” Narrative Ethics: A Narrative By Howa rd Bro dy a nd Ma rk C l a rk
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nce upon a time, medicine dismissed narrative as unimportant and uninteresting.1 Then, in the late 1980s, physicians and scholars became interested in how the study of narrative could enhance our understanding of illness and health care, and the field that came to be known as “narrative medicine” developed.2 Some of this scholarly activity focused on the idea of narrative ethics.3 After a flurry of activity around the turn of the twenty-first century, narrative ethics seemed to stall. The general interest in narrative in medicine continued but with few new ideas about how one might use narrative toward ethical ends. In the last few years, however, forward momentum has returned.4 The timing seems appropriate, therefore, for a “state of the field” report of sorts. To anchor this report, we will first return to a summary of narrative ethics that one of us offered in 2003.5 The summary was tentative and preliminary, and identified a number of blank spaces that needed to be filled in. Today’s state of the field report is also tentative but in a different way. Instead of imagining that more spade work will fill in the blanks, we are better able now to see why certain things will remain unclear and in tension because of the very nature of narrative ethics. Arthur Frank argues that stories inherently “make trouble.” We don’t tell stories when everything happens exactly as expected; we tell stories when ordinary routines are disrupted in ways that create difficulties for the characters.6 Recent work in narrative ethics could be viewed, therefore, as making trouble for some earlier conceptions in productive and suggestive ways. Narrative ethics, in this manner, is firmly situated as a hermeneutic and dialogic enterprise.
Howard Brody and Mark Clark, “Narrative Ethics: A Narrative,” Narrative Ethics: The Role of Stories in Bioethics, special report, Hastings Center Report 44, no. 1 (2014): S7-S11. DOI: 10.1002/hast.261 January-February 2014
An Earlier Assessment
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decade ago, narrative ethics seemed to have a number of important features. What counts as “narrative ethics”? While some included under the term such uncontroversial activities as using stories merely as illustrations for the applications of ethical rules or principles, two claims seemed substantive enough to qualify as true narrative ethics. One might claim that we can gain ethical insight and wisdom directly from narratives and without appealing to rules, principles, or other ethical constructs. Or one might claim that when we do appeal to principles, for example, narratives play a crucial role in shaping or determining those principles. Theoretical homes for narrative ethics. To claim a theoretical foundation for narrative ethics would misrepresent its hermeneutic character, but various ways of thinking about ethics provide a congenial home for narrative approaches. One such home is feminist ethics, with its emphasis on moral responsibilities within interpersonal relationships.7 Another such home is neuroscientific assessments of ethics that focus on the inherently narrative structure of thought and brain activity.8 Ways to do narrative ethics. These congenial theories in turn suggest promising ways of doing narrative ethics, which might be termed keeping faith and trying on. In keeping faith, one recognizes the narratives that have shaped one’s moral identity, makes a judgment that one approves of that identity, and then decides how a person with that identity would behave in the present circumstances. Trying on refers to how one uses narrative imaginatively to discern possible next chapters of the story that is now unfolding and then to choose the actions that best “fit” one’s core values as displayed in previous chapters and that produce the best overall outcome for the story. HAS T I N GS C ENTER RE P ORT
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Rigor in narrative ethics. Narrative approaches would not be ethical unless they required and enabled the critical weighing of interpretations and actions. One area of agreement among most writing about narrative ethics is that the enterprise proceeds comparatively—one critiques a story with other stories. Since stories are ultimately what one uses to critique a story, it helps to know something about narrative structure and how stories operate. Finally, stories are layered, something like a nest of Russian dolls. Stories exist at many levels ranging from particular to general. The most general stories define a community, society, or culture and inform us what particular stories we can tell. This is not to say that all stories emerging from within the nested system are wholly determined by the system—simply that they are significantly shaped by it. A particular story that deviates too much from the model narratives or genres that our culture supplies for us will be a challenge to understand, even though such “trouble-making” stories are critical in expanding our ways of thinking about ethics.9 Therefore, the stories with which one is attempting to do ethical work can usefully be compared both to other particular stories and also to more general stories or genres. There are thus many ways we can be critical and reflective in our narrative ethics work. These observations about narrative ethics still appear generally valid a decade later. More recent work, however, permits a considerable expansion of our account of the field. The Current State of the Field
Stories are essential and performative. To lay the groundwork for a focus on narrative in ethics, it helps to be reminded that stories are central to human life and society. Frank quotes Joan Didion’s assertion, “We tell ourselves stories in order to live,” and adds, “[N]arrative makes this earth habitable for human beings.”10 One misconception that allows us to imagine that we could do without stories is that stories are nothing but a pale reflection of some set of “real” events that occur in the outer world. A better account views stories as performances—they act on the world to make things become true, rather than merely reporting external truths.11 Thinking about stories in this way is already to take an ethical stand, because to listen to a story, to enter into dialogue with the storyteller, is to decide to open oneself to the other’s way of seeing the world. Stories organize and evaluate the world. Frank argues that our stock of stories becomes our default selection and evaluation guidance system to deal with what William James famously called the “blooming, buzzing confusion” the world presents to us: S8
