Narrative Psychiatry Research Articles

Shame and the moralemotions: Issuesin cross-cultural clinicalpractice.

Three interrelated topicsare examined in this paper. These are (1) the study of shame and the other moral emotions (guilt, regret, remorse) as it relates to clinical approaches in cross-cultural psychiatry; (2) the examination of methodological problems and choices in researching and treating shame in persons who have experienced forced departure from their country of origin and immigration into ambivalent host countries, in which shame experienced as part of the power differentials between host and refugee is added to whatever shaming experiences the person endured within the violence of the country of origin; and (3) an examination of the suitability of evidence-based psychiatry(EBP) and narrative psychiatry as vehicles for providing clinical assessment and care that is scientifically rigorous and also establishes a reciprocally respectful relationship between two humans working on a single task of developing and understanding the life story of the person who has experienced the stresses of life as a refugee. The three topics outlined above (shame viewed at many levels; experience of entering and receiving hospitality from a host country fraught with political resentment and bureaucratic institutional procedures, yet holding the possibility of rebuilding a life with the support and assistance of the healthcare professions and other agencies; the limitations of EBPand suitability of Narrative Psychiatry are discussed at theoretical and practical levels as these domains interact in seeking, through a true partnership, the common ethical goals of providing the best course of action for this patient at this moment. We present two case vignettes as illustrations of how shame or respect arises and is responded to in the context of a psychiatry session.

No Pills, but Letters. Saul Bellow’s Herzog: The Recovery of a Depressed Academic

In this article, I discuss the illness and recovery of the depressed Moses Herzog, the protagonist of Saul Bellow’s novel Herzog (1964). Using this novel as a case study, I criticize a one-sided (neuro)biological and drug-based approach to depression. Referring to the hermeneutic anthropology of philosophers like Paul Ricoeur and Marya Schechtman, I argue that the treatment of depression could benefit from a broader approach that takes into account existential and social-cultural factors as well as biological factors. I suggest that narrative psychiatry offers a framework wherein various models of mental illness may be combined in ways that move beyond a pro/contra bio-psychiatry binary. By investigating depression using philosophical ideas and a literary text, this article aims to illustrate how the humanities may contribute to our thinking about depression.

Narrative psychiatry: Healing through storytelling

IntroductionWe all have the innate ability to tell our story and the way we do it can determine the impact that each problem has on our lives. Storytelling can play a critical role in psychiatric practice and, from this premise, a new way of practicing psychiatry has recently emerged: narrative psychiatry.ObjectivesThe objective is to offer a unified vision of narrative psychiatry, providing details on the historical and academic context of this approach.MethodsA narrative-type literary review focused on narrative psychiatry will be presented.ResultsNarrative psychiatry is an innovative clinical approach in line within narrative medicine and with a specific subtype of postmodern psychotherapy, the narrative therapy of Michael White and David Epston. This novel way of practicing psychiatry arises from critical movements within the discipline but it is an integrative and collaborative perspective: the position of each problem in the patient’s personal narrative is discussed and different therapeutic proposals are addressed, including for instance psychotropic drugs. This integrative posture gives the narrative psychiatrist enough flexibility to equally integrate the scientific achievements of biological psychiatry and the humanizing component of narrative practice. In this literature review, the key tools proposed by the main narrative psychiatrists worldwide for the narrative clinical interview will be exposed.ConclusionsNarrative psychiatry is a novel approach that narrows the therapeutic relationship and that puts in evidence the history of resistance of the consultant, healing through its own storytelling.

Narrative Psychiatry and Family Therapy: Promoting Resilience and Collaboration with Persons with Intense Mental and Emotional Experiences at Risk of Causing Violence

Narrative psychiatry identifies meaning‐making as a primal force in our lives and guides family therapists and psychiatrists in cultivating narratives of resilience that support safety and wellbeing when working with families in which a member is dealing with intense mental and emotional experiences and may be at risk of causing violence. These contexts are fraught with implications about power, control, identity, and ethical responsibilities of care for those consulting with us and for the wider community. Offering benefits distinct from pathology‐focused psychiatric practice, narrative psychiatry applies the practices of narrative therapy in psychiatric contexts, focusing on strengths and meaning and honouring how values, intentions, and commitments compel and constrain our actions. Illustrated by case conversations, this paper describes five key practices of narrative psychiatry, including emotional attunement, understanding the person without the problem, externalising problems, creating narratives of resilience, and collaborative treatment planning. It shows how narrative psychiatry facilitates risk reduction through helping a person identify values and narratives that support non‐violence and strengthening abilities, relationships and resources that help them stay true to this commitment. Practical ways that family therapists and psychiatrists can use conversations about resources, including medicines, to deconstruct damaging discourses and generate narratives of resilience are described. Discussion is offered about how narrative psychiatry can support clinicians in ethically negotiating clinical dilemmas in which the preferences of the person or family are in conflict with the clinician's ethical and legal duty to protect life.

