Narrative Psychiatry – A Review

Biological psychiatry is afflicted by an ague. Or maybe it’s the pox. The precise diagnosis in unimportant, and it may not even be a terminal decline, but there is serious discontent with the brain that was once thought to be broken. The pharmaceutical industry is cutting back its funding for neuroscience research. Astra Zeneca has cut 2,200 jobs from research and development for 2014. This follows on from similar cuts by Glaxo-SmithKline, Pfizer, Merck, Sanofi and Novartis (InPharm, 2012). Most of these cuts are in ‘serious mental illness’ research, not Alzheimer’s disease. As far as day-to-day clinical practice is concerned Professor Tim Kendall (2011) has pointed out that there is no evidence that so-called second generation neuroleptic drugs are any more effective than first generation drugs in the management of psychosis. He is funded by the National Institute for Health and Clinical Excellence (NICE) in England to develop clinical practice guidelines for the National Health Service. Blockbuster drugs are turning out to be a busted flush; their days are numbered. Their decline is hastened by the problem of the harm they cause. Their long-term use is associated with seriously adverse effects on health, including obesity, heart disease, brain atrophy, sudden cardiac death and increased mortality. Graham Thornicroft has recently described this as a violation of the right to health under Article Twelve of the International Covenant on Economic, Social and Cultural Rights (Thornicroft, 2011). So, where does psychiatry go from here?

In his book Narrative Psychiatry, New York psychiatrist Brad Lewis points out that neuroscience has restricted psychiatrists’ ability to practice, especially when it comes to working with people empathically and on a deeply personal level. The failure of neuroscientific research to deliver interventions that are safe and effective means that the profession must face up to the question where do we go from here. The search for the answers to this is now the most pressing task facing critical and postpsychiatry. Lewis’s book is an important step forward in this search.

I admire the approach he adopts. His style is approachable with a gentle pétillance. He doesn’t denigrate biological psychiatry. He doesn’t attack neuroscience. He doesn’t even develop a critique of the field. Rather, the real problem with biological psychiatry is its sterility. It has nothing to say about the complexity of human lives and their dilemmas. He makes his point through his skilful use of Chekhov’s play Ivanov, which he uses to illuminate what he means by a narrative view of psychiatry and psychiatric practice. This is a view that engages with the multiplicity of meanings and thus the indeterminacy of human lives. There is no single, monological truth about human beings, but this does not mean a descent into the morass of relativism. Instead, he argues that it forces us to engage with our patients’ (and our own) values, and ultimately the moral implications of psychiatric practice. This is because narrative psychiatry is not concerned with the truth status of different stories, but with the consequences of different stories about madness and distress, and the sort of lives arise that from these stories.

In chapters two and three he shows how narrative in medicine and psychotherapy have illuminated clinical practice, as a prelude to setting out his ideas about narrative psychiatry in chapter four. Narrative ‘…provides a way for savvy educators, reformers, and practitioners to negotiate the contradictions in the field without falling into swirling polemics or developing rigid ” anti-this” or “pro-that” dichotomies – such as antipsychiatry versus propsychiatry, or drug therapy versus talk therapy.’ [64] Of course, this is talk that will make biological fundamentalists, the seekers of the ultimate truth about madness, rail and rant.  Instead, Lewis sees psychiatric practice in terms of prioritizing clinical stories. Psychiatric patients enter the clinic with a vast array of complex narratives. The most important task for the psychiatrist is to engage with these stories respectfully and empathically. This means caring for and about the person whose story you are listening to. His use of Chitra Divakaruni’s short story Mrs. Dutta Writes a Letter in the final chapters of his book sets out how narrative psychiatry works in practice, whilst drawing attention to the value of literary narratives in understanding clinical practice.

