Cheryl Mattingly PhD
Professor, joint appointment with the Department of Anthropology at the USC Dornsife College of Letters, Arts and Sciences
Room: KAP 348G
Phone: (213) 740-3550
Cheryl Mattingly is a professor jointly appointed to the USC Division of Occupational Science and Occupational Therapy and the Department of Anthropology at the USC Dornsife College of Letters, Arts and Sciences. She is currently a Dale T. Mortensen Senior Research Fellow at the Institute for Advanced Studies at Aarhus University (Denmark). She is a frequent Visiting Professor of Anthropology and Philosophy in the Department of Culture and Society at Aarhus University. She has also been PI and Co-PI on multiple large-scale federally funded research grants.
Her primary research and theoretical interests include narrative, moral reasoning and experience, phenomenology, the culture of biomedicine, chronic illness and disability, the ethics of care and health disparities in the United States. She has published extensively on these topics, including numerous peer-reviewed articles and book chapters. She received the Polgar Essay Prize from the American Anthropological Association's Society for Medical Anthropology for her 1998 journal publication "In Search of the Good: Narrative Reasoning in Clinical Practice." She has also written six books (including one currently in press). She received the Victor Turner Prize from the American Anthropological Association for "Healing Dramas and Clinical Plots" (1998) and the Stirling Book Prize from the Society for Psychological Anthropology for "The Paradox of Hope: Journeys through a Clinical Borderland" (2010). Her other books include "Clinical Reasoning in a Therapeutic Practice" (1994), "Narrative, Self and Social Practice" (2009) which she co-edited with Uffe Juul Jensen, and "Moral Laboratories: Family Peril and the Struggle for a Good Life" (forthcoming Fall 2014).
As an anthropologist, a major area of Cheryl Mattingly's work has been the study of stories in healthcare. Interest in narrative has grown tremendously over the past several years in all the health professions, including among physicians. Stories can be especially relevant for occupational therapists because it is often through hearing stories that people learn what it is like for someone to live with disability. And the stories people tell also give many clues about what they care about, what matters most in their lives. This is important because when occupational therapy is most effective, it connects treatment interventions to those areas of deep concern to clients.
A second area of Dr. Mattingly's work has been the study of how clients, families and clinicians work together — or run into problems trying to work together — during the practice of rehabilitation. She has been particularly intrigued with how collaboration occurs across large cultural divides, that is, when clients and therapists come from very different cultural worlds but must find some kind of common ground in order to work together toward goals.
Finally, Dr. Mattingly has written extensively about clinical reasoning in occupational therapy, especially the role of narrative in the thinking of occupational therapists, the kinds of stories they tell about their clients and the influence of stories in helping therapists devise treatment approaches tailored to individual clients and their particular needs and strengths.
National Institute of Mental Health Research Fellow in Clinically Relevant Anthropology
Harvard Medical School, Department of Social Medicine
Doctor of Philosophy (PhD) in Anthropology and Urban Studies
Massachusetts Institute of Technology
Mattingly, C. F. (2010). The paradox of hope: Journeys through a clinical borderland. Berkeley, CA: University of California Press. Link to full text
U. J. Jensen & C. F. Mattingly (Eds.) (2009). Narrative, self and social practice. Aarhus, DK: Philosophia Press. Link to full text
Mattingly, C. F. (2003). Clinical reasoning: Forms of inquiry in a therapeutic practice. Philadelphia, PA: F.A. Davis Press.
C. Mattingly & L. C. Garro (Eds.) (2000). Narrative and the cultural construction of illness and healing. Berkeley, CA: University of California Press. Link to full text
Mattingly, C. F. (1998). Healing dramas and clinical plots: The narrative structure of experience. Cambridge, U.K: Cambridge University Press.
Mattingly, C. F., & Fleming, M. H. (1994). Clinical reasoning: Forms of inquiry in a therapeutic practice. Philadelphia, PA: F. A. Davis Press.
