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

Bradley Lewis, psychiatrist and professor at New York University, seeks to position narrative as the unifying force in contemporary psychiatry. Narrative Psychiatry is a manifesto for a narrative consensus in psychiatric practice, a tour through multiple forms of psychotherapy, and not least, a demonstration of the heuristic power of fictional examples to illustrate therapeutic issues. Particular readers might wish the book offered more or less of any of these three objectives, but I cannot imagine anyone being bored. Not least of Lewis’s talents is his capacity to keep the story moving.

Lewis’s psychiatric colleagues, after reading his earlier book, asked: “‘What do you do differently in your clinical work with these insights from postpsychiatry?’” (xii). His present book does not attempt to answer that question with systematic descriptions of narrative practice, and that might disappoint some readers. But readers will finish the book with an expanded sense of clinical possibility, and that seems Lewis’s best answer to the question of what he does differently: he imagines the broadest range of possibilities for what he might do. Narrative is presented as the common denominator of these multiple therapeutic options.

Lewis begins with Chekov’s play Ivanov, framing his discussion as a response to Peter Kramer’s argument that “the play has been ‘sapped of any moral consequence’” for the simple reason that “what Ivanov needs today is an antidepressant” (5). Lewis is at his best showing all that such a reductive comment neglects. The issue is not that Kramer is wrong; antidepressants might have helped. “Both in the play and in the extension of the play to today’s psychiatry,” Lewis writes, “the issue is not the medical interpretation in and of itself but the overconfidence with which it is asserted” (10–11). Ivanov “scolds Dr. Lvov [his physician] primarily because he oversells his diagnosis” (10), and Lewis scolds Kramer, and by extension, contemporary psychiatry, for the same reason.

Narrative, in Lewis’s particular usage, unfolds as a generalized antidote to such overconfidence. Narrative is a perspective that sees clearly what Lewis neatly describes as “the challenge of a polyphonic world and . . . the multiplicities of consciousness and experience” (11). The primary narrative recognition is that any single version of anyone’s problems is a reduction. The narrative response is “that simple reductions become less problematic when we multiply them” (15). Thus, Lewis advocates “the trope of narrative multiplicity” (15). “Through multiplication,” he writes, “each simplicity loses the violence of totalitarian control” (16).¹

Following this provocative and insightful introduction, Narrative Psychiatry proceeds in two parts. In chapters 2–4, Lewis argues that psychiatry once sustained a balance—never an even balance but sufficiently inclusive—between humanistic psychiatry with a psychoanalytic orientation and biomedical psychiatry that understands its work as Peter Kramer understands Ivanov’s needs, best treated with psychopharmacology. That balance has been lost, and the controversy is whether this constitutes the advance of medical science or the regression to an oversimplified view of human suffering. Lewis’s first chapter makes a strong case for the latter. So, what is to be done?

The book’s second half begins with another literary narrative analysis (chapter 5), this time of a short story by Chitra Divakaruni, “Mrs. Dutta Writes a Letter.” The entire story is included as an appendix (173–188). Mrs. Dutta is a widow in early old age who has moved from India to San Francisco to live with her son, daughter-in-law, and grandchildren. The story is about the disjunction of what sociologists call habitus: the collection of tastes, preferences, priorities, obligations and duties that become second nature to any person, guiding his or her judgments and actions. At the end of the story (spoiler alert, as film reviewers say), Mrs. Dutta writes to her best friend in India, planning her return, not because she does not love her family and feel loved by them, but because the conflicts of proximity are damaging that love.

Mrs. Dutta...