What lies within

by Michael

or, The body as the antithesis of narrative

I dislike it when people refer to science writing as a form of translation because it suggests to me that these people think you can just interpret each bit of scientific jargon into an understandable phrase, string them all together and get a readable output. But this may be doing them a disservice if they are, in fact, considering a notion of translation I learned about at the Narrative Medicine conference today, called Skopos theory.

In this, the translator takes into account the purpose of the original text as well as the literal meaning of the text. For science writing, there may not be an original text to translate, but the purpose is to communicate certain concepts and facts. With this in mind, the finished article could be considered a translation of some kind of (perhaps hidden) scientific text. This is closer to my view that what I do is communicate scientific concepts using a different set of constraints to those of a scientist, for a different audience.

Opportunities to reflect on my writing, both professional (sciencey) and non (fictiony, formerly theatry), constitute a truly exciting benefit of attending this conference. The highlight today was perhaps Peter Carey’s talk. He described for us the moment during the long genesis of Oscar and Lucinda when “I knew I had a novel”. This was before the characters were conceived: in order to find them, he had to ask, “Who would really do that, and with what consequences, and with what meaning?”

Some other quotes (direct and indirect) from his talk that I liked:

  • Characters can’t come to life unless you love them.
  • “The order of release of information”.
  • “A story is a dark room until you say something” to the reader – so tell them where the furniture is to stop them barking their shins.
  • Writing is mostly failure. The desire to fix the text is what keeps us going.

Healthcare as a commodity

The focus of most sessions I have attended so far has been the facilitation of patients’ narratives in order to empower them as individuals (ie not just another patient) in the moment of the doctor-patient encounter. But doctors are individuals too. The treatment of clinicians as a generic group who must adapt to the needs of individual patients perhaps stems from a concept of healthcare as a strict service, in which the patient can expect a standard of care and attention. That may be entirely appropriate and desirable, but where does it leave doctors? They are no longer – at least in my part of the world – well-known members of the community, with whom people can have non-medical relationships within which their professional conduct can be understood. They are service providers, and we are service users.

Doctors have training, expertise and experience from which to draw insights and make decisions about people’s health. That ‘epistemic’ privilege may have been overstated in the past but to what extent can a patient, who is visiting a doctor in the expectation of some medical service, then set aside the doctor’s privilege in order to express their own? Does every social encounter need to be conducted on level terms?

However, I would also argue that a doctor examines the patient’s body in relation to population-level information and knowledge – the doctor knows what is expected in the ‘average’ body. False negatives, for example, are far from impossible in medicine but within the medical infrastructure, further investigation of every negative cannot be afforded unless or until there is reason to think it may have been false. For the patient, especially the hypochondriacal patient which was a focus of Catherine Belling’s excellent and enjoyable talk this morning, this leaves only the frustration of not having their story believed and acted upon. It was interesting later in a presentation about the Medical Protection Society when Paul Nisselle pointed out how patients are likely to have rehearsed their story before going to see the doctor. I certainly do this and it is frustrating when your performance of that rehearsed story is apparently undervalued or interrupted.

I wonder if the empathy I expressed for doctors above stems from my (albeit limited) ‘insider knowledge’ as a science writer, or if it comes from a feeling of fellowship. Another speaker today acknowledged that she and other lecturers talk about students (the general student body, I think, rather than individuals) in less than flattering terms behind their backs and she assumes clinicians do the same with their patients. Do writers do that with their readers? In the writer-reader encounter, too, there are privileges: the writer is the only one who can ‘speak’, but the reader can choose whether to ‘listen’. On whom is it incumbent to imagine the potential interpretations by the other?

Self-expression

Another dominant theme of the conference is getting what is within to come out. Belling discussed the use of certain medical procedures (and personnel) in torture, drawing attention to the fact that information extracted under duress is unreliable. Many ultimately beneficently intended medical procedures involve a degree of discomfort bordering on torture (particularly if the patient is unaware of the motive – for example, a young child) – do we have to consider that blood and cerebrospinal fluid samples taken under stressful conditions may also be less than accurate in describing the normal, ‘resting’ state of the individual and their disease? What about the stories patients tell when stressed?

Belling contrasted language’s secrets with the body’s secretions. Both words come from the Latin to separate. Does the separation of something inside us from our self change its relationship to our body or mind? Is our identity tied more closely to what is within, or to what we perform to an external audience of others? Maybe I’ll find some answers tomorrow….

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