The Voice of Experience and the Voice of the Expert‐Can they Speak to each Other? more

From: Gabriel, Y. 2004. The voice of experience and the voice of the expert: Can they speak to each other? In B. Hurwitz, T. Greenhalgh, & V. Skultans (Eds.), Narrative research in health and illness: 168-186. Oxford: Blackwell. THE VOICE OF EXPERIENCE AND THE VOICE OF THE EXPERT – CAN THEY SPEAK TO EACH OTHER? YIANNIS GABRIEL1 Imperial College, London The facts: A nightmare – a computer defies K's instructions and keeps reverting to an old-fashioned snooker game, from which K cannot escape. A routine visit to the doctor turns into something more serious. An urgent referral to the hospital, a batch of tests, an anxious wait. Testicular cancer? A chance meeting with an old school flame at an airport lobby. Instant revival of relationship. A wedding. A pregnancy. Three sequences of events involving different persons, or perhaps the same person, simultaneously or in succession. Notice immediately the temptation to discover some meaning in these facts, a purpose, a point. This may be accomplished by seeking additional facts (Who are the protagonists? In what sequence did the events take place? What was the diagnosis? etc.), by looking at the meaning of the events to the protagonists (Why was the computer nightmare upsetting? Was the pregnancy wanted? etc.) and by identifying some key emotions that were experienced by them. It is through the juxtaposition and sequencing of facts, their 'engagement' with each other and with the intentions and experiences of their characters, that meaning begins to emerge. For instance, on the day after the nightmare, K went for his routine check-up. Or alternatively – the day after the welcome news of pregnancy, he was diagnosed as having testicular cancer. Facts, even seemingly trivial ones, invite being placed in a story, through the magic of the plot. 1 Many thanks to Dr Trisha Greenhalgh, whose extraordinary enthusiasm for medical narratives was a great source of inspiration for me, in looking at stories and storytelling from an angle that I had not considered earlier. All three editors of this book have been extremely helpful with suggestions and comments on earlier drafts of this chapter. My thanks to all of them. Notice too, another temptation – the temptation to silence. Why bother about a case of testicular cancer, a nightmare, or a pregnancy. Why indeed care about them, in the light of personal and world events that cry out for meaning and explanation? Of course, if the protagonists in the above incidents happen to be oneself, or one's spouse, one's son or daughter, one's close friend or acquaintance, then the search for meaning may be burning. But if the subject is one of the anonymous thousands who are diagnosed with testicular cancer, rediscover romance or get pregnant, then the search for meaning may all but vanish. The very requirement that meaning should reside in the facts disappears. They become mere statistics, data, information. Facts rarely speak for themselves – and never in isolation. Narratives and stories enable us to make sense of them, to identify their significance, and even, when they are painful or unpleasant, to come to terms with them and live with them. This is why many narratives revolve around human misfortune, notably accidents, illness, injustice and loss. As sense-making devices, narratives and stories, do not merely help us infuse events with meaning, but also enable us to mould them to our own needs and desires, to comment on them and to contest them. As such, they help us process our experiences, communicate them to others and re-arrange them within larger narratives of identity and selfhood. This chapter reviews how narratives and stories enable individuals and groups to discover their voice, articulate their experiences and even shape their self-identities. I will argue that stories and narratives are shaped within fragile social encounters, in which storytellers and audiences are bound by a psychological contract which regulates legitimate and nonlegitimate forms of representation or 'regimes of truth'. These psychological contracts accord considerable authority to the person who speaks from personal experience, who has witnessed events with their own eyes, an authority that can sometimes be abused, but an authority which stands in direct opposition to the authority of the expert, founded on generalizable and impersonal expertise. The juxtaposition between the voice of first-hand, personal experience and the voice of scientific expertise is played out in many fields, including medicine, law, history, therapy, education; I conclude with some thoughts regarding the possibility of these two voices coming together in a dialogue. I have deliberately set out to temper some of the current enthusiasm regarding narratives and stories displayed by scholars, researchers, practitioners (medical, management, professional) and others. In the first place, narratives, and particularly stories, are relatively special events, capable of great sense-making feats, but also easily drowned in the din of information, lists, numbers, opinions, rationalizations and theories that saturate many organizational spaces, or remaining still-born in environments dominated by relentless preoccupations with efficiency, rationality and action. In short, stories require time, patience and trust, qualities that are not in great supply in today's organizations, medical and otherwise. Furthermore, while stories can be vehicles of contestation, opposition and self-empowerment, they can also act as vehicles of oppression, self-delusion and dissimulation. Nor do stories, as is sometimes argued, obliterate or deny the existence of 2 facts but allow facts to be re-interpreted and embellished – this makes stories particularly dangerous devices in