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Surviving Online: An Analysis of HowBurn Survivors Recover from Life CrisesJulien Christian Mirivel a & Avinash Thombre aa Department of Speech Communication , University of ArkansasPublished online: 28 Jun 2010.

To cite this article: Julien Christian Mirivel & Avinash Thombre (2010) Surviving Online: An Analysisof How Burn Survivors Recover from Life Crises, Southern Communication Journal, 75:3, 232-254,DOI: 10.1080/10417940903377151

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Surviving Online: An Analysis ofHow Burn Survivors Recover fromLife CrisesJulien Christian Mirivel & Avinash Thombre

This study is a qualitative analysis of e-mail communication between burn survivors.

Grounded in 200þ e-mail messages between participants of an online support group,

the study shows how burn survivors manage multiple, albeit contradictory, discourses

of recovery. Using a narrative approach, we first highlight how burn survivors manage

a tension between acceptance of their situation and resentment toward their circum-

stances. Then, we reveal how they cope with multiple meanings of beauty. Our study

shows that online support groups can also privilege or enforce particular ways of thinking

about recovery, such as valuing acceptance over resentment. In the conclusion, we suggest

that surviving is a communicative accomplishment and propose that practitioners should

engage in supportive communication without being patronizing.

Feeling really low today, keep on being horrible to my family. Been feeling so lowover the past couple of days, with the pain, not feeling well and the fact that I looklike an alien, and that I have to have another operation on my right eye lid on the29th of this month. I know this sounds awful, but I really wish there was an easyand a sure fire way of killing myself. I can’t keep on coping with all this. I can’t facemore surgery, more pain. People looking at me, people pitying me, having to livewith my parents when I am 30 years old. I really do have a great deal that I shouldbe grateful for, but . . . Sorry to be such a winger and put a downer on all of youwho are always so positive and strong. Sorry.

–Amanda, a burn survivor

Julien Christian Mirivel, Department of Speech Communication, University of Arkansas; Avinash Thombre,

Department of Speech Communication, University of Arkansas. Correspondence to: Julien Christian Mirivel,

PhD, Department of Speech Communication, University of Arkansas, 2801 South University Avenue, Little

Rock, AR 72204-1099. E-mail: jcmirivel@ualr.edu

Southern Communication Journal

Vol. 75, No. 3, July–August 2010, pp. 232–254

ISSN 1041-794x (print)/1930-3203 (online)

# 2010 Southern States Communication Association. DOI: 10.1080/10417940903377151

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Surviving a crisis is never easy. For people whose bodies have been burned, the scars

are more than physical; they are an ever-present reminder of struggle, pain, and

suffering. As the story above poignantly illustrates, burn survivors may wish to end

their lives or relinquish the drive to survive. What also is striking is how the writer

compares her appearance to that of an ‘‘alien’’ and expresses resentment for how

people stare at her. This, we would say, is a fundamental part of the experience of

being a burn survivor. That is, concerns about how to best cope with adversity

and managing the meaning of one’s bodily appearance lies at the heart of what burn

survivors experience daily. Grounded in narratives like the epigraph, this essay reveals

how burn survivors who participate in an online support group via a listserv talk

about how to recover from crisis and how to manage their bodily appearance. This

project is important for scholars to more fully understand the role of communication

in surviving burn injuries.

Our goal is two-fold. First, we give voice to those who need to ‘‘become storytellers

in order to recover the voices that illness and its treatment often take away’’ (Frank,

1995, p. xii) in part because ‘‘our most difficult duties as human beings is to listen to

the voices of those who suffer’’ (p. 25). Second, we extend current research on online

support groups and illness narratives by documenting how burn survivors manage

recovery through mediated interaction with other survivors or their families. This

essay will do more than describe communication that is consequential for parti-

cipants; we hope it will nourish empathy for practitioners and scholars alike. We

agree with Spiro (1993): empathy ‘‘underlies the qualities of the humanistic physician

and should frame the skills of all professionals who care for patients’’ (p. 7). The task

for communication research and theory is to make this possible.

The essay proceeds as follows. First, we describe the theoretical-disciplinary

approach that guides the study. Then, we introduce the project and the methods used

to collect and analyze the data. The core of the paper reflects an inductive, thematic

analysis of several months of textual conversation between burn survivors. Our

analysis reveals how burn survivors individually and collectively manage competing,

contradictory, discourses about health and beauty. In the conclusion, we consider the

implications of this one study for burn survivors as well as medical professionals who

work in burn units.

Theoretical and Conceptual Framework

Health Narrative Approach

First, this study draws on a health narrative approach (for a review, see Sharf &

Vanderford, 2003) to reveal how burn survivors recover in and through computer-

mediated narratives. The health narrative approach stems from social construction-

ism (Berger & Luckmann, 1966) and the constitutive model of communication (see

Craig, 1999, 2001). It is also influenced by the work of Fisher (1987). In short, this

perspective emphasizes that a ‘‘narrative is a fundamental human way of giving

meaning to experience’’ (Garro & Mattingly, 2000, p. 1). Originally used to reclaim

patients’ voices, this approach helped to cultivate the patient-centered model of

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medicine (Stewart et al., 1995) and narrative medicine (Charon, 1993, 2004). Today,

it reflects a dominant paradigm in health communication research. Consider what

the perspective foregrounds.

First, the health narrative approach distinguishes disease from illness. As Kleinman

(1988) explained, disease is ‘‘what practitioners have been trained to see through the

theoretical lenses of their particular form of practice’’ (p. 5). For physicians, disease

refers to the symptoms and disorders of the body. Illness, however, is how patients

experience disease; it refers to ‘‘how the sick person and the members of the family

or wider social network, perceive, live with, and respond to symptoms and disability’’

(p. 3). For example, cancer, for physicians, is a disease ‘‘characterized by uncontrolled

growth and spread of abnormal cells.’’ As an illness, cancer includes how patients and

family members experience the disease and includes dealing with death, managing

family life, and the difficulties that come with having cancer (e.g., J. O. Anderson

& Martin, 2003). Mishler (1984) suggested a similar perspective when he argued that

physicians and patients operate with a different voice; physicians speak the ‘‘voice of

medicine’’ and patients speak the ‘‘voice of the lifeworld.’’ As he explained, the voice

of medicine and the voice of the lifeworld represent ‘‘respectively, the technical-

scientific assumptions of medicine and the natural attitude of everyday life’’

(p. 14). While the voice of medicine sees only disease, the voice of the lifeworld

privileges illness. The health narrative approach, thus, values the perspective of the

sufferer and highlights that ‘‘storytelling is for an other as much as it is for oneself’’

(Frank, 1995, p. 17).

