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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: 03 March 2021

Externalizing and Unpacking the Problem:Understanding Symptoms and Suffering

Externalizing and Unpacking the Problem:Understanding Symptoms and Suffering

Chapter Four Externalizing and Unpacking the Problem:Understanding Symptoms and Suffering
The Art of Narrative Psychiatry

SuEllen Hamkins

Oxford University Press

Seeing the problem as separate from the person is a stance that informs narrative psychiatry. This stance gives us firm footing in responding to our patients with respect and empathy and frees us to nimbly and creatively work with them to mitigate the unwanted effects of problems in their lives. We don’t blame patients for their problems. Rather, we align with them side-by-side to look out at the problem together and see what can be done about it. What this means is seeing problems as separate from our patients’ identities; that is, as outside of what they value and who they are striving to be. In doing so, we see both the problem and the person more clearly. Externalizing the problem in this way is a therapeutic practice that is one of our most powerful narrative interventions. It shifts the psychological landscape in which we are working. Patients often experience their problems as all encompassing. By externalizing the problem, it becomes circumscribed and we can more easily unpack it: characterize it, determine its boundaries, discover how it is impinging on a person’s life, expose the ways in which it operates, and discern what supports it and what weakens it. Separating the problem from the person makes it easier to see how patients are succeeding in living their lives in ways that they find satisfying and how they have freed themselves from the influence of the problem. We can more easily discover areas of the patient’s life in which the problem is not operating or is powerless, and we can more readily discover strengths and resources that a patient can draw on to overcome the problem. Not seeing problems as integral to who patients are provides immediate relief from negative identity conclusions, which are often piled on top of other unwanted effects of problems. These discoveries are energizing, inspire hope, and point the way toward effective treatment. The practice of externalization was developed by Michael White as a way to objectify problems instead of objectifying people.

Keywords:   The Carson Center, eating disorder, fluoxetine, hallucinations, paranoia, posttraumatic stress disorder (PTSD), resources, schizophrenia, substance abuse

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