Can 'anecdote' ever be research?

Abstract

A story has three defining features: an account of the unfolding of events over time; emplotment (i.e. the rhetorical juxtaposing of these events to convey meaning, motive and causality); and trouble (a breach from something that was expected). Trouble is the raw material from which plot is woven. Heroes are made when individuals tackle their own troubles or step in (courageously, determinedly, selflessly) to help others out of theirs. In the illness narrative, the focus of trouble is death, disability, disfigurement, intractable pain or loss of freedom. The plot conveys how well or how badly health professionals, caregivers and patients evade or face up to these adversities. Arthur Frank divides illness narratives into four broad genres: restitution (the doctor-hero accurately diagnoses and successfully treats the illness); tragedy (the doctorhero does his or her best but the patient nevertheless succumbs); quest (the patient-hero embarks on a journey to find meaning and purpose in his or her incurable illness); and chaos (the story is incoherent, unsatisfying and does not make sense). 1 Arguably, the various forms of ‘talking therapy’ offered to the ill—counselling, psychotherapy and the intermittent dialogue of longterm continuing care—constitute above all else the witnessing of tragedy or quest narratives, or, if chaos abounds, attempting to co-construct a new narrative that holds some meaning for the patient and can begin to unfold (for better or worse, but as a story should). Jerome Bruner divides all reasoning into logicodeductive (i.e. rational, objective and scientifically verifiable) and narrative-interpretive, based on the features of a ‘good story’ (i.e. literary coherence, aesthetic appeal and moral order, e.g. when the hero gets his just reward or the villain her come-uppance). 2 The rigorous and conscientious application of logico-deductive truths (as in evidence-based medicine) is undeniably a critical dimension of good doctoring. Equally critical is the empathetic bearing of witness to the patient’s story—especially to his or her account of personal trouble and heroic efforts to face and resolve it. 1