Shared Modes of Narrative, on the Limits of Expressing One’s Unique Experience

I begin my comments with a first-person narrative. I know Octavio, Erotildes, and Nuria from the time I worked at the Institute of Psychiatry and was very close to the field of mental health. They are people whose work I admire and appreciate. I comment on this text from the point of view of someone who has never worked directly in mental health assistance and whose knowledge about severe mental illness therapy has occurred mostly from a third-person perspective. My comments are based on parallels with situations and experiences that I have been studying lately.

First of all, I want to say that I fully agree with the authors’ argument that “experiences and narratives about illness, treatment, and recovery are fundamental aspects of every clinical experience, in the sense that they provide a foundation for it” (p. 156). Having said that, I will raise some questions that I hope will serve as a lever for a fruitful debate.

Initially, I would like to argue that evidence-based medicine may have effects contrary to those pointed out in the text. In the case of the movement toward the humanization of pregnancy and childbirth, for example, traditional obstetrical knowledge (seen as a producer of obstetric violence) has been totally disavowed through systematic reviews and meta-analyses based on evidence-based medicine. In such a way that the hierarchy of medical evidence referred to by the authors—which has supported, in the psychiatric field, the biological and reductionist view of mental disorders (and their treatment)—in the case of childbirth and pregnancy promoted a pro-humanization stance in public policies. Furthermore, new narratives about childbirth are being constructed based on first-person narratives of women who give birth, which are increasingly published and publicized on social networks. From this point of view, a “new childbirth” is being constructed from first-person narratives (Alzuguir & Nucci, 2015). It is interesting to consider how these narratives of individual and entirely personal experiences of pregnant women become a collective narrative, constituting a new way of conceiving motherhood itself. I return to this point later.

The parallel can be taken further: childbirth is an experience that was organized “from the outside” by obstetrics, somewhat within the model of disease used as a counterpoint of illness. The experience of the woman—according to the current discourse of “humanized childbirth” activists—was entirely disqualified or concealed. At the same time, it is possible to think of childbirth, although it is not a disease, as a disruptive experience that demands meaning and the reorganization of life. In fact, this universalizing point of view bothers me. I would say that pregnancy and childbirth have lost the meaning they once had in other times and contexts owing to their intense medicalization, and they ask for a new meaning when this medicalization is challenged. I do not know to what extent the same can be said of mental illness, that is, that the transformation of a strange or disturbing experience into a “serious mental illness” by psychiatry deprived it entirely of a meaning different from an objectively attributed psychiatric diagnosis. In this case, the proposal of a narrative constructed together with those involved in an episode of mental illness is a way of giving meaning to an experience that, outside the parameters of biomedical psychiatry, becomes inexplicable and disorganizing. The problem, as the article argues, is that traditional psychiatry constructs a third-person narrative, displacing the agency of those who suffer the episode. It is not that there is no meaning there, but it is a certain kind of meaning that sees the “patient” as a passive subject, who must undergo a certain type of intervention.

The construction of narratives with psychiatric patients, as in the case of deliveries performed by “humanized” obstetricians, aims to empower the patient and the woman who gives birth by allowing them to experience the protagonism biomedicine had taken away from them.

Going back to what I had been saying a while ago, it is not true that childbirth is in itself a disorganized and meaningless experience...