This essay discusses Susan Smiley’s documentary film, Out of the Shadow (2004), and Tina Kotulski’s memoir, Saving Millie: A Daughter’s Story of Surviving Her Mother’s Schizophrenia, as filmic and narrative treatments of their mother’s schizophrenia. Mildred Smiley, and her diagnosis of and treatment for schizophrenia, is at the center of both her daughters’ treatments of mental illness, and in these texts, all three become witnesses to the multiple experiences of mental illness and the multiple events of (...) psychiatric power. As I will argue, these two texts are treatments of schizophrenia that both see and don’t see Mildred Smiley’s experience of mental illness. Through these texts, we—viewer and reader—are asked to look again, or to look for the first time, at mental illness, and we are positioned as having the agency to look or look away. As we look and try to make sense of what we see (and don’t see), we too participate in the production of mental illness as a category of analysis. (shrink)

Although historians of addiction have long debated whether an oral culture of “sharing” or “Big Book”-based reading practices are foundational to 12-step recovery culture, the role other types of media have played in the development of contemporary recovery discourse has remained largely unexplored. This essay compares the production, reception and formal elements of the films The Lost Weekend and Smash Up in relation to the popularization of the disease concept of alcoholism. Through an analysis of archival sources, addiction narratives, and (...) nascent alcoholism research, this paper argues that, by emphasizing the importance of popular representations of alcoholics above scientific inquiry, early recovering “experts” successfully promulgated the disease concept of alcoholism, but the testimonials of later recovering alcoholics became relegated to the sphere of popular culture. (shrink)

Background: Electroconvulsive therapy is one of the most effective treatments for major depressive disorder. Recently, there has been increasing attention to evaluate the effect of ECT on resting-state functional magnetic resonance imaging. This study aims to compare rs-fMRI of depressive disorder patients with healthy participants, investigate whether pre-ECT dynamic functional network connectivity network estimated from patients rs-fMRI is associated with an eventual ECT outcome, and explore the effect of ECT on brain network states.Method: Resting-state functional magnetic resonance imaging data (...) were collected from 119 patients with depression or depressive disorder, and 61 healthy participants, with an age mean of 52.25 years old. The pre-ECT and post-ECT Hamilton Depression Rating Scale were 25.59 ± 6.14 and 11.48 ± 9.07, respectively. Twenty-four independent components from default mode and cognitive control network were extracted, using group-independent component analysis from pre-ECT and post-ECT rs-fMRI. Then, the sliding window approach was used to estimate the pre-and post-ECT dFNC of each subject. Next, k-means clustering was separately applied to pre-ECT dFNC and post-ECT dFNC to assess three distinct states from each participant. We calculated the amount of time each subject spends in each state, which is called “occupancy rate” or OCR. Next, we compared OCR values between HC and DEP participants. We also calculated the partial correlation between pre-ECT OCRs and HDRS change while controlling for age, gender, and site. Finally, we evaluated the effectiveness of ECT by comparing pre- and post-ECT OCR of DEP and HC participants.Results: The main findings include depressive disorder patients had significantly lower OCR values than the HC group in state 2, where connectivity between cognitive control network and default mode network was relatively higher than other states, Pre-ECT OCR of state, with more negative connectivity between CCN and DMN components, is linked with the HDRS changes. This means that those DEP patients who spent less time in this state showed more HDRS change, and The post-ECT OCR analysis suggested that ECT increased the amount of time DEP patients spent in state 2.Conclusion: Our finding suggests that dynamic functional network connectivity features, estimated from CCN and DMN, show promise as a predictive biomarker of the ECT outcome of DEP patients. Also, this study identifies a possible underlying mechanism associated with the ECT effect on DEP patients. (shrink)

In this essay, I analyze two memoirs—Rafael Campo's The Poetry of Healing: A Doctor's Education in Empathy, Identity, and Desire and Abraham Verghese's My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS—which describe the effects of treating HIV/AIDS on each doctor's identity, on his desire for community and belonging, and on his identification and/or disidentification with the medical profession in the United States. My readings of Campo and Verghese revolve around three key (...) terms provided by Campo's subtitle: identity, empathy, and desire. I shift the order of these terms in Campo's subtitle because I want to read identity, empathy, and desire in Campo and Verghese through and along with the theoretical “pragmatics” of Gilles Deleuze and Felix Guattari. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Priming and Narrative Habits in the Phenomenological InterviewReflections on a Study of Tourette SyndromeThe author reports no conflicts of interest.In "Dimensions, Not Types: On the Phenomenology of Premonitory Urges in Tourette Syndrome," Lisa Curtis-Wendlandt and Jack Reynolds provide new insights into some of the experiences characteristic of Tourette syndrome (TS). Their study is an excellent example of applied phenomenology (Burch, 2021), combining philosophy and qualitative research methods to (...) illuminate experiences that have often been mischaracterized in the existing literature. In their study, they focus on what is commonly referred to as a "premonitory urge" (PU): the "anticipatory urge that is often thought to precede the onset of the motor and phonic tics that are part of Tourette Syndrome" (Curtis-Wendlandt & Reynolds, 2024, p. 26). They ask not only whether PU is a necessary feature of TS, but also whether the very concept of PU accurately portrays the experiences and behaviors that it's intended to refer to. They point out that existing scales used to assess PU, for example, seem to implicitly narrow the relevant experiences by assuming that they are a) always negative and b) always internal, or inwardly focused (Curtis-Wendlandt & Reynolds, 2024, 26). Curtis-Wendlandt and Reynolds question these in-built assumptions about PU, suggesting that they may provide an overly narrow depiction that misses the genuine diversity of experiences that precede the onset of a motor or phonic tic.To explore these phenomena in more detail, they conducted a study intended to elicit fresh descriptions of these experiences. They interviewed 12 teenagers with a diagnosis of TS about their experiences of ticcing and tic suppression. Using the micro-phenomenological method (Petitmengin, 2006), they asked participants to reflect on a specific tic or tic suppression event and to recall the event in detail. Throughout the interview, [End Page 43] they asked open-ended questions about sensory, cognitive, or affective experiences surrounding the event. Through these interviews, they were able to generate rich descriptions of these experiences and investigate how these descriptions differed from standard accounts in the existing literature.Curtis-Wendlandt and Reynolds provide a detailed account of how they designed their phenomenological study, both philosophically and empirically. However, there is an important aspect of their method that they discuss only in a cursory or implicit way, which is what I want to focus on here. Throughout their study, they were concerned that participants might simply parrot back well-worn medicalized characterizations of PU. Such characterizations risk simplifying or even occluding key aspects of the participants' experiences that might be difficult to reflect upon or describe. However, despite stressing the importance of eliciting fresh descriptions, Curtis-Wendlandt and Reynolds provide only glimpses of how the interviews actually unfolded and what kinds of techniques they used to elicit these descriptions.In my experience, it is quite common to hear phenomenological psychologists and psychiatrists express concern that people may simply repeat common psychiatric or medicalized characterizations of their condition, rather than genuinely reflect upon and describe their first-person experiences. The philosophical assumption is that we all fall back on culturally sedimented language and terminology when describing our experiences. Someone who has spent extended periods of time interacting with psychiatrists and other healthcare professionals, for example, is likely to have picked up common ways of describing their condition—ways that may have helped them receive a diagnosis or obtain treatment. There is nothing inherently wrong with falling into these culturally sedimented characterizations. They facilitate everyday communication through a shared language and terminology. But phenomenologists are often concerned that this kind of culturally sedimented language covers over or obscures the phenomenon or experience they are trying to investigate. For example, if a psychiatrist has often described their patient's depressed mood as "sadness," then that patient may be likely to self-describe their mood as sadness in an interview setting. It might, in fact, be the case that their mood is best described as sadness. But it could also be the case that their mood would be more accurately described as, for instance, a sense of emptiness or feeling deep despair. The challenge is therefore to know whether someone's self-description is... (shrink)

