IJCAIP Featured Article
Ethnodramas About Health and Illness
Staging Human Vulnerability, Fragility, and Resiliency
We are all vulnerable and fragile human beings, regardless of situation, circumstance, or social context. Resiliency, however, varies from person to person depending on his or her personality. Vulnerability's root meaning is "to wound," with its most salient definitions as "defenseless against injury" and "open to attack or damage." Fragility's root is "to break," and is defined as something "easily broken or destroyed." In the context of this paper, fragility's other definitions include "delicate health" and "unusually susceptible to ill health or physical harm."
As for resiliency, there are multiple roots, including "to jump back," "rebound," and "leap." Though the first definition is "returning freely to a previous position, shape, condition," in the contexts of health and illness these ideas resonate: "capable of withstanding shock without permanent deformation"; and "to regain strength or high spirits after weakness or depression."
I am a theatre artist, and certainly not an expert in the quantitative and qualitative research literature about health and illness. But I speculate that themes of vulnerability, fragility, and resiliency weave throughout most of these studies, for they are most apparent in the related ethnodramatic literature.
In this paper, I share a descriptive, selected literature review of 38 ethnodramatic play scripts about health and illness.1 A few of these titles are documented play productions but without available written play scripts for analysis. I include excerpts from exemplars of the genre, hoping that these may serve as a sampler of models for the reader's own ethnodramatic writing. I will focus on the four most frequently addressed topics in this genre: cancer, health care, HIV/AIDS, and substance abuse/addiction.
The non-theatre-going public is perhaps more familiar with commercial films and television programs about health and illness. These titles include such works as Philadelphia, Wit, ER, Grey's Anatomy, and others. Illness may not play a central role in selected film plots but can become a major component of story lines in such fictional works as Steel Magnolias, Angels in America, and Terms of Endearment. Most ethnodramatic work about the subject originates from the academic and scientific communities, with a handful of works by theatre artists and performance studies scholars with social or personal investment in health and illness issues. The history of theatre and its contemporary forms include documentation of performance events and dramatic modalities with pedagogic albeit sometimes didactic goals. Medieval morality plays preached wholesome spiritual living to the European masses; puppet plays are performed in Mexico to teach children proper hygiene; drama therapy utilizes improvisational work for psychotherapeutic goals; and digital storytelling projects are conducted in children's hospitals with terminally ill patients.
Ethnodramatic representations and presentations of health and illness bring participants' vulnerability, fragility, and, in most cases, resiliency to heightened prominence. Perhaps more than the academic journal article, the ethnotheatrical performance—if well done for a receptive audience—holds potential to increase awareness, deepen understanding, and provide experiences that generate sympathetic and empathetic responses and memories for future applications and transfer into clinical practice and possibly health care policy. If the shared goal of theatre and qualitative inquiry is to explore and learn more about the human condition, then the outcomes are doubly if not exponentially increased when the two disciplines merge, bringing with them their best representational and presentational modes of expression to the dramatic text.
Categorizations of ethnodramas about health and illness can be approached from multiple angles, but in this paper I classify these selected works by the specific health or illness issue addressed in the plays.
In the ethnodramatic bibliography, the majority of plays about illness address cancer, with women's breast cancer as the most frequent subtopic. This category includes works about:
Ethnodramas about cancer range from the monologic and realistic one-woman play, to dialogic and expressionistic ensemble work. Character representations include the cancer survivors themselves, their caregivers, and significant others coping with their loved ones' illness. A few plays include symbolic representations as characters, suggesting a need to abstract the magnitude of the illness in order to grasp and make sense of it.
Perhaps the most-performed play about women's breast cancer is Susan Miller's (2006) autoethnodramatic My Left Breast. The opening scene of her comedy-drama sets the tone of a woman both vulnerable and resilient with her immediate disclosure to the audience:
As a dialogic example of ethnodrama (a form underutilized in the genre), Mulchay, Parry, and Glover (2009) researched people with cancer and created Between Diagnosis and Death. In this play, the Father is a composite character whose words are taken from multiple interviewees' transcripts, but Caitlin M. Mulcahy, one of the co-authors, served as the basis for the Daughter. Vulnerability and fragility are experienced not just by the ill but also by their family members. In the scene below, Father and Daughter are sitting on a park bench on a cold day. The Daughter is "haunted by a ghost she cannot escape" (p. 30), but the character appears onstage alongside her. Notice the italicized stage directions in the excerpt, evoking not just character action but subtext and irony for audiences:
The second most frequent subcategory of ethnodramas address health care issues from the perspectives of both recipients and caregivers (though not necessarily within the same play):
These ethnodramas, unlike those about cancer, tend to be more "documentary" in tone and construction, though the emotional urgency of participants is still quite vivid. Plays about cancer tend to be case study in nature, whereas ethnodramas about health care are polyphonic collages of mini-monologues—a revue, if you will, of people's perspectives frustrated with a vulnerable and fragile system.
