The project of narrative medicine is to emphasise subjectivity and the particular in the consideration of a patient's condition. This approach is in contrast to the usual objectifying and universalising lens of modern medicine. In other words, the doctor's interest and concern ought to be as much about the objective facts about cancer of the colon, for example, as about how the unique individual in front of him or her subjectively experiences their situation and what this means for this particular individual's life. Now, it could be argued that what the project of narrative medicine is striving for is only relevant to internal medicine and the surgical specialties. For, psychiatry by definition is as much about objective facts as about the meaning that both patients and their psychiatrists attribute to the facts of psychiatric disorders.
Bradley Lewis's thesis is that there is intrinsic poverty in the offerings of biopsychiatry, despite its ascendancy as an intellectual driving force in psychiatry and its triumph over psychoanalysis in the USA. For Lewis, narrative psychiatry ‘seeks a deep and empathic understanding of the patient as a person’ (p. 74), and ‘appreciates that the process of recovery often involves reauthoring and retelling the stories of our lives’ (p. 74). He argues that narrative psychiatry is aware of the use of medication and the distinction between disease and illness. But, more significantly, that ‘narrative psychiatrists are… self-reflexively adept at a narrative understanding of the many stories psychiatrists tell as they are at understanding the stories of psychic life that their clients tell’ (p. 74).
It is a truism that storytelling is at the heart of human life. Lewis makes the point that some understanding of narrative theory – the pervasive place of metaphor in language and its impact on communication, and the role of plot and character in the management of time and action in narration – is important for clinicians. He distinguishes between ‘thin’ and ‘thick’ stories; the former being the account summarised by clinicians and the latter the rich, complex and involved account consisting of the particularities of a life.
Lewis succeeds in making a case for a narrative approach in clinical psychiatry. However, I am not persuaded that one need accept or appeal to Foucault to see the benefits of narrative theory to clinical practice, nor that the arguments of post-psychiatry or the recovery movement are germane to his thesis. Storytelling is an integral part of human life. We all do it effortlessly, more or less, in exactly the same way that we all use language. But like language, we may need to be reminded of the unobtrusive infrastructure on which stories are built. For this reason alone, Lewis's book is very much welcome.
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