10.13135/1971-8551/7056
Introduzione: questo articolo riassume brevemente alcuni concetti contenuti nella Logica del senso, di Gilles Deleuze e propone un metodo di analisi strutturale di un testo narrativo di malattia.
Metodi: i concetti principali sono la distinzione delle Cose dagli Eventi, l'importanza della superficie che li separa, i concetti di problema e di istanza paradossale. Viene proposto un processo di analisi testuale in otto fasi.
Risultati: un esempio sviluppato chiarisce le fasi del metodo e fornisce alcuni suggerimenti per l'uso didattico di questo tipo di analisi testuale.
Discussione: l’ approccio proposto è utile quando l'attenzione è rivolta all'analisi del discorso sociale e delle strutture sociali che possono essere fonte di oppressione per alcuni gruppi sociali. Tuttavia può essere usato anche per aumentare la consapevolezza sul modo in cui il senso viene prodotto nella produzione verbale.
application/pdf
1971-8551
7056
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en
Fabrizio Consorti
Tutor
illness narrative; textual analysis; structuralism
Gilles Deleuze and the search for “sense” in the stories of illness: a methodological proposal
Text.Serial.Journal
https://ojs.unito.it/index.php/tutor
22
Original articles
2023-01-10
2022-10-06
2022-08-23
2023-01-10
1
Fabrizio Consorti
2023/01/10
10.13135/1971-8551/7056
Dipartimento di Scienze Chirurgiche, Università Sapienza di Roma
1971-8551
1
illness narrative; textual analysis; structuralism
Gilles Deleuze and the search for “sense” in the stories of illness: a methodological proposal
https://ojs.unito.it/index.php/tutor/article/download/7056/6160
22
                                                                                        VOL. 22, N. 1, 2023: 24 - 32
                                                                                     DOI: 10.13135/1971-8551/7056




      Gilles Deleuze and the search
      for “sense” in the stories of
      illness: a methodological
      proposal
      Fabrizio Consorti
      1   Dipartimento di Scienze Chirurgiche, Università Sapienza di Roma - fabrizio.consorti@uniroma1.it



ABSTRACT
Introduction: this article briefly summarises some of the concepts in the Logic of Sense, by Gilles
Deleuze and proposes a method of structural analysis of a text of illness narrative.
Methods: the main concepts are the distinction of Things from the Events, the importance of the
surface separating them, the concepts of problem and of paradoxical instance. A eight step process
of textual analysis is proposed.
Results: Worked example clarifies the steps of the method and some suggestions for the
educational use of this kind of textual analysis is provided.
Discussion: this is a useful approach when the focus is on analysing the social discourse and social
structures that can be a source of oppression for some social groups, but also to increase the
awareness about the way in which sense is produced in verbal production.

Keywords: Key words: illness narrative; textual analysis; structuralism


ABSTRACTI

Introduzione: questo articolo riassume brevemente alcuni concetti contenuti nella Logica del senso,
di Gilles Deleuze e propone un metodo di analisi strutturale di un testo narrativo di malattia.
Metodi: i concetti principali sono la distinzione delle Cose dagli Eventi, l'importanza della superficie
che li separa, i concetti di problema e di istanza paradossale. Viene proposto un processo di analisi
testuale in otto fasi.
Risultati: un esempio sviluppato chiarisce le fasi del metodo e fornisce alcuni suggerimenti per l'uso
didattico di questo tipo di analisi testuale.
Discussione: l’approccio proposto è utile quando l'attenzione è rivolta all'analisi del discorso sociale
e delle strutture sociali che possono essere fonte di oppressione per alcuni gruppi sociali. Tuttavia,
può essere usato anche per aumentare la consapevolezza sul modo in cui il senso viene prodotto
nella produzione verbale
Parole chiave: Illness narrative; analisi testuale, strutturalismo




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Volume 22, Numero 1



TAKE-HOME MESSAGE
 (1) the analysis of stories of illness is a powerful educational method
 (2) different approaches are needed to attain different learning outcomes
 (3) the proposed approach can be used both in teaching and in qualitative research




