Narrative Psychiatry: How Stories Can Shape Clinical Practice

9. Doing Narrative Psychiatry

144 chapter nine Doing Narrative Psychiatry 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 against the grain of this clinical training because the hidden pedagogy of science contains an unstated ontology of one, and only one, true world. Clinicians identified within this ontology will find it hard to make sense of the possibility that all these interpretations of Mrs. Dutta could be “true.”After all, there’s only one Mrs. Dutta.There must be only one truth of her situation. For these psychiatrists, the idea that all these interpretations could be “true” borders on the absurd, even the insane. And yet the evidence in our interpretive exercise puts the seeming absurdity of multiple interpretations in question. The work we did in the last three chapters shows that “Mrs. Dutta Writes a Letter,” like so much of literature, lends itself easily to different and multiple interpretations. Divakaruni did not write the story as an exercise for mental health workers . She was surely not even thinking about the many different clinical and alternative meanings to Mrs. Dutta’s sadness. Yet what is most fascinating about our interpretive exercise is that each new interpretation was easily relevant to Mrs. Dutta’s situation and few of the interpretations had to stretch. If Mrs. Dutta came to see a psychiatrist at the time of her crisis, or worse, if she came after her darkest despair had continued for a few weeks, she would easily receive a diagnosis of major depression. However, there are still multiple ways Mrs. Dutta could proceed. The story contains seeds of a biological interpretation but also a psychoanalytic one. It contains kernels for a cognitive behavioral therapy but no Doing Narrative Psychiatry 145 more so than for family therapy. It opens itself to a humanistic reading but also a political, spiritual, and creative reading, just to name a few. Each new approach foregrounds aspects of the story that were left out by the previous approach. Each allows us to make sense of Mrs. Dutta’s troubles, each provides metaphors for selecting key elements of attention, and each provides guidance for the future. Each could be used by Mrs. Dutta to help restory her troubles, and each provides the fundamental plot structure of a new narrative identity. It is critical to have a firm sense of this phenomenon before doing narrative psychiatry because this is exactly the background awareness needed for narrative work. The practical implication of this awareness is that a narrative psychiatrist would have a deep appreciation of the multiple options available for Mrs. Dutta. With this awareness in mind, if Mrs. Dutta came to see a narrative psychiatrist, the first step would be to use the tools of narrative medicine to develop an empathic connection with Mrs. Dutta. This step helps Mrs. Dutta move beyond her isolation with her situation, and, as discussed earlier, this step alone can be one of the most healing tools that clinicians can offer. The next step would be to help Mrs. Dutta make choices about how to proceed. Following the basic ethical principle of informed consent, the narrative psychiatrist would give Mrs. Dutta background on the array of treatment options so she could make informed choices. The narrative psychiatrist would explain that she herself practices a narrative approach that integrates resources from a variety of treatment models and beyond. This approach recognizes that any number of therapeutic schools can be helpful for people and that a variety of insights and strategies can be woven together to form a hybrid narrative of a person’s past, present, and future that can be helpful. The issue of medication would be included in the mix of therapeutic options. The narrative psychiatrist would explain that many psychiatrists would recommend medication treatments either alone or in combination with psychotherapy for severe depression. The narrative psychiatrist would explain the risks and benefits of the medication options along with a careful review of the outcome studies for the medicine’s effectiveness. The decision of medication, like decisions about other options, would remain with Mrs. Dutta.1 If a narrative and integrative approach like this were to sound good to Mrs. Dutta, she and the...