Introduction

All humans are vulnerable to physiological and social harms. However, this vulnerability should not be characterised merely as a weakness because it is an ontological condition of our humanity [1]. It is only through being vulnerable in this way that we can develop self-understanding, autonomy, and virtuous lives. This inescapable vulnerability of being embodied and social creatures might be called ‘universal vulnerability’ to distinguish it from another, more familiar, notion, ‘context-dependent vulnerability’. Context-dependent vulnerability refers to the variation in vulnerability caused by specific social and physiological situations. A person is more vulnerable in the latter sense when his context increases the chances that harms will undermine his values (e.g., he is more likely to suffer from financial hardship, disease, or abuse).

This article investigates universal and context-dependent social vulnerability through the lens of narrative self-constitution. A narrative self-constitution view is useful for investigating social vulnerability because it highlights the influence others have on both the content of one’s self-narrative and authorial power. Narrative self-constitution views claim that we constitute ourselves, in part, through the stories we tell of our pasts and of our anticipated futures. In developing our narratives we necessarily (and often pre-reflectively) draw on socially-sourced content from cultural archetypes and detailed co-authoring provided by others. We rely on others to find out who we are and who we can become, which requires us to be somewhat open and, thus, vulnerable, in the universal sense, to co-authoring. A self-understanding informed by co-authors is one of the conditions for autonomy. However, our dependence on co-authors leaves us prone to context-dependent vulnerability. We may be unavoidably exposed to excessively dominant (perhaps malicious) co-authors or we may only have access to apathetic co-authors when we need help understanding ourselves. Therefore, others may contribute content to our narratives that we disvalue and/or leave us without content that we need. In worse cases, co-authors can undermine our authorial power leaving us unable to (re-)establish a valued self-narrative. Equally, others rely on us to find out about themselves and so they are vulnerable to our co-authoring. If we dominate or under-contribute to others’ narratives (which we may do unwittingly), then we can have detrimental effects on their self-narratives and authorial power. This concern is especially pressing in therapeutic situations where the client is relying on a professional to help reconstruct and redirect his self-narrative or redevelop his skills of self-narration.

I begin the article by outlining narrative self-constitution and explaining why self-narratives are necessary for autonomy. I then explain how self-narrative development requires a universal vulnerability to co-authoring. This universal vulnerability, however, entails a potential for context-dependent vulnerability where co-authors contribute disvalued content to one’s self-narrative and undermine one’s authorial skills. To illustrate some of the effects of context-dependent vulnerability to co-authoring, I draw on the first-hand reports of several women who survived sexual abuse as children. Finally, by looking at the challenges these women have faced in the healing process, I describe how people can escape context-dependent vulnerability to co-authoring and how others, including professionals, can best help them.

Narrative self-constitution

Narrative self-constitution is the view that we constitute (and reconstitute) important aspects of our self-concept by narrating our lives [2–7].Footnote 1 A narrative can be defined as a structure (usually linguistic) that specifies a causal, teleological, or thematic connection between events to make some sense of them; narratives need not meet the more stringent aesthetic requirements of novels or films [3]. In self-narration, the agent develops meaningful links between the events in her life that catch her attention and that are relevant to her values and projects. To make sense of her life, she needs to narrate her plans, desires, and contingent circumstance so that they make sense in light of each other. However, the diverse interests and experiences of agents entail that not everything is meaningfully related to everything else. Therefore, the agent does not typically try to connect everything in her life into a single coherent story, but rather, she develops a collection of many partially overlapping, partially interconnected, narrative threads [9, 10].

Self-narration is a creative process involving iterative self-interpretation and self-projection. Any state of affairs underdetermines how it should be narrated, so even when narration is purely post hoc and descriptive, the agent can choose which of many narrative interpretations best suits her experience. In narrative projection, the agent narrates an imagined future based on her current narrative self-interpretation and then attempts to enact that projection. Self-interpretations limit, but do not fully determine, which narrative continuations are plausible, and so, it remains for the agent to imagine plausible narrative continuations and enact the one she evaluates most highly. This line of thought ultimately leads to the view that when we successfully enact our narratives, ‘we invent ourselves…but we really are the characters we invent’ [7, p. 58]. However, there are practical limits on which narratives can become self-constitutive. First, physical reality sets some limits on what is possible. For example, one cannot narrate one’s life as being a werewolf or (currently) traveling to another solar system in a self-constitutive way. Second, and this is the focus in this article, our social reality restricts the narratives to which we can lay claim.Footnote 2