the hands of image-makers, hoaxers and spin doctors. In all of these ways, I would like to reclaim some usefulness for the concept of 'ideology', a concept that some authors may have prematurely buried, following the collapse of the Soviet Union and subsequent decline of Marxist scholarship. While, I do not claim that ideology is an automatic set of false ideas which is determined by an immovable material base, ideologies, whether political, religious or medical, systematically conceal some of the assumptions which they carry. This applies equally to the ideology of science, which privileges the voice of the expert, and the ideology of personal experience which seeks to defend and bolster the authority of the person who has lived through certain events at first had. Narratives, stories and experience Narratives are particular types of text involving temporal chains of inter-related events or actions, undertaken by characters. They are not mere snapshot photographic images, but require sequencing, something noted by most systematic commentators (Bruner, 1990; Culler, 1981/2001; Czarniawska, 1997, 1999; Labov, 1972; MacIntyre, 1981; Polkinghorne, 1988; Ricoeur, 1984; Van Dijk, 1975; Weick, 1995). Stories, for their part, are narratives with plots, which 'knit events together', allowing us to understand the deeper significance of an event in the light of others (Czarniawska, 1999, p. 64f; Polkinghorne, 1988, pp. 18-9). If plot (involving characters, sequencing, action, predicaments etc.) is a crucial feature of stories, a second key feature of many stories is their claim to represent reality. Stories, in other words, purport to relate to facts that happened, but also discover in these facts a plot or a meaning, by claiming that facts do not 'just happen' but that they happen in accordance with the requirements of a plot. Such stories are not 'just fictions', nor are they mere chronologies or reports of events as they happened. Instead, they represent poetic elaborations of narrative raw material, aiming to articulate and communicate facts as experience, not facts as information (Benjamin, 1968). The link between stories and experience is of the greatest significance, since different people may experience the same events in very different ways, or, alternatively, they may experience very different events in the same ways. Experience is shaped by emotions, desire, perception and interest, all of which have a direct bearing on the stories we tell and our responses to the stories we hear (or refuse to hear). When a teacher recounts an incident involving a threatening pupil, when a patient recounts the onset of the first symptoms of his illness, when a physician recounts the success of failure of a particular treatment to her peers, some of the requirements for precision are relaxed and the requirements of meaning, sense-making and communication take 3 precedence. In this sense, such stories are different from the reports that one may give a police investigator or a commission of inquiry, where accuracy of information is of paramount consideration. The same applies to many of the stories that patients tell their doctors, as Kleinman has described it: "The illness narrative is a story the patient tells, and significant others retell, to give coherence to the distinctive events and long-term course of suffering. The plot lines, core metaphors, and rhetorical devices that structure the illness narrative are drawn from cultural and personal models for arranging experiences in meaningful ways and for effectively communicating those meanings." (Kleinman, 1988, p. 49) Thus, storytellers enjoy a unique narrative privilege, poetic licence, that enables them to maintain an allegiance to the effectiveness of the story, even as they claim to be representing the truth. Poetic licence enables the storyteller to buy the audience's suspension of disbelief in exchange for pulling off a story which is communicating something authentic and meaningful. The story is a poetic elaboration on events, one that accords with the needs of the teller and the audience, and one that requires considerable ingenuity on the part of the narrator. Drawing connections, highlighting what is important and unimportant, expressing emotion, commenting on what is bad and what is good, what is accidental and what is typical, attributing motives and emotions, these are all elements of story work (or poetic labour), the work that goes into generating a story that both carries meaning and claims to represent reality. This is no easy task. Many events defy containment within narratives, leaving us in a state of confusion – a lack of the resources necessary for making sense of them. This is especially the case with events that leave us in a state of shock, when we may need the help of someone else (a counsellor, a confidante, a friend) in order to construct a convincing and plausible story, or indeed we may 'buy' someone else's story as our own story. Think of the meaning vacuum (in much of the UK and the USA, though not in certain other countries) following the events of September 11, 2001, and the importance of those first utterances of world leaders which constructed those events through the use of words like "war", "crusade" and so forth. There are events that require enormous amount of story work before they can be accommodated within a meaningful scheme, others that readily fall within a well-established and easily recognisable plot. Yet, stories are quite fragile entities which can be called into question and even destroyed by two deadly questions. The first one is the 'So what?' question, the abyss that faces every storyteller (Labov, 1972, p. 360) when the story fails to carry meaning. A story can carry meaning, yet may fail the second test, the test of verisimilitude. In addition to the "So what?" question, which