As one example, Saunders (2008) reports on the dilemmas of United States citizens without accessible and affordable health care by first reviewing and contextualizing the statistics before the participants' stories are presented. A narrator tells the audience:
But statistics in a report do not always have to be sweeping in scope. The smaller numbers we deal with on a daily basis can provide points of reference for understanding different situations. Below, a Canadian health care worker relates the costs associated with meals at a nursing home for the elderly as she reflects on her coffee house purchase:
Aside from the monologic narratives of people's dilemmas with health care, one play by Nimmon (2007) utilizes dialogue to highlight conflicting tensions. Monica is an immigrant still learning the English language and needs medical attention. Note her resiliency to get the help she needs:
Ethnodramas in this subcategory tend to assert more socially conscious agendas. The plays range from sympathetic portraits by performance studies scholars, to awareness training by researchers for health care providers:
One of the most provocative and well-executed ethnodramas in the literature is Margarete Sandelowski, Frank Trimble, Elizabeth K. Woodard, and Julie Barroso's (2006) collaboration to create the DVD production, Maybe Someday: Voices of HIV-Positive Women. Intended as a training documentary for health care providers and social service workers, plus a resonating forum for HIV-positive women themselves, the rigorously researched literature on women with HIV/AIDS was used primarily by Trimble to write and weave informational narrative with reconstructed monologues based on interviews with HIV-positive women. The composite-based resilient characters in the DVD are two African American women, one White woman, and two Latinas. In one scene, a narrator's voice-over prompts the viewer:
Maybe Someday focuses primarily but not exclusively on the themes of stigma associated with HIV status, as this monologue relates:
Ethnodramas about abuse and addiction are explicit and raw in their tone and action, with most titles venturing into a surrealistic style with overt "theatrical" devices in their staging. The skewed, nightmarish reality that results from substance abuse and addiction seems to transfer into the script and staging of the issue.2 Resilience in these plays' characters is minimal. Scripts include:
In the monologue excerpt below, female playwright Tifani Pust (2008) unabashedly and graphically describes her relationship with her speed-/meth-addicted male lover in The Demon. Notice the vulnerability and fragility in both characters' psychological states and actions:
Additional Ethnodramas about Health and Illness
Length restrictions of this article do not permit me to examine in depth other categories of ethnodramas about health and illness, but the listing below refers readers to the topics addressed in other plays:
Aging and Mental Health
Death and Loss4
I offer the following personal and subjective recommendations to those interested in writing and producing ethnodramas about health and illness:
First, writers with a theatre background, or health care workers/academic researchers who collaborate with theatre artists, tend to generate higher quality ethnodramas. Both practitioners bring their respective expertise to the project, creating a synergistic product that more effectively balances science and art. I encourage those in health care who wish to use the medium of theatre as a forum for their issues to actively seek and consult with playwrights, stage directors, or drama educators for creative guidance.
Second, I would encourage exploration of the scripted dramatization of some of the field's best qualitative studies in health and illness. In my ethnotheatre course at Arizona State University, students experimented with improvising, as studio exercises, scenes from such works as Michael Angrosino's (1994) "On the Bus with Vonnie Lee," a case study of a developmentally disabled adult. Is there ethnodramatic potential in dramatizing scenes from such books as Denzin's (1993) The Alcoholic Society, or some of the descriptively rich grounded theory studies in illness by sociologist Kathy Charmaz?
Third, I stated in an article of my own autoethnodramatic project (Saldaña, 2008) that you can't learn how to tell someone else's story until you first learn how to tell your own. The reflective practitioner, the autobiographical and autoethnographic examination of one's own career and practice, or even your own history and experiences about health and illness, is rich material for experimental writing of an original monologue or one-act play about your personal stories. In the future, I plan to dramatize the story of my recent and first ambulance ride to a hospital emergency room after a side-effects seizure from a high prescription dose of amitriptyline for my sleep disorder. Metaphorically, the experience was an epiphanic "wake up" call for me to critically examine the work overload in my life.
When we read or attend ethnodramas about health and illness, what we gain from the event depends on our experiential backgrounds. If we are health care providers, we might learn more about an illness from the patient or client's perspective. If we share the same illness or health issue dramatized on stage, we might find resonance and comfort knowing we are not alone in our suffering because others face the same struggles we do. And if we are neither of these populations, we might come to a greater understanding of those affected by illness and health care matters by perhaps unconsciously acknowledging that the participant's plight could very well be our own some day.