This study elaborates on narrative resources emerging in the treatment of longlasting musculoskeletal and psychosomatic disorders in Norwegian psychomotor physiotherapy. Patients’ experiences produced in focus group interviews were analyzed from a narrative perspective, combining common themes across groups with in depth analysis of selected particular stories. NPMP theory expanded by Løgstrup’s and Ricoeur’s philosophy, and Mattingly’s and Frank’s narrative approach provided the theoretical perspective. Patients had discovered meaning imbued in muscular tension. Control shifted from inhibiting discipline and (...) cognitive strategies, towards more contingence with gravity and sensation, and increased freedom to be what and who they were. Trust, time, open speech, and being respectfully listened to were described as therapeutic pre-conditions. The body was experienced as the source of their voice as their own. As tension patterns transformed, novel experience in sensation appeared to feed narrative imagination, reshaping past plots, embodied identity and future prospects. NPMP was disclosed as a treatment integrating detection, battle and repair as narrative subplots, but the core narrative was the journey of transformation. Novel embodied narrative resources nourished the quest for a life and identity in tune with the body as one’s own. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:To Recognize the Person: Learning from Narratives of Psychiatric TreatmentLinda J. MorrisonTo know what patients endure at the hands of illness and therefore to be of clinical help requires that doctors enter the worlds of their patients, if only imaginatively, and to see and interpret these worlds from the patient’s point of view(Charon, 2006, p. 9).These narratives of psychiatric hospitalization are rich and evocative. We are fortunate to have (...) twelve descriptions appearing side-by-side, each unique in its focus, outlook, detail and narrative tone. Together their interwoven contexts describe personal and work relationships, internal and external help-seeking, encounters in community and hospital settings, and experiences of the psychiatric (psychiatrized) self as supplicant, victim, recipient, participant, product, and active agent over time (Morrison, 2005).Through their collected narratives, the authors create a distinct counterpoint to the more familiar clinical narratives of psychiatric encounters. Ordinarily the professional narrative drives interpretation of a clinical experience, whether medical or psychiatric. The caregivers populating these narratives would probably tell different stories, and the hospital notes and treatment records yet another (Hinsby & Baker, 2004; VanDerNagel et al., 2009). The disjunction between professional and patient narrative is especially true for psychiatric hospitalizations, in which the inpatient’s active narrative becomes a part of the diagnostic and treatment process (Steslow, 2010).In this symposium, the patient’s narrative is a window for interpretive insights into personal experience of the process. Each is a situated retrospective, in which added dimensions of feeling, thought and interaction provide the reader a fuller and more complex awareness of the experience of psychiatric hospitalization. The narratives provide insights about choice and agency, control and harm, safety and strength, hope and frustration, resilience and recovery, empathy and humanity; they also reveal various ethical issues related to the experience of help-seeking and treatment.It is vital to consider what each person wrote: what choices they made in representing their experience; what aspects they focused on, and what they (we imagine) left out. The authors used their own voices to create their own representations. In each narrative, “the person” provides an important standpoint. Who is this person, what is his or her experience? Where is the person in the situation; in what way does he or she appear to those who provide treatment or care? How, if at all, is the treatment pertinent to the person’s concerns? Does it feel helpful or harmful? How does the person find a way to continue, to push through, with the help of (or in spite of) those we hope are providing care? This is the first sign of agency, of choice, of “dreaming.” [End Page 35]As V. Barnard writes in Dreaming: A Recovery Story, “to make a film, one has to dream it first.” All of the authors in this symposium took the risk and the opportunity to create their own stories: what to include, what to leave out, how to tell what they wanted to say. These choices gave them the power to dream: how it was, how it might have been; how it felt, good and bad; the chance to represent their own reality—to themselves, and to unknown others (Morrison, 2006).Dreaming, Choice and Agency“My psychiatric illness is only one part of me. I am a person with hopes, dreams, love, an artist and a fellow helper of my peers.” V. BarnardV.’s narrative describes the potential for positive action, of dreaming herself as a whole into existence. Her themes of choice and agency emphasize the importance of autonomy and the capacity for autonomous action. On the farm, V. was free to choose and take risks, to take on responsibilities, to be “treated with respect as a human being trying to get better rather than a criminal suffering from something that was optional.” From disconnection, she was able to find connection, on her own terms.The support of peers adds a valuable dimension. Being recognized as a peer, a person who shares similar psychiatric experiences and respects the challenge of everyday life, brings another level to supportive relationships. Negative judgments and stigma are reduced by mutual support and acknowledgement of common goals. Mental health... (shrink)

Ayahuasca is a psychedelic beverage from the Amazon rainforest, used in spiritual and religious settings for medical purposes. Since the 1990s onwards, several religious and neo‐shamanic groups have been using it in Uruguay within the psychospiritual networks. Some participants go to rituals of ayahuasca looking for therapeutic alternatives to certain ailments, such as substance use disorders (SUDs). In this chapter, three cases of former patients who recovered in a neo‐shamanic center that uses ayahuasca for the treatment of SUDs are described (...) and analyzed. The center is conducted by a psychologist trained in the Peruvian vegetalismo tradition. An ethnographic description of the ritual setting as well as the process of psychotherapeutic intervention of the center are described. In‐depth interviews were used to collect the narratives of the three patients. A medical anthropology perspective is used, focusing on different subjective trajectories: the general biographic trajectory, SUDs trajectory, spiritual trajectory, and the trajectory under the entheogenic field, ayahuasca included. As we discuss, the impact of ayahuasca rituals ceremonies should be explained not only by ayahuasca as a psychedelic compound, but as a psychotherapeutic tool immersed in a social, cultural, and spiritual setting aimed at the treatment of SUDs. (shrink)

While law and justice issues are well represented in the vast and diverse world of Japanese Manga, the medium’s predilection for fantasy tends to produce futuristic or overblown fiction far removed from everyday life. Fantastic treatments may also reflect relatively low awareness of legal matters in a society of low crime and litigation. One law and order institution that most people are familiar with, however, is the network of community police boxes that covers Japan, and this has spawned a (...) gag-ridden yet somewhat more realistic genre of justice-related comics. This article focuses on Ishikawa Chika’s KOBAN, whose humour revolves around the contrasting personalities and petty squabbles of two cops in their dealings with mundane police work. The characters, plots and conversations are visually supported by juxtaposing the weaponry and equipment of law enforcement with childlike facial features and cute mascots, thereby constructing the police box as a halfway house between local neighbourliness and state bureaucracy. (shrink)

One goal of this paper is to argue that autobiographical memories are extended and distributed across embodied brains and environmental resources. This is important because such distributed memories play a constitutive role in our narrative identity. So, some of the building blocks of our narrative identity are not brain-bound but extended and distributed. Recognising the distributed nature of memory and narrative identity, invites us to find treatments and strategies focusing on the environment in which dementia patients (...) are situated. A second goal of this paper is to suggest various of such strategies, including lifelogging technologies such as SenseCams, life story books, multimedia biographies, memory boxes, ambient intelligence systems, and virtual reality applications. Such technologies allow dementia patients to remember their personal past in a way that wouldn’t be possible by merely relying on their biological memory, in that way aiding in preserving their narrative identity and positively contributing to their sense of well-being. (shrink)