all narrators must face, storytellers must also face the "Did it really?" question, which questions whether the story accurately represents reality. The "So what?" question indicates that the plot is failing to carry meaning, while the "Did it really?" indicates that the plot fails 4 to carry verisimilitude. Between these two questions, storytellers must walk on a tricky tightrope, since meaning may be created at the expense of verisimilitude and vice versa. Poetic licence is part of a psychological contract between the storyteller and his/her audience, that allows the storyteller to twist the material for effect, to exaggerate, to omit, to draw connections where none are apparent, to silence events that interfere with the storyline, to embellish, to elaborate, to display emotion, to comment, to interpret, even as s/he claims to be representing reality. All of these poetic interventions are justified in the name of experience – they are the storyteller's attempt to make sense of events that could otherwise be entirely puzzling, arbitrary and incoherent. I shall refer to this psychological contract as a narrative contract. This is a contract that regulates the terms of a narrative or a story, the acceptable deviations from documentable reality, the drawing of inferences and making of connections, the legitimate exaggerations and omissions. Different types of narrative, such as historical accounts, chronicles, fairy-tales, jokes, myths, film, novel and opera, involve different types of narrative contracts between authors and their audiences or readers. The stories we hear in pubs, hospitals, consultation rooms, schools, business organizations and other places are governed by their own narrative contracts, establishing their own permissible modes of representation, their own regimes of truth. Narrative contracts – a small digression to the genre memoir Small print is a feature of the narrative contract, as it is of all contracts. Its significance becomes clear when the narrative contract is tested, violated or broken. Consider, for example, a recent imbroglio involving a literary memoir, par excellence the literary genre that voices experience. Fragments: Memories of a wartime childhood written by Binjamin Wilkomirski (1996), described through the eyes of a child the experience of surviving the horrors of the Holocaust. The book appeared to give voice to the silent sufferings that had scarred the protagonist's entire life. On publication, it was widely acclaimed and showered with awards, in spite of reservations expressed by distinguished scholars like Raoul Hilberg and Yehuda Bauer. Numerous factual errors in the book were dismissed as insignificant, trivial distortions affecting an adult's recollections of childhood experiences, when compared to the book's moral force. The book presents unspeakable suffering told by the a person who was at once a victim, an eye-witness and a survivor, and generates powerful emotions in the reader – compassion for the victims as well as admiration for their courage, outrage against the oppressor, awe at what people are capable of doing to each other. Gradually, however, and largely through the efforts of Swiss journalist Daniel Ganzfried and historian Stefan Maechler (2001), it became clear that the book was a fake. Wilkomirski (real name Bruno Doesseker, born Grosjean) was neither a Holocaust survivor nor even a Jew and his narrative had been entirely the work of fantasy. "I was there, not you", exclaimed Wilkomirski to 5 his detractors, implying that no historical research, could deny his experience which was authentic through and through. Yet, the damage to the narrative contract between author and audience was already done. The author was seen as someone who abused trust and violated the limits of poetic licence to present fictions as facts. His book was discredited even as a literary document and withdrawn, as were many of the awards that had been given to its author. Some have defended Wilkomirski. Israel Gutman, for example, the director of the revered Yad Vashem and a Holocaust survivor, said that "Wilkomirski has written a story which he has experienced deeply; that's for sure. ... He is not a fake. He is someone who lives this story very deeply in his soul. The pain is authentic" (Finkelstein, 2000, p. 61). Others have argued that Wilkomirski spoke not just for himself but with a collective voice, on behalf of a whole class of disempowered and silenced victims. Some indeed have seen this as a perfectly legitimate defence, refusing to acknowledge any difference between factual truth and a presumed symbolic truth (Binford, 2001; Gledhill, 2001). The mere contestation of testimonies like Wilkomirski's, according to such defendants, amounts to a denial of every survivor's experience, a virtual blasphemy. Extreme though the case Wilkomirski may be, it is by no means unique (See (Finkelstein, 2000) for numerous similar ones). What it suggests is in the first place the possibility of grave breaches of the narrative contract, whereby the narrator exceeds the prerogatives of poetic licence and ventures into the field of misrepresentation. Verisimilitude gives way to dissimulation. The narrator is no longer a creditable one and having proven untrustworthy once, s/he remains so for ever – his/her narrative damaged beyond repair. If we hesitate to refer to Wilkomirski as a hoaxer, it is because his deception is, by all accounts, a self-deception as much as a deception of others. (This in itself generates a new type of literary narrative, the literary exposé, which has emerged as the antithesis of the memoir, establishing its own psychological contracts between authors and their audiences. Others may take a less extreme view – they may, for instance, seek to understand why a very strong identification with the experience