The Illness of Narrative

Reframing the Question of Limits


You see, we have reached the point where we look upon real ‘living life’ almost as a burden, almost as servitude, and we are all agreed amongst ourselves that it is much better to live life according to books. […] Yes indeed! Look more carefully! […] Leave us alone, without books, and we’d instantly trip up, get lost — we don’t know where to place our allegiance, what to hang on to; what to love and what to hate, what to respect and what to despise. We even find it difficult to be human beings — human beings with our own flesh and blood; we’re ashamed of it, we consider it a disgrace and strive to be some kind of imaginary general type. We are stillborn, and for a long time we have not been begotten of living fathers and this pleases us more and more. We are acquiring the taste. Before long we’ll think up a way of being somehow begotten by an idea. But enough; I don’t want to write any more ‘from the underground’. [1]

Dostoevsky, Notes from the Underground, 1864

The primary medium within which identities are created and have their currency is not just linguistic, but textual: persons are largely ascribed identities according to the manner of their embedding within a discourse — in their own or in the discourse of others. [2]

Shotter and Gergen, Texts of Identity, 1989

In the first of our opening quotations, a great 19th-century novelist points to the role of books in supplying ‘texts of identity’ and to the “negative relationship to human embodiment that is engendered by this process of textualization.” [3] For Dostoevsky, our reliance on “books” is symptomatic of the illness he ascribes to the moderns, a condition that stems from a superabundance of (self-)consciousness. Being “too conscious” is a “genuine full-blown illness” not only because it paralyses any capacity to act — by trapping man in an infinitely regressive process of interrogating motives, causes, justifications — but also, ultimately, in that it confounds the very categories of pride and shame, pleasure and pain, illness and health:

‘Ha, ha, ha! Next you’ll be trying to find pleasure in toothache,’ you’ll shout with a laugh. ‘And what if I do? There is pleasure in toothache,’ I’ll reply. [4]

It is this profound and dangerous lack of orientation, this having lost touch with the spontaneous values of nature and truth, that calls for “books” in Notes from the Underground — narratives on which to model allegiances, affects, preferences, indeed identity. [5] The narrator would rather be an insect, he assures us, than bear the burden of the detached, vacillating half-existence to which his heightened consciousness condemns him. At the same time, his predicament, and that of his generation, is to have acquired a taste for this perverse form of existence: soon, he ventures, we will figure out how to do away with flesh and blood altogether, how to be “begotten by an idea,” in complete abstraction from “real ‘living life.’”

A century and a quarter after the publication of Notes from the Underground, this “prophecy of de-realization” appears to have come true in the second quotation, by Shotter and Gergen. [6] In one of the founding statements of the narrative turn in psychology, what for Dostoevsky had been the symptom of a modern illness becomes a full-blown cure. From at least the late 1980s, textuality and narrativity have been associated with a ‘postmodern’ promise of emancipation, not from the shackles of the body as such, as flesh and blood, but from the shackles of normative forms of identity (sexual, gendered, racial, and so on) until then presumed to inhere in the body — in ‘nature’ and ‘truth’ as discursively defined from without, by the powers that be. Inspired by a heady mix of speech-act philosophy, hermeneutics, ethnomethodology, structural linguistics, pragmatics, semiotics, post-structuralism, and literary theory, many social scientists and critical psychologists deployed the notion of discourse and its variants (narrative, text, story) to launch challenges to the positivistic mainstream. This mainstream was perceived to be unquestioningly oriented toward natural scientific modes of practice accused of ignoring the historical and cultural constitution of human subjectivity and sociality. Davies and Harré, for example, developed the post-structuralist concept of “subject positioning” to theorize “the constitutive force of […] discursive practice,” announcing no less than that “among the products of discursive practices are the very persons who engage in them.” [7]

