'Let me explain': narrative emplotment and one patient's experience of oral cancer.

摘要

Recent research has investigated the way in which serious illness potentially poses a threat to peoples' sense of ontological security by throwing into doubt assumptions about time and the future. One of the main ways in which people adjust to such threats is through the use of narrative (either consciously or unconsciously) which helps to make sense of illness. Of particular relevance to people learning to live with a cancer diagnosis, is the concept of 'therapeutic emplotment' developed by Del Vecchio Good et al. (1994). This concept refers to the way in which oncologists are taught to structure temporal horizons for their patients in a particular way in order to instill and maintain hope in the context of arduous and toxic treatments. Using a case-study of one man's process of adapting to oral cancer (John Diamond's posthumously published serialised diary entries in The Times), this paper investigates the way in which such 'therapeutic emplotment' is implicitly incorporated by the patient, providingan underlying plot structure to his story. Following Diamond's diary entries over the 4 years duration of his illness, this paper analytically divides them into six main stages, documenting the underlying temporal structure and themes accompanying each stage of adaptation. The paper illustrates the way in which 'therapeutic emplotment' encourages the patient to focus on the immediate present and to place faith in the efficacy of specific treatments. However, it also explores how the attempt to live in the context of such a plot is fraught with anxiety for the patient, and how it co-exists with other largely 'unspoken narratives' of uncertainty, fear and skepticism in relation to the power of medicine. The main aim of the paper is to document, for the first time, the process of 'therapeutic emplotment' from the oral cancer patient's point of view.