Stories are better imagined . . . as a tacit system of associations that makes particular aspects of the world seem worth attending to and suggests default evaluations of what is selected. Selections and evaluations are constantly being overridden by other, often more conscious considerations; they are, I emphasize, a default system. Nevertheless, as nondetermining as this selection/evaluation guidance system is, it processes a large proportion of what might be called candidate-experience: what happens to a person that, if attended to, becomes that person’s experience. Candidate-experience becomes experience because it fits stories people know.12
Frank adds, “Stories teach people what to look for and what can be ignored; they teach what to value and what to hold in contempt.”13 The library of stories that we carry about with us therefore largely determines what experiences of the world we have. If the world presents us with something that fits none of our stories, the chances are good that we’ll simply ignore those stimuli and never have that candidate-experience at all. Stories in the library become the larger Russian dolls, within which are nested the smaller Russian dolls that represent the specific stories we construct to explain and recount specific incidents in our own lives. Stories link values to actions. Stories teach us that good things will happen if we act in certain ways in certain circumstances and that bad things will happen if we act differently. Stories, as the selection and evaluation guidance system, then help us make sense of our experience of the world and point out to us when circumstances of the relevant sort are actually occurring.14 Stories’ plots tell us what should happen next. Stories can link values to actions through what we previously labeled “trying on,” expanding Alasdair MacIntyre’s widely quoted statement, “I can only answer the question ‘What am I to do?’ if I can answer the prior question ‘Of what story or stories do I find myself a part?’”15 Since the library of stories we grow up with is a product of culture, anthropologist Pierre Bourdieu’s term “habitus,” which might be translated as “dispositions” or “second nature,” is helpful here.16 People within a society, on being told an uncompleted story, have a general sense of what would count as a good or satisfactory ending. There are a finite number of possible plots, in turn partially determined by the number of narrative genres available to us. Frank adds, “People’s habitus of expected plot completions is nothing less than their sense of life’s possibilities.”17 Stories and virtue. The concept of “keeping faith” may be deepened by relating it to narrative accounts of virtue. Most ethicists today distinguish ethical rules and principles, which try to tell us how we should act in various circumstances, from a virtue approach to ethics, which instructs January-February 2014/ H A S T I N G S CE NTE R RE P O RT
Stories succeed in doing what they do precisely because they capture so much of the indeterminacy, contingency, and luck that characterizes human social life. us as to what sort of moral character to develop over a lifetime. This distinction, however, can be overdrawn—one way to tell us what to do is to tell us what sorts of persons we ought to try to be.18 Frank illustrates the close relationship between character and specific actions by recounting a story about Coyote from Native American tradition, in which Coyote, like Orpheus in Greek mythology, goes to the spirit world to try to find and bring back his dead wife. Coyote’s guide tells him that he must under no circumstances touch his wife until the journey back to the human world is complete. As she approaches that world, however, she assumes more and more closely her accustomed form, and finally Coyote cannot resist. As soon as he touches her, she of course returns irretrievably to the world of the dead. The exasperated comment of Coyote’s guide may be translated as, “You inveterate doer of this kind of thing!”19 This story does blatantly what most, if not all, stories do more subtly—present a dramatic situation in which a character is called on to display his or her essential moral nature, according to how he or she responds to a particular challenge. This aspect of narrative makes sense of MacIntyre’s argument that the notion of virtue requires in turn a notion of the narrative form of a human life.20 Stories are unmatched vehicles for showing us in the most engaging and compelling way, first, what it means to be a person of a certain moral character and how one comes to be such a person and, second, how a person of that moral character will behave when confronted with a pivotal and decisive situational challenge. Bad and dangerous stories. Early works on narrative ethics tended to agree with Didion that we need stories to live, and so they portrayed stories almost invariably in a positive light. An important exception was Wayne Booth, who noted that the stories we listen to or read become the company we keep, and that we would not want to be found in certain types of company.21 One of the ways more recent work makes trouble for narrative ethics is by insisting that since stories are so powerful, they can also be dangerous. Good stories often tend to be dangerous in the sense that they depict and promote transformation: they challenge habits of thought and ways of being and acting in the world as prescribed by ideology. But stories can be dangerous because they are bad, and figuring out just what is dangerous about bad stories helps to assure that narrative ethics achieves proper critical rigor.
