Wednesday, May 21, 2008

Narrative Medicine and the Audience

I am in Stony Rapids at the top of Saskatchewan. I just took off the article from Mothering on Hypnosis and Birth because I thought they had published it long ago and it turns out they haven't yet published it! They saw it up on the blog and asked it to be taken down. What amazed me was that someone actually read my blog (e.g., the editors at Mothering). There's an illusion I suppose that no one is out there. I'll have to check with them if it's ok to leave up the original paper from the American Journal of Clinical Hypnosis 2004, but I suspect that it is. My apologies to mothering. And thanks for giving me the experience that someone actually reads this blog.

That brought my awareness to a message from Renae on Coyote Wisdom discussion group. She was writing about Bakhtin's perspective that all dialogue involves an audience. She wrote about Bakhtin's perspective on our internal, silent dialogue always being for someone. She brought my awareness even further to the importance of the audience in what we do. In our most silent and alone moments, isn't every one of us aware of being watched. Some would say we have created an imaginary audience. Other pre-moderns would say the spirits and the ancestors are always watching us, which is a feeling I have -- of my grandparents and other spirits watching what I do, which, of course, makes me accountable to my perception of what they would think of what I am doing.

So the stories that we perpetually live are being lived for someone. Who is our audience? Who are these "ghosts within" who watch what we are doing and planning. I think what Bakhtin was getting at was the way conversations are memoralized. We don't just store the story. In order to properly store the story, we must store the context in which it occurred and the audience who heard it. Whenever I remember with language, it seems that I am telling a story (silently, of course), but to someone. When I remember without language, then I feel what happened to me, but it seems that there is no way of changing or resolving without language. The non-language parts of the story are immutable without the words themselves which allow us to change the tone. So when I start to tell myself a story, I use words and their associated images and I do imagine an audience. Sometimes it is a friend. Sometimes I have the feeling that my grandfather is listening. Sometimes I imagine some element of the Greatest Mystery being aware of me and my tale. Always there's someone.

So when Renae wondered how changing the audience would change the story, that became central to my meditations today. When a person enters our office, they come not only with multiple stories begging to be heard, but also with multiple audiences who listen as well to these stories and influence their telling. In our interviews and discussions, we need to be more conscious in asking about the audience. Perhaps, we should ask, who do you think about when you are alone? Do you ever have the experience of feeling that you are rehearsing what you will say to someone in your mind? We'll have to be careful because the experience of what actually happens within us sounds psychotic to the conventional psychiatric mind. To me, I suspect voices in part arise from these internally constructed imaginal beings who eventually become able to talk back to us or comment on us. When we lose the story that goes with them, they become "as if disembodied." The voice loses its context and remains to torment the individual. Psychotic voices, by the way, are almost always disturbing and critical these days. Once upon a time, perhaps they were more spiritual.

More later....

4 comments:

San said...

Who are the "ghosts within"? Why, they're Hollywood talent scouts of course.

Come over to my place and read my post "Travel Tips for a New College Graduate." And, if you'd like, express your well-wishing to our Flannery.

Unknown said...

I have a friend who says he has only positive voices now.

And I have a memory of someone telling me that there is a culture where the voices are generally positive. Or perhaps the story is that they were positive, until modern psychiatry got hold of them.

So if we 'write' memories with a professor in mind as audience, should it make them easier to recall at exam time?

Lewis Mehl-Madrona said...

Dear Barbara and San,

I suspect San's comment is more true than jocular. We're all waiting to be "discovered" and have an internal audience that consists of those talent scouts who could recognize us for who we really are.

Schwartz writes about this ideas also in Internal Family Systems Therapy, though not so much in a narrative framework. I appreciate his ideas though I think that group should take Wittgenstein's advice and speak in plain language rather than invent technical terms.

I suspect you are right, Barbara, that modern culture and religion (especially those who believe in hell and devil) have pointed voices toward the negative. Modern culture only has the pathological context for ecstatic experience so that's what happens.

Lewis

Anonymous said...

Bahktin, reprise

I’ve been thinking about my own question of who is the audience for my stories, and especially the audience for my journal entries, as I am prolific when it comes to journaling. Lewis’ thoughts have me coming to some new ideas that are pulling threads together. Barb’s as well.