Mattingly, C., & Jensen, U. J. (2015). Practical philosophy and hope as a moral project among African-Americans. In S. Liisberg, E. O. Pedersen, & A. L. Dalsgård (Eds.), Anthropology & philosophy: Dialogues on trust and hope. Oxford, England: Berghahn Press. Link to full text
Mattingly, C., & Jensen, U. J. (2015). What can we hope for? An exploration in cosmopolitan philosophical anthropology. In S. Liisberg, E. O. Pedersen, & A. L. Dalsgård (Eds.), Anthropology & philosophy: Dialogues on trust and hope. Oxford, England: Berghahn Press. Link to full text
Lawlor, M. C., & Mattingly, C. (2014). Family perspectives on occupation, health, and disability. In B. A. B. Schell, G. Gillen, & M. E. Scaffa (Eds.), Willard & Spackman’s occupational therapy (12th ed.). (pp. 150-162). Philadelphia, PA: Lippincott Williams & Wilkins. Link to full text
Mattingly, C. F. (2010). Moral willing as narrative re-envisioning. In K. M. Murphy & C. J. Throop (Eds.), Toward an anthropology of the will. Palo Alto, CA: Stanford University Press.
In Chapter 3 (“Moral Willing as Narrative Re-envisioning”), Cheryl Mattingly examines
the case of an African American mother whose son was badly burned in an accident at the age of
one. Following the accident, the mother faced a series of difficult moral choices, including whether to allow her son to have risky surgeries and whether to show anger toward her niece, who was supposed to have been watching him at the time of the accident. For most of these
dilemmas, there was not a single moment of individual choice, but rather an extended process
involving emotional struggle and personal growth, as well as consultation and support from family and the community. The mother’s experience of making a moral choice was not so much about the act of choosing, but instead the psychological work she undertook to “re-orient” herself
to the choice she needed to make, as well as the effort she applied to carry it out. This holistic perspective is typically absent in psychology research on moral decision-making and the will. When experiments ask participants to read about a hypothetical moral dilemma and choose between two options (before moving on to another, unrelated dilemma), the choice can be made with little re-orientation or effort—an impoverished experience compared to what happens in real life. Similarly problematic are experiments on conscious will that ask participants to report the precise millisecond they chose to act—an odd task if choice is experienced not as a single moment, but as an ongoing process.
Mattingly, C. F. (2009). Senses of an ending: Self, body and narrative. In U. J. Jensen & C. F. Mattingly (Eds.), Narrative, self and social practice. Aarhus, DK: Philosophia Press.
Mattingly, C. F. (2009). Narrative, self and social practice. In U. J. Jensen & C. F. Mattingly (Eds.), Narrative, self and social practice. Aarhus, DK: Philosophia Press.
Mattingly, C. F. (2008). Stories that are ready to break. In L. C. Hyden (Ed.), Health, illness, culture: Broken narratives. London, U.K: Routledge.
Lawlor, M. C., & Mattingly, C. F. (2008). Understanding family perspectives on illness and disability experience. In E. B. Crepeau, E. S. Cohn, & B. A. B. Schell (Eds.), Willard & Spackman’s occupational therapy (11th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Mattingly, C. F. (2007). Acted narratives: From storytelling to emergent dramas. In J. Clandinin (Ed.), Handbook of narrative inquiry methodologies. Thousand Oaks, CA: Sage Publications.
Mattingly, C. F. (2004). Performance narratives in clinical practice. In B. Hurwitz, T. Greenhalgh, & V. Skultans (Eds.), Narrative research in health and illness. London, U.K: Blackwell Publishing (BMJ books).
Mattingly, C. F., & Lawlor, M. C. (2003). Disability experience from a family perspective. In E. Crepeau, E. Cohn, & B. Schell (Eds.), Willard & Spackman’s occupational therapy (10th ed.). Philadelphia, PA: Lippincott.
Garro, L. C., & Mattingly, C. F. (2000). Narrative as construct and construction. In C. Mattingly & L. C. Garro (Eds.), Narrative and the cultural construction of illness and healing. Berkeley, CA: University of California Press.
Mattingly, C. (2000). Emergent narratives. In C. Mattingly & L. C. Garro (Eds.), Narrative and the cultural construction of illness and healing. Berkeley, CA: University of California Press.
Garro, L. C., & Mattingly, C. (2000). Narrative turns. In C. Mattingly & L. C. Garro (Eds.), Narrative and the cultural construction of illness and healing. Berkeley, CA: University of California Press.
Fleming, M., & Mattingly, C. F. (2000). Action and narrative: Two dynamics of clinical reasoning. In J. Higgs & M. Jones (Eds.), Clinical reasoning in the health professions. Oxford, U.K: Butterworth-Heinemann.
Mattingly, C. F., & Lawlor, M. C. (1998). Illness experience from a family perspective. In M. Neistadt & E. Crepeau (Eds.), Willard & Spackman’s occupational therapy (9th ed.). Philadelphia, PA: Lippincott.
