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01-08-2013 | Scientific Contribution

The role of narrative and metaphor in the cancer life story: a theoretical analysis

Author: Carlos Laranjeira

Published in: Medicine, Health Care and Philosophy | Issue 3/2013

Abstract

Being diagnosed with cancer can be one of those critical incidents that negatively affect the self. Identity is threatened when physical, psychological, and social consequences of chronic illness begin to erode one’s sense of self and challenge an individual’s ability to continue to present the self he or she prefers to present to others. Based on the notion of illness trajectory and adopting a Ricoeurian narrative perspective, this theoretical paper shall explore the impact of cancer disease on identity and establish the crucial importance of metaphor in the narratives of life with cancer. Findings indicate that in cancer narratives the illness experience supplies the narrative structure with temporal and spatial meeting points that make the narrative comprehensible and meaningful. Cancer forces identity changes not only from having to endure the long-term physical and psychosocial effects of the disease, but also from inevitable existential questions about life’s meaning. Improved medical knowledge today means improved ethnomedical practices. Metaphor can bridge the gap between the cancer experience and the world of technology and treatment, helping patients to symbolically control their illness.

Narrative inquiry is the methodology for investigating the interpretation of human experience as it is described in the storied lives of individuals grappling with making sense of life events (Chase 2003; Connelly and Clandinin 2006). Using narrative inquiry, one attempts to understand how people think through events and what they implicitly assume (Riessman 2008).

Ricoeur reveals how the art of creating a plot responds to the aporia of time. This aporia refers to a gap between a phenomenology of time (mortal, subjective) and cosmic time (scientific, objective). Cosmic time refers to infinite age of the cosmos considered as endless and natural time (the time of astronomy and physics). Phenomenological or mortal time refers to the average finite life span of humans. The contrast between these two times is what defines us along a continuum of life-to-death: “Would we speak of the shortness of life, if it did not stand out against the immensity of time?” (Ricoeur 1988, p. 93).

The lived body is an inseparable unity of mind, body, and world, which is always oriented towards the world outside itself, in a constant flow. It is the place where the world reveals itself, a consistency of meaning and significance. The body is the medium through which a person intentionally carries out daily tasks and activities, and through which a person comes to know the body not through abstracting it but through living it. In other words, we do not have our bodies; we are our bodies. A person’s embodied presence in the world is the necessity of all knowledge and experience (Merleau-Ponty 2002; Bullington, 2009).

Personal identity is constituted by an inextricable tie between ‘idem’ an ‘ipseity’. Without both forms of identity, there can be no self because a self has both an idem and an ipse identity. However, both aspects of identity are quite different. Idem identity is that which gives the self it spatio-temporal sameness; ipse identity gives the self its ability to initiate something new. For Ricoeur, identity is not idem; it is selfhood: “I have repeatedly affirmed, identity is not sameness” (Ricoeur 1992, p. 116).

Maslow propounded a theory of motivation based on a hierarchy of five human needs. These needs in ascending order are physiological, safety, love/belonging, esteem, and self-actualisation. According to Maslow, personal growth is contingent on the sequential fulfillment of these needs.

Another pertinent theory worthy of mention here was proposed by Bronfenbrenner (1979) who created ecological systems theory, later renamed the bioecological systems theory. According to this theorist, the development of a person is viewed as a combination of biological disposition and environmental forces.

Halliday (1975) has defined text as a semantic unit containing specific components that make the text internally cohesive and able to function as a whole.

Ricoeurian philosophy works with the idea of ‘discourse’ as a way in which language and texts are used in our understanding (narratives) of the world, to enable or disable particular ways of acting or being acted upon.

Subjectivity, broadly speaking, refers to an individual’s sense of self. An individual’s subjectivity involves a continual process where the self is produced through interactions and experiences with others. Subjectivity is both being ‘subject to’ and ‘subject of’ cultural narratives and the discourses that enable them (Ricoeur 1991a, b).

