community building), grammars (e.g. emplotment and temporality), and types (e.g. institutional and societal stories) of narrative activity (Harter et al. 2005). Narratives endow experience with meaning by organizing events across space and time, identifying characters and their relationships, and determining causes and effects (Harter 2013). Personal narratives provide a way of sensemaking in uncertain or chaotic circumstances and enable a sense of control in the face of threat or disorder. They help transform personal identities regarding how individuals view themselves and are perceived by others, and they help create identification among people experiencing similar problems, thereby building a sense of community in place of social isolation (Sharf and Vanderford 2003; Sharf et al. 2011). Finally, narratives increase public awareness, challenge master narratives (i.e. stories that underlie, reflect, and perpetuate predominant cultural values), and propel health advocacy and social activism (Sharf 2001; Zoller 2005). Sharf et al. (2011) envision the latter contributing to new directions in health communication scholarship, namely “a parallel continuum of stories of illness to stories of prevention, healing, and mobilizing resources” (p. 42).
Narrative Problematics
In their seminal collection of health and illness narratives, Harter et al. (2005) advanced a typology of what they consider core dimensions – or vital problematics (i.e. assumptions) – of narrative theorizing that are pervasive but often unarticulated in the way scholars do narrative work. First, the problematic of knowing and being foregrounds how individuals narratively co‐construct and understand personal and social life. As one example, Yamasaki and Hovick (2015) revealed how African American older adults characterize their understandings of health‐related conditions from storied family histories and then rationalize their motivations and constraints for sharing that information with current family members. Second, the problematic of continuity and disruption, which “concerns disorder and the human desire for coherence” (Harter et al. 2005, p. 14), describes how storytellers construct and weigh “the past/present/future flow of continuity and disruption to give force to some understanding of the distinction between ‘now’ and ‘then’” (pp. 15–16). To illustrate, Pangborn (2019) poignantly demonstrated how teenagers at a family bereavement camp rely upon aesthetic and embodied narrative experiences to reject confining scripts for “appropriate” grief, acknowledge the value of their perspectives, and reengage in life in affirming ways.
Next, the problematic of creativity and constraint “foregrounds the human struggle to be individuated (i.e. assert creativity) and still identify with a group (i.e. respond to social and institutional constraints),” emphasizing connections between the personal and cultural (Harter et al. 2005, p. 19). Health communication scholars have engaged this problematic in studies that explore how “narratives emerge as contested terrains, open to challenge by those who seek to reshape perceptions of health issues and construct alternate narratives” (Harter et al. 2005, p. 23), including embodied, aesthetic stories that transform meanings of age (e.g. Sharf 2017; Yamasaki 2014), disability (e.g. Harter et al. 2006; Quinlan and Harter 2010), and baby loss (e.g. Willer 2016; Willer et al. 2019), among others. Finally, the problematic of the partial and indeterminate recognizes that the nature of narrative knowledge is always situated and shifting: “People live stories, and in the living of these stories, reaffirm them, modify them, and create new ones” (Harter et al. 2005, p. 27).
Narrative Medicine
Storytelling in healthcare reflects the narrative impulse and is a powerful form of experiencing and expressing suffering, loss, and healing (Sharf 1990; Sharf et al. 2011; Vanderford, Jenks, and Sharf 1997). Indeed, healthcare would be impossible if not for the capacities of participants (i.e. patients and providers) to order and represent experience in narrative form (Harter 2013). These clinical encounters involve both patient and provider in the creation and negotiation of a plot structure within clinical time, which Mattingly (1994) termed therapeutic emplotment. Patients story pared‐down autobiographical accounts of illness that reveal lay beliefs about cause and effect, while healthcare providers rely on narrative activity to gather information, keep records, make therapeutic decisions, build relationships with patients, and respond to their concerns in the contexts of their unfolding lives.
The narrative medicine movement signifies growing acknowledgment that clinical judgment is an interpretive act of coupling narrative logics with the scientific reasoning of biomedicine (Harter 2013; Sharf et al. 2011). Widely recognized as the authority in the practice of narrative medicine, Dr. Rita Charon (2006, 2009) – who is both a general internist (with an MD from Harvard University) and a literary scholar (with a PhD from Columbia University) – claims that narrative sensibilities humanize healthcare by enabling providers to join with patients who are suffering and to be responsive to their plight. Narrative medicine (see also Chapter 6) calls for providers to study literary texts to deepen their abilities – what Charon (2006) deems narrative competence – to absorb, interpret, and respond to the stories of others. Because narrative provides an important “road toward empathy and reflection” (Charon 2006, p. 131) by orienting individuals aesthetically and imaginatively to the way they live, literary ways of thinking can help providers adopt contradictory points of view, embrace the metaphorical as well as the factual, and be moved by what they hear (Charon 2006).
Physicians who practice narrative medicine make sense of their patients’ experiences through a mutual dialogue of storytelling and story‐listening. First, they attend to what their patients are saying and how they are saying it; then, they represent what they have witnessed by creating something new, by writing their experiences to perceive and display their thoughts, feelings, and perceptions of the situation (Charon 2006). From this perspective, narratives invite providers to stretch their imaginations to empathically grasp events befalling their patients: “The boldness of the imagination is the courage to relinquish one’s own coherent experience of the world for another’s unplumbed, potentially volatile viewpoint” (Charon 2006, p. 122). Ultimately, narrative medicine is a relational accomplishment: providers must be attentive without becoming overwhelmed, and patients must be willing and empowered to story their experiences (Harter 2013).
Autoethnography
Autoethnography has become increasingly popular in the social sciences, especially in health‐related research (Chang 2016). By definition, autoethnography “operates as a bridge, connecting autobiography and ethnography in order to study the intersection of self and others, self and culture” (Ellingson and Ellis 2008, p. 446). Autoethnographers incorporate the “I” into research but analyze the self as if an “other” (Ellingson and Ellis 2008, p. 448), describing and systematically analyzing their personal experiences to understand cultural, social, and political meanings. Autoethnographic research is socially just and often critically reflective of taken‐for‐granted aspects of the social world (Ellis et al. 2011). Indeed, autoethnographers “seek the good” for society and themselves, sharing “the hope (and determination) that the moral, political, and practical work of autoethnography can give meaning to our lives and the lives of other people touched by this work” (Bochner and Ellis 2016a, p. 213).
As with other approaches described in this chapter, autoethnography intertwines theory and method from a social constructionist perspective, rendering it both process and product. Forms of autoethnography differ in a variety of ways, including how much emphasis is placed on the study of others and on the researcher’s self in interaction with others (Ellis et al. 2011). Indeed, scholars view autoethnography as a “broad and wonderfully ambiguous category that encompasses a wide array of practices” (Ellingson and Ellis 2008, pp. 449–450) – with analysis and representation once again falling across a continuum. Still, autoethnographers have begun to recently distinguish their work as either evocative or analytic (Anderson 2006), with the former focused on narrative presentations that evoke emotions and inspire conversations (i.e. storyteller) and the latter concerned with developing theoretical explanations of broader social phenomena (i.e. story‐analyst; Bochner and Ellis 2016b; Ellingson and Ellis 2008). Although autoethnographies