A study of coherence as an ableist norm within discussions of broken narratives

Abstract

This paper reports on the ways that coherence emerged as an ableist norm within a systematic review of literature around broken narratives. It was undertaken as part of a larger programme of research investigating the experiences of those with impaired speech. The review identified 34 sources, within which we explored the ways that coherence was discussed. Throughout the review we argue that these texts draw on, and in many cases re-enact, coherence as an ableist norm. Discussions of broken narratives were often built upon the concept of coherence, a concept which has been naturalised and rendered essential to the formation of meaning and personhood. This norm is then employed to fuel a constitutional divide between broken and unbroken narratives. However, some of the texts provide the impetus to question the usefulness of normative ideals of coherence, and to re-evaluate how we can ensure the voice of impaired speakers is heard.

Points of interest:

• This study examined 34 articles and book chapters about broken narratives. These texts came from many different disciplines and talked about many different types of illness and disability.

• Many of these texts talked about the importance of coherence in peoples’ lives.

• Coherence was discussed not merely as an element of communicative success, but rather as a prerequisite to a healthy and functioning self.

• However, the stories of disabled people often do not follow cultural expectations of what a narrative should be. As a result disabled narratives are thought of as broken.

• When we try to enforce coherence on narratives or voices which do not fit our expectations we can end up silencing disabled people.

• These texts demonstrate the need to rethink the ways we understand coherence, allowing space to discover new ways of listening to disabled narratives.

Keywords:

• broken narratives
• coherence
• impaired speech
• ableism

Introduction

As human beings, the way we speak, and the way our speech is attended to, is intrinsically linked with notions of coherence and what it means to be a unified and functioning whole person (Beasley 2021; Campbell 2012; Kokanović and Stone 2018). Our very understandings of speech are products of the ableism which pervades our culture and shapes what it means to be a wholly human person. Fiona Kumari Campbell describes ableism as ‘a network of beliefs, processes and practices that produces a particular kind of self and body (the corporeal standard) that is projected as the perfect, species-typical, and therefore, essential and fully human’ (Campbell 2009, 5). Within this compulsory able-bodiedness is a demand for coherent and intelligible speech, a norm which disabled speakers are expected to emulate or else risk being marginalised. To be a good speaker requires that we speak in certain ways, ways which demonstrate adherence to ableist norms of competence, mastery, and coherence (Beasley 2021). Good speech similarly demonstrates a coherence of narrative, of biography, and of self.

The ability to speak in a coherent manner and to construct coherent narratives is considered to be crucial to the development and maintenance of the self (Smith and Sparkes 2008; Wasson 2018), with illness and disability often being thought to disrupt this link (Hyden and Brockmeier 2008; Kokanović and Stone 2018). Recognising that disability is a wide category which encompasses many different experiences of coherence, the narratives of many disabled people, and particularly those with impaired speech, struggle to conform to norms of coherence, often leaving their narratives unheard, or at best devalued or dismissed. Please note that the word ‘impaired’ here is chosen to highlight ableism’s role in ‘impairing’ speech, as opposed to a biological impairment.

In this paper we interrogate the functioning of coherence as an ableist norm through a systematic review of its emergence in a particular body of literature which pertains to incoherent speech; the literature around ‘broken narratives’. Discussion around broken narratives has emerged sporadically over the last two decades, and is valuable for its unique engagement with, and the valuable insights it may bring to, our understanding of disabled voices and narratives. The foundational idea within discussions of broken narratives is that illness and disability can disrupt peoples’ ability to convey their narrative and indeed to construct and convey who they are in the world (their identity). Hyden and Brockmeier (2008) introduced broken narrative as a fluid concept ‘emphasizing problematic, precarious, and damaged narratives told by people who in one way or another have trouble telling their stories, be it due to injury, disability, dementia, pain, grief, psychological or neurological trauma’ (2008, p. 10).

The literature around broken narratives is a useful tool through which to explore not only the experience of incoherent speech, but exists also as a demonstration of the ways that incoherent speech is itself constructed through ableist norms which demand coherence and position the speaker deemed incoherent as less of a whole human person. We have chosen to read the literature through the lens of Campbell’s discussion of the mechanisms of ableism. This enables consideration not only of how narratives (and peoples’ opportunities to resist ableism) are broken by incoherence, but of how incoherence itself is constructed through reference to the norm of coherence.

As such this paper will employ Campbell’s discussion of the ways ableist norms function to enforce a compulsory able body (Campbell 2009), discussing: first, the way that the norm of coherence is naturalised as a prerequisite for narrative and selfhood; second, the mechanisms which construct a constitutional divide between coherent and incoherent narratives, rendering incoherence as brokenness; third, the potential responses to, and resistance to, the norm of coherence, at least within academic discussions; before ending with some reflections and theorising on what might exist outside of ableist norms of coherence.

Method

The databases Scopus, Medline, Eric, ProQuest and Jstor were searched for literature on broken narratives. Search strategies involved combinations of the keywords broken narratives, rupture, disruption, silence, and coherence, as well an additional layer of the search targeting the keywords disability, health or illness. Where appropriate, search terms were truncated in order to retrieve as many variations of the keyword as possible, i.e. disruption was operationalised as ‘disrupt*’ to retrieve not only disruption, but disrupts and disrupted. Ultimately, three separate search queries proved useful. These are provided in the Figure 1 below.

Figure 1. The search terms used to retrieve literature.

Throughout the process, sources were reviewed and their reference lists surveyed to identify commonly referenced authors and papers. This lateral approach proved useful in relation to this topic, with literature being situated around two key data sources: Hyden and Brockmeier’s seminal book Health, Illness & Culture: Broken Narratives (Hyden and Brockmeier 2008), and a 2016 conference entitled ‘Broken narratives and the lived body’ (Kokanović and Stone 2018). These key texts enabled us to explore not only the range of essays included in these projects, but also additional texts which reference these main texts.

Titles and abstracts of potentially relevant articles were further reviewed to ensure their relevance. At this point, strict exclusion criteria were enforced. To have been included in this review, sources must have been published in English, and must have concerned broken or disrupted narratives or voices. Additionally, sources must have related to disability or illness.

Inclusion in this review was not limited by date of publication, nor was it limited to empirical research. Broken narratives is a relatively exploratory area within the literature, one which tends to be theoretical, and works to investigate the stories of those who are not often heard. Therefore, we tried to be inclusive in the data collection processes, including not only peer-reviewed journals, but also surveying wider literature sources including book chapters. However, sources were only included where full-text was available through the databases which were searched.

As articles and chapters were read, a data extraction table was used to note key assumptions of the texts. This table provided space to comment on the bibliographic data of the text, the type of text (for example, editorial, case study, autoethnography), as well as information about the participants where relevant, and the methods used. In addition, it also provided space for notes about how various themes were talked about throughout the text. These themes included subjectivity, narrative, brokenness, voice, and disability. These headings provided structure when thinking about how coherence has been discussed through the literature (Table 1).