Mattingly, C. F., & Beer, D. (1993). Interpreting culture in a therapeutic context. In H. Hopkins & H. D. Smith (Eds.), Willard & Spackman's occupational therapy (8th ed.). Philadelphia, PA: J. B. Lippincott & Co.
Mattingly, C. F. (1991). Narrative reflections on practical actions. In D. Schon (Ed.), The reflective turn: Case studies in and on practice. New York, NY: Teachers College Press.
Mattingly, C. F. (1988). Perspectives in clinical reasoning for occupational therapy. In S. Robertson (Ed.), Mental health focus: Skills for assessment and treatment. Rockville, MD: American Occupational Therapy Association.
Mattingly, C. (2014). The moral perils of a superstrong Black mother. Ethos, 42, 119-138. doi:10.1111/etho.12042. Link to full text
Investigations into clinical communication and interaction have provided an avenue for a Foucauldian-style analysis of how subject positions are produced in clinical settings through various practices of moral subjugation, often drawing upon such concepts as biopower and biosociality. I take an alternative approach. In exploring the moral vulnerabilities of coming to inhabit a particular subject position, I build upon a first person neo-Aristotelian virtue ethics rather than a Foucauldian-inspired one. My central claim is that although a focus on biopower is enormously fruitful, moral vulnerability is about more than being morally subjugated. This does not sum up the moral perils that people may face, especially the possibility of moral tragedy. In the context of an ethnographic case centering upon one mother, Dotty, and her very ill daughter, Betsy, I argue for why a conception of tragedy is so important to moral life and why a first person virtue ethics is invaluable for its exploration. This case centers upon Dotty's interactions and relationships with the doctors caring for her daughter. It is drawn from a 15-year ethnographic study of African American families in Los Angeles who have children with significant illnesses and disabilities.
Mattingly, C. (2013). Love’s imperfection: Moral becoming, friendship and family life. Suomen Antropologi: Journal of the Finnish Anthropological Society, .
Mattingly, C. (2013). Moral selves and moral scenes: Narrative experiments in everyday life. Ethnos: Journal of Anthropology, 78, 301-327. doi:10.1080/00141844.2012.691523. Link to full text
Mattingly, C., Grøn, L., & Meinert, L. (2011). Chronic homework in emerging borderlands of healthcare. Culture, Medicine, and Psychiatry, 35, 347-375. doi:10.1007/s11013-011-9225-z. Link to full text
The task of caring for those with chronic illnesses has gained a new centrality in health care at a global level. We introduce the concept of “chronic homework” to offer a critical reflection on the treatment of chronic illnesses in three quite different national and local contexts: Uganda, Denmark, and the United States. A major challenge for clinicians, patients, and family caregivers is how to navigate the task of moving health care from clinic to home. By “chronic homework,” we refer to the work patients and families are expected to carry out in their home contexts as part of the treatment of chronic conditions. Families and patients spend time receiving training by clinical experts in the various tasks they are to do at home. While this “colonization” of the popular domain could easily be understood from a Foucauldian perspective as yet another emerging mode of governmentality, this a conceptualization can oversimplify the way specific practices of homework are re-imagined and redirected by patients and significant others in their home surroundings. In light of this re-invention of homework in local home contexts, we foreground another conceptual trope, describing chronic homework as a borderland practice.
Jacobs, L., Lawlor, M., & Mattingly, C. (2011). I/We narratives among African American families raising children with special needs. Culture, Medicine, and Psychiatry, 35, 3-25. doi:10.1007/s11013-010-9196-5. Link to full text
This paper examines a statistics debate among African American caregivers raising children with disabilities for insights into the work of "African American mothering." Using ethnographic, narrative and discourse analyses, we delineate the work that African American mothers do—in and beyond this conversation—to cross ideological and epistemological boundaries around race and disability. Their work entails choosing to be an "I" and, in some cases, actively resisting being seen as a "they" and/or part of a collective "we" in order to chart alternative futures for themselves and their children.
Mattingly, C. (2009). Reading medicine: Mind, body, and meditation in one interpretive community. New Literary History, 37, 563-581. doi:10.1353/nlh.2006.0050. Link to full text
This essay challenges the common conception that biomedicine operates by separating the mind from the body, and by attending to the biological rather than spiritual. In actual practice, there are practical and strategic concerns that bring the spiritual into play. This is because, at least in the case of chronic illnesses, clinicians cannot simply fix bodies; they must create partnerships with patients and family caregivers who also assume responsibilities in providing clinical care and making medical decisions about course of treatment. Drawing from a longitudinal ethnographic study of African American families who have children with serious chronic medical conditions, I examine how these families bring spiritual practices and spiritual ways of "reading the body" directly into the clinical encounter. Patients and family members creatively remake or reinterpret the oral and written words of clinicians and incorporate them within their own narratives of miraculous recoveries, the power of faith, and the centrality of meditative prayer. In doing so, they unite spiritual with physical healing in ways not dissimilar to the pre-modern practices Brian Stock describes. For these families, such meditative practices are often part of life-long journeys, connecting practices of healing to a general philosophy of life well understood by the ancients.
