Welcome back to the Daily Dose and a segment for MedHum Mondays. Today, we feature a guest post by recent PhD Lea Povozhaev on some of her work concerning addiction and narrative. Recent work has been done in the fields of anthropology and narrative medicine, particularly about the embodied experience of patients. Welcome, Lea!
Conceptualizing Addiction and Narrative Understanding
It is essential to listen to patients’ expressions of their thoughts and emotions because in them, they tell of embodied realities that effect physical well-being. My resent research of conversations between an addiction doctor and his patients illustrates a disconnect in communication, particularly when the doctor fails to hear and respond to patients’ utterances about these thoughts and emotions. When doctors perceive their conversations with patients as narratives through which patients express senses of “selves” (including explanations of emotions that lead to behaviors and effect one’s body), it leads to greater facility in treatment and understanding.
Like most people, I have met with doctors who seem to perceive me as “merely” a body. I have, however, also known a doctor who took my story into account and became more aware of who I perceived myself to be, which effected the over-all way that I felt. I’ll begin here as an example.
I’d been meeting with my family doctor for the past decade, and I was comfortable with her. She was always open to hear stories of my life, to understand me emotionally and physically. While she, like other doctors, budgeted the valuable minutes we shared, she did so with a keen ability to interpret my utterances on emotional and physical well-being in symbiotic relationship. For example, when I later picked up my medical records, there were many notes regarding anxiety written alongside notes on my physical conditions throughout the years. She had an ability to tie together the workings of my body in relationship to social situations in my life. She listened to my complaints of a sinus infection and also heard the pains of having in-laws move from Russia to the States. At that session, she watched my two small boys bounce around the exam room and she seemed to understand more than I complained of, as evidenced when she suggested mothering wasn’t always easy. With this fuller story in her mind, she counseled me as she was able. She seemed to take seriously my complaints of digestive problems. However, she encouraged me to seek counseling as a way to deal with stress and anxiety, even as she also referred me to an internist.
Interestingly, when I met with the internist, she listened to my narrative only to segue into a number of tests (most of them ultimately wasteful and unnecessary), even going so far as to say that it would be “good if I had HIV,” which I did not, because then we’d know the root of the “problem.” She added that there were many good medications now for HIV–and I realized then, as I realize even more now, that doctors’ utterances shape the narrative with the patient. It certainly affected how I felt about myself and about the encounter. As a result, I wanted to understand from a rhetorical perspective how this interaction worked. At one of our last appointments and after expressing my research interest, my family doctor (not the internist) suggested I do a study at a nearby addiction clinic.
At this clinic, I studied the rhetoric of addiction by investigating the doctor’s and his patients’ manner of thinking about addiction by their conceptual metaphors in their conversations. My study shows how one doctor and twenty patients characterize addiction with their utterances of emotion, thought, and activity, and with their responses to each other during conversations within patient-doctor interview sessions. I borrow Conceptual Metaphor Theory (CMT) from George Lakoff and Mark Johnson (1980) and code the metaphorical expressions, or utterances, in my study as disease or illness experience. I find that the doctor typically speaks of addiction as a disease, and the patient typically speaks of addiction as a personal illness experience. However, the doctor at times characterizes addiction as illness, and the patient at times characterizes addiction as disease, and these exceptions occur with certain patterns of response. In the typical conversation, modifications of the conceptual metaphors deployed by the doctor and patients suggest a change in how the participants respond to the topic addiction and to each other. Furthermore, with their utterances and responses, the doctor and patient ultimately construct a conversational illness narrative. And this is important.
Doctors and patients construct a rhetorical position along a spectrum of consensus and resistance. There are times when the patient and/or doctor seem to understand each other and respond, and there are other times when the patient and/or the doctor do not respond to each other. When anyone fails to respond to “the other,” the conversation becomes one-sided and the listener may “resist” the speaker’s conceptual frame and fail to work with him/her and past addictions.
In the context of my study, “addiction” is one’s personal experience of mental and physical illness from chemically altering one’s own consciousness. Therefore, my study of the rhetoric of addiction observes first and foremost that addiction is conceptualized by embodied experiences. One understands addiction from the particular lived accounts one has had with it. For the doctor, medical studies and the wider medical community with which he associates frame his understanding of addiction. In contrast, the patient’s on-going personal experiences with addiction frame his (or her) understanding, and is informed by the doctor’s perspective on his (or her) condition. Therefore, the patient is vulnerable and developing a sense of the disease, while the doctor is “sure” of what addiction is and what needs to be done. Furthermore, a patients’ communities, including friends and family, affect their perspective, which can be at odds with the doctor’s perspective. Because patients are informed by others’ perspectives and don’t yet have a decided perspective on addiction, contradictory suggestions frequently cause confusion. As a result of their different positions with respect to illness, the doctor’s and the patient’s conceptual metaphors underlying these expressions are essentially different. Understanding that–and the narrative quality of the encounter–is thus incredibly important.
Medical humanities, in its focus on intersections between medicine and narrative, can offer important interdisciplinary perspective that allows for greater understanding of the interconnection of patients’ minds, bodies, and spirits. My research continues to investigate ways doctors’ perspectives of patients may become more realized with skills of narrative understanding. For example, recognizing patients’ expressions of thoughts and feelings as characterizing who they perceive themselves to be can be informed by the manner in which the doctor responds to them and shapes their narrative encounter. Currently, I continue research on the science and psychology of addiction to better understand the “addicted brain” and also how this concept intersects with one’s illness narrative.
Dr. Lea Povozhaev earned a PhD this August, 2014, and published her dissertation Addiction Rhetoric: Conceptual Metaphors in Conversational Illness Narratives with Scholars Press. She has an MFA, specializing in non-fiction, 2007, and an MA in Composition, 2004, from the University of Akron. Her memoir When Russia Came to Stay, appeared in 2012 with the Orthodox Research Institute. She is a non-fiction writer with multiple publications ranging from spiritual and creative to academic and literary. Dr. Povozhaev currently teaches composition as an adjunct at Lake Erie College, fueling her passion for medical humanities with research on the science and psychology of addiction.