Diagnostic knowledge

pp. 153-169

in: James A. Marcum, Humanizing modern medicine, Berlin, Springer, 2008

Abstract

"There are two modes of cognitive functioning, two modes of thought," according to Jerome Bruner, "each providing distinctive ways of ordering experience, of constructing reality" (1986, p. 11). The two modes of cognitive functioning are paradigmatic or objective and narrative or subjective.1 They represent distinct kinds of knowing and are not only irreducible to each other but are also complementary to one another. The first mode of knowing, paradigmatic-Bruner's preferred term-"attempts to fulfill the ideal of the formal, mathematical system of description and explanation. It employs," he continues, "categorization or conceptualization and the operations by which categories are established, instantiated, idealized, and related one to the other to form a system" (1986, p. 12). Paradigmatic knowing depends upon empirical verification and rational skills to develop a sound argument.Narrative knowing, however, "deals in human or human-like intention and action and the vicissitudes and consequences that mark their course. It strives," Bruner claims, "to put its timeless miracles into the particulars of experience, and to locate the experience in time and place" (1986, p. 13). It is concerned with a good story that reveals the human condition. Sarah Worth (2008) substitutes the term "discursive" for Bruner's term paradigmatic or logico-scientific, because discursive depicts best the immediateness or directness of reasoning and knowing. In this chapter, her terminology is adopted.