Mattingly, C. (2008). Reading minds and telling tales in a cultural borderland. Ethos, 36, 136-154. doi:10.1111/j.1548-1352.2008.00008.x. Link to full text
In this article I consider “narrative mind reading,” the practical capability of inferring the motives that precipitate and underlie the actions of others. Following Jerome Bruner, I argue that this everyday capacity depends on our ability to place action within unfolding narrative contexts. While Bruner has focused on narrative mind reading as a within-culture affair, I look to border situations that cross race and class lines where there is a strong presumption among participants that they do not, in fact, share a cultural framework. Instead, interactions often reinforce actors' perceptions of mutual misunderstanding and cultural difference. Drawing on a longitudinal study of African American families who have children with severe illnesses, I examine narrative mind reading and misreading in one mother's interactions with the clinicians who treat her child. I further explore how narrative misreadings are supported through chart notes and “familiar stranger” stories. The focus on miscommunication grounds a theory of the reproduction of cultural difference in interactive dynamics and brings Bruner's emphasis on narrative into dialogue with contemporary anthropology of cultural borderlands.
Grøn, L., Mattingly, C., & Meinert, L. (2008). Kronisk hjemmearbejde: Sociale håb, dilemmaer og konflikter i hjemmearbejdsnarrativer i Uganda, Danmark og USA [Chronic homework: Social hopes, dilemmas and conflicts in homework narratives in Uganda, Denmark and the USA]. Tidsskrift for forskning i sygdom & samfund [Journal of Research in Health and Society], 9, 71-95. Link to full text
On the basis of three practical examples of Uganda, Denmark and the United States, we discuss in this article patient and family homework in relation to chronic conditions. The three cases dealing with an AIDS patient in a "Home Based AIDS Care" program receiving medical treatment and counseling at home, a diabetes patient who is trying to implement lifestyle changes in his life and a father with a chronically ill child who is expected to perform rehabilitation exercises at home. We examine these three examples of chronic homework with narrative concepts to highlight aspects of time - especially future and hope. Hjemmearbejdsnarrativer relate to the expectations of physicians, patients and families have the treatment undertaken in a clinical context and to unfold when brought home.
In this article, we discuss how patients perceive and deal with dilemmas in work and responsibilities between hospital and home. We suggest that homework involves complex issues for both patients and professionals. We point specifically on the temporal and social dimensions of homework and the dilemmas that patients and families experience when they try to do their homework. We also discusses how there may be conflicts between patients and professionals hjemmearbejdsnarrativer. Homework is done in it, Kleinman called the popular sector, and finally we asked the question whether homework points to a 'expert-driven' colonization of the popular sector.
Mattingly, C., Lutkehaus, N. C., & Throop, C. J. (2008). Special issue: Troubling the boundary between psychology and anthropology: Jerome Bruner and his inspiration [Guest editor]. Ethos, 36. Link to full text
Mattingly, C., Lutkehaus, N. C., & Throop, C. J. (2008). Bruner's search for meaning: A conversation between psychology and anthropology. [Special issue: Troubling the boundary between psychology and anthropology: Jerome Bruner and his inspiration]. Ethos, 36, 1-28. doi:10.1111/j.1548-1352.2008.00001.x. Link to full text
We introduce a special issue of Ethos devoted to the work of Jerome Bruner and his careerlong attempts to seek innovative ways to foster a dialogue between psychology and anthropology. The articles in this special issue situate Bruner's meaning-centered approach to psychology and his groundbreaking work on narrative in the broader context of the developmental trajectory of both of fields of inquiry. Bruner's work has been enormously influential in the subfields of cultural psychology and psychological anthropology, especially because of his important contributions to our understanding of the intimate relationship between culture and mind. We examine Bruner's past and ongoing engagement with such luminary figures as Lev Vygotsky, Jean Piaget, Alfred Kroeber, Claude Lévi-Strauss, and Clifford Geertz to highlight points of convergence and tension between his version of cultural psychology and contemporary theorizing and practice in psychological anthropology. We also review his practical and theoretical contributions to the fields of medicine, law, and education.
