issues in research

Narrative and narrative enquiry in

health and social sciences
Claudia KY Lai looks at the building blocks of narrative and
how it can be used as a research tool
Abstract
Increasingly, narrative and life story are being used in health and social sciences,
and other disciplines. Narrative analysis assumes multiple forms in a variety of
analytic practices, with no single or correct way to analyse stories. This paper
explores the concepts and meanings of narrative and narrative enquiry; their
ontology and epistemology, and their use as a research method will be dis-
cussed as well. Ethics will be addressed briefly. This paper will help readers to
grasp the essential elements in understanding narrative and narrative enquiry.
key words

narrative
▲ ▲ ▲ ▲

narratology
narrative enquiry
life story

Introduction
The terms ‘narrative’ and ‘story’ are used in academic writing, although it is
difficult to capture the exact meaning of these terms as used in qualitative
research. Is narrative a perspective, a method or a special form of speech or
writing? Are narratives and stories the same?
Narrative is frequently taken ‘to connote the threading together of a set of
events or experiences in a temporal sequence in order to make sense of them’
(Dean 1998). It can refer to:
n The process of making a story, the cognitive structure of the story or the
result of the process (stories, tales or histories) (Polkinghorne 1988).
n A particular way of collecting data (asking people to tell stories) or apply-
ing to the data obtained (the stories and accounts they provide) (McAdams
1996).

72 NURSERESEARCHER 2010, 17, 3

n A mode of thinking or a way of making sense of experience (Bruner 1990).
Charon (2006) outlined five elements of a narrative (Table 1).
Discourse refers to the language in which a subject or area of knowledge is
discussed (Murfin and Ray 1997). Thus, a story is a sequence of events and a
discourse is the narrative presentation of events (Culler 2004). Elicited stories,
anecdotes and folktales are regarded as a genre of narrative (Collingwood
1993, Boucher et al 2005).
Narratology is a multidisciplinary study of narrative that negotiates and
incorporates the insights of that which is represented in the story (Onega
and Landa 1996). The term is used in academia for study of the literature,
whereas ‘narrative enquiry’ – the study of the phenomena of development
and transition in people’s lives (Widdershoven 1993) – is popular in applied
sciences, such as nursing. Narrative methods include life stories and personal
accounts (McAdams 1996).

Table 1. Elements of a narrative

Element Definition

Temporality The temporal order of events; the beginnings, middles and ends
of human events.

Singularity The uniquely irreplicable experiences of individuals; no narrative

repeats any other performance in the same manner.

Causality/ A narrative has a plot and urges us to make sense of why things
contingency happen.

Inter- When two subjects meet, the experiencing subject comes

subjectivity alive, assessing perception, interpretation and the personal
transformation consequential to human interaction.

Ethicality Obligations incurred in narrative acts. The recipient/listener of

another’s narrative owes something to the teller by virtue of
knowing it.

Source: Charon (2006)

NURSERESEARCHER 2010, 17, 3 73

issues in research

Narrative enquiry in health and social sciences

Storytelling dates back to the earliest record of human existence (Davis-
Berman and Berman 1998) and is used widely in anthropology (Mattingly
and Garro 2000). Psychology and sociology have embraced logical empiri-
cism in a search for certainty in understanding human behaviour (Cohler and
Cole 1996) and the impact of researcher-subject interaction on observed
outcomes has gained recognition.
Within psychology, Freud used narratives to apply psychoanalytic theory to
individual lives (Atkinson 1998). Later, Murray studied individual lives using
life narratives to understand personality development and although popular,
narrative methods have never been part of the mainstream psychological
endeavour (Josselson 1995). In sociology, using life stories as a research
source is well embedded (Roberts 2002), although its popularity has waxed
and waned since its inception in the early 20th century (Cohler and Cole
1996).