Table 1. Summary of 34 articles and chapters reviewed.

Reference (Author, Year, Title, Source)	Author Profile (Area of Expertise, Country)	Participant Profile/Data Source (inc specific Medical Conditions)	Methods and Ethics clearances	Coherence (Type, No. times mentioned, Normative ideal challenged)	Results/Conclusions
Antelius, E. (2009). ‘Would you like to use one of these or would you rather be able to talk?’–Facilitated and/or augmentative communication and the preference for speaking. Scandinavian Journal of Disability Research	Health and Society, Medicine and Health Sciences.Sweden	20 participants at a Swedish day care centre, of mostly Swedish origin, aged between 28 and 64.Condition of interest: acquired brain injury	This article draws on a social interactionist framework to explore concepts of identity and personhood in relation to people with severe communicative disabilities. The researcher positioned herself as a participant observer.No ethics approval mentioned, but there was a short discussion of the ethical issues around informed consent in this population.	Discusses the ability to be coherent – unintelligible speechNo. times ‘coherence’ mentioned: 0Norm challenged: no	The authors found three main strategies in interactions between able-speakers and impaired speakers: (1) perfunctory, (2) jigsaw puzzle, and (3) conjectural. Interestingly, the article found a strong preference for spoken communication rather than augmented on the part of impaired speakers.
Altman, C., Avraham, I., Meirovich, S. S., & Lifshitz, H. (2022). How do students with intellectual disabilities tell stories? An investigation of narrative macrostructure and microstructure. Journal of Applied Research in Intellectual Disabilities	EducationIsrael	The sample included 33 participants studying at Bar-Ilan University, age range: 22–55 years, 17 intellectually disabled participants and 16 typically developing participants	This study analyses the structure of narratives from intellectually disabled students in comparison to typically developing studentsEthics approval was obtained.	Discusses the ability to be coherent – cognitive processes.No. times ‘coherence’ mentioned: 21Norm challenged: no	Adults with intellectual disability exhibit weaknesses in terms of coherence, syntactic complexity, and grammatical sentences. However, they exhibit strengths in narrative macrostructure and story scheme
Barker, S. (2017). “Subject to pain: Ricoeur, Foucault, and emplotting discourses in an illness narrative.” Subjectivity	Sociology.Australia	No participants.Condition of interest: chronic pain	Barker conducts a close reading of a short autobiographical pain narrative, ‘Marcus: Injured lifting a child.’ He approaches this reading by drawing on Foucault’s subjectification and Ricoeur’s narrative subject.No ethics approval mentioned	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 5Norm challenged: yes (somewhat)	Pain is subject to various competing discourses which exist similtaneously, shaping what it means to experience it.Incomensurable discourses can result in discordances and ambiguities within the illness narrative.
Bitenc, R. A. (2018). “No Narrative, No Self”? Reconsidering dementia counter-narratives in Tell Mrs Mill Her Husband Is Still Dead. Subjectivity	Germany	No participants.Condition of interest: Dementia	An analysis of ‘Tell Mrs Mill Her Husband Is Still Dead’, a collection of nearly fifty stories by people with dementia	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 31Norm challenged: yes	Bitenc argues that although the narratives of Dementia patients are ‘broken,’ they continue to be used by the patient to construct and reinforce identity.
Brockmeier, J., & Medved, M. (2008). Talking About the Unthinkable: Neurotrauma and the “Catastrophic Reaction.” In L.-C. Hydén & J. Brockmeier (Eds.), Health, Illness and Culture: Broken Narratives	Psychology.France	The article uses excerpts from an interview with Mrs E. Mrs E had been admitted to hospital 9 months earlier following an aneurysm.Condition of interest: brain injury	The authors explore how narrative may be used to gain insight into Goldstein’s catastrophic reaction. They utilise a case study from previous research No ethics approval mentioned	Discusses the ability to be coherent – cognitive processes.No. times ‘coherence’ mentioned: 22Norm challenged: no	Narratives serve coherence, distancing, evaluative, communicative, and explorative functions.
Bülow, P. (2008). You Have to Ask a Little”: Troublesome Storytelling About Contested Illness. In L. C. Hyden & J. Brockmeier (Eds.), Health, Illness and Culture: Broken Narratives	Social work.Sweden	Draws on a series of interviews with one participant, Tony.Condition of interest: contested illness	A case study which explores the difficulties in telling stories about contested illnesses such as chronic fatigue syndrome.No ethics approval mentioned	cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 10Norm challenged: no	In the case of contested illness, ‘illness has to be “storied” to “exist.”’ p 131. Illness narratives are therefore limited by available discourse and the ways of telling stories which are culturally legitimate. If a story violates these limitations, they are taken as broken. In this way, the author highlights the co-constructed nature of coherence.
Danely, J. (2017). Carer narratives of fatigue and endurance in Japan and England. Subjectivity,	Anthropology. United Kingdom	Author conducted interviews with 35 current or recently bereaved carers (22 in Japan, 13 in England).Condition of interest: carer narratives	Employed a narrative phenomenological approach . Data came from open-ended interviews, participation in support groups and volunteering at respite centres and community activitiesNo ethics approval mentioned	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 1Norm challenged: yes (somewhat)	The author views narratives as the process through which experience becomes meaningful. However, he argues that personal narratives are often fragmented and lacking a coherent structure, bringing them into contest with cultural narratives.
Flavin, M., & James, B. (2018). ‘To give an outsider an idea of what it could be like’: A case study of the creative representation of hearing voices. Arts and Humanities in Higher Education	Education and music. United Kingdom	No participants.Condition of interest: Schizophrenia	A description of a creative project which aims to recreate the hearing voices symptom in schizophrenia	Unclear as to type of coherence discussed.No. times ‘coherence’ mentioned: 3Norm challenged: no	This was an interesting report on a creative project in which the student layered multiple audio recordings to imagine the experience of hearing voices.
Freeman, M. (2008). Beyond Narrative: Dementia’s Tragic Promise. In J. Brockmeier & L. C. Hyden (Eds.), Health, Illness and Culture: Broken Narratives	Psychology.USA	No participants.Condition of interest: dementia	Freeman’s essay draws on his experiences with his mother to explore the ways that narrative both shapes and frustrates her experience of life.No ethics approval mentioned	Both types of coherence discussed.No. times ‘coherence’ mentioned: 3Norm challenged: yes	Freeman constructs dementia as a liminal space an suggests that as much as narratives form the self, they can also act as limitations to being present and happy in the present. He toys with the idea of unselfing, where the individual abandons their autobiographical narrative in order to attend to the other and be present with it.
Green, G., Todd, J., & Pevalin, D. (2007). Biographical disruption associated with multiple sclerosis: Using propensity scoring to assess the impact. Social Science & Medicine	Health and human sciences. United Kingdom	The MS sample came from 916 randomly selected members of the UK MS Society (n = 783) and those accessing the MS Society website (n = 133).Condition of interest: Multiple sclerosis	Quantitative survey with a focus on measurable variables: household composition, marital status, employment status and household income.Ethics approval mentioned	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 0Norm challenged: no	‘The results of the matched analysis show that both men and women with MS are significantly less likely to be employed than those in the general population and are significantly more likely to have a ‘below average’ household income, despite the fact that they are in a higher social class and have higher educational levels than people in the general population. Differences between the MS and GHS samples in terms of marital status become non-significant when socio-demographic variables are controlled for using propensity scoring’ p524
