery showed the audience what makes a story. 4 purposes, often accomplished by a 3 act structure. Engaging, understandable, and memorable all lead to the fourth purpose: actionable. The 3 act structure, as illustrated below.

3 Act Structure

Although this 3 act structure seems to be relatively pervasive in our society, I found it interesting that illness narratives represent one of the few genres that often defy this standard. Just as disease pushes against the normal functioning of the body, illness is defined by a deviation from the norm. And since illness narratives are created to mirror the illness experience, illness narratives resists the 3 act structure.

So what are the effects of this resistance? The most powerful deviation in my mind was that while 3 act narratives imply that conflict allows for an individual to achieve greater stability. This in many ways embodies the triumph narrative, which Conway so persistently cautioned us about. The 3 act structure suggests that the restitution narrative allows for not only a restoration but a progression, where an individual becomes better off than they were in the past. Illness narratives that break free from the model of the triumphant overcome of illness, then, also escape the confinement of the 3 act structure.

After Montgomery had established a basic understanding of narrative and explored the individual change that narratives can inspire, Mike Mosallam discussed the social changes that can arise from narratives. Leading with the powerful question “What is my story?,” Mosallam gave us a glimpse of his own narrative and introduced us to his reality TV show All American Muslim to show how theater can instigate social change by creating dialogue, building bridges, and humanizing groups of people such as Arabs/Muslims.

One story that particularly struck me was Mosallam’s anecdote about acting as a patient for medical school students. Mosallam described how a key part of using narrative revolves around preserving the “authenticity of stories.” There were some medical students who he said he would never want to have as his doctor. “You can’t guide and manipulate,” he explained. “Let the subject direct the narrative.”

Taking a step away from the commonly linguistic nature of narrative, Kody Chamberlain walked us through the process and the power of incorporating art into narrative. He opened my mind to thinking more about what is entailed by the creative process, which is really an interdisciplinary challenge that shares many similarities between different realms. It was fascinating to think about the impact of images, especially in the spaces between words or as replacements to words. Chamberlain’s advice about the creative process, the persistence and the depth involved in works of art, was extremely interesting, and I felt like he dispelled many common stereotypes of art with ideas such as “inspiration is a placebo.”

These three speakers left us all with a challenge:

What do you want to do? How do you want to do it?

And how can you incorporate the power of narrative?

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February 13, 2013 · 8:00 am

The Closing of the Bell Jar

While the first half of The Bell Jar introduces the reader to the character of Esther and the world she inhabits, the second half truly allows the reader to witness firsthand how Esther’s mind unravels as depression takes its toll on her. Esther meets Dr. Gordon, who insists on administering shock therapy when talking results in no improvements. The experience of shock therapy feels like slumber when done correctly, but Esther’s consciousness during parts of the shock therapy leaves her traumatized despite her external appearance of recovery.

Life goes on, but Esther’s depression lingers as she is consumed by suicidal thoughts. She contemplates and half-plans a variety of attempts: cutting herself in the bathtub with a razor blade, drowning in the depths of the sea, hanging herself with her mother’s bathrobe drawstring. She becomes aware of her body’s physiological desire to live, and its resistance to her suicide attempts. Finally, she finds her answer in her mother’s sleeping pills, and she overdoses within the comfortable confines of the cellar.

Miraculously, her groans give away her hiding spot and Esther’s mother finds her. She is initially admitted to the state hospital, but her sponsor Philomena Guinea has her transferred to a better private hospital. While taking insulin injections, Esther spends time with Valerie and Miss Norris before Joan, the girl that Buddy once took to a school dance, is admitted as well. She establishes a good relationship with Dr. Nolan, and gets moved up to Belsize with Joan, the final step before she reenters the real world. Although Dr. Nolan had initially assured her that she would not have to receive any more shock treatment, Dr. Nolan stands by Esther’s side and makes sure that it is done properly.

As winter semester draws nearer, Esther seems to be doing better. She gets fitted for birth control and loses her virginity to a professor named Irwin, but she feels pain rather than pleasure and bleeds tremendously. Joan helps her to the hospital, but this emergency seems to traumatize Joan for she hangs herself just a few days after. The novel draws abruptly to a close, just as Esther enters into a room full of doctors to demonstrate her readiness for restitution.