In the fields of medicine and health, the emancipatory promise of this textual turn was, for obvious reasons, quickly confronted with the limits of the body. The event of sickness — the irruption of flesh and blood as agents of narrative devastation — foregrounded embodiment as a constraining factor on what stories could be told. In the field-defining work of Arthur Frank, both selves and narratives are embodied, and his approach posits a “complex mutual relation between the body and culture.” The typology of body-selves he develops in The Wounded Storyteller, based on how each type addresses everyday “problems” that arise by the simple fact of being/having a body, implies that our experience of embodiment is always already structured by culturally available discursive models, even if these remain typically implicit until disrupted by an event of illness. Illness, as Frank well puts it, “requires new and more self-conscious solutions,” and thereby offers the opportunity not only to become aware of previously implicit narratives, but also to narratively reconstruct oneself in new ways. [8] Thus, despite the encounter with embodiment that illness makes inevitable, Frank’s position retains the distinctive welcoming orientation to the notion — so disturbing to Dostoevsky — that human beings are “begotten by an idea” or, more specifically, that we are begotten by stories: “[S]tories conduct people as a conductor conducts an orchestra.” [9] What is more, the idea that alarmed Dostoevsky is given a boost by the explicit suggestion that the stories we live by constitute us as ethical (or unethical) beings, and that this quality in turn is intimately related to the potential that stories hold for being agents of therapeutic change. Since “selves act in ways that choose their bodies,” the key to the healing properties of narrative lies in a moral imperative to engage in a “perpetual self-reflection on the kind of person that one’s story is shaping one into, entailing the requirement to change that self-story if the wrong self is being shaped.” [10] What is this, if not a prescription for superabundant self-consciousness? What Dostoevsky had described as the illness afflicting “underground man” has come full circle, as in Shotter and Gergen, to being described as a route to emancipation, an ethical norm, and a norm of health.

Where Dostoevsky wanted to contrast the one who truly lives with the one who lives only through stories, Frank seems to want us to acknowledge that, actually, it is only stories that really live. When he insists that we human beings merely “hitch a ride” on stories he is teasingly aware that those unfamiliar with the death-of-the-author trope will be disturbed by this “de-stabilizing of the sovereignty of consciousness.” [11] Only the un-reconstructed can retain the illusion that it is they who tell stories based on their experience. In fact, it is stories that are the real living, breathing things: it is they that animate us. What the unreconstructed amongst us glibly think of as our experience is in fact nothing but the pale imitation of what is given by a story. According to Frank, the great writers like Tolstoy tell us this truth better than anyone. But Frank’s appeal, he assures us, is not merely to the greats:

I do not believe that stories breathe because Tolstoy so clearly depicts it in his story of Mademoiselle Bourienne. Instead, I believe Tolstoy’s story because it expresses what is already my own lived experience, and at the beginning of that experience as I can know it are stories. [12]

This is a remarkable theoretical move on Frank’s part. His reason for believing that experience is constructed by and for stories is that he has experienced this directly himself: he has experienced the fact that his experience is constructed by stories. This is an appeal to lived experience that essentially disqualifies lived experience because lived experience can only be storied-into-being. Dostoevsky’s angst has long been forgotten: Frank, like many who are enthusiastic about the healing powers of narrative, has acquired the taste for being begotten by a story. Furthermore, one wonders — given this premise that experience is conducted by stories — on what basis Frank’s perpetually self-reflecting story-shifter comes to the conclusion that they have been using the wrong story to shape the wrong self. Why tell the story that one has been telling the wrong story?

2_What is the Problem with Narrativity? A Contemporary View

This is not the place to revisit the story of how and why ‘illness narratives’ have come to matter in medical education and clinical practice, after emerging and evolving as a distinctive literary genre in the second half of the 20th century. [13] The literature on the topic is so vast that, by now, it is not unusual for new contributions to be prefaced by disclaimers as to any comprehensiveness of scope or intention. Much of this literature has addressed the nature of the relationship between narrative and experience, or what anthropologist Cheryl Mattingly, in a text that still usefully synthesizes the key issues, has described as the “mimetic question.” By “mimetic” Mattingly means any theoretical stance that puts experience prior to narrative by assuming that narrative represents or even ‘imitates’ experience. Mattingly discusses a range of anti-mimetic positions, the most extreme one of which is that experience itself should be regarded as a phenomenological “illusion” created by narrative: “There is no reality without narrative. […] Because we have stories, we believe we are having experiences. Experience is, at best […] an enactment of pre-given stories.” [14] This position treats stories as if they were ‘platonic forms’ and experiences, by contrast, as the somewhat incidental and accidental manifestations that these stories take when they happen to be ‘earthed’ by a passing individual. This, as we have seen, is the position endorsed by Arthur Frank.