Greenhalgh (2017). Adjuvant chemotherapy: An autoethnography. Subjectivity	Medical doctor and Professor of Primary Care Health Sciences. United Kingdom	Greenhalgh was the primary participant, although she did enlist several academic friends as ‘interlocutors’.Condition of interest: cancer and cancer treatment.	This article employs autoethnography to explore the author’s experience of chemotherapy and the impacts on her subjectivity.No ethics approval mentioned.	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 0Norm challenged: no	Greenhalgh flags the contested position of early stage breast cancers themselves, highlighting the fluidity and constructed nature of ‘illness’.
Gurung, K. (2018). Bodywork: Self-harm, trauma, and embodied expressions of pain. Arts and Humanities in Higher Education	Sociology.Australia	No participants.Condition of interest: self harm	Essay	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 1Norm challenged: yes (somewhat)	Gurung highlights the existence of socially acceptable (accepted) and unacceptable ways to act in and respond to one’s situation. If a person acts in one of the ‘unacceptable’ ways, they will be labelled abnormal regardless of their perception of themselves. She argues that self-harm can be more usefully understood as an embodied practice which retells complex, fragmented stories
Hjelmblink, F., & Holmstrom, I. (2006). To cope with uncertainty: Stroke patients’ use of temporal models in narratives. Scandinavian Journal of Caring Sciences	Department of Public Health and Caring Sciences, Health Services Research.Sweden	Nineteen recently discharged stroke patients, aged between 56 and 89.Good description purposeful sample.Condition of interest: stroke	This study aimed to explore stroke patients’ use of time models in their narratives. It involved interviews which were audio-taped, transcribed, and analysed thematically to extract references to time Ethics approval mentioned	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 10Norm challenged: no	The experience of stroke disrupts participants’ narratives by making them hyper aware of the temporality of life and uncertainty of the future. Participants used three main models of time to reconstruct their past and future: time cycles and dissolution of time limits; exchange of time; and exclusion from time.
Holloway, I., & Freshwater, D. (2007). Vulnerable story telling: Narrative research in nursing. Journal of Research in Nursing	Health and Social Care. United Kingdom	No participants.Condition of interest: Nursing	Essay	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 1Norm challenged: no	The authors argue that vulnerable stories, while useful and important, are vulnerable to exploitation. We therefore need to be mindful of how we elicit and utilise them. The authors that through narrative interviewing we can elicit stories in a more holistic, less interrupted way.
Hyden, L. C., & Brockmeier, J. (2008). Introduction: From the retold to the performed story. In Health Illness and Culture: Broken Narratives	Psychology.Sweden, France	No participants.No particular condition of interest.	Introductory chapter	Both types of coherence discussed.No. times ‘coherence’ mentioned: 3Norm challenged: no	The authors suggest that we should approach narratives as performative action which is often undecided, fragmented and broken.
Hyden, L. C. (2008). Broken and vicarious voices in narratives. In J. Brockmeier & L. C. Hyden (Eds.), Health, Illness and Culture: Broken Narratives	Psychology.Sweden	No participants.Condition of interest: Acquired brain injury and dementia	Essay	Discusses the ability to be coherent.No. times ‘coherence’ mentioned: 3Norm challenged: no	Hyden differentiates between two different types of voice, either of which can be broken: the authorial voice; and the sounding voice. He is particularly interested in vicarious voices, how they come about, and how they interact with the broken voices they attempt to reconstruct.
Hyden, L. C. (2013). Storytelling in dementia: Embodiment as a Resource. Dementia	Psychology.Sweden	The essay draws on examples from two previous studies.Condition of interest: dementia	Essay	Discusses the ability to be coherent – cognitive processes.No. times ‘coherence’ mentioned: 2Norm challenged: yes	Viewing narratives as primary texts may risk limiting understanding of storytelling in people with dementia. Instead, narratives should be understood as collaborative and embodied. Storytellers are conceptualised as problem-solvers who utilise multiple modes of communication to tell a story.
Hyden, L. C., & Antelius, E. (2011). Communicative disability and stories: Towards an embodied conception of narratives. Health	Psychology.Sweden	No participants.Condition of interest: dementia	Essay	Discusses the ability to be coherent – cognitive processes.No. times ‘coherence’ mentioned: 5Norm challenged: yes	The authors argue that often narratives are treated like written stories rather than performances. They propose an ethnographic approach towards the study of speech, one which places speech and communication in its wider context as an interactional resource. They argue that we should take notice of not one what people say, but what they cannot say.
Hyvärinen, M., Hydén, L.-C., Saarenheimo, M., & Tamboukou, M. (2010). Beyond narrative coherence: An introduction. In M. Hyvärinen, L.-C. Hydén, M. Saarenheimo, & M. Tamboukou (Eds.), Beyond Narrative coherence	Psychology Sweden	No participants.No particular condition of interest.	Editorial	Both types of coherence discussed.No. times ‘coherence’ mentioned: 101 times.Norm challenged: Yes	Normative ideals of coherence marginalise certain stories and story-tellers, as well as blinding researchers to different ways of reading human experience.
Kenny, K., Broom, A., Kirby, E., Wyld, D., & Lwin, Z. (2017). Terminal anticipation: Entanglements of affect and temporality in living with advanced cancer. Subjectivity	Sociology, Medical oncology.Australia	46 men and 34 women, aged 31–85, with a good degree of spread across major cancer types and rarer forms of the disease, disease progression and prognostic outlook.This paper uses the data from 5 participants.	In depth interviews with 80 participants living with cancer, and later together with carers, drawing on the interpretive traditions in qualitative social research.Ethics approval mentioned	coherence discussed.No. times ‘coherence’ mentioned: 0Norm challenged: yes	The authors argue that we must challenge the normative assumption of coherence, as well as paying attention to the way the the future features in the present.
Kokanović, R., & Flore, J. (2017). Subjectivity and illness narratives. Subjectivity	Sociology of Health and Illness, Health, Society and Medicine Research.Australia	No participants.No particular condition of interest.	Editorial	Both types of coherence discussed.No. times ‘coherence’ mentioned: 18 times.Norm challenged: Yes	The authors call for researchers to be reflexive in the way we present the narratives of others, recognising the co-construction of narrative and subjectivity.
Kokanović, R., & Stone, M. (2018). Listening to what cannot be said: Broken narratives and the lived body. Arts and Humanities in Higher Education	Global, Urban & Social Studies, psychiatry.Australia	No participants.No particular condition of interest.	Editorial	Both types of coherence discussed.No. times ‘coherence’ mentioned: 5Norm challenged: yes	The self is constructed through narratives, and, as such, can itself be ‘disordered’ (p 21) when narratives are disordered by illness.The authors wish to challenge the coherent unified self as constructed through narratives