Ontology and epistemology

Scholars and scientists are aware that there are multiple realities and no single
version of the truth – the observer and the observed affect the outcome and
how the world is perceived. Stories are not a set structure, but interactive
and constructed by the teller and the listener. Contemporary study of narra-
tive has roots in four literary national traditions (Culler 2004, Polkinghorne
1988):
n Russian formalism: identifying the definitive features of literature
(Hogan 2000).
n American new criticism: systematic and rigorous study of text (Spurgin
1997), which is not dependent on its history or relation to the author’s life
or intent (Hedges 1997).
n French structuralism: all elements of human culture are parts of a system
of signs (Murfin and Ray 1997).
n German hermeneutics: the theory of interpretation of texts, whereby
reader and author define content (Murfin and Ray 1997).
Currie (1998) and Charon (2006) have provided introductory texts to nar-
ratology, although there are variations in the theories and interpretation

74 NURSERESEARCHER 2010, 17, 3

of narratives among different traditions, and each theorist has concepts or
categories of his or her own.

Life and story

From a hermeneutic point of view, human life is interpreted in stories.
MacIntyre (1984) suggested that life is lived according to a script – ‘human
life has a determinate form, the form of a certain kind of story’ – and this is
what renders it comprehensible. Life becomes human by being articulated
in a narrative way, whatever the form. Ricoeur (1984) perceived the herme-
neutic relationship between life and story in a different way, suggesting that
life has a ‘pre-narrative’ structure: humans possess a ‘pre-understanding’
of the world of action, similar to their ability to recognise which groups of
words can produce meaningful sentences before the sentences are produced
(Polkinghorne 1988).
In the process of developing a plot for a story, the relatively unclear pre-
understanding of daily life is changed into a clearer literary structure. The
relationship between life and story is therefore a hermeneutic circle: the
story is based on the pre-understanding of life and the stories told about life
change it into a more fully developed understanding of life (Lawn 2006).
MacIntyre (1984) and Ricoeur (1984) see life and story as influencing one
another: both share an emphasis on the story as the instance where meaning
is created. Widdershoven (1993), however, argued that they underestimated
the role of life in the creation of meaning.
Merleau-Ponty characterised the hermeneutic relation between life and
story as a relation of ‘Fundierung’: life has an implicit meaning that is made
explicit in stories (Merleau-Ponty 2002). The ‘pre-reflective’ experiences – the
existence of self-awareness prior to reflection (Zahavi 2003) – are placed in
the centre of narrative enquiry and are the foundation of reflective notions.
Merleau-Ponty (2002) challenged the position that thought and language can
be understood as independent of and disconnected from human existence
(Polkinghorne 1988) as the process of rendering the meaning explicit presup-
poses that something is already present. What is present is not there just to
be uncovered but to be shaped and structured in a process of telling. Life is,
therefore, the foundation of story (Widdershoven 1993).

NURSERESEARCHER 2010, 17, 3 75

issues in research

Three ways to interpretation

A hermeneutic perspective holds that stories are interpretations of life, that
there is no meaning prior to interpretation (pre-reflexive) and that life and
story are only meaningful in and through mutual interaction. In herme-
neutics, there are at least three views of interpretation (Widdershoven 1993):
n As re-enactment.
n As dialogue with the text.
n As a process of placing a text in a different context.

Collingwood’s theory of re-enactment

Collingwood (1993) proposed that the historian cannot go back to the past
but can understand the past by re-thinking the thoughts of historical actors.
He maintained that the historian can understand the past because he lives in
the present, which enables him to see things from a distance. The effect of
the distance in time was likened to a prism, to separate the important from
the unimportant, or a magnifying glass – to render access to the essence
of an idea (Widdershoven 1993). According to Widdershoven (1993),
Collingwood’s concept of history was a re-enactment of past experience in
the interpretation of human experience and narrative. In application to a per-
son’s life, a story is a reconstruction of life by which past experiences survive
in a purer manner because the non-essential is removed.