Second, the perspective emphasizes that narratives1 are imbued with cultural and

historical meanings. As Kleinman (1988) explained, ‘‘illness idioms [for instance]

crystallize out of the dynamic dialectic between bodily processes and cultural

categories, between experience and meaning’’ (p. 14). Garro and Mattingly (2000)

agree: ‘‘Creating a narrative, as well as attending to one, is an active and constructive

process—one that depends on both personal and cultural resources’’ (p. 1). As an

example, Kitzinger (2000; also see Wilkinson & Kitzinger, 1993, 2000) revealed

how cancer patients often talk about their recovery in terms of the value of positive

thinking with utterances such as ‘‘ ‘I feel very positive;’ ‘I started looking on the posi-

tive side;’ or ‘you just have to think positive’ ’’ (p. 122). These utterances are part of

an interpretive repertoire; that is, they reflect a culturally dominant, and habitual, line

of argument (see Lawes, 1999; Whetherell, 1998). In consequence, and as Kitzinger

(2000) argued, patients may ‘‘experience intense pressure to ‘think positively’ ’’

(p. 122). In short, the health narrative approach suggests that illness narratives lie

at the nexus of individual experience and cultural-ideological discourses.

Third, the health narrative approach suggests that illness narratives serve salient

functions. Sharf and Vanderford (2003), for example, argued that participants inter-

pret and make sense of events surrounding the illness (interpretive sensemaking) by

telling stories. Their review of the literature also revealed that through narratives

survivors assert control in the midst of crisis and reveal their decisions and choices.

In addition, patients’ narratives reflect changes in their identity as they become

transformed by the implications of living with, or healing from, disease. Many studies

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document these transformations. Thombre and Rogers (2009), for example,

documented how cancer survivors search for meaning by sharing their stories of

survival with others. As another example, Moi and Gjengedal (2008) showed that

burn survivors’ narratives function as an attempt to produce meaningful coherence

in their lives. Our point is simple: Narratives are an integral part of meaning-making.

Finally, illness narratives serve a community function. According to Sharf and

Vanderford (2003), communicators build community ‘‘by helping disparate indivi-

duals with common maladies provide support to one another, by raising public aware-

ness about specific issues inherent in experiences of illness, and by serving as highly

recognizable discourses for advocacy’’ (p. 27). A strong example of this function is

displayed in research by Adelman and Frey (1997), who examined how people living

with AIDS live and die together at Bonaventure House. The authors showed how

venting at support groups helped to build cohesion in a fragile community. Another

example is the success of the Susan G. Komen’s initiative to fight breast cancer and to

make it a part of everyday discourse. Stories, thus, often transcend the storyteller.

Sunwolf and Frey’s (2001) review of narrative communication research makes a

similar point. As they explained, a narrative ‘‘offers both a way of knowing and

remembering experiences, as well as providing a powerful structure for binding

together in a meaningful way seemingly isolated events’’ (p. 119). The authors suggest

that storytelling serves both cognitive and communicative functions. Narratives

bridge and connect people, construct the self, serve as explanatory accounts, produce

versions of reality, as well as mediate the past, present, and future. Narratives also

serve rhetorical functions; they highlight and obscure, reflect and invent, create

and transcend. To echo Austin’s (1962) famous work, narratives do things. For those

affected by illness and crisis, telling a story also is a way to heal and offer social

support (J. O. Anderson & Martin, 2003; Braithwaite, Waldron, & Finn, 1999; Kelly,

Soderlund, Albert, & McGarrahan, 1999). Illness narratives are thus fundamentally

therapeutic (Davison, Pennebaker, & Dickerson, 2000; Pennebaker, 1997); to com-

municate is to heal the self and others. This point is well displayed by the literature

on social support.

Social Support

Although narratives are personal communicative acts, they are often performed for

and=or with others. In fact, a central function of illness narratives is to offer support

for others. This is well visible in communication that occurs in support groups,

whether it is face-to-face (e.g., Barton, 1999; Stringer Cawyer & Smith-Dupre,

1995) or online (e.g., Shaw, Hawkins, McTavish, Pingree, & Gustafson, 2006, Wright,

1999, 2000, 2002; Wright & Bell, 2003). The literature on social support offers an

important framework to reflect about the functions of various communicative acts

in support groups, particularly those in which participants’ health is at stake

(Albrecht & Goldsmith, 2003).

By definition, social support is ‘‘verbal and nonverbal communication between

recipients and providers that reduces uncertainty about the situation, the self, the

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other, or the relationship, and functions to enhance a perception of personal control

in one’s experience’’ (Albrecht & Adelman, 1987, p. 19). Social support, communi-

cation researchers would suggest, nourishes the health of others as well as the self,

both physiologically and mentally. As Barnes and Duck (1994) described it, social

support includes all ‘‘behaviors that [. . .] communicate to an individual that she or

he is valued and cared for by others’’ (p. 176). The evidence from scholarship is clear:

‘‘[S]ocially supportive interactions are related to a variety of positive outcomes

including reducing stress (e.g., moderating emotional and psychological distress),

enhancing self-esteem, and providing tangible assistance with stressful experiences’’

(Caplan & Samter, 1999, p. 245). Social support also can help others manage

problems more effectively (Kohn, 1996). In one study, for instance, Wright (2002)

revealed that ‘‘social support is related to a greater sense of internal control over

cancer, reduced depression and anxiety over cancer, and members tend to experience

fewer symptoms and less stress than nonmembers’’ (p. 196). Overall, then, research-

ers know that social support has positive consequences on individuals’ health.

Research on social support also provides a vocabulary for analyzing com-

munication. For instance, the research shows that ways of providing social support

include informational support, emotional or esteem support, as well as instrumental

support (e.g., Braithwaite & Eckstein, 2003). In the context of health, Albrecht and

Goldsmith’s (2003, p. 265) review of the area suggested that

Helpful supportive resources include 1) expressions of encouragement, hope,reassurance, caring, concern; 2) feedback about one’s health behavior and healthrisks; 3) general health information and modeling of healthy behavior for healthpromotion; 4) facilitating coping; 5) provision of lay referrals to professionals inthe health system; and 6) assistance.

Research on social support, thus, shows that the communication that takes place in

online support groups is positively consequential for its members. Group members

benefit from empathetic support from others, have a safe avenue to disclose and

can build relationships with others (see Wright & Bell, 2003). But, and this should

not be underestimated, social support can sometimes be problematic. As Adelman

and Frey (1997) showed well in their study of people living with AIDS, ‘‘It is naıve,

however, to believe that social support always is helpful [. . .] reliance on others for

support often does not help a person’s self-esteem and may even produce the

opposite effect by promoting learned helplessness’’ (p. 52).

