NARRATIVE PRACTITIONER CONFERENCE PROCEEDINGS 2007

EDITED BY: ALEX CARSON GAVIN FAIRBAIRN MARJORIE LLOYD NIKKI LLOYD-JONES

WITH ACKNOWLDGEMENTS TO CONFERENCE TEAM:

ALEX CARSON MARJORIE LLOYD NIKKI LLOYD-JONES GAVIN FAIRAIiRN DENISE ORAM COLLETTE BLEAKLEY ROS CARNWELL SALLY ANN BAKER GILL FAIRCLOUGH ROS HARRISON

©2008 Published by School of Health, Social Care, Sport & Exercise Science, Glyndwr University Plas Coch Campus Mold Road Wrexham LL11 2AW also available at:

www.thenarrativepractitioner.co.uk
ISBN 9780-0-946881-61-1

The Narrative Practitioner Inaugural Conference 2007
Forward from the Conference Chairperson The papers that follow represent some of the conversations that took place during the First International Conference between 11th June and 13th June in 2007. The weather was fine and participants enjoyed a lively few days, which we have tried to capture in the pages that follow. Of course, it’s impossible to capture the excitement and passions that animated these conversations, but these proceedings do give a glimpse of those memorable few days. A diverse group of people, united by a sense that stories are the glue that gives recognition and respect to us all, shared their own stories with each other. As well as academic papers, there was poetry, music, art and theatre; all combining to constitute an atmosphere aimed at a shared understanding. The proceedings may seem dry and rather stuffy after the many colours of the conference itself, but I hope that some of the excitement is contained in the chapters that follow. For a clearer picture of those few days, readers are encouraged to view the proceedings on our website: www.thenarrativepractitioner.co.uk These proceedings have taken a long time to appear but they have finally made the light of day. Can I thank all the participants at the conference and those authors who have agreed to have their work and life published in this book. Can I especially thank Colette Bleakley for her unstinting support and encouragement throughout. The papers do not represent a final word about anything but the beginning of a conversation which I hope, you the reader, will join in with.

Alexander M. Carson

Contents
Contents Alexander M. Carson. Glyndwr University. The Narrative Practitioner Keynote Paper Brenda Blondeau: York University Toronto Canada: Incest Narratives: Difficult Discourses of a Re/Membered Body Grzegorz Wiącek, PhD, John Paul II Catholic University of Lublin (KUL). Using narrative approaches in research with deaf-blind people Mike Carter, John Handscombe University of Bedfordshire Geoff Tookey, Wooden Hill Theatre Company PROJECT VENA – LEARNING AND UNLEARNING SCRIPT Vera Kalitzkus, PhD / PD Arndt Büssing, MD / Prof. Peter F. Matthiessen, MD: Severe Illness Episodes and Inner Development: A Biographical-narrative Approach Johanna Hunt, Judith Good, Pablo Romero, University of Sussex: The Informative Workspace: Narratives in Software Development Practice A/Professor Carol A V Holmes University of Notre Dame Fremantle, Western Australia Narrative Intelligence: Variations on a Theme Dr Nollaig Frost University of London: The transition to second-time motherhood: an exploration of maternal narratives using a flexible narrative analysis approach Dr Tammi Walker University of Bradford England. ‘Seeing beyond the battled body’ – Narratives of women’s self-harm Christine Savvidou Intercollege Cyprus: Constructing a dialogic space for storytelling in teacher education Martin Hird & Bill Penson Leeds Metropolitan University England : Book Clubs or Lectures? : Facilitating learning in higher education using stories told about mental health problems. Dr Richard Dover NEWI Wrexham. “Keeping it in the Family”: Kafka’s Metamorphosis and the Narratives of Family Psychodynamics. Dr Paul Johnson, University of Wolverhampton England. Making it up as we go along: 98 103 111 115 121 126 131 139 Construction of narrative in Immersive Museum Theatre Jan Rae South Bank University London: The Play’s The Thing … An exploration of the use of narrative in Forum Theatre Dr. Helen Halpern & Dr. John Launer, Tavistock Clinic. London: Narrative Based Clinical Supervision for Doctors Angela Shaw, Shawpathways. England Encounters in the Enchanted Wood Phil De Prez. NEWI Wrexham. Aunty Betty and the sunny day Maggie Jackson University of Teeside England What’s the Story? Developing ways of encouraging undergraduate social work students to think about loss. Richard Mottershead NEWI Wrexham. Including the Excluded: Weathering the Storm Dr Gavin Baker NEWI Wrexham: The use of narratives in the Negotiated Dramaturgy 90 83 75 68 56 48 41 34 25 19 14 4 6

Marion Clark University of Birmingham England: KNITTING UP THE UNRAVELLED SLEEVE My Journey through Mental Distress to Recovery Tracey Holley University of Birmingham England.: A Service User’s Story - the Narrative Edge: An account of my own illness and the resulting implications for research and teaching in health and social work and beyond. Marjorie Lloyd NEWI Wrexham : Dancing to the music: Ethno-narratives of the mentally ill Ayeray, Medina Bustos Leeds Metropolitan University Healing Narratives: Curing through words - The reconstruction of memory in Latin America Sue McBean University of Ulster. Writer and reader journeying with loneliness - "The story of my father" (An Alzheimer's memoir) M. McGrath, M. Vernon, K. Cennamo, P. L. Newbill. A Chapter from Phoebe’s Field: Using Narrative and Design to Communicate “How to Think Science” 181 174 169 153 161 146

Alexander M. Carson. Glyndwr University. The Narrative Practitioner Keynote Paper

Abstract This paper will outline what it is I mean by a narrative practitioner. In articulating this practitioner, I want to say something about narratives and practice, particularly focussing on research but I consider education and professional practice to be practices. Alasdair Macintyre tries to characterize modern life as an attempt to separate narratives from human life. This paper is an attempt to recover, if it was ever really lost, the place of narratives in our lives. The paper will articulate the narrative practitioner as a person who can remember that action or a human practice are enacted narratives and is fired with a passion.

Introduction Can I thank everyone as co-authors of this paper, this setting and this community. The Greeks used to define their community as a polis, which relied upon conversations for its sustenance and development. Over these past three days, we have engaged in a variety of conversations and these conversations have been our polis, our community as an enacted narrative. This quote illustrates the point of my talk today. Insights originate in the conversations we have with other people, texts, ideas or ourselves. I want to suggest that rather than moving away from this source, we need to develop methodologies that keep as close as possible to this source. My assertion is that conversation is the methodology that we can all engage in, without any specialist knowledge. In any conversation there are always participants. I say participants because although empirically we may assume that there are at least two people in any conversation, we all also carry on conversations with ourselves. In this paper, I want to try and get a clearer view of participants in our conversations, the narrative practitioners. As I see it, the narrative practitioner is the person who wants to engage in conversations. These conversations take different forms and methods. Some do poetry; some do therapy, and some do art, while others do clinical practice, philosophy and so many other activities. Our practices can be very different but what we all share is recognition of the value and centrality of narratives in our practices. Alasdair Macintyre says that: …man is in his actions and practice, as well as in his fictions, essentially a story(1985:216) telling animal

I’m not sure that we cannot say something more about who we are but Macintyre points to something essential, something we cannot do without. Deprived of narratives, our lives would collapse into a series of disorganized and unrelated activities. Even this might be describing things too optimistically as without some narrative coherence even our activities would become simply a series of random movements. Narratives are essential to our having some grasp of the world and our place in it. So in this paper, I want to sketch out some of what I consider to be the essential features of the narrative practitioner and the world in which he or she lives in. To do this, I will be talking about human identity, the ethical life and our quest for it. Before doing this, I want to say something more about the relationship between narratives and our lives. Narratives as Life The narrative practitioner, like Isaiah Berlin’s hedgehog, knows one big thing. That is that narratives are an essential part of human life. Without narratives, we would not know who we are, where we came from and where we might be going. The life of any one person gets its unity through narrative. We were born into an ongoing narrative, which we call our tradition. We did not make it and it will survive our leaving. Of course, we can re-make that tradition and we certainly hope that our own life as a narrative can ‘make a difference’ and so can become part of that great conversation. But we cannot begin to understand ourselves or our culture without the stock of stories which constitute our tradition. Many see narratives as less important than that; they see our tradition as an oppressive ‘hang-up’ or burden that we should simply throw off. Many of these people also see identity or our notion of a self as being equally suspect. The modern existentialist, as depicted by Sartre, wants to

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resist any attempt at giving the modern agent any sense of a coherent self and would resist any attempt at a unifying narrative. Despite this Sartre and others wrote narratives. It is the case that we can only understand ourselves and others through narratives. Polkinghorne wrote that we should think of narratives as a ‘kind of organisational scheme expressed in story form’ (1988:.13). I want to agree with this but I also want to point out the reflexivity in this. All research and practice are reflexive productions, where we impose, sometimes unconsciously, an organisational structure on what we see and what we do. Intelligibility Narratives are a way of organizing in an intelligible way what we or someone else is doing. As I have already indicated, we do this through narratives: they are our way of accounting for what is going on or what we see. Every narrative is a practice that orients itself to some rule. Take an example such as voting. We see someone going into a polling station and we immediately see that ‘she is going to vote’. That narrative of voting makes intelligible someone’s actions. We see the context ‘polling station’ and we make sense of the action by applying a rule to the observable movements. The person might not really be voting but our description of the situation meets the standard of intelligibility. Why? One reason is that there is also within the narrative a wider context. To understand a particular behaviour as voting, one has to understand a particular form of life (Wittgenstein, 1967). The narrative points a form of life that contains political parties and some understanding of government. Voting as a description of a particular behaviour, would lose its coherence without these background understandings. And it is not simply the case that this could be a radically individualistic description of behaviour. Intelligibility itself needs a cultural consensus for its own validation. Imagine a society or culture where authority was decided by deciding who should rule by how tall a person was. Here no voting would be required, simply a tape measure. In this society to characterize someone’s behaviour as ‘voting’ would make no sense; people in that kind of society would have no concept or background cultural understanding to understand voting: it would be unintelligible. So narratives are methods we use for making sense of things. But they also imply or pre-suppose a shared culture. Is someone asks me what I am doing and I say that I am voting, that narrative not only says what I am doing, it also appeals to a shared background understanding. Equally, without these narratives, there would be no shared culture. I am talking here in general terms but it is also the case that narratives also constitute particular cultures. So healing narratives can make particular appeals to people in healing communities, medical narratives to health care practitioners, art narratives to artistic communities and so on. In addition, narratives articulate historical or traditional contexts; they constitute that history, that tradition. Not just this particular healing context but the whole history and philosophy of healing, not just this particular medical context but the whole history and philosophy of medicine are constituted in each narrative. Voting gets its meaning from that history and philosophy of democracy etc. My wife always votes because ‘people died for this right’. Voting for her is a positive affirmation of a historical process for women to be socially valued as equal to men. Without narratives, we would have no way of making sense of things and no method for constituting and developing a shared culture. As well as doing this, they locate each of us within this shared culture. It is within each narrative that we try and locate ourselves; narratives help to constitute our identity. Some modern theorists would claim that we do not have any fixed identity; that our identity is nothing more than a contingent or contextual production. I do not agree with this position. If we were nothing more than selves who constantly changed from context to context, from one role to another, we would have no tradition or experience in deciding what to do next. Take Sartre’s version of the modern agent. Sartre tells the story (!) of a young man who is faced with a choice between joining the Resistance and staying at home to look after his elderly mother. For the radically individualistic existentialist there is no tradition, no communal or cultural resources which could help the young man make his choice. Sartre suggests that the young man should simply choose one option ‘without regret’. However, while radical choice has a certain initial appeal, it begins to seem incoherent, when explored further. First of all, someone has to tell the story. What makes this a difficult choice and what Sartre is relying on is our shared understanding of what makes it a ‘difficult’ choice in the first place. After all, it is not the same kind of choice as deciding whether to have a strawberry or vanilla ice-cream. It is difficult because we share Sartre’s cultural context where mothers and nations are more important than icecreams. What Sartre seems to be suggesting is that we can forget who we are (a son, a patriot) and just

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make a radical choice? I do not think that we are like that, persons with no experience or cultural roots, and I do not think that we can approach situations as ‘another first time’. In Sartre’s story, there is a conflict in values and identities. Sartre thinks that his story has no history or tradition but seems to rely on our shared history and tradition for us to understand this choice as a dilemma. If we had no history or tradition, the choice might look more like a choice between going to the left or going to the right. It is because each narrative makes an appeal to a form of life that we hear this story in the way we do and I think Sartre forgot that. Narratives, then, say something about who we are and pre-suppose and indicate a particular form of life or cultural context in which the narrative makes sense. Narratives are our principal way of understanding ourselves and others. Of course, certain research communities, educational institutes and professional groups think of narratives as somehow second best or an inferior way of gaining this understanding. We could characterize this group as the majority. Yet is seems strange that something as essential as narratives could be seen in this way. One further reason for this suspicion of narratives is that it seems that narratives have no measure for judgement. Subjects and Objects This was the issue that in a sense the modern European Enlightenment was a response to. As we all know, the grand narrative of the Enlightenment was a corrective to the mediaeval narrative that placed an implicit trust in the limitations of ordinary perceptions and an absolute faith in God’s perception. Modern science, the ancestor of the Enlightenment, has provided a significant insight into the real workings of the natural world by showing that our ordinary ways of seeing were wrong. This meant that narratives that we told ourselves about the natural world were, in many cases, mistaken. This stronger, scientific narrative revealed new ways of understanding this natural world, leading to what Max Weber calls the ‘disenchantment’ of this world. The Enlightenment narrative gave us our notion of the world having a ‘thing like’ appearance. It allowed us to penetrate into the heart of these ‘things’. A cost that we paid for this progress was the relegation of our stories from a central place in our lives, at least in epistemological terms, to a secondary level. Narratives were dismissed as anecdotal evidence, not amounting to the status of real knowledge. However, we, ordinary people, continued to live through narratives. Science’s ability to develop insights into the real workings of the social world is less impressive. One of the main reasons for this failure is that our ordinary perceptions, our stories, are the real workings of our social world. In phenomenological or ethno- methodological terms, our perceptions or ‘natural attitude’ constitute or reflexively produce this social world. Science, with its more rigorous perceptual instruments such as microscopes, telescopes, scans etc., cannot access this social world. This limitation of science helped in the development of more qualitative methods that were on the surface at least sensitive and sympathetic to ordinary perceptions and our social world. However, qualitative research, in a real sense, acts in the same way as positivism. Rather than explicitly correcting our ordinary perceptions, by the use of a superior method, Interpretivism interprets these perceptions. The use of methods of analysis such as grounded theory, thematic analysis or discourse analysis is designed to amalgamate, reduce and synthesise these ordinary perceptions. Ordinary perceptions themselves are even sometimes used as ‘themes’ or ‘categories’, but even here, these ordinary perceptions are used out of context. Qualitative research, like science and its positivisms, are taking on our ordinary perceptions or narratives and another narrative, usually the researchers, is imposed on it. So, in a fundamental way, both qualitative and quantitative methods are philosophically and methodologically linked in their aspiration to correct our ordinary perceptions or narratives. Positivism, at least, is honest in its intentions to correct our ordinary ways of seeing things. In a real sense, qualitative research is acting in bad faith, in claiming to represent the ‘view on the street’. Respondent validation is an acknowledgement of the possibility of bad faith. The researcher, in both traditions, is someone who is situated outside ordinary perceptions and thus outside our social world, the traditional ‘view from nowhere’. This represents a lack of commitment to the humanity of the people who are being researched. A category or a theme is not the same thing as a person; something is missing in this type of research. Both methodologies assume that there is something ‘out there’, an object that they can grasp with one or a combination of the methods inherent in their respective methodologies. Almost invariably, they do ‘discover’ something out there. However, the irony is that

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what they think that they discover is, in reality, what they invent or construct. This is because all research is a social practice, reflexively producing what it claims to find. There is a lot of confusion about what exactly reflexivity is. I would refer anyone to Garfinkel’s seminal work, Studies in Ethno methodology (1967). Reflexivity is the social practice that reconstructs subjective values as objective facts or reality. While the world has a ‘thing like’ appearance, this is only because we usually forget that we have produced this appearance. Another way of saying the same thing is to look at Wittgenstein’s later work, where he sees reality as a product of language games. Sometimes I ask my students to write down or shout out one word to describe the room we are in. In the same class, some say it is bright and others dull; some say it is clean and some say it is dirty. When these students look around the room, they see or more accurately produce a particular room. It looks real to them. This is what we do when we produce research; it looks real to us. Mixed methods, traditionally understood, will not give us a more accurate grasp of reality; it will just give us more realities. Garfinkel wanted to correct the impression that one could distinguish between the methods used by scientists and researchers to produce their reality and the methods produced by ordinary persons. All were subjective methods that mistakenly assumed that they were responding to an objective reality that they were themselves constructing. I think that we need to concede this at least; qualitative research is a social practice that invariably produces what the researcher needs. This means that any talk of a distinction between subjects and objects or people and reality is a mistake. Research cannot be defined in terms of subjects (researchers) finding objects (modes of communication, decision- making strategies etc.). What both Positivism and Interpretivism do is privilege the researcher’s narrative, while reducing or distorting the perceptions or narratives of the researched. Researcher’s perceptions are given additional validity by their adherence to the structural requirements of whichever methodology they situate themselves in. On the surface, they seem to be more coherent and reliable than our ordinary methods of producing reality. Research is always the researcher’s chosen epistemology and practice, which is reflexively evidenced in the research report. To say this to many of you here today is to say very little. Many acknowledge this and indicate that their work can be externally validated by their adherence to their chosen methodology. However, the justification for privileging a researcher’s perception by reference to its adherence to a particular research methodology is now viewed by suspicion by other more critical perspectives. The argument here is that a researcher’s perception, validated by following methods laid down within a particular methodology, has no more validity than any layperson’s; they are all simply social practices. Just because research is a social practice does not make it bad or wrong. However, uncritically adopting either of these research methodologies will not help us to answer the harder question of value of the research we carry out. However, one question that we could ask of both qualitative and quantitative research is whether it can help people. Helping people is at the core of what we are all about. It would be reasonable to apply the same standards to all our research.

The Foundations of Research and Practice One person who was suspicious that these methodologies do not really help people is Foucault. Michael Foucault wanted to examine the foundations of our modern social practices. While we consider many of our modern practices including health care, criminology and psychology as benevolent, Foucault considers them to be oppressive and dominating. Modern life, for Foucault, is constituted by a ‘normative order’ that appears civilized but is, in reality, a form of imprisonment, invisible to us, but disempowering. For example, he shows, in the Birth of the Clinic (1967, the way that modern medical perception, the clinical gaze, was initiated and refined. His point is that modern illness is now seen as a job for experts, where we lay people, are ignorant of our own bodies and minds. More sinisterly for Foucault, this modern expertise robs us of our potential to be self- sufficient by encouraging us to believe in and depend on expert knowledge. Foucault wants us to resist the idea that expert knowledge is good for us by showing us that it is restricting and malign. He wants to show us that this normative order is both a historical production and a form of domination that works because it looks good to us. I do not propose to spend a lot of time doing a critique of Foucault but I will make the obvious point. Foucault is doing the very thing he cautions us to resist. He, the expert, can correct our ordinary

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perceptions with his ability to see better than us. He can do this on the basis of his new technique, which he calls archaeology. While wanting to resist the positivism inherent in qualitative and quantitative methodologies, he produces himself as the scientist who can see more clearly than us. Should we resist him? Foucault would probably say yes. He wants us to see that there are no universal just a number of contextual truths or realities. This would mean that research, whether qualitative or quantitative, was only true in its own context and subject to the ongoing agreement of researchers themselves. Of course, when Foucault says true, he means you to say it with a knowing smile. Research, for Foucault, is another way of oppressing and dominating people and rather than helping people makes them helpless. While I do not agree with Foucault, as I think that modern life is a qualitative improvement from the days when life was ‘poor, nasty, brutish and short’, I also think that he asks us an important question that we need to answer. It is not enough to look for validity in research in rules for validity produced within research methodologies themselves. Research is not legitimate because it conforms to the precepts laid down as standards for ‘proper’ research. Foucault’s claim is that it encourages us to be helpless and we need justify our research in terms of its ability to help people. While Foucault is often accused of being a postmodernist, I think that there is a difference between the two. Postmodernism is more relaxed about traditional research. Lyotard, an important postmodern theorist, would want to say that traditional research paradigms, far from helping people, have helped the ‘system’ at the expense of people. When I sometimes look around a hospital car park and see all those fancy cars, I see that it does help the system. Postmodernism wants us to be sceptical about these meta- prescriptions or ‘grand narratives’ that promise universal solutions. Instead Lyotard suggests that we adopt more local and time- limited solutions to social problems. This is the age of the parttime contract, flexible working and flexible relationships. In this reality, commitments only last as long as participants want them to. But our commitment to helping people is not circumstantial or contingent but must be a part of all our relationships with clients. Postmodernism refuses to judge, seeing all narratives as relative and of equal value. Two points need to be made here. While postmodernism would not want us to resist universal research methodologies or grand narratives, is postmodernism not just another grand narrative? Secondly, I also think that as professionals we need to demonstrate that our perceptions or narratives or practices are better than the clients we claim to serve. If we accept, as we must, that perceptions can be wrong, we need to develop ways of examining our and our client’s perceptions. Currently, it seems to me, we, as researchers, educators and practitioners, have two models of practice. One is the expert model, where what we do can be validated by an appeal to a scientific tradition. The other option is the ‘cultural dope’ model, where we give up responsibility and just try to report on what the client says. User participation and other new methods are very popular at the moment. However, client’s perceptions of the situation can be wrong. Should we just allow them to prescribe their own treatments, which may be harming them, or should we do something? If so, what? Put succinctly, if there is no such thing as objectivity and subjectivity can be harmful to the subject and others, we need to go beyond these two methodologies and develop newer research methodologies. I think that narratives have that potential. We need to go beyond sterile arguments about objectivity and subjectivity or quantitative and qualitative methodologies and look elsewhere for validation for what we do. We do have a responsibility to show that what we do can really help people. For this we need a more ethically conscious research methodology. Narratives as Practice I want to say something now about the relationship between narratives and practice. After all, the title of the conference and this paper is the Narrative Practitioner. Narratives are not about practices, as if on the one hand we had practices, that after reflection were given substantive form as a narrative. Narratives are the practice. This is so because of the inherent reflexivity of social life. We do not have, despite Husserl’s hope, any way of validly describing an external world abstracted from all social contexts or sediments of meaning. All we have are descriptions as interpretations. All our narratives share this characteristic. They do not claim to be reflective of an underlying reality: narratives do not hide anything. Nor do they, as Positivism and Interpretivism, try to hide the researcher behind the production. So the worry that narratives may be true or false is misplaced; narratives, as has been said, are socially constructed methods for making our and other people’s actions intelligible and are the only reality we have. We may have got it wrong, but they must at least be intelligible. The narrative practitioner knows this.

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Knowing that narratives can be wrong means that they do not claim to be able to say it all or that they are the last word on any topic. Narratives are a possible answer to particular questions; they invite further questions. Aristotle says that all practices aim at some good. So we can question the good of any narrative. We can first of all judge its intelligibility but we can also question the good that it aims at. All the presentations at this conference are aiming at some good. We can engage in a conversation with each of these narratives and ask what good it aims at. The narrative practitioner is someone who is open to conversation, who knows that he or she does not know. Rather than being seen as an obstacle, this fact frees the narrative practitioner to initiate conversations. This is unlike other research methods which try to make claims about other people’s practices. Positivism tries to reveal an underlying reality by developing more technical ways of getting beneath our narratives. Equally, Interpretivism tries to reduce all narratives to one single narrative, usually the researchers. My version of the narrative practitioner is the person who sees these attempts as ways of correcting other people’s narratives and in an ethical way failing to respect the tellers of these stories. I have articulated this more clearly in another paper (Carson & Fairbairn 2002). In research terms, I see narratives as an integrative and inclusive way of bringing all enquiry together, without imposing any pre-ordained meaning on the process. Narratives are open and invite further conversations. Other Stories/Other Minds Because narratives are situated within other narratives, they naturally follow a conversational approach. My quote at the beginning gives a clue to what I am driving at. Unlike Foucault, I do think that there are some intrinsic and external values in conversations per se. But unlike Lyotard, I do not think that the campfire or conversational model is enough. As professionals, we need to move away from mechanical models of research to more organic methodologies. There are many ways of doing narrative research. Many of researchers who use narratives see them as simply data that they can then proceed to reduce or dissect with their favourite analytical bag of tricks. As I have indicated elsewhere, this way of dealing with narratives fails to respect the teller of the story as a whole person. I want in this final section to quickly outline my methodological approach to narratives, briefly outline my analytical method analysis and suggest a practical way of engaging in narrative research. Telling stories is a social practice that is sustained by the values that constitute it. In addition, it is a social practice that we, clients and professionals, already know how to do. We are all tellers of stories. In the context of research, any talk of values leads many to reach for their revolvers. I hear bad words such as ‘contamination’ and ‘bias’ all the time; these are other words for values. Many researchers fear that their work may be contaminated by their values. I have news for them; it already is. Two assumptions inform my analysis of narratives. These are that all narratives are social practices that are constituted or constructed from values and that all these practices aim for some good. The assumption that all narratives, as practices, aim at some good allows us to question the initial narrative from inside the narrative itself. The analyst begins by looking through the narrative to identify both the good that the practice aims at and the values that have constructed the narrative or practice. The good or essential or significant value of the narrative is then used as a standard in which to judge the more contingent values that constitute the narrative. One could think of this is as the narrative or practice reflecting on itself. The idea here is to judge whether the practice could really meet its aim or if something more is needed. We could think of this as an evaluation of values. The methodology does not look for something outside of itself in which to do the analysis. Everything that is required for analysis is already in front of us. Research, using narratives, is about looking again at what we do. The method is similar, at the beginning, with many current ways of carrying out discourse analysis. The first phase of analysis could be likened to a Deconstructive phase of analysis. The analysis then proceeds to develop a critical conversation between the good that the practice aims for with the values that constitute the practice/ narrative. The point of analysis is to judge whether the practice can meet the aim or good that it proposes. Unlike other forms of discourse analysis, the analysis goes on to reconstruct the practice. Here, the Reconstructive Phase shows whether the practice can meet its goals and if not to suggest ways that the practice/ narrative can be re-articulated in a better way. In this way, the aim of researching the narrative/practice is to say more about the practice. In this sense, narrative research does

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not stop at simply deconstructing our current practices. I think that as researcher, we have a responsibility to do something other than raise an arched eyebrow or put everything in parenthesis. To act in this way is to act as the expert, viewing the human condition from somewhere outside it. Narratives, as I have outlined them, provide an opportunity for researchers and respondents to engage in critical conversations, where both accept responsibility for what they do. In education and practice, I have suggested elsewhere (Carson 2001) that it may be helpful to articulate more than one narrative of a situation to show that there are different ways of seeing the same situation. Charles Taylor shows that this way of analysing narratives is something that we already do from time to time. The researcher comes with one story to the situation, the respondent or client with another. Rather than simply subsuming the client’s story into our own grand narrative, these two stories can be explicitly evaluated by engaging with both in a dialogue between researcher and researched. This approach is an ethical evaluation that judges both lay people’s and researchers’ perceptions by engaging in a critical conversation. Of course it means that either/ or the wise and the many may be wrong and it requires courage on our part. However, it forces us to justify ourselves in a more explicit way rather than just assuming that we know best. So research reports, using this method, would allow readers to see where everyone was coming from and the ultimate standards or values that we have used. Readers could see what our judgements were and the justification we have used. It would also allow researchers to become more conscious of their own practices. As we know, our practices are reflective of who we are as well as what we do. The researcher’s identity becomes the criterion or standard that drives the practice. I know that this may expose us rather more than we might like but I think that it is `a more responsible response to the people who we are trying to help. I appreciate that this is necessarily a brief outline of my analysis but I hope that I have said enough to show that this is a reflective form of analysis that allows the narrative to reflect on itself and its abilities to meet its professed aim. The analysis is an ethical evaluation. This is necessarily so as the foundations of all health and social care is, as I have already indicated, an ethic of help. It is also working with people rather than with data. It respects the tellers of stories by not simply imposing an assumed ‘superior’ narrative upon respondent’s own perceptions. However, just because it respects others does not mean that the assumption is that clients or respondents are always right. We have a responsibility as researchers, educators and practitioners to be more explicit about what we offer and sharing stories is an effective way of doing it. I also believe that it is the surest way for researchers to really connect with practitioners as currently few practitioners read the latest research to the extent that they change their practice. Narrative analysis gives everyone to think about and change their own practice. Research in health and social care is about re- searching or looking again at our practices and narratives can help us to do this. It helps to judge the value of both expert and lay perceptions and provides an opportunity, by developing a critical conversation between researchers and respondents, for both to see beyond their own perceptions and to say something more about their practices. Finally, I wanted to say something about how practical they are. People have made a good point when they say that yes, narratives look promising but no research funder will give money for such a different undertaking. My answer is the same one that applied for many years to people who wanted to get money for qualitative studies and were continually rebuffed. A second practical difficulty expressed by some is that they are unclear what research would look like. One example is obviously to mimic a case study approach, with a number of narratives from all participants in the same situation used as basis for a closer conceptual analysis as outlined above. I am currently working on an analysis of the narratives of a group of lecturer- practitioners in health care who construct narratives to help student nurses to mediate the theory- practice gap. However, it is early days and I am sure that new methods for presenting and disseminating this kind of research will be needed. The Narrative Practitioner To sum up. I have said something about how essential narratives are in our life. Attempts to subsume narratives within another existing methodology were attempts to correct or harden our perceptions. They have their place and have certainly improved the quality of our life. However, given modern critiques of the value of our traditional methodologies, I would suggest that we see other research methodologies as simply other narratives. In our world, narratives still carry more weight with the many. The narrative practitioner sees all research as a process in self understanding and all research methodologies as attempts to develop this understanding.

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The narrative practitioner reveals him or herself in the narratives that he or she constructs. This practitioner knows that the narrative is a possible answer to a question. The narrative practitioner knows that the narrative is not the limit but an invitation to further conversations. He or she is fired with a passion to engage others in this conversation. The narrative practitioner recognises that our tradition is also not the limit. The interaction of narrative and tradition can be developed by all who join this conversation.

References Carson A. M. (2001) ‘That’s another story: narrative methods and ethical practice’ British Journal of Medical Ethics 27:0-4 Foucault M (1967) Birth of the Clinic, London, Penguin Garfinkel H. (1967) Studies in Ethnomethodology. California: Prentice Hall; Lyotard J.-F. (1992) The Postmodern Condition: A Report on Knowledge. Manchester: Manchester University Press Macintyre A (1985) After Virtue a study in moral theory London, Duckworth Polkinghorne D.E.(1988) Narrative knowing and the human sciences. New York, New York University Press Taylor C. (1985) Human Agency and Language Philosophical Papers Vol. 1 Cambridge: Cambridge University Press Taylor, C. (1992) Sources of the Self: The making of the Modern Identity Cambridge: Cambridge University Press Wittgenstein L. (1967) Philosophical Investigations Oxford: Basil Blackwell.

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Brenda Blondeau: York University Toronto Canada: Incest Narratives: Difficult Discourses of a Re/Membered Body Abstract As an anti-racist, anti-oppression feminist, I constantly advocate for the telling of seemingly unspeakable horrors, in an effort to identify, challenge and eradicate myriad forms of oppression in the lives of women. I strive to break silences, to tell, and to hear, the previously unspoken stories – the stories that have often been deemed too ‘difficult’ to share. As I work through the stages of researching and writing my dissertation, I interview women survivors of incest to determine whether, or when, they felt they had any means of resisting at any point during the abuse, or in their subsequent survival/recovery. I constantly struggle to merge the ‘difficult knowledge’ provided by the participants with my own story as an incest survivor. Academically, I advocate for the political power to be gained in presenting women’s narratives; more recently, I have taken up the pen to plot my personal narrative as a woman who recalled episodes of incest through kinesthetic—‘body’— memories. Interestingly, it was in the moments of sheer terror when I began to recall the abuse that I literally, and figuratively, began to re/member my body. I gently began to gather my fragmented feelings; my scattered senses; my dissociated demons. I had no further desire to leave my body, despite the fear of being touched, fondled, grabbed, or violated by an unseen and therefore unidentified abuser. I struggled to privately and publicly challenge this invisible invader. I began, slowly, to move gracefully and gratefully back into my flesh. Now, years later, as I continue to re/member my body, I write for wholeness and health; I bear witness publicly and personally to tell the stories—mine, theirs, ours—to challenge the power of perpetrators who would render all abused women scared, submissive and silent. Working through the many difficult, albeit necessary, stages of researching and writing my dissertation has, at times, been completely debilitating, as my personal history insidiously intrudes upon my academic endeavours. Despite having moved through various levels of healing, the physical and emotional toll I experienced while conducting the research has been far greater than I would ever have imagined. Still, my personal desire to practice what I advocate is just as important as my need to care for my emotional and psychological well-being, and I find that I cannot abandon the process – that I cannot shake the need – to present the myriad stories. And, as I remain dedicated to my project despite my seemingly slow progress, my personal commitment to integrate my story with those of the participants has not wavered. It is how I maintain integrity in the process, as I take personal risks alongside those women who so bravely participated in my research. I often wonder why I feel driven to include my own story along with the stories of my research participants. Or, rather, why is it so important that I foster the organic joining of the stories—the development of my own narrative alongside the difficult details divulged by the respondents—despite the potential risks for each of us? At first, I felt it was rather self-indulgent and self-serving to bring myself into the picture. Now, after working through the process for several years, I understand that it is one of those things I do, simply because I cannot do it any other way. First, let me explain that when I say I take risks alongside these women, it is not to glorify my own disclosure; rather, it is to acknowledge and validate the concerns of many of the participants (academics and non-academics) who seemed genuinely concerned with maintaining their anonymity at the same time as they were more than eager to share their personal narratives. The possibility that they could be identified caused them much anxiety. One woman, who I accidentally called by name, immediately stopped the interview while I erased any identifying information from the audio-tape. Another woman hesitated when I asked her to sign the consent form. She wanted to know who would ‘see’ her real name. Despite the fact that she claimed to have no family or friends in Toronto, she was careful to maintain her anonymity. And yet another woman agreed to sign the consent form, but declined the honorarium, because I would have to submit that form for the reimbursement of my research costs. In an attempt to understand these women’s concerns, I think back to my pilot interview and my first research participant. That woman spoke of the first in-class video she had seen on incest. Upon seeing it she felt physically sick; she was certain that her intimate knowledge of the subject matter must be written on her face for all of her classmates to see. Clearly, a significant portion of the women I interviewed believed that their individual stories were so unique that they would be instantly recognized by anyone reading my dissertation. And, as I continue to listen to their narratives, with their differences and their similarities, I feel a wrench in my heart because, as a researcher, I see that the details and boundaries blur and that many of the stories could, in fact, be any of the stories. Each one becomes another…and

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an/other…and an other. The pain each of the women carries, often alone, bears a striking resemblance to the pain carried by other survivors…by many survivors…by too many survivors. And why is it so important to include my own story? To be clear, I self-identified in my ethics forms and in my dissertation proposal, and I will self-identify in various places throughout my dissertation, although I will not include as much of my story as I offer in today’s rendition. I will, however, continue to weave my story, sometimes on its own and sometimes in relation to the participants, into various creative forms of writing and research. To further explain my determination, desire, and need to present my own story from various subject positions, I refer to Janice Williamson, who writes of Elly Danica’s pivotal autobiography Don’t: A Woman’s Word. As Williamson (1992) explains, Danica’s feminist account is an enactment in a language of a woman’s pain; this embodied tortured knowledge is unmediated by a comfortable framing narrative that would provide the reader with a safe critical distance. Language is at the centre of Danica’s remembering. Boundaries of language are exceeded by writerly suffering and the reader’s horror (p 139). This deftly sums up my experience of listening to my research participants. There is often no ‘framing narrative’ as the gory details of the women’s lived experience of the initial act of incest and of its long-lasting after-affects flow from a stark landscape of pain with no buffer to prevent me, the listener, from becoming enmeshed in the story of suffering and resistance. My visceral responses propel me into a world beyond words, while forcing me, through language, to acknowledge and share the women’s pain. At the same time, the rebel in me is moved to action when I read of the negative reactions faced by those academics stepping forward to share their own incest narratives. For example, Janice Williamson (1992) explains that, over lunch with feminist scholars, I am told that sexual abuse and incest are inappropriate topics of conversation…I am unsure of anything but a story my body has recently remembered…I become aware that others’ resistance may derive from their own secreted memories. I ask myself once again whether my storytelling comes out of mere self-interest. Or am I responding to the interest of another woman at the table who reaches out to say, ‘Sometimes it is important to tell the inappropriate story’ (p 143). Despite the possibility of facing the same type of stigmatization as discussed by Williamson, I continue to locate myself as an academic researcher who is also an incest survivor. Having worked with women survivors and having seen their positive response to my disclosure, I argue for the absolute necessity of continuing to present my personal narrative along with those of my participants. As I work through my dissertation, it is imperative that I bear witness to the ways in which my mind and my body continue to betray me; or, if I were to be completely honest, to recognize how they continue to protect me. With this in mind, my personal narrative of bodily integration and re/membering would remain incomplete without a clear acknowledgement of the physical, emotional, psychological and spiritual pain I continually experience in this research process in which I have become completely enmeshed. And so, to begin ‘my story’ I will step back and begin by briefly relaying, in the form of stream-of-consciousness vignettes, my emotional and visceral reactions to some of the interviews I conducted in 2005. This, I hope, will show the effects of my constant revisiting of abuse in the process of conducting my dissertation research. It is my experience as an incest survivor, researcher, and writer who was not always allowed that ‘safe critical distance’ and it clearly maps some of the contradictions inherent in conducting this type of close, personal, and difficult research. Clearly, as much as I appreciated the women’s generous participation in my research, the interview process was painful. I often felt ‘trapped’ as the women’s narratives brought up memories of my own experiences of victimization and survival. However, despite my seemingly negative mind-chatter offered in the following vignettes, I remain deeply indebted to the women for their courageous sharing, and I feel honoured to have spent time with each participant. Vignette #1: ‘This one seems promising’ I arrive at the door, coffee in hand. A large coffee. Small hands. Shaking. As always, a bit out of breath when I arrive, and more than a bit anxious. This woman seems pleasant, but the cats are a bit too friendly for my taste. She talks. I listen. I talk. She listens. We work together to create today’s amazing and yet painful story. The air conditioner is loud. Too loud. I worry about the quality of the recording. I am secretly grateful that the woman does not seem too ‘needy.’ I’m not sure how much more I can give, and supporting takes so much emotional and physical energy. The interview continues for more than four hours. I am hungry: hungry for food, and hungry for something that will stuff down these unpleasant feelings. The interview is great. It would be better if it was over. I sternly remind myself to ‘stay present’ as I feel myself slipping away, the dark edges of the tunnel narrowing

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my vision. I focus on the woman. I think about her courage in e-mailing; in phoning; in being home when I arrived. I’m squirming, although maybe this isn’t visible. I’m starving and yet—I’m not sure how much more of her pain I can consume. Still, she places it before me and I continue to devour it greedily. ‘If I can just get through this interview,’ I tell myself, ‘I will go to McDonald’s.’ I know I will stuff myself with food, both to deal with my physical hunger, and also to deal with the anxiety that persists in eating its way up into, and through, my stomach. During the interview, I use this as an incentive. It is the carrot I dangle before my own eyes as a means of bribery and survival. Isn’t it enough that I was made to stay in one place when I didn’t want to, all those years before? Now, I perpetrate the abuse, as I find a hundred excuses to stay despite the voice in my head that is screaming for me to run…to hide. Finally, the interview is over. We are both hungry, and we both talk about eating, although neither of us suggests sharing a meal. We both may need to distance ourselves from the ‘other’ who has just scratched back a barely healed scab and exposed the raw, fleshy wound to the stinging air. I know I need to be away from this woman; this very articulate, funny, intelligent woman whose story of victimization and survival is so different from all the rest, and yet so similar… Vignette #2: ‘Self-Abuse’ I answer the phone; I respond to the questions; I begin the screening process. The woman seems friendly…engaged. I open a space for dialogue. Shit! I’ve opened it too wide. She has come in, waytoo-close and way-too-fast. Now what? How can I back away, when my back is already against the wall? How can I stop her from repeating herself over and over…the mantra of her abuse…the mantra of her abuse…the mantra of my abuse? Centre. Focus. Try to stop the screaming in my head…try to retreat and return to a place of safety. Okay, so I need another interview and this could be my last opportunity. Take it, and be damned. I take it. I’m damned. I meet her in a public place. It is an unusual location for an interview, but it is her choice. Such a personal story for such an impersonal space. How odd. How perfect! The boundaries blur. It is a comedy of errors. She wants counseling on her current love-life. I’m reaching for research data. For three hours I hold the tape recorder up so that it catches her voice. I have captured her voice, but I have not silenced her. I force myself to sit through the interview. I am truly grateful for her time and her story, but all I want is to be away from her. She pushes all of my buttons, and once again, I am small and anxious, with silent screams reverberating through my mind and my body. I stay until she begins—finally—to lose interest. She walks with me to the corner. I make some lame excuse about having to go somewhere. I go. I find another McDonald’s. I stuff down the food. And, as I further abuse my already-traumatized body, I remind myself that, once again, I am simply doing what I must in order to survive. Vignette #3: ‘Strength’ I am looking forward to this interview. This was my second respondent, but my 13th interview. Lucky 13. She persisted, despite the logistical difficulties. She made the arrangements. I just have to show up. I am impressed by her determination. She arrives. We go into a hot and noisy room, grateful for the privacy. We talk. She’s interested in discussing today’s painful topic, and in asking questions as she goes along. Again, the story for today is a generous co-creation, an empathetic sharing of pain and growth. Her story is at odds with…her story. She speaks of multiple abuses, from a number of family members. She was abused everywhere she went. And she kept going. Abused…moved…abused… moved…abused…moved… It seems like a story of absolute helplessness and powerlessness. It’s not. This is the story of a girl who wasn’t afraid to challenge her abusers; who wasn’t afraid to call the authorities for protection. She worries, though, about having lied that one time. She told the social worker that she was physically abused. She didn’t say she’d been raped. She’s a recovering Catholic. She still feels bad about having told that lie. I don’t know if I should laugh or cry. Throughout the interview, I marvel at her strength—at the stark contradictions in her life. She was so badly abused…and yet, she refuses to be in physically abusive relationships. She shows the utmost courage and strength, while she seems (to me) lonely and a bit sad. She has no friends. She has no family with whom she is in contact. She does not work. She once held a job for about six months. She moves often, from province to province. As we leave the building after the interview, I ask her if she will be okay. I remind her that she can call me if she is in distress. Then, she asks me if I will be okay. It is such a simple, sincere and yet poignant question. I cry every time I remember this.

In a time before the vignettes…before the research…back to a time of re/membering

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Time is not linear. Life does not move in straight simple lines that stretch only forward. My father died in 1985. I began to recover body memories in the early 1990s, and I began graduate studies in 1998. It would seem, then, that I could easily separate these events, but I often find the narratives intertwine. My personal story of survival and healing blends into my academic research, and into the narratives provided by the women who responded to my call for participants. In the beginning, though, the only word was mine. I was not searching for their stories. I was simply looking to survive. I felt my first twinge of recollection around the time of my father’s death. While visiting him, my shoulder twitched almost incessantly, and I couldn’t bear to look down the seemingly endless corridors in the hospital basement. It reminded me of the infinite line of images a person sees if she hits the correct angle while using one mirror to look behind her into another. I have always hated and feared those reflections that went on-and-on. The corridors in the hospital elicited that same anxiety. This type of infinite repetition still bothers me, although I now understand why my reaction is so immediate and so visceral. It tweaks my subconscious, brushing the edges of those shadowy recollections that fill me with dread. It reminds me of abuse, of being forced to endure something that went on and on…and on and on…seemingly forever. I still abhor seeing or feeling anything that reminds me of those never-completely-forgotten and yet not-quite-remembered moments of silent struggle. Six years after my prophetic twinge, and six years after my father’s death, I lived through what seemed like an endless period of sheer terror in my home, as my body began to release the memories that my mind could not yet comprehend. I experienced unexplainable and chilling kinesthetic memories. I would lie in bed at night and feel someone crawl in behind me. I would sit in the bath, humiliated and disgusted, as some unseen person or entity burrowed into my crotch. I slept on my couch for 18 months because I was afraid to sleep in my bedroom. When I finally slept in my room I kept the blinds open for another year. The worst of this was that I lived alone so I had to face my fears, and my feelings, on my own. The kinesthetic memories mirrored the terrifying tales of a thirdrate horror story of demonic possession – I understood only later that the demons who were attacking me were family members and that the incidents had actually occurred years earlier, in a time when it was unsafe for me to remain at the site/sight of the crime. In my dissociative state, I stuffed those memories into my cells, as deliberately and as unconsciously as I later stuffed down the food – to hide the evidence and to bury the pain. And, as surely as I had stuffed them down, they had come back up again, with a vengeance. No, life does not move forward in straight simple lines. It can quickly turn back upon you when you least expect it. And, like many of the women I interviewed, I’ve suffered many abuses – some of them more than once: first, many years ago in the initial process of victimization; then later, in the terrifying ordeal of recovering memories; and still later when I began to disclose. But today’s story is not one of defeat or ongoing victimization; rather, it is a story of survival despite facing what have often felt like insurmountable odds. I really have moved back into my body, and as time presses on, it feels like a safe, comfortable home. I continue to draw together snippets of my past, intuitively retrieved through kinesthetic memories. I struggle through night time dreams of abuse and resistance, as I reconfigure the story of my childhood. I gently ease myself into wholeness and health, and I absolutely insist on the benefits of an ongoing creative re-telling and re-shaping of a life molded by incest. In this way, I honour my past, my present, and my future, and I hope that I honour the women who have so generously shared their own narratives of pain, suffering, survival and resistance for my research. It has been, after all, in the telling of their stories that I have begun to recognize the unquestionable necessity of presenting and re/presenting my own survivor narrative. Endnotes According to Laura Ahearn (2001) “agency refers to the socioculturally mediated capacity to act” (p112). She argues for both social and grammatical acts of agency, recognizing “language as a form of social action” wherein resistance can be identified in particular linguistic features (p124). In my interviews and analysis I carefully negotiate the various ways in which women and girls act agentively. I do not expect girls to resist their abusers; however, as I have found, there are many points at which girls do, in fact, show a certain level of resistance. In some cases, this can be the (sub/conscious) act of dissociating; in other cases, agency is enacted in the retelling of the horror, as the detailed process of transcription, coding, and analysis uncovers myriad acts of linguistic agency.

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Many theorists advocate for the necessity of witnessing the difficult knowledge presented in particular narratives, including those of rape and incest victims and of holocaust survivors. See, for example, Brison, S. J. (2002) Aftermath: Violence and the Remaking of a Self. Princeton, Princeton University Press. See also Felman, S. and Laub, D. (1992) Testimony: Crisis of Witnessing in Literature, Psychoanalysis and History. New York, Routledge. And, finally, see Avni, O. (1995) ‘Beyond Psychoanalysis: Elie Wiesel’s Night in Historical Perspective’ in Kritzman, L. D. (ed.) Auschwitz and After: Race, Culture and ‘the Jewish Question’ in France, p203-18. New York, Routledge. Briefly, the stages of my dissertation include: designing the project; submitting the proposal for ethical review; soliciting for respondents; screening respondents; conducting interviews (from two to four hours in length); transcribing the audio-taped interviews using the conventions of discourse analysis; coding and analyzing the transcriptions. I have drawn upon a diverse range of perspectives to develop my methodological and theoretical frameworks. For discussions of the difficulty, and of the career-damaging potential, of self-disclosure within the academy see Ford, L. A. and Crabtree, R. D. (2002) ‘Telling, Re-telling and Talking about Telling: disclosure and/as surviving incest’. Women’s Studies in Communication, vol. 25.1, 53-87. See also Ronai, C. R. (1995) ‘Multiple Reflections of Child Sex Abuse: An Argument for a Layered Account’. Journal of Contemporary Ethnography, vol. 23.4, 359-426. See Elly Danica’s (1988) autobiography Don’t: A Woman’s Word. Charlottetown, PEI, McClelland & Stewart Inc. References Ahearn, L. (2001) ‘Language and Agency.’ Annual Review of Anthropology, vol. 30, 109-37. Williamson, J. (1992) ‘I Peel Myself Out of My Own Skin’: Reading Don’t: A Woman’s Word’ in Kadar, M. (ed.) Essays on Life Writing: From Genre to Critical Practice, pp133-51. Toronto, University of Toronto Press.

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Grzegorz Wiącek, PhD, John Paul II Catholic University of Lublin (KUL). Using narrative approaches in research with deaf-blind people Abstract Research with deaf-blind people is problematic, because the sensory difficulties they experience lead to difficulties in communication, language and other cognitive and social processes. As a result, questionnaire surveys are of little use as a way of obtaining information about them and their lives, and structured interviews, though better, are difficult. In this paper I want to suggest that narrative methods offer a solution to some of these problems, arguing that storytelling is both more informative and practical than either questionnaire or interview, and more ethical, because it is more respectful to deaf-blind people. Narrative methods can allow us more easily to identify not only weaknesses, but also the strengths that deaf-blind people often develop, either in spite of or as a result of, their sensory impairments. Giving people the opportunity to tell their stories engages them. Listening to their stories takes us into a more personal relation with our respondents. Listening to a person’s story gives us a deeper look into her life and thinking, and allows us to gain more information about it. Of course, such an approach has certain limitations, which arise, for example, from the fact that deaf-blind people often have poor language skills. I will consider such limitations.

In this paper I am going to discuss the use of narrative approaches as a way of doing research with deaf-blind people. Before I do that, however, I would like to tell a little about the landscape of deafblindness by introducing a few people. Grzegorz Kozłowski The first person I want to introduce is Grzegorz Kozłowski, a man of about 40 years of age, who has a charming wife and four lovely children. Grzegorz works in Polski Związek Niewidomych (The Polish Association of the Blind). He is also the president of Towarzystwo Pomocy Głuchoniewidomym (Help for the Deaf-blind Association) in Poland. Legally Grzegorz is both deaf and blind, but since he has some residual vision and hearing ability, he can see and hear in certain conditions. For example, using very specialised equipment - a monocular, a very strong magnifying tool, which is a kind of a small, 5 inches long telescope, he can read text on a computer screen. Apparently, using such a tool feels like looking through a key hole, so you have to be very well concentrated to cope with reading in such conditions. Grzegorz can also talk to other people, listening to them through two separate hearing aids, one for each ear, and an FM-radio system, which consists of a microphone with a small radio, and two receivers for each hearing aid. Even with all of this very specialised equipment, however, Grzegorz often needs help from other people. For example, at times he needs the help of a person to guide him while going somewhere. And sometimes he will need someone to speak to him using a specialised alphabet for deaf-blind people, to describe what is going on and to translate what is being said. Without his equipment, Grzegorz can’t see or hear anything, so without it he is not only legally but actually deaf and blind. Zdzisław Koziej The second person I would like to introduce is Zdzisław Koziej. Like Grzegorz, he has a family and a job. He also is a sportsman and has been selected to represent Poland in sporting events, for several years. For example, he runs in marathons and plays goal-ball, which is a special game for blind people, using a ball containing a bell. Recently he began ten-pin bowling. Like Grzegorz, Zdzisław is a deaf-blind person, although he has wider sensorial abilities, than Grzegorz Kozłowski. Nonetheless, like Grzegorz, at times he needs a guide-interpreter, and he needs good light and a long while to recognise someone’s face, even when they are no more than a yard from him. Zdzisław also has some problems with language. Sometimes, for example, he doesn’t understand what is said, and sometimes it is difficult for people to understand what he says.

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Mirosław Luszawa The third deaf-blind person I want to present here is Mirosław Luszawa. He is about 45 years old. He lives with his mother and is a totally deaf-blind person. He uses sign language to communicate with others, but the only person who had relatively good contact with him was his father who unfortunately passed away two years ago. Now, even staff from a Deaf Rehabilitation Centre have problems with understanding Mirosław properly, because he, and his father, jointly modified general standards of Polish deaf signs in a way that others have not yet learned. Even in his family there is no-one who can talk to him now. Who is a deaf-blind person? Looking at these three people, who share only some characteristics, raises the question of what criteria must be fulfilled before we would classify a person as deaf-blind. There are many definitions. Most start with two sensorial impairments – related to vision and hearing – that all deaf-blind people have in some measure (see, for example, Gothelf, Petroff & Teich, 2003). But we can’t stop here. In addition it is necessary to take account of the very specific problems that result from these impairments, and are to be found in every aspect of the life of a deaf-blind person. We are moving here towards the definition of deaf–blindness offered by Majewski (1995) who writes that a deaf-blind person is ‘an individual with concomitant vision and hearing impairment, which cause specific problems in personal, occupational and social life that can be addressed only by very specialised services’ (p 41). In order to address such specialised problems it is necessary to develop specialised solutions. Together with their sensory impairments come complex functional problems in the life of deaf-blind people. Some of these are inevitable in vision and hearing loss. They include problems with locomotion and communication – two main areas of deaf-blind people’s problems in everyday life. A deaf-blind person usually can’t leave home alone; in addition their communication difficulties usually mean that they can hardly talk, for example, to a clerk in an office, or to a doctor in a health centre; and in some cases they will be unable to do so at all. As a result deaf-blind people commonly need the help of a guide-interpreter – a specialised person who supports them in everyday activities. At another level, problems of a psychological kind often occur in deaf-blind people. Majewski (1995) who carried out an international literature review, points, for example, to low quality of life, loneliness, little control of one’s life, challenging behaviours, and depression. All of the above mentioned issues, come about as a result of the disabling effects of impairment, but it is very important to note that they do not necessarily belong to their lives. Some deaf-blind people overcome much. Categorization of the deaf-blind population The three people described at the beginning of this paper give us a feel for the diversity to be found in the deaf-blind population, which depends both on the extent of their vision and hearing impairments and on when those impairments began - for example, on whether the person was deaf-blind from birth or became such an individual later in life. This diversity is significant in determining the lives and abilities of deaf-blind people. For example, it makes a great difference whether a person has total or partial sight loss, and is totally deaf or has a partial hearing impairment. Deaf blind people have been categorised in different ways, using different criteria. Some authors divide them into 16 groups, using the above mentioned criteria of time and extent of impairment. Others talk about only 3 or even 2 groups, based on level of functioning. Bruce (2005) and Hart (2006) both focus on problems with language and cognitive development that are experienced especially by people with congenital vision and hearing impairment. For the purposes of this paper I would like to categorise the deaf-blind population simply into three groups, depending on language communication. I. The first group consists of individuals whose communication and cognition is at an average level when compared to the rest of society. Into this group would fall people like Grzegorz Kozłowski, the first deaf-blind person I presented. Grzegorz is fluent in the Polish language. His cognition is unaffected. This makes a situation in which, using technical aids, such as FM-system, computer, Braille screen or others, we can communicate with him fairly well. So the first group of deaf-blind

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people in my categorisation are people with whom we can usually communicate adequately in Polish or English, or whatever national language they know. What is important for the purposes of research is that such communication is efficient enough, to employ standardised research tools, such as personality questionnaires. 2. The second group consists of people like Zdzisław Koziej – the deaf-blind sportsman. His communication and cognitive processes are quite good, but there are some limitations. Someone can easily have a chat with Zdzisław about everyday activities. For that purpose some problems in understanding aren’t so important. However, a different situation would arise if we wanted to do a psychological test or use a questionnaire with someone like Zdzisław. Then we might have doubts, about whether our respondent was getting the point of our questions, about whether he really was trying to say to me, what I think I can hear in his words. In the end there is some doubt about whether such a person can recognise and communicate properly his own feelings, experiences and assessments. 3. The third group consists of people with very limited linguistic and cognitive skills, such as Mirosław Luszawa, the third – and totally deaf-blind person to whom I introduced you earlier. Contact with such people is difficult, even in relation to simple everyday things and situations. Their vocabulary is very limited and their way of speaking/signing may not be clear for other people. These things make for a situation where it is impossible to use sophisticated tools in research, and even a simple interview is very difficult and hardly worthwhile, in terms of providing proper and reliable information. Methodological issues in research with deaf-blind people Now that I’ve given a brief description of some of the major characteristics of the group of deaf-blind people, I would like to move towards methodological issues in research with this group. First, I would like to tell about some problems that I think arise with questionnaire surveys and other similar methods. Then I’ll explore the possibility that a narrative approach can help to address these problems. At the end I’m going to draw your attention to possible limitations with employing narrative methods in deaf-blind people, related to some specialised issues in this group. Problems with standardised methods There are two main problems when trying to conduct research in the deaf-blind population. The first is specific to research with deaf-blind people, whereas the second is common in much psychological research, but has a special meaning for research with this group. 1. Vernon and Hammer (1996) point to difficulties caused by the lack of psychological tests normalized for a deaf-blind population. They also drew attention to the need for a good command of the English language, as a condition for being assessed by existing instruments. In my opinion the latter is the real problem, and it arises because of the great range of cognitive and linguistic level in the deaf-blind population, to which I referred earlier. You will remember my threefold categorisation: • • • People with good linguistic and cognitive skills. People with some limitations in these skills. People with very limited linguistic and cognitive abilities.

The problem is that only the first of these groups can be accessed using a questionnaire. Admittedly there has been worthwhile research on deaf-blind people, in which surveys were employed, but in each case, the researchers had to make special efforts in order to produce reliable results. For example, like Lieberman and Stuart (2002) they limited the sample they used very carefully, by only including deaf-blind people with good language and cognitive skills. Limiting the sample in this way has consequences in terms of the extent to which outcomes can be generalised. This means unfortunately, that we can extend knowledge in only a limited way, using research of this kind. Another effect of such an approach is that it is impossible to include deaf-blind people who don’t have sufficient language and/or cognitive skills in quantitative research programmes based on questionnaire surveys. Interestingly enough, this group is in even more need, of the help that might follow from the research, than the first one described earlier, because they have more complex needs and less abilities to cope with problems. This raises ethical issues, because we have there a very poor group of people, who are left without any support, just because of the supposed need for ‘methodological purity’.

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2. The second problem, as I have said, is a more general one in psychological research. It relates to difficulties in researching some subtle issues, using questionnaires. I am referring to matters such as personality changes, including some that can cause problematic behaviours; the view of individuals of their own situation; the problems individuals experience and the coping strategies they employ, and the perceived and actual roles in the family that a deaf-blind person plays. Accessing such information using questionnaires is quite a common problem in psychological research, but with deaf-blind people, it has a stronger voice, because of the extreme situation they are in. We can expect that having such strong difficulties with cognition, communication and mobility can result in some changes or adjustments in personal functioning of these people. What we cannot expect is that these changes will make a whole different person or personality. Therefore we need a research tool, a method that is sensitive enough to uncover and to allow us to describe such changes or adjustments in deaf-blind people. Advantages of using narratives in research with deaf-blind people I want to suggest that a narrative approach offers a solution to the problems I have mentioned. It also has some other advantages • First of all, using narratives in research with deaf-blind people, can allow us to include a larger part of this group in research. • Furthermore using a narrative approach can: • Give us more and better, that is, richer and more complex information about deaf-blindness and about deaf-blind people. • Grant us access to areas that would be difficult to reach in another way. • Another advantage of narratives as a research method is that it can make research with deafblind people less onerous. • Finally, a narrative approach conveys positive ethical advantages. I’d like to expand on each of these points. Larger group of respondents in narrative approach Thinking back to the three fold categorization I proposed earlier, it is clear that we can employ narratives not only in research with people who have good language and cognition (i.e. average in the society), but also with the second group I described, which consists of people who have some problems in language, such that we can never be sure whether they have understood some complicated instruction or item in a questionnaire. However, if we just ask a person to tell us a bit about her life, or about her problems and how she copes with these problems; or to tell a story about her disability – we will have a story, or narrative that we can analyse in different ways. The adequacy, richness and extent of information that we can obtain I would like to emphasise that there is very little literature about deaf-blind people. As Rönneberg and Borg (2001) say, a body of research in this group of people is just beginning to build up. We don’t know much about: their lives, • the problems that they meet, • the strengths that they develop to cope with problems, and have as normal a life as possible. Against this background, I would like to draw attention to the fact that it is much better to use as open a methodology as possible in exploratory research, in order to avoid importing into the matter any of our expectations or preconceptions as researchers. This throws up another advantage of using narratives in research with the deaf-blind population, since such methods are definitely more open and thus more effective in exploration, than standardised questionnaires and other similar tools. The information that we can obtain using narrative methods is rich and complex. The openness of narrative to whatever a respondent wishes to share means that the stories that deaf-blind people will tell us can contain not only information that is interesting to us, but importantly, that they will also contain information about things that are important and interesting to them. Therefore we will be able to find out about their problems, and also about their strengths, memories and opinions, views and feelings.

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What we need now is only to employ the most helpful method to analyse this rich information, and then we will have a chance to discover the subtle issues I mentioned earlier – changes of perspective in life, motivational factors and mechanisms, self-image adjustments, or changes in family situation. All of these issues can also be compared to people with other kinds of disabilities to find possible patterns of functioning among and between them. Narrative methods can make research with deaf-blind people easier for them, as well as for researchers. This is another benefit from using narratives, because deaf-blind people simply find it really hard to talk to other people. Even if a deaf-blind person can communicate using language it is often more difficult for her than most people, because she needs to use one of the time-consuming and tiring methods based on touch, that are open to her. Even if a deaf-blind person can see or hear a little it will often be necessary for her to use aids, and to focus very carefully in order to understand what is being said as well as possible. And this is, of course, tiring as well, especially when the talk is about difficult and abstract issues, which will perhaps be unfamiliar and sometimes strange, as often occurs in psychological questionnaires. In comparison to such a situation, giving people the opportunity to tell their stories engages them. Sharing stories is also a more natural way of talking with a person. The motivation of the respondent to engage in a narrative interview can allow us to gain more reliable information. So both the level of engagement and the naturalness of topics that will arise when a person is invited to share stories about her life are likely to result in an easier and less tiring situation for a deaf-blind respondent. In addition there is another knock-on gain, this time for researchers, because having less tiring tasks in research can allow researchers to be more confident with their data and consequently with results from this research. Positive ethical advantages of using narratives in research with deaf-blind people. For each of the issues I have presented so far, there is an ethical side. 1. As I said above, the bigger part of the deaf-blind group can participate in research using narrative methods. As a result we will be able to provide help to the same bigger group of the deaf-blind population. Importantly, this will extend the help provided to people who are in most need because of their more serious problems and lower ability to cope. 2. The second ethical reflection concerns the better quality of information that we gain using narratives in research with deaf-blind population. By ‘better quality information’ I mean information that is more adequate to our needs as researchers and practitioners – including, for example, information covering more areas of deaf-blind people’s lives. Such information will certainly make it possible to provide better help, and this is definitely an ethically good outcome. 3. The third ethical issue has to do with the practical side of conducting research with deafblind people. Using narratives, we can organise a research programme that is more interesting and less tiring for them. Therefore a narrative approach seems to be more ethical in terms of respect for participants’ effort and for the time that they put in it. 4. Finally, I would like to say that asking for and listening to a person’s story takes us into a more personal relation with our respondent. We treat her as more of a person, indeed, when we are interested in her view of certain things; when we are open to what she wants to say, and to what she finds important in her life. Such an attitude makes our relation to a deaf-blind person and the research that we invite her to participate in, more ethically acceptable. Problems with a narrative approach In finishing off my sketch of narrative methods in research with deaf-blind people, I would like to say a little about some problem that could arise in such research. They relate to the linguistic and communicative skills in this group. Obviously, we can use narratives only with people who can tell us a story, and as I’ve already presented in this paper, some deaf-blind people do not have strong enough skills in language and cognition, to do so, even in a simple way. Therefore, employing narrative methods, there will still be people who won’t be able to participate in our research. However, the exclusion of deaf blind people because of their inability to tell a story is less likely to be a problem than their exclusion because of their inability to respond to research using other methods.

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There is another important issue, relating to deaf-blind people who are somewhere in between these who can tell a story and those who definitely can’t. One example of such a group is deaf-blind people who use sign language, whose stories can be difficult to analyse. More than that, with individuals whose language skills are so limited, it can even be difficult to decide what the whole story they are telling is, because it may arrive in several small snippets, rather than as a more or less coherent whole. Both of these situations call for adjustments in the method of gathering stories. Summing up To sum up my considerations, I have drawn attention to some problems in employing questionnaires and other similar methods in research with deaf-blind people. In order to address these problems, my view is that we can use narratives as they have certain advantages in relation to research with this group. Certainly, there are limitations even with the use of narrative, and there could be a need for adjustments in especially quantitative analysis to conduct in described situation, but their use will allow us to access the lives of a bigger group of deaf-blind people. My hope is this will allow us to extend the help and support that can be provided.

References Bruce, S. M. (2005) ‘The Impact of Congenital Deaf-blindness on the Struggle to Symbolism’, International Journal of Disability Development and Education, 52 (3) 233-251. Gothelf, C. R., Petroff, J. G. and Teich, J. W. (2003) ‘Imagine: Relaxation and Guided Imagery with People Who are Deaf Blind’, Journal of Visual Impairment & Blindness, 97 (2) 97-105. Hart, P. (2006) ‘Using Imitation with Congenitally Deaf-blind Adults: Establishing Meaningful Communication Partnerships’, Infant and Child Development, Special issue: Imitation and SocioEmotional Processes: Implications for Communicative Development and Interventions, 15 (3) 263274. Lieberman, L.; Stuart, M. (2002) ‘Self-determined Recreational and Leisure choices of Individuals with Deaf-Blindness’, Journal of Visual Impairment & Blindness, 96 (10) 724-735. Majewski, T. (1995) Edukacja i rehabilitacja osób głuchoniewidomych, Warszawa: Towarzystwo Pomocy Głuchoniewidomym, Polski Związek Niewidomych. Rönneberg, J; Borg, E. (2001) ‘A review and evaluation of research on the deaf-blind from perceptual, communicative, social and rehabilitative perspectives’, Scandinavian Audiology, 30(2) 67-77. Vernon, M. and Hammer, E. (1996) ‘The state of the evaluation and diagnosis of deaf-blind people: psychological and functional approaches’, Journal of Vocational Rehabilitation, 6 133-141.

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Mike Carter, John Handscombe University of Bedfordshire Geoff Tookey, Wooden Hill Theatre Company PROJECT VENA – LEARNING AND UNLEARNING SCRIPT Abstract PROJECT VENA is a multi-disciplinary project integrating staff and students in the departments of Social Work and Performing Arts at the University of Bedfordshire with local theatre company, Wooden Hill and young people who have trained with them. These young people have themselves all been involved with social services and many of them have lived in care, or still do. Through their Trainer Training programme, Wooden Hill develops their skills and confidence as drama workshop leaders and Project Vena gives them an opportunity to exercise these skills and apply their ‘knowledge-from-experience’ of care and social work. Participants in the project work mostly through the medium of drama and the acting skills of the Performing Arts students are therefore central. The climax of the project is social worker training sessions incorporating forum theatre techniques and led by the ‘Young Trainers’ from Wooden Hill. What seems to mark the practice as unique is the way in which the three groups work collaboratively in a safe environment where there is no hierarchy and where the benefits are mutual. Social workers and service users often only ever meet as client and professional, here they can work constructively as equals with a common aim; that is to increase understanding of one another and develop good social work practice. Introduction Project Vena operates within the realms of therapy, pedagogy and performance and functions on a number of levels and in different ways according to the perspectives of the various participants. ‘Narrative’ as a concept, has been integral to the dramatic, the educational and the therapeutic elements of this project. Through their input, the Young Trainers aim to change the narrative of their own lives as well as those of service-users and young people coming into care in the future. For the Social Work department the project offers strong training opportunities and an exploratory entry to Narrative Theory (Fisher 1984 and 1987) and Narrative Therapy (White and Epson 1990). For the theatre practitioners it offers experience of a unique cross-disciplinary model of practice as both facilitators and performers. They are well used to working empathically and creatively with characters and their narratives. As well as their acting skills the Performing Arts students bring with them an important vocabulary. The terminology of the theatre e.g. role, script, performativity etc has been shared by people working in the fields of psychology and sociology and theorists of identity in order to find a vocabulary that articulates culturally determined (or at least influenced) processes and behaviours. Such language emphasizes the perception that identity and behaviours are often constructed, learned and played out according to a predetermined paradigm or social expectation – a script. In 2002, an article posted on the Community Care website reported that “Care leavers are more likely to leave school with no qualifications, be unemployed, suffer mental health problems, fall into homelessness, serve a prison sentence and be a teenage parent.” For the Young Trainers working on Vena there is always the danger that not only their circumstances, but also the description of them as being in care will be defining. That label can turn them into stereotypes with stock traits: a ‘problem’, a ‘no-hoper’ etc. There are lots of negative statistics (see e.g. Barnados and Brook) about young people in care and although these statistics are flagged up to encourage agencies to address problems, they can also inadvertently reinforce the stereotypes. Through Project Vena the young people in care are challenging this narrative and endeavouring to understand themselves as actors able to create new roles and identities for themselves and others. The Social Work File is also something of a double-edged sword. It is both a necessary and (to some degree) informative document, but it is limited and laden with stigma for its subject. As a narrative it is a compilation of usually the most negative events in a service user’s life. For all the words therein, it may only amount to what Narrative Therapists (White and Epston 1990) would refer to as a “thin description” of the service user. Within the drama work and training of Project Vena the file is an important symbol of thin description, self-fulfilling script and social stigmatisation. Whilst we do not cast ourselves as Narrative Therapists we believe that our work shares similar goals to those outlined here by Freedman and Combs (1996, p.16): Narrative therapists are interested in working with people to bring forth and thicken stories that do not support or sustain problems. As people begin to inhabit and live out the alternative stories, the results are beyond solving problems. Within the new stories, people live out new self images, new possibilities for relationships and new futures.

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A Note on Style In this, the main body of our paper, we take a non-traditional approach to presenting information. It is a shared narrative written in the form of a theatre script. In so doing, we hope to embody the interdisciplinary/interagency nature of Project Vena and represent the way our three voices and perspectives interweaved throughout our work. Also, we reflect the thematic threads of script and narrative. Background and Rationale John - Wooden Hill has been working with young service users for about four years. We train them as trainers (with the option of undertaking an NVQ) so they can deliver drama based training to their peers and adults who work with young people. Before Project Vena we had tried to engage in multidisciplinary working, but most of the time it was like wading through treacle. Even when individual workers from different agencies were keen to work together on a project, it was often difficult for them to convince their managers to support it. Geoff - Then Wooden Hill began to work with the university’s Social Work department in Bedford. Amongst other things the Young Trainers took an active part in the interview process for prospective Social Work undergraduates. Mike - In autumn 2005 Wooden Hill approached the university’s Performing Arts department with a view to working together. They delivered some workshops to final year students. John – And by summer 2006 some of these students (having recently graduated) were working professionally with us on a Theatre in Education project about entrepreneurship commissioned by Business Link. Mike - It was around this time that the seeds of Project Vena were first conceived by John. John - There were two key inspirations. The first was that, as an independent organisation who’d worked with both the Social Work and Performing Arts departments, Wooden Hill saw the potential mutual benefits of the two working together. The second was a character called Vena from the Red Rose Chain (2001) film Moving On Up. We had been using this film for some time in training and Vena had come to epitomise bad practice in social work. Part of our approach within training is not to mention words like ‘role-play’ and ‘acting’ because they may carry a stigma for the young people. Instead, forum theatre techniques are referred to as ‘Vena’ exercises. Geoff – When we first came up with the idea of Project Vena, I thought we were just going to make a better training film! In any case we, the Social Work Department, had a problem: in the context of a module entitled Social Work Skills, how could students experience meaningful simulations of situations they would typically encounter in their work after graduating? Some departments and module leaders opt to bypass this problem altogether by working through theory alone, teaching hypothetically what needs to be said and done in such a situation. But we would not expect a teacher, for example, to start work as a professional without having had an opportunity to practice and enhance their skills in a safe learning environment. Social work is no less interactive than teaching, and demands no less skill as a communicator. It seems absurd that applying theory by practicing these skills does not have a more central place in undergraduate social work programmes in general. Even though social work students do a total of two-hundred days on practice placements, the idea that novices gain their first experience of practicing their skills in real situations has ethical and safety implications for both parties. They are simply (and rightly) not allowed to take part in the most delicate and challenging of situations. Clearly there is a need for them to rehearse more complex interactions in a classroom situation. However, for those departments who endeavour to embed more practice the options seem limited with in-house role-play being the default activity. Typically, social work students pretend to be service-users for each other to ‘test’ their social work skills. The problem is that what often becomes most challenging in such a session is not the practice of social work skills but the students’ ability to act convincingly in front of an audience – a terrifying prospect for some. It is no surprise then, that when interviewed about role-play, few Level 2 undergraduates responded positively, most recorded a groaned disdain through to an utterly inhibiting fear. With no disrespect to Social Work students, taken collectively they are not skilled or confident actors. This then calls into question the efficacy of such role-play as a practice. Perhaps it remains more worthwhile than theoretical preparation alone, but it is far from ideal.

