The Vulnerabilities of Re-presenting Practtice: From Clinical Gaze to Narrative Frames of Acceptance

Ethnography often entails being a vulnerable observer (Behar, 1996). There is nothing more heartbreaking than the tasks of analysis and re-presentation when attempting to do justice to troubled yet hopeful transactions in “clinical borderlands” where the stakes are high for everyone involved (Mattingly, 2003; Mattingly & Lawlor, 2001). When data foregrounds potentially conflictive moral issues and dilemmas, representation itself is a negotiation with one’s own multiple gazes as clinician and ethnographer as well as those of all involved. It is a balance—a walk on that fragile field among multiple perspectives. Reflexivity is a central tenet of qualitative and ethnographic research methods. It is critical to the subsequent representation of findings where there are implicit power asymmetries between researcher and participants. For clinician-researchers, the first move towards understanding the experience of another often demands a movement away from biomedical or clinical gazes and/or the inclusion of the research participants’ voices (see the issue on qualitative research methods, AJOT, 57/1, 2003). However, little work has been done reflecting on how narrative representation necessarily entails the use of genres or frames that are themselves historically situated, and of cultural practices replete with their own forms of power. This presentation stems from my own experiences as a vulnerable observer, making sense of and re-presenting data that was potentially conflictive for myself as a clinician, a colleague, and an ethnographer. Data from this research project of the dyadic interaction within pediatric occupational therapy sessions will be used to illustrate how narrative representation builds upon historically situated frames of acceptance such as the tragedy, the quest, or the comedy (Burke, 1937/1984). Choices in terminology are not benign, but highly ethical decisions of which can easily frame—construe or misconstrue—individuals as heroes, victims, or comedians (Burke, 1966). This presentation encourages discussion about how illness stories (Frank, 1995), as well as the representation of research are also historically-situated, cultural practices embedded with issues of power. It proposes that intersubjective understanding, if fraught with issues of power and control (Jackson, 1998), is nothing short of a comedic “perspective by incongruity” (Burke, 1935/1984), and a deeply vulnerable affair