The burgeoning use of experimental methods to consider questions of human nature and personal identity has been a fruitful and exciting development, yielding significant and provocative results. This essay argues for the value of including reflection on the treatment of these topics in fictional narratives to complement and deepen results in experimental philosophy. Experimental vignettes are by necessity brief and schematic. This is part of what makes them so effective in the experimental context. The space afforded for detail, complexity, and (...) ambiguity by the format of fiction allows it to highlight and explore issues that cannot easily be incorporated into experimental method. By juxtaposing a fictional narrative in which we are led to view a character as fundamentally bad with a structurally similar experimental vignette in which participants judge the protagonist to be fundamentally good, I demonstrate how reflection on fiction can contribute to debates in experimental philosophy and reveal distinctions between different dimensions of questions about identity and morality. (shrink)

Understanding how meaning mechanisms are unleashed in film has been at the center of numerous theoretical surveys of the last few years. Emphasis has especially fallen on seeing as a constructive, meaningful activity and on the diegetic implications of vision. This book is an attempt to extend film theorizing into a new realm, where hearing proves as important as seeing and where the relevance of filmic narrative is differently explored. New paths for future research are suggested by means (...) of associations with the works of linguists or philosophers who have never addressed film theory directly in their writings. Nonetheless, several concepts posited by them (relevance, natural versus non-natural meaning or the notion of Mental spaces) find their application in the present survey. A wide range of examples starting with point-of-view and editing occurrences, passing through the use of music and sound and culminating with the study of whole filmic ensembles, enables the reader to re-examine code-bound or, on the contrary, deviational structures. These are often drawn from familiar sources, proving that not only art films of the Eisenstein or Godard type enhance innovative meaning spaces. Finally, the viewer is seen as a «silly little kitty», an active not passive receiver of textual structures who relies on patterns of known visual or aural backgrounds open to an unlimited field of perspectives. (shrink)

Patients with insomnia complain of problems with sleep onset or sleep maintenance or early morning awakenings, or a combination of these, despite adequate opportunity and circumstances for sleep. In addition, to fulfill the diagnostic criteria for insomnia the complaints need to be associated with negative daytime consequences. For chronic insomnia, the symptoms are required to be present at least 3 days per week for a duration of at least 3 months. Lastly, for insomnia to be defined as a disorder, the (...) sleep complaints and daytime symptoms should not be better explained by another sleep disorder. This criterion represents a diagnostic challenge, since patients suffering from other sleep disorders often complain of insomnia symptoms. For instance, insomnia symptoms are common in e.g., obstructive sleep apnea and circadian rhythm sleep-wake disorders. It may sometimes be difficult to disentangle whether the patient suffers from insomnia disorder or whether the insomnia symptoms are purely due to another sleep disorder. Furthermore, insomnia disorder may be comorbid with other sleep disorders in some patients, e.g., comorbid insomnia and sleep apnea. In addition, insomnia disorder is often comorbid with psychological or somatic disorders and diseases. Thus, a thorough assessment is necessary for correct diagnostics. For chronic insomnia disorder, treatment-of-choice is cognitive behavioral therapy, and such treatment is also effective when the insomnia disorder appears comorbid with other diagnoses. Furthermore, studies suggest that insomnia is a heterogenic disorder with many different phenotypes or subtypes. Different insomnia subtypes may respond differently to treatment, but more research on this issue is warranted. Also, the role of comorbidity on treatment outcome is understudied. This review is part of a Research Topic on insomnia launched by Frontiers and focuses on diagnostic and treatment challenges of the disorder. The review aims to stimulate to more research into the bidirectional associations and interactions between insomnia disorder and other sleep, psychological, and somatic disorders/diseases. (shrink)

Narrative Empathie liegt dann vor, wenn der empathische Nachvollzugsprozess der (emotionalen, epistemischen) Situationen anderer Personen oder fiktiver Figuren durch ein Narrativ, das heißt eine sinnzusammenhängende Erzählung, ausgelöst und strukturiert wird. Der Aufsatz knüpft an den phänomenologischen Ansatz von Empathie als direkte Wahrnehmung an, vertritt aber die These, dass gerade bei Narrativen die Imagination und die Perspektiveneinnahme hinzukommen müssen, damit retrospektiv, prospektiv oder gegenwärtig die Situation des Anderen und seiner individuellen Perspektive vergegenwärtigt und verstanden werden kann. Der narrativen Empathie wird (...) ein indirekter ethischer Wert zugeschrieben: Durch das empathisch anschauliche Anteilnehmen am Narrativ des Anderen und einen damit verbundenen Perspektivwechsel können auch unsere eigenen Perspektiven erweitert werden; dies kann zu besserem Verständnis ungewohnter Sichtweisen führen und moralische Gefühle und Handlungen motivieren. Narrative empathy is the complex re-presentation of an (emotional, epistemic) situation of another person or a fictional character by means of a narrative, which is a structured and perspectively colored context of meaning. The paper sympathizes with the phenomenological approach of empathy as direct perception though at the same time arguing that in cases of (literary, filmic, dramatic) narratives imagination and perspective-taking is also needed in order to be able to comprehend and to understand the other’s situation retrospectively, prospectively or at present. According to the author, narrative empathy has an indirect moral value: the vivid empathetic participation in the other’s narrative and the process of perspective-taking can help to broaden one’s horizons; this can lead to a better understanding of unfamiliar and other worldviews and motivate moral emotions and actions. (shrink)

In recent years, several studies have advocated the need to expand the concept of patient autonomy beyond the capacity to deliberate and make decisions regarding a specific medical intervention or treatment (decision-making or decisional autonomy). Arguing along the same lines, this paper proposes a multidimensional concept of patient autonomy (decisional, executive, functional, informative and narrative) and argues that determining the specific aspect of autonomy affected is the first step towards protecting or promoting (and respecting) patient autonomy. These different manifestations (...) of autonomy are not mutually dependent; there may be patients who have problems in one dimension, while at the same time being fully autonomous in others. Nevertheless, a close interaction has been observed between the various dimensions and indeed, a phenomenological analysis shows that damage to or a reduction in one aspect of people’s capacity for self-government generally affects other aspects of their autonomy, which in turn disrupts their identity and the way in which they see themselves and are seen by others. In this paper, I shall examine some of these interactions and show how they may lie at the heart of the problem of poor treatment adherence (where adherence is defined as being the extent to which a patient’s behavior over time coincides with the recommendations made by and agreed with their health professional). One example given is that of psoriasis, a chronic skin disease with a very poor adherence record. In Spain, it is calculated that 85% of patients diagnosed with mild to moderate psoriasis fail to comply properly with their treatment, and figures from other parts of the world are similar. Although there are many possible causes for non-adherence among psoriasis patients, assessing their decisional, executive and narrative capacities and taking appropriate action based on the results may help increase adherence rates. (shrink)