of someone else may come to be felt as a self-experience.) What makes such breaches of the narrative contract possible? I would contend that the main factor here is the ability of certain narratives to inoculate themselves against criticism, precisely by emerging as the voice of authentic experience, an experience that cannot be denied, without violating the integrity of the narrator. This is especially true when the experience is one of suffering and victimization, in which case questioning the narrative amounts to compounding the injury through its denial. Wilkomirski's "I was there, not you" rings with an authority that is very hard to contest. This 'inoculation' of a claim from legitimate criticism, its elevation to incontestable truth, is not far from what can be labelled ideological, an ideology of unquestioned respect for the personal experience of the victim, whose articulation of this experience enables them to 'discover a voice'; it is in this way that the victim ceases to be a victim and becomes a 'survivor', the two being very distinct characters in most story plots. 6 But what if the experience of trauma and injury, as in the case Wilkomirski, is based on events that did not take place or at least did not directly affect the victim? We can no longer believe that the “truth of stories lies in their meaning, not in their accuracy” (Reason & Hawkins, 1988), since the meaning of stories is radically different, depending on whether the facts reported were experienced at first hand or not. The trauma experienced by individuals like Wilkomirski may be real, but the meaning of the trauma is different, depending on whether they actually experienced the brutality at first hand or whether they imagined they experienced it. The argument here is identical to the issue that has long made psychoanalysis a target to criticism, namely that what matters is the experience of trauma, not whether the events causing the trauma actually happened or not (See (Crews, 1995; Forrester, 1997; Gabriel, 1999). While the experience of trauma may conceivably be very similar in the cases of individuals who were brutalized by their parents and those who imagined themselves brutalized by their parents, I would contend that the meaning of the trauma is very different. What I am arguing here is that the listener may legitimately then read the meaning of the story very differently from the teller. What we learn from the Wilkomirski affair is that once the credibility of the storyteller has been corrupted and the narrative contract lies in tatters. The storyteller then becomes a story, a story of abuse of trust, of pathological lying or of something else. To the two questions feared by every storyteller “So what?” and “Did it really happen?” we must now add a third one, one that is never as direct as the other two, yet one which is looming in the background. “Who are you to speak with authority?” Once the authority of personal eyewitness experience has been supplanted, the story becomes absorbed in a new narrative, a narrative of deceit, delusion or manipulation. Poetic licence then must be seen as part of a very complex contract between storyteller and audience which entails the granting of the audience of attention, a temporary suspension of disbelief, a temporary curbing of criticism and inquiry, in exchange for delivering a narrative which makes sense, is plausible, yields pleasure or consolation (entertainment or catharsis), but sustains numerous hidden assumptions about legitimate and non-legitimate forms of representation. Distortion then can be equally legitimate poetic licence within a narrative contract or a violation of the contract. But distortion is unavoidable within any story, and this includes stories told by patients to their physicians. "Retrospective narratization can readily be shown to distort the actual happenings (the history) of the illness experience, since its raison d'être is not fidelity to historical circumstances but rather significance and validity in the creation of a life story." (Kleinman, 1988, p. 51) This, of course, does not imply that all or most of what a storyteller says is distorted or inaccurate. Experience is constantly processed, interpreted and re-interpreted in the light of subsequent events, its meanings re-considered 7 and re-assessed within changing stories and narratives. Truths (literal and symbolic), half-truths and fantasies all have a part in our evolving narrative constructions of experience. Even the foundation of all claim to experience, the claim to having lived through an event at first hand, must be seen in this way. When a storyteller says “I witnessed it with my own eyes” this may be literally accurate and yield strength and authenticity to his/her story; alternatively, it may be legitimate distortion for effect, or, in some instances, entirely fraudulent, relying on sequestered authority. Poetic truth, therefore, becomes a product of this narrative contract, which continuously defines legitimate and non-legitimate deviations from the facts, legitimate and nonlegitimate forms of representation. Who speaks with authority? The voice of the expert and the voice of experience Over the centuries, various voices have rung with authority. The voice of the prophet with his or her personal line to the divine, the voice of tradition which Burke (1790/1998) sought to reclaim, the voices of the artist, the intellectual or the outsider who dare speak their minds with what the Greeks called parrhesia (the courage of one’s opinion, uninhibited by fear, expediency or tactfulness). Modernity undoubtedly elevated one type of the authority, the authority of the expert, the specialist, the scientist above all others. Scientific knowledge seemed to melt away other sources of authority as mere superstition, hearsay and opinion. Nowhere is the