Storying Domestic Violence

Frontiers of Narrrative

H:G>:H:9>IDG
David Herman
Ohio State University
Storying Domestic Violence

Constructions and Stereotypes of Abuse

in the Discourse of General Practitioners

Jarmila Mildorf

UNIVERSITY OF NEBRASKA PRESS • LINCOLN AND LONDON

 Source acknowledgments
for
previously published material
appear on p. xiv. ¶
©  by the
Board of Regents
of the
University of Nebraska
All rights reserved
Manufactured
in the
United States of America

¶ Library of Congress
Cataloging-in-Publication Data
¶ Mildorf, Jarmila.
¶ Storying domestic violence :
constructions and stereotypes of abuse
in the discourse of general practitioners
/ Jarmila Mildorf.
¶ p. ; cm. —
(Frontiers of narrative)
¶ Includes
bibliographical references
and index.
¶ >H7C-: ----
(cloth : alk. paper)
¶ >H7C-: ---
(cloth : alk. paper)
¶ . Family violence.
. Discourse analysis, Narrative.
. Narrative medicine.
. Physician and patient.
. Physicians (General practice)
I. Title. II. Series.
[9CAB: . Physician-Patient Relations.
. Domestic Violence.
. Narration.
. Truth Disclosure.
L  Bs ]
G6.B 
. 'dc—
¶ 
¶ Set in Quadraat
& Quadraat Sans by
Kim Essman.
Designed by R. W. Boeche.
For my parents and the best sisters in the world, Jana and Julia
Contents

Preface ix

Acknowledgments xiii

Transcription Conventions xv

. Introduction 

 . Narrative
Theoretical Background 

 . Domestic Violence and the Role of General Practice

A Narrative-Analytic Approach 
 . Signs of Abuse
“Classic” Disclosures and Narrative Trajectories 
. Setting the Scene of Abuse
Metaphors and Spatiotemporal Mapping 

. Mythologizing Time, Mythologizing Violence

Backgrounds and Explanations of Domestic Abuse 
. Agents of Their Own Victimization
The Women’s Role in the <Es’ Narratives 

. Evaluating Abuse
Storied Knowledge and Salient Facts 

. Conclusion 

Appendix 

Notes 
Bibliography 

Index 
Preface

Between one quarter and half of all women in the world experience domestic
violence at some point in their lives, according to World Bank figures (Bunch
1997:42). Local surveys and studies throughout the world confirm this find-
ing. Since domestic violence causes both acute physical injuries and long-term
chronic illness, abused women are likely to appeal to their family doctors or
general practitioners as one of their first resources for help. However, general
practitioners rarely report domestic violence in their practices. Why do doc-
tors not notice domestic violence, and why do women not disclose it to them?
What makes communication about domestic violence between doctor and pa-
tient so difficult? This study’s unique contribution to the problem of preva-
lence and oversight is its examination of doctors’ narrative practices around
treatment rather than the women’s stories of abuse, which have received more
attention in previous research. In addition, the study proposes solutions from
within the same narrative paradigm.
A few studies over the last years have focused on general practitioners’ atti-
tudes toward and perceptions of domestic violence and have also, albeit mostly
cursorily, taken into account stigmatizing discourses and stereotypical imag-
ery. By considering general practitioners’ narrative discourses about domestic
violence against the background of theories of narrative and knowledge and by
applying narrative-analytic tools, this study opens up new vistas for the appli-
cation of narrative research in this field. The book has emerged from two of my
main areas of interest: the relationship between language and social problems,
on the one hand, and the study of narrative, on the other. As a result, this work
seeks to answer two interrelated questions: first, to what extent and in what ways
are notions of “language,” “discourse,” and “narrative” relevant for the func-
tioning of social life and of people’s everyday social practices in general as well
as for the emergence and recurrence of social problems in particular? Second,
can linguistic analysis and the study of narrative forms in discourse contrib-
x Preface

ute to the understanding and solution of social problems? Narrative research

has gained currency in a number of disciplines over the last four decades, and
it has increasingly informed interdisciplinary approaches. This study demon-
strates how microlevel structural analyses of narratives can be linked to cog-
nitive and sociocultural dimensions or macrolevels of narratives and thus how
narrative analysis can be operationalized for the social sciences.
The data used for the analyses were generated in in-depth interviews with
twenty general practitioners in and around the city of Aberdeen, Scotland. Since
in my view domestic violence is a universal phenomenon the root problems of
which are not necessarily determined by local particularities, the study con-
stitutes a case study that should be useful for researchers and interested read-
ers anywhere in the world. Aberdeen is in many ways comparable to other cit-
ies. Situated in northeastern Scotland and home to a population of 212,125, it
is a cosmopolitan port of approximately 184 square kilometers that functions
as a major retail, leisure, cultural, and educational center in the country. Tra-
ditional industries such as fishing and farming still flourish in and around the
city, but its economy is mainly based on the oil industry, which has earned the
city a new epithet as the Oil Capital of Europe. Despite being northerly, Ab-
erdeen is not isolated, thanks to good road, rail, sea, and air communications
with other major cities and European countries. As throughout the United
Kingdom, general health care is provided on a governmental level through the
National Health Service (nhs), which is administered in Aberdeen by the re-
gional health authority, the Grampian nhs Board. The Grampian nhs Board
is responsible for, among other things, the health services in the Grampian re-
gion, covering primary and community care as well as hospital services, the al-
location of Scottish Executive funding, and health promotion.
Sociologists, anthropologists, folklorists, linguists, sociolinguists, discourse
analysts, narratologists, psychologists, and philosophers will find this interdis-
ciplinary study interesting for theoretical and methodological reasons. While
the notion that narrative encodes and conveys cultural values and attitudes
that constitute and shape experience and meaning will be old news for some
researchers, it is nonetheless desirable from an ethnographic point of view to
address rather more than less social problems and their speech situations with
sociolinguistic description. Because of its practical implications, the study is
also important for policy makers, patient advocates, and health care profession-
Preface xi

als working with domestic violence. And medical humanists and medical eth-
icists as well as physicians themselves will benefit from an awareness of their
own communication practices around an issue of great moral depth. The anal-
yses of the gps’ narratives inevitably involve linguistic detail and terminology,
but every effort has been made to keep the technical and methodological appa-
ratus at a minimum to facilitate access and enhance readability.
Acknowledgments

I owe a great debt of gratitude to the following people: first and foremost to
David Herman, without whose encouragement and trust this study would per-
haps not have been turned into a book. I would also like to thank Ladette Ran-
dolph and her team at the University of Nebraska Press for their professional
and rigorous work.
Furthermore, I owe great thanks to Barbara Fennell, who accompanied my
research from the beginning, and to Linda McKie and Karen O’Reilly for their
help and advice on research in the sociology of health and illness and domes-
tic violence.
I would also like to thank Anna de Fina, Alan Palmer, and the anonymous
reviewers of my manuscript for reading my work and for making invaluable
comments and suggestions. Needless to say, all remaining shortcomings are en-
tirely my fault. Thanks are also due to John Fowler for proofreading the book
and to my copyeditor, Mary M. Hill.
The research presented in this book could not have been conducted without
the financial assistance of the Faculty of Arts and Divinity and, during the ini-
tial phase of my project, the Department of General Practice & Primary Care
at the University of Aberdeen.
I must also thank the twenty doctors who kindly agreed to be interviewed
and thus made this project possible. I hope they will not view my work as un-
just criticism but as an attempt to show ways for improving the status of do-
mestic violence in the health care setting.
Furthermore, I wish to thank the Aberdeen Domestic Abuse Forum for let-
ting me participate while I conducted my research. I learned a lot about the var-
ious agencies in Aberdeen that do a tremendous job in working with battered
women, their children, and their violent partners.
Last but not least, I wish to express my thanks to my family and all my close
friends for believing in me.
xiv Acknowledgments

Earlier versions of parts of this book appeared in the form of journal arti-
cles, and I am grateful for permission to draw on the following:

Jarmila Mildorf, “Opening up a Can of Worms’: Physicians’ Nar-

rative Construction of Knowledge about Domestic Violence,”
Narrative Inquiry  . (). Copyright  by John Benjamins.
All rights reserved.
Jarmila Mildorf, “Narratives of Domestic Violence Cases: <Es De-
fining Their Professional Role,” in Peter L. Twohig and Vera Ka-
litzkus, eds., Making Sense of Health, Illness and Disease ().
Copyright  by Rodopi. All rights reserved.
Linda McKie, Barbara Fennell, and Jarmila Mildorf, “Time to Dis-
close, Timing Disclosure: <Es’ Discourses on Disclosing Domes-
tic Abuse in Primary Care,” Sociology of Health and Illness  .
(). Copyright  by Blackwell. All rights reserved.
Transcription Conventions
The transcription conventions used for this study are adopted, with slight mod-
ification, from Norrick (2000). The aim is to keep transcription symbols to a
minimum in order to enhance readability.

Right. Period indicates falling intonation in the preceding element.

What am I going to do
Question mark indicates question with or without rising intonation.
here?

Comma indicates a continuing intonation, drawing out the preceding

I had, er, a girl who
element.

^so nice Arrowhead pointing upward indicates stress on the following element.

A -em dash indicates that a speaker stopped speaking midword or

in —— [insight]
midsentence.

Say, “Well, you should Double quotation marks show speech set off by a shift in the speak-
leave him” er’s voice.

Curly braces on successive lines mark the beginning and end of over-
{}
lapping talk.

[laughs] Square brackets enclose editorial comments or elements whose tran-

drug [user] scription is not entirely certain.

A question mark within square brackets indicates that the recording

[?]
is unclear.

= Equals signs on successive lines indicate latching between turns.

... Ellipsis points indicate faltering speech.

— An em dash indicates a sudden break in speech.

Boldface type is used throughout extracts taken from the narratives to

Saturday night ritual highlight items discussed in the text. In the appendix the narratives are
marked by boldface type.
Storying Domestic Violence
1. Introduction

I’m sure there’s lots of individual factors that makes people stay with
people that abuse them. And it’s very difficult to tease them out.
Um, if I, I mean I would never ever ever advise anybody to stay in
that relationship. I just think that’s just daft. I remember the first
time I saw it, quite cl——. I can still vividly remember the first time
I came across a girl who’d been beaten by a guy and I was working
in casualty. She was just a young girl and he’d, I [was] just newly
qualified, and this guy had hit her. And I said, [?] he had the house
keys. Now then I said: “Could I have the house keys, please?” She
wanted her flat keys. [And I said she wanted to be ?] she just wanted
to be here at the moment. And he got really, really, quite aggressive
with me. And, fortunately there was police around and they got the
keys and everything off him and, er, sat him down and told him to
behave himself. I had a long chat with her, and she left with him.
You know, she went back to him. I said: “Look, he’s done that and
you’ve forgiven him for once, he’ll do it again to ya.” And you just,
I just wonder what happened, you know. But, you know, I thought,
you know, if you let him do it this once he’ll always think he can
get away with it again. And, she obviously, I don’t know, I don’t
know why she went back.
Young female gp from an Aberdeen city center practice

This story related by a young female gp working in a city center practice in Aber-
deen, Scotland, voices some of the frustration and helplessness of medical doc-
tors when faced with patients who suffer domestic abuse from their partners.1
In this emotional story the gp aligns herself with the patient and shows their
affinity in youth and inexperience. Both women in this story suffer from an
abusive man: the young woman who was beaten by her partner and the young
 Introduction

doctor who is verbally abused by the same man while trying to examine and
treat the woman. The story becomes vivid and more “dramatic” through the
use of direct speech, and it illustrates the young doctor’s pang of frustration
when the woman finally returns to her partner. The gp cannot understand why
the woman went back, thereby echoing the frequently asked question, Why do
battered women stay with the men who abuse them? Is that not “just daft,” as
the gp has it? This “unreasonable” behavior and the doctor’s helplessness seem
to be the lasting impressions that have become part of the gp’s “storied knowl-
edge” of domestic violence and that are reinforced in the storytelling situation
of the interview. We learn nothing about possible reasons for the woman’s de-
cision and about how doctors can deal with this empathetically rather than dis-
missively. If narratives like this reproduce what doctors “know” about domestic
violence, then what inferences can be made about doctors’ knowledge concern-
ing the problem? Furthermore, what do such stories tell us about domestic vi-
olence and medical practice? Like many of the other narratives in my corpus,
this narrative also shows the problem of the unfinished story for the doctor: “I
just wonder what happened.” The beginnings of stories seem to be endlessly re-
peated, but one rarely gets the end of the story: abuse prevented, patient “cured.”
Do doctors simply not narrate, or do they also not see and intervene?
I began this book with one of the stories from the corpus for my study be-
cause it is the story of a novice’s encounter with domestic violence, just as the
reader at this stage is a novice to the materials I present. This is one of thirty-
six narratives that emerged during interviews I conducted with general practi-
tioners in the city of Aberdeen about their experiences with domestic violence
cases. In many ways the story is typical of most of the narratives in the sample
and gives a flavor of what this book is all about: it presents general practitio-
ners’ responses to domestic violence from a primarily narrative-analytic point
of view; that is, it seeks to combine the investigation into a social issue with a
detailed linguistic analysis of interview narratives. More precisely, this study

. analyzes the discursive and narrative strategies general practi-

tioners apply in interviews when they talk about their experiences
with victims of domestic violence in their practice work;
 . states what these strategies reveal about <Es’ perceptions of and
attitudes toward domestic violence as well as about the way they
Introduction 

linguistically (re)construct knowledge and realities of domestic

violence in their narratives;
 . demonstrates what this indicates with regard to the construc-
tion of medical knowledge in general practice;
 . identifies the problems the <Es’ discursive practices might reveal
and, at the same time, engender for their daily work;
. offers solutions from within the narrative framework as part of
a larger endeavor to encourage cross-disciplinary collaboration.

Let me clarify these points by providing an outline of my book and by antici-

pating some of the central questions and answers.
Powerful discourses on a great number of topics pervade society and influ-
ence directly or indirectly, consciously or unconsciously, people’s views and
perceptions and thus also their sense of the world that surrounds them. As the-
orists such as Bourdieu (1991) maintain, language is at the heart of modern civi-
lization, and meaning is always negotiated in people’s interactions, which func-
tion largely on the basis of communication. One assumption is that discourse
not only depicts reality but in fact also reproduces it by setting up parameters
and conceptual frameworks according to which people judge and perceive other
people and their actions as well as their own experiences (Fairclough 1992; van
Dijk 1997). In this sense discourse is constitutive and constructive, and it be-
comes a potent commodity by which knowledge is produced and maintained
and social power is seized (Foucault 1981). Likewise, narrative cannot only be
regarded as a discourse mode; it is also a cognitive device that helps us order our
life experiences and make sense of the world (Herman 2002). On a wider soci-
etal level stories contain the common knowledge a group of people share, and
narratives thus become the storage space as well as the vehicle for transmitting
cultural knowledge and wisdom (Celi and Boiero 2002). It is not least for this
reason that narrative analysis has an important place in a number of current so-
cial sciences and other research areas, including artificial intelligence, cognitive
and social psychology, linguistics, medical philosophy, and sociology.
As I demonstrate in chapter 2, narrative analysis in sociolinguistics has in
the past contributed to the investigation of social problems and has tried to put
forward possible solutions, for example, in the area of emergency calls (Imbens-
Bailey and McCabe 2000) and the study of people’s perceptions of the German
 Introduction

reunification (Dittmar and Bredel 1999). However, what moves the analysis pre-
sented here beyond traditional discourse-analytic approaches such as Critical
Discourse Analysis (cda), for example, is the cognitive dimension in the inves-
tigation of narrative data. Drawing upon Herman’s (1999b) concept of “socio-
narratology,” with its emphasis on linguistic, contextual, and cognitive factors
in narrative production, I analyze the gps’ narratives not only with regard to
their linguistic form and the situational context in which they were produced
but also with a view to identifying the cognitive processes that might under-
lie and inform these narratives. The assumption that a link can be established
between gps’ knowledge of domestic violence and the way they relate case sto-
ries mainly draws upon the theoretical background of Bruner’s (1986), Sarbin’s
(1986), and Schank’s (1990) work on narrative thinking and narrative knowl-
edge, which I discuss in chapter 2. The questions raised for my study are, How
can one establish a link between macrolevel and microlevel structures or, in
this specific context, between gps’ narrative discourses and the cognitive pro-
cesses by which they conceptualize and understand domestic violence? What
do the narratives reveal about doctors’ knowledge of the problem? From a so-
ciolinguistic standpoint the aim of this study is to emphasize the social side of
the discipline by applying discourse-analytic techniques to a social problem
with real-life implications. By emphasizing narrative in this study I test the ap-
plicability of narrative tools to a social problem and thus not only provide fur-
ther insights in the area of narrative research but point toward solutions to the
problem from within the narrative framework.
As I argue throughout the book, narrative stands out as a special discursive
device because it attends to particularities and detail in people’s experiences.
It offers a special way of ordering events and experiences in a person’s memory
and also of recounting them to other people. Narrative forms the basis for the
way people make sense of and give meaning to their lives by imposing ordered
narrative structures on what would otherwise be perceived as chaotic life ex-
periences. By indexing and storing narratives in their memories, people also
compile what Polkinghorne (1995) calls “storied knowledge” about other peo-
ple, events, experiences, and so on. This storied knowledge can be retrieved at
any time when the situation requires such specific information. Narrative is also
a successful and popular discursive device, I argue, because it is engaging and
often entertaining, which makes it ideal for negotiating and exchanging ideas,
Introduction 

life experiences, values, attitudes, and feelings. If we consider the way the news
media, for example, employ narrative structures, it becomes obvious that one
big advantage narrative has over other discursive devices is the fact that it can
be captivating and that it is more suitable for the expression of affective mean-
ing, for example. Narrative also offers us an indirect and therefore less threat-
ening way of conveying our opinions and values. In a sense, narrators can “hide
behind” the story they tell, and thus narratives are less confrontational than
other forms of discourse. If we accept the premise that narrative constitutes
as well as (re-)creates knowledge and the reality people perceive, then the gps’
narratives about their experiences with patients who suffer domestic violence
also reveal their perceptions of the issue and, at the same time, reinforce a cer-
tain “reality” of domestic violence cases in their minds. In chapter 2 I also dis-
cuss to what extent doctors draw upon narrative knowledge constituted by sto-
ries about patients and cases.
It is not surprising then that almost all the gps I interviewed related narra-
tives at least once during the interview. Some gps repeatedly resumed the same
narrative, while others told me more than one. Some of the narratives can be re-
garded as fully fledged narratives in the Labovian sense (i.e., they follow largely
the diamond diagram of narratives, which I outline in chapter 3), while others
appear abbreviated or are not fully expanded upon. This may be attributed to
the restrictions imposed by the interview format. Equally important in this con-
text are questions of politeness (Brown and Levinson 1987) as well as the Gricean
maxims of relevance and brevity, which I explain in more detail in chapter 3. Ul-
timately, any dialogue must be regarded as “talk-in-interaction,” during which
participants collaborate to have a successful conversation. Likewise, oral nar-
ratives are always coconstructions between storyteller and listener or narrator
and narratee, respectively, another guiding assumption in my study.
Since narratives are never related in a vacuum but are always situated in a spe-
cial linguistic and interactional context and are told to other people for a spe-
cific purpose (Schiffrin 1993; Schegloff 1997; Imbens-Bailey and McCabe 2000;
Norrick 2000), the analysis of narratives requires a theoretical framework that
incorporates the notion of complex layers of interaction. In the frame model
that I propose in chapter 3 the interactional character of a joint narrative pro-
duction within the interview frame is captured by embedded frames of expec-
tations and of rules for interaction. The two frames considered in the actual
 Introduction

analyses of the gps’ narratives are the narrative frame and the interview frame.
The narrative frame imposes rules and expectations concerning the structural
and thematic elaboration of narratives and the roles of narrator and narratee
in narrative production. The interview frame is equally important in this con-
text, as it also sets up behavioral rules for the interaction between interviewer
and interviewee. In my analyses I take account of these influential factors by
paying close attention to features typical of talk-in-interaction. Thus I discuss
hesitation markers, defensive answers, self-criticism, politeness features, phatic
features, and high-involvement style. As the analyses reveal, the gps were aware
of the interview situation and therefore accommodated their speech in order
to maintain face as well as to allow myself as the interviewer to maintain face
(Goffman 1967; Giles and Smith 1979). Some gps chose their words with care, as
could be seen in a number of self-monitoring devices. In sum, the influence of
the mechanisms of interpersonal perception (Laing, Phillipson, and Lee 1966)
and various expectations based on differences in gender, age, and status could
sometimes be felt and observed in the gps’ discourses. After all, I was not a col-
league whose moral trajectory could be assumed and a woman whose feminist
agenda might be hidden. All this is explained more fully, for example, in chap-
ters 7 and 9. In one narrative that I discuss in chapter 9 silence also in a way en-
acts on a discursive level a strategy often adopted in society: to collude with the
victims’ silence rather than to challenge abuse. The question of taboos and of
“unspeakable” stories is thus another crucial point in my book.
As I discuss in chapter 4, one of the problems emerging from the gps’ nar-
ratives is that of divergent narrative trajectories in doctors’ and patients’ sto-
ries. A lot of the narratives in my sample are “incomplete” in that they either
leave out the women’s stories (e.g., what their personal backgrounds were, how
they experienced the violence, etc.) or lack closure in the sense that either vio-
lence is prevented or treatment proves successful. I discuss this finding some-
what flippantly by contending that what is missing in the gps’ narratives is “hero
stories.” Perhaps we cannot expect medical doctors to find “cures” for domes-
tic violence. We can, however, expect them to be receptive enough to keep the
gates to salient help resources open. For this purpose it is essential that medi-
cal narratives, with their mostly linear trajectory of presentation–diagnosis–
treatment–cure, converge more strongly with battered women’s life narratives,
which may not follow the same pattern. In chapter 3 I present statistical stud-
Introduction 

ies that reveal that gps frequently miss cases partly because they lack the nec-
essary sensitivity to hidden signs of abuse. In addition, feminist researchers
have focused on ideological issues surrounding the perpetuation of male-de-
fined cultural myths and stigmatizing discourses. While all these studies offer
great insights, there has hitherto been no research that illuminated the micro-
level linguistic mechanisms by which doctors (re-)create discourses and con-
cepts on domestic violence. Through its primarily linguistic focus and detailed
narrative analyses this study therefore closes a gap in this particular research
area. I argue that one way of working toward improvement in the disclosure
and subsequent treatment of domestic violence cases is by erasing the mismatch
between doctors’ and patients’ expectations, views, and attitudes, which man-
ifest themselves in their divergent narratives and narrative practices. This pro-
cess needs to commence in people’s minds.
I already indicated that my study is an interdisciplinary endeavor and as such
draws upon insights and research from a number of disciplines as varied as so-
ciolinguistics and discourse studies, sociology, social and cognitive psychology,
narratology, and philosophy. Since the narrative paradigm is the overarching
framework that holds together my various approaches and analyses, I begin by
providing a theoretical discussion of the significance of narrative in people’s
lives and its treatment in various disciplines in chapter 2. In the third chapter
I provide further background information to my study by surveying the litera-
ture on domestic violence in the health care setting. This allows me to highlight
some of the complexities in doctor-patient interaction surrounding domestic
violence that have already been identified in the literature and also to demon-
strate in what ways the narrative-analytic approach I adopt here can enhance
our understanding of these complexities. In chapter 4 I introduce data from my
sample that function as “normalizing data” to the actual narratives I analyze
in subsequent chapters. These largely nonnarrative data from the interviews
provide kinds of information that are missing from much of the narrative ma-
terial, for example, with regard to signs of abuse and “typical” scenarios. I dis-
cuss this discrepancy by looking at the concept of narrative trajectories, which
has played a major role in life narrative research. After this fairly general ap-
proach to my data I then undertake close linguistic analyses of the gps’ narra-
tives by investigating four major areas: spatiotemporal mapping and metaphors
in chapter 5; the mythologizing of time in general practice and of backgrounds
 Introduction

and explanations of abuse in chapter 6; agency and the role of social as well as
professional actors from the perspective of both the woman and the doctor in
chapter 7; and, finally, the gps’ evaluation of both the severity and significance
of domestic violence cases in chapter 8. In narratological terms I move from a
discussion of circumstantial narrative matters, or the “setting,” to a presenta-
tion of the narratives’ “characters” and then to the narrator’s “point of view.”
Detailed analyses of linguistic features such as spatiotemporal language, met-
aphors, modalities, thematic roles, and active/passive constructions as well as
evaluative devices are the tools for unraveling the mechanisms that set up gps’
conceptual explanatory frameworks about domestic violence. The conclusion
in chapter 9 pulls together these various strings and demonstrates in a summary
to what extent the diverse approaches of the previous chapters yield overlap-
ping results. I show how the gps reveal their perceptions of and attitudes toward
domestic violence in their narratives and to what extent these might be prob-
lematic. More important, however, as this study uniquely illuminates these is-
sues as a wider problem of narrative practices, I will then point in the direction
of possible solutions that narrative analysis has to offer for medical training.
Since the value of narrative discourse for both practitioner and care recipient
is increasingly acknowledged in the medical setting, a good case can be made
for the type of narrative-analytic “take” I propose here.
Before I move on to the discussion of the theoretical background to this
study I need to clarify some of the terms that will be used throughout and that
also imply my own position. No research takes place in a vacuum, and the in-
terpretation of data is always influenced by the particular cultural, sociohistor-
ical, and political lens through which the researcher views the data. I refer to
battered women as “victims” in acknowledgment of the fact that domestic vi-
olence is overwhelmingly perpetrated by men on women and because I believe
that domestic violence, whatever its individual reasons and circumstances, is
ultimately also a result of a wider imbalance of power and inequality between
men and women and of still latent misogynist attitudes in society. I am aware
that the term has also been contested by feminist researchers, as it potentially
frames abused women as helpless and passive (Lamb 1999). This is not the way I
want to use it here. “Cultural myths” about domestic violence refer to a number
of preconceived ideas about the problem that I discuss in greater detail in chap-
ter 3. The underlying assumption is that “knowledge” of domestic violence is
Introduction 

also constructed in and through the discourses of individuals, advocates, insti-

tutions, the media, and so on. Hence I use the term discourse in Foucault’s (1981,
1982) sense as an intersection where knowledge is produced and maintained and
thus becomes a site for constant power struggles. This “macrostructural” level
of ideas and conceptions of domestic violence is interrelated with the “micro-
structural” level of actual discussions and discursive practices.
Finally, I do not consider “stereotypes” a priori as distortions of reality, that
is, as negative, as is often the case in common parlance and in some of the so-
cial psychology literature on the issue. On the contrary, I follow McGarty, Yzer-
byt, and Spears (2002) in assuming that stereotypes are sets of “relations be-
tween knowledge, labels and perceived equivalences” (McGarty 2002:18) whose
primary function is to provide explanatory systems and to form meaningful
beliefs about social groups. Stereotype formation is a context-dependent dy-
namic process that allows groups to develop tools “both to represent their mem-
bers’ shared social reality and to achieve particular objectives within it” (Haslam
et al. 2002:161, emphasis in original). As my discussion of the gps’ narratives
demonstrates, a problem arises when stereotypes of victims and perpetrators
of domestic abuse are oversimplified and lead to one-sided pictures of the prob-
lem. Let me now provide an overview of narrative research traditions and the
theoretical framework to my study.
2. Narrative
Theoretical Background

There is no knowing without theory, that is, a set of assumptions and categories
that can be tested and then reformulated or modified through further theoriz-
ing. As the literary critic Terry Eagleton puts it: “All of our descriptive statements
move within an often invisible network of value-categories, and indeed without
such categories we would have nothing to say to each other at all” (1996:12). In
order to clarify how I arrived at my results I need to say first what questions and
assumptions concerning narrative guided my research. I will accomplish this
in this chapter, in which I first consider the relationship between narrative and
social problems, then narrative as an intrinsic human feature and activity, and
finally narrative as a special discursive element in the medical setting.

Narrative and Social Problems

Stories have formed part of any culture known to us. Anthropologists point out
that for hundreds of years stories have ensured the survival and passing down
of knowledge and beliefs (Celi and Boiero 2002; Kirmayer 2000). As Celi and
Boiero contend in their study on Native American narratives, stories are a ve-
hicle for conveying knowledge:

Poetic storytelling presents to our imagination something that

resembles the human actions with which we are directly acquaint-
ed through experience. Stories are composed of the knowledge peo-
ple share and this shared knowledge serves as a vital base that has
the potential to help them discover meaning in other contexts. . . .
Stories do more than delight us and give us pleasure; they certain-
ly instruct in a manner that is comparable to the instruction we
receive from works of science, philosophy, theology, history and
biography. (2002:61)
Narrative 

In a similar vein Herman defines narrative not only as a discourse genre but also
as a “cognitive style,” and he contends that “stories both have a logic and are a
logic in their own right” (2002:22); that is, narratives not only are structured
in specific ways in order to be understood but also constitute a “logic by virtue
of which people (including writers) know when, how, and why to use stories to
enable themselves and others to find their way in the world” (2002:24). Put dif-
ferently, stories serve concrete functions (e.g., to make or illustrate a point, to
convey a moral, etc.), and we generally know when to use such stories.
The notion that language plays an essential role in social life and therefore in
the social sciences has had a long tradition in linguistics. An early example are
Edward Sapir’s influential ideas about language and environment, which were
further elaborated by Sapir’s student, Benjamin Lee Whorf, and which have be-
come known in linguistics as the Sapir-Whorf hypothesis. The main argument
is that the language one uses and that is the expression of one’s culture essen-
tially shapes one’s view of the world.1 Although Sapir recognized the importance
of the study of language for a better understanding of social reality as early as
the late 1920s, it was not until the 1960s that the relationship among language,
social structures, and social problems started to be systematically investigated
and thus gave rise to a “new” branch of linguistics, namely, sociolinguistics. Ever
since, the application of linguistic expertise has not only provided deeper in-
sights into social problems but often assisted in solving these problems.2 In the
1980s linguists’ interest in the relationship between language and social prob-
lems reached a first peak. For example, in 1988 the journal Social Problems ded-
icated a special issue to the relationship among language, interaction, and so-
cial problems. The editor and one of the authors in this special issue, Maynard
(1988), emphasizes that a language-oriented social science that pays special at-
tention to the organization of the interaction order can matter significantly to
scholars’ understanding of social problems and the sociology of deviance. In
other words, the analysis of people’s linguistic interactions can contribute to
the understanding of wider social issues, since linguistic interactions are at the
heart of these issues.3 The argument is that social structures manifest them-
selves in the sequential organization of linguistic interaction to the extent that
interactants display their awareness of and sensitivity to the situational con-
text in which the interaction takes place and, accordingly, accommodate their
speech (Wilson 1991:37). As a consequence, language not only offers tools for
 Narrative

forming different types of interaction (e.g., storytelling) but is equally shaped

by already existing preconceptions and expectations to which speakers orien-
tate themselves. It is in this sense that narrative interaction reinforces and, at
the same time, reconstructs social structures.
A research area where the sequential analysis of talk has been applied and
has foregrounded problems is the analysis of emergency calls (Whalen, Zim-
merman, and Whalen 1988). Imbens-Bailey and McCabe (2000) approach the
problem by applying sociolinguistic narrative analysis. They argue that calls to
the emergency department “share key components with the typical narrative
genre” (Imbens-Bailey and McCabe 2000:289), for example, orientation infor-
mation and complicating actions that relate the nature of the emergency.4 How-
ever, the discrepancy between narrative form and the requirements imposed
on emergency calls may lead to communication problems and subsequent lack
of salient help provision: “The descriptions of events in an emergency call are
constrained by their dual functions of maximizing the speedy transfer of vi-
tal information while minimizing the inclusion of superfluous detail. It is this
trade off between concerns such as efficiency and the urge to narrate human
experience that may contribute to an inherent communicative tension in plac-
ing a 911 call” (Imbens-Bailey and McCabe 2000:289). Clearly, Imbens-Bailey
and McCabe consider narrative a fundamental device in human communica-
tion that is used daily by speakers to convey their meaning to others. Narrative
is more than a discursive device, however. In fact, it can be argued that narra-
tive pervades human thinking and thus resembles other acts of comprehension,
as Robinson and Hawpe contend: “Stories are a means for interpreting or rein-
terpreting events by constructing a causal pattern which integrates that which
is known about an event as well as that which is conjectural but relevant to an
interpretation” (1986:112).
Research conducted in Germany offers a poignant example of the way nar-
rative interaction and the construction of social structures are related. Dittmar
and Bredel (1999) analyzed in their study of East and West Berliners’ narratives
about the fall of the Berlin wall on November 9, 1989, how the historical events
of that night had been perceived and also related differently by people from the
eastern and western parts of the city. Moreover, Dittmar and Bredel showed to
what extent the narratives (re)constructed images and stereotypes of “Ossis”
and “Wessis” (i.e., East Germans and West Germans), which even ten years af-
Narrative 

ter reunification created a distance between easterners and westerners and thus
impeded a successful integration of the two former Germanys. This example
demonstrates in what ways linguistic narrative research not only helps unravel
social problems but also offers possible solutions. By compiling their data in a
narrative corpus that is also available on the internet, Dittmar and Bredel set
up a “collective memory” that could be used for discussions in the classroom,
for example, and ideally raise awareness about people’s perceptions and the dis-
cursive strategies by which they convey their perceptions.
Labov and Waletzky’s (1967) groundbreaking article “Narrative Analysis:
Oral Versions of Personal Experience” is probably the most significant exam-
ple of the growing interest in narrative structure in the 1960s. This article has
been very influential and initiated a whole subdiscipline within the area of soci-
olinguistics, the extent of which is captured in the special issue of the Journal of
Narrative and Life History published in 1997 (Bamberg 1997), in which eminent
scholars from various disciplines reflect on thirty years of narrative analysis.
Although this collection gives the impression that the study of narratives has fi-
nally become an interdisciplinary endeavor, there was relatively little cross-fer-
tilization between disciplines until almost two decades after Labov and Waletz-
ky’s article. In the eighties the need for a “contextualist narratology” (Tolliver
1997) was felt and expressed by narratologists and linguists alike (Lanser 1981;
Farrell 1985), and attempts were made to systematically integrate linguistic and
literary approaches to narrative (Fludernik 1996; Kanyó 1986; Toolan 2001).
The second theoretical pillar of my study, Herman’s (1999b) concept of “so-
cionarratology,” has emerged from traditional narratology, which was influ-
enced by French structuralism and set in motion as a more systematic disci-
pline after the appearance of the English translation of Vladimir Propp’s (1968)
morphological study of fairy tales.5 Herman’s innovative, integrated approach
offers a conceptual model that “situates stories in a constellation of linguis-
tic, cognitive, and contextual factors” (1999b:219). In his analysis of oral ghost
stories Herman includes notions and methods from classical narratology, con-
versation analysis, and interactional sociolinguistics to illuminate the context
in which the stories were told. The underlying assumption is that narrative-
ness, or “narrativehood,” as Herman puts it, requires more than specific struc-
tural properties: “What makes a story a story cannot be ascribed to narrative
form alone, but rather arises from the interplay between the semantic content
 Narrative

of the narrative; the formal features of the discourse through which such nar-
rated content manifests itself; and the kinds of inferences promoted via this in-
terplay of form and content in particular discourse contexts” (1999b:229). In
a vacuum narratives, like language in general, do not really “mean” anything.
Narratives must be told to someone for a purpose. By taking into account the
functional and contextual dimensions Herman adds more depth to his con-
cept, and it thus proves a good working model for the kinds of narratives I an-
alyze in this study.

Homo narrans; or, Why Do We Tell Stories?

The subtitle of a special feature in the Journal of Communications 35.4, “Homo
Narrans: Story-Telling in Mass Culture and Everyday Life,” suggests that story-
telling is an intrinsically human characteristic, much as language as such seems
to be a biological faculty most highly developed in the human species (Chom-
sky 1988; Pinker 1994, 1997). Rhetorician Walter Fisher borrows the term Homo
narrans from Plato and uses it in his description of the “narrative paradigm,”
which “can be considered a dialectical synthesis of two traditional strands in
the history of rhetoric: the argumentative, persuasive theme and the literary,
aesthetic theme” (1984:2). In Fisher’s view the narrative paradigm competes
nowadays with the scientific paradigm and thus with a discourse of technical
reasoning. The great contest for the logos, that is, the competition between the
narrative and the scientific paradigm as to which one will dominate public dis-
course, has “contributed to the contemporary condition by repressing the re-
alization of a holistic sense of self, by subverting the formulation of a humane
concept of rationality and a sane praxis, by rendering personal and public deci-
sion making and action subservient to ‘experts’ in knowledge, truth, and reality,
and by elevating one class of persons and their discourse over others” (Fisher
1985:87). Fisher proposes the narrative paradigm as a model that reunites the
different components of discourse in the conceptualization of human beings
as storytellers. The narrative paradigm also becomes a theoretical framework
for the analysis of how people create social realities. Fisher contrasts the con-
cept of storytelling as an intrinsic human characteristic with dramatism as it
is proposed in Goffman’s (1974) frame theory, for example:

Dramatism implies a prescribed role for people; they are actors per-
forming roles constrained or determined by scripts provided by ex-
Narrative 

isting institutions. The narrative paradigm sees people as storytell-

ers—authors and co-authors who creatively read and evaluate the
texts of life and literature. It envisions existing institutions as pro-
viding “plots” that are always in the process of re-creation rather
than as scripts; it stresses that people are full participants in the
making of messages, whether they are agents (authors) or audience
members (co-authors). (1985:86)

I argue that dramatism and the narrative paradigm need not necessarily ex-
clude each other. On the contrary, these two concepts seem to have the poten-
tial to act as complementary theorems in an interactional narrative theory that
views narrative production as a joint project undertaken by speakers in a set-
ting that is influenced equally by social and institutional rules. This approach
can prove particularly useful in studies such as the one presented here, in which
informants are not only individuals but also representatives of a specific pro-
fessional and therefore institutional group, in this case medical doctors. The
question of narrative discourse in this wider social context thus also assumes
sociopolitical dimensions, as it has implications for current medical practice
and for medical training.
As I mentioned above, the notion of Homo narrans presupposes storytelling
as an innate human characteristic. Research on narratives by aphasics indeed
seems to suggest that sentence-level surface devices, which are located along
with other language features in certain parts of the brain, have an important
function in the creation of hierarchical and evaluative structures in narratives
(Ulatowska and Streit Olness 1997). However, whether this mainly biological
explanation gives a complete picture or whether other factors such as culture
and the socialization process also have parts to play in narrative production re-
mains debatable and calls for more extensive research in this field. At any rate,
there can be no doubt that telling stories forms an essential part of human in-
teraction. Whether children tell their parents stories about what they have ex-
perienced, or parents couch lessons about what is right or wrong in the form
of fairy tales and other narratives, or we tell our friends, roommates, or part-
ners in the evening about what has happened to us during the day, or we throw
in personal stories while we discuss topics with other people, narratives play a
significant role in our everyday lives and form an elementary basis of our daily
conversations with others.
 Narrative

Sarbin identifies narrative as a root metaphor for psychology and consid-

ers the narratory principle, that is, the fact that “human beings think, perceive,
imagine, and make moral choices according to narrative structures” (1986:8),
an organizing principle in human thought essential for survival in modern so-
ciety: “The rituals of daily life are organized to tell stories. The pageantry of
rites of passage and rites of intensification are storied actions. Our plannings,
our rememberings, even our loving and hating, are guided by narrative plots.
The claim that the narratory principle facilitates survival must be taken seri-
ously. Survival in a world of meanings is problematic without the talent to make
up and to interpret stories about interweaving lives” (1986:11). Put differently,
personal narratives, with their fairly conventional spatiotemporal structures,
help us order our otherwise chaotic experiences of life as constant flux and pass-
ing. The argument that narratives facilitate orientation in a bureaucratic world
sounds perfectly plausible if we consider language a symbolic system within
which values are negotiated. Or, to adopt Bourdieu’s metaphoric image of the
marketplace, “linguistic exchange . . . is also an economic exchange which is
established within a particular symbolic relation of power between a producer,
endowed with a certain linguistic capital, and a consumer (or a market), and
which is capable of procuring a certain material or symbolic profit” (1991:66).
The “profit” that discourse can yield manifests itself, for example, in power and
authority. Narrative as one of many discursive devices consequently also partic-
ipates in the symbolic marketplace, and we can infer that people who success-
fully employ the narrative mode to convey their meanings and to achieve their
goals have a better standing in our linguistically encoded society.
The political and institutional power of discourse has been explored, for ex-
ample, by researchers in Critical Discourse Analysis (Titscher et al. 2000). As Fair-
clough points out, “power in discourse is to do with powerful participants con-
trolling and constraining the contributions of non-powerful participants” (1989:46,
emphasis in original). Discourse influences people’s perceptions of other peo-
ple, and it thus becomes a potent tool in establishing power relations: “Hav-
ing the power to determine things like which word meanings or which linguis-
tic and communicative norms are legitimate or ‘correct’ or ‘appropriate’ is an
important aspect of social and ideological power, and therefore a focus of ide-
ological struggle” (Fairclough 1989:88–89).6 Political, legal, educational, and
other institutions in any given society are thus in a powerful position, as they
Narrative 

determine to a large extent which discourses are acceptable and made avail-
able to people. As far as the medical setting is concerned, it is overwhelmingly
the case that doctors’ discourse is more powerful than patients’ discourse, par-
ticularly in a society in which professional expertise is highly valued. If we ac-
cept the premise that gps’ discourse ultimately has an impact on the way they
work, then a close analysis of their discourse is imperative for understanding
dynamic processes in general practice.
A lot of medical doctors’ work can also be viewed in terms of a “ritual,” in
Sarbin’s sense, by means of which patients and doctors try to establish the cause
of the problem presented in the consultation. The way gps often explain proce-
dures while they perform an examination can also take a narrative form, espe-
cially if the gp has to translate technical terms into the language of the layper-
son. For patients, storytelling can even become a means of reclaiming power
in doctor-patient communication, as Ainsworth-Vaughn argues, and stories
play a crucial role in diagnosis: “Patients use the ‘Why I’m here’ narrative to
set the scene for diagnoses; they suggest candidate diagnoses (diagnostic sto-
ryworlds), they offer evidence for and against possible diagnostic storyworlds,
and they may even challenge physicians’ conclusions as to the correct diagnos-
tic storyworld” (1998:169). Strong (1979) talks about the “ceremonial order” in
consultations, that is, a medical frame in which both doctor and patient act out
their expected roles and try to reach a satisfying and agreeable conclusion to
their conversation. However, communication between doctor and patient and
subsequent provision of salient help can be impeded if doctors’ and patients’
narratives do not match: “While, to some extent, differences in narrative are
inevitable between the clinician (a well person) and the patient (inhabiting ill-
ness), problems arise when clinicians use their disease-category narratives to
dominate patients’ illness narratives to such an extent that the patients’ [nar-
ratives] are obliterated, leaving them demoralised, and sometimes, misdiag-
nosed” (Donald 1998:23–24). It is to such mismatches in doctors’ and patients’
narratives that I will turn in my analyses.
Moreover, narratives seem to hold an important place in people’s assertions
of who they are, what they do, and why they do it, in short, their identity. Lin-
guists, sociologists, and psychologists alike have repeatedly emphasized the
role that narrative construction plays in establishing identity (Johnstone 1990;
Schiffrin 1996; Antaki and Widdicombe 1998; Crossley 2000; De Fina, Schiffrin,
 Narrative

and Bamberg 2006). Furthermore, stories are essentially performative and are
often used strategically in order to establish group identity and to reinforce or
challenge the status quo of a group’s values and beliefs, as Langellier and Peter-
son (2004) demonstrate in their study on family storytelling in Franco-Ameri-
can families. On an individual level we can argue with Schank that “we are the
stories we like to tell” (1990:137), and we gradually become the stories that we
like to tell often. Stories in that sense also constitute an important factor for
self-understanding: “We tell stories to describe ourselves not only so others can
understand who we are but also so we can understand ourselves. Telling our
stories allows us to compile our personal mythology, and the collection of sto-
ries we have compiled is to some extent who we are, what we have to say about
the world, and tells the world the state of our mental health” (Schank 1990:44).
People often attempt to live up to the “personal mythology” they have created
about themselves (or in fact that others have created about them). Narrative
psychology offers further poignant examples for the validity of Schank’s con-
tention, since in this line of therapy patients are encouraged to overcome their
problems by gradually revising their self-narratives.
To come back to the argument put forth at the beginning of this chapter, we
can even consider storytelling part of human knowledge, as Bruner (1986) ar-
gues in his book Actual Minds, Possible Worlds. If one takes into account the
etymology of the word “narrate,” which is cognate with the older Latin word
for “knowing,” gnarus (Rigney 1992), the connection between narration, truth,
and knowledge seems to be one that ancient philosophers partly recognized but
that gradually faded when narrative came to be viewed as part of the fictional
and fantastic realm (Fisher 1985). Bruner distinguishes between two modes of
cognitive functioning that provide distinctive ways of ordering experience and,
moreover, of constructing reality.7 On the one hand, there is what Bruner calls
the “paradigmatic” or “logico-scientific” mode, which “attempts to fulfill the
ideal of a formal, mathematical system of description and explanation. It em-
ploys categorization or conceptualization and the operations by which cate-
gories are established, instantiated, idealized, and related one to the other to
form a system” (1986:12). On the other hand, there is the “narrative” mode, or
“storied knowledge,” as Polkinghorne (1995) relabeled this form of cognition.
In contrast to paradigmatic cognition, narrative cognition focuses on the par-
ticular characteristics of actions and picks out a specific episode rather than
Narrative 

trying to establish a general type. It takes into account the diversity of human
behavior and “attends to the temporal context and complex interaction of the
elements that make each situation remarkable” (Polkinghorne 1995:11). This
narrative knowledge is maintained in stories. In exchanging narratives with
other people, in our “transactions,” to use another of Bruner’s terms, we nego-
tiate and constitute our knowledge and thereby create social realities. Accord-
ing to Bruner,

meaning is what we can agree upon or at least accept as a working

basis for seeking agreement about the concept at hand. If one is argu-
ing about social “realities” like democracy or equity or even gross
national product, the reality is not the thing, not in the head, but in
the act of arguing and negotiating about the meaning of such con-
cepts. Social realities are not bricks that we trip over or bruise our-
selves on when we kick at them, but the meanings that we achieve
by the sharing of human cognitions. (1986:122)

Knowledge is consequently only perceptible when people talk with others about
what they know, or, as Bruner puts it, “psychological reality is revealed when a
distinction made in one domain—language, modes of organizing human knowl-
edge, whatever—can be shown to have a base in the psychological processes that
people use in negotiating their transactions with the world” (1986:92). Since
language is the main vehicle for conveying ideas and thoughts, discourse lin-
guistics and, more specifically, narrative analysis prove to be valuable tools for
methodically unraveling the underlying principles in forms of talk, and they
are therefore useful disciplines for coming to terms with cognitive processes
preceding and accompanying talk-in-interaction.
I should add the caveat here that establishing a link between conversation
and cognition is not unproblematic and that it has been contested by, for exam-
ple, discursive psychologists, who argue that all we can observe in conversations
is what people do by using certain discursive strategies and what they achieve
by doing this in the given context (te Molder and Potter 2005). I believe, how-
ever, that linguistic interaction always also involves mental functioning in the
sense that interlocutors try to intuit what the other person is thinking, aiming
at, suggesting, and so on and that this is also true of interactions between in-
formants and researchers. As Sanders points out, “our ‘observations’ of what
 Narrative

has occurred actually are interpretations of the discourse objects in question,

as well as interpretations of relevant specifics in their environment (including
the specification of what makes such specifics ‘relevant’)” (2005:59). In other
words, what linguists and social scientists unravel by means of discourse or
narrative analysis always also reflects their own interpretations of their infor-
mants’ linguistic behavior and thus not only the informants’ but also their own
cognitive functioning in the research process. For this reason I consider it per-
fectly legitimate to attempt to arrive at an understanding of underlying cogni-
tive aspects, especially if they can be tied to wider cultural considerations. In
this study, for example, a close analysis of logical connectors, metaphors, mo-
dalities, and spatiotemporal mapping as well as of character presentation and
evaluation in the doctors’ narratives reveals both the way these gps negotiate
their views and knowledge of domestic violence with the interviewer and, ulti-
mately, their knowledge as such. As my analyses will demonstrate, this knowl-
edge itself is embedded in cultural assumptions concerning domestic violence
that are not only reflected by but also reproduced in the gps’ narratives.
Psychologists as well as researchers in artificial intelligence have attempted
to establish the relationship between storytelling and knowledge. In the late
1970s Schank and Abelson (1977) presented knowledge in terms of the “concep-
tual dependency theory,” a theory based on notions of the interplay amongst
scripts, plans, goals, and understanding. “Script” is a crucial concept in this the-
ory. It is “a structure that describes appropriate sequences of events in a partic-
ular context. A script is made up of slots and requirements about what can fill
those slots” (Schank and Abelson 1977:41). The restaurant script, for example,
would contain the gist of what can be expected to happen in a restaurant: or-
dering food, being served by a waiter, and paying the bill at the end of the meal.
Scripts offer a way of labeling and encoding very specific and detailed knowl-
edge of certain situations in a generalized form. If people had to consciously
remember every single detail that belongs to the restaurant script, for instance,
their memory would be overtaxed. Instead, recurrent situations or events are
indexed and stored as scripts, facilitating a later retrieval of knowledge about
these situations. Understanding, then, can be viewed as “a process by which peo-
ple match what they see and hear to pre-stored groupings of actions that they
have already experienced. New information is understood in terms of old in-
formation” (Schank and Abelson 1977:67). Likewise, when we remember and
Narrative 

tell stories we retrieve them from and at the same time reestablish them in our
long-term memories. As Schank (1990) points out, even seemingly ad hoc nar-
ratives are stories that we have already thought about at some point and that
have thus become part of the memorized stock of narratives surrounding our
experience. In that sense, stories are knowledge, and in telling stories we not
only recall this knowledge but actively readjust and even re-create it and thus
also create reality in our minds.
As far as my interviews with the doctors are concerned, this means that,
through their narratives about their experiences with domestic violence pa-
tients, gps might also express their preconceived ideas about the issue; in short,
the doctors’ responses reveal what they think and know and indeed what they
think they know about domestic violence. The stories doctors tell are based on
cases that were in some way memorable and that have consequently been in-
dexed and stocked in the gps’ “storied knowledge” about domestic violence. Since
stories in our culture usually relate “reportable events” (Labov 1972a), that is,
events that are worth telling, the doctors’ narratives reflect what aspects of do-
mestic violence cases they consider important, memorable, and worth report-
ing. Therefore, doctors’ stories can be said to indirectly reveal their attitudes
toward domestic violence and the extent of their knowledge base concerning
this issue, which they have acquired through their daily work experience. How-
ever, narratives are not simply transparencies to gps’ attitudes. As the preced-
ing discussion demonstrates, what Labov calls “narrative transformations of
experience” might also be presentations of self.