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Mike – And that’s where the Performing Arts undergraduates had a contribution to make. For them it would be an opportunity to test their specialist acting skills in a meaningful context that may have real and positive consequences. They would benefit from the experience of working as performers and facilitators alongside a professional company to gain experience of the kind of work they do. They would also develop their skills and CV. John - So a number of initial meetings took place (at the beginning of the academic year) to figure out exactly what it was we wanted to achieve and how we were going to do it. Mike – We soon realised that we were onto something quite new on a collaborative level, with much potential and agreed that we should consider our practice as research. Project Aims Due to the range of participants, the aims of the project were quite varied. In terms of the content of the work we aimed: to begin to examine ‘narrative’ as an educative tool, a theoretical framework, a therapy and a means by which to challenge stereotyping and empower young people; to explore ‘script’, both literally (in relation to the actor) and as a metaphor, and; to deepen understanding of the experience of both young service users and social workers in their encounters with one another. Formally we aimed: to utilise techniques drawn from forum theatre to provide effective simulated training opportunities for students of social work; to simultaneously provide meaningful (work) experience for undergraduate theatre practitioners, and; to assess the mutual benefits for all parties of this cross-disciplinary model of pedagogical practice and its potential for development. Finally, from the point of view of personal and social development we aimed: to empower young social service users with the opportunity to effect positive change, both within themselves and through the training of professionals; to challenge stigma and prejudice between social groups by enabling those groups to work constructively together, and; to foster in all participants greater confidence in their own developing skill base. Methodology Setting up the Project Geoff – The project in itself raised a number of ethical and safety issues and these were increased by our intention to use our practice as research. Our proposal was approved by the Research Ethics Committee at UoB in Bedford. Throughout we applied the Social Work Values and Codes, we referred to Roger Hart’s (1992) Ladder of Young People’s Participation as a guide by which to monitor the role of the Young Trainers and ensure that we were enabling them to share in decisionmaking at every stage of the planning process. Students were informed and consulted throughout. We sought consent to use people’s stories and experiences and built a shield of anonymity into the work. The earliest sessions of Project Vena were Child Protection training sessions delivered by myself to both the Year 2 Social Work undergrads and Year 3 Performing Arts undergrads who would be involved in the project. John – Wooden Hill delivered two workshops to the Performing Arts students. We explored the use of drama as a training tool and specifically forum theatre techniques. Forum is an interactive form pioneered by Augusto Boal (1979, 1992 and 1994) in the early 1970s. In forum, the actors work through improvisation and the audience are enabled to tackle obstacles or ‘oppressions’ and test strategies to overcome them. They can control the actors - stop a scene mid-flow to ask the characters questions, request that a character behaves differently, change their lines - and even step into the scene, taking the place of the ‘actor’. When the scene is replayed, the actors will respond to the changes that have been made. Mike - So the work becomes a kind of theatrical debate, in which experiences and ideas are shared and problems are tackled, creating more than a sense of unity within the group. Importantly, in forum theatre the narrative of a given scene is not fixed and the participants are made fully aware that the narrative can ‘stem’, or change course at any point. Because of the changes made, the outcomes of a given scene may end up being quite different from how they began.

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John - So the ‘spectactors’ (as Boal calls the active audience) may be inspired and empowered by the work and perhaps given the confidence to make similar changes in their own lives. The forum session was followed up by drama workshops for a mixed group of Performing Arts students and young trainers from Wooden Hill. These were partly led by the young trainers. The sessions focused on a specific forum-centred model developed by TiPP in Manchester about a fictional ‘everyman’ character, Jo Blagg. Mike - The subject-matter of a forum workshop will usually be something of direct importance to the participants, often based on a shared life experience. The character of Jo Blagg is determined by the participants and it gives them a chance to explore things of interest to them without having to open up their personal lives, although this may happen. In these particular workshops, Jo was trying to deal with serious domestic problems. John - Meanwhile, Wooden Hill had collaborated with a local film company called Moon Watcher on a training film entitled Unbeatable. Unbeatable was a response to the Young Trainers, who wanted to develop their own training tools to use with social services and break down some of the stereotypes about both young people and social workers. Mike - The success and effectiveness of this film prompted us to use it as the basis for the climax of Project Vena in which all three groups (Wooden Hill, Performing Arts and Social Work) would collaborate on workshop sessions that were primarily designed as training for the Social Work students and involve them in meaningful role play. Geoff - Unbeatable focuses upon the character of Robin, a seventeen-year-old who has lived in care, estranged from his mother, for ten years. Regularly in trouble with the police and seemingly locked into destructive patterns of behaviour, the film flashes back to pivotal moments in the narrative of Robin’s life. These centre on his removal from the family home because of his mother’s physically abusive partner and his subsequent relationships with a plethora of social workers. The Final Training Sessions John - In preparation for the training sessions (held in the last week of March) everyone had watched Unbeatable beforehand. Mike – The plan was to focus on Robin’s narrative. We should note that the character of Robin was created through a Blagg-like process. The young people from Wooden Hill developed him from a shared experience. Therefore his story is typical. So we were bringing a ready-made, fleshed-out character to the session, but one the Young Trainers had made earlier. Geoff – And the numerous social workers in the film represent the wide range of characters and practices they have encountered in their lives, both positive and negative. John - Once all three groups were together in one room we set group rules and began with a series of drama games chosen to get everyone talking and enjoying themselves, to reduce anxiety and create a safe working atmosphere for everyone taking part. Geoff - Then the group was asked to recall moments from the film and these were reconstructed live by the performers. The final one was always a point where Robin throws his file on the floor and papers spill out. He remarks: “There’s my life on the floor, waiting for someone to walk all over it.” Participants were then invited to take up the blank paper and create a range of documents from Robin’s file. This is done partly by drawing and partly by writing. The documents are then fastened to the wall in a ‘timeline’ to highlight the narrative of Robin’s life and causal links between events. Mike - Then came the central activity of the workshop. Participants were asked to focus on key moments where interventions could have made a difference to Robin’s narrative. John - Having been armed with the tools and rules of forum theatre the participants split off to work in small groups. Social Work students were given two or three actors to work with and each group was facilitated by a Young Trainer from Wooden Hill who could also act in the role play. The actors were required to play both social worker and service-user. Because the Performing Arts students had little

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knowledge of social work, they were able to play ‘naïve facilitator’ and encourage advice and input from the Social Work students. Geoff - Each group is able to explore the chosen points of intervention according to the interests of the Social Work students who may use the actors as ‘puppet’ social workers who they can manipulate/direct or – if they are confident enough - they may step into the scene to take on the role of the social worker. Mike - The sessions ended with some focused reflection as a whole group, first by returning to the narrative line of Robin’s life and discussing the difference that alternative interventions and their outcomes have made to it. Finally participants were invited to feed back in various ways about any aspect of the workshop.

Collecting Data Geoff – We should say something here about our methodology; how did we collect data? First, by observation and reflective discussion at every stage of the journey. One of the final training sessions was filmed to aid this process after the event. Anonymous questionnaires were completed by participants before and after the training sessions. Participants were urged to keep journals throughout and could submit entries anonymously. During and after the training sessions a private Big Brotherstyle video diary room was available for participants to record their comments and there was the option, once again, for them to do this anonymously on paper. John – It would be impossible to describe in any detail here what ‘happened’ even in just the small group forum part of the session. The key moments of Robin’s narrative that were tackled had considerable variation although some trends did emerge. More often than not, groups were very keen to enter Robin’s story at the point where the new social worker does. Geoff - This probably reflects the pre-occupations of the trainee social workers. Mike - From there the trend was to go back in time, often to the point where Robin is removed from the family home as a small boy since this came to be understood as the pivotal intervention in his life. And from there, still further back to when the family are first brought to the attention of Social Services. In all I think this reflects the deepening understanding of Robin’s narrative engendered by the work and a stronger sense of the causal links between events in his life. Outcomes Narrative and Script Mike - The art and work of the actors in Project Vena embodies the understanding that in life we are performers in a narrative that we have some control over and what was merely metaphor is now literally happening in the room. They are actively demonstrating the changes brought about by new understandings, different choices and good social work practice immediately. In order to enable others to see how script can be unlearned, they must first go through a process of preparation wherein they in another (theatrical) sense learn the script. They are aiming to closely simulate the ‘real’ world and to realise characters who are, to all intents and purposes, representations of actual people. In order to achieve this the actor will mobilise various approaches to bridge the gap between themselves and the character they are playing – learning to speak, behave, think and feel as their character. What is the motivation for their actions, for what they say? The actor constructs the back-story, understands and absorbs the contexts of the narrative and the social mechanisms working on the character. They aim to form a fully rounded understanding of the role in order to ‘live it’ as convincingly as possible. The actor works upon the understanding that there is more to the character they are to become than the thin description they have been given on the page, whether that is in the form of a play or a social work file.

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John – So if we relate this process to Robin, the main character in Unbeatable and the subject of our training sessions, then we’re saying that there is much more to him than the reports in his file. His life isn’t a book written by others, but much, much more – a point of view that he struggles to believe. And through Robin, all the participants in Project Vena are made fully aware of this. Mike – Generally speaking, realistic approaches to character prohibit a reduction to stock (stereo) types. Instead characters are fleshed out in three-dimensions, psychologically sophisticated and feel and/or convey genuine emotion. On a literal level, in the Vena training sessions we are going through a process of ‘thickening’ our understanding of Robin and the people around him. John – One of the most amazing things for me about this project was how it revealed a crossover of experience: young trainers as actors and teachers, performing arts students who had grown up in care, social work students with experience as service users and with drama backgrounds. The distinctions and the stereotypes were crumbling right before our eyes. Geoff - These comments were recorded by Social Work students immediately after the training sessions: “Benefits of the session included the range of perspectives in the room and realising the links between social work and performing arts.” “I appreciated the role play as it gave me insight into the importance of initial contact with a client. It was made clear to me that as the social worker in this situation I could contribute positively or negatively. I was able to evaluate good and bad practice and make holistic links between attitude, posture, timing, language, eye-contact and how this impacts upon the person in need of a service.” Geoff (cont.) - In terms of the learning and unlearning of script, somewhere ‘between’ the actors and the young people are the Social Work students who are testing themselves in the ‘role’ of social worker. They have come to appreciate during this training, that in the ‘real world’, as it is here, Social Worker is indeed a role (or rather number of roles) which they must learn to play effectively and which requires as much attention to lines, gestures, facial expression etc as an actor might give to a role. Project Vena has raised their consciousness of the persona they project to a client and given some of them the confidence to play it. Yet in the course of their work on Vena, the Social Work students can also be said to have unlearnt script in at least the following two ways. First there is the story of an experienced social worker on secondment to the department who had, some years before, reason to be working with one of Wooden Hill’s Young Trainers in a professional capacity. When she arrived at the session and met him she was initially disturbed because her recollection was of him in an enraged state and brandishing a cricket bat. The script she had constructed for him was largely on the basis of this one negative event and yet here he was living a quite different version of himself, calmly and responsibly leading aspects of a drama-based training session for social workers! Partly because of this overarching narrative (hidden to the rest of the participants) she found the experience of the training session a profoundly enlightening one. Prior to the training sessions, social work students were given a questionnaire designed to gauge their attitudes and predisposition to particular behaviours. Results placed them in one of three groups. Type A describes a social worker who reacts strongly and swiftly to situations as they arise. They are quick to intervene and apply the full force of their powers. Type C social workers prefer a response that is more sensitive to the needs of the client at risk. They will seek to intervene but in a way that causes least disruption and improves the situation from within. Type B is generally a balance of A and C. After the session they were given the questionnaire once again and measured against a control group who had not participated in the Vena training. Results showed a significant drift away from Type A towards Type C. The social work students’ unlearning of script in the shape of such changes in perception is significant because of the way it in turn impacts upon the narratives of service users who come into contact with them. This new and more positive attitude may be reflected back to the service-user so that s/he may sense in the social worker’s belief in a different possibility for him/herself. Impact and Evaluation

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John – Generally, we all agree that Project Vena has been successful. Clearly it has been mutually beneficial to all parties – a ‘win win win’ situation. It’s going to run again next year and beyond in a revised form and these revisions will be made in order to eliminate some negatives and in a quest for improvement. We’ll discuss some of the strengths and weaknesses of the work here. Mike – I’d like to reflect more upon our use of Forum Theatre at this point. First I think it’s important to stress that we are not ‘doing forum’ as Boal did, nor is our work rooted in anything like the same distinct social and political contexts. It would be more accurate to say that we are applying and adapting some of the techniques and principles developed by Boal. Secondly we should note that we have quite deliberately moved away from some of the language employed by Boal, largely because of the way we are applying and reapplying forum techniques. For example, the concept of ‘oppression’ is a loaded one. At no point in the work has a group of people been identified as oppressors, in the sense that they have made a (political) decision to oppress. The ‘forum’ work undertaken by Wooden Hill with their Young Trainers identified (amongst other things) that the practice of some social workers can be oppressive to them. The work that followed, in Unbeatable and in Vena is a constructive response to this oppressive behaviour that involved working collaboratively with those who could potentially behave oppressively (trainee social workers) in order to prevent such behaviour occurring, which is an outcome desired by both parties. Finally, it is not a ‘black and white’ situation. If we take, for example, the scenario of the meeting between social worker and service-user, then it is of course as likely that the client might behave in ways the social worker finds oppressive. So the Vena training session becomes as much about empowering the social worker with ways to deal with that, through the use of forum techniques. In future I would like to see a greater recognition of this balance – the problem is in the meeting not the people who meet – and of the feelings of both parties in what is a difficult situation for both of them. Someone at conference suggested that our work might be more accurately described as “anti-forum”. I’m not sure of that personally. We’ll let the reader decide. Geoff - Here is another quote from a Social Work student who participated in the Vena training: “For years I have been put off courses because of uncomfortable feelings about role-play. This was an excellent teaching method which gave me the opportunity to practice communication skills.” This is typical of much of the feedback received from Social Work students. Many of them reported a newfound confidence with role-play and redefined themselves as people who can do it. Those students who developed greater confidence by testing themselves in such a role might see their new or strengthened sense of identity as a significant narrative change. Of course the important thing about Vena for them was that they were spared the negative experience of acting ‘badly’ in the role of service-user. Instead, if they took on a role then this was the role of social worker. The workshop gave them the opportunity to make the connection between themselves and their future professional role. Another outcome of the project was an increased interest in Narrative Therapy. Students at the end of Level 2 are required to write an essay comparing two therapies. In previous years very few students have assessed Narrative in this work but following Vena there has been a quite remarkable interest in it, with the vast majority choosing to research it further and assess it in their essays. It seems that tackling the theory through practice has given them great confidence in its potential and in their understanding of it. Mike – What did Project Vena give the Performing Arts students? It has clearly tested them as actors. They have had to thoroughly prepare for the training sessions and then, in the event, be very flexible. They have had to react spontaneously to direction and, when in the role of service-user, to the changes made to the behaviour of the social workers. The feedback from some of them indicated unhappiness at times with their role in the sessions, particularly when playing social workers. Whilst their relative naivety about social work made them ideal ‘puppets’ for the trainees, one or two of them reported that they felt under pressure and “criticised” for behaving inappropriately in the role, when to some extent that was the point! Clearly we could have done more to ‘prepare the ground’ in these cases: by ensuring that everyone, including the trainees, clearly understood the actors’ role in the session, by considering beforehand how to give and receive instructions during the sessions and by enabling the young trainers to feel fully empowered to uphold codes of conduct. Another solution that I would like to see introduced next time is to bring the social work students and the performing arts students together before the training sessions, perhaps to share experience and skills. Almost all of the Performing Arts students reported that Vena had been both an enriching personal and ‘professional’ experience. For some, this experience has sparked a change of direction and engendered

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the desire to work in these fields. One woman who ultimately wants to pursue a career in drama therapy has just got a job as Youth Worker with the Town Council. John – The model of Project Vena invites individuals to stand outside their own narratives and view themselves as the author of and performer in their own lives. That stance is highly empowering, particularly for the young trainers at Wooden Hill who may not have properly considered the choices they have made or the options that lie ahead of them. Through Vena they’ve met and worked with people they wouldn’t have ordinarily come across and have identified that as a real strength of the project. Some have developed an interest in drama, becoming regular visitors to the university to support student productions and finding a sudden appetite for theatre. Some now see university as a real possibility – either to study theatre or social work. To Conclude The perception that key aspects of our personality and behaviour are merely learned performance, akin to what an actor does on stage, is empowering. It can give us - the ‘actors’ in our own lives control again through an understanding of the structures, mechanisms or events from our past that are working upon us and an awareness that they can be challenged. It opens the possibility for new ways of behaving to be imagined, improvised and tested. We no longer have to enact the script that has been handed to us; we can be the authors of and protagonists in a new one. Perhaps the Young Trainers’ experience of Vena can be best summed up by the young person we here refer to as ‘Cricket Bat Boy’ who was recently leading training for a mixed group of teenagers and social workers. Discussion got on to the negative statistics about care leavers and how that made young people feel and he launched into a speech saying that it’s up to us to change that image – that we don’t have to buy into the stereotypes – we can make our own destiny and so on. It was a measure of the distance he’d travelled and his new understanding of narrative. Cue spontaneous applause, tears in the eye… and not a cricket bat in sight. So Project Vena encourages all participants to understand the lives of young care users more richly through narrative. It forces them to appreciate that social workers do not stand outside the narratives of the young people but are integral to them and indeed can have a powerful effect upon them. And, perhaps most importantly, it provides an opportunity for the young people in care to live out a new script and identity. References BARNADOS (2006) Failed by the System: Barnados reveals what you really need to know about the 2006 GCSE results. [Internet] Ilford, Barnados Media Centre. Available from: <http://www.barnardos.org.uk/news_and_events/media_centre/press_releases.htm?re f=23014> [Accessed 10/09/07] BOAL, A. (1979) The Theatre of the Oppressed. UK, Pluto Press. (3rd Ed. 2000). BOAL, A. (1992) Games for Actors and Non-Actors. UK, Routledge (2nd Ed. 2002). BOAL, A. (1994) The Rainbow of Desire: The Boal Method of Theatre and Therapy. UK, Routledge. BROOK (Unknown) Brook’s position on teenage pregnancy. [Internet]. London, Brook. Available from: <http://www.brook.org.uk/content/M6_4_teenage%20pregnancy.asp> [Accessed 10/09/07] COMMUNITY CARE (2002) Councils slow to apply act as care leavers continue to struggle [Internet]. Sutton, Community Care Magazine. Available from: <http://www.communitycare.co.uk/Articles/2002/10/17/38412/councils-slow-toapply-act-as-care-leavers-continue-to.html>[Accessed 10/09/07]. FISHER, W. R. (1984) Narration as Human Communication Paradigm: The Case of Public Moral Argument. In: Communication Monographs 51. pp. 1-22. FISHER, W. R. (1987) Human Communication as Narration: Toward a Philosophy of Reason, Value, and Action. Columbia: University of South Carolina Press. FREEDMAN, J. and COMBS, G. (1996) Shifting paradigms: From systems to stories. In Narrative Therapy: The social construction of preferred realities. New York: Norton. HART, R. (1992) Children’s Participation from Tokenism to Citizenship. Florence: UNICEF Innocenti Research Centre. Moving On Up. (2001) Film. Directed by Joanna CARRICK. UK, Red Rose Chain. Unbeatable. (2007) Film. Directed by Colin SKEVINGTON. UK, Moon Watcher and Wooden Hill.

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TiPP. Blagg - The Manual: A Blagger’s Guide. Manchester, UK. WHITE, M. and EPSTON, D. (1990) Narrative Means to Therapeutic Ends. New York, W W Norton & Co Ltd.

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Vera Kalitzkus, PhD / PD Arndt Büssing, MD / Prof. Peter F. Matthiessen, MD: Severe Illness Episodes and Inner Development: A Biographical-narrative Approach Abstract A growing number of qualitative studies look at illness experiences of patients. These studies show that despite of their suffering some patients nevertheless experience a positive change in their life and, in retrospect, claim that the illness experience accounts for that change and development of their personality. The factors that enable such a development are not yet fully understood, neither are ways of how such a development could be fostered in the medical encounter. The meaning of an illness episode for the biography of a person gains particular relevance, if one is to broaden the pathogenetic perspective towards a salutogenetic one, as suggested by Antonovsky (1987). This is to focus not only on the recovery of the body, but also on the healing of the whole person – with or without physical recovery. In this sense, we understand a healing narrative as a specific story of a self-realization of a person in health and in illness. To analyse how an illness can contribute to the inner development of patients, we chose a biographical, narrative approach. The work is in progress, thus we will present the theoretical approach, hypothesis and methodology. As the above mentioned experience of patients is also relevant for medicine itself, we will propose ways of how a narrative approach could also be included in the medical encounter. Introduction A growing number of qualitative studies look at illness experiences of patients. These studies show that despite of their suffering some patients nevertheless experience a positive change in their life. In retrospect, they claim that the illness experience accounts for that change and development of their personality. The factors that enable such a development are not yet fully understood, neither are ways of how such a development could be fostered in the medical encounter. To analyse how illness can contribute to the inner development of patients, we chose a biographical, narrative approach. How to make Sense of Illness and Suffering Illness and suffering are key components of human life, an anthropological given. Nevertheless, illness poses a challenge to a person, a condition he or she needs to position herself, psychiatrist Blankenburg states. This positioning always happens in the frame of the life of a person – historical as well as in the given situation, including the social, societal and cultural environment. Thus in the context of health and illness two questions need to be asked: • How is the illness situated within the human biography and how is it influencing it? • What is the meaning of biographical aspects in dealing with and forming of an illness? (Blankenburg 1986: 98-99) Illness can be experienced as an eruption or – on the contrary – as a logic consequence of the life as it has been lived so far. Within the family a person acquires a specific attitude towards health and illness as well as specific behaviour patterns that can be more or less harmful or health fostering. But even more so, a person is also formed by the experience of severe illness and death happening in her family, circle of friends or to her herself. All these factors together determine the potential of a person to cope with illness and suffering. The meaning of an illness episode for the biography of a person thus gains particular relevance, if one is to broaden the pathogenetic perspective towards one that is oriented at the resources of the patient. In his aim to understand what keeps people healthy, medical sociologist Aaron Antonovsky coined the term salutogenesis for such an approach (Antonovsky 1987). He was intrigued by the result of a study that about 29% of women who survived concentration camps appeared to have an exceptional good health despite of their traumatic experiences. He looked at what distinguished those women from others and found that, what he later termed Sense of Coherence (SOC) was central to their keeping healthy. Antonovsky understood the SOC as “a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments are predictable and that there is a high probability that things will work out as well as can reasonably be expected.” (Antonovsky 1987) The Sense of Coherence is comprised of the sense of comprehensibility, manageability and meaningfulness in a persons’ life. The sense of meaningfulness he found to be of highest relevance for the well-being of a person. It includes not only the cognitive level, which is more important in the

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sense of comprehensibility, but even more so the emotional level. Only the emotional involvement stimulates initiative and motivation to face the problems and challenges of life. Without a strong sense of meaningfulness, a high level of comprehensibility and manageability seem to be only of short duration (Antonovsky 1997: 35-38). This resonates with the conviction of Viktor Frankl, psychiatrist and founder of logotherapy and existential analysis. He points out that the need for and the question about the meaning (logos) of life especially flares up, if one is suffering badly. He experienced that for example in dying persons or in survivors of Nazi concentration camps – a destiny he has endured himself (Frankl 2005: 17, Frankl 1997). For Frankl the “will to meaning” and self-transcendence of man are essential for being human. According to the anthropology underlying logotherapy and existential analysis – man is not only determined by his innate drives, but by something beyond that – the aforementioned will to meaning and fulfilment. Frankl identified three ways of bringing that “will to meaning” into life: There is a meaning in producing/accomplishing something, a meaning to experience life, to love. But in case of restricting inner or outer circumstances (like severe illness, war or loss of a beloved one), man can still, and in the conviction of Frankl, is asked to develop a specific attitude towards life and his destiny. Only her attitude allows a person with an irreversible destiny to give testimony of what only humans are capable of: to alter suffering on a human level into an achievement (Frankl 1997: 31-32). This addresses the question of how a person carries her destiny and what kind of sense she finds in her suffering. For Frankl – and this is crucial and corresponds with Blankenburg – “it is not man who poses that question, What is the meaning of life? But he who is asked this question, for it is life itself that poses it to him” (Frankl 1997: 29). Thus, man has to respond to that question – and that response is always an individual one: “What is always involved in an response is the concreteness of a person and the concreteness of the situation in which he is involved” (Frankl 1997: 29). Hence, the interpretation, the ‘meaning’ of illness or suffering can only be found by the person herself and not be opposed onto her by others. In that respect Frankl goes beyond psychosomatic approaches in that he introduces nous (greek; mind, spirit) and a transcendental dimension in his model. In taking a stand towards somatic and psychic problems, a new dimension is opening up, he states: “the dimension of noetic phenomena, or the noological dimension – in contradistinction to the biological and psychological ones” (Frankl 1988: 17). Nevertheless, the „language of the body“and its potential to communicate or react via specific mechanisms should not be ignored. As we are concentrating on the individually experienced reality of patients this also includes areas going beyond the rational and/or conscious realm, because, as Uexküll points out: “This reality must be understood not only as the brightly lit stage where consciously experienced interaction with fellow humans and objects of the environment takes place, but also as the areas behind the scenes where moods, emotions determine the changes in the foreground lighting.” (Uexküll 1997: 1) The analysis of the empirical data will thus also be informed by the bio-psycho-social model and integrative medicine (Uexküll/Wesiack 1997) as well as the philosophy of Viktor von Weizsäcker (1973 [1940], 1956). Nevertheless, we are not aiming at statements about ‘causes’ for illness, but at insights into the human capacity to personal development and growth. From a salutogenetic perspective, overcoming an illness on the physiological level means to stimulate the so-called self healing capacities of an organism (with or without medical support) and thus also includes a process of development, leading quite often to a higher degree of health than before (Matthiessen 2006: 58). This is true not only for biological or psychosomatic reactions, but also for the biography of a person with its challenges for coping and self realisation in times of illness as well as of health. The diagnostic process based on nosological knowledge thus has to be complemented by the knowledge about the unique and irreproducible situation of that individual person in that specific time and place (Matthiessen 2006: 61-62). Illness Coping Strategies and Biography There is ample research on coping/adaptation strategies (e.g. Bishop 2005, Fife 2005, Fournier 2002, Gignac 2000, Lazarus 1987, Livneh 2006, 2004 to name only a few), self efficacy (e.g. Williams 1990) as well as patients’ salutogenetic ressources and SOC (e.g. Bahrs et.al 2004, Bahrs/Matthiessen 2007, Cole 2007, Eriksson 2007, Hakanen 2007, Sumikawa 2007). They document the correlation between coping potentials and ideas for shaping one’s life, biography and ‘world view’. For example, in a qualitative study on coping with Multiple Sclerosis social scientist Griesehopp found out that there is a notable interrelation between biographical freedom of action and the specific coping strategies of a person. This led her to the conclusion that not the illness in its concrete form itself, but

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the way it is perceived or – in sociological terms – subjectively constructed by the individual, influences the way a person can come to terms with it. This has implications for our understanding of coping strategies that connect with Frankl’s thesis on how to make sense of and give meaning to suffering. As Griesehopp says, with interpretation the person constitutes the meaning of her illness and her life respectively (Griesehop 2003: 225). From here, we would like to go one step further and ask how some patients may even see a specific gain in their suffering which may have an impact on their personal growth. Illness confronts us with the vulnerability of human existence, and with that can help to bring clarification into the way a person leads her life. Medical sociologist Arthur W. Frank accounts from his own severe illness experience: “Only in full awareness of our vulnerability do we learn to discriminate. (…) It means to find in the core of every action an affirmation for life that goes way beyond a decision between where, what, and when.” (Frank 1991: 34) Frank wants to use the illness event to give meaning to life and to view it as a chance for self reflection – although he’s warning not to idealize an illness as “a kind of enlightenment” (Frank 1991: 163). Accordingly, we are asking about the insights of individuals being confronted with such a task. As studies from our department showed, more than 50% of patients with chronic diseases, particularly cancer patients, see a ‘meaning’ in their illness or even a ‘chance’ for personal development (Büssing et al. 2005a, 2005b, 2007). This positive interpretation of disease was highlighted to be of outstanding importance for patients with severe diseases, and was found to correlate well with an existentialistic form of practice, and strongly with search for meaningful support (Büssing et al. 2006, 2007). Nevertheless, even patients without an explicit interest in any spiritual issue can interpret illness as an opportunity to change their life, or to reflect upon what is essential in life. This fact has to be taken into account for conventional care-giving, and might be an opportunity to widen the perspective of these patients in the psycho-emotional struggle with their disease. Narrative Biographical Interviews with Chronically Ill Patients Coming to terms with an irreversible destiny, a life changing illness – and even more so to experience that as personal development – might be grounded in the zeal of a person to find a meaning in her suffering. Drawing on this logic, we decided to concentrate on patients claiming a positive development for themselves – despite of their suffering. Furthermore, it implies that our focus is not on the recovery of the body, but on the healing and development of the whole (psycho-physical) person – with or without physical recovery. To gain deeper understanding of how such a development in severe illness is possible, we chose the perspective of the person herself as main point of reference. We will analyse how patients “construct” and make sense of their suffering and life. This can best be done, if one looks at the whole biography from the patients’ perspective. Questions to be asked in the analysis of the biographical interview are: • What kind of life did he/she live? • What options did he/she have and didn’t use? • What kind of challenges has he/she been confronted with? • What decisions did he/she make and how is that connected to his/her inner believes – about life, destiny, spirituality or religion? We explicitly focus on “successful” coping strategies independent of a specific disease. Only, our informants should have had enough time after the onset of the disease or severe incident, so that one could infer sustainable changes in the life of this person. We want to analyse the interview material in respect of overarching structures or conditions that might enable a person to achieve such a development. In this sense, we understand a healing narrative, according to Matthiessen (2006), as a specific story of a self-realization of a person in health as well as in illness. Methodology – a Narrative Approach We chose a biographical-narrative approach as this is the only way to give the informant freedom to talk about his life freely. And this is necessary as the topic under study is complex and cannot be asked for or extracted via structured questioning. We begin the interview with an open, narrative eliciting question. Thus the interview partner is encouraged to talk about what is most important and

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meaningful to him. Only in the second part of the interview do we ask questions on topics that need clarification. We analyse the data according to three categories that go back to sociologists Fischer/FischerRosenthal: - The lived life (objective data given in the interview) - The life as narrated by the informant (self presentation in the interview) - The experienced life (level of emotions and meaning) (Fischer-Rosenthal/Rosenthal 2000) The last category is of high importance for our research question. It is also the level, where narratives play a crucial role. In contrast to other forms of text such as argumentation or report, narratives contain a whole story, no matter how brief. The narrator wants to convey plausibly something he has experienced, something meaningful and/or of high emotional content. Narratives, Greenhalgh and Hurwitz point out in their volume on narrative based medicine, can offer us not only simply “knowledge about” something, but the experience of “living through it”. Generally, a narrative consists of four parts: orientation, complication, solution, and evaluation/coda. These elements make it easy to identify respective parts in a biographical interview for detailed analysis. The example given below is the English translation of a narrative from a biographical interview with a German patient, aged 40, about getting her diagnosis of Multiple Sclerosis: ”When I got the diagnosis MS I was about 27. Yes, that was when it happened the first time, and thank god at that time I didn’t know that it is MS, because I believe that would have been worse in the beginning, because I couldn’t move. Two years later the next incident happened and I went again to my neurologist, quite cheerful. I thought [talks in a different voice]: ‘There isn’t anything at all!, because there never has been anything with me.’ [Orientation] But then she sat there and read the medical report to me and said: ‘There are a few centres in the frontal loop’ and here and there and this and that. ‘Centres? What’s that?’ You know? Really, like: ‘Mmh?’ – ‘Yes’, she said, ‘it looks like an inflammatory disease of the central nervous system.’ And I say: ‘What’s that?’ I haven’t had a clue what she was talking about. Well, I have a little bit of medical background, but in that moment I thought: ‘Eh? What does she mean?’ What, what is that? (…) And then I was totally shocked, and she only said: ‘Yep, with your clinical finding, I wonder, how you managed coming in walking!’ You know? And I really thought: ‘Boah! There, she really stroke the wrong note!’ With that sentence! Other than that, she was quite nice, but she probably thought I am quite tomboish and tough (…) and I only could swallow. [Complication] And then she gave me a book and said: ‘Well, read that! And we’ll see each other in two weeks!’ Then I went home, and I still remember that I walked my bike. I walked my bike, because I didn’t dare any more to mount it and I cried without end, cried without end, and I went home then and I was totally finished. [Solution] Well, and that I digested it at least to some degree – well, I had, well, the first – thank god, I believe, it has been only the first two weeks that I totally hit rock bottom, where I didn’t knew at all what was happening. And then I started reading, reading, reading. And then, the more I read the more I could put my mind to rest.” [Evaluation/Coda] From that narrative, which only took a few minutes, one can learn a lot about the patient’s personality, her experience as well as her resources in dealing with her illness. Doctors could learn from that not to take her outer appearance and manner as a sign for being tough. It can be seen quite clearly, how knowledge possessed before (she is a physician assistant by training), is forgotten when being in a state of shock. Thus, relevant information needs to be delivered carefully and maybe repeatedly. In the complication part of the narrative, it becomes apparent how severe the diagnosis has affected her sense of trust and reliability in her body and her abilities. The patient then showed in the solution part that learning about the disease on a cognitive level is actually a passable form of illness adaptation for her. Reading is helping her to understand what is happening to her body and her life – and gives her comfort and helps her to relax. The Healing Narrative – and Implications for Medical Practice Why should medical practitioners study narratives? Doctors are always dealing with patients who, according to Frankl, are also confronted with the question whether their life in the face of inevitable suffering has lost its meaning altogether. The task of doctors is not only to make patients able to work and to enjoy life again, but also to assist them in carrying their ordeal and help them develop a respective attitude, Frankl says (2005: 89-90). This means caring for the soul of the person as well.

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That kind of counselling – Frankl uses the German term Seelsorge (pastoral care) – is a legitimate and necessary task within the medical realm (Frankl 2005: 85). Hence, it is necessary for the medical profession to become sensitive to that dimension of human existence – and at best that goes hand in hand with their inner development as well. Because, if they see illness and suffering as only something that needs to be fought and conquered, and consequently the failure of doing so as their personal defeat, they will hardly have the willingness to open up to the experience of the patient and to support him/her in that struggle. With narratives about illness and inner development, we believe to provide a means for doctors and carers to learn about this side of experience of their patients. This is an endeavour that is also pursued by others, for example Rita Charon, who established a narrative medicine program at the College of physicians and surgeons of Columbia University (USA). “Any doctor and any medical student can improve his or her capacity for empathy, reflection, and professionalism through serious narrative training,” she is convinced (Charon 2007). Narratives, especially patient narratives, incorporate the question of causality and thus foster the understanding of the patient’s illness perception. In the words of Greenhalgh and Hurwitz: “Narrative provides meaning, context, perspective for the patient’s predicament. It defines how, why, and what way he or she is ill. It offers, in short, a possibility of understanding which cannot be arrived at by any other means.” (Greenhalgh/Hurwitz 1998:6) This resonates with Viktor von Weizsäcker, who also demanded to include the patients’ experience into the medical endeavour. As he said, an illness narrative tells us not only about a specific medical case, but about an intensive, ultimate and truest reality for the life of a person or the death of that person. The narrative is not only a description of something pathological, but it is the involvement of life in that being ill – and that can only be the life of a concrete person (von Weizsäcker, acc. to Konnitzer 2005: 126). Furthermore, we want to sensitise doctors and carers for that theme in their daily practice. Understanding the richness of the experience shining through in patients’ narratives might be the starting point. What, according to Greenhalgh and Hurwitz, is the potential of narratives in the diagnostic encounter? Narratives, they state - are the phenomenal form in which patients experience ill health - encourage empathy and promote understanding between clinician and patient - allow construction of meaning - may supply useful analytical clues and categories. (Greenhalgh/Hurwitz 1998:6) Narratives of illness and suffering, especially though healing narratives, entail the question of meaning – with or without finding an answer. Nevertheless, even listening to the stories without an answer is precious as it opens a path for empathy, Harold Schweizer points out in his analysis of Camus’ The Plague: “By articulating this waiting for an answer, by not avoiding the question about the meaning of suffering, the solitary, unsharable experience of the sufferer has been filled with language and has thus been made accessible for empathy.” (Schweizer 2004: 18) The implementation of a narrative approach into the medical encounter is not as easy as one might think: well, just sit there and listen! First, one needs time: not as much as medical professionals are afraid of, but definitely more than the few minutes a doctor-patient-encounter lasts in the daily routine.1 Second, patients need to learn that their doctor really wants to listen to them, and that they are indeed welcome to share their story. And third, doctors need to learn to ask the right questions. They are trained in anamnestic history taking having the goal of eliciting the relevant medical facts from the patients without too much story, too much “useless” information around. “One of the most difficult tasks in health care,” family physician John Launer states, “may to be manage each consultation so that it continually meets both narrative and normative requirements.” (Launer 2006: 338, see also his paper in this volume). Nevertheless, asking questions that are prone to elicit narratives can be trained. But after posing the right questions, doctors must also be able to listen and understand the quite often complicated and contradictory stories of suffering: “Pain, suffering, worry, anguish, the sense of something just not being right: these are very hard to nail down in words, and so patients have very demanding ‘telling’ tasks while doctors have very demanding ‘listening’ tasks.”, Rita Charon explaines (Charon 2007). Becoming a good listener can be trained, as she and others show with their teaching, but apart from all techniques, one has to develop a certain attitude towards the patient that is informed by real interest, curiosity and respect.
1

According to a study 7-8 minutes in Germany and 9 minutes in UK (Brink-Muinen A et al.1999).

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Konnitzer, Martin (2005): Narrative based Medicine. Wiedereinführung des Subjekts in die Medizin? Sozialer Sinn, 1/2005: 111-129. Launer, John (2006): New Stories for Old: Narrative-based Primary Care in Great Britain. Families, Systems, & Health (2006), Vol. 24, 3: 336-344. Lazarus RS, Folkman S. (1987): Transactional theory and research of emotions and coping. In: Laux L, Vossel G. (eds.). Special Issue. European Journal of Personality 1987; 1:141-170. Livneh, Hanoch (2006): Psychosocial Adaptation to Chronic Illness and Disability: A Preliminary Study of its Factorial Structure. Journal of Clinical Psychology in Medical Settings, vol. 13 (2006), 3: 250-260. Livneh, Hanoch (2004): Patterns of psychosocial adaptation to chronic illness and disability: a cluster analytic approach. Psychology, Health & Micine, vol. 9 (2004), 4: 411-430. Matthiesen, Peter F (2002): Perspektivität und Paradigmenpluralismus in der Medizin. In: Fuchs B, Kobler-Fumasoli N (ed.). Hilft der Glaube? Münster, LIT, pp.3-34. Matthiessen, Peter F. (2006): Der diagnostisch-therapeutische Prozess im interprofessionellen Dialog. In: Peter F. Matthiessen, D Wohler (eds), Die schöpferische Dimension der Kunst in der Therapie. Ein interdisziplinäres Symposion. Frankfurt a.M., VAS-Verlag, pp 65-86. Matthiessen, Peter F (2006): Zur Verschränkung von Pathogenese und Salutogenese. In: Streit, Eva; Rist, Lukas (ed.): Ethik und Wissenschaft in der anthroposophischen Medizin. Beiträge zu einer Erneuerung der Medizin. Bern, Peter Lang, p. 49-65. Schweizer, Harold (2004): The question of meaning in suffering. In: Peter Twohig / Vera Kalitzkus (ed.) Interdisciplinary perspectives on health, illness and disease. Amsterdam/New York: Rodopi, p. 9-22. Tsuno, Yoko Sumikawa (2007): A comparative study of Sense of Coherence (SOC) and related psychosocial factors among urban versus rural residents in Japan. Personality and Individual Differences, vol. 43 (2007), 3: 449-462. Uexküll, Thure von (1997): Introduction. In: Uexküll, Thure von, Rolf H. Adler, Jörg M. Herrmann, K Köhle, O.W. Schonecke, W. Wesiack (eds.): Psychosomatic Medicine. München, Urban & Fischer, p.1. Uexküll, Thure von; Rolf H. Adler; Jörg M. Herrmann; K Köhle, O.W. Schonecke; W. Wesiack (eds.) (1997). Psychosomatic Medicine. München, Urban & Fischer. Uexküll, Thure von; Wesiack, Wolfgang (1997): Scientific theory: a bio-psycho-social model. In: Uexküll, Thure von, Rolf H. Adler, Jörg M. Herrmann, K Köhle, O.W. Schonecke, W. Wesiack (eds.) (1997). Psychosomatic Medicine. München, Urban & Fischer, p. 11-41. William, ST. (1990): The relationship among stress, hardiness, sense of coherence and illness in critical care nurses. Medical Psychotherapy 1990; 3: 171-186. Weizsäcker, Viktor von (1956): Pathosophie. Göttingen, Vandenhoeck & Rupprecht. Weizsäcker, Viktor von (1973 [1940]): Der Gestaltkreis. Theorie der Einheit von Wahrnehmen und Bewegen. Frankfurt a.M., Suhrkamp.

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Johanna Hunt, Judith Good, Pablo Romero, University of Sussex: The Informative Workspace: Narratives in Software Development Practice

Abstract: This paper is part of a larger study into narrative communication in software development practice. It presents a part of a narrative-ethnographic study into computer programmer communication over a period of process implementation. This paper will present a study into the implementation of a software development process at one company. The process aims to develop an informative workspace, with the view that the workspace of a team should be informative for, and about, the team. A workspace should aid the working practice of the team and make their work and progress visible to outsiders. This is achieved through three main practices. Firstly, open plan working areas are recognized as conducive to team communication and collaboration. Secondly, big visible charts (which can be whiteboards, flipcharts, pinboards or even electronic displays) make visible the working practice of a team and are used to display the state of projects or the progress of a team; these are generally monitors or manual processes which activate on a change in state and provide audial or visual feedback to the team. For example, a common technique is to use a lava lamp set to activate when a build fails, thus providing visible and active feedback. This paper looks specifically at the narratives told about the implementation of this software development process in an organization and considers what these small stories can tell us about the development of software. Introduction This paper introduces stories told about a work environment as told by participants in a narrativeethnographic study of process implementation at a software development company. The original intention of the study was to observe what and whether stories were told by developers in their day-today work, and what that means in relation to their working environment and the production of software. Software development methodologies provide principles and practices for developing software; each methodology advising using selected practices and process techniques to aid the software development effort. The Informative Workspace is a core practice of the revised eXtreme Programming (XP) software development methodology (Beck, 2004), which is one of a number of increasingly popular methodologies which fall under the banner term of Agile software development (Williams & Cockburn, 2003). All the Agile methodologies strongly value and encourage communication, collaboration and responsiveness to change and propose methods, principles and practices for organising people and structuring work. They reflect a shift in practice acknowledging the importance of programmer dialogue and interaction within software development practice, and the practices they propose are targeted to support this. The informative workspace practice was one investigated as part of a broader ethnographic study of narrative communication during process implementation at a UK-based software development company (Hunt, 2006; 2007). This paper presents a quick overview of the rationale behind this type of narrative research, followed by a discussion of each of the three elements of the informative workspace as told in this case in interview and observation by the participants. It considers the individual narratives told about the implementation of this software development process within the organization. Our review leads us to the conclusion that enabling such a process change is highly dependent on co-control and ownership over the space. Narrative Research Narrative Analysis (Riessman, 1993; Labov, 1972) is a qualitative research technique which focuses on the ubiquitous ways in which people make and use stories to interpret the world. Narratives can be analysed in a multitude of ways (textually, conversationally, culturally, politically/historically, and performatively) and there is no single approach to how to study the domain, nor even about what constitutes a narrative. This lack of agreement is compounded by the differences in requirements and priorities between those who use narrative to study an aspect of social life, and those who investigate narrative in itself. Social science and psychology generally place more emphasis on the process of storying oneself and reflectively looking back on a considered life. People studying narrative from a linguistic perspective generally favour considerations of the mechanisms and devices for organising

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and presenting narratives. These are often presented as a dichotomy: “the ‘how’ of narrative on one hand and the ‘about’ of narrative on the other” (Georgakopoulou, 2006). However, despite this, the kinds of narrative data used for narrative research are typically all autobiographical; past event stories based on personal experience presented to an audience. These are stories which are generally elicited in interview situations where interviewees are asked to reflect and present either important events or their life as a whole. Narratives of this traditional type have been named ‘big stories’. Historically this similarity leads back to the work of Labov and Waletzky (1967) and Labov (1972), which was the starting point for many researchers in the field. The approach has become paradigmatic, and to some extent has functioned normatively, within the field of narrative research. Labov and Waletzky (1967) define narrative as a specific type of speech act, which appears to exclude what we would want to also call narratives (such as habitual narratives, future narratives, co-constructed stories). There is increasing recognition that the most basic and prevalent form of narrative actually arises as the product of ordinary conversation (Ochs, 1997; Georgakopoulou, 2006; Norrick, 2000). There has been increasing debate recently within the narrative research community about the importance, status and ramifications of what Bamberg and Georgakopoulou have named ‘small stories’ (Georgakopoulou & Bamberg, 2005): […] the term “small stories” is meant to refer to stories told in interaction; stories that do not necessarily thematize the speaker, definitely not a whole life, but possibly not even events that the speaker has lived through […] Rather, “small stories” are more the kinds of stories we tell in everyday settings (not just research or therapeutic interviews). And these stories are most often about very mundane things and everyday occurrences, often even not particularly interesting or tellable; stories that seem to pop up, not necessarily even recognized as stories, and quickly forgotten; nothing permanent or of particular importance – so it seems. (Bamberg, 2006b): The term ‘small story’ has been used as an umbrella term for many under-represented narrative activities, such as tellings of ongoing events, future or hypothetical events, shared (known) events, but also allusions to tellings, deferrals of tellings, and refusals to tell. Such stories can include very recent, ongoing or anticipated events and can be seen as a kind of “immediate reworking.” They can be fictive or elaborations used as an argument point, they can be fragments, they can also be failures or promises to tell. One example of what constitutes a small story is the case of troubleshooting stories, such as those studied by Julian Orr (1997) as part of his ethnographic study into technicians. Freeman (2006) believes ‘small story’ and ‘big story’ research can complement each other: “the distance that is intrinsic to big story narrative reflection creates opportunities for understanding that are largely unavailable in the immediacy of the moment. Big stories and small stories thus complement one another; taken together, they represent a promising integrative direction for narrative inquiry” (Freeman, 2006). For him big stories offer opportunities for reflection and understanding, whereas small stories offer interactional insight into fleeting and partial aspects. Thus the two could be theoretically combined. It is not just whether “we actually should care about the differences between what has recently been coined ‘small’ versus ‘big’ stories because they represent very different approaches to narrative inquiry” (Bamberg, 2006a) but more that we should be excited about the possibilities opened up for exploration of stories in context and in interaction. The broader research explores the small and the big narrative observed in the ethnographic context of a software development workplace and this paper presents a small part of this. The purpose of the field study was to observe work-in-interaction over a period of six months at a software development company. The aim was to consider technical stories in the context of staff meetings and day to day work, combined with personal narratives generated through semi-structured narrative-elicitation interviews. Every three months semi-structured narrative-elicitation interviews were conducted. It was expected that these interviews would naturally support observations of ‘small stories’ from the field study. This paper presents small stories from the Informative Workspace practice. As previously stated the Informative Workspace is a core practice of the revised eXtreme Programming software development methodology (Beck, 2004). The practice states that any workspace should be informative for, and about, the team. A true informative workspace should aid the working practice of the team and make their work and progress visible to outsiders. A workspace should be informative about the working practice of the team. There are three elements by which this process should be realised; open-plan working areas, feedback devices and big visible charts. Each of these three elements will now be considered in turn through the voices of those concerned. Quotes are taken directly from individual interviews unless otherwise stated. Open Plan Offices

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The practice calls for open plan working areas, and this is a feature already met by the modern converted loft space: “I love the space we are in. [...] I quite also like the fact that there are other companies in there. [...] I think the vibe you get out of having designers-types in there is quite a nice vibe to have.” The office space was located at the entrance of the top floor of the building and was light, airy and very open plan. The loft space was shared between the software company and two small graphic design companies. With a kitchen at one end and a meeting area at the other end, both ends of the office were shared by all the people working in the space. The majority of developers in the company shared a long workbench style desk which was affectionately called the ‘last supper table’. This long shared desk encouraged communication and interaction between team members. However it also led to a distracting, messy and noisy working environment. Stories were told by the group about the ‘last supper’ table, about how although it was good for face-to-face communication, it could also be a distracting place to work. Two factors strongly came into play, mess and noise. Open plan space can often mean lack of personal space. This includes personal storage, since furniture is restricted to keep all companies in the space coordinated in design. There was constant concern about the tidiness of desks within the company; as was requested in one meeting: “Can you try and keep your desks tidier pleeease? They do get rather messy. Jungle-like.” In interview another noted: “When it gets a bit busy, my desk gets a little bit tatty. There’s no personal storage space for me.” However, another contrasted this view with: “It’s like a teenager’s bedroom sometimes. I’m not good like that. … I think even if we had storage I don’t think that would lead to a nirvana of nice clean desks.” The lack of personal space was also aggravated by company growth: “It can feel cramped, and you can feel very open” and “I think we are a bit too crammed. [...] We already have the problem, of that if there wasn’t anybody in there we would certainly fit a lot more easily into that space.” The space was naturally conducive towards high interaction between all people in the space, this impacted on relationships with clients. High-interaction led to an awareness of a lack of privacy; both in company and between companies. Although it was a good feature in a space while staff numbers were low, it detrimentally impacted on the group when numbers were high - as distractions and noise were unavoidable. As numbers increased on the long table there was a correlated increase in headphone use: “I find I put my headphones on more and more. You get so much noise and you can’t concentrate any more.” The use of controversial ‘do not disturb’ signals ended up being put in to place by some. “Any conversation on that big desk interrupts 6, 7 people, which is appalling.” The shared space had resulted in a lack of quiet space for work to be completed. Adding to the noise at the desk was the additional noise from the other companies within the space; not just because there were several more people in the room, but also because they chose to have the radio on at all times. It could be heard from anywhere in the shared loft space. It was observed to enter conversations regularly; both in meetings and during the average work day. People would spontaneously start singing along or discuss a particular singer. There was an opposition in taste between those who worked mainly as developers and those who worked mainly as designers and this was anecdotally referred to as a problem caused by a difference between programmers and designers: “It appears that designers like the radio so that they can let their mind wonder, probably give them inspiration, maybe conjure up an image. Whereas [...] we have a goal to get to, it’s been designed, boom. The music is just a background irritation. And the amount of times I have heard a song on the radio that I know, and I’ve actually, while typing, put a lyric in my code by accident because it’s going through my head.” This small humorous story indicates the differences in needs and goals between designers and developers and helps explicate the differing needs of the two groups. It also added to the noise, making people aware of the lack of control they had over their environment: “I think it’s as much that we don’t control the radio as it is the noise. I think people might choose to have some music on in the background if they had some say on it.” As one commented: “I personally have been in the company for two years, yet I don’t feel comfortable asking to turn the radio down.” To reduce noise the team members resorted to using headphones, thereby losing the natural, helpful communication that would otherwise occur in an open-plan workspace. This lack of control was also apparent in other elements of the workspace. There was a bookcase and a single whiteboard available for use by the company. There was no other wallspace free for use for two reasons; the space was so open that limited wallspace remains, and the little bit which did remain was not usable. This meant that any visible charting or brainstorming needed to be conducted on the one whiteboard (which sat directly behind two of the developers, so they could not help but be distracted and involved by its use). This is discussed further in the section on big visible charts.

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There was an awareness of what would be better in an open plan office, and prospective stories told around it: “Lots of wall space is what we need.” The first of the three elements of the Informative Workspace is reliant on there also being an ability to control environmental factors within the workspace. Open plan was not enough to make an ideal workspace. Build Monitors The second element of the Informative Workspace practice was incorporating feedback devices. A feedback device is one which actively gives information back to the team about their work. Common examples are items that change colour or make distinctive noises (such as lava lamps, ambient orbs, traffic lights). They should be very visible, fun, useful, and give active feedback to the team about current projects. The company had reprogrammed a ‘Nabaztag’ wireless rabbit toy. These rabbits were wireless devices designed as fun items that can move their ears, light up and speak; thus interact and receive messages. They can be used to send and receive MP3s and messages and can either speak the information out loud or use indicative lights, sounds and motion. They have multiple uses; such as weather forecasts, stock market reports, news headlines, alarm clock, e-mail alerts, rss feeds etc. In this case it was reprogrammed to act as a build monitor so that whenever the project being worked on was not working (i.e. the code base contained errors in some way) the rabbit would activate, flash, move its ears and name the person that caused the error. They agreed that the principle was good: “Public, again it’s making something a little bit more visual. It makes sense. [...] It seems like a very good idea.” They discovered that the noise that the feedback device made was potentially vital to whether the device was an annoyance or a pleasure. In this case a repetitive jingle that it played encroached in an irritating way on all the other people in the room. Not everyone works in the same company, let alone on the same project, so not everyone wanted to know. “I have mixed feelings about the rabbit. [...] When we had that annoying music, that clarinet thing that was going on for ages, that was just driving me insane, and I knew it annoyed a lot of other people in the office.” Again, this is a small story that closely ties in with the other issues of noise in the office space – lack of control over the noise being pushed to people. This was not the only problem in initial introduction that they had faced. Because the company ran several small projects at any one time, they started by applying it to only one small project. This had the outcome that it originally activated just when something went wrong on one developer project meaning that it originally only ever named one person and only ever in a negative way - which was far from ideal. “[...] it was reporting that I was failing builds constantly, and I was the only person, that was a horrible thing. Try spending four months with a rabbit shouting your name, saying that you’d failed the build. [...] You try not to feel depressed. [...] In fact it was encouraging me to not write more unit tests because that was just more that could fail.” For the person above the rabbit was an angry creature, shouting that he had failed. It was actively discouraging his work. Lessons were learned about how best to present the noise that comes from it to minimise both these issues. As it was something created by the company they had control over changing it. Once adjusted the rabbit continued to prove useful for providing rapid feedback on the status of a project, and making all involved aware. It became a central part of team projects: “I’ve grown to like that rabbit. We’ve adapted it over time.” As one person commented: “It’s something we own as well. We did that.” Big Visible Charts The third and final element of the Informative Workspace practice is that of using large visual charting systems. These have been ethnographically studied elsewhere (Sharp, 2006). The idea is that visual systems push information to those in the room, as opposed to computer systems where we need to go look for further information. Such chart systems are generally large but very simple, providing important information to anyone passing through an area; drawing information to the attention of team members and clients. They generally track progress through work and are also normally very casual, tending more towards the hand-crafted and creative but also disposable and easily changed.

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A trial implementation of an index-card tracking system was run in the company, after discussions around this aspect of the practice. Although tasks were already tracked by a computer system, the idea of a tracking system that visually pushed information was appealing. A chart system based on moving index cards depending on task completeness was devised and trialled on one project. Each card represented a pre-estimated unit of work which would normally be worked on by one person. The trial ran over a four-week time frame to cover the duration of the project. Such physical chart systems are supposed to aid visibility and create a sense of ownership over the elements in the project. Each person is responsible for the movement of their task cards across the board—from ‘to do’, to ‘in progress’, to ‘done’ where it would be stamped with a special stamp—such that everyone can see how everyone else was progressing with their work. Everyone would feel more involved, be able to see what was happening at present through just a glance, and physically work with it: “I liked the physical sense of doing something and stamping it, and putting it up on the board so that everyone could view.” Due to the constraints of the physical space, as mentioned previously, there was a lack of suitable space to put such a chart. In the end the whiteboard was the only available space where the chart system could be placed. The board only related to the work of those involved in the project, which was half of the people in the company, and had to be used for other purposes at the same time. Those who were involved in the project had less input in the set up of the system than would have been ideal. Tasks were written on cards for them; each person was to remove the related card when it was being worked on, and to stamp them done when they were thought completed. As the team members had not been involved in generating the cards task delineation was not as clear as it could be - sometimes a person could be working on five cards at once: “I actually took all the cards from the board which were mine, kept them on my desk, and put them up when I had done a load of them. Which isn’t the way to do it.” This led to confusion; monitors covered in multiple cards at a time, and one card was even lost on the first day! By observation it was possible to see that these were just cards which they were shown on a wall - to take when working on and stamp when finished - and therefore meaningless: “I don’t think we understood it. . . I really like the idea. I can see how it would work, I think it’s just the initial bit of putting the tasks on the cards that I haven’t quite understood.” The team had not been involved in planning the features, they had not been involved in setting up the system, and they had not written the cards themselves. There was a resultant lack of ownership on the side of the developers; the cards meant nothing to them. Even the stamp they were using to mark tasks as completed was a baffling choice: “The stamping thing, . . . it’s the ‘this thing has been done stamp’ which is annoying because we kept putting them back, but that hasn’t been done, but it’s stamped, it’s in the wrong place. Pointless. [...] It’s like ‘Aha, I have defeated you.’ It said ‘Staple this to your face’, why, of itself as a product, it doesn’t mean anything. I don’t know why it said that.” The lack of involvement of the team in the initial stages also resulted in an interesting shift in perspective. The stories told, in observation and interview, referred to being children in primary school. They felt like they had been placed in the role of children; having been given cards and ink: “…like the whole idea of stamp, tear, and it’s gone. It’s ripped up, it’s in the bin. [...] It did feel a bit puerile, childish, but a bit like you had to show teacher and it was a bit theatrical.” They wondered whether, if they did this well, they might get gold stars. Similarly the project manager despaired at finding themselves in the role of primary school teacher (especially when they had to confiscate the ink as it kept getting spilled over the desks). Although the visual aspect was appreciated and other, smaller, charting systems for tracking time and work have since proved useful, in this case the approach did not work. The lack of control over space impacted on the process, and there was just not enough space to work in. There was not enough developer involvement in the card creation process; to make them feel more enabled, involved and adult. Overall this particular charting system did not work well for the team and was discontinued. As one person reflects: “We gave them a chance, but it wasn’t much of a fighting chance. We shot them in the foot and then wondered why they weren’t running away.” Discussion The stories told in interview and observation supported the notion that the company members were very concerned with control over their environment. As one person commented: “We don’t control our environment, which is a problem. It means for historical reasons we have an environment which is not suitable for software development and we are making the best of it. We have too many people there, we have not (until recently) had any flexibility with space, which compounds the problem.”

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Visibility in a workplace is a good thing, and in all cases the three practices reflect it. Visibility is good for communication, understanding and information transfer. However, there was a single theme which spread through the discussed experiences with implementing all aspects of the informative workspace: the importance of control and ownership of the environment: “I would like to see who’s doing what a lot more visible than it is now. [...] I don’t think we have that. I think it’s not so much for information purposes, although it may be useful occasionally, I think it’s just more a question of ownership…” Firstly, while open plan offices are good, they work best when there is control over the other aspects of the environment. If you don’t have that you can be limited and constrained in the space by other factors. The number of people in close proximity also plays an important role. These factors also impact on feedback devices - in a shared open-plan space a device which makes noise is not always ideal, other people do not wish to have such information pushed to them. With restricted space chart systems may not fit, may end up forced, cramped or, even worse, may be opposed. They may end up visibly confusing, or even hard to get to without disturbing others. However the stories being told remained optimistic about the future: “We’re moving in to a new room, where there won’t be a radio. We’re moving in to a new room, where there won’t be a hundred-thousand people. There will be five of us, in a small quiet room, where we can control the atmosphere, where we don’t have to check with other companies. [...] I might put a poster up.” This brief summary of the Informative Workspace practice demonstrates the reality that software development is a team process. To produce non-negligible software programmers must collaborate and communicate. Thus, one of the major problems faced by any software development endeavour is sociological in nature, as distinct from technological. While the stories told here are still fleeting, partial or prospective they are worth addressing given the revised view of narrative research presented earlier. It is expected that this avenue of approach will provide interesting results, letting us consider stories in context alongside personal interview narratives. It is hoped that deeper consideration of the small, fleeting, partial and prospective stories in context may reveal aspects of team collaboration in this context and provide useful insight for the future. References Bamberg, M. (2006a). ‘Stories: Big or small: Why do we care?’ Narrative Inquiry 16:1 (2006), 139147. Bamberg, M. (2006b). ‘Biographic-narrative research, quo vadis? A critical review of ‘big stories’ from the perspective of ‘small stories’’. In K. Milnes, C. Horrocks, N. Kelly, B. Roberts, and D. Robinson, (Eds), Narrative, memory and knowledge: Representations, aesthetics and contexts. Huddersfield: University of Huddersfield Press. Beck, K. (2004). eXtreme Programming Explained: Embrace Change (Second Edition). San Francisco: Addison-Wesley. Freeman, M. (2006). ‘Life “on holiday”?: In defense of big stories’. Narrative Inquiry 16:1 (2006), 131-138. Georgakopoulou, A. (2006) ‘The other side of the story: Towards a narrative analysis of narratives-ininteraction’. Discourse Studies, 8, 265-287. Georgakopoulou, A., & Bamberg, M. (2005). ‘Small is beautiful: Small stories as a new perspective in narrative analysis’. Paper presented to the 9th International Pragmatics Association Conference, Riva del Garda, 10–15 July 2005. Hunt, J., Romero, P. and Good, J. (2006). ‘Stories from the Mobile Workplace: An Emerging Narrative Ethnography’. Proceedings of PPIG 2006 (18th Annual Workshop), September 7-8, 2006, Brighton, UK. Hunt, J., Hume, T. and Lozdan, D. (2007). ‘On Rabbits, Space and Cards: Moving Towards an Informative Workspace’. Proceedings of Agile 2007, August 2007, Washington D.C. Labov. W., & Waletzky, J. (1967/1997). ‘Narrative analysis: Oral versions of personal experience’. In J. Helm (Ed.), Essays on the verbal and visual arts (pp. 12-44). Seattle, WA, Washington University Press. (Reprinted in: Journal of Narrative and Life History, 7, 3-38). Labov, W. (1972). Language in the Inner City. Philadelphia: University of Pennsylvania Press.

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Norrick, N.R. (2000). Conversational Amsterdam/Philadelphia: Benjamins.

narrative.

Storytelling

in

everyday

talk.

Ochs, E. (1997). ‘Narrative’. In Teun van Dijk (Ed.), Discourse as Structure and Process, pages 185– 207. London: Sage. Orr, J. (1997). Talking about machines: An ethnography of a modern job. NY: Cornell U.P. Riessman, Catherine Kohler (1993). Narrative Analysis. London: Sage, 1993. Sharp, H. (2006). ‘The role of story cards and the wall in xp teams: A distributed cognition perspective’. In Proceedings of the conference on Agile 2006. IEEE. Williams, L. and Cockburn, A. (2003). ‘Agile Software Development: It’s All about Feedback and Change’, IEEE Computer, Vol. 36, 6, 83-85.

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A/Professor Carol A V Holmes University of Notre Dame Fremantle, Western Australia Narrative Intelligence: Variations on a Theme Abstract Storytelling, myths and parables are age old ways of imparting deeper truths. It is now well documented that human experience is organised and recalled in the form of stories. Stories provide information about the narrator and infer meaning through the creation of contextual allusion. During the last ten years storytelling has been recognised as an important source of knowledge in the field of medicine. The presentation will provide a contemporary interpersonal model and method of narrative communication. The seminar will focus on the significance of the authentic personal and interpersonal dilemmas that can be inferred from the stories that patients spontaneously impart. Current research suggests that narrative communication is an adaptive protective device, which offers an evolutionary advantage by enabling the communicator to relay contradictory messages about their immediate concerns in an encoded form. The seminar will tender a definition and description of narrative communication derived from diverse disciplines, a method for decoding narrative. The author believes that the ability to discern and appreciate different levels of narrative can provide medical students, practitioners, health workers; teachers etc with an important interpersonal, therapeutic skill and enhance their narrative intelligence. It is claimed that human experience is organised and recalled in the form of stories. The suggestion that stories serve as a distraction and as a means of obscuring the truth is endorsed by the common expression ‘telling stories’. On the other hand as we know story telling can also stand as a subtle, guarded and recreational method for conveying hidden meaning and universal truths, as noted in the examples of fables and religious parables. Stories provide information and infer meaning through the creation of contextual allusion, which arouses our imagination and emotions. Storytelling is now recognised as an important source of knowledge in many areas, including the corporate world, in education, psychotherapy and in the field of medicine. Generally, narrative practitioners believe that when a person tells a story, however obscure, they give the listener a glimpse of their inner world and world-view. Narrative has become a catchall term to describe the ingrained human proclivity to tell stories. The Oxford English dictionary defines narrative as; ‘A spoken or written account of connected events; a story; the practice or art of telling stories (p. 1169). Terms, such as, storyline, scenario, cameo, anecdote, depiction, portrait, catharsis, and stream of consciousness also appear synonymously under the heading of narrative (Roget’s Thesaurus p. 217). The focus of this paper is on the little known but ubiquitous area of interpersonal encoded narrative communication. In setting the scene, I will firstly refer to some relevant research from evolutionary psychology and then briefly introduce some alternative narrative models and their usage. Evolution of language and narrative Dunbar (1993) proposed that the major evolutionary impetus for the increase in human brain size, which enabled the development of sophisticated human language, was the need to maintain group cohesion. The expansion of human language provided the capacity to deal with increasingly intricate social issues by elaborating our ability to communicate information about the social environment. The Social Brain Hypothesis (Byrne & Whiten, 1988) also referred to as the Gossip Hypothesis, (Dunbar, 1996, 1998) postulates that the acquisition of human language functions as a powerful tool for social grooming and is comparable to, and evolved from, the physical grooming observed in non-human primates. Research findings from the field of developmental psychology suggest that children are primed from almost the beginning of life to recognise stories and that this predisposition is closely related to subsequent social competencies (Engel, 1995; Read & Miller, 1995). Dautenhahn suggests that oral narrative abilities entail the capacity to tell stories, an awareness of other peoples’ stories, as well as the personal capability to express thoughts and feelings through the mode of story-telling (2001, p257). The Narrative Intelligence Hypothesis (Dautenhahn, 1999) proposes that narrative communication evolved as a necessary and highly efficient adaptive tool specifically to relay and receive information about other peoples’ behaviour (gossip). Such prior knowledge could therefore provide the recipient with a strategic advantage, as they would be forewarned on the grapevine of any double-dealing. It is therefore understandable why the Social Brain Hypothesis is also described as Machiavellian

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Intelligence, given that our story telling skills are considered to have also evolved to give us the opportunity to exploit others for our own benefit.

Narrative Medicine The American physician Dr Rita Charon pioneered and developed the groundbreaking work that embodies the narrative medicine movement (1993, 2006). Dr Charon’s long standing experience of working with patients, plus her keen interest in literature, as well as her current research has led to her assertion that patients describe their illness primarily through the medium of narrative. So much so, that it is now mandatory for all second year medical students at Columbia University to attend seminars in narrative medicine. In contrast to the conventional medical model, students are required to maintain two patient charts, the first of which contains the customary physiological data and a corresponding chart (parallel chart), which documents the patient’s story as recalled by the clinician plus the student’s written responses to the patients story. Dr Charon’s research results suggest that this kind of patient/doctor reciprocity increases the student’s ability to listen and empathise improves their diagnostic capacities and aids in the patient’s recovery (2001). The implications of Charon’s research have had a burgeoning effect on the field of medicine in general as witnessed by the growing number of medical humanities departments in training hospitals. The application of narrative based medicine is also permeating into the wider field of health and medical education for nurses (Scott, 1998) in primary care and GP work (Launer, 1998; Heath, 1998). Narrative in the Corporate World Steve Denning is internationally renowned for his workshops and books on the power of narrative and its ability to augment corporate identity and business productivity (2004, 2005). In a nutshell, organisational storytelling is business focused at the level of developing and employing narrative competencies to construct, establish and underline the marketable features of companies and their products. The strength of a companies narrative is also gauged by its ability to inculcate and encourage staff to identify with the values of their organisation, to enhance management performance, leadership skills and team collaboration. In his current book The Secret Power of Leadership (2007a) Denning explains with numerous examples how the art of narrative communication can counteract the negative stories that can sometimes abound and detrimentally harm organisations credentials. A good manager is one who can tell a story that will capture her/his staffs imagination and inspire them to believe in their product. For Denning narrative intelligence is earmarked by the ability to think in narrative. Narrative intelligence is reflected in; ‘A recognition that the narrative aspects of the world matter, because human goals matter, and narrative encapsulates human goals’. He further states that; ‘An ability to act and react agilely in this quicksilver world of interactive narratives is the gist of narrative intelligence’ (2007b). Narrative Therapy Family therapists are interested in the interactive and competing stories that members of a family tell about their family experiences. Dallos defines narrative as ‘an account or story about how the current situation has arisen, what events/experiences in the past have moulded individual personalities, ways of relating and so on’ (1997, p.125). The focus on narrative in family therapy is a relatively modern influence and has been described as a ‘third wave’ (O’Hanlon, 1994). The narrative therapy model originated from the work of Michael White and David Epston culminating in their first book, Narrative Means to Therapeutic Ends, (1990), In essence, the model asserts that the way we author our lives will inevitably power how we view the world and ourselves. Problems arise when our stories become sedimented, that is, when we assume that a problem is an integral aspect of the self such as; ‘I am an angry person’, rather than ‘I have a tendency to get angry’. The work of the narrative practitioner is to question and explore with the client the prejudicial and assumptive aspects of their dominant narrative and to underline the external rather than organic nature of the problem. The narrative therapist encourages the person to reflect on alternative ways of viewing the problem by examining the arbitrary nature of the client’s prevailing story, narrative therapy provides the opportunity for the person to re-author and reconsider the problem in a different light.

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Philosophically, narrative therapy is comparable to the existential school of thought, which avers that we are freer than we would wish to believe, that our identities are not set in stone and we often confuse our assumptions for personal values. Our stories are therefore likely to contain attitudes and feelings that are more related to how we think we should feel and behave rather than what we truly believe. Interpersonal Encoded Narrative The term narrative encoded communication refers specifically to a form of interpersonal communication, which is considered to be generally outside of the awareness of both the communicator and recipient of the message. The classical model of the mind developed by Freud attests to the idea that human motivation is essentially internal and insulated. This model is in direct contrast to contemporary research, which claims that human beings are constituted by their relationships with others and is the focus of this paper. Evolutionary Psychology From and evolutionary perspective internal psychological processes are considered to have emerged to maximise our capacity for emotional survival and as adaptive method for coping with complex relational issues. The imperative for cooperation (referred to by evolutionary theorists, as reciprocal altruism) is unequivocal, as it has been shown to be a vital factor in the survival of the individual, the community and the species. Although interpersonal conflict is also viewed as a mandatory survival trait, it is not difficult to understand why it also stands in direct opposition to cooperation. This fundamental and ongoing human struggle to negotiate between the contradictory impulses of self-interest and shared needs has led evolutionary psychologists to take a keen interest in the area of deception and its counterpart self-deception. By sheer definition the notion of cooperation depends on the expectation that others will reciprocate and return the favour. If survival is considered to be dependent on the ability to avoid being deceived then the need to acquire counter-measures to deal with such manipulations, according to Cosmides and Tooby (1992) has therefore necessitated the development of an internal automatic process, which is alerted and attuned to sensing interpersonal infringements and deception in others behaviour. Current evolutionary thinking seems to offer a plausible explanation of the wholesale aptitude to camouflage our true intentions and elucidates the correspondence between deception and selfdeception. Badcock succinctly précis’s the intimate connection between the two: ‘The most effective liars would be those who had convinced themselves that their lies were in fact the truth. Having achieved the feat of self-deception, duping others would be all the easier. Now they could lie in total sincerity!’ (1995, p.72). The intimate connection between deception and self-deception is also underlined by Trivers; ‘An unconscious deceiver is not expected to show signs of stress associated with trying to perpetuate deception’. (1988: vii). The psychologist Paul Eckman (1985, 2003) is noted for his extensive crosscultural research into non-verbal communication. His findings suggest that even the most sophisticated of double-crossers are prone to exhibit telltale signs or ‘non-verbal leakage’, which indicate their true intent. It is claimed that such involuntary behaviour is directly related to anxieties about being ‘caught in the act’. It is therefore, understandable why the ability to lie un-self consciously is considered by evolutionists to be an adaptive trait, as it eliminates the emotional pressure that produces non-verbal leakage. The Unconscious The idea of the fallibility and distorted characteristic of the unconscious is firmly embedded in Freud’s classical model of the mind. However, more recently knowledge accrued from the fields of evolutionary biology and psychology, as well as evidence from cognitive psychology suggest a very different state of affairs. In brief, this research reinforces the idea that there is an element of the mind, which is profoundly alert to and concerned with interpersonal reality and focused on inconsistencies in the behaviour of others. Especially in terms of issues related to the inappropriate use of power and discrepancies between appropriate levels of intimacy and separation. In other words a lack of correspondence between what people say and what they actually do. In a nutshell it is related to

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concerns about trust, which is a ubiquitous human dilemma. Some researchers, such as Gregory Bateson (1972) who was responsible for developing one of the most compelling interpersonal theories of schizophrenia, have suggested that the denial of these contradictions (double bind) are the most potent factors that can drive people crazy. Furthermore, In order to protect themselves from such disturbing messages, Bateson’s research has shown that people will often resort to communicating at a metaphorical level. Unconscious perception There is now a corpus of research, which supports the idea of unconscious perception. Unconscious perception refers to the spontaneous ability to perceive interpersonal reality authentically and accurately. Unconscious perception is expressed primarily through the mechanism of displacement and disguise and can be recognised as stories that that people automatically impart that relate to the behaviour of people and situations that are manifestly unrelated to the current situation but are considered to represent valid unconscious insights of the person’s perceptions of the immediate interpersonal encounter. It is mooted that this mode of communication has developed over time in evolutionary terms as way for human beings to both express and mask their more profound interpersonal emotional concerns. It is possible that narrative communication, which tends to be outside of the awareness of both the recipient and the sender of the message serves the purpose of reducing anxiety for both parties. Narrative communication enables the communicator to consciously deny the other persons hurtful contradictory behaviour and also enables the recipient to consciously deny and remain protected from the personal, often critical theme that is underscored in the narrator’s message. Storytelling is often used as a symbolic medium of expression in plays and films when one character wants to impart a crucial but disturbing truth to another. The recipient of the intended message is also unlikely to decode or overtly comment on the narrative, as this could be tantamount to an admission of blame regarding an issue that both parties would prefer to sidestep. Narrative Communication The encoded narrative communication position asserts that we experience unconscious perceptions of others in our everyday lives and communicate these perceptions in a convoluted and camouflaged way. The significance of narrative communication is supported by research from cognitive psychology in the work of Robert Haskell (1999, 2001), which he refers to as (Subliteral communication), and in experimental psychology on subliminal perception in the work of Norman Dixon (1971, 1987). Robert Langs (1980, 2004) an American psychiatrist and psychoanalyst also developed a therapeutic method based on interpersonal narrative communication, which he refers to as derivative communication. Illustrations Narrative in Therapy A client after agreeing with the therapist’s request to tape-record a session for supervisory purposes then went on to tell a story abut having hassle at work. ‘Some of the people there really don’t know what they are doing they just try to ingratiate themselves with the bosses. It’s hard for me to speak openly. I’m worried that some of them may be eavesdropping, which makes me feel very insecure. They have no integrity and it really annoys me. I just wish they would let me get on with my job. It is not entirely unusual in a psychotherapy session for a therapist to ask to tape-record a session, especially when they are in training, in fact, some training institutes see this as an important requirement. Nevertheless, paradoxically most schools of therapy also agree that the rule of confidentiality is the sine-qua-non for effective and ethical treatment, so much so that this proviso is normally stated to the client at the initial consultation. Although the client manifestly acquiesced to the therapist’s request to tape the session the themes that are encapsulated in the client’s ensuing story appear to stand in stark contrast to this agreement. She tells of people who are untrustworthy, disingenuous and of her concerns about being secretly listened in on and of how these frustrations are interfering with her ability to get on with her work. The manifest story is of course relevant, in so far as it highlights some of her work relationship issues, which may also be linked to current personal relationship concerns. However, the overall theme of her narrative is clearly, validly and systemically represented in the here-and-now encounter.