Online support groups, like the one in this study, offer an interesting site to exam-

ine the nature of supportive communication. One important facet of such groups is

that they function as weak ties. Weak tie networks are beneficial because (a) indivi-

duals are not constrained by the pressures and dynamics of close personal relation-

ships (Wellman, 1997), (b) they can obtain objective and=or new information about

their illness, and (c) they can benefit from a deeper understanding of their own

experiences (e.g., Wellman & Gullia, 1999). In their review of the literature on

health-related computer-mediated communication, Wright and Bell (2003) argued

that ‘‘much more research needs to be conducted in the area of computer-mediated

communication so that scholars can gain a thorough understanding of how the

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medium affects interpersonal communication’’ (p. 50). They also argued that future

studies should draw on the social support literature and advocated that ‘‘one

theoretical perspective that could be applied to the examination of different types

of groups would be the narrative paradigm (Fisher, 1987), since this approach focuses

on how participant worldviews are constructed through the use of personal

narrative’’ (p. 51). In this study, we answer these two calls to examine how social

support is managed, contested and sometimes resisted at the individual and group

level. We ask: How do group participants provide support when individuals and

the group struggle with the best way to survive and live?

In sum, the health narrative approach and the research on social support offer a

rich theoretical and conceptual framework to explore burn survivors’ written narra-

tives in an online forum. Specifically, we describe how burn survivors discursively

manage life after being burned. Our central goal is to make visible how burn

survivors reconcile multiple, contradictory, discourses of recovery. We show how

they negotiate their attitudes and stances toward life and death as well as explore

and debate what it means to be beautiful. We now describe the materials and

methods that anchor this study.

Methods

The Data

The data for this study were collected during 5 months between November 2005 and

March 2006. The materials are continuous discussion threads of 200þ e-mail

exchanges between members of Surviving Together,2 a listerv that people join volun-

tarily to seek or offer social support. Like all group life, participation varied. On some

days, participants were active in writing and responding. But, the group also went

through periods of nonparticipation. Participation was also affected by the topic that

was initiated. For instance, when newcomers e-mailed for the first time, many responded

quickly to offer support and welcome the new member. The listserv thus offers a form of

dialogic conversation (see R. Anderson, Baxter, & Cissna, 2004) for individuals in the

process of coping from a tragic burn accident. Family members, survivors, and friends

come together to tell their everyday stories and to reflect about their suffering, chal-

lenges, or difficulties. From describing the actual tragic event to advice giving about

how to cope with everyday life, the listserv offers a unique context to explore how those

affected by tragedy support each other in and through communication. The members on

the listserv correspond daily with hundreds of fellow burn survivors, sometimes care

providers, on issues involving burns, recovery, and continued care.

Data Collection Procedures

To conduct the study, and although the listerv is open to anyone, we first contacted

the organization’s CEO. After gaining his support to conduct the project, we submit-

ted a proposal to the Institutional Review Board and received approval. Then, one of

the authors subscribed to the peer support e-list services to gain access to the e-mails.

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Upon receipt, e-mails were placed in a word document to form a continuous thread.

The document, which is the primary data for this study, consisted of 181 pages of

single-spaced text.3

We did not contact listserv participants individually because we did not want to

interfere with, or influence in any way, the nature of the conversations and discus-

sions, or lead a group discussion about the study. However, we carefully protected

the confidentiality of participants in two ways. First, we replaced the names of par-

ticipants with pseudonyms. Second, we deleted identifiable information that could be

linked to a participant (e.g., names of family members or references to locations). We

were thus able to provide anonymity.

Data Analysis

The discussion threads were analyzed using an interpretive framework that is often

used to analyze oral narratives, transcripts of interviews, or texts. Lindlof and Taylor

(2002) use the term ‘‘analytic coding’’ to capture this analytic process. Analytic

coding involves ‘‘deriving codes and categories to capture major themes of relevance

to the study’’ (Braithwaite & Baxter, 2006, p. 35). Starting inductively, we examined

e-mails for common themes to sort out the main functions of participants’

communication exchanges. As the inductive process took place, we worked more

abductively, using our readings of scholarly research on narratives and social support

as theoretical lenses to make sense of the data.

In the beginning, we identified broad categories. Through further study, these

categories were refined into the themes presented in this article. As Braithwaite

and Baxter (2006) described well, ‘‘Analytic coding is an inductive process in which

a given datum is compared to prior data for its similarity or difference. Each time a

datum is perceived as different from prior data, a new coding category is added.’’

Categories, then, occur as an emergent process until ‘‘the coding categories as a set

do not require further modification with additional cases’’ (p. 35).

The two researchers actively participated in the inductive, heuristic process. In the

beginning, researchers worked independently to identify the major themes. The

newfound categories were talked about, debated, renamed and sometimes deleted.

This study, therefore, reflects our own communicative process.

Managing the Aftermath of Being Burned: Dominant Discourses

When crisis strikes, managing the aftermath is difficult. For survivors, postcrisis

events often means dealing with both physical and mental trauma; often, and because

the burns may never go away, the process of recovery is lifelong. For many survivors,

the postcrisis experience involves talking to other group members about the past

or the present. Through their discourse, both telling and responding to narratives,

participants seek to make sense of their everyday lives. But, it may be a challenge

to find meaning in life postcrisis without drawing on an existing cultural discourse

(Lieblich, Tuval-Mashiach, & Zilber, 1998). In fact, our analysis of burn survivor

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online’s discourse suggests that participants consistently draw on, and managed,

cultural ideologies of recovery. Specifically, we make visible the burn survivors’ talk

about how to recover and manage the postcrisis through contradictory discourses of

healing and beauty.

To proceed, we first display what is a major preoccupation of the group’s talk: scar

appearance and management. Then, we demonstrate the ways in which burn

survivors discuss their own and others’ recovery in terms of resentment and=or

acceptance. Finally, we make visible the group members’ struggle with the meaning

of ‘‘beauty’’ to argue for seeing beauty ‘‘on the inside’’ rather than ‘‘on the outside.’’

In short, our analysis suggests that burn survivors privilege a particular way of talking

(and thinking) about how one should recover. The value of this project is to help

scholars consider what recovery is and what it should be.

Managing Scars

Burn survivors naturally struggle with their bodies and its appearance, especially the

physical scars that remain from the incident. In response to living with scars, group

members discuss the best way to manage them. Many seek answers or ask questions

about scars; others give advice and support. One participant, for instance, sought

advice from the group: ‘‘Can anyone recommend a product for softening scars. I have

major burns to a lot of my body. I believe Lux Flakes added to bath water can be

helpful’’ (Karl).

