Subversion

This chapter explores the second stage of the metagnostic narrative arc: subversion. Following the conception of a metagnostic revelation as both recognition and misrecognition, it examines the ways in which the revelation may unsettle labels and categories. First, central concepts of disability studies are introduced and explored, and it is suggested that terms such as disability and impairment are illuminated and interrogated by a metagnostic revelation, as it breaches the expected mapping between body and classification. Indeed, situating a given revelation requires a sudden renegotiation of the ontological balance between biological impairment and socially constructed disability, and also subverts customary narrative strategies for situating disability. Second, the individual’s relationship with a given disease is seen anew and challenged in light of metagnosis, as are concepts of disease, illness, and sickness. This chapter also serves as an introduction to key concepts in disability studies and philosophy of medicine.

Recognition

This chapter begins Part III: Seeing Metagnosis, which explores the narrative arc of metagnosis itself, including the stages of recognition, subversion, and renegotiation. Here the subject is recognition, the first metagnostic stage. Beginning with the model of passing, it traces experiences and forms of recognition through real-world examples as well as those drawn from speculative fiction literature and film, particularly Blade Runner. Drawing upon recognition’s conceptualization—from Aristotle to twentieth-century science fiction editors to literary theory and criticism—it describes a form of misrecognition which characterizes, too, the experience of metagnosis, in which the terms of knowledge have shifted.

Blindsight

In situating the author’s retrospective visual field “defect” revelation, this chapter begins with the neurological condition of anosognosia—being unaware of a disease—exploring its manifestations and philosophical implications. In addition, another means of understanding the author’s visual field “defect” emerges in the figure of “blindsight,” or unconscious vision. Tracing the relationship between vision and thought in the Western philosophical tradition as well as the philosophical role of blindsight, the chapter then proposes that blindsight models a particular epistemic stance encompassing the known and unknown, one which will prove useful in addressing the phenomenon of metagnosis and beyond.

Halfsight

Here the author continues her ophthalmic narrative, describing the surprising revelation of a long-standing, yet undetected, condition—a visual field “defect.” Discussing the narrative frames of diagnosis, questions of medical error and uncertainty are addressed. The particular challenges of accounting for a retrospective revelation are explored in detail, invoking themes of narratology, communicability, intelligibility, metaphor, and semiotics. In addition, the ways in which metagnosis invokes various stances toward the relationship between narrative and identity are investigated. This chapter offers an introduction to key concepts in illness narratives, narratology, semiotics, and narrative identity theory, discussed in relation to the author’s experience.

Flatsight

This chapter begins Part II: Sight, wherein the author recounts her own metagnostic narrative concerning vision. Describing the experience of having strabismus and “lacking” stereoscopic vision, the author’s story is put into conversation with others, deploying narrative scrutiny and exploring themes of communicability and alterity. From nineteenth-century Flatland to “Stereo Sue” to Oliver Sacks, these stories raise questions about the degree to which it is possible to imagine other ways of seeing; philosophical debates about the nature of qualia, or phenomenal experience; and the potential consequences of telling a given story. This chapter also offers an introduction to key concepts in the analysis of illness narratives, and it begins to unpack the particular challenges accompanying metagnostic revelations.

Diagnosis

This chapter describes the phenomenon of metagnosis, defined here as a revelation of a long-standing undetected condition effecting a change in the terms of knowledge. In the medical sense, it can occur when a condition has remained undetected and/or when the diagnostic criteria have shifted, as with autism spectrum disorders. It also describes nonmedical revelations of knowledge bearing upon selfhood, such as unexpected genetic test results. The phenomenon’s relevance to individuals who experience it and to clinicians is discussed, as it offers a potentially new framing of identity and experience. In addition, its relevance to our understanding of medical knowledge as such is explored, for it alerts us to the presence of unknown unknowns and prompts us to reconcile this awareness with our conception of diagnosis and clinical authority. Finally, the plan for the book is outlined, its thesis and structure summarized.

Metagnostic Narratives

This chapter begins Part IV: Looking Forward. It explores a selection of metagnostic stories drawn from memoir and oral history, tracing the narrative trajectory of recognition, subversion, and renegotiation and comparing a range of accounts. First are revelations of autism spectrum disorder, in which individuals absorb a diagnosis in midlife and seek to reconcile it with their experience, often renegotiating the terms of identity, normalcy, and pathology. Second is a discussion of prosopagnosia, and particular experiences understood in the context of an individual’s life experiences. Third is ADHD as a paradigmatic case of contemporary metagnosis, given its changing criteria and prevalence, raising questions concerning medicalization and the role of pharmacology. Fourth is synesthesia—not understood as pathological, but offering a complementary metagnostic example. Throughout, the themes and patterns of these accounts are discussed in relation to the metagnostic narrative arc discussed in Part III.

Treatment

This chapter describes the narrative medicine methodology of this project, comprising three pillars. First is interdisciplinarity, bridging clinical and scientific research; history of science and medicine; literature and film; literary criticism and theory; and philosophy, among others. The use of rhetoric in such discourses is discussed, as well as the opportunity for meaningful critique in truly transdisciplinary work. Second is narrative attentiveness toward creative and clinical texts, illuminating and critiquing their rhetorical forms and effects. Third is the creation of a challenging writerly text—in this case, in moving between different roles, such as that of diagnostician, patient, critic—and highlighting the author’s own embodied experience, inviting the reader’s active involvement. This orientation shifts the narrative medicine emphasis on the clinician as reader/listener/interpreter to a mutually participatory engagement in which those in the patient role are understood as writerly readers. Finally, the figure of blindsight as a “prescription” for metagnosis is introduced.

Freedom

This chapter returns to the narrative medicine methodology discussed in Chapter 2, elaborating upon the relationship between literature and medicine and proposing that metagnosis is the key to making a readerly/writerly diagnosis. As literary movements such as metafiction expose the fallacies and limitations of literary realism, metagnosis constructively exposes the representational practices of biomedicine. The confluence of metagnosis and metareferentiality is explored in the work of contemporary comedian Hannah Gadsby. In addition, the implications of metagnosis are shown to extend beyond the context of health and medicine to revelations concerning identity (e.g., Dani Shapiro’s Inheritance) and to the cultural discourse of identity writ large (e.g., Appiah, Haider, Zadie Smith). Understanding metagnosis as a revelation effecting a change in knowledge—and employing our blindsight to address the apparent binaries structuring our understanding—is integral to our understanding of ourselves and of identity itself as we move into an increasingly dynamic future.

Renegotiation

Following the narrative stages of recognition and subversion, metagnosis often provokes a renegotiation of the terms which have been unsettled—the third stage of the metagnostic narrative. Drawing analogies with a range of contexts such as historical diagnosis, historiography, literary interpretation, and translation, this chapter frames the issue in epistemological and semiotic terms, asking how it is possible to effect a renegotiation. It is proposed that the pragmatic theory of the sign offers a path forward, alongside blindsight as a strategic epistemic stance. Metagnosis demonstrates that positivism and constructivism can be understood in relation to one another, joining a range of strategies and theorists such as Soja, hooks, Haraway, and Sandoval.