Interpretation as dialogue
Collingwood proposed that the original meaning of the thoughts of an
author or actor can be understood by re-enactment and that the essence of
a story does not change. Gadamer declared that there is no original meaning
and that the meaning of a text is never fixed but is always changing in and
through its interpretations (Hahn 1997).
The dialogue that takes place between two participants in a conversa-
tion and the dialogue which an interpreter conducts with a text are similar
(Grondin 2003). A text is interpreted in a horizon and always begins with
a question; in reading a text, we apply this horizon to our present situa-
tion. This results in a fusion of horizons, in which a new perspective is pro-
duced from combining the perspective of text and reader (Dostal 2002).

76 NURSERESEARCHER 2010, 17, 3

Interpretation is regarded as a form of dialogue in which the actor and the
reader (or interpreter) try to understand the truth in a process of mutual
understanding. Gadamer’s theory of interpretation can be applied to the
relationship between experience and story in a person’s life; in telling stories
about past experiences, we try to make clear what these experiences mean.
By telling a story about our life, we change our life.

Interpretation as citation
Derrida founded ‘deconstruction’ (Kates 2005), suggesting that reading a text
takes it out of its context and places it in a different one (Polkinghorne 1988).
Through interpretations, a text is related to other texts in an uncontrollable
way (Widdershoven 1993). When the text is transferred to a new context,
we are not necessarily closer to the essence of the thoughts expressed in the
text as Collingwood would suggest nor closer to the truth as Gadamer would
argue. To Derrida, the transfer of the text means that new relations are cre-
ated and new meaning produced (Hawkes 1997).
Derrida disputed the idea of an origin of meaning: he considered that there
is no unity in interpretation (Widdershoven 1993). When applied to indi-
vidual life, the interpretation of life in stories told does not result in unity and
continuity. Attempts to unite experiences into a pattern also create divergence
(Widdershoven 1993). However, elements that do not fit into the pattern
may be temporarily repressed. In a story, the experience is not reconstructed,
nor is its meaning expanded through a fusion of horizons. The experience is
transferred and brought into a new fabric of relations.
In summary, the hermeneutic relation between life and story by Collingwood
would mean that the relationship is a reconstruction: to Gadamer, it is dialogi-
cal, and to Derrida, it is intertextual (Widdershoven 1993).

Forms of narrative enquiry

The various forms of narrative research in the literature are a broad range of
epistemological, ideological and ontological understandings of the phenom-
enon being examined (Clandinin 2007). In the social sciences, life stories
have been approached from two alternative but often combined perspec-
tives, either used as material in studying lives in their social contexts (socio­

NURSERESEARCHER 2010, 17, 3 77

issues in research

structural) or viewed as texts that reflect individuals’ personality or identity

construction (sociolinguistic) (Alasuutari 1997).
The sociostructuralists examine the ‘facts’ in a story (Alasuutari 1997);
structure can be seen as a metaphor to give the impression of stability in the
object-narrative meaning (Currie 1998). Structural analysis of narrative gives
priority to syntax and semantics as opposed to origin, function, or substance
(Prince 2003).
Sociolinguists posit that life-story narration has a function in constructing
self and identity (Alasuutari 1997). They use the linguistic and narrative form
in autobiography to make inferences about the personality of the storyteller.
For example, Chafe (1980) suggested that when a person is telling a story,
they chunk their material into units that are identifiable in terms of prosodic
information (such as intonation), pauses (as in the case when idea units are
separated by a brief pause) and syntax (an idea unit consisting of a word or
a phrase or a clause). To be valid as testimonies of one’s personality, life sto-
ries as told must not be affected by the interaction between the interviewer
and the interviewee. In this approach, one assumes that every person has a
genuine personality that can be understood by studying the person’s life story
(Alasuutari 1997).

Narrative enquiry and post-structuralism

Narrative enquiry moved from assumed objectiveness towards acknowl-
edging that the reading of narratives, however rational and scientific, con-
structed its object (Currie 1998). Post-structuralists moved away from the
treatment of narratives and language as solid objects in the world, such as
a building, towards the view that narratives were inventions construable
in an almost infinite number of ways (Currie 1998). Rather than analysing
the frames or narrative structures of life-story narrating, some researchers
study life-story narrating as an everyday life phenomenon in its own right
(Alasuutari 1997). The stories that are selected by the biographer to present
his or her life history are not regarded as a series of isolated experiences
told in a chronological order but a biographical construction. Individual
experiences are understood as storied accounts embedded in a coherent,
meaningful context (Rosenthal 1993).

