Dialogical Narrative Analysis Research Articles

Food translation under occupation: Apples, identity, and resistance in Indian-occupied Kashmir

ABSTRACT In 2019, Indian Occupied Jammu and Kashmir was changed from an autonomous region to a union territory by the Indian government. On August 5, 2019 India cut off all internet and phone communication into and out of Kashmir and restricted movement into and out of the country. The shutdown occurred during the height of the apple harvest, and as apples rotted on trees and the harvest was lost, signs of resistance to the shutdown were written on the apples themselves. In this article we explore how apples translate as identity and resistance in the postcolonial context of Indian Occupied Kashmir. Using the communication blackout and ongoing occupation of Kashmir as a focal point, we examine how narratives about apples can be translated as a cultural discourse of agency, even as structured spaces for and means of resistance are increasingly eliminated by the Indian state. Central to our analysis are theoretical frames of translation, postcoloniality, and food system sovereignty and communication. We utilize dialogical narrative analysis as methodology to understand how the meanings of apples, a mundane but central part of everyday life for many, have communicated resistance, identity and agency during the last several years since the shutdown.

Stories of Skills and Values: What Therapists Can Learn From Autistic Young People in Mumbai, India

Research on autism in the past two decades has primarily focused on medical characteristics and psychological consequences. What remains largely undocumented are the lived experiences of autistic young people. The current study explores the skills and values of autistic young people in the Indian context from the first-person perspective. The inquiry was guided by narrative inquiry and dialogical narrative analysis, embedded in the social constructionist framework. Six autistic young people, between 10 and 18 years old, were interviewed; analysis of the results brought forth four commonalities of skills and values: (1) diverse understandings of autism; (2) understanding social situations, their own needs, and others’ responses; (3) thinking outside the box; and (4) helping and caring for others. Rather than having a diagnosis of autism labeled as a deficit, these findings open up possibilities for therapy work to look different by supporting people to hold on to their identity as autistic people.

Kalevala and Finland's Atlantean Past

Nationalistic interpretations of history were prevalent in Finland until the Second World War. A unifying past for Finns was sought in antiquity, often influenced by interpretations of the Kalevala, regarded as the Finnish national epic. The Kalevala also inspired writers in the Theosophical Society, who promoted various alternative views of humanity’s past. In this article, I analyse the late 1930s writings of Wilho “Willie” Angervo (1875–1938), a medical colonel and author who had a central role in the Finnish Order of the Star in the East and the Theosophical Society in his time. Inspired by the Kalevala, Angervo traced the origins of the Finns to the lost continent of Atlantis and aimed to revitalize the pre-Christian “faith of the forefathers”. Dialogical narrative analysis is employed to explore how Angervo portrayed the Finns’ past, combining Theosophical and nationalistic ideas to construct an ideal Finnishness. I argue that Angervo utilized the Theosophical timeline and concepts to construct a spiritually oriented national narrative for the Finns that would surpass any polit-ical quarrels and challenge both the Church and more military-oriented nationalism.

Transforming self-experienced vulnerability into professional strength: a dialogical narrative analysis of medical students’ reflective writing

Medical students’ efforts to learn person-centered thinking and behavior can fall short due to the dissonance between person-centered clinical ideals and the prevailing epistemological stereotypes of medicine, where physicians’ life events, relations, and emotions seem irrelevant to their professional competence. This paper explores how reflecting on personal life experiences and considering the relevance for one’s future professional practice can inform first-year medical students’ initial explorations of professional identities. In this narrative inquiry, we undertook a dialogical narrative analysis of 68 essays in which first-year medical students reflected on how personal experiences from before medical school may influence them as future doctors. Students wrote the texts at the end of a 6-month course involving 20 patient encounters, introduction to person-centered theory, peer group discussions, and reflective writing. The analysis targeted medical students’ processes of interweaving and delineating personal and professional identities. The analysis yielded four categories. (1) How medical students told their stories of illness, suffering, and relational struggles in an interplay with context that provided them with new perspectives on their own experiences. Students formed identities with a person-centered orientation to medical work by: (2) recognizing and identifying with patients’ vulnerability, (3) experiencing the healing function of sharing stories, and (4) transforming personal experiences into professional strength. Innovative approaches to medical education that encourage and support medical students to revisit, reflect on, and reinterpret their emotionally charged life experiences have the potential to shape professional identities in ways that support person-centered orientations to medical work.

'Staying cool, calm and positive': A dialogical narrative analysis of emotional reactions in narratives about operable lung cancer.