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Medical Narratives A consultant, a group of junior hospital doctors and some students, visited a patient who had been admitted with a suspected cardiac condition. The consultant duly asked the patient how she was feeling, commented on the tight squeeze in the room and then said ‘this shouldn’t take too long’. To which she replied ‘I always say the more the merrier’. The consultant then discussed the details of her case with his team literally over the patient who remained silent. After some minutes the doctor said I am pleased to tell you that you will be able to go home tomorrow. Out of the blue the patient then related a story about an event that took place just before she was admitted to hospital. She talked of going to Marks and Spencer’s to buy some knickers and of how invisible she felt at the cash desk because the shop assistants had ignored her and just carried on talking among themselves about one of those new fangled face creams. She also mentioned, as a parting shot ‘you would think that one of them would have been able to help me’. The inconsistency between the patient’s initial conscious remark, ‘the more the merrier’ and her subsequent story is readily apparent. Her comment of buying knickers may also be a reference to something intimate and private being discussed rather publicly. The allusions to being ignored while people talk among themselves about something that is new fangled, implies a concern about being inappropriately neglected by people who behave unprofessionally, as they talk among themselves about issues that are primarily of interest to them. Her final aside may be discerned as a piece of unconscious supervisory advice, that one person, presumably the consultant, could, (with hindsight) have been more sensitive and alert to her needs. A middle-aged man suffering from emphysema arrived at his local hospital for his regular check up with a specialist that he had been seeing for a number of years. The doctor began by telling the patient that this would be their last meeting as he was about to take up a post in a hospital some miles away and then reassured him that he would be well looked after by Dr Blank. The doctor then enquired after the patient’s health since they last met. The patient replied that he had been feeling OK although he was still suffering from a loss of breath, even though he had managed to stay off the fags. He then talked of his sadness at losing a treasured watch that had been a gift from his late wife and of how much he still missed her. He also mentioned his younger brother who had been killed in a road accident a few years ago and of the gap that his passing had left in his life. The theme of loss is embodied in the patient’s narrative as he speaks of a loss of breath and is reminded of the loss of his wife and brother and the loss of a treasured possession. The encoded narrative position claims that the impetus for the automatic emergence of the patient’s story is an authentic (albeit camouflaged) response to the news of yet another loss in his life. Such narratives are considered to arise spontaneously in the here-and-now situation as recollections of something similar happening yet again. Everyday Narratives A friend of mine who is familiar with encoded communication told me about a visit she had with her nephew who she only saw occasionally. His mother (her sister) had asked (Unbeknown to him) if she would pay him a visit as he had just been discharged from hospital after a drug overdose. His aunt then phoned to see if he would like her to visit and Fred gave her some rather vague directions. The aunt eventually managed to locate the house, which was situated on a very busy highway. On her arrival she found the front door was padlocked. Fred explained that he was concerned about the lack of security at the house, which had prompted him to buy a lock for the door and the front window. His aunt then enquired how it felt for him to be staying on his own. Fred then recounted how frantic the past few days had been. His father had visited and stayed the night. His mother had also paid him a visit and taken him shopping. On noticing a photograph of the son of the house the aunt asked whether her nephew was still in contact with him. Fred said ‘no but Alan had been coming past the house a lot to see if I am doing the right thing’. He also talked about his concerns regarding the lack of safety at the property and said that anyone could force their way in. Subsequently after acknowledging his concerns about security and people checking up on him his aunt said perhaps this is how he may also be feeling about her visit that she too is checking up on him for his mother. Although Fred did not respond verbally to his aunt’s comment, on reflection, after their meeting she felt it important to allow her nephew to initiate any subsequent meetings, feeling that this might help to allay some of his intense feelings of powerlessness and vulnerability that were underscored in his narrative. After giving him her phone number she said she would be happy to call in again at his request or alternatively, if he wished, he could pay her a visit.

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Children’s Narrative This is a story told to me by an early childhood teacher. At the time of this event the teacher was six months pregnant. Amy is 5 she and her mother have lived mostly with Amy’s maternal grandmother and their four cats. Her mother has also left Amy in the care of her grandmother for a number of both short and long periods of time. Her mother has now set up house with the father of her five month old baby, which is a six hour drive from the grandmother’s home and is arranging for Amy to move in with them. This means that she will be leaving the community school, her friends and grandmother. Her teacher had noticed a distinct change in Amy’s behaviour and on the last day of school Amy told her that one of her cats was missing. Amy was crying and clearly very upset and said that both cats where going to be left behind and her grandmother would let them go to live in the bush on their own. She said they would be very hungry but might be able to look after themselves by catching birds and mice. She said they would be very lonely and would never be patted or stroked. She said her mother didn’t want them at her new house, as there would be too many cats so she was leaving them behind. She told her teacher that her mother had taken her favourite cats to the new house. She said that snakes would probably bite the cats and that they would die, as there was no one to help them. The teacher said she was disturbed by the event and realised that evening that Amy’s story may also have been related to the child’ s concern about being abandoned by her mother again. She also remembered telling her class about her pregnancy and recalled how angry Amy had seemed and her subsequent enquiry as to whether the teacher would be leaving. A 71 year old woman school volunteer had been working with an 11year old boy diagnosed with dyslexia on a one-to-one basis to help him with his reading difficulties. During his lessen the boy said that he didn’t want to do the reading but wanted to teach the volunteer to play chess. At the end of their session the volunteer said ‘Its time to go back to your teacher now’, to which the boy replied ‘I don’t want to go, Miss Jones needs a face-lift, her face is all wrinkly’ and he pulled his face down to make himself look old. He also said she has a silly voice, which he then mimicked and said that she wears funny clothes. The volunteer reprimanded the boy and said that he shouldn’t speak about his teacher in that way, it was very rude and she couldn’t help how she looked and that she was sure that Miss Jones was a very nice person. Subsequently, the volunteer retold this story and in passing said; ‘I wonder what he thinks of me and my wrinkles’? She also mentioned that his teacher was in fact a very young woman. The volunteer was then reminded of her own childhood and remembered that she had been a rather disobedient child, which had prompted her mother to sometimes lock her in the bathroom. She recalled promising to be good if her mother let her out, while thinking that she had no intention to do so. She then connected these thoughts and her own childhood to her relationship with the boy and of her own tendency to be strict like her mother was with her. Although the volunteer was not fully aware that the boy’s story was, among other things, also a communication to her, on reflection, the spontaneous connections that she made regarding her manner of relating may influence and ameliorate her subsequent encounters with her pupil. Furthermore, the likelihood of improving her empathic skills, her self-awareness and narrative intelligence could be vastly enhanced if she were able to receive supervision/tuition in the area of interpersonal encoded narrative. The defining features of narrative communication are that they arise spontaneously, appear at first glance to contain trivial information in relation to the immediate situation and tend to contradict previous cognitive remarks. It is possible that encoded narrative may function as the verbal equivalent of non-verbal leakage (Eckmann) as both are considered to be far more authentic indications of a person’s immediate emotional state due to the involuntary nature of the communication. Furthermore, it is also suggested that non-verbal leakage like its narrative counterpart is primarily concerned with immediate interpersonal conflict. Some Preliminary Thoughts On Narrative Intelligence The concept of repression is central to the framework of psychoanalysis. According to Freud the defence of repression is based on the human tendency to preserve a tolerable level of homeostasis (1911). Freud’s explanation of repression may approximate to contemporary evolutionary thinking, which endorses the ongoing struggle between cooperation and self-interest. Even at a conscious level the need to maintain some equilibrium in our social, professional and personal relationships enables us to justify the ‘white lie’. Nevertheless, blaming others, feeling resentful, angry, mistrustful and

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contemptuous are some of the typical strategies that fuel and exacerbate conflict and also help to distance us from ourselves and others. It is little wonder that the sense of unease that accompanies interpersonal conflict instinctively activates adaptive procedures to reduce anxiety and ambivalence. Paradoxically, such tension often leads to denial, avoidance and a disingenuous impulse to accommodate and concede to the opinions and wishes of others. Hopefully, it will have become clearer as to why narrative intelligence from this encoded perspective does not come naturally and in fact generally goes against the grain. Firstly, it would require, not just an understanding of the human tendency to often camouflage our true intentions but a thorough commitment to the existential maxim that it is only through other people that we can become aware of ourselves. It would also necessitate a relentless tenacity to appreciate the principle of interdependence, which may then enhance our capacity to focus on relationships rather than people as objects in isolation, and to consider the significance of processes and patterns above content. Conclusion As far as I am aware there is no training available which deals with the development and acquisition of the skills required to understand and address interpersonal narrative communication. As this paper is a work in progress the following preparatory list includes some general areas that this author believes are worthy of attention. Personal Attributes An acceptance of one’s strengths and limitations. A level of self-confidence. A degree of humility and the motivation to augment one’s self-awareness. A curiosity to consider one’s interpersonal idiosyncrasies and inconsistencies. An awareness of the power issues and imbalances in one’s position and behaviour that may stimulate and influence encoded narratives in others. Listening Attributes A willingness to appreciate the authentic layers of interpersonal meaning contained in stories. A readiness to discern the major narrative themes and their interpersonal implications. The capacity to listen to others silently, actively and respectfully without the need to interfere. Creative Attributes A capacity for symbolic recognition. An ability to see the big picture. An aptitude to consider the connections and similarities between ideas and people. References Badcock, C. (1995) PsychoDarwinism: The New Synthesis of Darwin and Freud. London: Flamingo. Bateson, G. (1972) Steps to an Ecology of Mind. New York: Ballantine Books. Byrne, R. W. and Whiten, A. (eds) (1998) Machiavellian Intelligence: Social Expertise and the Evolution of Intellect in Monkeys, Apes and Humans. Oxford: Oxford University Press. Charon, R. ‘The Narrative Road to Empathy’ In Empathy and the Practice of Medicine: Beyond Pills and the Scalpel, edited by Howard Spiro et al, 147-59. New Haven: Yale University Press, 1993. Charon, R. ‘Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust.’ Journal of the American Medical Association. 286 (2001): 1897-902. Charon, R. (2006) Narrative Medicine: Honoring the Stories of Illness. Cosmides, L. and Tooby, J. (1992) Cognitive adaptations for social exchange. In J.H. Barkow, L. Cosmides, and J. Tooby (Eds), The Adapted Mind: Evolutionary Psychology and the generations of culture (pp. 163-228). New York: Oxford University Press. Dallos, R. (1997) Interacting Stories: narratives, family beliefs and therapy. London: Karnac Books. Dautenhahn, K. (2001) The Narrative Intelligence Hypothesis: In Search of the Transactional Format of Narratives in Humans and other Social Animals. In M. Beynon, C. L. Nehaniv and K. Dautenhahn (Eds.) Proceedings of the Fourth International Cognitive Technology Conference, CT 2001: Instruments of Mind (pp. 248-266). Berlin: Springer Verlag. Denning, S. (2004) Squirrel Inc: A Fable of Leadership Through Storytelling. San Francisco: JosseyBass.

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Denning, S. (2005) The Leaders Guide to Storytelling: Mastering the Art & Discipline Of Business Narrative. San Francisco: Jossey-Bass Denning, S. (2007) The Secret Language of Leadership: How leadership Inspire Action through Narrative. San Francisco: Jossey-Bass. Denning, S. http://www.stevedenning.com Dixon, N. (1971) Subliminal Perception: The Nature of a Controversy. London: McGraw- Hill. New York. Oxford University Press. Dixon, N. (1987) Our Own Worst Enemy. London: Jonathan Cape. Dunbar, R. I. M. (1993) ‘The co-evolution of neocortical size, group size and language in Behavioral and Brain Sciences 16; 681-735. Dunbar, R. I. M. (1996). Grooming, Gossip, and the evolution of Language. London: Faber and Faber. Dunbar, R. I. M. (1998). ‘The Social Brain Hypothesis’. Evolutionary Anthropology 178-90. Ekman, P. (1985) Telling Lies: clues to deceit in the Marketplace, Politics and Marriage. New York: W. W. Norton. Ekman, P. (2003) Emotions Revealed: Understanding Faces and Feelings. London: Weidenfeld & Nicholson. Engel, S. (1995) The Stories Children Tell: Making sense of the Narratives of Childhood. New York: W. H. Freeman and Company. Freud, S. (1911) Formulations On The Two Principles Of Mental Functioning, The Standard Edition Of The Complete Psychological Works of Sigmund Freud (ed. J Strachey), vol, X11. London: Hogarth Press. Haskell, R. E. (1999) ‘Unconscious Communication: communicative psychoanalysis and subliteral cognition’, Journal of the American Academy of psychoanalysis, 471-502. Haskell, R. E. (2001) deep listening: hidden meanings in everyday conversation. Massachusetts: Perseus Publishing. Heath, I. (1998) ‘Following the Story: continuity of care in general practice’, in T Greehalgh and B. Hurwitz (ed.) Narrative Based Medicine. London: BMJ Books. Langs, R. J. (1980) Interaction: The realm of Transference and Countertransference. New York: Jason Aronson. Langs, R. J. (2004) Fundamentals of Adaptive Psychotherapy and Counselling: London: Palgrave Macmillan. Launer, J. (1998) ‘Narrative and Mental Health in Primary Care’, in T. Greehalgh And B. Hurwitz (ed.) Narrative Based Medicine. London: BMJ Books. O’Hanlon, W. (1994) ‘The Third Wave’. Family therapy Net Worker, November-December; 19-29. Oxford Dictionary of English (2005), C. Soanes and A. Stevenson (eds.), 2nd edition revised. Oxford: Oxford University Press. Read, S. J. and Miller, L. S. (1995) ‘Stories are fundamental to meaning and memory: For Social Creatures, could it be otherwise?’ In R. S. Wyer (Ed.), Knowledge And Memory: The Real Story (pp. 139-152). Hillsdale, NJ: Lawrence Erlbaum Associates. Roget’s Thesaurus of English Words and Phrases (2000), B. Kirkpatrick (ed.), new edition. London: Penguin Books. Scott, P. A. (1998) ‘Nursing, narrative, and the moral imagination’, in T. Greenhalgh And B. Hurwitz (ed.) Narrative Based Medicine. London: BMJ Books. Trivers, R. L. (1988) Introduction to J.S. Lockhard and D. L. Paulhus (eds.) Self Deception: An Adaptive Mechanism? Englewood Cliffs, NJ: Prentice Hall. White, M. and Epston, D. (1990) Narrative Means to Therapeutic Ends. New York: W. W. Norton.

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Dr Nollaig Frost University of London: The transition to second-time motherhood: an exploration of maternal narratives using a flexible narrative analysis approach

Abstract Research into maternal identity often describes the transition to motherhood (e.g. Smith, 1999; Miller, 2004). The literature can be infantocentric and frequently suggests the existence of only one child. By examining narrative accounts this paper explores aspects of the transition to second-time motherhood from a maternocentric perspective. It highlights and discusses interpretations of narratives gathered from women over a year-long period, that begins when they are six months pregnant with their second child. Close analytical attention is paid to the nuances of the stories and their telling. Feminist, psychoanalytic understanding enriches the interpretations and enables further insight to the meanings ascribed to the experiences by these women through their storytelling. The narratives of the mothers’ perceptions of pregnancy and the births of their children illuminate the ways in which they use their maternal experience to prepare for becoming a mother again. Stories of conflicts evoked by mothering two children, and ways of managing these, show the questioning of the maternal ideal by these women. Stories of the encumbrances needed for life with two children underline the women’s sense of change in the availability and use of space around them. The findings suggest that having a second child offers the women the opportunity to reappraise themselves as mothers. Recognising the impossibility of being the ‘perfect mother’, these mothers acknowledge their feelings of ambivalence and their desire for space of their own. Identifying these findings advances contemporary understanding of the experiences of mothers by raising questions about the reality of second-time motherhood. Notation notes: All participants’ names have been changed. All participants’ words are shown in italics. Interview identification written as: (Participant name, Interview number: Page no./Line nos).

Introduction This paper presents a narrative analytical exploration of the accounts of London based, middle-class, professional women speaking about becoming mothers for the second time. It focuses on my use of narrative analysis to explore their accounts and of a feminist, psychoanalytic framework to interpret the findings made. I consider the content, form and context (Halliday, 1973) of the narratives alongside other perspectives such as the story telling function and the unspoken interactions and nuances of the narration of stories and explore narratives through a contemporary psychoanalytic lens for influences of gender, culture and other nuances. Systematic deconstruction of the text alongside considered subjective reflexivity ensures the rigour of the process. This paper was written for presentation at the ‘Narrative Practitioner Conference: Developing Excellence in Research, Education and Practice’ (June 2007). In keeping with the theme of the conference its aim is to demonstrate and discuss how narrative analysis can be used to gain insight to the meaning of accounts. It provides examples of how its application reveals that one woman’s perception of the birth experience was indicative of her perception of a link with the experience of subsequent motherhood and that analysis of another woman’s description of her children’s bath-time illuminated her emotional conflicts about mothering two children. It will also show that narratives of taking up too much space with a second child can be understood to be representative of the women’s perception of changes in their psychic space. Why Narrative Analysis? Narrative inquiry in social research has been said to have arisen from an increasing interest in subjectivity (Squire, 2005). The use of traditional positivistic approaches in psychology allows for testing of existing theories but does not consider context nor the generation of new theories derived from a bottom-up approach to data (Willig, 2003). Psychoanalysis and its (feminist) critics are considered to have raised awareness of questions of subjectivity, the ‘unconscious’ and ‘desire’ (Squire, 2005). Squire suggests that work on narrative allows for the combination of ‘modern’ interests in description and interpretation, which arose in the early and mid twentieth century with ‘post-modern’ concerns with representation and agency. The questions of subjectivity in research therefore may be seen to be combining modern and post modern thinking and to allow for the linking of identity and action (Squire, 2005). Narrative analysis takes as its object of investigation the story being told by the participant. This often describes an event or action and analysis of its telling and its meaning can provide insight to the

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narrator’s sense of self. Narrative analysis regards individuals as storied and of selecting pertinent features from a personal experience to construct their account around. They make sense of the events by adding interpretive elements to bring coherence to the narrative. A critical approach to narrative inquiry, such as advocated by Emerson and Frosh (2004), recognises the co-construction of the account between research and narrator, within the interview itself and also in its subsequent interpretation and re-presentation. It achieves this by including the researcher’s role and interventions in the accounts so that they are involved in the analysis from the outset. The analysis of narrative adopts a social constructionist approach to meaning-making. Individuals are believed to construct their reality in their interaction with others. The critical narrative researcher thus considers the context and interpersonal relations of the story construction when drawing on its content and form to examine it. The researcher brings their subjective perspective to the objective, socially constructed text (Frosh and Emerson, 2004). In aiming to keep the text as un-fragmented as possible narrative researchers explore the entire interview text for stories and meaning making. Decisions as to which aspects of the text to single out and identify as stories are taken with the aid of formal models that identify the story structure (e.g. Labov, 1972). The choice of which model to use is often influenced by the researcher’s field and interest and each model alone does not answer the question of why the story was constructed or what message it was intended to convey to the interviewer. Neither do the models address the issue of unspoken messages and interactions contained within the narration of stories. The conventional western form of story telling is of it having a ‘beginning, middle and end’. Labov and Waletsky’s model (1967), the first formalised model of narrative analysis, advocates this by suggesting that stories are identifiable by the sequence of phrases incorporated within them (see Appendix 1). Labov & Waletsky (1967; Labov 1972) propose that stories that capture the attention of the audience generally contain these phrases in this order so that a story is identified by its temporal ordering of a sequence of events. However Becker (1999) proposes that looking around the text of stories identified by this model may enable the analyst to see alternative endings or circularity in the way a story is told (Becker, 1999). Similarly Gergen points out that gender differences in story telling also means that not all narratives adhere to this model (Gergen, 1992). However using Labov’s model (1972) to initially transcribe the interview text highlights the parts of a story that pertain to a particular element and can illuminate the researcher’s understanding of what the participant is trying to convey. Understanding the causal coherence that the participants bring to the story can illustrate the ways in which they are hoping to convey their meaning. This model can therefore be used as a starting point rather than an end point in the interpretation of narratives (Riessman, 1993; Emerson and Frosh, 2004). Other models have developed around researchers’ interests. Linguistic concerns led to the development of a model by Gee (1991), for example. This focuses on the pitch glide and spoken words in the story telling as indicators of significant aspects of a narrative. Riessman (1993) developed this approach further by considering the performative function of the recounting of the significant events as stories. Others have identified ‘illness narratives’ (Weingarten, 2001), chaotic narratives (Frank, 1995 ) and progressive or regressive narratives (Gergen and Gergen, 1986) Narrative analysis therefore offers many ways of uncovering layers of meaning. The flexibility of the approach I used was achieved by using the initial transcription of the interview texts to guide my first choice of analytical model on the data. Following the initial transcriptions and analyses I returned to the text to further understand the initial findings. I looked at the positioning of the story in the interview, the questions that had led to it, the unspoken interactions and the text that preceded and followed the identified story. I sometimes re examined the story using different models to identify alternative meanings, sub stories or different endings to it. By systematically applying different narrative analyses to their accounts I captured the complexity and diversity of each woman’s experiences. Using narrative analysis in this way recognised that women may not feel free to speak openly of their feelings about themselves as mothers or their experience of motherhood by acknowledging that meanings can be conveyed in all manner of ways through the use of stories. The detailed uncovering of the different layers of meaning acknowledged and respected the individuality of the meanings of the experiences to each mother. Adopting a psychoanalytic lens through which to view the texts allowed factors such as the interpersonal relationship, the context of the interview setting and the reflexivity of the researcher to be considered. There is recognition of the fluidity of meaning dependent on these factors and that alternative interpretations of texts are equally viable. A belief in the importance of background features and fantasies behind the conveyance and maintenance of individuals’ attitudes and beliefs enriches interpretation of the interview texts. As in psychoanalytic practice, the interpretations of the

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data are suggestive and tentative. Confidence in them comes from their grounding in the text and systematic application of models of analysis. My emphasis on maintaining the focus of the interpretation on the narrative and not on the narrator uses and positions psychoanalytic ideas in the words of the participants rather than in their person. This is achieved by working with the text and so that interpretations are made on the basis of narrative analysis of the written or spoken word and psychoanalytic ideas are used to discuss the possible meanings of the interpretations. Miller and Parker (Miller, 2004; Parker, 1997; 2005) suggest that applying psychoanalytic thinking to accounts allows an alterity of women as mothers to emerge. Similarly, I was aware that analysing the accounts some time after their narration meant allowing for changes in the contexts of their telling and their interpretation. This was addressed using field journals and peer scrutiny to heighten my reflexive awareness of possible meanings. I wanted to ensure that the stories were those of the participants and not a reflection of my own and this meant remaining open to their changing meanings and endings. This paper illustrates the process and some of the findings by asking how a narrative analysis approach can be used to gain insight to the experience of women making the transition to second-time motherhood.

The Study Interview texts were gathered from seven mothers over the period of a year. Each woman was six months pregnant with her second child at the start of the year process and was interviewed three or four times. The women all lived in London and had been raised in Western cultures. They were all professional women and ranged in age from early to mid 30s. At the start of the interview process all were planning to return to work following the birth of their second child. At the end of the year, two women had decided that they would instead remain at home full-time. All women were white and in stable relationships with the father of both children. Each woman was interviewed by me.My interview style was to have a list of seven questions to hand but to adopt a conversational and free flowing style with each woman – a ‘conversation with a purpose’ (Kvale, 1996). The questions aimed to elicit accounts about the women’s expectations and realities of having initially become a mother, entering second-time motherhood and being a mother of two children. Sometimes I asked all the questions but sometimes the flow of the interview took unanticipated directions. One of these directions led me to the first finding to be discussed here. I found that each woman chose to tell me about the birth of her first child during our first interview. This was despite me not specifically enquiring about this. (i) Stories within stories

The narratives about the birth were usually provided in response to my question: N: “What do you think it will be like to have a second child?” A response from one participant, Gemma, provided a clearly identifiable temporally ordered story. I transcribed it using Labov’s model (see Appendix 2, Table 2.). The transcription captures the plot and the sequence of events of the birth in a conventionally structured ‘beginning, middle and end’ style. It tells me that Gemma experienced the birth differently to how she had hoped. Instead of the natural, non-medicalised birth she had wanted, she had a protracted hospital stay and an intrusive emergency medical procedure. Gemma told me that the reason for this had been due to her being asked to push too early by hospital staff. This had resulted in trauma to the baby and the need for an emergency Caesarian delivery. Gemma had declined the hospital’s offer to take up a complaint against it. As she narrated the story to me I wondered why Gemma was telling me about her decision not to seek likely recompense or apology for the error and what this might tell me about her experience of the birth. I sought clarification by asking Gemma about her reference to “the year”. Her response provided me with an account of the initial difficulties of feeding her baby because of the delay in having skin-toskin contact arising from necessary post-Caesarian medical procedures. Gemma’s narrative then returned to the notion of something ‘starting off’ saying, “but I ended up feeling like the whole thing was a bit humiliating really. It was a bit of an unfortunate way to starting off”. I asked again for clarification and Gemma answered: “Just motherhood really”. This remark immediately made clear to me the meaning of Gemma’s comment ”starting off the year”; for her it represented entering motherhood. This knowledge contextualised Gemma’s earlier

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description of the birth, so that the disappointment she experienced alongside the trauma of the birth was highlighted. Before the birth Gemma’s mother had told her that “the pain of childbirth was a positive thing”, the yoga classes she attended emphasised the importance of a natural birth for the baby’s gentle entry to the world, and the antenatal groups she was part of had spoken of immediate postnatal skin-to-skin contact to ensure successful feeding of the baby. The reality of the experience for Gemma was very different to the expectations she had developed using this information. Far from beginning motherhood as she had been led to expect by those around her Gemma found that she instead felt “weird” and “traumatised” by an ordeal she described as “brutal”. The information she had been given by others had led to false expectations. In addition to this she had then been given incorrect medical advice, to begin to push too early. Gemma’s narrative of the detail of the birth and the accompanying medical procedures, belie the story of her disappointment and dashed hopes about how she would experience her entry to motherhood. Yet another error, made by staff instead of family and other advisers, seemed to confirm Gemma’s reality that all around her had been wrong. Her narrative about her preparations for the second birth told at a later interview, strengthens this interpretation (see Appendix 2, Table 3). I transcribed it using Gee’s model because I had been drawn to the rhymicity with which it had been spoken. This transcription highlights once again Gemma’s feelings of disappointment in the first birth experience and provides poignant insight into how she felt about her “failure to progress”. Adding weight to the interpretation of her disappointment in what she had been led to expect, Gemma’s narrative describes her perception that other people would not want information from her (Stanza 3) and that by giving it to them she would frighten them (Stanza 2). These are the feelings Gemma described about herself at her first birth. Tellingly, she describes how during her second pregnancy she did not attend yoga classes, developed her own exercise and diet schedule and planned an elective Caesarian. Telling me this demonstrates how she used her own experience to plan for the second birth and does not this time rely on that of others (Miller, 2004). Gemma described a positive second birth experience and her narrative reconfirmed her perception of a link between the birth and subsequent motherhood experience. For Gemma the second birth was: “…really exciting. And it just was I mean it just was a really joyful experience in a way that the first one wasn’t. And it was really lovely it was really a good start and she immediately latched on and things like that so it was good start”. (ii) Whose story?

We saw above that the initial identification of a story using Labov’s (1972) approach allowed subsequent analysis to reveal the depths of its meaning. The description of feelings, expectations and consequences within the narrative however was uncovered by looking beyond the text transcribed using this approach. What follows is an illustration of how I combined reflexive awareness with applications of Labov’s model (1972) on the same piece of text to reveal different perspectives of meaning. In doing so I combined systematic analysis with my subjective awareness that I too was a mother of two children talking to another about a common experience. In response to a question about her decision to stay at home instead of returning to work, Karen told me a story about children’s bath-time. Its transcription is shown in Appendix 3, Table 4. During its transcription I noticed that in addition to a story about the children in the bath, this narrative also contained a story about Karen. This is transcribed in Appendix 3, Table 5. The first story told of the children playing together. The second story told of Karen’s understanding of herself as a mother of two children. During the narration I had been struck by the way in which Karen had told the stories: the capitals highlight her verbal emphases and indicate the energy and intensity with which she infused their telling. Recognising this meant that the absence of context and of the presence of the interpersonal relation between us in this transcription seemed to be particularly important. When I first heard the story of the children I had felt a resonance with this tale and this perpetuated through subsequent listening and reading of it. I thought I could recognise that moment of mixed feelings of relief and joy at the end of a day with two young children. To explore this subjectivity further I re examined the text for affect, as shown in Appendix 3, Table 6. This approach uncovered a narrative about Alice spitting (Part 1) and another other about the children laughing (Part 2). The stanzaic structure of each brings coherence to its construction and development. However, layered within these conventionally structured narratives are nonconventional descriptions of Karen’s thoughts and feelings during the unfolding of the event.

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Examination of these identifies her feelings as being in direct opposition with each other: the first narrative is interwoven with Karen’s expectation of another bout of screaming, the second with her feeling of “how lovely” she finds it to see the children laugh. The narration of these opposing feelings illustrates a tension in the structural background of the narratives and echoes the tension Karen describes by experiencing such oppositional feelings. The tension is emphasised in the narrative by the short tight two-line Stanza 3 and the ensuing relief portrayed by the longer Stanza 7. It is almost as if the latter represents a relieved exhalation of the breath, drawn tersely in (Stanza 3) when the water is first spat. The beginning and ending of the narratives are clearly linked by the Frames. The word “improvement” is included at the beginning to describe the children playing and “a lot better” at the conclusion of the narrative. This study of her feelings identifies a positive progression in Karen’s experience of caring for two children, which would not have been apparent from examination of the narrative structure alone. These were further emphasised when I recognised my own understanding, as a mother of two, of the significance of reaching bath-time at the end of a trying day at home with two young children. (iii) Using Theory

I had noticed several references to space being made throughout the interview process. The women spoke of wanting more space, of taking up space, of seeking space away from their children and of filling the space in the days at home. Analysis of the accounts that included references to space showed that some accounts followed conventional narrative form but many did not and were spoken as statements, comments and asides (e.g. “which we could do if we had more space”). The narratives indicated expansions and contractions in the women’s perceptions of the availability of the space around them as they changed from being the mother of an only child to being the mother of two children. Several mothers spoke about space by describing how much would be taken up by the equipment needed for two children. Hannah told me: “The biggest thing is like the whole like the double buggy thing you know. I hate taking up too much space. And that monstrosity over there is a three-wheeler that Jim, when we were moving from the country to the city, was like I want my baby to have shocks. Although it does take up alot of room. And that’s my thing I don’t want to be one of these people walking around London taking up the space of eight people. You know what I mean?” (Hannah, 1: 6/L201-213) Hannah’s description of the city being populated with people who take up the space of eight suggests crowds. Combined with her husband’s desire for the baby to be protected by having a stroller with shock absorbers, this also suggests exposure and vulnerability. Hannah’s assertion that the stroller was her husband’s choice and that her “thing” is the amount of room this “monstrosity” takes up, seems suggestive of her concerns about space. She follows this narrative with an account of a recent airport trip involving a travel seat to contain Christopher, plus a buggy to move him around the airport, a rucksack to contain the seat and a number of suitcases to contain the clothes and equipment that would be needed by the three of them whilst abroad. This non-conventional narrative can be understood by considering the importance of the mother as a container for her children’s experience and feelings but also by considering the threat to her own boundaries by exposure to the primitive emotions of young children and infants (Raphael-Leff, 1989). Hannah’s focus on the need to manage Christopher with the right equipment and how much larger the equipment needed for two children will be may then be understood as an expression of her concerns about having a second child. On the one hand she recognises that to “make everything manageable” the equipment needs to be large. On the other hand the “monstrous” size of it is a daunting prospect to an individual feeling unsupported and isolated within an unfamiliar world. It seems possible that although talking of the unfamiliarity and challenges of London, Hannah might also be representing her concerns about entering the world of second-time motherhood. She may sense that as a mother of two children she is no longer able to contain these feelings within herself. Paradoxically the container that will enable her to safely manage the children also draws attention to her and so raises the risk of exposure of her uncontained feelings. Discussion Identifying and analysing narratives in the ways outlined here has provided insight to the meanings of the women’s accounts. Lieblich et al (1998) describe the narrative approach as one that allows for

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individuals to both discover themselves and to reveal themselves to others through the stories they tell. These women tell stories of mothers whose realities are different to their expectations and who experience conflicting feelings about being mothers of two children. Analysing them from many perspectives and exploring the findings through a contemporary psychoanalytic lens allows layers of insight to the complexity and diversity of the changes in themselves and the relationships around them. Gemma’s narrative can be considered using Raphael-Leff’s work to understand more about finding of the significance of the birth experience to her. This concerns the psychological processes of pregnancy and childbirth (Raphael-Leff, 1985; 1988; 1993) and describes models of the ‘Regulator’ and the ‘Facilitator’ to explain differences in women’s approaches to pregnancy, childbirth and parenting. The models are based on the conflicts facing parents within a society that on the one hand promotes gender based divisions of roles between fathers and mothers with suggestions of biologically determined predisposition to motherhood and its associated tasks, and on the other hand offers an increasing degree of choice to women about when and whether to have children. She suggests that the essence of the Regulator model is that of the mother who expects the baby to adapt to her and the Facilitator model being that of the mother who expects to adapt to the baby. Raphael-Leff suggests that these orientations, present in pregnancy, result in different approaches to childbirth and perpetuate consistently at least until the birth of the next child (Raphael-Leff, 1985). Perhaps Gemma prepared for her first experience of birth as a Facilitator and then found the event so unlike she had expected and hoped for that her preparation for the second birth altered to that of a Regulator to incorporate her need to control the event and reduce the likelihood of distress and discomfort. Karen’s story also told of her hopes for and her reality of becoming a mother of two children. She had already discussed with me her desire to have a second child in order to have the opportunity to enjoy what she felt she had missed out on with her first baby by returning to work. She had told me that that she regarded having a second child as another opportunity at motherhood. The story of the perfect moment during bath-time described rare feelings of maternal fulfilment for Karen and further exploration of it revealed a backdrop of tension and demands in her life as mother. The existence of simultaneous feelings of love and hate towards their children can be hard for mothers to talk about, particularly in a society that idealises mothers (O’Grady, 2004). Considering this from a psychoanalytical perspective suggests that the co-existence of the feelings provoke mothers to feel guilt and anxiety. They fear damaging their baby and losing its love by driving it away with their hatred (e.g. Winnicott, 1947; 1950). However, Parker (2005) points out that the recognition of the ambivalent feelings can bring a constructive differentiation of self from the baby. The mother can recognise the baby as separate to her and she can feel a sense of responsibility in ensuring the mitigation of the feelings of hate with those of love. She finds ways to manage the feelings of hatred so that that the fantasised destruction of the baby does not enter external reality. Perhaps Karen’s description of her relief was a recognition of the strength of her love for her children and one that she wished to inform me of. To explore the narratives about space I drew on Winnicott’s theories of the use of transitional space (1967; 1968; 1970) and the capacity to be alone (1958). I regarded the mothers’ narratives about changes in the space around them as representations of their perception of changes in the availability of their internal space. This enabled me to understand the narratives to be about these mothers’ feelings of needing to be ever-vigilant and provide attention to their children constantly. It suggests that they are prevented from finding a space of their own when in their children’s presence – an impossibility of ‘being alone in the presence of their children’. All the findings were reached initially by drawing widely on the broad repertoire of analysis available in the study of narratives. I reached my understanding of women’s experiences by allowing for consideration of many aspects of their construction and narration and by privileging the women’s words and regarding them as more than simple representations of events in their lives. Combing the systematic analysis with psychoanalytic understanding enabled these meanings to provide insight to the ways in which they made sense of the disruption to their sense of self, brought about by having another baby. Narrative analysis views the construction of narratives as drawing on the cultural and social knowledge that constitutes ‘meta narratives’ (Somers, 1994). Ways in which these are used in the construction of the women’s expectations about motherhood allowed me to gain insight to the significance of this in the formation of expectations about second-time motherhood. I obtained a depth of meaning within the recounting of experiences by drawing on the depth of narrative analytical understanding offered in its many models and applications.

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As a mother of two children I was able to be reflexively aware of (sometimes unspoken) evidence of shared knowledge assumptions and understandings. This however also demanded that I retained a heightened alertness to withholding my own story from imposition on those of the participants. Whilst confident of this, further research could usefully explore the flexible use of narrative analysis of texts elicited from mothers by someone who is not a mother. Use of multi-models approaches such as this is commonly associated with quantitative research methods, often as a means of providing validity to results. In applying different approaches in this research my aim has been to highlight and uncover the depth of meaning of narratives and their telling. The development of models in narrative analysis that focus on structural, linguistic and other aspects of a narrative each has its place in detailing the meanings of narratives. My choice to use a psychoanalytic framework to bring meaning to them is a subjective one; other frameworks exist, as do other models of narrative analysis. This paper has, however, sought to illustrate that guidance from the story itself can enable otherwise inaccessible layers of meaning to be revealed. References Becker, B. (1999) Narratives of pain in later life and conventions of storytelling, Journal of Aging Studies, 13 (1): 73-87. Bruner, J. (1987) Life as Narrative, Social Research, 34 (1): 11-34. Emerson, P. & Frosh, S. (2004, Critical Narrative Analysis in Psychology: A Guide to Practice. London: Palgrave. Frank, A.W. (1995) The Wounded Storyteller: Body, Illness and Ethics. Chicago, Illinois: University of Chicago Press. Gee, J.P. (1985) ‘The Narrativisation of Experience in the Oral Style’, Journal of Education, 167: 935. Gergen, K. and Gergen, (1986) ‘Narrative Form and the Construction of Psychological Theory’ in T. Sarbin, Narrative Psychology: The Storied Nature of Human Conduct New York: Praeger. Gergen, M (1992) ‘Life Stories: Pieces of a Dream’ in G.C. Rosenwald & R.L. Ochberg Storied Lives. New Haven: Yale University Press. Halliday, M.A.K. (1973) Explorations in the Functions of Language. London: Edward Arnold. Hollway, W. (2001) From motherhood to maternal subjectivity, International Journal of Psychoanalysis, 2: 13-38. Kvale, S. (1996) InterViews: An Introduction to Qualitative Research Interviewing. Sage Publications, Inc. Labov, W. (1972) ‘The Transformation of Experience in Narrative Syntax’ in W. Labov Language in the Inner City: Studies in the Black English Vernacular, Philadelphia: University of Pennsylvania Press. Labov, W & Waletzky (1967) ‘Narrative Analysis: Oral Versions of Personal Experience’ in J. Helms (ed.) Essays on the Verbal and Visual Arts. Seattle: University of Washington Press. Lieblich, A., Tuval-Mashiach, R. & Zilber, T (1998) Narrative Research. London: Sage. Miller, T. (2004) Making Sense of Motherhood: A Narrative Approach. Cambridge University Press. O’Grady, H. (2005) Women’s Relationship with Herself: Gender, Foucault and Therapy. Routledge. Parker, R. (1997), The Production and Purposes of Maternal Ambivalence, in Hollway, W & Featherstone, B (1997) Mothering and Ambivalence, Routledge London. Parker, R. (2005) Torn in Two: The Experience of Maternal Ambivalence, (second edition) Virago Press. Raphael-Leff, J.(1985), Facilitators and Regulators: Participators and Renouncers: Mothers’ and Fathers’ Orientations towards Pregnancy and Parenthood, Journal of psychosomatic Obstetrics and Gynaecology 4: 169-84. Raphael-Leff, J.(1986) Facilitators and Regulators: Conscious and Unconscious Processes in Pregnancy and Early Motherhood, British Journal of Medical Psychology, 59: 43-55. Raphael-Leff, J.(1989) Where the Wild Things Are, International Journal of Prenatal and Perinatal Studies, 1: 79-89. Raphael-Leff, J.(1991) The Mother as Container: Placental Process and Inner Space, Feminism and Psychology, 1, (3): 393-408. Raphael-Leff, J.(1991), Psychological Processes in Pregnancy and Childbirth. London: Chapman Hall. Raphael-Leff, J.(2003), Pregnancy: The Inside Story. Karnac Books. Riessman, C. K. (1993), Narrative Analysis. Sage Publications, Inc.

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Sarbin, T. R. (1986) Narrative Psychology: The Storied Nature of Human Conduct. New York: Praeger. Somers, M.R. (1994) ‘The narrative constitution of identity: a relational and network approach’, Theory and Society, 23: 605-49. Squire, C., (2005) Reading Narratives, Group Analysis, 38(1): 91-107. Weingarten, K (2001) ‘Making Sense of illness narratives: Braiding theory, practice and the embodied life’ in (Collection) Working with the Stories of Women’s Lives. Dulwich Centre Publications. Willig, C (2001) Introducing Qualitative Research in Psychology. Open University Press. Winnicott, D.W., (1935) ‘The Manic Defence’ in Through Paediatrics to Psychoanalysis (1982). London: Hogarth Press. Winnicott, D.W., (1947) ‘Hate in the Counter Transference’ in Through Paediatrics to Psychoanalysis (1982). London: Hogarth Press. Winnicott, D.W., (1950) ‘Aggression in Relation to Emotional Development’ in Through Paediatrics to Psychoanalysis (1982). London: Hogarth Press. Winnicott, D.W., (1951) ‘Transitional Objects and Transitional Phenomena’in Through Paediatrics to Psychoanalysis (1982). London: Hogarth Press. Winnicott, D.W., (1956) Primary Maternal Preoccupation in Through Paediatrics to Psychoanalysis (1982). London: Hogarth Press. Winnicott, D.W., (1958) The Capacity to be Alone, The International Journal of Psychoanalysis, 39: 416-420. Winnicott, D.W., (1960) Ego Distortion in Terms of True and False Self, in The Maturational Process and the Facilitating Environment, (1965) London: Hogarth Press. Winnicott, D.W., (1960a) ‘The Relationship of a Mother to her Baby at the Beginning’ in The Family and Individual Development (1965). London: Tavistock.

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Appendix 1

Table 1: Labov’s Model of Transcription (1972) Abstract: Orientation: Complicating Action: Resolution: Coda: What was this about? Who?, What?, When?, Where? Then what happened? So what? Return to present – end of story

Appendix 2 Table 2: Transcription of Gemma’s Story of the Birth of her First Child using Labov’s model (1972) Abstract: “That wasn’t that great actually” Orientation: “It probably didn’t start the year off in a brilliant way” Complicating Action: “Like it was my first major hospital stay, I had quite a long labour, like between 24 and 36 hours labour” Resolution: “and then it was emergency Caesarian” Evaluation: “It was just um it was annoying” Complicating Action: “because they got me pushing too early and then they couldn’t rectify it” Evaluation: “and it was all unfortunate because” Coda: “I was hoping for a natural birth” (Gemma,1:9/L502-512) Table 3: Gemma’s Narrative of her Feelings about her First Birth Experience, Transcribed Using Gee’s model (1991) Stanza 1 “Because I felt really ashamed to go back there and I shouldn’t have been because I had a lovely beautiful child Stanza 2 “But I felt… and also I didn’t want to frighten the people there.” Stanza 3 “I think when you haven’t gone through childbirth yet you probably don’t want somebody who tells you she had an emergency Caesarean but you know its all fine.” Stanza 4 “But I did have quite a strong sense of failure particularly as they did put it down as failure to progress And I think it was. But the whole thing was.” (Gemma,1:10/L592-596) Appendix 3

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Table 4: Karen’s Story of the Children Playing in the Bath, Transcribed Using Labov’s model (1972) Abstract: Orientation: “And quite recently they suddenly started playing together in the bath” “The first incident of that I remember it was just an AWFUL day”

Complicating Action: out”

“And then I saw Alice take a mouthful of bathwater and spit it

Evaluation: “and I was just about to go “STOP DOING THAT IT’S DISGUSTING, YOU’RE SPITTING IT IN GEORGE’S FACE” Resolution: from him” “and suddenly there was this noise from George, it was genuine giggling laughter

Complicating Action: Evaluation: Resolution:

and then she did it again”

“and I didn’t have the heart to say “Spitting’s disgusting don’t do it” “because he laughed again”

Coda: “and then she laughed and then suddenly they were both giggling together” (Karen, 3: 2/L54-90)

Table 5: Karen’s Story about Herself Watching the Children Playing in the Bath, Transcribed Using Labov’s Model (1972) Abstract: “And the other big improvement in the last week has been that the two of them playing together” Orientation: “it was just an AWFUL day and I just remember sitting there thinking THANK GOD I’m on these antidepressants” Complicating Action: “They’re in the bath” Evaluation: “Thank GOD for that” Complicating Action: “and then I saw Alice taking a MOUTHFUL of bathwater and SPIT it out” Evaluation: “and I was just about to go “STOP DOING THAT ITS DISGUSTING, YOU’RE SPITTING IT IN GEORGE’S FACE”, and my first reaction was to think” oh my god here we go” and you know he’s going to go again screaming” Resolution: “and then suddenly they were both giggling together”

Coda: “and I thought “oh my god my god this is IT this is why I had two look at them laughing together how lovely”, and since then they have um you know they do play a lot better together”

Table 6: Transcription of Karen’s Story of the Children in the Bath, Using Gee’s Approach (1991) adapted by Riessman (1993) Frame (narrative)

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And the other big improvement in the last week has been the two of them playing together um up to very recently Alice would mainly just ignore him or frighten him and he was just frightened of her as well and quite recently they suddenly started playing together in the bath or you know at other times

Awful Day (Affect, non-narrative) and the first incident of that I remember having it was just an AWFUL day and I just remember sitting there thinking THANK GOD I’m on these anti depressants I couldn’t I would never have got through a day like this or without feeling like I was going to run out the door screaming but this has been an AWFUL day it’s nearly over they’re in the bath thank GOD for that Part 1: Alice spitting (narrative) Stanza 1 and then I saw Alice taking a MOUTHFUL of bathwater and SPIT it out Stanza 2 and I was just about to go “STOP DOING THAT ITS DISGUSTING, YOU’RE SPITTING IT IN HIS FACE” and you know and suddenly there was this noise from George Stanza 3 He’s going to go again (affect) and my first reaction was to think oh my god here we go and you know he’s going to go again screaming

Part 2: Children laughing (narrative) Stanza 4 and it wasn’t it was laughter it was genuine giggling laughter from him Stanza 5 and then she did it again and I didn’t have the heart to say “Spitting’s disgusting don’t do it” Stanza 6 because he laughed again and then she laughed and then suddenly they were both giggling together Stanza 7: How lovely (affect) and I thought “oh my god my god this is IT this is why I had two, look at them laughing together how lovely” It was, it was, it just, it didn’t go, it went on for about five minutes I suppose Frame Stanza 8 but I thought it was longer at the time it was a real moment of epiphany I guess

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and since then they have um you know they do play a lot better

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Dr Tammi Walker University of Bradford England. ‘Seeing beyond the battled body’ – Narratives of women’s self-harm Abstract Deliberate self-harm is broadly characterised as any act intended to harm one’s own body. It is a complex and contested phenomenon and until recently social and clinical inquiry has marginalised self-harm as an area of exploration. When practitioners encounter self-harm they often remain anxious, fearful, frustrated and challenged about such individuals, principally because they are constrained to understand and respond to self-harm almost exclusively within a problematised discourse. That is, a problem that must be diagnosed and contained. This paper reports the findings of a narrative study of women with a diagnosis of borderline personality disorder (BPD) who self-harm. Women who have been diagnosed with BPD are often portrayed as being risky, chaotic and their identity can be unstable. Women who self-harm exist as subjects of discourses that construct a dialectical tension between sense of self and deviance Narrative segments are presented in this paper. These narratives reveal some of the ways that the selfharm has affected their selfhood and sense of agency. Further, they will highlight how the external signs of self-harm on the body take over how others communicate with them in the health care interaction. Utilising the narrative segments in this research may advance understanding of the complexities of the phenomenon and allow practitioners to see the ‘woman’ behind the battled body. Introduction Deliberate self-harm is broadly characterised as any act intended to harm one’s own body. It is a complex and contested phenomenon and until recently social and clinical inquiry has marginalised self-harm as an area of exploration. Current research shows that many acts of ‘self-harm’ do not come to the attention of healthcare services (NICE 2004) and hospital attendance rates do not reflect the ‘true’ extent of the problem (Hawton, Rodham, Evans and Weatherall,2002; Melzer, Harrington, Goodma, Jenkins and Brugha, 2002). This is because many incidents of ‘self-harm’ are treated at home (Arnold, 1995). According to a survey of 76 women performed for the Bristol Crisis Service for Women in 1994/95, 74% had begun self-injuring during childhood or adolescence (0-19yrs) and 69% had been inflicting injuries on themselves for more than five years (Arnold, 1995). Further, a study conducted in Ontario in the early 1970s by Johnson, Frankie and Ferrence investigated incidents of ‘self-harm’ over 12 months in nursing homes, general practices and hospitals. This piece of research showed that there was an annual rate of 730 occurrences of ‘self-harm’ per 100,000 population, committed by 559 individuals per 100,000 population, but they hypothesised that the ‘true’ rate was 1433 episodes per 100,000 (cited in Tantam and Whittaker, 1992). In 1998 a report by the Department of Health highlighted that the rate of self-harming had increased so significantly in the United Kingdom (UK) that there was an estimated 400 cases per 100,000 population. This is higher than other recorded rates in Europe (NHS Centre for Reviews and Dissemination, 1998). To further support this, in 2002 a national interview study was conducted in the UK and the research showed that between 4.6% and 6.6% of individuals have self-harmed (Melzer, Lader, Corbin, Singleton, Jenkins and Brugha, 2002; NICE, 2004). Overall, from this study, and other published research (Kreitman and Foster, 1991; Yeo, 1993) it has been estimated that at least 1 in 600 people ‘self-harm’ to such an extent that they need hospital admission and/or treatment (Tantum and Whitaker, 1992). Self-harming, once begun, also tends to be repeated (Favazza, 1987; Favazza and Conterio, 1988) and it has been estimated that approximately one-quarter of all the people who attend a general hospital following an episode of ‘self-harm’ will die by committing suicide in the following year (Owens and House, 1994). This is between 50 and 100 times greater than the rate of suicide in the general population (Hawton et al, 2002; Owens, Horrocks and House, 2002). ‘Self-harm’ is reported as one of the top five causes of acute medical admission for women and men in the United Kingdom (Hawton and Fagg, 1992; NHS Centre for Reviews and Dissemination, 1998). However, many authors have noted that women are more likely to ‘self-harm’ than men (Pao, 1969; Simpson, 1976; Cross, 1993; Favazza, 1987) and studies suggest that rates are 2-3 times higher for women than for men (Hawton, Fagg and Simkin, 1997; Department of Health, 2002). When accessing service provision to receive support and treatment more women than men are shown to access mental health services for self-harming behaviour (Bird and Faulkner, 2000; Department of Health, 2001).

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Research (Cookson; 1977; Horrocks, House and Owens, 2002; Department of Health, 2002; Burrows, 1992; Smith, Cox and Saradjian, 1998) suggests that women who ‘self-harm’ have described a wide range of behaviours that they have used to cause harm to their bodies. According to the Bristol Crisis Service for Women 90% of a sample of female self-harmers had cut themselves and a third had inflicted blows or scalded themselves (Arnold, 1995). Further, overdosing, burning with cigarettes or caustic agents, self-strangulation, inserting/ingesting sharp or other harmful objects (Cookson; 1977; Horrocks, House and Owens, 2002; Department of Health, 2002), stabbing, scratching or scraping their skin, gnawing at flesh, biting, picking at wounds, pulling hair out and banging their head against something (Burrows, 1992; Smith, Cox and Saradjian, 1998) have also been highlighted as ways that women harm themselves. It must also be noted that ‘self-harm’ can also include many behaviours that are culturally and socially acceptable and which in turn can result in self-inflicted physical or psychological damage (NICE, 2004), such as smoking, excessive alcohol consumption, drug use, over eating or dieting (Favazza, De Rosear and Conterio, 1989; Lacey, 1993; NICE, 2004). In addition, ‘self-harm’ can happen as part of a religious practice, as a form of political or social protest (NICE, 2004) or as an act of ‘body enhancement’ (Babiker and Arnold, 1997; Walsh and Rosen, 1988). Thus it might be argued that there is a divergence in both the literature and the health care field in the way that ‘self-harm’ might be defined within wider society. When practitioners encounter self-harm they often remain anxious, fearful, frustrated and challenged about such individuals, principally because they are constrained to understand and respond to selfharm almost exclusively within a problematised discourse. That is, a problem that must be diagnosed and contained. Women who self-harm are often portrayed as being risky, chaotic and their identity can be unstable. They often appear to exist as subjects of discourses that construct a dialectical tension between sense of self and deviance. The findings of this research have led to the suggestion that some of the ways that the self-harm has affected their selfhood and sense of agency. Further, it seems that the external signs of self-harm on the body appear to take over how others communicate with the women in the health care interaction. In this research, understanding the experiences of women needed to be considered in the context of the women’s lives as a whole in order to illuminate their significance. In order to acknowledge the women’s voices and experiences it was decided that the approach to the research would be from a theoretical position which focused and examined the material, discursive, and intrapsychic aspects of experience. This standpoint which is put forward by Ussher (1999; 2000) does not privilege one level of analysis above the other, all of these different levels of analysis and experience (Ussher, 1999), need to be taken into account when analysing women’s lives. It is a multi-dimensional approach. Briefly, ‘material’ factors are those that exist at a corporeal, a societal or an institutional level. Ussher (1997) maintains that this would include biological factors associated with psychological symptomatology, such as hormones or physiological arousal; material factors that institutionalise the diagnosis and treatment of experiences as Borderline Personality Disorder (BPD); and previous history of abuse or trauma. There may also be many material consequences of experiencing or being treated for self-harm and BPD, in terms of physical and psychological vulnerability, as well as may be powerlessness at an economic and societal level (Collins, 1991). The ‘discursive’ centres on the social and linguistic domains – language, visual representation, ideology, culture and power (Ussher, 2002). With regard to this research what is arguably of most relevance is the discursive constructions of self-harm and BPD, of mental health and illness (Foucault, 1977; Ussher, 1991), and of gender (Smith, 1988; Ussher, 1997). With regard women’s mental health in general there is now a growing body of feminist social constructionist, researchers (Caplan, 1995; Figert, 1996; Rittenhouse, 1992) who argue that certain diagnoses have been discursively constructed in society to account for a whole range of distress and dysfunction experienced by women. For example, in the case of Premenstrual Syndrome (PMS) Chaturvedi (1994) has provided evidence that indicates that in societies where ‘PMS’ does not circulate widely as a discursive category, women do not associate the pre-menstrual phase of the cycle with psychological symptoms, and ‘PMS’ as a diagnosis is rarely applied. As a result of this some feminist writers (Figert, 1996; Ussher, 1999) have rejected ‘PMS’ as a diagnostic category and maintain that it merely acts as a mechanism to medicalise the unhappiness and distress of women. ‘Intrapsychic’ factors are those that operate at the level of the individual and the psychological: factors which ‘…are traditionally the central focus of psychological analyses of women’s madness.’ (Ussher, 2000, p.221). Analysis of this area may therefore focus upon the way in which women blame themselves for problems in their lives, and psychological explanations for why this is so. Ussher (2002) argues that such factors as low self-esteem, the impact of previous neglect or abuse, guilt,

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shame, fear of loss or separation should also be incorporated. Further analysis would include an examination of the psychological defences that the women may use, such as denial Overall, the material-discursive-intrapsychic model does not privilege either psychological or biological factors and gives equal status to discursive representations. Although Ussher’s materialdiscursive-intrapsychic model (1999; 2000; 2002) discusses these three factors separately it does assume that it is their relationship with each other that produces experiences for women. From this perspective the three levels of experience are irretrievably interconnected and one cannot be understood without the other. Using the material-discursive-intrapsychic model, this paper will examine the narrative segments in this research and indicate how they may advance understanding of the complexities of the phenomenon and allow practitioners to see the ‘woman’ behind the battled body. The interview study: method and participants Four women who had a history of self-harming behaviour and who met the diagnostic criteria for Borderline Personality Disorder (DSM-IV) (APA, 2000) took part in in-depth narrative interviews (Reissmann, 1993). The women were purposively selected, their ages ranged from 30 to 54 and none of them were in paid work at the time of the interviews. Narrative interviews were conducted by the author and the aim was to examine and explore the women’s subjective experiences of self harm. Drawing upon Reissman (1993) several broad areas were explored in the interview in order to elicit narratives. These included the first time that they had self-harmed, how they coped when they selfharmed and an exploration of the support from health services that they had received in relation to self-harm. The interviews often followed the woman’s lead, asking questions of clarification as and when necessary. The interviews were therefore framed as a dialogue between two people, rather than a question and answer situation. The analytical framework used for the women’s accounts drew upon aspects of the ‘performance’ approach developed by Langellier (1989; 2001) and a ‘narrative thematic’ approach (Reissman, 1993). The performance approach is underpinned by an ontology that sees human interactions and communication as fundamental aspects of lived human experience. With regard to this research the ontological stance was that storytelling is one of the principal ways in which individuals make sense of their own experiences and of the world around them. A performance approach to personal narrative views it as oral storytelling in a social situation – in a word, a performance (Langellier, 1989). A story involves storytelling - a reciprocal event between a teller and an audience (Reissman, 2000). Further performance as an analytic framework gives access not only to the social, structural and cultural contexts in a narrative account but also the embodied context. Performing narrative requires bodily participation: hearing and voicing, gesturing, seeing and being seen, feeling and being touched by the storytelling (Langellier and Peterson, 2004). Thus, Langellier and Peterson (2004) argues that a performing narrative is ‘…not a discrete event –somehow external to the body…it is lived through the body and it is meaningful to the storyteller…it is a site of intrapersonal contact’ (p.9). This approach therefore allowed the diversity of the women’s accounts to be embraced. A ‘casecentred’ rather than ‘category- centred’ (Reissman, 2004) was used in the research which meant that each interview account was a separate case study exploring individual accounts to emphasise the performative elements and features rather than being led by a search for commonalties. Thus, much attention was paid to the differences and contradictions within and between the accounts as was paid to similarities and consistencies. Approaching the individual accounts in terms of performance (Langellier, 1989; 2001) allowed for consideration of what it means to tell a story in a certain way, what is described and in what way (Daiute, 2004). In this way it is recognised that when we tell stories about our lives we perform our (preferred) identities (Langellier, 2001). Each account therefore needs to be understood and explored within the context within which it was produced. To emphasise the performative element is not to suggest that identities are inauthentic, only that they are situated and accomplished in social interaction (Reissman, 2000). Applying these insights to the women’s accounts allowed the indentification of how the women want to be known in the stories that they developed collaboratively with me (Langellier (2001). The women in their accounts would not “reveal” an essential self as much as they perform a preferred self, selected from the multiplicity of selves or persona that individuals switch between as they go about their lives (Reissman, 2000). Social positioning in the stories was also analysed. That is, how the women chose to position the audience, characters, and themselves in their accounts. It was envisaged that they might shift among positions as ‘…fluid positioning, not fixed roles, are used by people to cope with the situations they find themselves in…’ (Harre and van Langenhove, 1999, p.17). The analytical strategy also explored how the narrative accounts had been co-constructed between the participant and me. Thus, the analytical strategy used here in the women’s narratives enabled the women’s individual agency to be

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considered whilst also examining the social, material, and cultural domains which institutionalise their experiences. Secondly, as a case centred approach, this method allowed the research to recognise and highlight the variety and difference of women’s experiences and challenge the notion within the mental health care arena that they are homogenous group with identical experiences. The analysis presented in this paper draws on the interviews undertaken with two of the four women, Maddy and Charlotte, both of whom had a long history of self-harming behaviour. The narrative segments that are presented in this paper reveal some of the ways that the self-harm has affected their selfhood and sense of agency. Further, they will highlight how the external signs of self-harm on the body take over how others communicate with them in the health care interaction. The research study gained ethical approval from the University Ethics Committee and the Local Research Ethics Committee.

Results: narrative analysis of interviews ‘Self-harm’ – seeing beyond the scars Towards the end of their narrative accounts of ‘self-harm’ both Maddy and Charlotte talked about how they felt that self-harming had affected their life as a whole. Maddy stated that ‘self-harm’ had affected her by the scars it left upon her body, Maddy: ‘em (2) I think now people tend to see the scars instead of the person, em, and I’m treat, I think, I feel sometimes like I’m treated less of a person because of the scars than other people would be without them.’ Maddy continues her account by explaining that she had not only experienced this from the health profession when she had sought support and help but also from the general public whilst on holiday, Maddy: ‘We went on holiday about 6 or 7 weeks ago and I actually went round in just a vest, so my scars were on show, em and I was in the public toilets washing my hands and someone stood at the side of me and just said oh you poor dear and that’s the only time I’ve actually had a comment about my scars. Em, which was kind of a positive response in a way.’ Tammi: ‘Right and how did you, when you say positive response, what do you mean?’ Maddy: ‘Em (2) well I was, she didn’t look horrified, it was, you know she looked more sympathetic than sort of horrified that I’d got these scars. I think she though I’d been in an accident and been ill.’ For Maddy it appears that the external signs from her ‘self-harm’ may have taken over her identity and others no longer see her or even treat her for who she is herself. It could be suggested that because the scars are seen and are permanent, they have become a stigma because of their visibility. Although in Maddy’s story she talked about a positive experience she does comment that the women in her story ‘didn’t look horrified’ which suggests that in the past when others have seen the scars they have been horrified. It therefore seems that Maddy’s sense of being depends upon the reactions that she receives from others. Her sense of self seems to be based upon her developing a situation consciousness, as she must assess in advance the impression her scars will make in various contexts and situations (Asbring and Narvanen, 2002). In relation to Maddy’s account here she appears to be given the identity of a ‘sick person’ who requires sympathy and understanding because the scars appear to be the result of an ‘accident’ and thus not intentional. ‘Being known’ as a self-harmer In contrast to Maddy, Charlotte suggested that ‘self-harm’ had had a different impact on her life as a whole it was not to do with the scars on her face and body but more about being ‘known’ as someone who self-harms. To emphasis this point Charlotte talks about an experience at accident and emergency where she had attended for help with a possible infection, Charlotte: ‘I’d got an infection and seen my GP and she agreed and told me to go to A & E so I gets there and they sticks me in this room, no bedding on the trolley. And this woman says, this sister says she’s overdosed again to another nurse and I hadn’t, I’d got an infection. Anyway then this nurse come in, not how are you or anything. What you took now? I says I haven’t took anything. I was shivering, I were red hot. Anyway, no sheets on mattress whatsoever, nothing. This doctor comes in, we’re gonna have a blood test and so they took a blood test and it came back I’d got an infection in my body, so they gave me antibiotics and sent me home, but they treated me as if I’d overdosed.’ Tammi: ‘Right, so, you’d gone in with another problem?’

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Charlotte: ‘Yeah. But because they knew me history of ‘self-harm’ they presumed I’d overdosed. I felt awful. I mean I’d gone with a different illness, I expected treatment.’ Charlotte opens her account by positioning herself as ‘ill’ and she feels supported in this claim because her GP appears to agree with her. However, in her story she is aware that when she encounters other health services she is not treated by health professionals as other women would be if they attended with a similar presentation. This is evidenced by her comments about the nurses placing her in a room that is not equipped with the right material to look after an ‘ill’ person. It appears that the professionals are positioning Charlotte as ‘not worthy’ as the same standard of care as other women. Charlotte in her account appears to have an almost ‘invisible’ presence because health professionals then proceed to talk around her without asking her anything. However, when they do interact with her it appears to be in a manner that is not caring and irritable (Creed and Pfeffer, 1981; Platt and Salter, 1987) and this is indicated in the account by the strong emphasis of ‘now’ in the text. Charlotte continues to say in her account that she has not self-harmed but it appears that she is not heard, she has no voice in the health care interaction. Charlotte is a silent protagonist in this story under the power and surveillance of the health care professionals. Her lack of mobility and speech in this story is highlighted further in this story when she states ‘This doctor comes in, we’re gonna have a blood test and so they took a blood test…’ Charlotte does not appear to be given a choice over this nor does she have any control she is disempowered and excluded from the health care interaction. It is not until they have some physical evidence that the professionals decide that she has an infection and treat her accordingly. In this account Charlotte highlight the constraints on her agency and illustrates that she is not active and intervening within the medical examination, speaking and giving ‘speech’ rather she is invisible, voiceless and immobile. The account indicates that Charlotte is known and seen by her scars as a selfharmer and that professionals may never see beyond this. Conclusion These narratives reveal some of the ways that the self-harm affects women’s selfhood and sense of agency. They highlight how the external signs of self-harm on the body take over how others communicate with them in the health care interaction. The presentation of these narrative segments in this research may advance understanding of the complexities of the phenomenon and allow practitioners to possibly see the ‘woman’ behind the battled body. Acknowledgement This research was funded by a grant from the University of Huddersfield for the author’s doctoral studies. Thanks are extended to the women who participated in the research. References American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorder (4th Edition, revised) (DSM-IV-R). Washingtion: APA. Arnold, L. (1995) Women and self-injury: A survey of 76 women. Bristol Crisis Service for Women. Babiker, G. & Arnold, L. (1997) The language of injury: Comprehending Self-Mutilation. Leicester, British Psychological Society Books. Bird, L. and Faulkner, A. (2000) Suicide and Self-harm. Mental Health Foundation. Burrows, S. (1992). ‘The deliberate self-harming behaviour of patients within a British Special Hospital’, Journal of Advanced Nursing, 17,pp. 138-148. Caplan, P.J. (1995) The myth of women’s masochism. Toronto, University of Toronto Press. Chaturvedi, S. (1994) ‘Prevalence of premenstrual symptoms and syndromes: preliminary observations’. National Institute of Mental Health and Neuro Sciences Journal, 12(1) pp. 9-14. Collins, A. (1991) ‘Premenstrual distress: Implications for women’s working capacity and quality of life’. In M. Frankenhaeuser (Ed.) Women, work, and health: Stress and opportunites. New York, NY, USA: Plenum Press. Cookson, H.M. (1977). ‘A survey of self-injury in a closed prison for women’. British Journal of Criminology. 17(4), pp. 332-334. Creed F.H. & Pfeffer J.M. (1981) ‘Attitudes of house physicians towards self-poisoning patients’. Medical Education 15, pp. 340-345. Cross, L.W. (1993) ‘Body and self in feminine development: implications for eating disorders and delicate self-mutilation.’ Bulletin of the Menninger Clinic, 57(1) pp. 41-68.

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Smith, D. E. (1988) Texts, Facts and Feminity: Exploring the Relations of Ruling, New York: Routledge. Smith, G., Cox, D. and Saradjian, J. (1998) Women and Self-Harm, London: The Women’s Press Limited. Walsh, B. and Rosen, P. (1988) Self-Mutiation: Theory, Research and Treatment. New York: Guilford Press. Tantum, T. and Whitaker, J. (1992) ‘Personality Disorder and Self-wounding’, Journal of Psychiatry, 161, pp. 451-64. Ussher, J. (1991) Women’s Madness, Misogyny or Mental Illness? Hemel Hempstead: Harvester Wheatsheaf. Ussher, J. (1997) ‘Towards a material-discursive-intrapsychic analysis of madness, sexuality and reproduction’. In J. Ussher (Ed.) Body talk: The material and discursive regulation of sexuality, madness and reproduction. London: Routledge. Ussher, J. (1999) ‘Premenstrual Syndrome: Reconciling disciplinary divides through the adoption of a material-discursive epistemological standpoint’. Annual Review of Sex Research, 7, pp. 218-252. Ussher, J. (2000) ‘Women’s madness: a material-discursive-intrapsychic approach’. In D. Fee. (Eds.) Pathology and the Postmodern: Mental illness as discourse and experience. London: Sage. Ussher, J. (2002) ‘A woman-centred psychological intervention for premenstrual symptoms, drawing on cognitive-behavioural and narrative therapy’. Clinical Psychology and Psychotherapy, 9, pp. 319331. Yeo, H.M. (1993) ‘The cost of treatment of deliberate self-harm’. Archives of Emergency Medicine, 10, pp. 8-14.

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Christine Savvidou Intercollege Cyprus: Constructing a dialogic space for storytelling in teacher education Abstract This study proposes that the interface between narrative knowing and new technologies can provide a space for dialogical storytelling in Teacher Education. This space not only links personal and social realms of meaning-making, but also enables teachers to move from knowledge-sharing to knowledge construction. Typically, narrative approaches to teacher education have tended to focus on the reflective dimensions of storytelling for learning (Johnson and Golombek, 2002). Highly personalized and contextualized stories are seen as ways for teachers to inquire into their own experience and reflect on the social and tacit knowledge that is embedded in their stories (Linde, 2001). However, in addition to being a reflective process, storytelling is also a social process that has the capacity to bind communities; while stories are the ‘artifacts’, storytelling is part of the ‘shared repertoire’ of communities of practice (Wenger, 1998). This study outlines a teacher development project which explores the potential of storytelling as a tool for dialogic inquiry (Wells, 2001). In a tertiary level educational institution in Cyprus, 12 language teachers participated in a professional development project to create their own digital stories about aspects of professional learning. Based on Bakhtin’s (2004) theory of speech communication, stories are perceived as links in a chain of communication. It is through dialogue that this chain can extend ‘into the boundless past and the boundless future’ (Bakhtin, 2004, p.170). From this perspective, there are no limits to this dialogic context as teachers’ stories become part of a dialogue between them and within them. Introduction There is a growing interest in the stories told by teachers to make sense of their professional lives (Burley, 2003; Clandinin & Connelly, 2000; Craig, 1999, 2007; Johnson & Golombek, 2002; Phillion & Connelly, 2004; Ritchie & Wilson, 2000). This interest is based on the belief that teacher knowledge cannot be reduced to list of generic items on a check-list but, rather, emerges from the multiple voices, actions and events that teachers encounter daily in their professional lives (Doyle, 1997). It is only when these voices, actions and events are transformed into story that teachers begin to understand their teaching. ‘Story’, claims Doyle (1997, p.95), ‘is quite an appropriate, if not the only way of knowing teaching’. It is the idea of teacher knowledge as a narrative construct (Bruner, 1991) that lies at the foundations of the present study to develop a dialogic space for teacher storytelling. This paper reports on a study which explores the capacity of storytelling for teacher learning. It describes the development of a “storytelling space” in which storytelling is viewed as a form of dialogue. Narrative analysis of the stories told in this space looks at the connections that were created through storytelling and explores the way that these connections enabled a group of teachers to develop awareness and construct new understandings of their professional learning. “Stories” and “storytelling” in the context of teacher learning Within the literature, there are many quite specific definitions of “story”; for example, it is defined as a “conduit” for teachers personal practical knowledge (Clandinin & Connelly, 2000); it is characterised by structure, plot and internal logic (Denzin, 1989); and it is the temporal ordering of personal experience (Labov & Waletzky, 1967). However, in this study, ‘story’ is defined according to Denzin’s (1989) definition of a ‘personal experience narrative’ in which the storyteller ‘relates the self …to a significant set of personal experiences’ (p.38). Subsequently, ‘storytelling’ refers to the process of recounting these personal experiences. The concept of storytelling in a professional context also draws on Boje’s (2001) ideas of stories emerging from a process which is ‘fragmented, polyphonic (many voiced) and collectively produced’ (p.1). From this perspective, teachers’ stories are not viewed as discrete rhetorical structures to be deconstructed and analysed for meaning, an approach used in the research of Labov and Waletzky (1967). Rather, teachers’ stories are viewed as emerging from the storytellers’ interactions within a specific context. Experience is storied and re-storied according to the particular setting, audience and time of the storytelling. Moreover, storytelling is viewed as a method of inquiry (Clandinin and Connelly, 2000). It is one of the ways that teachers make sense of their professional roles and identities.

