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Narrative Psychiatry

How Stories Can Shape Clinical Practice

Bradley Lewis, M.D., Ph.D.

Publication Year: 2011

Psychiatry has lagged behind many clinical specialties in recognizing the importance of narrative for understanding and effectively treating disease. With this book, Bradley Lewis makes the challenging and compelling case that psychiatrists need to promote the significance of narrative in their practice as well. Narrative already holds a prominent place in psychiatry. Patient stories are the foundation for diagnosis and the key to managing treatment and measuring its effectiveness. Even so, psychiatry has paid scant scholarly attention to the intrinsic value of patient stories. Fortunately, the study of narrative outside psychiatry has grown exponentially in recent years, and it is now possible for psychiatry to make considerable advances in its appreciation of clinical stories. Narrative Psychiatry picks up this intellectual opportunity and develops the tools of narrative for psychiatry. Lewis explores the rise of narrative medicine and looks closely at recent narrative approaches to psychotherapy. He uses philosophic and fictional writings, such as Anton Chekhov’s play Ivanov, to develop key terms in narrative theory (plot, metaphor, character, point of view) and to understand the interpretive dimensions of clinical work. Finally, Lewis brings this material back to psychiatric practice, showing how narrative insights can be applied in psychiatric treatments—including the use of psychiatric medications. Nothing short of a call to rework the psychiatric profession, Narrative Psychiatry advocates taking the inherently narrative-centered patient-psychiatrist relationship to its logical conclusion: making the story a central aspect of treatment.

Published by: The Johns Hopkins University Press


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pp. v

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pp. vii-xvi

Psychiatrists listen to stories more than anything else they do.1 Their very first questions—“What brings you here?” and “What seems to be the problem?”— are open-ended invitations to a story. Patients respond to these invitations by telling psychiatrists about their life and their troubles. They give narratives of when their difficulties began, what they believe to have caused them, and what kinds of problem solving they have...

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1. Listening to Chekhov

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pp. 1-17

Despite the seriousness of what we call mental illness in contemporary times— both its pervasive incidence and the extensive suffering it causes— this is an era that struggles with how to understand the multiple interpretations of psychic suffering and psychic difference. Most psychiatric discourse embraces a biological model that articulates mental illness as a medical disease involving neurological pathology. This model...

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2. Narrative Medicine

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pp. 18-31

Many in psychiatry may fear that a turn to narrative will risk alienating their hard-nosed medical cousins. They may think to themselves, “With the recent decade of the brain, the growth in ‘hard’ science research, and the explosion of pharmacological interventions, we are finally starting to get some respect from our medical colleagues. We are no longer a ‘soft’ specialty, one that is not ‘really medicine.’ We can hold...

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3. Narrative Approaches to Psychotherapy

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pp. 32-56

Leading thinkers in psychotherapy, what we could consider the “other side” of psychiatry, have recently taken a narrative turn. And just as we had to tell a story to understand the rise of narrative medicine, we must also tell a story to understand the emergence of narrative approaches to psychotherapy. The story of psychotherapy I will tell, like many others before me, begins in the late nineteenth century with...

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4. Narrative Psychiatry

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pp. 57-74

Having reviewed the emergence of narrative medicine and narrative approaches to psychotherapy integration, we are now in a position to draw out the implications for narrative psychiatry. The history of psychiatry has led to its own conceptual knots and practical predicaments. As for narrative medicine and narrative psychotherapy integration, the turn to narrative provides a way out of these difficulties. This...

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5. Mrs. Dutta and the Literary Case

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pp. 75-85

Narrative psychiatry insights become clearer when we use them to consider case examples. Through case examples, narrative theory becomes concrete and the relevance of narrative psychiatry is brought vividly to life. Case examples also demonstrate much of the wisdom of narrative theory because they tell a story about a person and that story is necessarily shaped by the tools of narrative I have discussed: plot, ...

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pp. 86-103

In the last chapter, I asked readers to imagine Mrs. Dutta, the main character from Chitra Divakaruni’s “Mrs. Dutta Writes a Letter,” as a potential psychiatric client. Divakaruni carefully and beautifully describes how Mrs. Dutta becomes increasingly sad and hopeless as she realizes the impossibilities of her current living situation. I asked readers to imagine that Mrs. Dutta comes to see a psychiatrist at this time of crisis and that her...

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pp. 104-120

The model of suffering adopted by interpersonal psychotherapy makes an important shift from the models we have discussed thus far. Interpersonal psychotherapy moves the focus from the individual person to the person’s interpersonal context. The founder of interpersonal psychotherapy, Gerald Klerman, associates the emergence of this approach with the pioneering work Harry Stack Sullivan (Klerman, Weissman, Rounsaville, and Chevron 1984, 6). The epigraph to Klerman and his associate’s first...

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pp. 121-143

Mainstream clinical stories only begin to help us imagine alternatives for Mrs. Dutta. This means that narrative psychiatry must look to additional clinical stories for important narrative resources. There are a host of additional approaches on the margins of what we could call “clinical” and many more that move beyond the clinics all together. As a group, I refer to these additional possibilities as “alternative stories,” and...

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9. Doing Narrative Psychiatry

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pp. 144-156

How can practicing clinicians make sense of the last three chapters? For many psychiatrists there will be something deeply disquieting and disorienting about the exercise. Many psychiatrists will have internalized their training in science, data, and clinical trials and will be distant from the worlds of literature, narrative, and theories of meaning. Seeing Mrs. Dutta’s story interpreted in vastly different ways can go...

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10. Critical Reflections

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pp. 157-172

The evidence of Mrs. Dutta’s story and the efforts of bioethics and the recovery movement make a compelling case for adopting narrative approaches, but there are also many objections to putting narrative psychiatry into wider practice. It helps to work through these objections because responding to critics moves us beyond theory and creates space to consider more practical concerns. In addition, working through...

Appendix: “Mrs. Dutta Writes a Letter,”

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pp. 173-188


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pp. 189-195


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pp. 197-210


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pp. 211-214

E-ISBN-13: 9780801899799
E-ISBN-10: 0801899796
Print-ISBN-13: 9780801899027
Print-ISBN-10: 0801899028

Page Count: 240
Publication Year: 2011