Making sense

 

Making sense of living

The  daily life of a researcher and research supervisor is helping people make sense of what they do. Life is literally about making sense, with the activity on making - this is a constructivist approach to human knowledge which fits well with the broad spectrum of methods known as qualitative research. When we talk about what we do, this also includes health and sickness talk. We talk about falling ill and becoming well. How we regain health, and what that status of health is, is reflected in the ways in which we talk about it and how we explain this to others. When we recall how sickness fell upon us and how we regained our health then we inevitably tell a story; these are the narrative approaches to life that we have. Narratives have characters, events and themes and these are the very stuff of qualitative research. One of the difficulties of medical research is that while being increasingly proficient at refining concepts of disease and their treatment, there is little headway being made into those areas where health is defined and how that seemingly elusive status that we know as health can be achieved.

My work explores the role of a narrative approach in helping to investigate and understand dimensions of health and integrated medicine (CAM)

Health care is invariably defined in positivist terms as an object, phenomenon or a delivery system (Aldridge 2004). Knowledge gained through scientific and experimental research is deemed objective, quantifiable, stable, and measurable (at best measurable by instrumentation reducing human error). In qualitative approaches, however, we have a shift in paradigm. Knowledge about health is considered to be a process, a lived experience, interpretative, changing and subjective (at best gleaned through human interaction as personal relationship). Indeed, from this qualitative perspective we may be encouraged to think of the gerund form of the word "health" as "healthing". In the same way, we can also consider what we do as professionals, and what our patients are involved in continually, as the relationship of healing (Aldridge, 2000).

Qualitative research is not a testing mode of enquiry but a discerning form of enquiry requiring the collaborative involvement of those participating in that healing relationship. This emphasis on the verb healing rather than on the noun health goes some way to explain why qualitative approaches have found such resonance in nursing research, with its emphasis on nursing and caring as relational activities, rather than health care research, which is by definition nominal and objective.

A social science perspective

If healing is a relationship, then we have to ask ourselves how we evaluate relationships. Would we take friendship, for example, and rate it on a one to five Likert scale or would we value our friendships for their various qualities? It is possible to meaningfully explain to another person what the value of a relationship is without quantifying it if we wish to demonstrate the nature of that friendship. So too for the relationship that is healing. We need to discern those personal qualities that people use to explain healing. However, this is a major opposition between scientific paradigms and the first question often asked of qualitative research in medicine is 'Is it scientific?' The short reply to which is 'Yes, it is social science'. Medicine, being a social activity, is susceptible to being understood by a social science paradigm as much as it is by a natural science paradigm. To fulfill the functions of health caring adequately, we need both quantitative and qualitative approaches. While medical science may concentrate on the external laws of the Universe, qualitative research will concentrate on our internal understandings and their coherence with the way in which we live our lives.
Social psychology, ethnography and medical anthropology are acceptable scientific approaches for studying human behaviour and qualitative research takes much of its methods from those fields. Indeed, suffering, distress, pain and death are experiences relevant to understanding health care but elusive to measurement. Similarly, well-being, hope, faith, living a full life and satisfaction are experiences central to health care but not immediately amenable to quantification. But they can be apprehended by understanding  and these understandings are gleaned in relationship, the central activities of which are listening and telling stories. Stories are central to the therapeutic relationship, and a vital part of qualitative research, and it is this concept that I am developing at the Chair.Suicide.html

David Aldridge

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