This now classic version of narratology has been subject to substantial criticism in medical humanities over the past decade or so. Of particular concern are the normative assumptions at play in endorsing narrativity as a universal, a-historical, and health-preserving feature of human experience. These are what Angela Woods, following Galen Strawson, describes as the psychological narrativity thesis, or the notion that “human beings typically experience their life as a narrative or story of some sort” and the ethical narrativity thesis, or the notion that “a richly narrative outlook is essential to a well lived life, to true or full personhood.” [15] Woods does not dispute the quality of the intentions of those who advocate the use of narrative specifically in relation to illness and to medical contexts. They, she writes, share “a commitment to understanding the centrality of the illness experience to the medical treatment of disease, taking seriously stories of illness, and valuing the individual as the empowered author-narrator of her own story,” all of which are commendable goals. [16] Neither does she propose that we should aim to “do without” narrative or discourage doctors and patients from telling stories. Nevertheless, synthesizing a range of previous critiques, Woods articulates an urgent need for reflexivity, stressing the importance of querying how specific and dominant kinds of narrative may function to “produce Western middle-class, liberal and neo-liberal modes of being.” Inspired by Strawson, even if critical of some of his arguments, she then goes further, proposing we query not only the normative value of particular kinds of narratives, but the “attachment to, and valorization of narrativity” as such, against the assumption that these are universally shared. [17]

In essence, the critique of narrativity articulated by Woods via Strawson takes aim at the notion that narrativity should be treated as an anthropological norm, with two potentially harmful consequences: one is for narrative forms to be imposed on individuals or groups who do not spontaneously articulate their own experience in this way; the other is for narrative forms to be privileged or nurtured at the expense of other means of accessing (and managing, or transforming) the experience of illness. Metaphor, philosophy, and the visual arts are briefly discussed by Woods as viable alternatives, or as potentially

useful ‘ways in’ to the meanings of experience generally and of illness specifically, avenues of exploration which might well intersect with or contribute to narrative but do not take storytelling as the starting point or telos. [18]

In other words, the concern about the limits of narrative — as presented in Woods’ important text — is a concern about what and whom the privileging of narrative excludes, and how (expectations of) narrativity might produce negative effects in so-called non-narrative people, regardless of their socio-cultural background. The assumption that this approach leaves implicit is that narrativity retains its positive and possibly ‘foundational’ qualities for those individuals or groups whose norms of life and psychological make-up it reflects. It is this assumption that thinking with Dostoevsky allows us to take some distance from, in order to formulate a critique of narrativity based on quite different premises.

3_What is the Problem with Narrativity? A View from the Underground

We are now in a better position to understand the value of approaching these debates from the perspective of the 19th-century looking forward into the 20th and 21st, rather than from the perspective of the present looking back, a mere few decades, to the ‘narrative turn’ in the humanities and social sciences. The character who narrates himself in Notes from the Underground does not assume the universality of narrative as an anthropological norm. On the contrary, the text reads almost as if Dostoevsky had written it to pre-empt all the key elements of contemporary critiques of narrativity in medical humanities. His anti-hero, the person of “heightened consciousness” whose identity is predicated on “books,” is presented from the start as an historically specific type and, in fact, as the “antithesis of a normal person” (l’homme de la nature et de la vérité). [19] He is also clearly situated in sociocultural terms, as an educated person and a civil servant living in the city of St. Petersburg, on the threshold between the old Russian empire and fast-modernizing Europe.

The whole text is oriented by the contrast between the character of the narrator — “a person touched by progress and European civilization […] a person ‘torn from the soil and from his native roots,’ as we say nowadays” — and his socio-historico-anthropological counterparts, the latter variously described as “spontaneous man,” “normal man,” man “with strong nerves,” and man “of action,” but also “stupid” and “coarse” (all the while insisting that these are not necessarily negative features, as one might assume, but possibly “very fine” and indeed enviable characteristics). [20] As for the concern, often expressed in relation to experiential narratives of illness, that narrative may not be “true to ‘life itself,’” again, for Dostoevsky this is a point of departure rather than a retrospective discovery or objection. [21] If there is a core message to Notes from the Underground it is that, in the same way that the narrator is the antithesis of a normal person, so living-by-narrative is antithetical and inimical to “real ‘living life.’” For the same reason, the potential for narrative to be harmful rather than redemptive comes first in the novel, rather than as a critical afterthought. It seems, in other words, that the objections raised by the critics of the psychological and ethical narrativity theses address assumptions that became consolidated as such considerably later than when Notes from the Underground was written — in a development that, as we have seen, is prophesized in the novel and that is fulfilled by the ‘narrative turn’ as exemplified (for the medical humanities) in the work of Frank.

