Bury, M. (2001). Illness narratives: fact or fiction?.

Sociology of health & illness, 23(3),

263-285. Retrieved from: https://onlinelibrary.wiley.com/doi/pdf/10.1111/1467-
9566.00252

INTRODUCTION

This article is about what illness narratives are and the role they play in helping
researchers to understand the social realms of patients suffering from chronic
illnesses, as Bury calls these narratives “an attraction of sociological analysis”. Bury’s
purpose for writing this article is derived from his concern that illness narratives are
usually ignored in the medical field, and this concerns him because he believes that
illness narratives provide strong evidence for the development of illness and provide
a snippet of the patients’ lifestyle. Therefore, Bury seeks to find the importance of
studying illness narratives, the forms illness narratives and, he attempts to discover
the limitations that exist in the study of illness narratives.

THE IMPORTANCE OF ILLNESS NARRATIVES

Illness narratives play an important role in the diagnosis and understanding of illness,
and it is important for the following reasons. In the past, there was need for patient-
doctor relations for the purpose of diagnosing diseases and illnesses. This is due to
the fact that modern medicines and advancements were still undiscovered therefore,
doctors largely relied on the patients’ accounts. However, as time progressed, medical
advancements emerged as well, and patients’ narratives did not hold the same value
as they did before as research excluded individuals and illness was looked at as a
separate entity. To add on, the advancement of treatment was as a result of the rising
cases of chronic illnesses and human initiated causes of illness. Additionally, during
the 18th and 19th century, illness approaches were heavily influenced by political and
social reforms, and they were made to spite professionals and modern science as it
was deemed rebellious and abnormal. Bury acknowledges that modern medicine has
empowered and emancipated individuals, as they have the ability to treat their own
bodies and to speak freely of their sicknesses, unlike how it was in the past where
people did not have the luxury of self-expression. Furthermore, the availability of
alternative medicine hinders medical professionals from accessing new information as
narratives become more inapplicable. This shows that health care improvement relies
on narratives as evidence-based care is inadequate.

FORMS OF ILLNESS NARRATIVES

Bury explores illness narratives in three sections, each containing different types of
narratives, namely; contingent, moral and core narratives, which give different
perspectives of the development of the illness. To add on, he uses the 3 forms to show
clear distinction of how the society affects the individual and their narrative, and from
these finding, he develops his conclusion about how the society links to the body, self-
image, image of others and the shaping of the narrative.

Contingent narratives

Bury finds out that contingent narratives focus on the patients’ knowledge of the instant
causes of the condition, the early signs, and the toll the disease takes on the patients
physical and mental being, including the people around them. Additionally, Bury
explains that the emergence and dominance of science has resulted to the
classification of illness narratives as a cultural based approach of understanding
illnesses. Furthermore, the article looks at two different views to contingent narratives.
Firstly, the categorial view which looks at the symptoms as the focus of the narratives.
Here, signs are compared to existing knowledge hence, the illness is clarified from the
start. Secondly, the article looks at the spectral view, which is perceives illness as a
social process. This means that the intensity of the illness is judged according to
societal reaction and social contexts. Moreover, through interviews, Bury discovers
that occurrences involving family matters, relationship disruption or work-related
events, were very important in the contribution of the rising illness.

MORAL NARATIVES

This assesses the relationship between the personal and social dimensions to
patients’ lives. Additionally, patients desire to use their story to provide an explanation
as to why their bodies are operating in certain way, holding themselves and society
accountable for the illness. Furthermore, Bury acknowledges that sometimes illness is
overlooked, considering the amount of personal problems one has, illness may be
elevated due to that strain. Moreover, individuals blame themselves for being ill and
relate illness to unfaithfulness. Furthermore, Bury suggests that using morality in
chronic illness portrays health as a virtuous state, and illness as a result of bad
behaviour. Additionally, patients struggle with their moral conscious as they feel
shame for being a financial burden and for being unable to take care of themselves.
This shame influences the way they view themselves and how they think people see
them therefore, recovery is based on rediscovery and self-development. Lastly, Bury
explains a social distance that patients as other people may become discriminatory.