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Storytelling and teacher learning Typically, narrative approaches to teacher education have tended to focus on the reflective dimensions of storytelling for learning. Highly personalized and contextualized stories are viewed as ways for teachers to inquire into their own experience. Johnson and Golombek (2002) offer numerous teachers’ stories to show how teachers come to align their theoretical knowledge to their personal beliefs and values about teaching; how teachers learn about themselves through their students; and how teachers re-story their past and come to see their teaching as socially and historically situated. This view of storytelling as reflective learning is grounded in Dewey’s (1991) belief that learning emerges from the ‘Active, persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it, and the further conclusions to which it tends’ (p.6). Through storytelling, learners are able to reflect as they ‘recapture their experience, think about it, mull it over and evaluate it’ (Boud, Keogh and Walker (1985, p.19). Similarly, McDrury and Alterio (2002) present a formalised storytelling approach which supports learners in reflecting on the connections they make between their thoughts and practices. However, the value of narrative approaches for teacher education is questioned. Goodson (1997) suggests that the emphasis on narrative approaches to teacher education may disengage teachers from the wider debate on teacher professionalism. It is one of the ‘paradoxes of postmodernism’, claims Goodson (1997), that narrative approaches to teacher education have become increasingly popular at a time when the teaching profession is becoming ever more technicized and bureaucratic. Indeed, in an educational climate which debates the ‘usefulness’ of educational research, and calls for ‘evidencebased practice’ (David Hargreaves, 1996), storytelling might be considered inward-looking, contextspecific, and with little relevance for those outside the context. Consequently, there is a need to develop a storytelling model of teacher learning which seeks to link the personal dimensions of learning to the wider social context of teaching. One area, which attempts to link storytelling to social and cultural processes, is in organizational and communication research (Boje, 2001; Gabriel, 2000; Linde, 2001; Orr, 1996; Wenger, 1998). In this area of research, stories are viewed as powerful communication tools that transmit knowledge of the ethos and values of an organization. This is demonstrated in Wenger’s (1998) research into Communities of Practice in which stories are viewed as the “artifacts” of a community, and storytelling is part of the shared “social repertoire” which has the capacity to bind communities together. It is through this repertoire, claims Wenger (1998) that professional identities can be constructed, social relationships can be formed, conflict can be managed and new members can be socialized. Storytelling as dialogue Embedded in the idea of a shared “social repertoire” is the concept of dialogue. The etymology of “dialogue”, which derives from the Greek δια (through) and λογος (word), can be understood as the search for meaning “through word” (Bohm, 1996). Within the literature, there is a suggestion that storytelling can be viewed as a form of dialogue. This suggestion is based on three interrelated ideas: (1) storytelling, like all language, is inherently dialogic; (2) storytelling is a process of negotiation between the storyteller and the addressee; and (3) the consequence of one storytelling can be the triggering of another storytelling. The first point relates to Bakhtin’s essay ‘The Problem of Speech Genres’ (1986). In this essay, Bakhtin (1986) proposes that all language is inherently dialogic. For Bakhtin, meaning is not to be located in the structure of language but in the “utterance” The utterance may consist of a single spoken word or the text of a novel, and is defined by the speaking subject. So, when one speaker ends an utterance, a new utterance begins when it is taken up by another. In the words of Bakhtin (1986), “an utterance is a link in a chain of speech communication, and it cannot be broken off from the preceding links” (Bakhtin, 1986, p.94). It is Bakhtin’s idea of the utterance which can also be applied to storytelling; in short, every story told is connected to a preceding story in a chain of speech communication, and when one story ends, another begins. Just as stories are connected to proceeding stories, they are also connected to anticipated, future stories. This leads to the second point about dialogue in storytelling, that storytelling is not just a response to a proceeding story but also to a future story anticipated by the storyteller. In this approach, storytelling becomes a process of negotiation when storytellers must anticipate the expectations of the addressee. As Linde (1993) observes “one is not simply free to construct a life story in any possible way. Addressees make a number of social demands on the nature of the teller’s story” (Linde, 1993, p.7). In other words, the stories we tell are shaped by the anticipated responses of others.

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Both of these ideas relate to the third point which sees every storytelling as a trigger for new stories. When stories are told, new stories are triggered. As Schegloff (1997) observes “one consequence of a storytelling can be the touching off of another storytelling’ (p.103). For Conle (2000), this describes the process of resonance in storytelling. When the story of one person elicits a feeling of familiarity in another person, it is often vocalized as “that reminds me of…” These three ideas present a view of storytelling as dialogue and challenge the idea that storytelling is an individual construction. In everyday social interactions, stories are not presented as monologues in which the storyteller is the sole author of the story. Rather, storytelling is conceived as an interactional event, a conversation, in which stories are mutually constructed by storytelling participants and whose roles as storytellers and addressees are interchangeable. Continuing professional development and institutional change The study described in this paper looks at how stories and storytelling might be considered as part of teachers’ continuing professional development (CPD), which is defined by Day (1999) as ‘all natural learning experiences and those conscious and planned activities which are intended to be of direct or indirect benefit to the individual, group or school’ (p.4). Typically, CPD focuses on the ‘conscious and planned activities’ undertaken by teachers, such as participation in research, conferences, seminars and workshops. It is the purpose of these activities to extend teachers’ knowledge of subject-content and pedagogy. This approach to CPD tends to neglect other aspects of teachers’ professional knowledge, such as personal subject constructs (Banks, Leach and Moon, 1999), or knowledge of self (Day and Sachs, 2004), which focus on teachers’ values, experiences and relationships to teaching and learning. However, it is these social, cognitive and affective aspects of teacher learning which have recently become recognised as powerful factors in shaping teacherlearning (Hargreaves, 1998). It is these aspects of teacher knowledge which are the focus of this study. The context of this study was a higher educational institution in Cyprus. The purpose of the project was to construct a venue for dialogue, a space in which teachers could not only share knowledge but could also construct new understandings of their professional development in a context of change. The college where this study took place was undergoing a period of rapid change as it applied for university status. Confronted by demands for greater accountability in teaching and research, the question which shaped this study was how could storytelling support teachers CPD in a context of change? One potential answer to this question was to conceptualize a storytelling tool in which teachers could tell and share their stories of professional learning. The rationale was that learning would take place firstly through the telling of the story and then through the constructing of a digital story. Another layer of learning was added as teachers were asked to listen to, select and respond to colleagues’ stories in another digital story. In this way, a dialogic space for storytelling was constructed through a cycle of telling, interpreting, sharing and responding to stories. Setting up a dialogic space for storytelling While storytelling may be defined as a “natural learning experience”, finding teacher-storytellers was a challenging process. This is supported by research by Clandinin & Connelly (1995), Little (1990) and Vance (2004), who show that sharing stories outside one’s circle of trusted friends and colleagues is relatively uncommon. The study therefore made use of chain sampling. One teacher who expressed interest in sharing her story of professional development started the storytelling chain. She told her story and then recommended the name of another teacher who might also wish to participate. The chain of participants grew as more names were suggested, and as the number of participants grew so did teachers’ interest in the storytelling project. In this way, the project gained momentum as teachers were integrated into a chain of storytelling. In the end, 12 teachers from the Department of Languages participated in the project. These included 9 full-time and 3 part-timer teachers. From these 12 teachers, 10 were female and 2 were male. The growing number of teachers provided an opportunity for teachers to interact through their storytelling. The teachers were divided into two cohorts: the initial storytellers (seven teachers) and the responding storytellers (five teachers). The process for dialogic storytelling involved 5 stages, which I refer to as attending, telling, interpreting, sharing and responding. • Attending

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The first stage involved the first cohort of teachers, the initial storytellers, attending to personal and significant experiences of “learning”. The “trigger” question asked teachers to share a personal learning experience which was in some way significant to them. Stories were self-selected so as to reflect teachers’ own definitions about what constitutes professional learning. • Telling In the second stage, the initial storytellers were videoed telling their stories. Stories ranged in length from three minutes to twelve minutes. • Interpreting The next stage involved the initial storytellers interpreting their own stories. Teachers reviewed the video of their story and on PowerPoint slides highlighted aspects of the story which they felt were significant to understanding the story. By making interpretative decisions about the meaning of their story, certain aspects of their story are enriched with significance, while other parts are diminished. • Sharing In the fourth stage, the initial storytellers were shown how to transform their story into a digital story which could be shared with colleagues. Microsoft Producer 2003, which integrates audio and visual media files, was used. All stories were published onto password secure website, which could be viewed by colleagues in the department. • Responding Finally, the second cohort of teachers, the responding storytellers, was asked to view all the stories and respond to any of them through their own digital stories. They responded by constructing their own story in which all the stages of the process (attending, telling, interpreting and sharing) were repeated. Type of stories about professional learning Through narrative analysis, stories were explored for the links that teachers made between their stories and the stories of others. The purpose was to look at how teachers made sense of their professional learning by transforming their individual experience into a shared professional one. Within this storytelling space, opportunities were created for teachers to tell their own stories of learning, and listen and respond to the stories of others. These stories included stories from novice teachers about their first year of teaching and learning to manage a classroom. Stories from more experienced teachers also included their experiences of juggling personal and professional roles and identities, participating in a teacher exchange programme, doing practitioner research and studying for a PhD. These stories triggered new stories from the second cohort (the responding storytellers), who told their stories about using the internet in their teaching, teaching in a new cultural context, the challenges of studying for a PhD and the effect of having a PhD on one’s personal and professional life. • Storytelling as dialogic networks

From a Bakhtinian perspective, each story can be considered a response to a proceeding story or to an anticipated one. In this sense, each story, by itself, represents a node in a ‘network of fragments’ (Boje, 2001, p.74). In other words, it is only by placing stories in the context of this network that meaning about the nature of professional learning emerges. In effect, these stories together represent a dialogue by teachers on the theme of teacher learning. It is a dialogue in which teacher learning is broadly defined and covers a range of learning experiences which also include the social and affective dimensions of teaching and learning. The data collected showed that with the exception of one initial story, links were created between the initial stories and the responding stories. These links were explicit when teachers made concrete references to each other’s stories: I mean when I was listening to [Name of teacher] I really felt like umm like I was listening to myself (Teacher 12) And also implicit: yes I can relate to most of the stories that I watched …umm recently, as many of them …applied to my situation …as well I am a new research …PhD candidate … research student umm and I figured out that many of the problems, troubles that my fellow colleagues have been facing or faced up to this point…It seems that I am going through the same things as well now … (Teacher 11)

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Each responding story began with a bridge which connected their story to the stories of others. Moreover, many of the storytellers reinforced this connection by echoing some of the actual words and phrases from the initial story in their own story: ‘Yes, you said that you juggle.. err your family life with your professional life and that means teaching and researching and that there is an interaction between the two …but sometimes you feel that … you feel a bit guilty, that you may not be doing your best at this…’. (Teacher 9) This particular excerpt echoes the exact words and phrases of an earlier story when the storyteller recounts her experience of studying on a postgraduate course: ‘…I think umm the biggest challenge has been trying to balance my professional and personal life … umm its sort of like the idea of juggling family life, work, teaching, research with umm varying degrees of success and not actually, you know feeling like you manage to achieve your best in all areas, something always is umm sacrificed depending on the particular pressures that you are facing in one area at a particular time… umm so that gives you a kind of sense of guilt that you are not really doing your best in all areas…’ (Teacher 7) • Dialogues in monologues

Teachers’ stories can also be understood in terms of their inherent dialogic features. While ‘dialogue’ relates to the interaction between stories, “dialogism” explores the interacting discourses (or voices) within the same story. The concept of “dialogism”, translated as either “double-voicedness” or “double-wordedness” (Vice, 1997), is a literary term devised by Bakhtin (1986) to analyse the competing discourses in the work of Dostoevsky: In every voice he could hear two contending voices, in every expression a crack, and the readiness to go over immediately to another contradictory expression; in every gesture he detected confidence and lack of confidence simultaneously; he perceived the profound ambiguity, even multiple ambiguity, of every phenomenon. (Bakhtin cited in Vice, 1997, p.55) Therefore, in this study, “dialogism” in teachers’ stories is indicated by a degree of self-consciousness as teachers recognize their dual roles as both storyteller and listener. This is exemplified in the following story in which a teacher responds to another teacher’s story on his research into teachers’ use of the Internet in teaching. As a listener, the responding teacher (Teacher 3) connects and echoes parts of the initial teacher’s (Teacher 6) story: I agree that the internet is very impressive, all the things it can teach you, all the different ways of learning … (Teacher 3) But this teacher takes on the role of storyteller when she develops aspects of the initial story in relation to her own experiences and beliefs of teaching using the Internet: ... but at the same time it can be…its not as simple as it sounds, it needs a lot of work, a lot of preparation beforehand and during the actual …teaching if you are going to do it with computers … and uh…my colleague who also mentioned it as well and I agree with it … the confidence aspect is very important … (Teacher 3) Within this story, there is also the contending voice which draws attention to the tensions the storyteller experiences of teaching in this particular context: … but, the question comes … why would I do this if I don’t feel that I’m going to be rewarded by the system, by the educational system of that particular institution, by my colleagues, who won’t look at me in any other way, who won’t even realize that I’ve done it…by lots of…even students themselves who probably won’t even appreciate it unless I make sure that I clarify how these particular points that we’re dealing with in this lesson will be in your midterm exam or in your final (…). (Teacher 3)

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The format of the story possesses a dialogic quality: the voice of the educator which discusses the pedagogical considerations of this approach to teaching, and the voice of the part-time teacher, a teacher who feels undervalued by the institutional system for which she works. It is the constant interaction of these two voices which lead her to construct an understanding of her experience of professional learning: …uh but I think the most important point I think is the one I’ve just mentioned, that as a part-timer you’re not really motivated, I don’t know about full-timers, but as a part-timer, you need more motivation to actually go through this process with a good positive, creative stance… (Teacher 3) Through the dialogue generated by storytelling, this teacher extends the scope of the issues involved. From her perspective, the use of the Internet in teaching is not simply a matter of understanding different pedagogies and student epistemologies, as emphasized by Teacher 6. The issue of teacher motivation is central to her story; she questions the reasons why she would put in all this work if her efforts are not recognised by the institution, her colleagues, or even her students. For this teacher, her own experiences of learning to teach using the Internet in teaching are seen through the lens of her status as a part-time teacher.

The significance of dialogic storytelling for teacher learning Firstly, the significance of this study for teacher learning is that teachers’ digital stories act as “significant others”, for learning. This idea relates to socio-cultural theories of learning (Vygotsky, 1978) in which interaction with a “significant other” can extend the boundaries of an individual’s development by creating what Vygotsky (1978) calls a zone of proximal development. There is no reason, suggests Wells (2001), that a “significant other” cannot be an artifact as well as a person. So, in the case of this study, “significant others” are represented by both colleagues and their stories. Moreover, a digital storytelling space can support teachers’ professional dialogue and help them overcome the temporal, spatial and relational constraints that may separate colleagues. This is exemplified in the storytelling interaction between Teacher 3 and Teacher 6, who teach in the same institution. What makes this interaction significant is that the storytellers are separated by time, space and, also, socially. The second teacher, Teacher 3, responds to the first story three weeks after it is told by Teacher 6. Whilst the first story is told in the institutional setting where these teachers work, the second story is told in a home setting. Moreover, while both teachers are affiliated professionally, they are separated by differences in nationality, gender, age, employment status and educational background. The first teacher, a British male teacher in his late-thirties, is a full-time teacher with a PhD in the area of ICT in Language teaching; the second teacher, a Greek-Cypriot female teacher, in her mid twenties, is a part-time teacher in her second year of teaching with a background in creative writing. Finally, a formalised storytelling space can support teachers in linking personal experiences of professional development to wider issues of professional learning; it enables teachers to move from storytelling as knowledge-sharing to storytelling as knowledge construction. Teachers do not just add stories to their repertoire of personal and practical knowledge; rather, they actively interpret stories, their own and others, and construct new meanings and understandings of their professional development. Through a process of dialogue, teachers are able to locate their personal experiences in the macro structures of educational policy and theory. In this way, storytelling is far from the inwardlooking and context-specific model of storytelling to which Goodson (1997) refers. Final thoughts Based on socio-cultural theories of learning, storytelling is conceptualized as a dialogue that is both “social” and “inner”. It is “social” in that it involves teachers interacting with others to make sense of their “learning”. It is also an “inner” dialogue that individuals have with themselves as they look for meaning in their daily professional lives. As a model of teacher learning, there are several questions which need further exploration, such as the following: • Bakhtin (1986) says ‘there is nothing more terrible than a lack of response’ (p.127). Therefore, what are the implications of those stories which fail to trigger a response?

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• •

How far is the storytelling model sustainable? In other words, how far will stories trigger new stories and extend the storytelling chain? Do teachers’ stories resonate for others outside the immediate context? What are the specific way that a dialogic storytelling space be of “direct or indirect benefit to the individual, group or school” (Day, 1999, p.4)

However, this present study has attempted to demonstrate how the interface between new technologies and storytelling can transform storytelling from a “natural learning experience” which is part of teachers’ daily lives, to a conscious and planned activity. Moreover, in this space, teachers’ voices and teachers’ stories are represented by teachers themselves, rather than researchers or teacher educators, and it is their definitions of and concerns about professional learning that are heard. This is especially significant in a climate of educational upheaval where change is imposed on teachers from top-down. The creation of a dialogic storytelling space offers teachers the opportunity to share their experiences and make their voices heard. Finally, the construction of a dialogic space for storytelling enables teachers to move from knowledge-sharing to knowledge construction. By making connections between stories, teachers extend their understandings of their professional learning and the implications for their professional roles and identities. In this way, a dialogic space for storytelling offers teachers opportunities to link their individual experiences to wider professional concerns. Consequently, a storytelling space has the capacity to transform teachers’ continuing professional development from an individual and reflective activity, to a social and dialogic one.

References Bakhtin, M. M. (1986) Speech Genres and Other Late Essays. Translated by V.W. McGee. Texas: University of Texas Press. Banks, F. Leach, J. & Moon, B. (1999) New Understanding of Teachers Pedagogic Knowledge. In: J. Leach, J. & B. Moon (eds.) Learners and Pedagogy. London, California, New Delhi: Open University Press, pp. 89-110. Bohm, D. (1996) On Dialogue. Oxon, New York: Routledge. Boje, D. (2001) Narrative methods for organizational and communication research. London, Thousand Oaks, New Delhi: Sage. Boud, D., Keogh, R. & Walker, D. (1985) Reflection: Turning Experience into Learning.. London: Kogan Page. Bruner, J. (1991) The narrative construction of reality. Critical Inquiry, 18, pp. 1-20. Burley, S. (2003) Preparing future English teachers: The use of personal voice in developing English student teachers’ identities as language teachers. English Teaching: Practice and Critique, 2 (1), pp. 54-67. Clandinin, D. J., & Connelly, F. M. (1995) Teachers’ professional knowledge landscapes. New York: Teachers College Press. Clandinin, D.J. & Connelly, F.M. (2000) Narrative Inquiry. San Francisco, Jossey Bass. Conle, C. (2000) Narrative Inquiry: research tool and medium for professional development. European Journal of Teacher Education, 23 (1), pp. 49-63. Craig, C. (1999) Parallel stories: a way of contextualizing teacher knowledge. Teaching and Teacher Education, 15, pp. 397-411. Craig, C. (2007) Story constellations: A narrative approach to contextualizing teachers’ knowledge of school reform. Teaching and Teacher Education, 23, pp. 173-188. Day, C. & Sachs, J. (eds.) (2004) International Handbook of the Continuing Professional Development of Teachers. Buckingham: Open University Press. Day, C. (1999) Challenging Teachers: The Challenges of Lifelong Learning. London: Falmer Press. Denzin, N. K. (1989) Interpretive Interactionism, Newbury Park: Sage. Dewey, J. (1991) How We Think. New York: Prometheus Books. Doyle W. (1997) Heard Any Really Good Stories Lately? A Critique of the Critics of Narrative in Educational Research. Teaching and Teacher Education, 13 (1), pp. 93-99. Gabriel, Y. (2000) Storytelling in Organizations: Facts, fictions, and fantasies. London: Oxford University Press. Goodson, I. F. (1997) Representing Teachers. Teaching and Teacher Education, 13 (1), pp: 111-117.

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Hargreaves, A. (1998) The Emotional Practice of Teaching. Teaching and Teacher Education, 14 (8), pp. 835-854. Hargreaves, D. (1996) Teaching as a Research-based Profession: possibilities and prospects. Teacher Training Agency annual lecture. London: TTA. Johnson K.E. & Golombek P.R (2002) Teachers’ Narrative Inquiry as Professional Development. Cambridge: Cambridge University Press. Labov, W. & Waletzky, J. (1967) Narrative analysis: Oral versions of personal experience. In: Helm, (ed.) Essays on the verbal and visual arts. Seattle, WA: American Ethnological Society, University of Washington Press. pp. 12-44. Linde, C. (1993) Life stories: the creation of coherence. New York: Oxford University Press. Linde, C. (2001) Narrative and social tacit knowledge. Journal of Knowledge Management, 5 (2), pp. 160-171. Little, J. W. (1990) The persistence of privacy: Autonomy and initiative in teachers’ professional relations. Teachers College Record, 91 (4), pp. 509-536. McDrury, J. & Alterio, M (2002) Learning through Storytelling in Higher Education. Using Reflection and Experience to Improve Learning. London: Kogan Page. Orr, J. E. (1996) Talking about machines: an ethnography of a modern job. Ithaca (NY), Cornell University Phillion, J. & Connelly, F, M. (2004) Narrative, diversity, and teacher education. Teaching and Teacher Education, 20, pp. 457–471. Ritchie, J.S. & Wilson, D. E. (2000) Teacher Narrative as Critical Inquiry. Rewriting the Script. New York & London: Teachers College Press. Schegloff, E. (1997) Narrative analysis: Thirty years later. Journal of Narrative and Life History, 7, pp. 97-106. Vance, V. (2004) The persistence of privacy in teacher professional development online. Proceedings of the AARE Australian Association for Research in Education National Conference, November, Melbourne, Victoria. Vice, S. (1997) Introducing Bakhtin. Manchester and New York: Manchester University Press. Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press. Wells, G. (1999) Dialogic Inquiry: Towards a Sociocultural Practice and Theory of Education Cambridge: Cambridge University Press. Wenger, E. (1998). Communities of Practice: learning, meaning and identity. Cambridge: Cambridge University Press.

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Martin Hird & Bill Penson Leeds Metropolitan University England : Book Clubs or Lectures? : Facilitating learning in higher education using stories told about mental health problems. Abstract The dominance of the medical narrative in people’s experience of illness has often required ‘narrative surrender’ (Frank 1995) by users of health services. In mental health care however, there is a growing recognition of the importance of the individual’s experience of recovery, in contrast to a focus on the treatment and therapy technologies believed to be helpful in engineering that recovery (TurnerCrowson & Wallcraft 2002). Engaging medical and psychological models as narratives rather than scientific givens, places them within culture and time and as methods for articulating stories (McLeod, 2006). This change of focus is accompanied by growing interest in recovery narratives (e.g. Scottish Recovery Network 2006). Following a period of development and consultation for a new mental health course, we prepared and delivered a Higher Education module titled ‘User–led Recovery’ (ULR) for mental health workers. Our aims were to enable students to engage with first person accounts, make sense of this for their practice and make best use of narratives within an evidence- based context, identifying strategies for developing their practice within a model of recovery. Module delivery included four sessions calculated to equip the students to work with narratives, followed by subsequent meetings in a Book Club format. In the Book Club, students discussed the narratives in small groups. We chose narratives in a range of genre including novel, diary, documentary, interview and live presentation from people who have used services. An Associate Lecturer, employed on the basis of his service user expertise co-delivered throughout the module. In the paper we explore the value of using narratives to achieve the aims stated above; outline our students’ experience of the module and; discuss the continuing learning needs of lecturers committed to working with narratives. User-led recovery module “Sometimes we simply have to keep our eyes open and look carefully at individual cases – not in the hope of proving anything, but rather in the hope of learning something!” Eysenk (1976) . Having all read the Bell Jar by Sylvia Plath, we then sat down together and discussed our reactions to the story. Some felt frustrated at the task of being given a novel to read that only began to refer to explicit mental health problems on page 118. Others spoke of their sense of distance from the book’s main character – how they failed to connect with her or like her. I spoke of how the metaphor of lifting a bell jar had resonated powerfully with me as an image describing recovery Was this Book Club a useful thing to do in a packed curriculum? Did it meet the imperative placed on mental health training to involve those people who have used mental health services? What value has the study of personal stories against learning therapeutic techniques for mental health workers? In a setting that values ‘evidence based practice’ what place does an individual’s story have? Development and structure of the module The ULR module was developed within a new faculty wide Continuing Professional Development Programme for mental health practitioners. The module is accessed by two awards, at 3 levels and can also be taken as a stand alone unit. Initially the focus of the module was around learning from service users and carers, however, given the challenge of identifying an adequate range of service user’s stories, we decided to limit our focus to their stories, rather than extending it to also to include those of carers. Service users, carers, academics and local practice stakeholders took an active role in the module design. The ULR module made use of a number of forms of delivery including large group learning, book club and individual reflection. Students were presented with some information around narratives and their use as a means for locating the stories engaged with. Additionally students generated a ‘checklist’ of questions they thought would be useful to apply to each narrative used. The student group was divided in two and met with a tutor facilitator, having agreed which narrative would be discussed in advance. During the module we studied the following narratives:

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o o o o o o o

Excerpts from Linda Hart’s Diary Stephen Fry: The Secret Life of the Manic Depressive. Part 2. BBC Patricia Deegan’s recovery story The Bell Jar by Sylvia Plath Personal stories recorded in Romme and Escher’s book on Accepting Voices Videotaped interview with Jayne Meeting with 2 people who presented aspects of their stories through their art, object art and song.

The value of studying narratives in mental health. “….the academic world was not in touch with the everyday world of experience, the ordinary world. The research literature offered me data, labels, categories, and theoretical explanations but it didn’t express how loss felt and it didn’t invite engagement with the particularities of the experience.” (Bochner et al 1997, p. 424.) At its worst, mental health education is biased towards a uni-dimensional framing of mental health problems and a recipe book approach to therapeutic responses: rule based, non-context specific knowledge. While there is a place for students learning skills of accurate assessment and therapeutic techniques, this paper argues that there is a place for balancing this with material that enables students to engage with the experience of living with mental health problems. Arguably, they already do this in practice placements and in the work based learning settings where they engage with ‘real’ people. However, in these settings, as staff they are involved in the issues of the day – the pressing needs, the crises, and the organisational demands. Moreover, the involvement is with individuals amongst others, either as one of many appointments in a day, or in a residential setting as one of a group of people. This involvement is in the power dynamics of care giving relationships (Felton and Stickley 2004), under the clinical gaze (Foucault 1973), and in contexts in which there is a presumption of response from the caregiver.

It was as if I knew how it felt to lie in her side room and hear the nurses strutting round the ward with their keys jangling. Although I’ve had countless people talking to me at work about their gripes about the care system – reading this diary seem to have a power ……….it took me into her experience in a different way. In the classroom setting there are opportunities for a different type of engagement with people’s stories: case studies, reviews of critical incidents, role playing and simulations being some commonly used methods. Rossiter (2002) identifies a number of good reasons for using stories in teaching settings, not least because they are memorable and entertaining. However, she also goes on to suggest that as well as being informative, they have the power to be transformative because they transport us to another place as we live within the stories. In this place we are forced to frame questions and to fill gaps, in doing so - making sense of the story - we connect with our own story. As Frank (2006 p.23) observes: “Stories make themselves available to consciousness because they support many view points; the same story makes a different point to different listeners. As actors in relation to other actors, stories are always a bit out of control”. Additionally McDrury & Alterio (2002) recommend that stories and storytelling have great potential especially in areas of learning that value reflective practice. Am I in the right job? Her experience of services hits the nail on the head – combine it with Patricia Deegan’s observations 20 years ago and not a lot has changed. A DVD I watched on a woman with Dissociative Identity Disorder portrayed the helping relationship to be one working right out of the box of normal therapeutic boundaries and service constraints. So much of what I do day in day out goes against my deepest human instincts – driven by risk aversion and resource management rather than “User-led” And we seem to be so ineffectual with some people. Everywhere I look now I see people’s stories and many of them seem to be speaking to me! An example of the power of stories to connect with our own lives came in the module when we heard Jayne’s story – recorded in a video interview. She spoke of the limits of secular therapies as compared with the profound impact which a religious reformulation of her problems had on her recovery. In the classroom this led to an energetic discussion and thereafter continuing reflection about our own worldviews and religious positions and the impact of these on our working with people of different faiths along with a humbling recognition of our constraints as practitioners. This session contrasted

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favourably with one run the next day with a different group focussing on spirituality. In this latter session one of the authors presented the evidence base on the interrelationship between sprituality and mental health. In marked contrast, discussion in this group was characterised by questioning the relevance of the subject to practice and even hints of religious intolerance. Since personal stories involve a human encounter, they stimulate empathic responses, in so doing they have the potential to foster tolerance, an appreciation for diversity and a capacity for perspective taking.

So remind me ……… why am I reading a NOVEL? How does this fit in with the Evidence Based Practice they keep banging on about? At the same time as we are doing this, in another module we are struggling with an essay critically appraising the evidence for family interventions. So if Jo Bloggs says family interventions floated his boat and I include that in the essay will I get the marks? …………… I think not! On all the hierarchies of evidence I’ve seen, personal - even ’expert’ opinion is bottom of the ladder. So what’s the value of this? I could see it, if I could use it by sharing a ‘recovery story’ with someone I’m working with who might be stuck or discouraged ………… but that seems a bit crass …….. no-one in the Book Club saw that as a way forward. I’ve not read any research into the use of stories as therapeutic tools. A dominant discourse in healthcare is that of evidence based practice. Within this discourse there is a tendency to value most highly the evidence derived from comparing treatments using large sample sizes. In addition there is also a tendency to value quantitative over qualitative research, disregarding the service user, individual practitioner and context (Ryecroft-Malone et al 2004). A hierarchy of evidence has become familiar through its prominence in such landmark documents at the National Service Framework for Mental Health (Department of Health 1999) This hierarchy places the comparisons of treatment at the summit but expert opinion, including the views of people who have managed their own mental health problems, at the bottom. The dominance of this hierarchy of evidence and its associated relegation of individual experience to low value, assumes that the key issue in healthcare is the comparison of treatments. However, in mental healthcare there are other pressing questions to be addressed, for example about the aetiology and essence of mental health problems, the impact of social factors such as employment on mental health and the impact of value conflicts on experience of service use. The level of knowledge about mental health is in many fields at the level of exploratory or prescience (Kuhn 1970). As such, studying individual experience could have a high value, with the the potential to lead to paradigm shifts as practioners are engaged in making sense of all the competing explanatory models which could be engaged to understand the experience of distress, illness and recovery. Within a practice context Laughne (2002) argues that: “The practice of mental health care should not be a scientific exercise but an exercise in humanity, informed by ethical and moral choices”. (p56) We would argue that the challenge for this potential paradigm shift sits at the centre both of the ULR module, but also at the centre of many current mental health discourses: essentially what is good evidence for practice in an area often lacking robust constructs and evidence? Service user’s stories as involvement The Department of Health review of Mental Health Nursing of 1994 called for people who use mental health services to be involved in nurse training. This was later echoed, in a review of the needs of all mental health staff across professional disciplines (Sainsbury Centre 1997). However, in 2004 a review of service user involvement in education concluded that it is characterised by tokenism rather than partnership, as power structures remain largely unaltered (Felton and Stickley 2004). They argue that though service users value human qualities most (Mental Health Foundation 2000), rational knowledge and the medical model dominate both care and education. Furthermore, they comment that in their opinion, service user involvement in education is characterised by tokenism rather than partnership, as power structures remain unaltered. The traditional methods of involving service users in education have been for user groups to contribute to curriculum planning and for service users to contribute as lecturers to programmes, either in a capacity as guest lecturers or as core members of staff. However, using recorded narratives sidesteps the problem of freezing individuals in roles as ‘service users’. In this module we initially worked in alliance with a woman who had recently experienced an episode of poor mental health and hospital admission. She had written an autopathograph, but had reservations about co-presenting the module, since she feared developing a fixed identity in the students eyes as a ‘service user’. In the

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event she was offered full time work elsewhere and this took the decision out her hand about coworking with us. Her story is however on file and with anonymisation and following negotiation with her, it has potential to release a powerful story which will engage readers with her experience of illness and recovery as constructed and told by her then. Her own story is continuing to move on – leaving her free to re-construct her identity without a need to maintain it as a ‘service user’. An attractive option for the time pressed student is to read one of the range of reviews of recovery narratives, which often seek to identify common themes and from that, build theory about the nature of recovery (e.g. Allott & Loganathan (2002)). The value of engaging directly with raw, complete narratives is however, that it allows people who have used services unedited, uninterrupted voices to speak in the curriculum. However, with the constraints of time, there is still a necessity to engage in a process of selecting the narratives – in effect - tutors taking an editorial role by setting texts for the Book Clubs and module reading lists. Our intention was to provide a helpful guide to reading however, the result is that our selections took precedence. It would be interesting to have students select narratives that they have found engaging and a useful aid to learning. Of course all our student practitioners have access to service user narratives on a day to day basis and could in theory apply their learning in their practice. This perhaps highlights the need for clarity in learning outcome: are we asking students to learn from particular narratives or to relate new skills to any narrative? If engaging with stories and narratives is of value, then there may be a necessary time commitment and emotional commitment that cannot be, and arguably, should not be reduced (Moja-Strasser, 2005). Frank (1995) recognises the appeal of ‘Restitution’ narratives with their modernist construction of heroic intervention and happy ending. However, the other types of story - quest and chaos – need also to be represented, but in what proportion? In this module with ‘recovery’ in its title, questions were asked by students about some of the material we included and the nature of recovery which it was portraying. In defence of including a range of stories is the discussion that followed our reading of Patricia Deegan’s story. This included a revealing description of the strategies she used to survive the first years after diagnosis with schizophrenia. Though at that stage in her story neither restitution nor quest were visible, students in the Book Club were most strongly engaged by this part of her story, feeling challenged to work towards understanding the dynamics maintaining people they were working with who they perceived to be “stuck” i.e. not apparently recovering. Challenges of using stories for teaching staff Given both the time constraints of the module and the desire to include consideration of a range of types of narratives, presented in a range of media, the issues of selecting the narratives became a dominant challenge during the preparation for delivery. Rather than being led by a theoretical model, the pragmatic considerations which influenced the ‘short-listing’ of narratives sought to ensure inclusion of: • a range of mental health problems, • a range of types of experience (using Frank’s (1995) chaos, restitution and quest typification), • a historically significant story (Deegan 1988, 1996) and • stories presented in a range of media, including novel, film, interview, documentary and art. Since the range of narratives available far exceeded the available time, an additional resource list was developed and shared with the students. Quickly the students nominated further material to add to this list. A web-based discussion page was started to encourage students to interact about the material they were studying outside of the sessions. As facilitators, we felt our limitations as novices, both in working with literature and narrative. We found encouragement from a colleague who was already teaching on cross cultural understanding of mental health problems using the medium of literature and from a research fellow who was harnessing the power of narratives to present his research. Having now delivered the module and experienced the value and power of using narratives we have a commitment to continue to develop, but remain unclear about particular lines of professional development we would need to pursue to enhance our skills in this field. In the Book Clubs we sometimes felt a tension between ‘thinking with’ rather than thinking about stories (Frank 1995). This was experienced as a tendency for the students to use an element of a story as a springboard out of the story and onto issues shared by other group members. Techniques derived from the literature on storytelling in teaching e.g. McDrury, J. & Alterio, M. (2002) seemed relevant, but the confidence to use them sometimes eluded us. Assessing learning

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I need to be getting on with my essay………….. where do I start? Each story was so different. It’s hard to bring together my reflections into one piece – particularly when this is only one of the many things happening. Some of the stories – like the one in which the woman’s friends would ‘go along with’ her ideas of being bitten by snakes – seem to be so far from my understanding of ‘what’s right’ that I don’t know where to start reflecting on it. A number of tensions are apparent in the assessment of learning in the User Led Recovery module. Students experienced the module as interesting and stimulating and in part this may have been through novelty, given it did not match easily the style and content with other learning being undertaken alongside it. A large number of our students were enrolled on practice based courses, with this module as an elective module. Typically these modules are assessed through presented case work, the classic 2000 word theory essay, and providing practice evidence and making use of conventional texts. The challenge was to have student assessment that ‘constructively aligned’ (Biggs, 2003) with the whole module but did not depart from the familiar, to the extent that the students could not engage with it. Constructive alignment is the notion that for the whole module - its aims and intended outcomes through to assessment - there is a sense of congruence. Assessment strategies should have a clear rationale and test the meeting of learning outcomes. We need to find a way of enabling students to do this well, without having to demonstrate an unrealistic range of new skills such as having to demonstrate skills of literary criticism. (For some the act of reading a novel had already been new.) We also need to maintain our aim to articulate how they have applied this unique learning to practice. We ran with an essay requiring the student to demonstrate their learning from service users through reflection and drawing on a range of sources. The outcome was fairly typical of modules with a range of results, academic skill and engagement in the assessment. Given the reflection and discussion in this article the practice of student assessment for this module will need further review and reference to practices within the broader field of medical humanities. We propose to modify the module before its next delivery to make the assessment either an annotated bibliography, or a scrap-book style of punctuated reflections in the belief that these formats are more constructively aligned. Students evaluation of the module I feel myself holding back from some of these stories – they seem to be drawing me to the edge of a precipice at which I will be forced to look down into the darkness of my own breakdowns. Will I be able to ‘just look’? Maybe the ground under me will begin to crumble so that I fall over that edge. Why this fear when I work each day with people – and hear their stories? The students evaluated the module very favourably – the following quotes being typical of the overall picture: “ Through the module I have revisited and reconsidered my own experiences and related these to the experiences of others and vice versa ” “The module has created a fresh sense of hope, lost somewhat by working in a fairly negative environment” “The module has helped me to understand service users as a person first, to enhance values” When asked to comment on ways in which the module could be improved the comments were clustered around increasing the duration and frequency of the Book Clubs and challenging us to increase the cultural diversity of the stories selected. Conclusion There is an increasing interest in narratives and stories of services users in the field of mental health practice and policy making. There remains a dominance of clinical and medical models which are often at odds with this. Our understanding of mental health problems, particularly in areas such as psychosis, is changing as the positivistic and pathological models are experiencing some robust challenges. ( e.g. Bentall (2004) and Boyle 2002)) . For the user led recovery module, the only sensible means to meet the intended learning was through engaging stories and to take up the opportunity to work with a range of media. This departed from our usual area of teaching, requiring a steep learning experience for the teaching team as well as students. Pedagogical issues remain unresolved for us, particularly in student assessment, requiring further

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thought and preparation, probably engaging with teaching methods already tried and tested in the field of medical humanities. References for Book Club materials Hart L. (1997) Phone at nine just to say you’re alive. London: Pan Books Fry, S (2007) The Secret Life of the Manic Depressive. Part 2. BBC Deegan, PE (1988) Recovery: the lived experience of rehabilitation Psychosocial Rehabilitation Journal 11(4): 11-19 Deegan, PE (1996) Recovery as a journey of the heart Psychiatric rehabilitation journal 19(3) 91-98 Plath, S. (1963) The Bell Jar London: Faber Romme, M. and Escher, S. (1993) Accepting Voices London: Mind Publications References Allott, P. & Loganathan, L.(2002) Discovering Hope For Recovery From A British Perspective - A review of a sample of recovery literature, implications for practice and systems change. West Midlands Partnerships for Mental Health, Birmingham: www.wmpmh.org.uk Aronson, JK. (2000) Autopathography: the patients tale. BMJ 1599-1602 Bentall, R.P (2004) Madness Explained: psychosis and human nature. London Biggs, J (2003) Teaching for Quality Learning at University. Buckingham. The Society for Research into Higher Education & Open University Press. Bochner, AP., Ellis, C. & Tillman-Healy, L. (1997) Relationships as stories. In S. Duck (Ed) Handbook of personal relationships: theory, research and interventions (2nd Edition. 307-324) New York: John Wiley Bochner, AP (2001) Narrative’s virtues Qualitative inquiry, 7(2), 131-157 Boyle, M. (2002) Schizophrenia: A Scientific Delusion? Routledge. Hove. Department of Health (1999) National Service Framework for Mental Health: modern standards and service models. London; DOH Eysenk, H.J. (1976) Introduction. In H.J. Eysenk (ed.) Case studies in behaviour therapy (pp1-15) London: Routledge Felton, A. and Stickley, T. (2004) Pedagogy, power and service user involvement. J. of Psychiatric and MH Nursing 11, 89-98 Foucault, M. (1973) The Birth of the Clinic New York: Pantheon Books Frank, A. (1995). The wounded storyteller. University of Chicago Press. Frank, A. (2006). Health stories as connectors and subjectifiers. Health, 10(4),421-440. Kuhn, TS (1970) The structure of scientific revolutions (2nd Edition) Chicago: University of Chicago Press Laugharne, R. (2002) Evidence- the post-modern perspective. In Priebe, S. & Slade, M.(Eds) Evidence in Mental Health Care. Hove. Brunner-Routledge. McLeod, J. (2006) Narratives and Psychotherapy. London. Sage. McDrury, J. & Alterio, M. (2002) Learning through Storytelling: Using Reflection and Experience in Higher Education Contexts. Palmerston North. Dunmore Press Mental Health Foundation 2000 Knowing our own minds London: MHF Moja-Strasser, L. (2005) Dialogue and Communication. In van Deurzen, E. & Arnold-Baker, C. (Eds). Existential perspectives on human issues; a handbook for therapeutic practice. Basingstoke. Palgrave Macmillan. Rossiter, M (2002) Narrative and stories in adult teaching and learning ERIC clearninghouse on adult, career and vocational education Rycroft-Malone, J., Seers, K., Titchen, A., Harvey, G., Kitson, A. & McCormack, B. (2004) What counts as evidence in evidence-based practice? Journal of Advanced Nursing 47. (1), 81-90 Sainsbury Centre for mental health (1997) The Capable Practitioner. London: SCMH Scottish Recovery Network (2006) Journeys of Recovery: stories of hope and recovery from long term mental health problems. Scottish Recovery Network Turner-Crowson, J. & Wallcraft, J. (2002). The Recovery Vision for Mental Health Services and Research: A British Perspective. Psychiatric Rehabilitation Journal, 25 (3), 245 – 254. Warne, T and Stark, S. (2004) Service users, metaphors and teamworking in mental health J. of Psychiatric and MH Nursing 11, 654-661

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Dr Richard Dover NEWI Wrexham. “Keeping it in the Family”: Kafka’s Metamorphosis and the Narratives of Family Psychodynamics. The significance, even the necessity, of narrative within the therapeutic process can be assumed to be a given. From the rawest of narrations, the dream which is recounted (and which may perhaps only be known in the telling), via the constructive retellings of the narratives by which we live or which others want us to live, through to the narrative subtleties and intricacies of the psychoanalytic ‘case study’, there is little need to emphasize the living and vital connections between narrative, narration and the processes of therapy. Narration can itself be seen as linked integrally to the processes of therapy, in the original Greek sense of the word, as a form of ‘attendance’ or ‘service’: through narrative, whether through the processes of (re-)telling or listening to tales, there is an implied engagement with the healing process. The ‘Talking Cure’ is also a ‘Narrating Cure’, and the cure may apply equally well to the reading and attendance of narratives as to the telling and weaving of tales. But do such considerations apply to those very sophisticated forms of narrative and symbolic production labelled ‘literature’? Can literary texts, as complex forms of narrative, provide such forms of attendance, a basis for healing? Psychoanalysis has also already mined the depths lurking within ostensibly naïve forms of narrative such as myth, fables, fairy stories, and demonstrated the extent to which such texts can be seen to be repositories of psychological significance and value. Freud’s own case studies are an obvious starting point, but Bettelheim (1976) provides seminal psychoanalytic readings of the fairy tale and their psychological resonances. Within the Jungian tradition (Jung himself or followers such as Maria Von Franz) the reading and active engagement with the fairy tale is viewed as an integral element of the training process, and a means of elucidating and working with the dynamics of the psyche. Such narratives provide a means of engaging with the processes and dynamics of the psyche at depths below that of the personal dream or the competing narratives of the self within therapy. Can such approaches, and those allied with the mythopoetic movement of the early 1990s (Bly, 1990; Moore, 1991), be used with value and profit in the reading of literary texts? Could such approaches, indeed, provide a basis for a rehabilitated notion of the ‘literary’ itself, as more than hallowed cultural artefact or preserve of the ‘Academy’, but as text and narrative, integrally related with the life of the psyche? And what implications would such an approach have for the processes of reading and engagement with literary narratives, moving away from the heroics of hermeneutic mastery and towards a view of reading itself as part of a process of therapy? This paper opens up such questions, applied to one of the most disturbing and compelling narratives of the last century, Kafka’s The Metamorphosis (1915; 1961). It is a narrative which has lost little of its original power to bewilder, frighten, irritate, shock and entertain its readers, at whatever conscious or unconscious level they engage with it. It is a text which has provided literary critics with multiple possibilities for interpretation, whilst also stubbornly resisting the possibility of any single and authoritative final reading, and without loss of psychological power and emotional impact for successive readers. This might well signal the need to read in a different light. “What do you think of the terrible things that go in our family?” Kafka’s question to a close acquaintance shortly after the publication of his novella The Metamorphosis in 1915 sets a clear agenda for reading the novella as a study of that crucible of psychodynamic relations called ‘Family Life’. The question echoes Tolstoy’s opening sentence in Anna Karenina, that “Happy families are all alike; every unhappy family is unhappy in its own way.”, reminding us that narrative is itself founded on disequilibrium, instability and the necessity for transformation – in the happy family there is no narrative, it’s simply happy. The Samsa family, however, is far from this happy state, and this narrative of family transformation provides one of the most brutal and disturbing expositions of the turmoil and unhappiness lurking behind the twitching of bourgeois curtains. The novel’s arresting first paragraph provides a logic to all that follows: As Gregor Samsa awoke one morning from uneasy dreams he found himself transformed in his bed into a gigantic insect. He was lying on his hard, as it were armour-plated, back and when he lifted his head a little he could see his dome-like brown belly divided into stiff arched segments on top of which the bed quilt could hardly keep in position and was about to slide off completely. His numerous legs, which were pitifully thin compared to the rest of his bulk, waved helplessly before his eyes. (p8) In the narrative that follows (and this is not the last time it will be told) we are provided with a compelling, ironic, and highly disturbing set of perspectives on what might initially have been taken as the normal bourgeois family. Gregor works as a Commercial Traveller, rising at 4 each morning to get to work and fulfil his order: he is the sole wage-earner, supporting his parents and sister following

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the collapse of his father’s business venture some years previously. On the morning of the transformation Gregor oversleeps, and fears that he will be lose his job. His parents call him at 7 and, just as he fears, no less than the chief clerk knocks at his bedroom door to find out what is going on: What a fate, to be condemned to work for a firm where the smallest omission at once gave rise to the gravest suspicion! Were all employees in a body nothing but scoundrels, was there not among them one single loyal devoted man who, had he wasted only an hour or so of the firm’s time in a morning, was so tormented by conscience as to be driven out of his mind and actually incapable of leaving his bed? (p15) And almost immediately insinuates that he is in danger of losing his job and putting his family at risk. Gregor, struggling to make himself understood and move his body, struggles to open the door, for when his family and his chief clerk catch sight of the transformed Gregor, they recoil in horror: his mother and sister are hysterical, and his father furiously shoos him back into his bedroom. From this point Gregor’s fate is sealed. Whilst his sister attempts to feed him, and his asthmatic mother struggles to be maternal, Gregor has moved from breadwinner to scandal and liability. He is imprisoned within his room, but the climax of the narrative occurs when he is lured from his room by the sound of this sister’s violin playing, and walks into the parlour which now contains the 3 mysterious lodgers which the Samsa family have had to take in. His father attacks him, hurling apples at him, and he is forced back to his room to die, ending his days as a shrivelled husk swept up by the charwoman. At which point the remaining members of the family realise that, with Gregor now dead, they are now free, and can afford a little holiday. The narrative ends an indication of a second metamorphosis, with Father, Mother and Sister Grete travelling into the countryside: Leaning comfortably back in their seats they canvassed their prospects for the future, and it appeared on closer inspection that these were not at all bad, for the jobs they had got, which so far they had never really discussed with each other, were all three admirable and likely to lead to better things later on. … While they were thus conversing, it struck both Mr. and Mrs. Samsa, almost at the same moment, as they became aware of their daughter’s increasing vivacity, that in spite of all the sorrow of recent times, which had made her cheeks pale, she had bloomed into a pretty girl with a good figure. They grew quieter and half unconsciously exchanged glances of complete agreement, having come to the conclusion that it would soon be time to find a good husband for her. And it was like a confirmation of their new dreams and excellent intentions that at the end of their journey their daughter sprang to her feet first and stretched her young body. (p63) The narrative is told in the detached third person and, with the exception of the closing paragraphs, focalised through Gregor’s point of view and the “logic” of his reasoning, relying on the reader to supply the necessary sympathy, compassion or outrage. And Gregor’s perspective is unremittingly that of the family martyr and victim, his actions wildly misunderstood as he bloodies himself trying to manoeuvre himself backwards through doors on his many legs, or trying to open the door to his room using his new toothless jaws. From the start his point of view is predicated on neurotic insecurity “worrying about train connections”, fearing for his job and repaying the family’s debts, his eagerness to please and be understood – and the logic of the victim and of the abused: “I cannot be loved because I am worthless, and I must be worthless because I am not loved.” The impact of this perspective is all the more intensified through the meticulous reference to detail (the self-injury he inflicts in trying to open the door, with a brown fluid issuing from his mouth, for example,) or the narrator’s cruel comedy, as Gregor struggles to get himself out of bed or when he manifests himself in front of 3 horrified lodgers who are obsessed with bourgeois cleanliness and who are horrified to see that a huge dust-encrusted dung beetle has residing upstairs. As a narrative it is part realist representation, part fable, part expressionist drama, part parable, and part case study. In engaging with it the natural starting point is to read through to authorial psychobiography, as personal testament and the exorcism of personal ghosts, to move from narrative to implied narrator. And there proves fertile ground, as any preliminary reading of Kafka’s life will testify. Metamorphosis is the work of the German-speaking Jew living in Prague, tortured by personal demons in his relations with a domestic tyrant of a father who he felt could never accept his weakly and artistic son (and to whom he poured out his soul in his Letter to His Father (1919): “My writing was all about you; all I did there, after all, was to bemoan what I could not bemoan upon your breast. It was an intentionally long-drawn-out leave-taking from you.” It was a life tortured through his impossible relationships with women, most notably the tortuous onoff engagement to Felice Bauer, able to promise her only “a monastic life side by side with a man who is fretful, melancholy, untalkative, dissatisfied and sickly.” The work of a writer who is employed as a clerk dealing with insurance claims submitted by victims of horrific industrial accidents. And it is, in the grimmest of senses, a prophetic text: Kafka himself dies prematurely, of tuberculosis, but many of his family, including all three of his sisters, were murdered in the Nazi Death Camps, their bodies

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treated like Gregor’s dead husk of a body. Writing, for Kafka, was both ordeal and necessity, the pain most graphically outlined (and the pun is intentional) in his story In the Penal Colony, where prisoners are tortured through multiple engraving of the name of their crime on their body. Kafka’s instruction to his friend was that all of his work should be burnt, yet another confirmation of a tortured and masochistic commitment to his own narrative of self-loathing and the inevitability of failure and not being understood (Kuna, 1974). This psycho-biographical narrative is a compelling meta-narrative framework for Metamorphosis, and provides an immediate means of delimiting its power and immediacy, as symptomatic expression of extreme authorial psychopathology. Like Van Gogh’s ‘Self Portraits’ such a romantic narrative, the art work as tortured self-expression and the parading of wounds, of creative madness and self-hatred for being unable to attain unattainable, enables the reader to package and contain the power of the narrative. But Metamorphosis resists limitation to this critical narrative, providing fertile ground for multiple competing and supplementary narratives. For some it is the supreme expression of early twentieth century existential angst and alienation, a symptomatic expression of dehumanisation and inner exile in a post-Nietzschian world, trapped in a world of signifiers without final and authoritative signification. For others, most notably Kafka’s friend and biographer Max Brod (1963), the impetus of Kafka’s writing is religious, and Metamorphosis a parable of human suffering and divine indifference. Kafka’s writing, Brod asserts, is haunted by the possibility of redemption and revelation of the Truth of the Law, placing the text within the Judaic tradition, successor to the Book of Job, an attempt to come to terms with the contractual relation between Jehovah and his creation. It is from this perspective that Kafka’s observation to Brod might be read, We are nihilistic fragments, all of us; suicidal notions forming in God’s mind. Passing over the narrative’s Jewish roots, notably the tradition of the Talmud, there are critics who retell Gregor’s tale as that of a Messiah, a Christ-figure who must die to save and redeem his family. Alternatively, eschewing transcendental perspectives, Metamorphosis may be re-narrated as symptom and expression of emphatically materialist and social conditions, as expression of contemporary social and family relations under advanced capitalist economies (Robertson, 1985). From this narrative framework Gregor and his family are already victims of the dehumanisation and despiritualisation which comes with wage slavery, the struggle to maintain appearances, the tyranny of clock-watching, train timetables, schedules and the reprimands from the line-manager. The processes of psychic alienation induced by such social relations are clearly evident from Gregor’s waking fears, of being late, of getting sacked, and of his family being forced into penury and destitution. From such a perspective Gregor’s transformation could actually be seen as a release, his tale a narrative of redemption and freedom from wage slavery and the dehumanisation of contemporary social relations. And there are other possibilities also, to read the narrative as parable of the artist and writer, struggling to be authentic and to express himself or herself, but wildly and cruelly misunderstood, viewed as mad or incomprehensible, and shut away in society’s top attic. Metamorphosis responds to this critical retelling, noting that an integral part of Gregor’s metamorphosis means that he is now responsive to music, whereas before his interests were limited to fretwork and the study of railway timetables. As he is lured from his room by the sound of his sister’s violin playing he asks himself: Was he an animal, that music had such an effect upon him? He felt as if the way were opening before him to the unknown nourishment he craved. (p53) Stripped of biographical considerations there is a clear basis within the text to see it as an essentially psychological narrative, a variant of the classic forms of psychological tales, the dream and the case study. This approach to the text, which is the preferred perspective for this paper, has evident applicability, whether the narrative is viewed as overall expression of neurotic self-loathing, as study in family psycho-dynamics and the games that families play (and the games that family members within families play), and as a narrative which enables therapeutic engagement with and selfassessment of personal conscious and unconscious psychodynamics. As Freudian case study Metamorphosis provide fertile territory, within its inversion of the primal Oedipal myth and the Father’s quashing of the Son. From perspectives drawn from depth psychology and post-Jungian insights, the relation between Gregor’s schizoid Cartesian ego and archetypal dimensions also provides a basis for creative re-narration of the text, and further possibilities for use of the text as a basis for insight and self-knowledge, possibly also for therapeutic and clinical practice, art and drama therapy, possibly. At one level the above account, itself a narrative or assemblage of narratives, illustrates only the most basic of literary issues, that there are instances of multiple interpretation and that a text as complex as Metamorphosis provides fertile ground for competing interpretations, creative retellings, critical metanarratives. Adjudication between competing interpretations, accepting their individual validity, becomes an issue of weight of evidence, rhetorical persuasion, and final preference. For the purposes

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of this paper, however, where these accounts lead is towards more fundamental issues of reading, of engagement with texts, and issues of pedagogic practice, the processes of directing and enabling proactive engagement with the text. These issues are focused on contrasting sets of questions: what does the narrative mean? What is the narrative about? Or alternatively, what is the value of the narrative? In what ways is it significant? Questions of textual value and significance shift the focus away from considerations of securing the master narrative which will explain a text such as Metamorphosis, providing a supplementary perspective rooted also in the idea of value, significance, purpose and resonance. These views will be returned to in more detail, but they have been outlined here to provide an informing context for this presentation and its expressed preference on specific psychological engagements with Metamorphosis (specifically post-Jungian rather than post-Freudian). Such a preference rests on both a conviction of the validity of such a perspective as a means of textual elucidation, but also on the recognition of the power, significance and value of the narrative because of the range and depth of the psychological issues with which it deals. From such a perspective the basis for textual engagement, for reading into and through the text, lies in the interactive processes of assimilation, negotiation and retelling. From such a perspective reading is based, in part, on a quest for meaning, but also for value and significance. From a Jungian perspective it is alchemical, implying a dual emphasis on the work of reading, and also on the transformational nature of the reading process itself. The power and value of a text such as Metamorphosis, in other words, resides in the potential for changing the reader, for enabling personal engagements with the text which might be described as ‘therapeutic’ or grounds for enhanced self-knowledge and self-discovery. As psychological narrative, and narrative of a psychology, the most obvious starting point is Gregor’s point of view. As case study there is a clear sense from the start of the wounded thinking boy, a figure who wakes from “uneasy dreams” and, having realised that he has awoken with rather more legs than he had the night before, immediately panics about having over-slept and missing his train, and then of being late, and then being reprimanded and disciplined by the Chief Clerk, and then of losing his job, and then not being able to pay off his family’s debts and them being hurled out onto the streets. There are indications of self-knowledge on Gregor’s part, that all is not well: Oh God, he thought, what an exhausting job I’ve picked on! Travelling about day in, day out. It’s much more irritating work than doing the actual business in the office, and on top of that there’s the trouble of constant travelling, of worrying about train connections, the bed and irregular meals, casual acquaintances that are always new and never become intimate friends. The devil take it all! (p10) But, whilst Gregor harbour grandiose fantasies of putting his boss straight (“That would knock him endways from his desk! “) the impulse to rebel is weak, hampered by thought of his parents and the need to pay off their debts (“that should take another five or six years”). He is already quashed by the Critical Father within his own mind. With the ironic distance provide by the narrative framework it is clear that Gregor lives within his head, caught within a “logic” of his own making: of inherent inferiority, worthlessness; the need to support and even redeem his family; of insecurity, inability to sustain intimacy, with his fleeting memories of snatched pleasures: a chambermaid in one of the rural hotels, a sweet and fleeting memory, a cashier in a milliner’s shop, whom he had wooed earnestly but too slowly. (p47) Apart from his need to save the family he has little to sustain him, as his Mother confides to the chief clerk who so early in the morning to check up on him: his fretwork, the railway timetables he pores over, the intriguing fur-clad woman figure, the Venus in Fur figure with its conscious echoes back to Sacher-Mosoch’s study of erotic master/slave relations), who adorns his wall and to which he appears unnaturally attached (quite literally). He dreams of funding his sister to study music at the Conservatoire, and had planned to announce his scheme to the family on Christmas Day. There are a number of points where Gregor’s self-loathing manifests itself, including the following point where Gregor is banished to his room and, filled with shame, attempts to ease as much of his body as possible under the sofa: He stayed there all night, spending the time partly in a light slumber, from which his hunger kept waking him up with a start, and partly in worrying and sketching vague hopes, which all led to the same conclusion, that he must lie low for the present and, by exercising patience and the utmost consideration, help the family to bear the inconvenience he was bound to cause them in his present condition. (p58) Throughout the narrative, even to the end, the logic of his point of view is predicated on selfdeprecation and self-denial, as he feeds away, chased back to his room with the apple thrown at him by his father mouldering in his back:

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The rotting apple in his back and the inflamed area around it, all covered with soft dust, already hardly troubled him. He thought of his family with tenderness and love. The decision that he must disappear was one that he held to even more strongly than his sister, if that were possible. In this state of vacant and peaceful meditation he remained until the tower clock struck three in the morning. The first broadening of light in the world outside the window entered his consciousness once more. Then his head sank to the floor of its own accord and from his nostrils came the last faint flicker of his breath. (p58) He dies, alone, a dried out husk, swept away by the charwoman, having found no satiation for his hunger. It is, at one level, a tragic death, but in other respects it is a release and a redemption, a release from suffering and cruelty and the logical inevitability of disappointment. One may question whether his “life” prior to the transformation was any sort of life at all, but rather a numbing enslavement to work, grief and shame, the repayment of debt, being taken for granted by the family who both depend upon him and take him for granted. Gregor’s point of view is defined in relation to his family members: the narrative provides ample evidence of this essentially relational basis to Gregor’s tortured and masochistic self-logic, and no more clearly than in his relation with his Father. One of the most telling, and touching details emerges after the family realise that Gregor’s transformation is not temporary, but requires them to rethink their financial affairs. He overhears the family’s discussions as they begin to take stock of their situation, and his father confirms that actually they have not been as poor as Gregor had imagined and that there are some savings after all: Behind the door Gregor nodded his head eagerly, rejoiced at this evidence of unexpected thrift and foresight. True, he could really have paid off some more of his father’s debts to the chief with this extra money, and so brought much nearer the day on which he could quit his job, but doubtless it was better the way his father had arranged it. (p33) Gregor is ‘Slave’ to his Father’s ‘Master’, and the relation between them is a duel based on psychic as well as financial currency. At the start of the narrative it is his Father who knocks gently on the door with his fist, asking what is the matter with him, so that he can return to the breakfast which usually lasts him all morning. It is his father’s debts, brought on by the failure of his business speculation, which Gregor the Son agrees to repay, leaving his Father, a former soldier to live a life of weary idleness, growing fat and sluggish as Gregor works tirelessly to pay off his business debts. As the narrative opens the latent instability of this relationship can no longer be sustained, and here we note that Gregor’s transformation precipitates three further transformations, for his Sister, his Mother and most dramatically for his Father. As Gregor wastes away his Father has found himself a job as a Bank Messenger, and even Gregor is amazed by the changes: Truly, this was not the father he had imagined to himself; admittedly he had been too absorbed of late in his new recreation of crawling over the ceiling to take the same interest as before in what was happening elsewhere in the flat, and he ought really to be prepared for some changes. And yet, and yet, could that be his father? The man who used to lie wearily sunk in bed whenever Gregor set out on a business journey; who welcomed him back of an evening lying in a long chair in a dressing gown... Now he was standing there in fine shape; dressed in a smart blue uniform with gold buttons, such as bank messengers wear; his strong double chin bulged over the stiff high collar of his jacket; from under his bushy eyebrows his black eyes darted fresh and penetrating glances; his onetime tangled white hair had been combed flat on either side of a shining and carefully exact parting. (p43) Mr Samsa resumes control over the Family, taking command of their finances, and from the start is brutally indifferent to his Son’s suffering. On seeing Gregor’s horrific appearance for the first time all he can do is to knot his fist with “a fierce expression on his face as if he meant to knock Gregor back into his room”, and then seizes a walking stick and newspaper to shoo Gregor angrily back into his bedroom and out of the family’s sight. And again, when Gregor ventures down to the parlour whilst his family and the 3 sinister lodgers listen to Grete playing the violin, it is his Father who angrily chases him back to his room, bombarding him with apples, including the single (symbolic) apple which lodges in Gregor’s back and eventually hastens his death. At this point Gregor knows that he cannot stand up to him: But Gregor could not risk standing up to him, aware as he had been from the very first day of his new life that his father believed only the severest measures suitable for dealing with him. (p43) This Father/Son relationship is impossible, cannot be sustained, but remains all the more necessary because of it, the Son who feels himself worthless and unlovable because he cannot be loved by a Father who cannot respect a Son who he sees as worthless and a disappointment. This dialectical counterposing of shame and contempt provides one of the most potent symbolic negative expressions of the Father/Son relationship ever rendered, all the more powerful and affective given the ironic and dispassionate narrative framework. From the Father’s point of view Gregor represents scandal,

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disappointment, the donor transformed into a parasite, the Son who has stolen command of the Family, who ends the narrative as commanding Patriarch, ready to marry off Gregor’s sister. And from Gregor’s perspective Father is the angry, heavily-booted and fearful Patriarch, who celebrates that his Son is dead so that the Family can now get on with their lives, and can afford to live now that they can find a “smaller and cheaper but also better situated and more easily run apartment than the one they had, which Gregor had selected.” (p62) And so too with the Mother/Son relationship, also a dialectic of misunderstanding. His asthmatic mother attempts to be maternal in the first instance, endeavours to care for him and protect him from his Father, but ultimately her role is (tellingly) undeveloped. By the end of the narrative she has reconciled herself to Gregor’s transformation but, set against the commanding focus represented by her husband, her role as mother as provider of maternal sustenance and compassion is almost incidental. Gregor’s own relations to her, his expectations and needs as a Son to her, are rapidly transformed. Hers is the first “gentle voice” at his door on the morning of the transformation, who then defends her son against the implied rebukes of the chief clerk – “The boy thinks about nothing but his work. It makes me almost cross the way he never goes out in the evenings…” but her first glance of her son’s transfigured appearance leaves her heaving on the floor, sobbing. As Gregor’s transformation continues he longs to see her, and she does indeed do what she think is best, persuaded by her daughter, to empty his room of its familiar furniture so that he can be free to climb walls and ceiling, until she faints with horror and has to be revived. She makes attempts to protect Gregor from his father, but cannot be described as her son’s champion, and, by the end, her feelings have transferred to numb acceptance, as she looks at the dried out husk, all that remains of her former son: “Dead? “ said Mrs. Samsa, looking questioningly at the charwoman, although she could have investigated for herself, and the fact was obvious enough without investigation. “I should say so,” said the charwoman, proving her words by pushing Gregor’s corpse a long way to one side with her broomstick. (p59) Of the three it is Grete’s transformation which is most dramatic, beginning as the caring and devoted sister, the one who shows most compassion for Gregor, attempting to identify, through trial and error, whether he will eat food which is fresh, savoury or rancid, and attempting to clear his room so that he can be free to roam the walls and the ceilings. By the end of the narrative, however, her sisterly logic has hardened, and the nubile seventeen year old reasons differently about her brother: “He must go,” cried Gregor’s sister, “that’s the only solution, Father. You must just try to get rid of the idea that this is Gregor. The fact that we’ve believed it for so long is the root of all our trouble. But how can it be Gregor? If this were Gregor, he would have realized long ago that human beings can’t live with such a creature, and he’d have gone away on his own accord. Then we wouldn’t have any brother, but we’d be able to go on living and keep his memory in honour. As it is, this creature persecutes us, drives away our lodgers, obviously wants the whole apartment to himself and would have us all sleep in the gutter. (p56) Gregor is astonished that the sister he loves, whom he hopes will realise her talents as a musician, should end up being fearful of him, and position herself in such an ironic dramatic tableau: Yet Gregor had not the slightest intention of frightening anyone, far less his sister. He had only begun to turn round in order to crawl back to his room, but it was certainly a startling operation to watch, since because of his disabled condition he could not execute the difficult turning movements except by lifting his head and then bracing it against the floor over and over again. He paused and looked round. His good intentions seemed to have been recognized; the alarm had only been momentary. Now they were all watching’ him in melancholy silence. His mother lay in her chair, her legs stiffly outstretched and pressed together, her eyes almost closing for sheer weariness; his father and his sister were sitting beside each other, his sister’s arm around the old man’s neck. (p57) Gregor’s eventual death enables the surviving triumvirate – Father, Mother, Sister – to survive and most likely to thrive. Their narratives are of release and redemption, the possibility of rebuilding the Family’s fortune, the possibility of a good marriage, the hope of prosperity and solid bourgeois success based on the transformation of their daughter from someone they regarded as “somewhat useless”, to a highly marketable commodity on the marriage market. As an exercise in negative pedagogy it is easy to see the narrative as one of family psycho-dynamics, as symbolic exploration of the psychological and behavioural dynamics within families, of the games and laws which operate within family relations. There is, in short, material here for many volumes of family therapy, and clearly much of the power of the narrative and its impact on successive generations of readers has rested on its uncompromising and disturbing portrayal of the laws and logics within families. Like the grit which becomes a pearl, so the reading of a text such as Metamorphosis may irritate and get under the skin, demand to be transformed by each reader into an encounter with primal family experiences.

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From an extended depth psychological perspective, however, the narrative yields further insight, with its emphasis on the relativization of ego-based consciousness and the renewed emphasis on the relations between ego and archetypal patterns and modes. From this perspective the emphasis shifts moves from the ego’s conscious relationship to the Family without to the Family within. Identification and sympathy with Gregor’s point of view alone, that of the passive but necessary victim, the martyr whose gratitude is cruelly re-rendered as control and emasculation, provides a partial perspective. An extended perspective, which takes in the points of view of each of the four family members, and emphasises the relational and co-defining nature of their respective psychologies, as separate expressions of the same continuum. That Gregor is his Father’s and his Mother’s Son: the Son’s sense of Shame has made the Father’s Contempt, and the Son’s Need invokes the Mother’s inability to care. This is the point where perspectives from depth psychology can yield further insights, to see the narrative as an overall expression of the singular psyche, within which all elements and characters, as in a narrated dream or the case study, are elements of the whole. From these terms Metamorphosis shifts, from being a narrative of Gregor’s relation to his family, to a narrative of the whole Self, with its unique constitution of archetypal elements and characters. In other words, like characters in the dream, all characters and their respective points of views, relations and dynamics are co-dependent parts of the whole psyche. On this basis a narrative such as Metamorphosis can be seen to offer privileged insight into the relational and dynamic nature of the elements within the psyche, and their relations to the relativized ego. Father, Son, Sister, Daughter are part character and point of view, but part also disposition, archetypal formation, reactions and latent possibility. Essentially what is implied here, therefore, is a kind of analysing of the text not from the standpoint of the ‘Heroic’ or ‘AntiHeroic’ Ego, Gregor’s consciousness, but rather a psycho-analysis of the narrative as a whole, as a narrative instance and expression of the psyche. In one sense there is a returning to full circle to psycho-biographical readings of the text, to psycho-analyse the implied author. The one important difference, however, is that the author/implied author can be kept out of the picture and still yield fundamental insights into the nature and dynamics of the psyche. The text, therefore, moves from a personal articulation and exorcism to an articulation of the collective interest and value, as a narrative of the inner Family rather than of Gregor’s family, Kafka’s family. The narrative, finally, reveals itself as a case study of inner family dynamics, of the relation between conscious ego and the archetypal elements from which it draws energy, form and direction. The virtues of this post-Jungian and mythopoetic framework are best illustrated through application to the text. At the heart of Metamorphosis is the primal quaternity, of Father/Son/Mother/Sister, defined in these terms in relation to Gregor, but also defined in relation to each other and taking shape and point of view from that relation – Grete as Sister to Gregor, Daughter to Father and Mother. From the opening of the narrative Gregor defines himself, archetypally as the Self-shaming Son, the Martyr and Victim, who must atone for the financial sins of his family. Such a polarised negative self-perspective induces equivalent polarisation for the Father. As the Son’s self-shame is manifested as physical transformation into the disgusting beetle, so the Father’s Anger and Contempt is manifested as Rage and Violence. Within the whole psyche of the narrative’s “Self” we are a world away from integration and harmony, rather there is radical imbalance and disharmony between the contemptuous ‘Father’ (Authority/Husbandry/Leadership/Patriarch) and the self-shaming ‘Son’ (Potential/Youth).In postJungian terms the narrative provides witness to warring and unintegrated archetypal elements within the whole Psyche, directing the formation of the ego, the consciousness, which rests on these archetypal foundations and draws strength from it. The symbolic Father/Son relationship, rendered in archetypal terms, is powerfully articulated through the text-as-parable, with the Hostile Critical Patriarch hurling apples (from the Tree of Knowledge) into Son’s side. There is no reconciliation here, no possibility of a fresh start, unlike the possibility outlined in Kafka’s undelivered Letter to His Father of 1919 This, your usual way of representing it, I regard as accurate only in so far as I too believe you are entirely blameless in the matter of our estrangement. But I am equally entirely blameless. If I could get you to acknowledge this, then what would be possible is—not, I think, a new life, we are both much too old for that—but still, a kind of peace; no cessation, but still, a diminution of your unceasing reproaches. In the portrayal of the polarised archetypal relation between Son and Father within the narrative of Metamorphosis, as Master/Slave, Contempt/Shame, there little possibility of that new life, a different transformation for the Gregor component of the narrative’s consciousness. This narrative of the Father/Son relationship, Critical Senex and Shamed Puer, (Hillman, 2005) dominates the narrative, but there are other archetypal dimensions to consider, most notably the

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twinning of Gregor and Grete. This Brother/Sister parallel immediately invokes, from within Jungian typology, the archetypal pairing of Anima and Animus, leading towards the view of Grete as the undeveloped feminine potential within the narrative, expressing itself through initial care and sympathetic dedication to Gregor’s needs (the attempt to find the right food, clearing his room). From the start we are made aware that, whilst Gregor lives to support his family, it is Grete to whom he is devoted, and he directs energies to funding her musical studies at the Conservatoire. She similarly is devoted to him, at the beginning, but by the end she displays clinical disengagement from her brother, taking him by surprise with her haste to lock him back into his room (“At last!” she cries, to her parents) and with her clear siding with her Father against Gregor. For Gregor this is not “betrayal” – his final thoughts are of love and sympathy for all his family, especially for his sister. The rotting apple in his back and the inflamed area around it, all covered with soft dust, already hardly troubled him. He thought of his family with tenderness and love. The decision that he must disappear was one that he held to even more strongly than his sister, if that were possible. (p58) The text’s negotiation of the Ego/Anima relation, rendered through the twinned narratives of Gregor/Grete is, as might be expected from the rendering of the Father/Son relationship, characterised by polarisation and the impossibility of reconciliation. In the final sentences Grete’s metamorphosis has been won on the back (excusing the pun) of Gregor’s death. The narrative chooses to provide no further adjudication of blame and responsibility, leaving us with the necessity to interrogate and continue the narration. From the standpoint mapped out above Metamorphosis emerges as a powerful testimony of internal family psychodynamics, of the relations between the members of the inner (and internalised) archetypal family upon which the narrating ego-consciousness is founded, and which govern and direct the terms and trajectory of its development. Here indeed is a powerful inner psychodrama, a rendering of internal archetypal psychodynamics which, like the vivid dream or the arresting case study, demand further interrogation and retelling as narratives both of and for the self. And, as a case study and testimony of polarised psychic disharmony and psychopathology, it is a narrative which, whether as positive or negative pedagogy, cannot simply be read and experienced neutrally and without impact. Metamorphosis emerges as necessary contemporary narrative, and one that raises profound and fundamental issues of reading and engagement. The temptation might well be to seek for the commanding master narrative which will explain it, provide grounds for explication and reduction, solely within the realms of hermeneutic mastery. In reading it as a radically psychological narrative, however, there is a need for a wider sense of “reading” itself, as a kind of therapeutic practice, away from intellectual curiosity and dispassionate clinical (dis)interest. Here, rather, we find a text which requires a reading based also on value and significance as well as meaning, a reading based on personal interrogation and psychic involvement. It is a reading and retelling of narrative which, following Jung, should be seen as akin to an alchemical process, with an emphasis not solely on the work outside, the transformation of matter and substance, but as a basis also for self-interrogation and self-transformation. This in turn offers the possibility of a rehabilitated notion of practices of reading founded on therapeutic grounds, of personal exploration and self-questioning, a recognition of the value and significance of text, and the necessity of a psychopathological narrative such as this. References Bettelheim, B., (1976), Uses of Enchantment: The Meaning and Importance of Fairy Tales. Vintage Bly, R., (1990), Iron John. Reading Mass. Addison-Wesley Brod, M., (1963), Franz Kafka. A Biography. New York, Schocken Heller, E., (1974), Kafka. London, Fontana Hillman, J., (2005), Senex and Puer: 3 (James Hillman Uniform Edition). Puttnam Conn., Spring. Kafka, F., (1961) ‘The Metamorphosis’, (translated Edwin Muir), Metamorphosis and Other Stories., Harmondsworth, Penguin. All page references are to this edition Kuna, F., (1974), Kafka. Literature as Corrective Punishment. London, Elek Moore, Robert and Douglas Gillette, (1991) King Warrior Magician Lover: Rediscovering the Archetypes of the Mature Masculine. San Francisco, Harper Robertson, R., (1985), Kafka: Judaism, Politics and Literature, Oxford, Clarendon Von Franz., M.L., (1997), Archetypal Patterns in Fairy Tales (Studies in Jungian Psychology by Jungian Analysts). London, Inner City Von Franz, M L., (1996), The Interpretation of Fairy Stories. New York, Shambhala

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Dr Paul Johnson, University of Wolverhampton England. Making it up as we go along: Construction of narrative in Immersive Museum Theatre Abstract This paper discusses the construction of narrative in the Immersive Museum Theatre work of Triangle, resident theatre company at the Herbert Gallery, Coventry. Triangle have developed a remarkable method (receiving two national awards - The Museums and Heritage Award and the Roots and Wings Award) of engaging young people with theatre work regarding history, location, artefacts and narrative and this research will analyse the development of this work through in-role participation. The defining feature of Triangle’s immersive museum theatre work is that all parts of it are carried out in role, by both the facilitators and the participants, and the most profitable way of undertaking research is similarly in role. Following a ‘research through practice’ model for writing about immersive museum theatre the construction of narrative in a three day event in March 2006 is discussed. The techniques used to build character and to encourage immersion in the role also encourage a free construction of narratives, and chance events can become central to this emerging narrative. It is argued that a ‘closed’, carefully prestructured narrative which is then discovered could not match the richness or spontaneity of the ‘realworld’ environment which is used to provide narrative material. It is in fact the open responsiveness of the narrative that is constructed that enables the participant to achieve a flow-like engagement with the experience.