Self-narratives are necessary for autonomy. Autonomy, roughly, is the capacity to critically reflect on and evaluate one’s desires, character traits, beliefs, commitments, and values, and act on the basis of that reflection. A self-narrative provides a way to understand how the past led to the present and, therefore, a way to narrow reasonable expectations and plans for the future. Without such an understanding, the agent does not know why things happen or how to respond reasonably [13, 14].Footnote 3 Armed with a self-narrative, the agent has a way of predicting how the world and others will react to her and how she will react to them. Her self-narrative, therefore, provides some basis for imagining projections that best meet her commitments and further her values [8, 15]. Furthermore, self-narratives are required to develop authentic projects, i.e., projects that make sense given who the agent takes herself to be. Before developing a self-narrative, the agent has little idea of who she is and so does not know what is authentic for her. Of course, self-narratives are insufficient for autonomy; they can incorporate inaccurate or coerced content and so fail to guide successful and authentic action. Although self-narratives are necessary for autonomy, the agent cannot create one on her own; co-authoring is essential for developing a self-narrative.

Universal vulnerability to co-authoring

An agent’s self-narrative is inter-subjectively constructed in three inter-related ways. Others provide narrative content, support (or undermine) the agent’s status as an author, and vet the agent’s contributions to her own narrative. I consider them in turn.

Not only do others provide personalised narrative material for the agent’s self-narrative but both the agent and her co-authors draw on more general narrative content from the cultural store of narrative archetypes. Narrative archetypes include fairy tales, legends, and a wide range of stereotypical narratives of varying generality. For example, boys grow up liking trucks, cars, and guns, while girls prefer dolls, make-up, horses, and dressing up; men’s midlife crises involve buying sports cars; more general archetypes include rags to riches stories and tragedies. Narrative archetypes provide shortcuts to understanding our lives, which we can then adjust or build on. We rely most heavily on co-authored content early in life when we are yet to develop our authorial capacity. At this stage co-authors develop the agent’s narrative for her and much of this is pre-reflectively adopted.

As a result, ‘we enter society…with one or more imputed characters—roles into which we have been drafted…’ [8, p. 56]. The agent finds herself with assigned roles which guide what others expect of her and what she should expect of herself. For example, a girl born into an aristocratic family may be expected to marry someone of appropriate social standing, develop certain skills of etiquette, learn certain languages, and so on. Actions and self-interpretations that are excluded from the relevant archetypes are implicitly discouraged. Despite this coercive aspect, co-authoring also empowers the agent. Children cannot self-narrate from scratch, as MacIntyre observes:

It is through hearing stories about wicked stepmothers, lost children, good but misguided kings, wolves that suckle twin boys, youngest sons who receive no inheritance but must make their own way in the world and eldest sons who waste their inheritance on riotous living and go into exile to live with swine, that children learn or mislearn both what a child and what a parent is, what the cast of characters may be in the drama into which they have been born and what the ways of the world are. Deprive children of stories and you leave them unscripted, anxious stutterers in their action as in their words. [16, p. 216]Footnote 4

By pre-reflectively adopting co-authored content for our self-narratives, we develop a base self-understanding to which we can begin to contribute once we develop our own authorial skills.Footnote 5 Even when we can provide our own narrative content, co-authors continue to provide narrative material that allows us to create a more detailed self-understanding than we would be able to create on our own. This is especially the case when an agent finds herself in unfamiliar circumstances through trying to develop aspects of herself that are new, or by trying to deal with unexpected contingencies. For example, when faced with a terminal cancer diagnosis, co-authoring drawing on archetypes might suggest that the agent feel angry, be in denial, write a ‘bucketlist’, or discover a heightened value in everyday activities. Similarly, the agent can learn things about herself by seeing herself through others’ eyes, for example, the agent’s friends might point out how she always likes to be right [18]. Her new self-understanding opens up new possibilities for action. She might try to eliminate that aspect of herself, adjust it, or embrace it as it is. Co-authoring, therefore, can helpfully suggest possible self-interpretations and projections for the agent to consider.

