A PORTABLE WORKSHOP: EMBEDDING STORYTELLING IN PSYCHIATRY
Vol 8 #8
Caroline Giroux, MD, FRCPC
Associate Clinical Professor, Psychiatrist, UCD Trauma Recovery Center Director, Department of Psychiatry and Behavioral Sciences, UC Davis Health System, Sacramento, CA, USA, [email protected]
“The purpose of a writer is to prevent civilization from destroying itself.”
Stories are ubiquitous. Whether we invite cinema into our living room one evening, we go to the opera (or used to), we tell frightening stories by the camp fire, such literary gems have crossed generations, continents, languages. They can even be found on wine bottle labels, license plates, advertisement, or crunchy details from real life vignettes published in a newspaper such as a Farmer’s Dispatch from 1913! Their perennial nature indicates our lifelong craving to hear and also tell unexpected, enlightening, fantastic stories.
Way before those mini stories found in every corner of daily life, you had probably been enraptured by rather morbid tales that were passed down from generation to generation because they speak to so many children’s unconscious. When we analyze Cinderella, Hansel and Gretel, Snow White, Rapunzel etc, we discover inept or abusive parental figures who seem incredibly crafty in the various ways they manage to abandon or terrorize their children. Their abusive and exploitative behavior shocks the reader who wants to read or hear more, to make sure this ends favorably, because the bond of sympathy towards the main character is immediate. These stories are so popular and necessary because they give us hope and can inspire us to triumph from adversity and to become, too, the hero of our own life.
Later, those fairy tales can be enacted on the theater of life. If we choose a helping profession, stories become an integral part of our encounters with people. We hear countless stories and are part of as many. As doctors, we listen to and have to write “histories of present illness”. We construct a narrative, or diagnostic formulation, with each patient we meet. That is a story. As part of their healing, we help them identify destructive scripts and then develop a counter-narrative that allows them to reclaim their life and identity, because stories are part of our legacy, and they give us the power to define ourselves in a way that overrides society’s damaging categorizations.
Aspiring to live as a writer is not incompatible with being a psychiatrist. It makes sense that both functions feed each other. Viktor Frankl, a psychiatrist and neurologist who survived the nazi concentration camps is a great example. He saw finding meaning in life (as atrocious as some of its aspects might be) like a motivational force and he developed logotherapy. Helping our patients to find meaning in their life adversities can take place through the use of literature, mythology, journaling, or art-therapy. We end up embarking in a self-discovery journey in parallel to theirs.
As I started sharing my writing in various venues over the recent years, I discovered the leverage that exists from writing patients’ stories and articles about the challenges in medicine. It is cathartic not only for the author but also for some readers. Other physicians I had the chance to read such as Deepak Chopra and William Osler have used writing in an impactful way. Writing can rekindle a dialogue and makes us break the silence. As advocates for our patients, we must be a voice for them when they don’t feel empowered enough to seek social justice. A few years ago, I led a creative writing group at the county clinic where I was the director. This experience and other art-therapy initiatives that followed have been very powerful for the group and taught us a lot about resilience. It also confirmed to me that storytelling is a universal need that can heal and help people create positive meanings out of life. It abolishes the “us-them” divide that sometimes still exists between patients and their clinicians. Through the exchange of stories, we also share our inner self, our vulnerabilities, which can be used as a momentum for change. Shared stories create a connection through identification and solidarity and can give rise to a tidal wave of revolutionary compassion.
As we try to heal from difficult events, editing or transcending a trauma narrative allows the creation of beauty, and even the reframing of difficult or shame-inducing experiences in a positive way. For instance, a person reminiscing on regrettable choices during adolescence could choose to view them under the lens of archetypes or other non-shaming, compassionate, normalizing or developmental framework; people evolve throughout the lifespan, and it might be useful and even interesting to depathologize by finding the archetype (wanderer, orphan, warrior etc) that was the most likely to be active or learn through trial and error during a particular challenging life chapter. In her quintessential book, Goddesses in Everywoman, psychiatrist and Jungian psychoanalyst Jean Shinoda Bolen walks us through that path. It is never too late to become the author of one’s life, and the ordinary hero of our personal fairy tale. Writing one’ story helps escape the chaos of our world and the constant chatter of life in an esthetic dimension that is elevating, transformative, almost magical.
