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The Art of Narrative PsychiatryStories of Strength and Meaning$
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SuEllen Hamkins

Print publication date: 2013

Print ISBN-13: 9780199982042

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199982042.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 06 December 2021

Cultivating Stories of Strength and Meaning and Deconstructing Damaging Discourses: The Course of Treatment

Cultivating Stories of Strength and Meaning and Deconstructing Damaging Discourses: The Course of Treatment

(p.75) Chapter Five Cultivating Stories of Strength and Meaning and Deconstructing Damaging Discourses: The Course of Treatment
The Art of Narrative Psychiatry

SuEllen Hamkins

Oxford University Press

Listening for narratives of strength and meaning that have not yet been told but are implicit in the patient’s experience is key to the art of narrative psychiatry. In any conversation, there are many openings for finding exceptions to the activities and effects of problems. Each exception to the problem is a seed that can be cultivated into a narrative by fleshing it out with detail, linking it to other exceptions over time, and articulating the meanings that these exceptions have for the person. This new narrative offers fertile ground for freshly imagining what might be possible in the future. It sustains valued aspects of identity and points the way toward freedom from the problem. At the same time that we are nurturing nascent stories of skill and resilience, we are also listening for narratives that fuel problems, so that they may be examined, dismantled, and replaced with narratives that support well-being. Stories that fuel problems come from many sources. For example, someone who is dealing with depression may be influenced by a family story of being the “problem child,” a local story that derides those who seek mental health treatment, and a wider cultural story that narrowly defines a successful life in terms of money. These narratives can be named and closely examined in light of the patient’s own values, allowing the patient more choice over which narratives are taken up and which are set aside. Narrative psychiatry continuously attends to the patient’s social context. Often, the people who consult with us are living under the influence of cultural discourses that make negative claims about their worthiness, seek to limit their prospects, and engage them in processes of self-scrutiny that lead to anxiety or despair. By discourses I mean narratives and practices that share a common value. These discourses include those that privilege or denigrate people on the basis of their race, gender, gender preference, sexual preference, body type, financial status, education, health, or ability. Narrative psychiatry attends to issues of power—of privilege and oppression—and deconstructs the operations of power as they influence someone’s life.

Keywords:   anorexia, aripiprazole, bulimia, collaborative therapeutic alliance, eating disorder, fluoxetine, landscape of identity, panic disorder, personified problem, resilience, risperidone, schizoaffective disorder

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