Narrative and Medicine: Doctors’ Stories

Language plays a crucial role in the work of medical doctors but not only with
regard to doctor-patient communication. Foucault contends in his Birth of the
Clinic (1973:95) that the perception of the body and of disease is related to the
syntax of a descriptive language that comprises both signs and symptoms. In
other words, disease only exists when it has been recognized and codified with
the signifiers of medical discourse. As Dingwall has it: “There are no diseases
in nature, merely relationships between organisms. . . . Diseases are produced
by the conceptual schemes imposed on the natural world by human beings,
which value some states of the body and disvalue others” (1992:165). Label-
ing disease, giving a name to the physical state in front of one, thus becomes
 Narrative

an essential activity in medicine. Doctor-patient interaction in a consultation

can therefore be regarded as a highly specialized linguistic situation. A ma-
jor part of medical doctors’ work consists of analyzing and labeling the symp-
toms a patient presents in a consultation. Doctors interpret the signs and then
make a diagnosis.
Labeling as such often has far-reaching consequences, as Maynard (1988)
maintains, because to give a name to a “trouble” or a “problem” means that one
reinforces at the same time the status quo of this problem as given. Maynard
exemplifies this with an extract from a dialogue between a pediatrician and a
mother whose child seems to be developmentally disabled. Maynard points out
that as soon as the doctor attaches a linguistic label to what he perceives to be
wrong with the child, the child’s difficulty becomes a fact, which raises a prob-
lem if the parents resist the labeling. Giving labels is also an activity negotiated
during talk, and it becomes the starting point for further interaction:

Stated differently, that a person has a problem can become a taken-

for-granted or presumed feature of interaction between clinician and
parent so that they can then negotiate specific diagnoses or labels.
Such a presumed feature is no automatic, cognitive “seeing and say-
ing” process that participants share, but rather a methodic accom-
plishment that resides in discourse practices such as those of mak-
ing and accepting problem proposals within an organized sequence
for the delivery of diagnostic news. (Maynard 1988:319–20)

In the context of domestic violence victims doctors’ labeling becomes problem-

atic if the labels convey a picture of the woman as incompetent. As Loseke and
Cahill (1984) show in their study on the social construction of notions of devi-
ance, experts on battered women such as academic researchers, social service
providers, journalists, and political activists have created a new category of de-
viance by defining victims of domestic violence in a deeply discrediting man-
ner, presenting them largely as women who are unable to manage their own
affairs. This ultimately leads to an indirect form of victimization: “As a result,
the experts on battered women have constructed a situation where victims of
wife assault may lose control over their self-definitions, interpretations of ex-
perience, and, in some cases, control over their private affairs. In a sense, bat-
tered women may now be victimized twice, first by their mates and then by the
Narrative 

experts who claim to speak on their behalf” (Loseke and Cahill 1984:306). It is
therefore important to look closely at the way gps label and define domestic vi-
olence, and one objective of this study is to find out whether the gps’ discourse
reveals indirect victimization on the linguistic level.
Hunter (1991) draws an analogy between doctor-patient interaction and
reading by contending that, in a sense, doctors “read the patient as text.” They
match the symptoms with well-known patterns of illness and finally create
their own narratives of what they have diagnosed and of how they arrived at
their conclusion:

Medicine is practised by means of a series of narrative accounts of

illness told in a relatively self-enclosed dialect and according to strict
rules that define the genre. These stories or case histories are them-
selves readings and interpretations of events as they have been repre-
sented in patients’ narratives or as they have left marks on patients’
bodies. . . . Physicians are the readers of these texts, and, like all read-
ers, they read by understanding the signs and fitting them together
into a recognizable, communicable whole. (Hunter 1991:8)

Fitting the patient’s story into “a recognizable, communicable whole” refers

to the ways in which patients’ narratives are recoded in a very specialized and
powerful language that manifests itself in gps’ notes and case reports. Doctors
“rewrite” the patient’s original narrative of what he or she thought might be
wrong. This process comes close to what Fairclough terms “rewording”: “An
existing, dominant, and naturalized, wording is being systematically replaced
by another one in conscious opposition to it” (1989:113).
In her study on protective order interviews with Latina survivors of domes-
tic abuse, Trinch (2001a, 2001b, 2003) demonstrates how the requirements of
writing a protective order application in a district attorney’s office and in a pro
bono law clinic lead to the “rewriting” of the victims’ narratives as reports and
even hinder narrative production during the interviews: “In both settings, nar-
rative trajectories are at best negotiated between clients and interviewers and at
worst, interviewers impose them. In this regard, both paid paralegals and vol-
unteers act as gatekeepers. Rather than giving clients a chance to narrate freely
and represent abuse according to their own narrative practices, both sets of in-
terviewers elicit from clients what it is that they believe is needed to obtain an
 Narrative

order” (2001a:496). Thus, Trinch argues, victims may feel unaccompanied in

the sociolegal system, and, as a consequence of the interviewers’ gatekeeping
function, they may “perceive a ‘second assault’ by the institutions meant to
serve them” (2001a:475). Lawless (2001) makes similar observations about the
discrepancy between the stories women tell when they seek refuge in shelters
and the “official” narratives that are required in police investigations or court
proceedings, for example. She contends that institutional rewordings of abused
women’s narratives in fact deprive these women of their trust in the validity of
their own narratives and thereby also impoverish otherwise powerful testimo-
nies of violence: “We teach them to disbelieve and to dishonour their own words
and stories by the ways in which the institutions that are supposedly in place for
their assistance seek to reshape their words and rewrite their stories to fit the
discourse of the service organizations and the courts of law” (Lawless 2001:41–
42). What is needed, Lawless argues, is an acknowledgment of “the power of
narrative with which we speak ourselves into being” (2001:159).
If victims of domestic violence were given more opportunities to “speak them-
selves into being” during a consultation and to disclose the violence they suffer,
many of the problems general practice currently has with dealing with this is-
sue could be solved (see chapters 3 and 4). After all, a collection of cases or, bet-
ter, “stories” about cases becomes the knowledge base gps can draw upon over
the years: “Physicians acquire a collection of cases that they have either treated
themselves or observed directly, and they augment these with others reported
in journals. . . . [T]his practical knowledge informs the interpretation of each
new case as the clinician goes about fitting it to the clinical taxonomy of diag-
nosis and therapy” (Hunter 1991:44–45). Moreover, the cases doctors remem-
ber also give them indirect guidelines as to what to look out for the next time a
patient comes in with similar symptoms. Narratives consequently form a cru-
cial element in medicine, especially where the symptoms presented by the pa-
tient do not match the biomedical model alone.
A lot of the illnesses doctors encounter nowadays have a psychosocial dimen-
sion to them and run the risk of remaining undiscovered or underestimated
within a “hard science” paradigm in medical practice. As Hunter repeatedly
emphasizes in her book, medicine is not, strictly speaking, a science but “a ra-
tional, science-using, inter-level, interpretive activity” (1990:25). This insight
has gradually made its way into medical theory and has informed a number
of studies on the relationship between narrative and medicine, as can be seen
Narrative 

in a collection of articles entitled Narrative Based Medicine (Greenhalgh and

Hurwitz 1998). This collection is mainly addressed to health care profession-
als and aims at raising awareness about the importance of language in medi-
cal encounters. Elwyn and Gwyn, for example, conclude their article on doc-
tor-patient discourse in consultations by stating that “by being aware of certain
signalling practices and discourse markers in the patient’s talk, general prac-
titioners might be able to listen more constructively to their patients’ stories”
(1998:174). Ironically, research on doctor-patient communication and on the
problems arising from it has a long tradition in sociolinguistics (Shuy 1976;
Cicourel 1981; Fisher and Todd 1983; West 1984; Tannen and Wallat 1986) and
in the sociology of health and illness (Bennett 1976; Mishler 1984; Silverman
1987). The fact that these findings have only recently started to be taken more
seriously in medical practice shows the lack of communication amongst dis-
ciplines in the past, communication that could have proved useful a lot earlier
for all disciplines involved.
It is not only the patients’ narratives, however, that should be given more
attention. Patients’ narratives have been addressed so assiduously as to imply
that physicians do not have any. While gps are assumed to be the custodians of
expert knowledge expressed in a scientific discourse, patients are taken as pos-
sessors of folk beliefs expressed in vernacular stories. It is not only important
to reintroduce narrative in professional communication and to make the nar-
rative mode acceptable even in “scientific” areas (Perkins and Blyler 1999), but
the narrative practices that are already in place in professions such as health
care also need to come under closer scrutiny. My narrative angle of entry illu-
minates something different from the expert knowledge typically attributed to
medical professionals. It reveals that physicians are also a folk group with nar-
rative traditions and private lore.
After all, doctors’ stories about domestic violence also reflect gps’ partici-
pation in a certain “community of practice,” that is, “an aggregate of people
who come together around mutual engagement in an endeavour. Ways of do-
ing things, ways of talking, beliefs, values, power relations—in short, prac-
tice—emerge in the course of this mutual endeavour” (Eckert and McCon-
nell-Ginet 1992:464). This means that gps share, for example, the sources of
their case-based knowledge to the extent that they read the same journal arti-
cles and discuss problematic cases with each other. Moreover, gps, like people
from other walks of life, often engage in conversations with each other outside
 Narrative

their professional domain because they have become close friends, for exam-
ple, or because they pursue the same hobbies. Doctors tell stories to other doc-
tors. It is by virtue of these in-group tellings that folklore can become “storied
knowledge.” Furthermore, gps are not only members of a professional group,
but they are also part of a larger social institution: the health care sector. We
can therefore ask, Are there signs of a common knowledge base and a code of
practice that gps both draw upon and also re-create and reinforce during the in-
terviews? Is it possible to sift a common narrative out of all the individual nar-
ratives that indicates that gps’ linguistic behavior is informed by their profes-
sional “community of practice”? As Linde points out, “narratives in groups and
institutions are not solely individual productions, but rather are constrained
by the narratives that have a long-term life within the institution, as well as by
the practices and occasions on which narrative [sic] are told” (1997b:286). The
sum of narratives that are related to (re)produce the identity and culture of in-
stitutions in bureaucratic settings forms what Linde calls “institutional mem-
ory,” and narrative also functions “to project the future, in constructing a re-
cord that can serve as an institutional memory available in case of possible
challenges” (1999:139).8
The concept of institutional memory is not static, as Trinch (2001b) argues,
since it allows for novel narratives that may gradually change an existing insti-
tutional memory.9 Trinch further contends that institutional memory can also
be deficient, as it is “only as complete as the interactions that go into the narra-
tive stories and reports that produce it” (2001b:579).10 Do doctors also have “in-
stitutionalized” narratives about domestic violence, and if so, how accurately
do they reflect women’s manifold and complex experiences of violence? If the
gps’ narratives analyzed in this study prove to be very similar in both their con-
tent and their linguistic presentation, we can infer that the doctors’ discourse
has not only been influenced by the linguistic community of practice in which
the gps participate but also that their shared notions about domestic violence
incorporated in their “institutional memory” have established a social real-
ity surrounding the issue of domestic violence that gps take for a fact. Follow-
ing from there, a case can be made for sociolinguistic analysis as a crucial tool
in investigating the relationship between structural linguistic units and social
practices (Linde 1997a). This seems to be particularly relevant in the context of
Narrative 

present-day society, “where the public life of society members is materially af-
fected by public agencies” (Gumperz and Cook-Gumperz 1982:4).
In this study primary health care as part of the larger medical sector and
thus by default also as a social institution comes under closer scrutiny. I dem-
onstrate to what extent gps’ narrative constructions of domestic violence as a
social problem reveal and at the same time underpin professional practices that
might have an impact on the relevant service provision women suffering do-
mestic abuse may or may not receive when they go to see their family doctor. A
number of studies have analyzed the community response to violence (Eekelaar
and Katz 1978; Borkowski, Murch, and Walker 1983; Pahl 1985; Tayside Women
and Violence Group 1994), including legal, medical, and social services. Other
studies have concentrated on individual areas such as the criminal justice sys-
tem and criminology (Stanko 1985, 1990), social work (Dobash, Dobash, and
Cavanagh 1985; Lloyd 1995), and the response to domestic violence in psychiat-
ric and medical emergency departments (Bograd 1987; Warshaw 1993; Camp-
bell et al. 1994; Keller 1996; Pahl 1995). More recently, studies have also taken
into account general practice as one setting where domestic abuse is disclosed
(Bradley et al. 2002; Richardson et al. 2002). Despite the diverse characteris-
tics of these institutions, the results are strikingly similar in that they portray a
relatively gloomy picture as far as the service provision for victims of domestic
abuse is concerned.11 One aim of this book is to uncover, by means of narrative
analysis, possible problems underlying doctor-patient interaction with regard
to domestic abuse. For example, do the gps’ narratives and their linguistic fea-
tures offer any explanation for the lack of consistent service provision? I take a
closer look at domestic violence and general practice in the next chapter.
3. Domestic Violence and the
Role of General Practice
A Narrative-Analytic Approach

Cohen (1992) shows that women have sought shelter and, at the same time, have
been institutionalized for a wide array of reasons ever since the Middle Ages,
including protection and assistance but also punishment and rehabilitation. In
the past institutions for women were mainly run by the church, and their di-
verse functions presented a double-edged sword: on the one hand, women were
offered material help and refuge in their socioeconomic plights; on the other
hand, clerical institutions also saw it as their task to “reform” prostitutes and
equally “deviant” women (Cohen 1992:169). This example demonstrates that
violence against women has had a long history and that, moreover, it has largely
been condoned by society. At the same time, the boundaries between domestic
and institutional violence are shown to be far from clear-cut. Despite its long
history and prevalence in our society, domestic violence only became topical
as part of a more general feminist resistance to patriarchal structures and male
dominance in the late 1960s and came to be perceived as a political issue in the
early seventies, when the battered women’s movement started to emerge in Brit-
ain under the auspices of Erin Pizzey and her associates (Johnson 1995:102–4).
The first British community center for women and their children was set up in
1972 under the name of Chiswick Women’s Aid, which received extensive me-
dia coverage, and from there information as well as practical help were offered
throughout the country.
The emergence of Women’s Aid groups and the politicization of domestic
violence were accompanied by growing research interest in domestic violence,
particularly its various forms, causes, and consequences (Steinmetz and Straus
1974; Gelles 1976; Eekelaar and Katz 1978; Dobash and Dobash 1979).1 Since re-
searchers in preceding decades had hardly addressed the issue, one major con-
cern in the seventies was to find out the extent of domestic violence. As a con-
Domestic Violence and the Role of General Practice 

sequence, quantitative studies and survey research abound in the literature of

the time. These data were closely linked with researchers’ attempts to generate
theories of family violence. Gelles identifies three main explanatory models in
the seventies within which theories of violence were formulated: (1) the “psychi-
atric model,” which focuses on the perpetrator’s personality and related factors
such as mental illness and alcohol or drug abuse; (2) the “social-psychological
model,” which examines external environmental factors such as stresses, fam-
ily histories of violence over generations, and family interaction patterns; and
(3) the “sociocultural model,” which takes into account macrolevel structures
of inequality, cultural attitudes, and norms (1980:881). These explanatory mod-
els have partly survived and still constitute frameworks for investigation. Will-
son et al. (2000) and Johnson (2001), for example, analyze the correlations be-
tween alcohol or drug abuse and violence against women by intimate partners.
Although Willson et al. identify a correlation between alcohol or drug abuse
and intensity of violence, both Willson et al. and Johnson caution against the
oversimplified view that there is a causal connection. Johnson in particular con-
cludes from her data that “male attitudes and beliefs in the rightness of control
over female partners made a more important statistical contribution than did
alcohol, age, type of relationship, or class variables. The acting-out of negative
attitudes toward women, especially men’s rights to degrade and devalue their
female partners through name-calling and putdowns, was an especially impor-
tant predictor and, once entered, reduced the effects of alcohol abuse to nonsig-
nificance” (2001:68). Feminist researchers have also challenged the attribution
of intimate partner violence to external stress factors such as low income, un-
employment, and so on as well as cycle-of-abuse theories and transmission of
violence over generations. Such explanations are problematic, since “in a vari-
ety of ways, violence is socially legitimated” (Johnson 1995:116). Johnson con-
tinues by arguing that “while stress resulting from poverty, inequality and vari-
ous forms of deprivation may be contributory factors in domestic violence, only
a small proportion of those who experience such conditions behave violently
towards their partners, and many of those who do behave violently are neither
poor nor deprived” (1995:116). This raises questions concerning the generation
and interpretation of survey figures in studies operating within the social-psy-
chological framework. In their review of data from the first National Family Vi-
olence Survey conducted in America by Straus, Gelles, and Steinmetz, Johnson
and Ferraro (2000) show, for example, that the effects stated in cycle-of-violence
 Domestic Violence and the Role of General Practice

theories are in fact small. While Straus, Gelles, and Steinmetz claimed that the
wife-beating rate for sons of violent parents was 1,000 percent greater than that
of sons of nonviolent parents, Johnson and Ferraro reinterpret the actual rate
of 20 percent as “meaning that even among this group of men whose parents
were two standard deviations above average in level of partner violence, 80%
of the adult sons had not even once in the last 12 months committed any acts of
severe violence toward their partners” (2000:958). In other words, the fact that
some men witness violence as children does not necessarily mean that they be-
come abusive themselves. Williamson argues along the same lines by stating
that “without more consistent and thorough evidence, cycle of abuse theories
cannot be utilised as an adequate explanation for the occurrence of domestic vi-
olence, as they do not explain why men who also experience domestic violence
as children do not go on to abuse their own partners” (2000:95).
Most researchers nowadays agree that domestic violence is not tied to any
specific sociodemographic factor but that it occurs across all social classes, cul-
tural and ethnic backgrounds, and age groups. However, differences may exist
in terms of types and presentations of abuse, which requires further differen-
tiation and attention to subtle details, as Johnson and Ferraro (2000:959) pos-
tulate. I would argue that it is equally important to consider the wider social
context in which violence is made possible and the influential role of social in-
stitutions and their discursive practices in the process of victimization.
The violence women experience takes many forms and covers a wide range
of abusive behavior that can be subsumed under at least three categories: physi-
cal violence, emotional abuse, and sexual abuse (Mazza, Dennerstein, and Ryan
1996:15). In addition, Gay (1997) investigates “linguistic violence” as a special
form of violence. Violent men beat, cut, and burn their partners, they break
their bones and teeth, they tear out their hair, and they rape them. It is not
surprising that general practitioners are often the first person to see and wit-
ness the results of abuse (Scottish Needs Assessment Programme 1997). Fur-
thermore, the often prolonged duration of abusive relationships and the sever-
ity of violent attacks some women are exposed to often lead to chronic illness
and a range of emotional and psychiatric problems such as depression, anxi-
ety, post-traumatic stress disorder (ptsd), and suicide (British Medical Asso-
ciation 1998:30; Campbell 2002). For these reasons the Department of Health
highlights right at the beginning of its resource manual for health care profes-
Domestic Violence and the Role of General Practice 

sionals the unique role health services potentially fulfill: “Health services have
a pivotal role to play in the identification, assessment and response to domes-
tic violence, not only because of the impact of domestic violence on health, but
crucially because the health services may often be the only contact point with
professionals who could recognise and intervene in the situation” (2000:2).2 All
that is said here about medical services in general also applies to gps, who often
have an even closer relationship with patients in their role as family doctor. As
Annandale (1998:143–44) points out, women from around the age of ten to the
midsixties are much more likely to consult their gp than men. And yet studies
have shown that doctors and other medical staff do not always detect domes-
tic violence in their patients.3 This raises a number of questions concerning the
disclosure and detection of domestic violence in general practice. Do gps really
encounter only a few patients who suffer domestic violence, or do they overlook
possible cases? If they do not detect domestic violence, is it because women do
not open up or because gps are reluctant to broach the subject? Are they not
sensitized enough to possible underlying issues? If this is the case, what could
be the reasons? Abbott and Williamson locate the problem in gps’ “failure” to
find out about domestic violence: “These figures suggest that health care pro-
fessionals significantly underestimate the extent of domestic violence and are
failing to ‘detect’ it as the cause of injuries and other health problems reported
by their female patients” (1999:91). It is also a fact, however, that women of-
ten need a long time before they disclose their problem to their gp. Henderson
(1997) points out that some patients return to their doctor’s office up to thirty
times before managing to disclose domestic violence. A prevalence survey con-
ducted in Melbourne by Mazza, Dennerstein, and Ryan (1996) showed that only
27 percent of the women who had experienced partner or childhood physical
abuse had actually disclosed this to their doctor. The main reason respondents
offered for not communicating their problem to their doctor was “not because
they were afraid, embarrassed or untrusting, but because they were never asked”
(Mazza, Dennerstein, and Ryan 1996:16).
Why do women not disclose and doctors not ask? Dobash and Dobash talk
about a “conspiracy of silence” (1979:181) between doctor and patient, that is, a
mutual denial of the violence at stake where women fabricate explanations for
injuries and doctors accept them without further inquiry. Studies have shown
that women often deny violence because of shame, fear of retaliation, and con-
tinued trauma (Dobash and Dobash 1979:180) but also because they sense a lack
 Domestic Violence and the Role of General Practice

of advocacy and interest from their gp (Williamson 2000:47–65). An ethno-

graphic study by Sugg and Inui (1992), who are also medical doctors, yielded a
number of interesting results concerning doctors’ reluctance to ask about do-
mestic violence. First, doctors stated a close identification with patients of the
same socioeconomic background. This entails two consequences: on the one
hand, patients from a higher social background are less likely to be identified
as victims of abuse because they are not asked; on the other hand, the miscon-
ception of domestic violence as a product of poverty is perpetuated through
the selective questioning of patients from lower social classes (Sugg and Inui
1992:3160). Another issue raised by physicians was their fear of offending the
patient, which Sugg and Inui regard as stemming from cultural constructs of
what is private. In other words, doctors do not think they are in a position to
interfere in patients’ private matters, and domestic violence is regarded as a pri-
vate matter. A third concern was related to doctors’ feeling of powerlessness and
a sense of inadequacy, as medical tools were regarded as inappropriate. This
argument was closely linked to a fourth problem, namely, the gps’ frustration
with their lack of power in a situation in which they could not control whether
a patient accepted and followed their advice. However, the most pervasive and
driving fear expressed by the doctors was the time factor. Time pressure is likely
to prevent a physician from delving into a problem that is potentially offensive
or difficult to resolve. As I show in my analyses, these explanations are con-
stantly recycled in gps’ narrative discourse and thus preclude a paradigm shift
at the level of gps’ “storied knowledge” of the problem.
The severe lack of communication between gps and patients who experience
domestic violence has far-reaching consequences and huge implications for pri-
mary care in terms of morbidity, gps’ workload, and long-term costs.4 It is not
least on these grounds that primary care ought to be seen as a key setting for
further exploration. More important, however, I would argue with Williamson
that “healthcare professionals have a moral imperative to deal with the issue
of domestic violence as social citizens, in conjunction with their professional
responsibility” (2000:59). Even though gps cannot treat the causes, prevent
the effects, or assure the cures for men hurting women, they are gatekeepers
to whom women might disclose because their injuries precipitate narratives of
how the injuries were sustained. As I mentioned above, women have periodic,
intimate, and physical contact with gps that might serve as an occasion of dis-
Domestic Violence and the Role of General Practice 

closure even if there are no physical symptoms. In my view gps have a moral
obligation to at least keep the gate open and facilitate disclosure.

The Biomedical Model and the “Appropriation of the Sick Role”

In order to understand the difficulties gps might have in dealing with cases of
domestic violence it is important to clarify the concept of the biomedical model
of medicine first, since this is the model upon which most of today’s main-
stream medical practice is based. The history of medicine and of conceptual
models used in medical practice was highly influenced by two major develop-
ments: first, the rise of the hospital as a medical institution, initially in France
in the early nineteenth century (Foucault 1973); and second, the emergence of
“laboratory medicine” in the mid-nineteenth century, that is, medicine that
was informed by increasing scientific knowledge of physiochemical processes
(Annandale 1998). Thus the “birth” of modern medicine, to draw upon Fou-
cault’s metaphor, can be located in the wider context of the industrial revolu-
tion, with its dynamic processes of industrialization, the movement of the pop-
ulation from the countryside into the cities, and the rise of capitalism. While
up until the eighteenth century medical practitioners worked within a “per-
son-oriented cosmology” (Annandale 1998:5), in which judgments were made
by taking into account the patient’s personality as a whole, the patient gradu-
ally disappeared into the mass of hospital patients waiting for treatment. What
is more, since the rise of the hospital provided doctors with greater financial au-
tonomy, doctor-patient relationships were no longer based on good rapport and
negotiation of interpretations of illness, and the control over medical knowl-
edge was entirely passed from the patient to the doctor. This development was
of course supported by doctors’ increasingly specialized knowledge in the area
of biomedicine. The patient, on the other hand, was almost reduced to a ma-
terial entity to be analyzed. As Annandale puts it, in “the eighteenth century
the sick person was conceived as a ‘whole person’; today the body is typically
viewed as a complex machine apart from the mind” (1998:6).
In line with the biomedical model doctors treat whatever is physically wrong
with the patient, but they do not judge the patient on personal or moral grounds.
In a way, doctors are claimed to be “clinical” in every sense of the word. As
O’Connor remarks: “In keeping with the scientific tradition, modern biomedi-
cine has striven to separate itself from broader cultural concerns and influences”
 Domestic Violence and the Role of General Practice

(1995:22). When it comes to identifying and treating medical problems that do

not match the biomedical model alone but that have psychosocial origins, how-
ever, these assumptions obviously pose difficulties. In the case of domestic vio-
lence abuse cannot, strictly speaking, be viewed as an illness and thus does not
fall within the duties and responsibilities of medicine. Furthermore, since the
causes of abuse are not definable within a biophysical framework, gps may find
it puzzling to identify their own role as suitable to deal with this problem.
Another factor in this context is what Williamson (2000) calls the “appro-
priation of the sick role,” that is, the process whereby patients’ illnesses are le-
gitimized by the doctor. As Williamson points out, the “sick role” encompasses
a number of components:

First, the sick role legitimates abdication of social responsibility for

the duration of the illness. Second, the abdication of social and fa-
milial responsibilities is dependent on the seeking of professional
help and advice. Third, the individual is responsible for assisting
in the recovery process, through adherence to the professional rec-
ommendations they receive. Finally, there is an expectation that in-
dividuals seek help from specifically trained, and therefore legiti-
mated, health providers. (2000:19)

All these components instantiate the social control function of doctors and of
medical discourse: a patient is considered “genuinely ill” only if his or her ill-
ness is defined as such by the doctor. The appropriation of the sick role has, of
course, implications for victims of domestic violence. What do general practi-
tioners regard as “illness” or “disease” in medical terms? What do they assume
concerning the level of responsibility and agency women attain in domestic vi-
olence situations? Doctors may well assume that women are partly responsible
for the violence they experience and therefore consider resulting injuries as al-
most self-inflicted. Similarly, if women do not follow doctors’ advice to leave
an abusive partner, this might be viewed as a breach of the rules pertaining to
the sick role. As a consequence, doctors may distinguish between “legitimate”
and “illegitimate” states of health and illness, which deserve different levels of
treatment. This differentiation in turn can lead to the stigmatization of the pa-
tient’s behavior as inappropriate (Williamson 2000:20).
Domestic Violence and the Role of General Practice 

Cultural Myths and Explanatory Frameworks

Keller proposes psychological explanations for the problem and sees the eval-
uation of a battered woman as a “crisis setting” (1996:8) that can lead to psy-
chological pressure on service providers. Countertransference mechanisms can
then cause misguided projections of anger, sadness, or anxiety onto the patient
and thus prove detrimental for treatment or therapy. Bograd analyzes clinical
approaches to battered women from a feminist perspective and reaches the con-
clusion that they are “based less on scientific formulation and research than on
prevailing male-defined cultural myths about women” (1987:69). Williamson
(2000) also reveals gps’ reluctance to tackle the problem and uncovers some of
the misconceptions and stigmatizing clichés gps succumb to and, at the same
time, reinforce in their discourses about patients. What are these myths? Since
I also use the term cultural myths when referring to some of the gps’ conceptu-
alizations, I provide an overview at this point to make the framework for this
study more transparent to readers.
In line with Schornstein (1997:24–30), who surveyed a great range of empir-
ical studies on domestic violence and to whom I would like to refer the inter-
ested reader, I take the following twelve assumptions to be myths about causes
for and dynamics of domestic violence:

. Myth: The victim caused the violence. She “asked for it.”
Fact: The batterer caused the violence. He is responsible for his
actions.
. Myth: The victim enjoys the abuse. If she didn’t enjoy it, she
would leave him.
Fact: No one enjoys being beaten.
. Myth: Domestic violence is a family or private matter.
Fact: Domestic violence is a crime against the victim and against
society.
. Myth: If the victim left the batterer, the violence would stop.
Fact: Most victims are in greater danger of increased violence
after they leave the abuser.
. Myth: Alcohol and drug abuse cause domestic violence.
Fact: Generally speaking, alcohol and drug use do not cause vio-
lent behavior.
 Domestic Violence and the Role of General Practice

. Myth: Domestic violence only occurs in lower socioeconomic

groups.
Fact: Domestic violence occurs in all socioeconomic groups.
. Myth: The incidence of domestic violence is overstated. It is not
that much of a problem.
Fact: Domestic violence is a significant problem for women all
over the world.
. Myth: Women are just as violent as men.
Fact: Men make up the overwhelming percentage of domestic
violence perpetrators.
. Myth: Battered women gravitate to abusers. Even if such wom-
en leave their violent partners, they will just find other men who
will beat them.
Fact: Women do not seek abusive partners.
. Myth: The assault is an isolated incident, unlikely to happen
again.
Fact: Battering is part of a complex pattern of domination and
control.
. Myth: Domestic violence is merely “a push and a shove.”
Fact: Batterers engage in countless forms of violence.
 . Myth: If he beat her up, he must be mentally ill.
Fact: Mental illness is not a prerequisite for domestic violence.

I consider domestic violence a complex and multifactorial problem that is also

culturally constructed and “made sense of” by means of discursive practices.
Williamson (2000) too emphasizes the significance of doctors’ discourse in her
study, and yet her discussion of interview excerpts remains largely a content
analysis. So how is domestic violence linguistically constructed? How can a nar-
rative-analytic approach yield insights into the construction of cultural and in-
stitutional narratives about domestic violence? Before I move on to a discussion
of the narrative frame model for my study I briefly present my research meth-
odology and the data used for the analyses.

Research Methodology
The twenty in-depth interviews for this study were conducted in the city of
Aberdeen between March and July 2000. Aberdeen is a cosmopolitan port in
Domestic Violence and the Role of General Practice 

northeastern Scotland. Compared to other countries such as Finland and Swe-

den, for example, Scotland takes a national partnership approach toward do-
mestic violence based on gendered notions of the problem (McKie 2004). The
Partnership Strategy (Scottish Executive 2000), which followed the advent of
the first Scottish Parliament in three hundred years in 1999, initiated multia-
gency partnerships and required local authorities to devise action plans and
strategies. Reviewed legislation enhanced the protection of women. Thus, the
Protection from Abuse(s) Act came into force in 2001, and the Criminal Jus-
tice Bill and the Sexual Offences Act 2002 reinforced protection, particularly
from sexual offenses. In other words, I conducted this study at a time when the
problem of domestic abuse was prominent in public debates and therefore also
had some media coverage.
The respondents for this study were selected by means of purposive sam-
pling from a list of doctors’ office addresses issued by the Grampian nhs Board.5
Purposive sampling involves respondents’ selection according to certain prees-
tablished criteria (Mason 1996:94). The criteria for this study were (1) an equal
split of male and female gps in the sample and (2) practices from a wide geo-
graphical catchment area comprising both city center and suburban areas of
Aberdeen. The aim was to have a variety of practices with patients from differ-
ent socioeconomic backgrounds in order to test the assumption that this may
influence doctors’ experiences with domestic violence.6 It was difficult to con-
trol the sample for the age variable, since information on age is not easily avail-
able. Other difficulties included problems of access and nonresponse. Thus
when I phoned up to arrange an interview it required patience and insistence
to pass by receptionists in order to speak to the gps themselves. Receptionists
obviously fulfill a gatekeeping function in medical practices. Their task is to
ward off all “unwanted” calls or callers asking for the gp’s time who are not pa-
tients. Eventually, out of the fifty-five gps I wrote to, thirty-seven declined to be
interviewed. Most of them mentioned lack of time as the main reason for why
they could not participate. A few gps stated that they did not think domestic
violence was an issue for them.
Nevertheless, the sample finally included gps from a fairly wide age range
and, more important, a wide range of years of experience in general practice,
with some gps being at the beginning of their careers and others nearing re-
tirement. The range was between three and thirty-three years of general prac-
tice work. The sample of twenty gps consisted of eleven male and nine female
 Domestic Violence and the Role of General Practice

doctors from sixteen different practices, three of which were situated in the city
center, eleven in the wider city area, three on the outskirts of the city, and three
in suburbs to the north, northwest, and southwest of Aberdeen. The fact that
eight of the doctors in my sample worked in joint practices and thus held of-
fice hours in at least two different parts of town throughout the week allowed
for an even wider catchment area to be covered. Whether the practice was sit-
uated in an affluent, upper-middle-class area or in a deprived area in town did
not seem to matter too much in the interviews because many gps were able to
draw on experiences they had had elsewhere, in other practices, in other cities,
even in other countries.
The interview schedule was semistructured and considerably loose. The ques-
tions I asked were phrased freely around the following catchwords, which had
emerged from previous pilot interviews: time; silence; emotions when dealing
with patients; definition of domestic violence; experiences; reasons for domes-
tic violence; problem of opening up; reluctance to broach the subject; relevance
in general practice; status of domestic violence in the health care system in gen-
eral; consultation; signs/signals of domestic violence; action/steps to be taken;
range of services available to women; training. The length of the interviews
ranged between fourteen and thirty-seven minutes due to the gps’ concerns
about their lack of time, with most of the interviews lasting for approximately
half an hour. All the interviews were taped and transcribed. The transcription
conventions used for this study (see also “Transcription Conventions”) are ad-
opted, with minor changes, from Norrick (2000). The overall aim was to leave
the interview text as readable and accessible as possible.7 Thus, an analysis of
metaphoric language or of passive constructions does not necessarily require a
close phonetic transcription, for example, while an investigation into turn tak-
ing, back channels, and other interactional features demands a minimum no-
tation of pauses and intonational patterns (e.g., stress).

The Corpus
In sum, thirty-six narratives could be extracted from the interviews (see ap-
pendix). Narratives were identified by the following criteria for a prototypical
story: “A prototypical story identifies a protagonist, a predicament, attempts to
resolve the predicament, the outcomes of such attempts, and the reactions of
Domestic Violence and the Role of General Practice 

the protagonists to the situation. Causal relationships among each of the story
elements are also explicitly identified in the prototype” (Robinson and Hawpe
1986:112). In other words, passages in the interviews are considered narratives
if they depart from gps’ general accounts and discussions of domestic violence
and introduce a personal story that incorporates some or all of the above cri-
teria. Not all narratives in my data match the “prototype” entirely. Thus a few
narratives were only initiated but not related in full length. Other narratives
appeared fragmented throughout the interview, for example, when doctors
referred back to a case they had mentioned earlier or when I prompted them
to tell me more about a case. In these instances narratives were identified and
counted but not necessarily included in the analysis because they did not lend
themselves to the narrative approach as it is adopted here.
Another reason why I did not take some of the narratives into account is
the fact that they are only marginally related to the issue of domestic violence.
One narrative, for example, depicts a case of child sexual abuse, and another
one discusses the practice work of a gp’s former colleague. The narratives gen-
erated in my sample are of two kinds: twelve were interviewer initiated, that is,
they were told in response to questions such as “Can you tell me about your ex-
periences?” and “Is there any case that’s particularly vivid in your memory?”;
twenty-four narratives, however, can be classified as “spontaneous,” as they
were told in contexts in which I had not explicitly asked for a story. This un-
derlines the argument put forward in this study and by other authors (Bruner
1986, 1991; Schank 1990; Herman 2002) that narratives are a widely used device
in conversation and that they play a crucial role both in the shaping of human
understanding and in human interaction. “Storied knowledge” forms a refer-
ential framework from which people can retrieve remembered experiences in
order to apply them to new or similar situations.

Narrative-Analytic Tools
How can we combine these macrostructural assumptions about narrative and
knowledge with the microstructural level of narrative analysis and its narrato-
logical tools? The tools for the narrative analysis undertaken in this study are
mainly drawn from the sociolinguistic tradition initiated by Labov and Walet-
zky’s (1967) groundbreaking article. Labov and Waletzky and Labov (1982, 1997)
 Domestic Violence and the Role of General Practice

capture the structure of a standard oral narrative in the diamond diagram of

narratives. In the orientation section the narrator identifies the time, place, per-
sons, and their activity prior to the narrated event or the general situation. The
narrative is then developed in a complicating action sequence, which leads to a
result or resolution. The narrative can be preceded by an abstract, which gives a
very brief summary of the following story, and it can be concluded with a coda,
that is, a general observation or comment made by the narrator to signal that
the narrative is finished.
Another key concept is Labov’s notion of temporal juncture. Two clauses
can be said to occur in temporal juncture “if a reversal of their order results in
a change in the listener’s interpretation of the order of the events described”
(Labov 1997:399). Temporal juncture is used by Labov to define a “minimal
narrative”: “A narrative must contain at least one temporal juncture. . . . Tem-
poral juncture is the simplest, most favored or unmarked way of recounting
the past” (1997:399). Narratives can of course take different shapes, for exam-
ple, through syntactic embedding, use of the past perfect, and so on. In Labov’s
view these forms are more marked, however. Such markedness is often related
to “reportability” in narratives, discussed in greater detail in chapter 9. The as-
sumption is that storytellers usually depict extraordinary or in some ways cap-
tivating events in order to justify their telling of the story and to ensure its suc-
cess in a given situation.
A few caveats need to be added at this point. As I already emphasized above,
this study regards narrative as representations of gps’ memorized experience of
domestic violence cases and does not aim to present a detailed conversation-an-
alytic approach with close attention to the sequential organization of narrative
production. I think that a detailed description of my responses involving mainly
back channels such as “mm-hmm” and “yeah” would not really add much to the
analyses if it was undertaken for each single narrative, and it would certainly
make the narratives tedious to read. For this reason the narratives are mainly
treated as products of the interaction between interviewer and gp rather than
as sequential interaction as such and are presented accordingly. My choice of
line breaks follows Labov and Waletzky’s (1967) typology of narrative clauses,
which is based on the concept of temporal juncture. The analysis of sequen-
tial elements on the narrative context level is restricted to instances where the
interactional nature of the interview situation manifests itself in, for example,
Domestic Violence and the Role of General Practice 

features expressing politeness, reluctance, self-monitoring, and so on. We must

not forget, however, that the distinction between “narrative level” and “narra-
tive context level” is not always as clear-cut. The distinction at best serves as a
schematic model. This is nevertheless useful, I think, as it brings into sharper
relief factors influencing narrative production.

A Frame Model for Interview Narratives

In order to understand what is linguistically going on in the interviews with the
gps and hence in their narratives it helps to consider the interview situation at
large. An analytical model of oral narratives needs to take into account at least
the medium, spatiotemporal contexts, the role of the participants, and the pur-
pose or function of a narrative in any given situation. Schiffrin (1993), for exam-
ple, shows in her study on the phenomenon “talking for another” that the inter-
view situation sets a dominant frame to which participants accommodate their
speech but at the same time apply strategies of “in-frame” and “out-of-frame”
conversation, that is, conversation that either remains within the expectational
boundaries of the interview frame (e.g., the question-answer pattern) or goes
beyond it. Any linguistic interaction can be interpreted in terms of frames of
expectations and socially codified rules, as Tannen (1993b) points out. Frame
theory goes back to the work of Erving Goffman, who conceptualized conversa-
tion as a staged play during which participants act out their roles as individuals
but also as social and professional personae: “Often what talkers undertake to
do is not to provide information to a recipient but to present dramas to an au-
dience. Indeed, it seems that we spend most of our time not engaged in giving
information but in giving shows” (1974:509). The term frame includes organiza-
tional rules for interaction on both social as well as personal levels. Thus, Goff-
man assumes that “definitions of a situation are built up in accordance with
principles of organization which govern events—at least social ones—and our
subjective involvement in them” (1974:10–11). Goffman labels the sum of these
basic principles underlying a given situation as a “frame.”
I adopt Goffman’s concept of frame in order to depict the contextual frames
relevant to my study. The schematic model in figure 1 captures the embeddedness
of interview narratives within these larger conceptual and interactional frames.
The interview narrative forms the nucleus of a first interactional frame, the nar-
rative frame. Narratives, and with them the narrative frame, are optional ele-
ments inside the interview frame; that is, they occur as one of several discursive
 Interview Frame
Narrative Frame
Interview

Interviewer Interview Interviewee

Narrative
(Narratee) (Narrator)

devices the interviewee can but need not necessarily draw upon. One interview
script in my sample does not contain any narrative, for example. The narrative
frame is embedded in a larger contextual frame, namely, the interview frame.
Let me provide an overview of the different frames and what they entail.

The Narrative Frame

Within the narrative frame the storyteller relates a “story” to the listener. Since
the listener, or “narratee,” however, brings certain culturally and socially de-
fined expectations to bear upon the narrative frame (e.g., judgments as to what a
“good” narrative should be like and whether it is relevant in the particular con-
versational situation) and since to some extent the storyteller accommodates his
or her narrative to these expectations, it is more appropriate to talk about a “co-
construction,” or a jointly created narrative. Gumperz distinguishes two types
of inferences speakers make in conversation: “First, there are those inferences
that retrieve background knowledge on what the frame or activity is. That is,
knowledge that suggests what the interaction involves, what the appropriate re-
lationships among interactants are, and what outcomes are expected. Secondly,
there are the inferences that enter into what we may call conversational man-
agement, such as the allocation of turns at speaking, the maintenance of the-
matic cohesion and the signaling of topic change” (1997:195). Gumperz clearly
favors a conversation-analytic approach that is founded on detailed analysis
of the sequential organization of talk. In the context of interview narratives,
however, a close sequential analysis is not always useful, since the interviewer’s
Domestic Violence and the Role of General Practice 

turns are mostly marked by back channels such as “mm-hmm,” “yeah,” and so
on, which are normally used as fairly neutral interaction devices to encourage
the interviewee to hold the floor. Moreover, as I mentioned above, narratives
can be regarded as products of speakers’ memorized stock of narrative knowl-
edge and can therefore be analyzed holistically. Nevertheless, an in-depth anal-
ysis of the narrative frame has to take into account not only the structural de-
tails of the narrative proper, or what I would like to label “narrative features,”
but also assumptions about exactly those expectations and norms that inform
“online” narrative construction and all aspects surrounding the narrative, its
“narrative context features.” These features include not only linguistic cues and
aspects but also gaze, gestures, and body language.
“Interview talk” should never be confused with “natural speech,” as Wolf-
son (1976) emphasizes. Interview talk is not “natural,” as it is always influenced
by speakers’ consciousness of the presence of the tape recorder. Labov calls this
phenomenon the “observer’s paradox” (i.e., the observer tries “to find out how
people talk when they are not being systematically observed” [1972b:209], and
the only way to obtain these data is by systematic observation). During the in-
terviews the observer’s paradox was noticeable in the way some of the gps re-
peatedly glanced at the dictaphone. One gp openly stated after the interview
that the presence of the dictaphone had been “intimidating.” The presence of
the tape recorder certainly has to account for omissions in the doctors’ stories
and for self-monitoring mechanisms, which could be seen in statements such
as “I’m not gonna make defensive answers.” As a consequence of the observer’s
paradox, interview narratives are not introduced in a natural manner and solely
on the interview subject’s initiative. Instead, they are often direct responses to
interview questions or prompts and therefore appear more like summaries:
“The conversational narrative is related to and inspired by the topic under dis-
cussion. Changes in topic are usually motivated by something within the con-
versation. In contrast, the question/answer rule of the interview prevents the
speaker from introducing topics of narratives” (Wolfson 1976:192). Wolfson
makes a valid point. The narrative data generated in my interviews with the
gps would look different had they been derived from private conversations be-
tween doctors and their spouses or partners, doctors and their colleagues, or
even doctors and their patients. I am not saying that those conversations would
be more “natural,” but they would certainly be less formal and would follow
different rules and principles.
 Domestic Violence and the Role of General Practice

We could object here that doctor-patient communication is also very for-

mal and highly regulated. This is true; and yet, from a gp’s point of view, the
whole situation would probably be regarded more as a professional routine in
which a doctor simply acts out his or her more or less predetermined role (Young
1997:16), while in an interview the fact that another person asks questions and
that the interview is being taped can be quite intimidating. The main differ-
ence, I think, lies in the power dynamics between the conversational partners
in these two speech situations. As Marková and Foppa point out, any dialogue
contains asymmetry as a built-in feature:

While dialogues must, by definition, be reciprocal, interlocutors

differ in their control of the content, quality and quantity of their
dialogical contributions and, consequently, equality or symmetric-
ity between them is exceptional. . . . As interlocutors set and take
perspectives, mutually construct the meaning of what they say, de-
velop intersubjective relationships and impart knowledge, they re-
duce certain dialogical asymmetries while establishing others. In
this sense asymmetries are inherent in the dynamics of dialogue.
(1991:259–60)

The interview situation becomes even more asymmetrical when interviews are
conducted with professionals. Strangely enough, the asymmetry works in two
ways: on the one hand, there is an axis going from the interviewer to the inter-
viewee, with the interviewer as the person who asks questions being in a more
powerful position; on the other hand, another axis runs diametrically opposed
to the first one from the gp to the interviewer because now the focus is on the
gp as an expert in his or her field from whom the researcher wishes to gain in-
formation. This in itself is already an interesting point for consideration, since
the aim in this study was also to find out how doctors as professionals react lin-
guistically to a topic such as domestic violence.

The Interview Frame

As indicated in the model, listener and storyteller take up their roles as inter-
viewer and interviewee, respectively, in the interview frame. These roles pre-
suppose certain situationally determined behavioral rules and expectations
with regard to the organization of turn taking (Sacks, Schegloff, and Jefferson
1974) and the choice of topics to be discussed. As Rubin and Rubin point out, a
Domestic Violence and the Role of General Practice 

“normal conversation can drift along with little goal, but in interviews, the re-
searcher gently guides the discussion, leading it through stages, asking specific
questions, and encouraging the interviewee to answer in depth and at length”
(1995:124). Both interviewer and interviewee are of course not merely actors in
a more or less clearly demarcated arena, but they also bring into the interview
frame the requirements of their social and professional roles and possibly per-
sonal and affective characteristics. Another issue is the way interviewer and
interviewee perceive each other and how that in turn influences the course of
the conversation. In their groundbreaking study on interpersonal perception
Laing, Phillipson, and Lee (1966) demonstrate how people’s perceptions of each
other are in fact the result of complex constructions and reconstructions of self-
identities (my view of myself) and meta-identities (my view of your view of me).
The interplay of self-identity and meta-identity applies to any human interac-
tion, but it comes into sharper relief in an interview, in which interviewer and
respondent consciously adopt their respective roles in the interview frame and
accommodate their speech and behavior to what they think the other person
expects of them. Accommodation theory offers a useful conceptual framework
for understanding this process. Interpersonal accommodation theory states that
speech style shifts occur among speakers “so as to encourage further interac-
tion and decrease the perceived discrepancies between the actors. The assump-
tion then is that in such situations, the speaker and the listener have shared a
common set of interpretative procedures which allow the speaker’s intentions
to be (i) encoded by the speaker, and (ii) correctly interpreted by the listener”
(Giles and Smith 1979:46–47). In other words, communication is usually based
on a common code of practice. Speakers’ styles are marked by either “conver-
gence” (i.e., “the processes whereby individuals shift their speech styles to be-
come more like that of those with whom they are interacting” [Giles and Smith
1979:46]) or “divergence” (i.e., speech “shifts away from the interlocutor’s style”
[Giles and Smith 1979:52]).
The gps’ responses are probably influenced by the fact that they wanted to
come across as knowledgeable health care professionals. Equally important are
linguistic cues that indicate that the doctors had certain expectations or made
assumptions about my expectations of them or what I thought about them as
doctors. gps clearly had the interview frame in mind when they said things like
“I’m not being very helpful here” or “My interview is probably flavored by the
 Domestic Violence and the Role of General Practice

fact that I’ve actually been asked to speak on domestic violence in pregnancies.”
Defensive answers, by contrast, might indicate that the gp felt threatened by po-
tential criticism. We must also not forget the sensitive nature of the topic. Since
interpersonal perceptions are crucial determinants of talk-in-interaction, so-
ciodemographic variables such as age, gender, occupation, educational back-
ground, and so on have to be identified, if possible, and traced in the dialogues
that emerge between people. More specifically, we can look out for hedges and
boosters as indicators of power dynamics (Holmes 1995), for example, or back
channels, self-corrections, and repairs in turn taking as means of establishing
rapport and of negotiating meaning between interviewer and interviewee.
What is also at stake here is a question of politeness (Lakoff 1977). The in-
terviewee may regard it as potentially impolite behavior to hold the floor for
too long in a conversation. As Sacks, Schegloff, and Jefferson point out, “once
a state of talk has been ratified, cues must be available for requesting the floor
and giving it up, for informing the speaker as to the stability of the focus of at-
tention he is receiving” (1974:697). If a speaker requests the floor for too long,
he or she may appear to be too demanding and ultimately lose the listener’s at-
tention. Politeness also plays an important role in interviews, since interviewer
and interviewee meet as strangers who act out specific roles. Researchers may
feel more obliged to behave in a polite manner, since they request the interview-
ees’ time and are thus granted a favor.
Another influential factor in social interaction is what Goffman calls “face-
work,” that is, “actions taken by a person to make whatever he is doing consis-
tent with face. Face-work serves to counteract ‘incidents’—that is, events whose
effective symbolic implications threaten face” (1967:12). In other words, inter-
actants make an effort to save face and to avoid threats to the other person’s
face.8 Goffman assumes that people have an inherent knowledge of the rules re-
quired for successful interaction with others, so-called social skills. Thus peo-
ple know how to evade potentially “face-threatening acts” (ftas) (Brown and
Levinson 1987). For example, interlocutors remain within the boundaries of the
set expectational frame of a social situation. Taking this as a baseline, we must
approach interview narratives with a view to identifying topics that “are part
of the officially accredited flow” (Goffman 1967:35) and those that go beyond
the interview frame. In my interviews, for example, it is worthwhile exploring
whether the gps’ responses and narratives were given in such a way as to “save”
the gps’ face and to portray them in a specifically positive manner. On the other
Domestic Violence and the Role of General Practice 

hand, we can also look at the strategies gps applied when they decided to com-
mit a face-threatening act, for example, if they challenged what they perceived
as the interviewer’s point of view. All this is considered in the analyses of the
gps’ narrative discourses in the following chapters. To illustrate the rather the-
oretical outline of mechanisms of talk-in-interaction with an example, I pro-
vide a brief discussion of an interview excerpt here to allow the reader to catch
a first glimpse of the data.

Influences of the Interview Frame on Features of

Talk-in-Interaction and the Negotiation of Identities
Anticipatory self-criticism occurs relatively frequently across the interviews,
albeit to different degrees, and it is indicative of the high level of self-monitor-
ing in the gps and of the dynamics inherent in the interaction between inter-
viewee and interviewer. It becomes clear from the data that it is extremely dif-
ficult to judge in the different instances whether the self-criticism was genuine
or whether it was used as a linguistic gesture to create a certain identity of the
“good” doctor who knows his or her limitations. Some gps, by contrast, were
quite adamant about not being concerned whether they missed domestic vio-
lence cases. The following excerpt shows the interaction between me (the in-
terviewer) and one male middle-aged gp:

J: Mm-hmm. Do you feel concerned about this, I mean . . . ?

Dr.: Only when you sit down and think about it. But, er, no [clears his
throat]. What you do, you really have got to think what you do,
you’ve got plenty of other patients as well. You know, when you
think in terms of each individual patient then yes, you’re obvi-
ously concerned. When you’ve got a surgery of twenty-five patients
to see then you’ve got twenty-five patients to think about. So,
it’s just trying to get, to get the balance. What I’m saying is,
sometimes you get the balance right, hopefully most times you
get the balance right, sometimes you don’t. {You’ve got to live
with that. You’ve got to live with that.}
J: {Yeah. Yeah. It’s like in any . . . }
Dr.: You know, you’ve just got to live with it and accept that it might
happen and hope, you know, the opportunity arrives subsequent-
ly [?] to almost remedy the situation.
 Domestic Violence and the Role of General Practice

One can see in this excerpt which discursive strategies this gp employs to “per-
suade” me of his point of view. First of all, the gp prepares himself physically to
put forward his argument by clearing his throat. Throughout the passage the gp
uses “you know” a number of times to establish a participatory framework with
me. I supported this strategy by using the back channels “yeah, yeah,” which in-
dicate to the speaker that his argument is followed by the listener. The gp’s style
is highly affirmative, as can be seen in the interjection “yes” (“when you think
in terms of each individual patient then yes, you’re obviously concerned”) and
in the numerous repetitions of the auxiliary verb “have got to,” which empha-
size the gp’s absolute and unquestionable obligation to consider all his patients
equally: “you really have got to think what you do,” “When you’ve got a sur-
gery of twenty-five patients to see then you’ve got twenty-five patients to think
about.” The argumentation is also marked by syntactic parallelism (“when you
think,” “when you’ve got,” and “sometimes you get the balance right, hopefully
most times you get the balance right”) as well as by the repetition of impor-
tant lexical items such as “balance.” In using all these discourse features the
gp creates what Tannen (1989) calls a “high-involvement style,” that is, a style
that aims at involving both speaker and listener to the greatest possible extent
in talk-in-interaction. That this strategy is successful in this example can be
seen in the speech overlap:

{You’ve got to live with that. You’ve got to live with that.}
{Yeah, yeah. It’s like in any . . . }

I tried to make a supportive comment and was so keen that I overlapped the
interviewee’s argumentation by prematurely taking up my next turn. Again,
this shows that oral narratives are contextually situated and that their linguis-
tic shape is inevitably influenced by the given situation. In my analyses I com-
ment on similar features of talk-in-interaction where they quite noticeably had
an impact on narrative construction.
Let me now turn to the actual data of my study. In the next chapter I com-
mence by presenting interview materials against which the subsequent narra-
tives are shown to deviate in content and structure.
4. Signs of Abuse
”Classic” Disclosures and Narrative Trajectories

Narrative research is sometimes criticized for focusing on certain types of data

while neglecting others. Some anthropologists, for example, are concerned that
social action may be oversimplified when interpreted in narrative terms and
that “a focus on narrative may blind the researcher to the nonverbal aspects
of meaning in cultural action” (Mattingly 2000:188). While other qualitative
methods such as grounded theory and participant observation, for example,
take into account all the data elicited and transcribed for a piece of research,
narrative research inevitably leaves out large parts of a sample in order to con-
centrate on material that is specifically narrative in nature. Some may argue,
and perhaps justifiably, that this selective approach can introduce bias into anal-
ysis and results. However, as Riessman points out, narratives “are interpretive
and, in turn, require interpretation,” while “analytic interpretations are par-
tial, alternative truths” (1993:22). I have made every effort to use all the inter-
view material where applicable rather than only the narratives on their own in
order to provide a bigger picture of what the gps had to say about domestic vio-
lence. For the same reason I also introduce what one could consider “normal-
izing” data in this chapter, that is, data from the interviews against the back-
ground of which the narratives in my sample can be demonstrated to deviate in
intriguing ways. In particular, I look at the signs and symptoms gps discussed
as relevant indicators for domestic violence issues, possible forms of disclosure
in consultations, and narrative trajectories concerning both the patient’s life
story and the story of the (non)disclosure.

Signs and Symptoms

One of the questions I asked during the interviews concerned possible signs or
symptoms that would indicate to the doctors that domestic violence might be an
issue for a patient. The gps in my sample answered this question from two per-
 Signs of Abuse

spectives: the way domestic violence came out into the open and indicators of
the problem that might not necessarily lead to disclosure. Thus, a gp could dis-
tinguish between overt and covert forms of presentation. Doctors spoke about
patients being “up front” concerning the problem or about “oblique presen-
tations,” for example. The signs or symptoms of abuse can in turn be divided
into physical or psychological ones. Physical signs like marks and bruises, bro-
ken bones, black eyes, and so on are fairly obvious unless hidden under clothes,
while psychological symptoms are harder to identify and, if identified, may not
necessarily lead to the suspicion and detection of a domestic violence back-
ground. It is not inappropriate or even immoral for doctors to go by physical
symptoms. However, in the case of psychosocial problems such as domestic vio-
lence, to go by physical symptoms alone can be detrimental, as causes of illness
may remain opaque, and therefore treatment may be ineffective. If nonphysical
symptoms are deliberately overlooked for reasons of fear, helplessness, or lack
of interest, then I think doctors’ moral stance in domestic violence cases ought
to come under closer scrutiny and be challenged. Even though we have to ac-
knowledge that general practitioners are perhaps not in a position to treat the
causes or prevent the effects of domestic violence, they are nevertheless gate-
keepers to salient help resources and as such have a moral responsibility to leave
the gates open. As I discussed in chapter 3, women might disclose domestic vi-
olence to their gps because their periodic, intimate, and physical contact offers
occasions for disclosure even without physical symptoms. Recognizing this po-
tential and working toward improvement in the health service provision to bat-
tered women is imperative if we seriously wish to tackle the problem.
The gps’ responses yield a number of results with regard to possible signs of
abuse. I conducted a type and token analysis on the interview transcripts, draw-
ing up a list of “typical” signs that recurred in the gps’ responses and for which
I counted the tokens, that is, the number of occurrences of each type, across the
interviews. For each respondent I counted each mentioned type only once, even
though some types may have been mentioned several times during the interview
or may have contained various subtypes. The types of signs are either physi-
cal or psychological. I attached general labels or headings to each subcategory,
under which I then subsumed the gps’ various responses. Thus, under physi-
cal symptoms I included physical symptoms such as the ones mentioned above
(marks, bruises, etc.); unexplained injury, that is, injuries that were not compat-
 Physical symptoms Number of Psychological symptoms Number of
mentions mentions
Physical symptoms 11 Psychiatric/psychological illness 2
(bruises, black eyes, etc.)
Unexplained injury 7 Depression 12
Physical symptoms on 2 Psychosomatic disturbances 4
children Sleeplessness 3
Nervousness, anxiety 4
Emotional problems 7
Relationship problems 8
Alcohol or drug abuse 4
Change of behavior 2
Totals: 20 46

ible with the story the patient provided or that “didn’t add up,” as one gp put it;
and physical injuries on children, which pointed toward a violent background
in the home. The psychological symptoms include psychological or psychiat-
ric illness in general; depression; psychosomatic disturbances such as stomach
pains; nervousness and anxiety; sleeplessness; relationship problems or, in the
words of one of the doctors, “domestic unhappiness”; emotional problems such
as distress, being upset, irritability, and stress in general; alcohol or drug abuse
in the women as a result of domestic violence; change of behavior; and low self-
esteem or confidence. The count yielded the figures shown in table 2.
What is interesting in these findings is that physical symptoms, although
they were mentioned by most gps (eleven gps mentioned physical symptoms,
seven mentioned unexplained injury, and two referred to physical symptoms
on children as signs of domestic abuse), are clearly outweighed by the num-
ber of psychological symptoms the gps listed (forty-six mentions of psycholog-
ical symptoms in comparison with twenty mentions of physical signs). This
shows that gps are aware of the fact that domestic abuse need not present it-
self overtly but is in fact often hidden among a range of other problems. This
could also be seen in the forms of disclosure the gps discussed. Thus, twelve
gps said that women were fairly up front if they wanted to disclose and sim-
ply admit that domestic violence was an issue, while the same number of gps
conjured up scenarios where women came into the practice with something
else, with minor problems or even presenting their children rather than them-
selves. As the gps contended, this kind of covert presentation usually went on
for some time before the actual problem came out or the women felt ready to
 Signs of Abuse

reveal their real reason for coming. Two doctors maintained that in most cases
the problem was disclosed in retrospect, often long after the actual incident,
and often at moments when the woman had already decided to leave her part-
ner, for example. Some gps mentioned as a special form of overt presentation
cases where either other members of the health care team such as nurses or
health visitors alerted the gps to possible violence or where family members of
patients reported that their mother, daughter, or other female relative suffered
abuse from her partner.
Interestingly enough, only five of the thirty-six actual narratives in the sam-
ple explicitly mention or provide examples of psychological and/or verbal abuse
(narratives 2, 7, 27, 30, 33). This stands in stark contrast to the general responses
gps offered when asked about signs of abuse. It looks as though knowledge about
signs and symptoms is theoretical and stored in a more schematized knowledge
repertoire, while the instantiations of this knowledge in narratives of practi-
cal experiences reveal a much narrower conceptual context, with an emphasis
on physical signs. In other words, while gps know about nonphysical presen-
tations, their practice experience seems to be largely founded on cases where
physical violence was an issue and where the resulting physical marks brought
that violence to their attention or facilitated the woman’s disclosure. As one
young male gp commented:

1. Well, sometimes you just get an inkling that there’s, you know,
relationship problems through, er, what the patient actually tells
you herself, you know, they usually, invariably they’re open in say-
ing, you know, “my husband,” or, you know, “he has hit me in the
past.” And they’re, they tend to be more on the timid side when they
present like that, um, whereas the ones [laughs] who come in with
black eyes and things tend to be the aggressive type.

