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To Recognize the Person: Learning from Narratives of Psychiatric Treatment

From: Narrative Inquiry in Bioethics
Volume 1, Number 1, Spring 2011
pp. 35-41 | 10.1353/nib.2011.0006

In lieu of an abstract, here is a brief excerpt of the content:

To know what patients endure at the hands of illness and therefore to be of clinical help requires that doctors enter the worlds of their patients, if only imaginatively, and to see and interpret these worlds from the patient’s point of view

(Charon, 2006, p. 9).

These narratives of psychiatric hospitalization are rich and evocative. We are fortunate to have twelve descriptions appearing side-by-side, each unique in its focus, outlook, detail and narrative tone. Together their interwoven contexts describe personal and work relationships, internal and external help-seeking, encounters in community and hospital settings, and experiences of the psychiatric (psychiatrized) self as supplicant, victim, recipient, participant, product, and active agent over time (Morrison, 2005).

Through their collected narratives, the authors create a distinct counterpoint to the more familiar clinical narratives of psychiatric encounters. Ordinarily the professional narrative drives interpretation of a clinical experience, whether medical or psychiatric. The caregivers populating these narratives would probably tell different stories, and the hospital notes and treatment records yet another (Hinsby & Baker, 2004; VanDerNagel et al., 2009). The disjunction between professional and patient narrative is especially true for psychiatric hospitalizations, in which the inpatient’s active narrative becomes a part of the diagnostic and treatment process (Steslow, 2010).

In this symposium, the patient’s narrative is a window for interpretive insights into personal experience of the process. Each is a situated retrospective, in which added dimensions of feeling, thought and interaction provide the reader a fuller and more complex awareness of the experience of psychiatric hospitalization. The narratives provide insights about choice and agency, control and harm, safety and strength, hope and frustration, resilience and recovery, empathy and humanity; they also reveal various ethical issues related to the experience of help-seeking and treatment.

It is vital to consider what each person wrote: what choices they made in representing their experience; what aspects they focused on, and what they (we imagine) left out. The authors used their own voices to create their own representations. In each narrative, “the person” provides an important standpoint. Who is this person, what is his or her experience? Where is the person in the situation; in what way does he or she appear to those who provide treatment or care? How, if at all, is the treatment pertinent to the person’s concerns? Does it feel helpful or harmful? How does the person find a way to continue, to push through, with the help of (or in spite of) those we hope are providing care? This is the first sign of agency, of choice, of “dreaming.”

As V. Barnard writes in Dreaming: A Recovery Story, “to make a film, one has to dream it first.” All of the authors in this symposium took the risk and the opportunity to create their own stories: what to include, what to leave out, how to tell what they wanted to say. These choices gave them the power to dream: how it was, how it might have been; how it felt, good and bad; the chance to represent their own reality—to themselves, and to unknown others (Morrison, 2006).

Dreaming, Choice and Agency

“My psychiatric illness is only one part of me. I am a person with hopes, dreams, love, an artist and a fellow helper of my peers.” V. Barnard

V.’s narrative describes the potential for positive action, of dreaming herself as a whole into existence. Her themes of choice and agency emphasize the importance of autonomy and the capacity for autonomous action. On the farm, V. was free to choose and take risks, to take on responsibilities, to be “treated with respect as a human being trying to get better rather than a criminal suffering from something that was optional.” From disconnection, she was able to find connection, on her own terms.

The support of peers adds a valuable dimension. Being recognized as a peer, a person who shares similar psychiatric experiences and respects the challenge of everyday life, brings another level to supportive relationships. Negative judgments and stigma are reduced by mutual support and acknowledgement of common goals. Mental health professionals who recognize the value of peer support can encourage such relationships in hospitals and communities...


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