Theatre artists and entertainers are taught several folkloric lessons in how to conclude an evening. Such words of advice include, "Always leave them wanting more," "End a show with 'heart'," "Make them smile as they leave the theatre," and so on. One of the most vital lessons I've learned as both a playwright and audience member is that, regardless of the play's story, subject matter, and themes, end with hope. This is not to suggest that there must always be an artificially applied happy ending, or that we sugarcoat or negate the seriousness of the problems and issues we address. I advocate that we need to write theatrical experiences with the sense that obstacles can be overcome. We need to know that we can endure, despite the odds against us. We need to know that vulnerable and fragile human beings can also be quite resilient, when necessary.
Johnny Saldaña is an Advisory Board member for The International Journal of The Creative Arts in Interdisciplinary Practice IJCAIP. He is a Professor of Theatre in the School of Theatre and Film at Arizona State University where he has taught since 1981. Johnny Saldaña is a playwright, actor, and director of ethnodramatic work, and the author of Longitudinal Qualitative Research: Analyzing Change Through Time (AltaMira Press, 2003), a research methods book and recipient of the 2004 Outstanding Book Award from the National Communication Association's Ethnography Division; Ethnodrama: An Anthology of Reality Theatre (AltaMira Press, 2005), and The Coding Manual for Qualitative Researchers (Sage Publications, 2009), a handbook on qualitative data analysis. His forthcoming textbook, Understanding Qualitative Research: The Fundamentals, will be published by Oxford University Press in 2011.
Article originally published, August 2010 Johnny Saldaña , J., Ethnodramas about Health and Illness, Staging Human Vulnerability, Fragility and Resilency, p. 167 – 184 "Creative Arts in Interdisciplinary Practice Inquiries for Hope and Change", Eds. C. McLean, R. Kelly, Detselig Temeron Press, Calgary.
Angrosino, M. V. (1994). On the bus with Vonnie Lee: Explorations in life history and metaphor. In J. Creswell (2007) (Ed.), Qualitative inquiry and research design: Choosing among five approaches (pp. 251-263). Thousand Oaks, CA: Sage.
Case, G. A. (2005). "Tic(k)": A performance of time and memory. In D. Pollock (Ed.), Remembering: oral history performance (pp. 129-42). New York: Palgrave Macmillan.
Caswell, J. J., Jr. (2008, February). Shots: A love story. Performance at Mesa Arts Center, Mesa, AZ.
Cole, A. L., McIntyre, M., & McAuliffe, K. (2001, April). All about Alzheimer's: Who can tell what we know? Performance at the 2001 American Educational Research Association Conference, Seattle.
Corey, F. C. (Ed.). (1993). HIV education: Performing personal narratives. Tempe, AZ: Arizona State University.
Denzin, N. K. (1993). The alcoholic society: Addiction and recovery of the self. New Brunswick, NJ: Transaction Publishers.
Dillard, S. (2000). Breathing Darrell: Solo performance as a contribution to a useful queer methodology. Text and Performance Quarterly 20(1), 74–83.
Ellis, C., & Bochner, A. P. (1992). Telling and performing personal stories: The constraints of choice in abortion. In C. Ellis & M. G. Flaherty (Eds.), Investigating subjectivity: Research on lived experience (pp. 79–101). Newbury Park, CA: Sage.
Gray, R. E., & Sinding, C. (2002). Standing ovation: Performing social science research about cancer. Walnut Creek, CA: AltaMira Press.
Kaplan, C. (2003, March). The unspeakables. Performance at the Strand Theatre, Houston, TX.
Kontos, P. C., & Naglie, G. (2006). Expressions of personhood in Alzheimer's: Moving from ethnographic text to performing ethnography. Qualitative Research 6(3), 301-17.
Lobel, B. (2007, February). Ball and other funny stories about cancer. Performance at Arizona State University, Tempe.
McIntyre, M. (2009). Home is where the heart is: A reader's theatre. The International Journal of The Creative Arts in Interdisciplinary Practice, IJCAIP http://ijcaip.com/archives/CCAHTE-Journal-7-McIntyre.html
McLean, C. (2004, August). Awareness about aging and autonomy—"Remember me for birds." Performance at the National Association for Drama Therapy Conference, Newport, RI.
Mienczakowski, J. (1996). An ethnographic act: The construction of consensual theatre. In C. Ellis & A. P. Bochner (Eds.), Composing ethnography: Alternative forms of qualitative writing (pp. 244–64). Walnut Creek, CA: AltaMira Press.