Put differently, women who present physical injuries are more likely to disclose
violence, as the signs are obvious to the gp, whereas in cases with nonphysical
signs the abuse may go unnoticed unless the woman opens up. The following
response by a young female gp is telling in this respect:

2. Um, occasionally you come across funny bruises and things, very
occasionally that would happen. Um, it’s more likely to be some-
body who’s coming in feeling stressed and depressed and when you
Signs of Abuse 

ask more about it, um, they may hint and then you can enquire fur-
ther, but some of them will come in and tell you, you know, it’s their
husband or whatever, but not many.

This gp clearly identifies psychological or emotional problems as triggers for

suspicion, but again, unless the woman is prepared to volunteer further in-
formation (“they may hint”), domestic violence may not be established as the
cause of these problems.
Even when there are physical signs, women may not be willing to open up.
One late-middle-aged male gp, when asked about indicators, responded:

3. Well, the type of injury, obviously, and the circumstances the pa-
tient comes in, that they’d been nervous, not willing to, er, go to
casualty, er, not willing to discuss how the injury came about or
they give you some daft story, or there’s more than one person in
the household who’s got bruises, like the child, if there was a child,
that’s what I think, there’s lots of, just if there was a change of be-
havior in the patient as well to a certain extent, um, er, you know,
these things are all, they’re just indicators. There’s nothing, unless
somebody says that they’d been assaulted you can’t be a hundred
percent certain of anything, can you?

Does this uncertainty warrant gps’ lack of action or reluctance to probe the is-
sue further? The following response by a middle-aged female gp suggests that
doctors might indeed act along the lines of such reasoning:

4. I mean, yeah, I mean I’m, yeah, I think, um, if it’s someone you’re
seeing a lot and, you know, you’re, you feel you’re just on the brink
of something, there’s times where obviously you think this is go-
ing to just cause ripples. And, and, yeah, I mean I think you’re al-
ways [?] you’ve got to feel that they’re ready to deal with it as well
’cause, er, you know, if you challenge patients about it they may not
be ready to face what you’re, what you’re saying ’cause of the way
they’ve been living so, I think, if, if they come up with it, it’s differ-
ent. If you’ve got a hunch then you’re probably waiting to pick up
the right cues about when is the right time. If you don’t think it is, I
think you would, you know, in a way we collude with them slightly, I
 Signs of Abuse

think, until they’re ready to talk about it because it may make things
worse if you challenge someone that, you know, “I think this is hap-
pening at home. Do you want to tell me about it?” They may never
come back if, you know, if you challenge them at the wrong time
and I think it’s, it’s, it’s, difficult ’cause you might be wrong even
when you decide to talk about it but I think you’ve got to maybe
try and pick up when they’re ready. And, to be honest, it seems to
be more when there’s a crisis and then they come to you and then
you can say, “Well, you know, I’m really glad you, you said that. I’ve
had a suspicion but I wanted to wait for, for you to tell me,” so, you
know, that, that’s, that tends to be the pattern. Mmm.

This response already raises a number of issues that I address in more detail in
the subsequent chapters, issues concerning agency, responsibility, moral im-
plications, anxiety, doctor-patient relationship, sensitivity, time, role defini-
tions, and so on. The response thus also shows that disclosure of domestic vi-
olence in general practice is a highly complex topic and that in order to even
begin to understand its complexity we have to pay closer attention to the inter-
play of the issues involved. It is not least for this reason that a narrative inves-
tigation into the discursive encoding and construction of domestic violence in
general practice is a suitable method, as it allows a gp to attend to particular-
ities in life experiences and, more important, to the affective side of such par-
ticularities. This can be seen, for example, in the last gp’s reenactment of part
of a (fictive) consultation by means of direct discourse, which is a feature that
recurs frequently throughout the interviews and in the narratives in particu-
lar. By using direct discourse the gp brings the doctor-patient encounter to life
within the interview and thus emphasizes her own emotional state, which she
imparted to her patient in the consultation and later indirectly to me, the in-
terviewer: “I’m really glad you said that.”

“Standard” Scenarios
The response in (4) is also interesting as it relates a scene of disclosure that this
gp considered common or, as she said, that “tends to be the pattern.” Other gps
made similar statements about “standard” presentations. Consider the follow-
ing responses:
Signs of Abuse 

5. a. Some will come up very up front [fortunately ?], saying that

they’ve been beaten up. Some will do the classic introduction that
they come with something very minor

b. [Sighs] I suppose one of the classical indications from a gp’s

point of view is, er, a pattern of unexplained and recurring, er, in-
jury. Um, possibly a, either in addition or separately, a history of,
er, emotional, oblique psychiatric illness, um, or unexplained psy-
chosomatic, er, conditions. Er, relationship problems in the home,
particularly with the children, er, someone becoming more intro-
spective, er, these are some things that might alert me. [Only] still
the best one, I think, is possibly a pattern of [?] unexplained or badly
explained, er, injuries.

c. Um, [pause] I’m trying to just think back, um, the things I’ve
seen, er, very often it’s, rather than being an acute situation and
someone’s been, been attacked, er, it may come out in, you know,
later, later discussions of, where they’re presenting with some sort
of emotional distress, um, I think that’s, that’s a normal, the nor-
mal sort of way we come, get to know about it. Occasionally people
come in and present their, their bruises but, er, yeah. Um, there’s,
[there are], usually it’s wives involved, there, I think there’s the odd
occasion of a, er, er, some older people being, being, well, claiming
they’ve been attack—— or alleging they’ve been attacked by rela-
tives. That sometimes happens so, but, er, as I say, but it, la——,
largely it’s just in, in retrospect rather than at an acute stage.

d. Okay. It’s usually, I would say, usually one of two ways, er, it, it
can present. It may be that the woman turns up at the surgery with
an appointment, er, either on an urgent basis or as part of a routine
appointment, and will usually in the course of the consultation say
that she wants to, um, confide that she’s been abused. Um, often it
isn’t the first time that they discuss it, they will often come in maybe
later on in the consultation, um, and in that situation, obviously,
um, we listen, we record what happened, we record any injuries, I
um, and the other way that, er, that they present is in retrospect
 Signs of Abuse

through the solicitors, when we get a letter in from the solicitor

saying that this lady perhaps wants a divorce or is gonna be sepa-
rated from her husband on the basis that he’s been violent towards
her and can we provide any record of that and, sometimes we have
a record of that incident and [if] we don’t, um, so, ach, that’s prob-
ably one of the commonest way it presents.

e. I mean the other thing which is fairly straightforward is if you

have evidence of physical violence and they come for that and they
say: “Oh, I ran against the door.” Typical thing to say when they
have got a black eye and I’ve never seen, you don’t get a black eye
from running against the doors, it’s just mechanically not really
possible.
J: Yeah?
Dr.: Yeah. Um, then, but then it would be obvious very often, I
don’t think that, that patients very often present with that. Then it’s,
but then it’s [virtually] straightforward although I could imagine
that then there might be a temptation for gps to overlook that and
take the evidence at face value and, and send them away because it’s
more convenient than touching on the, the underlying thing.

f. Um, but mostly it’s, it’s the, the scenario that things aren’t, that
the patients have said things aren’t going well and they’ll tell you
that the, their partner sometimes hits them, say, when they’re drunk
or, or that sort of thing. Sometimes they’ll tell you in retrospect,
you know, that they’ve left him because obviously he was just “lift-
ing the hand,” that’s always what they say up here. “He was lift-
ing his hand and, um, that’s why I left.” And, um, that’s quite com-
mon as well that they sometimes don’t want to tell you actually at
the time. Sometimes they do.

Given these responses, “common” presentations of domestic violence cases

seem to include one or more of the following features: covert presentations,
whereby the women come to the practice allegedly for some other reason, as
in (5a) and (5d); physical symptoms that remain unexplained or for which the
women make up a false story, as in (5b) and (5e); violence disclosed in retro-
spect rather than at an acute stage, as in (5c), (5d), and (5f); overt presentation,
Signs of Abuse 

where the woman voluntarily broaches the topic, as in (5f). I must add the ca-
veat that it is very difficult to gauge what exactly a “standard” presentation of
domestic violence in general practice is, as the concept will always be based on
what gps and patients tell an interviewer rather than on observed doctor-pa-
tient consultations. Thus, “standard” presentations are themselves discursively
constructed concepts, just as domestic violence itself is to a certain extent dis-
cursively and culturally constructed. In the above examples this can be seen in
the use of euphemisms such as “lifting the hand” (5f) and in redefinitions of
violence such as “ran against the door” (5e).
What is intriguing with regard to more global narrative structures, how-
ever, is the fact that only a few of the gps’ narratives of real practice encounters
with domestic violence victims follow the pattern of the “standard” scenario
the gps discussed elsewhere in the interview. As the analyses in subsequent
chapters demonstrate, many of the narratives, albeit not all of them, depict
cases where the violence was not presented in retrospect but at an acute stage
when the physical symptoms played a major part in detection and treatment.
In fact, a number of gps related incidents they had come across while working
in emergency rooms rather than in general practice. Other narratives depict
surprising and unexpected disclosures after lengthy periods during which the
gps were unaware of the possibility of domestic violence. This combines co-
vert presentation with disclosure in retrospect, albeit with a rather passive part
played by the gp. Yet other narratives do not deal so much with the disclosure
itself as with the pangs of frustration and helplessness gps experienced once a
domestic violence case had come out into the open and they felt inadequately
equipped to deal with it. In other words, what is also missing in much of my
data is “hero stories,” that is, narratives about successful encounters between
doctors and battered women.
One of the problems underlying this finding, I contend, is a general mis-
match of narrative trajectories. Young observes that “physicians characteristi-
cally treat storytelling as an interruption of, distraction from, or incursion into
the realm of medicine” (1997:68). In cases of domestic violence the narrative
trajectory of the woman’s life story often does not overlap with or sufficiently
feed into the trajectory of the medical consultation, that is, the story of the
encounter between doctor and patient within the practice environment. This
undoubtedly also has to do with cultural expectations of what can be told in
 Signs of Abuse

certain situations. Frank points out for illness narratives in general: “From their
families and friends, from the popular culture that surrounds them, and from
the stories of other ill people, storytellers have learned formal structures of nar-
rative, conventional metaphors and imagery, and standards of what is and is not
appropriate to tell” (1995:3). Thus, women may feel that it is not appropriate to
tell their gp about their abusive relationship, especially if the gp does not give
the impression that he or she is receptive to such a narrative.

Narrative Trajectories
The term “narrative trajectories” is widely used in the study of life narratives
and biographies. Some of the most prominent representatives in the field are
Anselm Strauss and Barney Glaser. I mainly draw upon the work of the German
sociologist Fritz Schütze (1981, 1983), whose research is informed by Strauss’s
and Glaser’s work. Schütze defines social trajectories as very dense, conditional
(but not intentional) chains of events that display a global sequential structure
(1981:90–91). The sequential order of events implies changes in features and def-
initions of situations of the social unit under investigation, whereby its self-def-
initions play an important role. This social unit could be an individual person,
a group of people, or an organization. Negative trajectories restrict our possi-
bilities for action and development, while positive trajectories open vistas for
action and development on the grounds of enhanced possibilities for new so-
cial positionings. Action in these concepts is tied to heteronymous conditions,
which either increase and thereby cause the social subject to lose control or de-
crease and thus augment our power of action. At certain points in life trajec-
tories we can identify action schemas (i.e., ways people deal with given situa-
tions), which have an impact on the progress and direction of these trajectories.
Thus, we can talk about initiation, reversal, control, interpretation, normal-
ization, and end. These action schemas can be in the hands of the social indi-
vidual or people in this individual person’s social surroundings, for example,
friends, family, and colleagues.
Illness narratives can also be analyzed with regard to their trajectories and
their impact on wider life trajectories. Frank (1995), for example, describes pat-
terns of illness narratives in terms of a range of plot lines: the “quest narrative,”
the “restitution narrative,” the “chaos narrative,” for example. A problem arises
in doctor-patient interaction, Schütze argues, when the professional, that is,
Signs of Abuse 

the doctor, does not leave room for the patient’s hesitation in decision taking
(e.g., with regard to treatment options) and thus infringes on the patient’s au-
tonomy for action:

Geht der Professionelle—gerade aus technologisch orientierten Ra-

tionalisierungsvorstellungen heraus—nicht in dieser Weise auf die
Entscheidungsautonomie des Klienten ein, wird die handlungs-
schematische Aktivitätsstruktur des Klienten als betroffenen Bi-
ographieträger vollends gebrochen. Er wird dann zu einem pas-
siven Objekt professionellen Handelns degradiert, das in den Han-
dlungsvorgaben des Professionellen nur noch gehorchen, reagieren
und erleiden kann, dessen Eigenaktivitäten also überhaupt nicht
mehr adäquat unter dem Leitgesichtspunkt intentionalen Handelns
analysieren [sic] werden können. (Schütze 1981:87)
[If the professional, for reasons of technologically oriented con-
cepts of rationalization, does not thus take notice of the client’s au-
tonomy in decision taking, the structure of the client’s action sche-
mas as the person telling his or her biography is disrupted. He or
she is then downgraded to a passive object of professional action
who can only listen to, react, and suffer within the action rules set
up by the professional and whose own activities can therefore no
longer be adequately analyzed under the main aspect of intentional
action. (my translation)]

In other words, if patients’ biographies and life stories are pressed into a tem-
porally and narratively restricted professional framework such as the consulta-
tion, the patient’s autonomy regarding the telling and shaping of his or her life
story at this point is also limited. The same applies to consultations in which
domestic violence is an issue. Battered women bring to the consultation a whole
gamut of experiences, their personal life trajectories, which may not fit into the
somewhat limited trajectory of the medical encounter. In order to illustrate this
point I discuss the problem of narrative trajectories in greater detail in one of
the narratives of my sample.

The “Cloak-and-Dagger Stuff”

Six of the thirty-six narratives in my sample tell stories of women who man-
aged to leave their violent partners. Thus, in narrative 32 the woman eventually
 Signs of Abuse

“got rid of her boyfriend”; in narrative 6 it was the danger for the child that fi-
nally made the woman leave her violent partner; in narrative 25 an older woman
moved away from home after many years of violence; narrative 36 relates the
story of a patient who had already contacted a lawyer because she was planning
to sue her husband (although the outcome of this is never established in the
narrative); and narratives 10 and 12 relate stories in which the women went to
hostels. Let us take a closer look at one of these “success stories”:

Narrative 10
1. =Oh, I do remember.
2. I do remember.
3. An amazing case.
4. Yes, I had an amazing case in casualty once when, um,
somebody had, um,
5. that was a long time ago,
6. somebody had come in
7. and obviously had been, you know, really quite badly beaten
up
8. and was terrified to, to go home.
9. And her partner arrived in casualty at the front door,
demanding to see her.
10. Um, and we didn’t know what to do really
11. and what we did,
12. we phoned Women’s Aid
13. and we spoke to this amazing lady who has now retired.
14. She was a, a professor’s wife at the hospital, um,
15. and she arranged everything.
16. And she, it was almost as the cloak-and-dagger stuff,
17. she appeared in the back door and smuggled this woman out.
18. Then she went to the hostel.

The narrative relates a consultation in an emergency room. Even before she starts
her narrative the gp evaluates it by calling the case “amazing,” which she rein-
forces later in the narrative by likening what happened to the “cloak-and-dag-
ger stuff.” This is interesting, as it suggests that, first, helping a woman escape
her violent partner is not something doctors normally do and, second, the res-
Signs of Abuse 

cue was experienced by the gp as something almost “unreal,” or like an adven-

ture story found on tv or in popular fiction. The overall structure of the narra-
tive coincides with what we could classify as the commonly expected narrative
trajectory in medical encounters: presentation, treatment, cure. Thus, the ori-
entation sequence in lines 1 to 8 not only provides background information on
time (“a long time ago”), place (“in casualty”), and characters (“I” and “some-
body”) but, medically speaking, presents a case, typically through physical
symptoms: the woman was “really quite badly beaten up” (line 7). In the com-
plicating action sequence in lines 9 to 14 the medical staff, faced with the vio-
lent partner’s threatening intrusion, take action to help the woman: “we phoned
Women’s Aid and we spoke to this amazing lady” (lines 12 and 13). This parallels
the process of “treatment” in medical encounters. The result of this “treatment”
is “cure”: thus, in the narrative’s resolution, the doctors manage to “smuggle”
the woman out of the hospital and help her move into a hostel and leave her vi-
olent partner. Admittedly, the comparison is flawed, as it is not, strictly speak-
ing, “medical” intervention that helps the woman in the end. Furthermore, we
do not learn whether the woman stayed in the hostel or what happened to her
after that. This is exactly where the problem for medical narratives surfaces:
the lack or insufficiency of the woman’s life story for the doctor.
In narrative 10 we learn nothing about the woman’s previous life and the cir-
cumstances of her violent relationship. What was her socioeconomic situation?
Did she have friends and family? What was her relationship like? Were they mar-
ried? How did her partner abuse her? Likewise, there is no information on what
happened after the woman went to the hostel. Did she find herself a place of her
own? Did her partner leave her alone or threaten her? Did she divorce him (if
they were married)? Did she go back to him? It is this lack of additional infor-
mation about the women’s life stories that makes the gps’ narratives an unsat-
isfactory genre. Put differently, the lamination of the narrative trajectories of
the women’s stories and the medical narrative trajectories is mostly incomplete.
This incompleteness, I argue, underlies much of the problems general practitio-
ners encounter in consultations where domestic violence is an issue.
We might object here that the lack of additional information about the woman
can be attributed more to the fact that this narrative was told in an interview
rather than to problems underlying doctor-patient conversation. However, Trinch
(2003) demonstrates how battered women’s stories are transformed in institu-
tional settings—in her study, legal institutions—in order to fit the fairly rigid
 Signs of Abuse

genres of affidavit and protective order application. Trinch contends that “this
imposition of one genre on the other causes fragmentation in women’s stories
that leaves them open-ended and even vulnerable to discrepancy” (2003:215).
As the analyses of the narratives in this book show, it is precisely the discrep-
ancy between divergent teleological directions of the women’s and the doctors’
stories in addition to inherent differences in the framing and fashioning of the
narratives themselves that lead to difficulties in doctor-patient relationships
concerning the disclosure of domestic violence, as I mentioned in chapter 3. In
the following chapters I demonstrate to what extent gps’ telling of their stories
within a biomedical framework, their discursive constructions of space and
time, of agency and role definitions may impede successful outcomes of con-
sultations with women suffering domestic abuse.
Before I move on to more detailed analyses, however, let me introduce briefly
another narrative from my sample that stands out in terms of its overall struc-
ture and with regard to its component narrative trajectories.

Narrative 30
1. She, well, she’s interesting.
2. She’s a schiz——, she’s labeled as a schizophrenic
3. but she’s not, she’s not really, she’s not, er, particularly bad in
that way
4. and she lives, um, in a flat she has bought
5. and she has a partner who she wants to get out of the flat, who’s
really ins——, er, installed himself in there and [has lived] there
for a number of years
6. and, um, he, er, er, he’s, er, mentally and physically abusive to-
wards her
7. and, um, he really just, er, pushes her around
8. and makes her do all the shopping,
9. he makes her carry everything,
10. he turns off all the lights and the telly when he wants it off,
11. he changes the tv program if he doesn’t like it on,
12. and he resorts to physical violence
13. and, and she came in the other week, last week, with a big black
eye and some bruising
Signs of Abuse 

14. and then I had a chat with her about it

15. and, er, [she felt ashamed]
16. and then, before I suspected it
17. I’d never actually known that he’s been physically abusive
18. but, er, she obviously is unhappy with him
19. but can’t get him out of the flat.
20. He pays rent
21. and he’s fairly, er, aggressive [?].
22. She likes to watch some television program,
23. he prefers if she puts it, the, the nasty, aggressive things on the
telly.
24. So she’s in a bit of a dilemma
25. and, being mentally unwell, she, she hasn’t worked for a num-
ber of years,
26. she doesn’t have, um, she, she’s not very skilled at times to or-
gani——, to manage this situation.
27. She does have support from the cpn [clinical psychiatric
nurse]
28. but I don’t think, er,
29. it’s very difficult to know how best to help her actually ’cause
30. I said to her last week she should go to, to seek legal advice.
31. I suggested that she maybe goes to the Citizens Advice first to
get some help with that.
32. She’s not, well, financially, she’s badly off
33. so she’s worried about all sorts of legal fees.
34. I suggested to her that one option might be to come out of the
flat and seek refuge
35. and then [the Citizens Advice section] will get him out
36. but she understandably is reluctant to do that because it’s her
flat,
37. she actually pays the mortgage
38. and he pays her rent.
39. That’s pretty minimal
40. but he does.
41. So she’s in a very unhappy situation
 Signs of Abuse

42. and she really doesn’t want to get involved with him
43. but she can’t get rid of him.
J: All right. But she was fairly up front about the {problem?}
Dr.: {Very, yeah.}
44. Well, I’ve known her for quite a, about ten years or so, she
45. and, er, with her schizophrenic illness it’s taken awhile getting
her to talk about things
46. but she’s actually quite well from that point of view,
47. she’s not psychotic at all at the moment
48. and I don’t think, er, that’s an issue.
49. I think there’s an issue in that she is not very good at managing
the situation and,
50. and she’s, and she’s not working,
51. she’s only forty-six
52. but she’s not working.
53. She has no other financial, er, input of actual benefits.
54. Um, but I mean it was obvious when she had the black eye that,
that she’d been assaulted
55. but she was quite moved from that how it happened
56. and she did say this wasn’t a new thing,
57. it happened several times in the past.

Narrative 30 obviously does not represent a typical Labovian oral narrative.

First of all, it employs both present and past tense rather than only the more
common past tense, and it also deviates from the diamond pattern in that its
overall structure is cyclical and repetitive, which makes the narrative much
longer. I have marked the parts that can be considered the “narrative proper”
about the consultation in bold type to illustrate its fragmentary and repetitive
nature. The protagonist of the story had already been briefly mentioned ear-
lier in the interview, which accounts for the fact that the gp starts his narrative
with the anaphoric personal pronoun “she.” The lengthy orientation section in
lines 2 to 6 provides background information on the patient’s schizophrenic ill-
ness, her relationship, and her violent partner. Interestingly enough, this back-
ground information is supplemented and thus made more vivid by a list of ex-
amples of domestic violence as perpetrated by the patient’s partner: “he really
just, er, pushes her around and makes her do all the shopping, he makes her
Signs of Abuse 

carry everything, he turns off all the lights and the telly when he wants it off, he
changes the tv program if he doesn’t like it on, and he resorts to physical vio-
lence” (lines 7 to 12). What strikes us as unusual here compared to all the other
narratives in the sample is the amount of detail with which the gp depicts do-
mestic violence. Physical violence appears as only one form of abuse among a
whole range of mainly emotional types of violence, which indicates that the
doctor acknowledges not only the physical or “medical” side of the patient’s
problem but also the emotional and mental implications, as can be seen in the
gp’s own classification of the partner’s violence: “he’s, er, mentally and physi-
cally abusive towards her” (line 6, my emphasis).
Information about the patient’s background is repeatedly and extensively
brought up in the narrative (lines 18–21, 24–27, 32–33, 36–43, and 44–53), and
it centers around the following major themes: the patient’s schizophrenia, her
resulting lack of ability “to manage the situation” (line 26), which ties in with
the woman’s unemployment and thus her financial dependence on her violent
partner. Although other doctors in the sample also mentioned women’s deviant
behavior as part of domestic violence, whether as a reason or a consequence, this
doctor is very cautious when talking about his patient’s illness. The self-repair
in line 2 indicates a high degree of self-consciousness in the interview as well
as an awareness of the problem of labeling: “She’s a schiz——, she’s labeled as a
schizophrenic.” Instead of immediately attaching the label “schizophrenic” to
his patient, the doctor metalinguistically refers to labels, and he explicitly em-
phasizes several times during the narrative that the illness is not an issue for the
patient and, more important, that it does not relate causally to the violence the
woman suffers: “she’s not, er, particularly bad in that way” (line 3); “but she’s
actually quite well from that point of view, she’s not psychotic at all at the mo-
ment and I don’t think, er, that’s an issue” (lines 46–48).
Where the gp draws a causal connection, however, is between the woman’s
illness and the fact that she does not work, which, in turn, contributes to her fi-
nancial dependence on her partner and her inability to cope with the situation.
The causal relationship is linguistically conveyed through the close collocation of
clauses expressing these aspects: “being mentally unwell, she, she hasn’t worked
for a number of years, she doesn’t have, um, she, she’s not very skilled at times to
organi——, to manage this situation” (lines 25–26); “I think there’s an issue in
that she is not very good at managing the situation and, and she’s, and she’s not
 Signs of Abuse

working, she’s only forty-six but she’s not working. She has no other financial,
er, input of actual benefits” (lines 49–53). The financial situation is mentioned
as a crucial factor that hinders the woman from leaving her violent partner or
getting him out of her flat. Again, the clauses used to describe the situation are
strikingly similar and repetitive: “she has a partner who she wants to get out of
the flat, who’s really ins——, er, installed himself in there” (line 5); “she obvi-
ously is unhappy with him but can’t get him out of the flat. He pays rent” (lines
18–20); “she understandably is reluctant to do that [i.e., leave the flat] because
it’s her flat, she actually pays the mortgage and he pays her rent. That’s pretty
minimal but he does” (lines 36–40); “she can’t get rid of him” (line 43). What
emerges is a fairly complex picture of a relationship in which both external and
internal pressures keep the woman from leaving her partner.

Detail and Narrative Trajectories

The fact that this gp has such detailed knowledge of all the circumstances so
that he is able to relate them in an elaborate narrative indicates two things: first,
the woman’s own narrative must have been very elaborate, which shows that
there must have been sufficient time for narrative production in the consulta-
tion; second, the gp displays great interest in his patient’s case and the under-
lying circumstances because he considers them “reportable” enough to pres-
ent them in the interview to such an extent. The woman’s narrative trajectory
was projected into the consultation and was then to some extent mapped onto
the interview I conducted with the gp. The gp even displayed awareness of the
patient’s feelings during the consultation: “she felt ashamed” (line 15); “she
was quite moved from that” (line 55). The actual narrative about the consulta-
tion during which the patient finally opened up about her problem is thus en-
riched by an array of circumstantial information that is missing from most of
the other narratives. Interestingly enough, however, the narrative proper here,
which also stands out through the use of past tense, shares more common fea-
tures with the other narratives. The core of the story is the gp’s surprise when
he hears for the first time that domestic violence occurs in the woman’s rela-
tionship: “and then, before I suspected it, I’d never actually known that he’s
been physically abusive” (lines 16–17). It is astonishing that this comes out af-
ter the woman has lived with her partner “for a number of years” (line 5), and,
as in some of the other narratives, the trigger for disclosure is a physical sign of
Signs of Abuse 

abuse: “and she came in the other week, last week, with a big black eye and some
bruising” (line 13). Physical signs thus again appear to be more easily identifi-
able in general practice and are more likely to raise suspicion in the gp. They
form part of the typical “story skeleton” (Schank 1990) of most of the gps’ nar-
ratives in my sample. Nevertheless, narrative 30 differs from most of the other
stories in that it allows for the unfolding of the trajectory of the woman’s life
story within the medical narrative trajectory.
We can speculate now to what extent this may further sensitize the gp or
make him more alert in future consultations. I venture to argue here that the
more scope is given to women’s life narrative trajectories within consultations,
the more likely disclosure of domestic violence is to take place. As far as doc-
tors’ narrative knowledge about domestic violence is concerned, this also im-
plies that the more complex gps’ story skeletons about domestic violence cases
are, the more knowledge these gps will be able to retrieve in another consulta-
tion where this knowledge may become relevant. However, as I said earlier, most
of the narratives in my sample present a different picture. It is to these narra-
tives that I now turn in greater detail.
5. Setting the Scene of Abuse
Metaphors and Spatiotemporal Mapping

In this chapter I investigate how gps linguistically create spatiotemporal and

other metaphorical frameworks for their narratives and to what extent these
frameworks indicate mental images that reveal the gps’ perceptions and defi-
nitions of domestic violence, on the one hand, and of their own work in gen-
eral practice, on the other. I present how gps verbalize their encounters with
domestic violence victims in the consultation room and in what ways time and
space influence their relationships with patients.
Metaphorical language has been a central point of discussion ever since Ar-
istotle’s poetics, and opinions on the purpose and functioning of metaphors
have been diverse. Scholars from a variety of disciplines such as literary stud-
ies (Birus 2000; Wellberry 1997), linguistics (Ortony 1993), cognitive science,
anthropology (Celi and Boiero 2002), and language philosophy (Stern 2000)
continue to contribute varied and fascinating insights into both the use and
meaning of metaphor. I adopt Turner’s definition of metaphor: “Metaphor con-
sists of the employment of an attribute of a given semantic domain as a predi-
cation or representation of an attribute of a different domain, on the basis of a
perceived similarity between the two attributes” (1991:121). The concept that is
expressed in different terms is often called the “tenor” or “topic”; the term that
expresses it is called the “vehicle.” The perceived similarity or common quality
underlying both expressions is sometimes referred to as tertium comparationis,
that is, the “third [element] of the comparison.”
Like narrative, metaphor can be considered from a realist perspective as orig-
inating from a process of “resonating to perceptual information in the world”
(Dent-Read and Szokolszky 1993:227), or it can be defined in constructionist
terms as “a sui generis mode of giving form and identity to the otherwise in-
choate experience (at least, experience of self-identity) of phenomenological
Setting the Scene of Abuse 

subjects” (Turner 1991:126). In other words, metaphors are rooted in the “real
world” to the extent that tenor and vehicle are usually derived from existing and
well-known things or concepts. On the other hand, metaphors construct new
and often multiple meanings and thereby invite interpretation. Stern points out
that “it is our semantic knowledge of the character of a metaphor that enables
us to express knowledge and information by the metaphor in addition to that
expressed in its (propositional) content (in context)” (2000:261). Metaphors
may thus convey attitudes toward and feelings about a given issue. As Kirmayer
maintains, “each type of trope achieves its effect by presenting the listener with
information that can be used to construct some set of implications that are rel-
evant to the speaker’s implied intentions” (2000:177). If one follows this line of
reasoning, it should become clear why an investigation into the use of meta-
phors in gps’ discourse on domestic violence is essential: not only do the meta-
phors doctors use to describe victims and perpetrators tell us something about
their (unconscious) attitudes toward and feelings about these people, but the
same metaphors may give us an indication of how these doctors perceive their
own embodiment in their professional domain, which may in turn point to-
ward ways in which they interact with their patients on a day-to-day basis. After
all, metaphors may well become “self-fulfilling prophecies” (Lakoff and John-
son 1980:156) in the sense that people accommodate to the “truth” and the co-
herent experience they perceive in these metaphors.
Some scholars have focused on the cognitive dimension of metaphor. Thus,
Lakoff and Johnson (1980) maintain that human thought processes are largely
metaphorical, and Lakoff’s (1993) concept of “cross-domain mapping” cap-
tures the process by which people comprehend one mental domain in terms of
another. Lakoff defines the term “metaphorical expression” as “a linguistic ex-
pression (a word, phrase, or sentence) that is the surface realization of such a
cross-domain mapping” (1993:203). Metaphors therefore determine to a large
extent our understanding of the world, as Lakoff and Johnson maintain: “What
is real for an individual as a member of a culture is a product both of his so-
cial reality and of the way in which that shapes his experience of the physical
world. Since much of our social reality is understood in metaphorical terms,
and since our conception of the physical world is partly metaphorical, meta-
phor plays a very significant role in determining what is real for us” (1980:146).
 Setting the Scene of Abuse

The assumption is that metaphoricity is out of awareness and therefore indica-

tive of unconscious dispositions, which in Lakoff and Johnson’s model of em-
bodied reality consist of body sets. In other words, the roots of metaphor can
be found in the body and one’s experiences of physical processes. Thus, for ex-
ample, it is very common for people to say “I feel low” or “down” when their
overall emotional state is negative because this state is associated with a slop-
ing physical posture, while to feel good can be expressed in statements such as
“I’m on a high today,” a feeling that goes along with an upright body position.
What is at stake here is that originally spatial terms have come to be used for
the expression of emotional states.
This cognitive view of metaphor is useful and makes sense on introspec-
tion of our own use of language, yet we must not forget that metaphors are also
culturally and socially situated and are ultimately expressions of culture. Even
seemingly “obvious” concepts such as time and space are in effect culturally
constructed. The ethnographic works by Sapir and Whorf provide early ex-
amples of the ways different cultures conceptualize and, consequently, verbal-
ize time and space differently. Metaphors furthermore need to be considered
more locally within the discourse context out of which they emerge. As Cam-
eron points out, “processing metaphorical language takes place in context and
draws on the discourse expectations of participants” (1999:25). Since “it is pre-
cisely the interaction between the cognitive and social in language use that pro-
duces the language and behaviour that we observe and research” (Cameron
1999:4), I take the interview and cultural contexts into account where possi-
ble in my analyses.
Metaphors are also frequently found in narrative language, since they offer
ways of expressing something differently and less directly. As Prickett points
out in his study on religious and scientific “narratives” produced over the last
three centuries, “the magic of language allows us to formulate metaphors for
aspects of reality that cannot, and never will be, either perceived or directly
approached. . . . Descriptions of something we have not seen rest on analogies
with things we have seen: the first atom bomb was ‘brighter than a thousand
suns.’ . . . Every metaphor we use . . . is founded on just such a process. They
are all of them, in effect, little narratives” (2002:226–27). Metaphors thus pres-
ent narrative possibilities. Kirmayer contends that we can articulate ourselves
through metaphor “without appeal to elaborate stories of origins, motives, ob-
Setting the Scene of Abuse 

stacles, and change,” and metaphors thus “may function as gestures toward a
story that is not taken up and completed or as reminders of a story that is al-
ready authoritative” (2000:155). As I demonstrate below, the reduction of po-
tential narratives to metaphorical expressions can also become problematic in
the gps’ discourse on domestic violence.

Spatiotemporal Metaphors
Since spatial imagery forms the foundation of much of metaphorical language
in English, I dedicate a considerable part of this chapter to the analysis of such
imagery. When people experience the world they are inevitably confronted with
the dimensions of time and space. Without a knowledge of space, for example,
we would not be able to fulfill seemingly simple tasks such as doing the shopping
or getting to our workplace or, more generally, finding our way around places.
Downs and Stea refer to people’s organized representations of some part of the
spatial environment as “cognitive maps” (1977:6), that is, mental images of the
environment that have been transformed into, for example, sketch maps show-
ing the route to our house, travel brochures, a list of places we consider danger-
ous, and children’s drawings of their houses and neighborhoods. “Cognitive
mapping,” by contrast, is the dynamic thought process by which such mental
images and models are conjured up, and it is vitally important in the sense that
it enables people to know where to go and how to get there. However, cogni-
tive mapping encompasses more than simply a means of orientation. Downs
and Stea point out that “in some very fundamental but inexpressible way, our
own self-identity is inextricably bound up with knowledge of the spatial envi-
ronment. We can organize personal experience along the twin dimensions of
space and time” (1977:27). In other words, notions of time and space are neces-
sary in our lives because they help us structure mentally not only the environ-
ment in which we live but also our everyday experiences of events, encounters
with other people, and so on.
If space and time pervade our lives to such an extent as to be vital for our
survival, we can assume that space-time parameters are also essential in per-
sonal narratives, which are often related to capture and order our life experi-
ences. Herman argues that “such cognitive mapping is fundamental and oblig-
atory for narrative understanding, not a derivative or optional aspect of telling
and comprehending stories” (2001:518). Narratives are set within and, at the
 Setting the Scene of Abuse

same time, create a certain “spacetime region” (Herman 2001), that is, the in-
cidents related in narratives are located spatially and temporally, and this spa-
tiotemporal grid is linguistically conveyed to the listener. In the gps’ narratives
mainly two locations can be identified: first, the practice environment where
the consultation takes place; second, the setting or scene of a violent incident
in particular or of violence in general.
Time, the second component of spatiotemporal maps, has received consid-
erable attention from scholars in the social sciences and in narrative research.
Labov regards time as one of the most important structural features of oral nar-
ratives. He maintains that narratives directly reflect the order of the experienced
events in their sequential ordering of clauses: “Narrative, then, is only one way
of recapitulating this past experience: the clauses are characteristically ordered
in temporal sequence; if narrative clauses are reversed, the inferred temporal
sequence of the original semantic interpretation is altered” (Labov 1972a:360).
Since, as Herman contends, the study of narrative is “also an inquiry into how
modes of storytelling—in particular, strategies for ordering—help shape peo-
ple’s intuitions about what is and what is not the case” (2002:235), the investi-
gation into the time frames of the gps’ narratives presents itself as another im-
portant research question.
The gps’ narratives, while themselves located in the given time frame of the
interview, also functioned as windows to wider timescapes that constituted the
background to their stories of abuse. This is a common feature in oral narra-
tives, as Laurier points out: “Narrative in talk although not detachable from its
present situation is part of a shifting out of a narrow and strongly contingent
present tense of a conversation to a wider time span that may embed other sto-
ries directly or may borrow their formal structurings” (1999:192). Like spatial
maps, time can also be considered a metaphor. Adam comments on the use of
“time” in our everyday practice and in social science research by emphasizing
the difference between clock time and lived, real time: “This socially created,
artefactual resource has become so all-embracing that it is now related to as if
it were time per se, as if there were no other times. . . . The metaphor, in other
words, is transposed on to the subject of inquiry and we tend to forget that
qualitative variation precedes the uniform, abstract quantity of human origin”
(1995:91). In the next chapter I investigate to what extent time can even be my-
thologized in general practice.
Setting the Scene of Abuse 

I am aware of the fact that metaphoric expression appears in diverse forms, for
example, not only in noun metaphors, which are most commonly used as exam-
ples, but also as verbs, prepositions, and so on. The selection of metaphors from
a set of discourse data can be difficult, as one has to determine what counts as
metaphor and what does not. Many idiomatic expressions (e.g., “We can’t turn
back now”) may not be perceived as metaphors by speakers and have sometimes
been classified as “dead metaphors” in the literature, that is, metaphors that are
so widely used that they no longer seem to be conspicuous. However, even such
idiomatic expressions “do not exist individually as random clichés, but reflect
different aspects of our ordinary metaphorical conception” (Gibbs 1999:34) of
things. I have mainly applied two criteria to select metaphors: domain incon-
gruity and frequency. Thus, when doctors used expressions from other non-
medical domains to map onto the consultation, for example, these expressions
constituted potential candidates for metaphorical analysis. In addition, a num-
ber of such expressions recurred frequently throughout the interviews and in
various doctors’ narratives. To give the reader a flavor of how spatiotemporal
mapping bears on the doctors’ narratives I start by analyzing one narrative in
detail before providing examples of metaphor from the entire sample.

Limitations of the “Medical Gaze”

gps, although they are probably more familiar with their patients than other
doctors, have only a very restricted view of their patients in the confined space-
time region of the consultation room. Within a five-to-ten-minute appoint-
ment they usually catch mere glimpses of what might be going on in the pa-
tient’s background. The following narrative related by a middle-aged female gp
in a student health center illustrates this restricted field of vision of what Young
calls the “deciphering gaze” (1997:83) of doctors in medical examinations. This
literal gaze focuses on the deciphering of physical symptoms and is thus em-
bedded in Foucault’s (1973) more abstract notion of the “medical gaze,” that is,
medicine’s objectifying visualization and reconceptualization of the body and
of patients. The story was told in response to the question “What did you feel at
that time?” which referred to a story the gp had told immediately prior to narra-
tive 11. The gp stated that “the problem was that we never knew what happened.
You know, you never know how, how things turned out in the long term.” Nar-
rative 11 can be regarded as an explanation of this statement.
 Setting the Scene of Abuse

Narrative 11
1. Um, we had another case here actually.
2. That’s, that, we had a little girl who was a drug addict
3. and her boyfriend was a drug addict
4. and that was really sad
5. and she was coming in with black eyes and, you know, bruises
and all sorts of things
6. and she was different in that she just couldn’t do anything about
it.
7. You know, no matter what we suggested
8. she . . . wasn’t able to, to break away from this guy.
9. Unless while he was in prison, which was all right, she was much
better then
10. and she just, she didn’t finish her degree
11. and she just looked iller and iller and more and more tired
12. and eventually she just disappeared
13. and we don’t know what’s happened to her.
14. She left Aberdeen
15. and goodness knows where she is now.

The narrative begins with an orientation section that comprises lines 1 to 3.

By using the indefinite determiner “another” the narrator links the case back
to the case she related previously.1 The gp thus obviously takes advantage of
the fact that she has sole power over the floor at this point and uses the oppor-
tunity to tell another explanatory story. The narrative proceeds by introduc-
ing the protagonists, a girl and her boyfriend, who are both drug addicts. This
fact is emphasized through the use of syntactic parallelism in lines 2 and 3, the
only difference being that the girl’s drug addiction is mentioned in a defining
relative clause, while in line 3 the boyfriend’s drug addiction forms part of the
predicate: “we had a little girl who was a drug addict and her boyfriend was a
drug addict.” The girl is defined not only in terms of her addiction but also with
regard to her physical appearance: she is presented as “little,” which automat-
ically evokes a mental image of the girl as being weak or feeble. This image of
feebleness is reinforced in lines 6 to 8 and, at the same time, is associated with a
lack of willpower, since the girl is presented as unable to “break away from this
Setting the Scene of Abuse 

guy.” The verb phrase “break away” expresses quite a violent notion of sepa-
rating oneself from another person, and it therefore appears in stark contrast
to the depiction of the girl as weak both in physique and in character. More-
over, the verb metaphorically implies a unity between the boyfriend and the girl
that can only be disrupted by means of forceful action. Thus, the gp implicitly
establishes a causal link between the girl’s weakness and the fact that “she just
couldn’t do anything about it” (line 6).
The doctor’s own helplessness is expressed in the conditional clause in line
7, “no matter what we suggested,” and in the evaluative clause in line 4, “that
was really sad,” where the intensifier “really” again stresses the gp’s emotional
judgment. Interestingly enough, the gp uses the fact that the girl did not leave
her partner as a means of classifying her as “different.” In other words, the gp
implies that other victims of domestic abuse normally manage to escape the vi-
olence. This might hint at the gp’s misconception of violent relationships, which
are often of longer duration and might involve continued violence even after
the woman has left her partner (Schornstein 1997:26). It is also noteworthy that
the gp presents the domestic violence case against a background of drug-tak-
ing and criminal activities. A common cliché is drawn upon and at the same
time reinforced (see chapter 6).

The GP ’s Expression of Her Limited View of the Patient in Narrative 11

Narrative 11 is marked by a lengthy complicating action sequence, which ranges
from line 5 to line 11. One would expect an end in line 6, the end either of the
girl’s embedded story (she was abused) or of the gp’s framing story (she realized
that the girl was being abused). However, the end is elided in favor of listing a
number of subsequent events. In other words, the story never comes to an end,
thereby beginning to clarify why doctors do not do well with domestic violence
cases. Many of the narratives in my sample are similarly narratologically com-
plicated. The use of the past progressive form in line 5 (“and she was coming in
with . . .”) indicates that the girl must have come regularly within a certain pe-
riod of time that is not further specified. The signs of violence are fairly obvi-
ous: black eyes, bruises, and “all sorts of things” (line 5). The description also
becomes vague through the less specified noun phrase. Line 9 is significant in
the narration, as it interrupts the continuity of this girl’s story of recurrent inju-
ries and repeat visits to the health center. The girl was “much better” while her
 Setting the Scene of Abuse

boyfriend was in prison, that is, while she was not exposed to his violence. This
clause almost appears as a ray of hope in the gp’s narrative, and it can be seen as
equivalent to a delaying factor in the development of this tragic story.
The allusion to the overall structure of tragedies seems adequate in this con-
text if we consider the remainder of the complicating action sequence in lines
10 and 11: “and she just, she didn’t finish her degree and she just looked iller and
iller and more and more tired.” The negator in “she didn’t finish her degree”
(line 10) and the combination of the repeated comparators “iller and iller” and
“more and more tired” mark the gradual but definite physical decline of this
girl and thus her overall downfall, which can be interpreted as a falling action.
The catastrophe, however, is not fully borne out, since the ending is left open:
the gp does not know “what’s happened” to the girl (line 13) because the girl
“just disappeared” (line 12). In a sense, the girl’s bodily consumption culmi-
nates in her physical disappearance.
The clause in line 15 functions as a coda and ties the action of the narrative
back to the present. At this point the gp states that “goodness knows where she
is now.” The formulaic expression “goodness knows” implies in an almost fa-
talistic tone that it cannot possibly be in the gp’s power to know what happened
to the girl or where she is located at present. The conjunction “where,” indicat-
ing place or, in this case, a lack of spatial orientation, reveals the limitation of
the “medical gaze”: if patients do not come to the gps to present their problems,
there is no way for gps to know what else is going on in patients’ lives, and doc-
tors do not even feel it is their place to do anything about patients’ problems.
One young female gp commented:

1. But part of me also makes me think, and it’s perhaps unfair, but
part of me makes me think that I wish women had the confidence
and tell us if there was a problem. . . . It’s hard enough to do anyway
but we’re not mind readers and if we’re having a busy surgery and
all we see is the pink page in front of us. We’re not looking through
notes all the time and analyzing everybody’s consultation. So, if they
come in with a sore throat we deal with their sore throat and then
they go but if they just gave us some, some better clues.

What strikes one immediately in this passage is the gp’s reluctance to appear
critical of patients. The hedge “it’s perhaps unfair” and also the noun phrase
Setting the Scene of Abuse 

“part of me” indicate that the gp is not entirely sure whether her statement will
be interpreted by the interviewer as unjust criticism and therefore requires mit-
igation. These features illustrate the validity of the theoretical proposition that
discourse is always socially situated and that speakers accommodate linguisti-
cally to each other by means of word choice, for example. At the same time, one
of the assumptions I made in chapter 3 is borne out by the data, namely, that
defensive answers might indicate that the gp felt threatened by potential criti-
cism on the part of the interviewer.
This doctor, like most of the female gps in the sample, is fairly open in ad-
mitting that it is difficult to deal with domestic violence. By using the im-
age of the “mind readers” she depicts domestic violence as something obscure
that can only be revealed in a paranormal or supernatural way unless the pa-
tients give “some better clues.” Patients become equivalent to the “pink page”
in front of the doctor, that is, they are reduced to a fact sheet that presents in a
very abbreviated and specially encoded way the patient’s history of illness. The
consultation is depicted as an event limited both in time and space. The doc-
tor not only has little time available during a “busy surgery,” but he or she also
lacks the time to look through notes and to investigate a patient’s case history
more holistically. The case as such is in turn confined to the “pink sheet” of
the medical record. The only way domestic violence can be discovered in such
a restricted context, it seems, is by means of very obvious external evidence in
terms of physical signs of abuse. Otherwise, as one late-middle-aged male gp
pointed out, “there is no magic way of finding it out.” The same gp expanded
on the mental image of magic by conjuring up a whole consultation scenario
with a touch of science fiction attached to it:

2. Um, sometimes it’s very well hidden. Now, should I be expected

to have x-ray specs to be able to in all cases find, er, each and ev-
ery case? It depends on degree I think. I, we can’t, we know, we’re,
we’re general practice specialists but, um, we do not have, um, some
magic scanner that comes [on over the door] with flashes when
somebody’s undergoing, er, abuse. Er, I think we are well placed to
discover it when it’s at a level which does become obvious.

Domestic violence is depicted as something that is “hidden” and that gps can
only “discover” when it is “obvious.” The impossibility of finding out about it
 Setting the Scene of Abuse

in all other cases is dramatized in the futuristic image of the “x-ray specs” and
the “magic scanner.” By using this highly technical imagery the gp implicitly
points out medicine’s inadequacy in dealing with problems that do not follow
the biomedical model and that can therefore not be discovered by means of
medical apparatus. After all, high technology is “the epitome of the ‘biomedi-
cal model,’” as Annandale (1998:271) maintains.
Another interesting feature in this passage is the gp’s mentioning of a “de-
gree” or “level” of violence, thus assuming that violence is gradable in terms
of severity. This is a line of reasoning that appears frequently in the gps’ dis-
courses. Doctors conceptualized domestic abuse as a “continuum” that could
thus be dealt with “on different levels.” In other words, the severity of the vio-
lence displayed to the doctor has an impact on the gp’s reaction and subsequent
provision of salient help. In the excerpt above the message is fairly straightfor-
ward: unless domestic violence is “obvious,” visible as marks or bruisings, the
gp cannot discover it. As one middle-aged female gp remarked, “it’s almost got
to be in your face.” These comments indicate that gps possibly lack sensitivity
to subtler signs of abuse or that they tend to overlook problems that do not “fit
the medical wardrobe,” as one female gp put it metaphorically. While there is
at first glance nothing wrong with physicians dealing primarily with physical
symptoms, a problem arises when doctors focus so much on the physical side
of things that they overlook other possible signs and miss a diagnosis, as I dis-
cussed in the previous chapter. Moreover, doctors’ immersion in the biomed-
ical model can be detrimental if it causes them to deny their responsibility in
“nonmedical” problems. A number of gps in my sample emphasized that they
did not think it was their place to do anything about domestic violence, since it
was primarily a social problem. (This particular explanation is explored further
in the next chapter.) That gps are sometimes quite remote from their patients’
lives and their problems not only spatially but perhaps also conceptually can be
seen in the way the gps spoke about their work and the practice environment.

Path Schema
One metaphoric category that pervades the gps’ narratives is the path schema.
As I mentioned above, paths are important, since they connect the spatial world
around us. As Johnson points out, the “path schema is one of the most com-
mon structures that emerges from our constant bodily functioning” (1987:116),
Setting the Scene of Abuse 

and it therefore serves as a basis for a number of metaphors: “In our culture, for
example, we have a metaphorical understanding of the passage of time based
on movement along a physical path. We understand mental activities or oper-
ations that result in some determinate outcome according to the path schema.
And we understand the course of processes in general metaphorically as move-
ment along a path toward some end point” (1987:117). The gps in my sample reg-
ularly used spatial language in order to depict the way they would try to find
out more about underlying issues or, once domestic abuse has been established,
what their next steps would be. To see how the path schema is borne out in the
gps’ responses, consider the following examples:

3. a. I think it would be a case of flying by the seat of your pants, see

what kind of reaction you’re getting and, er, exploring this more.

b. You’re obliged to ask how things are at home and to follow that
avenue in addition to what’s happening at work, financial pressures,
and all the other pressures that are on us today.

c. I suppose you have to backtrack really and see what their pattern
of consultation has been and what exactly they’re coming along
with.

d. In a sort of roundabout way, I suppose, that’s what we’re really

asking.

e. We probably don’t go out [of our way] because we know, we know

it’s a difficult area, we don’t feel we can do much.

f. There are difficulties with culture, with admitting to, to depres-

sion and other kinds of mental illness and it causes offense to ask
these questions whereas it doesn’t cause offense to, to go down the
physical route.

4. a. I sympathized with her, I sent her on her way.

b. Even if it’s just a few girls that we could set off in the right direc-
tion, give them a fresh start it’d be worth it.
 Setting the Scene of Abuse

c. I still think, at the end of the day, that the, the person who is be-
ing victimized has to make the first step. I don’t think people can
do it for them. If they’re willing to just accept it, that is, as I say, hard
luck. They just have to be prepared to go forward and get help.

d. You can’t really stop them and say: “Look, this isn’t my problem.
Go to a social worker!” If you do that you’re not gonna do them any
favors ’cause it might be the only, the one and only time that they’ve
spoken to somebody about it. To stop them in their tracks at that
point really wouldn’t be any good.

e. You have to hope that if they’re coming then they actually are
looking to find a way through to talk about it.

f. I think, if, er, if they’ve got information about places that they
could go so then, even if they go home to the same situation and
do nothing, if they’ve got those numbers, should it recur or should
there be a crisis then at least they feel they’ve got a safety net or
they’ve got an escape route.

What strikes one immediately in these responses is the fact that gps concep-
tualize different paths for patients and for themselves in their cognitive map-
pings. The answers in (3) represent paths taken by gps in their practice work,
while the answers in (4) illustrate the paths gps envisage for their patients.
Thus, doctors can take the “physical route” in a consultation, that is, examine
a patient merely with regard to physical problems, or they can follow the route
of asking more private questions and “fly by the seat of their pants” in order to
discover more hidden issues. In other words, gps can rely on their experience
in certain cases. Interestingly enough, the option of flying by the seat of one’s
pants in (3a) is introduced in the hypothetical mode through the modal aux-
iliary “would” and is thus indirectly presented as a rather unusual option for
gps.2 This could be related to the fact that gps perceive cases of domestic vio-
lence as infrequent in their practices, or it might point toward doctors’ reluc-
tance to ask questions concerning violence. As the gp in (3e) admits, “we prob-
ably don’t go out of our way” because domestic violence is a “difficult area” and
thus potentially dangerous.
Setting the Scene of Abuse 

The notion of danger as well as of adventure and risk taking is evoked not
only through the verb phrases that construct paths for the gps (“flying,” “ex-
plore,” and “go out of our way”) but also through the mentioning of the “escape
route” that women can access once they have obtained sufficient information
on “places that they could go” (4f). This imagery indicates gps’ conceptualiza-
tion of domestic violence as “dangerous ground” that they might wish to avoid.
One way of doing this is to disentangle mentally the spatial networks of doctors
and patients and to pass the responsibility of finding appropriate paths onto
the woman. Thus, gps can set patients “off in the right direction” (4b), but, ul-
timately, the victim is “on her way” (4a, my emphasis), and she has to “go for-
ward and get help,” as the gp in (4c) put it bluntly. Victims of domestic violence
have to “find a way through” (4e) to their gp, which again implies a distance be-
tween doctors and patients, as the “way” or “path” described is not one that the
gp equally enters and follows. By linguistically creating different “route maps”
for their patients and for themselves, gps reinforce the spatial distance that is
already in place through the layout of the consultation room, which is secluded
from the life world of the patient.

