Narrativity as a Tool to Understand Suffering and Promote Healing

Journal of Psychiatry Reform vol. 10 #7, July 2023

Caroline Giroux, MD, FRCPC

Author information:

Professor of Psychiatry, Psychiatrist, University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA. [email protected]

Caroline Giroux is a psychiatrist who grew up and studied in Canada, where she lived and worked until her migration to California in 2007, at the time of her pregnancy with her first son. Words and stories have been her refuge since childhood and especially as she navigated major life transitions, processed losses, or coped with trauma and existential crises. She believes in the power of reclaiming one’s voice through story sharing and she incorporates narrative approaches in her work as a clinician and educator. Her own writings are full of things she loves the most, including her three sons, insights from her patients, and fond travel memories.

Narrativity, or the art of telling stories, is ubiquitous. It can be found in the three words on the license plate of Quebec, the Canadian province where I grew up: “Je me souviens” (“I remember”), or in the picture of an African American on a wine label and who was part of the French Resistance during WWII, or wrapped in the lyrics of your favorite song.

When we think of stories, we often think of the printed form, like newspaper clippings. But narrativity is different than gossip or advertisement. Instead of shaming, brainwashing or creating sensationalism, it seeks to elevate.

A quote from Jhumpa Lahiri really resonated years ago and I often share it during some lectures to illustrates how creating, putting into words or reading someone’s story (fictitious or not) can help validate complex experiences, such as being uprooted from one’s own country of origin:

“…being a foreigner (…) is a sort of lifelong pregnancy, a perpetual wait, a constant burden, a continuous feeling out of sorts. It is an ongoing responsibility, a parenthesis in what had once been ordinary life, only to discover that that previous life has vanished, replaced by something more complicated and demanding. Like pregnancy, being a foreigner (…) is something that elicits the same curiosity from strangers, the same combination of pity and respect.” [1]

In my case, both the phenomenon of migration and the metaphor of pregnancy happened concomitantly, making these words even more powerful for me to identify with. Stories create a compass when we lose all our cues. Stories we tell are a refuge in times of shaken identity, challenged values or uncertain dreams.

Why is narrativity important to the health professions like medicine? We help patients make sense, name the distress or suffering through the symbolic enactments in their body. Through their writing of their dynamic biographies, we encourage them to reclaim parts of their lives that were taken by trauma, make sense of a complex experience, edit, create (new, positive memories), express creativity and improve memory. For healers, writing can help us process complex emotions that can occur during overwhelming counter-transference, whether it is pleasant (attachment) or unpleasant (disgust). Rehearsing (for advocacy work) allows us to slow down, pause and practice mindfulness. Reviewing one’s biography helps gain perspective while building a bridge to past, culture and legacy, and might alter transgenerational patterns. Finally, storytelling can bring closure, transcendence of an event and healing.

For physicians who wish to incorporate more narrative elements in medicine, it is recommended that they unlearn, move away from clinical jargon because an extended, specialized vocabulary can actually be a hindrance to narrativity. So, our patients have an advantage. Therefore, we should let them teach us narrativity. Here is an example of what we might be conditioned to include in our history of present illness of a patient with depression:

“Patient has no energy or appetite. He lost weight. He cannot find pleasure in activities. He feels sad most days and reports low self-esteem. he was diagnosed with depression and his family doctor prescribed an SSRI. Sometimes he forgets to take it, partly because of side effects”.

And here is what the experience would sound like if read from a patient’s journal:

“Ugh… I already hear the food and meals weeping, as they rot, neglected, in the refrigerator. I am beyond sorrowful about their fate, they gave up on me by being flavorless, just like my days. The experience of trying to get out of bed every morning can be contained in these three letters: U-G-H. My duvet becomes heavy and evolves into a sense of dread. Why get up to live? I already feel dead. After hours of negotiating with myself to leave my bed, another tug-of-war takes place through the oscillations within my aching and nauseated body regarding this blank square of calendar full of promises and betrayals.”

In summary, write like the characters in Grapes of Wrath speak, or Life Ahead (“La Vie Devant Soi” is French novel written by Romain Gary who was recently made into a poignant movie). Write with candor, as if you don’t aspire to be a writer…

What comes to mind when you read these words: abandonment, envy, neglect, invalidation, kidnapping, exploitation, infanticide, devouring love, incest… Trauma? Adverse childhood experiences? It is correct. This collection of situations also turns out to be a list of frequent themes depicted in fairy tales and fables. So problem-solving starts earlier than we think: in the nursery. Stories, by illustrating archetypes (the orphan, the wanderer, the rebel, the magician etc.), inspire us in overcoming adversity.

Hero is another archetype, and it can be prominent in any of us at various times in our lives. Each archetype that dominates the psyche is supposed to guide the person for their growth. But consolidation or being stuck in the same for too long leads to symptoms, mental illness, personality disorder… It is a helpful framework when I work with survivors of trauma in my storytelling group. For instance, many who have suffered neglect or emotional abandonment might relate to the orphan archetype.

In the workshops and lectures I give on storytelling, I invite the audience to participate in self-reflective exercises. There should be only one rule though: suspend judgment, especially of oneself. It is an experiential process that knows no right or wrong. So there is no risk, except maybe to be pleasantly surprised or astonished…

Reflective pause

Do a 10-min writing exercise using any of the following prompts:

-Highlight of the week. Tell us about a sweet moment. Where in your body do you feel it, does it have a temperature, color, sound…

-Tell us the story of your name: its meaning, who chose it, why, and do you like it or not.

