Response to Chan's critique
Article first published online: 14 JUL 2003
Journal of Advanced Nursing
Volume 43, Issue 3, pages 320–321, August 2003
How to Cite
Fredriksson, L. and Lindström, U. Å. (2003), Response to Chan's critique. Journal of Advanced Nursing, 43: 320–321. doi: 10.1046/j.1365-2648.2003.02752_2.x
- Issue published online: 14 JUL 2003
- Article first published online: 14 JUL 2003
We agree with Chan that adherence to ethical standards is of vital importance in a study involving a vulnerable group of participants. Ethical approval from a research ethics committee was therefore applied for and the study did not commence before this approval was granted. This means that standard policies were met, such as guaranteeing patients that their care would not be changed if they choose not to participate or to withdraw from the study. Likewise, the standard policies include an obligation that the study does not have a threatening approach and does not inflict further suffering.
We also agree with Chan that the relationship between the patient and the health professional is in danger of becoming a relationship in which one person exercises power over another's will. However, we do not agree that this fact is basically due to societal norms or to the norms of the medical profession but rather it is due to the fact that, in a caring conversation, the patient is suffering. According to Ricoeur (1992), suffering implies passivity which makes the relationship between patient and health professional asymmetrical. How the asymmetry in a caring conversation can be handled from an ethical and moral point of view, and this is dealt with in another article (Fredriksson & Eriksson 2003).
The aim of the present study was to increase and deepen the understanding of how psychiatric patients narrate their experience of suffering. It remains unclear to us how we have, according to Chan, excluded patients when choosing a sample from a population of psychiatric patients. Is it the case that Chan holds an underlying assumption that there is a ‘true narrative’ underneath the narratives told, and that this narrative cannot be told because the patient is in the psychiatric setting? In the article we have argued for a view of knowledge that is not necessarily derived or induced from observations of the world itself, but rather as one that emerges from the way we see the world. Thus the actual truth of the narratives is not of supreme importance. It is not authenticity but relevancy – that is, that they are relevant accounts of the patient's experience of suffering – that is the validity criterion at issue (cf. Cöster 1981).
Chan argues that the findings of the present study with regard to the plots are incompatible with findings of other studies quoted. This argument, however, is not correct. The present study identified some, but not all, of the plot structures found in other studies (Frank 1995, Wiklund 2000). This is not at all surprising as most narratives, both oral and written, follow one of the plots proposed by Wiklund (2000) or Frank (1995). More interesting is the question of whether certain plots are associated with the alleviation of suffering. If that is the case, then health professionals should help the patient to create a narrative following such a plot. On the other hand, by giving preference to a certain type of plot, we are in danger of silencing narratives that do not fit in. The findings concerning plot structures are discussed in the article and further research in this area is suggested.
As Gadamer (1988) points out, appropriation is a fundamental element in hermeneutic authentic understanding, an understanding that is deeply rooted in man's being. An understanding that paves the way for a deeper insight can create new possibilities for acting that can lead to actual progress in clinical practice and not only to temporary changes. It is our hope that this study invites the reader to an appropriation in a hermeneutic sense, an understanding of suffering where the ethical dimension is also taken into consideration; and hence that we have succeeded in what Peirce (1990) emphasizes in relation to pragmatism: namely, that we make our ideas so clear that they open the way for new thinking that leads to an approach and a way of conduct that alleviates the patient's suffering.
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