Thursday, 7 April 2011

The importance of narrative

So my word of the month has been ‘narrative’. This is wholly derived from Paul Corrigan, with whom I am in danger of developing a twitter crush. There is probably a term to describe the disconnect between the sense in which I feel I know him from his blogging, and the sense in which I don’t know him at all, but I do not know what it is. I suspect this is a thoroughly modern and no doubt unremarkable admission to be making to you.

But the wonder of the modern age is that he has been able to reach me, and teach me something new. I have always understood the importance of language, and often revel in the intellectual masturbation of seeing how ‘eloquent’ I can make a sentence. This is some idiosyncratic measure of complexity of a sentence coupled with unusual turn of phrase.

However, it is Paul Corrigan who has introduced me to the importance of narrative, with the personal learning for me being that a sentence, paragraph or whole document does not stand alone: it only makes sense in terms of what has been said before, and what comes after. And this is crucial.

Of course, Paul is concerned mainly with thinking about the Health Bill at the moment, and this is a good example. The listening exercise can be currently understood in terms of  the government’s need to redress the nature of the dialogue being used about the Bill. They probably believe that the Bill addresses some very real problems with the Health Service, but the nature of the debate recently has only addressed what is wrong with it, and not what it right with it. My personal views on this are not relevant to this current debate, as the point that Paul Corrigan has been making with clarity and consistency for the last few weeks is that the government has lost control of the narrative, and in those circumstances it doesn’t matter what they say, they are never going to be able to get their point across. For example, if everyone is saying ‘there is nothing good in the Health Bill, and the government just wants to privatise the health service’ and the government says ‘we are not privatising the health service, we are just making it more responsive to the patients needs’, no one is going to believe them. However, if the prevailing discussion says something more along the lines of ‘we are not sure what problems the health bill is solving?’ there is still an issue with communication, but it is feasible for the government to say ‘The health bill helps us make the health service more responsive to the needs of the patient by doing x, y and z’, they have some chance of getting their message across.

If the narrative exists on a substrate of distrust, then meaningful dialogue is impossible. The listening exercise is designed to address this prevailing feeling.

And now I have ‘narrative’ on the brain, I am seeing it everywhere. I am doing some revision for some public health exams in June, and the issue of narrative cropped up when I was thinking about environmental risk assessment, and how the evidence shows that the public view risks very differently to the people who assess risks for a living, such as doctors or policy makers. A good example of the difference was seen in the MMR story, where the risk from autism from having the vaccine was more salient than the risk of measles, mumps or rubella from not having the vaccine. Again, the narrative was key here: while we were hearing that the the MMR had been linked with autism, the only response that was being heard from the medical profession was that it isn’t, and in the context of the willingness to believe that the vaccine could be linked with autism, it was impossible to hear any other message getting through.

So my learning this week, is that the content of the message is important, but life is much more complicated than that. One truth that has coming sailing home for me in recent months, is that we have to be cleverer than that if we have a message, and the timing and delivery of any message needs to be judged in the context of the environment and culture in which it is being given. If we imagine for a moment that truth is subjective (and this is not a consistent belief of mine) then we have also to accept that this truth needs to be acknowledged, whether or not, in an empirical sense, it is true. If you are faced with a mother who believes that MMR will harm her child, how can you persuade her it won’t? It certainly won’t be enough to tell her.

If the public believes that the NHS is being cut, it certainly won’t help to tell them that it is not. If the medical profession believes that the Health Bill will be bad for patient care, then the narrative needs to demonstrate how it won’t be.

So having understood this point, all I have to do now is work out how to deal with it. More on that later.

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