Although I knew that this was a book about mental illness, the intensity of Plath’s writing and the pain of experiencing Esther’s suicidal thoughts took me aback. My experiences of reading the novel in many ways seemed to parallel Esther’s experiences of coping with mental illness as embodied by the metaphor of the bell jar. There were times, particularly as she described her elaborate suicide schemes, where I felt as though a bell jar was enclosing around me. I was overwhelmed by the naked honesty and bold vulnerability of Esther (or Plath, if interpreted autobiographically) as she exposed her mind in such an unhindered way. Interspersed amongst these painful passages of depression were moments when Esther was doing better, and it was at these times that her personality shined through, other aspects of her character came to life, and I could feel the bell jar lift from around me. This speaks to Plath’s incredible success at capturing her experiences and illuminating mental illness by carefully crafting language.

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Discussion Questions:

  1. How does Esther’s depression manifest itself in the writing style of the second half of the novel?
  2. What is the role of supporting characters, particularly other psychiatric patients, in exposing the psychiatric ward? How do these interactions influence Esther?
  3. How does viewing the novel through an autobiographical lens illuminate certain aspects of the plot and the language and eclipse others? An illness narrative lens?

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February 11, 2013 · 12:00 am

Remembering Sylvia Plath: 50 Years Since the Suicide

Fifty years ago today, Sylvia Plath locked all the doors. She kept her children safely in the next room, using towels to seal the empty spaces that still connected her to them. She turned on the gas stove. She reached her head into the darkness, breathing deeply. Exhaling life, inhaling death.

Until about a week ago, Sylvia Plath was just a name to me, a famous poet who’s tragedy I had forgotten. Now, I can’t stop thinking about her. Learning about the kind of person she was, the struggles that she faced, the ways she thought, has in many ways changed my own thoughts. There’s something about her and about her tragic, eery story that has granted her a sense of immortality.

I remember reading Plath’s poem Daddy in high school. I don’t remember when, I don’t remember the class or the teacher, I don’t even remember what we discussed. But I remember her voice. Rereading the poem, I can still hear Plath’s voice, the rise and fall of her words as they tumble off her tongue, her sharp pronunciation of words like daddy.

Plath’s ambitious love for language. Her persistent drive despite publication rejections. Her internal challenges with mental illness. The highs and the lows of her marriage to Ted Hughes. Her suicide, both her attempts and her success. The cascade of suicides that followed in suit over the years– Hughes’ second wife, who followed Plath’s methods; Nicholas Hughes, her son. I am both intrigued and torn by the mystery of Plath’s life. I’ll be discussing my thoughts and admirations of The Bell Jar, a somewhat autobiographical account of her experiences with mental illness,  later this week. .

Three years ago, around this time of the year, I wrote about the immortality of The Catcher in the Rye in honor of J.D. Salinger’s death. Two years ago, I wrote about the importance of commemorating poets in honor of Elizabeth Bishop’s 100th birthday. Now, I am writing in about the powerful resonance of Sylvia Plath in honor of the 50th anniversary of her suicide.

I am honoring her life today, on the day that she that she ended it.

Sylvia Plath's grave

Photo by Anosmia. CC:BY.

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February 6, 2013 · 8:00 am

Entering the Mind of Esther: Plath’s The Bell Jar

In Sylvia Plath’s The Bell Jar, the reader enters into the mind of Esther Greenwood, an Honors English student who works in fashion and an aspiring poet studying in New York. Living in the Amazon hotel with other college girls, she has many adventures from going out with Doreen to getting food poisoning from a food tasting event. Esther is a hard worker who has no dreams of getting married, and she enjoys going out on dates and meeting men with unique names.

We learn about Buddy Wilkins, the man who was once her love interest; now that he loves her in return, she has unearthed his flaws of hypocrisy and is no longer interested. Their relationship grows as Buddy introduces her to the life of a medical student and she exposes him to the world of poetry. He admits to her that he has known one other woman, and this knowledge makes Esther feel inexperienced and uncomfortable with his innocent façade. Illness brings their accelerating relationship to a halt: Buddy has TB and is sent to a clinic in the mountains.

When Esther accompanies his father to go visit him, Buddy proposes to her. Esther denies him, claiming that marriage is not her plan and using her neuroticism as a scapegoat. Buddy, however, insists persistently in being with her, and the conversation lingers. He takes her skiing for the first time and she breaks her leg.

