Chapter 1 excerpt 2

(Continuation of chapter 1, The Art of Narrative Psychiatry by SuEllen Hamkins (Oxford Press, 2013) pp._

Our identities are constituted in the meanings we give the events in our lives—in what we value. That is, our identities are based on the stories we tell about ourselves, stories such as: I am a psychotherapist. I am a fiddle player. I am a success. I am a failure. When patients are suffering emotionally, the meanings they give to the events of their lives often follow themes of personal failure, regret, unworthiness, pointlessness, isolation and so on, themes that can increase their suffering and foster an impoverished sense of who they are. Cultivating narratives that honor our patients’ integrity and resourcefulness despite their duress—that offer alternative plot-lines to the stories of their lives—can bring energy, inspiration, clarity, hope, direction, companionship and emotional relief. That is, these new stories can be healing.
What we can know and remember about ourselves and the world depends on inclusion in a narrative. Prominent narrative philosopher Paul Ricoeur writes, “human action is an open work, the meaning of which is ‘in suspense.’” The meaning we give an action ushers it into a particular story with particular consequences: Last week I missed a day of work; I am on the road to failure, I might as well give up. Last week, I went to work four days; I am on the road to success, I can keep going.

Our intentions arise from what we give meaning and our intentions mold our actions. Jerome Bruner, a cognitive psychologist whose work informs narrative psychiatry, writes, “the central concept of a human psychology is meaning and processes and transactions involved in the construction of meanings.” He resists understanding human nature “as nothing but the concatenation of conditioned reflexes, associative bonds, transformed animal drives.” Bruner emphasizes how our intentions are a paramount force in determining how we experience ourselves and what we do. When we help our patients clarify their values and intentions, they develop a fresh sense of what might be possible for their lives.

We make meaning and become who we are through our relationships in the context of our culture. Meaning-making and story-telling are social phenomena. We negotiate our identities in relation to the narratives that others hold about us, those close to us as well as discourses in the wider culture. Discourses are narratives and practices that share common values. Often wider cultural discourses are invisible as such and are taken for “common sense”. Discourses include expectations, stories, standards, customs, laws, and so on that have real effects on our lives: You are a success and can join our group. You are a failure and cannot join our group. Narrative psychiatry seeks to identify and understand the discourses that are affecting our patients. In doing so, discourses that fuel problems can be countered and stories and practices that are life enhancing can be nurtured.

When I first learned these key narrative ideas in my intensive course on narrative therapy at what was then The Family Institute of Cambridge back in 1998, I was excited and intimidated. Excited because the ideas rang true, promoted awareness of social issues and were intellectually beautiful; intimidated because they were completely foreign to how I had been trained as a psychiatrist and psychotherapist. The turning point for me occurred in a conversation I had with a psychologist who, like me, had been initially trained in psychodynamic psychotherapy. We realized that we had been attending to our patients’ narratives all along, but now, instead of primarily uncovering stories of that which was painful or conflicted in their lives, we could use our psychotherapeutic skills to uncover stories of what was sustaining and inspiring.