1. INTRODUCTION                                 (Lupton, 1992; Peckover, 2018).
The stories of illness written by patients      Among the philosophers referred to in
and caregivers are a rich source of clinical    medical      education   literature,   Gilles
knowledge and a means of understanding          Deleuze has a small but rather peculiar
the experience of illness and the essence       space. Some of his ideas have been used
of care. Illness stories - starting with Rita   – for example - to interpret the construct
Charon's seminal text (Charon, 2006) -          of frailty (Cluley, 2021), the living condi-
have been at the origin of the narrative        tion of women with leprosy (Gonçalves,
medicine movement, which in Italy has           2021), trust in volunteers in commercial
achieved many results, not last the official    drug trials (Mwale, 2020), and the concept
guidelines by the Istituto Superiore di San-    of desire (O'Byrne, 2011).
ità (the Higher Health Institute) (ISS, 2014)   The “Logic of Sense” (LoS) is one of the
We can analyse a story according to its         French philosopher's most significant
content, its structure, the development of      works (Deleuze, 2014), a philosophical
dialogues and the relationships between         essay written in an original format of
characters. A story can also be interpreted     chapters called “series” and an occasional-
according to different theoretical models,      ly funny tone, although with a very dense
depending on the researcher's choices and       and sometimes obscure language. Deleuze
aims: the contents can be thematized and        considered a legacy of the ancient stoic
classified (Maguire, 2017) and the rela-        Greek philosophers, namely the concepts
tionships between the classes used to           of “event” and “surface” and argued how
build a theory, as is the case in grounded      sense and non-sense is produced in writ-
theory (Chun, 2019). If the interest is pre-    ten propositions. Deleuze did not describe
dominantly in lived experience, the theo-       a formal method, he wrote a philosophical
retical perspective is phenomenology            reflection on the sense as a mode of
(Giorgi, 1997), evolved into hermeneutics       thought. This article proposes how to ex-
if the researcher aims to consider not only     tract from the LoS indications for the in-
the living experience in itself but in its      terpretation of a narrative text. The pro-
dialogue with the historical and cultural       posal is not a structured method, rather a
context (Paterson, 2005). Finally, we can       set of guidelines and comes with a
seek the fundamental structures of a story      worked example of interpretation of a
in accordance with a semiotic approach          story of illness.
(Corso, 2014) or socio-political or philo-
sophical theories, as in discourse analysis


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                                    Gilles Deleuze and the search for “sense” in the stories of illness


2. METHOD                                         have a depth.
2.1 Theoretical foundation                        The surface is also the relation between
In this paragraph I synthesize some of the        the different propositions in a text.
basic concepts discussed in the LoS.              Deleuze recalls Bertrand Russel’s classifi-
These concepts will be the theoretical            cation, stating that a proposition can ex-
foundation of the method of interpreta-           press the attributes of things or a state of
tion.                                             affairs (denotation: Fabrizio is a doctor), a
1 - Things, events and the surface                belief or the internal state of the speaker
In the second chapter-series, Deleuze sets        (manifestation: Fabrizio said he was hap-
a first distinction between Things and            py), the relation of a situation with a gen-
Events. Things are objects, animals, and          eral principle (signification: Fabrizio is a
persons, they are expressed by nouns and          doctor, hence he got a degree in medi-
have attributes (adjectives); even if we can      cine). Finally, Deleuze adds a fourth di-
talk of them in the past or in the future,        mension for a proposition, the sense,
they only exist in the present and are the        which is expressed in any type of proposi-
cause of both other things and of the             tion, incorporeal to the surface of things,
events. Events are effects, incorporeal, log-     an irreducible complex entity, a pure event
ical attributes of things. They are ex-           that insists and subsists in the proposi-
pressed by verbal forms and since they are        tion. Hence, we have a duality between the
pure becoming, they only exist in the past        two faces of the surface, the two dimen-
or in the future, because as soon one tries       sions of a proposition: the structure of a
to grab them, they are not yet or already         proposition and its sense
passed. Events are “quasi-causes” of other
events. A clinical example to make these          3. Series, paradoxes and “exoteric words”
concepts clearer is the condition of a per-       Since the sense subsists in a proposition
son who got a virus, which caused the             that deals with something else, the same
person to become ill. The patient and the         proposition cannot explicitly talk of the
virus are things, the virus is the cause of       sense it states, but the writer can use an-
an event (becoming ill). The illness is the       other proposition to implicitly or explicitly
quasi-cause of        other effects-events        mean the sense of the previous one. A se-
(coughing, raising of temperature, swelling       ries of propositions is the double chain of
of nodes,...). Deleuze introduced finally the     propositions in which the sense of the
idea of surface, as the ideal contact be-         first one (the signified proposition) is ex-
tween things and events.                          pressed by one of the following proposi-
2 - Propositions and sense                        tions (the signifying proposition) For ex-
The surface is an important concept in the        ample: “Fabrizio is a doctor, hence he got
third series, in which the different types of     a degree”: the sense of the first proposi-
proposition are described. The term sur-          tion could be to state that Fabrizio has
face is often used in LoS to express both         been studying for a long time, as the sec-
the idea that events are incorporeal, only        ond proposition is signifying. The signify-
thin surfaces and to mark their difference        ing is mainly an event (has been studying),
with things, which are corporeal, thick and       as a logical attribute of a signified thing