Mattingly, C. (2006). Pocahontas goes to the clinic: Popular culture as lingua franca in a cultural borderland. American Anthropologist, 108, 494-501. Link to full text
Urban hospitals constitute an example of what is arguably the most visible site in anthropology these days-the border zone. Negotiating health care requires trafficking in tricky spaces where patients and their families must pay vigilant attention about when to submit, when to resist, and how to collaborate. Drawing from ethnographic research carried out over the past nine years among African American families who have children with severe illnesses and disabilities, I examine how children's popular culture operates in the fraught borderland that constitutes the urban clinic. Global icons like a Disneyfied Pocahantas can function as a lingua franca, offering a language of publicly available symbols on which families, health professionals, and children can draw to create a shared imaginative space across race and class divides and across the sometimes even more radical divide between sufferer and healer.
Mattingly, C. (2006). Hoping, willing, and narrative re-envisioning. The Hedgehog Review, 8(3), 21-35. Link to full text
At first glance, hoping and willing do not seem to have much to do with one another. They evoke quite disparate turns of mind, in fact. Hope, which Aristotle called a "waking dream," is associated with imagination, daydreams, and wishful thinking. Willing, on the other hand, is aligned with practical effort, discipline, and acting against one's inclinations. Despite their lack of obvious affinity, in some communities-especially in the face of extreme suffering-the two acts may develop a close kinship. Hope as a moral task, even a narrative quest, can demand the arduous cultivation of the will. Hope is not necessarily something people easily acquire-not a matter of mere wishful thinking when life becomes difficult, but a difficult moral obligation that must be assumed as a way to confront pain and despair.
Mattingly, C. (2005). Toward a vulnerable ethics of research practice [Special issue: Narrative, ethics and informed consent]. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 9, 453-471. Link to full text
This article considers ethical dilemmas concerning the protection of confidentiality that often arise in carrying out ethnographic research. A number of problematic assumptions are highlighted that generally (implicitly or explicitly) guide the practice of contemporary research ethics review committees: (1) ethical rules are context free; (2) there is always an ethical 'right answer'; (3) there is an objective position from which to judge what one ought ethically to do. Notably, this is a position of emotional detachment from the situation; (4) this objectively identified ethical position can be articulated in explicit and unambiguous public language. The troublesome character of these assumptions is raised in the context of fifteen years of ethnographic research among African American families in clinical settings within the urban United States, with special attention to an ongoing relationship with one research participant the author has known for eight years. Finally the article suggests an alternative ethical framework drawn from recent philosophical work in an Aristotelian-inspired 'virtue ethics'.
Riessman, C. K., & Mattingly, C. (2005). Introduction: Toward a context-based ethics for social research. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 9, 427-429. Link to full text
Mattingly, C. (2005). Den narrative udvikling i nyere medicinsk antropologi [The narrative turn in contemporary medical anthropology]. Tidsskrift for forskning i sygdom & samfund [Journal of Research in Health and Society], 2, 13-40. Link to full text
In the mid-1980s began anthropologists to examine the narrative and its relationship to suffering and healing in biomedical treatment context. This narrative development allows anthropologists to explore suffering from different perspectives, to criticize Western biomedicine and to explore the hidden demands in biomedicine practice. This article outlines five key areas in which the narrative has been associated with healing in western biomedicine. Based on the analysis of a specific clinical interaction argued that a study of narrative action gives anthropologists a good position to participate in the broader interdisciplinary matter to make biomedical discourse and practice more human.
Mattingly, C. (2003). Becoming Buzz Lightyear and other clinical tales: Indigenizing Disney in a world of disability. Folk: Journal of the Danish Ethnographic Society, 45, 9-32. Link to full text
Increasingly, anthropologists are investigating the place of mass media in our lives, for we live, as Ortner (1999) notes, in a 'media-saturated world.' This paper explores the role of (globalized) children's mass media — with particular emphasis on Disney — and its influence on one particular community of consumers. The community consists of African American children who face serious disabilities and chronic illnesses, as well as the families who care for them. Disney films and characters permeate the lives and imaginations of these children and parenting kin. While the compelling power of Disney can legitimately be construed as a form of global domination, an emphasis on domination and on the consumer as unwitting victim easily underestimates the agency of the audience.