Brad Lewis’s view of narrative psychiatry sits comfortably, in my view, alongside Jo Moncrieff’s drug-centred model of psychotropic medication (Moncrieff, 2008). Both books are really important in moving from critique to practice. Furthermore, narrative psychiatry opens the way for much-needed future work, for example how psychiatrists might use diagnosis, medication (especially the placebo effect), psychotherapy (especially the non-specific factors common to all forms of psychotherapy). Most important of all narrative psychiatry has the potential to equip us to work more respectfully with people whose cultural beliefs differ from our own. And, until such time as governments decide that the practice of psychiatry is to be uncoupled from social control, how we might work with coercion. In conclusion, this is an important book. All psychiatrists, psychologists, and mental health professionals should read it.

Lewis, Bradley (2011) Narrative Psychiatry: how stories can shape clinical practice. The Johns Hopkins University press, Baltimore.

            Hardcover: 240 pages

            Publisher: The Johns Hopkins University Press (31 Jan 2011)

            Language: English

            ISBN-10: 0801899028

            ISBN-13: 978-0801899027

References

 InPharm (2012) The Brain Drain published on 05/04/12 at http://www.inpharm.com/news/172099/brain-drain accessed on 25th September 2012.

Kendall, T. (2011) The rise and fall of the atypical antipsychotics. British Journal of Pychiatry, 199, 266–268.

Moncrieff, J. (2008) The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. Basingstoke, Palgrave Macmillan

Thornicroft, G. (2011) Physical health disparities and mental illness: the sandal of premature mortality. British Journal of Psychiatry, 199, 441-442

 

 

2 COMMENTS

  1. “And, until such time as governments decide that the practice of psychiatry is to be uncoupled from social control, how we might work with coercion.”

    It is a fact, that psychiatrists basically WRITE modern forced psychiatry legislation, and it is a fact, that nothing gets in the legislation, or out of the legislation, without the huge input of institutional psychiatry ‘thought leaders’.

    Forced psychiatry, does not happen in a policy vacuum, it is a closely guarded nexus of coercive political power nurtured and expanded upon, by psychiatric academics and medico-legal technocrats who take their cue from psychiatric so-called science.

    Not to mention, if there were no “professionals” willing to get up in the morning and make their living coercing, if conscientious objectors outnumbered those willing to rape the brains of innocent strangers, it would also not exist.

    It is not possible, to talk of empathetic narratives and respectfully muse on ways to “work more respectfully with people whose cultural beliefs differ from our own”, when psychiatry stands ready, willing and able to sick a pack of goons masquerading as “nurses” on a perfect stranger, a distressed person, hold them down against their screams of nonconsent, strip their clothes from them, and stab them with a needle full of tranquilizer drugs, raping their brain.

    Here’s a novel “cultural belief” of mine I’d like respected. I believe real doctors examine and prove disease in the organ they claim to be an expert on. When said doctor doesn’t examine said organ, I label him/her a quack, and do not consent to a relationship with him/her.

    When the doctor/patient relationship is formed in violence and violation, there is no relationship other than one of domination, submission and terror.

    The hyper-violence, hyper-violation, and hyper-terror of forced psychiatry, is not something that psychiatry has been burdened with passively by “governments deciding” to give your profession these powers. Your profession actively spreads apologia throughout the world and the press for its violent and cruel coercions.

    Government is WAY beyond mere social control with forced psychiatry. Social control would be a carceral system of pre-crime due-process-free detention, and active suicide immobilization, ONLY (if such a horrendously due-process-free system could be tolerated in a free society).

    No, forced psychiatry today is nothing short of a set of laws riddled with psychiatry’s “medical” assertions, that does nothing less than offer the potentiality to deliver the never-proven-diseased brains, of every man, woman and child in the land, to psychiatry’s hands, with minimal pesky due process to the enterprise.

    Forced psychiatry today, is premised on the government believing, and all innocent people forced into the system believing, that the brains altered by force, are in fact, as-good-as objectively proven diseased, and Government hands the brains of its citizens over to your profession why? Not mere social control. No. Not this decade, and this hasn’t been the case in recent decades. No. It is much more specific, the “stated rationale” for this these days.

    Government somehow got the impression that the people who lose their right to own their own body under forced psychiatry legislation are people with literal brain diseases.

    Who/what profession, gave government THAT idea?

    Did government give itself that idea?

    Did psychiatric survivors give government that idea?