It might be that no stories are bad in and of themselves; they become bad only in relation to particular persons and situations. Perhaps one can generalize and say that stories are bad when we need to understand something by moving on to different stories told from different perspectives but cannot because the initial story prevents us from seeing this and from seeking those alternative stories.22 Stories that call us to violence toward other groups of people and simultaneously make it seem disloyal to seek other points of view are extreme examples of bad stories that are commonly used to justify war and genocide.23 Frank introduces the useful phrase “holding one’s own” to describe not only the crucial role stories play in human life but the way, too, that some stories prove to be bad ones.24 Stories commonly feature heroes who are able to hold their own against major challenges. The critical question readers and listeners need to train themselves to ask is this: if this story makes it possible for an individual to hold his or her own or for a group to hold their own, are there other people for whom this story makes it harder for them to hold their own? And if so, how could the story be told differently from the perspective of that second group? How would our understanding of the situation be expanded if we heard both stories side by side, instead of only the story we were originally told? Criticizing stories by comparing stories. Bad stories illustrate how we can become trapped within stories that teach us to act in dysfunctional ways, but we need not be trapped. Here we return to earlier ideas that narrative ethics works comparatively, and that one’s total library of stories is a major determinant of one’s character and actions. Knowing what makes bad stories dangerous, we can learn to detect stories that make it too hard for the vulnerable to hold their own. We can learn to respond to such stories with a demand for additional stories—not just any additional stories, but ones in which the point of view shifts to favor how the world looks to the characters previously marginalized. Frank suggests that “some fairly obvious qualities of less-dangerous stories includ[e] openness to more stories; depiction of characters who acknowledge mistakes and work to set things right; making heroes of characters who cooperate; and giving antagonists names, faces, and purposes that cannot be immediately dismissed. Less-dangerous stories make the world and actions more complicated.”25 The indeterminacy of stories. We are now in a better position to see why some of the tentativeness that surrounds
SPECIAL REP ORT: N a r r a t ive E t h ic s: T h e Ro le of S tori e s i n B i oe th i c s
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any account of narrative ethics is not resolvable. A “state of the field” report may create the mistaken impression that narrative ethics can proceed by following something like a formula. Actually, stories succeed in doing what they do in human social life precisely because they capture so much of the indeterminacy, contingency, and luck that characterizes life. If stories permit humans to live, they permit us to live within that world of indeterminacy. Stories reflect the notion of culture as portrayed by anthropologists like Bourdieu and Levi-Strauss: the cultures we live in present us with a variety of choices, but the cultures themselves and their outlines are largely unchosen.26 Ironically, the indeterminacy of stories—that they are both chosen and unchosen, that they both pass on and conceal information, that we can tell them in the way and to whom we wish and yet they remain out of our control— gives them the power to do what they can do. Stories try to make a complex and confusing world one in which human beings can live and carry out their purposes, and to do so they must walk fine lines: “The value of stories is to offer sufficient clarity without betraying the complexity of life-in-flux.”27 To lead ethical lives, we must tack back and forth between acknowledging stories’ ability to clarify and recognizing the need to regularly exchange overly simple views of the world for more nuanced and complex ones. Reason versus emotion in ethics. The fine line stories force us to walk between clarity and indeterminacy sheds some light on a recent debate in moral psychology over how much of ethics is based on reasoning as opposed to emotion. Jonathan Haidt, for example, employs the metaphor of a man riding an elephant.28 Once in a while, the man can steer the elephant, but a good deal of the time, the elephant goes where it wants to. Reasoning in ethics, Haidt claims, does most of its work by rationalizing after the fact as to which way the elephant has gone. It is only in the unusual case that reason actually steers the elephant.29 This is exactly what we’d expect if stories, especially unchosen stories that guide our lives unconsciously, direct much of our everyday behavior. We commonly make choices quickly and instinctively, and if need be, we later go back to fill in the reasons for our choices.30 None of this eliminates our ethical responsibilities to live well with our stories. Conclusion
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dvances in narrative ethics during the last decade help us appreciate how narrative brings into closer congruence three approaches that have historically been separated. People who want to talk about what to do in specific situations and who believe that moral wisdom is to be found in general rules and principles have embraced the approach characterized (or caricatured) as principlism. Those who also want to talk about specific situations but who think S10
that moral wisdom resides in close analysis of the particular situation itself have tended to practice casuistry. And those more interested in enduring moral character and less in what a person should do here and now have employed virtue ethics. Relatively few recent scholars of health care ethics have blended these approaches; most seem content to reside in one of the three camps. Stories can combine the strengths of all three approaches and do so in especially vivid and compelling ways. The cases that casuistry presents us with are already in narrative form. We can decide what to do by looking carefully at the “facts” of the case, but we also decide what to do by comparing stories with other stories—both other particular stories and the more general narratives that present us with the genre-possibilities of our culture, instructing us, to paraphrase MacIntyre, on what story or stories we find ourselves a part. What have come to be called “principles” often turn out on inquiry to be the themes of those general genre-narratives. Finally, stories are a superb vehicle for demonstrating to us how the sorts of persons we are determine how we will act in specific situations and how specific situations call forth and shape our enduring moral character, blurring any useful distinction between “situation ethics” and virtue ethics. The way stories combine all three approaches becomes clearer when we imagine a health professional and an ethics consultant in dialogue. The professional is trying to work through her inner library to deal with the case at hand, in a way that allows her to hold her own in a challenging situation. The consultant, to be effective, has to appreciate the affective drive to hold one’s own and also to get a feel for the other’s inner library. The tasks of keeping faith and trying on then become shared tasks, as the consultant may suggest new stories to incorporate into the inner library, unused resources that the library already contains, and new perspectives on the stories that are being employed. As we seek to advance our understanding further, always keeping in mind narrative’s inherent indeterminacy and the hermeneutic nature of the inquiry, we need the work of both narrative theorists and social scientists. The former can teach us more about how stories are structured and what possibilities are inherent within genres. The latter can teach us how living, breathing stories perform their social and cultural roles in the world. We find ourselves in the middle of stories to which we don’t know the ending, and we wonder what we should do. We turn for guidance to stories with which we are familiar and for which we know the ending. Deciding what to do based on those familiar stories often works out well, especially for the great many ethical actions we take daily that are so mundane we never notice them. Human life has predictable patterns and rhythms, and there are only so many January-February 2014/ H A S T I N G S CE NTE R RE P O RT
general story plots. But sometimes stories, slippery devils that they are, mislead and betray us. Other ethical theories sing to us sirenlike from their rocks, insofar as they promise to resolve all dilemmas and relieve our moral anguish. All those theories do indeed indicate partial paths to wisdom, and they can be helpful when our normal default guidance system of stories goes haywire. But for those theories to live up completely to their tempting promises of resolution, life would have to be a great deal less complex and more certain than is the reality that the world offers us. Often, muddling through with our stories and seeking to expand and enrich our libraries of stories to select from is the best that we can do.31 1. K. M. Hunter, “‘There Was This One Guy . . .’: The Uses of Anecdotes in Medicine,” Perspectives in Biology and Medicine 29, no. 4 (1986): 619-30. 2. A. F. Kleinman, The Illness Narratives: Suffering, Healing, and the Human Condition (New York: Basic Books, 1988); H. Brody, Stories of Sickness, 1st ed. (New Haven, CT: Yale University Press, 1987); K. M. Hunter, Doctors’ Stories: The Narrative Structure of Medical Knowledge (Princeton, NJ: Princeton University Press, 1991); R. Charon, Narrative Medicine: Honoring the Stories of Illness (New York: Oxford University Press, 2006). 3. A. Frank, The Wounded Storyteller: Body, Illness, and Ethics (Chicago: University of Chicago Press, 1995); H. L. Nelson, ed., Stories and Their Limits: Narrative Approaches to Bioethics (New York: Routledge, 1997); H. L. Nelson, Damaged Identities, Narrative Repair (Ithaca, NY: Cornell University Press, 2001); R. Charon and M. Montello, Stories Matter: The Role of Narrative in Medical Ethics (New York: Routledge, 2002); H. Brody, Stories of Sickness, 2nd ed. (New York: Oxford University Press, 2003). 4. A. W. Frank, Letting Stories Breathe: A Socio-Narratology (Chicago: University of Chicago Press, 2010). Frank refers to this work as a “socio-narratology” and primarily intends it to inform narrative research among his fellow social scientists. We rely heavily here on this work as it might be reread as a treatise primarily about ethics. 5. Brody, Stories of Sickness, 2nd ed., 172-261. 6. Frank, Letting Stories Breathe, 27-29. 7. M. U. Walker, Moral Understandings: A Feminist Study Ethics (New York: Routledge, 1998). 8. M. Johnson, Moral Imagination: Implications of Cognitive Science for Ethics (Chicago: University of Chicago Press, 1993). 9. We are grateful to an anonymous journal reviewer for suggesting the need to expand the discussion at this point. 10. Frank, Letting Stories Breathe, 11, 46. 11. Throughout Letting Stories Breathe, Frank hints that, to remember this aspect of narrative, it helps to think of stories as pri-
marily oral tellings to an audience and only secondarily as becoming written texts. This may explain his preference for illustrative stories drawn from the Native American oral traditions. 12. Frank, Letting Stories Breathe, 47. 13. Ibid., 48. 14. Frank implies that values don’t come from stories but from bodies, in ways analogous to how our bodies know that pain is bad. Stories tie the values that our bodies give to us to trains of actions and consequences: “Stories most evidently teach what counts as good and bad by linking characters’ actions to consequences that listeners feel are good or bad. Children need not be told explicitly that Cinderella’s stepmother is acting badly or that Cinderella marrying the prince is good. Good and bad are embodied feelings experienced before they can be learned as moral principles” (Letting Stories Breathe, 36). 15. Ibid., 186, citing A. Macintyre, After Virtue, 2nd ed. (Notre Dame, IN: University of Notre Dame Press, 1984), 216. 16. Frank, Letting Stories Breathe, 52. 17. Ibid., 54. 18. R. L. Walker and P. J. Ivanhoe, eds., Working Virtue: Virtue Ethics and Contemporaty Moral Problems (Oxford: Oxford University Press, 2007). 19. Frank, Letting Stories Breathe, 50. 20. A. MacIntyre, After Virtue (Notre Dame, IN: University of Notre Dame Press, 1981), 203. 21. W. C. Booth, The Company We Keep: An Ethics of Fiction (Berkeley, CA: University of California Press, 1988). 22. Frank, Letting Stories Breathe, 147-53. 23. Ibid., 76, citing P. Smith, Why War? The Cultural Logic of Iraq, the Gulf War, and Suez (Chicago: University of Chicago Press, 2005). 24. Ibid., 78. 25. Ibid., 159. 26. Ibid., 14, 25; P. Bourdieu, Pascalian Meditations (Stanford, CA: Stanford University Press, 2000); C. Levi-Strauss, “Myth and Meaning,” in More Lost Massey Lectures (Toronto: House of Anansi Press, 2008), 275. 27. Frank, Letting Stories Breathe, 37. 28. A widely cited popular work on this debate is J. Haidt, The Righteous Mind: Why Good People Are Divided by Politics and Religion (New York: Pantheon, 2012). 29. As a secondary point, popular accounts ignore the fact that this theory is still consistent with an important and robust role for reason in ethics, even if the total number of instances where reason is employed is small. 30. Frank, Letting Stories Breathe, 186, note 25. 31. A. W. Frank, “Biovaluable Stories and a Narrative Ethics of Reconfigurable Bodies,” in After the Genome: A Language for Our Biotechnological Future, ed. M. J. Hyde and J. A. Herrick (Waco, TX: Baylor University Press, 2013), 139-56.