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(Fabrizio).                                   question denotes a problem which is “the
Deleuze stated that in a series of proposi-   labelling” of a person through the name
tions you can always find a paradoxical el-   of the illness, a paradoxical stance, with a
ement floating between the two aspects        loss of sense in the propositions that deal
of the series. This element has a paradoxi-   with the clinical data (usually signified
cal nature because it is defective of sense   propositions), an excess of sense in the
in the signified propositions and has an      propositions which deal with the life of
excess of sense if the signifying ones. The   patient (more often signifying proposi-
paradoxical elements can be implicit and      tions): the “name” of the illness is much
extracted by the reader at the surface be-    more than a name! So, the name is just a
tween the two aspects of a series, as in      label - indispensable to drive a medical
(Consorti, 2022), in which “identity” had     treatment - and - at the same time - an
both an individual AND a social nature.       existential condition.
The paradoxical element sometimes is de-
noted by an “exoteric” word, which can be     2.2 Guideline for the interpretation of a
a neologism of a metaphor. The exoteric       text
word is not the paradoxical element, but      As stated in the Introduction, the LoS
can be a clue for it. For example, in the     does not propose a method for the inter-
worked example below, a metaphor like         pretation of a text, such as an illness nar-
“my heart was in pieces” points to the loss   rative. Nevertheless, from the theoretical
of control on one's body.                     premises described above, it is possible to
                                              derive a set of suggestions to interpret a
                                              text, looking for the sense (or the senses)
4. The problem                                that subsists in the propositions of the
In the ninth chapter, Deleuze developed       text. The procedure is composed by 8
the relation between the events, the sense    steps:
and the problem, the latter intended as a
dimension, a problematic space. A prob-       1. reading carefully the text at least twice,
lem always receives the appropriate reso-        to familiarise yourself with
lution in accordance with the criteria used   2. looking for the “speaker” and the prop-
to identify it as a problem, hence the           ositions expressing the speaker’s “mani-
events are both the way to identify a prob-      festation”. In a text, the speaker is not
lem and to define the field of possible so-      necessarily the author of the text, and
lutions. The problem is determined by the        there can be more than one character
propositions that correspond to the series,      speaking. In the worked example, the
but the question which denotes the prob-         only speaker is the mother of Simone,
lem is denoted through the erratic ele-          who is also the writer. Nevertheless,
ment that corresponds to the paradoxical         there are other agents of events/verbs
element.                                         (Simone, the doctors)
For example: in many stories of patients      3. listing the events/verbs, grouped by
with a rare disease, the question often is       their agents. It’s a flat list, ordered ac-
“What is the name of my illness?”. This          cording to the appearance of every