Larsen, H., Friis, P., & Heape, C. (2018). Improvising in the vulnerable encounter: Using improvised participatory theatre in change for healthcare practice. Arts and Humanities in Higher Education	Participatory innovation, theatre, education.Denmark	No participants.Condition of interest: Chronic pain	The authors describe the development of improvised participatory theatre.	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 1Norm challenged: no	This theatre method can be used to engage healthcare practitioners, patients and lay people in order to reappraise practice and reimagine the nature of illness.
Mattingly, C. F. (2008). Stories That are Ready to Break. In L. C. Hyden & J. Brockmeier (Eds.), Health Illness and Culture: Broken Narratives	Anthropology and Occupational Science.USA	Two children and their occupational therapists.Condition of interest: serious illness and disability in children	Mattingly presents an essay based on two case studies from her ethnographic research, exploring the fragility of illness narratives.No ethics approval mentioned	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 2Norm challenged: no	The authors found that clinical settings suppress dramatic stories in which the patient emerges as a complex central character, while simultaneously finding efforts to cultivate these narratives as healing narratives.
Mäkelä, P. (2017). “They brought you back to the fact you’re not the same”: Sense of self after traumatic brain injury. Subjectivity	Rehab physician. United Kingdom	One 19 year old man who has experienced Traumatic Brain Injury, interviewed with his mother	Narrative case study, Narrative inquiry, guided by a grounded theory approach to the data and drawing on a social constructivist paradigm.Ethics approval mentioned	Both types of coherence discussed.No. times ‘coherence’ mentioned: 0Norm challenged: yes	The author points out that the participant’s sense of self may not always align with the assumption of the ‘broken self,’ and highlights the possibility of reading injury as part of the self, rather than a disruption to it.Broadly, Makela is exploring how the self is alternately reconstructed by both the brain injured person and those around him, demonstrating the need to explore issues of interaction-driven disruption to self.
Mundle, R. G. (2011). O Word That I Lack! Silence, Speech, and Communicative Bodies in the Rehabilitation (and Redemption) of Stroke Patients with Expressive Aphasia. Journal of Religion, Disability & Health	Spiritual Care Practitioner.Canada	No participants.Condition of interest: Stroke and aphasia, speech impairment	Essay	Discusses the ability to be coherent – cognitive processes.No. times ‘coherence’ mentioned: 0Norm challenged: no	Identifies three types of illness narratives restitution chaos quest
Nolte, L. (2018). Weathering a violent storm together – Witnessing and co-constructing meaning in collaborative engagement with those experiencing psychosis-related challenges. Arts and Humanities in Higher Education	Clinical Psychology. United Kingdom	Excerpts included from interviews with 7 participants.Condition of interest: psychosis	This article draws on interviews from a larger study conducted, by the author, into parenting and psychosis. No further information was given within the paper about the study or its methodology.No ethics approval mentioned	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 2Norm challenged: no	Narratives of distress are socially constructed, and, within the clinical encounter (Nolte of course speaks from a very clinical, interventionist perspective), meanings are negotiated, co-constructed, and re-authored.
Parker, J. (2018). Stories, narratives, scenarios in Medicine. Arts and Humanities in Higher Education	English studies. United Kingdom	No participants.No particular condition of interest.	Introduction to special issue	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 1Norm challenged: no	Parker draws on the presupposition of a storied life to suggest that the fragmented narratives of illness can illuminate the layers which make up a unified narrative identity. She frames narratives as constructions, constructed both by the patient and by the healthcare professional, drawing on the conceptions of illness culturally available
Pohjola, H. (2020). Acquired disability in young women: A challenge for identity?, Journal of Youth Studies	Social sciences.Finland	three autobiographical accounts of women who became disabled in adolescence.Condition of interest: acquired disability	A close analysis of autobiographical accounts of women who had become disabled in adolescence.No ethics approval mentioned. However, permission to use texts was obtained by writers as part of separate social project.	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 10Norm challenged: yes	Pohjola suggests that chaos narratives (as opposed to restitution or quest narratives) may hinder identity development, as the identity being formed is hidden, silenced or neglected.
Ryan (2018). Honouring a life and narrative work: John’s story. Arts and Humanities in Higher Education	Sociology, research director in the Health Experiences Research Group. United Kingdom	1 participant, John, a 63 year old man with Asberger’s syndrome.Condition of interest: autism	Case study employing a biographical interpretive narrative method.No ethics approval mentioned	cultural coherence listener expectation discussed.No. times ‘coherence’ mentioned: 0Norm challenged: no	John’s narrative within the interview was an attempt to understand, form and reform his experience. However, participant narratives can be disrupted by researchers in an attempt to elicit expected narratives. In this way, coherence, or the search for normative coherence as something which can obscure meanings in narratives.
Shapiro, A. B. (2011). A story to create: Stroke survivors’ broken narratives. Topics in Stroke Rehabilitation	Visual artist.USA	No participants.Condition of interest: stroke	This essay reflected on Shapiro’s experience of Stroke.	Both types of coherence discussed.No. times ‘coherence’ mentioned: 3Norm challenged: no	This article is about the ways that life stories (internal narratives) are broken by the experience of stroke. Shapiro argues that these narratives are reconstructed or replaces post-stroke, and argues that the information given by medical professionals has a great deal of influence on these emerging narratives.
Sile, A. (2018). Mental illness within family context: Visual dialogues in Joshua Lutz’s photographic essay Hesitating beauty. Arts and Humanities in Higher Education	Art studies. United Kingdom	No participants.Condition of interest: Schizophrenia	an analysis of Joshua Lutz’s Photogrographic essay Hesitating Beauty (2012)	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 2Norm challenged: no	In this essay, Schizophrenia breaks down the possibility for communication. Interestingly, Sile disconnects coherence from communicative success by describing speech as more or less coherent, yet unreliable.
Wasson, S. (2018). Before narrative: Episodic reading and representations of chronic pain. Medical Humanities	English and creative writing. United Kingdom	No participants.Condition of interest: Chronic pain	Essay	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 34Norm challenged: yes	Normative work is achieved through conventions of narrative telos. In incoherent or chaos narratives this narrative arc is often missing, and stories become vulnerable. ‘Broken’ narratives may require episodic reading, rather than a reading in search of coherence.
Williams, S. J. (1999). Is anybody there? Critical realism, chronic illness and the disability debate. Sociology of Health & Illness	Sociology. United Kingdom	No participants.No particular condition of interest.	An exploration of the trajectory of biographical disruption as a concept.	Cultural/biographical coherence discussed.No. times ‘coherence’ mentioned: 1Norm challenged: no	This article is an observation that stressful events, disruptions, can cause disability.

