Healing Dramas and Clinical Plots: the Narrative Structure of Experience

Cheryl Mattingly Cambridge University Press, £14.95, pp 192 ISBN 0 521 63004 5 ——————— Rating: ★★ In this book anthropologist Cheryl Mattingly analyses communication by occupational therapists treating life altering illnesses such as spinal cord injuries. Her opening statement admits that the book gave her trouble as her thoughts developed over a decade. She also wondered how much of her personal opinions and feelings should be openly expressed, and her analysis ultimately reflects the interaction between patients, therapists, and observer. The book, which builds on existing work, does not read as an introductory text and would probably appeal most to those with a particular interest in narrative research. Looking into the connection between language and action, Mattingly weaves philosophical and psychological arguments into her discourse, concluding that healing words and gestures follow a story-like structure. Some of the concepts detailed by Mattingly are neither new nor unique to rehabilitation therapy. For example, she observes that the present is configured by the past (as a reference point to help put illness in a life context) and by anticipation (the story toward which one is heading). She notes that therapists draw from their global experience yet must individualise their therapeutic approach, and she refers to the desired congruence between therapists’ and patients’ goals. Other publications (such as M Stewart and colleagues’ Patient-Centered Medicine) discuss such matters in a language more accessible to a practitioner. Comments on the challenge of deciphering not only the language but also the actions of others can also be found, in succinct but clear form, in texts like D L Sackett and colleagues’ Clinical Epidemiology. Mattingly is at her best when describing the challenges specific to occupational therapy (“therapeutic plots”), such as the need to make the treatment process matter to patients in spite of a long path rewarded by only small, irregular gains. Her description of encounters between patient and therapist is so vivid that one can actually visualise the individuals and feel their emotions. She emphasises the need to focus on a plot structure rather than on a succession of doings, since the ultimate goal is to have patients integrate the problem solving process into their lives and continue to apply it even when the therapist is no longer present. This book will be of interest to most occupational therapists, but it has particular value for those considering occupational therapy as a career because of its meticulous description of that profession’s challenges.