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nce upon a time, medicine dismissed narrative as unimportant and uninteresting.1 Then, in the late 1980s, physicians and scholars became interested in how the study of narrative could enhance our understanding of illness and health care, and the field that came to be known as “narrative medicine” developed.2 Some of this scholarly activity focused on the idea of narrative ethics.3 After a flurry of activity around the turn of the twenty-first century, narrative ethics seemed to stall. The general interest in narrative in medicine continued but with few new ideas about how one might use narrative toward ethical ends. In the last few years, however, forward momentum has returned.4 The timing seems appropriate, therefore, for a “state of the field” report of sorts. To anchor this report, we will first return to a summary of narrative ethics that one of us offered in 2003.5 The summary was tentative and preliminary, and identified a number of blank spaces that needed to be filled in. Today’s state of the field report is also tentative but in a different way. Instead of imagining that more spade work will fill in the blanks, we are better able now to see why certain things will remain unclear and in tension because of the very nature of narrative ethics. Arthur Frank argues that stories inherently “make trouble.” We don’t tell stories when everything happens exactly as expected; we tell stories when ordinary routines are disrupted in ways that create difficulties for the characters.6 Recent work in narrative ethics could be viewed, therefore, as making trouble for some earlier conceptions in productive and suggestive ways. Narrative ethics, in this manner, is firmly situated as a hermeneutic and dialogic enterprise.
Howard Brody and Mark Clark, “Narrative Ethics: A Narrative,” Narrative Ethics: The Role of Stories in Bioethics, special report, Hastings Center Report 44, no. 1 (2014): S7-S11. DOI: 10.1002/hast.261 January-February 2014
An Earlier Assessment
A
decade ago, narrative ethics seemed to have a number of important features. What counts as “narrative ethics”? While some included under the term such uncontroversial activities as using stories merely as illustrations for the applications of ethical rules or principles, two claims seemed substantive enough to qualify as true narrative ethics. One might claim that we can gain ethical insight and wisdom directly from narratives and without appealing to rules, principles, or other ethical constructs. Or one might claim that when we do appeal to principles, for example, narratives play a crucial role in shaping or determining those principles. Theoretical homes for narrative ethics. To claim a theoretical foundation for narrative ethics would misrepresent its hermeneutic character, but various ways of thinking about ethics provide a congenial home for narrative approaches. One such home is feminist ethics, with its emphasis on moral responsibilities within interpersonal relationships.7 Another such home is neuroscientific assessments of ethics that focus on the inherently narrative structure of thought and brain activity.8 Ways to do narrative ethics. These congenial theories in turn suggest promising ways of doing narrative ethics, which might be termed keeping faith and trying on. In keeping faith, one recognizes the narratives that have shaped one’s moral identity, makes a judgment that one approves of that identity, and then decides how a person with that identity would behave in the present circumstances. Trying on refers to how one uses narrative imaginatively to discern possible next chapters of the story that is now unfolding and then to choose the actions that best “fit” one’s core values as displayed in previous chapters and that produce the best overall outcome for the story. HAS T I N GS C ENTER RE P ORT
S7
Rigor in narrative ethics. Narrative approaches would not be ethical unless they required and enabled the critical weighing of interpretations and actions. One area of agreement among most writing about narrative ethics is that the enterprise proceeds comparatively—one critiques a story with other stories. Since stories are ultimately what one uses to critique a story, it helps to know something about narrative structure and how stories operate. Finally, stories are layered, something like a nest of Russian dolls. Stories exist at many levels ranging from particular to general. The most general stories define a community, society, or culture and inform us what particular stories we can tell. This is not to say that all stories emerging from within the nested system are wholly determined by the system—simply that they are significantly shaped by it. A particular story that deviates too much from the model narratives or genres that our culture supplies for us will be a challenge to understand, even though such “trouble-making” stories are critical in expanding our ways of thinking about ethics.9 Therefore, the stories with which one is attempting to do ethical work can usefully be compared both to other particular stories and also to more general stories or genres. There are thus many ways we can be critical and reflective in our narrative ethics work. These observations about narrative ethics still appear generally valid a decade later. More recent work, however, permits a considerable expansion of our account of the field. The Current State of the Field
Stories are essential and performative. To lay the groundwork for a focus on narrative in ethics, it helps to be reminded that stories are central to human life and society. Frank quotes Joan Didion’s assertion, “We tell ourselves stories in order to live,” and adds, “[N]arrative makes this earth habitable for human beings.”10 One misconception that allows us to imagine that we could do without stories is that stories are nothing but a pale reflection of some set of “real” events that occur in the outer world. A better account views stories as performances—they act on the world to make things become true, rather than merely reporting external truths.11 Thinking about stories in this way is already to take an ethical stand, because to listen to a story, to enter into dialogue with the storyteller, is to decide to open oneself to the other’s way of seeing the world. Stories organize and evaluate the world. Frank argues that our stock of stories becomes our default selection and evaluation guidance system to deal with what William James famously called the “blooming, buzzing confusion” the world presents to us: S8