Time jumps forward, and Esther is heading home for the summer, eagerly awaiting her acceptance into a summer writing program at Boston. She had been confident and expectant about the course, and the news that she has been rejected is earth shattering to her. She is trapped at home, and she struggles to escape the tragedies of her situation by fantasizing about the future. Things take their toll on her, and her inability to sleep or read leads her to the family doctor; she refers Esther to a psychiatrist.

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Discussion Questions:

1.     How does the disjointed dimension of time illuminate the narrator, Esther?

2.     Through the juxtaposition of Esther’s passion for poetry and Buddy’s interest in medicine, what does Plath reveal about the intersection of these fields?

3.     How do metaphors and similes function in this narrative? How do they enhance or complicate the reader’s understanding?

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January 30, 2013 · 8:00 am

Insectifying Illness in Kafka’s The Metamorphosis

In Franz Kafka’s The Metamorphosis, Gregor wakes up to find that his “anxious dreams” are in fact reality: he has been changed into a “monstrous verminous bug” (1). Late for work, he struggles to free himself from the confines of his bed but is unable to escape. His family begins to knock anxiously on his door, and his manager scolds him angrily for his tardiness. Gregor tries to respond in self-defense, but he can no longer speak in words and is not understood by the others. With great effort, Gregor makes his way to the door; at the sight of Gregor, the manager departs hurriedly and the family stands aghast.

Gregor’s ill state has been established, and he is kept in his room. His sister feeds him and takes care of him eagerly at first, keeping his room clear so he can crawl around. His father seems to stay strong in denial while his sensitive mother pines. Gregor hides from his family by situating himself under the couch and shielded by a sheet. On one occasion, Gregor’s mother faints at the sight of her son and Gregor’s father lashes out at him, throwing apples that result in an immobile state of injury for Gregor.

Since Gregor had been the primary breadwinner for the family, each family member is forced to step up and take on new responsibilities for pay. The family takes on three tenants to help pay for rent. When they see Gregor, they immediately decide against the lease, disgusted by the familr. For the Samsa family, this is the last straw. Gregor is no longer a “he” but an “it” instead, which allows them to forfeit their claim and responsibility for him. That night, Gregor dies. Gregor’s death frees the Samsa’s, for their lives no longer need revolve around him, and they are able to return to a state of normalcy.

I have always found Kafka’s works to be incredibly compelling, and this one certainly did not disappoint me. One of the things that I found to be most fascinating was the role of the 3rd person omniscient narrator. Although the story seemed to be told through the eyes of Gregor, the narrator was not inside his head but rather an objective observer. I felt that the narrator’s intimacy with Gregor was transformed just as Gregor’s own transformation evolved throughout the novella. As Gregor’s insect identity became more and more consuming, the narrator joined the Samsa family in distancing himself from Gregor. If anything, this shows just how isolating Gregor’s insectification really was- even the narrator who is telling his story abandons him.

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Discussion Questions:

1. What parts of the text can be identified as representative of a chaos narrative? A quest narrative? A restitution narrative?

2. What words does Kafka use to allude to Gregor’s insect-like state?

3. What is the effect of the 3rd person narrator? How does the narrator’s stance evolve throughout the novella?

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January 28, 2013 · 8:00 am

The Art of Illness

What I find fascinating about the idea of using art to express the illness experience is that it translates the physical and mental components of illness into a visual image. While some illnesses are often visible, others remain invisible. Art has the power to visually illuminate the visible and unveil the invisible.

As I explored artistic depictions of illness, I found that art seemed to be used in three main ways: to encourage another person’s illness experience, to express one’s own illness experience, and to depict the illness experiences of others.

Fiber Arts and Loose Ends includes a series of quilts created as tributes to survivors, an uplifting collection for sufferers. While some are more abstract, including depictions of plants used in cancer treatment, others incorporate language into this artistic medium. Words of Love by Annabel Ebersole incorporated the words “Courage,” “Love,” “Faith,” “Belief in Miracles,” “Hope,” and “Trust.” These encouraging words reminded me of the triumph narrative, but they also embody an optimistic take on the quest narrative.

While art is sometimes turned to for relief and encouragement, it can also be used as a space for self-expression and release. William Utermohlen used art as a form of narrative, to tell the tale of his transformation with Alzheimer’s. His drawings reflect his gradual loss of self and identity through the distortion of his facial features. Incorporated colors seem sporadic (the fourth drawing in particular seems to reflect the chaos narrative), until ultimately Utermohlen has become a faceless black and white charcoal sketch.

