A narrative approach to mental health in general practice

This is the second in a series of five articles on narrative based medicine

There is a tension between the complex narrative that a patient brings into the consulting room and a doctor's understanding of what is really going on as formulated in a diagnosis or an idea about pathology. Which is a “truer” account of reality: the patient's or the doctor's? Can both be true? If so, how?

These questions are particularly relevant in mental health care for a number of reasons. Firstly, sociology and ethnography have identified psychiatry alone among the medical specialties as peculiarly culture bound. 1 2 Secondly, psychiatry lies in an uncomfortable no man's land between conventional medical science and the search for meaning which may extend into political and religious domains.3 Thirdly, mental health professionals often use confusing and contradictory language to describe their observations. When compared with the babel of explanatory models which often seem to disqualify each other or which may simply be a way of asserting the therapist's power, the patient's own story may gain in authority and seem saner than the professional's version.4 Finally, psychiatry is the only area of specialist medicine in which talking and listening are explicitly understood to be therapeutic.5