This seemingly straightforward information-seeking question received immediate

responses by several members:

Joseph: I have found that emu oil and coconut oil helped a lot.Stacy: Rub, rub, rub and best way to make your scars softer is to get someone

massaging.Marc: I use saran wrap to heal my scars. I have done so much research on burns

and treatment since my injury, somehow thinking that maybe there’ssomething out there that the doctors just don’t know about. I doubt there’smuch, but I just feel like there have to be cheaper ways of managing scars.For instance, I talked to one person who said that NONE of the creamsworked for him but cocoa butter had worked wonders.

Anna: I wrote about this last year as well but I know there are always new peoplehere. I am almost 23 years post burn and I still experience itching, some-times it is even worse on my do not sites then my scars. What I have foundworks for me is taking vitamin D. As I take calcium I get my Vit. D with thecalcium pills. I am taking 250 IUD per day and I really notice the differencewith I forget for a few days.

Surviving Together functions as a support group. Some participants ask for advice

to manage a problem while other members respond to the inquiry. Seeking and

giving advice is important but it is both a strength and a weakness. As Albrecht

and Goldsmith (2003) noted, ‘‘computer-mediated support groups may increase

comfort in disclosing difficult topics [. . .] but may provide inaccurate information’’

(p. 276). Even though pieces of advice might not be supported by science and

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research, it can still work for individuals or provide hope. The bottom line is that

exchanging advice is an important form of social support.

In addition to discussing how to treat physical wounds or exchanging medical

advice, the group often turned to the issue of coping emotionally with the recovery.

It is, in fact, the emotional impact of having visible scars on one’s body that leaves its

own marks on the spirit and ultimately takes its toll. To manage their ‘‘new’’ physical

appearance and bodies, burn survivors revealed an emotional rollercoaster

constituted by moments of resentment and acceptance. We now document these

two discourses.

Managing Resentment and Acceptance

Having been burned on the body and sometimes disfigured, participants engaged in

conversations about their bodies by expressing feelings of resentment toward their

bodies, their crisis, or the meaning of life. These two excerpts make visible how

certain members of the group expressed resentment:

John: I hate these burns. I hate the scarring! I’m tired of weird looks. The traumamade my family think I’m a total quack!!!!! My anniversary is coming andI’d stop time just so it doesn’t come!!!!!!!!! I’ve gone through 3 counselorsand am starting on my fourth. People think I’m strong but I’m so weak.

Mary: I hold a lot of resentment for all that I have had to face and overcomebecause of my scars. Not a day goes by that I don’t look in the mirrorand wish them away. Wonder who I would be had I never been burned,but no matter how much I wish they are always there.

As cued in each of these examples, burn survivors express resentment toward their

bodies, their families, their scars, as well as strangers who only offer ‘‘weird looks.’’

Resentment is an inherent part of coping; it also is a call for social support. Where we

found messages of resentment, we also immediately encountered its counterforce: mes-

sages of acceptance and praises for the value of being burned. Consider two examples:

Terri: Many of us have lost what we used to do. How we accept is a big part ofour recovery isn’t it?

Jonas: Again, this is a normal part of the process. A lot of survivors (&, again, Iam talking globally—not just burn survivors) become very egocentric dur-ing the aftermath of their event. There is so much going on: recovery,financial worries, relationship issues with family=friends, etc. that ourworld becomes very small, that our focus centres ourselves. As we recoverand our situation improves, the blinders fall off and we gradually becomemore connected to the world around us. This is a good sign of youremotional healing and that you are truly getting on with your life. Thisis part of what separate the thrivers from the survivors, as is the abilityto graciously accept the foibles of those who are less enlightened.

In both messages, the writers emphasize the value of accepting one’s emotional and

physical state. In both e-mails, ‘‘acceptance’’ is framed as part of the natural process of

recovery. In the second e-mail, in particular, acceptance of self and one’s life is

described as normatively better; acceptance is for those who are ‘‘enlightened’’ and

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a ‘‘good sign of your emotional healing.’’ Many narratives, in fact, described accept-

ance as a superior state of being. But, some members of the group questioned the idea

that acceptance and resentment should be thought about as separate states of being. As

Carla put it, ‘‘I mean I hope eventually I will be at a point where I can accept myself

and my scars for what they are, but that’s a loooong way off, if ever.’’ Some narrative

accounts, as shown below, constructed the experience of recovery and healing by

navigating from acceptance to resentment, and back, in a single narrative:

Karen: I am a burn survivor 5 years of age now 42. I hate my burns also Ialways say why me; what did I do to deserve these scars. The way Iget over this is I try to think of someone in a worse situation thanmyself. This is the only thing that gets me through sometimes. Hangin there it does get easier.

Samantha: I believe that there must be some sort of plan for me. I’m still trying tofigure it all out. I have 3 wonderful children with my husband. Yet Istill wonder why I am still [alive] some days! I know they say timeheals a person, but I don’t think we ever actually heal mentally frombeing burned. We survive and do what we can with life, but not oneday goes by we don’t wonder what if! I hate that I can’t take my kidssledding because it’s too cold and my blood clots up in my legs. I hatein the summer that I have to wear jeans so people don’t stare at me infront of my children.

In both narratives, the writer makes sense of the experience of recovery by formu-

lating both resentment and acceptance. In the first example, the writer first expresses

resentment when she says, ‘‘I hate my burns’’ and asks, ‘‘[W]hat did I do to deserve

these scars[?]’’ Her next move, however, is to point toward a way of accepting her

situation and self: ‘‘This is the only thing that gets me through sometimes,’’ she says.

In her narrative, acceptance is the force that helps to deal with resentment. The

second narrative frames her situation as inescapable; surviving, according to the

narrative, is what life is about. Burn survivors, thus, propose their own stances and

attitudes toward recovery. Their ways of talking reflect strong stances toward either

resentment or acceptance; others include both forces in their accounts. At a group

level, however, the pressures to accept or conform are great; messages of resentment

can be seen negatively because they have consequences on others’ well-being.

As the theory of relational dialectics (Baxter, 2004a, 2004b; Baxter & Montgomery,

1996, 1998) suggests, interacting involves managing contradictory, but mutually

meaningful, tensions. Resentment and acceptance is a dialectical tension that also

was managed in the course of dialogue. Typically, the structure emerged when one

community member proposed resentment toward the scars and the healing process.

The next responses counteracted the resentment force that could affect others’ reality.

There always is the potential for personal comments to affect group climate

positively=negatively. Consider these exchanges.

Stacey writes:

I got 3rd degree to both my feet it’s only been 4 months but I just want them toheal and be fine. I saw my OT and they gave me some silicone gel sheets (Cica-care)which are fillers to fill in the space between my pressure garments that don’t give a

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perfect fit in those hard to reach spots between my toes. [. . .] I just want to haveone day that I don’t think about my burns, hopefully the day will come soon.

