Elements of a holistic caring approach to rheumatoid arthritis
Introduction
The narration of a story, irrespective of whether it relates to other people or about oneself, is generally the same the worldwide. The advancement of language in human life, both on personal and evolutionary basis, leads to the intricate use of metaphors and features of speech, and hence a narrative form. All human societies rely on such symbolic inventories in order to attain a bare minimum of social integration. In such circumstances narratives convey and comprise an infinite pool of meanings and comprehension, although these are inhibited by linguistic rules and social customs. Language and narrative do not only assist in sustaining and establish the fabric of everyday life; they participate prominently in the reparation and refurbishing of meanings when they are in jeopardy. Under circumstances of adversity, individuals often sense a pressing need to re-evaluate and refurbish their personal narratives in an effort to maintain a feeling of identity (Johnson, 1987).
Hence, universal, cultural and personal levels of human survival are embedded together with narrative threads. Individuals are not only born into complex social narratives, they also experience, comprehend and guide our lives as narratives that we live through. Whatever human rationality is contained in, it is unquestionably tied up to the story structure and the pursuit for narrative unity, we cognize ourselves inevitably in narratives. In modern era, the study of narratives has gained considerable awareness, in both human and socio-cultural sciences, particularly in anthropology and sociology in relation to medical issues. The study of illness narratives comprises of dual processes, in evaluating these dynamics. The evaluation of chronic illness narratives may shed light on the characteristics of disrupted experience, its connotations and steps taken to handle it. However the investigations of such narratives have the capacity to reveal a broader set to significant issues to do with the bonds between identity, encounters and late modern cultures (Taylor, 1989).
Chronic illness and bio-medical narratives
Literature on the history of medicine defines the significance of illness narratives, specifically with the increase of doctor-patient rapport in early modern times. Before the introduction of the bio-medical model of illness in the comprehension of disease, from the mid to the late 19th century, the ability of a doctor to exhaustively take history from a client was of at most importance. This information constituted the clients lifestyle, moral attitudes and the broader environment in which the client lived. Eschewing all but the most fundamental physical evaluation of the client, the aristocratic doctors of the 17th and 18th century was required to attend to his client’s narratives and develop management regimens appropriately, occasionally through procedures that reinstated the body’s equilibrium. Basing on the principle that these procedures, involved bleeding, cupping and purging, they were implausible to bring forth any efficacious result, only served to strengthen the need for the practitioner to focus on attending to the client’s narrative (Lawrence 1994).
With the advent of scientific bio-medicine, concomitant with the development of the present day hospital and laboratory, the significance of the clients experience, and hence the narrative of the client may be perceived to have diminished. As the research and management of disease became alienated from the individual, and situated within the body systems only knowledgeable to the experts, the need to listen to the client was reduced to extracting information about the impartial signs and symptoms of the ailment (McSherry & Ross, 2010). The role of doctors, in the 19th and 20th centuries was to interpret these pieces of information into conclusive diagnosis that connected the disease to particular biological origins and outcomes, rather than to the clients contexts or lifestyle, lest their beliefs or values. While the 18th century medicine, had been preoccupied by the natural, and with disease as a digression from the individual client’s natural state, whereas the 19th century became concerned with the normal, and with disease as a departure from statistical norms, autonomous from specific experiences or circumstances (Featherstone, 1992).
Most of the sociological interpretations of the progressive divergence of the medical approach of disease from the amateur experience of illness, and the increasing power of the clinical profession in the 20th century to describe what constitutes and what does not constitute illness, have highlighted, however, the adverse effects of the recognizable gulf between amateur and professional worlds (Freidson, 1970). In Europe and North America by the year 1920, the notion of disease as individual pathology had developed into a dominant paradigm, and was indistinguishably linked to the growth of a bounded clinical profession, that exercised almost absolute jurisdiction over illness and its management. The hastening of this process with the gargantuan expansion of the medical and surgical management and techniques from the 1940s and beyond only tended to reinforce the propensity to render the client passive; subjective descriptions of the client were virtually irrelevant (Lawrence 1994).
However, though many enquiries have emphasised the overwhelming of the clients view by bio-medicine, many factors have proceeded to bring amateur narratives back into the spotlight in recent years. The two procedures are of particular note. First and foremost, is the relative decline in significance of the infections upon which the bio-medical paradigm was founded, and the increasing impact of deteriorating and chronic illnesses (Strauss, 1995). As the daily experience and medical practice has progressively had to contend with the consequences of an aging population, and the associated predominance of degenerative physical and psychosomatic illness, hence administration and care have supplanted treatment and cure (Bury, 1997). Secondly, as advanced technological bio-medical care continues to be expensive to afford, and exposed to accumulative questioning and assessment, the health care systems yields to renewed prominence on primary care. Active debate within principle care and general practice in regard to value of holistic medicine and of paying attention to the client, which commenced in Britain in the 1950s also present a chance for clients narratives to be given opportunity and attention (McSherry & Ross, 2010). Currently, illness narratives, and the connections to history taking in medicine, have been linked with measures to improve care that do not depend entirely on what may be considered as a constricted view of scientific medicine or its assessment and procedures that are evidence based (Greenhalgh & Hurwitz, 1999).