Mapping out the Consultation

Although gps also conduct house calls, their normal workplace is the practice
and, within the practice, the consultation room of each individual doctor. Pa-
tients usually go to the practice to present their problems, and both the exami-
nation of the patient and the gp’s diagnosis as well as the initiation of treatment
take place within the confined space of the consultation room. In other words,
the location of medical interviews is relatively fixed, and the doctor as one actor
in this setting is also a more or less stationary “object” in this spatial environ-
ment. The patient, on the other hand, appears as a variable and mobile actor:

5. a. There’s a lot of domestic disharmony, er, and on occasions peo-

ple will come along with stories of, well, physical violence or men-
tal violence, mostly mental, I think.

b. Occasionally people come in and present their, their bruises.

c. When they come in the door they’ve decided what they’re go-
ing to say.
 Setting the Scene of Abuse

d. I certainly do have a lot of depressed patients coming, um, through

my doors.

e. Unless they see it as a medical problem they’re not probably gonna

walk through the door with that.

f. It may be that the woman turns up at the surgery with an ap-

pointment, er, either on an urgent basis or as part of a routine ap-
pointment, and will usually in the course of the consultation say
that she wants to, um, confide that she’s been abused.

g. If you’re a doctor you have to give it high priority in your surgery

but, I mean, you’re not in control of that. You don’t know what’s
coming in that door. Somebody comes in the door and [might]
have a stroke in front of you, that’s not going to take half an hour,
it’s not, y——, you’ve got no control of that.

The spatiotemporal map that is created in these examples is based on two spa-
tial vectors: one mobile vector, whereby the patient “comes in that door” (5g),
and one static vector, which indicates what happens “in front of” the doctor.
Temporally, the incident is unpredictable, that is, it can happen anytime in any
consultation, and it clearly disrupts the flow of the consultation and, ultimately,
of the entire appointment schedule.
“Come” is by far the most commonly used motion verb in the gps’ dis-
course, and it is normally combined with the spatial adverbs “in” or “along”
to delineate the patients’ movements. Significantly enough, “come” in narra-
tives presents movement of a person other than the speaker from a farther re-
moved place toward the speaker: “come, arrive, walk in are used of entry into
the space (corridor, room or office) which is nearest to the observer in each ep-
isode” (Brown 1995:190). In the doctors’ responses the point of view taken up
is the one of the gp, who is located at the center both of the practice environ-
ment and of the narrative concerning the encounter with a patient during a con-
sultation. In addition, the locatives “in” (5b), “in the door” (5c), “through my
doors” (5d), and “through the door” (5e) create a mental image of the practice
as an enclosed place, as they evoke the container metaphor (Lakoff and John-
son 1980). The practice is envisaged as a kind of “container” with an opening,
Setting the Scene of Abuse 

the door, through which patients move in and out. The following comment
made by a middle-aged male gp illustrates the perception of patients “passing
by” through the practice:

6. It’s not something that you see every week or every month. Some-
times you see it, it’s like buses, you know, [they] come along, you
know. . . . Um, I mean it’s rare for it to be declared. You know, it’s
not common for women to come in and say, you know: “I’m suf-
fering.” Er, it’s generally uncovered in, in other ways.

The simile “like buses” refers to the folk saying that they come all at once or not
at all. It draws upon the image of movement of one object (bus, patient) rela-
tive to a person (traveler, doctor). By equating himself with a traveler waiting
for a bus, the gp implicitly defines his own role as passive and thus limited. He
himself does not move anywhere but waits in his practice for patients to “come
along.” At the same time, domestic violence is presented as something the doc-
tor does not encounter very often in patients. The tautology of “rare” and “not
common” emphasizes the infrequency of disclosures of domestic abuse, which
is depicted twice in this comment: first, through the passive infinitive construc-
tion “to be declared,” and second, through the active construction whereby
“women come in and say, you know, ‘I’m suffering.’” The active role of the pa-
tient is stressed by direct speech. Ironically, however, this active part is already
negated by the doctor’s statement that this type of disclosure is rare. Another
interesting feature in this comment is the past participle “uncovered,” which
conveys an image of domestic violence as being something hidden.

Spatiotemporal Mapping and the (Re)Construction

of Domestic Violence as a “Hidden” Problem
The estimated frequency of visits by patients who suffer domestic abuse varies
considerably in the interviews. Variations in the responses sometimes occurred
even in interviews conducted within the same practice. Few doctors were able to
quantify their encounters with domestic violence victims, and among those who
provided a figure, it ranged from “one or two a fortnight” over “one a month”
to “two or three times a year.” One young male gp stated that he had never had
a case of domestic violence in the practice that he was working in at the time of
the interview, and a middle-aged female gp said that she could “count on one
 Setting the Scene of Abuse

hand” all the cases she had ever encountered. Interestingly enough, this female
gp worked in a practice with patients from mainly deprived social backgrounds.
Moreover, another gp from the same practice who had been interviewed in the
first round of pilot interviews had stated that he frequently saw patients suffering
domestic violence. Does this contradiction indicate that the female gp is possi-
bly unable to detect the problem? Likewise, out of three gps who worked in the
same health center two (young, male and female) stated that they saw domes-
tic violence frequently in their patients, while the third middle-aged female gp
said that she did not encounter it as regularly as she had done when she worked
in Edinburgh in the 1980s. The discrepancy in these gps’ responses shows that
gps may perceive the frequency of domestic violence cases differently, depend-
ing on previous work experience with this problem. If the third doctor, how-
ever, indeed encountered fewer patients who suffer domestic violence than her
colleagues despite the fact that they all work within the same practice popula-
tion, then questions arise as to whether this may have to do with less awareness
of or receptiveness to the problem.
We cannot necessarily generalize by correlating the occurrence of domestic
abuse with lower social status. However, the interviews revealed a tendency of
gps working in socially deprived areas to be, on the whole, more aware of do-
mestic violence in their patients. One explanation might be that domestic vio-
lence is disclosed more frequently by patients from lower social backgrounds,
while middle-class patients are more strongly inhibited by the social stigma at-
tached to domestic abuse. As one male gp nearing retirement observed, “they
don’t bother to cover up in the same way as do the more affluent areas.” It is
equally plausible, however, that gps do not expect domestic violence in middle-
class patients and therefore fail to notice indirect signs of abuse such as depres-
sion, nervous conditions, sleeplessness, and fatigue. This indicates that the dis-
closure of domestic violence depends on gps’ perceptions and on whether they
are alert to underlying issues or not rather than on the socioeconomic status
of the practice population.
Most of the gps in my sample said that domestic violence was not some-
thing they encountered very often, and gps regularly admitted that a lot more
might be going on without them being aware of it. The following responses il-
lustrate this awareness:
Setting the Scene of Abuse 

7. a. I’m probably aware statistically [that] there’s a lot more goes

on but, er, there’s, er, there’s not all that, in the course of a year, not
all that many get positively brought to our attention.

b. We know from research that it is a lot more common than we

usually pick up. . . . So we also know there is a huge number of, um,
there are a huge number of women out there who probably experi-
ence domestic violence.

c. I’m not, not a lot is disclosed to you.

d. Not much, to be honest, um, or people don’t approach me

particularly.

e. I think there’s an awful lot underlying that we never really

broach.

f. I mean there’s times where you’re, you’re almost certain that it is,
that they, the woman won’t admit it or you have a hunch but they
don’t want to talk about it and they, you know, they’ll, they’ll cov—
—, they’ll cover it up, and other times, I’m absolutely positive, we
don’t think about it.

g. I’m trying to see it from their perspective, that they have come and
they may find the door shut. They expect us to try and open the door
and we didn’t. And then they may then go back into their old situa-
tion and go, “There’s nae point in going to see the [doctor] because
. . .” you know [clears his throat]

h. I think there’s a hidden, huge hidden, you know, mass of it that

no one comes forward

The spatiotemporal language in these comments reveals a number of expecta-

tions and visualizations. First of all, domestic violence is presented as a problem
that appears to be more frequent than gps recognize in their practice work. Fur-
thermore, domestic violence is presented as “hidden” (7h) and as an “underly-
 Setting the Scene of Abuse

ing” (7e) problem that patients “cover up” (7f). The spatial position of domestic
violence is thus defined as “low,” “on the ground,” or even “underground,” which
can also be seen in the frequently occurring verb phrase “pick it up” (7b). The
vector representing movement in this mental image reaches from the ground
upward and thus locates the object to be picked up on ground level.3 gps de-
scribed domestic violence as a “bottomless pit,” the “root problems” of which
they could not solve. Cases “bubbled up on the surface” in “oblique presenta-
tions,” which makes it particularly difficult for gps to bring them out “into the
open.” gps are also often not prepared to “dig deeper in a dodgy clinical his-
tory,” as one young male gp put it, drawing upon the pit image. One late-mid-
dle-aged male gp cynically contended that domestic violence “gets just swept
under the carpet by everybody. The perpetrator, the victim, the doctor, the po-
lice, everybody.” The reason this gp offered for the kind of active and collective
neglect of domestic abuse includes people’s unwillingness to assume responsi-
bility: “Because, if you can’t quantify it and if you can’t qualify it and you can’t
be certain that it’s happening how can you do anything about it?” Despite this
open critique, the same gp continued by justifying gps’ behavior, stating that
it was “beyond the gp’s role” to deal with domestic violence in the limited con-
sultation time. The preposition “beyond” creates a further spatial image with
regard to domestic violence cases. Domestic violence is not only “low” and
“underground” but also spatially removed from the gp’s sphere of activity and
responsibilities.

Spatiotemporal Limitations and GPs’ Explanations

for the Nondetection of Domestic Violence
Another spatial relationship depicted in the gps’ responses is the one between
doctor and patient. Example (7b) is interesting in this respect because it cre-
ates an image of a divide between patients and their doctors: there are a lot of
“women out there who probably experience domestic violence.” Significantly
enough, women who suffer abuse are not located inside the practice. In other
words, this gp implicitly recognizes the absence of domestic violence in the se-
cluded environment of the practice. What also features very strongly in the gps’
responses is their expectation that the patient discloses her problem, as can be
seen in (7a), (7c), and (7d). gps seem to expect patients to “approach” them or to
“bring” problems to their attention, and if patients fail to do so, doctors “never
Setting the Scene of Abuse 

really broach” (7e) certain issues. As the middle-aged male gp in (7g) comments,
patients might also come with certain expectations and sometimes find the
“door shut” because the gp failed to “open the door.” The door and gatekeep-
ing metaphor again evokes a sense of distance and separation between doctor
and patient, but this time the blame for this separation is put on the gp.
Response (7g) is particularly interesting, as it reveals the culture specificity
of people’s expectations and their linguistic renditions. The “open door” meta-
phor relates to the Western notion of an “open door policy,” for example, which
involves receptiveness, readiness to be helpful, and so on. This kind of behav-
ior may be expected by patients who are hoping to disclose their problems to
their gp. On the other hand, the image of “closed doors” also has to do with no-
tions of privacy and prohibitions to trespass on other people’s private spheres.
This is the view gps might adopt when they do not wish to interfere with their
patients’ private lives. The door metaphor itself thus creates problems through
its polysemy, which may lead to concrete difficulties in doctor-patient interac-
tion. The relative frequency of this image in the gps’ responses, however, indi-
cates that it belongs to a cognitive framework by which gps rationalize their re-
lationships with their patients.
The reasons that emerge for nondisclosure and nondetection of domestic
violence are twofold: on the one hand, doctors tend to expect patients to play
a more active role and to open up; on the other hand, gps themselves often de-
liberately refrain from broaching the subject with patients for reasons of time,
stress, or fear of emotional involvement.

Spatiotemporal Mapping, Metaphors, and the Threat

to the “Ceremonial Order” in Medical Consultations
When doctors and patients meet they automatically assume their roles in what
Strong calls the “bureaucratic role format” of medical encounters, which com-
prises, among other elements, doctors’ authority over patients and control of
the interaction as well as a heavily routinized speech style that allows only lit-
tle information to be imparted to patients and that affords them only few op-
portunities to express their own views (1979:9, 199–200). This bureaucratic role
format by necessity involves the negotiation of identities, and identities, in turn,
incorporate moral status, as Strong emphasizes:
 Setting the Scene of Abuse

Identity is the central topic on which any ceremonial order legis-

lates, and moral status is a fundamental part of that identity. But
since the ceremonial order is a matter of outward show, the moral
order which it creates is regularly threatened by the actual facts of
the case and by the incidents and upsets that occur in any form of
human intercourse. In consequence, the parties to an encounter
are presented with a series of constant challenges, either actual or
potential, which threaten their moral worth or that of their fellow
participants. (1979:41)

Domestic violence poses a threat to the ritual “ceremonial order” of medical

encounters, according to which the encounter “normally” takes place smoothly
and without major disturbances. It frequently comes out somewhat unexpect-
edly for the doctor, and it also involves questions of confidentiality, responsibil-
ity, and agency. Put another way, domestic violence is something that doctors
do not feel in control of once it comes to the surface. This threat is linguistically
conceptualized in the “tip of the iceberg” and the “can of worms” metaphors,
for example, by which gps implicitly express their fears and anxieties.

Metaphors Expressing Doctors’ Anxiety

The Journey Metaphor
One metaphor that can be regarded as a subcategory of the path schema is the
journey metaphor. This metaphor has been internalized by speakers of Eng-
lish to such an extent that it is often no longer conspicuous, as Lakoff (1993)
emphasizes in his discussion of the love-is-a-journey metaphor. Since the jour-
ney image is such an internalized concept, however, it is worthwhile analyzing
the cognitive mapping that underlies this metaphor in the gps’ narrative dis-
course. One young male gp stated, for example, that “gps are the most likely
first port of call” for patients who suffer domestic violence, that is, the practice
is the place where patients expect to end their often long “journey” of suffering.
While this metaphor potentially opens vistas for lengthy life stories, the nar-
ratives of the gps often refer to but rarely elaborate on the patient’s “life jour-
ney.” In a sense, the metaphor thus becomes a substitute for fully fledged, tem-
porally extended narratives.
Patients’ suffering is often described by doctors as part of a many-faceted
picture of misery, as in the following explanation for the occurrence of domes-
tic violence provided by a middle-aged female gp:
Setting the Scene of Abuse 

8. You have to go round some of the areas in Aberdeen to see these

houses and think, well, you know, if you’re trooped up with three
kids in a room with no carpets and, you know, you’ve got into a
habit of drug abuse, say, but, you know, the tensions must be ab-
solutely awful if there’s, if there seems to be no future for people,
which, I think, is often in the deprived areas, that seems to be the
major thing, there’s no jobs, the housing’s poor, everyone is [?] in
the same boat.

Domestic violence is correlated with a low socioeconomic background and poor

living conditions, and these factors are captured in the military imagery present
in the predicative adjective “trooped up” and the voyage metaphor that envis-
ages all these people “in the same boat.”4 Life is a journey is the underlying met-
aphor in this mental image. The journey metaphor, however, is also used in the
more specific context of the consultation, as the following response shows:

9. Um, and, you know, a lot of them will, um, be just [waiting] to
see if you’re gonna be receptive to what they’re saying and they’ll,
they’ll give you a few minutes to see if you’re listening and then
they’ll tell you what they’re really here for. And I think you have to
sort of take that on board.

Here, the consultation is indirectly mapped onto the image of a voyage dur-
ing which specific facets of the consultation and the patient’s behavior can be
“taken on board,” that is, considered, by the gp. This metaphor, although it will
be understood by most speakers of English, also avoids an exact statement of
how this action is undertaken. In other words, the metaphor abbreviates a lon-
ger narrative of “how” the patient’s behavior can be “taken on board” by the
doctor. The concept, and thus perhaps also its underlying practice, remains
vague and opaque.

The Iceberg Metaphor

Another metaphor that five of the twenty gps used was that of the iceberg. Do-
mestic violence is equated with an iceberg, and the common denominators for
this equation are size and the fact that the largest part of the mass remains un-
derwater. Put another way, the problem of domestic abuse is conceptualized as
a “huge” problem, but it is also a problem of which doctors see only the small
part that is brought out into the open. Consider the following examples:
 Setting the Scene of Abuse

10. a. So it’s, it’s, so this is, there’s a huge mountain of, you know, it’s
like an iceberg. Whether there’s a whole lot of people under the sur-
face there that just don’t speak about it at all, you don’t hear about
it, er, I really don’t know.

b. I mean, we only probably see the tip of the iceberg though, um,
sort of stressed, depressed people who if you sort of enquire a bit
further, you discover that there’s a bit of it going on.

c. It’s quite a horrible thought to think that we are probably miss-

ing a lot of it but I’m sure there must be, you know, it must, it must
just be the tip of the iceberg what we’re seeing.

Domestic violence cases are visualized as an amorphous lump rather than as

a quantifiable medical problem, and this image is primarily used by the gps
to explain why they probably miss so much of it, namely, because the prob-
lem is not easily quantifiable and thus not identifiable, or vice versa, and be-
cause it remains secret, opaque, and hidden in most cases. The iceberg meta-
phor also carries undertones of fear and helplessness. Icebergs are commonly
considered dangerous exactly because there is this huge hidden mass under
the water that can destroy ships even when they seem to be far away from the
tip of the iceberg. Bearing this additional facet in mind, gps’ reference to the
iceberg metaphor in their narratives can also be interpreted as an indirect ex-
pression of their feeling of being threatened by a problem that they are inade-
quately equipped to deal with. In a similar vein, one male gp commented: “It’s
too big a, er, it’s too big a job to, to take on board, er, personal issues from peo-
ple,” thereby evoking the journey metaphor, albeit in negative terms. And a fe-
male gp described her decision as to whether to broach the issue with a patient
or not in the following way:

11. It can depend entirely on how relaxed you feel like, you know, if
you don’t feel there’s any pressure to get this surgery [appointment]
finished on time or whatever else, then those are the days when you
may well decide to dip the toe in the water or the, the, you know,
sometimes it’s just not possible.
Setting the Scene of Abuse 

The image used here clearly emphasizes gps’ hesitant behavior when it comes
to dealing with emotional problems in their patients.

Opening up a Can of Worms

One phrase that six of the gps used to explain why they often deliberately re-
frained from broaching the issue of domestic violence with patients is “open-
ing up a can of worms.” By using this metaphor doctors implied not only that
the problem of domestic abuse might not be closed again once it was opened
up but also that it is difficult to control because it might branch out into vari-
ous directions. The following responses reveal this concern:

12. a. Um, you certainly can detect that there might be a can of
worms there, and you then have a choice of whether to open the
can or not open the can. And I think, as a doctor, you, you, you may
[have to] follow your judgment sometimes.

b. We’re overwhelmed by people’s physi——, physical problems and

mental problems. Trying to deal with social problems as well, you
know, is, is just, yeah, it’s probably easier not to ask that question,
to open that can of worms in a lot of cases.

c. I mean if, if it’s been going on for ages, er, and I know that it would
be a can of worms that would be opened, I will maybe leave it.

d. There’s a bit of a fear about bringing things out into the open as
well ’cause [that] can open up a huge can of worms and, and that
probably, you know, we probably save our time in the long run if we
were to bring this out into the open because a lot of these girls I’m
sure are coming along with minor complaints and, you know, some
things that we can’t ex——, can’t perhaps explain and there is do-
mestic violence underlying all of this so, in the long run, we might
save ourselves appointments but sometimes you’re scared just to
open up that can of worms ’cause often I don’t know, I don’t feel
there’s an awful lot practical we can do to support them.
 Setting the Scene of Abuse

e. What I as a gp have got to offer is, I guess, quite limited. [They

might sort of think that] can be opening a can of worms that I
can’t deal with.

f. Um, and a lot of it is, I think, I think they feel that [if] they speak
to their gp they’re opening a can of worms and that it can’t be closed
again and what do they do after that?

A can of worms evokes associations with uncontrollability and also with a no-
tion of ugliness of the issue. Worms are considered to be unpleasant or a nui-
sance and are thus something that people would rather not have to deal with.
Similarly, domestic violence can contain a number of other unpleasant issues,
not least the patient’s distress in that situation. The container metaphor is drawn
upon in this image, but this time the container is not empty like the “bottom-
less pit” mentioned above. Instead, the container is full of “ugly” problems and
further difficulties that are uncontrollable. Once the worms are out of the can
they cannot be put back into it. Consequently, gps feel “scared” (12d) to open
this can of worms because they are already “overwhelmed” by people’s “phys-
ical” and “mental,” in other words, medical, problems (12b). The metaphors
and spatiotemporal expressions used by the gps reveal their mental “visualiza-
tions” of domestic violence cases and point toward underlying concerns and
anxieties. Due to these anxieties doctors may well decide not to broach the is-
sue with a patient even if they have a suspicion that something else is going on.
They have “the choice of whether to open the can or not open the can,” as the gp
in (12a) put it in a Hamletish manner, and very often they decide to just “leave
it” (12a) and “not to ask that question” (12b). In other words, whether disclo-
sure takes place within a consultation also depends very much on gps’ judg-
ment and on their decision about whether they want to uncover things or not.
gps can either pass over the issue altogether, whether deliberately or uninten-
tionally, in order to decrease the disrupting effect of disclosure or they can at-
tempt to formalize the situation and make it more “orderly,” as it were, by fol-
lowing the “paths” currently available in general practice, which mainly involve
treatment of physical injuries and onward referral to other agencies. In (12e)
and (12f) the doctors attempt to adopt their patients’ point of view by stating
that disclosure can mean opening a can of worms for victims, too, especially
Setting the Scene of Abuse 

if they think that the gp cannot really help them further. This view, however,
especially if it becomes part of doctors’ “storied knowledge,” only perpetuates
gps’ belief that they are ill equipped to deal with domestic abuse, which might
ultimately influence their practice work and thus also be reflected in their pa-
tients’ reactions to them.
Methodically, the analysis of the gps’ linguistic representation of “space-
time regions” in their narratives shows how microstructural and macrolevel ap-
proaches can be combined: the gps’ discursive strategy of distancing reveals and
also reinforces their conceptual separation of their own, that is, medical, space
from their patients’ personal space, on which domestic violence has an impact.5
This distance can also be seen in gps’ linguistic “visualizations” of backgrounds
to domestic violence situations, which I discuss in the next chapter. While the
focus in this chapter lay on metaphors, including spatiotemporal frameworks,
the next chapter expands on this discussion by investigating the ways in which
gps use such conceptual frameworks in order to mythologize both their own
work conditions and backgrounds and scenarios of abuse. I demonstrate that
the myths thus created serve as explanations and excuses for doctors’ seemingly
limited scope of action with regard to domestic violence cases.
6. Mythologizing Time, Mythologizing Violence
Backgrounds and Explanations of Domestic Abuse

If we follow the pioneering work of structural anthropologist Lévi-Strauss (1986),

we can conceive of myths as cognitive devices, as ways of organizing and under-
standing reality in a given cultural context. In his Mythologies Barthes (1972)
defines myths as secondary semiotic systems that mystify reality and that peo-
ple are made to believe. Myths are steeped in a culture’s beliefs and values. To
give a very simple example, the specific shape and horsepower of a particular
brand of car signifies that car owner’s economic power and social status. In ev-
eryday myths a second reality is constructed and naturalized. The strength of
myths lies in their ability to cater to the “need for a single, comprehensive ac-
count” (Spence 1998:221). As Spence points out, the “mythic explanation, as it
feeds on other popular accounts, tends to suppress complicating variations and
replace them with a kind of uniform simplicity” (1998:221). Myths are created
to be integrated into certain organizational discourses, in this particular case
the discourse of the medical profession, that in turn help establish and sustain
power relationships (Fairclough 1989, 2001). In chapter 3 I listed a number of
myths surrounding the problem of domestic violence. In this chapter I inves-
tigate in what ways the gps’ narratives also perpetuate such common myths
and to what extent this may have an influence on how doctors perceive their
own role as health care professionals who have to deal with this problem. The
constitutive nature of gps’ discourse thus becomes a crucial question and re-
quires further exploration in my narrative analyses. While sociological stud-
ies have concentrated on the surface realizations of myths and stereotypes in
social discourses, this study goes a step further and uncovers the linguistic
mechanisms in operation that create such myths in the gps’ discourse. I com-
mence this chapter with a discussion of time as a recurring theme in the gps’
narratives, thereby tying back to my investigation of spatiotemporal mapping
in the previous chapter.
Mythologizing Time, Mythologizing Violence 

Mythologizing Time in General Practice

Time invariably flared up as a topic during the interviews and in the gps’ nar-
ratives. On the one hand, the doctors viewed time with regard to the patient,
who often suffers domestic violence over a lengthy period of time. Below I dis-
cuss cycle-of-abuse theories and family histories of violence as explanatory
frameworks in the gps’ narratives. On the other hand, the doctors related time
to general practice and health care and to their own job and training as gen-
eral practitioners. The impact of “clock time” on the consultation can in turn
be viewed from two perspectives. First, patients are not granted enough time
to elaborate their possibly complex self-narratives; and second, doctors do not
have the opportunity to explore their patients holistically and consequently fail
to create a “medical narrative” with sufficiently detailed information. Instead,
their rather schematized medical record may well lack clues to adequate treat-
ment. As a study on decision making and consent to treatment in general sur-
gery has shown, doctors’ lack of time very often hinders successful interaction
and communication between doctor and patient (Meredith 1993). The same
result has been found for consultations on domestic violence (Sugg and Inui
1992). Warshaw’s (1993) study on the treatment of battered women in an urban
emergency room demonstrates that time constraints linked up with overwork
and understaffing led to nondetection and nonintervention and, more impor-
tant, to a lack of response and receptiveness by nurses and doctors. I would ar-
gue that gps’ tendency to use medical “shorthand” rather than complex narra-
tive in medical examinations precludes the emergence of holistic patient stories
with salient hints at possible underlying problems. Moreover, as I discussed in
the previous chapter, time pressure coupled with the emotional and psycholog-
ical demands of dealing with domestic violence cases may lead to anxieties.
One young female gp in my sample considered time such an important fac-
tor that it even became the topic of a lengthy narrative. Narrative 28 was related
in the context of a discussion of time with regard to the problem of asking pa-
tients about domestic violence. The gp maintained that, in spite of time con-
straints, she “would tend to ask them anyway.” The narrative, however, illus-
trates the problem of time pressure in a consultation.

Narrative 28
1. I had one girl who, ach, she had a horrible family.1
2. She, her, her mother told her when she was, ach I don’t know, just
 Mythologizing Time, Mythologizing Violence

about eighteen, that her father wasn’t her father and “by the way,
that’s your father over there.”
3. And so she’d become very confused
4. and I tried to approach him
5. and then, a year or so later, the mother said: “Now, that was all
a lie, he’s not your father at all, blah blah blah”
6. and there was a whole big [discussion] about the families
7. and she was very upset about it.
8. You know, she was dressed,
9. she set to work, when you actually went into it,
10. and you really had to go into that in detail,
11. but I said to her: “Well, you know, we’ve cer——, I’ve [been]
speaking for about twenty minutes. [I’m kind of] running out
of time.”
12. So, get her to come back
13. and some will come back, some won’t.
14. She did come back
15. but, um, you do have to give them the chance to say it.

Time Constraints as “Reportable”

Narrative Topic: Analysis of Narrative 28
The narrative is interesting, as two stories intermingle in it: the one of the pa-
tient’s family and the story about the consultation during which the patient re-
vealed her family background to the doctor. What strikes us about this story
is its confusion and lack of more detailed information. The gp tells the inter-
viewer how the girl found out about her father, and she does it by combining
indirect and direct discourse: “her mother told her when she was, ach I don’t
know, just about eighteen, that her father wasn’t her father and ‘by the way,
that’s your father over there’” (line 2). In switching from a report of the moth-
er’s speech to a direct representation of it, which also involves a shift in deictic
features such as the personal pronoun “you” and the locative “over there,” the
gp discursively brings the scene to life as it probably occurred between mother
and daughter. A similar strategy is adopted in line 5, where the gp again “quotes”
directly what the mother said. The gp even goes as far as to mock the mother’s
talk by presenting it as general blabber: “That was all a lie, he’s not your father
Mythologizing Time, Mythologizing Violence 

at all, blah blah blah” (line 5). On the one hand, this ridicules and downgrades
the mother; on the other hand, it abbreviates the narrative. Thus, the informa-
tion given remains rather incomplete and causes the listener to be as confused
as the patient in that situation.
Lines 6 and 7 again summarize in very brief terms what happened after this
disclosure and how it affected the patient: “and there was a whole big [discus-
sion] about the families and she was very upset about it.” Part of the confusion
created in this narrative can be attributed to the fact that the gp uses an ellipti-
cal time frame to relate the story. Thus, for example, there is a gap between the
time the patient hears for the first time about the family situation—“she was,
ach I don’t know, just about eighteen” (line 2)—and the time when her mother
negates her previous statement—“then, a year or so later, the mother said” (line
5). The only two snippets of information concerning the interim period relate
to the patient’s reaction and the fact that the gp attempted to mediate between
her and the alleged father: “And so she’d become very confused and I tried to
approach him” (lines 3–4). The sequential order of these events is indicated
by the consequential coordinators “and so” as well as the order of the clauses.
Generally speaking, the narrative remains rather skeletal, as it does not pro-
vide any further information on what exactly the background to this strange
family situation was or why the mother lied to her daughter. More important,
the gp does not even clarify whether there was any domestic violence at stake,
which, after all, was the main topic of the interview.
The reason for this brevity becomes obvious in the second part of the story,
when the gp moves toward the actual point of the narrative, namely, her lack of
time in the consultation with this particular patient. The clauses in lines 8 and
9 seem to be misplaced at first glance, as they also provide general information
and thus belong to the orientation: “You know, she was dressed, she set to work,
when you actually went into it.” The discourse marker “you know,” by contrast-
ing with the conjunction “and,” which started the five preceding clauses, intro-
duces a new topic: the way the patient was perceived by the doctor during the
consultation. The family history can thus be recognized in retrospect as a pre-
liminary story that was probably related by the patient during the consultation.
Put another way, the gp relates in her narrative a story that had been told in yet
another storytelling situation: the consultation. At the same time, the gp de-
fines her own role in that storytelling situation as “going into it,” that is, trying
 Mythologizing Time, Mythologizing Violence

to gain more information from the patient: “and you really had to go into that
in detail” (line 10). Thus, the gp presents herself as a doctor who complied with
and supported the patient’s need for narrative in her confused and desperate
state. This, however, is immediately countered by the impact of clock time on
the consultation and thus also on the storytelling situation: “but I said to her:
‘Well, you know, we’ve cer——, I’ve [been] speaking for about twenty minutes.
[I’m kind of] running out of time’” (line 11). The contrastive coordinator “but”
clearly indicates a change in action (Schiffrin 1987), in this case the gp’s inter-
ruption of the patient’s narrative due to time constraints.
The fact that the gp repeats her words verbatim places an emphasis on this
action and expresses the gp’s feeling of pressure at the time. However, it also
contradicts the gp’s previously mentioned strategy of “going into that in de-
tail.” What remains to do in that situation, according to the doctor, is to initiate
repeat visits: “So, get her to come back and some will come back, some won’t.
She did come back” (lines 12–14). The elliptical clause “some won’t” indicates
that lack of time can also keep patients away from the practice, but, as the gp
contends almost apologetically in the final clause of the coda, “you do have to
give them the chance to say it” (line 15). gps’ obligation to give patients oppor-
tunities to speak is emphasized by the auxiliary “do” and the modal “have to.”
Ironically, while the gp seems to be adamant about this facet of doctor-patient
communication, her narrative illustrates important shortcomings of present-
day medical practice exactly in that respect: narrative as a discursive genre is
precluded in situations where patients may find this the only feasible means of
communicating their problems.

Time, Self-Disclosure, and Narrative Production

Self-disclosure is generally seen as a “mechanism by which relationships be-
come personal and intimate” (Brown and Rogers 1991:150). Applied to the par-
ticular case of disclosing domestic violence, this means that a certain degree of
intimacy is established between patient and doctor or is even required prior to
disclosure, which is incompatible with a rigid time frame. Where time is short,
good psychological insight becomes necessary in general practice: “The abil-
ity to assess appropriately in a short space of time requires more than just lis-
tening skills; it requires a psychological understanding of the dynamics of pre-
senting problems and what may underpin them” (Hudson-Allez 1997:6). As
Mythologizing Time, Mythologizing Violence 

far as domestic violence victims are concerned, this understanding can best
be achieved by narrative production (Lawless 2001). Narrative helps patients
make sense of their lives not only for themselves but potentially also for their
gp. Time pressure therefore obviously plays a significant role not only in mak-
ing the consultation formal and impersonal but also in impeding greater psy-
chological insight on the part of the gp. Time and the disclosure of domestic
violence might be an even bigger issue for female doctors. The literature on self-
disclosure (Brown and Rogers 1991:151–52) suggests that women in general (1)
disclose more than men, (2) disclose about topics different from men’s, (3) dis-
close more to other women than to men, and (4) receive disclosures from oth-
ers more often than men do. Applied to women doctors, this means that they
may be seen as more readily available for “emotional” talk, which in turn may
put them under stronger pressure in a consultation.

Doctors’ “Myth of Time”

In raising their lack of time as a central point during the interview the gps
evoked what Wodak calls doctors’ “myth of time”: “After all, the role cliché ex-
ists of the doctor who is constantly on call and thus permanently under pres-
sure of time, and who corresponds to the ‘prophylactic emergency behaviour’”
(1997:194). Everyone seems to take it for a fact that gps are very busy and that
their time is more valuable than others’. As McKie, Fennell, and Mildorf dem-
onstrate, responses such as “We are extremely busy,” “We don’t really have
time,” “There are so many calls on our time,” “gps’ time is a premium” form
“the starting point as well as the result of a dynamic, dialectic process in which
gps mythologise time, drawing upon various concepts and types of time, but
at the same time reinforcing the time myth” (2002:332–33) in their narratives.
Put another way, the time myth becomes an argument for a number of diffi-
culties doctors may encounter in general practice, especially with regard to do-
mestic violence cases and other “nonmedical” problems, and since the “fact”
of lack of time is hardly challenged by doctors and patients alike, the argument
always remains valid.
On the other hand, a consultation is undoubtedly limited by external time
constraints imposed on general practice mainly because of financial consid-
erations. The succinct “time is money” argument increasingly influences the
health care system, and consequently the gps’ time is considered a resource that
 Mythologizing Time, Mythologizing Violence

must be managed and accounted for. This puts the gp under pressure to keep
the consultation within a set time frame. Consider the following comments,
in which gps discuss reasons why they would perhaps refrain from broaching
the issue of domestic violence:

1. a. [I am] reluctant only in terms of time constraints during a

particular consultation. I mean if, if it’s been going on for ages, er,
and I know that it would be a can of worms that would be opened,
I will maybe leave it.

b. I mean I’ve seen women with clearly, er, [pause] domestic abuse
injuries and they, they just don’t say it, you know, and sometimes
you don’t ask, depending on how long you, you have.

c. And I would never raise the subject in a ten minute consultation

un ——, unless the patient wants to.

d. Often people will come in with a very, um, minor complaint and
they’ll woffle on about that for ages and you say: “Right, well, is
there anything else I can do for you?” ’cause you feel there proba-
bly is and then, you know, they burst into tears and say whatever
and that can be quite hard if that’s sort of nine and a half minutes
into your consultation [laughs], I: “Oh, no!” but, you know, you
still feel that you have to ask them.

e. Yeah, and then it’s what, [sighs] what do you do thereafter, you
know? Um, it shouldn’t be an issue but partly the time issue as well.
I mean we’ve got seven and a half minutes, ten minutes and, um,
it shouldn’t be an issue but I think, in reality, it is.

f. It is a pressure type of consultation for us, not so much for deal-

ing with that individual but knowing that you’ve still got people
who are waiting to see you inside as well.

g. We’re not, um, we don’t have the time or resource[s] to deal with
that. We have more and more illness and, er, more and more medi-
Mythologizing Time, Mythologizing Violence 

cal things that we have to do. Our workload is going up all the time
and this is a time, er, consuming, er, subject in the area.

Indeed, it can be easier for gps within a limited consultation time not to open
this “can of worms” (as the gp in [1a] put it, thereby drawing upon another met-
aphor I discussed in the previous chapter) than to face all the consequences and
responsibilities a disclosure of domestic violence might trigger. Example (1d)
exemplifies the situation where a patient simply needs more time to build up a
narrative about her problem, and the doctor feels stressed by the length of this
process (“Oh, no!”). On the other hand, doctors’ feeling of constant time pres-
sure may keep them from probing further even if they have a suspicion that do-
mestic violence is at stake. This can be seen in the responses in (1a) and (1d), in
which the gps partly conjure up the “horror vision” of a patient suddenly open-
ing up in a consultation “sort of nine and a half minutes into your consulta-
tion” (1d) and “if it’s been going on for ages” (1a). Time is presented as an ex-
ternal factor gps are not in control of.
Interestingly enough, however, the gps were by and large also of the opin-
ion that they could “make time” if that was necessary and that time constraints
could always be circumvented by means of repeat visits, for example:

2. a. But the answer to the question “Do I have any hesitation in

asking [about it]” is “no.” In case of timing, do I have to do it there
and then, the answer to that question is also “no.” You don’t have
to dive in there and then, you say “Oh, there’s a bruise,” you say,
“Er, will you come back? I want to see you next week and I want
to give you a ten minute appointment or a double appointment.”
And then you say: “While you were in here last week I noticed that
you had . . . ”

b. Time is an issue and we have, we’re on determined appointments

from sort of two to fifteen minutes. So that gives a little leeway but,
er, we don’t sit there with an egg timer and if there’s a need for, to
talk, we can let them go on to some extent. And if you run out of
time and there’s obviously more to discuss then they come back
later. There’s also the facility for a long appointment at the end of
the surgery if, if that’s needed.
 Mythologizing Time, Mythologizing Violence

c. But I think, as a gp, you have to allow one or two people extra time.
And, um, I think it’s one of the skills of the doctor to work out who
needs it. And I think you can always ask people to come back.

d. If it were a major problem, obviously you would just have to

make the time. You can’t hurry them out in that situation. You’ve
got to accept that you’re gonna be delayed for another ten minutes
while you try and, particularly if it’s the first time you get to speak-
ing about it, you can’t really stop them and say: “Look, this isn’t my
problem. Go to a social worker!” If you do that you’re not gonna do
them any favors ’cause it might be the only, the one and only time
that they’ve spoken to somebody about it.

e. I mean, gps always have this excuse of lack of time but, um, there’s
no harm in running over the appointment time, you know, patients
don’t mind waiting. They know that one day it might be them. Or
you can get the patient to come back. You can say: “Ah, it seems as
if we need to talk about it a bit more. Why don’t you make an ap-
pointment or the last appointment in the surgery or a double ap-
pointment.” It is possible.

Time becomes a double-edged sword in the gps’ discourse, which can be seen in
the way the gps contradict themselves when they speak about their time man-
agement. On the one hand, time is presented as an external factor that the gps
do not have control over and that therefore puts them under stress; on the other
hand, time is turned into an object that gps can manipulate at will. So are gps
in control of time or not? What are we supposed to make of the doctors’ con-
tradictory representations of time? This is exactly where the idea of mytholo-
gizing comes into play. As Barthes contends: “Myth is a value, truth is no guar-
antee for it; nothing prevents it from being a perpetual alibi: it is enough that
its signifier has two sides for it always to have an ‘elsewhere’ at its disposal”
(1972:123, emphasis in original). The myth of time in a sense also becomes a
value during the interviews, a value that is constantly negotiated between the
gps and the interviewer. To draw upon Bourdieu’s (1991) metaphor of the lin-
guistic marketplace, the topic of time becomes a discursive commodity that the
doctors in my sample tried to “sell” to the interviewer. Depending on the con-
Mythologizing Time, Mythologizing Violence 

text, time was attributed higher or lower “value.” Thus, when doctors talked
about general pressures involved in the treatment of domestic violence cases,
time played a major role. As soon as they referred to themselves as professionals
dealing with this issue, time lost its strength and was presented as flexible and
possible to manipulate. The gp in (2e) even critically talks about the “excuse of
lack of time,” thus implying that the time myth is deliberately used by doctors
to cover up other reasons for nonintervention. A problem arises when doctors
internalize the time myth to such a degree that they become easily stressed by
a disrupted schedule.
Doctors’ myth of time can be even more harmful when the patients also in-
ternalize it. Women may feel that they should not make “unjustified” claims
on their gp’s time, or, as one gp put it, “people don’t want to bother you if it’s a
waste of time.” If we bear in mind that storytelling always requires both nar-
rator and listener, since the listener tests ways of listening to and understand-
ing the story (Hydén 1997), it becomes clear why patients sometimes feel that
gps are not accessible or receptive to their narratives. The time myth hinders
doctors from spending more time with a patient, and patients do not feel they
have the right to disturb the gp’s tight schedule. Thus, gps’ mythologizing about
time can ultimately influence their behavior toward patients in a consultation
as well as the patients’ behavior, and it is therefore not surprising that women
who suffer abuse return to surgeries frequently before they finally manage to
disclose. However, time was not the only argument put forth by the gps to ex-
plain their rather passive role in domestic violence cases. In the following sec-
tion I discuss the ways in which gps conceptualized backgrounds of domestic
abuse and hence defined their own professional role in domestic violence cases
as inadequate.

Backgrounds and Explanations of Abuse

One of the questions I asked the gps during the interviews was “Why do you
think domestic violence happens at all?” or the similar question “What are the
reasons for domestic violence?” This question elicited a wide range of responses
that reveal gps’ concepts of and attitudes toward domestic abuse. Before I dis-
cuss these responses I would like to digress by presenting Ptacek’s (1990) re-
search on the way batterers explain their violent behavior. Following research
conducted by Scott and Lyman (1968), Ptacek divides the explanations offered
 Mythologizing Time, Mythologizing Violence

by the eighteen men he interviewed into two broad categories, excuses and jus-
tifications: “Excuses are those accounts in which the abuser denies full respon-
sibility for his actions. Justifications are those accounts in which the batterer
may accept some responsibility but denies or trivializes the wrongness of his
violence” (1990:141). The denial of responsibility is mainly accomplished by
an appeal to loss of control, on the one hand, and a strategy of victim blaming,
on the other hand. Thus, batterers blamed the influence of alcohol or drugs for
their behavior, or they described their violent attacks in terms of a frustration-
aggression model, whereby the violence resulted from an accumulation of in-
ternal pressure. Violence was also reconstructed as a “response” to women’s
physical or verbal aggressiveness, which placed the blame for violence on the
victim. One of the main strategies for denying that the violence was wrong is the
trivialization of the women’s injuries. Furthermore, batterers found fault with
their partners, blaming their failure to fulfill the requirements of being a “good
wife” such as cooking, willingness to have sex, deference, faithfulness, and so
on. Ptacek argues that “these rationalizations represent culturally sanctioned
strategies for minimizing and denying violence against women” (1990:151). In
his article Ptacek examines the literature written by social workers, psycholo-
gists, psychiatrists, and other professionals directly involved in working with
men who batter women:

Most striking is that batterers and clinicians use similar language

to characterize “loss of control.” The batterers speak in terms of ir-
rational attacks (“I went berserk”; “I wasn’t sane”; “temporary in-
sanity”); uncontrollable aggression (“I had no control over myself”;
“it’s a condition of being out of control”; “uncontrollably violent”);
and explosion metaphors (“I just blew up”; “blowout”; “walking
time bomb”; “outburst of rage”; “eruptions”). Like the batterers,
many clinicians also describe the violence as irrational or psycho-
pathological. (1990:152)

In a similar vein Ptacek argues that clinicians accept batterers’ rationalizations

for the violence with regard to victim blaming. The conclusion Ptacek puts for-
ward at the end is that the excuses and justifications he outlines in his study are
“ideological constructs”: “At the individual level, they obscure the batterers’ self-
interest in acting violently; at the societal level, they mask the male domination
underlying violence against women. Clinical and criminal justice responses to
Mythologizing Time, Mythologizing Violence 

battering are revealed as ideological in the light of their collusion with batter-
ers’ rationalizations” (1990:155). In other words, discourses help (re)construct
and perpetuate conceptualizations of domestic violence that are based on myths
and informed by patriarchal ideologies. Since I subscribe to the same view, I in-
vestigated the gps’ responses in my sample with a view to identifying excuses
and justifications for violent behavior.
If we extract explanations out of all the interviews, it is possible to list a seem-
ingly wide range of reasons. Responses included the following twelve broad
factors:

1. Alcohol or drug abuse

2. Deprivation and low social background
3. Family history of violence and socialization process
4. Lack of education
5. Lack of communication and social skills and conflict resolution
by means of physical force
6. Relationship problems
7. Aggression and jealousy
8. Biological preconditions such as physical size and power
9. Male dominance and viewing the partner as property
10. Men’s feeling of inadequacy and threat through women’s grow-
ing independence
11. Manifestation of affection
12. Women’s low status in some cultures

Many of these explanations can be mapped onto Ptacek’s out-of-control or

blame-the-victim strategies. Thus, for example, the reasons in 1 through 4 lo-
cate the problem outside the perpetrator’s power, that is, violence is said to hap-
pen because of external factors rather than because the man wants it to happen.
Relationship problems and jealousy are problematic as explanations, since they
suggest that part of the problem is also the woman’s fault. Although all these
items, taken together, convey a picture of variation and balance in the gps’ re-
sponses, we must not forget that some of these explanations were offered by
only a few doctors and thus do not necessarily represent mainstream lines of
reasoning. Thus, only a few female gps alluded to the reason given in 9, namely,
that domestic abuse can be interpreted as a result of men’s dominant status in
 Mythologizing Time, Mythologizing Violence

society and some men’s tendency to view women as property, while the expla-
nations offered in 10 and 11 primarily occurred in explicit terms in some of the
male gps’ responses. All the doctors in my sample provided a mixture of some
of the reasons above, and by far the commonest explanations across all the in-
terviews, regardless of age or gender of the gp, were the ones stated in 1 to 5. It
is important to note that these are mostly explanations that researchers on do-
mestic violence have identified as common cultural myths as outlined in chap-
ter 3. In a sense, by drawing upon these explanations gps indirectly reinforce
and perpetuate already existing myths that stigmatize victims and thus also
contribute to a further tabooing of the issue.

Stereotypical Scenarios: Alcohol, Low Social

Background, and a Family History of Abuse
Doctors also contradicted themselves, for example, when they stated that the
problem of domestic violence was multifactorial but then went on to linguisti-
cally present scenarios of social deprivation, alcohol-related violence, and drug
abuse. The following responses illustrate this point:

3. a. I don’t think we were ever taught anything about it. Er, we were
told that it existed, that it was a social phenomenon, you know, part
of the Saturday night ritual of husband getting plastered after the
football match, going home and beating up his wife, and falling
asleep. The sort of thing that we regularly saw when I was working
in casualty in the late sixties but we never really thought it was, er,
a, as widespread and as malignant a problem as I think it’s proba-
bly turned out to be.

b. There might be somebody who goes out and gets pissed and [lives
in a] horrible neighborhood and, so that’s all distressing, they’re
unemployed and all that sort of stuff, then beats up his wife. It’s
not a health issue.

c. You know, I mean, sometimes there is a background of, of drug

taking, er, often alcohol use, both by one or both partners, er, I think
sometimes people are difficult to live with and people find diffi-
culty living with each other and, and depending on er, er, their own
Mythologizing Time, Mythologizing Violence 

parenting, the way that they’d been brought up and their expecta-
tions of what living in a partnership is about, er, and, er, whether
they have discovered that, er, life is about sharing and not being self-
ish or, I mean just, I mean learning how to live. Um, many of them
don’t have those skills and I think when they find themselves in,
er, a close relationship, I mean close physically in, you’re living, you
know, in the same space, er, with different ideas about, er, what to
do with the money that’s coming into the household or how to bring
up the children or what drugs to take that night or, you know, let’s
go out and get smashed on a Friday night, you know, [?]. Um, they
find it difficult to cope.

Interestingly enough, these scenarios were conjured up by male gps, while fe-
male doctors were less likely to dramatize their explanations of domestic abuse,
although they also mentioned alcohol and drugs as frequent triggers of violence.
The gps create what they perceive as typical scenes of domestic abuse and even
accommodate their speech in terms of colloquialisms and lower register in or-
der to mimic the kind of language a batterer might use: “getting plastered,”
“gets pissed,” and “get smashed.” The scenarios are also interesting because
they draw upon stereotypical notions of what men usually do: they go out on
a Friday night or watch a football match on Saturday, get drunk, and then beat
up their partners. The gp in (3a) sees domestic violence as part of a “ritual” that
has turned out to be far more “malignant” and “widespread.” In other words, as
long as domestic violence can be explained as part of this Saturday night ritual
in connection with alcohol it can be understood and dealt with, whereas now-
adays it seems to be far more subtle and deviant. Ironically, the gp depicts do-
mestic violence in medical terms, as one would talk about ulcers or carcinoma,
although he states that domestic violence is a “social phenomenon.”
Example (3b) illustrates the correlation that gps draw between social fac-
tors and abuse. The logical and temporal connector “then” links up domestic
violence in a causal relationship with unemployment and poor housing condi-
tions, which are emphasized in the judgmental expanded noun phrase “horrible
neighborhood.” In (3c) the gp provides a lengthy explanation with numerous
factors, but all these explanations are linguistically embedded in a framework
of notions of drug taking and alcohol abuse. Thus, the gp starts his explana-
tion by mentioning exactly those two factors, and he ends by almost cynically
enacting the way such drug taking or alcoholism might manifest itself in a
 Mythologizing Time, Mythologizing Violence

relationship. Another middle-aged male gp mentioned power dynamics within

relationships and the potential threat some men may perceive, but he then al-
most ridicules the whole argument by conjuring up a scene where a batterer
plans his violent behavior, again in connection with alcohol and against the
background of the going-out ritual:

4. [One could have] some sociological theory, I mean, power in a

relationship and the [other] dynamic within a relationship, er, and
the use of power in a relationship. Or the abuse of power. . . . And,
it happens when there’s a threat, or one party sees a threat to their
position within a relationship for whatever reason [?] in terms of
their freedom that “I want to go out with the boys and get pissed
and I come back and then, you know, you’re going to be my slave
and you [do what I want you to do].”

The most striking feature in this scenario is the use of “constructed dialogue”
(Tannen 1989:110). Constructed dialogue, which is marked by the insertion of
direct speech in an account or a narrative, is often used in conversation because
it “creates involvement by both its rhythmic, sonorous effect and its internally
evaluative effect” (Tannen 1989:133). Here it is supposed to convey the batter-
er’s thoughts or even words with which he addresses his wife, and it is mainly
used to give life to the scene. By drawing upon such a cliché this gp trivializes
the problem and neglects wider issues concerning male dominance that per-
vade our society. As the literature on domestic violence demonstrates, violence
can be triggered but not ultimately caused by alcohol abuse. Johnson (2001), for
example, contends that men do not batter their partners because they are in-
toxicated but because they have the power to do it (see chapter 3). In contrast to
example (4), consider the following comment made by an older female gp who
discusses the same issue and also uses constructed direct speech:

5. I don’t think men identify that actually overtly. Um, I think it’s
just something they do. They don’t sort of think, “Right,” I m——
, I mean, I don’t think they think consciously “Right, I’m the one
to take that power over you,” um, it just happens.

This gp presents the question of power in much more universal terms. That
men exert power over women is “just something they do” and is thus regarded
Mythologizing Time, Mythologizing Violence 

as a mechanism ingrained in society as a whole. Nevertheless, most of the re-

sponses reveal that explanations such as alcohol are often used by doctors as ex-
cuses not necessarily to condone but to understand violent acts. As I said above,
such explanations are problematic in that they divert attention from more fun-
damental questions concerning power and the acceptance of violence in our
society. These explanations have such a strong standing in general social dis-
courses that even victims themselves absorb and reproduce them, as one young
female gp pointed out: “I think some women accept it because their hus ——,
their husband only does it when he’s drunk, because they believe it’s the drink
talking rather than the, the chap talking.” The personification of “the drink”
points toward a strategy gps also regularly adopt in their explanations, namely,
to assign agentive power to social problems of all sorts and thus to deflect the
issue away from the male perpetrator.
Even where the perpetrator was moved into focus, which only occurred when
gps were specifically asked about reasons for domestic abuse, the violence was
mostly explained in terms of external factors. In the following response a mid-
dle-aged female gp rationalizes batterers’ behavior by drawing upon the typi-
cal family history explanation mentioned above and in chapter 3 as well as on
personal character, but the personality explanation is then supplemented by
a kind of biological excuse that men are physically stronger than women and
therefore resort to violence:

6. And some of it is because that’s what they’ve seen as children as

well so that it’s not unusual to hit mum if you’re, if you come home
and you’re annoyed or you maybe have seen that and, and that can,
that can lead them but, um, I mean I know it, it does happen in more
affluent areas as well. It’s unfair to say it’s all because of deprivation
but, I mean, I think a lot of it must be personality in the person that
does it and then they need to be in control and, and the only way
possibly in the relationship they can do that is physically usually
’cause the man is more powerful than the woman.

The scenario of the family violence background is conjured up through the use
of the colloquial noun “mum” and the generic pronoun “you,” which creates
a sense of general applicability. The shift from “they” to generic “you” also in-
dicates a shift from the speaker’s distant position closer to the point of view of
 Mythologizing Time, Mythologizing Violence

the “children” because “you” indirectly also includes the speaker. Thus, the gp
indicates that she can understand how these things come about, or, in her own
words, “you can see how it can happen.” The gp then moves on to an explana-
tion based on the perpetrator’s personality. Batterers “need to be in control,”
and the “only way” to achieve this is by physical violence, because “the man is
more powerful than the woman.” By using the attributive adjective “only” and
by applying generics for “man” and “woman,” the gp makes quite a categorical
statement about the correlation between a sense of power, physical strength, and
violence, thereby reconstructing another common cliché. The biological fact
that men are physically stronger is thus used to locate violent behavior within
a feasible explanatory framework.

The Construction and Reiteration of

Cognitive Maps and Explanatory Frameworks
By conjuring up specific backgrounds against which domestic violence occurs,
doctors also create cognitive maps yet on a more abstract, conceptual level. The
various backgrounds of deprived lives, poverty, underachievement, drug tak-
ing, alcohol abuse, family violence, and so on function as cognitive frameworks
within which domestic violence can be comfortably located, identified, and un-
derstood. In terms of theories of narrative knowledge (see chapter 2), the gps
(re-)create specific narratives about possible causes of domestic violence in or-
der to categorize and compartmentalize the problem and to make it thus com-
prehensible. In other words, my analyses show narrative to function as an or-
dering principle for people’s “transactions,” in this case, gps’ rationalizations of
a problem they encounter in their practice work. If the setting of violence does
not conform to the general or schematized cognitive map of violence, doctors
express their surprise or find the violence incomprehensible. Thus, one gp com-
mented that “it’s often been surprising to me, er, people I’ve known for a long,
long time, who’ve seemed like very decent, er, people, very, er, decent families,
decent relationships, suddenly came out with domestic violence problems.” In
other words, domestic abuse is more unexpected in “decent” people, that is,
presumably, people from a standard middle-class background, than in people
from a background gps are maybe less familiar with as far as their own personal
experience is concerned. Another older male gp related a narrative of one of his
patients and concluded by saying “and she was a, you know, nice, decent per-
Mythologizing Time, Mythologizing Violence 

son.” Again, the attribute of being decent is depicted as a contrast to people’s

involvement in domestic abuse. The implication is that it is incomprehensible
that a nice person could be subjected to violence or, put differently, that she
could have done anything to deserve violence. Thus, the doctor established an
implicit link between the occurrence of violence and the victim’s behavior that
corresponds with the victim-blaming strategy mentioned above.
Doctors’ cognitive maps of domestic violence also locate abuse in a socially
remote place. Most gps acknowledged that, statistically speaking, domestic
abuse occurs across all social classes and in all areas. Nevertheless, gps’ sce-
narios and narratives in the interviews depict predominantly deprived social
backgrounds. This indicates that doctors cognitively map abuse onto spatial re-
gions that they themselves do not inhabit, and thus they once again create a dis-
tance or at least some kind of “comfort zone” between themselves and their pa-
tients. We may object here that detachment is part of gps’ job and that they are
trained to keep their distance and not become too emotionally involved. This
standpoint is problematic, however, if it leads to gps’ early resignation in view
of domestic violence cases or, even worse, to their deliberate neglect of the is-
sue. By drawing upon the common excuses and justifications outlined by Pta-
cek (1990), gps reinforce cultural myths and stereotypes about domestic abuse
and, at the same time, widen the gap between patients and the medical profes-
sion. Thus, miscommunication and misconceptions that lead to mutual dissat-
isfaction and frustration are likely to persist in general practice and therefore
perpetuate a need for special training, as Williamson contends:

As with all of these explanations, it is important to consider the

wider social and political framework within which domestic vio-
lence occurs. This includes acknowledging the historical and cultural
acceptance of violence against women on a global scale. That such
theories were relatively common in the interviews with stage two
participants suggests that much more work needs to be conducted in
challenging social myths and stereotypes about domestic violence,
in the context of general basic awareness training. (2000:99)

In the final chapter I return to the issue of training and especially address the
need for a training module on narrative communication in medicine.
 Mythologizing Time, Mythologizing Violence

In addition, the explanations mentioned above define domestic violence pre-

dominantly within the social rather than the medical realm and thus keep the
problem out of doctors’ sphere of activities and responsibilities. In the follow-
ing sections I address the question of doctors’ agency.

