The Patient's Perspective (Sociolinguistic analysis of illness narratives)

Eva Demeter (University of Szeged)

As a teacher of the language of medical specialities (both English and Hungarian) for the past 18 years, I focused my linguistic research on the verbal application of this specific language.

Research in the social sciences has clarified the nature and problems of doctor-patient communication. My paper can be linked to the patient-centred approach of doctor-patient communication. This approach attaches significant importance to the narration of the patient, which illustrates the illness and its effects in the patient's life context with its various aspects. Rather than putting a hypothesis at test and proving it by means of quantitative research, my qualitative analysis focused on observing and understanding an unpredictable process. I examine ten illness narratives developed in conversations with ten female patients suffering from serious cancerous disease.

The importance of illness narratives lies in the fact that they reveal the subjective feelings of people in trouble, i. e. they give an insight into the ways patients account for their new situation when trying to find an explanation for the break in their life- world. Consequently, an illness narrative is a genre the function of which is the recreation of a balance by the self whose integrity has been lost.

Analysing these narrations I reveal the specific features of the discourse which are present at various stages, and pay special attention to the positions where the complexity of the self's social identity can be detected.

I examined three aspects of the narratives: the role of time factor, the formal features of the discourse (structure and coherence) and the process of meaning construction together with the components of meaning. Time has a special role in illness narratives as the prognosis is frequently uncertain, with the result that the specific events are revaluated, emphases change. When focusing on the structural components, I examine what narrative genres occurred and also what functions were associated with the complexity of genres. The meaning of illness has a significant importance due to polysemy. The illness is inseparable of a patient's story, thus the illness is accounted for according to various relation systems and meaning is modified parallel with the appearance of further explanatory fields.

Patients' intention to revaluate identity can be considered as a performative act during which they place themselves, the characters of their narratives and their audience into different positions. The choice of positions has a strategic importance that manifests itself at the different stages of the discourse.

The illness narratives of patients suffering from cancer provide efficient means to understand subjective experiences as they reveal those dynamic processes that patients create in order to adapt to their altered circumstances. Mapping and categorising illness experiences may help medical professionals to understand individual experiences better and also to account for some behaviour of their patients that might seem difficult to understand.