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                                     Gilles Deleuze and the search for “sense” in the stories of illness


   verbal form in the text, and grouped for           events, surfaces and metaphors it is
   the “thing” (usually a person) that is the         possible to figure out the question (or
   “cause” of the event                               the questions) that specify the prob-
4. identifying the series of propositions             lem/s. In the worked example, the ques-
   and the “surface” between them. In the             tion that emerged is “Can we take con-
   example, an instance of proposition                trol over our life and our body?” The
   that forms part of the signified and               events of the story define both the
   signifying series is “I spent night and            problem (the control) and the domain
   day with him in my arms, I tried to calm           of possible solutions.
   him in every way, but I couldn't, he was        7. looking for the paradoxical instance/s.
   always crying.” As defined above, the              This erratic element not necessarily is
   surface is the relation between the                named in the story, but is alluded to
   propositions, where the sense is made              through paradoxes, exoteric words,
   manifest. Here we have “I spent…” and              metaphors, and the relation between
   “tried to calm…”, “I couldn’t” and “al-            the series of propositions. In Deleuze’s
   ways crying”. On the two sides of this             words, the sense is ineffable, subsisting
   surface there is a mother's relentless ef-         in the propositions but cannot be ex-
   fort and her helpless failure.                     plicitly said.
5. looking for exoteric words, metaphors,          8. reconsidering the whole analysis for
   syllabic assonances and other figures              coherence between the identified para-
   of                                  speech.        doxical instance/s and the system of
   In the proposed example there are                  events and series of propositions.
   many metaphors and at least one asso-
   nance: “it almost felt like a dream” but
   also “all of that was a nightmare”, “or-        3. RESULTS: A WORKED EXAMPLE
   deal ... my life was over ... heart in piec-    In this paragraph I show a worked exam-
   es” and “Simone stopped breathing…              ple of the proposed method. I analysed a
   he put on the respirator” (in Italian the       story of illness taken from Bena et al.
   assonance is “Simone ha smesso di               (2017) (annex 1). The speaker is the
   respirare, ha messo il respiratore”)            mother of the patient, Table 1 lists her
6. defining the problem and the question.          manifestations, Table 2 the verbs of ac-
   After the first five steps, running             tion.
   through the lists of manifestations,

 The best day of my life was when I found out I was expecting … I felt over the moon … it al-
 most seemed like a dream
 I started to feel some small pains
 I felt inside that Simone had something else. I was sick, I felt his discomfort
 I was immediately scared
 It all seemed like a nightmare, but it was reality
 my world had fallen apart
 I could hear a little voice whispering to me: Simone is strong, and you will not lose him



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 My heart was broken
 I did it just for him, because I felt I had to, I am his mum
 I always pretended I didn’t hear that Simone is a vegetable
 My heart is shattered
 When I think about this, I feel bad ... I can only have hope ... I hope I will have the strength… I
 have not had the pleasure of savouring all the happiness ... what I did wrong to deserve this,
 what is the point of it all?
Table 1 - list of the “manifestations” of Simone’s mother. The metaphors are highlighted in bold


 1. verbs of motion and mother's action
 I found I was expecting; I was always talking to the baby, stroking my belly when he kicked,
 and singing songs to him to calm him down; I went to the hospital; we went home; we start-
 ed going round hospitals; I spent night and day; I tried to calm him down; we went to the
 hospital; we rushed back to Chivasso; to face my whole ordeal; I cried night and day; we took
 him home; we started our adventure again; we learned to be nurses and doctors; I shed riv-
 ers of tears but then I said enough! Now I am in charge; I took care of him without hesita-
 tion; I left my job, my life; I live off that; I went on my way; to love and care my unfortunate
 puppy; we equipped ourselves; we took Simone to Puglia; we have resumed our lives; I live
 day by day ... without thinking of the future

 2. doctors' action verbs
 they told us; they diagnosed; they admitted us again; they gave him an MRI; they put Simone
 in an incubator; they put him on a mechanical respirator; they discharged him.