The Discursive Construction of “Medical” and “Social” Problems

gps did not see their role as being “experts” in domestic violence; instead, they
emphasized their function as “generalists” or as “general practice specialists”
who were “just expected to do too many things” and therefore did not regard it
as their task to prioritize domestic violence. As one male gp put it: “I don’t want
to be a specialist in domestic violence.” This phrase is meaningful, as it reveals
gps’ defensiveness about their work and position within the medical setting.
Unlike doctors who specialize in a particular field, gps are expected to know a
lot about many different things. However, their rank in the hierarchy of doctors
is considerably lower and their job less appreciated than that of other types of
doctors. As Annandale points out, “gps have historically enjoyed less power and
status than senior hospital doctors, although their relative isolation has tended
to afford them a fairly high degree of clinical autonomy” (1998:241). Statements
such as the ones above may indicate gps’ dissatisfaction with their lower status.
However, the gps thus also separated “medical” from “social” problems, and
they indirectly set up limitations to their own responsibilities. The following
narrative illustrates this point. It was related by an older female doctor in the
context of a discussion of the status of domestic violence in the health care set-
ting. The narrative refers to an incident that occurred while the gp was on duty
with the regional emergency doctors (G-Docs = Grampian Doctors).

Narrative 9
1. I was in G-Docs, er, just a few weeks ago,
2. and, er, I was called out to something with, you know, that was
a domestic violence situation.
3. Um, it was kind of given a lower status than or a low——, lower
priority than say, maybe an elderly person with a stroke or a heart
attack or something like that.
4. So, you know, it was kind of a nuisance that we had to go out and
see it
Mythologizing Time, Mythologizing Violence 

5. and, er, then they got the social workers involved

6. and I say I think they kind of think, “Well, it’s the social work-
ers’ problem, it’s not ours,” you know,
7. and the police were involved as well, so,
8. they left it with the social workers, so.
9. Poor social workers, that’s not fair [laughs].

In this narrative the gp openly, albeit tentatively, addresses the problem that
domestic violence is often given low priority by doctors. The hedge “kind of” in
lines 3, 4, and 6 (“kind of given lower status,” “kind of a nuisance,” “they kind
of think”) indicates that the gp implicitly wishes to downplay the fact that do-
mestic violence was not taken too seriously by the doctors and thus to main-
tain her “face wants” (Goffman 1967), namely, not to be viewed critically her-
self by the interviewer. Higher up on gps’ agenda and thus presumably also at
the forefront of their attention, as the gp hypothesizes by using the modal ad-
verbial “maybe” in line 3 (“maybe an elderly person with a stroke”), we can
find a disease such as a “stroke” or a “heart attack” (line 3) that is easily identi-
fiable as a prototypical “medical” problem. Interestingly enough, the gp com-
partmentalizes such diseases by placing them in the same category, as can be
seen in the extended noun phrase “something like that” (line 3). Although the
category remains unspecified, the gp nonetheless indirectly draws a distinctive
line between “medical” and “other” problems.
In the case of domestic violence the emergency doctors find it “a nuisance” to
“go out and see it” (line 4). The postposition “out” in “called out” (line 2) and “go
out” (line 4) evokes both the container metaphor and the path schema whereby
the doctors are forced to leave their secluded medical sphere (“in G-Docs,” my
emphasis), especially as the roles are reversed in this particular setting and the
doctors now assume the part of the “moving actor” who approaches the patient.
This spatiotemporal condition combined with the above-mentioned partition
between “medical” and “other” problems discursively creates a seemingly valid
reason for doctors’ discontent. In other words, since domestic violence is not a
medical problem, it does not justify that they are called out. Consequently, the
gp expresses her own irritation in that situation, and she establishes a division
of duties for doctors and social workers in the direct quotation of her colleagues’
alleged thoughts: “Well, it’s the social workers’ problem, it’s not ours” (line 6).
The quote has as its central theme the delegation of further responsibility to
 Mythologizing Time, Mythologizing Violence

other agencies, and the fact that the gp uses the alleged thoughts of others to ex-
press this view also reveals the mechanisms of “face work” (Goffman 1967) and
“interpersonal perception” (Laing, Phillipson, and Lee 1966). In order to avoid
potential criticism on the part of the interviewer and to save her own face, the
gp “hides” her own opinion behind the one of her colleagues. The shift from
the deictic center “I” (line 2: “I was called out”) to “we” (line 4: “we had to go
out”) to “they” (lines 5, 6, and 8: “they got the social workers involved,” “they
kind of think,” “they left it”) and the use of passive constructions, which usu-
ally blur agency (Jackendoff 2002:248), in lines 3 and 7 (“it was kind of given a
lower status,” “the police were involved”) contribute to a certain discursive “self-
defense.” At the same time, however, the narrative itself reinforces on a micro-
linguistic level exactly those concepts that the gp seems to acknowledge as be-
ing problematic or at least open to criticism on the surface. Thus, for example,
the delegation of responsibility to other “social actors” is captured by the con-
trast between the frequently and fully spelled out noun phrase “social workers”
in lines 5, 6, 8, and 9 and the replacement of the noun phrase “G-Docs” by its
reduced form, the personal pronoun “they,” in lines 5, 6, and 8. In a sense, the
social workers are thus granted fuller cognitive presence in the narrative and,
hence, more importance, while the gps appear only as marginal actors in this
situation. Likewise, the domestic violence case as such is marginalized in the
narrative by means of underspecification through the vague pronoun “some-
thing” and the indefinite determiner “a” in line 2 (“a domestic violence situa-
tion”) as well as its further linguistic reduction through the pronoun “it” (lines
3, 4, 6, and 8). These rather tentative descriptors indicate the gp’s reluctance to
label the incidence in terms of domestic violence and perhaps also her embar-
rassment at speaking about the issue.
Despite the gp’s awareness that doctors’ refusal to prioritize domestic vio-
lence can be problematic, the narrative undermines this message by linguisti-
cally replicating the same refusal. It also demonstrates how deeply the gp’s dis-
course is immersed in and informed by the biomedical model, which justifies
the low priority of domestic violence on gps’ agenda because it leads doctors
away from the clearly demarcated “pathway” prescribed by mainstream med-
icine and thrusts on them a responsibility that they do not perceive as part of
their social role as medical professionals. As I mentioned in the previous chap-
ter, one young female gp used the metaphor of the “medical wardrobe” in which
Mythologizing Time, Mythologizing Violence 

domestic abuse does not fit; she continued: “So, as you can’t treat it, um, you
know, we don’t have a very big role to play in that.” In other words, if there is
nothing physically wrong with a patient, the gp cannot do much. Consider also
the following responses:

7. a. There’s nae very much I can really do about domestic

violence.

b. I think giving them sympathy but that’s about it.

c. It’s difficult ’cause it’s not, there’s not like a cure for it.

d. I kind of think: “Oh, heaven’s sakes, what am I going to do here?”

because it’s not really something you can, you can help people with
in a kind of “sorting it” way, you know, you can help and support
them but you can’t really fix it for them.

e. You feel a bit powerless actually. There’s not an awful lot you
can do for them.

f. You can’t really necessarily change the situation for them, you
know.

g. I don’t feel there’s an awful lot practical we can do to support

them. It’s usually referring on to other agencies.

h. Social services may be better placed to deal with this type of

thing.

i. [It is] [s]omething I’m ill equipped to deal with.

Again, the answers are strikingly similar, and this is only a small selection of re-
sponses, all of which follow the same linguistic pattern: negators combined with
the quantifiers “much” and “a lot,” which are sometimes strengthened by the
intensifiers “very” or “awful.” In (7c), (7d), and (7g) the presuppositions of the
medical framework shine through, assigning doctors the power to deal with a
physical problem “practically” by means of “fixing it” with “cures.” In the case
 Mythologizing Time, Mythologizing Violence

of psychosocial symptoms, however, gps are “ill equipped” and feel “power-
less.” By frequently evoking these adjectives in their narratives the gps created
another myth, namely, the myth of their own inadequacy when faced with do-
mestic violence cases. This myth, if generally accepted as a fact, may well hin-
der gps from adopting a more active role.
It is not surprising that the vocabulary most of the gps used when they spoke
about their role also conveyed a sense of the “clinical” approach to domestic
violence:

8. a. Well, if she’s got signs of physical abuse I would examine her

and find out if she’s got any injuries, the nature of the injuries, the
extent of the injuries.

b. So, often at a first disclosure, it’s only appropriate to note it, to

ask a little bit more about the circumstances, what’s happening in
terms of physical stuff.

c. Yes, my role is mainly, I suppose, medical or supportive.

d. And in that situation obviously, um, we listen, we record what

happened, we record any injuries.

e. I think as gps, our job is to try and identify it, um, and try to help
as much as we can but I think ultimately, I think it’s an ongoing
problem we end up referring onward to the others.

f. I think for the gp the main job is to detect the problem and find
out, is there a readiness to do something about it? And if there is,
facilitate the first steps and involve whoever needs to be involved
to do something.

g. Most of the women have come to have injuries cataloged.

h. What can you do? What are the immediate needs? You know,
is there anything broken, is there anything that needs some sort
of treatment?
Mythologizing Time, Mythologizing Violence 

i. We’re not mind readers and if we’re having a busy surgery and,
all we see is the pink page in front of us. We’re not looking through
notes all the time and analyze everybody’s consultation. So if they
come in with a sore throat we deal with their sore throat and then
they go.

j. And then you know, depending on what they want to do, we would
see them as regularly after that even if it’s just as support capacity
or treating a depression.

k. I have documented the intrusion and I have said to her I’d be

willing to support her.

The responses illustrate to what extent the gps’ narratives are informed by sci-
entific and bureaucratic discourses surrounding medical practice. Thus, do-
mestic violence has to be “identified” (8e) and “detected” (8f) through physical
“signs” (8a) just like other diseases caused by natural aggressors such as bac-
teria or viruses, and a normal institutional procedure is to “examine” (8a) the
patient and to “document” (8k), “record” (8d), or “catalog” (8g) any physical
injuries. The patient is thus implicitly reduced to the “pink page” (8i; see also
chapter 5) in front of the doctor; that is, the “deciphering gaze” (Young 1995) is
more or less restricted to the signs and symptoms that have entered the med-
ical record and thus medical discourse on the patient’s case history. By draw-
ing upon biomedical discourse, gps in a way also create a “comfort zone” for
themselves, as they can use nonemotional language, which furthermore signals
their membership in a specific professional group. Couser observes for medical
jargon that “the opacity and impersonality of this language may provide nec-
essary distance for the patient as well as the doctor, though its purpose is ap-
parently to ease the physician’s, rather than the patient’s, suffering” (1997:26).
Undoubtedly, to deal with cases of domestic violence can be emotionally tax-
ing. A problem arises when doctors’ emotions become so overpowering that
they impede action.

Myths of Powerlessness and Inadequacy

The theme of powerlessness runs predominantly through the female gps’ re-
sponses, whereas male gps seem to be more likely to reconstruct the medical/
social divide in their discourses in order to justify their lack of response and
 Mythologizing Time, Mythologizing Violence

action. Both explanations can be considered myths to the extent that they do
not necessarily represent what is “true” but what medical doctors “believe to
be true.” As I argued in chapter 3, general practice is in fact well placed to dis-
cover and to subsequently deal with domestic violence. However, gps’ sense of
being inadequately prepared in situations in which they encounter domestic
violence in patients was sometimes so strong during the interview that the gps
incorporated it into their narratives or even made it the main focus of a story.
In Labov’s (1972a) terminology inadequacy as a theme is given enough impor-
tance to become “reportable.” The following story related by a young female gp
from a practice bordering on the city center illustrates this mechanism:

Narrative 34
1. I had, er, a girl who,
2. oh, it was so strange,
3. who was, she, the story was she’d fallen down the stairs and at
the bottom of the stairs there was a glass door.
4. She’d fallen down the stairs and through the door
5. and her leg was in ribbons
6. and I sat about an hour stitching it up,
7. and her husband was a drug [user]
8. and he sat with me, the whole hour, saying sweet things in her
ear, you know, and, you know, being generally supportive and
^so nice and ^so kind.
9. And then when she came back to the dressing clinic, to st——,
to have her stitches out and see how her leg was doing,
10. she admitted that he’d actually pushed her through a glass door
and that he’d been violent towards her for a long time.
11. But he wasn’t, you know, he obviously wasn’t there, um, at that
point.
12. So, that was great she told me
13. and that gave me great in——, insight into what’s been hap-
pening
14. but I felt then totally unprepared to do anything about it.
15. I mean I did nothing.
Mythologizing Time, Mythologizing Violence 

16. I did nothing.

17. I sympathized with her,
18. I sent her on her way because, you know, we hadn’t been told,
19. I mean there’s the A&E [accident and emergency] training
20. but nobody ever mentioned issues of domestic violence.
21. Perhaps they do now, that was, um, ten years ago.

The narrative starts with a clause typical of most of the narratives in my sam-
ple. It introduces the protagonist in a complex noun phrase, “a girl who was.”
The expansion of the noun phrase is interrupted, however, by the insertion of
a clause that already gives a first evaluative statement before the story is actu-
ally told: “oh, it was so strange.” The discourse marker “oh” is very interesting
as it indicates the shift in information management at this point. As Schiffrin
contends, “oh pulls from the flow of information in discourse a temporary fo-
cus of attention which is the target of self and/or other management” (1987:74).
In this case, attention is drawn away from the actual storyline to the speaker’s
feelings about the story.
In the complicating action sequence two more actors appear on the scene:
the doctor, who “sat about an hour stitching” up the patient’s leg, and the pa-
tient’s husband, who is immediately characterized in negative tones by the gp’s
mention of his drug addiction. The narrative action is situated temporally by
the explicit reference to the duration of the treatment, “one hour,” which is un-
derlined by the use of the progressive form in “stitching” (line 6) and “saying”
(line 8). The progressive form indicates the speaker’s perception of this time pe-
riod as long, and it might hint at a certain degree of discomfort felt by the gp in
that situation. Another interesting linguistic feature in line 8 is the almost im-
mediate repetition of the discourse marker “you know,” which is used to cre-
ate involvement: “and he sat with me, the whole hour, saying sweet things in
her ear, you know, and, you know, being generally supportive.” Obviously, the
narrator reaches a point in her story where she becomes more emotional, and
this is conveyed linguistically to the listener.
The resolution of the story, however, is suspended until line 10, where the
truth is finally revealed. It comes out that, underlying the whole narrative, there
is a history of domestic abuse. After the narrative proper the narrator adds a
lengthy coda that gives room for the retrospective evaluation of the story. The
 Mythologizing Time, Mythologizing Violence

evaluation section at the end is considerably longer than one would normally
expect. This indicates that the point elaborated in this part is of major impor-
tance to the narrator. What is interesting here is that this narrative, like the nar-
rative at the outset of the book and other narratives in my sample, lacks narra-
tive closure in the sense that the woman’s story remains unfinished.

Inactivity and a Feeling of Powerlessness as

“Reportable Events” in Narrative 34
The coda from lines 12 to 21 summarizes what the gp thinks in retrospect about
the whole story: “So, that was great she told me.” The discourse marker “so”
clearly demarcates the end of the preceding narrative and indicates to the lis-
tener that something else is to follow. In lines 12 and 13 the incident is evalu-
ated positively as an experience that gave the gp “great insight”: “So, that was
great she told me and that gave me great in——, insight into what’s been hap-
pening.” The positive side is emphasized through the repetition of the adjec-
tive “great” in this context. However, this is soon countered with the contras-
tive coordinator “but,” which introduces a negative facet of the gp’s experience,
namely, the fact that she was “unprepared to do anything.” This is intensified
by the adverb “totally.” In line 15 the speaker marks, by using “I mean,” her at-
tention to the meaning of the statement she made in line 14 (“but I felt then to-
tally unprepared to do anything”): “I mean I did nothing.” The meaning of the
sentence in line 14 is further clarified to the listener, and the gp quite literally
“makes herself plain” by using a simple main clause to express her inaction: “I
did nothing.” The gp’s sense of being almost paralyzed by her patient’s story is
reenacted by the structure of this narrative, where the coda brings everything
to an uncommonly long halt. The coda furthermore reveals the socionarrative
nature of the story, as it is mainly marked by discourse markers used to enhance
speaker participation and mutual understanding. “You know” in line 18, for ex-
ample, is used by the gp to make sure that the interviewer understands why it
was so difficult for her to act appropriately in that situation: “I sent her on her
way because, you know, we hadn’t been told.” In lines 17 to 20 the gp explains
her reaction and her lack of agency through lack of training (“I sent her on her
way because, you know, we hadn’t been told, I mean there’s the A&E training
but nobody ever mentioned issues of domestic violence”).
Mythologizing Time, Mythologizing Violence 

Voicing a Lack of Agency and Self-Criticism

At the end of the story the gp focuses on her own lack of action and thus pres-
ents herself as an unintentional agent of the woman’s victimization: she actively
“sends her on her way.” This particular story as part of the gp’s “storied knowl-
edge” (Polkinghorne 1995) about domestic violence is retrieved at this stage of
the interview in order to illustrate a point, namely, that there is a lack of appro-
priate training for gps as far as domestic violence is concerned. The length of
the coda shows that the evaluation of this story is important, since it focuses
on the gp’s experience of inadequacy rather than on the incident related in the
story as such. This also suggests that this experience must have had a great psy-
chological impact on the doctor. The gp by telling this story almost makes an
apologetic gesture here. At another point in the interview the same gp criticizes
herself openly when she says:

9. But I’m maybe very bad, I don’t actually fit, pick up the phone
and phone Grampian Women’s Aid and make an appointment or
write a letter. I, I basically I usually put it back to the girl to contact
them and I don’t know if that’s, I mean how many of them actually
do contact them or not I’m not sure.

This self-criticism hints at the mechanisms of interpersonal perception under-

lying the interview situation. By criticizing herself and by placing this self-criti-
cism in an adequate explanatory frame (e.g., lack of training, insufficient expe-
rience, etc.) this gp linguistically anticipates potential criticism on the part of
the interviewer and thus presents herself in a more favorable light as a gp who
is self-conscious and aware of problematic issues surrounding her work with
regard to domestic violence.

Summary
In this chapter I considered a number of myths the gps drew upon and (re-)cre-
ated in their narratives. On the one hand, the gps’ explanations of domestic vio-
lence were shown to be influenced by common cultural myths surrounding the
problem, for example, the myths of causal relationships between social depri-
vation and violence or between alcohol abuse and violence. On the other hand,
 Mythologizing Time, Mythologizing Violence

I also demonstrated to what extent such explanations are used by gps to dele-
gate responsibility to society at large as domestic violence is reframed as a social
rather than a medical problem. Another myth, the “myth of time” in general
practice, proved to be another powerful discursive device to explain and to ex-
cuse doctors’ reluctance to tackle domestic violence more actively. The question
of agency is a crucial one when considering domestic violence and the health
care system. For this reason I devote the following chapter to the investigation
of the gps’ conceptualizations of the women’s as well as their own agency.
7. Agents of Their Own Victimization
The Women’s Role in the GPs’ Narratives

“Why do they stay?” is a question commonly asked by gps when they try to ra-
tionalize the behavior of patients who suffer domestic violence, and it is also
a question almost all the gps in my sample asked and answered at some point
during the interview. However, this question becomes problematic if the gps’
explanations convey a picture of the woman as incompetent (Loseke and Ca-
hill 1984). What is also at stake here is a question of agency, which can be viewed
from two perspectives: the woman’s relationship with her abusive partner, on
the one hand, and the gp’s role as provider of salient help, on the other. The an-
alytic parts in this chapter therefore have the following twofold structure. First,
I illustrate how female victims of domestic violence are linguistically presented
and how gps construct specific images of and identities for their patients. Second,
this is complemented by an analysis of the way gps conceptualize their own role
as health care providers, which I partially also explored in the previous chapter.
Here I investigate how general practitioners linguistically encode their role vis-
à-vis the victims’ behavior in their narratives. The analysis focuses in particu-
lar on the way passive constructions and modalities in the doctors’ narratives
set up and, at the same time, reinforce conceptual and expectational frames as
well as evaluative parameters by which doctors judge their patients.
Modalities, for example, may reveal doctors’ attitudes toward the factual-
ity and significance of cases and thus also their expectations concerning wom-
en’s behavior and lifestyle. According to Quirk et al.’s Comprehensive Grammar
of the English Language, “modality may be defined as the manner in which the
meaning of a clause is qualified so as to reflect the speaker’s judgment of the
likelihood of the proposition it expresses being true” (1985:219). One can dis-
tinguish between intrinsic modality such as “permission,” “obligation,” and “vo-
lition,” which involve some kind of intrinsic human control over events, and
 Agents of Their Own Victimization

extrinsic modality such as “possibility,” “necessity,” and “prediction,” which do

not primarily involve human control of events but do typically involve human
judgment of what is or is not likely to happen. Leech’s (1987) tripartite division
of the notion of likelihood into factual, theoretical, and hypothetical meaning
is also useful here. Factual meaning implies that the speaker takes the prop-
osition for a fact, whereas theoretical meaning states a proposition as an idea
rather than as fact. In Leech’s terminology a factual sentence can be said to be
“truth-committed,” while a theoretical sentence is “truth-neutral” (1987:114).
Hypothetical sentences, by contrast, imply the speaker’s assumption that “the
happening described did not, does not, or will not take place” (Leech 1987:118).
Leech calls this condition “negative truth-commitment.” Modal verbs also ex-
press factual, theoretical, or hypothetical meaning.
As modals indicate the speaker’s judgment of the likelihood of an event, this
could yield interesting results in the gps’ narratives about their patients. Thus,
doctors might not consider a patient’s presentation of domestic abuse in the
home credible or likely, or they might create a scenario of a relationship using
the indicative mood without even knowing what the real situation is. When
gps talk about consultations with patients, they might frequently use modals
such as “would” or “could,” thereby implying that the whole depiction is more
a theoretical or even hypothetical construct than an account based on real-life
experience. At the same time, modals expressing obligation might reveal how
gps judge and evaluate the victim’s role in terms of agency, for example. Modals
can also be used as a means of verbal distancing from a situation and may thus
indicate the gps’ lack of understanding or involvement. Some of these possibil-
ities are explored in the narratives presented in this chapter.
Moreover, in order to illustrate how “agency” in particular is constructed in
the gps’ discourses and used as a “commodity” in the sense of Bourdieu’s (1991)
“linguistic market place,” I draw in this chapter mainly on linguistic theta the-
ory, with its thematic roles of agens and patiens (Gruber 1965; Fillmore 1968;
Jackendoff 1972) and Goffman’s (1974) frame theory as well as the sociopsycho-
logical concept of role negotiation. After all, as Bruner (1986) argues, meaning
and human cognition only manifest themselves in people’s discussions and ne-
gotiations of concepts (see chapter 2).
Agents of Their Own Victimization 

Actors and Agents

Before I proceed with the analysis, the terms actors and agents, which I intro-
duce in the title of this section, require some clarification. The term actor is
borrowed from Goffman’s (1974) frame theory. As I briefly outlined in chap-
ter 3, Goffman conceptualized conversation as a staged play during which par-
ticipants act out their roles as individuals but also as social and professional
personae. The concept of “frame” includes organizational rules for interaction
on both a social as well as a personal level. Thus, Goffman assumes that “def-
initions of a situation are built up in accordance with principles of organiza-
tion which govern events—at least social ones—and our subjective involvement
in them” (1974:10–11). Goffman distinguishes between “natural” and “social”
frameworks, and the main difference between these two is the way individuals
are conceptualized with regard to agency:

A central difference between natural and social frameworks is the

role accorded actors, specifically individuals. In the case of natu-
ral perspectives, individuals have no special status, being subject
to the same deterministic, will-less, nonmoral way of being as any
other part of the scene. In the case of social frameworks, individ-
uals figure differently. They are defined as self-determined agen-
cies, legally competent to act and morally responsible for doing so
properly. In this latter connection, then, individuals have an en-
tirely special role in activity. Moreover, this role is diffusely rele-
vant. The properties we attribute to normal actors, such as correct
perception, personal will, a range of adult competencies, access
to memory, a measure of empathy regarding others present, hon-
esty, reliability, fixed social and personal identity, and the like are
counted on in a multitude of ways whenever interpersonal deal-
ings occur. (1974:188)

The notion of social frames and of participants’ expectations underlying in-

teraction can also be transferred onto the consultation, during which doctor
and patient are the actors in a more or less predetermined sequence of events:
presentation, examination, and diagnosis of illness, as well as the initiation of
treatment and remedy. In chapters 2 and 5 I mentioned Strong (1979), who re-
fers to the almost ritual procedures in medical encounters as the “ceremonial
 Agents of Their Own Victimization

order,” that is, the fact that both doctor and patient act out their expected roles
in the consultation frame and that they try to reach an agreeable conclusion to
their conversation. Young observes that framing in medical examinations “is
accomplished by greetings, forms of address, language about the body, defer-
ence and dominance behavior, costuming, role play, the management of verbal
and nonverbal delicacy, ritual, and metacommunication” (1997:11). The trans-
actional nature of medical encounters, as in any other socially organized ser-
vice encounter,1 requires that participants’ expectations of the interaction are
met; otherwise, they can lead to misunderstandings and disappointment.
In consultations where domestic violence is at stake, the gp might, for exam-
ple, expect to follow the biomedical consultation model with presentation, ex-
amination, and diagnosis, while the patient hopes to gradually open up about
her problem, possibly assisted by appropriate prompts offered by the doctor
(see chapter 5). Very often, doctors’ discursive practices are influenced, for ex-
ample, by the requirements of record keeping, as Ainsworth-Vaughn points
out: “First, physicians often have certain specific goals that they must accom-
plish during the talk. They have (justifiably) been required to memorize lists
of questions to be asked during the encounter. . . . The need to get specific in-
formation, to fill in the blanks in the mental and written forms, is very great.
This may push physicians toward regarding their talk with patients as non-
conversational” (1998:182). If different preconceptions by doctor and patient
impede a successful encounter, both may feel frustrated and powerless in that
situation. As I mentioned in chapter 3, the role allocated to patients in the bio-
medical framework also requires compliance with the treatment suggestions
made by the medical specialist in order to regain health. In cases of domestic
violence this predetermined patient role may pose a problem if women seem-
ingly do not adhere to what doctors may expect of them or even advise them to
do, that is, to leave their abusive partners.
Another important factor in the consultation frame is the way illness is per-
ceived by both doctor and patient. Illness and disease can undoubtedly be lo-
cated in a “natural framework,” since they are usually caused by natural aggres-
sors such as bacteria or viruses, which have a harmful impact on the physical
condition of a person. In that sense, people are seen as being involuntarily ex-
posed to disease, and they are not normally attributed an active role in the pro-
cess of becoming ill. The role of the doctor as a health care professional is to
Agents of Their Own Victimization 

help the individual patient who does not have the expertise to overcome the
problem alone. Yet, to come back to the questions I posed at the outset of this
book, what happens if the problem the patient presents in a consultation can-
not be explained in terms of the biomedical model alone and hence cannot be
remedied by merely prescribing medication? What if the “signs” have a psycho-
social origin and the problem must therefore be interpreted and dealt with in
a “social framework”? We must not forget that one of the perturbations of gps
is that even if they “fix” the damage, the patient might be hurt again. Agency
becomes vital in this respect, since it entails questions concerning blame and
responsibility. These questions must be considered against the wider back-
ground of medical ethics, which has traditionally been founded on three cor-
nerstones: doctors’ decorum, which includes politeness and respectfulness but
also courage and resoluteness; deontology, which refers to doctors’ duties and
obligations; and politic ethics, which has to do with doctors’ accountability to
the wider community (Jonsen 2000). When patients’ noncompliance with sug-
gested treatment measures is perceived by doctors to infringe on their profes-
sional requirements, they may well feel frustrated and start to blame patients.
O’Connor maintains that the “noncompliant” patient is considered “deviant,
uncooperative, negligent, stubborn, ignorant, unreliable, or at the very least
in default” (1995:174). This opinion “contributes to negative stereotyping and
the damage that stereotyping always does, and tempts or allows health profes-
sionals to blame patients for not getting well” (O’Connor 1995:174). As I dem-
onstrate below, stereotyping and blaming can also be found in the gps’ narra-
tives in my sample.
Linguistically, agency can be dealt with in two interconnected ways: first,
with regard to thematic roles (also referred to as theta roles) and, second, with
regard to active/passive constructions. The theory of thematic structures, or,
for short, theta theory, goes back to the early works of Gruber (1965), Fill-
more (1968), and Jackendoff (1972), who proposed that each argument of the
predicate (i.e., the subject or complement) carries a particular thematic role
and that thematic functions are drawn from a limited universal set. The the-
matic roles that are of interest for this study are agent/actor, that is, the insti-
gator of some action, and patient/theme, the entity that undergoes the effect of
some action (Radford 1988:373). I henceforth use the Latin terms agens and pa-
tiens instead of the English “agent” and “patient,” since the grammatical term
 Agents of Their Own Victimization

“patient” could obviously cause some confusion in the context of doctor-pa-

tient interaction. The function of these two thematic roles can be illustrated
with the following example:

John hits Jill.

Grammatically speaking, the subject in this sentence is “John,” and “Jill” is the
direct object. In terms of thematic roles “John” is the agens and “Jill” is the pa-
tiens of the action expressed in the verb “hit.” If we convert this sentence into
its passive voice, the grammatical structure changes:

Jill is hit by John.

Both arguments “Jill” and “John” maintain their thematic roles of patiens and
agens, respectively, but their grammatical relations change: “Jill” is now sub-
ject, and “John” appears in the oblique case. In any passive construction either
the agens can be left out completely and is thus removed from focus, or it can
be added in a prepositional phrase with “by,” which makes agency explicit and
brings it back into focus. In the following analysis of the gps’ discourses I inves-
tigate how agency is linguistically constructed and what implications this can
have for gps’ perceptions of and attitudes toward domestic violence victims.

Victims as Agents of Their Own Victimization

When the doctors in my sample spoke in general about victims of domestic vi-
olence, they frequently used passive constructions:

1. a. they’ve been beaten up

b. one or two middle-class people who are abused
c. they’d been assaulted
d. person who is being victimized
e. the last person I had in who’d been complaining of being hit
f. someone’s been attacked
g. she’s been abused
h. a lot of women are abused verbally
j. the girl that got her arm broken

In using passive constructions, which are often combined with the generalizing
pronoun “they” or the impersonal noun phrases “someone” or “person,” doc-
Agents of Their Own Victimization 

tors present violence as agentless, that is, the male perpetrator is left out of the
picture. Trinch also found in her study of Latinas’ and legal helpers’ abuse nar-
ratives that “the purpose of the passive construction is to deflect the importance
of the agent” (2003:20). This might have to do with the fact that the gp often
sees only the woman patient within the limited time span of the consultation,
or the gp might be the partner’s doctor as well and therefore be more concerned
about issues of confidentiality. If this is true, however, it also reveals doctors’ lack
of interest in engaging more in the personal circumstances and background of
patients and a reluctance to explore underlying problems further.
I must add here that the gps in my sample did occasionally talk about per-
petrators of violence and the possible reasons for their behavior, but this was
mainly done in response to the following question: “Why, do you think, does
domestic violence happen?” Patients, on the other hand, are quite literally as-
signed the role of patiens; that is, women victims are depicted as being passive,
and, what is more, their gender remains unspecified. Even where active con-
structions are used, the violence spoken about often remains vague:

2. a. women come in with injuries that they’ve sustained

b. there’s lots of folk who are involved in domestic violence
c. people who have had violent episodes
d. women who are experiencing domestic violence
e. a final hitting out
f. fights between partners
g. systematic torture a lot of women go through
h. they seem to have stumbled from one abusive relationship to
another
i. I know a lot of women who just continued to put themselves at
risk

In these examples the male perpetrator is as absent as in the passive sentences

in (1) above. The violent incident is described, for example, in a gerund con-
struction (2e) or in the extended noun phrase “fights between partners” (2f),
where agency is equally distributed to both parties in a relationship. In exam-
ples (2a) to (2d) victims are assigned the thematic role of patiens, but they re-
tain the subject position in the sentences, which implicitly makes them appear
more active in relation to the verb. The last two examples, (2h) and (2i), provide
 Agents of Their Own Victimization

the female victim with an agentive role. While in (2h) the verb “stumble” still
implies somewhat helpless and involuntary movement, the verb phrase in (2i)
clearly indicates deliberate action and thus agency on the part of the woman.
The attribution of agency to the victims is a striking and frequent theme that
pervades to a greater or lesser extent all the interviews, regardless of whether the
doctor was male or female. The following narrative told by a middle-aged male
doctor from a city-center practice illustrates how doctors frame women linguis-
tically as the agents of their own victimization. The narrative was told in re-
sponse to the question: “Is there any case that is very vivid in your memory?”

Narrative 5
1. I had one particular [patient] who’s, who is, you know, in her
second or third abusive relationship, er,
2. and I, I just feel powerless, you know.
3. I mean this woman by choice has sought out yet another
person.
4. Maybe not “sought out,”
5. I mean maybe it’s that, er, her, her social, er, mix is with people
who share that same, er, manner [?] to their previous partners.
6. You know, if they’re all boozers and they all meet in the pub or
whatever
7. then it’s likely that she’s gonna meet other people who, who are
similar,
8. you know, in that we all tend to, um, find friendship with peo-
ple who are or who have similarities.
9. So it’s, it’s maybe not so surprising.
10. But it’s most surprising to me why people choose, er, to, to, to
reenter, er, an arena of further physical violence, having got out
of a previous one.
11. I find that really tough.

The first clause, which offers an orientation to the subsequent story, intro-
duces the protagonist, who remains unspecified through the use of the indeter-
minate numeral “one” but who is then given special status through the adjec-
tive “particular,” which makes this patient stand out from other female patients.
Another interesting feature to note in this opening sentence is the switch from
Agents of Their Own Victimization 

past tense, the most commonly used tense in narratives of personal experience
(Labov 1997:400), to present tense. This indicates either that the case is still
open and currently being dealt with by the doctor or that the present tense is
used to underpin the universal validity of what is being said in this story. The
fact that the opening sentence is immediately followed by a clause that func-
tions as a first evaluative device (“I just feel powerless, you know”) seems to re-
inforce the idea that the narrative initiated here serves the purpose of repre-
senting an exemplary case, and it underlines the narrator’s opinion about this
patient and her behavior.
In line 3 the gp elaborates on the reason why he feels “powerless” with regard
to this patient: the woman “by choice has sought out yet another person” who is
violent toward her. Significantly enough, the thematic structure and the active
voice of the verb chosen here clearly attribute an agentive role to the woman. In
other words, the patient deliberately looked for another violent partner. This no-
tion of agency is emphasized even more through the insertion of the adverbial
prepositional phrase “by choice” between subject and verb phrase, which im-
plies again that the woman found an abusive partner by her own volition. The
motif of choice is resumed in line 10 in the verb “choose.” It is a motif that runs
invariably through the gps’ responses in the interviews, as I discuss below.

The Negotiation of “Agency” in Narrative 5

Line 4 (“Maybe not ‘sought out’”) is very interesting in this narrative because
it shows how interpersonal perception influences the way the interviewee for-
mulates his response and thus underlines the notion of oral narratives as socio-
narratives, that is, situated at the interface of linguistic, cognitive, and contex-
tual factors (Herman 1999b). The fact that this gp uses the self-repair “Maybe
not ‘sought out,’” thereby questioning his own word choice, reveals a high level
of self-monitoring in his speech. One may infer that the doctor was not entirely
sure how I as a woman with a research interest in domestic violence would react
to the wording of the preceding clause, which clearly presents the female victim
in a fairly negative and critical light. The self-repair strategy mitigates the previ-
ous comment and ties in immediately with an attempt at further explication.
Lines 5 to 8 contain a sequence of clauses that can be interpreted as an ex-
planatory sequence building up toward the main point of the story, namely, why
women’s seemingly irrational behavior can be explained to some extent but still
 Agents of Their Own Victimization

remains something of a puzzle for the narrator: “I mean maybe it’s that, er, her,
her social, er, mix is with people who share that same, er, manner [?] to their
previous partners. You know, if they’re all boozers and they all meet in the pub
or whatever then it’s likely that she’s gonna meet other people who, who are sim-
ilar. You know, in that we all tend to, um, find friendship with people who are
or who have similarities.” A number of things are conspicuous in the scenario
that the gp evokes in this sequence. First of all, we can find numerous discourse
markers such as “I mean” and “you know” on the narrative context level of the
interview frame. They are used to establish rapport between speaker and lis-
tener and also help interlocutors negotiate meaning and ensure mutual under-
standing (Schiffrin 1987). The gp clearly makes an effort here to convey to the
interviewer his way of rationalizing the woman’s strange life. The plausibility of
this explanation, however, is indirectly called into question through the repeti-
tion of the adverbial “maybe” in lines 5 and 9, which puts the whole story in the
hypothetical mode and presents it as the doctor’s speculation about how this
woman came to have another violent partner. In other words, the story the gp
relates is more or less fictional because the doctor does not really know, apart
from the limited knowledge he has of the woman through his practice work,
how she leads her life. Nevertheless, the scenario he conjures up is very vivid. It
is one that again reinforces the commonly held myths that domestic violence is
mostly caused under the influence of alcohol and that it occurs predominantly
in the lower social classes. Thus, the gp talks about the woman’s “social mix,”
which is mainly with other “boozers” who “all meet in the pub.” The stylistic
incongruity between a very elaborate, formal style throughout most of the in-
terview and a rather colloquial style expressed in the word “boozers” can be
interpreted as the gp’s attempt to evoke linguistically the social context of the
scene presented here, the pub, but it also creates a sense of “otherness” and dis-
tance between the gp and “that kind of scene,” as it were, since this lexical item
does not really suit the overall interview register and therefore almost seems
to convey a mocking tone. The emphasis on the idea of “two of a kind,” which
is repeated three times in the extended noun phrases “people who share that
same manner,” “people who are similar,” and “people who have similarities,”
also gives the impression that this doctor does not have a high opinion of his
patient. In fact, he puts her into the same category of people as her abusive part-
ner. The logical connector “then” in line 7 invites the listener to the conclusion
Agents of Their Own Victimization 

spelled out in line 9: maybe it is “not so surprising” after all that this woman is
in another abusive relationship if she socializes with alcoholics.
Lines 10 and 11 form the final evaluation section, in which the gp states, con-
trary to his preceding explanations, that he cannot really understand his pa-
tient’s behavior or indeed the behavior of any woman who falls victim to yet
another abusive partner: “But it’s most surprising to me why people choose,
er, to, to, to reenter, er, an arena of further physical violence having got out of a
previous one. I find that really tough.” The gp resumes the motif of choice and
attributes an agentive role to the victim with the verb “reenter,” which implies
that women deliberately find abusive men. The image of the “arena” is very in-
teresting in this context, since it evokes associations with ancient amphithe-
aters where violence formed part of the daily entertainment. In this sense, the
image indirectly conveys a sense of irony.
To sum up, not only does narrative 5 illustrate the way agency is constructed,
but the detailed linguistic analysis also shows how the gp attempts to negotiate
his viewpoint with the interviewer by applying the discursive strategies men-
tioned above.

Patient Noncompliance and Doctors’ Helplessness

gps’ incredulity and powerlessness in view of the fact that women often return
to their violent partners was one of the main themes running through the nar-
ratives. Although there have been a number of attempts to explain women’s de-
cision to stay,2 no theory can adequately accommodate all the possibilities and
provide a conclusive answer. As Schornstein puts it: “In working with victims, it
is important to recognize that there are no pat answers to explain the responses
of victims as a class. . . . Each victim is different, and she brings to the moment
of crisis a life time of her own experiences that may affect her reaction and re-
sponse to violence” (1997:54). The fact that some women stay with or return to
their partners may thus be difficult for gps to understand. The problem, I would
argue, is not so much one of gender or of social class differences between doc-
tor and patient as of divergent personal life experiences, which makes it diffi-
cult for doctors who may never have been victimized themselves to feel genu-
ine empathy for their patients. In that sense, what Donald says about doctors’
and patients’ divergent experiences of illness is also true of the experience of
domestic abuse: “Illness is a realm that the ill person inhabits, whereas disease
 Agents of Their Own Victimization

categories are often quite crude maps that health professionals use to interpret
the ill person’s experience, from the other side of the wellness-illness divide”
(1998:23, emphasis in original). If one considers that cases of domestic violence
can be emotionally taxing for doctors, too, then it is not surprising that wom-
en’s “noncompliance” with what, on the surface, seems to be the best solution
for them (i.e., to leave their partners) can lead to gps’ frustration and a sense of
helplessness (see also chapter 6). Let us have a brief look at another narrative
that deals specifically with these feelings. Narrative 26 was related by a young
female gp from a suburban practice.

Narrative 26
1. I mean I’ve got one in particular who,
2. her husband, um, is an alcoholic
3. and is abusive and aggressive towards her
4. and now towards her baby, er,
5. [he] use, you know, sort of uses her as a, as a weapon.
6. And she has tried to leave him
7. and has got an injunction against him
8. but then has changed her mind
9. and just gone back to him again.
10. And there’s not much more I can do in that scenario really, which
I find very difficult ’cause she’s still upset about it and she’s still
affected by it so.

The Transmission of Emotions: Analysis of Narrative 26

Like narrative 3 presented at the beginning of this book, narrative 26 also cen-
ters around the woman’s decision to stay with her partner, but it is less emo-
tionally charged than narrative 3. The narrative starts with a fairly extensive
orientation, which covers half of the entire narrative (lines 1 to 5). In this ori-
entation section the interviewer is given information on the family situation,
which is marked as current and habitual by the use of the simple present. The
violent partner is classified as “alcoholic” (line 2), which is reminiscent of other
narratives in the sample and reinforces the commonly held view that alcohol is
often related to domestic violence. Furthermore, the woman’s husband is de-
scribed as “abusive and aggressive” (line 3) toward both his wife and her baby,
Agents of Their Own Victimization 

and the violence is depicted in more detail in line 5: “sort of uses her as a, as a
weapon.” While the semantic roles of agens and patiens are clearly distributed
to the husband as the acting figure and the wife and her baby as sufferers in the
first half of the narrative, the roles are reversed at the beginning of the second
half, where the woman becomes the social actor who takes action against her
husband, the new patiens: “she has tried to leave him and has got an injunc-
tion against him” (lines 6 and 7). This sequence can be regarded as the com-
plicating action of the narrative, which culminates in the turning point in line
8: “but then has changed her mind.” As mentioned earlier, the logical connec-
tor “but” expresses opposing action (Schiffrin 1987), and in this case the wom-
an’s change of mind is contrasted with her previously active behavior. The pa-
tient’s lack of responsible and “reasonable” action finally results in her return
to her husband: “and just gone back to him again” (line 9). The locative ad-
junct “to him” is grammatically redundant in this sentence but is used to em-
phasize the target of the woman’s movement, of which the gp did not approve,
as she admitted after she had finished her narrative: “You just wish you could
say: ‘Right, just leave him!’”
What is most interesting in this narrative is the fact that there does not seem
to be any space for the gp. While semantic roles are allocated to all members of
the family, the family doctor is left out of the picture, which in a way epitomizes
the marginal role the gp sees for herself and even openly addresses at the end of
the narrative: “there’s not much more I can do in that scenario really” (line 10).
Although the narrative as such is unemotional in its tone, the gp finally men-
tions feelings when she says that she finds it “very difficult” (line 10) because
the patient is “still upset about it and she’s still affected by it” (line 10). The par-
allel structure in the last two subordinate clauses underlines the patient’s emo-
tional state, which also affects the doctor. Nevertheless, the “message” that is
conveyed does not focus on the patient’s background and possible reasons for
why she stays with her partner but on the fact that she went back and that this
makes it impossible for the doctor to take further measures. As for narrative 3,
one can argue that, if this rather undifferentiated narrative about a woman’s
return to her violent partner becomes narrative memory that can be consulted
in the future, then this might preclude the storage and implementation of more
detailed narratives that might introduce the woman’s perspective, on the one
hand, and provide space for doctors’ agency, on the other.
 Agents of Their Own Victimization

The Motif of Choice and GPs’ Lack of Comprehension

Narratives 5 and 26 seem to reconstruct agency to the disadvantage of the pa-
tients and thus reveal the doctors’ lack of understanding for why their patients
stay in a violent relationship. Viewed against the background of domestic vio-
lence research, most of the interviews appear to be marked by this lack of com-
prehension. Although the gps sometimes tried to explain the behavior of victims
in terms of financial dependence and the women’s concerns about their fami-
lies, the overall tenor of their responses makes it clear that battered women are
often implicitly blamed for being victims. The following quotes give an idea of
the range of comments made by the gps in my sample (note that the comments
presented in [4] were made by female doctors).

3. a. Why should they put up with it, you know, if they’ve got an al-
ternative, yeah, and get out? Er, but of course [you get all those who]
sometimes return to it, er, or on occasions, er, where by genetic dis-
position make the unfortunate mistake of picking another one vi-
olent partner in a second or possibly the third relationship.

b. There maybe is a mechanism for teaching women not to accept

that sort of behavior or, er, to unlearn it. It’s part of their culture.

c. At the end of the day, well, people can be trapped in [?] situations,
and if you’ve got kiddies and stuff they might feel more obligated
to carry on getting thumped or whatever, I don’t know.

d. I suppose, it’s, er, they’re even sort of, a degree of sadomasoch-

ism, that some people actually like being beaten up, er.

e. Certain people attract that, they’re just, because they put up less
resistance and, er, and that again makes it more difficult to just
be up front because being up front again takes courage, which is
what they don’t have in the first place. So, it’s a bit of a vicious cy-
cle, I suppose.

4. a. Er, I think a lot of it is ’cause the women allow it to happen. They

feel, er, dependent on, on individuals. Er, I think because they don’t
have that much, er, self-esteem herself [sic], awareness.
Agents of Their Own Victimization 

b. You know, I feel it’s so, it’s, it’s so wrong that somebody can allow viol—
— or, somebody can be violent to somebody else and other peo——,
and then . . . the victim can allow her- or himself to be
victimized.

c. Er, I mean, what we see is, women can be treated dreadfully by

men. I see a lot of that, not just violence but, you know, just, well,
allow themselves to become doormats and get pregnant over and
over again, you know, whatever, get a poorer image of themselves
and perhaps, yeah. So, um, downtrodden, yeah, so.

d. I mean, sometimes you just think people are rea——, being really
silly, you know, they’ve been beaten near to death on ten occasions
and still go back. I mean, what can you do? What can you do?

A number of the highlighted lexical items and phrases in the text are worthy of
comment. Example (3a) starts with a question related to the one mentioned at
the outset of this chapter, “Why do they stay?”: “Why should they put up with
it?” The modal auxiliary “should” expresses obligation, and its use here indi-
cates that the gp does not understand why women might feel compelled to ac-
cept violence. The noun “alternative” implies that women have choices, a theme
that runs consistently through the interviews. The logical conclusion from that
assumption is that if a woman suffers domestic violence it is because she has de-
cided to take up the victim role, which, hence, is her own fault, as can be seen in
the statements made in (4a) to (4c): “the women allow it to happen,” “the vic-
tim can allow her- or himself to be victimized,” “allow themselves to become
doormats.” Example (4b) is especially interesting linguistically, since it com-
bines the verb “allow,” which assigns the role of agens to its subject, “victim,”
with the passive construction “being victimized.” Women are paradoxically de-
picted as agents of what is otherwise seen as an agentless process, so one finds
either agentless victimization or agency on the victim’s part.
The linguistic reconstruction of victims as having choices can have far-reach-
ing consequences, as research conducted by Ehrlich (1999, 2001) demonstrates.
Ehrlich (1999) discusses in her article on the representation of sexual assault
the language used in a university sexual harassment tribunal. She shows how
the questions two of the tribunal members asked presupposed the deficiency of
the complainants’ signals of resistance. This alleged lack of resistance was then
 Agents of Their Own Victimization

interpreted as tantamount to consent, although both female victims charac-

terized their experience as assault. One of the strategies the tribunal members
used was to present the victims as having had “options” and thereby to imply
their inaction. They could have left the room, for example, or could have told
the offender to stop his advances. The women’s fear was minimized. Ehrlich
argues that the tribunal members constructed an interpretive frame in which
the female victims were “represented as having exercised some agency, or even
having chosen to engage in the sexual activities” (1999:245). At the beginning of
this chapter I discussed what Goffman (1974) calls “social frameworks,” whereby
victims are reconstructed as actors with a right to self-determination, legal com-
petence, and moral obligations. Ehrlich, however, demonstrates that this view
of victims neglects other factors such as fear and power relations between men
and women: “That is, constructing complainants as freely-choosing, autono-
mous individuals, as legal doctrine does, precludes a consideration of the mate-
rial conditions under which their consent is ‘meaningful’: conditions in which
the victims’ fear and paralysis (and not their minds) can be ‘dominant and
controlling,’ given the unequal power dynamics that potentially characterize
male/female relations in situations of unwanted sexual aggression” (2001:92).
Similarly, the gps in my sample indirectly present victims of domestic violence
as inactive and therefore responsible for their situation. At the same time, vic-
tims are reconstructed as “deviant.” Williamson contends: “Producing a notion
that women who experience domestic violence should leave violent relation-
ships, when there already exists a very powerful social discourse which advo-
cates that women should keep relationships and families very firmly together,
adds to those cultural myths which allow individuals both personally and pro-
fessionally within all agencies to perceive women within violent relationships
as in some way deviant or stigmatised in themselves” (2000:28).

Redefining Battered Women as the “Deviant Other”

Other explanations proposed by some of the doctors clearly stigmatize victims
as displaying a weak character or deviant behavior; for example, women choose
violent partners due to their “genetic disposition” (3a) or because “it’s part of
their culture” (3b). Female victims are framed as “victim types,” “vulnerable
individuals,” and “dependent women” who are possibly “less intelligent than
their husband.” They might have a tendency toward “sadomasochism” (3d), or
Agents of Their Own Victimization 

violence occurs because “certain people attract that” (3d). One male gp near-
ing retirement commented:

5. Um, for a start, who do you treat? Er, does the woman have a
problem, you know, because she’s being beaten up? Is that not a re-
sult of being beaten up or does she have a problem that perhaps, er,
meshes with her partner’s problem, um, I don’t know.

This doctor presents domestic abuse as a result of a “problem” both in the male
perpetrator and in the victim. The gp thus insinuates that being a victim of vi-
olence presupposes an “abnormality” of some sort in the woman’s character or
psychological disposition. Similarly, another middle-aged male gp suggested
“anything from counselling services to, er, Cornhill Hospital for psychiatric
or psychological assessment” as possible solutions, thereby implying that the
woman, not her perpetrator, has a psychological problem.3 A number of gps
mentioned alcohol as one common cause for the occurrence of violence, and one
middle-aged male gp presented a narrative about a couple where both partners
are alcoholics (narrative 29). This kind of response underpins the following as-
sumption made by Kurz and Stark: “We speculate that clinicians make an ‘im-
plicit diagnosis’ of abuse in which psychosocial sequelae such as alcoholism or
depression are viewed as its cause and where the woman—not her assailant or
his violence—is seen as ‘sick’” (1990:259–60). Although the term “sick” is not
necessarily used in a purely medical sense, the redefinition of victims as alco-
holics and depressed or even mentally disturbed women in a way legitimizes
the women’s role as patients and thus warrants treatment. The treatment bat-
tered women are offered is often misled, however, because it tackles physical
symptoms rather than the violence itself, as Bograd’s (1987) and Williamson’s
(2000) studies demonstrate.

Implicit Blame Culture and Stigmatizing Discourses

It is interesting that especially male gps seem to construct victims of domes-
tic violence as the “deviant other”: “other” not only in terms of gender but also
in terms of irrational behavior for which they cannot easily find an explana-
tion. And yet even some of the responses given by the female gps do not nec-
essarily show greater understanding. The highly judgmental and trivializing
verb phrase “being really silly” in (4d) and the “doormat” metaphor in (4c)
 Agents of Their Own Victimization

indicate disapproval that women might sense when they go to see their gp. Los-
eke and Cahill (1984) and Lamb (1999) maintain that professionals often de-
fine victims of abuse in a discrediting manner and thus indirectly victimize
women further. As Williamson’s research also shows, women frequently en-
counter in medical settings “the abusive social discourse of domestic violence
which blames women for the abuse they experience” (2000:49). One woman
in Williamson’s sample, Helena, tells the interviewer how a nurse implied that
she had provoked violence in her abusive partner: “a . . . nurse said to me, ‘What
did you do to upset him?’” (2000:49). Even though accusations are not made
as directly and openly by the gps in my sample, the pattern that emerges from
the gps’ responses indicates a (possibly unconscious) blame culture by which
women are held responsible for their situation.
The gps’ readiness to indirectly blame the victim herself is alarming. How-
ever, it is not a phenomenon that is unique to health care professionals, as, for
example, Meyers’s (1997) study of the representation of violence against women
in the news media shows. I will come back to this point in my final chapter. The
stigmatization of victims, whether conscious or unconscious, can be harm-
ful in a consultation when a woman experiencing violence senses the gp’s re-
sistance and consequently feels inhibited from opening up. For this reason it
is important to uncover the conceptual frames doctors apply to domestic vi-
olence with regard to women’s agency and, moreover, to unravel the underly-
ing linguistic mechanisms by which these frames are set up. It is equally im-
portant, however, to investigate how doctors present agency as far as their own
professional role is concerned.

“You just can’t fix it for them”: Modals

and the Delegation of Responsibility
In the previous chapter I considered the ways gps conceptualize domestic vi-
olence as a social rather than a medical problem and therefore deflect respon-
sibility from themselves. Here I complement this discussion by looking at a
similar strategy related to the construction of victims. Victims are implicitly
interpreted within a social framework in which they are given a role that entails
free will and decision making as well as a legal and moral obligation to take re-
sponsibility. This way of conceptualizing victims of domestic violence places
them outside the sphere of intervention by the doctor, and, consequently, gps
Agents of Their Own Victimization 

have a valid argument for denying agency to themselves. In other words, if the
victim does not take measures to change her life, it is not the gp’s place to do
anything about it either. The following comments made by the gps in my sam-
ple reveal this strategy of distancing:

6. a. There’s nothing, a lot of that is within the woman’s own hand.

