“Chaos narratives, however, defy our narrative expectations. There is no order, sense, or logical chronology but, instead, suffering without an apparent purpose or meaning.”
In early 2019, I read “Illness and Narrative,” a keynote speech that medical sociologist and bioethicist Arthur W. Frank had delivered in his book The Wounded Storyteller: Body, Illness, and Ethics. Frank describes three types of narrative formats in which we can classify stories of illness: restitution, quest, and chaos narratives.
The restitution narrative is a simple and cognitively satisfying structure for a story. A healthy person becomes ill, receives treatment, then is healed and returns (or is restored) to the state of health enjoyed before the illness. In the quest narrative format, there is a call to action, the person undergoes suffering from his disease and/or treatment, and then, after a turning point, the person returns to health and is rewarded for his suffering. Often, this reward takes the form of a deep insight or learned truths that the formerly ill person gains to share with the world; these insights provide a reason for the pain. Even if the person is not restored fully to the state of health he enjoyed before, he has grown or transformed in some other way or accomplished his “quest,” which provides a source of meaning.
We like restitution and quest narratives because it is compelling and morally fulfilling when we are able to solve problems with ingenuity and diligence or when righteous heroes triumph and villains meet an end worthy of their amorality. This is especially true with medical problems, which obviously have high stakes and are emotionally intense.
Chaos narratives, however, defy our narrative expectations. There is no order, sense, or logical chronology but, instead, suffering without an apparent purpose or meaning. Resolutions and endings prove elusive, and the individual can do little to influence the plot—or, rather, the senseless sequence of events that stands in for a plot. Chaos narratives ignore our moral sensibilities at best and offend them at worst.
“Chaos narratives sound terrible,” I thought to myself in 2019. “I hope that I never experience one.”
Then came 2020.
The stories of individual Coronavirus (COVID-19) patients can unfold according to any narrative structure, but I argue that the story of the pandemic is squarely a chaos narrative at the social level, which helps to explain our collective frustration and our lack of a uniformly productive response.
We had high hopes for our ability to respond to and overcome the pandemic, hopes which were informed by our strong moral preference for restitution and quest narratives. We hoped that lockdowns, then masking, then vaccines, and finally medications would end the pandemic. We also hoped that the hard work and sacrifices of the physicians and scientists who both treated COVID-19 patients and researched treatments would eventually liberate us from the pandemic. This would provide the ultimate source of meaning for their efforts and pain, as well as for the pandemic’s early victims.
It goes without saying that all of the treatments, sacrifices, and work have saved and improved countless lives, but the pandemic has continually defied restitution and quest narratives in that it continues without an end in sight despite our efforts. Quarantines helped, but even countries that implemented strict lockdowns and maintained very low COVID-19 case rates for a long time have experienced sudden, virulent outbreaks. Masking helps, but it is not perfect. We have very effective vaccines, and they have allowed many people to regain some sense of normalcy. They brought nothing short of a sea change in our pandemic response, but vaccinated people can still become ill; we do not know how long vaccine-derived immunity will last; and anti-vaccine sentiment hinders our quest to achieve higher vaccination rates. There are effective drugs on the market, but they, too, are not magic bullets. Even our COVID-19 tests are imperfect. We still have no cure. People are still sick. People are still dying. Some have what we call “long COVID.” As much as we wish the pandemic were over, it is decidedly not. We are especially frustrated with the pandemic because of the gap between the simple narrative types we hoped for and the chaos narrative that we are experiencing.
If the pandemic were a television show, no one would watch it for very long. Where is the resolution of the conflict? Where are the heroes? Who are the villains? Where is the justice? Where is the meaning in all of this tragedy? Contributing to the chaos of this horror movie we are living through, we have a sense of helplessness at the individual level: We can take a vaccine and wear a mask, but most of us cannot influence society at large. Some of us have even struggled to convince family members and friends to wear masks or to take vaccines.
We have the dubious honor of watching an infant virus evolve and grow, facing new waves and variants and fluctuating case rates on a random yet depressingly regular schedule of occurrences. We cannot predict the future; we are suspended in a state of uncertainty. We do not know what variant to expect next, whether it will be worse, when it will be better. It is utter chaos, and that makes for both bad television and very complicated real-world living. Sadly, though, we cannot just change the channel or choose a new show on a streaming website. We are collectively stuck here in narrative limbo. The pandemic upends all of our preferred medical storylines, and we are left at loose ends, unsure of how to respond.
Isabelle Breier is a recent graduate of the University of Pennsylvania, where she double majored in medical anthropology and global health and health and societies.