Michael Roemer opens his book, Telling Stories: Postmodernism and the Invalidation of Traditional Narrative, with the statement that: Every story is over before it begins…Stories appear to move into an open, uncertain future that the figures try to influence, but in fact report a completed past they cannot alter. Their journey into the future – to which we gladly lend ourselves – is an illusion. (1995: 3) Whether the theatrical work of art comes into being through the watching a performance by an audience, or if it exists in the text itself, the narrative in both of those cases is relatively fixed and unalterable. Although narrative is central both to drama and a large number of other performance traditions, it is perhaps surprisingly underused in Theatre/Performance Studies, perhaps as a result of the attempt to define these disciplines as not primarily concerned with the study of the dramatic text, where narrative is often investigated. Instead the focus is often on elements that are apparent only in the performance event itself rather than the text, such as the use of space, scenography, and relationship between performer and audience, where the impact of narrative is perhaps less easily discerned. There have been numerous forms of live performance that have experimented with different ways of unfixing narrative, from the performance poetry of the Dadaists, to the ‘nothing happens’ of Beckett, the rewriting of narrative by the spect-actor in forum theatre, or the experimental reconfigurations of narrative in Performance Art. This paper discusses the construction of narrative in a very different sort of performance work, the Immersive Museum Theatre work of Triangle, resident theatre company at the Herbert Gallery, Coventry. The work is described as immersive as all parts of it are carried out in role, and often developed through extended improvisations, lasting several hours, days or longer still. It is described as museum theatre not because, as with traditional (or interpretative) museum theatre, it necessarily takes place in a museum, or even because it interprets the collection, but rather because it is made as an artistic response to the idea of museum in general, and the Herbert in particular (for an analysis and description of interpretative museum theatre see Bridal 2004, Hughes 1998, Jackson et. al. 2002). Narrative can play a central role in the analysis of both participatory arts programmes and more conventional theatre; similarly narrative can be used to understand the ways in which visitors to a museum, gallery or heritage site construct meaning from the materials presented, whether these materials are objects themselves or different forms of interpretation, including live performance. This paper will loosely use the ideas of narrative analysis, where the story told to make sense of a particular participatory theatre event will be used to shed some light on the nature of the event itself. This story will be about the construction of narrative in a particular immersive museum theatre programme. Triangle Theatre was established in 1988 by Carran Waterfield, and has made a range of work, including a number of professional shows for theatre spaces, work with young people, and most recently as resident company at the Herbert. Their early work was notable for combining private

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stories and archive research in performances that were simultaneously deeply personal and almost mythically universal (see Trowsdale 1997 for an account of the early work of Triangle). For instance Looking for the Tallyman (1998) drew upon the family stories of Waterfield and co-performer Richard Talbot, as well as archive research into the lives of residents in a children’s home in Suffolk. Companies, such as Odin Teatret and Pan Theatre, which resist the easy satisfaction of an unambiguous narrative, have also influenced Triangle’s work, with Waterfield and Talbot training at various points with members of these companies. For instance in Odin Teatret’s 1985 production The Gospel According to Oxyrhyncus the characters speak deliberately incomprehensible languages (drawing upon Coinic Greek and Coptic) and exist in an uncertain location (For a full account of this production see Watson 1993: 141-145). Although eventually spectators might be able to establish the identity of the characters, some of whom are relatively recognisable, such as Joan of Arc or Antigone, even this does not produce a stable narrative. Within each character’s narrative the other characters are related to as whoever would be appropriate for that particular narrative, such as Creon within the narrative of Antigone, and this shifts from moment to moment. Consequently there can be no definitive understanding of a ‘true’ narrative for the piece, as the narrative is partially defined by perspective as each character identity is multiple and varying in time. This shifting uncertainty of narrative in different ways also permeates all of Triangle’s work. This paper builds upon my longstanding relationship with Triangle, and the primary research was the participation in a three-day training event in March 2006. This event was intended for performers, museums professionals, educators and others who were interested in exploring Triangle’s immersive museum theatre method. The first day was primarily concerned with an exploration of the work from the outside, as a spectator rather than as a participant, and at this stage there was certainly little opportunity to write ones own narrative. Although there was some degree of immersion and there were some elements of interaction, this was quite limited, and the more challenging elements of the work were viewed through demonstration, live performance, and video footage rather than through participation. The two days following this were significantly more challenging, and far more rewarding. My experience of this training experience forms the primary research material, and this remains deliberatively subjective. The intention is not to provide for analysis an objective account of the programme, or to analyse the experience of the other participants, but rather to explore the subjective experience of the construction of narrative in those final two days. Using this form of creative work as research raises interesting ethical questions, in that the researchers subjective experience only exists through interaction with other participants. However, in this case none of the participants can be identified from this documentation of the event, and they were made aware that research was being undertaken. Furthermore it could be argued that the performative nature of the work in some ways places it in the public domain, if only for a limited audience. There is a clear distinction that can be made between the use of narrative in ‘traditional theatre’ and the uses of narrative made in participatory theatre. Tony Jackson, in his article ‘Positioning the audience: inter-active strategies and the aesthetic in educational theatre’ (1997) argues that the placing of the audience within the theatrical frame makes theatre in education differ substantially from conventional performance. What is more the ongoing creation of the performance text by the participants would seem to “fail one of Jurij Lotman’s requirements of an ‘artistic text’, namely that its structure should not be subject to change” (Jackson 1997). Jackson indicates a further semiotic difficulty in that the particular frame through which the performance is viewed, “having been set, will predispose its audience to view and ‘read’ the performance according to a given set of unified ‘codes’ in a consistent manner from start to finish” (Jackson 1997). The way in which these frames are set is the result of a complex interaction of different factors, including the personal (horizon of expectation, etc), the public (venue, etc) and the theatrical (acting style, etc). How then can a performance which combines viewing, creating and participating in a range of different ways be understood if considered to be viewed through one unchanging frame? Jackson’s answer is that participatory theatre programmes ask their participants to view the work through a series of different frames (investigative, presentational, involvement and narrative), and the level and nature of the participation is determined by whichever frame is being used at any particular moment. This seems plausible for most traditional theatre-in-education work, where the spectators might have an influencing effect on what happens on stage, however rarely are they responsible for creating narrative. For instance with traditional forum theatre although supported by and created in response to an engagement with the oppressions facing the target audience, the initial narrative is presented as a given. Indeed for theatre in education, the narrative frame in Jackson’s schema clearly states that the students do not influence the narrative through that phase.

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The framework for the participatory element of the Immersive Museum Theatre training was The Whissell and Williams Training Camp. This framework has been used for three substantial projects, The Whissell and Williams Home Front Training Camp (2003), Coventry Kids in the Blitz (2005) and War is Over (2005). These projects, described by the company as “reality without the TV” used characters developed by Carran Waterfield and Richard Talbot, namely Mrs Williams and Mr Whissell, with a number of other performers playing numerous notionally different but almost identical Miss Williams. These projects worked with a range of different young people, both primary school children and trainee actors, as well as a number of other organisations. For instance Coventry Kids in the Blitz brought together organisations including the Herbert (as the Ministry of Arts and Heritage) the Transport Museum (as the Ministry of Transport) and Coventry Cathedral (as the Ministry of Faith). These projects enabled the participants to explore ideas relating to the Second World War such as evacuation, homecoming, atrocities and individuality and conformity. Although the general feel of the work was appropriate to the period (for example through the use of language and costume), the attitude employed was very different to what might be used in historical reenactment. Although some historically accurate documents were used, such as Identity Cards, there was never a dogmatic insistence on historical fidelity, but rather there was an insistence on immersion first and foremost, and on historical accuracy second. On the first day of the March 2006 training programme the participants were given a number, and told that they needed to remember it. When taken from the Herbert, where registration took place, to the Drapers Hall, where the majority of first two days work took place, participants were instructed to line up according to their numbers. Although this introduced a comic element, through for example, Miss Williams’ exasperation with people forgetting their numbers, it also, in a very simple way started the development of character. The notion was that the participants were being trained through the Whissell and Williams regime, and that we would all become either a Whissell or a Williams by the end of the programme. Whilst this might appear a rather limiting and uncreative activity, a valuable comparison can be made here with mask acting, and the use of the neutral mask in particular. In both cases through the imposition of an identical external element, either the mask or the Whissell or Williams character, the possibility for spontaneous responses within that is produced, and similarly with both a remarkably wide range of individual responses are possible. Indeed it is the constrained nature of the imposed element that produces the individuality of response. The second day began with a more extreme version of the first day’s roll call. After marching to the Draper’s Hall the participants were ordered to wait in the stairway while one by one they were taken inside, photographed, swabbed and lined up in two groups, each one led by a Miss Williams. Here the lack of insistence on historical accuracy can be seen, as the taking of a DNA sample is a historically anachronistic but artistically satisfying procedure. The purpose of this induction process was perhaps twofold. Firstly it helped to engender a sense of playful paranoia, a sense that there existed conspiracies and plots around us that were waiting to be discovered, and which became central in the production of narrative later in the work. Secondly it started the series of physical activities that were used in the development of character, and acted as a dividing line between the real world and the immersive fictional world that we were entering. In a wide range of actor training traditions there is a similar preparatory liminal process, such as the Michael Chekhov exercise Crossing the Threshold, or the very particular method used for donning or ‘shoeing’ the mask in a number of mask acting traditions. (Chamberlain, 2003, 116; Eldredge, 1996, 44-45). All of these externally very different processes are intended to allow for a state of enhanced freedom, creativity and spontaneity on the part of the participants following some form of stripping away of the every day life or self. In other words again it is a restriction that produces a greater freedom, or a unifying activity that provokes greater individuality. Furthermore all of these are physical procedure designed to cause a psychological change. It is also at this point that the first of a series of chance events began to have a significant impact upon the development of the narrative of the training. Due to an unexpected ‘real world’ crisis Talbot and Waterfield were unable to attend for much of the second morning. Again this added to the sense of paranoia, as the Miss Williams who were left in charge were themselves slightly uncertain as to what was happening. Secondly, ‘OW’ and ‘RO’, the two performers playing Miss Williams, had themselves trained at different stages of the development of the immersive museum theatre method, and as a result of this behaved with varying degrees of authoritarian discipline. This slight unplanned and inadvertent conflict between them resulted in much of the narrative that was developed over the following two days. This included that there existed factionalism within the Whissell and Williams regime, or that there were forces outside that were working against us. The majority of the first day was spent on activities that had the effect of developing us as either a Whissell or a Williams. Initially this was through a long sequence of rather exhausting physical work,

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continuing and developing the marching. Alongside this there were a series of simple tasks we had to accomplish, such as completing an Identity Card, including fingerprint and (anachronistically) hair sample. Additionally we were required to gradually assemble the appropriate items of clothing and props, including for example a clipboard and whistle for Whissell. Many of the items required for these tasks were contained in a suitcase, and the conflict that had developed between Miss Williams and Miss Williams was played out through a desire to possess the suitcase, with various negotiations and barters being made to ensure access. When Waterfield and Talbot returned each trainee had a one to one ‘interview’ with Mr Whissell and Mrs Williams. This was something that had developed out of the work with young people, where Mrs Williams in particular takes a pastoral role, although of course this, as with everything else, is done in role. The effect in this case was of being inspected by distant and rather menacing figures, partly because it was done in a large hall, with the trainee at one end and Mr Whissell and Mrs Williams at the other. The final stage of that days training was a trip into Coventry city centre to buy umbrellas and coats for those who did not have them. While this type of in character ‘invisible theatre’ is so common to be almost a cliché of over indulgent actor training, I found it an extremely uncomfortable experience, which had the effect of fixing the Whissell character, almost through a process of firing it in a kiln of public scrutiny and interaction. Roemer observes that “the concept of character has become obsolete…We have, moreover, lost all confidence that our once seemingly impregnable characters can withstand real pressure. Traditionally, in both life and fiction, character or self derived from and served a stable context, though it also preserved our integrity when the context crumbled.” (1995: 1617) The pressure placed on the characters at this stage helped to preserve it when a greater degree of autonomy was required the following day. Obviously the narratives that developed during this exercise were unplanned, though by this point we had worked together sufficiently to be able to respond to and develop chance occurrences. As an example of the continuing playful paranoia when the police were seen filming with a video camera that was taken as further evidence of plots and counterplots. The final day started again at the Herbert, to where the participants were told that they needed to travel to, or at least arrive, in role and in costume. We were blindfolded, and led through and out of the museum and onto a minibus, where we were driven out of Coventry, still blindfolded. The two groups were unloaded separately, and we, still blindfolded were marched (slowly) over rough ground, through fences, given the opportunity to go to the toilet (taken in whilst still blindfolded) and then finally allowed to remove our blindfolds. The final day took place at Rough Close Scout Camp, a site that is no longer used but rich with possibilities for dramatic narratives. There are a variety of buildings and locations spread over a large wooded site, and it is this rich environment that provides the opportunity for the free construction of narrative. The very fact that it was a natural site meant that it was unclear what was significant, and so in effect anything could become significant and a catalyst for the development of narrative. The most significant factor for the narratives that developed was the absence ‘RO’, of one of the Miss Williams. This was due to other work commitments, but this ordinary ‘real world’ reason became transformed, through this sense of playful paranoia, to abduction due to the factions within the regime. Furthermore, when the other group of trainees attempted to negotiate her release and return, it seemed natural for our group to go along with this, even though we knew that we did not actually have her. Eventually this resulted in one of the trainees disguised as Miss Williams with a blanket over her attempting to be returned to the other group, and in fact provided the majority of the ‘content’ for the day. Although it is likely that all participants ‘really’ knew that that the figure presented as Miss Williams was not actually someone else in disguise, it was perhaps more satisfying to be allow the fabricated narrative to continue until the deception could be more dramatically revealed. Perhaps a comparison can be made here with the open or closed text. Whereas even with the majority of participatory theatre work there is a limited narrative frame within which the action can develop, here the constriction of character and behaviour, combined with the richness of the immersive environment allow for a full response to chance events. The skill of the performers is in allowing the results of those chance events to develop and for narrative to form around them. As a participant the satisfaction of creating rather than merely uncovering narrative is great, and the training method provides the spontaneity to be able to do that. “Like all structures, story integrates and relates” Roemer argues, and narrative is primarily concerned with connections. (1995: 11) The great advantage of this immersive museum theatre work is that everything that falls within the attention of the participants can be relevant – there is no need for fire extinguishers or passing cars to be studiously ignored because they do not fit, the simple choice is ‘do I want them in the story we are making’? If the answer is yes, then that is how the story moves, and the task then is to make those

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connections, and whether audience or performer, or even whether in life or in theatre, that can be extraordinarily satisfying. The immersive museum theatre work provides an improvisatory framework that allows for the exploration of a wide range of ideas. The open structure provides opportunity for the creation of narrative in a remarkable free way, and the complexity of the environment provides a range of appropriate stimuli. Although the company provided documents that could have served as a starting point for developing narrative, the spontaneity of the narrative that developed from the chance events was ultimately more satisfying, and this work provides a valuable model for participatory performance work that can be carried out in a range of context, and with a range of participants. Roemer states that we “think we see differences between myth, in which fate and the gods determine the outcome, and the stories of today, in which people appear to be shaping their own lives. But all stories are over before they begin” (1995: 3). Perhaps the use of creative freedom within a constrained framework, as in Immersive Museum Theatre, and in particular the incorporation of found and chance objects and events, allows for stories which can genuinely be created by the participants, where they can to an extent shape their own fictional lives.

References Books Bridal, T. (2004) Exploring Museum Theatre Walnut Creek, Calif: AltaMira. Chamberlain, F. (2003) Michael Chekhov London: Routledge. Eldredge, S. (1996) Mask Improvisation for Actor Training and Performance Evanston: Northwestern University Press. Hughes, C. (1998) Museum Theatre Portsmouth NH: Heinemann. Jackson, A.R. (1997) ‘Positioning the audience: inter-active strategies and the aesthetic in educational theatre’ Theatre Research International v22.n1: ppS48(13). Jackson, A., Johnson, P., Rees Leahy, H., Walker, V. (2002) Seeing it for Real: An Investigation into the effectiveness of theatre and theatre techniques in museums. University of Manchester: CATR. Roemer, M. (1995) Telling Stories: Postmodernism and the Invalidation of Traditional Narrative London: Rowman and Littlefield. Trowsdale, J. (1997) ‘‘Identity – Even if it is a fantasy’: the Work of Carran Waterfield’ New Theatre Quarterly XIII.51: 231-247. Watson, I. (1993) Towards a Third Theatre: Eugenio Barba and the Odin Teatret London: Routledge. DVDs Coventry Kids in the Blitz (No date) DVD. Triangle Theatre. Coventry. Dugout! (No date) DVD. Triangle Theatre. Coventry. The Whissell & Williams Home Front Training Camp (No Date) DVD Triangle Theatre. Coventry War is Over (No date) DVD. Triangle Theatre. Coventry.

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Jan Rae South Bank University London: The Play’s The Thing … An exploration of the use of narrative in Forum Theatre

Abstract In order for organisations and the individuals within organisations to ‘learn the language of creativity and innovation, to ‘be prepared for surprise, both in their openness and adaptability to unexpected events’ three qualities need to be activated (Thrift 2000p681). Firstly, engagement of the senses; secondly the establishment of innovative groups able to deploy different techniques and the third is the development of spaces in which individuals can create their own learning (ibid). Thrift argues that each of these three qualities requires the ability to stage learning through the explicit design of memorable events, events which above all, ‘generate passion’. The use of theatre and drama in training, development and change management initiatives is seen as one method that can facilitate this type of learning. Since the late 1980s there has been a significant increase in the use of theatre based interventions within organisations, in particular Forum Theatre (Clark and Mangham 2004; Meisiek and Barry 2007). Forum Theatre ‘is a theatrical game in which a problem is shown in an unsolved form, to which the audience … is invited to suggest and enact solution’ (Jackson 1992:xxiv) of which the main components are narrative, dialogue and improvisation. This paper presents research into two different Forum Theatre interventions on Diversity in two public sector organisations. The paper will focus on the narratives that are part of each of these interventions and examine the proposition that such interventions can generate the type of experience that Thrift (2000) advocates.

Since the late 1980s there has been a significant increase in the use of theatre and drama in training, development and change management interventions. The exploration of theatre as a tool for organizational analysis through the dramaturgical metaphor (Mangham and Overington 1988) has received much attention. This interest has moved from treating social and organizational life as if it were theatre (Clark and Mangham 2004) to more practice based approaches, using theatre as a resource. The initial emphasis on role play by organizational theatre companies has diversified over the years and now encompasses a range of activities from individual skills training (for example, presentation skills training, personal development and team building which specifically draws on techniques developed in the theatre during rehearsal processes) through to the enactment of fully developed theatre performances aimed at larger scale audiences. As Nissley et al (2004) note: ‘a growing practice involves organizations hiring theatre groups to stage specially designed theatrical performances in from of organizational audiences, with the aim of using acting as a organizational intervention (that is, changing workplace behaviours)’ (p3). One particular practice, Forum Theatre, uses both performance and interactive drama to explore organisational issues. Forum Theatre typically draws on the techniques developed by Augusto Boal (1979; 1995) and what differentiates Forum Theatre from other types of theatre based interventions is the role of the ‘active-audience’ (Meiseik and Barry 2007). In this type of intervention the participants are both audience and directors; as an audience they are confronted with a new reality through the presentation of a narrative (Schreyögg and Hopfl 2004p698); as directors, they can change the outcomes of that narrative through interaction with the actors; thus ‘the responses of employees are endogenously shaped and cannot be anticipated’ Meisiek and Barry 2007p9). Typically a Forum Theatre event, whether two hours or a day will starts off with the presentation of a ‘drama’ which ranges from a full scale production, complete with lighting, costume, sound and effects to an unsupported 20 minute scene. The drama may be specially scripted to provide a mirror of the organization itself, it may be offered as a parallel universe or provide the audience with an overview of the specific issues under discussion with little specific reference to the organization itself. However, the common thread is that these ‘narratives’ lead into further improvised scenarios which are discussed by the audience. These shorter scenarios often lead to an impasse due to conflicting views - at this point the action is stopped and one of the actors asks for advice from the audience. In some events, the audience is divided into groups and are asked to direct one particular actor, who then resumes the scene with the other audience directed actors. At other events, one actor becomes the focus of attention and the audience are asked to make suggestions which the actor tries out.

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Two different Forum Theatre events are considered in this paper. Embracing Diversity which was developed for a local authority and Making a Difference for an educational establishment. While both case studies were presented to the organisations as Forum Theatre, the focus of this paper is on the performances that were used by the companies to start off the events. The interactive theatre that formed the second part of the event is not discussed within this paper. The dramas or plays were performed in order to raise awareness of the issues to be discussed over the course of the session through the presentation of a narrative. The issues chosen were intended to resonate in some with the experience of the audience. Theatre, Drama and Narrative Theatre, whether presented to the public, or within organisations has the ability to give audiences the opportunity to examine themselves, their behaviour, and/or their actions through the depiction of events on a stage (Meisiek and Barry 2007; Mangham 2000) engaging the audience in the process of sensemaking (Weick 1995). Weick views organisational narratives and stories as a key element in sense making, proposing that such narratives fulfil a number of functions, in particular enabling: ‘people to talk about absent things and connect them with present things’ (1995p129). Given that one of the espoused purposes of introducing drama into the workplace is to trigger discussion and dialogue within the organisation, it would seem that narrative has an important role to play in theatre based interventions, both through enabling engagement with an issue as well as providing the means of communicating shared experiences and meanings. Thus through the on-stage depiction of organisational experiences, it is potentially possible to both confirm shared experiences and meanings of organisational members and groups and (again potentially) amend and alter perceptions of organisational reality (Boyce 1995p9) through the depiction of both the present and imaginative truth (Cole 1975). Drama is: ‘the most economical, the least time-consuming, the most elegant ... method of communication’ (Esslin 1976p18). The information conveyed lies in the relationships or interaction between the characters in the drama. ‘Drama, by having a concrete representation of action as it actually takes place, is able to show us several aspects of the action simultaneously and also convey several layers of action and emotion at the same time’ (p18). Theatre is immediate and in organisational theatre this immediacy may enable the audience to interpret, to construct, and to make decisions about the nature of the problem, as in real life (Esslin 1975). Narratives form the back-bone of drama, but this aspect of organisational theatre to some extent has been overlooked. Although there has been considerable discussion around organisational stories as way of developing organisational communication and learning (Gabriel, 2003), most discussion around narratives tends to focus on the use of organisational story telling as: ‘the institutional memory system of the organization’ (Boje, 1991p196) or how differing perspectives on stories or narratives can impact on communication and sense-making (Myers, 2007). ‘The roots of theatre are in social drama’ (Turner 1982 p11) Through theatre performances the stories presented can increase a communities’ understanding of itself While the above examples are of large scale events being used to provide a theatrical experience similarly Turner’s (1982) concept of social drama can work on a smaller scale. Thus the potentially humdrum meeting in Making a Difference is presented as a piece of drama demonstrating the conflicts of interest, overt and covert political manoeuvrings, and the formation and breaking up of alliances – in other words, the stuff of drama whether Shakespeare or Ayckbourn. Sources of Narrative Organisational narratives and stories can point to aspects of organisational life and as noted earlier, much of the discussion around narratives in organisations is related to self-generated narratives. Forum Theatre activities are built on such organisational stories, and a study of the development of the narratives used may help to develop understanding of how such stories impact on the participants. The narratives and situations presented in the Forum Theatre events are intended to show the audience behaviours they could recognise, in order to make sense of those behaviours and, perhaps, through this recognition, facilitate diagnosis of the organisational issues (Weick 1995). In these cases Diversity was a key concept throughout, although, perhaps it should be noted that the fact the both case studies were designed to raise awareness of this particular issue is not that surprising – one consultant

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commented that requests to do sessions on Diversity was accounting for approximately 60% of their current work. Typically an Organisational Theatre Company will draw its dramatic material partly from the initial discussions with the commissioners of the event, but also, and perhaps more importantly from discussions with individual or groups of staff. The resulting series of narratives may then be presented either as a an actual representation of the organisation or a parallel universe. The following provides a summary of what is a typical approach to the initial development of the play. On a standard research day you’ll have a 45 minute meeting in the morning with the person who’s specifying the project and talk to them about what their targets are, and then spend the rest of the day … either doing a series of focus group discussions where you’ve got 3 or 4 people in or a series of one-on-ones, depending on the organisational culture. (Facilitator OT Company) ‘Making a Difference’ is one example of such an approach. A series of narratives related to perceptions of how ‘diversity’ was managed in the organisation were collected by the Organisational Theatre consultancy through discussions; initially with the commissioners who were drawn from the senior management team. The views of staff were also gathered, either through formally convened focus groups, or by the project managers hanging around in the canteen, staff restaurant and corridors chatting to passing staff about what they perceived to be the key issues around diversity. This information was developed, using improvisational methods, into story lines which were then presented to the designated audience. ‘Embracing Diversity’ provided a different type of narrative. A pre-written play is used which had been developed to work in a number of different organisational settings and is described as being ‘relevant but not specific’. In this instance, the drama which draws attention to generic issues by depicting a specific situation, in this case a sponsored parachute jump, in which a group of diverse individuals are thrown together and have to resolve their conflicts in order to meet the challenge set. Nevertheless, there can be slight customised modifications made to the pre-written the play to meet the needs of the organisation. A summary of the two types of narrative is depicted in Table 1. Table 1: Embracing Diversity and Making a Difference: Comparison of narrative sources

Audience Local authority including police, local health trusts, and outsourced departments Cross departmental but same organisation

Narrative developme nt Pre-written play with some with some customisation (e.g. phrases, language) Narrative developed through conversations with management and staff

Setting Outside organisation, e.g. outward bound weekend/ parachute jump Organisational setting but ‘parallel universe’

Case Study 1 Embracing Diversity Case Study 2 Making a Difference

Narrative plays a significant part in the development of Organisational and Forum Theatre interventions. The questions that are raised relate to the impact of the performances on the participants, and the extent to which these narratives support the overall aims of the intervention in terms of initially engaging the audience, generating discussion and enabling the development of shared understanding of the issues. The next section briefly describes the methods employed before going on to consider the findings relating to this exploration of narrative. Embracing Diversity and Making a Difference – Overview of the Events Embracing Diversity started with a play about a mixed group of individuals undertaking a sponsored parachute jump. It lasted an hour and a quarter and is fully staged with props, lighting effects – in

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other words something you might expect to see in the public theatre. Making a Difference started with a much shorter play, lasting about 20 minutes. No effects, a few props. In the both cases, theatre is being used as a mirror, albeit in different ways. The behaviours shown, whether on an outward bound course, or in a meeting aim to reflect the audience behaviours and thereby highlighting potentially challenging or difficult issues and enable discussion of those issues. After both the performances there was an opportunity for the audience to question the characters as to their motives, behaviours, which in turn was intended to stimulate discussion among the participants of the issues contained within the drama. While both events then moved on to introducing Forum or Audience Active theatre, through a series of improvised scenarios this paper focuses on the initial plays and in particular the development of the narratives and the impact on the audience. Method This paper is part of a wider piece of research into the process and impact of Forum or Audience Active theatre in organisations. I observed both of the programmes discussed above on several occasions and made notes on the scenarios presented and the subsequent discussions. After each event semi-structured interviews were carried out with a selection of participants. For Embracing Diversity I carried out six group interviews covering 30 participants; nine one-to-one interviews were undertaken after Making a Difference. The interviews took place between three to five weeks after the event in order that participants would have time to reflect, and perhaps act on what they had seen or felt during the event. The interview schedule can be found in Appendix 1. The following discussion focuses on the findings relating to the initial performances and not the Forum Theatre that followed on. Findings The findings from the participant interviews are presented in three sections; the impact of the production in terms of engagement and involvement with the play itself; the extent to which the narratives mirrored present reality and the extent to which the narratives induced a sense of shared experience leading to discussion and dialogue. Given the contrasting approaches, that is a play which was removed from the organisation itself and a play which presented a parallel universe I was interested in whether one or other method was perceived to be more effective in meeting the overall aims of the events, that is (in both these cases) to increase awareness of diversity and change organisational behaviours. Engagement In both cases the dramas were based on some aspect of social life, although the presentation, as discussed earlier, differed considerably. From my observations both events were professionally presented with a high standard of acting. The audiences seemed to be engaged; the participants conformed to the expected role of a theatre audience, as in mobile phones being switched off, sitting still and a posture of paying attention (Mangham 2000). There was laughter at appropriate moments in both plays humour was a key feature - and at times the audience could be heard making quiet asides to each other, commenting on aspects of the plays and performances. The interviews supported these observations. Enjoyment of and engagement with a production are normally linked, and for both plays there were many comments about the production, both in terms of the plays themselves and the performances by the actors. Embracing Diversity, the longer play, received the more positive comments in terms of the narrative, characterisations and performances. The following comments were fairly typical of responses. As the play progressed, you know, more and more was being revealed about why they behaved like that, you know, their emotional baggage and that sort of stuff. yeah, I found that very interesting... I thought they did it very well. It looked fresh. (Male ED) and I enjoyed the fact that it was scripted to reveal more and more as it went on, so from thinking one set of things about what’s happening... actually by the end of it you’re actually thinking different things about the characters than we thought in the beginning, and I thought that was really clever (Male ED). Less attention was paid to the characters in Making a Difference; this is unsurprising; Embracing Diversity lasted an hour and a quarter, Making a Difference 20 minutes, and it is not possible to undertake character development as well as introduce the full range of diversity issues such a short

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space of time. Nevertheless, there was recognition of its theatrical potential and enjoyment of the characterisation of individuals in Making a Difference. I felt it was like a play, starting with the one, well its funny, the thing about the one who wanted to chair the meeting and then he came in and sat down in his chair. In some ways I thought first it was a bit Micky Mousish, the way that she set it up, oh, this is very much a role play, but somehow it work, it works (Male MaD) However, perhaps one of the drawbacks of not being able to develop characters is that the stereotyping gets in the way of perceptions; one individual (echoed elsewhere, but not so strongly) felt that the drama was patronising, used simply to get laughs rather than deal with serious issues. So while it was vehicle to bring out discussion around the issues I think – it left me a bit cold … part of that was the way in which the actor who played the woman who done the course, I think that contributed to the generally cold feeling I had towards it …. I don’t know what we got out of it, maybe laughing at stereotypes (Male MaD) The perceived competency of the actors had a key role to play in the engagement of its audiences. One Making a Difference participant who had been twice and seen two different actors playing a part specifically commented on the differences in relation to her engagement and enjoyment. When you’ve seen that you can see and you’ve seen how powerful and touching his performance can be, it created in me … it stirred up things that the other actor in that role didn’t manage to do. (Female MaD). This was a recurring theme in all the discussions with participants, and highlights the importance of the actors in the event, and their ability to engage the audience. ‘The Mirror Up To Nature’ ‘Groups strive to see their own reality in new ways’ (Turner’s 1982 p23) Theatre is one such place that this can be effected (Mangham 2000). An often repeated espoused use of organisational theatre is to facilitate thinking and engagement with a particular issue, which in turn leads to discussion among the participants; this is even more apparent in Forum and Audience Active Theatre, where not only do participants watch a performance, or series of performances but have a role in deciding the outcomes of the drama. Although the Embracing Diversity narrative was not tailor made for the organisation, the participants indicated that they were able to recognise behaviours that were presented to them as part of the plot. I used to have a manager years ago who was very similar to that character and it kind of hit home because he was quite a bully, very aggressive, but unknown to me he did have a lot of personal things going on in his life (Female ED). Overall, the Embracing Diversity production provoked recognition with the characters as well as a reference to the nature of theatre itself; there appeared to be less concern about the reality of the situation and characters, and more interest in how the drama stimulated and engaged the audience. It didn’t matter to me that wasn’t realistic, I mean, I don’t think theatre is. So I think it was a stimulating and interesting vehicle … in one sense … if you see something that’s portrayed that’s very realistic, you realise how banal life really is actually (Male ED) Another participant of Embracing Diversity also commented on the way in which the drama highlighted issues, and the economic way that so many issues were raised in a short space of time (Esslin 1975). I think [the play] highlighted a tremendous number of situations which is someone had sat you at a table and said ‘think about diversity’ I’d challenge any of us to come up with a quarter of the situations that arose in the play … . (Female ED) Similarly the first play appeared to engender more engagement as well as recognition in spite of the fact that the play was not related in any way to the audience’s workplace. I thought, ‘You know that pulled your chain, didn’t it? For some reason you got stuck into that (Male ED) In Making a Difference, the story presented was far more rooted in the participants’ everyday life, (i.e. a depiction of a meeting played out with three characters, two lecturers and an administrator in a parallel organisation) but met with a more mixed reaction. It could be expected that the audience might relate more closely to the characters, given that the play was based on a mixture of real incidents, attitudes and behaviours. However, while the play was seen as humorous, it did not

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provoke any of the participants to say that they recognised those characters either in themselves or their colleagues. It (the playlet) wasn’t patronising; it was very funny, it broke down barriers, the characters were probably a bit over the top ... but you probably need to have it larger than life in order to deal with the issues (Male MaD) Participant Reflection The two plays generated discussion and reflection in the course of both the group and individual issues, but there is less evidence to date of the consequential actions - whether the individual dramas or the Forum Theatre as a whole – triggering discussion back in the workplace. This is even when individuals came with colleagues from the same department or knew of colleagues who had attended. If an individual did discuss the event with colleagues, the discussion tended to be focused on the method or process, in that they had seen an enjoyable and engaging piece of theatre which had raised some interesting issues but with little sharing or joint reflection on how the issues might impact on their future behaviour. Upon leaving the training I went on a mission to tell everyone they must go along because it was extremely rewarding … (Female MaD) Nevertheless, a number of participants had internally reflected on the experience, and to some extent the research interviews were used to try and articulate that reflection. …. it was about management solutions .. it’s about staff, whether the lowest grade, or highest grade, actually to respect human rights, to allow people to do the job they’re employed to do. And that the first time I’ve been able to succinctly say that. (Male MaD) Conclusions The limitations of the research are recognised. Given the range of approaches to theatre based interventions in organisations and that only two case studies are explored it is not intended to generalise from the findings. Rather this piece of research is intended to be a starting point to gain some understanding of the relationship between the source of the narratives and how the initial performances or plays impacted on the participants understanding and perceptions of the event overall. The comparison of participants’ experiences of these two events suggests that the source of narrative not necessarily a key factor but identification with the narrative in some way is important for engagement and discussion both during and after the event. Furthermore, this engagement is considerably enhanced by the quality of the acting. Arguably this is hardly surprising but has perhaps been overlooked by previous research into using theatre in the organisational context. There did appear to be more recognition of behaviours in Embracing Diversity which could be related to the ability of this piece to develop more rounded characters with ‘histories’. Embracing Diversity presented a ‘journey’ in which the characters changed in their interactions with others and ended with the triumph of making the parachute jump. Making a Difference presented a set of characters with defined opinions which did not change during the play – perhaps this could be better looked at as being Act 1 of a longer play! It was challenging to disentangle the impact of the initial dramas and the event overall, and probably only partially successful, but there did not appear to be a strong relationship between the view of opening performances and overall reaction to the event as a whole. In other words, even those who were critical of the Making a Difference play and were not particularly engaged by either the play or the Forum Theatre scenarios that followed still spoke positively about session overall. More research needs to be done to understand the post-performance impact, given the evident lack of discussion between participants after the events and is one of the espoused aims of Organisational Theatre interventions. If little dialogue is taking place afterwards between participants, how does sensemaking occur? One possible answer is through ongoing reflection and the application of those reflections to everyday occurrences. However, there was perhaps one example of a shared meaning emerging in relation to the organisations themselves, as in both sets of interviews there was mention of seeing the organisations in a more positive light in relation to their commitment to supporting diversity. This piece of research into the impact of using narratives needs to be seen as only one part of the process. The narratives as perceived by the audience are in reality Mangham’s (2000) triad of

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collusion between author, actors and audience; the audience’s willingness to engage in a suspension of belief. To refer back to Thrift’s (2000) requirements, certainly there was engagement with the process, and a perception by participants that the method employed was an innovative way to raise awareness. Certainly too the plays were memorable – most of the participants were accurately able to recall the characters and the scenes even after four to six weeks of attending the events. More understanding is needed of the different components beyond the narratives and how those components interact to produce the outcomes looked for by both providers and commissioners in the staging of such events. References Boal A (2000) Theater of the Oppressed London : Pluto Press Boal A (1995) The Rainbow of Desire London: Routledge Boje, D M (1991) The story telling organization : a study of performance in an office supply firm. Administrative Science Quarterly, 36, 106-26. Boyce, M. E. (1995) Organizational story and storytelling : a critical review. Journal of Organizational Change Management, 9:5 Clark T and Mangham I (2004) Stripping to the undercoat: a review and reflection on a piece of Organization theatre Organization Studies 25:5 Cole D (1975) The Theatrical Event : A Mythos, A Vocabulary, A Perspective Middleton, CT: Wesleyan University Press Esslin M (1976) An Anatomy of Drama, London. Temple Smith Gabriel Y (2003) Same Old Story or Changing Stories? Folklore, Modern and Postmodern Mutations. In Grant, D., Keenoy, T. & Oswick, C. (Eds.) Discourse and Organization. London, Sage. Jackson A (1992) A Translator’s Introduction in A Boal (1992) Games for Actors and Non-actors London: Routledge Mangham I. (2000) Looking For Henry. Journal Of Organizational Change 14 :3 Meisiek S and Barry D (2007) Through the Looking Glass of Organizational Theatre: Analogically Mediated Inquiry in Organizations Organization Studies (Forthcoming) Myers P (2007) Sexed up intelligence or irresponsible reporting? The interplay of virtual communication and emotion in dispute sensemaking. Human Relations 60 Nissley N, Taylor S, Houden L (2004) The politics of performance in organizational theatre-based training and interventions Organization Studies 25:5 Schreyrögg G and Hopfl H (2004) Theatre and organization : editorial introduction Organization Studies 25:5 Thrift N (2000) Performing cultures in the new economy. Annals of the Association of American Geographers 90:4 Turner V (1982) From Ritual to Theatre The Human Seriousness of Play,.New York : PAJ Publications Weick K (1995) Sensemaking in Organizations London:Sage

APPENDIX 1 Interview Schedule Participants 1. Why did you attend the event? What did you see as being the aim of the event for you? Were these aims made clear? Were they met?

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What (if any) were your expectations? Were they met? Thinking about the ‘event’, what worked well? Why? What didn’t work so well? Why? In your view did the scenarios/improvisations seem real? How would you describe your engagement with the performances? Did you participate in all the elements? Why or why not? 5. How would you describe the level of your participation in the event? 6. In your opinion did the event address (important) organisational issues for you? If so, did the event changed your understanding or views of these issues and, if so, in what ways? 7. What (if any) any parts of the event did you find challenging? What were these and why did you find them challenging? 8. Did the event offer any solutions to the issues being presented? If so, how were those solutions presented? 9. Have you taken any specific actions as a result of attending the event. If yes, can you describe what you did? If no, can you say why not? 10. Have you discussed the event with colleagues, acquaintances, friends members of your family? If yes, did you discuss the issues raised or the process of the event, or both? 11. How do you think this event could be followed up? 2. 3. 4.

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Dr. Helen Halpern & Dr. John Launer, Tavistock Clinic. London: Narrative Based Clinical Supervision for Doctors Abstract Clinical supervision is an established means of support for many professions including nursing, social work and clinical psychology. Theses professions recognise that opportunities for discussing cases and work-based issues are a prerequisite for professional survival and development. Although doctors have traditionally not received clinical supervision, an increasing number now understand that this can mean having someone “looking after you” and not “looking over your shoulder”. Narrative based supervision draws upon ideas and techniques form both narrative studies and narrative therapy, with the aim of applying these to everyday clinical practice. It starts form the premise that professionals often bring a “stuck story” to supervision,. They can be questioned in a way that invites them to reflect on their perceptions and assumptions. This helps them to construct a different kind of story: one that creates more sense of possibility, and of agency, for themselves and their patients. This paper/workshop describes collaborative work that has been going on over the past few years between two training institutions in the NHS in London: Tavistock Clinic and the London Department of Postgraduate GP education (the London Deanery). This work has been aimed at developing clinical supervision among doctors, and GPs in particular, using narrative ideas and skills. This work has included workshops for around 400 GP trainers in London, and a range of intensive courses, as well as 6 conferences and an ongoing seminar for senior GP educators. Introduction The aim of the workshop was to provide both a brief theoretical introduction to the concepts used and to give participants some experience of our approach to clinical supervision. Until recently there has been no culture of providing clinical supervision for established GPs, unlike that required for many of the other helping professions in Britain (Burton and Launer 2003). Within the profession there is still a lack of clarity about what is meant by clinical supervision. We have found Butterworth’s (2001) definition of clinical supervision helpful; “An activity between practising professionals to enable the development of professional skills”. Over the last few years a narrative based method has been developed and taught at workshops for GPs and GP educators (Launer and Lindsey 1997 and Launer and Halpern 2006). These have been held at the Department of Postgraduate Medical Education at London University, which organises and provides training for doctors in various specialities across London, and at the Tavistock Clinic, which is a large NHS mental health clinic in North London. The model we have been developing involves the promotion of narrative ideas and skills among doctors and using these to provide peer supervision. We believe that this is a reciprocal process in that through the provision of clinical peer supervision people learn how to listen to existing stories and facilitate new ones. The “narrative turn” (Brown et al 1996) has affected many areas of learning in the humanities and social sciences and has had a strong influence in the world of family therapy. A key belief shared by these is that through conversations we are continually creating new realities with people around us so that every person’s understanding of the world is “dialogical” in its origins and is shaped and developed through further dialogue (Bakhtin 1986). This idea is helpful in thinking about how to work with stories that have become stuck or where people are holding different and apparently irreconcilable stories. Narrative suggests a move away from interpreting what people do and say to becoming curious about how people understand and describe their experiences. The emerging field of narrative based medicine (Greenhalgh and Hurwitz 1998), which looks at the narratives patients bring to doctors and other health professionals, is predominantly research based. Narrative based clinical supervision looks at these and also at the narratives which doctors bring to their work, the narratives of the workplace and of their professional and political networks and how these interact. In this way we see narrative based clinical supervision as a link between narrative studies, narrative approaches to therapy and medicine (Launer 2002). It offers a framework that allows people to use various ways of understanding the world e.g. evidence based medicine, psychodynamic theory, clinical science as useful contributions that may or may not make a difference to someone’s story. It encourages us to see different discourses as sources of helpful hypotheses rather than absolute truths and lets us move flexibly between these.

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Narrative based practice encourages the exploration of “polyphony ” i.e. valuing the different stories that the patient is capable of telling about the same experience and the different stories that the practitioner is able to offer (Launer 2006a, 2006b). Hence, agreed “truths” are established by the process of dialogue itself , either between doctor and patient ( in the consultation) or between doctor and doctor (in supervision). We teach people to interview each other about their difficult cases or work problems using an approach that is oriented towards the evolution of narrative rather than towards problem solving. We hope that once they have learned to do this in the context of peer supervision they will find it easier to apply in the consultation and in other professional contexts (Launer 2003). What happened in the workshop We started by asking people to introduce themselves and their professional backgrounds. There were approximately equal numbers of people involved in using narrative as therapists and in theatre and education. There were no GPs present apart from us. John briefly explained the theoretical background to the work and presented The Seven Cs. These are seven concepts all beginning with the letter C which summarise the core principles of the narrative approach which we teach. They were originally written by John and continue to be revised and adapted as we use them and modify our thinking about them. 1. Conversations – This implies that the conversation itself is the working tool. Simply through taking place, effective conversations offer the opportunity for people to rethink and reconstruct their stories. Curiosity – This is the factor which changes chat into a more substantial conversation. It is used to develop the story about patients, colleagues and self. It involves paying close attention to both verbal and non-verbal language. It includes curiosity about the supervisor’s own responses; feeling of criticism, boredom, anxiety etc. An important feature linked to curiosity is taking a position of neutrality. This concept is similar to that of being nonjudgemental but taking a neutral stance allows us acknowledge our own position as well as becoming curious about the different positions others might take. Contexts – This develops an understanding of the person’s networks, their sense of culture, faith, beliefs, community, values, history and geography and how these may impinge on the case presented. One very important context is that of how power is understood. Who holds the power and how is this seen by others? Who is asking for supervision and for what purpose? Other important contexts are related to gender, age, social class, parenthood, sexuality. What differences and similarities are there between people that may promote or constrain what it is possible to ask about? Complexity – This involves thinking about things in a non-linear way, getting away from fixed ideas of cause and effect. It is a way of becoming more interested in interactions between people and between people and events over time to produce a richer description of the story. Creativity – This means finding a way to create a story which makes better sense for people. This includes using oneself, intuition and sensitivity to fine-tune the conversation. It also implies the creative process of jointly constructing a new version of the story through the process of supervision. Caution – This consists of looking for cues from the client to monitor their responses. It involves working on the cusp between comfort, affirmation and perturbation in order to get an appropriate level of challenge without being confrontational and without being too bland.. Care – This encompasses being respectful, considerate and attentive to patients, supervisee and self. It means ensuring that the work is carried out within an ethical framework.

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Facilitation Helen then facilitated the participants in carrying out an exercise in peer supervision. People were asked to work in groups of three with people they did not usually work with and preferably with a mix

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of professions. One person was asked to present a case or work-based dilemma on which they would like supervision, one person was asked to interview them as a clinical supervisor and the third person was to be an observer. The role of the observer was to notice the process of the conversation. Based on theory from the Milan team of family therapists (Selvini-Palazzoli et al 1980) about using hypothesising, circularity and neutrality to make supervision most helpful to clients, we gave the supervisors 3 instructions: • • • Only ask questions (this relates to the concept of hypothesising). Try to link each question to the response to the previous question (this relates to the concept of circularity). Do not give advice or interpretations of what is going on (this relates to the concept of neutrality).

The groups had ten minutes to carry out the supervision; many GPs work with 10 minute appointments. We then asked the observers from each group to give one comment each as feedback, followed by the supervisors and then the clients. Discussion The observers generally commented that the supervisors were able to stick to the rules given and had noticed that asking questions seemed to be an effective way of helping the client to think. The supervisors’ feedback was that it was extremely difficult only to ask questions and some of them would have liked to be able to be more empathic by making supportive statements or comments. Some of the supervisors were not sure if they had been helpful to their clients and were concerned about this. All the clients reported that they had found the exercise extremely helpful. They were surprised that it had taken so little time as their perception had been that they had had plenty of time to think and that the questions asked had helped them to develop some new ideas. All the groups were able to come to some kind of end-point after 10 minutes and some felt that the brief time available was quite helpful in concentrating thinking and focussing on the task. As supervisors become more proficient at these skills it generally becomes less difficult to conduct a piece of supervision mainly asking questions. In order to teach a particular method we suggest that people practise in this way. However in the context of everyday practice people bring a range of skills to supervision and would usually incorporate some of the empathic comments people noted to be missing in the exercise. Although the exploration of the client’s feelings is not a primary aim of this method of supervision, many conversations can touch important emotional areas. It is a common finding when asking people for feedback in our workshops that clients find a piece of supervision helpful even when the supervisor is not aware of this. For both client and supervisor there is an external conversation taking place between them and their colleague and also an internal conversation taking place in each person’s head. The supervisor can ask about what new thoughts and ideas the client has formulated during the supervision. In addition clients frequently report back that they have gone on thinking about some of the questions asked and have developed their new story beyond the supervision conversation. This fits with the description of how certain questions continue to have an effect on family members long after they were asked in a therapy session. (Tomm 1988) Conclusion This narrative based method of clinical supervision is rapidly gaining momentum (Launer and Halpern 2006). It seems to fit for many activities which doctors carry out in both primary and secondary care; consultations with patients, supervision of learners and peers, appraisal, management and career development. It is possible to provide worthwhile supervision in a short timeframe. The basic skills can be picked up rapidly. These are currently taught at training sessions lasting from one to three days through the London Deanery. However, many people have found it helpful to have further training and practice to become confident and competent. Longer workshops to develop these skills and to facilitate learners to become educators for clinical supervision take place over the academic year under the joint auspices of the Tavistock Clinic and the London Deanery. There seems to be increasing evidence that offering doctors the opportunity to think about their work with a colleague in this way may reduce stress and burnout, can improve communication skills and may make complaints and professional misconduct less likely. Evidence of reflective professional practice will increasingly be looked for throughout doctors’ professional development over their

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whole career and we believe that narrative based clinical supervision makes a significant contribution to this. References Bakhtin M., (1986) The problem of speech genres, in M. Bakhtin Speech Genres and other late essays. University of Texas Press. Brown B., Nolan P., Crawford P and Lewis A., (1996) Interaction, language and the “narrative turn” in psychotherapy and psychiatry. Soc. Sci. Med. 43, 11: 1569-1578. Burton J., and Launer J., (eds.) (2003) Supervision and Support in Primary Care. Oxford: Radcliffe Medical Press. Butterworth T., in J. Cutliffe, T. Butterworth and B. Proctor, (2001) Fundamental Themes in Clinical Supervision, London, Routeldge. Greenhalgh T., and Hurwitz B., (1998) Narrative-Based Medicine: Dialogue and discourse in clinical practice, London, BMA Books. Launer J., and Lindsey C., (1997) Training for systemic general practice: a new approach from the Tavistock Clinic. British Journal of General Practice, 47: 453-6. Launer J., (2002) Narrative-based Primary Care : a Practical Guide, Oxford: Radcliffe Medical Press. Launer J.,(2003) Narrative Based Medicine: a Passing Fad or a Giant Leap for General Practice? British Journal of General Practice, 53: 91-92. Launer J., (2006a) New Stories for Old: Narrative Based Primary in Great Britain. Families, Systems and Health, 24: 336-344. Launer J., (2006b) Narratives in Primary Care, In: Vetere A., and Dowling E., (eds.) Narrative Approaches to Therapy with Children and Families. London: Brunner Routledge. Launer J., and Halpern H.,(2006) Reflective Practice and Clinical Supervision: Promoting Clinical Supervision among General Practitioners. Work Based Learning in Primary Care, 4: 69-72. Selvini-Palazzoli M., Boscolo L., Cecchin G., and Prata G., (1980) Hypothesising, Circularity, Neutrality : Three Guidelines for the Conductor of the Session. Family Process, 19: 3-12. Tomm K.,(1988) Interventive Interviewing: Part III. Intending to Ask Lineal, Circular, Strategic or Reflexive Questions? Family Process, 27:1: 1-15.

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Angela Shaw, Shawpathways. England Encounters in the Enchanted Wood Abstract I work with people experiencing emotional distress in many forms, including depression, PTSD and OCD. I am accredited as a Human Givens practitioner, a form of solution-focused brief therapy, using a range of techniques. A key understanding is that we all move in and out of trance states (locked states of attention, relatively impervious to external stimuli) constantly and readily. Much of our time, therefore, we are entranced, enchanted, spellbound. These words resonate with negative and positive connotations- the Enchanted Wood is a place both of terror and beauty. Negative trances lock us into emotional distress but in trance we can also create new futures. Stories automatically generate trances. Typical brief therapy approaches emphasise focussed information gathering, but increasingly I encourage the client first to tell her story- as distinct from recounting her history- and as she does so the contours of her enchanted wood become apparent-the thickets of ensnarement, and the clearings of light. I am not immune to these processes; we all wander in the enchanted wood; this is a source of empathy and of misunderstanding. For many clients freedom lies in seeing the wood for what it is (ie a cognitive approach). For others, especially those with the most complex stories, our encounter in the enchanted wood may give birth to a new story, arising in my imagination but shaped by their imagery. When this happens, the therapeutic effect can be profound and immediate, as I demonstrate with case histories. Introduction My interest in narrative is focussed, in this essay, on the use of story-telling in therapy. I am an accredited Human Givens practitioner, working in private practice. I see clients with a wide range of difficulties, including depression, self-harm, phobias, anxiety, and PTSD. The Human Givens approach draws on a range of techniques, including storytelling – usually, but not always, to clients who are in a state of deep relaxation. The stories I tell my clients are most often created specifically for them, based on the stories they tell about themselves, and I am often astonished at the speed with which difficulties may resolve when the story is “right”. In the talk on which this essay is based I originally set out to explore something of how and why these healing stories “work”, and where they come from. In the course of developing it, I also found myself considering how stories can themselves illuminate the relationship between therapist and client. Human Givens Therapy The Human Givens approach to therapy is a relatively recent development, celebrating its 10th birthday in 2007. It was founded by two psychiatrists, Joe Griffin, and Ivan Tyrell. There are about 120 accredited practitioners, and many more trained in the approach and working in schools, hospitals, voluntary organisations, social work and so on. The approach is located in the positive psychology movements. (www.hgi.org.uk). The overarching concept is that we are all born with a range of physical and emotional needs, and have, or acquire, the resources to meet them – the “human givens”. It is when our needs are not met, and we lack or lose touch with the resources, that emotional distress arises, and the effective therapist will work with the client to identify the unmet needs, and to find or rebuild the resources. (Griffin and Tyrell 2003 pp 93-94.) Within this approach, diagnostic categories become largely irrelevant. A second major strand is that our understanding of needs and resources should be based on the best available evidence, and in particular draw on the rapidly expanding body of knowledge about the brain, and the role of emotion. HG practitioners use techniques from a range of therapies, but always seek to select them and understand their application in the light of contemporary knowledge.

Understanding Emotions and the Brain Perhaps surprisingly, therefore, my starting point is the structure of the brain, and the crucial role of emotions with it. There has been an ongoing explosion of understanding of the working of the brain in relation to emotions in recent decades. It is impossible to do justice to this in an essay of this length, but there are some key points to make in relation to my theme. The “emotional” brain is sited in the oldest areas of the brain (both in terms of our evolution as a species and our personal development in the womb). This is particularly true of those emotions which relate to threat and survival- fear and anger; the pathways for pleasure and motivation are more diffuse (Nettle 2005).

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Incoming information about our environment is directed to a number of sites in the brain, but it is evaluated particularly swiftly by the amygdala, (Ledoux 1998) so that subsequent evaluation by the cognitive brain refines and analyses information which is already coloured by an emotional response. Thus emotions precede cognition, and indeed the cognitive brain, having evaluated the information and recommended a course of action, refers back to the emotional brain for agreement to actually implementing the decision. In situations of extreme emotional significance, the emotional brain can by-pass the cognitive brain completely, and initiate action independently. (Damasio 2000) While we may, as individuals, inhabit different cultures, environments, and languages, this deep emotional structure is common to all of us- it is the point at which we most readily encounter each other with recognition. Between therapist and client, it is the point of equality and common experience The role of metaphor The emotional brain, then, evolved before, and outside of, those parts of the brain which produce language- it is essentially non-verbal, though it has, of course, now developed many connections with the verbal brain. It primarily apprehends the world, including the inner world, through images and feelings. However, our primary, though not only, means of communication with each other is verbal. Storytelling, poetry and metaphor, sit at the cross-roads of verbal and non-verbal communication, using words to powerfully evoke images and feelings. Paivio and Walsh write that through metaphor “knowledge is represented in visual and verbal modes” (Paivio and Walsh 1993) It is difficult to find words to describe emotions accurately, and we resort naturally to metaphor: I’m stuck; I’m drowning; there’s no light at the end of the tunnel; it’s like walking through treacle; I was over the moon; I’m floating on air. Indeed, recent discoveries indicate that metaphors are apprehended, at least in part, within the left angular gyrus, part of the left inferior parietal lobule (Ramachandran 2005). This area of the brain is described as the “association area of association areas” (Long, date unknown)– acting as “a way station between the primary sensory modalities and the speech area” and also integrating emotional associations from the amygdala (www.thebrain.mcgill.ca ). No wonder that short stories – extended metaphors- can speak powerfully to a troubled mind. The Enchanted Wood This then is an aspect of our common humanity, shared by (almost) all of us, this place in our head where words and images, thoughts and feelings, mingle and collide. If they have nothing else, the therapist and the client have this in common. It is the wood in which we all wander. It is a place where both beauty and terror can be found, and it is a place of enchantment. Enchantment is one of a large family of related words- enthralled, spellbound, enraptured, glamour, entranced; beguiled, possessed, charmed, captivated, bewitched, fascinated, - which all relate to magic, and all have both negative and positive connotations- though in our modern dis-enchanted world we have often lost one or other in our daily use. “Entranced” is a particularly interesting member of this family. It has entirely positive connotations now, yet many people are deeply uncomfortable with the idea of being “in a trance”. Nonetheless, we are all in and out of trances all the time (Griffin and Tyrell 2003 pp 59-60.) Trance states, which are connected with REM (Rapid Eye Movement) states, can be most usefully defined as being in a state of focussed attention, (Havens and Walters 2002 p 27) and therefore relatively unaware and unresponsive to outside stimuli. We are in a trance state for instance when we are daydreaming (as well, obviously, as dreaming in sleep), when we are concentrating hard on an activity, deeply involved in a piece of music or drama, reliving a vivid memory, and when we are in the grip of intense emotion. Trance states are in themselves neutral; like the enchanted wood, they are places where great creativity and learning may take place, or where we may be overwhelmed by terror. Most clients can be described as being in a trance- the trance of sadness and self-hate, the trance of phobic fear of illusory threats, the trance of bitterness and anger, the trance of remembered trauma. In all of these states, the client is unable to think past or round the trance state, or take in evidence which contradicts it. Most importantly, their lives are entirely constrained and controlled by the trance- they are literally “in thrall” to it, bound by the spell it has put on them. The metaphor of the enchanted wood is for me a particularly powerful way of understanding what is happening for clients. It is one which has resonated with writers throughout our history, in both folk and literary stories – for example, • The Enchanted Wood and the Magic Faraway Tree (children’s story) (Blyton 1939)

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• Enchanted April (novel and film) (Von Arnim 1922) • Midsummer Night’s Dream (play) (Shakespeare) • Hansel and Gretel ( traditional fairy tale) (Grimm J and W 1889) • The Lion, the Witch and the Wardrobe ( children’s novel) (Lewis 1950) These stories vary in their seriousness, and in the balance of light and darkness in them, but all share the theme of a space outside of “real life”, where strange, often beautiful, sometimes terrifying, always magical events occur. Those who enter this space may find out new things about themselves, may discover strengths and resources they did not know they had. Crucially, however, the stories end with the protagonists leaving the magical space- this is not a place where life can be safely or productively lived out. Tam Lin (Child 1882) It was as I was considering the significance of these stories for my theme that I began to look in greater detail at the folk ballad of Tam Lin, and realised that it was taking on particular significance for me as a metaphor of the relationship between client and therapist. This ancient ballad occurs in a number of versions. The details are different, but the main outline of the narrative is consistent. The heroine is either called Janet or Margaret, and she is usually the daughter of a local lord, who owns a wood (usually, sometimes it is not clear that what sort of countryside is meant)which is offlimits to, particularly, young women, as it is known to be inhabited by faery folk, and no young woman returns unscathed. However, Janet refuses to be intimidated, as she regards the wood as her own inheritance, and she goes to see it. On its outskirts she picks a rose, and a handsome young man, Tam Lin, appears. The ballads are coy about what happened next, but a short time afterwards it is clear that Janet is pregnant. She tells the scandalised court that the father is an elf, and returns to the wood, summoning Tam Lin by picking another rose. She tells him what has happened, and he reveals he is not an elf, but a mortal man kidnapped by the Faery Queen for his beauty, and held spellbound in the wood. He has seen many wonderful things in the company of the faeries, but is now very frightened, as each year, at about this time, the faeries pay a tithe to the Devil, and he believes this year it will be him, as the newcomer to the forest. Janet refuses to countenance losing her child’s father, so he tells her what she must do. She comes to the wood close to midnight the next night, and sees a company of faeries on horses. As instructed, she ignores all the horses, until she sees a white one. The rider is Tam Lin, and she seizes him and holds him tight. The Faery Queen is furious, and turns him into a series of frightening forms (snake, lion, flaming brand etc) but Janet holds tight to her knowledge of who he really is, and grasps him, until at last he is turned into a naked man, when she covers him with her green cloak, and they escape together from the enchanted wood. Tam Lin is rich with meaning and symbolism, and can be considered in many ways. For myself, it reads as a potent and moving allegory of the therapeutic process in counselling. Clients come to therapy spell-bound, in thrall to behaviours, emotions, beliefs, which circumscribe their lives, which they do not want, but from which they cannot alone break free. In this state they may also have developed insights and understandings, a richness of experience denied to those living more stable lives. However, ultimately these conditions are destructive to their wellbeing. The client is, nonetheless, the only person who really understands his own experience, and holds a “theory of change”. (Duncan, Miller and Sparks 2004) The role of the therapist is to listen to and work with that theory, while maintaining a clear view of reality, and a belief in and respect for the client’s essential humanity. However, that entails meeting the client in his own world, and that inevitably means taking the risk of entering that imaginative and emotional world which is shared by all of us. Creating stories It will, I hope, by now be clear why storytelling is a powerful therapeutic tool. The right story can pierce to the heart of the listener’s imaginative world, and can offer a new way of understanding, a new possibility of resolution, which speaks to the imagination and the emotions, as well as to cognition. Story-telling itself induces a trance state –Once upon a time there was a…..- and the effect is all the greater if the listener is already in a deeply relaxed state. Like any genuinely powerful tool for change, story-telling has the potential for abuse, and it is important that the client has safeguards built in, including, if desired, the taping of the story for subsequent re-listening. To be effective, the story needs to be targeted to the individual’s own imaginative landscape. This involves listening intently to the client’s own story. In my experience, clients who have seen a number of doctors and/or counsellors often start by giving what is essentially a medical history,

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sometimes complete with conflicting diagnoses, but it is more important to understand the client’s own narrative of what their experience means to them- what were the key moments, how do they feel it, how do they see it, what aspects of it frighten them, is there anything they value in it? Clients will often spontaneously use vivid metaphors –“ I need someone who can reach in and turn the key of the box I am in”; “I don’t expect my mind to become like a calm lake, but I would like to be less anxious”; “I am on the edge of a cliff, looking down”; “ I feel completely bogged down”. These of course provide the kernel of a healing story. I personally usually create a story specifically for an individual client, rather than tailor a ready-made story, although these too can be very effective. Sometimes that story will be based on the metaphorical clues a client has given me; sometimes it will be based on some aspect of the client’s history or interests which seems particularly powerful, and occasionally it will be based on an image or metaphor for the client’s situation which arises strongly but unbidden in my own mind. These, of course, are likely to be drawn from the vast repertoire of images, sayings, tales, which we all share; they will not work, because they will not be relevant, if they do not arise from true empathy and rapport, and speak truly to the client’s own understanding- if I have not truly encountered the client in the enchanted landscape. Looking at the evidence How can I know they do work? The true answer is that, most of the time, I cannot be sure. As a movement, Human Givens is embarking (October 2007) on a six-month evaluation of client outcomes, using a number of established tools. However, this will not address the differential effect of different techniques. Not all practitioners use stories, and even I do not use them with all clients, and I rarely use them as the only technique. Clients themselves sometimes hardly seem aware they have been told a story, and never, in my experience, say “It was that story you told me”, even when there is a good outcome from therapy. However, there have been enough instances, over the years, of indirect feedback to persuade me that, on occasion, stories have been a significant, and in some cases the major, factor in a good outcome. The rest of this piece consists of two examples , where I happen to be in a position to know both of the immediate and the long-term impact (and to ask for permission to use them). The Mountaineer. This story was told to a man in his early 40s who had had health problems for several years but had at one time been highly physically active, a soldier and climber. He still took pride in a “manly” persona. He had a variety of keen interests. He had “died” clinically on several occasions, and had responded with stoicism and optimism, but a few months before I had met him had had a truly shocking experience which had made him deeply aware of his mortality, and had left him depressed and traumatised, fearful even of leaving his home, and unable to engage with his interests. There was a real chance that this physical experience could recur, so merely detraumatising the original experience did not seem sufficient. I spent a long time listening to him, but this story was the main “intervention”. He was in a state of deep relaxation as I told it. I knew a man who loved to climb mountains. He had done so all his life, and loved the challenge of finding his way up the rocky sides, and the beauty of the views from the top. Sometimes, of course, he slipped as he climbed, but he never let it worry him, and climbed eagerly on. One day, however, something new happened to him. He was high up a steep, rugged face when he lost his grip, and fell some way before he came to rest on a tiny ledge. The fall had knocked the wind out of him, and he clung there, trying to get his breath back. As he did so, he glanced downward. The rockface stretched away below him; birds wheeled in the air far below his feet, and at the bottom tiny trees dotted a jumble of sharp boulders. For the first time ever he began to imagine what it would be like to slide and tumble through the air, and crash down onto those sharp rocks. As he gazed in horror, the rockface seemed to extend further and further away from him, and the ground seemed ever more distant. The man clutched the rockface, panting with terror, too frightened to think of moving. He felt sure that if he relaxed his grip for one second he would fall head over heels to the boulders below. The only safe thing was to hold on. However, time, as it does, went by. He began to breathe deeply, and as he did so, he began to think more clearly about his predicament. It was very uncomfortable on his little ledge. A cold wind was

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blowing, and his hands and feet were getting numb. It was also, he realised, very boring; all he could see was the rock in front of his nose. “Well” he thought, “now what? This is no fun at all. But if I start to move, I may fall.” The thought terrified him, so he clung a little while longer. But his hands were getting even more numb. “ Actually”, he thought “if I just try to stay here, sooner or later I am going to fall anyway. That’s if I don’t die of boredom first.” He hung on a bit longer anyway, but at last the thought came to him “ There is no alternative. There is only one thing to do, and that is – keep climbing”. And so he did. At first, his legs and arms were so stiff from hanging on that every move was difficult and took all his concentration and courage. But after a while he began to get back into his rhythm, and his confidence began to creep back. He noticed the small flowers blooming in cracks in the rock, and listened to the wind sighing around him, and he began to remember why he loved to climb mountains. In time, he reached the top, and stood watching the sun touching the tops of the peaks all around him, and felt a deep peace. ©Angela Shaw 2003 It took the client some time to fully become aware of his surroundings. Once he had done so he looked at me and exclaimed: “I don’t know what happened to your friend! I thought, I can’t stay here all day, there’s no choice but to go on up. So I climbed to the top”. Within days he had recommenced many of his old interests and activities; since then he has had to endure a number of serious further health problems, but has not (over 4 years) relapsed into depression and anxiety. The Bower bird. This client, also a man, in his fifties, had had childhood experiences which had left him deeply insecure. This manifested itself as bouts of withdrawal and sadness, which he had only recently thought of as depression. They were triggered particularly by any attempt to rid the house of a mountain of magazines and other equipment related to his many hobbies. These would pile up until it became impossible to walk through rooms, or get into the garage, but when he threw anything away he felt as if he were losing part of himself. He had a very supportive but baffled wife. Once we had established the probable link between his childhood and his behaviour, I told him this story. Do you know about bower birds? They are delightful creatures, who get their name because the male literally creates a bower for his prospective mate. He builds a nest on the ground, a little like a tent open to one side, and then he collects all the most beautiful things he can find. He collects shiny pebbles, shells, flowers, leaves, even iridescent insect wings. He arranges all these, in their own groups, in a pattern around the mouth of his bower. The female will choose to mate with the bird which produces the patterns she judges best, and the males spend great time and effort in arranging and re-arranging their exhibitions to best effect. There was, though, once a bower bird who built a very fine bower, with a lovely exhibition of the many beautiful things he had found and collected. Somehow, though, he found it difficult to stop. If his mate would love him for what he had collected, then surely she would love him even more if he collected even more. And so he found more and more pebbles and shells and flowers, and added them to his patterns, and then went out to get more. After a while it became almost impossible to stop, for how would he ever know when his bower was special enough? In time, it became impossible to get to the mouth of the nest, and the lady bird became quite distressed- and the bower bird sort of knew this, but still he could not stop building up the collections ever higher, so that they began to slip and slide and fall over one another.. And then one day, the Spirit of the Forest spoke in the bower bird’s heart. And he said, “Little one, what are you doing”? And the bower bird said, “I am collecting things for my nest”. So the Spirit asked “And what will happen if you stop?” And the bird answered, very quietly, “ I won’t have done enough. I won’t be good enough. No-one will love me”. And the Spirit laughed gently, and said “Oh, you have got it all wrong. You did enough long ago; the lady bird loves you for yourself, not for all these pebbles and shells. Don’t you know that nothing is more special in the universe than you are? There is a space in the Universe which only you can fill, and without you the Universe is not complete” And when the bower bird heard these words, his heart and mind were filled with joy. He went back to his nest, and looked at all these things he had collected, and soon realised that having more of everything was just becoming a problem. He decided there were some things that would be helpful, or just precious, to him, but that most of the things he had collected were of no use to him. So he chose

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to remove them, and revealed the lovely patterns beneath all the clutter, and then he and his mate were able to walk into the nest, and enjoy their lives. The client was clearly moved by this story, even in trance; a tear ran down his cheek as he listened to the Spirit’s words. As he became fully aware of his surroundings, he smiled and said “Thank you”. The following weekend he cleared his garage of its accumulated clutter. He has been able to engage in a number of activities since then (18 months) which would formerly have triggered depression. Conclusion These are only, of course, two stories, and the striking recoveries made by both clients may, of course, have been coincidental or due to some other factor. However, healing stories have been used down the centuries, and I have sought in this essay to demonstrate something of why and when they can be effective, and what is required of the storyteller as well as the story. References Blyton Enid 1939 The Enchanted Wood, many publishers including Dean & Son 2005 Child Francis James (ed) 1882 The English and Scottish popular ballads Vol 1 first pub 1882; pub 1962 New York by Dover Publications Inc,. Damasio Antonio 2000 The Feeling of What Happens ch 2 UK Vintage Duncan Barry, Miller Scott and Sparks Jacqueline, 2004 The Heroic Client ch5San Francisco JosseyBass Griffin Joe and Tyrell Ivan 2003 Human Givens: A New Approach to Emotional Health and Clear Thinking England Human Givens Publishing pp 93-94 Ibid, pp 59-60. Havens R and Walters C 2002 Hypnotherapy Scripts, a Neo-Eriksonian Approach to Persuasive Healing p 27, New York Brunner-Routledge, Grimm J and W 1889 this ed 2003 Grimm: The Illustrated Fairy Tales of the Brothers Grimm Germany Die Gestalten Verlag Ledoux Joseph 1998 The Emotional Brain: The Mysterious Underpinnings of Emotional Life ch 6 New York Touchstone Lewis C.S 1950 The Lion, the Witch and the Wardrobe Long C J (date unknown) Brain-Behavior Relationships: Angular Gyrus in Neuropsychology & Behavioral Neuroscience , www.neuro.psyc.memphis.edu/NeuroPsyc/np-l2-angul.htm. Accessed 14 September 2007 Nettle Daniel 2005 Happiness: the Science behind your smile ch 5 Britain OUP Paivio, A, Walsh, M 1993, “Psychological processes in metaphor comprehension and memory”, in Ortney, A (Ed), 1993 Metaphor and Thought, 2nd ed, Cambridge University Press, Cambridge, pp.309-28. Ramachandran Vilayanur S., Director of the Center for Brain and Cognition at the University of California, San Diego, reported in Science Daily May 27, 2005 Von Arnim Elizabeth 1922 The Enchanted April, , re-published in UK by Virago Modern Classics in 1991. www.thebrain.mcgill.ca The Brain from Top to Bottom, Models Of Spoken And Written Language Functions In The Brain, (Advanced level) (author unknown).

