4 - Helping patients tell their story: narratives of body, mind and soul

Summary

A patient who was a devout Christian was admitted to hospital as an emergency. She tried to explain to the duty psychiatrist the importance of her belief in ‘the Holy Ghost’, only to hear it reported in the ward round the next day that she had been seeing ghosts.

In this chapter, I aim to show that the narrative set in motion when a patient is seen by a psychiatrist is not only an account of an individual's life experience but also attuned to the expectations of the psychiatrist – more than either of them may be aware. This is especially relevant to soul narrative, which is often invested with profound personal meaning, yet can lead to confusion when not understood, or else is likely to remain unvoiced if a patient senses that their spiritual beliefs and concerns are not given credence. I conclude by illustrating how the soul narrative, when encouraged, can bring real therapeutic benefits.

The pre-eminence of medical diagnosis

In general medicine, taking a patient's history is followed by hands-on examination of the body, feeling for lumps and bumps, listening to the heart and lungs and testing for abnormalities of the nervous system, followed when needed by a battery of investigations. The unspoken contract between physician and patient enables doctors to divide their attention between relating to their patients as persons and yet examining their bodies with the detachment needed to identify pathology and arrive at an accurate diagnosis (in Greek, dia means ‘stand apart’, gnosis means ‘discern’).

The art of diagnosis has its roots in the ancient civilisations of Egypt, Greece and China. But the physician of our time is heir principally to a scientific method that began during the Renaissance with the study of human anatomy and which has brought extraordinary knowledge of how the body works. A correct diagnosis will generally indicate a disease that has recognisable pathology, a cause (aetiology), a natural history (it may progress or remit) and an outcome (prognosis).