The success of medicine in the treatment of patients brings with it new challenges. More people live on to suffer from functional, chronic or multifactorial diseases, and this has led to calls for more complex analyses of the causal determinants of health and illness. Philosophical analysis of background assumptions of the current paradigmatic model. While these factors do not require a radical paradigm shift, they do give us cause to develop a new narrative, to add to existing narratives that (...) frame our thinking about medical care. In this paper we argue that the increased focus on lifestyle and shared decision making requires a new narrative of agency, to supplement the narrative of “the patient”. This narrative is conceptually linked to the developing philosophy of person-centred care. If patients are seen also as “agents” this will result in a substantial shift in practical decisions: The development and adoption of this narrative will help practitioners work with patients to their mutual benefit, harnessing the patients’ motivation, shifting the focus from treatment to prevention and preventing unnecessary and harmful treatments that can come out of our preoccupation with the patient narrative. It will also help to shift research efforts, conceptual and empirical, from “treating” and “battling” diseases and their purported “mechanisms” to understanding complex contributing factors and their interplay. (shrink)

The choice to pursue fertility treatments is a complex one. In this paper I explore the issues of choice, agency, and gender as they relate to assisted reproductive technologies (ARTs). I argue that narrative approaches to bioethics such as those by Arthur Frank and Hilde Lindemann Nelson clarify judgments about autonomy and fertility medicine. More specifically, I propose two broad narrative categories that help capture the experience of encounters with fertility medicine: narratives of hope and narratives of (...) resistance. This narrative typology captures the inevitable conflict that women feel when they become subjects of fertility medicine. On the one hand, they must remain hopeful; on the other, they must not surrender themselves completely. Nelson's account of counterstories as narratives of resistance helps us see how women can reconcile the experience of a strong desire to have children with the desire to remain authentic and whole. (shrink)

Both in the Netherlands and in Britain, practices of ‘life story work’ have emerged in nursing for persons with intellectual disabilities. The narrative approach to care and support may at the same time be considered as an attempt to compensate for the ‘disabled authorship’ of many persons with intellectual disabilities and as a sign of controversy with standard practices of diagnosis and treatment that tend to neglect the personal identities of both clients and care givers, their particular historical and (...) relational contexts and their spiritual needs. This paper argues that narrative ethics not only offers an appropriate moral framework for practices of life story work, but that these practices are a narrative ethics in action. Starting with an account of the concept of ‘life story work’ as it has been introduced in nursing practices in the field of intellectual disability, the paper explains its relationship with key characteristics of narrative ethics. The teleological dimension in narrative ethics and in practices of life story work sparks off a dialectic process of understanding of the client and self‐understanding of the care giver. It also invites a respect for life in its openness toward the future and presupposes an openness toward other possible versions of the life narrative. The phenomenological and hermeneutic‐interpretative methodologies in narrative ethics aim at a ‘sudden moment of intimacy’ in relationships of nurses and clients. The ‘epiphany’ of this essential moment of recognition, insight and engagement cannot, however, be brought about by methodology. (shrink)

I begin my comments with a first-person narrative. I know Octavio, Erotildes, and Nuria from the time I worked at the Institute of Psychiatry and was very close to the field of mental health. They are people whose work I admire and appreciate. I comment on this text from the point of view of someone who has never worked directly in mental health assistance and whose knowledge about severe mental illness therapy has occurred mostly from a third-person perspective. My (...) comments are based on parallels with situations and experiences that I have been studying lately.First of all, I want to say that I fully agree with the authors’ argument that “experiences and narratives about illness, treatment, and recovery are... (shrink)

ABSTRACT‘Self-ambiguity’, we suggest, is best understood as an uncertainty about how strongly a given feature reflects who one truly is. When this understanding of self-ambiguity is applied to a view of the self as having both essential and shapable components, self-ambiguity can be seen to have two aspects: (1) uncertainty about one's essential or relatively unchangeable characteristics, e.g. one's sexuality, and (2) uncertainty about how to shape oneself, e.g. which values to commit to, actions to pursue, or essential features to (...) identify with. We explain how a narrative account of agency can accommodate these forms of self-ambiguity and argue that such an account also reveals another kind of self-ambiguity, namely, (3) uncertainty about whether one's established self-narrative represents who one really is. We illustrate this third form of self-ambiguity in the context of addiction where people's established addiction self-narratives make it difficult to identify with recovery. We argue that recovery will require embracing, especially, our third form of self-ambiguity as a chance for positive self-transformation. Treatment for addiction should, therefore, support people in going through and ultimately narratively resolving the inevitable self-ambiguities of the recovery process. (shrink)

Grant Gillett's (2009) welcome and extremely thought-provoking target article addresses many complex issues of such far-ranging consequence that it seems impossible to provide a commentary worthy o...

I am lying on a small table in a tiny room, dizzy with nausea and apprehension. A young woman busies herself with the preparations of a plaster mold that will be used to position my arm and chest for the twenty five ‘shots’ of radiotherapy that I will undergo during the ensuing five weeks. I had called the hospital that morning to say that I was too sick to come for this appointment. I had better come, said a young man (...) from the department, because if I missed this appointment I would I might not get a new appointment in time start the treatments within the recommended time frame. So I am here, on the table. I mention the nausea to the technician. My apprehension at this moment is that I might become so dizzy as to somehow swirl out of control. The young woman gives me a mask to blunt the smell of the plaster. The procedure will take twenty-five minutes. I keep my mind focused on each breath and get through the ordeal breath by breath. She seems, in contrast to me, gloriously free of distress and worry, listening to the radio while she works. I envy her good fortune. As we finish up the procedure I take a chance and share my experience: I say that being a cancer patient can be tricky because you are sometimes utterly in the grip of the idea that the cancer will spread and you’ll die soon and in a very unpleasant way. After each round of chemo I was admitted to hospital for extreme nausea and dehydration. During those days in the cancer ward some of those who were dying called out and moaned distressingly, sometimes for hours, during the night. I was, at those moments, unable to shake off the belief that I too would be in that state within a few months. The signs of cancer had been missed on the mammogram two years earlier and, when the lump made itself evident, I was in Stage III. When I mentioned this experience of being gripped by the idea of death she said “Oh I know exactly what you mean, my mother has breast cancer, and every time she has an examination I go searching the internet to find out what I can.” This young woman was twenty four, and I fifty six at the time, and she had given me an unexpected small precious gift that I took with me out of that little cupboard of a room.. (shrink)

Background: Depression is the largest cause of mental ill health worldwide. Although interventions such as Dance Movement Therapy (DMT) may offer interesting and acceptable treatment options, current clinical guidelines do not include these interventions in their recommendations mainly because of what is perceived as insufficient research evidence. The 2015 Cochrane review on DMT for depression includes only three RCTs leading to inconclusive results. It is therefore, necessary to also look beyond such designs in order to identify and assess the range (...) of current evidence. Methods: We therefore, conducted a systematic review of studies that aimed to explore the effectiveness in the use of DMT with people with depression. This led to a qualitative narrative synthesis followed by a subgroup analysis and a sensitivity analysis. In all meta-analyses a random effects model was used with Standardised Mean Differences (SMD) to accommodate for the heterogeneity of studies and outcome measures. Results: From the 817 studies reviewed, eight studies met our inclusion criteria. 351 people with depression (mild to severe) participated, 192 of whom attended DMT groups while receiving treatment as usual (TAU) and 159 received TAU only. Qualitative findings suggest there was a decrease in depression scores in favour of DMT groups in all studies. Subgroup analysis performed on depression scores before and three months after the completion of DMT groups suggested changes in favour of the DMT groups. When sensitivity analysis was performed, RCTs at high risk of bias were excluded, leaving only studies with adult clients up to the age of 65. In these studies, the highest effect size was found favouring DMT plus TAU for adults with depression, when compared to TAU only. Conclusions: Based on studies with moderate to high quality, we concluded that DMT is an effective intervention in the treatment of depression with adults. Furthermore, by drawing on a wide range of designs with diverse quality, we were able to compile a comprehensive picture of relevant trends. Despite the fact that there remains a paucity of high-quality studies, the results have relevance to both policy-making and clinical practice, and become a platform for further research. (shrink)