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Phil De Prez. NEWI Wrexham. Aunty Betty and the sunny day Abstract Rodriguez (2002, p4) argues that no narrative is meant to be kept to oneself, it is for sharing with others and with this sharing comes a social infrastructure that bonds and binds each of us to others in a inimitable way, and furthermore, a concept which allows individuals to critically examine the repercussions and outcomes of their actions. If it is accepted that narratives are a means for the individual to address and share these issues, what are the underlying processes that may effect the reflection of these issues to form a narrative. It is the intention here to question what may be one of the underpinning requirements of an individual to work within a narrative framework, the concept of self awareness, and in particular the ability to communicate this awareness to others. Carson (2001, p199) states that ‘all situations can be described in a number of ways which reflect not just an author’s values, but also, more crucially, an authors’ identity’. This paper will question whether there is a singular unified ‘self’, or as James (1892) maintains, the individual is a highly complex social entity and that we display ‘as many different selves as people we interact with’ The concept of self awareness will be explored through relevant historical and contemporary literature in order to attempt to discover who in essence is writing the stories recounted in a narrative. Introduction What exactly are narratives? There are numerous theoretical, historical, and contemporary definitions about what constitutes a narrative across a diversity of disciplines. Although I appreciate these ideas express the usefulness of narratives in many different settings, I still had a difficulty in grasping the concept of the use of narratives as a valid methodology for my own work. Why, for instance employ a narrative methodology to explore an individual’s experiences instead of asking them to compile a personal journal, or utilise an interview format and then scrutinise the information gleaned from the resulting transcripts. To me a narrative seemed to be a skewed way to look at an individual’s experiences because the narrative is predominantly a product of the writer’s individuality, and therefore constrained or distorted by this individualism within the zeitgeist. If it is conceded that as individuals develop and change over time, and they are also altered by their life experiences, surely the ‘act’ of creating a narrative will be a part of this change process and therefore make the narrative obsolete by the time it is completed, in effect as useful as yesterdays newspaper. This raises the question of who then actually writes the narrative and to what extent and importance does the notion of self awareness impact on the resulting narrative. This article attempts to explain my journey into exploring what narratives mean to me, and how they may be used to further my own research. Self awareness Self awareness is a concept that has been debated across both the centuries and across disciplines. It is inextricably linked with the notion of the self concept, self esteem and self image. Although it is difficult to isolate these closely related areas, I do not want to concentrate here on the processes and developmental theories of self per se, but to contemplate in more detail on how we actually perceive ourselves as an individual and how these perceptions may impact upon our personal interpretation over time, recall of events or experiences, and how we ultimately communicate our experiences through the medium of narratives. According to Hergenhahn (1997, p18) the perception of self stays relatively stable over time even though we may dramatically physically change. This view however, is not universally accepted. Hampson (1995, p30) argues that the idea of a unified concept of self may be too simplistic an approach and is not substantiated. In effect we become a social chameleon, we have the ability to adapt to each social situation or social interaction and we exhibit a different/alternative/modified version of ourselves to meet the demands of that situation/interaction. These roles it could be argued are social constructs (Hampson 1995, p32) and that the basis of these social constructs have their origins in language. Language could be considered to be a major constraining factor which not only limits the manner in which we perceive others; it also determines how we perceive ourselves. Rodriguez (2002, p4) argues as we are ‘languaged’ beings, ‘the nature of our language is the nature of our world’. Furthermore can narratives be considered to be complete or ‘perfect’ if language itself is neither perfect nor complete?

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Historically the self has been seen as a separate entity and referred to in several different ways, as the soul, as the mind or the more contemporary view of some that the self is the ‘organiser of experience’ (Hergenhahn 1997, p18). Tauber (2005, p49) argues that in the 17th century the rise in interest in self awareness was due in part to the desire to thwart the rise in skepticism by idealizing the ‘knowing self’. James (1892, p35) however is credited as being the first to question the concept of the self and to distinguish between the complexities of a multi faceted self and the notion of a singular self. James made the differentiation between ‘I’ as the knower, and ’me’ as the known. The ‘me’ James further believed was an integral part of the self which consisted of a material self (our possessions), the social self (as seen by others) and the spiritual self (a state of consciousness). This concept was embraced in later years by post Kantian philosophers (Hegel, Emerson and Kierkegaard) who furthered the notions of self consciousness. From a structuralism point of view, however, (as Hergenhahn cites it) self awareness or introspection is not a true representation of an event or experience, but an interpretation of it based on the memory of that event, furthermore by revisiting the event it would be inevitably changed by this re-visitation (p247). If the concept put forward by James is accepted, that we are as many selves as people we meet or situations we encounter, how can a narrative can be a valid representation of a person’s experience for more than a fleeting speck of time, as soon as the experience is thought about, time will distort the experience based on new experiences. Therefore it could be argued that a narrative cannot accurately reflect experience and be a true representation of the self. Can this though only be a small indication of what narrative methodology can offer, what if narratives are more than a mirror to gain insight into beliefs and behaviours surrounding an event, are they possibly a far more complicated process than this? If looked at in a broader sense can narratives be considered to be a method in which this reflective process allows a moment of ‘clarity’ in which an individual can gain an insight into the enduring self? At a family funeral recently I was speaking to my cousin and asking after the health of my aunty Betty. Aunty Betty is in her mid eighties and after having a couple of major strokes several years ago resides in a care home and requires 24 hour medical support. My cousin told me of a recent visit to the home in which she had a strange conversation with one of my aunties carers. It appears that one of the things the carers do to keep the client’s mentally active is ask them who they are. The carer told my cousin that one morning when asked who my aunty Betty was she replied ‘Elizabeth Sneddon’. No said the carer you are Betty Wynn, ‘no I’m not I’m Elizabeth Sneddon’ came the reply. After this went on for a few minutes the carer dropped the subject as aunty Betty was getting quite upset and frustrated, but adamant she was Elizabeth Sneddon. My cousin thought for a moment and told the carer that yes in fact Aunty Betty and Elizabeth Sneddon were one and the same, as although for the last 70 years she was known as Betty Wynn, Elizabeth Sneddon was the name she was known as when child in Scotland. As a researcher, this event raised several questions about my auntie’s behaviour, and one paramount to my area of study the concept of self awareness. Why had after a period of over 70 years had my aunty suddenly, and vehemently reverted to her childhood identity? Can such a strong sense of identity be enduring throughout a lifetime? Brown (2000, p5) in a similar vein proposes that trauma and the connection between this trauma and memory in older people is of immense importance of how an event is remembered, could the trauma in this case be the leaving from Scotland at an early age to settle in Wales? Brown further argues that the affect of traumatic events alters how the individual stores and retrieves the memories associated with the trauma, maybe associated with age. Without getting embroiled in the lifespan development of self awareness debates (see Bee 1989, p134), there is abundant research into the continued development of self awareness in adults. Gardner (2001, p27) in particular looked at the development of self awareness in social work students and found that the increased capacity and skill for self awareness in these students resulted in greater learning experience especially when a reflexive learning element was introduced. How though is this skill learned? Schneider (2002, p807) would argue that paramount to the learning of these reflexive skills is the relationship between self talk, self consciousness and self knowledge. Dunning (2006, p600) argues that although individuals may be able to develop a highly tuned concept of self awareness, this self awareness is susceptible to a high degree of bias which can lead to an exaggerated overestimation of their own characteristics or personality. For example individuals may overestimate how kind they are to others, how good a leader they are and how charitable to others they are. Dunning points out that even though we tend to overestimate our own self characteristics, perversely we are excellent (accurate) judges of our peers and other people’s characteristics (p601). Does the reason for this over- confidence have its origin in our cultural norms and the need to be seen as a successful person to be deemed socially acceptable (see Taylor and Brown 1998, p200) or are

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there other factors to be considered. If it is accepted that we overestimate our abilities do sociological factors influence or pressurize individuals to distort reality to see themselves as a ‘better’ person? Egan (2002, p179) argues that individuals may be well aware of these distortions attributed to their personalities but purposely develop ‘blind spots’ about them. These blind spots however might be something that we may or may not be consciously aware of. Carson (2001, p201) expresses surprise at how long students can maintain feelings of upset and anger (some ten or twenty years) but Individuals may through the process of self deception, decide not to confront certain issues in their lives because they are too painful or difficult to face, and they will in some cases utilize self defence mechanisms to manipulate their experiences by ignoring them or distorting them so they appear to be less intimidating and in a form that is more acceptable to them. For Goleman (1998, p47) however, the use of these maladaptive defense mechanisms should not be a constraining factor in the search for self awareness, instead self awareness should be a part of, and enhance, the individual’s ability to be free to experience their true feelings and our reflections on these feelings. To be self aware Goleman believes individuals have to have ‘some sophistication about their emotional lives’ (p48). Where does this emotional sophistication come from however? Goleman (1998, p54) maintains that the source of self awareness may have a neurological basis. Some individuals he argues may be more naturally attuned to introspection and self awareness and also be more effective at communicating their feelings and experiences. This communication of feelings may manifest itself in many ways, for example through music, through artistic works and through the creation of narratives. Astor (2005, p415) furthers this notion by claiming that novelists tend to take a problem from their own life and use the plot of the novel to address their own issues. If as Goleman proposes certain individuals are more in tune to their feelings and more self aware than others, this poses the question, is this just a neurological function without any sociological input. Although as previously mentioned, Schneider (2002, p807) claims that paramount to learning reflexive skills is the relationship between self talk, self consciousness and self knowledge, there is a view that suggests that to effectively know your own mind, it is imperative that the individual is able to understand the mind of others. Hobson et al (2006, p1) looked at the foundations of self awareness in relation to autism. In studies with autistic children it was found that the participants were limited in social and emotional self awareness. Hobson et al concluded that for children to develop a meaningful depth of self awareness they need also to identify with other people. This work reflects other mainstream studies by Robbins (2004, p129) who suggests that in order to fully understand ourselves we must first have the ability to understand how others think. Although this principle of empathy underpins humanistic psychology and counselling (predominantly Carl Rogers), it has over the years attracted considerable criticism (see Masson 1993, p229). What constitutes a good narrative? If verbally communicated does it have to be articulate, if it is written does it have to be structured and grammatically correct or are these incidental to the individual and the story? According to Nelson (1989, p23) narratives are an integral part of how we learn about our world as children, and Mateas and Sengers (1998, p1) believe we continue this learning process into adulthood. There has been an increase in the study of narratives from different perspectives in recent years, in particular the growing body of research into gender and narratives. Bohanek et al (2004, p51) have enriched this gender based research by exploring the way in which the memory of emotional events differed by both valence and intensity in women. It was found that negative narratives contained more negative words, whilst positive narratives contained more positive words; furthermore negative narratives were longer whilst positive narratives were more coherent, (see also studies by Ludvig (2006, p245) on gender and narratives, and Haines and Kray’s (2005, p643) study on women’s self identification and social power). Narratives as a research methodology The question arises of does the use a narrative require a level of empathic understanding to be displayed in order to see the other person’s point of view? If we look at empathy from a Rogerian perspective it could be argued not. Are the goals of narratives and empathic research poles apart or do they have more in common than may be initially thought. Karinol (199, p147) claims that if the transformation rule approach to empathy is employed, it is an excellent heuristic method to make predictions about other’s thoughts and feelings. Carson (2001, p201) would argue though narratives does not require the student to ‘be’ the other person, but instead to imagine it. So it may be that although empathy and narratives hold a common general view on researching individual differences and their experiences, there are fundamental differences in the methodologies of these two approaches. Schiff (2006, p19) however, argues that the use of narratives in psychology shows great

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potential and could play a prominent role into examining the meanings individuals attribute to their experiences, (see also Boudens (2005, p1285) on the use of narrative analysis on workplace emotions). Can the use of narratives and in particular their use in my own research be influenced by Geertz (1993) and the ‘thick description’ methodology, or by Ellis and Bochner (2000) and an autoethnographical approach, or as a psychologist am I looking for a more eclectic approach integrating some positivistic approaches as well. As yet I am undecided. Can however, these two factions be effectively used in conjunction. As Bond (2002, p137) points out ‘natural science’ and narratives have little in common. In natural science the researcher remains outside the phenomenon as observer, be totally objective, generalizes findings and aims to show reliability and validity in their studies. In narratives the researcher is at the heart of the study, subjective, allows the reader to make their own judgments and examines the trustworthiness of the research.

Conclusions If as James (1892) and Hampson (1995, p32) proposes, we accept that as individuals we are not one self but comprise as many selves as situations we encounter, are written versions of events as numerous as our ‘many selves’. (To take this concept to an extreme, as this article has been compiled over several weeks, how many versions of my self have contributed to it as my experiences have changed? Does it really matter though, as Rodriguez (2002, p3) points out ‘no interpretation or meaning is ever complete. There is always a new and different interpretation’. I have utilized several conceptual or experiential approaches to critique the use of narratives as a research tool, looking at the issues surrounding the processes associated with self awareness (or multiple selves) and the impact emotions have on the intensity of these reported emotions when retold at a later date and the use by individuals of defence mechanisms and ‘blind spots’ to keep themselves safe. I am not suggesting the use of narratives is just another paradigm that is a product of the Zeitgeist but that it does have its merits. One key area where I see narratives being of immense importance is how it attempts to humanize science and place paramount the individual, their unique life experiences and the way in which they make sense of these feelings and experiences. Rodriguez (2002, p4) argues that no narrative is meant to be kept to oneself, it is for sharing with others and with this sharing comes a social infrastructure that bonds and binds each of us to others in a inimitable way, and furthermore, a concept which allows individuals to critically examine the repercussions and outcomes of their actions. Because of, or in spite of these arguments surrounding the use of narratives as a methodology, it was only after sitting in the back garden of my house lying back on the lawn staring into the sky I realised how and why narratives may be beneficial to my work. Watching the aeroplanes floating across a pure blue, cloud free sky I thought how busy it was up there today. I chastened myself almost immediately by noting it was probably always that busy up there amongst the numerous flight paths but because of cloud, rain or fog the planes were invisible to the eye. This made me think of our enduring self, is it part of us all but as we grow from childhood into adulthood it is suppressed by socialisation and societal norms? Can as we grow older like my aunty Betty, discard some of these socialised layers and get a glimpse of who we really are. It is a little unrealistic to think that to gain in insight into our enduring self we have to wait until our dotage. Can narratives play a part how individuals can ‘access’ their enduring self earlier in their lifespan. Thinking of the analogy of the planes on a sunny day, can this be compared to how a narrative may be used to ‘clear’ the ‘mist’ and ’fog’ of everyday socialisations such as described by Taylor and Brown (1998,p200) and allow the individual an uninterrupted view of their enduring self. I mentioned previously the empathic approaches to research and therapy, and one key area I see as common ground to both narratives and humanistic ideals is the concept that although the past and past experiences have their importance, the emphasis could be considered to focus on the present. Crites (1971, p241) sums this up most succinctly by observing that there is a ‘present of things past, a present of things present and a present of things future’. References Astor, J (2005) ‘The self invented personality? Reflections on authenticity and writing analytical papers’. Journal of Analytical Psychology, Vol.50 (4), pp415-430. Bee, H (1989) The developing child, chapter 10. NY: Harper and Row.

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Bohanek, J.G. Fivush, R. Walker, E (2004) ‘Memories of positive and negative emotional events’. Applied Cognitive Psychology, Vol. 19(1), pp51-66. Bond, T (2002) ‘Naked narratives: Real research?’ Counselling and Psychotherapy Research, Vol.2 (2), pp133-138. Boudens, C.J (2005) ‘The story of work: A narrative analysis of workplace emotion’. Organisational Studies, Vol. 26(9), pp1285-1306. Brown, D. Scheflin, A W (1999) ‘Recovered Memories’. Journal of Psychiatry and Law, Vol. 27(1). pp 5-156. Carson, A.M (2001) ‘That’s another story: narrative methods and ethical practice’. Journal of Medical Ethics, Vol.27, pp198-202. Crites, S (1971) ‘The narrative quality of experience’. American Academy of Religion. Vol. 39, pp291-300. Dunning, D (2006) ‘Strangers to ourselves’. The Psychologist, Vol.19, pp600-603. Also cited Taylor and Brown (1998). Egan, G (2002) The skilled helper (7th edition), p179. Australia: Pacific Grove, CA: Brooks Cole. Ellis, C. Bochner, A.P (2000) Autoethnograph, personal narrative, reflexivity: Researcher as a subject, chapter 3. In Denzin, N.K. Lincon, Y.S (2000) Handbook of qualitative research (2nd Edition). Thousand Oaks. CA: Sage. Gardner, F (2001) ‘Social work students and self awareness: How does it happen?’ Reflective Practice, Vol.2 (1), pp27-40. Geertz, C (1993) The interpretation of cultures, full text. London: Fontana. Goleman, D (1998) Emotional intelligence, p47,48, 54. Great Britain: Bloomsbury. Haines, E.l. Kray, L.J (2005) ‘Self power associations’. European Journal of Social Psychology, Vol.35 (5), pp643-662. Hampson, S.E (1995) Understanding differences in personality, p32-35. London and New York: Longman Essential Psychology. Hergenhahn, B.R (1997) An introduction to the history of psychology (3rd ed), p18. London: Brookes Cole Publishing. Hobson, R.P. Chidambi, C.G. Lee, A. Meyer,J (2006) ‘The foundation for self awareness: An exploration through autism’. Monographs of The Society For Research In Child Development, Vol. 71(2), pp1. James, W (1892) Psychology the briefer course, full text. New York: Henry Holt. Karinol, R. Shomroni, D (1999) ‘What being empathic means’. European Journal of Social Psychology, Vol.29 (2), pp147-160. Luvig, A (2006) Differences between women? Intersecting voices in a female narrative, European Journal of Women’s Studies, Vol.13 (3), pp245-258. Masson, J (1993) Against therapy, p229. London: Harper Collins Publishers. Mateas, M. Sengers, P (1998) ‘Narrative intelligence’, p1. American Association of Artificial Intelligence, www.aaai.org. Nelson, K (1998) Narratives from the crib, p23. Cambridge, Mass: Harvard University Press. Robbins, P (2004) ‘Knowing me Knowing you: theory of mind and the machinery of introspection’. Journal of Consciousness Studies, Vol.119(7/8), pp129-143. Rodriguez, A (2002) ‘Redefining our understanding of narrative’. The Qualitative Report, Vol.7 (1), pp1-6. Schiff, B (2006) The promise (and challenge) of an innovative narrative psychology’. Narrative Enquiry, Vol.16 (1), pp19-27. Schneider, J.F (2002) ‘Relations amongst self talk, self consciousness and self knowledge’. Psychological Reports, Vol.91 (3), pp807-812. Tauber, A.I (2005) ‘The reflexive project: Reconstructing the moral agent’. History of the Human Science, Vol.18 (4), pp49-75.

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Maggie Jackson University of Teeside England What’s the Story? Developing ways of encouraging undergraduate social work students to think about loss. Abstract “Learning is an active process that occurs in the real world of everyday experience as well as in pursuits of knowledge, competency, and growth within any particular field.” (Goldstein 2001 p.148) I am going to describe a method of teaching I have used with third year undergraduate students of social work who have chosen to take on option module called “Working with Loss and Death”. The aim of the paper is to both tell the story of how the module has developed and then to consider why I think it seems to work. I cannot claim that it came from any clear thinking about methods of working before embarking on the venture but came from a sense that it seemed like a good idea and that by constant rethinking and reading around to make sense of what was happening I have been able to develop and improve the module and its impact on the student’s learning. Firstly I will tell the story of the significant aspect of the module which I want to consider (the use of photography and a visit to a local cemetery) and then I will go on to consider why this might be an effective way in to understanding the subject of loss and death. The paper will be constructed as a sort of narrative with an analysis of the pedagogy underlying the method. Considerations before we start: Talking about death and loss is not necessarily a very comfortable thing for many of us. It has become a common place to say that death is one of the last taboos in western societies in the late 20th and 21st centuries. Bronfen and Goodwin (1993) suggest that “culture makes it a forbidden subject, an embarrassment one would like to silence” (p.3). This is open to debate as it has become increasingly a subject of both popular cultural interest (consider the many books written by people wanting to tell their own stories) and also of academic interest. However it still remains a subject which can arouse painful and distressing feelings. Loss, in its broadest sense is something which my students need to be aware of, and will deal with – or avoid – on an almost daily basis in the course of their professional lives. So the module I teach is designed to help them begin to think about loss and death and to begin to make sense of it and its impact both on themselves and on the people with whom they work. In order to do this I have tried to find a way to help them approach the subject so that they can talk about it without fear. This seems to say both more than is possible and also to make the subject too daunting to even tackle. The problem for me was how to get hold of the subject without making it too theoretical and so distance it from the personal but to allow the students to make connections without feeling overwhelmed by it. My students need to understand theories, but need also to see that these are simply ways of explaining things and not just clever words which don’t connect to the “real world”. “A story provides the right balance between uniqueness and universality” (Robinson and Harper 1986 p. 113) The call to adventure: In an attempt to consider the development of the module as a narrative description of my own and the student’s journey into making sense of how to tackle the subject I will call the first part of the story “The call to adventure”. Campbell (1993) describes this setting out on a quest as “a blunder” (p.51) in which “apparently the merest chance- reveals an unsuspected world, and the individual is drawn into a relationship with forces that are not rightly understood” (p.51). Although, somewhat overstating the case, this to some extent describes the beginning of the work to make the module understandable and accessible to my students. For reasons which were not entirely clear to me it seemed that starting the work by going to a cemetery and taking photographs, of whatever stimulated the interest of the students, would be a good way to get into the subject of loss and death. Not far from the university where I teach there is a Victorian cemetery which is still in use and contains a wide range of gravestones both old and new, and a range of religious affiliations. This seemed like a good place to start. Taking photographs also seemed like a good and useful starting point. There was no need to understand anything prior to going there and the students would be simply asked to look and be interested by what they saw. They were to take photographs of anything

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they wanted to, for whatever reason and the aim was they should not censor their thinking or to need to have any idea of what they were looking at at that stage. After having the photographs developed (this was a low tech exercise) the students then were given their pack of photographs and asked to select from them those which they felt were most interesting to them, and to then make a collage of them and to tell the story of why they had chosen these images. They might chose to describe what they had felt about the images or what they thought they represented - the aim was to make some sense -even if it was to bring up more questions – of what they had seen and experienced. They then presented their collages to each other and were asked questions and other students made comments on what they saw and heard. At this stage the students had begun to think a little more about the meaning of the images and had begun to construct some sort of narrative about them. Into the unknown: What were the stories they told? The stories and the questions picked up themes of pain and of sadness of course but also of beautiful images –who was the woman lounging over the grave of the man? On the grave of twins who had died were the names Joy and Hope – how and when had the parent chosen these names – could the names really represent how the parents felt even when the toys they gave to their children were only those left by the grave. Who was the man who had been buried in the late 1800s (a Native American according to the gravestone) who was still visited by people who lay feathers on his grave. More questions than answers were perhaps elicited but the students began to make up some stories of why people came to the graves, who they might talk to when they were there – stories about a space which was not just for the dead but also for the living. It seems clear from this activity that “visual images…allow subtexts to appear unwittingly” (Bolton 2005 p.6). The students had approached the subject with interest and curiosity. They had allowed themselves to go into the unknown – perhaps with some anxiety but they had let themselves go into the adventure. Here we find that “the regions of the unknown (…) are free fields for the projection of unconscious content. (Campbell 1993 p.79). Without the need to “get it right” the students were able to consider the cemetery as a place of interest, of information or stories with which they were perhaps unfamiliar and in most cases had never ventured before. This was a place of taboo – a strange place into which one would not choose willingly to go. A place which they now could consider as one which held a wealth of information and challenges. Their stories (if I might call them that) showed that they have begun to think about the things from a different view point. Many were surprised at what they had seen – either by the variety in the cemetery or by the fact that they had not felt it (having visited) to be a place of sadness and misery, but a place of mixed emotions. To enter into this “world” the students have taken a first step on a journey to discovery, if you will, and the next stage of making sense of what they had seen challenged their assumptions and expectations. It also demanded to some extent that they face their own anxieties and fears about loss and death. “The original departure into the land of trials represents only the beginning of the long and perilous path of initiatory conquests and moments of illumination” (Campbell 1993 p.109). Transformation: There is a danger of pushing the idea of the narrative too far. The students went into a cemetery and were encouraged to think, but they did have to face demons and monsters to some extent and certainly the moments of illumination began to emerge as they were able to refer back to what they had seen and thought about. They were encouraged to think back to this experience to connect to theories being introduced in the lectures and in their reading. They were also encouraged to try to connect this to what they saw and felt, either in their personal lives or in the lives of those with whom they worked. The aim of the journey is to be transformed in some way and the hope of any educational process is that it should not leave the learner untouched but changed in some way, enlightened perhaps. Considerations of the pedagogy: I now want to change the focus of this paper from looking at the “what” to the “why and “how” of this method. The use of the camera and the visit to the cemetery with the subsequent construction (if very loosely) of a story behind the pictures seems to have engaged the students in the subject and allowed

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them to use it as a reference point throughout the module. What was it about this method that helped them to engage with it? Was it purely my enthusiasm and their willingness to go along with it? Is there something about looking through a lens? Is it the combination of picture and story? As I teach the module and cannot eliminate my self and the impact of my self from the module – certainly not here any way – then I will consider only the other two possibilities, that the process of taking a photograph may be significant and that also using that as the starting point for constructing a story somehow shapes the thinking the process and may cause the students to begin to engage with the subject in a way I had not previously found. It has been suggested (Tichy 2002 in Grisham 2006) that “the best way to get humans to venture into the unknown terrain is to make that terrain familiar by taking them there first in their imaginations” (p.493). As I have described above going into the physical space of the cemetery could be seen as going into unknown territory and certainly contemplating the impact of loss and death for many people will be unfamiliar terrain. So perhaps this method allows for the students to overlay the experience with an imagined or assumed experience - they can be at one remove. Whilst in discussion at a cemeteries colloquium some years ago talking about using the cemetery in teaching young children (Jackson and Colwell 2001), someone expressed their concern that going into the cemetery was a visceral experience and could be quite overwhelming for those unprepared for it. I am not sure I would agree entirely, but nonetheless there is something about entering the space that has an impact beyond merely talking about it, and which appears to allow for deeper thinking than would otherwise happen. Constructing the narrative: The beginning of the story must be when we are standing in the cemetery, and looking around and then deciding – however randomly – to take a photograph of some thing. What happens when we look through a lens? The photograph is in some ways a representation of the real world. We choose to capture an image of something in the world but we change it by capturing only part of it, or by choosing to take the photograph from a particular angle - what we are using is our “point of view”. “The signs in a narrative are not the same as those in the world: they are transformations of the world” (Cobley 2001 p.225). We have decided, consciously or otherwise, to represent the thing in a particular way. Of course the skill of the photographer will make a difference to how well this is done but nonetheless we still choose the point of view. When we tell a story we are constructing an account, we choose where we start from and what will be included. “Narrative imposes structure; it connects as well as records” (Lamarque p.131 (1990) in Nash (Ed)). Next the students choose which photographs to talk about – not simply to describe -but to begin to make some coherent story about. Even if the story consists mostly of questions they have begun to ask the listeners to consider the gravestones from a particular perspective. Who comes here? Why have they left a feather? Perhaps they talk to other people and share their news. The questions are the ones the students pose themselves; each person looks at the gravestone and asks different questions. To some extent we can see this as a projection of our own interests and concerns, which I suppose it is. This is important, however, in the understanding of loss as we will go on later, in the module, to consider a wide variety of theoretical explanations about the process and impact of loss. For each student to have begun to see that they have had different experiences in the cemetery helps them begin to consider that there are many ways of experiencing grief and not merely one prescribed way to be learned and applied to all circumstances. The use of the story, as a personal construct, helps to demonstrate that theories are only useful if they make sense - they are not some over arching correct interpretation of the world that must apply whether or not they appear to fit. Rom Harre (1994) suggests that “scientific” knowledge use a sort of rhetoric which sets itself up as beyond question, as if it purports to tell the truth by avoiding the use of the personal pronoun. “Functionally the disinterested voice and the assertoric style seem to be aimed to get the interlocutor to see things from the point of view of the writer or speaker” (ibid p.81) This may not be a problem but may prevent real questioning on the part of the reader and a quick acceptance of an assertion or theory as “fact”, Harre suggests that the writing is designed to be read as “you take my word for it” (ibid p.81). This is precisely what I would like the students not to do. But to try to match theory against experience – not just their own- although this is the starting point –but to consider that there are many narratives about the experience of loss and they may all have something to tell us.

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So the student in the cemetery will be interested by particular images – they may not know at this stage why –nor have thought about what the image means – indeed they are asked to just take pictures whatever interests them and not to think to much about why that may be. The next step is then the selection of the images – where they begin to construct some sort of narrative. “Narrative can be thought of as storylines that people use in making sense of their experiences”. (Brockbank, McGill and Beech 2002 p. 36) Clearly the focus of my exploration of the notion of narrative will now be about the purpose it serves in the organisation of learning. This means that the structure and meaning of the narrative itself – which at this stage of the process is actually not important – will not be considered. It also means that I have to make certain assumptions and align myself with those who consider that we think, naturally, in stories. So that according to Bruner (1986) narrative helps us to order our experiences and to construct reality. It is not the only mode of thinking we need to employ but for him it is as important as logico-scientific thinking. It is a natural building block in the learning process. It opens up new ways of thinking and thinking about the world. “By using stories we are able to tap into a spectrum of perspectives and possibilities.”(Lehman 2006 p.203 in White et al). Moon (1999) suggests that the process of deep learning which involves reflection, rather than simply rote learning or memorising facts, starts from the point of noticing and then goes on to making sense. She sees these as two key features of the learning process which need to happen before the next step of making meaning and the more complex step of working with meaning. The selection of the images and the sorting and choosing of them to make a story focuses the mind to order what may not have made sense - or may have seemed random. These steps become increasingly important when the aim of the teaching is not to have students know the “right answer”, but to be able to use competing explanations of human behaviour and apply them (or reject them). “Learning is a narrative process that is active and experiential.” (Goldstein 2001 p. 17). If this is the case, as I believe it to be, then hearing the stories of the other students who, apparently, all had the same experience, can only serve to enhance the notion that we make sense of the world in different ways. This cannot mean that we can think what we like and it will be true, but must help us to consider that there are multiple views which need to be matched and sorted before we can begin to make meaning. This demands that the student is engaged not in deductive thinking but generative thinking – or that they allow themselves to play with ideas. This type of learning and thinking demands “a curious, reflective, and inquiring mind that questions conventional assumptions about person and society...” (ibid p.52). So what have I said? The learning experience is not passive, it demands an effort on the part of the learner, but for me one of the difficulties in learning about loss and death is that thinking about the impact of loss and death is often painful and frightening. So it is sometimes easier, and perhaps wiser, to learn about theoretical understandings, to put them on a shelf inside the head to be taken down, used and applied when needed, but not to be thought about too much. This can cause less stress to the individual but I would suggest that it may mean that we do not hear what others are saying about loss and perhaps can remain disconnected from our own experience too. We need to hear the story – so we need to understand the stories that we ourselves tell. This is perhaps a threatening thing to do, we cannot just rely on the wisdom of those who have processed the information before us, but are asked to consider it in terms of how it matches against our own experience and that of those we meet. “These (stories) are dangerous because they threaten the fabric of the security into which we have built ourselves and out family. But they are fascinating too, for they carry the keys that open the whole realm of the desired and feared adventure of the discovery of self”. (Campbell 1993 p.8) So by entering into the “unknown” and retelling our experiences and sharing those experiences with others we can begin to make sense of the world around us, or at least to begin to ask the questions that will help us construct the story. Some of the students commented on the experience. “It was very peaceful and I was able to think about issues that had occurred in my life that I had not thought about or maybe even tried to blank out. Then when the pictures were shared in the classroom I got a sense of great calm and peace. Before this occurred I would have thought it very strange to just walk round a graveyard and even more strange to take pictures but now I see it as a good peaceful walk”. Another commented ”I went through a range of emotions whilst I was there. I was surprised at the new style head stones where people had personalised them for their specific family member. I was also curious about the

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people lying beneath. I enjoyed reading the head stones that had more detail about how the person had lived and even sometimes why they had died.” This shows in a small way the impact of the visit and how it may have helped them shaped their thinking and I hope illustrates and, perhaps, justifies this method of introducing the subject of loss and death.

References: Bolton, G. (2005) Reflective Practice: writing and professional development. London: Sage. Brockbank, A. McGill, I. and Beech N. (2002) (Eds) Reflective Learning in Practice. Aldershot: Gower Publishing Limited. Bronfen, E. and Goodwin, S. (1993) (Eds) Death and Representation. Baltimore: The Johns Hopkins University Press Bruner, J. (1986) Actual Minds, Possible Worlds. Cambridge: Harvard University Press. Campbell, J. (1993) The Hero with a Thousand Faces. Hammersmith: Fontana. Cobley, P. (2001) Narrative. London: Routledge. Goldstein, H. (2001) Experiential Learning: A Foundation for Social Work Education and Practice. Alexandria, VA: Council on Social Work Education Grisham, T. (2006) Metaphor, Poetry, Storytelling and Cross-cultural leadership. Management Decision Vol44 Number 4 2006 pp486-503. Harre, R (1994) Some Narrative Conventions of Scientific Discourse. In Nash, C. Narrative in Culture. London: University of Warwick Centre for Research in Philosophy and Literature. 81-101. Jackson, M. and Colwell, C. (2001) A Teacher’s Handbook of Death. London: JKP Lamarque, P. (1990) Narrative and Invention: The Limits of Fictionality in Nash. (Ed) Narrative in Culture: The uses of Storytelling in the Sciences, Philosophy and Literature. University of Warwick Centre for research in Philosophy and Literature. Lehman, J. in White, S. Fook, J. and Gardner, F. (2006) Critical Reflection in Health and Social Care. Bucks: Open University Press. Moon, J. (1999) Reflection in Learning and Professional Development: London: RoutledgeFalmer.

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Richard Mottershead NEWI Wrexham. Including the Excluded: Weathering the Storm

Abstract It has been identified that populations of students within Higher Education often report much higher levels of the symptoms of depression than the norm for their age group. In addition, levels of symptoms for anxiety can also be higher amongst students. A study found that reported levels of moderate to severe anxiety among second year students were nearly twice that of the general population (Webb et al 1996). Another later study conducted discovered that students were 1.64 times more likely to experience symptoms of mental ill health than the general population (Harrison et al 1999). The author has worked in the field of mental health both nationally and internationally. During this time the author has been fortunate and privileged to have encountered individuals who have shared their narratives regarding their endeavours to participate in Higher Education whilst managing their mental health. The authors aim was to utilise his current role as a lecturer practitioner to create opportunities for students to become aware of the supportive network within North East Wales Institute of Higher Education (NEWI) in order to improve the success rate of completing their chosen course of study. This process would be part of a generic lecture and therefore would create an opportunity for passive knowledge acquisition. Walking through the corridors of higher education establishments with our eyes wide open provides a useful insight into the mental health needs of our students, however this is often missed or ignored. The author will present a lesson plan that enables students and staff to become more familiar with services available in supporting students who are either trying to cope with the stressors of higher education or might encounter such stressors through the course of their studies. By improving the students awareness of the safe harbours that they can take refuge in at times of distress, we as educators are increasing their chances of completing their chosen courses and therefore increasing their opportunities in life. This supportive process allows for the widening of participation for the local community and will provide support to many students who are often misunderstood and not supported at home, due to them being the first person in the household to be on a degree course. Terminology and Definitions The very definition of mental illness is as much to do with acceptance as it is to do with the observers ethnic, cultural, social and to a large point the historical context in which that observer lives. The society in which the reader finds themselves will dictate, to an extent the views on what is seen or allowed as ‘normal behaviour’. This in turn will have symbiotic relationship in terms of what is viewed as mental ill health. The World Health Organisation (2001) states that there is no one “official” definition of mental health. Cultural differences, subjective assessments, and competing professional theories all affect how “mental health” is defined. However, most medical and nursing clinicians use the latest edition of the Diagnostic and Statistical Manual of Disorders (DSM)-IV (2000) in order to categorise and therefore apply relevant treatment practices to those illnesses. In relation to this, the World Health Organisation explains that mental illness can be used to define clinically recognisable patterns of psychological symptoms or behaviours that cause acute or chronic ill-health, personal distress or distress to others. The terms mental illness, mental health problems and mental distress are used throughout the text, the first two terms refer to clinically recognisable patterns of symptoms or behaviours that cause acute or chronic ill health. The later refers to the possible psychological stresses that confront students in academic life.

Introduction Mental health is increasingly seen and acknowledged as a building block for the foundation of a healthy life and serene well-being. Unfortunately, mental ill-health strays into all facets of socioeconomic political strata of society, making no one immune and a high probability of anyone of us experiencing a period of mental ill health or mental distress at some point in our lives. Statistics inform the reader that one in four people within the UK population are likely to experience some form of mental health problem in the course of a year (Bird, 1999) and that a smaller minority will encounter mental illness. The students narratives of mental health suggest that many people

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require in-depth support from mental health services for complex and enduring mental health problems. There are others who are capable of managing the mental distress that they are experiencing either by seeking early assistance from supportive networks or they are innately equipped with effective coping mechanisms that allow them to manage and or remove the mental distress from their lives. Mental health is a prerequisite for being human, it should not exclude, create stigma or be an excuse for “special treatment”. It is important to remember that people who experience mental health problems are capable of leading full and happy lives. Within this education and their right to education can be at the forefront of allowing the individual to transgress their problems. The educational process has been found to have varying levels of stress placed upon the student. Higher Education is linked to a number of significant stressors, including financial pressures and the emotional demands of a leap from the playground to the lecture theatre. Brown and Ralph (1999) found that students encountered significantly high levels of stress through academic life, which is supported and collaborated in later research by Aherne (2002). Indeed by many, stress can be seen as not only a necessity as a driving motivational tool but also an important aspect of the higher educational experience. Whitman et al, (1985) highlights this point by explaining that stress is an integral component of being at university. It is indeed a conundrum as to whether we as lecturers allow our student body to experience these turbulent stresses with the hope that the process will in some way make them stronger and more robust and better equipped to undertake the rigmaroles of life after University. By adopting this ethos, are we not simply subscribing to a Darwinist approach to education and justifying to ourselves that by allowing students to “go it alone” we are merely encouraging the process of natural selection?

Sink or Swim Crisp et al (2000) explains that is an all to common occurrence to encounter prejudice and stigma when the issue of mental health is raised. Indeed their research indicates that public opinion regarding people with mental illness shows that these individuals are viewed as difficult to engage with, have different feelings from those with good mental health and are unpredictable in nature. These negative overtones may not only have repercussions upon the access and rights to education that people with mental illness have but also how the educational establishment manages these people. The students narrative of finding support suggests that that the level of support can often depend upon the students tutor. The experience of teaching in order to unlock a students potential is an ultimately rewarding shared journey. However, as this narrative indicates it can carry a heavy responsibility. It is this very responsibility that is at the core of the educational process and demands that we ‘the staff’ prepare ourselves to tackle mental illness, which is a challenge not unlike dealing with cultural differences, or alternating between varying teaching styles. The Royal College of Psychiatrists (2003) published a report entitled ‘the mental health of students within higher education’. This report clearly identified that there has been an increase in recent years in the number of higher education students presenting with symptoms of mental ill health. The report also indicates that there has been a considerable increase in the number of students who have presented with more severe mental health problems. The Report highlights the disruptive and disabling effects of mental illness on the students ability to study and learn. It advises that institutions respond by promoting links with local health service providers so that policies can be created which encourage mental health promotion and improved well-being. Within Wales the ‘Reaching Higher Reaching Wider’ (www.hefcw.ac.uk) project has been established to widen participation in Higher Education. This project is managed by the Community University of North Wales (a partnership of the two Higher Education Institutions and eight further education colleges in North Wales) and funded by the Higher Education Funding Council for Wales (HEFCW). The project has been responsible for developing activities to encourage social inclusion as well as raising awareness and to nurture aspirations. Within NEWI it has been observed by the counseling services that there has been a 28% increase in the number of students registering for ongoing counseling support. However, of a 6000 strong student population this statistic equates to only 90 students. Of this number only 5 are European or International students. Through a narrative an international student told of their difficulty in acknowledging their mental illness because of the shame that they thought this would bring their family. The student explained that this perceived shame prevented them from wanting to engage in supportive networks as by doing so would confirm that they had a mental health problem.

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The Inverted-U Hypothesis It is possible to identify with the concept of mental causation when examining the relationship between mental distress and academic failure. Kim (1998) explains that typically the term is used to refer to cases where a mental state causes a physical reaction. To better understand this mental causation concept the Inverted-U Hypothesis can be utilised. This hypothesis is more commonly applied to the field of sport and exercise sciences than education. However, the author believes that it has clear validity in terms of exploring the problem at hand. The hypothesis states that performance improves as arousal levels increase up to an optimum point, beyond which it deteriorates. Within sport, this means that little excitement and stress associated with competition or performing in public can have a positive effect, but a situation that is too stressful is detrimental. The optimal levels vary between people doing the same task and for the same person doing different tasks. The hypothesis also explains that optimum arousal levels tend to be lower for more complicated tasks. This theory has its roots in the work conducted by Yerkes and Dodson in 1908, it is still very much in use today and the author beliefs can be easily transferred over to the student experience.

The above diagram shows the Inverted-U hypothesis in process. By utilising this model it is possible to highlight the relationship between stress, University life and mental distress. It can be observed that a student body that is lacking in stimulation will be under aroused and will therefore show low academic performance and possibly poor satisfaction with their University education. The section of students that find themselves moderately aroused will achieve optimal arousal therefore achieving maximum academic performance and possibly high satisfaction rates. However, the student body which finds itself over aroused and overly stressed will show poor academic performance. It is in this region that students may have a higher probability of encountering mental distress and mental health problems. Furthermore, the Inverted-U hypothesis also states that optimum arousal levels tend to be lower for tasks that are more complicated. If we envision not only the academic challenges undertaken within Higher Education but also the other existing complications of student life then we can surmise that there is an even less threshold in relation to striking a balance between good performance and being optimally aroused. Covert Teaching

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This lesson was conducted as part of the Common Foundation Programme (CFP) of the preregistration Nursing Degree. This encompasses generic nurse training before the second year when the programme branches into Adult and Mental Health. This module is designed to introduce the first year students to the role of the mental health nurse and increase awareness of key concepts and issues surrounding mental health nursing. These first year students will have already come into contact with patients with mental health illnesses through their placements. This session in part exists within the curriculum in order that critical thinking and active learning (Bandman and Bandman, 1995) may take place and that existing experiences and or preconceived notions can be reflected upon critically through active student participation. The NMC (2002) recommends the use of reflection in improving competences of practitioners. The lesson (see appendix A) was planned using PowerPoint, with intermediate use of flip charts to identify positive and negative mental health as well as specific causes of mental distress on students. By this process of identifying students as a vulnerable group. The author was able to establish empathy by giving a concrete referencing tool to the group. During the session, completed charts were placed on the walls of the lecture theatre in order that continued reference could be made throughout the lesson. By using the flipcharts in this way (and asking the students of their first encounters with mental health) it allowed the author to evaluate the knowledge base of the group. Dressel (1976) supports the use of evaluation as it forms a basis for rational judgments in decision-making. The task within the lesson was for the sixty-four students to split into a care team of five (there was one group of four) and to manage the care of an imaginary patient. They were given the information that their patient was experiencing some mental distress. The students were required to think of NEWI as a community and link and liase with local services (NEWI supportive network) in order that they could provide a package of care for their patient that would assist in the therapeutic recovery of that patient. Prior to the commencement of this lesson, the author had spent the previous day meeting with NEWI staff who provide support to the student body. The author ensured that they understood what I was attempting to achieve. These people and their departments included; the Counselling Service, staff at Service Information Desk (SID), Student Welfare, the College Chaplain, the College Nurses and GP surgery, Student Services, Disability Support, Staff at the Sports Centre, the International Office, Childcare Services, the Students’ Guild and the IT Department. The last department may be less obvious but equally important in providing up to date self-help guides via the NEWI website. A Swedish Study argues that there is growing literature to support the use of this self-care approach (Nevonen et al, 2006). The covert or subversive aim to this task was to raise awareness of the supportive networks that exist within NEWI so that if the students were to encounter difficulties they would know where to seek assistance and to prevent mental distress. This task would also allow those students who had pre-existing mental health problems to have a ‘first contact’ with the services under the guise of a teaching task. The task had the additional merit of allowing teaching staff to gauge the extent first year students were familiar with these services. The results were collected through a follow-up session, which saw the thirteen groups feedback their findings. Accessing Supportive Student Network Services/Gro 1 2 3 4 up SID √ √ √ Counselling √ √ √ Service Student √ √ Welfare College Chaplain College √ √ √ Nurses & GP Surgery Student √ √ √ Services Sports Centre Students’ √ √ Guild

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IT Department International Office Childcare Services Disability Support

Results

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The Results It can be observed from the results that no student care team achieved the 100% target. This could be a possible indication that these services are not being advertised to their full potential during the freshers week. Hawton et al (1995) explains that there should be an induction of students at the commencement of university life that promotes awareness and social integration. The Royal College of Psychiatrists (RCP, 2003) identify the trend of students experiencing mental health difficulties being directed, in the first instance, to their GP’s or to on campus paramedical, counselling or disability personnel. Within NEWI, there was a particularly low acknowledgement of the Disability Support but a relatively well recognized engagement with the Counselling Service and College Nurses and GP Surgery. None of the student care teams acknowledged the possible spiritual needs of their patient in alleviating mental distress. It is possible that this is either a reflection of the students own secular views or an inexperience as first year students of utilising a holistic approach to care. A study in the USA by Jensen et al (1993) found that those students who had strong religious beliefs tended to have better mental health but that there was marked increase in suicidal ideation and behaviour from students who showed no religious interest King et al (1996). No student care team identified the childcare facilities available at NEWI. The majority of the group were relatively young and it is possible that childcare needs were not at that time a priority. This again reflects a need for the student care teams to examine all of the need possibilities when creating a supportive package of care. In creating this task the author purposely did not identify the ethnicity of the imaginary patient, this allowed for a more complete examination of the students possible interpretations of what their patients needs might be. In relation to the failure to identify the International Office as a possible source of support, it can only be assumed that the student care teams did not consider the varying needs of NEWI’s international student body. Javed (1989) identified that there has been an increase in the symptoms of mental health of international students in the UK. As already identified, NEWI Counselling Services have reported that there is a substantive lack of International students seeking assistance from this service. This may indicate possible restrictions regarding language, however this trend has not been observed with the college nursing and medical staff who report high rates of assistance to the international students. One potential explanation can be sought when examining the work of Weiss (1969), who praised the advantages of the ‘fund of sociability’ in relation to the emotional resources that people give to each other. Within this, we can stipulate that the International students are seeking support from their immediate social network. More recently in The University of Leicesters’ study (Grant, 2002) an unfortunate trend was highlighted through the use of the Brief Symptom Inventory (BSI) in relation to International students and ethnicity. The BSI is designed to measure current psychological symptom status and is oriented towards psychiatric diagnoses. The BSI yields scores on nine syndrome constructs and provides three different total scores that indicate psychological distress. In The University of Leicesters’ study, students from ethnic minorities scored considerable higher on the subsections of the BSI. The results from the task also indicate that the students may not be aware of the positive association between physical fitness and mental health. In a number of narratives encountered by the author the students commented that they used a range of exercise and leisure activities to “distress” from life

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pressures. Gosselin and Taylor (1999) recognises that exercise is associated with a reduced level of state anxiety, and that exercise is also associated with decreased levels of mild to moderate depression and anxiety. Furthermore these researchers found that long-term exercise is usually associated with positive traits such as improved self-esteem and mood. It has also been established that physical activity results in reductions in various stress indices. Although the student care teams clearly identified the need that could be met through the nursing and medical staff, they failed to examine the social supportive networks. In the argument for a holistic package of care Morgan and Goldston, (1987) explain that severe depression usually requires professional treatment but exercise may act as an adjunct. Indeed Kirkendall’s (1986) study cited in Stull and Eckert (1986) indicated that by participating in physical activity students might be able to increase their academic achievements. Within North Wales, a study by Mottershead (2001, unpublished dissertation) showed that there existed evidence to support the use of sport and leisure activities as an alternative therapy for patients with mental health problems and that this participation assisted in the recovery process. Only one student care team accessed information from the NEWI intranet. As this team discovered there was a wealth of links to on and off-campus supportive networks. This self-help approach could be successful in cases were the student feels self-conscious about seeking assistance. The counselling service provides a free on-line relaxation programme. The course consists of eight recorded sessions with voice and music therapy. These links represent an easily accessible, readily available resource which although perhaps not a substitute for a trained professional may represent an initial point of contact for many. Surprisingly only one group made contact with the Disability & Learning Support Team. This team are experts in the implications of the Special Educational and Disability Act 2001 (2001). There is an appointed Disability Advisor who has a wealth of resources and expertise in dealing with contemporary issues surrounding the support of students with mental and physical disabilities. The Disability & Learning Support Team also help with needs arising from a disability or impairment, such as a visual or hearing impairment; specific learning differences, such as dyslexia or dyspraxia; or with medical conditions such as diabetes or Myalgic Encephalomyelitis (M.E); or a mental health difficulty. The student care teams reported that they were unaware of this service. The students had utilised the Service Information Desk and had relied heavily on the information disseminated to them. This may indicate a need to promote this service and the work that it undertakes. To illustrate this point, during the feedback phase the author informed the students of the supportive schemes offered to students with dyslexia. Two students commented that they had dyslexia and were unaware of the assistance that they are entitled to. There clearly needs to be further analysis undertaken to examine whether the supportive networks that exist within NEWI are coordinated, are working collaboratively and have an integrated strategy that allows for a seamless service. This task saw one student care team fail to access any services. The author is in no doubt that this team were merely advocating a laissez-faire approach in their search for adequate service provision. Indeed this team should be commended on their acknowledgment and demonstration of the supportive networks that exist within the student bar and outside designated smoking site, two areas that the author neglected to identify. Never the less, in order to satisfy any nay-sayers out there the author ensured that after the student care teams had provided feedback and the planned care they would recommend for their patient, the author purposely emphasised the importance of autonomy of learning (Fry et al, 2003) and it’s very real links to the clinical environments. Conclusions At the very core of this problem is the question how do we best support our students? Academic staff are fortunate that they find themselves in a role which can literally mould and improve a person, not just in terms of employability but more importantly allows the individual to transgress. Good mental health is crucial in allowing this process to occur smoothly. Yet the mentor duties of teaching staff can play such a finite part if the mental distresses are hidden and or the teaching staff feel they are inadequately prepared to meet the challenge of their students mental health. This is a cause for concern as student narratives have identified their tutors as being the key to receiving quality support. As previously mentioned there exists two opposing schools of thought. The first advocates for allowing students to experience the rigours of academic life as this earns them a place in the academic fraternity. The second opposing view is whether we (as the title of this paper implies) create a safe harbour from which we can stand along side our student, safe from the storm but at a vantage point where we can examine the problem together. The argument in itself may be redundant as increasing numbers of policies and procedures direct our actions and institutional ethos. The NHS has published a number of documents, which have a direct

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influence on the mental health of students in Higher Education. Most notably The Journey to Recovery: The Government’s Vision for Mental Health Care (DoH, 2001), National Service Framework for Mental Health: Modern Standards and Service Models (DoH, 1999) and The NHS Plan: a Plan for Investment, a plan for Reform (DoH, 2000). In 2000, Universities UK published Guidelines on Student Mental Health Policies and Procedures for Higher Education. The aim of this policy was to steer and guide institutional planning in dealing with student support and staff training in order to create a culture of responsibility in managing students with mental health problems. The document also made recommendations in supporting students and staff who work or study with students experiencing mental health problems. It is an unfortunate truth that although there are an increasing number of policies being created and Higher Education institutes are widening there supportive networks, there are still a number of students who struggle to complete their studies. It is probable that further research is required to establish whether there is sufficient collaboration between NEWI, the NHS, and local agencies to guarantee that students are provided with the best care possible. In the mean time the Institute must ensure that the ‘safety net’ that is thrown out is wide and all encompassing. The use of narrative practice has allowed the author to add substance and realism to the issues surrounding the creation of supportive mental health networks in the twenty first century. References Aherne, D. (2002) Understanding student distress: a qualitative approach, The Irish Journal of Psychology, 22(¾), 176-187. American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (Diagnostic & Statistical Manual of Mental Disorders. Ed 4. American Psychiatric Press. Bandman, E.L, and Bandman, B. (1995). Critical thinking in nursing. 2nd Ed. Norwalk. Appleton and Lange. Bird L 1999 The Fundamental Facts: all the latest facts and figures on mental illness. London: The Mental Health Foundation. Brown, M. & Ralph, S. (1999) Using the DYSA programme to reduce stress and anxiety in first year university students, Pastoral Care, 17(3), 8-13. Crisp, A.H, Gelder, M.G, Rix, S. (2000) Stigmatisation of people with mental illness. British Journal of Psychiatry, 177, 4-7. DoH (1999) National Service Framework for Mental Health: Modern Standards and Service Models. London. Stationary Office. DoH (2000) The NHS Plan: a Plan for Investment, a plan for Reform. London: Stationary Office. DoH (2001) The Journey to Recovery: The Government’s Vision for Mental Health Care. London: Stationary Office. Dressel, P. (1976). Handbook of academic evaluation. San Francisco: Jossey-Bass Fry, H. Ketteridge, S. Marshall, S. (2003). A handbook for teaching and learning in HE. London Gosselin, C and Taylor, A (1999) Exercise as a Stress Management Tool. Stress News October 1999 Vol.11 No.4 Grant A 2002 Identifying students’ concerns: taking a whole institution approach. In Stanley N & Manthorpe J 2002 Students’ Mental Health Needs: Problems and Responses London: Jessica Kingsley. Harrison J, Barrow, S, Gask. L, Creed. F. (1999) Social determinants of GHQ score by postal survey Journal of Public Health Medicine 21, 3, 283-288 Hawton, K. Simkin, S. Fagg, G. (1995) Suicide in Oxford University Students 1976-1990. British Journal of Psychiatry, 166, 44-50. HMSO (2001) Special Educational and Disability Act 2001.Crown Copy Right. Javed, MA, 1989, Mental health and overseas students, Ph.D. Thesis. University of Edinburgh. Jensen, L.C, Jenson, J. Wiederhold, T (1993) Religiousity, denomination, and mental health among young men and women. Psychological Reports, 72, 1157-1158) Kim, J (1998). Mind in a Physical World: An Essay on the Mind-Body Problem and Mental Causation. Cambridge, Mass.: MIT Press. King, S.R. Hampton, W.R. Berstien, B. (1996) College Students’ views of suicide. Journal of American College Health, 44, 283-287. Kirkenall, D.R (1986) Effects of Physical Activity on Intellectual Activity on Intellectual Development and Academic Performance. In: Stull GA, Eckert HM. Effects of Physical Activity in Children. Champaign: Human Kinetics, 1986: 22-9

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Morgan, W.P. Goldston, S.E. (1987). Exercise and Mental Health. Hemisphere Publishing. Washington DC. Mottershead, R. (2001) Is Sport and Leisure Benifical as an Alternative Therapy for Patients within a Psychiatric Hospital? Unpublished. Nevonen, L., Mark, M., Levin, B., Lindström, M., & Paulson-Karlsson, G. (2006). Evaluation of a new Internet-based self-help guide for patients with bulimic symptoms in Sweden. Nordic Journal of Psychiatry, 60, 463-468. Nursing and midwifery council (2002) Code of professional conduct. London. Royal College of Psychiatrists (2003) The Mental Health of Students in Higher Education. Council Report CR112. London Universities UK (2000) Guidelines on Student Mental Health Policies and Procedures for Higher Education. London: Universities UK. Webb E, Ashton C.H, Kelly P, Kamali F (1996) Alcohol and drug use in UK university students The Lancet Vol 348, 922-925 Weiss, R.S. (1969). The Provision of social Relationships. In Rubin Z (ed) Doing onto others. Prentice-Hall, Englewood Cliffs N.J. Whitman, N.A. Spendlove, D.C. & Clark, C.H. (1985) Student stress: effects and solutions, ERIC Clearing House on Higher Education, 85-91. World Health Report (2001) Mental Health: New Understanding, New Hope. World Health Organization. Yerkes, R.M & Dodson, J.D. (1908) The relation of strength and stimulus to rapidity of habit formation, Journal of comparative and neurological psychology, 18, 459-482.

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Dr Gavin Baker NEWI Wrexham: The use of narratives in the Negotiated Dramaturgy Abstract In this paper, I will discuss how my concept of a ‘Negotiated Dramaturgy’ is structured and reliant on narratives. A Negotiated Dramaturgy is an approach to Applied Theatre that encourages and relies on the contributions of all the participants to be successful. I designed it initially, as a medium to encourage dialogue amongst marginalised and/or diverse groups and as a means of creative conflict resolution. The Negotiated Dramaturgy consists of the following stages: Initial meeting, PreProduction Forum, Rehearsals and Staging, Dramaturgy and Feedback. Each of these is dependent on the use of narratives to varying degrees in order to achieve success. In this paper, I will explain the way in which I use narratives throughout the process. The concept of the Negotiated Dramaturgy originated in work being completed with corporations in South Africa during South Africa’s move to a democracy and as a means to creative conflict resolution between the Inkatha and ANC political factions in KwaDlangezwa, KwaZulu/Natal South Africa. I designed the Negotiated Dramaturgy to deal with the specific issues that existed there at that time; it is dynamic and heuristic. In Wales, the Negotiated Dramaturgy has been used successfully in communication skills workshop at Careers Wales in Wrexham. In my paper, I will give examples from all of these to illustrate the process of the Negotiated Dramaturgy and its reliance on narratives. The Negotiated Dramaturgy is the form of Work Place based theatre that works on the premise that all the stakeholders taking part in the process create the story lines and characters of the dramaturgy through dialogue and negotiation. Work Place based Theatre is A communication process that uses drama, drama techniques and theatre as a voluntary approach to educating, training, uplifting and informing stakeholders with the specific intention of maintaining or changing the stakeholders’ attitude to the organisation for whom they work (Baker 2000: 5). I began creating the Negotiated Dramaturgy in 1998 working with industries in South Africa, for example: Portnet and Richards Bay Coal Terminal (RBCT). This was at a time when South Africa was emerging from its Apartheid past and was trying to forge new business practices that were all inclusive and non-discriminatory. Industry was also trying to cope with issues of “Affirmative Action” and transparency. While these issues were necessary and easy to legislate at government level, they were a little more difficult to implement at grass-roots level. The Negotiated Dramaturgy was a communication tool designed to assist the process. A Brief outline of the Negotiated Dramaturgy The Negotiated Dramaturgy has five distinct stages. The first is the initial meeting, the second the pre-production forums where the issues are identified and individual stakeholders use narratives to negotiate the objectives and outcomes. The third stage is the rehearsal process where the practitioners create and rehearse the dramaturgy. The fourth stage is the dramaturgy. The stakeholders settle some of the issues in the forums while the practitioners deal with these and other issues in the dramaturgy. Within the dramaturgy stage, there are opportunities for free and open communication using Augusto Boal’s (1992) Forum Theatre. The fifth and final stage is the ‘feedback’ stage where the practitioners report on the process to all stakeholders, not only to the originators (usually management). This includes the plans of action, solutions and suggestions. Each stage of the Negotiated Dramaturgy will now be discussed in detail. The Initial Meeting The initial stage is the original meeting, in which an organisation presents the topic and issues for the campaign. At this meeting, the initiators give the practitioners information regarding the timing, issues, possible approaches, media and the sector of stakeholders involved in the process. The Pre-production Forums The next stage involves the broadening of the stakeholder base to include all concerned sectors of the organisation. The stakeholders divide into small groups in an attempt to create synergy, as they are both targets and agents for change (Samovar et al. 1996: 4). The groups are small to maximise and

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facilitate the interpersonal relations within the group. The practitioners facilitate discussion allowing for diversity of opinions and ideas while encouraging and allowing all the stakeholders to present their views on the issues. This diversity is best appreciated through the individuals’ use of narratives as a means for explaining themselves and their situation. The forums attempt to resolve the issues within their small group while gathering material for the dramaturgy. For example, when discussing the possible ways the supervisor character should act in the play, they are in fact debating the overall operational procedure of supervisors. The practitioners should ensure that as the participants discuss the negative or incorrect operational procedure that they establish the correct procedure as well. These procedures are often drawn form personal experiences, which the participants are encouraged to share with the group. Often the different sectors of stakeholders might disagree or have a different approach (based on different experiences). The forum would then encourage the practitioners to facilitate a negotiated settlement. Often a misunderstanding or lack of knowledge of the situation is responsible for the objective of the campaign. Practical experience has found that contextualising the play, and in particular, the creation of the characters helps establish better understanding of and empathy for each other. For example, management might be unaware of the domestic situation of many of the workers. This situation directly or indirectly affects the productivity of the worker. This knowledge might create the desired empathy and understanding that the stakeholders may use to help resolve an issue or improve conditions. This exercise encourages the participant to become aware of the Socio-cultural and Autobiographical circumstances that shape the communicator and the recipient in communication (Mersham et al. 1995: 55). The style of the negotiated dramaturgy encourages a creative approach to the pre-production forums. Negotiation The term negotiation is used as the creative process is the result of the participants negotiating the story. All the participants need to agree to the characters, storyline and its denouement. Situations and circumstances are brought to the fore, which previously were only known to a few. The essence of this negotiation is dialogue and the creation of an environment that encourages open and frank dialogue. A detailed discussion of Negotiation will occur below. Negotiation is the means to the entire process as it is the central function of each step in the process. As stated above, Negotiation is a communication process between all the stakeholders (Rojot 1991) it is highly interdependent on each party continuously incorporating information from the other party (Weingart et al, 1999) while attempting to achieve the greatest gain with the smallest possible loss (Nieuwmeijer 1988). “These parties exploit asymmetries of interest and power, each knowing that the other may disguise or misrepresent their real position” (Morley 1981: 86). This description of negotiation is negative and confrontational the Negotiated Dramaturgy tries to be creative and positive. This Negotiated Dramaturgy attempts to facilitate dialogue in small groups and through the dramaturgy. The practitioners partly achieve this facilitation through collective bargaining or collective negotiation. The purpose is to reach agreement on issues concerning the group. This negotiation involves both individuals (as members of the workforce or management) and agents (representing the interests of a particular group, e.g. trade unions), (Piron 1978 Nieuwmeijer 1988). This stresses the importance of establishing a suitable environment that appeals to the stakeholders as individuals and to the role they are playing as negotiators on behalf of a group. There is no guarantee as to the way in which an individual will act. Regardless of the negotiation issue, they will act with a degree of freedom in both their individual capacity and in the group capacity (Rojot 1991). It is therefore important to establish an environment that favours the resolution of the issues and the freedom of participants to act as individuals. The nature of this approach establishes tactics, strategies and a sense of trust that will influence its future (Rojot 1991), and the future climate of negotiations. Every section of the Negotiated Dramaturgy incorporates the principles of negotiation. The practitioners and stakeholders use these principles when discussing issues, creating the characters and the story line. Negotiation is also found in the dramaturgy during the in-role forum when possible solutions to the problems are discussed. During the rehearsal process, the practitioners negotiate the staging of the dramaturgy. Having looked at overall ideal the focus can now move to influence of theatre and drama on the Negotiated Dramaturgy. The Nature of Negotiation Reece (1991) states that in negotiation, one should avoid total defeat of one’s opponent. This loss of face will be such that the opponent will be unable and unwilling to co-operate ever again. In keeping face in the negotiation process, the participants should never personalise the debate. It should not

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matter whether one is able to win a slinging match against another person, but that one is able to negotiate a compromise through him or her. The Negotiated Dramaturgy was created with this rationale in mind. The writer’s research into creative conflict management (see Baker and Van der Merwe 1999) established that the ‘notion of a common goal’ (Reece 1991: 21) was effective in this regard. This research is equally applicable to a corporate context. The notion of the common goal encourages the stakeholders to focus on shared objectives. This occurs in the pre-production forums where the objectives are identified and ways in which they can be met are discussed. In these discussions, the stakeholders are encouraged to look at the issues from their and their negotiating partners’ perspective. They are encouraged to assess each other’s perspective, facilitating greater understanding and striving for workable solutions. This approach assist with the natural process of changing priorities as the process of finding a compromise draws on. The common goal is also the dramaturgy. The stakeholders need to create the characters and the storyline; they thus have a common goal that they are working towards. This approach to negotiation is similar to De Bono’s (1986) exploration idiom and using his ‘PMI’ (2006) approach to thinking. De Bono (1986) sees the ‘exploration idiom’ as an effective approach whereby parties do not attack existing ideas. Here participants are encouraged to explore completely new ideas and avoid “thought clichés”. This approach minimises time wastage resulting from stand-offs. A clash of entrenched ideas seldom produces symbiotic resolution; rather it produces unwilling concessions or forces one party to retreat from their position. This style of negotiation produces rigidity in thinking and directs the creativity and ingenuity of parties toward defeating opposing ideas rather than improving them. It results in choosing the options that are more strongly expressed not necessarily the exceptional ones. Argument is negative in that people tend to use it for one party to prove that the other party is wrong, stupid, ignorant or untrustworthy. People use it to impress others, or to set the emotional climate for negotiation. In opposition to this approach, one may use creativity in an argument to assist exploration of an issue, or to cast doubt on certainty and to bring about new insights. Negotiators should move away from the concept of ‘your idea vs. my idea’ and strive for ‘our idea’.

The Design Idiom The Negotiated Dramaturgy reflects De Bono’s (1986) design idiom in its structure. This idiom encourages thinking that involves the constructive investigation of a situation with the aim 191of designing an outcome. In Negotiated Dramaturgy terms, this is working through the pre-production forums, the dramaturgy and ending with setting the plan of action for the negotiators. De Bono (1986) suggests a variety of simple thinking tools to free people from becoming locked into traditional logicbased conflict modes. De Bono (1986:82) proposes that in the face of the complex manipulative designs of conflicts a process of un-design is required, “un-ravelling the strands that have come together in this way and seeking to put together in another way”. This involves identifying the minor disagreements that may lie at the foundation of major conflicts. These minor disagreements have festered and caused any possible opportunity for agreement to seem unobtainable. Ideologies may start far apart but grow closer over time, reducing actual contraposition on issues except in the minds of the parties involved. One may use design tools to explore the possibilities of achieving outcomes that accommodate seemingly incompatible views, or that are built on common elements of perceptions, i.e. by focusing on areas of agreement rather than on disagreement. The Negotiated Dramaturgy attempts to shift perceptions so that the stakeholders see things differently. It offers conflicting parties new objectives. In this way, conflict situations are broken down into small obtainable objectives the stakeholders can then make an effort to construct them into a new design. The process departs from the major dispute and focuses on working towards resolution of other smaller issues that help contextualise the greater one. The Using De Bono’s (1986) methodology the Negotiated Dramaturgy identifies desirable objectives and then works constructively through the pre-production forums and the dramaturgy towards achieving these objectives. The preproduction forums facilitate the brainstorming of ‘dream solutions’ as possible outcomes. The Negotiated Dramaturgy emancipates the thinking process by making small speculative changes (if x were the case then…). Role-play in the dramaturgy tests these speculative changes. The process actively overcomes and removes preconditions and blocks, working outside of the stakeholders’ boundaries rather than within them. The Negotiated Dramaturgy works down from broad pictures towards values and objectives rather than vice versa. It establishes core principles and then builds

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outcomes around these. This approach encourages the stakeholders to forego argumentative approaches in favour of conflict resolution. Rehearsals and Staging The practitioners base the story line and characters on the objectives established through the narratives shared in the pre-production forums. This dramaturgy is designed to be a three-dimensional form of these narratives while also creating the opportunity for further sharing during the forum. This process allows the stakeholders to become the communicator with the same status and credibility as the ‘original’ communicator(s) or initiator of the project. They have a sense of empowerment as their stories are being told in a way that they suggested. The Creative Process This process has its roots in the collective creative processes of production devising. Throughout the process, dialogue is encouraged. This occurs while creating the dramaturgy. Each small group in the preproduction forums has a responsibility for one part of the play. The participants are encouraged to create scenarios and characters that will work and that are real and typical of the organisation for which they work. This is opposed to the more ‘traditional’ approach where a director interprets a playwright’s text and creates a production through a particular production process (this approach is favoured by some Work Place Based Theatre practitioners). The practitioners use the principles of creative drama as the catalyst. Creative drama is associated with the notion of ‘play’. It is a dramatic learning activity, guided by a leader that allows participants to imagine, enact and reflect upon real or imagined human experiences. Pinciotti (1993) and Woodson (1999) argue that it nurtures both individual and group skills, enhancing the participants’ ability to communicate their ideas, images and feelings with others through dramatic action. The stakeholders share ideas as their imagination defines the story, the setting and the characters. This process is highly theatrical as practitioners encourage the participants to demonstrate (act out) their ideas rather than just talking about them. Personal experience shows that participants find it easier to express themselves in this way. For example, when a stakeholder struggles to share his or her idea or wants to reinforce its potential he or she often gets up and acts out the idea, sometimes alone, sometimes using others in the group. In many instances, this spurs the creativity of the others enabling the process. Undoubtedly, this varies from group to group but is universal in groups showing high levels of cohesion. Moore’s (1997) research into the cognitive processes of small groups documents this as a common occurrence. It is essential for the practitioner to create this cohesion. From the outset, the various practitioners might see themselves as opposing each other (for example, management and trade unions). Johnson (1998) argues that practitioners can improve cohesion by allowing the stakeholders to become aware of their similarities and what they have in common (the general good of the organisation) and the need to focus on a common goal (the creation of the story and characters). The dramaturgy needs to address issues that are specific to the campaign. The preproduction forums establish the needs, formulate the objectives, formulate the message and establish the time frames. The participants create the plot and the characters to deal with the needs, objectives and message of the campaign, while also defining the dialogue. The Characters The characters are dramatic creations of typical people found within the organisation. Often they are stereotypes and caricatures designed to appeal to as many of the stakeholders as possible. Experience shows that these characters should be blatant in their actions and their intentions. The characterisation must be clear to the diverse audience and represent an employee of the organisation. When creating the characters the participants are asked specific questions, such as: the age of the character, gender, where he or she lives, how they travel to work, what department do they work in, how do they get on with their colleagues, how they get on with their immediate line manager and with the rest of management. They are also asked to create a flaw, or problem that the character has, for example, not taking the necessary precautions when working with cleaning products. The idea of Brecht’s ‘Distancing Effect’ assists the practitioners in this style of characterisation. It draws the audience’s attention to a particular point or object (Brecht 1964) thereby eliminating the ‘magic’ of the theatre. Often theatre is associated with the creation of a magic reality in which the

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audience sits backs and enjoys the spectacle. The magic of the theatre absorbs the audience and therefore they are not required to think about what they are watching. The ‘distancing effect’ encourages the audience to adopt an attitude of enquiry and criticism in their approach to the story of the play (Brecht 1964 Counsell 1996 Mitter 1992 University of Queensland 1999). Brecht proposed that acting should show, and not evoke empathy (Brecht 1964). Following on from this, the group then create a playable scenario. They are asked to add as much information to the scene as possible, for example, location, time of day, task of the individual, what the line-manager’s reaction is and so forth. The group then resolve the issue, giving more than one solution if possible. Different types of solutions are discussed, different viewpoints shared some form of self-disclosure occurs situations, conditions etc are shared among the group The group then pass these on to the practitioners who use them in the rehearsal process when structuring and rehearsing the dramaturgy.