In an immediate response, Lauren wrote:

Everything you said sounds exactly right for your 4 months post burn timeline. TheCica-care did my arms the same way, couldn’t use it. Our bodies tell us what wecan tolerate and when. I used it again at about 12 months and did fine, but notvery long. By then, I was more comfortable with accepting the scars. The mentalpart is one day at a time and it changes like the weather. Surviving online has reallyhelped me. Just knowing I am not the only one like this is helpful.

Resentment and acceptance are part of the day-to-day reality of surviving. While

one member of the group experiencing a low point sends a message, other members

immediately respond with acceptance messages. The dialectic of resentment and

acceptance is not unique to burn survivors; whether one is facing challenges at work

or at home, facing AIDS (Adelman & Frey, 1997), or coping with tragedy, life is about

managing resentment and acceptance. For many burn survivors, the struggle is

constant because the physical scars never go away.

This community, we would say, privileges discourses of acceptance, because to

survive participants must believe that there is hope. The underlying expectation in

the discourse of Surviving Together is acceptance. Personal and cultural idioms

such as ‘‘staying positive,’’ ‘‘being strong,’’ ‘‘not letting go,’’ or ‘‘it will get better with

time’’ are privileged over resentment messages (Kitzinger, 2000). The underlying

logic is that resentment can be voiced, but it is nevertheless treated as problematic

and=or undesirable move by mere fact of contradiction. In the end, words of encour-

agement nevertheless serve their function; they help group members cope with some

of the most difficult moments of their lives.

Managing What It Means To Be Beautiful

Love to you all no matter what you look like.– Meagan

Physical appearance matters in U.S. culture. Sullivan (2001) explained, for instance,

that being attractive has significant social, psychological, and economical conse-

quences. For those who are meeting cultural expectations, there are serious benefits.

Mothers, for instance, pay more attention to attractive babies than nonattractive

babies (Langlois, Ritter, & Casey, 1995). Teachers think of their attractive students

as being more intelligent and competent (Ritts, Patterson, & Tubbs, 1992). Physicians

take attractive patients’ pain and complaints more seriously (Zebrowitz, 1997).

Attractive persons’ communicative messages are more likely to be perceived as

persuasive (Chaiken, 1979). The consequences of beauty, thus, spread through the

landscape of social life. It also is the case that one’s attractiveness affects the nature

of communicative contact. Communication researchers, for instance, have shown

that ‘‘physical attractiveness may determine if a person will approach another person

or not’’ and may ‘‘impact whether or not communication with another person takes

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place’’ at all (Richmond & McCroskey, 2008, p. 17). In short, one’s appearance is

communicatively consequential. When cultural ideals of beauty blend with a ‘‘body

project’’ mentality (Giddens, 1991), people will think of their bodily appearance as

the locus of their identity.

In examining burn survivors’ discourse, it became apparent that a large amount of

participants’ talk linked to issues of physical appearance. Burns do more than change

the bodily landscape; they affect participants’ sense of self, their encounters with

others, and how they see others see them (Laing, Phillipson, & Lee, 1966). That this

was the case was displayed in participants’ consistent complaints about their body.

Consider what two participants wrote:

Suzie: My name is Suzie. I know how you may feel because my whole face wasburnt and still is for over 37þ years. I could not afford to get an operation.I hope every day for a miracle or something. I have experienced and stillexperience crazy looks from people. It gets to me sometimes and I getdepressed but, I have to be strong for me. I also hate looking in the mirror,I do however, wear make-up it helps a little, I never leave the house with-out it. :) Sometimes I look like an older person ‘‘I HATE THAT SOMUCH’’ I just wanted to let you know that I’ve been there, and I knowhow you may be feeling. I hope things work out well for you. Ask Godto help you to be strong for you.

Sarah: These last few months have been very hard for me to cope due that the factthat I am a female teenager, and growing up in the last few years, its alwaysbeen about having the right clothes, the right look. Being burnt has severelychanged my life. There were times that all I did was cry every night due theway I look. Four months later, as each day goes by, I’m getting better andbetter. I know that its still going to take a long time for my skin to cometogether, and right now the scars are at its highest. It’s just so hard for meto cope with it, especially at this age. For all those that have been burnt formuch longer, how do you all cope with it??

Coping with the burned body, these excerpts emphasize, is to struggle with the

meanings of physical appearance and beauty. To think about how one looks is to reflect

about how others see us: ‘‘I see myself because somebody sees me’’ (van Maanen, 1990,

p. 25) or as the French philosopher Sartre (1956) put it, ‘‘I cannot be embarrassed by

my own body as I exist it. It is my body as it is for the other which may embarrass me’’

(p. 353). Suzie makes this point salient. As she puts it, ‘‘I have experienced and still

experience crazy looks from people.’’ It is how others make eye contact that brings

to life the feeling of being ‘‘depressed,’’ or in the case of Sarah to ‘‘cry every night.’’

The point is that managing the meaning of one’s ‘‘new’’ appearance also means to

manage one’s identity in the eyes of others; ‘‘being burned’’ implicates others.

Burn survivors reflect extensively about their physical appearance. As Hilhorst

(2002) explained, physical beauty ‘‘is not merely skin deep, but innately connected

to a person’s identity’’ (p. 11). The support group, then, is a space to sort out the

multiple meanings associated with beauty. In U.S. culture, there are several maxims

or beauty myths that pervade our discourse about beauty (see Langlois et al., 2000).

One cultural idiom is that beauty lies on the inside. People, from this perspective, do

not need to be physically attractive to be beautiful. It is a person’s personality, what is

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on the ‘‘inside,’’ that makes them beautiful in the eyes of others. Expressions such as

‘‘beauty is in the eye of the beholder’’ or to not ‘‘judge a book by its cover’’ perpetu-

ate the idea that beauty lies within. A secondary way of thinking about beauty is to

emphasize physical appearance: bodily symmetry, being slim and fit, and other fac-

tors help constitute a degree of beauty. In this section, we suggest that burn survivors

manage these contradictory myths as part of their recovery. Some survivors empha-

size that beauty lies on the inside; others take the stance that what makes someone

beautiful must also be located in their physicality. We first document these two ways

of talking about the body to then make visible how individuals and the group manage

these contradictory discourses.

Two Discourses About Beauty

A first way of thinking about beauty emerged when participants talked about their

bodily appearance by locating beauty ‘‘in the skin.’’ The physical structure and land-

scape of the body is, according to this view, the nexus of beauty. This conceptualiza-

tion of beauty infused participants’ talk about their bodies. For burn survivors, who

frequently report being stared at for how they look, it is not possible to forget that

beauty lies on the outside. If the skin is scarred or the face disfigured, it is both their

physical appearance and their social interaction with others that have been affected.