Patients with lung cancer suffer from physical, psychosocial and particularly emotional challenges. Twenty-five percent of patients with lung cancer are offered surgery as a potential cure. Nevertheless, 40% of surgically treated patients will experience recurrence. Paradoxically, research shows a dominant narrative of operable lung cancer patients 'being lucky', which silences other narratives about suffering, worries and emotional challenges. To explore narratives about operable lung cancer, particularly emotional reactions to illness and suffering in these narratives. A qualitative design was applied. Six women and four men diagnosed with operable lung cancer were included from one university hospital in Denmark and interviewed 1 month after surgery using active interviews. The interviews were subject to dialogical narrative analysis. The theoretical foundation is social constructivism, with socio-narratological inspiration. A typology of three emotional narratives emerged: 'staying cool', 'staying calm' and 'staying positive'. All three types of narrative are characterised by managing emotional reactions. Staying cool is characterised by not showing emotional reactions; staying calm narratives acknowledge emotional reactions, but that they need to be managed so that they do not burden relatives; and the last, staying positive, is characterised by managing emotional reactions in a positive direction. Together this typology of three emotional narratives revealed that operable lung cancer patients are under normative pressure from these socially preferred narratives of ideal emotional reactions to lung cancer. A typology of three emotional narratives were identified and can be called 'feeling rules' that guide patients after lung cancer surgery to manage their emotions. Consequently, if patients do not live up to these three emotional narratives of staying cool, calm and positive, they may be socially isolated and restricted from access to support.

A narrative journey into the borderland of patient safety: Toward an expanded, relational concept of safety.

"Patient safety" is routinely defined in health services globally as "safety for patients against harm and risk of injury in health care." (Danish Board of Quality in Health Care, 2022, p. 28; translated by the author). This is a standardized, broad, and general definition of what counts as safety. In this article, I argue for an expanded, relational concept of patient safety revolving around experienced patient safety. Recognizing safety as vital for all groups of patients, I follow a dialogical, critical-reflexive approach to focus on safety in a somatic hospital setting in Denmark as it is experienced by people with lived experience of mental distress. Safety in this context is often compromised, contributing to inequity in health for people with mental distress. I present and analyze the narratives of two experts by experience about their somatic hospital stay. As an analytical approach, I draw on Frank's dialogical narrative analysis together with elements from Bakhtin's theory of dialogue and Foucault's theory of power/knowledge. Forefronting voices of those rarely asked and seldom heard, dialogical narrative analysis provides insight into how "patient safety" is enacted through situated negotiations of meaning in the narratives of people with lived experience. The storytellers are continuously struggling to fit in and to be seen as human beings, trying to resist public narratives on mental distress that threaten to limit their scope of action and who they can become. The discussion highlights how unintended emotional and psychosocial harm limit the benefits of patient safety for certain groups in society. In particular, shame, individualized responsibility, and internalized inferiority hinder equity in health. Building on my analysis, I suggest a collaborative, participatory approach for coproducing further knowledge through joint analysis with people with lived experience and nurses from somatic hospital wards.

A dialogical narrative approach to transitions and change in young women’s lives after domestic abuse in childhood: considerations for counselling and psychotherapy

ABSTRACT Domestic abuse in childhood is seriously impactful, but very little literature uses a critical lens to consider implications for counsellors and psychotherapists working with young adults following domestic abuse in childhood. This article draws on research that explored 10 young women’s accounts of transitions to adulthood after domestic abuse in childhood. Interviews with young adult women in England were conducted and a feminist dialogical narrative analysis was used. Findings suggest that socio-cultural structures and ideologies that shape dominant discourses about what growing up after domestic abuse in childhood means, and what “successful” adult femininity looks like, shaped how women made sense of their experiences. This has implications for counsellors and psychotherapists working with this client group. This article concludes that storytelling could be a powerful therapeutic tool, and attention to power, ambiguity and tensions when working with this client group might facilitate and generate important meaning-making and knowledge in therapy.

‘We cannot afford outsiderness’

This article addresses social inclusion/exclusion – specifically the kind of exclusion we describe as outsiderness – in relation to sustainable development and arts education. Our idea is to address and discuss this on an individual/micro level and as a topic of social sustainability. Inspired by Irwin and Springgay’s a/r/tography, Frank’s dialogical narrative analysis, and different walk-along methods, we also explore alternative formats of the scientific article. In this text, we will thus present what became five threads of inquiry into arts education’s potential contribution to social sustainability. These threads describe our path through this field and relate to 1) the position of the arts in the UN’s Sustainable Development Goal (SDGs), 2) social inclusion in the SDGs, 3) research on the arts and health, 4) social inclusion in the arts, and 5) research on outsiderness. Throughout the article, we also exemplify our walk-along discussions through narratives, revealing more of the motivations behind this text. We end the article with a discussion proposing relational arts education to help avoid outsiderness and to promote inclusion, care, social sustainability, and diverging voices or what we describe as counter-voices, in arts education. Cover image: photo collage by Torill Vist

From symptom onset to treatment initiation: protocol for a narrative study exploring the journey of older adults with tuberculosis in the English Midlands, UK

IntroductionTime from symptom onset to treatment initiation in tuberculosis (TB) remains stubbornly prolonged despite reductions in disease incidence. Delays may contribute to increased morbidity, mortality, onward spread of disease and...

