The stories we tell have huge implications for the life we lead, structuring both our internal and social realities in different ways. In fact the stories we tell every day create an intersubjective reality which is arguably the single most important factor in leading to our species finding itself where it currently does. Our thumbs also come in useful.
So what does this have to do with Madness? The answer is two-fold, with the stories we tell having implications for the constitution of our inner life and for how we interact with others. From this angle Mad Studies becomes a countercultural story challenging the limitations of a psychiatric system which too often seeks to define people without stopping to think or ask what the impacts might be.
Understanding this it becomes important to ask what stories are and the purpose they serve. A view which can allow us to offer critiques when stories become limiting or damaging to people. Stories are in themselves amoral and within them people can find themselves sidelined as characters instead of fully fledged human beings. This contradicts a Mad philosophy which sees every human as deserving dignity and the possibility to travel on a journey towards their flourishing.
What are stories?
What constitutes a story is broad, including the works of Shakespeare but also any instance in which information is shared. This might appear as an overgeneralization but when information is considered as a gateway between what is objectively happening out there and what we are subjectively perceiving it becomes apparent that, whether or not grounded in facts, communicating information is never an encompassing reflection of something but a cherry picked understanding. It is a story we have chosen to tell.
To summarise, a story is a partial rendering of our internal or external reality which has implications for how we make sense of the world. We can now consider how this plays out in the psychiatric realm.
Stories and psychiatry
One of the most clear examples of storytelling is diagnosis. The intention of this is not to critique diagnoses which can be enjoyed and distrusted by people often at the same time but to consider what the implications of being on the receiving end of one might be.
Considering a diagnosis as a partial rendering of somebody’s lived reality should not be controversial, where there is likely to be disagreement is the extent to which they reflect a truth that can be validated as existing separate to human interference. Whilst this topic is welcome to further discussion here we will just consider the implications of being made a character in other’s expectations. Whilst this is not something which happens in a unified manner, but impacts on people dependent on particular relational dynamics, we can as an example consider the ways in which it shapes the relational space between a psychiatrist and their patient. With diagnoses potentially limiting the capacity for therapeutic engagement to occur from both sides.
Despite being the fundamental means through which we communicate and come to cooperate in a mutually agreeable fashion, as partial renderings of reality, stories are also always limiting. Therefore whilst psychiatric diagnosis as defined by the ICD and DSM series are the current dominant means of making sense of mental distress considered to be ‘abnormal’ they can have implications for how people experience the world. This is because they render expectations on individuals which are too often presented as cast iron limitations to somebody living in a way they would like.
Although this may sometimes be considered a ‘realistic’ structuring of somebody’s world it also risks falling victim to the damaging effects of labelling, in which individuals become trapped in psychological or social boxes which they struggle to break out. Consequently, like a character in a book destined to suffer the same fate whenever somebody flicks through the pages, psychiatric diagnoses can enforce on somebody a limiting view. A view which undermines their capacity to experience or be seen to experience the world as a multifaceted and complex individual with a raft of different desires, reactions and expectations. In this sense, a more nuanced capacity of the individual as a ‘knower’ of themselves is denied or limited; a form of epistemic injustice.
This problem is particularly pronounced when psychiatry hangs on to being an objective arbitrator of reality, setting strict boundaries of social acceptability and lacking the reflexive capacity to see not only how people can change but how the cultures we all live within are fluid and constructive. This relates to how stories are not a passive reflection of the world we live in but fundamentally shape it, meaning we can change reality if we begin to respect the impact of the stories we tell and go about altering them accordingly.
How can seeing the role of storytelling in psychiatry help?
It is a regular occurrence in the modern day to see stories that find their roots in science as infallible. Science being seen as a stern rendering of an objective reality detached from any subjective or intersubjective interference. Without resorting to a totalitarian postmodern relativism we can however see little sense in this idea, with all scientific understanding being born out of the inner worldviews of fallible human scientists. Whilst the nuances of this debate could fill a library, giving it a brief cameo opens up some of the fundamental concerns people hold towards psychiatry, not only as a discipline but as an intersubjective institution.
This is because whilst science can often get close to closing the gap between the external world and our internal collective understanding of it, this is not something that has been possible in psychiatry through any quantifiable measure. So whilst the 1990s were declared the ‘decade of the brain’ and mass amounts of funding have been chucked at neuroscience ever since, we still find ourselves as a species with little direct proof for chemical imbalance theories of mental distress or any specific aetiological markers which could be considered to constitute ‘illness’.
This raises problems surrounding the legitimacy or lack thereof of the stories we currently allow to culturally dominate about what mental distress is and how we can prevent it. Moreover, question marks begin to surround any harm caused by these stories and the extent to which they undermine the notion that psychiatrists are agents of care not control.
Encouraging a view in which the stories we tell are not carved into stone tablets but are culturally constructed and contested and so open to change can encourage a more reflective and malleable psychiatric system. This can encourage those who work within it to offer more attuned support, less bound by seemingly arbitrary parameters.