For Dostoevsky, then, narrativity and narrative selfhood are the symptom not of an anthropological norm, but of a modern illness. What is most remarkable about this critique of narrativity is, of course, that it comes to us, defiantly, as a story rather than a philosophical essay. What we have in Notes from the Underground is one of the greatest novelists of all times, using narrative to warn readers about the dangers of living-by-narrative. Furthermore, Dostoevsky is far from alone or isolated, among great novelists, in making this case. Another example is Miguel de Cervantes’ remarkable story of Don Quixote which is often discussed — rightly or wrongly — as the first of the great modern novels. [22] Here is the story of a man who falls into an illness of sorts as a result of his habit of reading too many chivalric tales. As with the underground man, Don Quixote comes to live his life as if he were the hero in one of the many stories he has read. And — as with the underground man — great comedic effect is garnered through the contrast of the Don with his earthy sidekick Sancho Panza (fine and natural yet stupid and coarse). The first great novel, it seems, is a profound warning against the effects of living through stories. But the examples do not end there. In this vein, in a previous collaboration we have offered a detailed analysis of Thomas Mann’s great novel The Magic Mountain. Again, this is a novel fundamentally about illness and its ambiguities: is Hans Castorp really ill? Is his illness physical or mental or something else entirely? The Magic Mountain is a novel that reflects profoundly and critically not just on the novelistic art, but also on a range of other forms of creative expression including cinema, painting, and music, and their relation to the condition Hans Castorp experiences during his time in the Davos sanatorium. [23]

4_Narrativity as a Modern ‘Condition’

The social theorist who has done most to bring to light quite how fundamental this warning against stories is to the institution of the modern novel is Árpád Szakolczai. In two recent monographs, Szakolczai presents a comprehensive view of the novel from its origins in Spain and France in the first half of the 16th century, taking in the birth of the realist novel in early 18th-century England, and moving through to Goethe, Dickens, and Dostoevsky before engaging in a detailed discussion of the works of Kafka, Mann, Broch, Doderer, Bulgakov, Blixen, and Hamvas. [24] His analysis of the novel builds on a systematic program of earlier work that develops a reflexive historical sociology of the genesis of modernity. Szakolczai examines the emergence in Europe of the modern public sphere during a phase of transformation associated with the collapse of the Renaissance. In his account, this collapse gave rise to the distinctively modern trilogy of economics (modelled on the fairground), politics (comedified and “carnivalesque”), and science (“alchemical” in its assumption that all can be unmade and remade). Szakolczai refers to the effects of this modern trilogy as the “theatricalization” of social life because of their connection to the 16th century rebirth of theatre. At this historical conjuncture, theatre came to function as a space where “new types of social relationships characteristic of the market society […] were ‘experimented’ with,” as in a “laboratory” or “incubator.” [25] In his more recent works, Szakolczai goes on to develop the argument — remarkable both in its frankness and in its breadth of scholarship — that the modern novel provides a “royal road” for those who wish to understand and challenge the theatricalized character of reality, in order to recover and affirm the possibility of a grounded and meaningful life. A theatricalized reality is a reality in which the distinction between the genuine and the fake has been systematically eroded and it is novelists — given the nature of their trade — who have been in the best position both to operate with the ambiguity between fact and fiction and to offer the most insightful critiques of the dangers of so doing. For Szakolczai, the trajectory of modernity has been toward an increasing experience of what he calls permanent liminality through which any sense of a limit to human possibilities is attacked and replaced with an opening towards unlimited potential. [26] Dostoevsky’s underground man — as noted above — is a radically specific character, but still he points to a modernizing trajectory of uprooting that happened, during Dostoevsky’s lifetime, to be best expressed in the chronotope of an increasingly europhilic St. Petersburg bourgeoisie.

