Narratives of mental illness and the joint creation of narrative in the patient-clinician relationship.

摘要

First-person published narratives of mental illness, despite their great number and long history, have been neglected in the growing scholarly literature about patient-written narratives of other kinds of illness. Scholars in such diverse fields as sociology, literature, ethics, and life writing have developed theses and theories based on autobiographical narratives of physical illness and injury, but not mental illness. There are good reasons for this having to do with the nature of the severe mental illnesses, which can, at the least, call into question the competency of the narrator to tell his or her story, and at the worst, occlude narrativity altogether. My training as a psychologist allows me to read narratives written by the mentally ill with a clinical eye, and my studies at the Institute for the Medical Humanities give me a broader and deeper humanistic perspective. With these melded viewpoints, I have closely read, both sympathetically and critically, several dozen narratives of mental illness, primarily those written by patients in the United States over the last hundred years. In this work I rely heavily on the work of sociologist Arthur W. Frank, who has developed what he calls a "listening device" to assist clinicians in hearing stories of illness: three plots, or storylines. These are the restitution narrative, the chaos narrative, and the quest narrative. I make the case that these plots are not easily transposed upon narratives of severe psychotic mental illness. I go on to suggest that the stories are often written with the underlying assumption of a certain model of mental illness, whether the model be medical, social, psychoanalytic, libertarian, or some other. My own model of mental illness, clinically and philosophically, is strongly biomedical as regards etiologies and necessary treatments, but biopsychosocial when it comes to treatment sufficiency. I conclude with an investigation into what the narrators of mental illness stories have said about the care they received in the past and about the care they can and should receive from modern-day medicine.