In “Whole Life Narratives and the Self” David Lumsden (2013) has provided us with a clear review of the debate over narrative and personal identity and has staked out his own position in that debate. Arguing against neo-Lockean views of an atomistic self, he defends a narrative component in personal identity. Specifically, he argues that personal identity or self involves “a bundle of narrative threads” (p. 1), but does not require the grand unity of a master (...) class='Hi'>narrative—a whole life narrative. It follows for him that the understanding—and treatment—of fragmented psychiatric states does not require whole life narratives. In his analysis, he is both defending a philosophical position regarding narrative and personal .. (shrink)

In researching the biomedically-engineered drug Neulasta (filgrastim), a breast cancer patient becomes aware of the extent to which knowledge about the development and marketing of drugs influences her decisions with regard to treatment. Time spent on understanding the commercial interests of insurers and pharmaceutical companies initially thwarts but ultimately aids the healing process. This first-person narrative calls for physicians to recognize that the alignment of commercial interests transgresses the patient’s humanity.

The ArgumentThe paper offers a reconstruction of one aspect of Bakhtin's philosophy, focusing on a deep-seated ambivalence that has been largely overlooked in studies based on his late works. Bakhtin's early work, 1920–23, is set within a distinctly metaphysical framework, an outlook that seems diametrically opposite to what has become known as the Bakhtinian conception of culture. That ideological rift is manifest in the different treatment of Dostoevsky's works in these two phases.Extrapolating Bakhtin's perspective onto Dostoevsky's work, the paper briefly (...) outlines a theory of modernism as a “crisis of authority,” with particular emphasis on the role of closure — i.e., retrospective framing, both literary and existential — in the absence of metaphysical grounding.Finally, the paper offers a comment on Bakhtin's wholesale assimilation into the postmodernist canon, in an attempt to problematize it and to reformulate some relevant and persistent questions on the significance of narrativity in human existence. (shrink)

This fascinating study presents a unique history of psychiatry in the twentieth century. It brings together the memories and narratives of over sixty patients and workers who lived, or were employed, in Severalls Psychiatric Hospital, Essex, UK. Personal accounts are contextualised both in relation to wider developments and issues in twentieth-century mental health, and in relation to policies and changes in the hospital itself. Organised around the theme of space and place, and drawing upon both quantitative and qualitative material, chapters (...) deal with key areas such as gender divisions, power relations, patterns of admission and discharge, treatments, and the daily lives and routines of patients and nurses of both sexes. (shrink)

I defend the view that a person's identity is injured when a powerful social group views the members of her own, less powerful group as unworthy of full moral respect, and in consequence unjustly prevents her from occupying valuable social roles or entering into desirable relationships that are themselves identity constituting. We may call this harm deprivation of opportunity. Further, a person's identity is injured when she endorses, as a portion of her self-concept, a dominant group's dismissive or exploitative understanding (...) of her group, and in consequence loses or fails to acquire a sense of herself as worthy of full moral respect. We may call this harm infiltrated consciousness. Either injury to the identity constricts the person's ability to exercise her moral agency. ;I argue that because identities are narratively constituted and narratively injured, they can be narratively repaired. The morally pernicious stories that construct the identity according to the requirements of an abusive power system can be at least partially dislodged and replaced by identity-constituting counterstories that portray group members as fully developed moral agents. I develop the concept of the counterstory: it is a purposive act of moral definition, developed on one's own behalf or on behalf of others. It sets out to resist, to one degree or another, the stories that identify certain groups of people as targets for ill treatment. Its aim is to reidentify such people as competent members of the moral community and so to free their moral agency. (shrink)

"For description and defense of the narrative configurations of everyday life, and of the practical and social character of those narratives, there is no better treatment than Time, Narrative, and History.... a clear, judicious, and truthful account, provocative from beginning to end." —Journal of the British Society for Phenomenology "... a superior work of philosophy that tells a unique and insightful story about narrative." —Quarterly Journal of Speech.

This study is part of a comprehensive investigation of ethical thinking among male and female physicians and nurses. Nine women physicians with different levels of expertise, working in various wards in paediatric clinics at two of the university hospitals in Norway, narrated 37 stories about their experience of being in ethically difficult care situations. All of the interviewees’ narrations were concerned with problems relating to both action ethics and relation ethics. The main focus was on problems in a relation ethics (...) perspective. The most common themes in an action ethics perspective were overtreatment and withholding treatment. The more experienced physicians reasoned differently from the group of less experienced physicians and they coped with pressure in different ways. The less experienced physicians disclosed their professional experience yet seemed uncertain, while putting on an air of certainty, but the more experienced physicians disclosed both their professional and personal experience of caregiving and they seemed to allow themselves to feel uncertain in their certainty. Both groups emphasized a need for deep discussion between colleagues about their being in ethically difficult care situations. (shrink)

Pain management has no meaning without the stories of men and women, and boys and girls whose lives are dramatically altered by the presence of pain in their own and their loved ones lives. In this narrative section, four people present their perspectives on the enigma and challenge of pain, its power, and our on-going efforts to limit its hold on our lives.In the first story, Dr. Robert McQuillan, an anesthesiologist with Creighton University School of Medicine, conveys the fear (...) some patients suffering chronic pain face when seeking pain medication over the long term. Dr. Christine Cassel, chair of the Department of Geriatrics and Adult Development at Mount Sinai Medical Center and immediate past president of the American College of Physicians, recounts the plight of a fellow physician whose pain treatment of a patient led to suspension of his professional license and to personal bitterness after many years of exemplary medical practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 361-367 [Access article in PDF] Psychopathology and Two Kinds of Narrative Account of the Self Tim Thornton Keywords self, narrative, reductionism, embodiment, Dennett, Strawson, McDowell The self plays an important role in psycho pathology. Conditions such as dementia raise the question of how much loss of memory and awareness there can be before there is, if ever, also a loss of (...) the self. Syndromes such as Dissociative Identity Disorder (DID) or Multiple Personality Disorder (MPD) raise the possibility of a fragmentation of one self into a number of selves. Depersonalization disorder suggests a kind of diminution both of the sense of self and the reality of the world. Symptoms such as thought insertion suggest a different kind of fragmentation of the coherence of thought within a self.At the same time there is something prima facie paradoxical about the very idea of the fragmentation or loss of self. It seems to be one thing for a self to suffer loss, quite another to think of the self as being lost. Although the experiences or beliefs had or entertained by a self might be disordered or chaotic, how can a self be anything other than whole and seem real and whole to itself?The narrative approach to the self looks like a tool purpose built to shed light on some aspects of psychopathology. The papers in this issue have examined its application to four revealing case histories and questioned its effectiveness in accounting for features of psychopathology. But in this short note I wish to stand back from the particular cases discussed in previous papers and to shed light on the general approach by setting out two contrasting versions of it. Crudely put, the first forges a connection between the concepts of self and personality; the second between the concepts of self and person. I will use the contrast between these two to draw some general lessons for the philosophy of psychopathology. Dennett's Austere Narrative Account I will start with Dennett's influential version of a narrative account of the self. His central idea is that the very idea of a self should be understood as dependent on a particular kind of interpretative strategy. Roughly, this contrasts with the idea that it is a more basic datum calling out for notice prior to adopting a specific theoretical perspective.Dennett suggests an analogy with centers of gravity both to outline the consequences of this view for the reality of selves, and the connection between the self and the interpretative strategy involved. [End Page 361] A center of gravity is just an abstractum. It's just a fictional object. But when I say it's a fictional object, I do not mean to disparage it; it's a wonderful fictional object, and it has a perfectly legitimate place within serious, sober, echt physical science. (Dennett 1992) The concept of a center of gravity is deployed within a branch of physics to describe and predict the behavior of physical systems acting under physical forces. It is the theoretical context that determines the nature of centers of gravity; at the same time, they contribute to that broader context. Dennett stresses that they are abstract or calculation-bound theoretical objects to contrast with objects that are also theoretically posited but causally interactive, such as microphysical particles (Dennett 1987, 53).Dennett has also used the analogy with abstracta to account for mental states such as beliefs, desires, and other propositional attitudes, which he suggests are ascribed using a particular interpretative strategy: the "Intentional Stance" (Dennett 1987, 13-42). The suggestion is that by showing the necessity of adopting that stance to make sense of human behavior he can defend a form of objectivity about mental states even while rejecting the industrial-strength realism that requires identifying mental states with physical, and thus causally interactive, internal states.Selves are given similar treatment. Like centers of gravity or mental states, they are theoretical, even fictional, entities articulated within an interpretative theoretical stance: A self is also an abstract object, a theorist's fiction... (shrink)