authority of the expert more clear than in the field of medicine, where the scientific treatment of disease was seen as driving away traditional, non-scientific 'medicines'. It is certainly not accidental that Plato, one of the greatest philosophical apologists of the expert, continuously invoked the metaphor of the physician in his political discourse. If we obey the doctor because we respect the authority of his/her expertise, does it not follow that we would obey our leaders if they could claim a similar indisputable expertise? And if the healthy soul is one in which the different parts functioning in harmony, does it not follow that a healthy state is one in which the different parts are doing the same? On of the main casualties of the expert's unassailable authority was 'everyday experience'. Where the voice of experience was not entirely silenced, it was relegated to the standing of 'mere opinion' (Plato called it 'doxa'), used in a condescending way by the expert as the raw material upon which to base diagnoses, generalizations and theories. In medicine the term ‘anecdotal’ was used to this end. Consider for example, the court case, one of the foundations of modernity's claim to rationality elevates the 'expert witness', above the mere 'witness' or the ‘anecdotal evidence’. Expert witnesses, not only speak with much greater authority, but are entitled to express opinions that are treated as authoritative evidence and accepted with a degree of deference that is withheld from testimony based on mere experience. Within a rational courtroom, submitted to merciless cross-examination, experience is regularly shown to be biased, inaccurate, or even entirely fictitious. 8 Within modernist medical discourses, experience was further devalued. Who needed to listen to the voice of the pregnant woman or even the midwife's tales of difficult deliveries when the obstetrician knew best how to deliver babies according to the latest medical theories? Who needed to concern themselves with folk medicines, faith healing and magic cures, given our understanding of placebo effects? It is not surprising that even such an astute commentator of modernity as Benjamin (1968) could sixty or seventy years ago seriously believe that storytelling, the voice of 'facts as experience', was doomed to permanent silence. The future seemed to belong to information, scientific knowledge and theories. In this sense, we can regard the high noon of modernity as a moment when the ideology of science (i.e. its elevation above criticism from alternative ideologies) appeared to eclipse the ideology of personal experience, along with many others. It is curious then that late modernity has not merely rediscovered an appetite for stories, but has rediscovered authority in personal experience Where modernity craved for the certainty of theories, late modernity would seem to thirst for the ambiguities of stories. The mass media far from reporting facts have turned largely into story-manufacturing factories, with spin-doctors and pundits who can directly affect and entertain the public. More specifically, we can argue that in late modernity, the authority of specialist expertise, the core feature of Plato's political philosophy, is certainly facing a determined challenge from the authority of experience, the authority of the person who lived and witnessed events at first hand. Whether it is as oral history, as medical narrative, as story of self-discovery and growth, personal stories matter again, even to the point of challenging the expert. Numerous documents capture this change of balance – in the field of medicine, it is instructive that the patient can now be referred to as an expert in his/her condition in official Government reports (DoH, 2001). Thus, late modernity has sought to re-assert the primacy of experience over other ways of establishing truth. As Eagleton (1996, p.67) has argued "one of the commonest forms of postmodernist dogma , … the intuitive appeal to 'experience', which is absolute because it cannot be gainsaid." A result of this has been an argument, implicit or explicit, that only he or she who has lived through a certain experience can speak authoritatively about it – thus, only black people can speak authoritatively about race, only gay people about sexual marginalization, and, more contentiously, only people suffering from cancer about cancer. In this way, the telling of the story becomes a process of discovering a voice, through which individuals and groups can build truth on their experience, communicate it, debate it and share it with other people – in short, build identities. The experts for their part have started to listen to such stories as contributions to this book testify. And rightly so. Psychoanalysis must be credited with being one of the first disciplines to take a deep interest in the stories of its patients. Yet, its approach to these patient stories was essentially symptomatic – the story was approached as evidence to be interpreted. In so doing, psychoanalysis, since Freud, had laid itself open to three charges: first, that it fails to honour the experiences of its patients, always suspecting ulterior 9 motives and hidden agendas; second, that it is indifferent to the material basis of experiences, notably whether traumas are caused by actual events or are imagined (a la Wilkomirski); and third, that in both of the above, psychoanalysis aligns itself with the discourses of the expert to deprive the non-expert of authority, even as the former listens attentively to the latter. We owe to Foucault the assertive linkage of knowledge and power, knowledge not merely being a tool or an instrument of power but being enmeshed with it. What is defined as knowledge is inextricably linked to the operation of power relations in both an oppressive and an empowering