It is important to note that while such tables have often been used to evaluate the strength of evidence within empirical studies (Khan et al. 2003), we employed the table primarily as a way to extract and document the relevant themes which emerged through the data. As we read through the literature, we became interested in the ways in which incoherent speech was discussed and the assumptions which were underlying these discussions. This came to influence the structure of the data highlighted within analysis.

The construction of this data extraction table became an iterative process, with new columns being added and refined as important themes emerged within the literature. The idea of coherence as an ableist norm became the subject of numerous columns which were added retrospectively as it emerged as a point of tension within the data.

This tension also became the focal point for discussion and analysis of the literature. The idea of coherence regularly emerged as the foundation on which descriptions of brokenness rested. At the same time, it was one that was being challenged within the literature in ways which were reminiscent of critiques of ableism. Consequently, we began to reimagine the literature around broken narratives as an extended discussion around the construction of the norm of coherence, the ways it is reinforced, and the ways it might be resisted. This tied back into Campbell’s description of the function of ableism, providing a framework for analysis.

Results

After evaluation for relevance against the established inclusion criteria and removal of duplicates retrieved from across different databases, the literature search identified 34 relevant texts.

Most documents clustered around two main sources. Fourteen articles were clustered in two special journal issues. These issues, and the articles they contain, arose from a 2016 conference. The conference ‘Broken Narratives and the Lived Body,’ held at the Monash Prato Centre, Italy, in April 2016, centred on an interdisciplinary discussion of ‘how people with neurological illnesses, psychiatric diagnoses, histories of trauma, cognitive “impairments” and neurodiversity (people diagnosed with autism spectrum disorders) might produce “broken narratives”’ (Kokanović and Stone 2018, 21). This conference informed two special journal issues, one in the Journal Subjectivity in 2017, and one in Arts and Humanities in Higher Education in 2018. The papers within these issues form the foundation of our discussion of broken narratives.

The special issue Subjectivity and Illness Narratives interrogates the illness narrative, recognising these narratives as processes through which subjectivities are produced and reproduced (Kokanović and Flore 2017). Kokanović and Flore (2017), in their introduction to the issue, emphasize the interconnectedness of illness and narrative, and their ability to reshape subjectivity. This issue provides us with six articles. A subsequent Medical Humanities special issue of the Journal Arts and Humanities in Higher Education aims to extend this discussion through a particular focus on narratives which defy conventional ideas of coherence (Kokanović and Stone 2018). This journal issue contributed nine articles to this review.

The second cluster within the literature emerged from Hyden and Brockmeier’s seminal 2008 book, Health Illness and Culture: Broken Narratives (Hyden and Brockmeier 2008). Hyden and Brockmeier’s collection brings together essays from an international and interdisciplinary group of scholars (Hyden and Brockmeier 2008). The essays within the collection explore the concept of narrative in order to map the relationships between illness, disability, dementia, pain, grief, or psychological trauma and are built on a recognition of the importance of biography and autobiography in the processes which surround health and illness. This text provided six articles for this review.

The articles in this review came primarily from the global north: the United Kingdom; Australia; Denmark; Sweden; France; and the United States of America. There was a wide range of disciplines represented including sociology, medicine. psychology, education, theatre, anthropology, English, art, occupational science, music and law. The articles discussed a variety of conditions including dementia, childhood illness, cancer, traumatic brain injury, intellectual disability, self harm, psychological distress, schizophrenia, autism and contested illnesses such as chronic fatigue syndrome. This range reflects the interdisciplinary appeal and utility of broken narratives as a site of investigation.

Articles also ranged in type, from editorial papers and theoretical discussions of topic, to qualitative narrative inquiry. Viewing the 34 articles as a whole, a key feature of these texts is their theory-based and often exploratory nature. Many of the texts, at least 17, included in this review were editorials or essays. Of the remaining articles, case studies were common, with five articles being identified as case studies. In all, only 15 of the articles were identified as having drawn on data from participants. The number of participants in these texts varied widely, from one participant for the autoethnographic studies and case studies, to 916 participants in the only quantitative study in this review. However, for the most part, articles were based on qualitative data from small numbers of participants.

This investigation ultimately became interested in the ways in which the body of literature around broken narratives treated the idea of coherence. Out of the 34 texts examined in this review, 29 of them contained the term coherence (operationalised through the search query ‘coheren*’ in order to capture both ‘coherence’ and ‘coherent’ as well as its opposite ‘incoherence’ and ‘incoherent’). Within those texts which did contain the term coherence, the frequency of use ranged from one to 101, with a mean of 13.7. This establishes the importance of interrogating the idea of coherence within discussions of narratives, and, in particular, broken narratives. It is a theme which is frequently drawn upon, and positioned as central, within these discussions, and is therefore worthy of further interrogation.

However, while broken narratives literatures rests upon ideas of coherence, it also provides us with the impetus to critique normative ideals. Ten of the texts reviewed here challenged the normative ideal of coherence. In order for a text to be identified as challenging the norm of coherence, authors had to do more than simply identify the potential for disability to cause breaks in coherence. Rather, they had to question the ways in which coherence has been constructed and naturalised as the only way in which to tell stories.

It is within this complexity that we now turn to a more in-depth discussion of the construction of coherence within the literature on broken narratives.

Discussion

We employed Campbell’s lens to interrogate the ways ableist norms function to enforce a compulsory able body with respect to speech and narrative, discussing the ways that the norm of coherence is naturalised, the mechanisms which construct a constitutional divide between coherent and incoherent narratives, together with the potential responses to, and resistance to, the norm of coherence within academic discussions. In our analysis we will interrogate coherence by marking it as an ableist norm.

Descriptions of ableism and broken narratives exist in surprisingly separate, and often opposing, domains. Discussions of ableism emphasise the socially constructed nature of disability. They arguably neglect the role of corporeality in the disabled body (Moser 2009; Shakespeare 2013), whereas the investigation of broken narratives, situated within medical humanities, renders this corporeality as foundational within narratives and ideas of selfhood. Discussions within the medical humanities reinstate the body in analysis by investigating the ways that the ill body, and lived experience of illness, can disorder narratives and, therefore, disorder understandings and expression of selves (Kokanović and Stone 2018). In this way, they explore the ways that ill and disabled bodies, and their limitations, can break through narratives.