This paper addresses a problem concerning the rational stability of intention. When you form an intention to φ at some future time t, you thereby make it subjectively rational for you to follow through and φ at t, even if—hypothetically—you would abandon the intention were you to redeliberate at t. It is hard to understand how this is possible. Shouldn't the perspective of your acting self be what determines what is then subjectively rational for you? I aim to solve this (...) problem by highlighting a role for narrative in intention. I'll argue that committing yourself to a course of action by intending to pursue it crucially involves the expectation that your acting self will be ‘swept along’ by its participation in a distinctively narrative form of self-understanding. I'll motivate my approach by criticizing Richard Holton's and Michael Bratman's recent treatments of the stability of intention, though my account also borrows from Bratman's work. I'll likewise criticize and borrow from David Velleman's work on narrative and self-intelligibility. When the pieces fall into place, we'll see how intending is akin to telling your future self a kind of story. My thesis is not that you address your acting self but that your acting self figures as a ‘character’ in the ‘story’ that you address to a still later self. Unlike other appeals to narrative in agency, mine will explain how as narrator you address a specifically intrapersonal audience. (shrink)

The paper contrasts Hegel's often quite negative treatment of Eastern thought with the generally more positive treatment by W. F. J. Schelling. Especially significant for Schelling's treatment are the exceptional importance of female deities in Eastern myths and systems of thought and the positive role played by storytelling and mythology in the East.

The paper examines narrative operations involved in the temporal configuration of experience within a general framework of the phenomenological treatment of temporality. Taking as its point of departure a most basic instantiation of temporal experience, namely that of a ticking clock, it argues that the narrative dynamics which give form and charge the interval between tick and tock with significant duration are directly derived from the time-constituting operations of the embodied mind and, as such, are independent of their (...) linguistic articulations. Thus, it critically invokes Husserl’s account of time-consciousness, more specifically his model of retention-primary impression-protention, first in the context of Francisco J. Varela’s account of the neurodynamics of lived time, and then with reference to David Carr’s argument for continuity between narrative and the world of our experiences and actions. Building on these critical trajectories, the paper outlines how proto-narrative elements of lived time form a basis for the properly narrative operation of emplotment and, in its final section, discusses some of the complex relations between lived time and narrative time by contrasting Carr’s account of narrative with Paul Ricoeur’s model of triple mimesis. (shrink)

RESUMO:Não é incomum que se tome o diálogo de Schelling conhecido como Clara por um estoque de proposições filosóficas, do qual se arrancam aquelas mais apropriadas para a tese que se queira sustentar. Procuramos nos afastar desse tipo de procedimento. Tomando seriamente seu tratamento literário, trata-se antes de investigar esse diálogo, apreendendo-o como um modelo, ensaiado pelo filósofo, para uma crítica do presente. Para tanto, analisamos a oscilação entre diálogo e narrativa, de modo a compreender sua composição e princípio formal, (...) o que acarreta uma reflexão, interna à obra, sobre o tempo histórico, o qual se apresenta numa dialética entre inatualidade e presente. ABSTRACT:It is not unusual that Schelling’s dialogue known as Clara is taken for a stock of philosophical propositions from which one may pluck ideas appropriate for the thesis one wishes to defend. In this article, we try to move away from this type of procedure. Taking Schelling’s literary treatment seriously, our purpose is to investigate this dialogue by looking upon it as a model, put forth by the philosopher, for a critique of the present. We therefore analyze the oscillation between dialogue and narrative in Clara in order to understand its composition and formal principle. This oscillation entails a reflection on historical time and presents a dialectic between inactuality and the present. (shrink)

This article argues that traditional, regulative principles of research ethics offer insufficient guidance for research in the narrative study of lives. These principles presuppose an implicit epistemology that conceives of research participants as data sources, a conception that is argued not tenable for narrative research. The case is made by drawing on recent discussions of research ethics in the qualitative and narrative research literature. This article shows that narrative ethics is inextricably entwined with epistemological issues--namely, issues (...) of narrative ownership and the multiplicity of narrative meaning. Finally, practical recommendations are made for the ethical treatment of research participants in narrative research. The article concludes by situating our approach with respect to the broad range of contemporary perspectives on research ethics. (shrink)

Trauma informed care (TIC) “realizes the widespread impact of trauma… recognizes the signs and symptoms of trauma in clients, families and staff; responds by fully integrating knowledge of trauma i...

Electroencephalography (EEG) is a non-invasive method to identify markers of treatment response in major depressive disorder (MDD). In this review, existing literature was assessed to determine how EEG markers change with different modalities of MDD treatments, and to synthesize the breadth of EEG markers used in conjunction with MDD treatments. PubMed and EMBASE were searched from 2000 to 2021 for studies reporting resting EEG (rEEG) and transcranial magnetic stimulation combined with EEG (TMS-EEG) measures in patients undergoing MDD (...) class='Hi'>treatments. The search yielded 966 articles, 204 underwent full-text screening, and 51 studies were included for a narrative synthesis of findings along with confidence in the evidence. In rEEG studies, non-linear quantitative algorithms such as theta cordance and theta current density show higher predictive value than traditional linear metrics. Although less abundant, TMS-EEG measures show promise for predictive markers of brain stimulation treatment response. Future focus on TMS-EEG measures may prove fruitful, given its ability to target cortical regions of interest related to MDD. (shrink)