The shy girl who became national team captain: a bioecological narrative of an Olympian’s life skills development

Bronfenbrenner’s bioecological theory scrutinized how the complex relationship between person and environment leads to human ­development. Although the concept of life skills is influenced by Bronfenbrenner’s work, exploration of the bioecological theory in sport psychology is limited. The bioecological theory was used to explore the life skills development of Júlia, a 38-year-old woman who competed nationally in track and field and internationally in rugby. Júlia completed a timeline and engaged in four interviews, and four social agents were interviewed to nuance her developmental journey. Inductive dialogic narrative analysis was conducted to present Júlia’s journey through creative nonfiction. Júlia developed life skills (e.g. communication, teamwork) from progressively more complex interactions through interpersonal relationships, experiences, and challenges in different contexts (e.g. school, work). Insights concerning the bidirectional nature of life skills development and transfer are discussed, as well as the influence sustained by the person’s biopsychosocial characteristics, culture, and time.

Stories of acceptance and resistance: illness identity construction in athletes (mis)diagnosed with a personality disorder

ABSTRACT Mental illness identities are personally and socially constructed and impact psychological wellbeing. This study explored how athletes diagnosed with a personality disorder construct their illness identity and the various ways this impacted experience. Guided by an interpretivist paradigm, we recruited two powerlifters, Samantha and Alex, who engaged in a series of one-to-one interviews. In total, 11 hours of data was collected and analysed using dialogical narrative analysis. The personality disorder diagnosis had significant but divergent influences on each athlete. Samantha accepted the diagnosis, aligning to dominant medical understandings of mental illness and using these to construct renewed understandings of the self. In contrast, Alex told a counternarrative to dominant medical discourses of mental illness, which was characterised by stories of activism. Alex sought an alternate diagnosis, autism spectrum disorder (ASD), which better validated their experience. We discuss implications of this work for those operating in sport, such as the importance of allowing athletes to develop their own understandings of mental illness to allow for the construction of an authentic self.

'A Story of Being Invisible': A Single Case Study on the Significance of Being Recognised When Needing Acute Healthcare in the Early COVID-19 Pandemic.

Severe illness is often an existential threat that triggers emotions like fear, stress, and anxiousness. Such emotions can affect ill patients' encounters with healthcare personnel. We present a single case study of an older woman who contracted COVID-19 and her challenge to be recognised by healthcare personnel in the early pandemic. Storytelling is vital to understand how patients can create meaning in illness as it gives them the opportunity to reshape and restore their past and to project a future. We used Arthur Frank's dialogical narrative analysis to explore how one patient experienced her encounters with healthcare personnel. Although she felt very ill from COVID-19, she experienced being almost invisible and not being believed by healthcare personnel in a system marked by high stress levels and uncertainty. Despite rejections and illness, she managed to mobilise her resources, even though she depended on significant others. Her story brings forward altered self-understanding and growth. The importance of facilitating dialogical settings for healthcare professionals through patient storytelling also contributes to a broader societal understanding of illness beyond a biological perspective.

Experiencing restraint: A dialogic narrative inquiry from a service user perspective.

In recent decades concerns about violence and programs for the minimization of physical restraint, amongst other restrictive practices, have proliferated within mental health policy and practice. Whilst nurses are often called upon when violence occurs within mental health care settings, they often find themselves having the conflicting roles of caring and controlling. Within such situations it is service users, who are experts by experience, who perhaps can offer more meaningful insight into being restrained and thus provide a more appropriate approach in dealing with mental distress. This paper presents the findings of a narrative study of individuals' experiences of physical restraint within the mental health care system. In total 11 mental health service users, who had experienced physical restraint, were interviewed. Frank's (2010, Letting stories breathe: a socio-narratology) guiding questions were used to undertake a dialogical narrative analysis of each story. For the purpose of this paper, four of the 11 stories are presented as these are representative of Frank's 'quest narrative'. However, whilst studies from the service user perspective regarding restraint are scarce, findings are discussed in relation to the grand narrative of restraint. The dialogical relationship between individual stories and the dominant grand narrative implies that the former has the capacity to shape and review the latter within mental health care. Adding to the growing body of evidence of restraint from service users' perspectives could enable nurses to provide more appropriate and meaningful mental health care in times of mental distress. [238].