One definition of chronic illness is an illness that lasts longer than 3 months, but chronicity is more than just a dimension of time. Other factors are its interference with the person’s physical or social functioning, the degree of permanence versus possible reversibility and the regimen of symptom management (Sidell 1997).

Transition is defined as “a passage from one fairly stable state to another fairly stable state and it is a process triggered by change” (Meleis 2010, p. 11).

For this article, ‘self-identity’ concerns both who we are and what we think of who we are and is influenced by social structures within a cultural context (Charon 2004).

Three subtypes of quest narratives are proposed. The first is memoir in which events are related simply. The second is manifesto in which illness becomes a motivator for social action or change. The third is automythology in which illness is expanded to reveal fate or destiny (Frank 1995).

Anderson, J.M., C. Blue, and A. Lau. 1991. Women’s perspectives on chronic illness: Ethnicity, ideology and restructuring of life. Social Sciences & Medicine 33(2): 101–113.CrossRef

Annas, G.J. 1995. Reframing the debate on health care reform by replacing our metaphors. New England Journal of Medicine 332: 744–747.PubMedCrossRef

Audi, R. 1999. The Cambridge dictionary of philosophy. Cambridge, UK: Cambridge University Press.

Audulv, Å., K. Asplund, and K. Norbergh. 2010. Whós in charge? The role of responsibility attribution in self-management among people with chronic illness. Patient Education and Counselling, 81(1): 94–100.

Aujoulat, I., O. Luminet, and A. Deccache. 2007. The perspective of patients on their experience of powerlessness. Qualitative Health Research 17(6): 772–785.PubMedCrossRef

Aujoulat, I., R. Marcolongo, L. Bonadiman, and A. Deccache. 2008. Reconsidering patient empowerment in chronic illness: A critique of models of self-efficacy and bodily control. Social Science and Medicine 66(5): 1228–1239.PubMedCrossRef

Ball, S. 1990. Politics and policy making in education. London: Routledge.

Barhar, Saba. 2003. If I’m one of the victims, Who survives?: Marilyn Hacker’s breast cancer texts. Signs 28(4): 1025–1052.CrossRef

Bridges, W. 2009. Managing transitions-making the most of change. London: Nicholas Brealey Publishing.

Bronfenbrenner, U. 1979. The ecology of human development. Cambridge: Harvard University Press.

Bruner, J. 2001. Self-making and world-making. In Narrative and identity: Studies in autobiography, self and culture, ed. J. Brockmeier, and D. Carbaugh, 25–37. Philadelphia: John Benjamins.

Bullington, J. 2009. Embodiment and chronic pain: Implications for rehabilitation practice. Health Care Analysis 17(2): 100–109.PubMedCrossRef

Carr, D. 1986. Time, narrative, and history. Indianapolis: Indiana University Press.

Charmaz, K. 1995. The body, identity, and self: Adapting to impairment. The Sociological Quarterly 36(4): 657–680.CrossRef

Charon, J. 2004. Symbolic interactionism, 8th ed. Upper Saddle River, NJ: Pearson Prentice Hall.

Chase, S. 1995. Taking narrative seriously: Consequences for method and theory in interview studies. In Interpreting experience: The narrative study of lives, vol. 3, ed. R. Josselson, and A. Lieblich, 1–26. Thousand Oaks, CA: Sage.

Chase, S. 2003. Learning to listen: Narrative principles in a qualitative research methods course. In Up close and personal: The teaching and learning of narrative research, ed. R. Josselson, A. Lieblich, and D.P. McAdams, 79–99. Washington, DC: American Psychological Association.CrossRef

Connelly, F., and D. Clandinin. 2006. Narrative inquiry. In Handbook of complementary methods in education research, ed. J. Green, G. Camilli, P. Elmore, A. Skukauskaite, and E. Grace, 477–487. Mahwah, NJ: Lawrence Erlbaum Associates.

Eagleton, T. 1996. Literary theory. An introduction. Oxford: Blackwell.

Ezzy, D. 2000. Illness narratives: Time, hope and HIV. Social Science and Medicine 50: 605–617.PubMedCrossRef

Fox, N. 1994. Postmodernism, sociology, and health. Toronto and Buffalo: University of Toronto Press.