This article examines the way in which selfhood is constructed in direct-to-consumer advertisements for antidepressant medications. The sample consists of advertisements that appeared in nine popular magazines between 1997 and 2005, television commercials that ran between 2003 and 2005, and online promotional Web sites. The analysis is divided into three sections. First, it is argued that the ads rely on metaphors of communication, information exchange, and plenitude to construct a relationship between biology and selfhood. Second, in offering the choice for (...) antidepressant treatment, the ads grant individuals a new capacity for the exercise of personal agency. Third, the author describes antidepressants as pills that perform a narrative “magic.” In contrast to religious and psychoanalytic narratives that required individuals to incorporate disavowed elements of their selves into an ongoing life narrative, antidepressants are medications that allow individuals to put aside, or jump over, inexplicable and painful moments in their life. (shrink)

This study reports on the preliminary outcome evaluation of the Magone Home Aftercare Program (MHAP), a faith-based juvenile justice residential facility in the Philippines that provides intensive aftercare treatment for adolescent males involved in the juvenile justice system after their time in a rehabilitation facility or community detention in their area of residence. Although evaluation studies are typically conducted using quantitative research methods, we believe a narrative research approach can be a useful methodology that elucidates “ why” and “ (...) how” or “ the story” behind the success of the program. As such, we evaluated the effectiveness of the MHAP in facilitating the reintegration of its beneficiaries through the stories they tell. Particularly, we analyzed and compared the life stories of MHAP beneficiaries who have been successfully reintegrated into their respective communities within the frame of redemptive narrative identity. The analysis of the interview data revealed that the life stories of these former beneficiaries contained redemption scenes in which they drew on adverse childhood experiences (extreme poverty, parental neglect, abuse, abandonment, and crime) in realizing their true selves (by gaining wisdom from the past, opportunities, new sources of strength, and desire to help others). Importantly, the redemption narratives also contained key life episodes that recognized the MHAP as the key to their successful reintegration into society. Such findings provide valuable information (i.e. how the program has achieved its objectives) to all levels of the MHAP, from program beneficiaries and front-line staff to decision-makers and funders, as well as community partners. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Narrative, Interpretation, and Plagiarism in Mr. Robertson's 1778 History of Ancient GreeceGiovanna CeseraniDays after the successful debut of his History of Scotland in 1759, Dr. William Robertson was busy consulting his friends about what project to undertake next. David Hume solicitously responded by expressing doubts about two of the possible topics—the age of Pope Leo Xth and the Emperor Charles Vth. The first would be difficult because it (...) would require the understanding of that age's "great Works of Sculpture, Architecture, Painting," while attaining the "competent Knowledge... requird of the State & Constitution of the Empire," including numerous European countries, necessary to carry out the second project "would be the Work of half a Life." Rather Hume recommended "the ancient History, particularly that of Greece": "I think," he wrote, "Rollin's Success might encourage you, nor need you be in the least intimidated by his Merit. That Author has no other Merit, but a certain Facility & Sweetness of Narration; but has loaded his Work with fifty Puerilities."1 Yet, after considering further the excellent historical narratives that survived from antiquity, Hume feared that they could indeed turn into a disadvantage for the aspiring modern historian: "For what can you do in most places with these Authors, but transcribe & translate them? No Letters or State Papers from which you coud correct their Errors, or authenticate their Narration, or supply their Defects. Besides, Rollin is so well wrote with respect to Style, that with superficial people it passes for sufficient." On the whole he thought, however, that a "History of Greece till the death of Philip... would be successful, notwithstanding all these discouraging Circumstances. The Subject is noble, & Rollin is by no means equal to it."2 [End Page 413]Despite his friend's advice, Robertson went on to write what became his most successful work, the History of the Reign of Charles V (1769), but Hume's letters are nevertheless revealing.3 Hume's acute concern with publishing success speaks, on the one hand, to his lifelong economic struggle, but also of the flourishing market for history books in his times, on which, before the professionalization of the discipline, authors more and more came to rely in lieu of the literary patronage of earlier times.4 But the issue of the status of the historian was more than an institutional one for Hume's contemporaries. While the classical model of the historian as political man writing history in his retirement from public life was in sharp decline, a clear successor was still to follow. As Pocock puts it: would one who studied, edited, or rewrote past history be an historian at all?5 Hume's concern with historical authority and his consciousness of the difference between a narrative based on experience, in the Thucydidean mode as he would have understood it, and one based on authorities, is clear in his letter advising Gibbon to transform the Decline and Fall's endnotes into footnotes.6 Hume's letters to Robertson show again this concern developed in parallel to a philosophical preference for manners over details of action, human explanations rather than divine ones. From this perspective he found "puerile" the French Jansenist educator Charles Rollin, who in the preface to his Histoire Ancienne (1730–38) set out the goal to reveal the design of divine Providence within human history and whose work was dominated by a moralistic reading of the past.7Hume's reflections and concerns neatly fit the influential interpretation that, more than half a century ago, Arnaldo Momigliano formulated for the genealogy of modern Western historiography. As Momigliano saw it, modern history developed precisely out of the eighteenth-century convergence of traditional historical narrative—what used to be linear accounts of mostly political events—and antiquarian research—scholarship traditionally devoted to systematic treatment of a variety of subjects that relied on the skills of paleography, epigraphy and the interpretation of archaeological material.8 This process—culminating with Gibbon—presupposed the philosophical shift of the age: "what used to be secondary becomes primary. What used to be primary—wars and dynasties—becomes secondary."9 Recent research has since [End Page 414] expanded the Momigliano's formula—this... (shrink)