78 NURSERESEARCHER 2010, 17, 3

Paradigmatic and narrative types of narrative enquiry
Polkinghorne (1995) classified the approaches of narrative enquiry accord-
ing to the ways that knowledge is produced – the paradigmatic and the
narrative. Paradigmatic reasoning (Bruner 1985) constitutes people’s expe-
riences as ordered and consistent, producing cognitive networks of concepts
that allow people to construct experiences by emphasising the repeating
elements. For example, the concept ‘chair’ is not the same as the concept
‘furniture’. Paradigmatic thoughts enable us to look at individual things
as belonging to a category. By understanding that this particular item is a
chair, people can anticipate and act on the knowledge they have of chairs
in general.
The narrative approach is an analytic process that produces storied
accounts through engaging in narrative reasoning, noticing the differences
and diversity of people’s behaviour. It focuses on the temporal context and
complex interaction of the elements that make each situation in a story
special. The cumulative outcome of narrative reasoning is a collection of
individual cases in which the researcher’s thinking moves from case to case
instead of from case to generalisation (Polkinghorne 1995).
Thus, narrative enquiry of the paradigmatic type produces knowledge of
concepts, whereas narrative enquiry of the narrative type produces knowl-
edge of particular situations.

Narrative analysis
The beginnings of narrative analysis can be traced to the interpretive stud-
ies of the Bible, Talmud and Koran (Czarniawska 2004). Interpretation
and analysis is inevitable because narratives are representations of life
experiences. Through narrative, researchers come into contact with their
participants as people engaged in the process of interpreting themselves
(Riessman 1993). Researchers work with what is said and what is not said,
in the context in which life is lived, and the context of the interview in
which words are spoken to represent that life. Researchers must decode,
recognise, recontextualise or abstract that life in the interest of reach-
ing a new interpretation of the raw data of experience (Josselson and
Lieblich 1995).

NURSERESEARCHER 2010, 17, 3 79

issues in research

Rosenthal (1993) discussed two levels of narrative analysis: analysis of the

experienced life history; and of the narrated life story. The purpose of the
former is a hermeneutical case reconstruction, and a reconstruction of the
life history; that is, the experienced, lived-through life history. Life story and
life history always come together, are continuously dialectically linked and
produce each other; therefore, we must reconstruct both levels, whether the
main target is the life history or the life story.
The analysis of the narrated life story is the reconstruction of the present
meanings of experiences and the reconstruction of the temporal order of the
life story when narrating or writing. This analysis is concerned with discover-
ing the mechanisms of selection guiding the biographer’s choice of stories
in relation to the general thematic orientation of the interview. Narrative
analysis has to do with ‘how protagonists interpret things’ (Bruner 1990).
Lieblich et al (1998) proposed examining narratives in two dimensions:
n The holistic versus the categorical approach.
n The content versus the form approach.
The first refers to the unit of analysis: is a section abstracted from a com-
plete text or is the narrative as a whole being analysed? The latter differenti-
ates between the content and form of a story, and refers to the traditional
dichotomy made in literary readings. Some analysis focuses on the explicit
content of an account – such as what happened or why, who participated
in the event and so on – from the standpoint of the teller. Other analysis
examines its form: that is the structure of the plot, the sequence of the
events and its relation to time.
Narrative analysis assumes multiple forms in a variety of analytic practices
in diverse disciplines (Daiute and Lightfoot 2004). The process of narra-
tive analysis is a synthesising of the data rather than a separation into its
constituent parts (Polkinghorne 1995). Narrative approaches can employ
literary tools (such as metaphors), linguistic devices (such as pronouns)
or cultural conventions (such as time) for insights in analysis (Daiute and
Lightfoot 2004). Depending on the purpose of discussion, a person’s ana-
lytic approach will vary (Atkinson 1995). There are highly varied forms of
narrative analysis (Clandinin 2007) and no single or right way to analyse
stories (Riessman 1993).

