The value and benefit of narrative medicine for psychiatric practice

Abstract

Summary This article describes how applying techniques from literary studies and considering patient histories as texts helps me understand and formulate systemic issues in psychiatric assessments. Psychiatrists are not generally taught to pay close attention to aspects of language, including metaphor and syntax, but I argue that paying attention to the form, as well as to the content, of the stories patients bring us, can make us better attuned to the contexts of their needs and distress, and therefore better placed to help.

Narration in medical care. Selected aspects of narrative medicine in psychiatry

“…In practice, it also means developing interpersonal skills and professionalism [33], which are essential when it comes to dealing with people with mental disorders. Following the principles of narrative medicine can be helpful in meeting current health challenges and can bring tangible benefits to the medical field of psychiatry [21].…”

“…Psychiatry seems to be an area where the narrative aspect is particularly important [4,20,21], because all search narrative and facilitate the development of new solutions and plans and alternative hopes for the future [14,17].…”

“…Narration in psychiatry draws attention not only to the existing psychopathology, but also to a broader aspect of the patient's functioning and undertaken activities, to the whole of his/her life, because mental health disorders are only a fragment of the patient's full knowledge [25]. During contact with the patient, it is particularly important to pay attention to the content of the stories told by them, because thanks to this it is possible to correctly read their entire context and assess their needs and emotions, and this has a direct impact on making effective interventions [21].…”

Historical empathy and medicine: Pathography and empathy in Sophocles’ Philoctetes

“…For example, Ahlzén (2019) concludes that empathy may be affected by reading literature under certain carefully specified circumstances but argues that the "narratological theory apparatus may at times stand in the way for the plot" and specific narrative skills should not be considered a necessary or even contributing condition for the clinicians' interest in stories of illness. 6 Nevertheless, contemporary health challenges, such as the facts that patients live longer, with more illness complexity and comorbidity than in previous generations (Dosani 2021) and that their narratives are more complex and require further interpretation (Zaharias 2018a, b), increase the physicians' need to be more attentive to meaning-creating processes. 7 "The norms of narrative competence govern the interaction with the patient in a way sensitive to a whole host of cultural, emotional, and contextualized aspects" (Vannatta and Vannatta 2013, p. 43) and help physicians fully understand the stories of their patients including the implicit meaning of narratives (Kalitzkus and Matthiessen 2009;Vannatta and Vannatta 3 Crawford (2021) also remarks that "compassion takes empathy one step further by taking some sort of action to try to help the suffering".…”

“…This also facilitates the practitioner to elicit the full exact spectrum of the patient's symptoms and risk factors (Schattner 2012) and thus make more accurate diagnoses. 8 Representative examples which demonstrate the benefits of narrative competence for medical practitioners are offered in Dosani (2021) who uses close reading in psychiatric practice, Vannatta and Vannatta (2013) who refer to cases of domestic abuse where the reading of related novels makes doctors more sensitive to the "unsaid" evidence for it in the clinic, and Scott-Conner and Agarwal (2021) who in their discussion of narrative medicine training in surgical education emphasize the need for recording a patient's story in the medical record with a language rich in metaphor, found in great literature, which can also contribute to other health care providers' understanding and empathic responses. Schattner (2012) also refers to cases in varied medical settings, where patients' clues and expressions of affect were not acknowledged by physicians, especially in primary care where the motivation of many visits are psychosocial problems which need to be addressed, and proposes that narrative competence is essential to the effective practice of empathic medicine.…”