    Or did biopsychiatric ideologues, actively lobby government and whisper in its ear LIES about the objectivity and standing and progress of biopsychiatry “science”?

    When strangers from the government arrive at your door to seize you and violently alter your brain using life shortening tranquilizer drugs, Government doesn’t see it that way, government sees it psychiatry’s way.

    Maybe government got that idea, from the liars who have whispered in its ear all these years.

    To intimate, in the slightest, that this is a simple matter of “until such time as governments decide that the practice of psychiatry is to be uncoupled from social control”, is to conjure an image of psychiatry saying “Who? Me?”, and to absolve, and transfer the blame for the horrifically terrifying state of forced psychiatry policy today, to government, when in fact, it is psychiatry’s hands that are dripping with blood, far more than legislators and voters.

    Legislators take their lead, from what are essentially, dogmatic ultrabiological determinist fanatics, with a coercive lust to get their hands on the living, conscious brains, of ANYONE in society, by brutal force, if the innocent strangers targeted dare exhibit one of the behaviors or thoughts outlined in the psychiatric bible.

    Once you’ve had your brain raped, is there really any other part of your body to rape?

    These atrocities, and the extreme level of unconscionable invasiveness and violence that psychiatry carries out in such a cavalier way, have yet to be truly grasped by mainstream society, and evidently, psychiatry itself.

    Walking brain diseases don’t feel pain and humiliation after all. Walking brain disease don’t grapple with the dissonance of being raised in a society where they were led to believe they had human rights and dignity and could feel safe, and then realizing, that society has forsaken them and turned them into living pin cushions for a bunch of drug-happy quacks.

    The dynamic at play across forced psychiatry facilities right now across the world, of which as you read this, no doubt thousands of people are being assaulted with forced injections and so on, is that the staff actively view the targeted person as an inferior, defective, diseased, less-than-human walking brain disease, and this is what allows them to ignore their quarry’s pleas to let them alone.

    The very same madhouse keeper’s chauvinism that animated the violence of bygone eras, animates the chauvinism and violence of today’s forced psychiatry facilities.

    The chauvinism against people with psychiatric labels, that says when we scream out NO, that is not of the same worth as when an unlabeled person screams out NO.

    The chauvinism against people with psychiatric labels, that allows a brain rapist to sleep at night, because they flicked through a medical journal, on the left page was a drug company ad, on the right page was a shiny fMRI image, which somehow “proves” that the human dignity that person raped at work that day, in the course of his “shift” on the “ward”, was somehow justified, because “these people” are “diseased” and if we can’t prove it this decade, we’ll prove it next decade, but they just have to take their lumps, and have their rights taken away TODAY. Have their dignity raped TODAY.

    Forced psychiatry, is NOT, as it stands today, something government has foisted on psychiatry as some kind of social control policy objective. It’s considered a “tool” in psychiatry’s “treatment quiver”, and psychiatry asks for, refines, and justifies it to government, not the other way around. Never forget that.

    I know I won’t.

    So if this author of this book, or this article says “until such time as governments decide that the practice of psychiatry is to be uncoupled from social control”….

    never forget who whispers in government’s ear to provide them the legislative framework to get inside people’s bodies against their will, and on what pretext, a brain disease ideology pretext, based on pseudoscience.

    There can be never be empathy, in a stolen relationship based on fear, terror, control, intimidation, and sickening invasive violation of the conscious brain.

    There is no way to apply an empathic narrative to the cowardly decision, to dominate a powerless stranger, and rape that stranger’s brain and human dignity.

    There can be no reform, no refinement, of coercion, of violence against the group you ostensibly aim to “help”.

    It’s not first do no harm when someone is brought through the door. It is first, load their brain with drugs, and if the targeted person has any feelings on this matter, those feeling are diseased feelings, invalidated by the steamroller of psychiatric invalidation that has been invalidating survivors of forced psychiatry, since forced psychiatry first started cracking open our bodies against our will, as it ever was.

    IM of a D2 agonist, stat. Back to the coffee and newspaper. Just another day at the nurse’s station.

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