fashion. Foucault also alerted us to a type of discourse, the confessional discourse, whose power agenda is not merely the humiliation or purification of the subject, but the definition of a domain of experience as a domain of surveillance and control: "The confessional is a ritual of discourse in which the speaking subject is also the subject of the statement; it is also a ritual which unfolds within a power relationship, for one does not confess without the presence (or virtual presence) of a partner who is not simply the interlocutor but the authority who requires the confession, prescribes and appreciates it, and intervenes in order to judge, punish, forgive, console and reconcile. ... A ritual which exonerates, redeems and purifies him." (Foucault, 1978) p. 61. I argued on page 000, the confessional discourse in late modernity has assumed a different power/knowledge configuration. As part of the ideology of personal experience, it proclaims aggressively "Thou shalt not deny my experience; thou shalt not silence my voice!", thus challenging the ideology of scientific expertise. Where does this ideology of personal experience draw its renewed claim to being authoritative knowledge? It would seem that, in late modernity, science is undergoing a decline in authority not unlike that experienced by religion and tradition as sources of knowledge in earlier times. As we saw, science has undoubtedly been guilty of long disregarding the voice of personal experience. In fields as diverse as medicine, architecture, history, engineering, to say nothing of the social and psychological sciences, the voice of experience was long lost in the midst of the authoritative proclamations of the experts. This may be changing now. Even in medicine, a field where the scientist's expertise still earns him/her enormous authority, it is now commonplace to encounter instances when medical science is questioned, challenged and discredited, at times by voices drawn from experience. Instances where physicians err assume wide publicity, seen increasingly as typical of scientific hubris. Consider, for instance, current publicity surrounding medical diagnoses of child abuse or infant death. The case of Sally Clark a solicitor (and interestingly, a member of the expert classes) is instructive – she was convicted for the murder of her two children, mostly on the grounds expert medical testimony by an eminent consultant paediatrician which rated the odds of the two children dying from 10 natural causes were 'one in 73 million'. There was no direct or circumstantial evidence to suggest that the children (aged 8 and 11 weeks at the time of their death) had been 'smothered' by their mother – the jury's judgement was largely the result of placing their trust on medical authority rather than on personal experience (which may have supported the view that 'normal' mothers do not ordinarily kill their children.) Subsequent evidence, however, led to the acquittal of Ms Clark and the discrediting of the medical testimony during her trial – the evidence in this case was also 'expert evidence', yet, it underlines the point that the authority expertise (just like the authority of experience) must be seen as provisional. What was 'hard science' ten years ago often emerges as mere belief, attitude and opinion. This is but one of the numerous instances where the authority of the expert comes up against the authority of personal experience and is found to be flawed. It would be entirely premature to consign the authority of the expert to the obsolete landscapes of modernity. Yet, it seems to me that in numerous battle-fields, it is being challenged by the authority of personal experience. Parents challenge social workers and teachers, patients challenge clinicians, students challenge lecturers, sometimes in courts of law. This may be more broadly connected with what has been described as a therapeutic culture, or even the ‘Oprahization’ of culture, i.e. the increasing hegemony of an incontestable confessional discourse which enables the victim to become a survivor through the magic of finding a voice and having their voice heard. When the knowledge of experts is routinely devalued (and often for excellent reasons), knowledge from introspection, divination or faith are virtually dismissed, and facts become infinitely accommodating of diverse interpretations and spin, we are left with knowledge and truth from authentic personal experience, and the different voices that it takes (art, story, memoir, reminiscence) which assumes pride of place. Suffering narratives It will not have escaped the reader’s attention that the kind of experience ideally suited to the confessional discourse is not that of heroic quest, ironic self-disparagement or romantic affection, but rather that of suffering and oppression; articulating such an experience can help the subject turn shame and rage into defiance and pride -- the acknowledgement of victimhood becomes a celebration of survival. Few human experiences call for narrative with the same urgency as suffering. And suffering poses some unique challenges to narrative, unlike many other human experiences. Triumphs, coincidences, conflicts, reversals, revelations and come-uppances, all spawn narratives, but they do not match loss, tragedy and suffering in narrative urgency -- suffering stretches human sense-making capacities beyond most other experiences. Triumphs can be attributed to personal efforts, qualities of character or good fortune; coincidences, reversals, revelations and comeuppances can be seen as the products of an engineering providence that ensures fairness and justice. Suffering, on the other hand, cannot be 11 accommodated into some sense-making schema quite so easily. And, among different types of suffering, our culture seems most ill-equipped to deal with narratives of