Stories are better imagined . . . as a tacit system of associations that makes particular aspects of the world seem worth attending to and suggests default evaluations of what is selected. Selections and evaluations are constantly being overridden by other, often more conscious considerations; they are, I emphasize, a default system. Nevertheless, as nondetermining as this selection/evaluation guidance system is, it processes a large proportion of what might be called candidate-experience: what happens to a person that, if attended to, becomes that person’s experience. Candidate-experience becomes experience because it fits stories people know.12
Frank adds, “Stories teach people what to look for and what can be ignored; they teach what to value and what to hold in contempt.”13 The library of stories that we carry about with us therefore largely determines what experiences of the world we have. If the world presents us with something that fits none of our stories, the chances are good that we’ll simply ignore those stimuli and never have that candidate-experience at all. Stories in the library become the larger Russian dolls, within which are nested the smaller Russian dolls that represent the specific stories we construct to explain and recount specific incidents in our own lives. Stories link values to actions. Stories teach us that good things will happen if we act in certain ways in certain circumstances and that bad things will happen if we act differently. Stories, as the selection and evaluation guidance system, then help us make sense of our experience of the world and point out to us when circumstances of the relevant sort are actually occurring.14 Stories’ plots tell us what should happen next. Stories can link values to actions through what we previously labeled “trying on,” expanding Alasdair MacIntyre’s widely quoted statement, “I can only answer the question ‘What am I to do?’ if I can answer the prior question ‘Of what story or stories do I find myself a part?’”15 Since the library of stories we grow up with is a product of culture, anthropologist Pierre Bourdieu’s term “habitus,” which might be translated as “dispositions” or “second nature,” is helpful here.16 People within a society, on being told an uncompleted story, have a general sense of what would count as a good or satisfactory ending. There are a finite number of possible plots, in turn partially determined by the number of narrative genres available to us. Frank adds, “People’s habitus of expected plot completions is nothing less than their sense of life’s possibilities.”17 Stories and virtue. The concept of “keeping faith” may be deepened by relating it to narrative accounts of virtue. Most ethicists today distinguish ethical rules and principles, which try to tell us how we should act in various circumstances, from a virtue approach to ethics, which instructs January-February 2014/ H A S T I N G S CE NTE R RE P O RT
Stories succeed in doing what they do precisely because they capture so much of the indeterminacy, contingency, and luck that characterizes human social life. us as to what sort of moral character to develop over a lifetime. This distinction, however, can be overdrawn—one way to tell us what to do is to tell us what sorts of persons we ought to try to be.18 Frank illustrates the close relationship between character and specific actions by recounting a story about Coyote from Native American tradition, in which Coyote, like Orpheus in Greek mythology, goes to the spirit world to try to find and bring back his dead wife. Coyote’s guide tells him that he must under no circumstances touch his wife until the journey back to the human world is complete. As she approaches that world, however, she assumes more and more closely her accustomed form, and finally Coyote cannot resist. As soon as he touches her, she of course returns irretrievably to the world of the dead. The exasperated comment of Coyote’s guide may be translated as, “You inveterate doer of this kind of thing!”19 This story does blatantly what most, if not all, stories do more subtly—present a dramatic situation in which a character is called on to display his or her essential moral nature, according to how he or she responds to a particular challenge. This aspect of narrative makes sense of MacIntyre’s argument that the notion of virtue requires in turn a notion of the narrative form of a human life.20 Stories are unmatched vehicles for showing us in the most engaging and compelling way, first, what it means to be a person of a certain moral character and how one comes to be such a person and, second, how a person of that moral character will behave when confronted with a pivotal and decisive situational challenge. Bad and dangerous stories. Early works on narrative ethics tended to agree with Didion that we need stories to live, and so they portrayed stories almost invariably in a positive light. An important exception was Wayne Booth, who noted that the stories we listen to or read become the company we keep, and that we would not want to be found in certain types of company.21 One of the ways more recent work makes trouble for narrative ethics is by insisting that since stories are so powerful, they can also be dangerous. Good stories often tend to be dangerous in the sense that they depict and promote transformation: they challenge habits of thought and ways of being and acting in the world as prescribed by ideology. But stories can be dangerous because they are bad, and figuring out just what is dangerous about bad stories helps to assure that narrative ethics achieves proper critical rigor.
