Cheryl Mattingly

The concept of therapeutic 'emplotment'

This paper considers the narrative structure of clinical action. I argue that clinical encounters involve clinician and patient in the creation and negotiation of a plot structure within clinical time. This clinical plot gives meaning to particular therapeutic actions by placing them within a larger therapeutic story. No therapeutic plot is completely pre-ordained, however. Improvisation and revision are necessary to its creation. In making a case for the narrative construction of lived time, of narratives that are created before they are told, this paper departs from the predominant mode of narrative analysis within medical anthropology that has focused on narrative discourse. Therapeutic emplotment is concretely considered through an interpretation of a single case, a clinical interaction between an occupational therapist and a head-injured patient.

Learning from Stories: Narrative Interviewing in Cross-cultural Research

This paper argues for the importance of eliciting stories when trying to understand the point of view and personal experience of ones informants. It also outlines one approach to eliciting and analyzing narrative data as part of a complex and multi-faceted ethnographic study. The paper draws upon ethnographic research among African-American families who have children with serious illnesses or disabilities. However, it is not a report of research findings per se. Rather, it is primarily a conceptual paper that addresses narrative as a research method. Features that distinguish a story from other sorts of discourse are sketched and current discussions in the occupational therapy and social science literature concerning the importance of narrative are examined. The heart of the paper focuses on a single narrative interview and examines what we learn about the client and family caregiver perspective through stories.

Two virtue ethics and the anthropology of morality

There has been a recent call for an anthropology of morality and a challenge to anthropologists that they have been insufficiently attentive to moral aspects of social life. The new anthropology of morality involves an attempt to modify the legacy associated with Durkheim and the idea of the moral as confined to unreflective norm following. Out of this has emerged a new interest in virtue ethics. In this paper, I examine points of convergence and crucial differences between a ‘first-person’ or ‘humanist’ virtue ethics and a postructural one inspired largely by Foucault. Despite their many convergences, poststructural and first-person versions of virtue ethics make not only distinct but in some cases irreconcilable claims. Instead of rushing to merge these positions, I would urge that we pause to look at how they differ and see why this debate might matter to our own ethnographic enterprises.

Moral Selves and Moral Scenes: Narrative Experiments in Everyday Life.

Through what kind of inaugural scenes is the moral self born? And what are the practices, within that scene, through which one tries to become a moral person, or a different sort of moral self, a person one is not but wishes to be? These questions are at the heart of the recent ethical turn in anthropology and sociocultural studies more broadly. In this paper, I explore three moral imaginaries: the trial, the artisan workshop and the moral laboratory. Turning to ethnographic material, I compare how these social imaginaries illuminate the moral work of people engaged in trying to create good lives for themselves and those they care about. Drawing upon a long-term study of a group of African-American families caring for children with significant illnesses and disabilities, I examine peoples attempts to transform not only themselves but also the social and material spaces in which they live.

Toward a vulnerable ethics of research practice

This article considers ethical dilemmas concerning the protection of confidentiality that often arise in carrying out ethnographic research. A number of problematic assumptions are highlighted that generally (implicitly or explicitly) guide the practice of contemporary research ethics review committees: (1) ethical rules are context free; (2) there is always an ethical ‘right answer’; (3) there is an objective position from which to judge what one ought ethically to do. Notably, this is a position of emotional detachment from the situation; (4) this objectively identified ethical position can be articulated in explicit and unambiguous public language. The troublesome character of these assumptions is raised in the context of fifteen years of ethnographic research among African American families in clinical settings within the urban United States, with special attention to an ongoing relationship with one research participant the author has known for eight years. Finally the article suggests an alternative ethical framework drawn from recent philosophical work in an Aristotelian-inspired ‘virtue ethics’.

Chronic Homework in Emerging Borderlands of Healthcare

The task of caring for those with chronic illnesses has gained a new centrality in health care at a global level. We introduce the concept of “chronic homework” to offer a critical reflection on the treatment of chronic illnesses in three quite different national and local contexts: Uganda, Denmark, and the United States. A major challenge for clinicians, patients, and family caregivers is how to navigate the task of moving health care from clinic to home. By “chronic homework,” we refer to the work patients and families are expected to carry out in their home contexts as part of the treatment of chronic conditions. Families and patients spend time receiving training by clinical experts in the various tasks they are to do at home. While this “colonization” of the popular domain could easily be understood from a Foucauldian perspective as yet another emerging mode of governmentality, this a conceptualization can oversimplify the way specific practices of homework are re-imagined and redirected by patients and significant others in their home surroundings. In light of this re-invention of homework in local home contexts, we foreground another conceptual trope, describing chronic homework as a borderland practice.

Introduction: toward a context-based ethics for social research in health

The idea for this Special Issue was born over dinner in a Greek restaurant. It was 2001 and each of us had just presented our work at a conference on narrative-based medicine in Cambridge, UK, sponsored by the BMJ. Although different issues were raised from the audience about our respective papers and others at the conference, many seemed to turn on particular questions: Were informed consent procedures followed properly? Were they sufficient to protect the confidentiality of vulnerable research participants who told lengthy narratives about their lives? Who ‘owns’ the stories collected during fieldwork? It is no accident that such questions should arise at a conference attended by health professionals. Institutional review boards (committees go by different names in different countries) began in the wake of massive abuses of power involving complicit physicians and nurses (Tuskegee, Nuremburg). But we sensed a narrow, individualistic and rights-oriented thrust to the comments. Like organs stolen from corpses in medical experiments, there was even a suggestion that informants’ stories had been appropriated by researchers – used for academic ends, rather than to benefit patients. The model of research ethics was medico-centric, appropriate for clinical trials perhaps, but bearing little relationship to ethnographic and narrative forms of social research. As seasoned researchers in sociology and anthropology, we had watched a medical model of ethics increase in influence on US university and hospital committees, composed largely of clinical researchers and others working in the experimental paradigm. We had witnessed the routinization of good intentions: standardized and scripted legalistic informed consent

I/We Narratives Among African American Families Raising Children with Special Needs

This paper examines a statistics debate among African American caregivers raising children with disabilities for insights into the work of “African American mothering.” Using ethnographic, narrative and discourse analyses, we delineate the work that African American mothers do—in and beyond this conversation—to cross ideological and epistemological boundaries around race and disability. Their work entails choosing to be an “I” and, in some cases, actively resisting being seen as a “they” and/or part of a collective “we” in order to chart alternative futures for themselves and their children.

The Machine-Body as Contested Metaphor in Clinical Care

There has been far more attention to narrative than to metaphor among scholars looking at clinical care. In this article, I consider the relationship between metaphor and narrative in a contested confrontation between family members and clinicians over a do-not-resuscitate decision. Drawing upon a key metaphor in biomedicine, the body as machine, I consider its canonical uses but also its limits and the way it is contested, refuted, and even “poached” by one family in its battle with clinicians. I also explore the relationship between metaphor and narrative as I consider the divergence of framing between clinicians and family as connected to the way the machine-body metaphor is embedded within different and perhaps even incommensurable narrative horizons

Moral deliberation and the agentive self in Laidlaw’s ethics

Comment on LAIDLAW, James. 2014. The subject of virtue: An anthropology of ethics and freedom. Cambridge: Cambridge University Press.