The Structure The structure of the dramaturgy is vital for effectively communicating the intention of the message. Hauptfleisch (1978) states that the playwright manipulates the ‘vocabulary’ of a play, particularly the scenes and episodes within the total plot, for a variety of purposes. The aim of the Negotiated Dramaturgy is to share an intended message with the stakeholders. The message (decided upon by the stakeholders) is broken down into objectives, which form the basis of each scene. Similar objectives are grouped together in one scene to create the narrative for that scene. These scenes become individual narrative units within the overall narrative structure of the dramaturgy. The scenes operate as if the narrative running through the entire dramaturgy was independent of time. This structure is likened to the episodic nature of Brecht’s theatre (Brecht 1964 Mitter 1992). Brecht’s Epic Theatre that makes use of closed ‘parable’ plays structured episodically, which focuses on a moral dilemma and allows vital questions to be unconditionally aired with a view to their resolution (Brecht 1964 Counssell 1996 Styan 1981). This allows the audience the chance to make its own judgement (Brecht 1964). Brecht’s theatre presents a structure that allows practitioners to use theatre for public discussion (Brecht 1964 Styan 1981). The Negotiated Dramaturgy shares the intentions of Brecht’s epic theatre. It is therefore inspired by its structure. Each scene may be a play in itself and not necessarily be one scene in an overall play. The scenes may refer to each other to establish cohesion. This cohesion supports the message(s) being shared by the dramaturgy. The practitioners style each scene as a ‘well made play’ using the Aristotelian idea of a beginning, middle and an end. These scenes have a horizontal organisation structure (Hauptfleisch 1978 quoting Smiley 1971) meaning that they are linear in their progression. These self-contained episodic scenes form part of a larger structure that is styled on Boal’s Forum Theatre, which in turn, was inspired by Paulo Freier’s (1968) Pedagogy of the Oppressed.. Using Boal’s (1992) “rules of the game” to formulate the structure of the dramaturgy it should have the following characteristics: The dramaturgy must clearly represent the nature of each character, identifying them precisely and accurately, so that the audience can easily recognise that the ideas and beliefs of each character. The solutions proposed by the practitioner must contain at the very least one consciously devised workplace error, which will be analysed during the in-role forum. The play must present a mistake or a failure, inducing the stakeholders to finding solutions and inventing new ways of confronting the issue. The practitioners must pose good questions, allowing the stakeholders to supply good answers. This action must open the channels of communication, creating a free, enabling environment for all parties to participate. The negotiated dramaturgy can be of any genre. Surrealism or the irrational should, however, be avoided as the participants find these styles difficult to understand, thereby limiting their chances of becoming actively involved in the process. This tends to alienate the audience, causing them to struggle to understand the objectives rather than being able to concentrate on the issues that the objectives present. Therefore, the style does not matter, as long as the objective is to discuss, through the medium of theatre, concrete situations.

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Practical experience shows that limiting each scene to two or three characters is the ideal. It keeps the scenes simplistic while enabling sufficient character development to deal with the issues and objectives. The practitioners rehearse the dramaturgy and conduct the pre-production forums simultaneously. This creates a ‘feedback’ channel between the stakeholders and the practitioners that allows for constant interaction on the narrative and characters as well on the technical correctness of the action and terminology. The ‘Feedback” Stage The final stage of the negotiated dramaturgy is the ‘feedback’ stage where the practitioners report on the success of the process to the originators. They comment on the issues raised during the preproduction forums and in the dramaturgy. This includes the plans of action, solutions and suggestions. The type of ‘feedback’ varies according to the brief given to the practitioners. ‘Feedback’ might take on one or more of the following forms: An informal discussion where the relevant points are raised A written report that briefly discusses the experiences and observations of the practitioners. A formal presentation that discusses the practitioners’ experiences and observations of the project. (This can include video, and stills photography footage). Submitting video and stills photography as well as a written report. Conducting post research into the effectiveness of the campaign, using questionnaires etc. and compiling a research document that addresses the objectives of the campaign in detail. A shortened version of the Negotiated Dramaturgy was used for one-day workshops on Diversity. In these workshops, participants were asked to create one simple scene in which to assist the participants with the theme of diversity. The majority of the first part of the session was spent creating the characters and the setting the scene. This involved the participants sharing experiences and creating a better awareness of themselves and their needs. This campaign was particularly successful amongst middle management grappling with the issues of “Affirmative Action” or Positive Discrimination. Its intention was to encourage dialogue and engender understanding. In conclusion, the dynamic nature of the negotiated dramaturgy encourages dialogue and empowers the participants to play an active part in the communication process. Through the creation of a dramaturgy based on personal narratives, they are able to address issues that are pertinent to the group then. Sources Consulted Baker, G. (2000). Negotiated Dramaturgy - Industrial Theatre as Communication in the Organisation. Unpublished D.Phil. Thesis. University of Zululand, South Africa. Baker, G. & Van der Merwe, M. (1999). Community empowerment - creating the tools from within: creative conflict management in KwaDlangezwa, KwaZulu/Natal. Paper presented at the South African Political Studies Association’s Biennial Congress on ‘Political Studies at the Turn of the Millennium’, 29 June - 2 July Boal, A. (1992). Games for actors and non-actors. London: Routledge. Brecht, B. (1964). Brecht on theatre: The development of an aesthetic. Willet, J. (ed. and trans.). London: Metuen Cathcart, R.S., Samovar, L. & Henman, L. (1996). Small group communication: Theory and practice. Seventh edition. Madison: Brown and Benchmark. Counsell, C. (1996). Signs of performance: an introduction to twentieth-century theatre.. London: Routledge. De Bono, E. (1986). Conflicts: A better way to resolve them Middlesex: Penguin Books. De Bono, E. (2006). De Bono’s thinking course: powerful tools to transform your thinking. London: BBC Archive. Freire, P. (1968). Pedagogy of the oppressed. London: Penguin Books. Hauptfleisch, T. (1978). The play as communication: A study of the language of drama. Pretoria: University of South Africa. Unpublished D.Litt. et Phil. Thesis. Johnston, C. (1998). House of games: Making theatre from everyday life. London: Nick Hern Books.

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Mersham, GM., Rensburg, RS. & Skinner J.C. (1995). Public relations, development and social investment: A South African perspective Pretoria: J.L. Van Schaik. Mitter, S. (1992). Systems of rehearsal: Stanislavsky, Brecht, Grotowski and Brook. London: Routledge. Moore, RM. (1997). The positive effects of cohesion on the creativity of small groups. in International social science review. Vol 72 Issue(3/4). pp 84-93. Morley, D. (1980). The ‘nationwide’ audience: Television monograph 11. London: British Film Institute. Nieuwmeijer, L. (1988). Negotiation: methodology and training. Pinetown: Owen Burgess Press. Piron, J.M. (1978). Theory of collective bargaining. in Journal of Roman-Dutch Law 41 March Pinciotti, P. (1993). Creative drama and young children: The dramatic learning connection. in Arts education policy review. July/August Vol. 94 Issue 6: pp 24-29. Reece, K. (1991). Trade unions and management. Johannesburg: Lexicon. Rojot, J. (1991). Negotiation: From theory to practice. London: MacMillan. Samovar, LA, Henman, L. & King, S. (1996). Small group process in Small group communication: Theory and practice. Seventh edition Cathcart, Samovar & Henman (eds.). Madison: Brown and Benchmark. Smiley, S. (1971). Playwriting: The structure of action. Englewood Cliffs: Prentice Hall. Styan, J.L. (1981). Modern drama in theory and practice 3: Expressionism and epic theatre. Cambridge: CUP. http://www.uq.edu.au/~enrfothe/brecht.htm. 15 University of Queensland, (n. d.). September 1999. Weingart, L.R., Prietula, M.J., Hyder, E.B., and Genovese, C.R., (1999) Knowledge and the sequential processes of negotiation: a Markov chain analysis of response-in-kind in Journal of Experimental and Social Psychology 15: pp 1-8. Wiseman, R. & Schenck-Hamlin, W. (1981). A multidimensional scaling validation of an inductively-derived set of compliance-gaining strategies. in Communication monographs. 48: pp 251270. Woodson, SE. (1999). (Re)Conceiving ‘Creative Drama’: An exploration and expansion of American metaphorical paradigms. in Research in drama education. September Vol.4 Issue 2: pp 201-225.

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Marion Clark University of Birmingham England: KNITTING UP THE UNRAVELLED SLEEVE My Journey through Mental Distress to Recovery Abstract This paper concerns the development of my personal narrative of recovery from a profoundly lifechanging experience of mental and emotional collapse. It includes: an inquiry into the mental and physical manifestations of my illness, which were both terrifying and fascinating; an account of building a new coherence through using every resource I could call upon from my own life experience to find my explanations for the situation in which I found myself; and discussion of the use of symbolic actions and metaphors in the recovery process. It also addresses some of the competing narratives underlying the responses from mental health services and reflection on the usefulness of some theoretical insights in addressing mental distress. Shakespeare: MACBETH Act 2, Scene 2 Macbeth: “Me thought I heard a voice cry ‘Sleep no More! Macbeth does murder sleep’ – the innocent sleep, Sleep that knits up the ravelled sleeve of care, The death of each day’s life, sore labour’s bath, Balm of hurt minds, great Nature’s second course, Chief nourisher in life’s feast,-“

INTRODUCTION The pattern of the sleeve For many years my life revolved around working, firstly in book publishing and then as a teacher of modern languages, being a political activist and bringing up my family. I grew up in a small town by the sea in Scotland, with a loving family who gave me lots of independence, and amongst kindly people. I was amongst the beneficiaries of the early welfare state, went to university, studied languages and travelled quite a lot. I had many interests – history, culture, music, art and other things. So you could say that for a long time the sleeve had quite a nice pattern – multicoloured and with lots of different designs – but unfortunately with quite a few holes in it! The sleeve unravels In autumn 1994 I underwent a profoundly life-changing experience of mental and emotional collapse which was given the label “psychotic depression”. (I will address later in the paper how I thought this collapse came about.) Over the next seven years and more I went through several episodes of what is termed psychosis, clinical depression, suicidal tendencies and paranoia. These episodes variously included conspiracy theories, the idea that people could read my thoughts, that I was being sent messages via the television, hallucinations of sight, smell and hearing, that someone was trying to kill me, and so on. I experienced acute anxiety because I thought I had to understand the messages. These experiences meant that my life, day and night, was consumed by the struggle first of all to avoid being overwhelmed by and later to understand the nightmare world I had entered. Mostly I managed the basic essentials of life but beyond that all my time and energy were given over to managing the distress I felt. There was no question of going back to my teaching job. My relationships with my husband, children, family, friends and the world in general completely changed. I changed from being a generally welcoming, open and friendly person to someone quite different. I often found it very difficult to relate to other people, even close friends, was anxiously preoccupied by trying to work out what conversations really meant and from time to time became a recluse, shutting myself away, physically and emotionally, from everyone. At other times I was hyperactive, had moods of complete euphoria and got very excited about some of the ideas milling around in my head. My situation now is that I have taken no medication and have had no “episodes” for several years. I have also resumed my interest in many of the things I used to enjoy and have gone back to work, as a User Involvement Coordinator at the Centre of Excellence in Interdisciplinary Mental Health, based in the University of Birmingham. So how did I get to where I am now?

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THE RESPONSE OF THE MENTAL HEALTH SERVICES My first contact with mental health services was through my GP. At that point I clearly had some control over my mental state because I was able to go to the surgery and explain in general how I felt – a feeling that if my life was a rug, then this had been pulled from under me and sent me tumbling into the outer darkness. My GP referred me to the local psychiatric hospital but after about three weeks, during which my mental state deteriorated significantly, my husband rang up and asked for someone to come and see me urgently. I then had several visits from a psychiatrist and was prescribed anti-psychotic medication. I was also referred to a consultant psychologist with whom I had three sessions. Over the next seven or more years I had intermittent episodes of psychosis, severe depression and paranoia. These episodes had somehow or other been managed with me being able to stay at home, with the support of my husband and family. One episode of acute paranoia resulted in a hospital admission – voluntarily, since I was aware by this time that I really needed help. However, it gradually became clear to me that although medication had reduced the severity of my symptoms, I was being given no explanations as to what those symptoms might mean. My husband (not me) was told that if I had only the one episode of psychosis it was unlikely to recur, but if I had another, then another, the likelihood was that I would never be free from psychosis. What I also found was that anti-depressants were not in themselves the answer to my depression, which became so severe that I was completely unable to function. I was prescribed stronger and stronger medication and was told that lithium and eventually ECT could be considered as treatments. My view is, as with the anti-psychotic medication, the anti-depressants were helpful to some extent but gave me no answers. Lithium, ECT and the notion that I would never be free from psychotic episodes and depression were a step too far for me; I reached the position that I had to find my own answers if I was ever to escape from these most debilitating conditions. It would not be true to say that everything I was offered from mental health services was negative or useless. Nor do I think that psychiatrists are the enemy. Soon after my contact with mental health services, I saw a consultant psychologist for three one-hour sessions who gave me two booklets explaining what depression is and what I could do about it. Reading through the material now, it is true that it could be helpful if you were someone who was able to change their behaviour in the ways suggested. However, at that time I was depressed, but more importantly, I was still floundering and traumatised by the episode of psychosis I had just gone through. I was in no state to read, absorb and act on the advice given. This does not seem to have been understood, and there were no follow-up sessions to check whether reading the literature had made any difference. I don’t know why this happened; perhaps I hid my thoughts and feelings very well (and I had thoroughly absorbed the idea that a mental health breakdown is very embarrassing and I wasn’t supposed to talk about what was going on in my head) and came across as a competent person who didn’t need that much help. Several years later, when I had basically resolved most of my problems of recovery, I was offered ten sessions of brief therapy. The best thing about this was that the therapist just sat and listened to what I had to say. He had a very affirmative attitude towards what I was saying about myself. After an argument with a psychiatrist (about evaluating my treatment after seven years), I was again referred to a consultant psychologist. I had to wait for about nine months for an appointment, during which time I got on with my own recovery plan. Again, the psychologist listened to and affirmed what I had to say, and would gently steer the discussions in a particular direction to elicit what might be missing, which I found very helpful. My husband (and children) were offered little advice over this time about how to cope. Some of the advice offered was unhelpful, e.g. that he was not to encourage me in my “delusions”. I remember one incident when I had been out somewhere and had experienced a group of people as being very hostile to me. When I went home and told him this, he said that it hadn’t happened – I was imagining it. This made me extremely angry because of course what I experienced was very real to me and I felt that by denying how I had experienced a situation he was invalidating me as a person. I distinctly remember throwing three glasses at him – luckily I threw to miss. For me this act of violence speaks volumes about the inadequacy of the mental health services and what that might lead to. FINDING MY OWN EXPLANATIONS

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Sometimes I found my “altered states” of “reality” quite welcome and not threatening, but all too often I found my experiences extremely painful and terrifying. The only way I could ever describe some of what I experienced was to say: “If you can imagine, or have experienced, extreme physical pain, then that’s what mental distress is: extreme mental pain”. Whilst I became disenfranchised and disempowered to an extent that I now find astonishing, it is also true that I found some of my experiences completely fascinating and absorbing; I was very curious about the causes of the hallucinations and my new thought processes and wanted to understand how these things could happen. Writing this paper is about reflecting on and describing the process I embarked on to find answers for myself. It is about questioning the fundamentals of some of the current explanations and the responses of mental health services to the distress of service users. It is also about how I used every resource I could call upon from my own life experience to build a coherent understanding and explanations of the situation I found myself in. . The question has been asked: Since the statutory services were giving you inadequate help, why didn’t you arrange for private counselling? My answer to this is that firstly, both I and my family put a lot of faith in the ability of the NHS to help us when in need and did not expect to have to look elsewhere, and secondly, what I went through was a profoundly isolating, alienating and confusing experience. It was deeply traumatic and it has taken me more than twelve years to get back to a level of functioning that most people consider “normal”. I was given no information about different therapies, nor about what service users have written about their experiences and what they find helpful. In fact, there is a large body of literature by users and survivors about their experiences, interpretations and conclusions. I would have found this material very helpful (for example, Bangay et al 1992; NorwichMIND:2004; O’Hagan:1994; Oxnam:2006; Smith:2004) I really did end up thinking there were no answers to be had except from myself. BUILDING A DIFFERENT COHERENCE Picking up the stitches The interpretation I made of the breakdown I experienced was that I had been living in a way that left little time or space for me. Bringing up children in a society which is not particularly child-friendly, working as a secondary school teacher in an education system which is also not child-friendly, being actively involved in politics – these are all areas of giving, of time, energy and effort. I lived with high levels of stress but had not really understood that that was what I was doing. I was also experiencing quite high levels of anxiety and some depression, but again was not particularly aware of this situation. Like many other people, I thought that that was life. Self A large part of finding answers was the decision to focus on ME/SELF. This seemed a radical thing at the time, since I was pretty thoroughly imbued with the idea that to put yourself first is to be egocentric, selfish and even sinful. I felt that over the years my “self” had become depleted, submerged in the various collectives of family, work, politics, and to become well I had to rebuild this “self”. I don’t see this situation as anyone’s fault – not even mine – but as facts, situations which developed whilst getting on with life and living in a society with which I was generally at odds. I cannot claim to fully understand the process of becoming ill (although I came to understand what the triggers were) and then emerging from it, but after each episode I would emerge thinking: what on earth was all that about? I spent a lot of time reflecting on what my unusual thoughts might mean. Most importantly, I felt that within me there was a small “core” holding on, and that what I had to do was to grow the core. This was a creative, organic and dynamic process; developing a coherent view took quite a long time, with a lot of trial and error, not to mention getting ill again. Concentrating on myself was a practical programme of taking each area of my life and identifying where I wanted to be. At first I set ambitious targets to be met in too short a time but I learned over time to identify one small thing that I could do and build from there. The areas of my life that I identified to work on were areas of life such as: Home Relationships

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Work Relaxation Health Creativity Study I read several self-help books, articles from women’s magazines that looked useful, odd books picked up in charity shops (unfortunately I can’t reference these as they have been given away) – anything that had some resonance with my situation. I also used ideas from my general knowledge of psychiatry and psychology, e.g. from Freud, Jung and Laing. Some useful theoretical insights – the “pick and mix” theory of recovery I have only a passing acquaintance with the seminal works of psychoanalysis and psychology, no more than the average moderately-read person. I vaguely remember Freud and Jung from a short psychology course when I was an undergraduate. I still have to go and look up what Freud actually said about the id, the ego and the superego, but what I did find useful was using this and other formulations to hang my thoughts on. I find it difficult to explain how I used these ideas but the fact remains that by using them and other ideas I managed to cobble together a recovery programme which worked for me. Jung’s ideas about the collective unconscious seemed to me to be very important, in that when striving to understand why I was having particular thoughts, I was aware that the huge amount of interaction and communication was having a significant effect on what I was thinking, saying and doing. I mean things like: I was born into north-west European, advanced industrialist culture, with its Christian roots; I had chosen to discard religion and firmly placed myself in the European tradition of rationalism and materialism in philosophy. However, what I found was that at some stages in my “illness” I became deeply – and terrifyingly – preoccupied with ideas of good and evil, God and Satan, to the extent of thinking that I was a truly evil person, responsible for the ills of the world and that I should therefore kill myself. I had “voices” telling me this. I also developed what I call the “Jesus complex”, whereby I was being called upon to sacrifice myself for the good of the world. In my view this kind of thinking on my part shows how deeply embedded these ideas from culture are, even though consciously rejected. But I think it’s also true that this seemingly bizarre thinking does come from aspects within my own personality and choices I have made in my life. When I was in a more balanced frame of mind, I found I was able to think through these questions of good and evil and take steps to deal with the terror that had accompanied my “altered” thoughts Identity As part of rebuilding my “self” I focused on the notion of who I was and what made up my identity. I saw my identity as being made up of: Woman Wife Mother Scottish, living in England British Working class origin Teacher of French Left-wing radical I perceived my identity as being eroded in some areas or too developed in others, and used the same method as before to “recreate” an identity, i.e. by taking each area in turn and deciding on something to change or do to reinforce a particular area. I would wear different “hats” at different times, so my family would on unexpected occasions be treated to some rousing Scottish bagpipe music! From my teaching experience I had learned that understanding what stage something or someone is at is essential to good teaching. Where I felt I had “missed out” stages in my life I decided that part of reinforcing my identity would be to “revisit” parts of my life and try to fill the gaps. As a teacher I had also learned that people learn at different rates and at different times in their life, therefore the whole concept of what “should” be was not a helpful one. We all know that we “should” eat more healthily, take more exercise, do this, don’t do that and so on, but this does not help to

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actually change anything. When I was feeling very depressed and unable to get out of bed, I would make a “to do” list to be ticked off in the evening – this would make me feel better. Of course, what actually happened was that usually nothing on the list would be done and I would end up feeling worse. So I decided to start from the bottom end – anything at all I managed to do in the day was a cause for celebration. Even if all I could do was get out of bed and wash my hands this was a great achievement and I would spend the rest of the day telling myself I was a wonderful person. Somehow this enabled me to build up the capacity to do more – I stopped beating myself up. Use of symbolism On reflecting upon what I did when I was either ill, in an altered state of consciousness, or however one wishes to formulate what happens in a psychotic episode, I noticed that the use of symbols was very important to me, for example I felt compelled to straighten everything up and would go around the house making sure bottles, tubes, hairbrushes, cutlery – as many things as I could find – were in straight lines. I interpreted this as me trying to sort out a chaotic world. This and other activities became obsessive in a way that took over my life; I had no control over them. So when I was in a frame of mind that enabled me to think why I should want to do those things, I decided that if they were so important to me and could make me ill, then I could use the same process to make me well and in control of my thought processes. I embarked on a programme of using symbols which I think became a way of life. If I was feeling that my thoughts were in a chaotic state, I would deliberately and consciously go around making things straight, tidy up piles of papers and so on. If I felt that I was “splitting” into different “persons” I would eat a pear as a symbol of a “pair”, i.e. two things united in one object. If I felt angry, I would avoid eating or wearing anything red (“red rag to a bull”), and would choose cucumber (as cool as ..) and other foods with “cool” connotations. If I was feeling depressed, I would eat an orange as a symbol of bringing some sunshine into my life, and so on. I wore make-up deliberately as a mask to deal with the feeling that the world was a hostile place and I needed to protect my “face”. I drank water for its cleansing and healing properties. I took a lot of notice of the colours I was wearing and what that might mean to me (navy – authority? Black – funereal? Red – blood?) I also decided at some point that what I was thinking and saying was not bizarre and meaningless, but had some purpose. I often followed a kind of “stream of consciousness”- type activity, but I found that following and acting on my thoughts led me to some terrible places, and I wonder sometimes if this is where my hallucinations came from (e.g. seeing “ghosts” and having powerful sensations of suddenly smelling things that were not in the room). I used visualisation a lot and created a strange and powerful world for myself, following thoughts and sensations that I was intensely curious about. Another thing that became very important to me was the question of balance; I would aim for balance in as many areas of life as possible. Eventually I came to understand that it was very easy for me to descend into a negative spiral of thoughts and feelings which resulted in depression and possibly episodes of psychosis, therefore what I had to do was to construct a positive spiral. I also developed a “small pools” strategy, i.e. creating small pools of happiness (and other good things) in my life, which hopefully would all join up at some time to form a large one! Necessary narcissism When observing what I said and did, I noticed that I quite often looked at myself in the mirror. The knee-jerk reaction to this would be that I’m a vain and egotistical person. My friends tell me that this is not the case. What I decided I was doing was part of trying to establish my own identity and self – looking at myself in the mirror was me “fixing” my identity in my own eyes. But this could only be done in a positive framework. The other side to it was, when experiencing the overwhelming feeling that I was a truly evil person, looking in the mirror awakened the terrifying idea that I was destroying myself, as in the story of the basilisk being confronted with its own ugly image. Knit one, purl one ……………. Another thing I did was to take the idea of “recreation” literally, in the sense that I wanted to “recreate” my life in a way that would make me relaxed, happy and productive. So, anything that had any connotation of “creating” became part of my deliberate and conscious activity. For example, if I was feeling fragmented, I might do some sewing – the idea being that I was literally showing my brain/mind/consciousness how to bring things together. Or else, following Shakespeare’s “sleep that

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knits up the ravelled sleave of care”, I would sleep a lot and sometimes do some knitting, again as a literal demonstration. The main point for me here, and it’s an absolutely central and fundamental one, is that I did these things with great concentration, deliberately and consciously, otherwise they had no significance. COMPETING NARRATIVES FROM MENTAL HEALTH SERVICES First of all, I recognise that I had a particular experience which is not necessarily the same as anyone else’s. (Indeed, I would not recommend anyone to do some of the things I did.) But it’s also true that I have found many similarities in user/survivor literature and in discussion with other mental health service users.(Azman:2007; Hart:1995; Jamieson:1995; Read and Reynolds:1996; Simpson:2004) So what was the underlying story I was faced with in the mental health services I was offered? - that people with severe mental distress have no autonomy and are incapable. Whilst I found this to be true at certain points, it is also the case that when “in remission” I was quite capable of analysing and discussing my own situation and what might help to resolve it. In fact, there was active opposition from the first psychiatrist I saw to my attempts to discuss some of the things I was thinking about. - The view that what I did, said and thought during an episode of psychosis was bizarre and inherently meaningless. This notion made the experiences even more distressing and inexplicable by turning everything into a mystery incapable of solution. The only thing to do with such thoughts, I and my family members were told, was to suppress them and forget about them. - The notion of inevitability and the “life sentence”. My husband was told that several episodes meant that I would probably never be free from psychosis. - the notion of escalation and containment being the only answers (i.e. stronger and stronger antipsychotic and anti-depressant drugs), even though this kind of treatment was clearly not working - the influence of thinking based on stereotypes. This is hard to prove, but I feel that assumptions were made on the basis that I was middle class, well educated, professional, with a partner able to look after me. One psychiatrist made derogatory comments about my politics, without actually knowing what my politics were. (Apart from the fact that, unless I raised politics as an issue, my politics were none of the psychiatrist’s business.) - what I came to understand eventually is that there are “fashions” in theories about mental distress and that some very useful ideas and work are dismissed and something else becomes dominant (e.g. the medical model, which of course also has positive aspects). For people on the receiving end, it is not helpful to set one treatment option against another. Time and again, over decades, mental health service users have articulated that what is wanted is a flexible approach, or approaches that are appropriate for the problem being addressed. (for example, Chamberlin 1988; Glynn and Ansell:2006; MHF:2000; Pembroke:1992). It seems to me now that I needed different approaches at different stages of my recovery journey: at some points Cognitive Behavioural Therapy (CBT) would have been useful and at other times solution-focused therapy (to name just two) would have been very helpful. As it was, I had to become my own therapist. THE USER/SURVIVOR MOVEMENT AND ITS ALLIES I came across the user/survivor movement in 2001 and was astonished to find that it had been in existence for decades and had produced a large amount of literature, as well as organising many important user-led events. (Campbell:2006; Stastny and Lehmann:2007). An important part of my recovery has been my contact and activities with other mental health service users and their allies, who have made a colossal contribution to forcing change in mental health services and increasingly to how mental distress and mental health are understood. Not nearly enough recognition and credit – let alone reward – is given to this fact, ample evidence of which is given in the material listed in the References. Since becoming involved with this movement, I have worked firstly with practitioners who are committed to improving mental health services, and now with academics who are committed to improving teaching and learning about mental distress. This offers great opportunities for collaborative work which is productive for all of us. In preparing this paper, I have been intrigued by the responses I have received from academics and practitioners who have read what I wrote. I have had discussions about the “false self”, what kind of therapies are available and so on. What is clear is that there are many resources to be called upon and what is needed is for those resources to get to the people who need them.

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TERMINOLOGY The terminology I have used throughout this paper is deliberately chosen to reflect how I wish to describe my experience. I am aware that terms like “illness” and others are a disputed area, and quite rightly so. But I would resist any attempt to tell me I wasn’t ill, since however fascinating some of my experiences were, I most definitely felt ill. NOT ALL GLOOM AND DOOM But I should also say that some of the things I worked out in my personal recovery strategy were enormous fun – it certainly wasn’t all gloom and doom. You can have a lot of laughs with symbols. It’s also important to understand that things have changed and are continuing to change. In November 2006 a user-led event was held at the Centre of Excellence in Interdisciplinary Mental Health (www.ceimh.bham.ac.uk) entitled “Two Decades of Change: Celebrating User Involvement”. In his keynote speech, Peter Campbell, a veteran activist of the user/survivor movement said: “[twenty years ago]….. we were not involved in debates about understandings about what madness, distress, mental illness is. Nobody listened to us. Nobody thought we had anything worthwhile to say about our own experiences because we were mentally ill, we couldn’t possibly have any ‘insight’ into what our lives were about. That has changed.” (Clark and Glynn:2007:.40) REFERENCES Azman, R. (2007) Depra. Chipmunka Publishing Bangay,F., Bidder, J and Porter, H. (eds), (1992), Survivors’ Poetry: From dark to light, Survivors’ Press, London Campbell,P. (2006) Broken linoleum, Green Lawns. Healing Eye Chamberlin,J. (1988), User controlled alternatives to the mental health system? MIND, London Clark,M. and Glynn,T (2007), Two Decades of Change: Celebrating User Involvement, Centre of Excellence in Interdisciplinary Mental Health, Birmingham Glynn,T. and Ansell,J.(2006) Survival and Abuse: What We Can Learn From It, Journal of Social Work Education, Vol.25, Number 4, June Hart,L. (1995) Phone at nine just to say you’re alive. Douglas Elliott Press Jamieson, K. (1995), An Unquiet Mind. Knopf Mental Health Foundation (2000). Strategies for Living, MHF, London Norwich MIND (2004) Escape to reality: five life stories from individuals who share experience of mental illness and recovery. MIND O’Hagan,M. (1994). Stopovers On My Way Home from Mars. Survivors Speak Out, London Oxnam, R. (2006) A fractured mind: my life with multiple personality disorder. Hyperion Pembroke,L. (ed), (1992), Eating Distress: Perspectives from personal experience. Survivors Speak Out, London Read,J. and Reynolds,R. (eds)(1996) Speaking Our Minds: An Anthology. Macmillan, Basingstoke Simpson,T (ed) (2004) Doorways in the night: stories from the threshold of recover. Local Voices Smith,R. (2004) Stop Paddling, start sailing: a journey and some ideas. Publish Britannica Stastny,P. and Lehmann,P. (eds.) (2007) Alternatives Beyond Psychiatry, Peter Lehmann Publishing

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Tracey Holley University of Birmingham England.: A Service User’s Story - the Narrative Edge: An account of my own illness and the resulting implications for research and teaching in health and social work and beyond. Abstract I will reveal a narrative journey from despair and suffering to recovery and empowerment, including concomitant personal analogy to help to describe the indescribable. Recounting my storytelling and lecturing in universities, I will highlight the immense power emotional discourse lends to the learning process. Provision of a service user/survivor as expert by experience - as narrator, provides added value to the often more discursive professional teaching process. The authentic user’s voice of experience enters into the narrative tradition of passing on wisdom through the spoken word and from the heart, for added impact. Speakers of their own stories, engaged in the learning of others, benefit from being heard. Centres of excellence provide a listening audience to an otherwise unheard experiential knowledge base; thereby inviting a previously silent and marginalized voice into the centre of academic discourse. The outcome is two-fold. I hope to illustrate how the pedagogic and therapeutic double-edged sword of employing the user narrative decapitates stigma, exclusion and self-doubt in one fell swoop. The spoken-me and lately the written-me has revealed, (serendipitously for me anyway), a unique learning experience for students and professionals as well as a process of self-affirmation for me. As Steve Sanfield ‘On the Master of Storytelling’ writes: “It is listening to your own inner voice, and then putting your heart and soul into every story”, ( Estes, Clarissa Pinkola, Rider, 1998a, p 505). Indeed, my impetus for engaging in the work I do is to “put the humanity back into professionalism”, (Holley, 2007a). As a vulnerable person, I was left in the hands of professionals; some more human than others. Those professionals making a positive impact upon my own recovery journey were unafraid to listen to their own inner voice. They were in tune with their own emotions; their own humanity. Such emotionally intelligent individuals knew the power of a Shared Humanness, (Holley, 2007b) in interactions with clients or patients alike. Goleman’s work on Emotional Intelligence, (Goleman, 1996a), and my own experience are the inspiration for this model. My expertise comes from a lived experience of mental distress and interactions with professionals from various disciplines over many years. Service users and survivors are known in the trade as experts by experience and I subscribe to the view of Steve Sanfield, (Estes, 1998c, and p505), who: “…cannot emphasize enough that the healing disciplines require training with one who knows the way and the ways, one who has unequivocally lived it - and for life.” This absolutely applies to the disciplines of Mental Health Nursing and Social Work, in which I am involved, and the related areas of psychiatry and psychology. The employment of mental health service users and survivors within the National Health Service is already being piloted in certain enlightened Trusts, but it needs to be the norm nationwide. Many Mental Health Trusts would do well to introduce experts by experience as trainers for its frontline workers within assertive outreach or home treatment teams, for example. In fact, I see huge gaps in terms of staff training around communication skills concerning emotional care and therapeutic interactions with vulnerable people. Trusts, and similar public services, despite attempts at modernization, tend to uphold a paternalistic culture towards service users as experts by experience. These organizations will be left behind in best practice by the leaders by example that recognize the value of this newfound expert knowledge base and champion the employment of service users. The St George’s model is leading by example in London. The anachronistic medical model, is still adhered to by many professionals. In my work as service user educator and recently survivor educator, (as is now another label I have acquired), I endeavor to emphasize, via my subjective approach, that although we are all individuals, we all share the commonality of existence of what it is to be human. From my journey; my odyssey even, from victim to survivor, I have developed the aforementioned Shared Humanness model. It illustrates how the emotional intelligence and appropriate self disclosure from the professional work hand in hand with connecting with people, thereby leveling the playing field between the service provider and the service user. Such practice results in a professionalism that is based on rapport and engagement rather than on power and containment. Shared humanness is, by its very nature, a genuinely interdisciplinary tool. I explain through my narrative, that all professionals ;( whatever their disciplines, from psychiatry to social work), are not a

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different species to those they care for. In fact, everyone is on the mental health continuum. In my opinion, this so called mental ‘illness’ is unequivocally part and parcel of the human condition, and less of an abnormality! The quality of being human is at the heart of my narrative; my story from the heart. Its lifeblood – its animating force, courses through the interactions between one human being and another human being; regardless of class, status, whether they are male or female, ‘ill’ or well. It highlights the sharing of humanity between the person behind the professional, and the person behind the illness. It is important that the service user and the professional have an egalitarian relationship based on collaboration rather than coercion. If both have the same goal – the service user’s recovery – then working as a team is not just desirable but essential. It is not about whether to stand behind or before each other; it is about standing side by side. The role of the subjective experience is appropriate here, as I am speaking from my own lived experience of anxiety and despair, (or clinical depression as the Medical Model would have it). I, alongside fellow experts by experience, have a personal perspective, which gives us the authenticity or authority that is our ‘unique selling point’. I relate my experiences of being treated well, (best practice), as well as my bad experiences, but I do so in a solution focused, rather than a recriminatory way. It is the combination of personal and impersonal interactions I have experienced with professionals that is at the heart of my teaching practice. Teaching sessions by speakers of their own stories provide an exclusive learning opportunity for professionals and future professionals alike; to be up close and personable to their subject and a unique chance to “rub shoulders with the experts”, (Holley, 2007d). One enlightened practice educator and expert by experience reminded me that: “People will forget what you said. People will forget what you did. But people will never forget the way you made them feel.” (Taylor, 2006) It is on such a basis that I emphasize how, as experts by experience, we have the narrative edge. For example, in Camus’ (Goleman, 1996b, p184 ‘The Plague’, he wrote of his character’s awe of the expert: “‘Who taught you all this, Doctor?’ The reply came promptly: ‘suffering’”. It is such a direct experience of suffering that is especially relevant towards an empathic understanding of mental distress. The most integral part of any session I give to students or professionals is the telling of my story, the main themes of which are shared humanness and alienation: the ‘Them and Us’ mentality so often present among the service user and the professional, the nurse and the patient, the care provider and the cared for. During my teaching sessions, I prefer to eliminate any sense of didacticism; of teacher at front, by arranging people’s seating to a traditional storytelling circle. Here, the storyteller is in among the listeners; with the emphasis on a sense of primeval fellowship not hierarchy, and where the warmth is no longer supplied by the focal point of a tribal fire but by the all encompassing warmth of shared emotion. In this way, I can start to really engage my students and the student/service user dynamic becomes apparent as I disclose my intimate emotions, thus leading them, by association, spontaneously, into their own emotional landscapes. Inherent in this method is a very collaborative approach to learning. Even in a classroom situation, before going out into practice, they have already begun to engage in a process of sharing humanity, whether they yet realize it or not. And so I tell my story. Recounting my experiences is often akin to trying to “describe the indescribable” (Holley, 2007e), and the process lends itself easily to allegory, analogy and the use of metaphor. I sometimes exploit the hypnotic rhythm, of the opening line of children’s storytelling tradition to engage my audience further into the trance-like state that is most receptive to emotions. Thus, the affective domain is more naturally entered into so that truly “effective affective learning” (Lawlor & O’Connell1983) ensues. Such an audience response to my narrative enables them to engage with a reflective and interactive sharing of their own humanity. Naturally, a student’s initial response can be one of discomfort, but I try to prepare them by talking through my mounting emotions as I recount distressing memories by using a de-escalating Cognitive Behavioral Therapy, (CBT), technique. (Padesky & Greenberger 1995). The emotion generated by me is verbally ‘honoured’ and I explain to concerned onlookers how I then have to ‘disassociate’ myself from this emotion as I have a message to impart, and then I am fine and able to continue. This process provides an all too rare opportunity of glimpsing the person behind the professional and of engaging them further into truly reflective practice. In addition, there is the powerful but subliminal message that service users can recover and regain control over their life. In my experience, rather than

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alienating my listeners with uncomfortable emotions, the audience is held by a common thread of humanity; a thread that quietly and gently binds our hearts, however ephemerally, purely from the universal nature of human emotion. Our narrative edge, as visiting lecturers, as service user educators, is that we are not just engaged in the process of lecturing. The real teaching and learning experience comes via the narrative of emotions. It becomes an even more educative process, as students are not just benefiting by hearing my words around mental distress, but also by hearing my silences, and by seeing the map of emotional reactions on my face. The speaker/listener dynamic also plays a unique part in bringing the student closer to seeing things through my eyes and possibly to relate more easily to my experience and perspective. My story would unfold as follows…. ‘Once upon a time there was a girl called Tracey who had lost her way and found, herself, [not unlike Dorothy in the classic film ‘The Wizard of Oz’], in a deep dark wood full of “lions and tigers and bears. Oh my!”……’ However, my escape route was not via ruby slippers but by becoming my own therapist via CBT. I recount my journey from victim to survivor, of the mental health services, as well as of mental suffering; explaining that my expertise came from not just suffering alone but from how I was made to feel at the hands of ‘professionals’. I impart how I felt shackled by stigma, by an increasing sense of exclusion, together with the intrusive paternalism of the medical approach and by the ever-tightening screw of self-doubt. Incidentally, I am including in this list my experiences as a woman, as a single mother and finally as being a Mental Health service user. At the start I had no insight that I was becoming my own expert by experience. However, the victim mentality I have witnessed being encouraged by the medical model in hospital, was soon abandoned by me as I exited hospital and entered into a more humane relationship with my key worker, Trish. It is from my interactions with such emotionally intelligent professionals, who practise what Goleman, terms Humane Medicine and Emotional Care, (Goleman, 1996c), that I have realized what an impact these wonderful individuals have on my recovery potential. Putting the humanity back into professionalism is the impetus for my work as a survivor educator. When I recount my story, the relationship between narrator and audience is one of integrity, of inclusivity and of acceptance. My story, like the recovery process itself, is not linear. It is not an ordered account of connected events and experiences but a depiction of disordered but connected thoughts, feelings and emotions. I recount experiences at random to illustrate what I need to convey depending on the dynamics of the audience at the time. My story and teaching is enriched over time as I become more insightful and retrospective – this only adds to the impact and strength that is our narrative edge. It is often the gaps that the established theoretical models of the Health Sciences leave, that are filled by the service user/survivor experience. For example, the textbooks of nursing students always seem to place the emphasis more on getting the patient functioning. I have found myself reminding students and tutors alike that it is also about how we are feeling. Similarly, it is not just about relief of symptoms but about communicating a sense of HOPE. Mental health professionals who make a difference are acting as temporary custodians of our misplaced sense of hope and believe in us even if we have no self belief of our own. Our unique selling point as educators is that we are not teaching from some secondhand textbook theory. Our expertise comes ‘straight from the horse’s mouth’; our own lived experience lends us authority. We have the inside story and we share our knowledge to the advantage of all, particularly the vulnerable. Service user wisdom and quotations from experiential expertise are taken from our own narratives – not just from thought or the cognitive domain – but from narratives of emotion; of feeling. Such narratives have a great impact on students and professionals alike; just as we want them to make a connection with us, so are we connecting with them. The rather cold and grey narrative landscape of ‘professional speak’ around mental health becomes punctuated with warm splashes of local colour, so that a somewhat calculated jargonistic terminology is ousted by the idiosyncratic phrases, vocabulary and metaphor of native speakers more akin to the human experience that is mental health. It concerns the “emotional mind’s special symbolic modes”, in Goleman’s terms, or the “language of the heart” (Goleman, 1996d, p54).The only authentic language that can describe the indescribable, (Holley, 2007f), and illustrate the struggle with mental distress is that of the native speaker of despair

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and recovery. There is no sanitizing of raw emotion by clinical terminology and objectivity is replaced by subjectivity. The Advocacy in Action group from Nottingham, (01602 500537), for example, have successfully included previously marginalised storytellers who effectively demonstrate that it is not always the eloquent few who get heard and who can also shed light on what it is to be human. The ability to enlighten the caring professions requires an understanding of the significance of revealing one’s own humanity and of not dressing it up in fancy words. In my view, the authentic human voice is priceless. We are speakers of our own stories and we speak from Practice not Theory and it is our own lived experience. It is an opportunity for the traditionally ‘spoken to’ to become the ‘speaker of’. One pseudo-anonymous individual, Kevin, from the aforementioned Nottingham experience, describes such a transformation brilliantly: “And I was a brilliant presenter on my life because it belonged to me and no-one else. And the story helped students become better social workers.” Incidentally, he did actually have a choice of anonymity under the guise of confidentiality and he had a sense of ownership and recognition of his own expertise. Ownership and choice are important therapeutic outcomes for service users as narrative practitioners. When I engage with storytelling; whether lecturing in universities or training sessions with police, housing associations, or advocates, (Spectrum, 2007), I recount a narrative journey of my own take on a personal journey from despair and suffering to empowerment and recovery. One fellow colleague reminded me that it is a journey of discovery rather than recovery. I, myself, have discovered a whole new self and, in the words of Simon Heyes recovery is not about; “returning to how things used to be. It’s about finding a better, healthier and more sustainable life”, (Heyes, 2007, p2). I have achieved this via meaningful work as an educator, my key worker and a brilliant psychologist, who empowered me to become my own therapist via CBT. I speak from practice, i.e., from my lived experience, encouraging a culture for partnership working and collaborative practice learning with the authentic voice of the expert by experience. As a narrative practitioner I am promoting interdisciplinary learning and teaching, where the service user’s story is integral to the process. Centres of excellence, like the University of Birmingham’s Centre of Excellence in Interdisciplinary Mental Health, (CEIMH), are leading by example and demonstrate best practice for empowered user involvement. Ownership of such expertise by users and survivors is vital as we no longer have endure being ‘done to’, but are the ‘doers of’, whether it be in terms of our own recovery/discovery, or as user educators, or even as user academics. It is an innovative professionalism, viewed as subversive by some, and welcomed by others as complimentary; not instead of, but as well as. It is a humane professionalism; a natural catalyst for interdisciplinary or interprofessional working for the benefit of all. It is not about personal agendas but an embodied use of self as part of the educative process to ensure better services. I attended a conference aptly entitled: ‘Broadening Our Horizons’, which introduced me to people who are turning the ‘I’ knowledge into ‘we’ knowledge, by training users with initiatives like Ex-in (van Haaster, 2007). It is the knowledge of the ‘inside story’, from the ‘insider’, that should be the predominant focus. Sharing one’s human experience is a narrative of the psyche and of the soul. It is not about political correctness but, as Sanfield explains: “It is not trying to please anybody. It is listening to your own inner voice, and then putting your heart and soul into every story” (Estes, 1998c, pp504-505). When I am trying to put across my message and my emotions come bubbling up to the surface and my chin begins to wobble, I automatically make a connection with my audience, as fellow humans. It is an organically interactive learning process, as the emotional response of the speaker causes an emotional response of shared humanness from the audience. Having students, including professionals, interacting with you, as a person, allows them to really engage with some of the issues my story highlights and this usually involves a sense of shared understanding between us. This service user/student dynamic emphasizes the fact that I am not just an exhibit but a person like them. One of the most serendipitous outcomes I have experienced as a usereducator is discovering “the person in the professional”, (Tang, 2007,

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www.ceimh.bham.ac.uk/newsandevents/mhheprofessional.shtml), and the realization that
professionals can be vulnerable too. Furthermore, professionals can maintain their own wellbeing not just through professional boundaries and objectivity, but through discovering their own emotional landscapes with the subjective experience of the user-educator illuminating the way. Such emotional learning via classroom encounters with users should form an integral role for a more intensive training of interpersonal skills where the emphasis is on an insight into shared humanness and emotional intelligence. In my view, there is a deficit of emotionally competent professionals which needs to be addressed. Training by users around emotional competence will lead to a more confident, healthy workforce. It will create a workforce which favours injecting an engaging sense of shared humanness, rather than just ‘medicine’ into the patient or client. The student’s encounter with the service user becomes a mutually therapeutic interaction. The impact I have on students always surprises me and how fulfilling it is when my experience of mental distress, (notice no diagnostic labeling), has meaning not just for me, but for students as future practitioners. One student nurse about to enter the mental health branch work placement wrote after one of my teaching sessions: “It’s very difficult to actually describe how the session made me feel, other than that it has made me realize that people with mental health issues still have feelings and thoughts, it’s easy to presume that their specific illnesses ‘mask’ these feelings.” (Holley 2007g). The pedagogic benefits of telling our story are many, and some I have already touched upon. Not least, is having an interactive real life storyteller in the classroom. It is the added impact of the visual, verbal and emotional experience; sharing each other’s humanity. Service user and survivors’ stories signpost the cognitive domain ;( knowledge and thinking), to the affective domain; (feeling and emotion). There are applications for reflective practice and Goleman’s Self Science Curriculum, (Goleman, 1996e, p303 Appendix E). Such applications can be generated by user insight and experience about rapport building and empathy and trust. These themes are inherent in the Shared Humanness model, where the judicial use of appropriate self disclosure within professional boundaries plays an important part. Furthermore, students and professionals can witness the transformation of users as victims, to users as educators – thereby debunking the ‘them and us’ culture they may encounter in professional practice. Kevin, from the Nottingham experience, illustrates this perfectly, when describing his experience: “I enjoyed the impact that my story had on students. I felt I was helping them to be better supporters to vulnerable people. I was able to build on my ‘people skills’ and my teaching abilities. I found I built myself up at the same time.” Kevin clearly demonstrates what a mutually beneficial experience it is. As a speaker at the European Interprofessional Education Network conference in Krakow, (EIPEN, 2007, Holley & Smojkiss), I became aware of the truly inter-professional nature of the user perspective for bringing humanity back into professionalism. Professionals may be from different disciplines but they are from the same species – human beings. Emotional insight and shared humanness are vital for successful collaborative working, and place user-educators at the forefront of best practice within education. Leaders by example view users as experts in our own right, ideal candidates as educators, and wholeheartedly promote the user academic and the recognition and development of service user/survivor models and theories. Centres of Excellence in Teaching and Learning, (CETL’s), like CEIMH, www.ceimh.bham.ac.uk) , recognize and celebrate users’ ownership of knowledge by encouraging academic referencing as well as developing emancipatory and user/survivor led research. I have recently been invited to contribute towards a Mental Health textbook, whereby I give my perspective on case studies of people on film describing their mental distress experiences, as well as my thoughts on what makes a good mental health nurse, (Holley, 2007). This initiative is most welcome, however, I eagerly await the day when indicative, and indeed, prerequisite reading for students includes textbooks written by user/survivors. The time when users are employed by every university as team members integral to the planning, development and marking of mental health modules in health and social work is long overdue.

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Excellence in teaching initiatives is demonstrated by the development of cutting edge film projects by the user led Suretech group, showcasing user narratives as an educative tool for health students and professionals and based at CEIMH. A survivor initiative, (Tathem, 2007), Suretech involves users in the process of filming, editing, scriptwriting and acting scenarios based on user narratives. Happily, there is now an emerging shift from a traditionally valued scientific objectivity, towards a more enlightened post-modernist acknowledgement of the value of subjectivity. It is a subjecvity with emotional discourse at its heart. Perhaps this apparent sea change will open up the floodgates and allow for more progressive models, such as the social and person-centred models, along with the unexplored waters of service user models and theory, to ‘drown out’ the antiquated medical model. However, we service user-educators as ‘end users’ cannot escape “the dominant discourse of psychiatry”, (Tew & Gould, et al., 2006a, p9) we have to be fluent in two languages – our own vital and raw language of human emotion, (from our own experiential knowledge base); and the clinical language of the medical model. This ‘bi-lingualism’ brings added value to the user educator bestowing us with a “more complex understanding of Mental Health and Mental Health services than those speaking from more than one position”, (Tew, Gould, et al., 2006b). CETL’s can provide a truly supportive workplace or voluntary arena for the involvement of users’ narratives. Such organizations would be in line with guidelines written for users by users. There are many examples of general guidelines. However, I have written user involvement guidelines specifically for the user-members of a Focus Group for Social Work (Holley, 2007), for example, based upon the individual needs of this particular group. The Tidal Model project for Birmingham and Solihull Mental Health NHS Trust, (Gordon, 2004), with the narrative of the inpatient at its heart uses a tidal metaphor to illustrate the ebb and flow of the interaction between nurse and professional. It highlights the importance of personal bespoke healing narratives for patients, where the patient is at the helm. I have had the privilege of being involved in the filming of user narratives, where our comments and feelings about this project have been filmed as a training resource for qualified nurses. Hopefully, the tide has turned towards a new respect from politicians and professionals for a new breed of empowered service users. We now have a more informed public and the Expert Patient Programme, with user-delivered training. Students, professionals and the general public can witness at first hand the movement of a once marginalized voice at the centre of academic discourse. True service user/survivor, (and carer), involvement is breaking down barriers of stigma, tokenism and social exclusion, although, like all cultural change, it is a slow process. Harbingers of hope and best practice come in the form of CETL’s, the Government’s Reward and Recognition (DH, 200?) guidelines, and the recommendations for “exemplar employers”, (SCMH,2006), for example. I will continue to uphold our right for ownership of expertise not exploitation, for the choice between anonymity and confidentiality or ownership and recognition. Mental health awareness and the involvement of users in paid work as trainers and experts to educate people about mental distress is vital for the wellbeing of a democratic and civilized society. User knowledge should also be integral to the planning and delivery of health services to level the playing field between service user and professional. When submitting my abstract for this paper I felt compelled to state my eligibility: although I was a practising educator – a narrative practitioner, I felt compromised not only by my self- esteem issues, (the legacy of depression), but by the almost ubiquitous stigma and prejudice around user involvement. I need not have worried, as service user narratives speak for themselves within such supportive and inclusive listening arenas. As a result, this once downtrodden depressive has reaffirmed her sense of worth as a human being through engaging in meaningful work, via the therapeutic vehicle of the healing narrative. Such a narrative was my experience within CBT, with an excellent therapist. And so as my story unfolds, a narrative of despair becomes a narrative of self-disclosure, of selfrevelation and of self-affirmation, even as I press these keys on my computer. Finally, I have a narrative of hope and a narrative of discovery! Sanfield (Estes, 1998d, p505) writes: “Having lived a particular story for years or a lifetime, that story would become part of the teller’s psyche, and the teller would tell from ‘inside’ the story”.

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However, I have discovered the ability to see from ‘outside’ of my story as well, from the impact my story has on my listeners as we connect to a shared humanity. The words of John Brian validate my experience as user-educator: “When people who are not used to speaking out are heard by people who are not used to listening, then real changes can be made” (Brain cited in Clark & Glynn,2006 www.ceimh.bham.ac.uk I now stand up, not only for the valiant cause of user involvement becoming the norm, but also for myself. It is cause for a celebration of the ‘spoken to’ becoming the ‘speaker of’, and of the disempowered becoming empowered. I used to share my story in a timid manner and with a voice lacking in conviction that what I was saying had any validity. During my recovery I have discovered a new me: a person of conviction. I am therefore empowered to convey the importance of my personal inner narrative. I had never deemed it worthy of utterance and certainly would not record it on paper in black and white. CBT enabled me to honour my emotional suffering and to realize my worth. The awareness of Tracey, as the teller of her own story, has enabled her to become the writer, or author, of her own story; of her own life, and I want to be a writer who can: “…say the unsayable, speak the unspeakable and ask difficult questions”. (Rushdie, 1995, 10.9.95) I am finding this process a truly life-affirming experience, which is exhilarating for someone who had previously just wanted to close her eyes and never wake up. However, as with the best of stories, the heroine does wake up, and rather than being rescued by someone else, she rescues herself.

References Department of Health (2006)Reward and Recognition document, Department of Health, www.dh.gov.uk accessed 12/12/06 EIPEN(2007), First International Conference of the European Interprofessional Education Network in Health and Social Care, in Krakow, 12-14 September, 2007, in association with Education and Culture Leonardo da Vinci, www.eipen.org accessed 5/9/07 Estes, Clarissa Pinkola, ‘Women Who Run with the Wolves – Contacting the Power of the Wild Woman’, (Rider, 1998a), Steve Sanfield ‘ On the Master Story Teller’, p.505 Goleman, D( 1996). ‘Emotional Intelligence – Why It Can Matter more than IQ’, Bloomsbury Heyes,S., 2007 speaker at WMHN’s AGM, featured in a supplementary newsletter of The Phoenix magazine Holley, T.L, 2007c, ‘Rubbing Shoulders with the Experts’: presentation, from CEIMH event: ‘Towards a New Vision for Mental Health Social Work Education’, unpublished conference presentation Holley, T.L, 2007a, ‘Putting the Humanity back into Professionalism’, unpublished ( conference presentation?) Holley, T.L,2007b , ‘Shared Humanness Model’, presentation unpublished, used in teaching sessions, and as separate handout at CEIMH event: Towards a New Vision for Mental health Social Work Education’, Holley, T.L., 2007e, contribution to mental health nursing textbook, including “what makes a good mental health nurse”, awaiting publication Holley, T.L., 2007f, Guidelines for involving members of the Focus Group in Health and Social Work at the University of Central England, yet to be published Holley,T.L.,2007d “Describing the Indescribable”, teaching handout, unpublished Lawlor, M. & O’Connell, P., 1983)SEAL – Society for Effective Affective Learning, www.seal.org.uk accessed 5/9/06 Padesky & Greenberger (1995) Mind over Mood London Guilford Press. Spectrum, 2007 Mental health Awareness training arm of WMHN delivered by mental health service users, survivors and carers

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Tang, L2007 on flyer for a Mental Health in Higher Education,(MHHE), workshop scheduled for 2 November, 2007 at CEIMH, ‘The Person in the Professional’ – the use of self in learning and teaching about mental health Tathem, Lloyd, 2007 instigator of the Suretech initiative based at CEIMH Taylor, S., 2007 – Practice Educator for Worcestershire Mental Health Partnership Trust; as teaching handout for Spectrum, the training arm of Worcestershire Mental Health Network, (WMHN). Tew, J. & Gould, N. (2006) ‘Values and Methodologies for Social Research in Mental Health’, p.9 Van Haaster, (2007) Broadening Our Horizon’s conference, held at UCE Westbourne Campus Birmingham England. SCMH (2006) ‘Leading by Example: Making the NHS an exemplar employer of people with mental health problems. Sainsbury Centre for Mental Health, www.scmh.org.uk accessed 2/2/06 b) Estes, op. cit., pp.504-505: “Having lived a particular story for years or a lifetime….” CEIMH (2006), Clark, Marion & Glynn, Tony: ‘Two Decades of Change – Celebrating User Involvement” , (Centre of Excellence in Interdisciplinary Mental Health, www.ceimh.bham.ac.uk ,accessed on 10/01/07 Rushdie, Salman: ‘Independent on Sunday’, 10 September, 1995 Appendix 1 An example of a model for professional practice, the shared humanity model, is outlined below. I have developed it out of my concern about putting the humanity back into professionalism - exploring my idea of a ‘shared humanness’ and making the connection between one human being and another within the bounds of vulnerability and professionalism. SHARED HUMANITY/HUMANNESS MODEL This builds on the shared humanity/humanness between the care provider and the ‘cared for’ between the social worker and client - between the nurse and the patient - between the professional and the service user; and obliterates any perceived power differentials................... • It starts with Appropriate Self Disclosure (ASD) - which includes, for example, not being afraid to reveal your own failings as a person, or making an appropriate joke that is meaningful to the service user • working hand-in-hand with Emotional Intelligence, ASD is vital for building rapport and ultimately for making a connection from one human being to another. • Without this connection you cannot engender trust and, in order for trust to be attained/earned, there has to be a certain amount of honesty from the professional about what they can and cannot do to help. • All the above not only levels the playing field as far as client expectations are concerned, but also reveal the limitations of the professional thus underlining this commonality of shared humanness during the process of an interaction. • The service user will still have faith in the professional’s capability because a connection has been made which in turn has engendered trust and the impact of having made a connection will override any doubt the service user may have that they are safe in their hands. • ASD and the common ground of shared humanity will foster hope which in turn will encourage empowerment (as the person will know that the worker is capable of ensuring their best interests ) • Showing belief in the person in such a way will facilitate their empowerment and ultimately their recovery and finally their independence. • However, this therapeutic process is only possible if the worker has self awarenesss, insight and a certain amount of emotional intelligence. • This will involve a solution focused approach - seeing beyond the problem and reaching out to the person behind the illness. Tracey Holley May 2007

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Marjorie Lloyd NEWI Wrexham : Dancing to the music: Ethno-narratives of the mentally ill

Abstract The narratives of mentally ill citizens are often difficult to hear and separate out from their illness narratives. Whilst social policy continues to promote the inclusion of people with mental illness in their own individual care as well as educational, research and service planning developments, collaboration can at times be onerous. Mental health service users are indeed valued for their contribution to society by helping to develop societal values such as education, conformity and reform but this can and may be at the expense of their own personhood. This paper will present some narratives from the field whilst the author was conducting research into service user involvement. Participant observation of a weekly musical gathering led to the understanding that mentally ill service users are willing to get involved when the conditions and outcomes are favourable to themselves. The service users in the music group saw no point in dancing to the music of the NHS unless it was of benefit to themselves and their overall wellbeing. Introduction Current health and social care places increased value on service user involvement in mental health care (Department of Health 1999, 2004, 2006, Faulkner 2005, SURGE 2005, Rush 2004, Repper 2000). This paper outlines a small-scale research project that sought to explore service user involvement in mental health care. The project was supported by a research fellowship awarded by Health Professions Wales (HPW), an organisation that provides professional support and guidance to employers, nurses and other professionals in Wales. This paper describes some preliminary work undertaken in identifying key issues that concerned users and carers when they engaged with professionals. Participant observation and focus groups were used to observe and listen to service user narratives of services and develop a basic outline of the needs of service users and carers involved in research education and practice Policy Context There is evidence within policy documents that services may be improved through the consultation of those who use the service. The National Service Framework for Adult Mental Health in England and in Wales recommends that service user narratives should be included in all areas of their care from developing services to individual care plans (Department of Health 1999, Welsh Assembly Government 2002/2005b). In addition, Section 11 of the Health and Social Care Act (2001) states that there is a statutory duty on NHS Trusts, Primary Care Trusts and Strategic Health Authorities to involve service users in service planning, in development of proposals and in decision making about service delivery. This is included in a best practice guide that has since been published entitled Getting over the wall: how the NHS is improving the patient’s experience (DOH 2004). In Wales, much work has been initiated on involving service users in mental health service planning and delivery but recent reports have found that efforts remain inconsistent (Wales Audit Office 2005a Miller & Waters 2006). Hodgson and Canvin (2005 p48) suggest that the rhetoric and practice of consumer involvement in health service development is “fundamentally flawed” in that a number of issues or obstacles may arise when serious attempts are made to involve service users and carers. These fall within three major areas; the type or level of involvement, the training that a service user might need to become fully involved, and what, if any, payment should be made towards equal involvement of service users who are expected to fulfil a role other people are paid to do as part of their job (Hanley et al 2003). While these three issues are all relevant, this research focused upon an assessment of the training needs of service users who wish to become more fully involved in research and planning. In addition, Turner & Beresford (2005) suggest that in the quest for professional identity researchers may overlook the needs of the consumer when involving them in research projects. The consequences of this are that the consumer then becomes incorporated into the professional theoretical underpinnings of the researcher and the consumer identity or personhood becomes lost. They suggest that researchers must ensure that they are not making assumptions about the involvement of consumers and their contribution to the research process and outcomes. Hodgson & Canvin (2005) support this view and argue that researchers may not be able to fully involve the consumer if they do not identify and uphold the consumer narrative within the research process. In a recent study by Lockey et al (2004) of the amount of training for service users involvement found that

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whilst it was available, it was inconsistent across the UK. Therefore Hanley et al (2003) suggest that a type of “job description” is drawn up before any involvement so that it is clear what is expected of the service user.

Background Literature In 2001, Baxter et al suggested that a common philosophy, shared definitions and understandings were important for a level playing field and flexibility in methods used that encouraged participation and involvement. Furthermore, resources should be adequate as it should not be assumed that consumer involvement is the cheaper option. Oliver et al (2004) reported similar findings in the first systematic study of consumer involvement. They recommend that it is only by involving consumers more, that researchers and research organisations will learn about working with consumers in adapting methods and developing new methodologies. The importance of including consumers in the process from the beginning emphasises the need for a shared learning culture between researcher and consumer towards developing projects. In response to recognising the needs of service users who participate in service development, the National Institute for Mental Health in England (NIMHE) support a Service User Research Group (SURGE 2005) who have published guidance for good practice. These include Clarity and Transparency, Diversity, Respect, Flexibility and Accessibility. If these principles or standards are ignored then barriers to developing partnerships will become evident. Hodgson & Canvin (2005) explored the literature on consumer involvement in health care and found that there were still some anomalies in relation to the concept of consumer involvement in service development. They point out that: it is assumed that researchers wish to involve consumers and that consumers wish to be involved, and it is assumed that researchers know how to involve consumers and consumers know how to get involved...Most significantly it assumes that there are groups of people that can be categorised as “consumers” and fails to acknowledge the difficulties of defining “involvement”. At present consumer involvement merely maintains the status quo by appearing to attempt to incorporate competing perspectives when it actually amounts to tokenism (2005:53) Turner & Beresford (2005) found that consumers do not necessarily agree with the assumption that they want complete control to the point that only service users can carry out research. Rather a participatory approach is preferred that provides equal opportunity to contribute to the process together with professional researchers and service providers. Figure 1 provides a visual map of how the issues of service user involvement may be cross-referenced at the different service implementation points of policy, consumer and research. This indicates that there are a number of issues to address when considering research with service users. It is useful therefore to explore what difficulties there may be in anticipation that these may be overcome with careful planning. This project was designed to investigate the interface of policy and practice by exploring what consumers need if they are to be genuinely involved. In the process, it provided an opportunity to develop a shared understanding about what ‘involvement’ really meant for them. In this study, the shaded area of identifying training needs and resources was the focus. Further study will be necessary to address other issues that have been identified from the above literature. The Study In view of the background information presented and recommendations made, the focus of this study was based upon identifying the training needs of service users who wish to be involved at a collaborative level in research, planning and education. It may be suggested that payment issues, whilst presenting a real barrier to consumer involvement, can only be resolved when it is known what exactly will be expected of the service user and what they need to meet those expectations. In addition, in taking the time initially to develop an understanding of the needs of consumers, a training programme can be developed to address some of those needs in advance of commencement of any project. It is therefore anticipated but not assumed, that prior planning and preparation will enhance any consequent projects requiring the involvement of consumers that will contribute to a shared understanding and culture in the process. This research project attempted to develop this shared understanding.

Research Methods

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A small scale study was proposed to explore, with service users, what the issues for training would likely to be for involvement in the field of mental health care. The research was completed within 12 months. The study was carried out using methods that included participatory observation and focus groups. This involved the researcher and service users meeting in both formal and informal contexts to develop a collaborative approach to data gathering. This grounded approach allowed issues to be generated by the service users and enabled the researcher to explore in more depth the issues that service users prioritised as being of significance to them. Initially, the research followed an ‘ethnographic’ participatory observational approach that involved observing service users in their own culture which “sets the stage for more refined techniques” (Fetterman 1998 p 35). The author obtained permission from the service users to observe over a number of weeks service users participating in a music group, which was developed and maintained by themselves with no professional input. The subsequent implementation of two focus groups provided an opportunity to reflect upon the process and identified issues as they arose (Hammersley & Atkinson 1995). The author had no professional connections with any of the service user but was introduced as a lecturer in mental health nursing from the local university. In addition to field notes gathered from participant observation of the music group, the focus groups were tape recorded and included eight people in each, some of which were support workers and three people attended both groups. The music group was voluntary and always well attended and a general feeling of participation was accepted whatever skill level people were at. People would arrive early to chat and meet up and it was at the pre group meetings that the focus groups were conducted. The focus groups, staged at weekly intervals, were used to validate the findings as they emerged and to suggest further issues which would be explored throughout the ethnographic phase (Porter & Carter 2000, Benton 2000). A total of 13 people took part in the study, 9 of which were service users. Most participants were male (11) and had a long experience of mental health services. All service users would therefore fall within the serious mental illness (SMI) category of being diagnosed with a mental illness for a long period of time that has limited their ability to function socially (Department of health 1999, Rugerri et al 2000). Participants were not paid for their participation in the research but a cold lunch was provided at the focus groups as a form of payment for attending an hour earlier. All participants were provided with an invitation letter, information sheet and consent form prior to attending the focus group.