I have been somewhat conscious of the audience I imagine for each journal entry and particular thoughts within it. I realize that indeed I do create different audiences and I think that the audience is the person(s) to whom I would LIKE to read the journal. Sometimes that is someone who is close to me and I have a secret desire for them to find the journal, break their own moral code, and read what I have written about them. Maybe then they would behave in the way I want them to behave—love me more, understand/respect me more, get really pissed at me, or maybe just change the toilet paper roll when it goes empty. All the things that I am unable to control. I know that I write/tell the stories censoring what I say, or modifying how I say something because I am thinking that the person the story involves may one day read it and I want them to respond in a particular way. I sometimes start berating myself for doing so—“you narcissistic jerk—who the hell is ever going to care enough to read your journal? Do you care to read theirs? No.” On the other hand there is something about thinking this way that I find helpful—it forces me to be mindful of the people who become my audience. I think there is some kind of practicing involved in being able to say the difficult things in a manner that is compassionate and loving while learning to honor and be truthful to myself. (This may be a more recent phenomenon for me as there are plenty of older entries written in such a way that the words continue to scream off the paper in a rage.) I found it remarkable that I realized that I wrote a question about my marriage using the exact same words in 2007 that I had used in 2002. There must be truth there. Only the second time there had been a shift. I think the shift was not only within me, but with the audience I imagined reading the sentence. The context of the sentence and the kind of energy embedded through the handwriting had changed significantly. Acceptance and compassion replaced the anger and shame.

This brings to mind the new term for memoirs, “creative non-fiction” as I realize that is what my journal is, that is what the stories are that I tell to my doctor and friends. Every good storyteller knows that one should never let the truth get in the way of a good story and a good story is always adapted to the audience and the situation.

So “heteroglossia” seems to be what may be created in intrapersonal communication which then gets modified to meet the socially constructed context of patient-doctor interpersonal communication. Maybe all those voices are creating the ideal context for the issue that is creating the “problem.” So the point may be to find a way, especially when dealing with psychosis, to allow the ideal /intrapersonal conversation to emerge within a medical/interpersonal context. The more the doctor can understand and “become” the ideal audience for a patient and their story, the more likely it is that the truth of the story will emerge. (I’m talking out my butt here—I’m an artist, not a doctor.)

Reminds me. A colleague recently said to me, 30 minutes into a conversation, “You are probably wondering why I haven’t said anything about your photograph in the current exhibition. (I hadn’t.) Well, it’s because I don’t care for it. It is too monochromatic. I think you need to have a greater range of tonal values.” My thought was, “well, you clearly are not the audience for my photograph, so instead of asking me to change the photograph to suit you and your aesthetic sensibility, possibly, if you want to enjoy the photograph, you might spend some time thinking about WHY I made it so monochromatic. Or, we could just have an understanding that we don’t speak the same aesthetic language.” I just found it interesting that her response to not liking my art/story was to suggest ways I could change it to fit her desires for what art/stories should be. I actually beat my head against a rock trying to explain to her that the work has a title (rare for me) of “Gentleness and Space” and, in my mind, a wide range of tonal values would not create gentleness and space.

Lastly, as certainly I am avoiding something by ruminating on this for so long (but not papers to grade!), Lewis’ mention of the desire to be “discovered” and made famous. This has always been in my mind, “ooooh, if I become a famous artist then these journals would be sooo cool for an art historian to find and write a monograph about me…” and I used to beat myself up for that. Then I stumbled upon Martin Luther King, Jr.’s “The Drum Major Instinct” speech from 1968. (www.stanford.edu/group/King/publications) The desire to be recognized, to be “best” at something, to have our accomplishments recognized, to be a leader of something, is a basic human desire. It is what we do with it that matters. Do we harness it for the greater good or do we use it to push others down? He tells the story of John and James asking Jesus to sit at His right and left hand and instead of condemning them for wanting to be so important, Jesus said, (quoting from the speech)
“Oh, I see, you want to be first. You want to be great.
You want to be important. You want to be significant. Well, you ought to
be. If you're going to be my disciple, you must be." But he reordered
priorities. And he said, "Yes, don't give up this instinct. It's a good
instinct if you use it right. (Yes) It's a good instinct if you don't
distort it and pervert it. Don't give it up. Keep feeling the need for
being important. Keep feeling the need for being first. But I want you to
be first in love. (Amen) I want you to be first in moral excellence. I
want you to be first in generosity. That is what I want you to do."


Now I must go put something on all these itchy spots that appeared on my legs after walking on the grass all weekend. Damn bugs. : )