Research: Silence

My dissertation focused on silences in narrative approaches to healthcare. The goal of the dissertation was to complicate our understanding of stories and silences in healthcare: to encourage more critical attention to different types of silences and silencings, how they arise, and why this matters for health and healthcare.

The launching point of my dissertation looks something like this:

  1. Patients’ stories can be important for health and healthcare (let’s call this position a “narrative approach” to healthcare).
  2. But being able to tell stories and to have them heard requires certain privileges and affordances.
  3. And not everyone has equal access to these privileges, especially those experiencing forms of oppression and injustices.
  4. So, not everyone has equal access to the benefits of a narrative approach that centres on stories.
  5. Importantly, these disparities in benefits can track existing injustices.
  6. Therefore, narrative approaches need to be supplemented by more critical attention to silences and silencings, not only to stories.

That’s my main argument in a nutshell. The bulk of the dissertation is trying to make that argument convincing, and then to expand on some things a more “critical” attention to silence would need to consider.

Here are a few (very simplified) examples of arguments I make about silence:

First, I argue that silence should not just be understood as an absence of voice, speaking, or storytelling. Equating silence with just one style of communication can ignore the many different ways we communicate. In particular, it risks miscategorizing many disabled people as necessarily silent, silenced, or (by common metaphor) disempowered, just because they do not communicate in commonly expected ways. In fact, some philosophers use disability as a metaphor for silencing, such as with “illocutionary disablement” in speech act theory. I think we should use “silence” in ways that better reflect the diversity of communication, that attend more closely to disability, and in ways that don’t equivocate between speech as liberation and silence as disempowerment.

Second, while silence is often considered an absence of communication, it can also be a presence and a form of communication. I review examples of how silence can be a way of communicating when words will not do or when our words will be misunderstood, how it can be a site of creation and transgression, and can even be an important site of resistance. This last point is especially important: if patients’ silences can be a form of resistance or self-protection, then we should be careful with centring stories over silences. For example, patients who are sex workers, newly pregnant, suicidal, or transgender will sometimes refuse to share parts of their lives that might be medically important, because disclosing that information can lead them to experience lower quality of healthcare, medical neglect or abuse, loss of insurance coverage, forced institutionalization, criminal persecution, among other harms. We will need to address these possible harms before we can try to address the silences.

Third, as a final example, I argue we should pay attention to how architecture can be involved in silencing. A lot of work on responding to silencing focuses on how we listen to each other: how my biases, habits, privileges, etc, impact what I say and how I listen to other people. But where we communicate can also make a difference in what communication is possible, how we share and how we listen. I might be able to talk orally with someone around the corner, but I usually can’t communicate with them using sign language. I can attend a therapy session or present at an academic conference, but not if the building is physically inaccessible. (And these inaccessible spaces are often the results of historically silencing and excluding disabled people!). Becoming a better listener will not turn concrete into glass, nor a staircase into a ramp, and so will not by itself address these types of silencing. Attending to silence and silencing will require that we attend to the physical material parts of our world too.

Exploring these and other arguments, I show that there are many different sources of silencing, that they cannot all be addressed by the same methods or approaches, and that we ultimately should be careful not to prioritize stories at the neglect of silence.

Want to think more about silence, absence, and listening?

My dissertation engages with a lot of different sources, and there are many others that I could not fit in. I’m happy to share sources with those interested, and I will link to my dissertation here when it has been published by the University. But if I had to pick just five resources that might help people think about silences and absences differently—and which you could access free through most public libraries, or buy for under $30 without being an academic—these might be:

(all links open in a new tab)

Content notes: It is difficult to cover content notes for all the above, especially since I do not know you or your needs and the books especially cover a lot of ground. I recommend reading book reviews and author interviews for a gist of the books’ contents. The shorter article “As Ice is to Water” can be harder to prepare for (since it does not have book reviews, interviews, or even an introduction or abstract), so I will note that it directly mentions: attempted murder, sexual assault, suicide, medical abuse (especially psychiatric abuse), and experiences with anxiety and PTSD.

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This page is subject to regular updates. Please contact me before citing.