Mattingly, C., Lawlor, M., & Jacobs-Huey, L. (2002). Narrating September 11: Race, gender, and the play of cultural identities. American Anthropologist, 104, 743-753. Link to full text
This article considers the September 11 tragedy as an event that has created a powerful experience—an astonishing and unthinkable "breach" from the expected and routine—that has riveted the American public and provoked personal storytelling. September 11 and its aftermath have provided an occasion for rethinking and reworking cultural identity. We explore how September 11 and subsequent events have been experienced, constructed, and narrated by African American women, primarily from working-class and low-income backgrounds. These stories, and the commentaries and discussions that surround them, provide vehicles for these women to ponder what sort of social contexts they inhabit, within what sort of subject positions they are placed, and how these may be shifting in light of the attacks and America's "War on Terrorism".
Lawlor, M. C., & Mattingly, C. F. (2001). Beyond the unobtrusive observer: Reflections on researcher-informant relationships in urban ethnography. American Journal of Occupational Therapy, 55, 147-154. Link to full text
Ethnographic research involves the creation and ongoing renegotiations of relationships between researchers and informants. Prolonged engagement contributes to the complexity as relationships deepen and shift over time and participants accumulate a substantial reservoir of shared experiences. Reflections about the relationships we have co-constructed with informants in several research projects have contributed to our identification of several critical aspects of building and maintaining researcher–informant relationships in cross-cultural research. Aspects of relationship work specifically related to conducting ethnography with children, within the communities in which researchers live, and within the practice of occupational therapy are discussed.
Mattingly, C., & Lawlor, M. (2001). The fragility of healing. American Anthropologist, 29(1), 30-57. Link to full text
This article explores a paradox—the simultaneous cultivation and suppression of "healing dramas" by pediatric rehabilitation therapists. Dramatic moments are defined as ones in which the routine exercises and treatment activities of therapeutic practice are transformed into narrative plots. These improvisational plots involve multiple characters, risks, suspense, and above all, a heightened sense that something is at stake. Experience itself becomes the focus of attention for the patient. Based upon ethnographic research in Chicago and Los Angeles, this article offers an anatomy of two such moments, investigating not only how healing dramas are constructed between patients and healers but how and why institutional discourses and practices invite their abandonment.
Mattingly, C., & Lawlor, M. (2000). Learning from stories: Narrative interviewing in cross-cultural research. Scandinavian Journal of Occupational Therapy, 7(1), 4-14. Link to full text
This paper argues for the importance of eliciting stories when trying to understand the point of view and personal experience of one"s informants. It also outlines one approach to eliciting and analyzing narrative data as part of a complex and multi-faceted ethnographic study. The paper draws upon ethnographic research among African-American families who have children with serious illnesses or disabilities. However, it is not a report of research findings per se. Rather, it is primarily a conceptual paper that addresses narrative as a research method. Features that distinguish a story from other sorts of discourse are sketched and current discussions in the occupational therapy and social science literature concerning the importance of narrative are examined. The heart of the paper focuses on a single narrative interview and examines what we learn about the client and family caregiver perspective through stories.
Mattingly, C. F. (1998). In search of the good: Narrative reasoning in clinical practice. Medical Anthropology Quarterly, 12(3), 273-297.
Based on ethnographic work among North American occupational therapists, I compare two forms of everyday clinical talk. One, "chart talk," conforms to normative conceptions of clinical rationality. The second, storytelling, permeates clinical discussions but has no formal status as a vehicle for clinical reasoning. I argue that both modes of discourse provide avenues for reasoning about clinical problems. However, these discourses construct very different clinical objects and different phenomena to reason about. Further, the clinical problems created through storytelling point toward a more radically distinct conception of rationality than the one underlying biomedicine as it is formally conceived. Clinical storytelling is more usefully understood as a mode of Aristotle's "practical rationality" than the technical rationality of modern (enlightenment) conceptions of reasoning.
Hunt, L. M., & Mattingly, C. (1998). Introduction: Diverse rationalities and multiple realities in illness and healing. Medical Anthropology Quarterly, 12, 267-272. doi:10.1525/maq.19126.96.36.1997. Link to full text
Hunt, L. M., & Mattingly, C. F. (1998). Special collection: Rationality in the real world: Varieties of reasoning about illness [Guest editor]. Medical Anthropology Quarterly, 12(3).