Foucault, M. 1980. The eye of power in ‘power/knowledge’. Harvester: C. Gordon and Brighton.

Foucault, M. 1991. Politics and the study of discourse. In The Foucault effect. Studies in governmentality, ed. G. Burchell, C. Gordon and P. Miller, 53–72. Chicago: University of Chicago Press.

Frank, A. 1995. The wounded storyteller. Chicago: University of Chicago Press.CrossRef

Frank, A. 2000. Illness and autobiographical work: Dialogue as narrative destabilization. Qualitative Sociology 23(1): 135–156.CrossRef

Freeman, M. 2006. Life “on holiday”? In defence of big stories. Narrative Inquiry 16(1): 131–138.CrossRef

Gabe, J., M. Bury, and M. Elston. 2007. Key concepts in medical sociology. Thousand Oaks, CA: Sage.

Gadamer, H. 1989. Truth and method (trans: Weinsheimer, J., and Marshall, D.). New York: Crossroad.

Giele, J., and G. Elder. 1998. Methods of life course research: Qualitative and quantitative approaches. Thousand Oaks, CA: Sage.

Hall, L. 1998. Illness, identity, and survivorship: Modern and postmodern breast cancer narratives. Illness, Crisis & Loss 6: 255–274.CrossRef

Halliday, M. 1975. Learning how to mean: Explorations in the development of language. London: Edward Arnold.

Harris, W. 1992. Dictionary of concepts in literary criticism and theory. Westport: Greenwood Press.

Heidegger, M. 1996. Being and time (trans: Stambaugh, J.). Albany: State University of New York Press.

Kleinman, A. 1988. The illness narratives: Suffering, healing, and the human condition. New York: Basic Books.

Kofman, S. 1993. Nietzsche and metaphor (trans: Large, D.). Stanford: Stanford University Press.

Kralik, D. 2002. The quest for ordinariness: Transition experienced by midlife women living with chronic illness. Journal of Advanced Nursing 39(2): 146–154.PubMedCrossRef

Kralik, D., T. Koch, K. Price, and N. Howard. 2004. Chronic illness self-management: Taking action to create order. Journal of Clinical Nursing 13(2): 259–267.PubMedCrossRef

Kralik, D., K. Telford, F. Campling Counsellor, T. Koch, and K. Price. 2005. “Moving on”: The transition to living well with chronic illness. The Australian Journal of Holistic Nursing 12(2): 13–22.PubMed

Marshall, P., and J. O’Keefe. 1995. Medical student’s firstperson narratives of a patient’s story of AIDS. Social Science and Medicine 40: 67–76.PubMedCrossRef

Maslow, A. 1998. Toward a psychology of being. New York: Wiley & Sons.

Mattingly, C. 1998. Healing dramas and clinical plots: The narrative structure of experience. New York: Cambridge University Press.CrossRef

Mayan, M.J., J.M. Morse, and P.L. Eldershaw. 2006. Developing the concept of self-reformulation. International Journal of Qualitative Studies on Health and Wellbeing 1(1): 20–26.CrossRef

Medved, M., and J. Brockmeier. 2008. Continuity amid chaos: Neurotrauma, loss of memory, and sense of self. Qualitative Health Research 18(4): 469–479.PubMedCrossRef

Meleis, A.I., L.M. Sawyer, E.-O. Im, D.K. Hilfinger Messias, and K. Schumacher. 2000. Experiencing transitions: An emerging middle-range Theory. Advances in Nursing Science 23(1): 12–28.PubMed

Meleis, A.I. 2010. Transitions theory; middle-range and situation-specific theories in nursing research and practice. New York: Springer Publishing Company.

Merleau-Ponty, M. 2002. Phenomenology of perception. London: Tailor & Francis Ltd.

Paal, P. 2010. Written cancer narratives: An ethnomedical study of cancer patients’ thoughts, emotions and experiences. Tartu & Helsinki: ELM Scholarly Press.