Can I Author Myself? The Limits of Transformation.

Narrative medicine is predicated on the importance of narrative to human life. Although that in itself is not controversial, an extension of this principle that has sprung up in narrative psychiatry--namely, that by coming to imagine a different life story one can become a different person--ought to be. One reason one cannot remake one's life in the image of a story is that life is not to be mistaken for a story in the first place. The seminal study of psychotherapy, Persuasion and Healing, although recommending that the demoralized absorb more uplifting stories about themselves, appears to recognize some limit to the possibility of modeling life on story. The same study likens therapeutic stories to placebos, but as it happens, placebos themselves have their limits, alleviating symptoms but not curing or "healing." In order for someone to become a different person through the agency of the placebo effect, it would have to be more robust than it is. The argument that life follows narrative is an ironic one for a discipline devoted to narrative to make, given the salience in the tradition of the novel, from Don Quixote forward, of works that explore the fallacies of that presumption. In keeping with its attention to narrative, this article challenges the use of a short story by Chitra Divakaruni as an illustration of the principles of narrative psychiatry.

Book review: The art of narrative psychiatry

Book review: The art of narrative psychiatry

The Four Ps, Narrative Psychiatry, and the Story of George Engel

The Four Ps, Narrative Psychiatry, and the Story of George Engel

The Art of Narrative Psychiatry: Stories of Strength and Meaningby HamkinsSuEllen. New York, Oxford University Press, 2013, 240 pp., $27.95.

Back to table of contents Previous article Next article Communications and UpdatesFull AccessThe Art of Narrative Psychiatry: Stories of Strength and MeaningSilvia L. Gaviria, M.D.Silvia L. GaviriaSearch for more papers by this author, M.D.Published Online:1 Jun 2014https://doi.org/10.1176/appi.ajp.2014.13121697AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by HamkinsSuEllen. New York, Oxford University Press, 2013, 240 pp., $27.95.Reading this book has been a wonderful experience because it becomes a trip through a psychotherapeutic approach about mental disease from a comprehensive perspective but mostly about the person.Dr. SuEllen Hamkins, whose training in psychiatry included the orientation of psychoanalytic psychotherapy and psychopharmacology with an intensive study of family therapy, discovers later on in narrative psychiatry that this therapeutic approach is a source of tools to help her patients, even those with severe mental disease. Narrative psychotherapy includes the role of human biology and contemplates psychotherapy and psychopharmacology as nonexcluding tools. Furthermore, it differs from other psychotherapeutic approaches because it is focused on searching for the sources of strengths in the persons, rather than finding the root of their problems. Narrative psychiatry takes into account the stories patients bring to the consultation and how the stories are influenced by their values, intentions, feelings, and cultural context; likewise, the richness each patient teaches in his or her story is taken into account. Another important aspect is the lineal relation between therapist and patient in which both participate in decision making, since, according to Hamkins, it is the patients who know the most about themselves and their lives.In the introduction, Hamkins comments, “Narrative psychiatry, like narrative therapy, is animated by the idea that we experience our lives and our identities through the stories we tell about ourselves and the world. It combines the understandings that meaning is socially created, that we can question the narratives that influence us, that we are embodied creatures fortified by and beholden to our biology, and that when these ideas are gracefully combined in compassionate practice, tremendous healing is possible” (p. xiv).The book has great strengths, among them is the story of the author’s experience with her patients. She shows how the treatment is developed, and at the same time she presents the dialogues held with her patients, their successes, frustrations, challenges, and positive emotions. Also, she shares her subjective experiences as a therapist, which is well reflected in her analysis about her clinical experience.Another innovative aspect is the series of reflections, points to highlight, and recommendations accompanying each chapter, turning the book into very didactic material. In every chapter, psychiatry in action can be appreciated, and elements of its great use and easy application are presented.The book constitutes two parts. In the first part, chapters 1–6, the first chapter is titled “What is Narrative Psychiatry? This chapter describes a general panorama, key concepts, and bases for the comprehension of the other contents. The following chapters, 2–6, are focused on the central elements of narrative psychiatry and offer elements applicable to the clinical practice. The second part of the book, chapters 7–9, enriches the work with the presentation of a challenging and complicated clinical case. Additionally, the author recounts how the supervision with other colleagues helps in critical moments when the tools the therapist has seem to be exhausted.This book is an eminent, human, and experiential work with excellent academic support.Dr. Gaviria is Head of the Department of Psychiatry, CES University, Medellín, Colombia.The author reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited ByNone Volume 171Issue 6 June 2014Pages 693-693 Metrics PDF download History Accepted 1 December 2013 Published online 1 June 2014 Published in print 1 June 2014