illness and pain. Indeed, some extreme forms of pain completely paralyse the human ability to speak, let alone to narrate (Scarry, 1987). And when pain does not paralyse speech, it raises an endless series of questions that are as pressing as they are hard to answer. Why should my child be born with a disability? Why should I be the one who suffers a stroke? Why have I lost my hearing/looks/partner? Can anything be done about my condition? Will I be able to bear it? What is the point of all this? In a pioneering work, Kleinman (1988) explored the different meanings of illness and some of the narratives through which such meanings come to the surface. What was original in that work (and sets it apart from earlier attempts by poets, novelists and social commentators to identify the meanings of illness (See (Sontag, 1991))) was the exploration of the meanings that illness has for the person who suffers, his/her family and wider cultural milieu. As patients seek the deeper significance of their suffering, the illness and its symptoms become embedded in life stories, which Kleinman claimed can tell us a great deal about the nature of the disorder and potential treatments. In many illness narratives, the 'pain' emerges as a character in the plot; sometimes it behaves in a consistent way, at others in an unpredictable erratic manner. In some narratives, the pain is a fierce enemy which must be fought, in others more like unpredictable child one must learn to live with. Of course, people speak about their pain not only to their physicians, but also to their friends, their relatives and to complementary or alternative therapists. In my own experience as a Greek who has lived most of his life in Great Britain, few issues divide cultures more sharply than the social acceptability of discussing pain and illness. In some countries, including Greece, one finds numerous people who are narrative virtuosos in discussing theirs and others' ailments, always sure to find appreciative audiences. In other cultures, the very mention of a source of pain is virtual taboo. "How is your knee?" my British mother-inlaw was asked after returning home following replacement operation (she had insisted that no-one visited her in hospital). "What knee?" was her telling answer. Denying an audience to someone who wishes to narrate their pain is as much a violation as forcing a pain discourse on someone intent on silencing it. Why do people seek to narrate their pain? Clearly eliciting sympathy is one reason; offering a warning is another. Yet, for the purposes of this discussion, the two functions I want to underline are what I would call the epistemological and the sense-making functions. The former places the pain in a forum where information is sought and given about different treatments, their effectiveness and limitations. In such forums (which resemble what in the case of professionals are known as 'communities of practice' (Brown & Duguid, 1991; Wenger, 1998, 2000)), people may seek and offer tips, in what amounts exactly to an exchange of 'narrative knowledge' (Czarniawska, 1999; Tsoukas, 1998) in quasi-gift transactions. Thus, people suffering from asthma, tinitus or a whole range of chronic disorders may seek recourse to support 12 groups of fellow sufferers or 'alternative medicines' instead of or in addition to the authority of the medical expert. The epistemological dimension of such stories is not the same as the sensemaking aspect. One can very well discuss different ways of dealing with asthma or sinusitis (through scientific or narrative knowledge) without exhausting their sense-making needs, i.e. without the sufferers reaching a satisfactory understanding of the ultimate meaning or significance of their condition. In telling a story of their illness, people, beyond seeking sympathy or information, and beyond offering warnings and tips, may struggle to come to terms with a deeper significance. This is perhaps the hardest challenge facing the suffering narrator. There is an arbitrariness in the unequal distribution of suffering, which is far harder to bear than the unequal distribution of money or power. This is why such narratives, i.e. those that aim at coming to terms with arbitrariness, are both very pressing and especially difficult. The result is that many narratives of illness are at the same time quests for narrative, in the exact sense described by the much abused term 'reflexive'. The plot of the story becomes the search for a plot. Thus, for instance, the "quest" narratives (Frank, 1995, 1998; Greenhalgh, 2002) become narratives questing the often evasive meaning of illness ("There must be some meaning to my illness"); the "chaos" narratives are narratives struggling with the chaotic consequences of illness ("My illness does not make sense"). Illness is, after all, an instance where disorder, even chaos, prevails over order. Of course, some narratives undoubtedly and unambiguously discover an underlying plot to illness or to suffering. As Greenhalgh has pointed out, tragic narratives may cast the illness as an evil adversary who is eventually going to be victorious, comic narratives may look at the funny implications of illness while restitution narratives generally look at illness as a test of character which is successfully overcome through courage, fortitude and medical know-how (Greenhalgh, 2002). Yet, there is something of a chaos narrative in all illness (Frank, 1998); even where a meaning has been arrived at, it requires a great deal of story work to reach it. This undoubtedly makes grave demands on the listener – time, patience, empathy. The story must be drawn out of the suffering person through empathetic listening, supportive interventions and co-narrating, always building a sense of trust. The listener is suffering with the narrator and part of this suffering