Such an understanding highlights a fundamental and essential connection between identity, selfhood, and the often visceral and corporeal experience of not being able to produce and communicate a narrative which is deemed by others as coherent. It provides tools for talking about the ways that the ill or disabled body may shape identity and selfhood, while simultaneously foregrounding the importance of speech and narrative. However, in its desire to recognise bodily experiences and limitations, it is brought into tension with much of disability studies and the long-held reluctance to concede the physical body as a biologically limiting one (these tensions are discussed at length by Shakespeare [2013] and Berger [2014]).

By viewing broken narratives through the lens of ableism, we can identify the potential pitfalls of an approach which foregrounds the ill and disabled body, better understanding how the connections between body, speech, and self are situated within cultural norms. From this clearer understanding, we are more able to identify the insights which may further our understanding of ableism, particularly those around the norms of coherence and the conceptualisation of incoherence. These new understandings are important to inform the formulation of policy and practices shaping our society and the experience and identity of disabled people.

It is important to state at this point that in our choice to analyse broken narratives, and the literature around them, through the prism of ableism, it is not our aim to invalidate broken narratives as an important area of investigation, or even to necessarily invalidate the insights that such an understanding brings forward. On the contrary, broken narratives are important as an area of interrogation precisely because they prompt a deeper understanding of the complex ways that ableism functions around the idea of coherence.

Analysing broken narratives, and incoherence, as constructed, at least in part, by ableist norms does not negate their realness in the experience of illness, nor the intimate connection between these breaks and the physical body as real or constructed. Instead, such an analysis provides deeper insight into the ways which coherence is naturalised as a prerequisite for healthy functioning selfhood, the ways incoherence is separated from coherence to become brokenness, and the ways these norms may be resisted.

Coherence as an ableist norm

At the heart of Campbell’s critique of ableism is an exploration of how compulsory able-bodiedness constructs disability (Campbell 2009). Similarly, we can explore broken narratives through their opposite, the naturalised and taken-for-granted norm of coherence. Within the literature reviewed here, coherence was not discussed merely as an element of communicative success, but rather as a prerequisite to a healthy and functioning self (Smith and Sparkes 2008; Wasson 2018).

Interest in narratives and narrative coherence stems from the assertion that we are a story-telling species (Kokanović and Stone 2018). Narratives are thought to be central to our experience of the world and are afforded a primary role in human experience, selfhood and identity. Narratives, within such inquiry, do not merely recount experiences or express thoughts. Rather, they are intricately constructed, co-constructed and reconstructed in a process which shapes the experience and subjectivity that they claim to reflect. In this way, narratives, and the processes of constructing and telling them, are often represented as processes of constructing meaning as well as personhood (Danely 2017; Kenny et al. 2017; Nolte 2018).

Crucially, coherence is not simply a prerequisite for human subjectivity, but rather is intricately tied to the healthy, able-bodied self. Coherence and the ill or disabled body emerge in a complex and circular relationship in which coherence is both the casualty and saviour of illness. Kokanović and Stone describe narratives as ‘constructing meaning and coherence out of disorder created by illness’ (Kokanović and Stone 2018, 21). This establishes a tension in which coherence is simultaneously rendered vulnerable by illness, as well as more vital in the presence of it. It also demonstrates clearly the naturalisation of the relationship between illness and incoherence. Here, it is not the limitations and experiences associated with illness which cause disorder and lack of coherence. Rather, it is the illness itself which brings incoherence, almost inevitably disrupting an individual’s self-narrative (Green, Todd, and Pevalin 2007; Greenhalgh 2017; Williams 2000).

Such a framework rests on notions of the storied self (Parker 2018) or narrative identity (Kenny et al. 2017), as well as notions of temporality (Holloway and Freshwater 2007; Kenny et al. 2017). The self is produced and understood through narratives which connect the past, present, and future, to maintain a stable identity over time. In the context of illness narratives, this connection with the past and future is particularly important, with narratives being conceptualised as an attempt to align the present self with pre-injury self (Mäkelä 2017), or as a process gesturing towards a healthy self (Shapiro 2011). Narratives are represented as a means of regaining coherence (Hjelmblink and Holmstrom 2006) and healing or reconstructing the self (Greenhalgh 2017). For Shapiro, ‘the experience of working with the injured body is an experience of self-identity and movement toward re-acquiring a coherent sense of self’ (Shapiro 2011, 20). Coherence here is a necessary element of the human experience, and one which is always being worked towards and in constant need of rearticulation.

This assumption is not universal within the literature, and is something that will be discussed further below, but highlights a fundamental element of the norm of coherence: namely, its compulsoriness. Not only must the norm of coherence be met or, indeed, enforced, but it also contains within it, through its linking with the healthy subject, a compulsion towards able-bodiedness, and an imperative to habilitate that which is assumed to be broken. Coherence can then be understood as an ableist norm in itself, working alongside other ableist norms around bodily mastery and agency. These norms, too, demand control over one’s corporeal state, a control which remains invisible until it is challenged by disability (Campbell 2009). Coherence is granted to those who conform to ableist norms. Illness itself is represented as antithetical to coherence, and so, in order to be bestowed with coherence, broken narratives must aspire towards recovery, or, if recovery is not possible, the ill/disabled person must be willing to conform to narratives which minimise the ‘disorder created by illness’ (Kokanović and Stone 2018, 21) (also seen in Mundle 2011; Pohjola 2020; Ryan 2018).

The constitutional divide: how do narratives become broken?

In what Campbell would refer to as a constitutional divide (Campbell 2009), a narrative which does not conform to norms of coherence is said to be broken. Such a narrative is rendered as abnormal, or even deviant, and the self which it is assumed to support becomes vulnerable. The idea of incoherence is often employed to explore the ways that illness and bodily uncertainty interrupts narratives, making it difficult for incoherent speakers to maintain coherent and culturally meaningful life narratives. However, it also provides us with a lens through which to interrogate the ways that norms of coherence function to divide narratives into those which are coherent versus those which are broken.

The maintenance of coherence relies on the strength of narratives around the self, those narratives which have been rendered an essential and compulsory part of selfhood. Anything disrupting this coherence becomes ‘broken.’ The narratives of disabled people are often in contradiction with normative cultural prescriptions (Kenny et al. 2017). Attempts at narrative coherence are thwarted by experiences which do not fit into cultural narratives about what about what a body should be able to do, or, indeed, narratives about what a disabled person looks like (Kenny et al. 2017). Certain experiences lie at the fringes of what can be talked about or what is acceptable to talk about (Nolte 2018). People dwelling in these fringes do not necessarily have the language to talk about their experiences in a way which is recognised as coherent, and their narratives transgress norms of agency and bodily mastery. Incoherence in these voices is translated into brokenness (Hyden 2008).