80 NURSERESEARCHER 2010, 17, 3

The use of narrative methods in health and social sciences
Through analysing the complex process of narration in specific situations,
the kinds of narratives of certain groups of people become known, as does
the cultural world in which those particular narratives occurred (Josselson
and Lieblich 1995). To the sociologically-oriented investigator, narratives
are useful for what they reveal about social life – culture speaks through an
individual’s story (Riessman 1993). It thus becomes possible to engage in
narrative enquiry to examine gender inequalities, racial oppression and other
practices of power that may be taken for granted by individual narrators.
In medicine, the field of narrative medicine has emerged gradually from
a confluence of multiple sources – humanities and medicine, primary care
medicine, contemporary narratology, and the study of effective doctor-patient
relationships (Charon 2006). Charon (2006) describes narrative medicine as
‘medicine practiced with the narrative competence to recognise, absorb, inter-
pret, and be moved by the stories of illness’. Narratives are used in counselling
(Atkinson 1998), group work (Dean 1998), and psychotherapy (Rybarczyk and
Bellg 1997). Narrative medicine provides healthcare professionals with insights
and observations to comprehend what patients endure in illness and what they
undergo in the care of the sick. Taking a narrative life history is entering clinical
practice (Charon 2006); to many medical sociologists, health care’s primary
duties are to bear witness to patients’ suffering and to honour their experiences
of illness (Charon and Montello 2002, Frank 1995).

Harm to researchers and participants in narrative enquiry

Josselson (1996) outlined the potential harm that we may do to our inform-
ants and ourselves in narrative enquiry. In the heat of the moment, an
informant may reveal more than they committed to when consenting to
take part in the study. When the interactions between the researcher and the
informant have developed over time through prolonged engagement, such as
in the method of ethnography, the researcher may find that unwanted actions
are expected of him or her outside of the role of researcher, as he or she has
become an insider of the group. Josselson argued that our search must find a
means to contain awareness of the possible harm rather than to silence it, to
conduct ethically sound studies.

NURSERESEARCHER 2010, 17, 3 81

issues in research

Conclusion
So much work has been done in the science of narratives that to attempt any
sort of synthesis, identifying areas of fundamental agreement or principal
issues in dispute would be a massive task (Culler 2004). This paper does not
claim this either, but presents an overview of the background and develop-
ment, the methods and claims. Instead of conforming to the conventional
rule of summarising this paper, I would like to discuss Gubrium’s (1995) view
on the validity of research that studies human experience. He argued that
the goal of life narrative is to give voice to experience, presumably to speak
of one’s life. He queried the general wisdom and manner with which we
conduct research, which usually is to ask our informants to reach back into
their lives to obtain answers to our questions, suggesting that life was not just
something lived like a cherished heirloom that one could look upon, inspect,
reflect, look ahead to, close off and open up to experience. Rather, the world
of an individual, as he or she gives an account of his or her life, provides
an account that is beyond the here and now. The life narrative reports a life
larger than the researcher can see or hear at the moment of the interview.
As I was preparing this paper, Gubrium’s insights helped me to reflect on
what I do as a researcher and a gerontologist. How should I interpret some-
one’s account of his or her life? Although this paper has briefly introduced
a number of ways of interpretation, there is no simple answer to Gubrium’s
piercing question. In the end, it is not about the traditions of narratology
or any philosophical roots of narrative studies that guide our practice and
research. Rather, it is our beliefs, values, and personal philosophy that frame
our perspective and lead us onward in our work. This paper provides an
overview of what are narratives and narrative enquiry, but the challenges in
its methods and analytic approaches are the remit of each individual in health
and social studies n

Claudia KY Lai PhD, RN is associate professor at the School of Nursing, the Hong
Kong Polytechnic University, Hong Kong, China

This article has been subject to double-blind review and checked

using antiplagiarism software

82 NURSERESEARCHER 2010, 17, 3

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