The liminal landscape of mentoring-Stories of physicians becoming mentors.

This study explores narratives of physicians negotiating liminality while becoming and being mentors for medical students. Liminality is the unstable phase of a learning trajectory in which one leaves behind one understanding but has yet to reach a new insight or position. In this study, we analysed semi-structural interviews of 22 physician mentors from group-based mentoring programmes at two Norwegianand one Canadian medical school. In a dialogical narrative analysis, we applied liminality as a sensitising lens, focusing on informants' stories of becoming a mentor. Liminality is an unavoidable aspect of developing as a mentor. Which strategies mentors resort to when facing liminality are influenced by their narrative coherence. Some mentors thrive in liminality, enjoying the possibility of learning and developing as mentors. Others deem mentoring and the medical humanities peripheral to medicine and thus struggle with integrating mentor and physician identities. They may contradict themselves as they shift between their multiple identities, resulting in rejection of the learning potentials that liminality affords. Mentors with integrated physician and mentor identities can embrace liminality and develop as mentors. Those mentors with contradicting dialogues between their identities may avoid liminality if it challenges their understanding of who they are and make them experience discomfort, confusion and insufficiency while becoming a mentor. Support of the mentoring role from the clinical culture may help these physicians develop internal dialogues that reconcile their clinician and mentor identities.

Where Is Communication Breaking Down? Narrative Tensions in Obesity-in-Pregnancy Clinical Encounters [ID: 1377560

INTRODUCTION: Health care professionals (HCPs) often view obesity in pregnancy as a condition associated with numerous adverse clinical outcomes and procedural difficulties. In contrast, patients characterize their challenges encountered because of stigma, their desire for a normal pregnancy, and may feel weight is overemphasized. The study's objective was to explore stories of patients and HCPs in tandem, in order to understand communication challenges within obesity-in-pregnancy clinical encounters. METHODS: Employing narrative inquiry, we conducted in-depth interviews with 16 patients and 19 HCPs. Stigma theory informed our research approach. Dialogical narrative analysis of interview transcripts was conducted. RESULTS: We identified five narrative tensions that contributed to communication challenges during clinical encounters. The first three tensions related to contrasting views on obesity: 1) obesity as a detriment to health versus acceptance of obesity; 2) a result of personal choice versus a result of uncontrollable circumstances; and 3) a regular pregnancy versus a high-risk diagnosis. Two further tensions related to characterizations of communication within the clinical encounter: 4) typical and problem-free versus a tremendously difficult clinical encounter; and 5) talking openly about obesity versus sidestepping the topic. How participants positioned themselves relative to prevailing societal discourses regarding obesity and being a “good” HCP/patient influenced these tensions. CONCLUSION: This study identified five narrative tensions and revealed specific areas where communication in the obesity-in-pregnancy clinical encounter is vulnerable to breaking down, accounting for the complexities in this interactive space. These findings can inform clinical practice and education and may be applicable to other clinical contexts.

Then Peter Stood Up: A Dialogical Narrative Analysis of Peter’s Preparation for Spokesperson at Pentecost

Dialogical Narrative Analysis (DNA) asks, in brief, what work a story does in the context in which it is told and on the teller of the story itself. In applying DNA to Peter, this article assumes the premise that Peter’s meaning-making, or construction of the dialogical self in dynamic relationship with Jesus, positioned him to be the spokesperson who narrated the events of Pentecost. Therefore, this article seeks to understand how Jesus’ naming and accompanying statement to Peter that “on this rock I will build my church” and the unfolding narrative of Peter’s discipleship uniquely prepare Peter for this role. This article is not about Peter’s Pentecost speech itself, rather, it is about Peter’s preparation to be the speaker. The article examines the movements of faith formation in the story Jesus told Peter about who Peter was in relationship to the Godhead, and then connects this first story with the act of Peter’s storytelling at the inauguration of the era of the church, tracing the change process that the identity narrative given by Jesus works in Peter.

Being and becoming ‘a frail older adult’: Meaning-making and resistance through storytelling.

