What is Narrative Psychiatry?

The world runs on stories, but are the stories that run your world… your own?

Humans rely on narratives as the mental blueprint for interactions with others. A narrative is the act of a narrator relaying a story - a set of characters that conduct actions over time - to an audience. The people who raised us, our community, and our societies are the main sources of these internal libraries.

Some narratives may include: a mother figure giving rewards to her toddler for changing their behavior; a father figure defending his child from another adult; a peer showing solidarity over a secret. These inform one as to how to manage one’s emotions like sadness, anger, fear, and shame.

The narratives above are sugar-coated, of course. Consider some other narratives: a mother figure erupting into shouting at all signs of misbehavior; a father figure disappearing as soon as the child exhibits weakness; a peer rejecting attempts at closeness. Obviously, these stories would direct one to react to one’s emotions in a different way.

Truth is, each individual has experienced a wide range of conflicting stories by the time one reaches adulthood. So why is it that a handful of narratives come to dominate one’s mental space? The answer lies in how one attaches emotional valence to one’s experiences. After many years of replaying the same story with different characters in different settings, the emotions and the stories become intertwined, one automatically calling up the other, and vice versa.

One can imagine a beautiful walk with one’s love interest evoking a memory of being held in childhood. More nefariously, a stressful moment at work with a supervisor who happens to be an older woman may evoke thoughts, feelings, and reactions similar to stressful moments with one’s mother figure. One is in control of one’s actions and words, but seemingly limited in scope to that of the internalized narrative.

//

Narrative psychiatry is the assessment and treatment of internalized narratives that have become counterproductive to your life’s trajectory.

First let’s consider the narrative that traditional psychiatry espouses. Psychiatry, as a specialty field of medicine, tells a story that if you listen to the doctor, they will take away all your suffering because there is a malfunctioning body part that can be fixed. As a doctor, I understand this is a very simplified view of the human experience of suffering. Even if it were true that a pill can take away depression and anxiety, learning how to live again is not at all trivial. Think of the years someone has to cope in particular ways with strong unpleasurable emotions: how does one grapple with that level of change?

Enter Narrative Psychiatry, a frameshift that I hope would be a balm for this outcomes-driven, patriarchal society. Placed at the forefront is the subjective experience of suffering, finally given its due respect. I understand that when an internalized narrative that used to run your life runs it into the ground instead, there is a feeling that a part of you has died. Counterintuitively, the same mourning would also occur if you were to relinquish your current way of existing even though it has been harming you.

As such, I also employ an appropriate degree of humility. I am only an expert on medication, therapy, and academic/government institutions related to mental health. As long as you trust me on those aspects, I trust that you are the expert on your own history and will be the director, producer, and lead actor in your life’s movie. I play the role of your industry advisor, injecting support and critical feedback where appropriate to help you fine tune your scripts.

I believe psychiatry is still the correct term here for my practice. Despite the flaws and relative lack of robust data for medications in psychiatry, we cannot neglect the visceral experience of depression, anxiety, and other deeply-rooted emotions. I have to respect your body’s memory of the former safety provided by internalized narrative; it is so strong that it often takes outside chemicals in the form of psychoactive medications to help you unlearn old habits.

//

That’s all nice and idealistic, but how does this translate into clinical care?

First, assessment and treatment is patient-driven. Our first encounters will be primarily utilized to stabilize and to co-create a game plan to change your life in the way you want it to be changed. I believe this is different from most physicians who listen for symptoms, slot you into some diagnosis given DSM criteria, and then prescribe medications to cure the symptoms. While I will also conduct a diagnostic interview with medication prescription, it is always toward a goal that we set together with the medications as your hammer and therapy your practice workbench.

Second, collaboration with outside providers including therapists is prioritized. I believe in a team-based approach. In Narrative Psychiatry, a phenomenological (as opposed to positivistic) stance of observation is taken. The more points of view we have of the object, the more data we have on the object. If you’re confused, don’t worry. There will be follow-up blog posts on this and other tenets of Narrative Medicine as conceptualized by Dr Rita Charon at Columbia University, from whom I draw much of my inspiration.

Finally, the underlying philosophy of treatment is born from a stance of witnessing rather than pathologization. I hope that in our sessions, my verbal and non-verbal forms of communication send a message that your suffering is being seen and accepted for what it is.

I honed this style of communication in my previous work, as the medical director at Mount Sinai Behavioral Health Center’s Intensive Outpatient Program and Partial Hospitalization Program. It is a comprehensive mental health program for people who would have otherwise been hospitalized. Alongside a team of highly-skilled and passionate psychologists and social workers, I conducted process groups, mindfulness groups, individual therapy, and medication management for the purposes of awakening people to the narratives trapping them in their suffering. I am so grateful for my time learning from their disciplines. Together, we helped people who survived trauma reconnect with a sense of belonging. We saw those who lost almost everything regain a sense of self.

Now, as I start this private practice, I want to bring my extensive experience of working with all ages, races, ethnicities, gender identities, and socioeconomic backgrounds. Whatever you call yourself, I will welcome you. If you’re suffering, I will listen. Then, when we’re ready, we’ll start that new chapter together.