Becoming patient : testimonial conditions and the (un)making of injury

Abstract

This dissertation examines three cases of what I refer to as testimonial conditions, health conditions marked by the requirement of the patient to establish the validity of their illness through narrative, rather than through modes of visualization and localization that clinical medical practice relies upon. By analyzing the ways military burn pit exposure, chronic pain, and sexual assault are approached within the U.S. healthcare system, I demonstrate how a logic of injury shapes how these conditions—and testimonial conditions more broadly—are cared for and conceptualized. The research presented in this dissertation is based on two years of formal ethnographic fieldwork and more extended experience of “observant participation” in clinical settings and patient groups in the northeast United States. Through interviews and accompanying patients as they navigate complex healthcare systems, I aim to illustrate how patients work to obtain and maintain care amidst intense bureaucracy and entrenched cultural and biomedical norms that define what counts as illness and injury. I demonstrate how patients learn to narrate their experience in ways that align with biomedical understandings of injury, yet, I argue, the genre of narrative is out of sync with the ways that these conditions manifest and are experienced. Instead, thinking through a lens of wounding, rather than injury, better accounts for the ways that testimonial conditions are approached and experienced.