CORE NARRATIVES

These narratives are focused on how patients come to term with their illness,
therefore, different people react in different ways due to their experience of the illness.
Additionally, people use events to shape how they represent themselves.
Furthermore, Bury explains the narrative genres that exist, and they are as namely;
progressive, stable and regressive frameworks, and these frameworks take different
forms as they either take heroic, romantic, ironic or didactic forms. In progressive
frameworks, patients use their goals to strengthen ad develop themselves, hence,
their experiences of the illness serve as a stepping stone to a redesigned image of
self. Furthermore, stable frameworks are used to describe patients who are stagnant
and remain in the same position which does not influence their condition. Lastly,
regressive frameworks describe patients who stray away from their priorities and
goals, as the illness takes a negative toll on them.

CONCLUSION

Bury’s conclusion appears to be consistent enough with his argument as he

acknowledges that narratives do play an important role in the development of
biomedicine and should therefore not be ignored, Additionally, he petitions for
vigilance when interpreting narratives as they may not be what they seem on the
surface hence, he provides a breakdown of the different forms of narratives in attempt
to exhibit the different meanings that exist in illness narratives. Furthermore, his
conclusion that narratives leads researchers to ask questions as to why that patients
narrate their accounts that way is very consistent with his explanation that narratives
are culture bound which provides a fraction perspective on how those cultures operate.
Moreover, I do agree with Bury because, as much as narratives help reshape the
biomedicine framework, they are not universal which makes it difficult to group certain
types of narrative to specific illnesses as they differ from individual to individual.
However, I also agree with Bury’s suggestion that narratives should not be ignored
because they provide an explanation as to why and how the patient developed the
illness, therefore, medical professionals learn the effects that different life patterns
have on individuals.

LIMITATIONS

Narratives are culture bound which makes the narratives unreliable to certain extent,
this also means that they are highly subjective. Furthermore, due to the possibility that
patients can change their accounts according to the number of events happening in
their lives, one account does not holistically cover the real events that may have led
to the emergence of the illness. Lastly, the interviews used were secondary data which
denies Bury the ability to learn the full accounts of the patients, which means that the
information he used might be limited.

RELEVANCE OF STUDY

As mentioned before, illness narratives are an important piece to the puzzle of holistic
medicine and for that reason it is very important to study them. Additionally, one cannot
generalise illness narratives due to their subjective nature which means that they are
constantly changing as the society changes. Therefore, Bury’s ideas that illness
narratives do not provide a true image of illness but can rather be used to study society
composition can be generalised due to the changing nature of the society. Therefore,
researchers may use Bury’s ideas to realise that the pattern of illness narratives may
change in the way they are told due to the beliefs associated with accounts and the
influence of societal reaction in relation to storytelling, as the society changes.
Furthermore, Bury does not address the effect that the patients’ knowledge has on the
way they narrate their experiences and shape the structure of the study of illness
narratives.

The body could be constructed in a way that gives explanatory information about what
illness narratives are and the different forms of illness narratives that exist. This could
help the reader to grasp a quick and highly informative overview of topic in general.
Thereafter, the writer could opt to provide various way in which researchers may use
illness narratives to develop an understanding of the society and medicine. In this
section, the relevance of segmenting illness narratives into different forms could be
used to provide narrower options of the study, which could be relevant to different
individuals in other schools of thought. For example, psychologists may be interested
in learning how illness influences behaviours which is found in moral and core
narratives. Finally, the writer could give suggestions on how the study of illness
narratives can be improved to become a greater asset to the study of medicine in order
to avoid to ignorance of narratives in the field of health.

Since this article was written, there has been new studies on empathy and illness
narratives. According to Kumagai (2008), narratives provide medical professionals
with a different understanding of illness compared to what is taught in academic
spaces. Therefore, students in the medical field are encouraged to undergo
psychological development training which assists them to become more empathetic
towards patient narratives in order to value the narratives and gain deeper knowledge
of societies that exist outside their own realities. Furthermore, Kumagai (2008)
explains that the patients close family and friends my experience empathetic distress
which defines the mental discomfort that one may experience from witness another
person in pain. additionally, sympathetic stress usually stems from empathetic distress
when individuals desires to find comfort through finds ways of helping the patient
develop and reduce the amount of suffering they experience. Therefore, the
experiences patients go through with other people by receiving empathy from
physicians, friends and family, largely influences their narratives and helps them
development from illness.