Disabled narratives disrupt the often taken-for-granted assumptions of the healthy body (Bury 1982). The idea of the ill or disabled body as interrupting bodily and temporal assumptions has been widely adopted by those interested in broken narratives, and rests heavily on the invisibility of the normative and coherent able body. Such work often suggests that the body is unusually salient in the lives of those who are ill or disabled, forcing them to confront realities of bodily vulnerability, uncertainty, and mortality (Bury 1982; Kokanović and Stone 2018). If one of the primary functions of narrative is to connect the past to the future in a coherent timeline (Kokanović and Flore 2017), then illness also becomes significant for its ability to challenge these assumptions, casting doubt on imagined futures (Parker 2018) and, potentially, the very possibility of the future. Life threatening illnesses such as cancer, or unpredictable conditions such as stroke or traumatic brain injury disrupt the fundamental existential assumptions through which we connect the present to the future, challenging the internal temporal coherence of narratives, casting doubt on the possibility for narrative resolution.

Within culturally accepted narratives, this sudden move towards incoherence demands ‘both explanation and work to restore a sense of normality (or, if that is impossible, to compensate for its absence)’ (Greenhalgh 2017, 349). Disability, then, is said to bring about a distorted narrative which must be remedied through the act of constructing and retelling stories. This is a recurring, and problematic, theme within the literature around broken narratives (and in the way we prepare health and allied health practitioners for their work in support of disabled people); the transition from health to illness is never talked about as simply a transition from one set of circumstances to another. Rather, the transition into illness, and the emergence of the physical body (and certain kinds of narratives) within awareness, is one of dysfunction and incoherence.

This dysfunction can also transgress norms of coherence around interpersonal autonomy and the individual’s role in relation to those around them. In the presence of illness, the ill person often becomes the recipient of care, and this necessitates a renegotiation of their (changing) relationships with the people around them. This is a source of tension which may grow into a lack of coherence (Shapiro 2011, 19), and in some cases, the absence of a coherent narrative is described as weakening the very boundaries between the self and the other who must now care for them (Danely 2017). Such ways of describing disability as disruption highlight problematic connections between disability and agency; set against norms of independence, narratives of dependence can be construed as broken. They also point to the damaging ways that agency and independence have been incorporated into the norm of coherence in such a way that incoherence can negate autonomy.

What we see here then is a circular relationship, where an apparent lack of agency and independence (based on ableist norms) can be read as incoherence, and any supposed incoherence in one’s narrative can be taken as cause to limit agency. These disruptions typically occur when the ill or disabled person attempts to assert a narrative which does not align with the listener’s conception of a coherent narrative, bringing the speaker into contest with cultural narratives of health (Danely 2017). Danely argued that it is the extent to which personal narratives diverge from or exceed cultural narratives which lead to the breaks in the narrative. This is especially relevant where various competing discourses which exist simultaneously.

The work of Gurung (2018), Mäkelä (2017) and Ryan (2018) takes up this point, to argue that even when a person has the language to talk about their experiences, their ways of talking can be rejected, and therefore broken, by the listener. In each of these studies, the subject possessed the ability to assert his or her chosen narrative, but was subject to the existence of socially acceptable and unacceptable ways to act in and respond to one’s situation (Gurung 2018) and was labelled as incoherent, and therefore abnormal, regardless of their perception of themselves. In this situation, people with incoherent narratives may be censored by the cultural expectations of others, or they may censor themselves.

The norm of coherence then, demands not merely an order to narratives, but an order which is culturally accepted. Its meaning is produced in relation to norms of able-bodiedness. An exploration of coherence, then, is not merely relevant to the study of disability, but ultimately cannot exist in isolation from theories of disability. In bringing them together, we gain a better understanding of both.

We have seen in the previous sections that coherence can be enforced rather than constructed, and in cases where the voice is incoherent, a coherent narrative is often constructed around the individual (Hyden 2008). When this happens these narratives follow cultural norms of coherence, discourses which reinforce ableist norms of disability in ways that are hugely damaging. There is a real risk of incoherent voices being subsumed into accepted cultural narratives. Resisting these enforced narratives of coherence involves interrogating the very notion of normative coherence.

Speaking otherwise about incoherence

Part of Campbell’s project around ableism is one of resistance (Campbell 2009). She became interested in the ways that disability was talked about, particularly by disabled people themselves, to explore the ways such individuals interacted with ableist norms. She argued that disabled people were often compelled to conform to ableist norms, mimicking or aspiring to coherent able-bodiedness. However, she also identified this interaction as a potential point of resistance, where disabled people could find new ways of talking and being. In what is perhaps her central question, she asks ‘How does the person with a disability negotiate the expectations and compulsions of ableism? In other words, do they choose to conform to or hypermimic ableism or do they go it alone and explore alternative ways of being?’ (Campbell 2012, p. 226).

We can perhaps ask this too of the ways we as researchers work with norms of coherence. It is a dynamic which we can explore in the ways that coherence is positioned within the broken narratives literature, particularly in discussions of how we should listen to incoherent narratives. We saw in the last section how a broken narrative is one which does not meet normative ideals of narrative coherence. However, tension emerges in the way we should respond to this insight. Should we approach broken narratives in a way which attempts to establish or restore coherence? Or should we interrogate the idea of coherence itself? Might what is conceived, according to ableist norms, as incoherence in fact be better understood as simply reflecting the natural diversity of coherence? This is a growing recognition within understandings of disability, reflected in the World Health Organisation’s understanding of disability as a universal construct; not a construct denoting a defined group of people, but rather an experience common to all human persons across their lifespan (World Health Organization 2001). Such considerations are important within any exploration of a non-normative narrative.

Literature in this space agrees that it is important that broken narratives are listened to. However, in the search for understanding, the norm of coherence is often reinforced rather than questioned. We saw earlier how the norm of coherence compels speakers to strive towards it, and many descriptions of broken narratives emerge as a search for coherence. These accounts talk about patients striving towards coherence through illness (and recovery) narratives (Shapiro 2011), or the ways that healthcare professionals can support patients to find coherence in their narratives (Nolte 2018) or reconstruct a coherent narrative on their behalf (Hyden 2008). In talking about crises of coherence, these understandings do not attempt to trouble the normative ideal of coherence. Instead, they suggest that within the interaction between patient and medical professional, coherence can be restored. This is a familiar effort to rehabilitate disability narratives towards an able-bodied norm rather than making an effort to listen to non-normative narratives, one which can result in us failing to hear what disabled people are trying to tell us.