I just try and give her the confidence and try to empower her, but
she should take some sort of action.

b. I can’t get too involved in that. There are too many things going
on. Er, but people, I guess, have some responsibility to themselves
and their own actions.

c. You can’t make somebody leave somebody, it’s not your respon-
sibility. People have to make their own decisions.

d. Patients have choices themselves or, you know, they can get in
touch with the police or social work.

e. You often do feel that your, your hands are a bit tied ’cause you
can’t, y—— you can’t initiate, er, sort of appropriate steps for them.
They’ve got to actually be willing to do it.

f. At the end of the day it’s the woman that decides.

g. And you can advise, you can get the health visitor involved, they
can see Citizens Advice, they can do all these things but unless they
want to do it, they won’t do it, you know.

h. And you can say to them and say to them and say to them and they
won’t want to change it. You just say: “Well, that’s their lot.”

i. I think it’s very much up to the patient or, what they want to do
about it.

j. But I think, I think they’ve got to decide what to, what to do about
it themselves.
 Agents of Their Own Victimization

The responses are strikingly similar (again, note that the comments presented
in [6f] through [6j] were made by female doctors). A common denominator
of all these responses is the theme of choice and the women’s responsibility to
make decisions themselves. The modal auxiliary “should” in (6a) (“she should
take some sort of action”) and the quasi-modal “have got to” in (6c) (“People
have to make their own decisions”), (6e) (“They’ve got to actually be willing to
do it”), and (6j) (“they’ve got to decide what to do”) are significant in this re-
spect, since they imply not only the women’s choices in making decisions but
in fact their obligation to do so. This attitude makes it easier for a gp to dis-
tance himself or herself from a patient’s problem and to avoid a feeling of frus-
tration if the patient does not accept his or her advice, as we can see in (6h): it
is “their lot,” not the doctor’s.
Occasionally, gps expressed the concern that some patients might regard
open questions about domestic abuse posed by their gp as intrusive. Interest-
ingly enough, this point is mostly elaborated through notions of “I” and “other”;
that is, the patient is again reconstructed as an individual on the other side of
the doctor-patient divide. The following statements illustrate this point:

7. a. I can’t impose the way that I choose to live my life and the prin-
ciples and moral-ethical, er, code that I use to order my life. I can’t
impose that on somebody else.

b. You can never tell people what to do. You can perhaps let them
tell their story and, er, explore their options, point them in direc-
tions where they can get help.

c. You can’t expect your values and what you think you would do
to follow on to each individual.

d. You feel like you want to empower them to do something but,

again, we can’t put our, you know, aspects onto them and it’s, it’s,
I think you’ve, you’ve got to try and be clinical in some respects for
them so that you don’t, you don’t become too emotive.

e. I think it’s not your place to say, “Well, you should leave him,”
but, er, people have very complex reasons for staying together, I
think, and you, I don’t think you should be intervening in that
too much.
Agents of Their Own Victimization 

In (7a), (7c), and (7d) the gps talk about their own lives, values, and expecta-
tions, which they cannot impose on the lives of their patients. The predomi-
nant modal auxiliary used in this context is “can” combined with a negative
marker such as “not” or “never.” It implies the impossibility of the action de-
scribed and, moreover, the speaker’s feeling about the inappropriateness of such
action and, consequently, his or her moral obligation not to take action. Fur-
thermore, it is interesting to see that in most cases gps choose the generic pro-
noun “you,” thereby generalizing the moral dilemma they present and, at the
same time, keeping it at a distance. Intervention or action on the part of the gp
is seen as potentially intrusive and therefore unacceptable. One solution to this
dilemma is to delegate the responsibility for dealing with the case to other agen-
cies, as is indicated in (7b): the gp can “point them in directions where they can
get help.” This phrase implies that help is not available from the gp but from
other sources that are spatially distant.

Summary
As this chapter shows, agency is a complex issue when considering domestic
violence cases. While victims of violence are often framed as passive and help-
less, cultural discourses on violence also present women as agents of their own
victimization in the sense that they do not take action and leave their partners,
for example. An insurmountable paradox is thus created that puzzles doctors
and other people alike. Agency also becomes crucial for the assignment of the
patient role. While patients are usually regarded as suffering involuntarily from
an illness, they are also expected to comply with the expert knowledge and
recommendations of doctors and thus to actively assume their patient role. In
cases of domestic violence, where women may decide to go back to their part-
ners, this patient role is not fulfilled in the sense of the biomedical model and
may thus lead to gps’ frustration and resignation. Perhaps one way of getting
around this dilemma is for doctors to accept that in many cases their task can
only be limited to the role of witness and listener, to validating women’s sto-
ries, and to having the necessary help resources at hand when required. As I
show in the next chapter, however, doctors’ readiness to help also depends on
how seriously they take cases of domestic violence and what status domestic vi-
olence has amidst a whole range of other health issues. The following chapter
deals with evaluation in the gps’ narratives or, in other words, with what the
gps deemed noteworthy and tellable in the stories they related.
BLOCKMMMMMMMMMMMMMMMMMMMMMMMMMM
 Evaluating Abuse

8. Evaluating Abuse
Storied Knowledge and Salient Facts

Evaluation is “that part of the narrative which reveals the attitude of the narra-
tor towards the narrative by emphasizing the relative importance of some nar-
rative units as compared to others” (Labov and Waletzky 1967:37). Evaluative
devices in a story signal to the listener that the narrated event is in some way
unusual and that it is therefore worth telling, or, in Labov’s words: “Evaluative
devices say to us: this was terrifying, dangerous, weird, wild, crazy; or amusing,
hilarious, wonderful; more generally, that it was strange, uncommon, or un-
usual—that is, worth reporting” (1972a:371). Evaluation in narratives answers
the questions, What is the point of this story? Why does the narrator want to tell
this story? In a sense, then, a speaker justifies to other interlocutors his or her
telling a particular story by adding evaluation. In his 1997 article Labov rede-
fines evaluation within the framework of what he calls “Sack’s Assignment The-
orem” (1997:405), namely with regard to turn-taking rules. He points out that
“telling a narrative requires a person to occupy more social space than in other
conversational exchanges—to hold the floor longer—and the narrative must
carry enough interest for the audience to justify this action” (Labov 1997:404–
5). Thus, evaluation comes to be viewed in more technical terms as a device for
justifying “the automatic reassignment of speaker role to the narrator” (Labov
1997:406). Consequently, speakers have to decide to report the “most reportable
event” before they embark on constructing a narrative, which then includes the
ordering of this most reportable event in a logical and meaningful way within
a series of other events. Speakers must, in a way, justify their telling of a story
by making this story sound interesting and relevant in the given context. Nor-
rick observes for storytelling in conversational discourse: “Since conversation-
alists tend to expect topical talk, stories on new topics routinely exhibit pref-
aces constructed to sell them as particularly interesting. Highly evaluative and
Evaluating Abuse 

emotionally loaded words and phrases fill this need” (2000:108). At the same
time, a speaker gives away his or her personal feelings, thoughts, and attitudes
toward the related story or some aspect of it.
In the interview situation the turn-taking mechanism underlying the gain-
ing and yielding of the floor is less compelling, since the interviewee is auto-
matically given more time to elaborate on a topic. That is, competition for the
floor is less marked in interviews, and, consequently, one may assume that the
telling of a story does not necessarily have to be based on considerations of the
story being “reportable” or exciting. On the other hand, however, narratives are
nonetheless expected to be to the point in a specific discursive situation. This
is even more true if the narrative has been elicited through a question posed by
an interviewer. I want to caution here against the assumption that some events
can be considered reportable in their own right. Rather, I would argue that re-
portability is also socially constructed; that is, there are cultural expectations
as to what counts as “interesting” or “reportable” elements of a story. Moreover,
reportability is constructed and negotiated by speakers during storytelling. In
other words, it emerges out of a specific narrative situation in which narrators
signal reportable events through linguistic cues. The various types of evalua-
tion are accompanied by a number of linguistic devices. Labov’s (1972a) con-
ceptual starting point is the assumption that there is a basic “narrative syntax”
along which all oral narratives are created. This narrative syntax contains the
following eight elements (adapted from Labov 1972a:376):

1. Conjunctions, including temporals: “so,” “and,” “but,” “then”

2. Simple subjects such as pronouns and proper names
3. An underlying auxiliary that is a simple past tense marker and is
incorporated in the verb; no member of the auxiliary appears
in the surface structure except in the occasional progressive form
in the orientation section and in quasi modals such as “start,”
“begin,” “keep,” “used to,” and “want”
4. Preterit verbs, with adverbial particles such as “up,” “over,”
“down”
5. Complements of varying complexity
6. Manner of instrumental adverbials
7. Locative adverbials
8. Temporal adverbials and comitative clauses
 Evaluating Abuse

Technically speaking, evaluative devices generally complicate this basic narra-

tive syntax by deviating from it.
As I mentioned in chapter 3, twelve of the narratives the gps related in the
interviews were interviewer initiated, while twenty-four narratives can be clas-
sified as “spontaneous.” Spontaneous narratives are probably more interesting
as far as evaluative function is concerned, because they are obviously related
on the narrator’s own initiative and thus reveal something about the narrator’s
aim in telling a particular story. As Daiute and Nelson point out: “Scripts, rep-
resenting what happens in general, do not require an internal evaluative compo-
nent. Stories, however, whether fictional or personal narratives, need a point of
view that incorporates an evaluative component implicitly or explicitly. What
happened was triumphant or tragic, surprising, gratifying, or disappointing”
(1997:208, emphasis in original). Therefore, the questions that arise for narra-
tive analysis are, What is the purpose or function of a narrative in a given dis-
cursive context? What does that indicate with regard to the narrator’s viewpoint
relative to the topic under discussion? In this chapter I investigate why the doc-
tors related the particular stories they told me in the interviews and not others;
what was especially memorable about these events; and, finally, what this indi-
cates with regard to the gps’ perception of domestic violence in general.

Evaluation and GPs’ Storied Knowledge of Domestic Violence

I start by comparing two narratives that were elicited in response to explicit
questions I asked during the interview. Narrative 32 was told by a young female
gp in a practice bordering on the city center, and narrative 15 was told by a late-
middle-aged male doctor in a student health practice.

Narrative 32
J: Right, okay, but can you tell me a bit about the experiences
you’ve had?
1. Um, so, I suppose, there was one girl in particular
2. I remember her being really quite a hard thing for me.
3. She was always at the surgery, minor, usually minor, minor
complaints
4. or she’d drag along her little boy
5. and it’d be something very minor with him, um,
Evaluating Abuse 

6. and they were here all the time

7. and then, one day, basically she admitted that, you know,
8. I’d actually visited her at home as well, in the presence of this
very “loving” in inverted commas boyfriend
9. and then one day she admitted to me that he’d been abusing her
for ^ years
10. but her son was out of, as a result of a rape,
11. and it was just horrendous.
12. Now, since that has come up I have never, I see her once a year.
13. So, in the long run, I’ve saved a lot of time
14. and she’s perhaps, she’s got rid of the boyfriend, which was the
real cure,
15. there was nothing medical I could do for her, um,
16. but that really sticks in my mind, that case.

Narrative 15
J: Is there any case that’s particularly vivid in your memory?
1. There was one girl, yeah, that was pinned to a wall and had her
head bashed in, and by someone, er, another student, um,
2. and she was terrified
3. and it definitely affected her in a bad way,
4. I mean, she, um, she left [?]
5. and the person that assaulted her, that was an atrocious sight.
6. She was bigger than me,
7. I remember that.
8. That’s the most, that’s the only one that has been in the last sev-
en years where there was a real problem, you know, where there
was a, a difficult outcome, if you like.
9. The rest, they were all minor.

General Analysis of Narrative 32

Narrative 32 begins with information on the person involved in the story: “one
girl”: “Um, so, I suppose there was one girl in particular.” It is interesting that
this doctor refers to her obviously grown-up patient and mother of a little boy
as “girl.” Since this gp classified all the patients she spoke about in the inter-
 Evaluating Abuse

view as “girls,” it might be inferred that she was not conscious of age. At the
same time, however, “girls” conjures up female patients who suffer domes-
tic violence as immature women who are perhaps too weak to deal with their
problem. Line 2 is the first evaluative clause in the narrative that states why the
doctor remembers this particular patient and why she therefore considers this
story worth telling: “I remember her being really quite a hard thing for me.”
The attributive adjective “hard,” which is doubly strengthened by the preced-
ing intensifying adverbs “really” and “quite,” signals to the listener that this
case is memorable because it was a difficult case for the doctor. The evaluation
is made more explicit in the very last clause of the narrative, where the doctor
actually says: “that really sticks in my mind, that case.” Moreover, the verb in
the present tense clearly marks the end of the narrative and the narrator’s re-
turn to the present situation, that is, the interview frame. In this sense line 16
can be regarded as part of the coda, which starts in line 12 with the temporal
adverb “now” (“Now, since that has come up”) and which is only interrupted
in lines 14 and 15, where the narrative is resumed to explain what the outcome
of the story was: “she’s got rid of the boyfriend, which was the real cure, there
was nothing medical I could do for her.” Line 15 is interesting as far as evalu-
ative devices are concerned, because the clause is part of the narrative proper,
indicated by the past tense, but at the same time it also indicates to the listener
how the narrator evaluates the case in retrospect: there was “nothing medical”
the doctor could do for her patient. In Labov’s terminology negatives func-
tion as comparators in the sense that they “compare the events which did oc-
cur to those which did not occur” (1972a:381). The claim that doctors cannot
do much for patients who suffer domestic violence because domestic violence
is not, strictly speaking, a medical problem is a major theme that runs through
almost all the interviews I conducted, as I discussed in chapter 6.
Lines 3 to 6 contain a sequence of short clauses that form the complicat-
ing action: “She was always at the surgery, minor, usually minor, minor com-
plaints or she’d drag along her little boy and it’d be something very minor with
him, um, and they were here all the time.” At first glance the action expressed
in these clauses seems rather trivial and hardly worth telling. Many people go
to see their doctor frequently and often for minor problems. There is nothing
unusual about the events presented here. What makes this sequence interest-
ing within the narrative, however, is the fact that the narrator implies a rea-
Evaluating Abuse 

son for these events. By emphasizing the repetitive and regular nature of this
patient’s visits through the modal auxiliary “would” and through the tempo-
ral adverbials “always” and “all the time,” which quantify the occurrence, the
doctor suggests that her patient came on purpose, namely, because she suf-
fered domestic violence and because she was seeking help. Bower terms this
type of clause a “deliberative action construct” (dac), that is, it is a clause that
“allow[s] us to see in some detail how referential and evaluative components
at multiple levels in the complicating action section operate to communicate
both action and meaning” (1997:57). Since the repetitiveness of the narrated
event is linguistically enacted in this sequence of clauses and also in the rep-
etition of the evaluative adjective “minor,” the whole complicating action se-
quence can be regarded as a device for building up suspense. Ironically, this
point does not seem to hold if one considers that I as the listener anticipated
the outcome of the story, since the interview was obviously on domestic vio-
lence, and that “suspense” therefore did not center around the question “What
happened in the end?” but rather “How did it all come about?” The fact that
this doctor still uses dacs points to the fact that, at least in the Western tradi-
tion, people have an inherent notion that building up suspense is an essential
element in the narrative repertoire.
The resolution section is introduced in line 7: “and then, one day, basically
she admitted that.” It is clearly set off from the complicating action section by
the temporal connector “then” and by the fact that the unspecified time scale
of the repetitive action in lines 3 to 7 is now brought to a stop, “one day.” The
content of the resolution section refers to the patient’s admission that her boy-
friend “had been abusing her,” a lengthy and ongoing ordeal that is empha-
sized by the progressive verb form and the phonetically stressed temporal ad-
verb “for years” in line 9. The final resolution, however, is again suspended by
the insertion of the clause in line 8, which should be part of the complicating
action section but has been extracted and shifted back within the narrative in
order to postpone the content of what the woman actually admitted to: “I’d
actually visited her at home as well, in the presence of this very ‘loving’ in in-
verted commas boyfriend.” This clause also receives evaluative force, since the
doctor reconsiders events of the past in the light of her present knowledge. The
“very loving boyfriend” was not really a loving boyfriend at all, as is indicated
by the linguistic gesture “in inverted commas,” but the doctor did not discover
 Evaluating Abuse

the truth until later. For this reason, the woman’s disclosure of domestic vio-
lence, the impact of which is magnified through the additional disclosure of
the rape story in line 10 (“but her son was out of, as a result of rape”), came as
a shock to the doctor and is duly commented upon in line 11: “it was just hor-
rendous.” The reportable event in this narrative is therefore not the fact that the
woman had been abused but that it took the doctor such a long time to find out
what was going on.

General Analysis of Narrative 15

Let us now turn to the second narrative to see in what way it differs from nar-
rative 32. Narrative 15 opens with a miniorientation section that introduces the
protagonist, again “one girl,” but it then moves immediately to the events and
even the outcome of these events in the case described: “There was one girl,
yeah, that was pinned to a wall and had her head bashed in, and by someone, er,
another student.” In contrast to narrative 32 there is no elaborate complicating
action sequence, but the listener is thrust right in the middle of the story, a story
that strikes us as being particularly shocking through its vivid description of a
high degree of violence. Interestingly enough, the violent action is presented in
a relative clause that depends syntactically on the noun phrase “one girl” and
that has the function of further specifying this noun phrase. It is unusual that
reportable events are put into a subordinate clause, which normally carries less
semantic weight than a main clause. This discrepancy between narrated event
and narrative presentation indicates two things: first, the doctor who told me
this story was reflecting on this case in retrospect and was therefore no longer
emotionally involved; second, he deliberately tried to appear unaffected in or-
der to deepen the shocking effect of these events. Since this gp did not comply
with the standard model of a narrative script in the Labovian sense, the imme-
diate presentation of the resolution section came as a surprise for me as a lis-
tener and consequently caused me to be rather taken aback. The affirmative
interjection “yeah” links the narrative to the interview situation. It could be
interpreted as either an expression of the doctor’s recalling the story to him-
self (“Yes, I remember this case”) or as a signal to the listener that this is a story
worth listening to (“Yes, I can tell you a story that will interest you”). The lat-
ter interpretation would ascribe evaluative force to this interjection.
Evaluating Abuse 

The violent action described in line 1 is conveyed in a passive construction.

This phenomenon occurs throughout my interviews, as I demonstrated in chap-
ter 7, and normally the passive construction is used to cut the male perpetrator
out of the picture. Considering the fact that around 85 percent of passive con-
structions in English are agentless (Celce-Murcia and Larsen-Freeman 1983:225),
that is, the focus is on the action rather than on the agent, instances where the
agent is made explicit are even more remarkable. In this clause the perpetrator
is explicitly mentioned and, moreover, the presence of a violent agent is em-
phasized by the addition of the prepositional phrase “by someone,” which is
followed by the explanatory apposition “another student.” Thus, the listener’s
attention is automatically drawn to this agent. This is done for a purpose that
becomes clear in lines 5 and 6 after a couple of explanatory clauses depicting the
emotional state of the victim in lines 2 and 3 (“and she was terrified and it def-
initely affected her in a bad way”) and a very brief summary of the outcome of
the story in line 4 (“I mean, she, um, she left”). Lines 5 and 6 contain a descrip-
tion of the perpetrator that is fairly lengthy in comparison with the overall nar-
rative: “and the person that assaulted her, that was an atrocious sight. She was
bigger than me.” Again, the focus lies on the perpetrator, as can be seen in the
left dislocation of the subject, which is taken up again through the depersonal-
izing demonstrative pronoun “that.” What is unusual about this violent agent
is conveyed to the listener in the judgmental adjective “atrocious” in line 5 and
the comparator in line 6: “She was bigger than me.” Not only is the perpetra-
tor female, which deviates from the fact that domestic abuse is overwhelmingly
perpetrated by men on women, but this female student is also extraordinary in
that she is very big, indeed bigger than a man, as the doctor emphasizes.
The evaluative clause in line 7 sums up in the verbum putandi “remember”
(“I remember that”) why this case is worth telling or, in other words, why it
is a reportable event, namely, because the violent agent was such a memorable
person and because the visible result of this violence was gruesome. This eval-
uation is made more explicit in line 8, which contains a complex construction
with the main clause and three subsequent relative clauses that depend on the
noun phrase “the only one”: “That’s the most, that’s the only one that has been
in the last seven years where there was a real problem, you know, where there
was a, a difficult outcome.” The unusual nature of this case is already antici-
pated in the use of the superlative “most” and the intensifier “only” and is rein-
 Evaluating Abuse

forced in the relative clauses that are introduced by the interrogative pronoun
“where.” The parallel structure of these relative clauses suggests an equation of
the noun phrases “a real problem” and “a difficult outcome” and thus also im-
plies the following logical connection: only if there is a difficult outcome can a
case be considered a real problem. This view is confirmed in line 9, where the
doctor classifies all other cases of domestic violence that he has seen as being
“minor,” in other words, not worth telling: “The rest, they were all minor.” One
may assume that those cases were also not worth memorizing in greater detail
and have consequently failed to become part of the gp’s narrative knowledge
of domestic violence.

A Comparison of Narratives 32 and 15 Regarding Evaluation

If we compare the narrative structures and particularly the evaluative devices
in these two narratives, it becomes clear that the two gps apply rather differ-
ent discursive strategies in order to interest the interviewer in what they have
to say. The first gp follows largely the narrative model as outlined in Labov
and Waletzky (1967). She uses dacs and the intermingling of complicating ac-
tion and resolution in order to create suspense and then reconsiders the whole
case in retrospect in a lengthy coda. Similarly, the second gp reflects the case
he talks about from his present-day position. The gp’s attitude in narrative 15,
however, appears to be much more detached and unaffected, which is revealed
in the lack of involvement in the narrative mode. Thus, the second gp does not
use a sequence of simple narrative clauses in order to build up suspense in a
complicating action sequence; instead, he presents a contracted version of the
events by jumping straight in, as it were. I have interpreted this technique as a
device for deepening the shocking effect of the violent story. This reminds us
of the writing style found in tabloid journalism: detailed depictions of violent
action that aim to shock people, a description of the emotional state of the vic-
tim, and a judgmental presentation of the perpetrator.
The two narratives also differ considerably in their evaluation. The evalu-
ative devices in the first narrative indicate that the gp sees the point of telling
her story not so much in the violent situation as such but more in the fact that
she as a doctor failed to realize, over a lengthy period of time, what was really
going on. The case as such is not remarkable in the sense that this kind of vi-
olence occurs on a daily basis in many families, but it has been made remark-
Evaluating Abuse 

able and indeed memorable in this gp’s rendition of that case. Narrative 15 is
different in that it already depicts a rather unusual or extreme case of violence
where the doctor had to face serious medical consequences resulting from it.
The evaluative devices the second gp applies in his narrative explicitly suggest
that this case has in fact only become memorable because of the high degree
of violence involved and because of the unusual perpetrator of this violence, a
big female student. Recall that Labov and Waletzky defined evaluation as the
part of a story that shows the narrator’s attitude toward the story “by empha-
sizing the relative importance of some narrative units as compared to others”
(1967:37). According to this definition, it appears that the first gp emphasizes
silence and secrecy, whereas the second gp focuses on factual evidence in the
form of physical signs of abuse. While the first gp generally evaluates domes-
tic violence as a “hard” case for gps because it is not easy to discover, the sec-
ond gp seems to consider as serious only those cases in which there is a diffi-
cult physical outcome. In fact, this gp said explicitly later in the interview that
none of the other cases he had had “stood out in the sense that they didn’t, you
know, bother me a lot.” Hence, following Schank’s (1990) reflections on the stor-
age of stories in memory, these other cases were perhaps not stored as detailed
narratives in the memorized stock of cases in this gp’s knowledge base and will
therefore not be as readily available as a resource for future reference when the
next patient suffering domestic violence walks into his practice. Moreover, the
provision of help may be measured against what “type” of case the gp is faced
with, that is, whether doctors deem a case “serious” or not. These issues will be
explored in the following section.

Reportable Events, Memory, and Stereotypes

Many of the thirty-six narratives that the doctors produced during the inter-
views followed the pattern of the second narrative in that they presented rather
extraordinary incidents of domestic violence or unusual encounters with pa-
tients suffering domestic violence. Doctors presented, for example, scenarios
where domestic violence occurred because both partners had a drinking prob-
lem or because the woman was schizophrenic and thus became an easier tar-
get for her abusive partner. Other cases involved the victim’s attempt at suicide
or a fatal outcome. It is important to stress that the physicians’ gender did not
really play a role in the way domestic violence cases were depicted. Both male
 Evaluating Abuse

and female gps conjured up approximately the same type of unusual scenario,
and even the wording overlaps sometimes. Thus, victims were depicted as be-
ing “pinned to a wall,” or perpetrators were presented as “going out and getting
drunk on a Friday night.” Individual variations can be noticed to the extent that
male gps tended to dramatize cases by bluntly presenting a high degree of vi-
olence. Thus, one middle-aged doctor in a suburban practice remembered an
alcohol-related case where the husband “didn’t realize that she was dead until
he sobered up and she had the head in the fireplace.”
The fact that the narratives related unusual events can to some extent be ex-
plained in terms of cultural expectations surrounding the narrative frame. In our
culture stories are usually exciting or extraordinary because that is required of
“good” stories. In that sense the doctors probably volunteered narratives of this
type because they assumed that that was what I as the interviewer expected to
hear. Viewed against the backdrop of Bruner’s (1986, 1991) and Schank’s (1990)
theories, the gps’ narratives can also be interpreted as indicating that mostly
unusual cases have become part of the doctors’ “storied” knowledge about do-
mestic violence, whereas the more common cases may not have been labeled
and stored in memory for later retrieval. This would also mean that cultural
myths and clichés are perpetuated through the gps’ discourses. To follow up
this assumption, let us consider another narrative. One older male gp related
a story about a patient who had sadomasochistic tendencies and actually en-
joyed being beaten up by her husband. Significantly, this story was unelicited
by me, the interviewer, and was related in the context of a discussion of rea-
sons for domestic violence.

Narrative 23
1. I suppose, it’s, er, they’re even sort of, a degree of sadomasoch-
ism, that some people actually like being beaten up, er, [?].
2. I mean I had a, a, I mean a patient many years ago
3. and she, I mean she used to come in and reg——, regale us
with the, the most bizarre and, er, tales of terrible sadomastics,
masochistic stuff and,
4. but she stayed with her husband for ten years, you know,
um, er,
5. it was, um, you know, it, it was, it was almost sort of schizoid
that, you know, she was,
Evaluating Abuse 

6. she’d sit there

7. and say, “He’s doing this, that, and the other,” you know,
8. “[took] me and beat me up”
9. and “Why don’t you leave?”
10. “Oh, I can’t leave!” [laughs], you know.

General Analysis of Narrative 23

The narrative starts with an abstract that introduces the topic of the following
story, namely, some people’s inclination toward sadomasochism: “I suppose,
it’s, er, they’re even sort of, a degree of sadomasochism, that some people actu-
ally like being beaten up.” The topic is introduced very cautiously through the
use of the hedge “sort of” and the expanded noun phrase “a degree of,” which
decreases the strength of the claim that domestic violence might be attributed
to sadomasochistic tendencies. Line 2 presents the protagonist of the story, “a
patient,” whose actions are further specified in line 3: “and she, I mean she used
to come in and reg——, regale us with the, the most bizarre and, er, tales of
terrible sadomastics, masochistic stuff.” The verb phrase “used to” indicates
a recurring pattern of this incident in the past that is reinforced by the modal
auxiliary “would” in line 6 (“she’d sit there”). The implication is that this pa-
tient came regularly and thus became memorable. The other memorable fea-
ture about her was that she told “tales.” By choosing this lexical item instead of
the less marked “stories” or even “accounts,” the gp indirectly implies that his
patient’s stories were so extraordinary that they almost bordered on the realm
of the fantastic. This is underlined by the attributive adjective “bizarre,” which
is intensified through the superlative formed with “most.”
The patient’s stories stood out in that they dealt with “terrible sadomas-
ochistic stuff.” The judgmental adjective “terrible” clearly gives away the doc-
tor’s disapproval of the woman’s sexual practices. It is also interesting that a
slip of the tongue makes the gp say “sadomastics” first before he immediately
corrects himself. This might indicate the gp’s excitement or embarrassment at
a point where he mentions to the interviewer something “unspeakable” from
the point of view of mainstream moral standards. The gp’s verb choice implies
that the whole incident is evaluated as being funny in retrospect. The woman
“regaled” staff members with her stories. The humorous side of the story is em-
phasized by the gp’s laughter in line 10. Laughter might indicate the gp’s em-
 Evaluating Abuse

barrassment about the story he relates or it might show that he finds the wom-
an’s conduct bizarre and impossible to comprehend. Another explanation for
“black humor” in medical practice could be that it offers doctors a way of re-
maining “clinical” and of not getting too involved in difficult issues. As an-
other male gp commented:

1. You just can’t take it home with you. You’ve got to learn not to get
involved in that sense. You know, you need to give them the time and
the ear that’s necessary but you can’t take it on, take it even personal.
Or you’re going nuts. . . . That’s why medical humor is very black.
. . . I think that’s, that’s the reason or one of the reasons for that and
why some people cannae understand it. We’re a weird bunch. We are,
because I think there is a one-way, a viewing of these sorts of major
problems that is subtly humorous. You could see it as sick, you know
[laughs]. And that’s how we cope, that’s how we deal with it.

While humor seems necessary as a means of psychological and emotional “self-

defense,” as it were, it can perhaps also be detrimental if patients’ experiences
are downplayed and ridiculed and not taken seriously anymore.
Despite the “terrible” sadomasochistic practices, the patient in this story
stayed with her husband for a lengthy period, “ten years,” which is made ex-
plicit and is also evaluated as incomprehensible behavior through the con-
trastive connector “but”: “but she stayed with her husband for ten years, you
know” (line 4). In line 5 the patient’s behavior is then labeled as pathological
through the adjective “schizoid”: “it was, um, you know, it, it was, it was al-
most sort of schizoid.” In a sense the gp reconstructs his patient as deviant and
abnormal. This discursive strategy is toned down, however, by the two preced-
ing hedges, “almost” and “sort of,” which can be regarded as indirect disclaim-
ers to the gp’s evaluation. Lines 6 to 10 form the core of the whole story because
the gp reenacts a scene as it occurred between himself and this patient: “she’d
sit there and say, ‘He’s doing this, that, and the other,’ you know, ‘[took] me
and beat me up’ and ‘Why don’t you leave?’ ‘Oh, I can’t leave!’ [laughs], you
know.” By using dialogue the gp dramatizes the encounter for the listener. As
Tannen points out, giving “voice to the speech of people who are depicted as
taking part in events . . . creates a play peopled by characters who take on life
and breath” (1989:103). The purpose of such dramatizations is to interest the
listener and to create involvement.
Evaluating Abuse 

The gp’s minidrama is marked by extremely short clauses and by ellipsis.

Thus, in line 7 the verb phrase is shortened from “she would say” to just “say,”
and in lines 8 to 10 the verba dicendi introducing the reported speech are left
out completely. The use of ellipsis heightens the dramatic effect of this scene be-
cause the patient’s and the doctor’s turns at talk are immediately juxtaposed, and
thus the whole scene comes to life in front of the listener. The reported speech
is not really “reported” but rather “constructed,” as Tannen argues, since the
words are not likely to be exactly those of the speakers at the time. When the
gp rephrases his patient’s accounts as “He’s doing this, that, and the other,” for
example, he already summarizes her various stories in an unspecified manner.
The point of replaying the scene rather than just telling the listener about it is
to present a scene that approximately captures the gist of what actually took
place on several occasions. Ultimately, the gp tries to convey to the interviewer
what exactly was so “funny” about these encounters, namely, the woman’s bi-
zarre stories and her strange behavior.
As I mentioned above, this story was related spontaneously during a discus-
sion of possible reasons for domestic violence. The fact that the gp chose this ex-
tremely unusual case as an example underlines my assumption that primarily
those cases become part of gps’ memorized stock of “storied knowledge” that
are uncommon, extraordinary, or at least in some way “different” from stan-
dard cases. Standard cases may be stored more generally as scripts (see chapter
4), but they do not seem to be labeled and indexed as “special” narratives for re-
trieval in storytelling situations. We might infer from this that circumstances
accompanying “normal” or more common cases are not remembered as well
as unusual circumstances, which may ultimately lead to gps’ lack of sensitivity
to less obvious signs of abuse presented by a patient during the consultation.
At the same time there is a danger of setting up rather unusual cases as stan-
dard frames of reference and to reinforce cultural myths rather than to tackle
the reality many women have to face.

Unusual Cases and the Mechanisms of Stereotyping

Many of the gps’ narratives present stereotypical rather than extraordinary
cases. Thus, the narratives regularly suggested alcohol and drug abuse, a de-
prived social background, and a family history of domestic violence over gen-
erations as the main reasons for domestic violence, as I discussed in chapter 6.
 Evaluating Abuse

Nevertheless, even these stories can be classified as “unusual,” since they por-
tray violent relationships only partially and leave out the fact that violence oc-
curs in supposedly “normal” families as well. In my discussion of the con-
struction of “deviance” above I already pointed out that some gps expressed
their surprise about the fact that they occasionally encountered domestic vi-
olence in seemingly “decent” patients. Stereotypes can be defined as “cogni-
tive preconceptions” (LaFrance and Hahn 1994). As LaFrance and Hahn point
out, stereotypes occur “when target individuals are classified by others as hav-
ing something in common because they are perceived to be members of a par-
ticular group. Stereotypes are often associated with salient physical charac-
teristics such as ethnicity, age, physical attractiveness, and of course, gender”
(1994:352). At the same time, stereotypes are often used as explanatory frame-
works for our understanding of social groups, as I discussed in chapter 1: “The
outcome of the process of stereotype formation is the derivation of knowledge
about categories that serves to explain similarities and differences on relevant
dimensions at that time in ways which are shared. We can put it no more suc-
cinctly than to say: we form stereotypes to explain aspects of and relations be-
tween social groups” (McGarty, Spears, and Yzerbyt 2002:198–99). Interest-
ingly enough, research in cognitive psychology has shown that “memory for
infrequent events is actually poorer than memory for frequent events” (Spears
2002:136). If stereotype formation is partially based on observed facts and peo-
ple’s perceptions of reality, this would suggest that gps are more aware of stereo-
typical or extraordinary cases. The following account given by an early-mid-
dle-aged female gp in a hospital-based health center illustrates the mechanism
of stereotyping with regard to victims of domestic violence as it can be found
in most of the interviews:

2. Um, so, a lot of times, it’s, you may see someone with bruises but
it’s actually not till months after that it comes out that actually the
cause of that was, er, you know, their partner. Or the other thing is
it’s just taken as being part of their everyday, you know, that they,
they’ll always explain how, or disguise things like their, their part-
ner’s taking them by the neck and pinning them up against the wall
and things but that’s part of, you know, they wouldn’t consider leav-
ing them, that’s just part of the relationship and how it’s, it’s always
Evaluating Abuse 

been and when you ch——, you know, challenge them about that,
whether they want to do anything about that, it’s just never crossed
their mind because, often they come from an abusive family back-
ground as well. This is what they’re in a way used to. Um, I mean,
I haven’t seen a great deal of bad bruising and things, it’s been, it’s
been more things that have been reported afterwards or, you know,
maybe when they’ve left the relationship they’re able to, er, explore
it more because it obviously has legacies if they go into another re-
lationship as well about how they feel about their new partner, too,
but, I mean, I certainly had some with, you know, fairly significant,
um, bruisings as well. Some of them because it’s the drug scene,
you know, if, if their partner’s actually their pimp as well then, you
know, there’s, there’s obviously even more implications there if, if
there’s a, a problem with the kind of business side of things as well.
We’ve got a few ladies who, who are kind of professional prosti-
tutes, if you like, and that can become a problem, too.

This gp starts her account of her experiences with a similar thematic line to that
drawn in narrative 32, namely, that instances of domestic violence are often re-
vealed only after awhile. As I discussed in chapter 4, this can be regarded as one
type of “standard scenario.” The violent episode depicted (“their partner’s tak-
ing them by the neck and pinning them up against the wall and things”), how-
ever, is more reminiscent of the dramatized action presented in narrative 15,
where the gp also spoke about the victim as being “pinned to the wall.” Another
interesting point to note here is again the attribution of agency to the women.
Women find explanations for their partner’s violence and “disguise” what is re-
ally happening, thereby assuming an active part in their victimization. On the
other hand, they remain inactive and stay in a violent relationship partly be-
cause “it’s never crossed their mind” to leave. This statement almost portrays
women victims as lacking judgment and common sense, and, as I argued in
previous chapters, it neglects other important factors such as financial or emo-
tional dependence and fear influencing women’s decision to stay. An “abusive
family background” is offered as one explanation, which is as stereotypical as
the connection between violence and drug abuse pointed out: “Some of them
because it’s the drug scene, you know.”
 Evaluating Abuse

Evaluating the Severity of Domestic Violence Cases

This gp indirectly also distinguishes between two types of domestic violence
cases, namely, those with or without “significant bruisings.” The cases where
the gp did not see any “bad bruisings” are said to be “reported afterwards,” and
they are contrasted with some “fairly significant” bruisings: “I mean, I certainly
had some with, you know, fairly significant, um, bruisings as well.” Interest-
ingly enough, the gp’s reference to significant cases is immediately followed
by scenarios with rather extraordinary circumstances. Thus, the gp alludes
to the drug scene and to the milieu of prostitutes and their pimps, and she es-
tablishes a causal relationship between these backgrounds and violence by us-
ing the logical connector “because.” Once again, the myth that violence is re-
lated to social background is reinforced. Although this account is not, strictly
speaking, a narrative, as it does not depict a particular case, the gp nonetheless
obeys Labov’s rule of the “most reportable event.” The fact that uncommon,
extraordinary cases are indirectly associated with significance and memora-
bility obviously raises problems for the way doctors might deal with domes-
tic violence cases.
Domestic abuse only seems to be considered a “real” problem if the case is
severe or if there is a sensational outcome. This underpins the following find-
ings by Lamb concerning the construction of images of victims:

The expectation that an abuse victim will develop symptoms is clear.

It is also clear that victims’ suffering must be long and severe, or
else their victimization is trivial and does not “count.” This expec-
tation is endorsed, ironically, both by victim advocates who cannot
believe that someone’s abuse is not the central meaning-making in-
cident in their lives and by backlash authors who do not count mi-
nor abusive experiences as “real” abuse, calling victims “whiners”
for so labeling these experiences. For abuse to count, the suffering
can never go away. (1999:113)

In other words, there is a tendency for people to distinguish degrees of salience

of domestic violence cases. In the context of medical care this practice of com-
partmentalizing victims into “severe” or “less severe” cases can have far-reaching
consequences if doctors adjust their own help resources depending on whether
they think a woman “really needs” and “deserves” help or not.
Evaluating Abuse 

Stereotyped Taboos and Their Impact on Talk-in-Interaction

Another striking linguistic feature in the excerpt above, especially toward the
end, is the frequent use of hedges. Hedges are commonly used by speakers to
avoid loss of face and to fulfill the face wants of the interlocutor (Brown and
Levinson 1987). They typically qualify and tone down statements “in order to
reduce the riskiness of what one says” (Wales 2001:185). In other words, speakers
try not to offend their interlocutors by what they say. At the same time, hedges
are often an indication of reluctance to talk openly about a certain topic. In
the extract above the gp’s use of hedges increases when she starts to talk about
the “significant bruisings” and the whole drug and prostitution scene. Apart
from the frequent discourse markers “I mean,” “you know,” and “um,” the gp
repeats the connectors “if” and “who,” the indexical determiner “there’s,” and
the indefinite article “a.” More important, the gp uses the hedges “a kind of”
twice in connection with the noun phrases “business side of things” and “pro-
fessional prostitutes.” This reveals the gp’s reluctance to speak about the topic
of prostitution and may be attributed to her wish not to offend the interviewer
or to her embarrassment about this topic, which is generally regarded as mor-
ally despicable in our society because it involves associations of deviant sex-
uality, crime, improper behavior, indecency, and so on. The gp’s sense of em-
barrassment is also revealed by the phrase “if you like” (“We’ve got a few ladies
who, who are kind of professional prostitutes, if you like”), which shows that
the gp is uncertain about the wording of what she wants to say. The phrase im-
plies that the gp signals to the interviewer that the lexical items chosen in this
context are perhaps not ideal, but, at the same time, the gp tries to reassure
herself of the interviewer’s approval of her word choice. This passage demon-
strates that the level of self-monitoring in speech can be high, especially if gps
talk about issues that they are presumably not familiar with firsthand and that
they may consider inappropriate in a formal context like the interview or an
unsuitable topic to discuss with a young, female researcher.

Silence, Hedges, and Euphemisms:

Discursive Evasions of a Taboo Topic
Since domestic violence is generally still considered a family or private issue (al-
though, in fact, the repercussions and resulting costs affect everyone [Schorn-
stein 1997:26]), people often treat the problem as taboo and find it difficult to
 Evaluating Abuse

talk about it. This could also be felt in the interviews when hedges and pauses
indicated reluctance on the part of the doctor to express violent acts directly
and openly, for example. Pauses are often deployed in narratives to create sus-
pense. As Auer, Couper-Kuhlen, and Müller point out, the “story is initiated
and then saliently interrupted at a turning point where crucial further events
can be expected. . . . Breaking up a locally established isochronous rhythmic
progression at the ‘point of incidence’ . . . is an effective synaesthetic linguis-
tic means to contextualize this suspense-creating strategy” (1999:180). In the
following narrative related by an older female gp pause and hedging underline
the theme of secrecy mentioned in the story and even enact it on the discourse
level of the narrative.

Narrative 8
1. there’s a, a patient I’ve got at the moment
2. and I think her husband mistreats her.
3. and, hem, um, the husband tends to come with the wife
4. and of course she’s not going to say that she’s [pause],
5. so, it may be even more hidden in an ethnic grouping than it is
in the Eu——, er, Western grouping. Yeah.

Narrative 8 is not typical of an oral narrative in the Labovian sense, as it em-

ploys present tense rather than the more common past tense. Simple present,
which is normally used to indicate a general state, habitual action, or some-
times instantaneous action (Quirk et al. 1985:179–80), shows, on the one hand,
a clear reference to the present time (also expressed in the temporal adverbial
phrase “at the moment” in line 1) and, on the other hand, the habitual aspect
of the patient’s visits in company of her husband: “the husband tends to come
with the wife” (line 3, my emphasis). The simple present in line 5, by contrast,
expresses a general state of affairs as perceived by the gp. The statement, how-
ever, is modified by the modal auxiliary “may” as a not entirely certain possi-
bility assumed by the gp: “it may be even more hidden in an ethnic grouping”
(line 5). In other words, instead of depicting a particular instance of a consul-
tation with this patient, the doctor refers to this case in more general terms,
thus also setting it up as an example of the occurrence of domestic violence in
ethnic groups.
Evaluating Abuse 

What is significant in this setting is the secrecy with which abuse is associ-
ated, as can be seen in the adjectival participle “hidden” (line 5). Interestingly
enough, however, not only is this secrecy mentioned in the text, but the nar-
rative itself epitomizes secrecy. Thus, for example, the gp uses euphemism to
describe violence: “I think her husband mistreats her” (line 2). Rather than
using verbs such as “abuse,” “beat,” and so on, the gp falls back on a more neu-
tral term that does not necessarily include physical violence and thus blurs the
concept. The statement therefore becomes more tentative. This is reinforced
by the “hedged performative” (Fraser 1975) “I think,” which expresses uncer-
tainty about whether violence is really at stake in this couple.1 The interjec-
tions “hem” and “um” in line 3 create a short discursive pause that I interpret
as showing the gp’s reluctance to talk about this case or her attempt to find ap-
propriate words to formulate the narrative. Either way, a sense of embarrass-
ment is conveyed in this somewhat evasive presentation, and this becomes par-
ticularly obvious in the lengthy pause in line 4, where the gp simply breaks off
the sentence: “and of course she’s not going to say that she’s [pause].” Silence
exactly coincides with the point of the narrative that deals with the patient’s
silence. On the one hand, the narrative’s discourse thus enacts and replicates
the contents of the story; on the other hand, it demonstrates that silence is im-
posed not only on the victim’s language but also on that of the responsible gp.
As much as the patient “hides” her problem from the doctor, the gp also holds
back an explicit verbal expression of her suspicion in the interview. In a sense,
narrative 8 thus demonstrates how potential service providers might indirectly
collude with the secrecy of victims and thus help perpetuate domestic violence
rather than challenge it. Mutual embarrassment between doctor and patient
about a taboo topic such as domestic violence may thus lead to the same paradox
that Trinch observed for the discussion of rape in legal advice settings: “Ironi-
cally, it may be that the nearly universal sociocultural repugnance against this
condemned act is precisely what contributes to the seeming hesitation of vic-
tims to come forward for help, as service providers too seem to prefer to hear
about other, perhaps culturally less offensive or at least conversationally less
sensitive, acts of violence” (2001b:601). Applied to the context of domestic vio-
lence in general practice, a tendency for euphemism and silence in gps’ narra-
tive practices can be detrimental, as it might suggest to women that their “per-
sonal” problems are not desirable topics in a consultation, which in turn may
lead to a general hush-up of domestic abuse.
 Evaluating Abuse

Female-on-Male Violence
Most of the narratives presented so far are unusual because they display a high
degree of violence or because the actors in these stories are to some extent “de-
viant” in terms of general moral standards. Narrative 15 stands out, for exam-
ple, because the perpetrator of the violence is a female student. Although vio-
lence is still mainly perpetrated by men on women (Williamson 2000:6), nine
of the male gps and seven of the female gps mentioned female-on-male vio-
lence at some point in the interview, and a few doctors (significantly enough,
men) elaborated on such cases in their practices. Most of the time female-on-
male violence was alluded to only in passing. The following examples illustrate
this. Note that the statements presented in (3) were given by male doctors and
the ones in (4) by female doctors.

3. a. Eventually they’ll come. And only this year, for the first time
I’ve seen two men.

b. I don’t feel uncomfortable discussing these things with my pa-

tients. I also had one man who was abused, by the way.

c. I think we mostly see, um, domestic violence in terms of, er, um,
man on female. It does happen the other way round as well but the
men don’t come and tell us about it so much.

d. I think there’s a hidden, huge hidden, you know, mass of it that no

one comes forward and I’ve never known of a male being assaulted
but I know that men do get assaulted by their wives.

e. And the last person I had in who’d been complaining of being

hit was actually a man who was complaining that his girlfriend had
been beating him up. So . . . [laughs]

f. And the other one will be “My husband hit me” or “partner hit”
[clears his throat] and occasionally it’s, it’s the other way around
where the male’s been, er, assaulted.

g. I suppose it’s often difficulties in relationships or just that, um,

some people are, well, well, we know some women beat up men as
Evaluating Abuse 

well but it’s some, some sort of way their character has been formed
and that’s the way they, they deal with their relationships.

4. a. You often get it maybe after the couple have separated and you’re
seeing the wife with depression. Um, there’s also the husband some-
times that gets beaten up but that’s not so common [laughs].

b. I think it is. Sort of just power, but then of course women beat
up men.

c. There’s no rhyme nor reason to it. Occasionally you come across

women who are abusing their husbands but it’s more often the
other way round, definitely, yeah.

d. Um, there’s also the other sort of issue of confidentiality, I mean,

the abuser, whether it be the husband that’s the abuser or the wife
that’s the abuser, they’re often patients of me as well.

e. I can’t imagine why any man would want to, you know, presum-
ing it’s a man hitting a woman although obviously it can be other
ways round but, you know, it’s just very cowardly.

f. I don’t think they think consciously “Right, I’m the one to take
that power over you,” um, it just happens. Um, I mean I’m sure,
sure that might happen the other way round as well but it’s not
that common, I don’t think.

Although these allusions to female-on-male violence are, on the whole, fairly

similar, one can notice a few differences between the men’s and the women’s
responses. First of all, as already mentioned, male gps referred more often to
particular cases they had come across in their practice work (“only this year,
for the first time I’ve seen two men” [3a]; “I also had one man who was abused”
[3b]; “the last person I had in who’d been complaining of being hit was actu-
ally a man” [3e]), while the women’s statements are always formulated in gen-
eral terms. A lot of the gps mentioned female-on-male violence while they were
discussing reasons for domestic violence, but, in addition to that, female gps
 Evaluating Abuse

brought it up in the context of power relations, as in (4b) and (4f): “Sort of just
power,” “I don’t think they think consciously ‘Right, I’m the one to take that
power over you.’” Interestingly enough, female-on-male violence is introduced
in these examples as a counterargument against the feminist proposition I sug-
gested in the interview that violence is possibly related to men’s power and dom-
inance in our patriarchal society. Female gps stated more regularly that female-
on-male violence was rare compared to male-on-female violence, while male
gps sometimes took the opportunity to make an ironical comment or to pres-
ent a particular case in a joking manner. Laughter indicated gps’ amusement
about the idea of female-on-male violence, and it may be interpreted as gps’ re-
sponse to something that contradicts their expectations of manhood and viril-
ity. Only one female gp laughed (“Um, there’s also the husband sometimes that
gets beaten up but that’s not so common [laughs]” [4a]) but, significantly, she
was nearing retirement, and we might assume that her ideas of manhood were
relatively conservative, inducing her to find the idea of a battered man “funny.”
Another explanation might be that this gp felt embarrassed about the issue and
laughed to cover up her feeling. One middle-aged male gp was amused by the
fact that “one guy has got a bigger beating-up than many women I have come
across,” and another male gp commented, laughing, “I mean if I was with a wife
like this, it’s absolutely terrible.” As I argued above, humor in these instances
might also point toward the ways in which gps try to deal with difficult and
professionally taxing situations.

Female-on-Male Violence and the Evocation of Gender Stereotypes

The response in (3g) is interesting as it demonstrates once again how male gps
sometimes presented violence as more deviant and as a result of a pathological
character trait if it was perpetrated by a woman: “I suppose it’s often difficul-
ties in relationships or just that, um, some people are, well, well, we know some
women beat up men as well but it’s some, some sort of way their character has
been formed and that’s the way they, they deal with their relationships.” The gp
talks first about reasons for domestic violence in general, focusing on “difficul-
ties in relationships.” By using this vague noun phrase the gp implicitly attri-
butes the cause of violence equally to both partners, as it does not become clear
who is responsible for the difficulties. As soon as the gp mentions female-on-
male violence, however, the explanation for it is a lot more clearly defined: it is
Evaluating Abuse 

“some sort of way their [i.e., the women’s] character has been formed.” In other
words, both in male-on-female as in female-on-male violence the cause is more
likely to be attributed to the woman, or, as Bograd (1987:73) puts it, women are
“defined as the locus of the problem.” Consider the following comment made
by a late-middle-aged male gp:

5. There are a few men that I am aware of, of, er, being subject to bat-
tering from their spouses. But they don’t come forward so often. You
know, quite vicious attacks sometimes, knives, pots and pans and,
premenstrual tension has been [blamed a great deal for this].

Women’s violence is depicted and, at the same time, evaluated in negative terms,
as “quite vicious attacks.” The adjective “vicious” implies women’s evil inten-
tions, that is, the cause of violence is clearly ascribed to the female perpetra-
tor. This contrasts with other depictions of “standard” violence cases where
agency and causation are often blurred, as I discussed above. The weapons this
gp mentions—“knives, pots and pans”—evoke the stereotypical, traditional
scenario of “woman in the house and kitchen.” This cliché is supplemented by
another common prejudice often cited to account for women’s “irrational” be-
havior, namely, “premenstrual tension.” Again, violence in these rather excep-
tional cases is depicted as something inherent in females. Interestingly enough,
in a first round of pilot interviews pms was used by a male gp as an explana-
tion for male-on-female violence in the sense that men “tend to react” to their
wives’ irrational behavior instead of “just walking away.” This type of gender-
related explanation underlines Bograd’s assumption that doctors’ approaches to
battered women are largely based on “prevailing male-defined cultural myths
about women” (1987:69). There is possibly a gender issue underlying doctor-
patient interaction with regard to domestic violence if the gp is a man, as male
gps might find it more difficult to fully empathize with their female patients.
On the other hand, large parts of the gps’ responses are very similar in tone and
topic, which indicates that the problem might be related to other factors such
as divergent life experiences and backgrounds, as I argued above.

Narrative Gaps and the Evaluation of Female-on-Male Violence

Sometimes what people do not talk about can be equally revealing as what they
do talk about in an interview. One male gp nearing retirement, for example,
 Evaluating Abuse

when asked about his experiences and whether there was a case he remem-
bered in particular, did not relate a narrative about male-on-female violence,
the more common form of domestic abuse, but instead elaborated a narrative
about a man who was abused by his wife:

Narrative 14
J: Yeah. Um, is there any case that’s particularly vivid in your mem-
ory, anything that was . . .
1. I think possibly, er, the one and only time I’ve ever come across
a, um, an abused man.
2. Because I’d read about them
3. but it took me completely by surprise when I actually met one
4. because he was a big-bellied chap who actually ran away from
Dundee
5. and allegedly a very small, er, wife who did, er, exhibit, er, vio-
lence towards him.
6. And again I couldn’t understand, er,
7. [I’ll] never be able to understand why [you have to use] violence
in a relationship
8. but I couldn’t understand why he accepted it for so long
9. but again, there was, he was a chap on the road.
10. I didn’t see him for very long,
11. I never established the truth of the situation.

Analysis of Narrative 14
Narrative cohesion is established through a number of repetitions and paral-
lel structures here. Thus, lines 4 and 5 (“a big-bellied chap who,” “a very small
wife who”) and lines 7 and 8 (“I’ll never be able to understand why,” “I couldn’t
understand why”) are marked by syntactic parallelisms, and among the repeti-
tions the verb “understand” stands out because it appears in three consecutive
clauses in lines 6, 7, and 8: “And again I couldn’t understand, er, I’ll never be
able to understand why you have to use violence in a relationship but I couldn’t
understand why he accepted it for so long.” This repetition emphasizes the fo-
cal point of the gp’s evaluation, namely, the fact that he can understand neither
people’s reasons for violence in general nor the patient’s reason for accepting vi-
Evaluating Abuse 

olence. The narrative starts with the orientation part: “I think possibly, er, the
one and only time I’ve ever come across a, um, an abused man.” In this orien-
tation the narrator sets up a temporal framework by stressing the fact that the
incident related in the following story occurred only once in the past: it was the
“one and only time” that the gp “ever” saw an abused man. The phrasal verb
“come across” with its underlying path metaphor (Lakoff and Johnson 1980),
which can be seen in the use of the spatial preposition “across,” implies that
the encounter with an abused man was experienced as something unexpected
and unforeseen and thus also as something unusual. The mental image that is
conjured up is one of the gp “stumbling” over this peculiar case in his hitherto
“smooth” path of practice encounters with domestic violence cases. It “took”
the gp “completely by surprise” when he “actually met” an abused man (line 3).
The adverb “actually” emphasizes the real-life experience in contrast to what
the gp had “read about them” (line 2). The whole encounter is presented like a
scientist’s first encounter with a rare disease or a less well researched species,
which is reinforced by the collective third-person plural pronoun “them” in
line 2 and the numeral “one” in line 3: “Because I’d read about them but it took
me completely by surprise when I actually met one.” The gp thus indirectly sets
up a category of people who could be classified as “abused men,” and this cat-
egory is depicted as nonstandard or outside the norm. By conveying the rarity
of such occurrences the gp justifies his telling of this story. He signals to the in-
terviewer that the narrative contains a “reportable event” and that it is there-
fore worth telling.
The protagonists in this story are described in contrastive terms in lines 4
and 5. While the man is colloquially depicted as “a big-bellied chap,” his wife is
only “very small,” which makes it even more remarkable, in the gp’s view, that
the man should have suffered abuse from his partner. The focus on people’s
physical size is reminiscent of narrative 15, where the gp also emphasized the
size of the female perpetrator. This points toward a notion of violence as being
correlated with mere physical strength and thus reveals again a common cli-
ché about the issue. What strikes us as unusual in the gp’s depiction of the vi-
olent action is the formality of the verb “exhibit” (“allegedly a very small, er,
wife who did, er, exhibit, er, violence towards him” [line 5]), which stands in
stark contrast to the previously colloquial tone and also diminishes linguisti-
cally the strength of the violent act, as it remains neutral and distanced. This
 Evaluating Abuse

discursive contrast highlights the discrepancy between doctors as a professional

or expert group and as a folk group that also uses folk language.
The fact that the referential meaning of the verb “exhibit” as such does not
entail violence underlines a “clinical” register that incorporates the discursive
strategy of disassociation. The reason for this strategy can be found in the gp’s
doubtful attitude, which is expressed in the adverb “allegedly” and in the last
evaluative statement in line 11: “I never established the truth of the situation.”
The gp implicitly conveys his uncertainty about the truth condition of this
case, and the case is thus presented as a story with an open ending. The reason
for this is that the gp “didn’t see” the patient for a long time, as he “was a chap
on the road” (line 9). This causal relationship can be established if we inter-
pret lines 9 to 11 (“but again, there was, he was a chap on the road. I didn’t see
him for very long, I never established the truth of the situation”) as a logical
sequence, with the cause provided in line 9, followed by its consequence and
the overall implication of this connection. Does the gp link the patient’s life-
style with the occurrence of violence and thus reinforce the cultural myth that
violence is related to social class? Or does he imply a relationship between the
man’s lifestyle and his acceptance of violence, thereby drawing upon the ste-
reotype of the “deviant other”? Or is the man’s life “on the road” simply men-
tioned to explain the fact that the gp was unable to find out the truth, since the
patient did not come regularly?
At any rate, this narrative contains the same discursive strategies and themes
that can be found in other narratives in my sample as well, for example, the gp’s
surprise and initial incredulity, stereotyping in terms of physical size and so-
cial background, and, finally, the gp’s lack of understanding in view of a vio-
lent relationship. The clause in line 7 (“I’ll never be able to understand”), which
moves temporally outside the story time through its future tense marker, states
not only in a negative but also in a categorical tone that the gp simply cannot
understand the use of violence in a relationship. As I mentioned above, this is
a view a great number of the gps in my sample expressed in the interviews but
mostly in terms of the more common male-on-female violence. It is interest-
ing that this gp related a narrative in the same fashion as most of the other gps
related “normal” cases of male-on-female violence, albeit unusual in other re-
spects, as I discussed above. The fact that this particular narrative was selected
in the context of the interview indicates that the case depicted by this gp must
Evaluating Abuse 

have been labeled and stocked as noteworthy and reportable, whereas the more
common cases of male-on-female violence do not seem to feature prominently
in the gp’s memory or are at least not considered interesting enough to be re-
lated in a storytelling situation. In other words, it is once again the extraordinary
that receives attention by means of narrative evaluation, while less conspicuous
cases, which probably reflect better the everyday reality women experience, are
excluded from the gp’s “storied knowledge.”