Second, an agent needs her peers to help her develop her authorial skills. Self-authorisation requires an agent to see herself as a competent source of self-narration. To see herself in this way, she needs to have certain self-evaluative attitudes, in particular, attitudes of self-respect, self-trust, and self-esteem [19]. To develop these attitudes, the agent needs others to acknowledge her as an autonomous agent. If others do not treat the agent as an autonomous agent (or, in the case of a child, a potentially autonomous agent), then that will undermine those self-evaluative attitudes [20]. She will then doubt her own capacity to self-narrate and become dependent on her co-authors to provide much of the material for her narrative and to reassure her of which narration is best.

Finally, self-authorization involves regarding oneself as being answerable to others for one’s self-narration (and being entitled to call on others to be answerable). Answerability includes being responsive to requests for explanation and providing reasons for one’s beliefs, plans, et cetera [21]. The agent must be willing to defend or revise her narrative in light of others’ critical questioning. By being answerable, the agent depends on her co-authors to verify, or at least not reject, the narrative material that she authors.Footnote 6 Answerability not only helps prevent the agent from developing delusional self-narrative threads but also allows co-authors to convince the agent to adopt or reject self-narrative threads that are at odds with her evaluative stance.Footnote 7

Context-dependent vulnerability to co-authoring—the theory

The inter-subjective influence on narrative threads gives them a self-fulfilling momentum [22]. Even though self-narrative threads begin as being one possibility among many, over time, certain narrative threads are consistently verified by others, and the agent comes to take these threads to represent facts about who she is and who she can hope to become. As a result, potential narrative threads that are contrary to long-standing, socially-endorsed narrative threads tend to seem delusional or alien to the agent. Her peers are also more likely to find them implausible because they deviate from accepted facts about her. Peers will exert stronger coercive pressure the more plainly the new narrative direction deviates from the accepted archetypes of someone with her existing narrative. For example, imagine a young woman living in a chauvinist society who has long planned to become a nun. She will come up against social pressure if she decides to marry and become a housewife because that narrative change goes against her long established narrative. However, she will come up against even more social pressure if she decides to train to become a doctor. Not only does that clash with her established narrative, it deviates from all the narrative archetypes that society makes available for women. In other words, her proposed narrative direction is now seen to clash with a much deeper aspect of her established narrative. If the agent attempts to adjust her established self-narrative threads, she has to work to persuade others and herself that the new narrative threads are true of her. That work is not easy and requires extra effort. As long as the agent continues to value her established self-narrative, this momentum is beneficial; she believes that she can succeed in her projects because she is the kind of person who will succeed. However, the further the agent wants to self-narrate from the established trajectory, and the longer that established trajectory has been socially endorsed, the more work that is required to change the narrative. Without doing this work, the agent will tend to enact her established self-narrative threads because even if she disvalues them, at least they provide some socially verified self-understanding.Footnote 8

If this is right, then contexts that provide a range of narrative content for us to choose from and use to foster our self-authorisation will help us develop autonomy-enhancing self-narratives. We will also tend to see ourselves as having significant authority to create and defend our self-narratives. Once established, these self-narratives will be relatively robust in the face of coercive co-authoring and stereotypes. On the other hand, if we are raised in an environment where self-authorisation is not fostered and only a narrow range of (perhaps disvalued) self-narrative content is available, we will tend to develop detrimental self-narratives. We will tend to rely too heavily on co-authors for content and will unquestioningly cede to the way others narrate us because we do not believe we are capable self-authors. That is, we will be vulnerable to further coercive manipulation of our self-narratives.

When an agent incorporates disvalued threads in her self-narrative, she may tend to feel alienated from the projects and self-interpretations of which those narrative threads most easily make sense. In those cases, the agent feels that there is some more authentic re-interpretation but is unsure exactly what it is.Footnote 9 In other cases, the agent might unconsciously adjust her values to suit the coerced narrative threads. This dissipates feelings of alienation at the cost of entrenching values that are potentially detrimental to the agent, e.g., women who support patriarchal domination because they have internalised the archetype [25, pp. 130–153]. Coercive narrative content can also contribute to undermining the agent’s authorial power. For example, if the agent has been encouraged to adopt self-narrative threads of, say, being overly emotional, forgetful, or lacking judgment, then she will tend to doubt her self-narration.