It is beyond the scope of this article to fully explicate, or indeed provide a critical analysis of, Szakolczai’s thesis about permanent liminality as epitomizing the modern condition. Let it suffice here to point to the fact that, in articulating this condition as the outcome of dynamics associated with modernity — rather than ‘post’-modernity, as might be expected — his thesis resonates strongly with the propositions of at least two other important thinkers: Alfred North Whitehead and René Girard. Whitehead wrote about the impact of the emergence of Newtonian science on the modern world. Central to his own analysis of the modern predicament is also a warning: in this case against what he called the “fallacy of misplaced concreteness.” [27] With this expression Whitehead addressed the mistaking of abstractions for concrete reality, a confusion akin to what Szakolczai draws our attention to through the concept of “theatricalization.” While Whitehead argued that we “cannot think without abstractions,” he also stressed that, for this very reason, “it is of the utmost importance to be vigilant in critically revising [our] modes of abstraction,” particularly when these prove to be inadequate for dealing with things that are important to us. [28] The distinctive, and historically unprecedented feature of modes of abstraction associated with the emergence of modern science is that they purport to describe what is really real against the evidence of our own senses, and of “nature as apprehended in our immediate experience.” [29] This is what Whitehead described as the “bifurcation of nature,” the splitting of our immediate experience of nature as a single reality into two ontologically different regimes of existence, one objective and value-neutral, the other subjective, sensuous, and brimming with values. [30] In his attempt to reconcile the scientific description of nature (whose practical value was beyond dispute) with morality, Kant sealed this bifurcation into a system of metaphysical assumptions that still informs our common sense today. The mistrust of experience that plagues Dostoevsky’s anti-hero has its roots in this bifurcation. In so far as what is really real cannot be directly apprehended in/as experience, underground man must rely — now more than ever — on “books,” or heteronomous norms and models, for any sense of direction. At the same time, he must operate under the Kantian notion that for a human being to be moral and dignified — or indeed properly human — requires that they act as an autonomous subject. Underground man, in other words, is caught in a situation of “double bind.” [31] In Szakolczai’s terms, the “reasons of [his] mind” have been severed from the “reasons of [his] heart:” what ensues is a dangerous sense of being unmoored, where “the mind keeps turning round and round, in search for a solution, as when the accelerator is pushed with the gear in neutral.” [32]

Like Szakolczai, albeit using different arguments, Whitehead — most notably in Science and the Modern World — also stressed the continuity between developments in the domain of science and those in other spheres of social life, positing an important relationship between scientific materialism and liberal political economy. The modern concept of nature as governed by physical laws has its parallel in economic abstractions that defined what have become known as ‘laws of the market,’ in a discourse that rendered the modern concept of the market akin to that of nature itself, as the natural foundation for social existence. In other words, the materialistic basis of modern science was reproduced in political economy, where

all thought concerned with social organization expressed itself in terms of material things and capital. Ultimate values were excluded. They were politely bowed to, and then handed over to the clergy to be kept for Sundays. [33]

With respect to the question of personhood, the corresponding abstraction is the one that imagines human beings as fundamentally motivated, indeed constituted, by (more or less enlightened) self-interest. Here it is important to note a resonance with the work of René Girard, which Szakolczai cites as an explicit source for his own thought. In his philosophical anthropology, and in stark contrast with Kant’s, Girard uses the concept of mimesis not as a critique of representationalism in art but as a core theoretical term that foregrounds the ‘imitative’ nature of desire itself. To simplify, where for Mattingly ‘mimesis’ concerns the vexed question of whether art imitates life (does a narrative faithfully copy an experience like a picture of a flower copies a flower?), for Girard the crucial question of mimesis is not about a representation modeling a reality but about the way in which one desire comes to be modeled upon another (is my desire to draw a flower copied from what I perceive to be your desire to paint a flower?). Girard’s thesis about mimetic desire is thus that the origins of desire are traceable neither to the desiring subject, nor to the desired object. Rather, desire is mediated by a third party, whose desires provide the model of what is to be desired. Girard was hugely inspired by his engagement with the works of Dostoevsky, acknowledging that many of his key concepts came from a close reading of Dostoevsky’s works. [34] For Girard, Dostoevsky is one of the writers who most clearly reveals the mimetic nature of desire. Indeed, the underground man is thoroughly enmeshed in the perverse complications that mimetic desire is bound to give rise to when it is unrecognized and unmoored from any constraints. Consider the famous scene in which he acts up at a party to which he contrived to get himself invited specifically because he did not want to spend time with these friends/rivals:

