Illness narratives: discursive constructions of self in pediatric oncology.

Abstract

Narratives from adolescents in treatment for cancer were examined for the variety of ways in which self is constructed in discourse. Narratives were elicited by the second author (Bearison) from 75 children ranging in age from 3 to 19 years and at various stages of treatment for cancer. The present study examined a subset of these data. According to discourse theory, narratives are a means of constructing and understanding the self, particularly during unsettling life events that perturb the self-system. Adolescents who have cancer strive to make sense of the threatening and uncertain consequences of treatment, and their narratives reflect this struggle and their attempt to resolve it. The present study identified three narrative domains of self (biomedical, social, and personal) and considered variations among them according to the following features: (1) degree of otherness (i.e., to what extent and in what manner are other people, family, peers, and medical staff brought into the discourse), (2) expression of self as agent versus object, and (3) a series of linguistic markers denoting the narrative voice: understatement, exaggeration, reassurance, passive voice, and the use of personal and impersonal pronouns. In addition, expressions of denial and control were identified as central issues of self in narrative. Findings indicated that there were patterns of co-occurrence of discourse features that constituted different narrative styles by which participants gave voice to their struggle to redefine the self.