Female-on-Male Violence and GPs’ Narrative Knowledge

Yet again, the story the gp remembered vividly was one that contains some ex-
traordinary element. It looks as though doctors’ perceptions of domestic vio-
lence and of the circumstances surrounding it are based on extraordinary, un-
usual, or stereotypical cases they remember and reproduce in their narratives,
while other realities (e.g., violence in “normal” middle-class families or more
hidden forms of violence such as psychological and verbal abuse) may be pres-
ent as basic knowledge schemata but do not pertain to the more vivid and par-
ticularized narrative knowledge base and thus to the narrative reality created
in gps’ minds. The mentioning of female-on-male violence by most of the gps
is a striking example. Although this is in fact a rare scenario compared to the
more common cases of male-on-female violence, male gps in particular com-
mented, sometimes in a joking manner, on cases they had had, or they elabo-
rated on such cases in narratives. These narratives are in line with other nar-
ratives related in the interviews, as they also contain an unusual element. For
example, violence related to alcohol comes to be regarded as a “standard” scene
or background for domestic violence, while in reality research has shown that
there is no inherent causal relationship between alcohol abuse and violent be-
havior and that instead men’s violent behavior can be attributed to their atti-
tudes toward women in general (Johnson 2001).
If these are the kinds of stories that doctors stock and remember in detail,
while less obvious or “insignificant” cases are only memorized as general scripts,
as we saw in chapter 4, this has far-reaching implications for gps’ practice work.
gps’ knowledge may thus, in the worst case, lack necessary information on in-
direct signs of abuse and on the complexities of relationships in which domes-
tic violence occurs as well as the complex psychological processes that underlie
both victims’ and perpetrators’ actions and behavior. My data pose a paradox in
 Evaluating Abuse

this respect: while the gps displayed at least theoretical knowledge about “hid-
den signs” of abuse, their particularized narratives of actual experiences fo-
cus more on extraordinary cases. Moreover, as I outlined in chapter 3, gps fre-
quently miss cases. The explanation I propose here against the background of
the cognitive approaches to narrative mentioned above is that gps perhaps do
not stock less dramatic cases in their memories and consequently are less sen-
sitized to more hidden signs of abuse.
Ironically, there is, then, a mismatch between doctors’ “experiential” knowl-
edge about a problem that does not fit the biomedical model and the factual re-
ality they encounter but perhaps do not fully recognize in their daily practice
work. This lack of adequate narrative knowledge of a psychosocial problem can
lead to other problems, including misdiagnoses and subsequent wrong treat-
ment such as the prescription of drugs. As Williamson’s interviews with vic-
tims of domestic violence revealed, women are often prescribed drugs paradox-
ically in situations when such drugs can potentially do more harm than good.
Drugs “can be damaging to a woman’s sense of safety, place her in a position
where she can act out para-suicidal tendencies, and reinforce a lack of control
within the help-seeking process” (Williamson 2000:58). All this points toward
special requirements as far as medical training is concerned. I will turn to this
question in my final chapter.
9. Conclusion

Narrative research has seen an incredible proliferation over the last four de-
cades, and the term narrative seems to be almost a buzzword in a great num-
ber of disciplines now. It is perhaps not surprising, then, that narrative research
has also called forth critics who consider current interests in narrative a passing
fashion. I hope that I have managed to dissipate some of the skepticism some
readers may initially have felt and that my book has shown the importance of
narrative research for the investigation of social problems such as domestic vi-
olence. Let me briefly address again some of the critical observations generally
held against narrative before I summarize the findings of my study.
One point of criticism is that narrative is perhaps not as universal a feature
as is often claimed, that it is highly dependent on cultural context, and that it
constitutes only a small part of a whole gamut of verbal and nonverbal forms
of interaction. Thus, it is important to consider the immediate context out of
which narratives emerge and to analyze the narratives within larger sociocul-
tural frameworks, especially where sociocultural problems such as domestic vi-
olence are at stake. This is a valid argument that needs to be taken into account
in any research set within the narrative paradigm and to which I have given suf-
ficient attention in this book. It is true that human interaction is also performa-
tive, that is, it is based on gestures, glances, body language, and other nonlin-
guistic signals, and ideally some of this should also be considered in narrative
research. However, people negotiate what they think and feel and know through
language, and it is mainly these discursive negotiations that formed the data for
my narrative-analytic approach. Narratives lend themselves as research mate-
rial as they accommodate both sociocultural discourse, which “speaks through”
individuals, as it were, as well as individual people’s perspectives. Narratives fa-
cilitate both an intellectual and emotional sharing of ideas and of human ex-
perience, a sharing that, as a number of philosophers contend, lies outside of
hardcore natural science and cannot be fully grasped by “scientific method”
 Conclusion

alone. And, as I demonstrated in this study, sometimes it is exactly the discrep-

ancy between scientific and narrative paradigms that can lead to the aggrava-
tion of social problems such as domestic violence.
Another point of criticism often raised against narrative research is that it
conflates an analytical framework with the data it investigates. As with other
qualitative research methods, it is probably true that one cannot make a clear-
cut distinction between the data one wishes to analyze and the tools one uses
for analyzing them. Thus, narratives are commonly elicited by means of “nar-
rative interviews,” for example. This need not be a flaw, however. In fact, one
of the great strengths of narrative research, I would argue, is that it enables one
to transform the research object in the very process of researching it. Thus, by
trying to understand what the narrative mechanisms underlying gps’ narra-
tives about domestic violence cases are and by trying to do this through narra-
tive interviews, I became more aware of my own and other people’s narrative
practices and I hope also raised awareness in the gps. One gp commented at
the end of the interview: “Um, and perhaps it’s like all these other things, like
depression or all that, we should, we should have our feelers out a bit more just
to see if we could pick it up. Um, I’m certainly more aware of it having spoken
about it today, you know, next time I’ll probably be asking everybody if they
[laughs], um.” As Eastern philosophies have it, the way is already the goal, the
method the result. On this note let me summarize the results of my study in
this concluding chapter.

The GPs’ Narratives Revisited

The twenty interviews yield very interesting and diverse results. Nevertheless,
some patterns can be found that mark many of the interviews and thus con-
tribute to a sense of similarity and overlap. In chapter 2 I hypothesize that, if it
was possible to find common features in the gps’ narratives or even a common
narrative pattern, we should also be able to identify a linguistic “community of
practice” (Eckert and McConnell-Ginet 1992), in this case, that of general prac-
titioners. It would be presumptuous to claim that there is one common narra-
tive that can be filtered out of all the gps’ responses because individual narra-
tives in the sample do in fact provide somewhat different perspectives. However,
it is not exaggerated to say that certain patterns emerge from the gps’ narrative
discourses that point in the direction of some sort of discursive community of
Conclusion 

practice with specific “members’ resources” (Fairclough 1989, 2001) and an “in-
stitutional memory” (Linde 1999; Trinch 2001b). This community seems to be
largely informed by knowledge about domestic violence that draws upon the
biomedical model, on the one hand, and common cultural myths and stereo-
types concerning the problem, on the other. Thus, the most frequently quoted
reasons for domestic violence in the gps’ narratives are alcohol or drug abuse;
a deprived social background and a family history of violence; lack of educa-
tion that is often combined with a lack of communication skills; and relation-
ship problems. Less frequently, gps mentioned reasons from the perpetrator’s
perspective, including aggressiveness and jealousy in the male partner; male
dominance in general; pms; the fact that many men nowadays feel threatened by
women’s growing independence; obsessive affection; and the biological “fact”
that men are stronger and bigger than women and “therefore” more prone to
violent behavior. Interestingly enough, the reasons from the male perspective
were invariably only offered if I explicitly asked about possible reasons or if I
introduced “male power” as a prompt for further discussions.
Although the gps in my sample generally acknowledged that, according to
research findings, domestic violence occurred across cultures, social classes,
and age groups, most gps re-created stereotypical backgrounds of violence in
their narratives, for example, by delineating the “Saturday night ritual” when
the husband goes out “on a bender” or “gets pissed” and then beats up his wife.
Interestingly enough, these narratives are often very lively because scenes are
linguistically reenacted by the gps through the use of colloquial expressions and
“constructed dialogue” (Tannen 1989), that is, the narrator’s “reconstruction”
of direct speech. In a similar fashion the gps’ narratives mostly depict not only
stereotypical scenes of violence but cases of violence that were in some way ex-
traordinary and “reportable” in Labov’s (1972a) sense.
Explanations such as socialization, deprivation, and alcohol or even biolog-
ical explanations regarding size, male and female social behavior, and so on are
problematic, as they deflect responsibility away from the perpetrator and dele-
gate it to external social or biological forces. Put another way, violence is almost
presented as inevitable, as something that happens because of x, y, and z rather
than because men do it purposefully in order to gain or keep control and to ex-
ert power or because present-day society still condones male dominance and
thus indirectly legitimizes violence. By using such explanatory frameworks in
 Conclusion

their narratives gps indirectly reinforce current “excuses” and “justifications”

frequently used by batterers themselves (Ptacek 1990) and thus perpetuate the
victimization of women on the institutional level of general practice.
At the same time, explanatory frameworks that relegate domestic violence
to the social realm also offer a justification for doctors to deny agency to them-
selves. One line of reasoning that a number of gps in my sample put forward
was that domestic violence is primarily a social problem with mainly social
origins, and therefore doctors’ role in this context is limited. Many of the gps
stated that “there is not very much we can do about it.” This attitude also seems
to be mainly informed by the biomedical model, in which the doctors’ role is
restricted to treating illness, and it also leads to gps’ sense of inadequacy and
powerlessness, which is often conveyed in metaphors such as the “tip of the ice-
berg” and the “can of worms” that express gps’ anxiety about dealing with do-
mestic violence. The spatiotemporal language the gps used to depict domes-
tic violence revealed the problem as something that is “hidden,” “low on the
ground,” or even “underground,” hence, both threatening and difficult to de-
tect. The reasons that gps identified for their feeling of powerlessness as well as
the fact that they might miss cases were mainly lack of time, training, and ad-
equate resources or knowledge about resources.
Whether these are simply valid reasons or partly also excuses for inaction
is very difficult to determine. At any rate, such arguments perpetuate the low
status of domestic violence in general practice and thus gps’ passivity rather
than encourage new perspectives and a readiness for change. The “institutional
memory” created through the gps’ narratives thus ultimately impedes a par-
adigm shift. In other words, we can argue that if doctors do not change their
discursive practices, there can be no significant change in their “institutional
memory” of domestic violence cases and consequently also no major change in
doctors’ work practices concerning the issue. This poses questions about gps’
training that I will address in greater detail below.
Even when domestic violence is disclosed and comes “to the surface,” as it
were, gps’ reactions may not be helpful or may even be counterproductive. Some
of the narratives that the gps in my sample produced indicate the stigmatiza-
tion and labeling of victims of domestic violence as “deviant” or as the incom-
prehensible “other” not only in terms of gender but also in terms of behavior.
Thus, women were occasionally pathologized as “schizoid” or as “sadomas-
Conclusion 

ochistic.” Such narratives are problematic, since they reinforce the notion that
women who suffer abuse are in some way “abnormal” or “different” from other
women, and they also blur the fact that psychological problems such as depres-
sion or schizophrenia may be results of domestic abuse rather than reasons for
it (Rosewater 1990). At the same time, these explanations reinforce and perpet-
uate a culture of victim blaming that can be harmful in a consultation when a
woman seeks support and understanding. Instead of listening to and validating
victims’ stories, doctors indirectly blame women for being battered.
While such narratives certainly portray extreme cases, other discursive de-
vices, for example, the use of generalizing noun phrases such as “fights between
partners” and the redefinition of violence as “relationship problems” or “dis-
harmony in relationships” are equally damaging, as they attribute the cause
of violence to both partners or blur agency and thus again implicitly put the
blame on the woman. I would argue that linguistic reconstructions of domes-
tic violence cases such as these are even more harmful than explicit forms of
victim blaming, since they are less easily uncovered and thus perpetuate vic-
timization on a subtler level. Spence describes the creation of everyday myths
as follows: “Very quickly, an official narrative is established, which feeds on the
details of the more sensational accounts; these become a kind of media virus
that instantly infect [sic] all current explanations. . . . The most popular grass-
roots explanation, as it gathers more and more persuasive details, rapidly as-
sumes the form of a myth with its own power to persuade and hold its ground
against all kinds of disconfirming evidence” (1998:220). Applied to the gps’
narratives, this also means that women’s experiences of violence may be dis-
torted if the women are discredited or agency is blurred. It is not least for this
reason that a close linguistic analysis of the gps’ narratives has proved to be a
useful methodological tool.
What is also uncovered in the gps’ narrative discourses is a sense of distance
between themselves and their patients. As I argued above, this distance can be
the result of divergent life experiences much in the same way as doctors and
patients are separated by the “wellness-illness divide” (Donald 1998). In this
sense, the gps’ discourses reveal a lack of comprehension and perhaps even ig-
norance about a problem the gps may never have experienced themselves. At
the same time, a kind of “comfort zone” is created that keeps unpleasant or even
disturbing facts of life at a distance. As Keller (1996) points out, this mechanism
 Conclusion

functions largely unconsciously and serves the purpose of emotional self-pro-

tection. The linguistic reconstruction of abuse victims as “deviant” is only one
of a number of discursive strategies in this respect. In reconstructing scenes of
domestic violence against the background of social deprivation and other re-
lated circumstances a distance is created between the spheres of activity and
lifestyles of doctors and their patients and thus reinforces a gap in understand-
ing that gps themselves admitted to.
Furthermore, the close analysis of the gps’ conceptualization of the “spa-
cetime region” (Herman 2001) of the consultation, for example, shows that gps
view their own role as “static” and passive, while the patient moves along a vec-
tor in and out of the practice and in a way “passes by.” A sense of distance clearly
emerges from the gps’ spatiotemporal mappings. Thus, the journey metaphor
and the path schema employed in the gps’ narratives indicate that women are
allocated different paths and locations from their gps’ (they are presented as
being “out there,” as having to “find a way,” or as being sent “on their way”),
while gps “go down the physical route” in consultations (they follow the path
opened to them within the biomedical framework, which involves primarily
treating physical injuries). Since the gp has only a very limited view or “gaze”
(Foucault 1973; Young 1997) of the patient and her personal and private back-
ground, which is often even reduced to the “pink sheet” in front of the doc-
tor during a consultation, it becomes extremely difficult for the gp to discover
or sense underlying problems unless the patient volunteers that kind of infor-
mation. gps often stressed that they wished patients would assume a more ac-
tive role in disclosing domestic abuse, while, ironically, women seem to expect
their doctors to help them to speak up by asking appropriate questions (Wil-
liamson 2000). This again indicates a distance and a lack of relevant commu-
nication between doctor and patient that can stem from different reasons: first,
both doctor and patient may feel constrained by the fact that domestic violence
is still a taboo subject and may thus refrain from discussing it, as raising the
issue might be interpreted as intrusive by the other party. Second, gps might
deliberately overlook the issue and enforce a “comfort zone” between them-
selves and their patients in order to maintain the “ceremonial order” (Strong
1979) of the consultation because they do not feel adequately equipped to deal
with domestic violence.
Domestic violence is out of the gps’ reach not only spatially but, it seems, also
cognitively in the sense that doctors’ storied knowledge draws upon a limited
Conclusion 

set of explanatory narratives that, as I maintained, are informed by a restricted

“medical gaze” and the same laypersons’ knowledge about the problem that can
be found in the media and other nonscientific sources. Thus, narratives were re-
lated where there was a fatal or at least sensational outcome or where perpetra-
tors used a high degree of violence; where victims and perpetrators were alco-
holics or drug addicts or even prostitutes and pimps; or where the woman had
a sadomasochistic streak or was “schizoid” or deviant in some way or another,
as I mentioned above. In the analysis I proposed two main reasons for why gps
might have chosen to relate these “unusual” narratives in the interviews: one
explanation concerns cultural expectations about what a “good story” should
be like; the other one is related to gps’ memorized stock of storied knowledge
about domestic abuse. Thus, we can assume that gps related unusual cases be-
cause they thought that was expected in the interview, given the fact that in our
culture “good” stories must contain some element that is exciting, extraordinary,
or “reportable” (Labov 1972a). At the same time, however, if we accept the argu-
ment that narratives represent and also re-create our knowledge about people,
experiences, and incidents, the gps’ narratives indicate that their knowledge of
domestic violence is very selective and that it is indeed informed by common
cultural myths and clichés about domestic violence.
Significantly, none of the gps in my sample mentioned the guidelines on
dealing with domestic violence published by the British Medical Association
(1998) or the resource manual for the medical profession that was disseminated
by the Department of Health (2000) before the interviews were conducted. In-
stead, gps spoke about articles they had read in the newspaper about the Zero
Tolerance campaign;1 short tv spots on the problem; media gossip about Rita
Johnson, Paul Young, Paul “Gazza” Gascoigne, Sean Connery, and Mike Tyson;
and the Jordache family in the British television soap opera Brookside. One gp
mentioned a play she had seen years before that dealt with domestic violence,
and another gp from the pilot interviews spoke about Roddy Doyle’s novel The
Woman Who Walked into Doors (1998) as a piece of writing that had brought
domestic violence more poignantly to her attention.
What do such responses reveal with regard to gps’ narrative knowledge? First
of all, these responses show that doctors are not merely professional experts but
are also part of a folk group, and therefore they also draw upon “folk” discourse
on domestic abuse. Moreover, the gps’ knowledge about domestic violence is
“narrative,” that is, it is informed by common narratives that pervade current
 Conclusion

nonacademic discourses on this topic. This kind of knowledge, however, un-

less it is filtered through a critical lens, might convey sensational and distorted
images of victims and perpetrators of abuse and offer explanatory frameworks
that are based less on “facts” of domestic violence than on simplistic stereotypes
and false preconceptions (Meyers 1997). If such images and explanations are in-
corporated into gps’ memorized knowledge base, then there is a danger that gps
might bring this knowledge to bear on the consultation, which in turn might
prove counterproductive if not harmful when a woman comes to seek help and
support. In other words, if gps reproduce sensational or at least unusual nar-
ratives about cases, they also create the realities conveyed in these narratives
as a given and thus perpetuate stereotypical notions of domestic violence and
images of women who suffer abuse that stigmatize as well as further victim-
ize them. What is therefore needed, I would argue, is a paradigmatic change in
doctors’ narrative knowledge as well as in their narrative practices concerning
psychosocial problems such as domestic violence. How this change might be
brought about will be addressed in the following, final section.

Narrative Teaching Modules in the Medical Curriculum

The study presented here demonstrates in what ways narrative analysis can
contribute to the uncovering and identification of a social problem such as
gps’ attitudes toward domestic violence. However, the aim of this book com-
prises more than applying narrative expertise to the unraveling of a problem: I
also wish to offer at least the beginnings of possible solutions from within the
narrative framework. The question, then, is, What does the study of narrative
have to offer to doctors in order for them to increase their awareness about do-
mestic violence and to improve their medical response? The narratives elicited
in the interviews clearly indicate that two major influences on gps’ conceptu-
alizations of the problem need to be tackled: assumptions stemming from the
biomedical model, on the one hand, and common cultural myths and clichés,
on the other. First and foremost, however, it is imperative to bridge the gap be-
tween doctor and patient and to enhance understanding and empathy. On the
one hand, gps need to learn about women’s narrative practices in the context
of disclosure in order not to restrict women’s stories by focusing too much on
the requirements of medical record keeping and the limitations placed on doc-
tor-patient encounters, for example. Furthermore, they ought to be able to val-
Conclusion 

idate women’s own narratives rather than impose an institutional narrative. As

Ainsworth-Vaughn has argued in her study of cancer patients’ attempts to re-
claim power in medical encounters, stories constitute a significant factor in the
healing process and therefore need to be taken seriously by doctors: “Patients
must continually rewrite their life stories, incorporating illness. The process
of doing this is a means of accepting a new reality. . . . So to interrupt a story
is to interrupt a healing process” (1998:186). It is therefore necessary that doc-
tors learn about the importance and functioning of narratives in everyday life
and that they are sensitized to the power of dominant discourses about domes-
tic violence by being exposed to the kinds of narratives transcribed and ana-
lyzed in this study.
On the other hand, doctors also need to learn how women think and feel
about the problem. Domestic violence is still mostly neglected in medical train-
ing and rarely features in medical textbooks (García-Moreno 2002:1511). Camp-
bell, who herself trains student nurses, emphasizes the importance of closing
conceptual gaps at an early stage in the career of health care professionals, and
she maintains that

these realities are difficult for us and for students to understand. It

is easier to categorize abused women in terms of pathological psy-
chology and thereby distance oneself from a reality that may be only
too close to home for female nursing students—which means most
nursing students. Student attitudes can only be changed with dialog
about these issues, sharing personal stories, and teaching about the
wider context of the domination of women. The fact that woman
battering is physical hitting and/or forced sex within a context of
coercive control that crosses all domains of a woman’s existence is
a reality not captured by simply teaching this definition. Students
need to get to know battered women personally in clinical experi-
ence and see role models of nurses conducting community advo-
cacy for change. (1992:469)

Campbell implies that some nurses may have firsthand experience of a violent
home or relationship and therefore feel reluctant to confront the problem in fe-
male patients. Other students may be too far removed from the lives some peo-
ple suffer in order to fully understand and empathize with them. The main way
to overcome such distances is by giving students the opportunity to meet vic-
 Conclusion

tims and to exchange stories about their experiences. Since it might initially be
difficult for students to become close to actual survivors of abuse, as Campbell
argues, she first uses novels such as Walker’s The Color Purple (1982), Morrison’s
Beloved (1987) and Sula (1982), Atwood’s The Handmaid’s Tale (1986), and Con-
roy’s The Prince of Tides (1986) to expose students to the “realities” of domestic
violence. Students are still able to “distance themselves—by putting the book
down when necessary” (Campbell 1992:469), but they nonetheless form an ini-
tial impression of what experiencing violence can mean to a woman.
As I pointed out in chapter 2, medicine and narrative are not as far apart as
we may at first imagine. To follow Hunter’s (1991) line of reasoning, doctors’
work can be regarded as “reading the patient as text,” and it consists largely of
interpreting the signs a patient presents with and of reformulating the interpre-
tation in a specialized jargon, which makes a medical examination somewhat
similar to literary studies. At the same time, gps sometimes employ a narrative
mode when talking to their patients in order to convey fairly complex medical
terminology to a layperson. Doctors’ diagnosis is also a retelling of the patient’s
own story of his or her illness in medical terms and entails the attachment of
certain labels. The medical record, finally, presents the patient’s case history and
thus also follows a narrative pattern in the broadest sense. Although the “reli-
ance on scientific observation, classification, and measurement and the sense
of mastery associated with these activities, continues to define the parameters
of much of medical practice,” as Squier (1998:137) notes, a number of authors
such as Hunter, Charon, and Coulehan (1995), Squier (1998), Rachman (1998),
Charon (2005), and others have emphasized the importance of humanist and,
more specifically, literary studies in the medical curriculum. The advantage of
literary texts as a teaching device is that they offer an insight into the complex-
ity of patients’ lives, as Squier contends: “Indeed, the chief value of literature
is the inherent complexity and holism of the story medium which reflects the
complexity of real people living real lives, thereby allowing the student to reach
a deeper and more comprehensive appreciation of the patient’s predicament”
(1998:131). There can be no doubt that the study of literary texts in the medical
curriculum ultimately will not replace real encounters with patients and, in this
case, with survivors of domestic abuse. Nevertheless, a narrative teaching mod-
ule could contribute to students’ acquisition of transferable skills such as com-
munication and listening, knowledge of human nature and of the diversity of
Conclusion 

people’s life experiences, lateral thinking, and the adoption and acceptance of
other people’s perspectives. Downie contends that “we learn from literature by
imaginative identification with the situations or characters in literature, and by
having our imaginations stretched through being made to enter into unfamil-
iar situations or to see points of view other than our own” (1991:96).
While the medical humanities and narrative medicine are only gradually
making their way into British medical schools and are still largely absent from
medical faculties in other Western countries, approximately 30 percent of Amer-
ican universities already offer literary teaching modules alongside courses in
medical ethics and communication skills to medical students as part of a Hu-
manities in Medicine course (Squier 1998:132). As Rachman points out, litera-
ture “has been used in medical instruction to promote moral and ethical reason-
ing, improve communication between doctor and patient, instill a deeper sense
of medical history, explore the therapeutic value of storytelling, advance mul-
ticultural perspectives, and increase self-consciousness on the part of medical
practitioners” (1998:123). More specifically, the study of literature and humani-
ties in medicine fulfils three major functions, which are captured in the follow-
ing conceptual approaches: the “ethical approach,” the “aesthetic approach,”
and the “empathic approach” (Hunter, Charon, and Coulehan 1995:789). The
ethical approach focuses on moral reflection and includes “images of healers
in literature, cultural perspectives on illness, questions of justice in society,
and the moral dimension of every patient-physician encounter.” The aesthetic
approach, by contrast, emphasizes “the literary skills of reading, writing, and
interpretation, using them in the service of medical practice.” In other words,
students learn about their role as listeners to or readers of patients’ stories and
about strategies for interpreting and understanding these narratives. The aim
is to encourage “tolerance for the ambiguity and turmoil of clinical situations.”
The empathic approach, finally, “aims to enhance the student’s ability to under-
stand the experiences, feelings, and values of other persons” (Hunter, Charon,
and Coulehan 1995:789). Since language and narrative are indeed so central to
medical practice, the sociolinguistic study of narrative is well placed to make
the underlying linguistic mechanisms transparent to medical practitioners,
and, similarly, the study of literature “makes the language of medicine, doctors,
patients, and disease entities—the cultural frame of illness—visible” (Rach-
man 1998:123). This kind of narrative approach is useful if not imperative in the
 Conclusion

context of psychosocial problems such as domestic violence that require more

than the kinds of treatment and help the biomedical model hitherto has to of-
fer. It would also encourage cross-disciplinary collaboration, which, I would
argue, is vital at a time when the rapidly accumulating amount of specialized
knowledge in each single discipline poses the danger that experts in their re-
spective field increasingly wear blinkers and thus perhaps miss important in-
sights gained in other research areas.
What could a narrative teaching module in medicine look like? First, I think,
it would be important to raise awareness among students about the importance
of narrative in people’s lives in general. Educators could, for example, alert stu-
dents to this issue by drawing their attention to their own uses of narrative in
their daily interactions with friends, family, and fellow students. Transcriptions
of narratives as presented in this study and sociolinguistic narrative analysis
would constitute core elements in this respect. This could be reinforced by short
creative writing exercises in which students are encouraged to write little pieces
concerning domestic violence. Charon (2005) demonstrates in what ways writ-
ing down their experiences can help (future) doctors sharpen their perceptions
of past events, reinforce their attention to narrative detail in patients’ stories,
and thus ultimately help them affiliate with patients and colleagues. Students
could also rewrite literary pieces from a new perspective, which, as Squier sug-
gests, should be at least the point of view “of someone of a different race, gender,
or age from the student” (1998:132). In order to bring their own possible uses of
myths and stereotypes to the students’ attention, it would be essential to make
tools for narrative analysis available to them so they could understand the dis-
cursive mechanisms they themselves may unconsciously apply.
Since their own narratives might reflect only their own frustrations back to
students and doctors, this preliminary stage should be followed by joint read-
ings and discussions of literary and nonliterary texts that bring in the women’s
perspective. In the context of domestic violence, for example, we could add to
the novels by Walker, Morrison, Atwood, and Conroy mentioned above Doyle’s
The Woman Who Walked into Doors and Fay Weldon’s short story “Alopecia”
(1981). More important, students and doctors should be acquainted with seg-
ments of women’s stories about their encounters with gps, especially with re-
gard to what the women did not manage to say but expected the physicians to
ask anyway. Data from empirical studies such as Williamson (2000) and Law-
less (2001) could be used for such purposes.
Conclusion 

Teachers could also include electronic narratives, which are available from a
number of online forums and databases (McLellan 1997). The advantage of elec-
tronic narratives for physicians is, McLellan argues, that they are “a window on
the ways illness can permeate lives and relationships, and on the ways the expe-
rience affects thinking and decision making. The texts often reveal truths that
sick people and their families cannot or will not otherwise tell” (1997:1620). It
is important to bear in mind that the discussions surrounding these texts ought
to be relevant to whatever the course objective is. Thus, it would not make sense
to undertake a close literary or discourse analysis with medical students if the
goal was to teach them something about medical practice, or, as Squier puts it,
“if the goal of a course is to further student understanding of patient and phy-
sician perspectives as part of the doctor-patient relationship course, asking stu-
dents to discuss the uses of metaphors in a story or rhythm and alliteration in
a poem may not advance, and may even divert attention from, this broad goal.
On the other hand, if the goal is to develop a deeper understanding of how hu-
mans communicate, this kind of literary discussion may well be appropriate”
(1998:133). Put another way, ethical and empathic approaches are sometimes to
be favored over the aesthetic approach. Narrative and discourse analysis as they
are applied in this study, however, ought to hold a central place in the training
of student doctors, as they show up potential similarities and, more important,
discrepancies between doctors’ and patients’ narratives. Furthermore, they of-
fer useful tools for analyzing texts, since they unravel deeper cognitive processes
and mechanisms of conceptualizing explanatory frameworks that contribute to
the (re-)creation as well as the reinforcement of powerful and, very often, det-
rimental discourses about a topic such as domestic violence.
Ideally, already practicing gps should be involved in some form of narra-
tive teaching, although it would be more difficult for them to find the time and
perhaps the motivation to attend seminars and workshops. The suggestions I
make here at the very end of my study can only be a first offer to those inter-
ested in changing current medical training. There is simply not enough space
in one book to also try and devise entire teaching modules.2 This remains a task
to be implemented in future research and policy making. I do hope, however,
that this study will at least raise doctors’ awareness by bringing to their atten-
tion the way they linguistically (re)construct their experiences with patients
suffering domestic violence in their narratives and thus also the way they in-
directly create knowledge and realities of the problem that can prove problem-
atic in their daily practice work.
Appendix
The GPs’ Narratives

This appendix includes complete transcriptions of all narratives, portions of

which have been quoted earlier in the text.

Narrative 1
GP1: middle-aged male GP in a deprived area on the periphery of the city center
J: Right. And do you think it affects any particular group in
society?
Dr.: No. It affects all groups of society. And I’ve had all groups of soci-
ety in here. From social class one to social class six or five or
whatever. A to Z or whatever the new sociological classifications
are.
J: Yeah, yeah. But, er, what, for example, about the difference between
women and men. Do more women come in, men . . . ?
Dr.: Uh, more women. As I say, only this year I had my first two
{males.}
J: {Men.} Aha. And do you find=
Dr.: =And [laughs] and, you know, one guy [has got a bigger] beat-
ing up than many women I have [come across].

Narrative 2
GP2: young female GP in a city center practice
J: Right. And looking back on all these years, what’s your expe-
rience with domestic violence? Can you tell me about your expe-
riences with domestic violence?
Dr.: [?] You don’t get an awful lot of people presenting with that as
a problem, although a lot of women present [it] as a problem. It
often comes out when you’re speaking to them about something
 Appendix

else. Er, usually they’ll come in ’cause [there’s a] history, they’re

depressed, and sometimes it’ll come out in that sort of situa-
tion. Or sometimes you’ll— [sighs] I’m thinking of one partic-
ular patient who brought her partner along with her. And it was
quite clear, he was abusing her the whole way through, through
my consultation. Verbally. You know, he was behaving in what
I, I thought was a completely unacceptable [manner] all the
way through in the interview. But I think he’s probably, you
know, he’s probably an extreme case. Er, so, it’s probably very
sporadic so you maybe don’t, I wouldn’t see a lot of people pres-
ent with it. And, and if you do find it it tends to be rather an inci-
dental thing you find rather than, than, er, something that stays
[sort of] about there.

Narrative 2 (continued) and Narrative 3

GP2
J: Yes. You were talking about this couple, er, where the partner
actually abused the woman in your practice. How did you react?
I mean that must have been really=
Dr.: =Well, I just told, I said to him: “Excuse me, could you just shut
up!” Because I was speaking to . . . [It was just, er,] I wasn’t alone.
The health visitor commented on that and just, he was really
very insulting to her but, she was having a baby with him. A pre-
vious relationship hadn’t worked out. She very much wanted to
make this one work. Um, she came from a fairly disrupted fam-
ily background. Um, she’s a vulnerable individual and [?] to go
into this vulnerable situation. But you know, he was expecting
her, while she was, she was heavily pregnant, to go and, he didn’t
wanna stay at her house, he wanted her to come up to his house
and just being totally unacceptable. I told her that. I told her
that he was treating her in an unacceptable way but she was just
so laid back, “well . . . ”[mocking tone]. I don’t think she saw it
as, as a violent situation. But I thought what’s [it] gonna take
for people to, just to lash out at her. If it was just a situation like
that and . . .
Appendix 

J: Maybe many women just don’t realize even, or they, they shut it
out in a way because they don’t want to see it.
Dr.: Yeah. Well, yes, if she’s seen that was happening and if she’s felt
that she was being abused then she would have put this, she
would have thought: “Gosh! I’m really stupid.” And it would be
easier for her to ignore it was happening or pretend it wasn’t hap-
pening. And then she wouldn’t feel so, so, you know, she maybe
didn’t feel so stupid. Although he’s trying very hard to do it to
her. And I, I, I can’t quite figure out, I’m sure there’s lots of indi-
vidual factors that makes people stay with people that abuse
them. And it’s very difficult to tease them out. Um, if I, I mean
I would never ever ever advise anybody to stay in that relation-
ship. I just think that’s just daft. I remember the first time
I saw it, quite cl——. I can still vividly remember the first time
I came across a girl who’d been beaten by a guy and I was work-
ing in casualty. She was just a young girl and he’d, I just newly
qualified, and this guy had hit her. And I said, [?] he had the
house keys. Now then I said: “Could I have the house keys,
please?” She wanted her flat keys. [And I said she wanted to be ?]
she just wanted to be here at the moment. And he got really, re-
ally, quite aggressive with me. And, fortunately there was po-
lice around and they got the keys and everything off him and,
er, sat him down and told him to behave himself. I had a long
chat with her, and she left with him. You know, she went back
to him. I said: “Look, he’s done that and you’ve forgiven him
for once, he’ll do it again to ya.” And you just, I just wonder what
happened, you know. But, you know, I thought, you know, if
you let him do it this once [doctor knocks on the table with
something] he’ll always think he can get away with it again. And,
she obviously, I don’t know, I don’t know why she went back.

Narrative 4
GP3: late-middle-aged male GP in a city center practice
J: Yeah, yeah, coming back to the consultation, have you ever felt
reluctant to ask a patient about, you know, whether there might
be a problem with domestic violence?
 Appendix

Dr.: Reluctant only in terms of time constraints during a particular

consultation. I mean if, if it’s been going on for ages, er, and I
know that it would be a can of worms that would be opened, I
will maybe leave it . . . Only to make sure that there was an open-
ing there to come back and discuss it further.
J: Right. Would it be the sensitivity of this issue=
Dr.: =I, I don’t feel uncomfortable discussing these things with my
patients. I also had one man who was abused, by the way.
J: Alright. Mmm. But that’s surely not a very common case.
Dr.: It’s very unusual. But, I mean, cranky, I mean if I was [with a
wife like this] [laughs], it’s absolutely terrible. Er, that’s [?] No,
I mean clearly it’s, it’s, it’s . . . But I don’t know, I, I have no per-
sonal difficulties about both bringing up the subject, er, about
dealing with its potential, er, aftermath of that discovery.

Narrative 5
GP3
J: Mmm. Is there any case that is very vivid in your memory or,
you know, which you can remember well?
Dr.: Um, I guess there are two or three but that’s more because of,
er, I had one particular who’s, who is, you know, in her second
or third abusive relationship, er, and I, I just feel powerless, you
know. I mean this woman by choice has sought out yet another
person. Maybe not “sought out,” I mean maybe it’s that, er, her,
her social, er, mix is with people who share that same, er, man-
ner [?] to their previous partners. You know, if they’re all boozers
and they all meet in the pub or whatever then it’s likely that
she’s gonna meet other people who, who are similar. You know,
in that we all tend to, um, find friendship with people who are
or who have similarities. So it’s, it’s maybe not so surprising. But
it’s most surprising to me why people choose, er, to, to, to reen-
ter, er, an arena of further physical violence having got out of a
previous one. I find that really tough.
Appendix 

Narrative 6
GP4: female GP nearing retirement in practice near the university
J: Okay. And looking back on all these years, can you tell me a bit
about your experiences with domestic violence?
Dr.: Um, well, not a lot. I’m not— not a lot is disclosed to you. Um,
sometimes women come in with, er, injuries that they’ve sus-
tained or sometimes they’ll, er, you know, they’ll come, er, for
information about refuges and, er, things like that. But on the
whole, er, not, not a lot presents to the gp. Um, sometimes you’ll
pick it, er, I had a, I had, um, one girl who was particularly bad
and her boyfriend broke her arm and she kept going back to
him and, um, so, I knew quite a lot about her, um . . .

Narrative 7 and Narrative 6 (continued)

GP4
J: Right. How about ethnic minorities? I could imagine you . . .
Dr.: I’ve got a lot of ethnic minorities. Again, um, I should have thought
about this be——, um, I’ve only had one family where I think
there was violence. And, again it was very much, I think it did
come out when the lady was very depressed and started to tell
me about her, her problems, um, and, er, she actually, er, tried
to commit suicide and that’s when it came out then. Her hus-
band was continually beating her up, um, maltreating her ver-
bally and physically, so, and mentally, [laughs] I was upset as
well. Er, but I, I think that was the only one . . . But most of the
ethnic people that I have here are university— um. I mean it is
present in all, um, sectors of society but, um, again maybe more
hidden if, er, with university . . . you know.
J: Yeah. Do you ever feel concerned you might not detect it {in a
consultation?}
Dr.: {Yes, I think so.} Yeah. I think quite often I might suspect it. It’s
the same pro—— possibly with child, um, um, vio——, er, er, vi-
olence to children. [Right]. I was telling you about the girl with
the broken arm. They have a small child and I suspect that the
 Appendix

child was maybe— er, and that was difficult because, you know,
of course you have to bring the social workers in and things like
that and that, I think that, er, concerns me more if that the chil-
dren are involved as well in a violence. Um, but yes yes, I think
they’re probably, I, there is probably a lot that I don’t pick up.
Yes. Mmm. Mmm.

Narrative 8
GP4
J: Yeah. I mean that’s something I can’t imagine, you know, how
you would react in that situation, um, because obviously it’s a
sensitive issue as well and I could imagine that you might not
want to touch it, you know.
Dr.: Er, you were talking about ethnic, now, it’s quite, um, it’s quite
difficult in ethnic becau——, er, because quite often the hus-
band comes with the wife in an ethnic— In fact, I tell a lie, I’ve
seen it with one, well, that was a really bad one but there’s a, a
patient I’ve got at the moment and I think her husband mis-
treats her. And, um, um, the husband tends to come with the
wife and of course she’s not going to say that she’s . . . so, it may
be even more hidden in an ethnic grouping than it is in the
Eu——, er, Western grouping. Yeah.

Narrative 6 (continued)
GP4
J: Have you ever seen people go back after {they’ve been here?}
Dr.: {Oh yes.} Yes, yes. The girl that got her arm broke——, went,
brok——, broken went back a few times but in the end she did
leave but, er, I think it’s because, er, danger of the child in the
end of the day that made the difference [for her], um. I’ve also had
people who have been in one violent relationship and then have
gone into another violent relationship and then that, that re-
ally is a thing that they need to unlearn [laughs], you know, what
kind of partners you choose, which again is often quite difficult.
Maybe assertiveness training and, er, things like that . . .
Appendix 

Narrative 9
GP4
J: Okay. Um, what do you think about the status of domestic vio-
lence in the whole health setting or the National Health Service,
for example? Do you think it’s maybe neglected?
Dr.: I think it probably is given a, given a low status, um. I’m just
thinking, I was in G-Docs, er, just a few weeks ago, and, er, I was
called out to something with, you know, that was a domestic vi-
olence situation. Um, it was kind of given a lower status than or
a low——, lower priority than say, maybe an elderly person with
a stroke or a heart attack or something like that. So, you know,
it was kind of a nuisance that we had to go out and see it and, er,
then they got the social workers involved and I say I think they
kind of think, “Well, it’s the social workers’ problem, it’s not
ours,” you know, and the police were involved as well, so, they
left it with the social workers, so. Poor social workers, that’s not
fair [laughs].

Narrative 10 and Narrative 11

GP5: early middle-aged female doctor in a student health practice
J: Right. Looking back on your experience before student health,
is there any case that you vividly remember or . . . ?
Dr.: Um . . . the ones I remember at the moment are more, it’s more,
you wanted domestic violence as opposed to child, the violence
towards children? Um, I can’t remember, I should have thought
about this before you came, um . . . No, I can’t, sorry. I’ll be think-
ing about it as we’re talking.
J: Yeah. Okay. Um, well, if someone comes in with signs of domes-
tic violence=
Dr.: =Oh, I do remember. I do remember. An amazing case. Yes, I
had an amazing case in casualty once when, um, somebody had,
um, that was a long time ago, somebody had come in and obvi-
ously had been, you know, really quite badly beaten up and was
terrified to, to go home. And her partner arrived in casualty
at the front door, demanding to see her. Um, and we didn’t know
 Appendix

what to do really and what we did, we phoned Women’s Aid and

we spoke to this amazing lady who has now retired. She was a,
a professor’s wife at the hospital, um, and she arranged every
thing. And she, it was almost as the cloak-and-dagger stuff, she
appeared in the back door and smuggled this woman out. Then
she went to the hostel.
J: What did you feel at that time, I mean . . . ?
Dr.: Well, it was quite, och, I think, the problem was that we never
knew what happened. You know, you never know how, how things
turned out in the long term. Um, we had another case here actu-
ally. That’s, that, we had a little girl who was a drug addict and
her boyfriend was a drug addict and that was really sad and she
was coming in with black eyes and, you know, bruises and all
sorts of things and she was different in that she just couldn’t do
anything about it. You know, no matter what we suggested she
. . . wasn’t able to, to break away from this guy. Unless while he
was in prison, which was alright, she was much better then and
she just, she didn’t finish her degree and she just looked iller
and iller and more and more tired and eventually she just dis-
appeared and we don’t know what’s happened to her. She left
Aberdeen and goodness knows where she is now.

Narrative 12
GP6: late-middle-aged male doctor in an affluent area near the city center
J: Okay. Um, can you think of any particular story a patient came
up with or . . . ? Is there any case that’s very vivid in your mem-
ory, for example?
Dr.: Um, yes, there was a wife of a taxi driver who was, er, accused of,
er, rape. Er, he used to, er, take female passengers, [first of all
there was alcohol and drugs] and ended up being caught and
eventually in prison. Um, during the court proceeding she was
generally reasonably supportive, I mean, saying that they
shouldn’t have raised these allegations that [?] that, er, settled
down when she was, er, away, um, they split up and, er, when
he came out of prison again she wouldn’t let him back into her
Appendix 

house, er, initially. Eventually he came back into the house and,
er, she ended up leaving and moving into a hostel with her kids.
Um, and she was a, you know, nice, decent person. Obviously
[being very hot-burnt with these . . . ] That’s a, an unusual case
maybe. Um, there’s always a lot of unhappiness in relationships
and when, um, people are obliged for all sorts of reasons to stay
together I think the situation is worse. Er, if the woman is de-
pendent on the male provider then it’s a lot more difficult for
them to move out of the situation. More women will leave men
than men will leave women.

Narrative 13
GP6
Dr.: And learned behavior from their own childhoods that hurts, a
lot of child abuse and, er, sexual abuse. Er, you look back and
see it happened there over generations. Um, I had a patient who,
um, er, had been sexually abusing his children, both boys and
girls and, when he died, I was quite surprised when his, when
the kids expressed pleasure that he’d actually died. But the fa-
ther himself had been abused in childhood. This is the sort of
violent behavior [that goes back for] generations. Er, if there is
a history in the family it’ll repeat itself down in generations [?].
Learned, learned behavior.

Narrative 14
GP7: male doctor nearing retirement working with the homeless
J: Yeah. Um, is there any case that’s particularly vivid in your mem-
ory, anything that was . . . ?
Dr.: I think possibly, er, the one and only time I’ve ever come across
a, um, an abused man. Because I’d read about them but it took
me completely [by] surprise when I actually met one because
he was a big-bellied chap who actually ran away from Dundee
and allegedly a very small, er, wife who did, er, exhibit, er, vio-
lence towards him. And again I couldn’t understand, er, [I’ll]
never be able to understand why [you have to use] violence in
 Appendix

a relationship but I couldn’t understand why he accepted it for

so long but again, there was, he was a chap on the road. I didn’t
see him for very long, I never established the truth of the situ-
ation. Or maybe . . . Yes, it’s, er, it’s often been surprising to me,
er, people I’ve known for a long, long time, who’ve seemed like
very decent, er, people, very, er, decent families, decent relation-
ships, and all of a sudden out of the blue they emerge maybe after
fifteen, twenty years, perhaps even from a, a son or daughter
that, er, the violent relationship or “Dad had been beating up
mum for a long time!” and, er, she put up with it and kept quiet.
So, it, it can be extremely surprising, it’s, you, you’re often light-
years away from guessing that it might be a problem.

Narrative 15
GP8: late-middle-aged male doctor in a student health practice
J: Is there any case that’s particularly vivid in your memory?
Dr.: There was one girl, yeah, that was pinned to a wall and had her
head bashed in, and by someone, er, another student, um, and
she was terrified and it definitely affected her in a bad way, I
mean, she, um, she left [?] and the person that assaulted her,
that was an atrocious sight. She was bigger than me, I remem-
ber that. That’s the most, that’s the only one that has been in the
last seven years where there was a real problem, you know, where
there was a, a difficult outcome, if you like. The rest, they were
all minor. And then in general practice, general work in here,
um, well, there’s quite a few, really, I mean, it’s, ’cause none of
these stood out because they were just, um, commonly, um, you
know, nothing, well, none of these stood out in the sense that
they didn’t, you know, bother me a lot. They maybe came with
a bruise [and that] and you don’t, you didn’t really know what
the outcome was unless they were divorced or something.

Narrative 16
GP8
J: Do you ever feel concerned that you don’t detect it? [?] or . . .
Dr.: No, I think if people complain about something, I think, I’m
Appendix 

reasonably aware that I [could pick it up] that there’s a prob-

lem or that there might be a problem and you can obviously ask.
Not, people may not come. I think there’s a hidden, huge hidden,
you know, mass of it that no one comes forward and I’ve never
known of a male being assaulted but I know that men do get as-
saulted by their wives. I have a friend who was assaulted by his
wife. So, I know it happens. And, er, he was, er, he was kicked
and various other things, um, and he ended up arrested. Incred-
ibly, even though I’m sure I know that it was her who assaulted
him. She admitted it, you know, and he was arrested. I just find
this, feminism’s just gone completely bananas as far as I am
concerned.

Narrative 17
GP8
J: Do you think that some gps maybe ignore the issue?
Dr.: Yep, because they’re people, because they’re men, because they’re
under stress, because there might be a woman who’s been brought
up in a very sheltered environment and hasn’t got a clue how
low people live their life, yes, I think [?]. And there’s all sorts of
reasons for that. I think it’s, yeah, I don’t know. It’s tricky. But
I think people, gps will ig——, I think, doctors [?]. Some doctors
are far better than others at communicating with patients. Com-
munication is not something that you were taught at medical
school much when I went to medical school. It might be taught
more now. You weren’t even taught to look somebody in the
[eyeball], you know. [To look in the eyeball of] somebody [can]
help you really understand what’s going on, you know. If you sit
and look at the desk when they’re speaking to you— and I had a
partner who did that, and I’m sure he couldn’t really be empathic
with any of his patients— not because he was a bad person be-
cause he wasn’t, but he just couldn’t look at them. You have to
give, you have to make people think you’re interested or they
won’t come back. Would you agree?
J: Yeah, I think so. I think communication skills are very impor-
tant . . .
 Appendix

Dr.: Yeah.
J: Mmm.

Narrative 18
GP8
And, I [always] think that it’s going a wee bit too far, you know,
when, I [can give you a really good little story.] Well, on Radio 4,
about five, six months ago, there was this news broadcast when
this, two kids were seen standing outside a school talking to a
man, right? Now, people saw this man talking to, [the] man
seemed to be talking to these children [who were] about nine,
right, or whatever, and they phoned the police. And the police
came [?] with the blue light flashing to the school, and the kids
had gone. And the man had gone, so they went, they went into
the school and they couldn’t find out who these two kids were
but, so they ended up doing a, a roll call, I think, and all the kids
were there, fine, no problem, and somebody said to the police
they’ll actually, [what] will they charge him with anyway, is,
can a man not speak to children? Now, it’s, it makes a point,
that story. A very big point. You can’t make outright assump-
tions that men are bad, right? Even in domestic violence situa-
tions, it, it’s not right. It’s [?] you get the hysterical one, um, you
know, to assume things in society. This is not how the world is.
The world is much subtler than that and I, I know I wouldn’t deny
for a minute that most emotional possibly, certainly the most
visible violence, domestic violence, is perpetrated by men on
women. I wouldn’t deny that. I think it’s grossly oversimplistic,
I think, that that’s the only issue there.

Narrative 19
GP9: middle-aged male GP in a suburban practice
J: Right. Is there any case that’s particularly vivid in your
memory?
Dr.: No. [laughs]
J: No.
Appendix 

Dr.: I’m not very helpful there. Um, no, as I say, it’s not an issue that
I’ve been dealing with very much of lately anyway so there’s noth-
ing very fresh, er, um, there’s, I mean in twenty-five years you’re
going to see an amount of this but it isn’t, it isn’t a major part of
my work. We’ve had, I’m only aware of one fatality from do-
mestic violence and that was through alcohol and, the chap’s
now locked up.
J: Alright. Did that end really badly?
Dr.: That was not good. [?] And there were, he didn’t realize that she
was dead until he sobered up and she had the head in the fire-
place. That was unpleasant.
J: Oh, God, how do you react as a gp when something like this hap-
pens, I mean . . . ?
Dr.: Well, um, supportively but I thought that, I mean, you know,
he declaring that it must have been an accident but, in fact, even-
tually he was arrested and taken away.

Narrative 20
GP9
I think it is mainly, er, mainly to do with, with, with sexual do-
mestic partners as being the, the center of it. Clearly, it extends
beyond that to, to families and so on. Um, I, that’s my, my sort
of, um, “view” of it, and I don’t think in terms of sibling-sibling,
I know that’s been a common thing, um, clearly parent-child
would be another sort of violence which is difficult to, or in-
deed child-parent for the elderly but, um, again, these are things
that we don’t see very much of or at least don’t recognize. Granny
bashing and child battering are not something that we see a lot
of, and again, maybe we miss some of it, I’m sure we do.
J: {Similar to . . .}
Dr.: {Similar to} male-female, yeah.
J: Right.
Dr.: And the last person I had in who’d been complaining of being
hit was actually a man who was complaining that his girlfriend
had been beating him up. So . . . [laughs]
 Appendix

Narrative 21
GP10: middle-aged female GP in a deprived city center area
J: Mmm. Mmm. So, what would you suggest to this person, you
know, I mean, once domestic violence has been established in a
consultation, what would your next step be or . . . ?
Dr.: Um, I mean I usually make sure that, that their physical, again,
it depends very much on what’s been presented to me, as I say,
it, it, och, the most recent things that I remember is actually
people who had got to that stage where they wanted to involve
the police and therefore needed a catalog of injuries in case they
have to do anything with it, you know, and that’s a sensible thing
that has to be done. And it’s, it’s a distracting thing as well. You
can do that while chatting and [?], so the physical thing has to
be dealt with.

Narrative 22
GP11: young male GP in a deprived area on the outskirts of the city
J: Mmm, mmm, right. Is there any case that’s particularly vivid in
your memory?
Dr.: I’ve had one lady who’s, er, she works in a [?] major department
store in town and she’s come in with sort of facial bruising and
then having to go to work. Or, at some point in the week going
to work. So, you know, it’s, er, sad, sad for her because then ev-
eryone else realizes what’s, er, or, [?].
J: Yeah.
Dr.: But, I mean I’ve never seen a real major, er, domestic abuse apart
from in, where I was working in casualty years ago.

Narrative 23
GP12: late-middle-aged male GP in an area on the outskirts of the city center
J: Yeah, yeah, I mean, what are the reasons for domestic violence
anyway, why does it happen?
Dr.: Um, well, I, I think drink often is, is a case and if, um, and if you
compound that with the man having, um, not, not being a ne-
gotiator of problems but just, just doing that so then, I suppose,
Appendix 

at the end of the day, because, because we all, we all have our own
rit——, rituals in, in our relationships, then, you know, if, if the
woman nags or gets on to someone and he, you know, he hits it
back and, it’s actually trying to change people’s behavior patterns
is very difficult so, so there may be a, you know, a, just a sort of
fixed pattern in behavior and in a relationship that goes like that
so, um, I suppose sex— you know, sexual, er, demands or refus-
als come into it as well, um, some people just, husbands may like,
some of them, they seem to like the power of, you know, of do-
ing that. Um, and [?] I suppose, it’s, er, they’re even sort of, a
degree of sadomasochism, that some people actually like be-
ing beaten up, er, [?]. I mean I had a, a, I mean a patient many
years ago and she, I mean she used to come in and reg——, re-
gale us with the, the most bizarre and, er, tales of terrible sado-
mastics, masochistic stuff and, but she stayed with her husband
for ten years, you know, um, er, it was, um, you know, it, it was,
it was almost sort of schizoid that, you know, she was, she’d sit
there and say, “He’s doing this, that and the other,” you know,
“[took] me and beat up” and “Why don’t you leave?” “Oh, I
can’t leave!” [laughs], you know . . .