The Art of Narrative Psychiatry: Stories of Strength and Meaning

The Art of Narrative Psychiatry: Stories of Strength and Meaning

Narrative Therapy in CAMHS: Creating Multistoried Treatments

This article describes how clinicians are working on establishing structures that will enable research on and producing evidence for narrative family therapy with families struggling with psychiatric illnesses. The aim is to suggest ways for clinicians working in Child and Adolescent Mental Health Services (CAMHS) to implement collaborative therapies in a psychiatric setting that favors evidence-based practices. Pragmatism and the narrative theory of multistoried practices offer the means to both speak and theorize about such dilemmas and suggest practices that enable clinicians to grapple with these challenges. We hope that this article will be part of the growing inspiration for others to practice “narrative psychiatry.”

Madness, childhood adversity and narrative psychiatry: caring and the moral imagination

The dominance of technological paradigms within psychiatry creates moral and ethical tensions over how to engage with the interpersonal narratives of those experiencing mental distress. This paper argues that such...

Less Rather Than More

I have recently read Lewis Mehl-Madrona's book Healing the mind through the power of story—the promise of narrative psychiatry. I think my reading stimulated the following idea when I reflected on the question of how to explain the decrease in treatment effectiveness: The team in a psychiatric ward is usually working to full capacity performing its routine clinical tasks. A project such as the introduction of a treatment pathway requires additional attention. Even if this happens for the patients' benefit, it means that less attention is available for the patients themselves. And the patients may possibly react to the loss in attention.

Narrative Psychiatry: How Stories Can Shape Clinical Practice (review)

Narrative Psychiatry: How Stories Can Shape Clinical Practice (review)

Improving clinical care through the stories we tell

Narrative Psychiatry: How Stories Can Shape Clinical Practice. Bradley Lewis. Johns Hopkins University Press; 2011. If there is any specialty that should be receptive to the proposition that stories can extend the limits of conventional medicine, it is psychiatry. The work of psychiatrists is

Book Review: Healing the Mind through the Power of Story: The Promise of Narrative Psychiatry

Book Review: Healing the Mind through the Power of Story: The Promise of Narrative Psychiatry

Narrative and psychiatry

The study of narrative has become increasingly important in the humanities and social sciences and there is a growing use of narrative in the clinical domains of medicine and psychotherapy. Narrative psychiatry is also on the rise and promises to help psychiatry be responsive to increasing critical concerns from inside and outside the field. The field of narrative is vast and cuts across a variety of disciplines. Contemporary scholars in narrative medicine build on 30 years of work in medical humanities and bioethics to rigorously understand human variables in medicine and to improve physician empathy. Narrative psychotherapists have developed a new model of psychotherapy and a meta-narrative theory of diverse mental health interventions. Psychiatrists have picked up these insights and are finding them invaluable for navigating contemporary issues in psychiatry. Narrative theory has become important in the humanities, social sciences, medicine, and psychotherapy for understanding human meaning making. Increasingly, the tools of narrative are proving valuable for psychiatry as well. Narrative psychiatry does not negate or supersede other knowledge and research in psychiatry, but it can help psychiatry understand how people use psychiatric knowledge, among other cultural resources, for making sense of psychic difficulties and psychic differences.

Narrative psychiatry: how stories can shape clinical practice

Narrative psychiatry: how stories can shape clinical practice