How to make writing fit into your busy life
One of the many great aspects of writing is that it is portable. Carry a compact notebook everywhere you go and 2 pens (in case one dies in the middle of a glorious sentence). A smart phone is fine too, but handwriting presents advantages by increasing vigilance, memory and general engagement of senses. When no pen, paper, restaurant napkin, tissue box, receipt or other device is available, use meditation to articulate your story; writing can still remain a very internal activity (my first phase of writing often takes place in my head while I am engaging in a completely unrelated activity). Observe your rhythms and the environmental cues (space, time of day, noise level, what you wear etc) that are most likely to channel and support your inspiration. Practice mindfulness to enhance your creativity and general wellbeing. Christophe André, a French psychiatrist, wrote marvelous books (Looking at Mindfulness, and Happiness) that illustrates the intersection between meditation and appreciation of art.
A gratitude journal can be a good way to start by creating a routine or regularity in writing, in addition to having well documented benefits on health (mental, physical, spiritual…). Listing 3 elements to be thankful for every night can help program the positive aspects of life into our brain and eventually shift the perspective to an optimistic one. In the morning, one could switch to a dream log or journal. Dreams are like fairy tales happening in our sleep that, through their vivid symbolism, might contain elements of solutions or wisdom to various life dilemmas. Freud’s landmark work on dream interpretation can inspire the dreamer to make sense of dream content.
Even making room for correspondence (handwritten letters, emails, cards) has helped curb the exacerbated isolation throughout my life (especially since the pandemic started).
Joining a writing or poetry group can enhance meaning through an added sense of belonging. It can enhance spirituality as you self-reflect and gain insight about the meanings of life and your value system.
Now, what will you do now to channel your creative writing energy?
If we apply Albert Camus’ quote to medicine, we see that using the spoken or written word can prevent also our field from destroying itself. I think our writing as doctors can help prevent medicine in general or psychiatry in particular from being completely high-jacked by the commercial interests. Our words can invite dialogue to better society, and when we quote our patients’, we are allowing them to educate society when something traumatic has happened to them. We are finally offering them the stage after they had been muzzled for so long. We give our time and presence by listening, and we help them evolve from the victim status to survivor and empowered person who can feel worthy because he/she inspires us. We acknowledge each patient as expert in their own life.
Writing also becomes a way to process our feelings as healers when we hear difficult stories and represents a strategy to access vicarious resilience (in other words, a patient’s own resilience that we witness and that inspires us). By writing with, for and about our patients, we legitimize their lives, bear witness to their struggles and we become part of their own, new narrative. Such a bond may help the survivor feel whole again.
Our world is still plagued with oppression of all kinds. Fear-based structures in which some patriarchal models have evolved perpetuate oppression and injustices. By speaking up the truths, we are planting seeds and we are fighting inequalities. We create a new, inclusive, de-stigmatizing language. We invite all the people to take responsibility for their actions. We are, after all, a helping profession. If we don’t speak up about social injustices, which often create symptoms that lead people in our emergency departments or clinics, who will?
- Frankl V. Man’s Search for Meaning. Beacon Press; 2006.
- Chopra D. Reinventing the Body, Resurrecting the Soul: How to Create a New You. Three Rivers Press; 2009.
- Osler SW. Sir William Osler, 1849-1919: A Selection for Medical Students. Associated Medical Services; 1982.
- Bolen JS. Goddesses in Everywoman: Powerful archetypes in women’s lives. Harper; 2014.
- André C. Looking at Mindfulness: Twenty-Five Paintings to Change the Way You Live. Blue Rider Press; 2016.
- André C. Happiness: Twenty-Five Ways to Live Joyfully Through Art. Rider Books; 2017.
- Freud S, Cronin AJ. The Interpretation of Dreams. Read Books Ltd; 2013.