It might be that no stories are bad in and of themselves; they become bad only in relation to particular persons and situations. Perhaps one can generalize and say that stories are bad when we need to understand something by moving on to different stories told from different perspectives but cannot because the initial story prevents us from seeing this and from seeking those alternative stories.22 Stories that call us to violence toward other groups of people and simultaneously make it seem disloyal to seek other points of view are extreme examples of bad stories that are commonly used to justify war and genocide.23 Frank introduces the useful phrase “holding one’s own” to describe not only the crucial role stories play in human life but the way, too, that some stories prove to be bad ones.24 Stories commonly feature heroes who are able to hold their own against major challenges. The critical question readers and listeners need to train themselves to ask is this: if this story makes it possible for an individual to hold his or her own or for a group to hold their own, are there other people for whom this story makes it harder for them to hold their own? And if so, how could the story be told differently from the perspective of that second group? How would our understanding of the situation be expanded if we heard both stories side by side, instead of only the story we were originally told? Criticizing stories by comparing stories. Bad stories illustrate how we can become trapped within stories that teach us to act in dysfunctional ways, but we need not be trapped. Here we return to earlier ideas that narrative ethics works comparatively, and that one’s total library of stories is a major determinant of one’s character and actions. Knowing what makes bad stories dangerous, we can learn to detect stories that make it too hard for the vulnerable to hold their own. We can learn to respond to such stories with a demand for additional stories—not just any additional stories, but ones in which the point of view shifts to favor how the world looks to the characters previously marginalized. Frank suggests that “some fairly obvious qualities of less-dangerous stories includ[e] openness to more stories; depiction of characters who acknowledge mistakes and work to set things right; making heroes of characters who cooperate; and giving antagonists names, faces, and purposes that cannot be immediately dismissed. Less-dangerous stories make the world and actions more complicated.”25 The indeterminacy of stories. We are now in a better position to see why some of the tentativeness that surrounds
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any account of narrative ethics is not resolvable. A “state of the field” report may create the mistaken impression that narrative ethics can proceed by following something like a formula. Actually, stories succeed in doing what they do in human social life precisely because they capture so much of the indeterminacy, contingency, and luck that characterizes life. If stories permit humans to live, they permit us to live within that world of indeterminacy. Stories reflect the notion of culture as portrayed by anthropologists like Bourdieu and Levi-Strauss: the cultures we live in present us with a variety of choices, but the cultures themselves and their outlines are largely unchosen.26 Ironically, the indeterminacy of stories—that they are both chosen and unchosen, that they both pass on and conceal information, that we can tell them in the way and to whom we wish and yet they remain out of our control— gives them the power to do what they can do. Stories try to make a complex and confusing world one in which human beings can live and carry out their purposes, and to do so they must walk fine lines: “The value of stories is to offer sufficient clarity without betraying the complexity of life-in-flux.”27 To lead ethical lives, we must tack back and forth between acknowledging stories’ ability to clarify and recognizing the need to regularly exchange overly simple views of the world for more nuanced and complex ones. Reason versus emotion in ethics. The fine line stories force us to walk between clarity and indeterminacy sheds some light on a recent debate in moral psychology over how much of ethics is based on reasoning as opposed to emotion. Jonathan Haidt, for example, employs the metaphor of a man riding an elephant.28 Once in a while, the man can steer the elephant, but a good deal of the time, the elephant goes where it wants to. Reasoning in ethics, Haidt claims, does most of its work by rationalizing after the fact as to which way the elephant has gone. It is only in the unusual case that reason actually steers the elephant.29 This is exactly what we’d expect if stories, especially unchosen stories that guide our lives unconsciously, direct much of our everyday behavior. We commonly make choices quickly and instinctively, and if need be, we later go back to fill in the reasons for our choices.30 None of this eliminates our ethical responsibilities to live well with our stories. Conclusion
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dvances in narrative ethics during the last decade help us appreciate how narrative brings into closer congruence three approaches that have historically been separated. People who want to talk about what to do in specific situations and who believe that moral wisdom is to be found in general rules and principles have embraced the approach characterized (or caricatured) as principlism. Those who also want to talk about specific situations but who think S10
that moral wisdom resides in close analysis of the particular situation itself have tended to practice casuistry. And those more interested in enduring moral character and less in what a person should do here and now have employed virtue ethics. Relatively few recent scholars of health care ethics have blended these approaches; most seem content to reside in one of the three camps. Stories can combine the strengths of all three approaches and do so in especially vivid and compelling ways. The cases that casuistry presents us with are already in narrative form. We can decide what to do by looking carefully at the “facts” of the case, but we also decide what to do by comparing stories with other stories—both other particular stories and the more general narratives that present us with the genre-possibilities of our culture, instructing us, to paraphrase MacIntyre, on what story or stories we find ourselves a part. What have come to be called “principles” often turn out on inquiry to be the themes of those general genre-narratives. Finally, stories are a superb vehicle for demonstrating to us how the sorts of persons we are determine how we will act in specific situations and how specific situations call forth and shape our enduring moral character, blurring any useful distinction between “situation ethics” and virtue ethics. The way stories combine all three