Irony is the expression of one's meaning by using language that normally signifies the opposite. Such expression would, prima facie, be anathema to appropriate and effective communication in healthcare settings which prizes and disciplines terse and univocal expression. However the use of ironic expression is often necessary in order to communicate complex, dynamic, and nuanced discursive locations and identities, as well as make reference to ideas, roles, actions, and settlements which exceed easy dichotomization and categorization. Three examples of these are (1) the social co-location of patients and caregivers; (2) their necessarily hybrid identities; and (3) the negotiated settlements of illness itself.

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Through a combination of conceptual analysis of Paul Ricoeur’s hermeneutics of irony, illustrated by literary examples and criticism of selected works from Kundera, Kierkegaard, and Borges, I argue that the uniquely fruitful ‘double vision’ effected through careful use of irony in healthcare contexts can respond to some problems raised in the three exemplary situations referred to above. As both a practice and transgression of aspects of narrative medicine, ironic expression can cultivate entry into the patient’s world while redescribing one’s own identities in the light of the encounter. Irony thus renders the plural commitments to self and other within the practical and material realities of caregiving. In so doing, the complex and dynamic construction of the nature of illness itself is disclosed as the horizon in which better outcomes for patient and caregiver must be situated and measured.

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