By inquiring into older adults' narrations about their lives in the present, past, and future, this study aims to learn more about home-dwelling older adults' lived experiences of being and becoming “frail”. This article is based on a dialogical narrative analysis of interviews with three home-dwelling older adults identified as frail by the home care services. We conducted a series of three interviews with each participant over a period of eight months. Our results demonstrate that while some older adults experience frailty as inevitable and irreversible, others experience it as a transition. Some narrated frailty as a comprehensive experience, while others' narratives were more situational and transitional. Being able to live at home was crucial and moving to a nursing home was associated with the risk of becoming frailer and the loss of valued relations to family and their home. Experiences of frailty were framed and shaped by the past, present, and future. Faith, fate, and previous capacities to overcome adversities were crucial in the older adults' narrations. Older adults' stories provide an opening to diverse and changing experiences of living with frailty. By telling stories about the past, present, and future, older adults can maintain identity, a sense of belonging, and balance in the midst of adversities. By engaging with older adults' stories, health and care professionals can support the older adult in the ongoing process of being and becoming ‘a frail older adult’.

A letter to my younger self: using a novel written data collection method to understand the experiences of athletes in Chronic Pain

ABSTRACT This study seeks to extend the variety of written methods used in sport and exercise research by outlining the use of a novel written technique for data collection: ‘a letter to my younger self’. The use of solicited letter writing has long been endorsed as a valuable technique as part of the therapeutic process, but has yet to be considered as a method of collecting qualitative data. In this study, 21 participants who had experienced chronic pain while playing sport were invited to write a letter back to their younger self. A dialogical narrative analysis was used to analyse the written letters and our results are presented in two forms. First, a ‘collective letter’, written using amalgamated participant quotations. Second, an accompanying commentary which illustrates the characterisations, structure, and narrative themes that were evident in the data collected. Our findings extend existing knowledge of chronic pain in sport, contrasting previous literature that has presented degenerative stories. Further, we also illuminate the danger of the performance narrative in privileging personal agency and the risks this poses to receiving support during chronic pain. We conclude by challenging researchers to consider the importance that should be attributed to hindsight and the value of re-describing experiences with wisdom and knowledge of the significance of the past.

‘It’s easier to just keep going’: elaborating on a narrative of forward momentum in sport

ABSTRACT In this article we elaborate on a narrative of forward momentum in sport drawing on multiple interviews (total = 37 interviews) over six months with thirteen current and former competitive athletes (9 women, 4 men) from various sports and different stages of their sport careers. Using Dialogical Narrative Analysis to guide the analysis, the results elaborate on a narrative of forward momentum and the ways it is drawn upon by athletes to make sense of their experiences in sport. A narrative of forward momentum emphasises concerns about continual progress and increasing achievements in performance over time, and athletes’ stories and lives were structured around the continual pursuit of success at the highest possible level in sport before the end of one’s career. Athletes felt ‘swept along’ by the structure of sport, and injuries and illnesses were seen as setbacks that could cause athletes to lose out on their progress and which they would have to ‘catch up’ on. We further elaborate on the concept of a contract within the narrative of forward momentum, wherein athletes invested hard work that would eventually ‘pay off’ and which promoted continual training and improvement in order to make progress and maintain momentum. A narrative of forward momentum is explored as a useful companion story, and as a potentially ‘dangerous’ companion story. We conclude by discussing the implications of a narrative of forward momentum for exploring the ways that athletes make sense of their experiences in sport.

‘We are all in this together’: a creative non-fiction story of older adults participating in power-assisted exercise

ABSTRACT In this study we aimed to explore older adults’ experience of community-based power assisted (PA) exercise and its potential impact on social exclusion, isolation and loneliness (SEI&L). The lead author obtained ethnographic data over a 6-month period using three primary methods: participant observation (900 hours), a reflexive diary, and 10 semi-structured interviews. Participant observation provided a rich lens into a PA exercise centre describing the scene, characters, and dialogue that enabled the ethnographer to interpret stories of SEI&L. Participants expressing stories of SEI&L (6 service-users, age 66–90 years) and participants working at the centre (3 staff members, age 41–50 years; 1 volunteer, age 69 years) were invited for interviews with the purpose of expanding on data from the field. We used dialogical narrative analysis to construct story themes and meaningful structures from the data that enabled a nuanced understanding of the plots and characters woven into the ethnographic creative non-fiction. Shifting our perspective from story analysts to storytellers, we have constructed two emotionally vibrant composite narratives to show the mechanisms and meanings of SEI&L for older adult exercisers following bereavement in later life and when living with a debilitating chronic health condition. The therapy centre provided a safe and inclusive space for older adults to reconnect through accessible modes of exercise and an atmosphere fostering a sense of belonging and togetherness. This work offers rich insight into older adult’s experiences of community-based exercise and raises awareness of SEI&L to help instigate personal and social change across multiple audiences.