I smiled contemptuously, and walked along the other side of the room, straight opposite the sofa, alongside the wall, back and forth between the stove and the table. I wanted, with all my might, to show them that I did not need them; meanwhile I deliberately stamped my feet, coming down on my heels. But it was all in vain. They didn’t pay me any attention. I had the patience to walk up and down like that, right in front of them, from eight o’clock to eleven o’clock, keeping always to the same spot… I’m doing it because I want to, and no one can stop me. [35]

The problem here is desire: the underground man desperately needs his friends/rivals to know that he does not need them. His sharpest desire is to show them that he does not care to show them anything! His biggest disappointment is that they do not trouble themselves to pay attention to his desperate efforts to show them that he does not want or care for their attention. And importantly, the underground man carefully conceals all this complicated and frustrated mimetic desire, not just from them (who see it anyway), but from himself: “I’m doing it because I want to.” Dostoevsky here and throughout his novels is forensically pinpointing the fundamental limitations of a concept of selfhood predicated on enlightened self-interest that, for him, characterizes the forward thrust of European modernization:

Oh tell me, who was it who first announced, who first proclaimed that man only does vile things when he does not know where his real interests lie? And that if he were enlightened, if his eyes were opened to his real, normal interests, he would at once cease doing vile things and would immediately become good and honourable, because being enlightened and understanding where his real advantage lay, he would indeed see his own personal advantage in goodness, and because it is well known that no one can knowingly act against his own personal advantage, he would find himself obliged to do good. Oh, you child! You sweet innocent babe! [36]

Dostoevsky’s novel systematically demonstrates, not just the naivety of the modern ideology of enlightened self-interest, but its polarizing and disruptive effects on the psychic and social orders of the ‘modern’ individuals who are swept up in its inexorable influence. Its effects are not harmonious progress or emancipation, but an uprooting that leads to the groundless paralysis of perpetual self-reflection that Szakolczai identifies with the paradox of permanent liminality — and that contemporary proponents of narratology elevate, as we have seen, to the status of an existential and ethical norm. The issue here is completely missed if one remains fixated on mimesis as a problem of how and whether a narrative qua representation corresponds to an experience or an external reality. It is not that “life and story […] imitate one another, ceaselessly and seamlessly:” life and story are both realities in the lives of real, concrete, flesh-and-blood people, and it is novelists who are best able both to see their connection and to tell their difference. [37] Frank is correct to want to orient attention to the great novelists and their views on narratology. But the message he draws from them ignores the profound warning that is at the core of Notes from the Underground and that, according to Szakolczai, runs across all great novels as a distinctively modern genre.

5_Conclusion: Narrativity as Pharmakon

In the preceding discussion we have proposed that the ‘limits of narrative’ can be articulated not only in terms of what (or whom) a privileging of narrativity excludes, but also in terms of the extent to which the construction of selves through narrative can and should be regarded as a ‘healthy’ norm, even for those in whom this activity appears to come ‘naturally. Through Dostoevsky and Szakolczai, we have drawn attention to the fact that many of the great modern novels present us with a profound ambivalence in relation to the functions of narrative, and that this ambivalence recurrently takes the form of a meditation on illness, often of an indeterminate character. In this interpretation, the modern novel — arguably the most accomplished form of narrative — can be conceived as a therapeutic intervention, a remedy. Like every remedy, however, it has the ambivalent character of a pharmakon.

Our thesis articulates the negative consequences of forgetting the ambivalent character of narrativity, or what happens when we elevate narrative to an ontological norm. What are the implications of this insight for contemporary narrations of illness, specifically? We opened this discussion by tracing the outlines of a historical trajectory, from Dostoevsky to Shotter and Gergen (and Frank), that saw the existential value of narrative turned upside down, or inside out. From the second half of the 20th century, we argued, textuality and narrativity have been associated with a ‘postmodern’ promise of emancipation from the shackles of forms of identity, norms, and values imposed from without. If identity is discursive, then, at least in principle, it can be unmade and remade at will, from within. When it cannot, it will be a matter of contesting the social structures that hold it in place. In the meantime, flesh and blood will be just that: indifferent matter, inconsequential matter, or at best plastic matter at the service of projects of identity construction.