As much as the idea of broken narratives is rooted in norms of coherence, sections of the literature urge a move towards a more nuanced understanding of meaning and the ways it can be constructed. In particular, they resist normative understandings of coherence, moving to expand the ways in which a narrative can be thought of as coherent (Bitenc 2018; Wasson 2018), or interrogate the idea of coherence itself (Danely 2017; Kenny et al. 2017; Kokanović and Stone 2018; S. Ryan 2018).

This resistance is largely based upon the recognition that the search for a culturally accepted normative coherence can obscure the meanings which speakers intend (Danely 2017; Hyvärinen et al. 2010; Kenny et al. 2017; S. Ryan 2018). The work of Bitenc (2018) and Wasson (2018) argues that even narratives which are incoherent (to others) are still understood and used by speakers to construct and reinforce their own identity. These papers argue that rather than reading narratives for coherence, we must consider the wider purpose of the narrative, as well as the social context. Wasson critiques in particular the available cultural narratives from which ill and disabled people are expected to draw in constructing their own narratives. Instead of reinforcing the coherence of the culturally accepted, and enforced, restitution and quest narratives, she instead turns to the incoherence of the chaos narrative as a way of ‘making a space for story that does not fit the expected form of ‘story’ at all’ (Wasson 2018, 106–7).

However, the interrogation of coherence can be taken even further, to question not only the coherence of narratives, but also the coherence of the self which it is supposed to construct. Such an interrogation argues that personal narratives in general are often chaotic, fragmented and lacking a coherent structure, bringing them into contest with cultural narratives, narratives which are themselves falsely bestowed with a sense of logic and order (Danely 2017).

The assumption of coherence is particularly challenged by illness and disability narratives, where the future, and therefore ending, of the narrative is precarious. Such a critique goes on to contend that normative coherence ‘privileges integrative unity and marginalises the dis-unity, uncertainty and precarity of bodily, temporal and existential disarray’ (Kenny et al. 2017, 388). Together, these critiques suggest that, far from being a natural and universal characteristic of narratives, coherence is an artificial construct which many narratives, particularly disabled narratives, can never meet. In order to conform to assumptions of coherence, fragmented and precarious narratives are edited, censored, and silenced.

Perhaps instead, narratives should be understood as a ‘site of struggle between normative coherence and the lived experience of credible bodily, temporal and existential disarray’ (Kenny et al. 2017, 376). This reintroduction of the chaotic allows, and encourages, exploration of narratives as partial, hybrid, and multiple, ‘revealing various coherences and incoherences within lived experiences that resist unificatory integration and thus fall outside of coherent normativity’ (Kenny et al. 2017, 375). Such exploration advocates ways of listening which attend to the silences and nonsenses of narratives, suggesting that these should be read, not as broken, but as a continuation of narration (Kokanović and Stone 2018). This is a means of problematising the distinction between coherence and incoherence, urging us to consider not only new ways of telling narratives, but new ways of listening to them.

In her account of ableism, Campbell postulates the possibility of speaking otherwise about disability, and the power that such speech might have to resist such norms (Campbell 2009). Might incoherence be a means of speaking otherwise? Campbell encourages us to imagine outside the context of ableist narratives. For this, we must interrogate the norm, and explore what is outside coherence. The task of interrogating normative coherence leads us to a second way of understanding incoherence; one which embraces the liminal. For hooks, the margins represent ‘… more than a site of deprivation … it is also the site of radical possibility, a space of resistance’ (hooks 1990, 149). This requires an approach which abandons appeals to sameness and normalisation, focusing instead on an attempt to ‘recover and apprehend the lifeworlds of humans living peripherally’ (Campbell 2009, 14). Embedded in this approach is an understanding of difference which is disconnected from evaluative judgements and fixed terms.

For Campbell, there are possibilities in ambiguity. The norm of coherence limits and recasts the possibility of ambiguity, instead rendering it as broken narrative. Free of norms of coherence, might incoherence provide access to the margins and radical possibility that hooks (1990) imagined? If so, then incoherence may in fact be crucial in the possibilities of resistance and speaking otherwise.

Conclusion

The discussion around broken narratives provides insight into the many ways in which the norm of coherence functions to render the narratives of disabled speakers broken. The discussions within it shed light on the importance of interrogating the themes of narrative, speech and voice within the context of disability, and especially in relation to experiences of incoherent speech. These discussions highlight the recognition that broken narratives do not necessarily hail from broken voices. Instead, they recognise the multifaceted nature of narratives, demonstrating the ways in which brokenness emerges not merely within the disabled narrator, but in interaction (and in relationships) with others and with the cultural expectations that govern these interactions.

Speech and narrative are regulated by ableist norms of coherence, which are constructed as being prerequisites for human subjectivity. These norms become naturalised and compulsory to the point where voices which fail to conform to specific ideals of coherence are considered broken. Within this cultural landscape, many disabled speakers face immense pressure to censor, rehabilitate, or alter their narratives in order to find legitimacy. Many experience hermeneutical injustice (when their narrative is not well understood by others) or testimonial injustice (where their narrative is dismissed by others) (Fricker 2017). It is critical that the narratives of impaired or incoherent voices are included within research. However, this article has suggested that instead of struggling to find the coherence of disabled narratives, we should instead interrogate assumptions around coherence and consider what alternatives to normative coherence might look like, and in so doing embrace the concept of diversity in communication.

Next steps

Moving forward, more research is needed to apply such a critique of coherence to the experiences of those with impaired speech, and particular attention is needed to investigate these issues in the global south.

Additionally, much of the discussion, particularly around the idea of biographical disruption, relies on an understanding of illness as a temporary shift from health to sickness, one where recovery is the ultimate goal (Greenhalgh 2017). This view of illness places it in tension with much of disability studies, and with the experience of many disabled speakers, where disability is life-long and permanent. However, the central idea of coherence, and the potentially subversive quality of incoherence, is extremely relevant to the lives of many disabled speakers. To move forward, we must wrestle with the flaws of coherence in our own research, probing at its edges to uncover new ways of speaking and being disabled.

The purpose of this discussion is not to suggest that we do away with the ideas of shared understanding and intelligibility. It is clearly dangerous to encourage the viewing of disabled people as lacking coherent subjectivity or personhood, thereby risking the further dehumanisation of populations who are already at risk. Instead, we need to find ways to talk about non-normative narratives without enforcing certain types of narratives and silencing others. Intelligibility will always be important for people with and without a disability. But perhaps if we are not beholden to normative ideas of coherence, then we can access new shared spaces of meaning in the territory outside of the particular ways of doing coherence which are prized within ableist culture. This is the opportunity which we now have moving forward.

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

This work was supported by the Australian Commonwealth Government through the Research Training Program Scholarship.