 3. Simone's action verbs
 kicked; Simone, my angel, was born; cried; eat; couldn’t open mouth; got worse; slept; stiff-
 ened; was dying; stopped breathing; reacted; felt; grabs hands; makes him understand; wants
 to be turned; gives me half a smile
Table 2 - list of the verbs of action. Two keystone propositions and one metaphor are in bold


In the proposed text there are some met-               the mother, up to the second keystone
aphors (in bold in Table 1 and 2) and an               statement “we have resumed our lives”.
assonance of words, evident only in the                The same dynamics is shown by the meta-
Italian text (Simone ha smesso di respirare            phors, starting with positive images like
autonomamente e ha messo il respiratore                “moon”, “dream” and “angel” and ending
meccanico).                                            in “nightmare”, the breaking of world and
The mother’s verbs of action-events in the             heart and a child like a vegetable. The as-
first half of the story are mainly all about           sonance with two verbs-events (quit
forced travels forth and back to and from              breathing – put the respirator) marks also
the hospitals and unsuccessful attempts to             a moment in which Simone lost the con-
control the baby. At the centre of the sto-            trol over his breathing and the control was
ry there is a keystone: “I shed rivers of              taken by a machine.
tears but then I said enough!”. From that              For these reasons I identified the problem
moment on, the events are controlled by                and its question as “How can we control


                                                                                                    73
                                    Gilles Deleuze and the search for “sense” in the stories of illness


our life and our body?”                           manifestations of emotions, feeling,
Hence, the paradoxical instance flowing           thoughts. If the educational focus is wid-
through the series of propositions is “the        ened to the relation of the story with the
control” of our life and our body. Control        cultural and organisational evolution of
on life is either in excess or missing, the       palliative care, then hermeneutics would
body is either angelic (vast potentiality) or     be appropriate, and the students may be
unanimated (totally subjected to outer            asked to interpret the story also in com-
control), ripped or under control, day by         parison with some scientific literature or a
day.                                              reference theory. The proposed approach
                                                  can be referred to the general theoretical
                                                  domain of structuralism, which may be a
4. DISCUSSION - CONSEQUENCES FOR                  useful approach when the focus is on ana-
MEDICAL EDUCATION                                 lysing the social discourse and social
In medical education, at all levels from un-      structures that can be a source of oppres-
dergraduate to continuous professional            sion for some social groups (Bordieux,
education, an illness narrative can be used       1997; Parton, 2019). Nevertheless, the
as a motivational trigger at the beginning        LoS offers a general point of view on how
of a learning activity, to foster self-           sense is generated and expressed in sto-
reflection, or to explore with the learners       ries and can be used to broaden the way
the relationship of the events with the so-       in which illness narratives are explored.
cio-cultural and economic context (Das-           The awareness that sense is automatically
Gupta, 2004; Kumagai, 2008; Law, 2011).           produced in everything we say or write, in
From an educational perspective, different        unpredictable ways, despite what we ra-
learning outcomes may require different           tionally think we are meaning, is a very
educational uses and interpretation of the        relevant learning outcome for our students
same story and not necessarily the as-            and for all teachers as well. Finally, this
signment for the students – either alone          approach can be a valuable help in quali-
or in a small group – must be free reac-          tative research.
tions and interpretation. The teacher may
propose a more structured way of analys-          5. REFERENCES
ing a story, and the one proposed in the          Bena, C., Iacono Pezzillo, E., Garrino, L.
example is not the only possible interpre-          (2017). Storie che curano. Fossano
tation of Simone’s story. According to a            (CN): Ed. Medico-scientifiche
content analysis, the story could be used         Bourdieu, P. (1997). Capital, cultural,
to discuss the opposition or integration of         escuela y espacio social [Cultural Capi-
hospital and home care, especially in rare          tal, school and social space]. Madrid:
diseases and palliative care. If the teacher        Siglo
is more interested in highlighting the lived      Charon, R. (2006). Narrative medicine:
experience and the emotions of the char-            Honoring the stories of illness. Oxford:
acters of the story, then phenomenology             University Press.
would be appropriate, hence the teacher           Chun Tie, Y., Birks, M., Francis, K. (2019).
will require a special attention to the             Grounded theory research: A design


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  meneutics as a qualitative research ap-         lance: A critical issue for health visitors
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  Rep. 10(2):339–357.                             mothers and children. Journal of clinical
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