–Glorify the not so glorious… Talk about your most spectacular inefficiency this past week. Write it in a way that will make people want to be as inefficient. Or tell us about an interaction in which you made a comment you wish you could take back…

–There’s awe in the unusual or unexpected. Put into words three to five secret quirks or eccentricities about you that most people don’t know about. Things you just barely start to admit to yourself, but that you would feel ready sharing to at least one person. Example: you like to dance with loud music when you are alone. Or you have a funny ritual before going on a trip. Or you are a big fan of an obscure author.

What emotions arose as you did the exercise? Did you gain new insights about yourself and your story?

During “Reboot Your Narrative” group therapy I have been leading since 2019, a patient, who used to run away a lot, wrote on the topic of “sacred spaces”. She used to go to the beach. The beach was her sacred space. “I was looking for something bigger than myself. It made my problems look small”. Sometimes writing is the only space where one can break rules or pulverize boundaries without major consequences.

We can also see a parallel between performance arts and the life theater. Just like sitting at the opera or enjoying a play, we engage in our own storytelling:

◦ For entertainment

◦ For oral transmission and education of society

◦ To help younger generations cope with universal struggles (fairy tales)

◦ To integrate trauma in one’s broader life narrative by creating beauty, and making sense of, editing, and transcending adversities

◦ To develop connections and break isolation

◦ To restore wholeness and self-concept by reframing shame-inducing experiences more positively

In Upside [2], a book on post-traumatic growth, the author invites us to make a paradigm shift and view suffering as an accomplishment, by not looking at “what’s wrong” but at the human potential. Isolation can be a catalyst to introspection (through deliberate rumination). Positive reframing of trauma and loss through narration forces us to reassess one’s priorities. The use of creative outlets is encouraged; expressive writing has many advantages. It is not contingent upon a listener (which reduces the risk of dismissal and invalidation). It is important to focus more on emotional experience and meaning than facts. Studies by Pennebaker and mentioned by the author revealed that the group who wrote about emotions (as opposed to just facts) reported significant changes in their lives, and in a study with med students, it translated into higher levels of antibodies after the flu vaccine for the group that wrote about the emotional experiences [2].

Telling one’s story is a freedom that moves us from external definition to self-definition. When defined by society or by an institution (a “sick person”, a “chronic patient”), it is more challenging to define ourselves. Narrativity reminds us it is time to dismantle the labels, go to the emotions and choose what is aligned with our truth (such as transgenerational resilience as opposed to trauma re-enactments)

Stories are your precious legacy. Narrativity helps you access your essence. If a story inspires others, it can change the world. Nobody (not even artificial intelligence) can question, tell or edit your story because it is your own. Your story lives in you and can never be stolen from you. Your story belongs to YOU and you have the POWER to do what you want with it. Go back to the fairy tale (the trauma), the hero and the story in you and find your voice!

Conclusion

Narrativity stands by itself and doesn’t seek to accomplish, nor please anyone. It only appeases the self. It is beyond technology. No AI can ever replace it. Narrativity is based on the unnamable, the raw, which frees it from the tyranny of upgrade (unlike our workplace, our phone etc). It helps deconstruct emotions, bring nuances to experiences, and see the turmoil inside as not bad but a compass towards understanding, growth and evolution. It is a refuge from the culture of annulation, the need to polish what we feel, think or say. It is where the loud, the messy and the frightening can create a strange alchemy leading to the blissful. Just like labor.

Narrativity is the continent of ambiguity, where imperfections, the not knowing are invited and find legitimacy. The raw, the messy, the indignities, the shameful, the non-pristine, the chaotic, all become fuel for narrativity. And narrativity, this space of freedom to feel, to tell, to mute or share, represents the soul’s captions as the body experiences life through all its senses. Narrativity allows us to find beauty in chaos and extract wisdom from disorder.

But voicing one’s truth comes with a risk. There is a risk in sharing the intimate, beyond the private. This risk takes various forms in the recipient: shock, judgment, rejection, attack. Yet, my deepest regret is not having spoken up more often when I felt the need to.

In a landscape that is constantly shifting, narrativity can be your vessel that grounds you between two waves. Its words land like anchors at the bottom of the sea, made of the verbs that hear, and see.

As divine creatures embodied in our tangible world, as delightful as literature may be as a way to seek pleasure, our drive is more towards avoiding suffering. And narrativity, outside of causing delight to our minds hungry for the refined and the tasteful, is a haven to escape suffering, for in its space, the narrator doesn’t let tragedy and loss dictate everything. The author is in charge, and no longer a spectator of external conditions, can be an engaged protagonist, main character and hero as it progresses to also become the director of one’s own life theater. The narrated scenario helps connect the dots of the randomness of occurrences and incongruities of life.

Narrativity is my sanctuary…

What is it that your soul is dying to tell the world at this moment? Open your ears wide to the whispers of your soul, take the leap, and SAY IT. Who knows, maybe you’ll end up creating magic.

Write in a way that makes the reader want more, that makes you want to write more. Just like we can only live fully one act of love at a time, we can tell our stories, share our dreams, one whisper, one word at a time.

References:

1. Lahiri J. The namesake. Houghton Mifflin Harcourt; 2003.

2. Rendon J. Upside: The new science of post-traumatic growth. Simon and Schuster; 2015 Aug 4.