approaches becomes clearer when we imagine a health professional and an ethics consultant in dialogue. The professional is trying to work through her inner library to deal with the case at hand, in a way that allows her to hold her own in a challenging situation. The consultant, to be effective, has to appreciate the affective drive to hold one’s own and also to get a feel for the other’s inner library. The tasks of keeping faith and trying on then become shared tasks, as the consultant may suggest new stories to incorporate into the inner library, unused resources that the library already contains, and new perspectives on the stories that are being employed. As we seek to advance our understanding further, always keeping in mind narrative’s inherent indeterminacy and the hermeneutic nature of the inquiry, we need the work of both narrative theorists and social scientists. The former can teach us more about how stories are structured and what possibilities are inherent within genres. The latter can teach us how living, breathing stories perform their social and cultural roles in the world. We find ourselves in the middle of stories to which we don’t know the ending, and we wonder what we should do. We turn for guidance to stories with which we are familiar and for which we know the ending. Deciding what to do based on those familiar stories often works out well, especially for the great many ethical actions we take daily that are so mundane we never notice them. Human life has predictable patterns and rhythms, and there are only so many January-February 2014/ H A S T I N G S CE NTE R RE P O RT
general story plots. But sometimes stories, slippery devils that they are, mislead and betray us. Other ethical theories sing to us sirenlike from their rocks, insofar as they promise to resolve all dilemmas and relieve our moral anguish. All those theories do indeed indicate partial paths to wisdom, and they can be helpful when our normal default guidance system of stories goes haywire. But for those theories to live up completely to their tempting promises of resolution, life would have to be a great deal less complex and more certain than is the reality that the world offers us. Often, muddling through with our stories and seeking to expand and enrich our libraries of stories to select from is the best that we can do.31 1. K. M. Hunter, “‘There Was This One Guy . . .’: The Uses of Anecdotes in Medicine,” Perspectives in Biology and Medicine 29, no. 4 (1986): 619-30. 2. A. F. Kleinman, The Illness Narratives: Suffering, Healing, and the Human Condition (New York: Basic Books, 1988); H. Brody, Stories of Sickness, 1st ed. (New Haven, CT: Yale University Press, 1987); K. M. Hunter, Doctors’ Stories: The Narrative Structure of Medical Knowledge (Princeton, NJ: Princeton University Press, 1991); R. Charon, Narrative Medicine: Honoring the Stories of Illness (New York: Oxford University Press, 2006). 3. A. Frank, The Wounded Storyteller: Body, Illness, and Ethics (Chicago: University of Chicago Press, 1995); H. L. Nelson, ed., Stories and Their Limits: Narrative Approaches to Bioethics (New York: Routledge, 1997); H. L. Nelson, Damaged Identities, Narrative Repair (Ithaca, NY: Cornell University Press, 2001); R. Charon and M. Montello, Stories Matter: The Role of Narrative in Medical Ethics (New York: Routledge, 2002); H. Brody, Stories of Sickness, 2nd ed. (New York: Oxford University Press, 2003). 4. A. W. Frank, Letting Stories Breathe: A Socio-Narratology (Chicago: University of Chicago Press, 2010). Frank refers to this work as a “socio-narratology” and primarily intends it to inform narrative research among his fellow social scientists. We rely heavily here on this work as it might be reread as a treatise primarily about ethics. 5. Brody, Stories of Sickness, 2nd ed., 172-261. 6. Frank, Letting Stories Breathe, 27-29. 7. M. U. Walker, Moral Understandings: A Feminist Study Ethics (New York: Routledge, 1998). 8. M. Johnson, Moral Imagination: Implications of Cognitive Science for Ethics (Chicago: University of Chicago Press, 1993). 9. We are grateful to an anonymous journal reviewer for suggesting the need to expand the discussion at this point. 10. Frank, Letting Stories Breathe, 11, 46. 11. Throughout Letting Stories Breathe, Frank hints that, to remember this aspect of narrative, it helps to think of stories as pri-
marily oral tellings to an audience and only secondarily as becoming written texts. This may explain his preference for illustrative stories drawn from the Native American oral traditions. 12. Frank, Letting Stories Breathe, 47. 13. Ibid., 48. 14. Frank implies that values don’t come from stories but from bodies, in ways analogous to how our bodies know that pain is bad. Stories tie the values that our bodies give to us to trains of actions and consequences: “Stories most evidently teach what counts as good and bad by linking characters’ actions to consequences that listeners feel are good or bad. Children need not be told explicitly that Cinderella’s stepmother is acting badly or that Cinderella marrying the prince is good. Good and bad are embodied feelings experienced before they can be learned as moral principles” (Letting Stories Breathe, 36). 15. Ibid., 186, citing A. Macintyre, After Virtue, 2nd ed. (Notre Dame, IN: University of Notre Dame Press, 1984), 216. 16. Frank, Letting Stories Breathe, 52. 17. Ibid., 54. 18. R. L. Walker and P. J. Ivanhoe, eds., Working Virtue: Virtue Ethics and Contemporaty Moral Problems (Oxford: Oxford University Press, 2007). 19. Frank, Letting Stories Breathe, 50. 20. A. MacIntyre, After Virtue (Notre Dame, IN: University of Notre Dame Press, 1981), 203. 21. W. C. Booth, The Company We Keep: An Ethics of Fiction (Berkeley, CA: University of California Press, 1988). 22. Frank, Letting Stories Breathe, 147-53. 23. Ibid., 76, citing P. Smith, Why War? The Cultural Logic of Iraq, the Gulf War, and Suez (Chicago: University of Chicago Press, 2005). 24. Ibid., 78. 25. Ibid., 159. 26. Ibid., 14, 25; P. Bourdieu, Pascalian Meditations (Stanford, CA: Stanford University Press, 2000); C. Levi-Strauss, “Myth and Meaning,” in More Lost Massey Lectures (Toronto: House of Anansi Press, 2008), 275. 27. Frank, Letting Stories Breathe, 37. 28. A widely cited popular work on this debate is J. Haidt, The Righteous Mind: Why Good People Are Divided by Politics and Religion (New York: Pantheon, 2012). 29. As a secondary point, popular accounts ignore the fact that this theory is still consistent with an important and robust role for reason in ethics, even if the total number of instances where reason is employed is small. 30. Frank, Letting Stories Breathe, 186, note 25. 31. A. W. Frank, “Biovaluable Stories and a Narrative Ethics of Reconfigurable Bodies,” in After the Genome: A Language for Our Biotechnological Future, ed. M. J. Hyde and J. A. Herrick (Waco, TX: Baylor University Press, 2013), 139-56.
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