April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: The Dramas of Terminating a Pregnancy for Medical Reasons
Research on narrative coping spans multiple disciplines, but most work in this area is built on the assumption that some stories serve us better (i.e., are more adaptive or functional) than others (Brown et al., 2006). Studies guided by this premise tend to focus on the adaptive and maladaptive features and forms of narratives, resulting in various typologies, including Frank’s (1995) tripartite typology of illness narratives. Although this typology has received considerable empirical support, Frank (2007) has since grown critical of the notion that stories “take care of people” (p. 383). Instead, Frank argues that certain ways of narrating, or communicating one’s story, are more or less functional. To underscore this subtle but significant change in thinking, Frank began referring to narratives as dramas and focused his attention on identifying the dramas that typify the illness experience.
Drawing on Bruner’s (1987) revision of Burke’s dramatic pentad to include troubles, Frank (2007) defines drama as a performance in which private troubles become public plights. Reflecting on his past work and own illness experience, Frank identified five dramas of illness—the drama of genesis, which emphasizes causes; emotion work dramas, or narrations depicting emotional labor and impression management; dramas of fear and loss, the telling of which are chaotic and anxiety-ridden; the drama of meaning, which frames life as a journey; and, the drama of self, or performances that evidence a re-orientation to the self. Despite Frank’s pleas for empirical tests of his five illness dramas, few researchers have answered this call.
To answer Frank’s (2007) call, we designed a study to identify the dramas that typify the experience of pregnancy terminations for medical reasons (TFMRs). Although little is known about how many parents choose to terminate wanted pregnancies due to concerns about the health of the fetus, research on the outcomes associated with abnormal prenatal test results indicates that most affected pregnancies end in termination (Hendrix et al., 2023). Despite evidence that narrative strategies predict parental adjustment post-TFMR, few studies focus specifically on TFMR narratives (Sandelowski & Barroso, 2005). As such, we gathered 78 personal accounts of TFMRs that had been shared on the top three most popular online TFMR support websites, and we conducted a narrative analysis rooted in socio-narratology to identify the dramas that characterize the TFMR experience. We found evidence of all five dramas within this dataset as well as two additional dramas. TFMR genesis dramas were characterized by a preoccupation with the cause of the abnormality, and TFMR emotion work dramas focused on defensive responses to anticipated stigma and efforts to protect others’ emotions. TFMR fear and loss dramas revolved around uncertainty; dramas of meaning depicted the problems with and potential for meaning-making amidst TFMR; and, dramas of the self focused on the evolution and transformation of the self post-TFMR. We also identified two additional dramas—the drama of morality, which considered and often rejected moral questions, and the drama of pain and suffering. The discussion provides possible explanations for these findings and considers their implications.
Drawing on Bruner’s (1987) revision of Burke’s dramatic pentad to include troubles, Frank (2007) defines drama as a performance in which private troubles become public plights. Reflecting on his past work and own illness experience, Frank identified five dramas of illness—the drama of genesis, which emphasizes causes; emotion work dramas, or narrations depicting emotional labor and impression management; dramas of fear and loss, the telling of which are chaotic and anxiety-ridden; the drama of meaning, which frames life as a journey; and, the drama of self, or performances that evidence a re-orientation to the self. Despite Frank’s pleas for empirical tests of his five illness dramas, few researchers have answered this call.
To answer Frank’s (2007) call, we designed a study to identify the dramas that typify the experience of pregnancy terminations for medical reasons (TFMRs). Although little is known about how many parents choose to terminate wanted pregnancies due to concerns about the health of the fetus, research on the outcomes associated with abnormal prenatal test results indicates that most affected pregnancies end in termination (Hendrix et al., 2023). Despite evidence that narrative strategies predict parental adjustment post-TFMR, few studies focus specifically on TFMR narratives (Sandelowski & Barroso, 2005). As such, we gathered 78 personal accounts of TFMRs that had been shared on the top three most popular online TFMR support websites, and we conducted a narrative analysis rooted in socio-narratology to identify the dramas that characterize the TFMR experience. We found evidence of all five dramas within this dataset as well as two additional dramas. TFMR genesis dramas were characterized by a preoccupation with the cause of the abnormality, and TFMR emotion work dramas focused on defensive responses to anticipated stigma and efforts to protect others’ emotions. TFMR fear and loss dramas revolved around uncertainty; dramas of meaning depicted the problems with and potential for meaning-making amidst TFMR; and, dramas of the self focused on the evolution and transformation of the self post-TFMR. We also identified two additional dramas—the drama of morality, which considered and often rejected moral questions, and the drama of pain and suffering. The discussion provides possible explanations for these findings and considers their implications.