Mienczakowski, J. (1997). Theatre of change. Research in Drama Education 2(2), 159–72.
Mienczakowski, J., Smith, L., & Morgan, S. (2002). Seeing words—hearing feelings: Ethnodrama and the performance of data. In C. Bagley & M. B. Cancienne (Eds.), Dancing the data (pp. 34–52). New York: Peter Lang.
Miller, S. (2006). My left breast. New York: Playscripts, Inc.
Minge, J. M. (2006). Painting a landscape of abortion: The fusion of embodied art. Qualitative Inquiry 12(1), 118-45.
Mitchell, G. J., Jonas-Simpson, C., & Ivonoffski, V. (2006). Research-based theatre: The making of I'm still here!. Nursing Science Quarterly 19(3), 198-206.
Montano, L. M. (2003). Death in the art and life of Linda M. Montano. In L. C. Miller, J. Taylor, & M. H. Carver (Eds.), Voices made flesh: Performing women's autobiography (pp. 265–81). Madison, WI: University of Wisconsin Press.
Mulcahy, C. M., Parry, D. C., & Glover, T. D. (2009). Between diagnosis and death: A performance text about cancer, shadows, and the ghosts we cannot escape. International Review of Qualitative Research 2(1), 29-42.
Nimmon, L. E. (2007). ESL-speaking immigrant women's disillusions: Voices of health care in Canada: An ethnodrama. Health Care for Women International 28(4), 381-96.
Paget, M. A. (1995). Performing the text. In J. Van Maanen (Ed.), Representation in ethnography (pp. 222–44). Thousand Oaks, CA: Sage.
Park-Fuller, L. (2003). A clean breast of it. In L. C. Miller, J. Taylor, and M. H. Carver (Eds.), Voices made flesh: Performing women's autobiography (pp. 215–36). Madison, WI: University of Wisconsin Press.
Passes, A. (2006). Chaos theory—a footnote: an experiment for radio. Anthropology and Humanism 31(1), 75-82.
Pineau, E. (2000). Nursing mother and articulating absence. Text and Performance Quarterly 20(1), 1–19.
Plourde, C. (2007). The thin line. Portland, ME: Add Verb Productions touring performance.
Preisinger, M. A., Schroeder, C., & Scott-Hoy, K. (2000, February). What makes me? Stories of motivation, morality and me. Interdisciplinary arts performance at the 2000 American Educational Research Association Arts-Based Research Conference, Albuquerque.
Pust, T. (2008). The demon. Unpublished manuscript.
Rosenbaum, M. E., Ferguson, K. J., & Herwaldt, L. A. (2005). In their own words: Presenting the patient's perspective using research-based theatre. Medical Education 39(6), 622-31.
Saldaña, J. (Ed.). (2005). Ethnodrama: An anthology of reality theatre. Walnut Creek, CA: AltaMira Press. Saldaña, J. (2008). Second chair: An autoethnodrama. Research Studies in Music Education 30(2): 177-191.
Sandelowski, M., Trimble, F., Woodard, E. K., & Barroso, J. (2006). From synthesis to script: Transforming qualitative research findings for use in practice. Qualitative Health Research 16(10), 1350-70.
Saunders, C. M. (2008). Forty seven million strong, weak, wrong, or right: Living without health insurance. Qualitative Inquiry 14(4), 528-45.
Schneider, B. (2005). Mothers talk about their children with schizophrenia: A performance autoethnography. Journal of Psychiatric and Mental Health Nursing 12(3), 333-340.
Shapiro, J., & Hunt, L. (2003). All the world's a stage: The use of theatrical performance in medical education. Medical Education 37(10), 922-27.
Spry, T. (2003). Illustrated woman: Autoperfomance in "Skins: A daughter's (re)construction of cancer" and "Tattoo stories: A postscript to 'Skins'". In L. C. Miller, J. Taylor, and M. H. Carver (Eds.), Voices made flesh: Performing women's autobiography (pp. 167–91). Madison, WI: University of Wisconsin Press.
Stuttaford, M., Bryanston, C., Hundt, G. L., Connor, M., Thorogood, M., & Tollman, S. (2006). Use of applied theatre in health research dissemination and data validation: A pilot study from South Africa. Health 10(1), 31-45.
Taylor, P. (2006). Beautiful menaced child. Performance at the New York University Forum on Ethnotheatre and Social Justice, New York City.
Yang, Z. (Director). (2001). Quitting [DVD]. United States: Sony Pictures