One example from Savannah makes this practice visible:

Savannah: I know where you are coming from regarding appearance. Even after ayear and a half I often look at myself and wish I could look normalagain, I guess my conclusion is that I will never look as good as Idid before so I have to make the most of what I have left. I like workingwith people and when I think about going to work—face it you arejudged by your appearance first. A company is judged by the firstperson that the client meets. Is there any employer who looks at meand is going to be willing to give me a chance to work for them andbe the first person that a client sees? No one is going to admit that theyaren’t willing to hire me because of my appearance but I have to berealistic about what is going to happen when I do start looking forwork again.

In her e-mail, the writer aligns with another participants’ e-mail with regard to the

topic of appearance. She mentioned that she ‘‘looks at herself’’ and that she wishes

that she ‘‘could look normal again.’’ As she states, ‘‘my conclusion is that I will never

look as good as I did before.’’ Through this move, the writer affirms that beauty is

physical appearance by marking that, because the body has been physically altered,

it also has ‘‘lost’’ its beauty. More important to her argument is that physical appear-

ance matters in social and institutional interaction; that is, people make judgments

about how people look in ways that carry consequences, such as being hired.

As visible in this excerpt as well as the two others above, it is clear that one version

of talking about beauty is to frame it as something that exists ‘‘on the outside.’’ This

way of talking permeated the group because it is hard to forget that physical appear-

ance matters: ‘‘I wish appearance didn’t matter, but of course it does. I have been a

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BS [burn survivor] since I was 8 years old and sadly, I can only see beauty in myself if

I am with someone who points it out to me’’ (Liz). In her e-mail, Liz highlights the

permanent struggle that burn survivors face: Their physical appearance has changed

and the scars are permanently visible.

A second way of thinking about beauty is to construct it as lying on the inside of a

person. In fact, many burn survivors advocated this version. For participants, this

is not a philosophical question; how to think about beauty and the body has conse-

quences for how to live and often means the difference between coping or not. The

point is not that group members explicitly verbalize the myth; this would be too

obvious. But, many group members’ messages are embedded with the cultural logic

that beauty lies on the inside:

Martha: The people in my life—me dad, sister & son — that would have a prob-lem with my looks I just choose not to be around, I don’t need their rudecomments about my looks—I have lost what little respect that I had forthem because of their attitudes. So I can’t really say how I would dealwith my family making comments about my appearance. Just know thatyou are still the better and stronger person for having come through thisand you are BEAUTIFUL! They are the one with the problem—not you.You are a very strong, beautiful, and incredible woman so hold your headup high and be proud of who you are. Take care and God Bless.

This survivor’s e-mail is a response to a narrative from another participant about

her mother’s remarks concerning her body. The group responded with outrage; some

asked for clarification, thinking that the e-mail reflected a typo or a misrepresen-

tation of what the writer was trying to say. In this excerpt, the narrator reassures

another survivor that she is not the problem, but that others ‘‘are the ones with

the problem.’’ The writer also emphasizes several times that the narrator of the

previous e-mail is beautiful. First, she casts her as a ‘‘better and a stronger person’’

and ends the sentence with ‘‘you are beautiful.’’ Her e-mail includes encouragement:

‘‘You are a very strong, beautiful, and incredible woman.’’ As many participants on

the listerv have not met each other, her comment cannot address the participant’s

‘‘outer’’ beauty. Within the context of this narrative, beauty is located within the self;

it is designed to refer to a variety of personality traits that together define what beauty

stands for. In fact, the writer’s use of the term ‘‘beauty’’ is clustered and thereby made

meaningful, by the use of ‘‘strong woman,’’ ‘‘incredible woman,’’ and normatively

‘‘better’’ in the sense of having character and courage. In short, the claim that beauty

lies on the inside is brought to life through personality traits that are seen as virtuous

or admirable. Strength, courage, and character become what beauty is about.

As participants defined what is beautiful, they shaped its semiotic meaning by

contrast. When beauty lies on the inside, it is personality that matters. What becomes

‘‘ugly’’ then, also, must be cued. For many, the contrasting terms were shallowness

and vanity. The following excerpts illustrate how these meanings were constructed

through individuals’ discourses:

Jessica: This morning, this raving burned beauty still got a kiss on the cheek byefrom my husband John before he went to work. Some of you young folk

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are concerned about will you have love in your future. Keep a good attitudeand wait patiently for the right person. You will attract the right person like aPhoenix to a Flame. Everyone in the world is not shallow or vain, there arereally nice people out there and I have met a lot of them right here.

Niomi: Just for old time sake cause that was the last time in my life I felt reallybeautiful in a swimsuit. Some of my friends here can’t relate to thatbecause they burned so bad that all their life they never got to remembera not-burned time. Many of you have always had to deal with your realreality value as a person & the true beauty of the inner or hidden person.You never got to have any of my ‘‘shallow and vain’’ years. I use to seedisfigured people and I would be so sorry for them. I would for a briefmoment be thankful that I didn’t have to look like that.

In Jessica’s case, we find similar characteristics. To be seen as beautiful, one must have

a ‘‘good attitude, be patient, and nice.’’ These traits, according to the writer, also are what

define (most of) the burn survivor community. This kind of beauty is what makes love

and (sexual) attraction possible; ‘‘beauty on the inside’’ will help survivors seeking love

to find their ‘‘phoenix.’’ Beauty, in Jessica’s narrative, also is framed through contrasting

terms: ‘‘shallowness’’ and ‘‘vanity.’’ In this sense, the narrator also (re)defines ugliness.

Similar moves are being made by Niomi as she reflects on two of her own identities:

the person she was before being burned (precrisis) and the person she is now (post-

crisis). The narrator first appeals to ‘‘beauty’’ as residing on the outside when she says,

‘‘I felt really beautiful in a swimsuit.’’ As the story proceeds, however, she contrasts this

notion of beauty with the ‘‘real reality’’ or ‘‘value’’ of a person, which she defines as

‘‘true beauty of the inner or hidden person.’’ Inner beauty, then, also is ‘‘true’’ beauty.

But, and as cued by her utterance ‘‘you never got to have any of my ‘shallow and vain

years,’ ’’ she also frames the idea that being beautiful on the inside is normatively

better. That is, through her story, she constructs herself as being more beautiful today

than in the past: She has learned what ‘‘real’’ beauty is.

From making complaints about their bodies, discussing how others gaze at them,

to complimenting each other’s inner beauty, burn survivors construct an understand-

ing of what beauty is. They also struggle with the meaning they seek to privilege. That

is, burn survivors cannot solely determine that beauty is one or the other. They must

manage both cultural meanings simultaneously. In fact, burn survivors manage these

two contradictory discourses.

