Discussion 2Arthur W. Frank(Department of Sociology, University of Calgary)

I had not heard these papers before today, so please understand, what I
am saying is extremely fragmentary. I am just picking up on particular things thatwere said. But what I’d like to suggest to you, first of all, is the difference between
the style of work that Dr. Imao was doing where the effort of the research is to try
to take two general explanatory models, and by looking at various data determine
the greater adequacy of one those explanatory models. In this case, the truth so tospeak is held to lie in the data themselves, which necessarily are understood as
coming from within the respondent and not being a feature of the respondent’s
relationship with the interviewer.
Contrast that to the really lovely statements in Ms. Kawaguchi’spresentation in which she says, “I just hope that as I carry on a dialogue, thepatient’s narrative comes to change even by a little.” This is to do a completely
different kind of work; there is no question here of an explanatory framework
which is to be proven more or less adequate. The point is a dialog between twovery particular people; Ms. Kawaguchi and whoever she is speaking to. So, I
want to underscore these two very different ways of doing research and of theobjectives of research that we heard today.
The second question that I’d like to raise is that when research does aim
at the kind of general explanatory model that we heard during Imao’s presentation;
the linear model versus the circular model or cyclical model, the question we needto ask what work that model is supposed to be doing for whom. Why do we wantor who wants one of these models and for whom is it important that one model beproven superior to the other model?
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I’ll then like to call our attention in Dr. Tagagi’s presentation to this very
difficult word “acceptance”. For me, the word acceptance has its origins in thevery influential work of Elisabeth Kubler-Ross in her famous model of the dying
process that came out in the late 60s and really came to prominence in the 1970sand 80s. Elisabeth Kubler-Ross’s stages are very close but not quite the same as thestages in Dr. Nehero’s presentation, I think.
The question that’s been raised clinically is exactly what acceptancemeans, and again who wants acceptance. The biggest problem with acceptance I
think goes back to the notion of emotion work that I was talking about. To put it
more simply, the care of the dying person or the critically ill person becomes mucheasier to the extent that that person does the emotion work of accepting theircondition. So again, with respect to acceptance, we need to ask this question of
who is doing what emotion work for whom. And as I was thinking about theactual circumstances of Dr. Kagagi’s interviews, these clearly are filled withvarious kinds of emotion work both within the interview and outside the interview,
carried over into the interview frame.
I was asking myself what are the forces in these people’s lives that havecreated these really surprisingly positive stories that you were relating to us andcould we imagine over a period of time what are the different interpretations of
that; that if you were to ask different questions over a longer course of interviewing,
and if you were to ask people about different aspects of their lives, could you in fact
generate a different story?
All of this brings us to very difficult words that were just raised in thediscussion of active and passive. And I really regret using the word passive quite
early in my own presentation, which made the comment fair enough.

Thedifficulty is that activity and passivity I think are not polar opposites in any tradition.
It’s not a binary opposition between being active or being passive.
In the Christian tradition, one is passive to the extent that one’s life isdedicated to doing the will of God, but one has to be active in that resignation to the－113－

will of God and in discovering what the will of God may be. And so, activity andpassivity fold into each other.
In the Buddhist tradition, it takes an enormous amount of work andmanuals of meditation are very clear about how ferocious one must be in that workin order to attain actively the emptiness of one’s self. One does not passively
become an empty self; it requires activity in order to become the emptiness that is
not passivity before activity, it is passivity after activity. And so, the difficulty I
think is seeing activity and passivity not as binary oppositions but as a perpetualin-folding, out-folding of one leading to the other where the new level is something
different because of the way in which it was arrived at. That’s complicated. It’sback to you.
Just as a last line which I think gives some closure to this and closure isanother very difficult word. This lovely phrase that Ms. Kawaguchi used, about
people narrating in order to reclaim their denied bodies, that’s what I’ve been trying
to talk about: that illness leads to a certain denial of one’s body and the point of
narrating is an attempt to reclaim this. I very much appreciate you underscoringthat phrase for us. Thank you.

Photo. (From left) Ms. Mitachi. Dr. Frank, Ms. Imao, Dr. Tagaki, Ms. Kawaguchi and Dr. Kojima－114－