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Focusing on four cases presented by Lloyd Wells, M.D., this paper addresses the relationship of clinical psychopathology to the philosophical concept of narrative identity. The paper begins with a review of the debate among historians, literary critics, and philosophers over the referential status of narrative identity, that is, whether the narrative self is a fictive structure unrelated to lived life or whether ordinary life is in fact lived narratively. Agreeing with those philosophers who argue for the reference of narrative identity to actual life, the author analyzes the four cases from the perspective of narrative identity to determine what light this philosophical concept sheds on the various psychopathologies. Then, having used the philosophical concept to illuminate psychopathology, he reverses direction and questions what psychopathology has to offer philosophy and its notion of narrative identity. The author argues both that the philosophical concept of narrative identity contributes to our understanding of psychopathology and that psychopathology offers challenges to the philosophical notion of narrative identity.