Managing the Contradictory Discourses

Burn survivors’ narratives revealed the group’s attempt to sort out the meaning of

beauty. When self-deprecating remarks or complaints about one’s body were made,

many others responded. Our analysis suggests that burn survivors individually and

collectively manage, and argue about, the meaning of beauty.

From an individual standpoint, some e-mails exposed the tension between these

two ways of thinking by calling attention to the fact they these discourses coexist.

In other words, some e-mails, like the one from Michelle, argued that beauty is both

on the outside and on the inside.

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I agree that appearance shouldn’t matter, and that we really shouldn’t care whatothers think about how we look, but is that realistic? I know for me at least Ihaven’t been able to draw that line. On the one hand of course I want to say screwyou to everyone who makes comments about my burns or looks at me funny, oreven when my mother tells me how disgusting they are. But is it possible to justshrug these off? Especially in a world where appearance matters quite a bit, I thinkthat it’s only natural to be affected by these types of things and to be extra aware ofhow different we look. I mean I hope eventually I will be at point where I canaccept myself and my scars for what they are, but that’s a loooong way off, if ever.

In this moment, the writer takes two simultaneous positions. First, Michelle

acknowledges that ‘‘appearance should not matter.’’ In making this claim, she speaks

of the ideal that is embedded within the ‘‘beauty on the inside’’ discourse. If beauty

lies on the inside, then, appearance should not matter. But, and second, she argues

that appearance does matter (i.e., ‘‘in a world where appearance matters quite a

bit’’). In making these two propositions, she frames beauty through the lens of

realism and idealism. The realist claim posits that beauty, because it cannot be sepa-

rated from physical appearance, matters. That is, it is not possible to live without

being seen (and judged) through the lens of physical appearance. This is a pressing

phenomenological problem for survivors: Scars and burns are visible to others; cour-

age (or other virtues) is not an immediate perceptual lens through which to interpret

and judge others. But, and as she cues by the use of the term ‘‘should,’’ if beauty lies

on the inside, it is an ideal that does not always materialize in practice. This point is

once again well illustrated in an e-mail from Liz:

I wish appearance didn’t matter, but of course it does. I have been a BS since I was8 years old and sadly, I can only see beauty in myself if I am with someone whopoints it out to me. I was married for 8 years and while married I thought I wasbeautiful, I guess because my husband thought I was beautiful. But now that Iam divorced I don’t see myself as an attractive woman. Isn’t this silly? I have beenburned most of my life and still I have trouble accepting it at times. I work in thehospital as a nurse, which I like, but almost every week a patient asks me whathappened to me. I guess because I have been reminded all the time of my burns,it’s just hard for me to feel like everybody else.

Our point, as cued by the two excerpts above, is that participants’ own individual

narratives and arguments were embedded with the contradiction of seeing beauty as

an internal versus an external state. In their stories, participants sought to manage

these incompatible cultural meanings. Burn survivors also managed the dilemma

at a group level. The tensions became most visible when advice was being given about

how to act in response to others’ gazes. Consider these two excerpts:

Patrick: I read these messages every so often and as just as a reminder, I was in anairplane crash and burned 36%. As far as what other people think aboutyour appearance, I say SCREW THEM, they have no idea what hashappened to you or what you have been through to get better. Peopleget so caught up in their lives, that when something like this happens,we burn victims learn real fast how precious live is. So I say, SCREWTHEM, WHAT OTHER PEOPLE THINK ABOUT YOUR APPEAR-ANCE. Sorry if I seem so harsh, but this is my feeling.

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In response, another survivor named Daniel claimed:

I agree it’s best to ignore the comments and attitudes from people who don’t likehow we look. But there is a flip side. Most of us want not only to be accepted, butenjoyed. Certainly we want more than just tolerance. My hands look pretty goodnow, but when someone recoiled last year when I offered to shake hands, it wastough to take. I’m married and I’m healing well, but I still like to feel my wifeenjoys looking at me and I would be very self conscious about my three differentskin tones and the scars if I were ‘‘in the market.’’ As Judy points out, looks andsuperficialities seem to count for a lot these days and it’s tough to find peoplewho see through them. Of course, those who do see through the superficialitiesare often the finest people around. And we need to be able to look past them aswe look for affection, appreciation, and intimacy. These burns are a challenge,and I do believe we are better for rising to that challenge.

In the first e-mail, Patrick takes a relatively firm tone to convey his message. His

advice is to not care about ‘‘what other people think about your appearance.’’ He

repeats several times ‘‘screw them’’ to position this view. His argument is grounded

in the ideal that physical appearance should not matter. But, when he raised this

position, many responded with alternative positions. In the second e-mail, Daniel

seeks to strike a balance. Ignoring ‘‘the comments and attitudes from people’’ is best,

but ‘‘most of us want not only to be accepted, but enjoyed.’’ The writer’s counterpo-

sition is that ‘‘looks and superficialities seem to count for a lot these days.’’ As Patrick

argues to not worry about what others think, Daniel responds by acknowledging the

difficulty of handling what many participants saw as tough circumstances: ‘‘when

someone recoiled last year when I offered to shake hands.’’ Similarly, and as Elizabeth

reported, ‘‘No one is going to admit that they aren’t willing to hire me because of my

appearance but I have to be realistic about what is going to happen when I do start

looking for work again.’’

As participants explain their stance, the group faces, and communicatively

manages, the contradiction of two dominant cultural idioms. Beauty is both ‘‘on

the inside’’ and ‘‘on the outside’’ because our ways of talking reflect and constitute

these idiomatic stances. The reality of social life is that how one looks matters but

also that people can move past the scars to see beauty in the qualities and traits of

a person. This is, in fact, what communication researchers would posit: Attraction

is not just physical but a facet of a person that can change in the course of interaction

with others. From a communication standpoint, then, a person can ‘‘gain’’ or ‘‘lose’’

degrees of attractiveness. We naturally wonder what the conversation would be like if

the group talked about beauty in those terms.

To conclude, Surviving Together offers a discursive space for managing the

meanings of beauty, but the group naturally enforces a dominant frame of reference.

When it comes to beauty and appearance, we would say that the discourse that is privi-

leged is the idealist discourse of beauty, which situates beauty on the inside. The domi-

nant message across e-mails is that burn survivors are the ‘‘beautiful ones’’ because of

who they are (i.e., survivors). In doing so, the group constructs its members in contrast

to those who have not been burned. In a powerful narrative, Emily puts it strongly: ‘‘I

feel that we as burn survivors have been through a life changing experience that so

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many others would have never made it through. [. . .] We have a strength beyond what

many others dream of having.’’

