Narrative reasoning is a central mode of clinical reasoning in occupational therapy. Therapists reason narratively when they are concerned with disability as an illness experience, that is, with how a physiological condition is affecting a person's life. In this paper, narrative reasoning is contrasted with propositional reasoning, and two kinds of narrative thinking are examined. The first is the use of narrative as a mode of speech that can be contrasted with biomedical discourse, in which disability is framed as physical pathology. The second involves the creation rather than the telling of stories. Therapists try to "emplot" therapeutic encounters with patients, that is, to help create a therapeutic story that becomes a meaningful short story in the larger life story of the patient.

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This paper offers a concept of clinical reasoning that differs from many of the traditional definitions of clinical reasoning in occupational therapy and the health professions in general. Here, clinical reasoning in occupational therapy is described as a largely tacit, highly imagistic, and deeply phenomenological mode of thinking. It is argued that clinical reasoning involves more than the ability to offer explicit reasons that justify clinical decisions because it is also based on tacit understanding and habitual knowledge gained through experience. Clinical reasoning also involves more than a simple application of theory, particularly theory as understood in the natural sciences, because complex clinical tasks often require that the therapist improvise a treatment approach that addresses the unique meaning of disability as it relates to a particular patient.

There is a growing interest in 'therapeutic narratives' and the relation between narrative and healing. Cheryl Mattingly's ethnography of the practice of occupational therapy in a North American hospital investigates the complex interconnections between narrative and experience in clinical work. Viewing the world of disability as a socially constructed experience, it presents fascinatingly detailed case studies of clinical interactions between occupational therapists and patients, many of them severely injured and disabled, and illustrates the diverse ways in which an ordinary clinical interchange is transformed into a dramatic experience governed by a narrative plot. Drawing from a wide range of sources, including anthropological studies of narrative and ritual, literary theory, phenomenology and hermeneutics, this book develops a narrative theory of social action and experience. While most contemporary theories of narrative presume that narratives impose an artificial coherence upon lived experience, Mattingly argues for a revision of the classic mimetic position. If narrative offers a correspondence to lived experience, she contends, the dominant formal feature which connects the two is not narrative coherence but narrative drama. Moving and sophisticated, this book is an innovative contribution to the study of modern institutions and to anthropological theory.