Narrative 24
GP13: middle-aged female GP in a deprived area on the outskirts of the city
J: Mmm. Do you find that your patients often go back to the same
situation?
Dr.: Yeah.
J: Yeah?
Dr.: They don’t come out of it, yeah. Or they, they are pregnant and
go back or, I can think of one woman who, you know, clearly
that was why she was so upset and [everything] and got her
through that but she wouldn’t leave him. That was an older
woman, you know, now middle-aged [?]. The stigma attached
to all the family and relations, she couldn’t extract herself out
of that. And it’s quite a thing for a woman of that age to become
single again and live on her own despite the abuser’s [?] it’s very
difficult . . .
 Appendix

Narrative 25
GP13
J: Yeah [skeptical facial expression]. [both laugh] It’s been going
on for so long and now you wonder if anything could be done.
Dr.: I know.
J: It’s quite depressing.
Dr.: It is. It is. I know, um, I don’t know why it should be. It’s to do
with power, I’m sure, in men [?] power and frustration and ways
of communicating that. [pause] Yeah. But sometimes the women
do get out and a very, very old lady [?] terrible test and she even-
tually learned to allow her husband in our sympathies. [?] how,
I mean, she’ll be fine ’cause, I mean, she must have been terri-
bly lonely ’cause this house was away from, er, all social net-
work but she put up with him for years and, er, she’s quite well.
And [?] she walked out on her own but she did it, you know. It
took her years and years. I mean, she took herself another house
[?].

Narrative 26
GP14: young female GP in a deprived area on the outskirts of the city
J: Mmm. Do you find that women often go back as well?
Dr.: Yeah, yeah. I mean I’ve got one in particular who, her husband,
um, is an alcoholic and is abusive and aggressive towards her
and now towards her baby, er, use, you know, sort of uses her
as a, as a weapon. And she has tried to leave him and has got
an injunction against him but then has changed her mind and
just gone back to him again. And there’s not much more I can
do in that scenario really, which I find very difficult ’cause she’s
still upset about it and she’s still affected by it so . . .

Narrative 27
GP14
J: Mmm. And once you’ve got a suspicion, how would you pro-
ceed, I mean, how would you pursue the issue?
Dr.: I would basically just sort of say directly, you know, “Is, is there
Appendix 

problems at home? Are you having problems with your partner

or your family?” and, you know, “What exactly is happening? Do
they hit you? Do they shout at you?” Sometimes it’s not even just,
I mean, you can have families where, yes, the husband’s perhaps
abusive towards the wife, he can be verbally abusive, but you
sometimes find even the kids are like that as well. I had one
woman whose grown-up kids have just seen the father be like
this and they were not physically aggressive but, um, mentally
aggressive towards their mother all the time, quite threatening
and, um, again, that’s a horrible situation if your whole fam-
ily seems to be getting on at you and giving you a hard time. It’s,
it’s not very good. I, I’m usually sort of fairly direct asking them,
sometimes they actually quite want to speak about it. They can’t
speak to anyone else.

Narrative 28
GP14
J: Um, a number of gps I’ve interviewed have said that time might
be a problem, that they might not want to broach the subject
because obviously you’re only on ten minutes or something and
then it might be difficult to open this “can of worms.”
Dr.: Um, I would tend to ask them anyway, um, and if there’s a hint
of something and we start getting involved, um, I had one girl
who, ach, she had a horrible family. She, her, her mother told
her when she was [?], she was about eighteen, that her father
wasn’t her father and “either way, that’s your father over there.”
And so she’d become very confused and I tried to approach him
and then, a year or so later, the mother said: “That was all a lie,
he’s not your father at all, blah blah blah” and there was a whole
big [discussion] in the families and she was very upset about it.
You know, she was dressed, she set to work, when you actu-
ally went into it, and you really had to go into that in detail, but
I said to her: “Well, you know, we’ve cer——, I’ve just [been]
speaking for about twenty minutes. [I’m kind of] running out
of time.” So, get her to come back and some will come back,
 Appendix

some won’t. She did come back but, um, you do have to give
them the chance to say it. And if you don’t pick up the cues then
they just maybe never come to the surface again, you know. So
I would, I would tend to ask and then, if need be, get them to
come back. Um, I tend to do that.

Narrative 29
GP15: middle-aged male GP in a suburban area
J: Yeah. How do you feel anyway when you encounter domestic vi-
olence? Do you ever feel upset, for example?
Dr.: I think you always do. I think there’s rarely a situation when
you don’t. But sometimes [tempered] if, um, we’ve got, um, one
couple in the practice who are both, um, alcoholics and she’s
the victim of, um, violence, um, and you, ach, I don’t know, and
it always seems to happen when they’re on a [bender] but, um,
but, er, he hits her, he punches her and kicks her and [pause]
and you still, I, I think you still feel sympathy for, for what’s
happened but, um, I think it’s frustration as much as anything,
you think, “Well, why do they do that? Why stay on? Why keep
drinking?” but, you know, it’s, it’s, it’s, it’s their life really. That’s
the way it’s always been, and it isn’t something that can be changed
usually [?]. But I think you always do feel sorry for the victim of
any violence, whether it’s male or female or whatever the cir-
cumstances, human nature, I suppose.

Narrative 30
GP16: middle-aged male GP in practice in the wider city area near the university
J: Okay. Well, first of all, thank you very much for giving me your
time because, as you can imagine, it’s not easy for me to get doc-
tors to talk to me=
Dr.: ={Probably.}
J: {Many of} them say they don’t have time, others say it’s not an
issue for them. So I wanted to ask you: Do you think domestic
violence is an issue for gps?
Dr.: Er, well, I think it, unfortunately, I think, it probably is because,
I mean, this morning alone, I’ve had a patient in who has trou-
Appendix 

ble with the family. It’s a difficult one to, to best try to man-
age [?]. Yes, so I’ve had a patient fairly recently and I’ve had one
or two of them in the past and, er, I find it difficult to know how
best to manage them ’cause where to send them and how to get
their best, where do they get their best advice, and, er, ’cause it’s
not something I can do a lot about except encouraging to seek
advice from appropriate sources.

Narrative 30 (continued)
GP16
Dr.: Yeah. I’m sure there’s a lot hidden, yeah. I mean, a lot of women
won’t admit to it, but if they came in with black eyes, you know,
obvious bruising, then, er, I think, I will confront them a bit
about it and discuss it and see what happened to this lady, for
example.
J: Mmm. Can you tell me a bit about . . . ?
Dr.: About this lady?
J: Yeah.
Dr.: She, well, she’s interesting. She’s a schiz——, she’s labeled as
a schizophrenic but she’s not, she’s not really, she’s not, er, par-
ticularly bad in that way and she lives, um, in a flat she has
bought and she has a partner who she wants to get out of the flat,
who’s really ins——, er, installed himself in there and [has lived]
there for a number of years and, um, he, er, er, he’s, er, mentally
and physically abusive towards her and, um, he really just, er,
pushes her around and makes her do all the shopping, he makes
her carry everything, he turns off all the lights and the telly
when he wants it off, he changes the tv program if he doesn’t
like it on and he resorts to physical violence and, and she came
in the other week, last week, with a big black eye and some bruis-
ing and then I had a chat with her about it and, er, [she felt
ashamed] and then, before I suspected it I’d never actually known
that he’s been physically abusive but, er, she obviously is un-
happy with him but can’t get him out of the flat. He pays rent
and he’s fairly, er, aggressive [?]. She likes to watch some televi-
sion program, he prefers if she puts it, the, the nasty, aggressive
 Appendix

things on the telly. So she’s in a bit of a dilemma and, being men-

tally unwell, she, she hasn’t worked for a number of years, she
doesn’t have, um, she, she’s not very skilled at times to organi—
—, to manage this situation. She does have support from the
cpn [clinical psychiatric nurse] but I don’t think, er, it’s very
difficult to know how best to help her actually ’cause I said to
her last week she should go to, to seek legal advice. I suggested
that she maybe goes to the Citizens Advice first to get some
help with that. She’s not, well, financially, she’s badly off so she’s
worried about all sorts of legal fees. I suggested to her that one
option might be to come out of the flat and seek refuge and then
[the Citizens Advice section] will get him out but she under-
standably is reluctant to do that because it’s her flat, she actu-
ally pays the mortgage and he pays her rent. That’s pretty min-
imal but he does. So she’s in a very unhappy situation and she
really doesn’t want to get involved with him but she can’t get rid
of him.
J: Alright. But she was fairly up front about the {problem?}
Dr.: {Very, yeah.} Well, I’ve known her for quite a, about ten years
so she and, er, with her schizophrenic illness it’s taken a while
getting her to talk about things but she’s actually quite well
from that point of view, she’s not psychotic at all at the moment
and I don’t think, er, that’s an issue. I think there’s an issue in
that she is not very good at managing the situation and, and
she’s, and she’s not working, she’s only forty-six but she’s not
working. She has no other financial, er, input of actual bene-
fits. Um, but I mean it was obvious when she had the black eye
that, that she’d been assaulted but she was quite moved from
that how it happened and she did say this wasn’t a new thing, it
happened several times in the past.

Narrative 31 and Narrative 30 (continued)

GP16
But, er, so it really depends on how, how sure you are that, in your
own mind, that things are wrong at home or with the partner.
Appendix 

But I’ve had a few come in with relatives, you know, son, grown-
up sons bringing their mothers in to say that she wouldn’t come
along but “I’m bringing her along because her boyfriend’s beat-
ing her up” or, or stepfather, “My stepfather is beating her up”
or that kind of, and that, you know, that’s another way of pre-
senting. The family eventually having had enough of it and say-
ing a word, you know, telling you about it over the phone and
expecting you to then bring it up with the patient when they
come in. So, there are different ways of getting to . . .
J: Mmm, mmm, yeah. Some of the gps I’ve interviewed so far have
mentioned time as a problem, that it might be difficult because
you have ten minutes or {something.}
Dr.: {It’s very difficult,} yeah. The only way is to get them to come
back and, er, er, I mean, this lady with schizophrenia, I saw her
last week, I’ve seen her this week and she’s coming back in two
weeks and I’ve suggested that she better try to, I might get and
see [her] back in again and see what’s wrong. I don’t hold that
much hope for her ’cause I don’t think she’s actually going to get
her act together and try and do anything but I have documented
the intrusion and I have said to her I’d be willing to support
her, you know, if she gets in touch with a lawyer that I can come
forward with what she’s told me today and, er, the injuries she’s
presented with. But time is difficult, I know that well. And we’re
referring on to, I suppose, other agencies, I mean, er, er, that’s,
that’s, that’s the other thing is knowing who to refer on to.
Again, you have to get the patient to comply with that and actu-
ally get in touch.

Narrative 32
GP17: young female GP in a wider city area practice
J: Right. Okay, but can you tell me a bit about the experiences you’ve
had?
Dr.: Um, [sighs] my interview is probably flavored by the fact that
I’ve actually been asked to speak on domestic violence in preg-
nancies, up at the maternity hospital ’cause I’m the antenatal
 Appendix

doctor here and I was asked to come and do a presentation. So

I kind of asked around and spoke to the midwives, spoke to the
health visitors to pick out a few families that they thought there
was something going on and so I did this sort of mini-audit of
their notes. Um, so, I suppose, there was one girl in particular I
remember her being really quite a hard thing for me. She was
always at the surgery, minor, usually minor, minor complaints
or she’d drag along her little boy and it’d be something very mi-
nor with him, um, and they were here all the time and then, one
day, basically she admitted that, you know, I, I’d actually vis-
ited her at home as well, in the presence of this very “loving”
in inverted commas boyfriend and then one day she admitted
to me that he’d been abusing her for years but her son was out
of, as a result of a rape, and it was just horrendous. Now, since
that has come up I have never, I see her once a year. So, in the
long run, I’ve saved a lot of time and she’s perhaps, she’s got rid
of the boyfriend which was the real cure, there was nothing med-
ical I could do for her, um, but that really sticks in my mind,
that case.

Narrative 33
GP17
J: Right. Do you think domestic violence is an issue for any other
group?
Dr.: Um, I don’t know if it is, I suppose that we’re a bit slanted up
here in Aberdeen but I just get the impression that some ethnic
minorities perhaps, maybe not so much in the way of physical
violence but actually psychological dominance by the males within
the family, I mean that’s maybe a cultural norm for them. I can
think of one situation where I’ve got a Bangladeshi family who’s
had, the husband is, is incredibly overpowering, um, to such an
extent, this very intelligent woman who has her own job and,
and, you know, runs the home, the job, and the children still
doesn’t really make any decisions on her, her own life. I don’t
Appendix 

know if you could classify that as violence. I think she’s very,

very dominated by what her husband says, er . . .
J: Yeah, it’s more like verbal abuse mainly . . .
Dr.: Yeah. And I think certain, you know, in certain cultures perhaps
the women are less perhaps likely to come and, and see, open up to
the, to ma——, you know, to the, um, health visitor or gp or
whatever.

Narrative 32 (continued)
GP17
J: So it’s really a question of awareness . . .
Dr.: Awareness, that’s the big one.
J: Yeah.
Dr.: Mmm. But part of me also makes me think, and it’s perhaps un-
fair, but part of me makes me think that I wish women had the
confidence and tell us if there was a problem. I sometimes feel,
you know, you’re taking this for so long, you know, it’s part, I
suppose part of it is building up a relationship with all your pa-
tients and, so they trust you and will come to you with problems
but, I mean, especially the girl that I, I was talking about, if she
told me even a year earlier, you know, and I just wish she had
’cause I felt like I had a good rapport with her and I felt like she
trusted me, um, I certainly had a lot of contact with her and I
feel why couldn’t, maybe it was my fault that she couldn’t say
but sometimes I feel women should, I mean I know their self-
esteem and their confidence has been shattered for many, many
years but I just wish they would feel that they could come and
tell us if there was a problem, ’cause we’re not gonna bandy it
about, you know, if it’s totally confidential. We can give them ad-
vice. If they don’t want to take our advice, fine, but I wish they
would let us, er, let us know. And I just wish that, you know,
there’s been a few adverts on the telly recently and it’s quite good,
domestic violence [funds] and, um, but I wish there was more
in the magazines, in the media to make it acceptable for women
to go and ask for help. It’s hard enough to do anyway but we’re
 Appendix

not mind readers and if we’re having a busy surgery and, all we
see is the pink page in front of us. We’re not looking through
notes all the time and analyzing everybody’s consultation. So,
if they come in with a sore throat we deal with their sore throat
and then they go but if they just gave us some, some better
clues.
J: Yeah. But maybe they feel they=
Dr.: =but maybe they are giving us clues. Sorry. [laughs]
J: Maybe they just feel they can’t bother you with this problem
{because}
Dr.: {I know.}
J: because they might not see it as a medical {problem}.
Dr.: {problem}. Yeah, but it is, they should, they should be educated
so they know that they can come and, and see us.

Narrative 34
GP17
J: Yeah. Do you think that’s maybe a shortcoming?
Dr.: [takes a deep breath] Yes, definitely but I think especially work-
ing in A&E [accident and emergency] and the amount of women
we saw, I had, er, a girl who, oh, it was so strange, who was, she,
the story was she’d fallen down the stairs and at the bottom of
the stairs there was a glass door. She’d fallen down the stairs
and through the door and her leg was in ribbons and I sat about
an hour stitching it up, and her husband was a drug [user] and
he sat with me, the whole hour, saying sweet things in her ear,
you know, and, you know, being generally supportive and so
nice and so kind. And then when she came back to the dressing
clinic, to st——, to have her stitches out and see how her leg was
doing, she admitted that he’d actually pushed her through a
glass door and that he’d been violent towards her for a long time.
But he wasn’t, you know, he obviously wasn’t there, um, at that
point. So, that was great she told me and that gave me great in—
—, insight into what’s been happening but I felt then totally
unprepared to do anything about it. I mean I did nothing. I
Appendix 

did nothing. I sympathized with her, I sent her on her way be-
cause, you know, we hadn’t been told, I mean there’s the A&E
training but nobody ever mentioned issues of domestic vio-
lence. Perhaps they do now, that was, um, ten years ago.

Narrative 35
GP19: young male GP in an affluent suburban area
J: Mmm. Do you think that the women in South Africa were more
up front about it? I mean, did they come out fairly quickly? You
say you saw it more than you see it here? Maybe it’s also an issue
of coming out? I don’t know.
Dr.: Well, I think their violence was more obvious, you know, if some-
one breaks his wife’s arms then that obviously is an obvious is-
sue. And I’m talking about these kind of things, you know. Um,
I had a once a woman where the, her son had a, an acute psy-
chotic attack because her husband was, had been pointing a gun
at her and things like this. So that, or, you know, rape and things
like this, really horrendous things and then it is just obvious.
Um, otherwise, I don’t think so, I don’t, I don’t, I don’t think Af-
rican, Africans are at all up front about many things that Eu-
ropeans are up front about and the other way round. So they’re up
front about different issues and, er, and in African society you
don’t talk much about issues that are related to sexuality, for in-
stance, and things that happen between husband and wife. So,
no, I don’t think they’re up front about it. It’s just that sometimes
it’s so obvious that, that you can’t hide it.

Narrative 36
GP20: late-middle-aged female GP in an affluent area near the city center
J: Right, mmm. Can you tell me a bit about your experiences with
patients who suffered domestic violence?
Dr.: It doesn’t seem to happen very often but, but, I mean, it, it does
happen a lot, I know that, um, patients don’t always present with
it that often. I mean I remember, this was years ago, my worst
patient came up with bruise marks all round her neck and she
 Appendix

was quite open about it and she came in and said: “I’d just like you
to make a note of all these injuries because my husband tried
to strangle me yesterday and, um, I, I just want you to all note
it because I’m going to sue hi——, I’m going to take him to
court” or whatever. She was very up front about it. Um, but
mostly it’s, it’s the, the scenario that things aren’t, that the pa-
tients have said things aren’t going well and they’ll tell you that
the, their partner sometimes hits them, say, when they’re drunk
or, or that sort of thing. Sometimes they’ll tell you in retrospect,
you know, that they’ve left him because obviously he was just
“lifting the hand,” that’s always what they say up here. “He was
lifting his hand and, um, that’s why I left.” And, um, that’s quite
common as well that they sometimes don’t want to tell you ac-
tually at the time. Sometimes they do.
Notes

1. Introduction
1. General practitioners (gps) are equivalent to family medicine practitioners in the
United States.

2. Narrative
1. I must add the caveat that the Sapir-Whorf hypothesis has come to be known in
two versions, the “weak” and the “strong”: “According to the strong version, people’s
cognitive categories are determined by the languages they speak. According to the weak
form, people’s behavior will tend to be guided by the linguistic categories of their lan-
guages under certain circumstances” (Fasold 1990:53). Although the strong version in
particular has received much criticism, the Sapir-Whorf hypothesis has been neither
fully accepted nor entirely rejected. Nevertheless, since language at least to a certain
degree conditions people’s conceptualizations of social problems and, indeed, of the
world around them, we can turn the argument on its head and maintain that the anal-
ysis of language is important in order to uncover the subtler mechanisms that facili-
tate such conditioning.
2. For a general discussion of misunderstandings and their consequences see Hin-
nenkamp (1998). Examples of how miscommunication can lead to fatal events like plane
crashes are provided in Cushing (1990, 1994). Another area in which the impact of lan-
guage has featured prominently is forensic linguistics. Tiersma and Solan (2002) pro-
vide a good overview of this study area. For examples of the significance of linguistic
expertise in court trials see Labov and Harris (1994) and Shuy (1993).
3. Zimmerman and Boden argue along the same lines when they propose “structure-
as-interaction” as a “way of articulating the agency/structure intersection”: “Members
can and must make their actions available and reasonable to each other and, in so do-
ing, the everyday organization of experience produces and reproduces the patterned and
patterning qualities we have come to call social structure. The organization of talk dis-
plays the essential reflexivity of action and structure and, in so doing, makes available
what we are calling structure-in-action” (1991:18, 19, emphasis in original).
4. The terms orientation and complicating action are derived from Labov and Waletzky
(1967) and are clarified in chapter 3.
5. Narratology originally began as a more generalist approach, the models of which
 Notes to Pages 16–26

were claimed to be universally applicable, regardless of what shape the narrative took
(Prince 1997:39). More recently, authors have put forward integrative approaches that
take into consideration not only aspects of “classical” narratology and discourse lin-
guistics but also perspectives on narrative borrowed from cognitive psychology and ar-
tificial intelligence (Herman 1997, 1999b, 2001; Jahn 1999; Nünning and Nünning 2002a,
2002b). These “new” approaches emphasize the contextual and processual nature of
narrative and thereby overcome the dilemmas of purely structuralist analyses, which,
no matter how accurate and detailed, always convey a sense of incompleteness.
6. Research on language use in the courtroom undertaken by Lind and O’Barr (1979)
shows that the distribution of “power and powerless speech” indeed influences jurors’
judgment and evaluation of witnesses giving testimony, on the one hand, and attorneys,
on the other. “Powerless speech,” that is, speech marked, among other things, by fre-
quent use of intensifiers (“very,” “so,” “too,” etc.), hypercorrect grammar, polite forms,
hedges (“kinda,” “I guess,” “well,” etc.), and rising intonation, was found to make wit-
nesses appear less favorable socially, especially if they were male. Similarly, test sub-
jects considered “fragmented” testimony more negative than “narrative” testimony:
“When differences do occur in reactions to narrative and fragmented testimony they
are in the direction of more favourable evaluations of witnesses giving narrative an-
swers” (Lind and O’Barr 1979:79).
7. Bruner refuted this dichotomy in his 2003 book Making Stories, not so much in
the sense that he disclaimed the existence of the narrative and the paradigmatic modes
of thinking but in that he reformulated their relationship. While in his earlier writings
Bruner regarded the narrative mode as translatable into the scientific mode (and thus
as subsidiary to it), he now claims that narrative thinking in fact shapes our percep-
tions of the world and is thus the starting point of all knowledge.
8. In Linde’s example a subordinate not only informs her boss about an incident of
violence perpetrated by one client on another but also relates the actions taken by her-
self and her colleagues to restore institutional order. Thus, her narrative in a sense re-
creates policy as well as notions of institutional mission and power relationships.
9. It is interesting to note in this context that the development of the “institutional
memory” of domestic abuse in the social sciences also changed over the years, moving
from virtual nonexistence in the 1950s and early 1960s (Gelles 1980; Hague and Wilson
2000) to a proliferation of research in the 1990s (Johnson and Ferraro 2000). In recent
years the issue has become more topical in social science studies, which can be seen in
the extensive research presented in articles and monographs (Dell and Korotana 2000;
Mooney 2000; Radford, Friedberg, and Harne 2000; Hague et al. 2002; Mezey et al.
2002), research projects undertaken in Britain, for example (Coid et al. 2001; Richard-
son et al. 2001, 2002; Bradley et al. 2002); and journals specifically dealing with this is-
sue (Violence against Women; the Journal of Interpersonal Violence).
10. In her study on protective order interviews with Latina survivors of abuse Trinch
shows how both victims and interviewers employ euphemisms to evade a direct discus-
Notes to Pages 27–37 

sion of the topic of marital rape during the interviews and thus reconstruct inaccurate
accounts of abusive relationships. This ultimately also falsifies the reports and statisti-
cal material that constitute the institutional memories of the district attorney’s office
and the pro bono law clinic investigated: “Thus, the statistical data they have compiled
are at best incomplete, and at worst, completely misleading” (Trinch 2002b:600).
11. The findings can be summarized by quoting the Tayside Women and Violence
Group: “Agencies do not offer a consistent service from one office to another, or even
from one worker to another. There is no standard or guarantee of the service which an
abused woman will receive—it may be excellent, mediocre or appalling. The reasons
underlying this inconsistency can be found in the lack of training, knowledge of re-
sources, policy statements and good practice guidelines” (1994:92).

3. Domestic Violence and the Role of General Practice

1. For a more extensive review of domestic violence research in the 1970s see Gelles
(1980).
2. The Department of Health is Britain’s governmental health authority. For further
information see http://www.doh.gov.uk.
3. For example, Borkowski, Murch, and Walker (1983:24) report gps’ estimates of
frequency of meeting cases of marital violence. The answers of the fifty gps they in-
terviewed ranged from once a week (2 percent), once a fortnight (9 percent), once a
month (35 percent), once every three months (24 percent), once every six months (15
percent), once a year (11 percent), to less often (4 percent). Results from a postal sur-
vey in a Midlands county yielded similar results: out of 254 gps, 15.5 percent stated that
they saw women who are suspected of having experienced violence more than once a
month, 76 percent said they encountered suspected victims only occasionally, and 8.5
percent claimed they had never seen any women who might be suffering abuse (Abbott
and Williamson 1999:90).
4. A study of the economic implications of domestic violence estimated between
87,000 and 136,000 general practice consultations related to domestic violence per an-
num in Scotland (Young 1995). Statistical data from the United States reveal that “medi-
cal expenses arising from domestic violence assaults cost more than $44 million per year
and result in 21,000 hospitalizations with 99,800 patient days of hospitalization, 28,700
emergency department visits, and 39,900 visits to physicians each year” (Schornstein
1997:4). We may assume that costs related to domestic violence could be even higher,
considering the fact that a lot of women self-medicate or utilize friends, relatives, or
informal health services (Williamson 2000). Costs for health care certainly also in-
crease over time because of long-term chronic illness or mental health problems. More
recently, the World Health Organization has also discussed the economic implications
of interpersonal violence and has called for action (Khan 2004).
5. Grampian Health Board, which is now subsumed under the Grampian nhs Board,
is the regional health authority whose main functions are strategic overview of the nhs
 Notes to Pages 37–89

(National Health Service) in Grampian, including the allocation of Scottish Executive

funding, public health, and health promotion.
6. I am not implying that practices in more deprived areas would have more pa-
tients suffering domestic violence, although doctors working in such areas seemed on
the whole (although not all of them) to be more aware of the problem. However, this
does not necessarily support the commonly held myth that domestic violence is also a
social class issue. As some gps pointed out, there may be more of a “hidden agenda” in
the higher social classes (see chapter 5).
7. We must not forget, however, that transcriptions are merely symbolic representa-
tions of interviews, the recordings of which are primarily auditory in nature. This has
implications for the validity of transcriptions, as Bailey, Maynor, and Cukor-Avila as-
sert: “Only recordings themselves have validity as texts: transcriptions serve as a guide
to the contents of the recordings and as an aid in auditing them. Transcriptions of re-
cordings are not reproductions but interpretations of texts, and like all other interpre-
tive acts they reflect the training, biases, and linguistic experiences of the transcriber”
(1991:14).
8. To “have face,” in Goffman’s adoption of the Chinese concept, means that a per-
son’s pattern of verbal and nonverbal acts “presents an image of him that is internally
consistent, that is supported by judgments and evidence conveyed by other participants,
and that is confirmed by evidence conveyed through impersonal agencies in the situa-
tion” (1967:6–7). People attempt to portray themselves in as favorable a light as possi-
ble, and this attempt is usually mutual and therefore coconstructive.

5. Setting the Scene of Abuse

1. On the level of cognition and memory this shows that the retrieval of one narra-
tive often triggers the remembrance of other related or similar stories. As Norrick (1998,
2000) points out, this process of “telling back” a similar story occurs frequently in ev-
eryday conversations, where conversationalists take turns in relating stories. In the 1960s
Harvey Sacks called this phenomenon of telling a next story that parallels a previous
one “second storying” and explained it as an indication of shared knowledge among
speakers. Strictly speaking, this particular story is not a second but a serial story, since
it is one of a set by the same speaker.
2. A more detailed overview of modalities and further examples are provided in
chapter 7.
3. The term vector is used in Linde and Labov’s (1975) study of people’s descriptions
of the layouts of their apartments to denote directions of movements. Linde and Labov
found that there were direct links between cognitive input, discourse rules, and the
rules of sentence grammar in people’s descriptions.
4. Incidentally, medical doctors appear to be especially prone to employing war met-
aphors when describing their activities (Gwyn 1999:206). As Sontag (1991) argues, the
Notes to Pages 93–185 

military metaphor is dangerous, as it provides an argument for marginalizing and re-

pressing certain illnesses and patients.
5. It is important to note that patients likewise separate medical and private spheres,
which, in the case of domestic violence issues, may also lead to women’s reluctance to
broach the problem with medical professionals.

6. Mythologizing Time, Mythologizing Violence

1. “Ach,” sometimes transcribed as “och,” is a Scottish locution equivalent to “oh,
my.”

7. Agents of Their Own Victimization

1. Whalen, Zimmerman, and Whalen (1988) observe a similarly routinized proce-
dure in emergency service encounters. Calls to an emergency service number “exhibit,
within a range of orderly variation, a distinctive organization of sequences as follows:
(1) Opening/Identification, (2) Request, (2a) Interrogative Series, (3) Response, (4) Clos-
ing” (Whalen, Zimmerman, and Whalen 1988:342).
2. For an overview of various theories see Schornstein (1997:55–62).
3. Cornhill Hospital is the local psychiatric clinic.

8. Evaluating Abuse
1. The term hedged performative goes back to George Lakoff’s (1972) article on hedges,
in which he mentions the observation made by Robin Lakoff that certain syntacti-
cal constructions such as “I think/suppose/guess that . . .” express performatives that
avoid commitment. Fraser applied this concept to the discussion of modal verbs and
quasi modals.

9. Conclusion
1. The Zero Tolerance Charitable Trust is an independent charity that campaigns
for the prevention of male violence against women and children. The trust was estab-
lished in 1995 and works mainly in the United Kingdom and Europe.
2. A book that has already begun to compile suggestions for topics, texts, and meth-
ods in teaching literature to medical students is Hawkins and McEntyre’s Teaching Lit-
erature and Medicine (2000).
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Index

Abbott, Pamela, 31, 215n3 175, 176, 184

Abelson, Robert P., 20 Birus, Hendrik, 68
Aberdeen, x, 36–37 blaming the victim, 104–5, 111, 136, 140, 177
abstract, 40 Blyler, Nancy, 25
accommodation of speech, 6, 11, 41, 77, 107 Boden, Deirdre, 213n3
accommodation theory, 45 Bograd, Michele, 27, 35, 139, 167
action schemas, 58 Boiero, Maria Christina, 3, 10, 68
active construction, 83, 127, 131. See also Borkowski, Margaret, 27, 215n3
passive construction Bourdieu, Pierre, 3, 16, 102, 124
actors, 7, 81, 114, 119, 125, 164 Bower, Ann, 149
Adam, Barbara, 72 Bradley, Fiona, 27, 214n9
aesthetic approach, 183, 185 Bredel, Ursula, 3, 12
affective meaning, 4, 54 British Medical Association, 30, 179
age, 6, 106 Brown, Gillian, 82
agency, 123, 124, 127, 151, 167; doctors’, 7, 121, Brown, Julie R., 98–99
140–43, 176; women’s, 7, 34, 128–40, 159, 177 Brown, Penelope, 5, 46, 161
agens, 127–28, 135. See also patiens Bruner, Jerome, 4, 18–19, 39, 124, 154, 214n7
Ainsworth-Vaughn, Nancy, 17, 126, 181 Bunch, Charlotte, ix
alcohol, 29, 106–7, 108–9, 132, 134, 139, 154, 157, bureaucratic role format, 87, 117
171, 175
Annandale, Ellen, 31, 33, 78, 112 Cahill, Spencer E., 22–23, 123, 140
Antaki, Charles, 17 Cameron, Lynne, 70
anthropology, 10, 49 Campbell, Jacqueline, 27, 30, 181–82
anxiety, 88–93, 176 case stories, 4, 23, 24
artificial intelligence, 20 Cavanagh, Katherine, 27
Auer, Peter, 162 Celce-Murcia, Marianne, 151
authority, 87 Celi, Ana, 3, 10, 68
ceremonial order, 17, 88, 125–26, 178
back channels, 40, 43, 46, 48 Charon, Rita, 182–83, 184
backgrounds, 7, 37, 84, 89, 106–10, 111, 157, 160. choice, 131, 133, 137–38, 142
See also alcohol; family history account; Chomsky, Noam, 14
social class; sociodemographic factors Cicourel, Aaron, 25
Bailey, Guy, 216n7 cliché, 75, 108, 110, 154, 167, 169, 179. See also
Bamberg, Michael, 13, 18 stereotypes
Barthes, Roland, 94, 102 coconstruction of narratives, 5, 42
battered women’s movement, 28 coda, 40
Bennett, A. E., 25 code of practice, 45
biomedical model, 33–34, 78, 114, 115, 126, 143, cognition, 3, 19–20, 114
 Index

cognitive framework, 110 deviance, 22, 65, 138–39, 156, 158, 161, 164, 166,
cognitive mapping, 71, 80, 88 170, 176–77, 178. See also stigmatization
cognitive maps, 71, 110–11 diagnosis, 17, 23
cognitive processes, 4, 19–20 dialogue, 5, 44
Cohen, Sherrill, 28 diamond diagram of narratives, 5, 40, 64
Coid, Jeremy, 214n9 Dingwall, Robert, 21
communication problems, 12, 32. See also direct speech, 1, 54, 96, 108, 175. See also
miscommunication constructed dialogue
community of practice, 25–26, 174–75 disclosure, 31, 50, 52–54, 67, 86, 98–99, 180
community response, 27 discourse, 3, 6, 8; as commodity, 3, 16, 102–
comparators, 76, 148, 151 3, 124; and knowledge, 3, 8; and power, 3,
complicating action, 12, 40 14, 16–17, 94; scientific, 25. See also medical
conceptual dependency theory, 20 discourse
confidentiality, 129 discourse markers, 119, 120, 132, 161
connectors, 98, 132, 135, 149, 156, 160, 161 discursive psychology, 19
constructed dialogue, 96, 108, 156–57, 175. See discursive strategies, 2, 152, 170
also direct speech distancing, 81, 111, 132, 141, 177
construction of reality, 3, 26, 105 Dittmar, Norbert, 3, 12
consultation, 17, 22, 57, 59, 77, 99, 125, 157 divergence, 45
consultation room, 73, 81 Dobash, Emerson, 27, 28, 31
container metaphor, 82, 92, 113 Dobash, Rebecca, 27, 28, 31
doctor-patient communication, 17, 21, 25, 32,
context, 5, 11, 173. See also interview, situation
44, 95, 98
control, 92, 102
doctor-patient divide, 17, 133–34, 142–43, 177,
convergence, 45
217n5
Cook-Gumperz, Jenny, 27
doctor-patient interaction, 22, 23, 33, 58–59
corpus, 38–39. See also sample narratives
doctors’ stories, 21–27. See also narrative, and
costs, 32, 215n4
medicine; patients’ stories
Coulehan, John L., 182–83
domestic violence, 8, 30–33; and general
countertransference, 35
practice, 27, 30–34; and illness, 30, 126,
Couper-Kuhlen, Elizabeth, 162
215n4; political dimension of, 15, 28;
Couser, G. Thomas, 117
prevalence of, ix; research, 28–29, 214n9
Critical Discourse Analysis, 3, 16 Donald, Anne, 17, 133–34, 177
cross-domain mapping, 69. See also metaphor Downie, Robert Silcock, 183
Crossley, Michele, 17 Downs, Roger M., 71
Cukor-Avila, Patricia, 216n7 dramatism, 14–15
Cushing, Steven, 213n2 dramatization, 107, 154, 156–57, 159
cycle-of-abuse theories, 29–30
Eagleton, Terry, 10
Daiute, Colette, 146 Eckert, Penelope, 25, 174
data collection, 38–39. See also research Eekelaar, John M., 27, 28
methodology Ehrlich, Susan, 137–38
defensiveness, 46, 77, 112 Elwyn, Glyn, 25
DeFina, Anna, 17 emergency calls, 12
deliberative action construct, 149, 152 empathic approach, 183, 185
Dell, Pippa, 214n9 ethical approach, 183, 185
Dennerstein, Lorraine, 30, 31 ethnicity, 162
Dent-Read, Cathy C., 68 euphemism, 163, 214–15n10
Department of Health, 30–31, 179, 215n2 evaluation, 7, 131, 144–46; and storied
detachment, 170 knowledge, 146–57, 171
Index 

excuses, 104, 109, 111, 176 gerund, 129

expectations, 5, 42, 57–58, 87 Gibbs, Raymond, 73
expert knowledge, 17, 25, 112, 170, 179 Giles, Howard, 6, 45
explanations of domestic violence, 7, 29–30, Glaser, Barney, 58
103–6, 107, 109, 138, 158, 175 Goffman, Erving: and face work, 6, 46, 113,
explanatory models, 29 114, 216n8; and frame theory, 14, 41, 124,
125, 138
face-threatening acts, 46–47 Grampian nhs Board, 37, 215–16n5
face wants, 6, 113, 161 Greenhalgh, Trisha, 25
face work, 46, 114, 216n8 Grice, H. Paul, 5
Fairclough, Norman, 3, 16, 23, 94, 175 Gricean maxims, 5
family history account, 109, 157, 159, 175 group: professional, 26, 117, 170; social, 15, 25.
Farrell, Thomas B., 13 See also professionalism; roles
Fasold, Ralph, 213n1 Gruber, Jeffrey Steven, 124, 127
female-on-male violence, 164–72 Gumperz, John J., 27, 42
feminist research, 6, 8, 29, 35 Gwyn, Richard, 25, 216n4
Fennell, Barbara, 99
Ferraro, Kathleen J., 29–30, 214n9 Hague, Gillian, 214n9
Fillmore, Charles J., 124, 127 Hahn, Eugene, 158
Fisher, Sue, 25 Harne, Lynne, 214n9
Fisher, Walter, 14, 18
Harris, Wendell A., 213n2
Fludernik, Monika, 13
Haslam, S. Alexander, 9
folk knowledge, 25
Hawkins, Anne Hunsaker, 217n2
folk language, 26, 83, 170, 179
Hawpe, Linda, 12, 39
Foppa, Klaus, 44
health services, 27, 31, 99
forensic linguistics, 213n2
hedged performative, 163, 217n1
Foucault, Michel, 3, 8, 21, 33, 73, 178
hedges, 46, 76, 113, 155, 156, 161–62, 214n6
fragmentary narrative, 64, 214n6
helplessness. See powerlessness
frame, 41
Henderson, S., 31
frame, medical, 40
frame model, 5, 41–47 Herman, David, 3, 71, 178, 214n5; and
frames of expectation, 22, 79, 208 socionarratology, 3, 13–14, 131; and story
frame theory, 14, 41, 125 logic, 3, 10–11, 39
frameworks, social and natural, 125, 126, 127, Hinnenkamp, Volker, 213n2
138, 140 Holmes, Janet, 46
Frank, Arthur, 58 Homo narrans, 14–15
Fraser, Bruce, 163, 217n1 Hudson-Allez, Glyn, 98
frequency, 83–84, 215n3. See also presentation humor, 156, 166
Friedberg, Melissa, 214n9 Hunter, Kathryn Montgomery, 23, 24, 182–83
frustration, 1, 32, 126 Hurwitz, Brian, 25
Hydén, Lars-Christer, 103
gaps, 167–68
García-Moreno, C., 181 identity, 17–18, 47–48
gatekeeping, 24, 32–33, 37, 50 ideology, 104–5
Gay, William C., 30 illness narratives, 58
gaze, 73; deciphering, 73, 117; medical, 73, Imbens-Bailey, Alison, 3, 5, 12
178–79 inadequacy, 32. See also myth, of inadequacy;
Gelles, Richard J., 28, 29–30, 214n9, 215n1 powerlessness
gender, 6, 99, 129, 133, 139, 153–54, 164, 166–67 inferences, 42
 Index

institutional memory, 26, 175, 176, 214n8, 5, 150; and observer’s paradox, 43; and
215n10 reportability, 21, 118, 144–45, 148, 160, 175,
institutions: and discourse, 16–17, 24, 26; and 179; on time, 72, 131, 162
domestic violence, 28, 30 LaFrance, Marianne, 158
interaction, 3, 11, 19, 46. See also doctor- Laing, Ronald D., 6, 45, 114
patient interaction Lakoff, George, 69–70, 82, 88, 169, 217n1
interpersonal perception, 45, 114, 121, 131 Lakoff, Robin, 46, 217n1
interpretation: of data, 8, 20, 49; in medicine, Lamb, Sharon, 8, 140, 160
23, 182 Langellier, Kristin M., 18
interview: format, 5; schedule, 38; situation, language: and culture, 11; as symbolic system,
41, 145; talk, 43 16
interviewee, 44–45 Lanser, Susan S., 13
interviewer, 44–45 Larsen-Freeman, Diane, 151
interviewer-initiated narratives, 39, 146. See Laurier, Eric, 72
also spontaneous narratives Lawless, Elaine, 24, 99, 184
interview frame, 5, 41, 44–47, 132, 148 Lee, A. Russell, 6, 45, 114
interview narratives, 41–42 Leech, Geoffrey N., 124
Inui, Thomas, 32, 95 legislation, 37
involvement, 48, 119, 152, 156 levels of narrative analysis. See narrative
context level; narrative discourse level
Jackendoff, Ray, 114, 124, 127 Levinson, Stephen C., 5, 46, 161
Jahn, Manfred, 214n5 Lévi-Strauss, Claude, 94
Jefferson, Gail, 44, 46 life experiences, 133, 167. See also doctor-
Johnson, Holly, 29, 108, 171, 214n9 patient divide
Johnson, Mark, 69–70, 78–79, 82, 169 life history research, 7, 58
Johnson, Michael, 29–30 Lind, E. Allan, 214n6
Johnson, Norman, 28, 29 Linde, Charlotte, 26, 175, 214n8
Johnstone, Barbara, 17 listener, 5, 44, 103, 183. See also storyteller
Jonsen, Albert R., 127 literary studies and medicine, 182–83, 184,
journey metaphor, 88–89, 178 217n2
justifications, 104, 111, 176 Lloyd, Siobhan, 27
locatives, 82
Kanyó, Zoltán, 13 logico-scientific mode. See also paradigmatic
Katz, Sanford N., 27, 28 mode
Keller, L. Eileen, 27, 35, 177 Loseke, Donileen R., 22, 123, 140
Khan, Abdullah, 215n4 Lyman, Stanford M., 103
Kirmayer, Laurence J., 10, 69, 70–71
knowledge: cultural, 3; of domestic violence, macrolevel structures, 4, 8, 39, 93. See also
2, 4, 8, 52, 66, 75, 153; medical, 2, 33; and microlevel structures
narrative, 18–19, 110, 171–72, 179–80; Marková, Ivana, 44
schemata, 171; in stories, 10, 20–21, 214n7. Mason, Jennifer, 37
See also discourse, and knowledge; storied Mattingly, Cheryl, 49
knowledge Maynard, Douglas W., 11, 22
Korotana, Onkar, 214n9 Maynor, Natalie, 216n7
Kurz, Demie, 139 Mazza, Danielle, 30, 31
McCabe, Allyssa, 3, 5, 12
labeling, 21–23, 65, 114, 139, 176 McEntyre, Marilyn Chandler, 217n2
Labov, William, 13, 39–41, 144, 152, 153, 213n2, McGarty, Craig, 9, 158
213n4, 216n3; and diamond diagram, McKie, Linda, 37, 99
Index 

McLellan, M. Faith, 185 narrative discourse level, 41, 43

meaning, 3, 4 narrative frame, 5, 41, 42–44, 154
media and domestic violence, 37, 140, 152, 179 narrative framework. See narrative paradigm
medical discourse, 17, 21, 62, 107, 116–17, 170, narrative knowledge. See storied knowledge
182 narrative mode, 18–19, 214n7. See also
medical ethics, 127 paradigmatic mode; storied knowledge
medical humanities, 183 narrativeness, 13
medicine: history of, 33. See also narrative, narrative paradigm, 3, 4, 7, 14–15, 173–74. See
and medicine also scientific paradigm
memory, 4, 20–21, 135, 153, 216n1. See also narratology, 13, 213–14n5
institutional memory narrator, 5, 103
metaphor, 7, 68–73, 88–93, 176; cognitive narratory principle, 16
account of, 69–70; and culture, 70; and National Family Violence Survey, 29–30
medicine, 216–17n4; and narrative, 70–71; National Health Service, x, 215–16n5
and spatiotemporal language, 71–73 negators, 76, 115, 143
Meyers, Marian, 140, 180 Nelson, Katherine, 146
Mezey, Gill, 214n9 noncompliance, 134
microlevel structures, 4, 6, 8, 39, 93, 114. See nondetection, 6, 31, 87, 95
also macrolevel structures nonresponse, 37
Mildorf, Jarmila, 99 Norrick, Neal, xv, 5, 38, 144, 216n1
minimal narrative, 40. See also narrative Nünning, Ansgar, 214n5
minimization, 138 Nünning, Vera, 214n5
miscommunication, 111, 213n2. See also
communication problems O’Barr, William M., 214n6
Mishler, Elliot G., 25 observer’s paradox, 43
modalities, 80, 113, 123–24, 132, 137, 142–43, O’Connor, Blair, 33
149, 155, 162 ordering function of narrative, 4, 16, 110
Mooney, Jayne, 214n9 orientation, 12, 40
moral implications, 32–33, 50 Ortony, Andrew, 68
motion verbs, 82
Müller, Frank, 162 Pahl, Jan, 27
Murch, Mervyn, 27, 215n3 paradigmatic mode, 18, 214n7. See also
myth, 94, 177; and domestic violence, 6, 8, 35– narrative mode
36, 106, 132, 154, 160, 167, 170, 175, 179, 216n6; Partnership Strategy, 37
of inadequacy, 116, 117–21, 176; of time, passive construction, 83, 114, 127, 128–29, 151.
99–103 See also active construction
mythologizing, 7, 102–3 path schema, 78–81, 88, 113, 169, 178
patiens, 127–28, 129, 135. See also agens
narratee, 5, 42 patient role. See sick role
narrative, 16, 18; as cognitive device, 12; as patients’ stories, 6, 17, 59, 62, 155, 183. See also
discursive device, 4, 12; and medicine, doctors’ stories; narrative, and medicine
6, 21–27, 98, 99, 181, 182, 183; practices, 7; pauses, 162, 163
production, 5, 15, 66; research, 13, 49, 173– Perception, 2, 5, 84, 158, 171, 214n7
74; syntax, 145–46. See also knowledge, in performativity, 18, 173
stories; minimal narrative; trajectories in Perkins, Jane, 25
narrative perpetrator: images of, 109, 129, 151, 152, 180
narrative analysis, 2, 13, 19, 39–41, 54, 185 Peterson, Eric E., 18
narrative clause typology, 40 phatic features. See back channels; discourse
narrative context level, 41, 43, 132 markers; involvement
 Index

Phillipson, Herbert, 6, 45, 114 rewriting. See rewording

Pinker, Steven, 14 Richardson, Jo, 27, 214n9
Pizzey, Erin, 28 Riessman, Catherine Kohler, 49
point of view, 7, 109–10 Rigney, Ann, 18
politeness, 5, 46, 214n6 ritual, 17
Polkinghorne, Donald, 4, 18–19, 121 Robinson, John A., 12, 39
Potter, Jonathan, 19 Rogers, L. Edna, 98–99
power and domestic violence, 8, 108 roles: social and professional, 41, 44, 45, 114,
powerlessness, 32, 116, 117–21, 133–34, 176. See 126–27, 140, 176. See also professionalism
also inadequacy; myth, of inadequacy Rosewater, Lynne Bravo, 177
practice environment, 38 Rubin, Herbert, 44–45
presentation, 50; covert, 50, 51–52, 56; overt, Rubin, Irene, 44–45
50, 51–52; standard, 54–58, 159. See also rules for interaction, 5, 15
frequency Ryan, Vicky, 30, 31
Prickett, Stephen, 70
Prince, Gerald, 214n5 Sacks, Harvey, 44, 46, 216n1
privacy, 32, 87 Sack’s Assignment Theorem, 144
professionalism, 26, 69, 112, 114, 117, 126– sample narratives, 5, 6, 39, 57, 153. See also
27, 170. See also expert knowledge; group, corpus
professional Sanders, Robert E., 19–20
Propp, Vladimir, 13
Sapir, Edward, 11, 70
psychiatry and domestic violence, 27
Sapir-Whorf hypothesis, 11, 213n1
psychology: discursive, 19; narrative, 18, 20;
Sarbin, Theodore R., 4, 16, 17
social, 9
Schank, Roger C., 4, 18, 20–21, 39, 67, 153, 154
psychosocial problems, 24, 127, 184
Schegloff, Emmanuel A., 5, 44, 46
Ptacek, James, 103–4, 111, 176
Schiffrin, Deborah, 5, 17, 41, 119, 132, 135
purposive sampling, 37
Schornstein, Sherri L., 35, 75, 133, 161, 215n4,
217n2
qualitative research methods, 49,
Schütze, Fritz, 58–59
174
Quirk, Randolph, 123, 162 scientific paradigm, 14, 24, 33, 78, 117. See also
narrative paradigm
Rachman, Stephen, 182–83 Scott, Marvin B., 103
Radford, Andrew, 127 Scottish Executive, x, 37, 216n5
Radford, Jill, 214n9 Scottish Needs Assessment Programme, 30
reading the patient as text, 23, 182 scripts, 20, 157, 171
record: medical, 95, 117, 126, 180, 182 second storying, 216n1
repairs, 46, 65, 131. See also self-correction self-correction, 46, 155. See also repairs
repeat visits, 101 self-criticism, 47, 121
reportability, 40, 66, 118, 144–45, 171, 175, 179. self-monitoring, 43, 47, 131, 161
See also evaluation self-presentation, 98
reportable events, 21, 150, 144–45, 151, 160, 169 sensitivity to domestic violence, 6, 78, 172
research methodology, 36–38 sequential organization of speech, 11, 40, 42
resolution, 40 service provision, 27, 35
resource manual, 30–31 setting, 7, 72, 113. See also backgrounds;
respondents, 37–38 consultation room
responsibility, 34, 50, 81, 86, 112, 113–14, 143, severity, 78, 160
175. See also agency; roles Shuy, Roger W., 25, 213n2
rewording, 23–24, 61–62, 182 sick role, 34, 126–27, 139, 143
Index 

signs of abuse, 49–54, 66–67, 75, 78, 117, 157, story logic, 10–11
171–72. See also symptoms storyteller, 5, 42–44. See also listener
silence, 6, 31, 161–63 storytelling, 14, 17, 103, 144–145. See also
Silverman, David, 25 narrative
situation. See context; interview, situation; storytelling situation, 97–98, 157
storytelling situation Straus, Murray A., 28, 29–30
Smith, Philip, 6, 45 Strauss, Anselm, 58
social class, 132, 133, 170, 216n6. See also Streit Olness, Gloria, 15
sociodemographic factors Strong, Philip, 17, 87–89, 125, 178
social control, 34 structure: social, 11, 12, 213n3
social problems, 3, 10–14, 112–13, 174 Sugg, Nancy Kathleen, 32, 95
social sciences, 11 suspense, 149, 152, 162
sociodemographic factors, 30, 46, 66. See also symptoms, 49–54, 56, 78, 117. See also signs
backgrounds; social class of abuse
sociolinguistic narrative analysis, 3, 26, 39, syntactic parallelism, 48, 74, 135, 152, 168
184 Szokolszky, Agnes, 68
sociolinguistics, 11, 13, 25
sociology of health and illness, 25 taboos, 6, 161, 163, 178
socionarratology, 3, 13–14, 120, 131 talk-in-interaction, 5, 6, 19, 47–48
Solan, Lawrence M., 213n2 Tannen, Deborah, 25, 41, 48, 108, 156, 175
Sontag, Susan, 216–17n4 Tayside Women and Violence Group, 27,
spacetime region, 71–72, 73, 178 215n11
spatiotemporal language, 7, 71–73, 79–80, teaching module, 182–83, 184–85
82, 85–86, 176, 178. See also metaphor, and te Molder, Hedwig, 19
spatiotemporal language; path schema temporal juncture, 40
Spears, Russell, 9, 158 tense, 66, 131, 134, 148, 162, 170
speech styles, 45, 132, 214n6 thematic roles, 127–28, 129
Spence, Donald P., 94, 177 theta theory, 124, 127
spontaneous narratives, 39, 146, 157. See also Tiersma, Peter, 213n2
interviewer-initiated narratives time, 32, 37, 77, 95–103; in narrative, 72, 131,
Squier, Harriet A., 182–83, 184, 185 162. See also myth, of time; tense
Stanko, Elizabeth A., 27 Titscher, Stefan, 16
Stark, Evan, 139 Todd, Alexandra Dundas, 25
status, 6, 84, 112 Tolliver, Joyce, 13
Stea, David, 71 Toolan, Michael, 13
Steinmetz, Suzanne K., 28, 29–30 training, 8, 111, 181
stereotype formation, 9, 158 trajectories in narrative, 6, 7, 57, 58–67
stereotypes, 9, 12, 111, 157–59, 170, 175. See also transactions, 19, 110, 126
cliché transcription of data, 38, 216n7
Stern, Josef, 68, 69 Trinch, Shonna, 23–24, 26, 61–62, 129, 163, 175,
stigmatization, 6, 34, 84, 106, 138, 176. See also 214–15n10
deviance Turner, Terence, 68–69
storied knowledge, 2, 4, 18–19, 21, 26, 32, 39, turn taking, 44, 46, 144–45
93, 121, 152, 154, 157, 171, 178–79. See also type and token analysis, 50–51
knowledge
stories, 38–39; unfinished, 2, 6, 61–62, 75. Ulatowska, Hanna K., 15
See also doctors’ stories; patients’ stories;
women’s life stories van Dijk, Teun, 3
storing and indexing, 4, 20–21, 135, 153, 171 variables, 46
 Index

vectors: spatial, 82, 86, 178, 216n3 Williamson, Emma, 30, 31, 32, 34, 35, 36, 111,
victimization, 22–23, 30, 130, 137, 140, 143, 138, 139, 140, 164, 172, 178, 184, 215n3, 215n4
159, 176 Willson, Pam, 29
victims, 8; images of, 22, 74, 137, 140, 148, 160, Wilson, Claudia, 214n9
178, 180 Wilson, Thomas P., 11
violence against women, 28, 30 witness, 143
Wodak, Ruth, 99
Wales, Katie, 161 Wolfson, Nessa, 43
Waletzky, Joshua, 13, 39–41, 144, 152, 153, 213n4 Women’s Aid groups, 28
Walker, Val, 27, 215n3
women’s life stories, 61, 143, 180
Wallat, Cynthia, 25
World Bank, ix
Warshaw, Carole, 27, 95
World Health Organization, 215n4
Wellberry, D. E., 68
wellness-illness divide. See doctor-patient
divide Young, D., 215n4
West, Candace, 25 Young, Katherine, 44, 57, 73, 117, 126, 178
Whalen, Jack, 12, 217n1 Yzerbyt, Vincent Y., 9, 158
Whalen, Marylin R., 12, 217n1
Whorf, Benjamin Lee, 11, 70 Zero Tolerance campaign, 179, 217n1
Widdicombe, Sue, 17 Zimmerman, Don H., 12, 213n3, 217n1
In the Frontiers of Narrative series:

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