Ethical Considerations This exploratory research was carried out within a local charitable organisation and ethical approval was sought from appropriate agencies including individual professional accountability (McHaffie 2000). However, in the particular situation of involving potentially vulnerable people in research a set of ethical guidelines or principles ensured that there was a deliberate effort to protect research participants from harm. Faulkner (2005) has researched with service users, some principles to be employed by research applicants and ethical approval committees as good practice. These principles include Clarity and transparency, Empowerment, Identity, Commitment to change, Respect, Equal opportunities, Theoretical approach, Accountability to society and service user groups, Protection from harm. The above principles whilst very similar to the principles outlined by SURGE (2005) ensure that the intentions of the research are in the best interests of the consumer, and acknowledge that the equity and empowerment valued by service users, is not overshadowed by the theoretical underpinnings that drive much of health care research (Turner & Beresford 2005). Data analysis consisted of ‘theoretical sampling’ (Glaser & Strauss 1967). Participant observation of the music group was used to initially develop some themes, which were then explored in more detail in the focus groups. Most of the participants had very little experience of being involved in research and / or the planning and delivery of mental health services. Therefore, much of the discussion took place around services provided to them such as care plans and Care Programme Approach (CPA) review meetings. An ethonmethodolgical approach to analysis was applied following Garfinkel’s seminal work, Studies in Ethnomethodology that looked at the methods whereby social actors succeed or fail to produce themselves as competent and their environment as stable and real (Garfinkel, 1967). Therefore, in this study, analysis sought to articulate the methods used by participants in constructing themselves as participants. Put another way, in constructing themselves as participants, service users pointed to an understanding or an assumption of what competent participation meant to them. Since all participants in the music group were motivated to be involved in it as it was voluntary, it seemed like a good example of genuine involvement and participation. The analysis sought to articulate the

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taken for granted assumptions that participants used in constructing themselves as competent participants genuinely involved in the group. Results Three particular narratives emerged as important for the group. These narratives were seen as essential for the construction and maintenance of the group. They indicate competencies that any meaningful engagement with service users should meet if it is to be a genuinely participative relationship. Feeling Good The music group was well attended by all the group members who needed no encouragement to get involved. During an evaluation of the music group one member stated that they attended not just to play music of which most members were novices but because it “made them feel good”. This investment in how the group made them feel was generally accepted by all group members regardless of their ability to play. Feeling good was a motivational factor in returning each week. It was an assumption that justified their ongoing involvement in the music group. Feeling good was a necessary condition for their voluntary participation in any activity. The informality and acceptance within the music group was in stark contrast to the experiences participants discussed in the focus groups. Here, participants discussed situations that did not make them feel good and so lessened their participation. They were particularly concerned when their perceived lack of knowledge led to them feeling disempowered with a consequent loss of identity. Participants discussed their medication as being important in developing their own knowledge, understanding and feeling good about their illness Sometimes I feel they don’t warn people of what side effects they have and sometimes people get distraught because they have strange side effects and they are not expecting them (P3) It was also not clear or transparent who would provide them with information on medication No I got some information off one the nurses about depixol you know what it does what’s in it and what the side effects are and that so I think that is quite good (P2) Talking about nurses I think sometimes it’s the psychiatrists that know a lot about the side effects of the drugs a lot of the nurses aren’t informed themselves about the side effects of the drugs and that so you ask the nurses and sometimes they can’t tell you (P3) Information was valued therefore as an investment in their care and well-being. This made the services users aware of how much other people and in particular professionals were actually interested in and respected their needs. This was a significant factor in which the service users would measure their own commitment to change and willingness to get involved. Avoiding the unknown There seemed to be need for a sense of belonging to encourage group participation as was observed in the music group. The group participants agreed in general that they would feel more comfortable attending a meeting where there was more diversity in that they knew one or two people and that there would be time to ask questions and to clarify the purpose and intent of attending such meetings. It’s like going into the unknown really isn’t it you are going into the unknown aren’t you unless you’re aware of what it’s all about to begin with (p3) The service users felt that it was not always clear what was the purpose and intent of becoming more involved with the services or even their own care. For example, when talking about the purpose of their care plan reviews some participants were confused over what or even who the meetings were for and who was accountable. This demonstrates a lack of information around who should attend review meetings and what were their roles. At least it shows that they are still paying attention doesn’t it and that they are keeping an eye on you (P3) And

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I think it gives you an opportunity to say about yourself as well because they haven’t seen you for six months it’s nice to have the opportunity to say how you are I mean because xxxx is quite vocal he will say exactly and he will ask lots of questions (P6) Language and terminology was found to prevent a sense of belonging and getting involved which consequently affected a service user’s confidence and well being Yes, eventually yes, they keep saying stupid things to you like but they’ve stopped now they’ve got the message now (P13) The purpose and intent of any meetings with professionals appears to be gleaned over time after a number of meetings and after the service user has gained some confidence in asking questions, which can be quite daunting for any new member of a group. I think it’s something that comes with time if you are going to a meeting at first its good to go with someone you know and then if you are going to a similar meeting again that’s going to involve the same people then, when you go at first you might get to know a few more people there so I could go again then (P3) However time did not always allow these protective relationships to develop and this was narrated by many of the participants who identified single events like conferences where participants wanted to ask questions but were not given the time. Becoming involved Being unable to ask questions or contribute in any way when they do attend events and meetings left the service users feeling as if they had not been heard. Some participants no longer saw the point of attending meetings I don’t know, I don’t see that much is going to change by going to these meetings that’s why that’s why I don’t go I know some people are into all that but (P9) Having a good support network around to encourage and protect service users was identified as a positive move towards becoming more involved I think that it’s because it’s just basically if you’re there with people who you don’t really know some people can find that a bit hard really. But I’m lucky because I live with P13 and I have a good support network there its a lot easier for staff there to go in with you if you want them to (P10) However, some were not convinced that any change would come out of attending meetings what about what about if you take part in a meeting or a series of meetings what could possibly change or what are we to do by taking part what’s at the end of it like? (P9) yes … if you go to a meeting and you think whatever you’ve got to say is just going to be ignored and nothing is going to be done about it anyway which does happen quite a lot (P3) Sometimes participants were able to identify where they had begun to feel that they were being heard at meetings but it appeared that the experience was not always comfortable: I just got a bit moody with some of the doctors you have a review every few months and it was just when I was having a review (P13) And I think I’m involved but I don’t think he’s being very fair to me you know, he’s not listening to my concerns with the medication you know I know its not anything to do with this meeting but (P12) The results of this study have exposed a number of concerns that service users have identified as affecting their involvement in research and service planning and delivery. It was not expected to find that not one of the service users had been involved in any form of formal meetings or activities giving the length of time that they had been consumers of the service. This led to a focus upon their own

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individual experiences of being involved mainly in planning their own care. The three main findings illustrate that part of any theoretical approach of engaging service users in research and service delivery must address these issues. Discussion The service users who took part in this study were experienced participants of a mental health service that has evolved from many changes over the last two decades. However whilst the government presses on with service planning and development (Department of Health 2004, Welsh Assembly Government 2005a), on the assumption that service users want to get involved (Hodgson & Canvin 2005), it appears that very little has changed for this group of service users. The methods narrated in this particular study on service user involvement suggest that service users as actors in the mental health field, produce themselves as competent survivors of the system by protecting their personhood or well being and only becoming involved in events that will make them feel good, such as the music group (Garfinkel 1967, Baxter 2001, Hodgson & Canvin 2005, Turner & Beresford 2005). Since beginning this study the Department of Health (2006) has published more guidance entitled A Stronger Local Voice which will lead to the abolishment of Patient and Public Involvement (PPI) Forums to be replaced by smaller local diverse groups as an investment in service user involvement. In addition, local organizations will be responsible to a scrutiny committee who will monitor how and when service users have been involved. It remains to be seen therefore if through the creation of small local group relationships will commit to change for service users and service providers in a genuine attempt to improve care outcomes (Oliver et al 2004). However, service providers should not assume that service users are willing participants of all research, planning and development initiatives as they may not see any connection with their own individual care or need (Hodgson & Canvin 2005). This small study has demonstrated through the dialogical action narrated by mental health service users that rather than assume that service users are willing to get involved in everything, service providers and researchers are accountable to disclose the purpose and intent of getting involved more clearly. The service user could then make an informed decision and be provided with the option of, whether to participate or not (SURGE 2005, Faulkner 2005). Service user involvement would also require some investment in providing information and support in a format that is understandable to service users rather than producing the more formal bureaucratic documentation for consultation purposes (Hanely et al 2003, Lockey et al 2004, Hodgson & Canvin 2005, Miller & Waters 2006) The services users in this study were very aware of the cause and effect of their involvement and were able to weigh up the costs and benefits of becoming more involved. As identified in the data real concern was expressed around being effective in any change and being able to make themselves heard (Turner & Beresford 2005). Involvement, when it did occur, appeared to depend upon the services users initiating dialogue rather than the professional and the costs of doing so could result in detainment or a complete lack of empowerment, both of which would have detrimental effects upon their self-esteem. This lack of recognition of the costs to mental health service users in particular has been influenced by the history of mental health services and the conflicting views of service users and providers of what service user involvement actually means. Rush (2004) supports Oliver et al (2004) and suggests that there is an urgent need to explore assumptions about involvement and a cultural change within the services to recognize service users needs. This view is also supported by the growing recognition of a recovery approach to mental health care provision where service users are encouraged to become more involved in managing their own mental health needs (Repper 2000). In comparison, participant observation of the music group was a place where the service users were sure to be heard with very little risk of being ignored or detained. This points to the main finding of the study that service users need to feel good about what they are doing or they will not value it. Becoming involved in any process must therefore contribute to the well being of the participant in order to maintain their sense of self and personhood (Baxter 2001). This was demonstrable in the music group which allowed all voices to be heard and was a key indicator of all participants wanting to participate. Limitations of the Study If participants are going to really participate and be empowered, this research has shown that feeling good or well being is a necessary pre-condition, with appropriate information and forward consultation, for genuine participation. Feeling good was a method that participants used for making sense of their involvement in the music group and is an essential consideration of any genuine

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empowerment model. This feature has not been clearly articulated in any previous study but needs to be seriously considered in genuine participative research and service development. Whilst the focus of the study was to explore ways of involving service users in research the experience of the participants was very limited to involvement in anything but their own care. Consequently the study took on a much broader view of service user involvement in general. This does not invalidate the findings as they remain true to the original intention to explore the taken for granted assumptions of service user involvement. The study also remained considerate of the ethical principles identified by Faulkner (2005) as respecting and empowering service user to voice their concerns by enabling them to create an identity for their own involvement. This however does not mean that all consumers will have the same experience of involvement as this group of people who fall into the category of Severe Mental Illness (Hodgson and Canvin 2005). Further and larger studies will be required to generalise the findings from this study. Conclusion This small study has identified some important areas of concern when attempting to involve service users in research or any other type of involvement. According to the literature government policy, whilst encouraging involvement on all levels has failed so far to recognise some of these issues experienced by service users when attempting to become more involved. This has led to apathy in some cases of not wanting to become more involved if the costs are going to be too high. However, the costs are not always financial ones, which it may have been previously assumed but personal ones. Mental health service users are perhaps the most vulnerable yet the most aware of what becoming involved might mean to their self esteem and mental health recovery. For them, self-preservation comes before the needs of the organization. The training needs of service users in mental health services will need to be developed in relation to the identified obstacles within this study. These are a lack of information and investment in service users becoming involved right at the beginning of any project. Also the purpose and intent of the activity or meeting needs to be clearly outlined to participants in language that is familiar to them so that they can make an informed decision and choice of whether to become involved. Lastly the costs and benefits of becoming involved as a mental health service user can greatly influence the decision if it were to have detrimental effects upon self esteem and / or relationship development within mental health services. This small study appears to have only scratched the surface of the meaning of service user involvement within mental health services. Further research is required to explore in more depth these three areas of involvement identified by service users as being influential to their involvement. Only when a clearer picture emerges of the needs of service users will involvement become a more collaborative process. Acknowledgements Sincere thanks to Dr Alex Carson who supervised this research project throughout and gave helpful comments and advice to the construction of this paper. References Baxter L Thorne L Mitchell A (2001) Small Voices Big Noises. Lay involvement in health research: lessons from other fields. Folk.us. University of Exeter. Benton D C (2000) Grounded Theory Chapter 13 pp153-164 in Cormack D. (Ed.) The research process in Nursing 4th Ed. Oxford. Blackwell . Department of Health (1999) National Service Frameworks for Mental health. London HMSO. Department of Health (2004) Getting over the wall How the NHS is improving the patient’s experience. London. HMSO. Department of Health (2006) A Stronger Local Voice. A framework for creating a stronger local voice in the development of health and social care services. London. HMSO, Faulkner A (2005) The Ethics of Survivor Research. Guidelines for the ethical conduct of research carried out by mental health service users and survivors. Joseph Rowntree Foundation Policy Press. Available at

Fetterman D.M. (1998) Ethnography 2nd Ed. London. Sage. Garfinkel, H. (1967/1984) Studies in Ethnomethodology. Cambridge Polity Press. Glaser B. & Strauss A. (1967) The discovery of grounded theory: strategies for qualitative research. Chicago: Aldine

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Hammersley M Atkinson P (1995) Ethnography. Principles in Practice.2nd edition. London Routledge. Hanley B, Bradburn J, Barnes M, Evans C, Goodare H, Kelson M, Kent A, Oliver S, Thomas S, Wallcraft J. (2003) Involving the public in NHS, public health and Social Care research. 2nd ed. INVOLVE Hodgson P Canvin K (2005) Translating health policy to research practice. Chapter 5 in Lowes L Hulatt I (Eds) Involving Service Users in Health and Social Care Research. London. Routledge. Lockey R, Sitzia J, Gillingham T, Millyard J, Miller C, Ahmed S, Beales A, Bennett C, Parfoot S, Sigrist G, Sigrist J. (2004) Training for service user involvement in health and social care research: a study of training provision and participants’ experiences (The TRUE Project). Worthing: Worthing and Southlands Hospitals NHS Trust. Oliver S Clark-Jones L, Rees R, Milne R, Buchanan P,Gabby J, Gyte G, Oakley A, Stein K (2004) Involving consumers in research and development agenda setting for the NHS: developing an evidence based approach. Health technology Assessment. Vol 8 (15) Miller L, Waters R (2006) Redressing the Balance, User involvement in the training of mental health nurses in Wales. Mind Cymru. Mc Haffie H.E (2000) Ethical issues in research. Chapter 5 pp51-61 in Cormack D (Ed) The Research Process In Nursing. Oxford Blackwell. Porter S Carter D E (2000) Common terms and concepts in research. Ch. 2 pp17-28 in Cormack D (Ed) The Research Process in Nursing. 4th Ed. Oxford Blackwell. Repper J (2000) Adjusting the focus of mental health nursing: incorporating services users experience of recovery. Journal of Mental Health. 9 (6) 579-587 Ruggeir M, Leese M, Thornicroft G, Bissoffi G, Tansella M (2000) Definition and prevalence of severe and persistent mental illness. British Journal of Psychiatry 177 149-155 Rush B (2004) Mental Health Service user’s involvement in England: lessons from history. Journal of Psychiatric and Mental Health Nursing. 11 313-318 SURGE (2005) Guidance for Good Practice. Service User Involvement in the UK Mental Health Research Network. Available at http://www.ukmhrn.info/dnn/Portals/1/Documents/surge/SURGE%20Guidance%20for%20Good%20 Practice%2006.pdf Turner M, Beresford P (2005) User Controlled Research; It’s meaning and potential. Eastleigh. Involve. Available at http://www.invo.org.uk/All_Publications.asp Wales Audit Office (2005) Adult Mental Health Services in Wales. A baseline review of service provision. Cardiff. Welsh Assembly Government. Welsh Assembly Government (2002) National Service Frameworks in Wales Adult Mental Health. Cardiff. Welsh Assembly Government (2005a) Designed for Life. Creating a World Class Health and Social Care for Wales in the 21st century. Cardiff. Welsh Assembly Government. Welsh Assembly Government (2005b) Adult Mental Health Services Raising the Standard. The Revised National Service Frameworks and an Action Plan for Wales. Cardiff. Welsh Assembly Government.

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Ayeray, Medina Bustos Leeds Metropolitan University Healing Narratives: Curing through words - The reconstruction of memory in Latin America Abstract In this paper I will argue that through storytelling, people can reconstruct their life histories and their selves. This process can bring healing, which can be not only individual healing, but also healing for the society and the culture of which those people are a part. In order to illustrate this idea I would like to tell you a little about the ways in which people in Latin America have tried to reconstruct their memories, their social and political experiences, through the stories they shared in their Truth Commissions. Narrative can help people to re-construct history and re-establish the societal memory of past events. The transmission of this memory allows the creation of new readings of the past, and the creation of new shared values and new identities in the community. In such ways individual and communal memories of traumatic events can be embedded in society in a constructive and helpful way. ‘Narrative offers meaning through evocation, image and the mystery of the unsaid’ Cheryl Mattingly In this paper I will argue that through storytelling, people can reconstruct their life histories and their selves. This process can bring healing, which can be not only individual healing, but also - in situations where communities have experienced trouble and loss, healing for the society and the culture of which those people are a part. In order to illustrate this idea I would like to tell you a little about the ways in which the people of Latin America have tried to reconstruct their memories, and their social and political experiences. By way of illustration I will relate some of the stories that were shared in the Truth Commissions in, for example, Argentina, Brazil and Uruguay. Truth Commissions seek to document and outline past human rights abuses. We can say that they are organisations of investigation created with the purpose of helping societies that have faced critical situations of political violence. Their aim is to enable nations to revisit the deep crises and traumas generated by the violence with which they have lived, in ways that bring hope and commitment to avoiding repetition of such events in the future. According to Cuya (2001) they seek to expose the causes of violence, investigating the background to atrocities and evidence of human rights violations. In South America the outcomes of Truth Commissions have been published in reports known as Nunca Mas2. Narrative and healing I want to suggest that a narrative approach to gathering and sharing experience can facilitate the development of understanding, allowing both storytellers and those who listen, to appreciate the significance and meaning of the stories we tell and the role they play in our lives. Freeman (1993) points out that narratives allow readers and listeners to share the thoughts, emotions, relationships and actions of storytellers. Though he would not buy into the idea that the simple sharing of stories necessarily allows us to share these things, Fairbairn (2002) argues that storytelling is a powerful way of facilitating the development of empathy. Telling and retelling stories about our experiences gives us the opportunity to develop insight, seeing those experiences in a new light with new meanings, whether those experiences are positive or not. More recently he has written that: …at times telling stories is a therapeutic necessity. Consider, for example, the way in which we deal with bereavement or with stressful situations - telling and retelling the story of what happened in the minutest detail, until - through telling - we come to accept the event that has upset us, to believe that it happened, and to own it in ways that allow us to deal with its practical consequences for our lives. Fairbairn (2007) Some people, including Freeman (1993) refer to this process of sharing and exploring difficult episodes through storytelling, as ‘healing narratives’. The fact that simply sharing the narratives of our lives can be therapeutic suggests an approach to the facilitation of psychological and personal change. One purpose of inviting people to share their stories is to enable them to transform and reshape their individual identities. By telling the stories that they have lived, narrators reveal their values and their reasons for acting in the ways that they have acted.
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The Spanish expression ‘Nunca Mas’ means ‘never again.

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But telling them openly can also facilitate the building of community by raising public awareness about what has happened, thus allowing individuals to see that their experiences are not isolated, but are shared with others. Healing through narrative in Argentina and South America I want now to say a little about the way in which narratives have been helpful in bringing healing after the conflicts through which Argentina and other South American countries have lived. The Nunca Mas projects in Brazil, Argentina, Chile and Uruguay, are a clear example of a positive use of narratives. Recognising the need for a shared memory they make a difference by giving people the opportunity to testify about what happened to them and those that they care about – in public and with real listening. They seek to document events and atrocities that occurred in those countries. Humphrey (2002) draws attention to the fact that in addition they create a publicly accessible shared memory of those events. This is how it was in Argentina where, in addition, the Truth Commission Report CONADEP Nunca Mas3 (1986) was intended to be the starting point for prosecution of the leaders of the Argentine Junta. Focusing on the development of a shared view about what happened is a way of beginning a politics of reparation for the harm that has been done that relates to truth. It takes into consideration the memory of the victims, in a way that allows them to produce new narratives of their experiences that contribute to better understanding. Jelin (1994) writes that reconstructing the past within historical memory entails an examination by society as a whole of the process of remembering and forgetting what happened and the significance it has nowadays. For some activists in Argentina, the slogan was: ‘Remember! So as not to repeat!’ It is good to recognize that there are several versions of what had happened, thus it is not easy to describe the ‘truth’. According to Humphrey (2002) the truth of individual suffering is offered as a source for rewriting national history and for recreating a moral community. However, memory is certainly not always accessible as a straightforward narrative. The memory of violence can be inaccessible and inexpressible, because it refers to traumatic experience, which is encoded, not in verbal narrative, and unable to be told because of psychological evasion. Remembering is often avoided as a defence against re-experiencing pain. In psychoanalytic terms, such defensive strategies include different mechanisms: Intellectualisation in which a person expresses their narrative in an abstract and discursive form to avoid affect; Rationalisation in which a person attempts to justify events and actions in terms that are rational or ideal as opposed to being true; Object splitting in which negative experiences and affects are projected into the bad object, while positive experiences are linked with the good object; Projection in which feelings and desires that are unacknowledged in the self are expelled and relocated in another person and reparation is made with an internal object which has little correspondence to the external world. Freeman (1993) pointed out the difficulty of putting pain into language. However, personal suffering has to be put into language if it is to be shared. Narrative is the most common way of establishing meaning as individuals transmit their personal experience by selecting stories. From a psychoanalytic perspective, testimony enables catharsis by getting the violence out of the body. The recovery of hidden memories of trauma through the narrativisation and recognition of the origins of traumatic experience resolves the ‘truth’ by identifying the origins of pain. The self is imagined as ‘healed’ through reintegration of identity and resolution of previously unassimilated experience. Giving survivors the opportunity to narrate what they have lived through allows them to keep the memory alive; telling their stories creates a new space in which they can share their experiences with others, revealing their fears and emotions. The narrative testimony entails individual recovery of memory about the past that helps to re-establish self-identity, to give it a new meaning (Humphrey, 2002).

CONADEP is the National Commission of Disappeared People. In the remainder of this paper I will use Nunca Mas rather than the full title CONADEP Nunca Mas when referring to the report of the Argentinian Truth Commission..

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Nunca Mas contains detailed descriptions by some survivors of Argentina’s ‘Dirty War’4 about what they lived through during their torture and/or imprisonment, and/or the torture, imprisonment or killing of members of their families or social groups. Their narrations are evidence of the human rights abuses perpetrated by the authorities at that time, which included kidnap, often of parents and other adults in front of children, and torture in the victim’s home, generally in front of the children as well. In a short paper it is not possible to offer extensive examples of the testimonies made before the Argentinian Truth Commissions and so I shall share only two brief examples, that we can find in Nunca Mas: …March 1st 1977 I was in the house of a friend, in the city of General Roca, Black River (Rio Negro), when a group of armed men entered, kidnapped both, hooded us and moved us in cars to a nearby ‘detention centre’ in the city of Neuquén. A posteriori I could understand why they kidnapped me; the niece of the head of personnel of the plant where I worked, who lived in Bahia Blanca, had gone to visit to General Roca and she stayed in the department in which we were kidnapped, in those days I had introduced her to the owner of the flat, my friend. The lady of Bahia Blanca that had in her notebook of addresses this department was kidnapped in that city, appearing soon after as having ‘died in confrontation’. A few days after her detention, they kidnapped us for being there. When realizing the mistake, we were liberated, first me and after five days my friend. Jorge Berstrin (Nuca Mas, File N° 2803) To have a too common last name increased the likelihood that a person would be a victim of the terrible hunt, by the militares, for dissidents. The women that were kidnapped pregnant or who arrived from other centres to give to birth at the ESMA represent one of the biggest pictures of horror, of superior cruelty that a person can plan and carry out; the cry of babies combined with torture screams. ….pulled up from their mothers within two or three days of being born with the promise that they would be given to their relatives, they continue missing (Nilda Noemí Actis Goretta - File N° 6321). Raúl Rosemary (Nunca Mas, File N° 2590) Most of the narratives that appear in Nunca Mas were gathered in open interviews, in which the survivors were given the opportunity to speak with a minimum of interruptions, and were encouraged to tell spontaneously their lived experiences. In this sense, they put into words what they had lived, reflecting like in a mirror, new meanings, new reflections, new emotions, and new possibilities; a sense of a deeply acknowledged understanding of the story. (Freeman, 1993) In 2004 the Nunca Mas Museum was inaugurated by former president Nestor Kirchner at the ESMA (Naval School of Mechanics) which was a concentration camp during the last dictatorship. Memory of the bad times has also been kept alive by former President Nestor Kichner’s love to establish March 24th as a permanent holiday to be called the ‘National Day of Memory for Truth and Justice’ (Rohter, 2006). Concluding remarks In this paper I have tried to offer some insight into the way that the healing power of narrative has been used in the Nunca Mas project in my home country, Argentina. Freeman (1993) believes that it is important to highlight the role of witnessing when we talk about Truth Commissions and narratives. The social and political context of witnessing shapes the possible articulation and narration of trauma. Where trauma is the product of political events, individual experience tends to become homogenized through dominant narratives about those events, when for example victims tell their stories in terms of the stories that have already been told. Their testimony more often reinforces established narrative themes than creates fresh ones. Through their testimonies, they construct their own culture and identity around group discourses of memory. Over time, these ‘survivor’ identities become condensed in iconic narratives and even metaphors. The fact that many survivors of the Dirty War in Argentina
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‘Dirty War’ (Spanish: Guerra Sucia) is the name given to the violent campaign against suspected dissidents, pursued by Argentine’s military dictatorship under Jorge Rafael Videla, from 1976-1983. During this time around 30,000 people were ‘disappeared’. (For more information, see http://en.wikipedia.org/wiki/Dirty_War) 

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only began to speak years after the event was a reflection of their own strategies for survival. The survivors did not only need to survive so they could tell their story; they also needed to tell their story in order to survive. Let me end by sharing a very personal narrative by a woman who was arrested, taken from her family and imprisoned, suffered torture at the hands of the Militares. My mother shares her narrative in a poem: Taken to the Horror Taken to the horror The evil murderers without Nation, attacked me with killer fury. Picana5, you were an ineffective torture, in spite of the brutal subjugation that my spirit and body suffered at that time. Wreck ‘transfer’. Winding way. Heavy boots. How many? Over my body. My eyes no longer see the light, the bizarre bandage impedes it The armed hand on my head reminds me that my eyes must not see those who already are no more human. I will not contemplate the monstrous faces that relieved me of greater torture. ‘Although I walk in valleys of shades of death, YOU will be with me’. Blessed vision, yearned for promise, my beloved daughters will be well-cared for. Executions! Atrocious manoeuvres, the life in me continues, but not because of your pity. Animal that friend of the man you are, and many lives you have saved. Your nature has been weakened, You have been used to destroy the innocent. When you cross yourself in my presence I cannot avoid the horror and the anguish. Heart rendering moans, agony, pain, the sinister ‘plan’ continues. Beloved brothers. Where are you? The horror became silence. I could not pronounce a word. I could not. My lips were sealed. Hours, days, months, years...? My whole self longed for the Light. ‘picana’ is the Spanish word for a ‘cattle prod’ – an electrical device used to deliver shocks to cattle to encourage them to move and commonly used in torture.
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That a thought, a pronounced word might bring. Mirta Bustos (2003)

References Bustos, M. (2003) ‘Taken to the Horror’, Bahi Blanca, Argentina.. CONADEP Nunca Mas (1986) Cuya, E. (2001) ‘El Impacto de las Comisiones de la Verdad en America Latina’ (The impact of the Truth Commissions in Latin America). Available at:

http://www.derechos.org/nizkor/doc/articulos/cuya.html
Fairbairn, G. (2002) ‘Ethics, empathy and storytelling in professional development’, Learning in Health and Social Care, 1 (1) 22-32. Fairbairn, G. (2007) ‘Academic writing, storytelling and ethics’, International Conference on The Narrative Practitioner, North East Wales Institute of Higher Education, June. Freeman, M. (1993) Rewriting the self: history, memory, narrative, London, Routledge. Humphrey, M. (2002) Politics of Atrocity and Reconciliation: From Terror to Trauma, London, Routledge. Jelin, E. (1994) ‘The Politics of Memory: The Human Rights Movements and the Construction of Democracy in Argentina’, Latin American Perspectives 21 (2) Rohter, Laryy. 2006. The New York Times. March 26.

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Sue McBean University of Ulster. Writer and reader journeying with loneliness - "The story of my father" (An Alzheimer's memoir) Abstract This paper arose from an Arts doctoral thesis by an academic and clinically active nurse. The title of the thesis is “An exploration of selected biographical & fictional literature demonstrating encounters with existential loneliness, through stories about illness, disability, dying and bereavement”. This true narrative by Sue Miller was chosen, rather than any of the other of many expositions about living and dying with Alzheimer’s disease, because of the craftsmanship of this best selling fiction writer. Drawing on the story it will be demonstrated how the reader can vicariously live through, or prepare for, difficult life events. Introduction Using published non-fiction instead of interviews, this research is presented as a previously unreported methodological approach. With taped, transcribed and qualitatively analysed interviews the raconteur is known as “participant” not author. In an interview lasting commonly one to two hours the participant has limited time to reflect on researcher questions. Interpretation is usually researcherled. A book written by a professional story-teller potentially adds more depth and subtlety of meaning and is no less valid. This textual narrative research uses an extreme form of purposive sampling or “cherry picking”. A convenience non random sample (Polit et al., 2001) is acceptable if the researcher chooses “a case because it illustrates some feature or process in which we are interested” (Silverman, 2001: p. 250). A prime inclusion criterion was superior communication ability. This non-fictional short memoir by fiction writer Sue Miller was chosen because of her reputation for craftsmanship. The book is an emotional evocation of what it is like to be the daughter of a man dying with Alzheimer’s disease, watching the unravelling of all that is most precious in life – ability, thought, habit, memory and relationships. The book portrays the isolated role of the carer (who is isolated from other carers, other family members and even from the patient) and also their powerlessness. Around the time that the memoir reflects, Donovan (1991) aptly described the progress of dementia and cost to family. She wrote that dementia is: “like a book. The first page contains the most recent memories, experiences and learning…..it is as if page after page is being torn from the book…the person loses their memories and learning…and a loss of social skills. Progressively the individual’s personality changes until they often become unrecognisable to loved ones…The person suffering from dementia ultimately finds themselves in a world of their own and it is the carer who needs support and guidance to cope with the illness.” (p. 180). Plot outline The story covers five years from recognition of dementia to memorial service. The reader is taken through the first experience of memory loss affecting daily life through adaptations to life (for example the reduced ability to live independently) to total disintegration of bodily function and lack of recognition of any person or event. The daughter watched with wifely intimacy and motherly concern over safety, nourishment and intellect maintenance. She listened to her fathers’ hopes and concerns, planned for his future and gave him what he could no longer supply for himself. Transforming remembered truth into art (Harvey, 1999) Miller said she wrote the book, that she might have wanted to read, as a personal therapeutic response to grief. Self reporting potentially sanitises material making the story palatable with glossing over and embellishment when memory or records fail. Accuracy ten years on is problematic but rather than recounting events it is a story of significant memories. Miller treated her non-fiction account as if it were fiction to enhance readability. Putting the middle of the story at the start she wrote that the “first chapter……works its tail off, pulling the reader in. It uses all the fictional devices – scene, dialogue, characterization, suspense” (Miller, 2006: p. 346). Rather than focus on describing events she set out to write about meaning (p. 348). Miller argued that the writer “owes” the reader a restructuring of “elements….so they begin to say to others what you’ve discovered they say to you” (p. 349). Interpreting the subject as the author, not the father, a more accurate title would be “A novelist observing the gradual loss of her father”. This is a Fourth Genre book. This movement promotes writing creatively about non-fiction. Judging authenticity of this account requires trusting that creative writing in a fictional style can be faithful to the lives it refers to. In the first edition of the

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journal Fourth Genre Harvey (1999) explained why creative story telling as art brings special value “The enemy of the text, then, is what happened, and this is true whether the work is fictional or not. What happened may matter to us, but it is lost on us if we do not transform it into art.” (page unavailable). Greenhalgh & Hurwitz (1998) (enthusiasts for narrative applications to medicine) explained how all narrative is selective: the “choice of what to tell, and what to omit, lies entirely with the narrator” (p. 3). They also defended the value of telling the story rather than simply repeating it and proposed that reading and listening may create a different story than the narrator intended. Comparing an earlier version (Miller, 2006) with the final Afterword of The Story of My Father exemplifies how Miller transformed truth into art. Marked differences can be seen in the following three passages. What can be seen through the evolution of these words is that Miller was determined that the memoir would be of use to others rather than simply useful for her. She used techniques of fiction writing not to make a fiction but to make the book readable. 2000 lecture: “The narrative, then, in this revision, is of my grief and struggle, and what it taught me.” 2003 book: “The drama that brought me to this memoir was my father’s illness and what it meant in my life.” 2000 lecture: “But what I learned, because I kept having to revise, and because revising is reseeding, rethinking, was that in this as in so many other ways, my father didn’t need me to give shape to his life.” 2003 book: “it was what happened to him, after all, that caused me to grieve, and to struggle…..But what I learned was that in this way, as in so many other ways, my father didn’t need me to rescue him, to make sense of his life.” 2000 lecture: “but I think there’s often something deeply revelatory about the detail or the story fragment that just “occurs” to you, out of the blue – and therefore worth examining and re-examining. In fact, I would call that repeated holding up to the light, turning details and fragments this way and that, an essential part of my revision process in fiction.” 2003 book: “The pieces I’d assembled, I discovered, made a different kind of story from the one I’d thought I was working on,.….No, what I came to see by accumulating my material, by holding it up and looking at it again and again, by revising and revising and revising over the years, was that there was no such narrative to be made of my father’s life…..For him his life and death already made sense.” Vicariously experiencing existential loneliness through this narrative Referring to an ethnographic search, rather than the phenomenological quest of this research, Ellis (1997) made a comment that seems relevant to a consideration of how we can learn about life from the narrative of others. She argued not only for the value of “writing emotionally about our lives” (p. 115) but also for the breaking down of “rigid disciplinary boundaries” (p. 115) and the bringing together of literature, arts and social science through “narrative modes of scholarship” (p. 115). She was interested in the subjective story because of the ability to illustrate lifelikeness and verisimilitude (Bruner, 1986 cited by Ellis 1997). Only two very personal accounts of what it is like to watch a family member dying with Alzheimer’s Disease have been found in international journals. Like Miller’s book, neither article uses conventional professional and detached commentary. Swenson (2004) uses diary and narrative style to descriptively chronicle event detail over seven months. Although an excellent account of memory deterioration and juggling employment with caring, the article is cluttered with pragmatic events like dealing with an overturned and used commode. Hodder (2006) provides an analysis and reflection of issues related to one central problem – that of chronic sorrow. Although both articles are non-fictional neither aspires to being Fourth Genre creative non-fiction. In contrast, The Story of My Father has the potential to be used as something more than simply detail of deterioration because it shows spiritual assurance in the face of existential loneliness. Vickers, writing in the Spectator, reflected precisely the position of this research in acknowledging the helpfulness of Bayley’s book about dementia suffered by Iris Murdoch (Elegy for Iris). She wrote “My own father, who for years valiantly did a John Bayley for my mother, says it is the only book which brought him real comfort…” and that “tales of fellow travellers…can be beacons of

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reassurance.”. Hodder and Swenson both demonstrate elements of lifelikeness in their texts but they do not have the ability, that Sue Miller has, to bring the reassurance of the complete story of both the patient and the author. Miller captures numerous examples of the carer encountering existential loneliness even in just the first 26 pages of text. These include the author’s verbal and forceful removal of her father’s autonomy; confirmation to the (now lucid) father that he has been seeing things; contradiction of her father’s reality; refusal to allow her father to go back to his old house again; observation of her father contemplating his own death and contemplation of her own death; interrogation of the father’s reality and recognition of the poignancy of his recent degraded existence and the witnessing of her father’s eloquent articulation about his understanding that he was losing his mind. Working definition of existential loneliness Toombs (1992, cited by Carter, 2000) explained that existential aloneness is unavoidably part of serious illness. In the clinical situation it represents a state of spiritual awareness and isolation when confronted with a diagnosis or deterioration of health or ability that will have significant personal consequences. Sand & Strang (2006) describe this as a change that induces an awareness of feeling unfamiliar with oneself. Describing the evidence of existential loneliness as a song “so often unvoiced and unheeded” (page unavailable) Carter (2000) suggests that the revealing and sharing of this song brings us close to others, and God, and turns the experience into something positive enabling us to be authentic and opening up possibilities of hope and creativity. Each of the eight emerging themes below has a summary of words that hallmark the theme and which evidence either the potential to feel this existentially lonely unfamiliarity with oneself or the quest to refind, or retain, familiarity. Reading the loneliness journey of the writer: existential loneliness in emergent themes Bad news Bad news arrived over a period of just over 24 hours and Miller dedicated one whole chapter and almost 10% of the book to this clearly very significant event. Blunt descriptions of transition through stages of insight and relationship change documented a rapid progression through increasing awareness, understanding and acceptance of the evidence of early signs of dementia. The daughter and father courted, and eventually embraced, the realisation that his ability to independently plan his life was threadbare and thinning further. Words that hall mark this period either directly in the narrative, or inferred through interpretation, are surprise, shock, fear, indignant, offence, alien, distrust, vulnerable, ill prepared and vivid. Prediagnosis engagement with a close family member This story is very different to internet narratives about life journeys with serious health problems. In most of those the first paragraph, and even the first sentence, is often about diagnosis (e.g. CancerHelp UK – “Your stories”). Diagnosis is by definition an event that occurs in the company of clinicians who can help the patient cope with bad news. Miller’s account is unusual in giving the reader an excellent picture of how the many difficulties arising prediagnosis, from the onset of dementia, had to be managed without the support or guidance of expert heath workers. Prediagnosis is a currently an under researched but recognised stage of ill health. Writing about the therapeutic value of encouraging patients to tell their narratives in clinical situations, Sakalys (2003) explained the significance of hearing the full plot – the story that is incomplete if started at diagnosis. Illness, she argued brings disruption of selfhood or personhood and lack of connectedness (presumably at least to self and maybe to others but she does not specify). Significant quotations about the prediagnosis stage include “The cancer experience invariably begins before the point of diagnosis” (Van der Molan, 2000: p. 47); prediagnosis is the stage that ends with “the naming of illness” (McCann, 1999: p. 68) and the “prediagnosis narrative” is where study participants “began their illness stories” (McCann, 1999: p. 68). Although from the medical perspective health care workers tend to emphasise the start of events as being the moment of diagnosis, this work from a professional storyteller starts naturally at the true beginning.

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Words that hall mark this period either directly in the narrative, or inferred through interpretation, are distance, defeat, proof, guilt, regret, anger, longing, rationalisation, disingenuousness versus honesty, excuses, startle, distress, deep unspoken fear, unconnected, lack of transparency and disengagement. Significant events in the prediagnosis story It is a condition of his particular illness that, poignantly, the father does not have insight or awareness enough to tell his own prediagnosis story. As prediagnosis is such a new area of discussion it is not surprising that this publication appears to be the first time this has been noted. The daughter had to tell the prediagnosis story for her father but she did so with a great deal of hindsight. In a close relationship the loss of the connectedness of verbal intimacy cuts right across the family narrative “lives, our family’s story, our work” - “I honestly think I saw the workings of his mind more clearly than my siblings did at that stage. Certainly I saw his oddness, when he was odd, more sharply. But even I didn’t really want to confront it. It came and went anyway, and so again and again I was able to argue myself out of acknowledging it.” (p. 29). So in cases of dementia, health care workers who care about the difficulties arising from the prediagnosis narrative will have to consider who can best tell the story when the patient can’t and in some circumstances even the relatives may be ill equipped. Words that hall mark this period either directly in the narrative, or inferred through interpretation, are engendering mistrust, questioning what is true, bizarre, shock, offence, deviant or odd behaviour, frightening others, distancing from others, futility, appearing profoundly and permanently lost, forgetfulness, eloquent nonsense, blankness, unkempt, sordid, degradation, squalor, pathetic, sad and dismal. The father losing autonomy and self determination Miller intuitively realised she had to assert control over the fathers life prediagnostically for his safety. Defeating his will by dripping tap argument, wearing down and manipulation does not necessarily mean acceptance by him – it may mean inability to fight against a power greater than you can defend against. This was to be a major recurrent feature in the narrative about the progression of the disease process. Here are three poignant quotes to demonstrate this: “I already had a long list of errands to do to get ready to go away. Now at the top of that list would have to be my father, and directly under him, ahead of my own concerns, there would have to be his list of things to do. I felt overwhelmed.” (p. 16). “….I think he saw his position clearly….and I saw it too, for the first time. He understood and we understood: we were taking the first step into his illness…..together. We would be in charge of him now. It was over in a few seconds. He looked back at me, then down. “No,” he said quietly. “No, you’re quite right.” “(p. 24). “I was, as they say, “in charge” of him as he moved through some of the more humiliating and degrading stages of the disease….Throughout my father’s disease, I struggled with myself to come up with the helpful response, the loving response, the ethical response. I wanted to give him as much of myself as I could. But I also wanted, of course, to have my own life. I wanted, for instance, to be able to work productively. I wanted not to let my sorrow and despair over dad color my daily relations with my husband or my contact with my son…..” (p. 33 – 34). Words that hall mark this period either directly in the narrative, or inferred through interpretation, are best interests, force, concede, agree, convince, non-negotiable, dishonesty, brutality, submission, defeat, wear down, stubborn, persistence, accede, insistence, contained anger, duty and domination of will. Family variation in response The narrative demonstrates another hitherto neglected topic – that family circumstances add hidden poignancy, difficulty and pain. Difficult family dynamics have not previously been the focus of the planned nursing care of an individual patient. There was the isolation of family denial in the prediagnosis period of what Miller saw so clearly. Not only did they deny there were any problems, they also blamed her for any problems that she identified: “I had noticed his failing early on, but no one else in the family shared my perception. “He’s fine with me,” my brother would say, and I would feel accused of imagining things or of responding to Dad in a way that was somehow responsible for making him seem vague.” (p. 29).

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Later there were non-negotiable assumptions about who would be the main carer. The narrative shows that after death the main carer had regrets that she could have done more but, while enduring being the main carer, there were niggling thoughts about the lack of help from others in the family. Arising from this narrative an interesting new insight emerged that may be a fruitful avenue for future investigation or therapeutic intervention – that the reader, imagined reader or maybe the words on a page and in a computer file (open to multiple revisions in Miller’s case) may have taken the place of a human ear. This may indicate that not only do the relatives (recent carers and future patients) need to tell stories but that people may benefit from a record of stories being made for them as with this memoir. Hodder (2006) uses a story telling approach to document not only how she felt about the dementia of a parent but also to explore painful issues such as chronic sorrow. Hodder is surprisingly brave, or angry, enough to risk alienation by asserting in the public medium of an article that “the situation had little or no impact on my siblings, who lived thousands of miles away and could not hear our mother’s cries.” (p. 64). Gratitude for such an insight must give way to concern for unmet family needs. Words that hall mark this period either directly in the narrative or inferred through interpretation are alienation, frustration, criticism, misunderstanding, bewilderment, denial, fear, anxiety and most especially loss now made worse by past loss. Patient insight into deterioration Recent research indicates that in early disease stages, people with Alzheimer’s disease are able to understand what is happening to them and successfully deal with necessary changes (Harris & Durkin, 2002 cited by Keady & Ashton, 2004). It is hard to know how much insight a patient who is rarely lucid may have. Miller saw that her arrival brought comfort to her father through recognition and even naming of her right to the end. It is particularly poignant to note Miller’s observations of the early, and predominantly, lucid father’s realisation of his demise: “We sat in silence for a while. Finally he smiled ruefully and said, “Doggone, I never thought I’d lose my mind.”... It was a moment as characteristic of him as any I can think of in his life, and as brave. Noble, really, I’ve come to feel.” (p.19) Miller described another touching period when the widowed father spent many days reading and tearing up all his letters to his wife and her letters to him as a “prolonged and permanent farewell to his own life, his past, his love” (p. 117). It appears that at this stage the father had insight into his ability to take control of his private letters and probably also insight that soon he would not be able to. This was perhaps the last lonely but lucid major journey he would take. The reader may reflect on similar awaiting personal end of life decisions. Words that hall mark this period either directly in the narrative or inferred through interpretation are noble, farewell, comfort and poignancy. Dying Diagnosis and death are juxtaposed which is disquieting to read. Instead of hope at diagnosis only relief is mentioned: “But the diagnosis signalled the end to the nameless anxiety that I’d felt had been mine alone for years, and for that, no matter what, I was grateful. My father’s obituary in 1991 said that he died of Alzheimer’s disease. Of course, no one, strictly speaking dies of Alzheimer’s disease. They die of other things, horrible things that happen to them because they have Alzheimer’s disease. “ (p. 32) Very reasonable needs for information appear neglected by her father’s carers and Miller felt guilty about not realising how close death was but no-one prepared her for it. Her physical and spiritual care for her father was outstanding, unselfish, intuitive and elegiac: “I held him, sang hymns to him, or read to him, mostly scripture, a lot of psalms.” (p. 152)…In all this, I tried to imagine what I would want, dying. To feel loved, I thought. To feel connected to those I had loved. So I held him. I stroked his face, his hands. I kissed him. I spoke the names of the people he’d loved: my mother, his parents, his children, his siblings. (p. 153)…fed him water from a straw, drop by drop onto a parched tongue, while he was dying (p. 161)” Words that hall mark this period either directly in the narrative or inferred through interpretation are in two groups with marked contrasts guilt, aloneness, harsh, deterioration, annihilation, parched, wizened, clutching, incompetent, slow, care, witness, comfort, holding, being with, warm, peace, relief, singing, praying and support.

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The moment of death The Financial Times suggested that Miller’s book is elegiac prose i.e. almost poetic in its reflection on the loss of the memory and life of the father. Bedell writing in the Guardian also used the word elegiac. This is exemplified by how she writes of the moment of death. Miller’s approach to describing that moment is to compare it with the isolation of a woman giving birth. There is more than isolation in the description. There is also mystery and awe, a freezing in time and a desire (on the part of the reader and author) to dwell at length in that moment of locked grief. It is a very moving and private account – a privilege to read. “Then one last breath, and I knew he was gone. His colour changed, nearly instantly. He was suddenly, palpably, absent. ……………life went on, then, for others. It would of course, go on for me too, but at that moment it seemed an impossibility. I felt locked into this grief, as though I’d never get out. I couldn’t imagine, actually wanting to. Dad’s dying had been like a long labor, the work mostly his, but the experience was for me as profound, as isolating, as the labor of birth…the amazing combination of agony and release...” p. 155. Words that hall mark this moment either directly in the narrative or inferred through interpretation are isolation, profound, absence, gone, calm sorrow, staying and engaging.

Concluding comments This unusual use of narrative has the potential for therapeutic application for lay and professional carers, relatives and patients. It is asserted speculatively that a reader can vicariously live through, or prepare for, difficult life events such as loss even though their story may be quite different in detail. A few people caring for a family member with Alzheimer’s disease anecdotally report (on the World Wide Web) that they have found it helpful at the start of a caring journey to read this particular book. Reading and reflecting on a book with relevance to practice constitutes Continuing Professional Development activity. The value of using books with a biographical approach (fictional or nonfictional) for developing awareness and skill is under-researched, although international websites specialising in major health issues commonly recommend biographical accounts on their reading lists. Ten years after death the writing of Tom Kitwood is still influential in the development of personcentred dementia care (Baldwin & Capstick, 2007). Kitwood illustrated his writing with what he called ‘examples’ and ‘case histories’. As ‘overviews’ these may be presumed to have been subjected to “narrative smoothing” (Spence, 1986, cited by Baldwin & Capstick, 2007: p. 101). One example, that he terms a psychobiography, covers eight decades of life in just three pages (Kitwood, 1990: p. 122 – 125) and this contains little that could influence carer behaviour. His ‘vignettes’ were entirely different and as snapshots of a brief encounter the short narratives have enormous potential to inspire. Writing about “Glimpses of everyday life” Kitwood (1998) described taking tea with George. After ten years of dementia decline, George was at crisis point in terms of home care, but still described as having only mild dementia. Kitwood pointed to a cherry and almond tart and called it a date and walnut slice. This confused the waitress but resulted in an empathic response from his guest who called it a “clanger” and reassured Kitwood that he made such mistakes “all the time” (p. 158). This intentional blunder resulted in a happy, close and very special time together – an oasis from home chaos. The Story of My Father is full of similar vignettes that bring insight to the nature of caring. References Baldwin, C. & Capstick, A. (2007) Tom Kitwood on dementia: A reader and critical commentary, Open University Press: Maidenhead. Carter. M.A. (2000) Abiding loneliness: An existential perspective on loneliness. Second Opinion, Vol. 3, September: 37 – 54. Donovan, L. (1991) Mental health problems in old age. Ch 30, pp. 175 – 180, in Garrett, G. (Ed.) Healthy Ageing: Some Nursing Perspectives, Wolfe publishing: London. Ellis, C. (1997) Evocative autoethnography: Writing emotionally about our lives, Chapter 6, pp 115 – 139 in Tierney, W.G. & Lincoln, Y.S. (Eds.) Representation and the Text: Re-Framing the Narrative Voice, (Albany, Sate University of New York Press)

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Greenhalgh, T. & Hurwitz, B. (1998) Why study narrative? Ch. 1 pp 3 – 16 in Narrative based medicine: Dialogue & discourse in clinical practice, Greenhalgh, T. & Hurwitz, B. (Eds.), British Medical Journal Books, London. Harvey, S. (1999) The Art of Self, Fourth Genre, Roundtable: Literal versus invented truth in memoir, Vol. 1, Issue 1: pp 133 – 156. Hodder, R. (2006) A sorrow cloaked with anger. Journal of loss and grief, 11: 53 – 69. Keady, J. & Ashton, P. (2004) The older person with dementia or other mental health problems, Ch. 19, pp 552 - 593 in Norman, I. & Ryrie, I. (Eds.), The Art and Science of Mental Health Nursing: A textbook of principles and practice, Open University Press, Maidenhead. Keady, J., Clarke, C.L. & Adams, T. (Eds.) (2003) Community mental health nursing and dementia care: Practice perspectives, Open University Press, Maidenhead. Kitwood, T. (1990) Understanding senile dementia: a psychobiographical approach, Free Associations, 19: 60 – 76 in Part 2.2 pp. 119 – 130, Baldwin, C. & Capstick, A. (2007) Tom Kitwood on dementia: A reader and critical commentary, Open University Press: Maidenhead. Kitwood, T. (1998) Toward a theory of dementia care: ethics and interaction, Journal of Clinical Ethics Vol. 9, No. 1: 23 – 34 in Part 2.5 pp. 155 – 169, Baldwin, C. & Capstick, A. (2007) Tom Kitwood on dementia: A reader and critical commentary, Open University Press: Maidenhead. McCann, J.J. (1999) Living with chronic illness: subjective contributions toward a patient-centred ethic of care with Crohn’s Disease as the focus, M.A. unpublished Thesis, University of Windsor, Ontario, Canada. Miller, S. (2006) From a lecture on revision, pp. 340 – 353 in Chapter 16, Stories of craft, pp. 326 – 362 , Perl, S. & Schwartz, M. (Eds.) (2006) Writing true: The art & craft of creative nonfiction, Houghton Mifflin: Boston. (Originally delivered as a lecture in memoir writing in 2000.) Morrissey, M. V. & Coakley, A-L. (Eds.) (1999) Alzheimer’s Disease: Beyond the medical model, Quay Books, Salisbury. Sakalys, J.A. (2003) Restoring the patient’s voice – The therapeutics of illness narratives, Journal of Holistic Nursing, Vol. 21, No. 3: 228 – 241. Sand, L. & Strang, P. (2006) Existential loneliness in a palliative home care setting, Journal of Palliative Medicine, Vol. 9, No. 8: 1376 – 1387. Silverman, D. (2001) Interpreting qualitative data: Methods for analysing talk, text and interaction, 2nd Edition, Sage, London. Swenson, C.R. (2004) Dementia diary: a personal and professional journal, Social Work, July, Vol. 49, No. 3: 451 – 460. Van der Molen, B. (2000) Relating information-needs to the cancer experience. 1. Jenny’s story: a cancer narrative, European Journal of Cancer Care, Vol. 9, Issue 1: 1 – 47. Vickers, S. (2003) Review: The Story of My Father by Sue Miller, Spectator, http://salleyvickers.com/pages/abouttheauthor/book_reviews_miller.htm last accessed 07/11/2007

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M. McGrath, M. Vernon, K. Cennamo, P. L. Newbill. A Chapter from Phoebe’s Field: Using Narrative and Design to Communicate “How to Think Science”

Abstract Phoebe’s Field is a collaborative project involving university students, faculty and practitioners from design, science, technology and education. It is both a children’s book and a proposal for an autonomous travelling science exhibition. The story is set amongst agricultural fields, which provide metaphors to connect Phoebe and “her pack” to the powerful concept of fields as used in science. Air, sound, temperature, water, earth, birds and bees become conduits to understanding fields as a type of invisible “glue” holding the universe together. The exhibit focuses on electromagnetic fields because of electromagnetism’s close tie to the communication-centric technologies of contemporary culture. Phoebe’s Field responds to two problems in science education. The first is readying the student’s “creative imagination” to meet the demands of science practice and, specifically, to harness creativity’s role in discovery. The second is the declining population of students deciding to pursue careers in science and technology, and in particular, the longstanding dearth of young women opting for this path. We suspect a link between these two dilemmas. In response to the National Science Foundation’s (NSF) solicitation for new ways to teach science, we propose to teach kids how to “think science” like Einstein by leveraging design studio pedagogy to build upon proven research on informal science learning. Phoebe’s Field has been supported by two prior grants from the NSF including a Planning Grant, where the project team established: 1). a set of science-based Field Principles to guide the exhibit design process; 2). exhibit design concepts for different types of fields; 3. a theoretical Learning Framework to guide instructional design (from a literature review); 4). effective Architectural Tactics using this framework; 5). preliminary guidelines on using metaphor and analogy (from front-end interviews with middle school children age 9-12); 6). and an effective process of collaboration, integrating university students, faculty, and practitioners from design, science, engineering and education. The project is currently under review for construction and travel funding. This paper will examine how a team of twelve architecture undergraduates participating in the Planning Grant engaged a complex task combining science learning with design. The team’s role was to design a science education exhibit in which architecture was more than just the walls and vitrines to contain the exhibit: architecture was, as an “extra-spatial” environment, to be the actual exhibit. This task required that the undergraduates develop an operational understanding of science principles and learning frameworks. The team achieved this through comparing multiple and iterative design approaches together in studio, thereby developing an understanding of the limits and strengths of each. In this way Parallel models became a model for active science learning for the design team and for the proposed visitor experience to Phoebe’s Field. As we will see, of particular interest was the use of narrative in the project, both as it communicated the aspirations of Phoebe’s Field to team members and influenced the architecture of the proposed visitor experience. Context What does it mean to “think science” as Einstein did? Einstein’s approach can be differentiated from how science is often taught today in two ways: his practice of visual thinking--using imagination to anticipate, structure and connect phenomena that might not be observable; and his place of work. Einstein did his work outside of a traditional setting: he took walks, rode a bike, had a job, and went sailing while making science. Schoolchildren learn the “scientific method” as a linear, rigorous experimental procedure performed in the controlled setting of a laboratory. The isolation of “external variables” places science outside of the day-to-day subjective happenings in life, and, therefore its perceived impact upon the world. Current research by the American Association of University Women (AAUW) and the Center for Children and Technology (CCT) indicates that the perceived lack of relevance is a large factor in children deciding in middle school (ages 9 to 12) not to pursue a career in science or mathematics. (AAUW, 2004; Brunner, 2006a) As Thomas Kuhn discusses in the Historical Structure of Scientific Discovery, creativity plays a pivotal role in discovery. Paradigm changes in science often occur through scientists being able to see what

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others have overlooked before: “Discovering a new sort of phenomena is necessarily a complex process which involves recognizing both that something is and what it is. Observation and conceptualization, fact and the assimilation of fact to theory, are inseparably linked in the discovery of scientific novelty.” (Kuhn, 1962). Thomas Friedman suggests that it is this intellectual property–our “creative imagination”–that can and must now determine a society’s global competitiveness (Friedman, 2005, p. 469). “A society that restricts imagination is unlikely to produce many Einsteins–no matter how many educated people it has. But a society that does not stimulate imagination when it comes to science and math won’t either–no matter how much freedom it has” (Friedman, 2007). Scientific literacy, as defined by the National Science Education Standards, is about living more knowledgeably with an awareness of science in our world (NRC, 1996, p. 22). But scientific literacy is most often narrowly conceived as understanding concepts in certain codified ways, through mathematical equations, for example. The Phoebe’s Field project demonstrates more imaginative and relevant ways to connect science to our lives and to comprehend–represent or model–scientific ideas, in ways that are more accessible to more people. Despite recent gains in physics degree conferrals for women, “physics has one of the lowest representations of women among undergraduate degree recipients of any of the science and engineering fields” (Mulvey & Nicholson, 2004, p. 12). Drawing girls into physics widens the net for general scientific literacy. Research suggests that girls at this age would invest in science if they could see through the science to its visibility and utility in their lives. (Brunner, 2006b) “Rather than use tools that enable them to merely transcend natural barriers, girls in essence are asking that tools enable them to become one with phenomena so they can understand them better from the inside out. They wanted to be active participants who could feel the transformations of data taking place. They wanted to see protons and electrons visualized...and to know how atoms come together and collide, and they wanted to be able to experience the collisions themselves in some way. (Brunner & Bennett, 2002). Phoebe’s Field uses analogies of sound and wind fields to explain the more complex concept of electromagnetic fields, and invites visitors to become active components of the fields (as source, data point or interference, for example) – to have a full-body, kinesthetic experience. The objective of our work is to increase scientific literacy through building skills in acquiring knowledge rather than in accumulating facts. Being “knowledgably skilful” (Lave and Wenger, 1991) is the ability to apply fundamental concepts and practices learned within a particular domain to new problems and situations. (Lave and Wenger, 1991)]. As a description of transference--the goal of meaningful learning—it is not only one of the most difficult challenges to effect in situated cognition (Bereiter, 1997), but also to evaluate. Scope and terminology The 2005-2006 chapter of the project recounted here centers upon the experience of a group of architecture undergraduates participating in the NSF Planning Grant. The scope of this paper is the project’s contributions from design to informal learning. In the Phoebe’s Field project we are investigating the transferability of lessons from “designerly ways of knowing”(Cross, 2001) to science learning through what we are calling “active learning.” Much of the existing research in transferring studio models to other disciplines is based on implementing design as probabilistic (best solution given the data). This has been termed “design thinking,” and views design as an engineering practice of needs-based problem solving. If design thinking works to expand the palette of inquiry; then “designerly knowing” would embody active learning. Glynn (1985) has suggested that “it is the epistemology of design that has inherited the task of developing the language of creativity, hypothesis innovation or invention that has proved so elusive to the philosophers of science.” In design, active learning comes about through hands-on engagement: by drawing and making models and by an iterative dialogue of these artifacts with the material and situation. One might think of the artist Richard Serra’s lifelong conversation with steel, or, of a quote by a bio-engineer Drew Endy, “As a biological designer, until I can actually design something, I don’t understand it.”(Endy and Sagmeister, 2006, p. 103) The term active here is the collaboration of the mind and the hand in conducting experiments where abstract ideas and concrete material (or environmental forces) impact the solution, and, significantly, the problem at hand. These problems are “wicked”— where the question and answer develop together (Rittel and Webber, 1973). To understand a design experiment in

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this way means that knowing in design often happens through unknowing: listening to the situation and input from tools, mistakes and serendipity. Carlo Ginzburg (2003) finds an analogous state in his research of history, “I believe that at decisive junctures in the research process one must allow oneself to be stupid--simply to dwell in the state of not understanding. That leaves one open to those chance occurrences from which unexpected discoveries spring.” A focus of our investigation concerns bringing designerly ways of knowing to science learning. The Story of Design (2006) Our experience as designers can serve as one “model” of the aim for kids to learn how to “think science.” The team of undergraduate architecture students at Arizona State University (ASU) demonstrates “designerly knowing” in practice. Because of principles and frameworks set-in place to support multidisciplinary collaboration in the Planning Grant, this experience is also a good example of an experiment in design. Of particular importance was the use of narrative in the project, both as it communicated the aspirations of Phoebe’s Field to new team members but also how it influenced the design outcomes. In the spring of 2006, seventeen architecture studio students were presented with a brief to design a science exhibit in which the exhibit is the architecture (and vice versa). This opportunity to participate in a NSF Planning grant was one of three options put forward to a senior undergraduate research studio at ASU. The theme of the exhibit was to be “invisible fields”; its aim, to model alternative paths of learning using the physics of fields as the subject matter. A multidisciplinary team at Virginia Tech (VT) had begun the planning process the previous fall (2005). As the focus of Phoebe’s Field developed towards an “off the page” experience, Mitzi Vernon, the Principle Investigator and author of the children’s book, realized that architects should be added to the team. Margarita McGrath was invited to join as an architectural advisor, and in turn, she suggested inviting her studio to participate. The majority of the group, twelve students, opted to join the Phoebe’s Field project. Field Principles as a Narrative Motif The first challenge the undergraduates faced, perhaps more daunting than stimulating, was the science itself. The design students wrestled with the basic concepts behind the physics of fields, borrowing textbooks from their roommates, going home and talking to kids in the neighbourhood (learning about what the kids knew and didn’t know), and knocking on the doors of university faculty in the physics department. The question for the students that lay heavy on the table was “how can we design an exhibit on science if we ourselves don’t understand it?” What helped immensely in finding a place to begin designing was the set of seven Field Principles that the VT team had derived the previous semester. The Field Principles evolved out of the early planning process as a necessary way of focusing the collaborative and multidisciplinary design process and as an ever-present reminder of characteristics of scientific fields. Fields Exist Fields are Invisible but can be Detected and Measured Fields are Three-Dimensional Fields Pass through some Objects Fields may be Blocked or Altered by some Objects Fields are Created by Sources Fields Map the Strength and Direction of Forces exerted by Sources Schedule was the second challenge. The ASU students joined the team with less than eight weeks until the evaluation meeting with the Advisory Board in mid-April, the close of the Planning Grant. Although they hadn’t mastered the science, the team decided that the Field Principles gave them enough criteria to begin their work. The Field Principles became a kind of program, analogous to a narrative “motif.” In this analogy a motif is the material--a list of characters and events--and imagery of which a story is made, minus the plot line or thread that makes it all come together in a meaningful way. A program in architecture is an explicit link to the use of a building--a list of spaces and functions. Just as characters might take on various roles in a story, spaces in an architectural program are often used in many ways. For example, a sanctuary might seat up to a thousand people on holy days and less than a hundred for an infant christening. The program would include that it serve both audiences well (everyone can hear and see on Easter Sunday; it doesn’t look empty on a Saturday morning ceremony).

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Learning Frameworks as Subtext Corresponding to the Field Principles “motif,” was a set of performance specifications. The narrative analogy here is less clear, but perhaps “subtext” comes the closest to representing how these specifications played out in the design. Literary subtext is implicit content, often presented through metaphor, which is understood by the observer of the work as the story unfolds. In Phoebe’s Field the subtext came into the design criteria through a set of Learning Frameworks for informal science, which included approaches particularly relevant to fostering how girls experience science. Conceptual Change Theory Learner Motivation Research Learning Games The Nature of Science Parallel Models The first set includes proven practices from learning research. Conceptual change involves "reconceptualizing" deeply rooted misconceptions through fostering cognitive disequilibrium. Inquiry is often motivated by indeterminate situations that provoke reasonable doubt (Dewey, 1963). Learning can also be initiated by putting a learner’s current understandings in question. Disequilibrium plays a different role in research into learner motivation: it beckons attention (Keller, 1986). Once the learner is “present,” motivation to learn comes into play: the content must have relevance in their world. Relevance is twofold, it could be a fit within a broader sociological context or an immediate situation–an opportunity to apply and test new knowledge. Learning games can provide relevancy and build confidence in children if done effectively, which, in the case of most girls, often involves providing social relevance through group games (as opposed to competitive). The nature of science and the use of parallel models establish the character of the Phoebe’s Field exhibit. This was transmitted to the design team through a definition of science and a mode of its communication: metaphors and models. The nature of science is a set of facts but also “a way of knowing.” It is the latter that Phoebe’s Field targets through modelling a method of inquiry that embodies active learning. Phoebe’s Field cultivates practices of learning in science through scaffolding alternative modes of knowing. The exhibit invites visitors to get inside of the workings of what scientifically drives communication, using their whole bodies as active components of electromagnetic fields (as sources, data points or interference, for example). Metaphors and models transformed from words and images into spatial experiences become the building blocks of the exhibit experience. Analogies help learners understand new concepts by comparing the new to something that is already understood (Duit, 1991). Albert Einstein’s “thought experiments” (Gedankenexperiment) were visual experiments conducted through metaphor, using mental pictures and stories as tools to think about scientific phenomena. As a vocabulary of thinking, a model – whether told as an analogy (riding a train through the universe) or constructed as a way to communicate to others (models of the solar system)--is a productive form of metaphor in science. By definition, as the root of metaphor is to transfer, metaphor returns us to the underlying aim of learning. The very concept of field is simply a metaphor used to describe the similarities between a number of physical phenomena. No single example of a field can explain all the properties of fields. Models have limitations that prevent them from being the reality that they represent. For example, symbolic models (drawings) of fields typically only represent the three dimensions of a field in two dimensions. Thus models can introduce misconceptions, which add to pre-existing ones that learners bring to the learning experience. The use of multiple expressed models in parallel that serve as examples of the concept to be learned is one of the best ways both to correct misconceptions and promote concept learning (Harrison & Treagust, 2000). By experiencing parallel models of fields in Phoebe’s Field, visitors are more likely to confront the limitations of their existing models and construct a meaningful knowledge structure into which information about other types of fields can be easily and effectively assimilated. Story and Back-story With motif and subtext established, the third frame for the project came from the story of Phoebe, and the back-stories from the autobiographical experiences of the story’s author, Mitzi Vernon. From the author’s own history the students took her quest to learn to “think science” by harnessing the small “Einsteinian” part that exists in everyone.

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I arrived at this work out of an earnest desire to teach myself something about difficult scientific concepts, which eluded me earlier in my education. After years of teaching, and working as an architect, I returned to graduate school to study product design in engineering, which made me realize that I had been using fundamental ideas without ever understanding their meaning or what they represented in physical terms. In fact, without being able to touch or see these ideas, I found myself lost in a myriad of still larger subjects such as electronics. Perhaps if teachers had painted physics for me, I might have glided through mechanical analysis. a2 + b2 = c2 might have been drawn for me, not as numbers in a right triangle, but as a relationship between gravity (the direction of “down”) and the horizon (the direction of “across”) as Jacob Bronowski (1973) suggested. So, I began to teach myself about sine waves and the Pythagorean Theorem with metaphors. I envisioned a way to use analogies in three-dimensional form to explain these intangible concepts to children. The metaphors grew into a collection of stories, which looks at abstract and scientific concepts and their intrinsic connections to each other and to us. Phoebe’s Field was not the original first story. In searching for a fundamental place to begin, atomic structure seemed logical at the time. But with new attention on field theory in the press, I wondered if fields might be a more essential place to start. Phoebe’s Field became that story. Fields, as a type of “glue” holding the universe together and as a base concept about space, are rich with cultural meaning and embedded metaphors. (Vernon, 2005) From Phoebe’s story the students found context. The story is set in Meadows of Dan, an agricultural community situated amongst cultivated fields of sunflowers and dormant fields overtaken by wildflowers. This metaphoric connection to fields as they occur in landscape was taken literally – the team sought to create an architecture of terrain rather than enclosure. One passage in Phoebe’s story, where she works intensely on drawing a mayfly for a presentation in science class, became a touchstone for the ASU team. Here Phoebe, while carefully observing the mayfly through drawing, notices something happening to the grid paper of the Rite-in-the-Rainfield books that she uses. The grid becomes “gooey,” and suddenly the mayfly is set loose from the page.

The magical transition from two to three dimensions became an inspiration for the team’s proposals. We can recognize this as Phoebe’s “down the rabbit’s hole” moment, an echo of Alice’s entrance into Wonderland through a rapid fall into a parallel universe where the ordinary is no longer ordinary. To an architect, this story is familiar in yet another way, as often the story of a building unfolds from intense observation of the setting at hand. Inspiration taken from this excerpt followed both formal and conceptual paths. Several schemes created a spatial experience to model this magical transition; others concentrated on scaffolding heightened observation of the ordinary world. Architectural Proposals Working in sub-groups, the team designed a total of seven schemes: porcupine; _nodes; infinity field; wind_board; edgeful_less; parallel_field; and modular.

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By designing the threshold of the exhibit –the opening of the story—as a “down the rabbit’s hole” experience the first set of schemes focused on priming the visitor for learning. Concerned that recounting Phoebe’s story would be artificial for the exhibit audience, these teams took the plot to heart but, rather than getting kids to re-enact sequences from the story, the designers made it inherent in how learners discover and explore the abstract science of fields. This was accomplished by studying moments from the narrative, specifically the transition into the gooey grid. The porcupine and _nodes schemes developed an architectural experience based on moving from a 2-d world into the extraspatial. Infinity field (fig. 4) addressed the nature of the space itself. The role of architecture in these projects was to scaffold this experience in space – both in the design of the threshold and in the environment of the extra-spatial world within. The form of the architecture in all three began as a sheet of paper from the Rite-in-the-Rain field book. In the porcupine scheme the threshold was a tear in the paper, which led to a magical world on the underside of the page (fig. 5). _Nodes and infinity field used the gridded structure of the graph paper to connect to the original metaphor of a field. The next pair of schemes, wind_board and edgeful_less, developed straight from the Field Principles and operated to transform the site (gallery in a science museum) into a spatial field. The wind_board (fig. 6) placed a piece of the exhibit on the exterior of the museum, with a monitor tracking the wind velocity mounted within the exhibit. The idea was that kids would create mental bridges between the two, thus blurring the boundaries between outside and inside. The edgeful_less (fig. 7) project took on the interior of the science museum. Deciding that the corners and the edges of the room were the most powerful shapers of enclosure, they worked on negating them. A menu of various tactics was created. One option was to multiply the number of edges in order to mitigate the singularity of the boundary. A

second series of interventions worked to blur the edges through strategic lighting and the creation of continuity between planes. The final two schemes focused on the Learning Frameworks. Their aim was to connect the exhibit experience to the day-to-day lives of the kids by creating concrete links between the exhibit and the outside world that the kids might re-experience. In this way the fieldtrip to the museum gains an afterlife. Resonance was achieved through repurposing ordinary materials in extra-ordinary ways. The parallel_fields (fig. 8) project was constructed out of plastic drinking straws (thousands were stacked together to create paralexic surfaces) and soda cans; in the modular (fig. 9), standard construction components were employed. Architectural Tactics As the Planning Grant deadline drew near, the architecture team realized the necessity to shift their attention towards communicating their findings to diverse audiences: the project author and instigator, Mitzi Vernon; the VT design team; and to the project’s Advisory Board of science, museum, and evaluation experts. Discussions led the team to two realizations. The first was the nature of their task as situated in a “Planning Grant” and, almost simultaneously, the second was recognizing the key role of the Field Principles and Learning Frameworks in their work. These realizations caused the team to move from talking explicitly about the seven projects that had developed in the studio to a set of Architectural Tactics that could be used by the next team of students in the funded-project design phase. Three concepts to “make invisible fields visible” were

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extracted from the design schemes to become a menu for transforming existing science museum galleries into a spatial field condition: Dissolve the boundaries of the exhibit. Displace the ordinary (Entfremdung). Distort the threshold between 2d/3d. The team developed a script that was plotted through this set of tactics, and “chaptered” by images taken from nature that corresponded with the main ideas of each project. Projects were shown as examples rather than solutions, telling a story as promised at the beginning of Alice in Wonderland, in images and words. The use of the story Alice was beginning to get very tired of sitting by her sister on the bank, and of having nothing to do: once or twice she had peeped into the book her sister was reading, but it had no pictures or conversations in it, “and what is the use of a book,” thought Alice “without pictures or conversation?” (Carroll, 1869) The emphasis in the design proposals on threshold resembles strategies in short storytelling. The storytelling device of a rupture, whether a passage through a rabbit hole, a looking glass, or a piece of grid paper illustrates a contract that the reader of these works makes with the author. Sarah Hardy (1993), in her article, “The Poetics of Immediacy: Oral Narrative and the Short Story” describes this as a pact to become listeners, “we [as readers] must agree at once to be present and to share the world of the story.” This call-to-be-present occurred in the concepts inspired by the gooey grid moment of Phoebe’s story, as these proposals made the experience inherent in how the kids discovered and explored the abstract science of fields. Although one might have expected that the architecture team adopt Phoebe’s story more directly in the design of the exhibit, we discovered that they didn’t. The ASU team specifically chose not to do so: not one proposal to adapt Phoebe’s story into a learning game was made. Why was this so? Discussions with the design team revealed that they questioned both the meaningfulness of re-enacting a story and its ability to assist in transference. Cornelia Brunner, a member of the Advisory Board, put it aptly at the 2006 New York Advisory Board Meeting, Narrative: the narrative structure here has to do with the experience itself, not with an outside story they may not know. Phoebe is an important icon because she says “girls are welcome here”, but she is just an image. The real story is in the experience itself, which is a group experience led up to by interesting, interactive investigations and followed up by more interesting interactive experiences, which can be group experiences, and which have conceptual assessments built in. The story, in other words, is in being part of an experience that deconstructs and provides a basis for understanding (at least metaphorically) a real-life phenomenon in which kids are genuinely interested, which is the mysterious ability to communicate sound, images and text across space and time... (Brunner, 2006a) The ASU students made their own story from the materials given to them—the Field Principles, Learning Frameworks, and Phoebe’s Story. The back-story behind the children’s book played a significant role in creating a common thread for the collective work of the team. In summary, the narrative of the children’s book informed the design in the following ways: From the author’s own history they took her quest to learn to “think science” by harnessing the small “Einsteinian” part that exists in everyone. From the project’s beginnings they took its inspiration from nature – sunflower fields, bees, and agricultural fields.

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From the story of Phoebe, they took the threshold moment. As it turns out, this ability to weave an authentic story from multiple sources—models, metaphors and back-stories, is what we want the learners in Phoebe’s Field to be able to do, too. Critical Finding As designers, our “down the rabbit hole” experience dropped us into an unfamiliar domain of the physics of fields. Our “contextual information” was being skilfully knowledgeable in our domain of architecture, and thus being able to transfer ways of knowing to the task at hand. In design this happens by processing observations through transference, in our case through “re-presenting.” Our disciplinary knowing occurs through active learning: representing our observations by drawing, making models, and telling stories. Given the iterative nature of our work, each new artifact functions as a new model, frequently demanding that we revisit and reinterpret all that has come before it. A majority of our studio time was spent around a large table in the centre of the room with the thirteen of us (twelve students + faculty) discussing together the approaches of each sub-group and evaluating multiple iterations generated for each proposal. Through comparison, both of differing approaches and of subtle iterations within each proposal, we developed an understanding of the limits and strengths of each in meeting the aims of the exhibit. Parallel models became a model for active science learning for the design team and for the proposed exhibit experience for the visitor to Phoebe’s Field. Acknowledgements This research was supported by NSF Planning Grant Award Proposal # 0442469 ($75,000) Planning Inside Phoebe’s Field. PI: M. Vernon; Co-PI’s: K. Cennamo, S. Harrison, M. McGrath, and M. Ermann. The ASU student team included: Shawn Nelson, Danielle Jones, Shaun Salazar, Dave Bowen, Ian Wolfersteig, Oliver Rodrigo Romo, Joe David, Mark McCulloch, Alissa Priebe, Stephanie Francis, Katie Scallon, and Thomas Allen. For a comprehensive view of the project please visit Phoebe’s Field at http://www.phoebesfield.org/.

--------------------Figures Fig. 1. The gooey grid. Image and excerpt from unpublished manuscript, Phoebe’s Field. Vernon, copyright 2005. Fig. 2 _nodes A grid is overlaid onto the gallery space as a masking technique similar to that used in camouflage. Dave Bowen and Ian Wolfersteig. Fig. 3 Infinity Field. The exhibits “live” in the shield's skin. The skin assembly is a gridded datum of "smart" panels which responsively displays visitor interactions with various field phenomena. Oliver Rodrigo Romo. Fig. 4 The team developed a script that was plotted through this set of tactics, and “chaptered” by images taken from nature that corresponded with the main ideas of each project. Endnotes NSF is an independent US government agency responsible for promoting science and engineering through funding research programs and education projects. Kinesthesia is defined as “a sense mediated by receptors located in muscles, tendons, and joints and stimulated by bodily movements and tensions; also: sensory experience derived from this sense”(Merriam-Webster). Used here it refers to the participatory “hands-on” and spatial experience of visitors to Phoebe’s Field. In architecture there are three kinds of specifications—proprietary, descriptive, and performance. Proprietary is self-evident, a specific manufacturer and product are named. A descriptive specification details the desired characteristics of what is required; a performance specification recounts the desired outcomes. A model is a “representation of an idea, an object, an event, a process, or a system” (Gilbert & Boulter, 1998, p. 53). The ability to manipulate and develop models is an important skill in science literacy because real scientists need these skills (Gilbert, 2004; Gilbert and Boulter, 1998, pp. 53-66). A good example of how models function in science learning is how they are used to teach kids about planetary orbits. A typical physical model of a solar system has rigid bars connecting each planet to a central point near the sun on the model. A graphical model of the same phenomenon shows the planets in the same order, but illustrates the elliptical shapes of their orbits. A verbal explanation can explain the role of gravity in keeping the planets in their orbits. Any single one of these models might create misconceptions with the learners. Taken together, and with clear explanations of the limitations of each

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model, the learners are more likely to construct a mental model that most closely resembles the consensus model. Rite-in-the-Rain is a paper created specifically for writing field notes in all weather conditions. www.riteintherain.com. References American Association of University Women (AAUW). 2004. Under the microscope: a decade of gender equity projects in the sciences. Washington, DC: Author. Bereiter, C. 1997. Situated cognition and how to overcome it. In: D. Kirshner & J. A. Whitson, eds. Situated cognition: social, semiotic, and psychological perspectives. NJ: Erlbaum, pp. 281–300. Brunner, C. 2006a. In: Vernon, M., et. al. Project book: planning Phoebe’s field. Limited edition manuscript. Blacksburg, VA: Author. Brunner, C. 2006b. On girls, boys and IT careers. Google Tech Talk. 6 April. [WWW] http://cct.edc.org/report_summary .asp?numPublicationId=220 (21 May 2007). Brunner, C. & Bennett, D.T. 2002. The feminization of technology. In: N. Yelland & A. Rubin, eds. Ghosts in the machine: women‘s voices of research with technology. New York: Peter Lang. Carroll, L. (pseudonym of Reverend Charles Lutwidge Dodgson) 1869. Alice’s adventures in wonderland. Boston : Lee and Shepard. (Original work published in 1865). Cross, N. 2001. Designerly ways of knowing: design discipline verses design science. Design Issues, 17, pp. 49-55. Boston: The MIT Press. Dewey, J. 1963. Experience & education, New York: Collier MacMillan. (Original work published in 1938). Duit, R. 1991. On the role of analogies and metaphors in learning science. Science Education, 75(6), pp. 649-672. Endy, D. & Sagmeister, S. 2006. The Seed Salon: Endy and Sagmeister. SEED, 2 (2), pp. 99-103. Friedman, T. 2007. China needs an Einstein. So do we. New York Times, April 27, p. A-27. Friedman, T. 2005. The world is flat: a brief history of the twenty-first century. New York: Farrar, Straus, and Giroux. Gilbert, J. K. 2004. Models and modeling: routes to more authentic science education. International Journal of Science and Mathematics Education, 2, pp. 115-130. Gilbert, J. K. & Boulter, C. J. 1998. Learning science through models and modeling. In: B.J. Fraser & Tobin, K.G., eds. International handbook of science education. Dordrecht, Netherlands: Kluwer Academic Publishers, pp. 53-66. Ginzburg, C. & Gundersen, T.R. 2003. On the dark side of history: Carlo Ginzburg talks to Trygve Riiser Gundersen. Eurozine. [WWW] http://www.eurozine.com/articles/2003-07-11-ginzburg-en.html (20 September 2007). Glynn, S. 1985. Science and perception as design. Design Studies, 6 (3). Hardy, S. 1993. The poetics of immediacy: oral narrative and the short story, Style, fall. [WWW] http://findarticles.com/p/articles/mi_m2342/is_n3_v27/ai_15473855/pg_14 (20 May 2007). Harrison, A. G. & Treagust, D. F. 2000. Learning about atoms, molecules, and chemical bonds: a case study of multiple-model use in grade 11 chemistry. Science Education, 84(3), pp. 352-381.

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