In addition to providing support for the ill, art can be used to spread awareness to the well. The Scar Project is a particularly powerful photography collection of breast cancer survivors, especially depicting women who have had mastectomies and are redefining the female body. With the motto “Breast Cancer Is Not A Pink Ribbon,” these works are a direct resistance against the pink ribbon that has become the face of breast cancer (and is also a form of the triumph narrative). These works also revise the restitution narrative of breast cancer by suggesting that rather than a return to normalcy, breast cancer can result in a redefinition of the female body and female identity.

Just as Frank’s narrative categories often overlap and intertwine elements of illness, art seems to transform and evolve illness, achieving a multiplicity of narratives within a single work of art.

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January 23, 2013 · 3:00 am

Concluding Ideas about Frank and Conway

In the second half of Illness and the Limits of Expression, Conway explores the literary methods of metaphor, narrative form, and endings. While Sontag critiques metaphor as something that confines individuals within stereotypes, others see metaphors as necessary to come as close to an accurate representation of the illness experience as possible.Narrative form often strives for linearity, a beginning, middle, and end; individuals seek to construct this sense of coherence but also to expose the interruptions and interjections caused by illness.

Conway discusses the complexity of the ending, and how there is often a desire to end on a happy note. Some authors feel themselves gravitating towards this triumphant conclusion, but they catch themselves in time to adopt an ending that is better suited with the rest of their narrative.

After laying out a basic foundation of illness narratives, Frank delves into his three types of illness narratives: the restitution narrative, the chaos narrative, and the quest narrative. He argues that illness narratives often contain elements and moments of each of these perspectives, and he explores the defining characteristics of each [see table].

The restitution narrative focuses on the conclusion of illness, the ultimate victory over illness, an individual’s reintegration into society and return to the normalcy of everyday life. The chaos narrative claims that “chaos is told in the silences that speech cannot penetrate or illuminate”; thus, the chaos narrative is an anti-narrative that highlights the interruptions caused by illness (101). The quest narrative focuses on the temporal enactment of the illness experience and an individual’s transformation over time.

Frank explains how these narratives coexist and intermingle to compose the illness experience. He toys with the idea of patients as witnesses to illness and illness narratives as a kind of testimony. The concluding chapter explores suffering, for “all illness stories share a common root in suffering as ‘an existential universal of human conditions’” (170). He relates suffering to illness narratives by showing how both telling and hearing stories has the power to heal.

This table outlines the 3 types of illness narratives. Click to enlarge!

Types of Narratives

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Discussion Questions:

1. What literary characteristics of an illness narrative can hint at a shift in the type of narrative? For example, what syntax, diction, etc.?

2. How does classifying the narrative type affect the analysis of an illness narrative?

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January 22, 2013 · 8:00 pm

Celebrating MLK Day: Listening to Health Disparities

The entire auditorium was silent as eyes followed the words on the screen and absorbed the image of the patient in a hospital room. These moments of patient narratives were interspersed throughout Dr. Carmen Green’s presentation today (the 50th anniversary of the “I have a dream” speech)  at the Martin Luther King, Jr. Symposium organized by the Health Sciences Program at the University of Michigan. People from all across campus, from the schools of medicine, dentistry, public health, pharmacy, etc., had all gathered to learn more about “Unequal Burdens and Unparalleled Opportunities: Achieving the Dream for Health and Pain Care Equity.”

Dr. Green is an accomplished woman, a Professor of Anesthesiology, Obstetrics and Gynecology, and Health Management Policy. Her passion and interest in addressing health inequalities was incredibly inspiring. Throughout her presentation, she balanced her personal experiences with shocking facts about American health care and disparities in treatment.

In addition, Dr. Green acknowledged the importance of listening and storytelling in health care. She admired “the power of narrative to embrace the art and science of medicine,” to transform it. It was exciting to see her advocate on behalf of this communication through language, because it helped bring to life some of the theories that I have been reading about. She demonstrated that narratives are indeed giving patients a voice, and slowly but surely, more and more physicians are listening.