In summary, in order to develop self-narratives, we need to be universally vulnerable to co-authoring. However, this also entails the possibility of context-dependent vulnerability to coercive or negligent co-authoring. The resulting self-narrative can alienate one from one’s values, encourage one to pursue self-defeating values, and damage one’s authorial skills.

Context-dependent vulnerability to co-authoring—case studies

In this section, I illustrate context-dependent vulnerability to co-authoring by drawing on the firsthand reports of several women who survived sexual abuse as children.Footnote 10 Although there is more to this abuse than the damage done to self-narrative and authorial skills, the narrative aspects of the abuse are particularly important as they explain many of the long-term effects of the abuse.

Stormy is now 25 years old.Footnote 11 Her father, other family members, and friends sexually abused her from when she was at pre-school into her teenage years. Her father was convicted and imprisoned when Stormy was in her teens, and she was placed in foster care where she was sexually abused by several foster carers. When Stormy tried to tell Family Services that a foster parent had sexually abused her, that person would not believe her and provided the following co-authored material for her self-narrative:

They said it was all in my head and that I was promiscuous. That kind of thing was normal, they’d say, for girls who had been abused. They said they are dirty and promiscuous and they said that was kind of normal that I’d imagine and have these fantasies. So I didn’t speak out about him [foster parent]. I just thought, I don’t know, maybe that’s what I’m there for—just to be men’s little puppet. [26]

As a teenager, Stormy was not in a position to challenge the co-authoring of these authority figures, so she took on the content of being ‘dirty and promiscuous’. She also attributed to herself the role of being a ‘little puppet’ for men since this was one way she could make sense of a world where authorities appeared to side with the people who had used her. This detrimental self-narrative then guides her behaviour—she does not want to speak out about the abuse any longer since, even if she had not imagined it, for a person like her, such events are ‘normal’. In addition to providing this detrimental content, Family Services undermined Stormy’s authorial power by contradicting her own version of events and replacing it with an alternative narrative. This suggests to Stormy that she is unable to correctly interpret her own life and that she cannot distinguish imagination from reality so that others will have to do this for her. As Stormy loses confidence in her authorial power, she, therefore, becomes even more reliant on others. This is particularly dangerous given that she is surrounded by people prepared to exploit her.

Cicada is 48 years old, is university educated, and works in a rape crisis centre. She was sexually assaulted by her uncle and her grandfather as a child and has been assaulted and sexually harassed during much of her teenage and adult life. Cicada despised her father and did not feel safe in the family environment. Cicada’s maternal grandfather, whom she had loved and trusted, raped her when he was visiting their family at Christmas. She did not tell her mother because everyone loved her grandfather visiting and she thought it would ruin Christmas. ‘I think that’s when I really, really stopped telling anybody anything and started really keeping secrets’ [26]. As it happened, she did not properly integrate the rape in her self-narrative and then only recalled it years later when in therapy to deal with other sexual assaults. Arguably, this was because she closed herself off to verificatory co-authoring and because of the lack of trustworthy co-authors. This detrimental context for co-authoring prevented her from developing her narrative in a way that could help her begin to recover from the trauma until years later.

Like Cicada, Joy struggles with an absence of healthy co-authoring. However, as an adult, Joy tries to re-engage with those co-authors to develop a healing, survivor narrative. She is 43 years old, has three sons, and is now divorced after a long marriage. Her father sexually abused her when she was an adolescent. Joy reports the difficulty she had in getting others to verify her narrative of the abuse she suffered and the subsequent value of her recovery. She describes how she finally had to tell her mother about the abuse she had suffered as a child: ‘I thought, I’ve got to have it out with her, I’ve just got to, it’s screwing me up something shocking. So I went and I told her and my brother who lives with her and her first reaction was, she just laughed and just said, “That’s in the past—forget about it”’ [26]. Joy’s mother discounts the narrative content that Joy wishes to have acknowledged by suggesting that it is something just to forget about.

Furthermore, Joy’s mother undermines Joy’s authorial power by refusing to engage in the interplay of answerability with her. Joy eventually succeeds in engaging her mother in a dialogue about the abuse but she puts herself through significant emotional stress to do so. However, she did not have the same success with her husband.

