Abstract
To understand the experiences of suffering (overwhelming somatic pain or illness and its anticipation and other forms of severe distress arising in the socio-moral context) and facilitate healing (developing an enabling meaning and value for one’s experiences when faced with suffering) have been the focus of medicine as a social institution throughout human history. However, the goals of Western biomedicine in the last few centuries shifted from taking care of these experiential concerns of the sufferers to predominantly the diagnosis and treatment of the symptoms of a disease. This article attempts to illustrate how the assumptions of the social constructionist paradigm (with its deconstructionist and reconstructionist facets highlighted in the writings of Kenneth J. Gergen) serve as a suitable metatheoretical framework to understand human experiences of suffering and healing. A critical review of the writings of Eric J. Cassell and Arthur Kleinman on endorsing and researching such experiences resulted in four themes that reaffirmed the utility of this new paradigm. These themes help comprehend that biomedicine’s ontological claims may enhance human suffering, suffering and healing experiences are socio-historically contextualized, such experiences are performances within human interaction and dialogic partnership between the researcher and the participant becomes a meaningful medium to study such experiences.
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Notes
I was fortunate to have studied at the Department of Psychology at the University of Delhi that enhanced my understanding of human life through not only the positivist paradigm but also through other meaningful paradigms like social constructionism, critical theory and participatory inquiry. There were no such Masters or Doctoral programmes in Psychology in any other university in India in 1999; the year I joined the Masters programme. Besides Professor Girishwar Misra, a social constructionist, being my Ph.D. supervisor, I was also nurtured under the supervision of Professor Vinay Kumar Srivastava, a social anthropologist, who facilitated my understanding of ethnographic field work.
It is also taken as a ‘new paradigm’ of social inquiry that has more similarities than differences with other new paradigms such as critical theory and participatory inquiry paradigms (Guba and Lincoln 2005).
It has also been reported that dealing with experiences of illness or ‘suffering’ is the concern of ill persons or their family members but paradoxically, the focus in modern medicine is on diagnosing the patient with a disease and providing treatment for that; something that usually does not address their concerns (Cassell 1975, 1991, 1999, 2004; Eisenberg 1977).
Cassell (2004) prefers to use of the term, ‘person’ to ‘self’ to avoid the general limiting meaning of ‘self-awareness’ associated with self. By invoking the term, ‘person’, he asserts that there are parts of oneself known only to others. To him, “self is that aspect of person concerned primarily with relations with oneself. Other parts of the person involve relations with others and the surrounding world” (p. 33). It is important here to note that Paranjpe’s (1998) notions of self that its boundaries are uncertain and socially constructed and Baumeister’s (1997) and Misra’s (2010) conceptualization of self as a socially constructed phenomenon are close to Cassell’s (2004) meanings of person in that self pivotally involves relations with others and the surrounding world and is not only synonymous with self-awareness. Therefore, in this paper, ‘self’ and ‘person’ are used interchangeably incorporating aspects of oneself that may be known only to others.
For detailed examples see the chapter 3 of Cassell’s (2004) book, The nature of suffering and the goals of medicine.
Michael Bury (1982) and Kathy Charmaz (1983) have used the terms ‘biographical disruption’ and ‘loss of self’ respectively to describe such spiraling consequences of having a chronic disease. For Bury, biographic disruption included the disruption of common sense boundaries of taken-for-granted assumptions and behaviour related with health and illness, rethinking of person’s biography and self-concept in terms of emerging disability and uncertainty related with illness and the disruption of social relationships affecting the person’s ability to mobilize much needed support or resources. For Charmaz, loss of self meant living restricted lives, experiencing social isolation, developing discrediting definitions of self (due to stigmatized identities and decreased participation of the ill person in the normal world) and burdening others.
Besides, through the social constructionist orientation, as we saw above in the section, ‘Theme One: How Biomedicine’s Ontological Claims may Enhance Suffering’, we may understand the economic and political (creating the dichotomy of ‘deficient other’ and ‘service-provider’; Sampson 1993) purpose for self-enhancement that scientific biomedical model might serve to the scientists and professional who implicitly or explicitly follow positivist paradigm.
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This article is dedicated to my teacher, Girishwar Misra and Kenneth J. Gergen who introduced me to the huge potential of social constructionist paradigm of social inquiry for the welfare and growth of humankind. I also acknowledge the encouragement and inspiration provided to me by Vinay Kumar Srivastava, Ajit K. Dalal, Eric J. Cassell, Arthur Kleinman, Kathy Charmaz, Arthur Frank and Alan Radley toward making meaningful efforts to explore human suffering and healing through social science research.
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Priya, K.R. Social Constructionist Approach to Suffering and Healing: Juxtaposing Cassell, Gergen and Kleinman. Psychol Stud 57, 211–223 (2012). https://doi.org/10.1007/s12646-011-0143-5
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DOI: https://doi.org/10.1007/s12646-011-0143-5