Her take-home message about narratives was that “we need to be able to listen actively, not passively.” This distinction stands up agains the common practice of failing to be engaged in conversation with patients. This means to pay close attention to the patient as a whole, the patient’s body language, the patient’s disposition, the patient’s praises, the patient’s complaints. Not only hearing everything that a patient says, but also responding to the patient. Failure to do so undermines the patient (this reminded me of Oliver Sacks’  A Leg to Stand On, which I haven’t read yet but Frank’s novel makes me feel as though I have). Particularly in regards to addressing pain inequity, I think that understanding and reacting to narratives is crucial, and Dr. Green’s placement of narratives throughout her talk suggests that she agrees.

Dr. Green’s talk concluded powerfully with her own dreams for what the future will hold 50 years from now, in 2063. She remains optimistic about our future: “Our strength is in our diversity and in our ability to see through multiple lenses.”

To see through multiple lenses, to hear through multiple narratives.

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January 21, 2013 · 2:06 am

Narrating Illness through Dance

This week, I’m on the look out for non-narrative illness narratives. Expressions of the illness experience that occupy any form of media.

I’m beginning my exploration of multimedia illness narratives with dance. As someone who has danced forever, I have always been fascinated by movement. Recently I have learned about dance therapy and movement programs, and I love how dance and movement have been adapted to help with coping.

I began with a youtube search for ‘illness dances’.

This first video is called Schizophrenia, and is “loosely based” on the illness.

These movements embody the marriage of chaos and calm, of sharp and fluid, of control and collapse.

Another video I found is called “An Interpretation of My Illness- Crohn’s disease.” Unlike the previous one, this dance is choreographed by an individual who has the illness that the dance expresses.

Her incorporation of movements on the floor demonstrate the “falling” aspects of her illness, the numerous head rolls reveal her anguish. An interesting aspect of this dance is the song chosen: “Her Diamonds” by Rob Thomas, a song written for his wife who has an auto-immune diseases.

Last but not least, how can I forget my own dance loosely choreographed about autism? After seeing this video, I was inspired to choreograph a dance last year to “Fix You” by Coldplay.

It’s interesting to look back on my own choreography through the lens of illness narratives. I didn’t even realize that I was depicting the light of triumph narratives. At the time, I described the circle as a moment of “chaos,”; now it seems like those movements express the “chaos narrative” that words cannot capture.

Haven’t had enough dance illness narratives? Here’s an epic production of “Childhood Illness…Our Story”, Part 1 and Part 2, telling the tale of “a mother and young daughter’s journey through chemotherapy.”

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January 17, 2013 · 8:00 am

Accepting the Limits of Language

While Arthur Frank’s The Wounded Storyteller explored the potency of illness narratives, Kathlyn Conway’s Illness and the Limits of Expression exposes the shortcomings inherent in many of these works. Conway outlines the paradoxical nature of illness narratives: “Literature offers the possibility of representing the shattering experience of illness, but it proves woefully inadequate for depicting the nature of physical pain and the dissolution of the self” (16).

Language as a form of expression, as a means of communicating physical or mental stress, falls short of its demands. Conway denounces the most popular form of illness narratives: the triumph narrative. This form of expression finds fault in its glorification of the illness experience. Often, these are written at the conclusion of an illness experience and reflect on past experiences rather than chronicling illness through its progression. This narrative form aligns with the cultural American belief that “anything is possible,” which makes it of great appeal to the general public (6). These stories are of overcoming illness and disability, of rising above the challenges that they present, and ultimately emerging from this learning experience with enduring strength.

Despite the temptation of reconstructing past illness as triumph narratives, Conway advocates for the importance of non-triumph narratives. She claims that a triumph narrative “enables individuals and the culture to ignore the needs of the ill and disabled,” when instead, illness narratives should illuminate the vulnerabilities of these conditions and the resulting implications (24). Illness narratives present an opportunity to strip illness down to its roots, to boldly expose it for what it is. These narratives track the evolution of the illness in conjunction with the evolution of the self.

Conway exposes the paradoxical nature of illness natures. Literature empowers those who experience illness, but it simultaneously belittles that very experience. While language allows individuals to dissociate the self from the body and to express physical pain through mental thought, narratives also enable the reclamation of the body through an intimate and honest engagement with illness.

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Discussion Questions:

1. In what ways are illness narratives paradoxical? What does this paradox reflect about illness? (55)

2. Why does Conway choose to address illness and disability together? How does this affect her argument and her definition of these terms? (14)

3. What is the right way to react or interpret illness narratives? Or rather, is there a right way? (19)

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