Contingent narratives
In contingent narratives, evaluation of illness narratives is involved with those features of the patient’s story or description that are related to beliefs and understanding about factors that influence the inception of disorder, its emerging symptoms, and its proximate outcomes on the body, personality and others. Caution should be taken not to transform narratives and stories into ideas, or norms and explanations of illness. Amateur responses to sickness often draw upon and, in turn, comprise culturally accessible concepts of disease and illness that robustly influence the moulding of narratives. For example in a study carried out on arthritis by Bury (1982), it was revealed that respondents’ narratives went back and forth between amateur concerns and perceptions, and a developing familiarity with medically-based ideology. Surprisingly, it was difficult to differentiate where the expert and amateur modes of thinking commenced and terminated (McSherry & Ross, 2010). This was predominantly evident when the issue of
Causation was deliberated. Patients would often discuss the beginning of the condition with reference to the probable effects of incidents occurring at the time of the commencement, yet maintaining an open mind to stringed medical explanations as well. A respondent recollected a series of hardships with her seven year old son before the beginning of the illness, concluding in the collapsing of the son in school, where, fortunately, she was employed as a dinner lady (Bury, 1982).
The narrative of this lady’s illness comprised of a number of elements which not only touched on the issue of beginning and probable causation, but also on her social condition into which her illness generated yet another component of hardship. Throughout the experience of her own and her
Son’s illness, she relied on ideas and forms of amateur knowledge that were frequently difficult to distinguish in terms of distinct spheres of amateur beliefs and medical expertise. Both were required to construct a consequential account of the progressing events, what is generally referred to as illness narrative, incorporating the symptoms and the outcomes of the illness into a new whole (Hyden, 1997). A more detailed study on the beginning of arthritis, from a long discussion with another patient, showed how contact with medical staff, and members of a social group, involving co-workers, could present complex settings in which the eventualities of illness onset may arise. The progression of symptoms, in this instance, could not be identified to a specific event, but developed over several months. Frequent visits to the general practitioner started to imply that her aches and pains were far much more than usual wear and tear, and on one incident the doctor suggested that the condition may be rheumatoid arthritis, administering aspirin for her symptoms (Burry, 1982).
Moral narratives
If contingent narratives define events, their immediate causes and their progressing effects in regard to the performativity in daily life, moral narratives present an evaluative dimension into the connections between the personal and social. Here, valuations appear, as patients seek to account for and conceivably justify themselves in the changed relations of society, self and body instigated by illness. If narratives provide an ordering of experience in light of disruptive occurrences they also provide expression to hidden dynamic relations among individuals and their social contexts (Good, 1994).
For example in Williams (1984), paper on narrative reconstruction, the redirecting experience as a consequence of illness, involves the taking into account the patient’s beliefs in regard to aetiology of the situation, and its role in their lives. But the amateur narrative that Williams (1984), illustrates brings together moral concerns which link the family background, concurrence of symptoms and biographical incidents, and the specific social contexts in which a part of them happened. A man’s accounts emphasised particularly on the occurrences surrounding exposure to noxious substances in the work environment and the beginning of his illness. Through his story this respondent could describe himself as a dynamic and politically knowledgeable individual, as well as a casualty of circumstance (Williams, 1984).
More significantly, perhaps in the present context, is the illustration of Gill in Williams’s narrative. For Gill, the commencement and progression of illness interacted strongly with other occurrences in her life, including her daughter’s departure from home, the demise of her husband, and later the passing away of her son in a road accident on a motorcycle. As time progressed, the understanding of illness to this woman’s life went past the impact of occurrences to notions of guilt and despondency. It shows how Gill lost religious faith and by the same instance that illness may illustrate a fall from grace. When the ethical opprobrium suggested by this was too much to cope with Gill shifted back and forth amongst various views of the body, involving stress and body wearing out (Williams, 1984).
As it can be evidently seen here story forms insinuating culpability can be joined with those that absolve the individual from blame, and assist to sustain self worth. According to Alan Young (1981), consistency in explanation of illness may not usually be an overriding apprehension in amateur views or in social relationships. In evaluation of specific narrative of one patient illness, called Mrs Fields, Williams (1984), shows how coping strategies formulated to optimise normal activities at home, revealed a weakness and a feeling of urgency which resulted to the pursuit of virtue. Secondly Mrs Fields recollection of her illness connected her desire to be seen as autonomous with a feeling of orderliness and sanitation in the home. The incapacitating consequence of her illness threatened to emasculate her ability to exhibit herself and her house respectfully (Williams, 1984).
Conclusion
Personal narratives are a way through which the connections between self, body and society are expressed. They are an appealing subject for sociological evaluation, particularly in the context of chronic illness, wherever biographical reflection or reconstitution may take place, against the backdrop of distracting events and experiences.
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