Polkinghorne, D. 1988. Narrative knowing and the human sciences. Albany: State University of New York Press.

Ramšak, M. 2007. Social and cultural imagery of breast cancer in Slovenia (trans: Mojca Ramšak and Franc Smrke). Ljubljana: Delo Revije.

Riessman, C. 1993. Narrative analysis. Newbury Park, CA: Sage.

Riessman, C. 2008. Narrative methods for the human sciences. Thousand Oaks, CA: Sage.

Ricoeur, P. 1976. Interpretation theory: Discourse and the surplus of meaning. Texas: The Texas Christian University Press.

Ricoeur, P. 1977. The rule of metaphor. Toronto: University of Toronto Press.

Ricoeur, P. 1988. Time and narrative, vol. 3. Chicago: University of Chicago Press.CrossRef

Ricoeur, P. 1991a. Narrative identity. Philosophy Today 35(1): 73–81.

Ricoeur, P. 1991b. Life in quest of narrative. In On Paul Ricoeur: Narrative and interpretation, ed. David Carr, 20–33. London and New York: Routledge.

Ricoeur, P. 1992. Oneself as another (trans: Blamey, K.). Chicago: University of Chicago Press.

Rotegård, A., S. Moore, M. Fagermoen, and C. Ruland. 2010. Health assets: A concept analysis. International Journal of Nursing Studies 47: 513–525.PubMedCrossRef

Rush Michael, S. 1996. Integrating chronic illness into one’s life. Journal of Holistic Nursing 14(3): 251–267.CrossRef

Sacks, O. 2007. The man who mistook his wife for a hat: And other clinical tales. Great Britain: Picador.

Schumacher, K., and A.I. Meleis. 1994. Transitions: A central concept in nursing. IMAGE: Journal of Nursing Scholarship 26(2): 119–127.CrossRef

Sidell, N. 1997. Adult adjustment to chronic illness: A review of the literature. Health and Social Work 22(1): 5–11.PubMedCrossRef

Smith, B., and A. Sparkes. 2008. Narrative and its potential contribution to disability studies. Disability & Society 23(1): 17–28.CrossRef

Somers, M. 1994. The narrative constitution of identity: A relational and network approach. Theory and Society 23(5): 605–649.CrossRef

Strauss, A. 1969. Mirrors and masks. Mill Valley, CA: Sociology Press.

Strawson, G. 2004. A fallacy of our age. Not every life is a narrative. Times Literary Supplement, 13–15.

Taylor, C. 1989. Sources of the self. The making of the modern identity. Cambridge: University of Cambridge.

Teucher, U. 2003. The therapeutic psychopoetics of cancer metaphors: Challenges in interdisciplinarity. History of Intellectual Culture 3(1): 1–15.

Thomas-Maclean, R. 2004. Understanding breast cancer stories via Frank’s narrative types. Social Science and Medicine 58: 1647–1657.PubMedCrossRef

Thorne, S., B. Paterson, and C. Russel. 2003. The structure of everyday self-care decision making in chronic illness. Qualitative Health Research 13(10): 1337–1352.PubMedCrossRef

Toombs, K. 1993. The meaning of illness: A phenomenological account of the different perspectives of physician and patient. Dordrecht, Netherlands: Kluwer Academic publishers Group.

Van Gennep, A. 1960. The rites of passage. London: Routledge and Kegan Paul.

Whittemore, R. 2005. Analysis of integration in nursing science and practice. Journal of Nursing Scholarship 37(3): 261–267.PubMedCrossRef

WHO. 2008. World health statistics 2008. France: World Health Organization.

Title: The role of narrative and metaphor in the cancer life story: a theoretical analysis
Author: Carlos Laranjeira
Publication date: 01-08-2013
Publisher: Springer Netherlands
Published in: Medicine, Health Care and Philosophy / Issue 3/2013
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI: https://doi.org/10.1007/s11019-012-9435-3

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The role of narrative and metaphor in the cancer life story: a theoretical analysis

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