Against this broad cultural background, in a further twist, illness and death (of flesh and blood) may be said to have acquired a specific and paradoxical value for the (post-)moderns: they have become the antidote to abstraction, anchors for the narrative forging of lives otherwise potentially adrift in a sea of arbitrary and theoretically limitless possibilities. If health, to cite the famous maxim by René Leriche, is “life lived in the silence of the organs,” that silence now epitomizes the fact that ‘life’ itself appears conspicuously silent as to how it should be lived. [38] Life lived in the silence of the organs is life lived under the imperative to fulfill an obligation to be free — for which illness itself, with the constraints it puts on what stories can be told, then becomes a possible and paradoxical cure. [39] The danger of forgetting the ambivalence of narrative, when this is elevated to an ontological norm, lies in the value that illness acquires as a potential basis for the construction of identity, and the resulting forms of existential investment. Dostoevsky makes this plain in the opening lines of Notes from the Underground, where his anti-hero introduces himself to us — this is who he is:

I am a sick man… I’m a spiteful man. I’m an unattractive man. I think there is something wrong with my liver. But I cannot make head or tail of my illness and I’m not absolutely certain which part of me is sick. I’m not receiving any treatment, nor have I ever done, although I do respect medicine and doctors. […] No, it’s out of spite that I don’t want to be cured. You’ll probably not see fit to understand this. But I do understand it. […] I know better than anyone that in doing this I shall harm no one but myself. Anyway, if I’m not receiving medical treatment it’s out of spite. If my liver is hurting, then let it hurt all the more! [40]

_How to Cite

Monica Greco and Paul Stenner. “The Illness of Narrative: Reframing the Question of Limits.” On_Culture: The Open Journal for the Study of Culture 11 (2021). <>.