All I wanted was for [my husband] to come to me and be involved and say: ‘I want to help you, I want to be part of your dealing with this—talk to me,’ but instead he just didn’t want to know about it.… Instead, he was just like another man saying, you know, ‘I just don’t want to know about it, it’s all bullshit,’ that sort of thing. So that really hurt…. [26]

Joy’s husband’s attitude was a significant factor in their subsequent divorce. His refusal to participate as a co-author in Joy’s attempt to deal with her abuse meant that she had to look somewhere else for co-authors who could help provide content and verify the self-narrative changes needed in the healing process.

Finally, Carol’s testimony provides one of the clearest indications of how an abusive co-author can prevent the development of authorial skills. She is a 32 year old single mother and has separated from her husband of 13 years. She was sexually assaulted by her biological father from when she was in pre-school.

I’ve thought for the longest time that he’s in my head. It doesn’t matter what I do or what I say, it’s been programmed by him. When we were growing up if I did something right, he’d told me to do it and if I did something wrong, he’d kick me when I was down: ‘You should have done what I told you.’ … There was this programme that I can’t do anything on my own, it’s been put there by someone else and I’ve never had an independent thought. I had to work long and hard on that one. I guess, because of the way I was brought up being told what to feel and what to say and all that, I doubt how I feel so I give people that same trust. [26]

Carol’s father never nurtured her ability to make independent judgments about how she felt or what she wanted. He forced her always to focus on his needs. As a result, she came to rely on him, and then on her husband, to know what to feel, say, or do. Damage to authorial skills is worse than just having disvalued content in one’s self-narrative because it leaves one without the skills to try to change one’s narrative at all. As Carol says, she still has to give people more trust than she perhaps should because she needs their help to know what to feel and do. She is forced to remain excessively open to co-authoring (leaving her at risk of more abuse) until she can further develop her own authorial skills.

In these cases, a focus on the co-authoring involved in narrative self-constitution highlights some significant effects of detrimental social networks and abuse. Stormy had to deal with having damaging self-narrative threads embedded in her narrative by detrimental co-authors. The presence of these narrative threads caused her to continue to shape her self-narrative (self-interpretations and action) in ways contrary to her best interests. Cicada responded to her abuse by becoming so closed to co-authoring that she could only address some of the issues and begin to heal many years later. Joy wanted to be more open to co-authoring and to begin to build on the narrative threads around her abuse but found that those who should have been her most helpful co-authors were either resistant (her mother) or completely unprepared to help (her husband). Carol’s abuse, on the other hand, left her authorial skills damaged so that she now tends to remain too open to co-authoring and cannot trust her own narration.

Therefore, context-dependent vulnerability to co-authoring can be seen to involve two spectra. On one spectrum, the agent can range from being overly open to co-authoring, particularly if he or she lacks authorial power, to being overly closed to co-authoring. On the other spectrum, the agent can range from being unavoidably exposed to excessively dominant co-authors to having access only to apathetic, distant co-authors. To overcome context-dependent vulnerability, then, the agent needs to (re-)establish a balance in these two spectra. In the final section, I outline how a vulnerable agent can re-establish a healthy balance of co-authoring, the reciprocal qualities supportive co-authors require, and the implications for healthcare professionals more specifically.

Re-establishing balanced co-authoring

The vulnerable agent needs to edit detrimental self-narrative content and develop skills of self-authorisation. These processes of self-narration require that she make herself vulnerable to co-authors, a significant challenge given that it was this vulnerability that was taken advantage of in her abuse. The risk can be mitigated by selecting appropriate co-authors, and in the cases of sexual abuse above, some of the best co-authors are other survivors of similar histories of abuse. As Stormy says,

Probably the only people that I’m ever going to be able to trust completely are other survivors who know where you are coming from, where your boundaries would be, and what the expectations are.… I’ve worked very hard to have a safe place for me to come to, to put in place people where I can come to and it’s safe and I know I can let my guard down, let my defences down. [26]

Stormy recognises how difficult it is for her to feel safe enough to ‘let her defences down’ and ‘completely trust’ another person. However, she can trust other survivors because they ‘know where you are coming from’. To ‘know where someone is coming from’ suggests an ability to understand that person’s narrative relatively easily, which should facilitate co-authoring, as should a trusting relationship in general.