Conclusion

In this study, we have reconstructed burns survivors’ shared experience in terms of

the dominant ways of talking (and thinking) that prevail. Our analysis suggests that

burn survivors who send and respond to e-mails manage contradictory discourses,

which by their nature reflect the challenges and difficulties of what it means to live

with burns. Specifically, we showed how group members communicatively construct

the experience of ‘‘being burned.’’ The study suggests that participants constantly

manage (a) resentment toward their situation and their bodies as well as acceptance

of their transformative journey and (b) multiple meanings associated with beauty.

More importantly, we see group members privileging, perhaps enforcing, a particular

discourse that asks its members to conceive of their bodies as ‘‘beautiful from the

inside’’ and to accept their crisis. We see several implications from this case study.

First, the findings underscore that recovering from traumatic events, and engaging

in social support, is a dialectical process characterized by relational and group-level

contradictions, which are also imbued with cultural meaning. As Baxter (2004a)

explained, ‘‘contradictions are located in the relationship between parties, produced

and reproduced through the parties’ joint communicative activity’’ (p. 121). This

study makes visible ‘‘how contradictions are enacted’’ (Baxter, p. 122) in naturally

occurring conversation. The findings, in fact, extend our understanding of how social

support operates in computer-mediated support groups and refines our understand-

ing of what it means to recover from crisis. Surviving, we showed, is first and

foremost a communicative accomplishment.

Our study showed that the group privileges ways of thinking about recovery. For

instance, the group pressures its participants to accept one’s circumstances, which,

could be argued, is also a form of group control. Interestingly, then, this study shows

that social support is managed, contested and resisted, rather than simply sent or

offered. A constitutive view of social support, thus, makes visible that communicative

messages serve multiple functions at once and that group members create and

struggle over competing ways of thinking about recovery. Social support is not

transmitted; it is created through group interaction.

Our first suggestion to burn survivors, then, is to respect and welcome the contra-

dictory nature of healing and recovery. The value of being part of a support group is

that participants can manage these contradictions in relationship with others and can

articulate what it means to survive. It is worth remembering that the contradictory

nature of recovery is an inherent part of what it means to survive. Burn survivors,

thus, should openly embrace their own as well as others’ contradictory accounts. It

is the act of expression that matters most.

A second suggestion relates to the group’s talk about beauty. In general, talk

about beauty focused exclusively on attempting to sort out where beauty lies, but

it is worth remembering that beauty and attractiveness also are communicative

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accomplishments imbued with culture; ‘‘physical attraction’’ fluctuates depending on

how people act. Thus, it may be to burn survivors’ advantage to think of beauty not

as a state of being but as an emergent and dynamic process.

We hope that this study functions as a pathography of sorts, because ‘‘stories from the

inside help nourish empathy’’ (Spiro, 1993, p. 5). There is a long-lasting goal in health

communication research to help physicians become more patient centered (see Street,

2003; Stewart et al., 1995; Thompson, 2003). Today, more than 80% of medical schools

teach interviewing methods influenced by the meta-model of patient-centered medicine

(Vanderford, Stein, Sheeler, & Skochelak, 2001). We agree with Spiro (1993) that medi-

cal professionals and future physicians need to build a reservoir of empathetic under-

standing to practice patient-centered communication. Health narrative scholarship,

thus, cultivates empathy by extending the voice of survivors. In this sense, this study

can serve as reading material to humanize medical students and professionals who work

in burn units. Health narratives can be the counterforce to the dehumanizing practices

that persist in medical school (Scheibel, 1996; Smith & Kleinman, 1989).

For medical professionals who play a crucial role in burn survivors’ recovery, this

study emphasizes that being burned is more than a physical trauma. Recovering from

burns is also about managing a new bodily identity, sorting through the meanings of

beauty, and finding a meaning in life. Many survivors will also deal with phases of

resentment and moments of acceptance. Survivors will also reflect about how to

survive, live, or die; when they do so, they depend on salient cultural-ideological

resources. Surviving from crisis, thus, is also a cultural act. One stance we encourage

professionals to take is to engage in supportive communication by giving advice,

answering questions or concerns, as well as offering words of encouragement without

being patronizing. But, we also encourage professionals to not pressure survivors

toward acceptance or to simply suggest ‘‘to think positively.’’ Respecting the fact that

surviving is an activity that involves both acceptance and resentment can make a

difference. In many ways, professionals would benefit from joining a listserv that

aligns with their specialty, even if it is to listen to the voices of patients who struggle

in their recovery. They could also be more active by joining the discussion when the

group focuses on medical issues and problems.

As a next step, future research in this area should pay heed to the subjective

meaning-making process of recovery that accompanies traumatic events. One

approach that would be beneficial is to examine how individuals within support

groups are transformed by the communication process itself. For example, one

relevant question to pursue is: What acts of communication make the most difference

in helping others recover from crisis? Any light that communication scholars can

shed on the process by which survivors begin to ‘‘live again’’ would be important.

For a richer understanding of how individuals get transformed through the process

of surviving a trauma, we urge future scholarship to combine the communicative and

biomedical approaches. Ongoing investigations should build a body of research that

accounts for how communicative actions serve as acts of agency and healing. A hol-

istic approach that is attentive to personal, group, as well as social and cultural ideol-

ogies would be especially desirable. Studies like this one can help in this endeavor.

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Finally, we see burn survivors’ narratives as particularly telling stories of survival.

To listen to their voices is to also recognize that ‘‘one’s own experience are the

possible experiences of others and also that the experiences of others are the possible

experiences of oneself’’ (van Maanen, 1990, p. 58). Support groups, whether they are

online or face-to-face, serve this important function: They help the self and others

find meaning in experience. Learning about how burn survivors survive and recover

is thus to recognize that there is meaning in suffering. As Frankl (1959) puts it, ‘‘We

must never forget that we may also find meaning in life even when confronted with a

hopeless situation, when facing a fate that cannot be changed. For what then matters

is to bear witness to the uniquely human potential at its best, which is to transform a

personal tragedy into a triumph’’ (p. 135).

Notes

[1] We use the term ‘‘narrative’’ as an elastic term to encompass many activities, including the

actual telling of a story as well as the overall communicative practice of speaking about

events and concerns in one’s life, whether this is done online or in face-to-face interaction.

The term, as Garro and Mattingly (2000) point out, poses an important terminological chal-

lenge. However, we align with Fisher (1987), who argued that human beings are essentially

homo narrans, ‘‘a species distinguished by its ability and predisposition to tell stories’’ (Sharf

& Vanderford, 2003, p. 14). In essence, we agree with the authors that ‘‘the most common

way of communicating our personally constructed ideas of the realities we experience is

through the social sharing of narratives—stories about our lives’’ (p. 14).

[2] All names that appear in the study, including the name of the group and participants, are

pseudonyms.

[3] E-mail messages included in the data were sometimes written by the same participants.

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