Feigned Narratives Do Not Always Satisfy Needs

Abstract

When Bradley Lewis announced in 2014 that psychiatry needed to make a "narrative turn", he backed up his appeal as follows: (1) the different explanatory models of mental disorders that are currently competing in psychiatry tell us different stories about mental health; (2) none of these stories has the privilege of being the only true one, and its alternatives the wrong ones; (3) the choice of a model in each case should be made in dialogue with the patient in order to ensure that the model will be chosen that best meets the patient’s goals and desires and, accordingly, would best support the process of recovery. The latter suggestion, however, is not easy to follow when the patients’ subjective goals and desires diverge from the clinical goal of returning the patients to a normal way of life, as is the case with the so-called factitious disorders. The problem is worsened by the theory-ladenness of the interpretations of patients’ first-person narratives. This paper argues against a common assumption that biases our understanding of abnormal behavior, in particular the behavior of those who feign illness. The assumption in question is the following: that such behavior satisfies certain – possibly unknown – psychological needs.