Furthermore, because other survivors understand the different ‘boundaries’ and ‘expectations’ of survivors, they can demand that the agent be answerable (as the agent must be in order to be self-authorising) but in a more sensitive way than the typical agent would. Cicada elaborates on this point, making an explicit link between trusting others and self-disclosure:

I’ve learnt to trust other survivors with myself more. I can tell them things that I still can’t tell other people. I’ve learnt to trust that they won’t reject the parts of me that the normal world would. Even if the normal world is in the shape of someone who actually likes me, they would still reject parts of me if I showed that to them, that’s been my experience. [26]

Even when other people are friendly, Cicada finds that they still won’t be able to accept all aspects of her self-narrative. The more sensitive standards of answerability applied by other survivors can build up the agent’s self-authorial power; typical agents might not be able to understand the justifications of the survivor and so tend to undermine the survivor’s authorial power. Cicada makes it clear that finding appropriate co-authors is a process of trial and error. She was not sure that other survivors would verify the important aspects of her self-narrative. She had to learn to trust even that select group of others. Similarly, she discovered through experience that ‘normal’ people tend to reject aspects of her self-narrative.

Although other survivors of abuse are particularly good co-authors for the most sensitive aspects of developing a healing self-narrative, different co-authors can better support other narrative developments. Cicada indicates the value she has found in widening the group of people she is prepared to accept as co-authors:

I was saying I didn’t trust anyone but survivors but I am learning to value women who haven’t been abused as friends. I am learning to look towards them for what it means to be normal, what it is to perhaps have a happy childhood.… I’ve learnt to value a lot of the validation I get from women and a lot of encouragement because I am meeting women now who know that I’m a survivor and know that it’s been a big struggle but who really encourage and support me to do what I want to do. I’m thinking of women who helped me become part of this acapella group, who have really encouraged me. [26]

The helpfulness of co-authors depends on the agent’s goals. In Cicada’s case, she is now aiming to develop a narrative that is more ‘normal’. The typical agent has a number of different foci for self-narration in her life, e.g., around career, hobbies, et cetera. For any particular focus, others who share experiences in relation to that focus are likely to be the most helpful co-authors because they know the relevant stories. Therefore, it now suits Cicada’s goals to begin to diversify the co-authoring she is exposed to, although, as she notes, it helps that they are mindful of her personal history.

As survivors develop their authorial power, they become better at controlling their self-narrative. They can edit disvalued aspects of their narrative and begin to add to it in ways that they value. Cicada, for example, is working to edit ‘victim’ out of her narrative and replace it with ‘survivor’.

And it’s been realising that I don’t have to be a victim. I can choose not to be if I don’t buy into all that negative stuff and load it onto myself that I can…. Survivor is for me a term I go through while I’m healing. I don’t know what I would like to call myself when I’m no longer a victim, I haven’t really thought of that but I think I’m going from victim to a survivor…. It’s a fact. [26]

The narrative archetypes of survivors are different from those of victims. Victims are defined by an act done to them; they are relatively passive and lack control and authorial power. Such self-narratives are more suited to functioning as an excuse for the present state of affairs rather than as a way to access future values [27]. Survivors, in contrast, have put the worst behind them; they are stronger for the experience; they are protagonists. Such self-narrative editing is much more than simply swapping one term for another (the resulting narrative would not make sense). To develop a survivor narrative the agent must reinterpret the past and develop new projections for her future, narrating whole new narrative threads. The new self-narrative content is not just valued more highly than the old, but, in this case, it also supports authorial power because it reinforces an image of strength and control.

Co-authors can help an agent escape context-dependent vulnerability to co-authoring by supporting the authorial skill of others, carefully judging when they are appropriate co-authors, and judging which content will be helpful. The co-author supports the other’s authorial power when they give priority and weight to the other’s self-narration. Stormy says, for example, ‘What feels good for me is when… the counsellor says: “Oh look I’m not really knowledgeable in this area so can you just tell me about it…”. And when they say that I feel really good, I feel… it’s my chance to teach someone about this stuff’ [26]. As an extension of this attitude the co-author should consider the other’s response to any co-authored content and not expect the other to take it up without question. Equally, however, a good co-author will enforce standards of answerability on the other in order to prevent self-deceptions, such as overly negative self-assessments or delusions of grandeur.