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  • [1] Fyodor Dostoevsky, Notes from the Underground and The Gambler (Oxford: Oxford University Press, 1991 [1864]), 122–123.
  • [2] John Shotter and Kenneth J. Gergen, eds., Texts of Identity (London: Sage, 1989), here: sleeve notes.
  • [3] Paul Stenner, “In the Name of the Father: Dostoevsky and the Spirit of Critical Psychology,” in Critical Psychology 8 (2003), 96–128, here: 97.
  • [4] Dostoevsky, Notes from the Underground, 16.
  • [5] The contrast case to “a person of heightened consciousness” is “l’homme de la nature et de la vérité” — see Dostoevsky, Notes from the Underground, 13.
  • [6] Stenner, “In the Name of the Father,” 97.
  • [7] Bronwen Davies and Rom Harré, “Positioning: The Discursive Production of Selves,” in Journal for the Theory of Social Behaviour 20 (1990), 43–63, here: 43.
  • [8] Arthur W. Frank, The Wounded Storyteller: Bodies, Illness and Ethics (Chicago: University of Chicago Press, 1995), 26 and 27.
  • [9] Arthur W. Frank, Letting Stories Breathe: A Socio-Narratology (Chicago: University of Chicago Press, 2010), 14.
  • [10] Frank, The Wounded Storyteller, 40 and 158. In the socio-narratology subsequently presented in Letting Stories Breathe, Frank offers a corrective to the individualizing ethical implications of his original argument through a discussion of “narrative competence” and “narrative resources.” In a nutshell, while the capacity to tell and understand stories is fundamental to “being human, and especially being social,” (13) narrative competence is not evenly distributed. Frank then follows Wayne Booth’s quasi-evolutionary “ethical criticism,” to effectively equate the possibility of living virtuous lives with having access to virtuous stories.
  • [11] Frank, Letting Stories Breathe, 25.
  • [12] Frank, Letting Stories Breathe, 25.
  • [13] The story has been told many times, in multiple and mutually complementary versions. Frank himself offers a plausible account through his description of the rise of what he calls “remission society,” occasioned by the epidemiological transition that took place from the mid-20th century onward (see Frank, The Wounded Storyteller); others have offered perspectives from literary history — see Anne Hunsaker Hawkins, Reconstructing Illness: Studies in Pathography (West Lafayette, Ind.: Purdue University Press, 1993) — or from the perspective of bioethics and its evolutions as an academic field, see Hilde Lindemann Nelson, “Introduction: How to do Things with Stories,” in Stories and Their Limits, ed. Hilde Lindemann Nelson (New York and London: Routledge, 1997), to cite just two.
  • [14] Mattingly, Healing Dramas and Clinical Plots, 33.
  • [15] Galen Strawson, “Against Narrativity,” in Ratio 17.4 (2004), 428–452, here: 428, cited in Angela Woods, “The Limits of Narrative: Provocations for the Medical Humanities,” in Medical Humanities 37 (2011), 73–78, here: 74.
  • [16] Angela Woods, “The Limits of Narrative,” 73.
  • [17] Angela Woods, “The Limits of Narrative,” 76. For a related argument see also Monica Greco, “Inconspicuous Anomalies: Alexithymia and Ethical Relations to the Self,” in Health 5.4 (2001), 471–492.
  • [18] Angela Woods, “The Limits of Narrative,” 76.
  • [19] Dostoevsky, Notes from the Underground, 13.
  • [20] Dostoevsky, Notes from the Underground, 17, 13, 15.
  • [21] Mark Freeman, “Life ‘On Holiday’?: In Defense of Big Stories,” in Narrative Inquiry 16.1 (2006), 131–138, here: 132, cited in Woods, “The Limits of Narrative,” 74.
  • [22] For a short precis and introduction, see Ana Puchau de Lecea and Vicente Pérez de León, “Guide to the Classics: Don Quixote, the World’s First Modern Novel — And One of the Best,” in The Conversation, June 28, 2018, accessed July 16th, 2021, <>.
  • [23] Paul Stenner and Monica Greco, “On The Magic Mountain: The Novel as Liminal Affective Technology,” in International Political Anthropology 11.1 (2018), 43-60.
  • [24] Árpád Szakolczai, Novels and the Sociology of the Contemporary (London: Routledge, 2016), and Árpád Szakolczai, Permanent Liminality and Modernity: Analysing the Sacrificial Carnival through Novels (London: Routledge, 2017).
  • [25] Árpád Szakolczai, Comedy and the Public Sphere: The Rebirth of Theatre and the Genealogy of the Modern Public Arena (London: Routledge, 2013), 2. Our summary of Szakolczai’s thesis here is adapted from Stenner and Greco, “On The Magic Mountain,” 45.
  • [26] The concept of liminality has its origins in the work of folklorist and ethnographer Arnold van Gennep in his analysis of rites of passage and was subsequently developed by anthropologist Victor Turner. See, among other works, Victor Turner, From Ritual to Theatre: The Human Seriousness of Play (New York: PAJ Publications, 1982).
  • [27] Alfred North Whitehead, Science and the Modern World (London: Free Association Books, 1985), 64.
  • [28] Whitehead, Science and the Modern World, 64.
  • [29] Whitehead, Science and the Modern World, 72.
  • [30] Alfred North Whitehead, The Concept of Nature (New York: Prometheus Books, 2004).
  • [31] Gregory Bateson, Steps to an Ecology of Mind (New York: Ballantine, 1972).
  • [32] Árpád Szakolczai, “Permanent (Trickster) Liminality: The Reasons of the Heart and of the Mind,” in Theory and Psychology 27.2 (2017), 231–248, here: 234.
  • [33] Whitehead, Science and the Modern World, 252.f
  • [34] René Girard, Resurrection from the Underground: Feodor Dostoevsky (New York: The Crossroads Publishing Company, 1997).
  • [35] Dostoevsky, Notes from the Underground, 77.
  • [36] Dostoevsky, Notes from the Underground, 22.
  • [37] Frank, Letting Stories Breathe, 21.
  • [38] René Leriche, quoted in Georges Canguilhem, The Normal and the Pathological (New York: Zone Books, 1991), 91.
  • [39] “Obliged to be free” is an expression coined by Nikolas Rose in Governing the Soul: The Shaping of the Private Self (London: Routledge, 1990); Arthur W. Frank, The Wounded StorytellerBodies, Illness and Ethics (Chicago: University of Chicago Press, 1995).
  • [40] Dostoevsky, Notes from the Underground, 7.