Mere viden

Failures of imagination: the refugee's narrative in psychiatry

Kirmayer, Laurence J.

Abstract

Refugees coming from war-torn areas sometimes face misunderstanding and frank incredulity when they encounter the psychiatric system. This failure of the clinical imagination reflects both reluctance to confront the enormity of patients' loss and cultural differences in self-presentation, self-understanding, memory and identity. This potential for incredulity is redoubled in the formal hearing before the Immigration and Refugee Board (IRB) where the claim for refugee status is adjudicated. Contemporary psychiatric practice is rooted in taking patients' stories at face value as accounts of their experience or reading through them to identify signs and symptoms of psychopathology. From this perspective any account reveals both the narrator's shifting experiential world and the current functioning of their cognitive machinery. Truth is 'experiential truth' and is relative to the narrator's social position, mental health and emotional state. In contrast, the IRB assesses the narrative of asylum seekers against the notion of a truthful story as fixed and isomorphic to a single historical sequence of events. From the perspective of the IRB members, any deviation from this fixed account is evidence of dissimulation designed to claim the valued status of refugee. The conflicting epistemologies of clinical psychiatry and the refugee hearing throw into relief the functions of social imagination in the construction, interpretation and assessment of the truth-value of narratives of identity and affliction.

Anthropology and medicine 10(2), 167-185, 2003

Knowledge structures in illness narratives: development and reliability of a coding scheme

Stern, Lara; Kirmayer, Laurence J.

Abstract

Illness narratives reflect patients’ underlying illness schemas or models of illness as well as efforts to position themselves vis-à-vis a specific interlocutor and social context. Although the literature on illness narratives in medical anthropology has been dominated by the explanatory model perspective, people may use other types of knowledge structures to frame and construct their conceptions of symptoms. For this study, we developed operational definitions and a coding manual for three types of putative knowledge schemas: prototypes, chain complexes, and explanatory accounts. The operationalized definitions were then applied to coding a sample of illness narratives collected in a study of help-seeking in an urban community population. It was found that all three knowledge structures could be reliably identified in these narratives. This method of analysis provides a way to test hypotheses regarding the role of knowledge structures in illness narratives.

Key words: attribution - discourse analysis - explanatory models - measures - symptom schemas

Why narrative? Why now?

Littlewood, Roland

Abstract

The current popularuty of narrative accounts in the anthropologies of medicine would seem to present at least 3 issues: (i) patients are now our “others”; (ii) narrative conveys a sesne of authentic resistance; (iii) patient narratives now seek to enter professional nosologies.

Anthropology and medicine 10(2), 255-261, 2003