lies in the fact that it is not clear whether the narrative will reach the safe harbour of a meaning. The "So what?" question cannot be put safely aside until the end of a narrative that may prove to be interminable. What happens when the listener is not a fellow-sufferer, a relative or a friend but a figure of authority, a physician? Since the work of Kleinman, much greater recognition is given to patients' stories in their own right rather than as vehicles to diagnosis. Frank (1995; 1998) advocates the role of a physician who maintains a 'critical distance' from the narrator, but who listens carefully to the latter's utterances as he/she tries to develop a narrative. Listening is not a task, but part of a gift relationship; instead of listening symptomatically, continuously on the look-out in the narrative for hints as to the 'true nature of the illness', (an approach Frank associates with Kleinman (1988)), the listener 13 gives unconditional attention to the narrator as part of a gift relationship. Both parties are enhanced by such an experience, as they make their needs known to the other party and see these needs 'honoured'. "One listens to ill people's stories not in order to fix them by doing something 'therapeutic', but rather to honor them. Again, people tell the stories they need to tell in order to work through the situation they are in." (Frank, 1998, p. 207) The idea of 'honouring' a person by respecting their narrative suggests that the physicians (or researchers) give up any presumption of understanding patients (or storytellers) better than these latter understand themselves and give up any right to 'use' the narrative to control the patients or their condition. It also surrenders the premise that the expert's time is more valuable than the patient's, a premise of which all patients are routinely reminded as they wait in long queues before their consultations. It is by surrendering some of the expert authority, that empathetic, non-symptomatic, non-motivated listening enables both physician and patient to escape their respective 'iron cages' created by the power/knowledge nexus in which they find themselves. The narrative contract delineated by this approach is one in which story is itself a gift; it is a gift offered by the teller (it remains his or her story) but one that could not have been produced without the participation of the listener, who offers his/her own gift of time, empathy and attention. Experience is honoured, emotions are honoured (Meyerson, 2000). However, the unqualified honouring of that which is presented as experience, as our digression into the case Wilkomirski suggests, can lead to grave violations of the narrative contract. It seems to me that if science can no longer be trusted to speak on behalf of people and groups to whose voices it is deaf, neither can the voice of experience be elevated to unquestioned and unquestionable authority. The voice of experience and the voice of the expert – can there be dialogue between them? It is true that humans suffer. But a mouse too can suffer, not least as the subject of experiments aimed at reducing the suffering of humans. What makes human suffering different is the irresistible search for meaning, which, in all its undoubted grandeur, may bring grace or may lead us to delusion. It is the combination of suffering and delusion that lies at the heart of humanity's uniquely tragic condition. Honoring the suffering, honoring the narrative and honoring the storyteller, does not mean accepting unconditionally the truth of the story. Where does this leave us? Undoubtedly, experience as a source of authoritative knowledge is here to stay. There is much to learn from direct experience and science can no longer disregard it or take automatic precedence over it. We are now aware that much of the knowledge on which we rely for our daily activities is narrative knowledge, i.e. knowledge deriving 14 from ours and other people's experience and disseminated through stories. Equally, however, knowledge from experience cannot be accepted without interrogation, verification and criticism. While Descartes' rationalism has lost much of its appeal in our time, we would do well to remember his warning about the "deceiver, supremely powerful, supremely intelligent who purposely always deceives me" (Meditation 2) and approach experience with a healthy dose of scepticism. Our own experience, no less than that of others, can deceive us, and, in our self-deception, we may deploy it to deceive others. The very narratives that help us make sense of our suffering and live with it can be deceiving us. Instead of accepting all voices of experience as equally valid and equally worthy of attention, I would argue that it is the job of researchers to interrogate experiences, seeking to examine not only their origins, but also those blind spots, illusions and self-deceptions that crucially and legitimately make them up. Far from being an unqualified source of knowledge, experience must be treated with the same scepticism and suspicion with which we approach all other sources of authoritative knowledge. Joining the postmodern choirs or ever smaller voices does little credit to academic research. Disentangling these voices, understanding them, comparing them, privileging those which deserve to be privileged and silencing those that deserve to be silenced, questioning them, testing them and qualifying them – these seem to me to essential judging qualities that mark research into storytelling and narratives as something different from the acts of storytelling and narration themselves. Deception, blind spots, wishful thinking, the desire to please or to manipulate an audience, lapses of memory, confusion, and other factors may help mould a story or a narrative. 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