Stories Matter: The Role of Narrative in Medical Ethics

By Rita Charon; Martha Montello | Go to book overview

CHAPTER 5

VOICE IN THE MEDICAL NARRATIVE

SUZANNE POIRIER

Literary terms that describe the elements and functions of stories are deceptively simple. As the other chapters in this section demonstrate, concepts seemingly as straightforward as plot, character, or context encompass a variety of choices on the part of the author and an equal variety of consequences for the reader. Voice is no exception. In the pages that follow, I examine the ways that three different literary scholars have discussed voice and consider how their ideas can illuminate the way physicians tell stories to themselves and to other health professionals. Finally, I demonstrate how the limitations of medicine’s narrative voice can, in turn, limit discussion of the ethical and human dimensions of medical care.

First, though, a brief reflection on grammar. Voice is both a noun and a verb. As a noun, it is a mechanism for conveying the spoken word. As a verb, voice implies agency, motivation. It always requires a direct object: “She voiced a concern”; “he voiced his agreement”; “they voiced their opinions.” And, as a verb, voice is attached to a subject, a person from whom the voicing emanates. Voice is thus deliberate, purposeful, and personal. The term disembodied voice, by contrast, usually refers to something supernatural or ethereal and is a cause for awe or fear, precisely because it removes from our sight or direct perception the embodied, identifiable agent.

Second, a brief consideration of a literary term related to voice: point of view. The contrast of the visual with the vocal implies an immediate difference, but the word point anchors sight to a particular person. The novelist Henry James probably stated it best in his preface to Portrait of a Lady:

The house of fiction has in short not one window, but a million…. [A]t each of them stands a figure with a pair of eyes, or at least with a field-glass,…insuring to the person making use of it an impression distinct from every other. He and his neighbours are watching the same show, but one seeing more where the other sees less, one seeing black where the other sees white, one seeing big where the other sees small, one seeing coarse where the other sees fine. 1

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