Supporting the self-authorisation of a vulnerable other sometimes involves verifying the other’s self-narration at a personal cost. Carol exhibited this virtue when she reported her father’s sexual abuse to a central database:

One thing that I did do that I’m really proud of is that I reported him … so if there’s ever any other reports of him molesting any other children, I am a corroborating witness and I can provide corroborating testimony. That was bloody hard because I thought: Oh God, you know, I’ve made myself visible. But I’m really pleased. It was only a small thing to do but at least if someone else comes back, I’m there. [26]

Just as one needs to judge which co-authors are appropriate for the development of particular aspects of one’s self-narrative, as a co-author, one needs to judge when one is an appropriate co-author for the other. One should only reject or verify another’s self-narration, or contribute content, when one has sufficient knowledge to do so.

Implications for healthcare professionals

The healthcare professional has an obligation to do what she can to heal her patients while respecting patient autonomy. The professional’s role as a co-author for her patients has several significant implications for that obligation. First, any implicit or explicit description of the patient may be taken up in the patient’s self-narrative. Therefore, the professional should be mindful of whether the self-narrative threads resulting from the therapeutic relationship will support healing and respect autonomy. For example, one hopes that diagnosis with type 2 diabetes will become integrated in the patient’s self-narrative so that the patient can manage her own care. In contrast, Family Services telling Stormy that she was ‘dirty and promiscuous’ contributed to a self-narrative that undermined healing and autonomy.

Second, respecting the patient’s autonomy involves supporting the patient’s authorial skill. At the most basic level, the professional can do this by carefully listening to the patient’s explanation of why they have come to the professional and what they hope to gain from the interaction [28]. To ignore the patient’s self-narration is to treat the patient as an object or a problem to be solved. This undermines the patient’s authorial power, which tends to hamper her healing, especially in cases where a lack of autonomy is contributing to her health issues. The professional also stands to learn details about the patient that may be crucial to the patient’s treatment and potentially generalizable to future patients. In fact, it is only by listening to the patient that the professional can recognise and repair important gaps that the patient might have in the self-narration of her medical situation; these are gaps that would otherwise undermine the patient’s autonomous role in her healing.

Third, the healthcare professional should aim to provide the patient with sufficient narrative resources, i.e., relevant archetypes and more specific stories, to construct a healing or disease management narrative. In some cases, the professional might know enough to do this personally. For example, general practitioners often provide simple healing narrative archetypes that are sufficient for their patients. However, the professional needs to judge the limits of her co-authoring ability. Sometimes that limit is one of bio-medical knowledge, in which case the patient might be referred to a specialist who can provide more specific treatment and more specific co-authoring. However, a general practitioner might recommend a colleague on the basis that their colleague just happens to have more experience in dealing with narratives of the relevant general type. For example, a young family might benefit from seeing a doctor who has the narrative resources developed from raising a family herself or a patient might benefit from the narrative resources of a doctor who shares her cultural background. For similar reasons, the professional might draw on the co-authoring potential of other patients. In group therapy, for example, each member of the group has narrative resources that can help the others. Together, they create a relatively safe environment for tentatively developing new self-narratives that could not easily be voiced or accepted outside the therapeutic setting.

To conclude, we all need to be somewhat vulnerable to co-authoring if we are to develop self-narratives. However, that vulnerability entails a risk of coercive or apathetic co-authoring, which can lead to the development of disvalued self-narratives and damaged authorial skills. The nature of self-narrative means that this damage can remain in the agent’s self-concept long after a detrimental relationship has ended. To rectify context-dependent vulnerability to co-authoring in one’s life, an agent needs to surround herself with co-authors who are sufficiently knowledgeable in the areas that she wants to develop. Those co-authors, including healthcare professionals, also have to be particularly sensitive to the reciprocal play of answerability so that they guide the redevelopment of the agent’s self-evaluative attitudes and authorial power. At the same time, the agent needs to be open enough to co-authoring to seriously consider, if not necessarily adopt, the narrative content others provide and to give weight to others’ verifications and challenges to her own self-narration. Yet, she cannot be so open that she accepts it without reflection because that would undermine her authorial power. If the agent can find appropriate co-authors and balance how open she is to co-authoring, then, over time, she will reclaim authorial power and edit coerced content out of her self-narrative.