Lawlor, M. C., & Mattingly, C. F. (1998). The in family-centered care. American Journal of Occupational Therapy, 52, 259-267. Link to full text
The recent movement toward family-centered care, which has been propelled by the implementation of the Education for All Handicapped Children Amendments of1986, poses considerable challenges to professionals trained in client-centered models of service delivery These challenges are compounded by the fact that our understanding of family-centered care lags considerably behind our attempts to implement responsive and efficacious services. When practitioners include family members more integrally as collaborators in pediatric treatment, their perceptions about families and the nature of the therapeutic experience is afficted. In this article, we present a number ofcritical dilemmas that are based on data drawn from ethnographic research, descriptive studies, and training seminars we conducted with pediatric practitioners and parents of children with special heath care needs. These dilemmas highlight the complexities involved in building effective partnerships among all the key players, the influence of multiple cultural worlds on everyday practices, and the need to provide supports to practitioners for the emotional and social dimensions of practice. Implications for practice and future research are presented.
Mattingly, C. F., Fleming, M., & Gillette, N. (1997). Narrative explorations in the tacit dimension: Bringing language to practice. Journal for Critical Social Science (Nordiske Udkast), 1, 65-78.
Mallinson, T., Kielhofner, G., & Mattingly, C. (1996). Metaphor and meaning in a clinical interview. American Journal of Occupational Therapy, 50, 338-346. Link to full text
This study examined the narrative features of 20 life histories gathered from psychiatric patients with the Occupational Performance History Interview. The aim was to identify how narrative features were present in the patient interview responses and to illustrate how such narrative features can be located. We found that the patients organized their interview responses with deep metaphors that served to "emplot, " or give meaning to, the life story. This article illustrates how patients used the deep metaphors to both circumscribe and frame possible solutions to the problems in their lives. Deep metaphors are consistent, recurring images of a life story that give coherence to, and aid in, the interpretation of the events of that life. Moreover, we explored how metaphors can be located in patient life histories and their implications for occupational therapy.
Mattingly, C., & Garro, L. C. (1994). Introduction [Guest editor: Narrative representations of illness and healing]. Social Science & Medicine, 38, 771-774. http://dx.doi.org/10.1016/0277-9536(94)90149-X. Link to full text
Mattingly, C. (1994). The terrible adventure of rehabilitation [Case Stories Series, Arthur Frank (Ed.)]. Second Opinion, 20(1), 40-45. Link to full text
Friendship with patients, caregivers are taught during their professional training, is to be avoided. Yet the capacity for friendship—to be "a person who emerges in her personhood and not simply as a professional"—may be crucial to effective therapy.
Mattingly, C. (1994). The concept of therapeutic 'emplotment'. Social Science & Medicine, 38, 811-822. http://dx.doi.org/10.1016/0277-9536(94)90153-8. Link to full text
This paper considers the narrative structure of clinical action. I argue that clinical encounters involve clinician and patient in the creation and negotiation of a plot structure within clinical time. This clinical plot gives meaning to particular therapeutic actions by placing them within a larger therapeutic story. No therapeutic plot is completely pre-ordained, however. Improvisation and revision are necessary to its creation. In making a case for the narrative construction of lived time, of narratives that are created before they are told, this paper departs from the predominant mode of narrative analysis within medical anthropology that has focused on narrative discourse. Therapeutic emplotment is concretely considered through an interpretation of a single case, a clinical interaction between an occupational therapist and a head-injured patient.
Del Vecchio Good, M. J., Munakata, T., Kobayashi, Y., Mattingly, C., & Good, B. J. (1994). Oncology and narrative time. Social Science & Medicine, 38, 855-862. http://dx.doi.org/10.1016/0277-9536(94)90157-0. Link to full text
Oncologists encounter the uncertainty of time horizons in their patients' lives. Although American oncologists are given a cultural mandate to instill hope in the therapeutic narratives they create with patients, uncertainty leads them to expressions of time without horizons or of time with highly foreshortened horizons as they seek to create for patients an experience of immediacy rather than of chronology. The distinctiveness of the American pattern is highlighted through comparison with Japanese exemplar cases and stories of therapeutic practices in oncology. Concepts drawn from narrative analysis of temporality and the construction of the therapeutic plot are employed.
Helfrich, C., Kielhofner, G., & Mattingly, C. (1994). Volition as narrative: Understanding motivation in chronic illness. American Journal of Occupational Therapy, 48, 311-317. Link to full text
This paper expands the current concept of volition in the Model of Human Occupation. The present version views personal causation, values, and interests as traits that determine choices to engage in occupations. Through a detailed investigation of the life histories of two persons with psychiatric disorders, this paper illustrates how volition is embedded in a personal narrative. Two features of narratively organized volition are highlighted: (a) how narrative places decisions and actions within a plot, thus giving them meaning in the context of a whole life, and (b) how the personal narrative motivates the person by serving as a context for choosing and action. Thus, the paper illustrates how persons seek to narrate their lives and live their life narratives.
Spencer, J., Krefting, L., & Mattingly, C. (1993). Incorporation of ethnographic methods in occupational therapy assessment. American Journal of Occupational Therapy, 47, 303-309. Link to full text
Many constructs of interest to occupational therapists can only be studied through qualitative methods. Such constructs include meaning of activity or the illness experience and the context in which these occur. The purpose of this paper is to describe how ethnographic methods used in research can be generalized and applied to clinical practice. Ethnography is compared with other qualitative research approaches, and a model clinical ethnographic assessment process is described.
Mattingly, C. (1991). What is clinical reasoning?. American Journal of Occupational Therapy, 45, 979-986. Link to full text
This paper offers a concept of clinical reasoning that differs from many of the traditional definitions of clinical reasoning in occupational therapy and the health professions in general. Here, clinical reasoning in occupational therapy is described as a largely tacit, highly imagistic, and deeply phenomenological mode of thinking. It is argued that clinical reasoning involves more than the ability to offer explicit reasons that justify clinical decisions because it is also based on tacit understanding and habitual knowledge gained through experience. Clinical reasoning also involves more than a simple application of theory, particularly theory as understood in the natural sciences, because complex clinical tasks often require that the therapist improvise a treatment approach that addresses the unique meaning of disability as it relates to a particular patient.
Mattingly, C. (1991). The narrative nature of clinical reasoning. American Journal of Occupational Therapy, 45, 998-1005. Link to full text
Narrative reasoning is a central mode of clinical reasoning in occupational therapy. Therapists reason narratively when they are concerned with disability as an illness experience, that is, with how a physiological condition is affecting a person's life. In this paper, narrative reasoning is contrasted with propositional reasoning, and two kinds of narrative thinking are examined. The first is the use of narrative as a mode of speech that can be contrasted with biomedical discourse, in which disability is framed as physical pathology. The second involves the creation rather than the telling of stories. Therapists try to "emplot" therapeutic encounters with patients, that is, to help create a therapeutic story that becomes a meaningful short story in the larger life story of the patient.
Mattingly, C., & Gillette, N. (1991). Anthropology, occupational therapy and action research. American Journal of Occupational Therapy, 45, 972-978. Link to full text
This paper describes the research process and methodology used in the American Occupational Therapy Association/American Occupational Therapy Foundation Clinical Reasoning Study. This study examined the clinical reasoning of occupational therapists through a 2-year ethnography of therapists at one hospital site. The research was innovative in several important respects. One important innovation was a combined ethnographic and action research design that involved collaboration between the research team and those therapists being studied. Therapists who were research subjects became actively involved in examining and reflecting on their own practice through group analysis of videotaped sessions with clients. One outcome of this action research component was that the study served as both a research and a staff development project.
Niehues, A., Bundy, A., Mattingly, C. F., & Lawlor, M. C. (1991). Making a difference: Occupational therapy in public schools. Occupational Therapy Journal of Research, 11(4), 195-212.
Gillette, N. P., & Mattingly, C. (1987). Clinical reasoning in occupational therapy. American Journal of Occupational Therapy, 41, 399-400. Link to full text
The year 1986 heralded the beginning of a significant research study in occupational therapy. The American Occupational Therapy Founuation (AOTF) and the American Occupational Therapy Association (AOTA) jointly funded a year long pilot study to examine the clinical reasoning processes that reflect the occupational therapist's knowledge and use of theory in practice The impetus for this study came from a presentation to the Commission on Education at the AOTA Annual Conference in Kansas City in 1984. Donald Schiin, PhD, a faculty member in the department of urban planning, Massachusetts Institute of Technology, presented his work on the reflective practitioner. Schon argued that in the practice of any profession, theory emerges through transactions between client and professional when tough, unique solutions are required in areas where a field's accumulated knowledge has not provided adequate answers for the immediate dilemma. In earlier work with medicine, architecture, and urban planning, Schon and his colleagues had demonstrated that the accumulated knowledge of a field can never be adequate to provide solutions to all problems presented by clients. Therefore, these scholars argued, it was imperative that professions reconsider the emphasis on content while increasing the educational focus on the reasoning process.
Mattingly, C. F. (1999). Rewriting the self: History, memory and narrative. Transcultural Psychiatry, 36(4), 513-515.
Mattingly, C. F. (1998). Time, narrative and cultural action. American Anthropologist, 100(1), 184-186.