Objectives: To elicit the perceptions and preferences of patients with rheumatoid arthritis regarding information and participation in treatment decision-making. To analyse the patients’ narratives on the background of the ethical discourse on various approaches to treatment decision-making. Design: In-depth interviews with themes identified using principles of grounded theory. Participants: 22 patients with long-standing rheumatoid arthritis. Main outcome measures: Qualitative data on patients’ perceptions and preferences regarding information and participation in decision-making about treatment. Results: Decision-making about treatment has been described by (...) the patients as a process consisting of different stages with shifting loci of control and responsibility. Patients initially received one treatment recommendation and were not aware of alternative treatment options. Those participants in this study who wanted information about negative effects of a treatment cited “interest in one’s own health” and the potential “use of information” as reasons for their preference. The physicians’ expert knowledge and clinical experience regarding the effects of medication were cited as arguments by patients for a treatment recommendation. Conclusions: The patients’ accounts of decision-making about treatment differ from models of physician–patient relationship that have been put forward in ethical discourse. These differences may be relevant with respect to the starting point of an ethical analysis of treatment decision-making. Patients’ accounts with respect to a lack of information on treatment alternatives point to ethically relevant challenges regarding treatment decision-making in clinical practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Narrative Formulation RevisitedOn Seeing the Person in Mental Health RecoveryAnna Bergqvist (bio)The use of narrative in mental health contexts models consciousness as something necessarily embodied, as already part of the world, in an inherently value-laden and perspectival way. As such narrative presents a powerful tool for critical reassessment and reevaluation of preconceived ideas in relating to difficult concepts in clinical interactions.Narrative structures can reveal psychological (...) differences between persons in a way that matters for the provision of effective treatment and management. As emphasized by Solomon (2015), narrative reasoning is also motivated by distinctly first-personal concerns that are operative in the practitioner–client relationship. I maintain that the dynamics of that interpersonal relationship are part and parcel of what it means to address the patient's needs to be seen as a person in humanistic empathetic care—without thereby reducing truth to an individual person's perspective to encourage positive transformation.1The notion of empowering narratives to encourage positive change is a core concept behind the emphasis on the critical role of empathy in explaining human development and psychoanalytic change within the self-psychology tradition but is also key to recovery-based models of the significance of person-centered quality of life in medicine more generally. This is defined in mental health as recovering a good quality of life as determined by the values of (by what matters or is important to) the individual concerned (Allott, Loganathan, & Fulford, 2002; Fulford, 1989, 2004; Fulford, Peile, & Carroll, 2012). The importance of strengths in this regard was reflected for example in the UK government program on values-based mental health assessment. The 3 Keys program, as it was called (National Institute for Mental Health in England, NIMHE, and the Care Services Improvement Partnership, 20082) identified three shared 'keys' to good practice in mental health assessment: three things that were identified in a wide-ranging consultation as being important alike by health professionals of all kinds and by 'service users' thus understood as patients and carers (Fulford, Duhig, Hankin, Hicks, & Keeble, 2015a; Fulford, Dewey, & King, 2015b). The third of these keys was defined in [End Page 7] the subsequently published Good Practice Guidance, as "a person-centred focus that builds on the strengths, resiliencies and aspirations of the individual service user as well as identifying his or her needs and challenges" (NIMHE, 2008: 6); and the guidance included a number of real-life case examples of best recovery practice reflecting this aspect of mental health care (Slade et al., 2014).What my (Bergqvist, 2018, 2020, 2022, forthcoming) account adds to this claim is that while such choices are revelatory or expressive of a distinctly first-personal stance, they do not constitute or determine selfhood and self-interpretation in a fixed way. Moreover, the reason is that one can also adopt a second-personal stance on one's own experience and address oneself, where the relationship between the first- and the second-personal narrative perspective on experience and self-understanding is itself a dynamic and open-ended evaluative process.Anna Bergqvist Anna Bergqvist is Reader in Philosophy at Manchester Metropolitan University since 2021, and has been Postgraduate Research Coordinator and AHRC North West Doctoral Pathway Consortium Lead for Philosophy since 2020. I was elected to a Visiting Fellowship at St Catherine's College University of Oxford for Michaelmas Term 2021. Her service to the profession out with the University includes acting as Secretary of the World Psychiatric Association (WPA) Section for Philosophy & Humanities in Psychiatry (October 2020 – present), Executive Committee Member of the Royal College of Psychiatry (RCPsych) SIG in Philosophy (February 2020 – present) and External Examiner, University of Liverpool (November 2019 – present, 4-year tenure). She is also Director of the Values-based Theory Network at St Catherine's Collaborating Centre for Values-based Practice at the University of Oxford, and Member of its Whiteness and Race Equality Network. Her approach to philosophy bridges the disciplines of moral philosophy, moral psychology and philosophy of psychiatry to improve lives through her reputable expertise in moral perception and co-production as a mechanism for change.Notes1. Here I side with Goldie (2012) and Solomon (2015), who... (shrink)

In this paper, we respond to a critique by Erik Thorstensen of the ‘Deepening Ethical Engagement and Participation in Emerging Nanotechnologies’ project concerning its ‘realist’ treatment of narrative, its restricted analytical framework and resources, its apparent confusion in focus and its unjustified contextualisation and overextension of its findings. We show that these criticisms are based on fairly serious misunderstandings of the DEEPEN project, its interdisciplinary approachand its conceptual context. Having responded to Thorstensen’s criticisms, we take the opportunity to clarify (...) and develop our approach to narrative. We articulate the need for novel, theoretically robust approaches to the formation of public attitudes which transcend the limitations of both survey-based approaches—which remain wedded to methodological individualism and which presume that individuals hold distinct and relatively stable attitudes and preferences—and interactionist approaches to public talk, which focus too strongly on individuals-in-interaction as reasoning agents and which ignore the constitutive role of culture and discourse in the formation of public opinion. We suggest that our use of narrative can help to better understand the process through which public attitudes to emerging technology develop out of interactive an engagement with wider cultural arguments and accounts of science and technology. We finish by pointing to parallel developments in social thought—from Charles Taylor’s treatment of social imaginaries to recent developments in post-Bourdieuian cultural sociology—as related projects in understanding the cultural resources and grammars that provide the conceptual infrastructure for modern social life. (shrink)

Based in narrative phenomenology, this article describes an example of how lived time, self and bodily engagement with the social world intertwine, and how our sense of self develops. We explore this through the life story of a woman who lost weight through surgery in the 1970 s and has fought against her own body, food and eating ever since. Our narrative analysis of interviews, reflective notes and email correspondence disentangled two storylines illuminating paradoxes within this long-term weight (...) loss process.Thea’s Medical Weight Narrative: From Severely Obese Child to Healthy Adultis her story in context of medicine and obesity treatment and expresses success and control.Thea’s Story: The Narrative of Fighting Weightis the experiential story, including concrete examples and quotes, highlighting bodily struggles and the inescapable ambiguity of being and having one’s body. The two storylines coexist and illuminate paradoxes within the weight loss surgery narrative, connected to meaningful life events and experiences, eating practices and relationships with important others. Surgery was experienced as lifesaving, yet the surgical transformation did not suffice, because it did not influence appetite or, desire for food in the long run. In the medical narrative of transforming the body by repair, a problematic relationship with food did not fit into the plot. (shrink)

The move to patient-centered medical practice is important for providing relevant and sustainable health care. Narrative medicine, for example, suggests that patients should be involved significantly in diagnosis and treatment. In order to understand the meaning of symptoms and interventions, therefore, physicians must enter the life worlds of patients. But physicians face high patient loads and limited time for extended consultations. In current medical practice, then, is narrative medicine possible? We argue that engaging patient perspectives in the medical (...) visit does not necessarily require a lengthy interview. Instead, a new orientation to this process that emphasizes dialogue between practitioners and patients should be considered. In this new model, the purpose of the visit is to communicate successfully and develop a mutual understanding of illness and care. (shrink)

The present narrative review seeks to unravel where we are now, and where we need to go to delineate the active ingredients in psychotherapy delivered by conversational agents (e.g., chatbots). While psychotherapy delivered by conversational agents has shown promising effectiveness for depression, anxiety, and psychological distress across several randomized controlled trials, little emphasis has been placed on the therapeutic processes in these interventions. The theoretical framework of this narrative review is grounded in prominent perspectives on the active ingredients (...) in psychotherapy. Based on search terms derived from various theoretical perspectives, we conducted a systematic literature search of four scientific databases and identified 17 studies. Across the selected studies, three themes emerged: relationship variables, emotional venting, and cognitive factors. While methodological issues compromise the epistemic value of this evidence base, core questions also remain to be answered. Such questions include, but are not limited to, whether humans can form affectionate bonds to inanimate beings and whether these kind of mental health treatments should be understood as psychotherapy or something else. Researchers should therefore be cautious when applying theories of psychotherapy in the realm of conversational agents. We conclude the paper by introducing recommendations for future research, which we hope will help instigate methodologically sound studies in this field. (shrink)

The article presents a model of understanding that takes into account interaction, cultural knowledge, and the constraints of organizations and institutions. It analyzes discourse and cognition in high school biology classes and clinical consultations involving discussions of genetics. The analytical lenses of constraint satisfaction, coherence-based reasoning, and collective cognition reveal multilayered social, cultural, and interactional components of authority and agency that influence understanding. The analysis reveals similarities across settings in discourse structure and the ways that participants relate to local constraints. (...) In both types of settings, participants attempt to develop process narratives that present a sequential or causal relationship between information and lead to remembered understandings of concepts. However, the absence of certain process information that links terms or concepts functions like a missing plot point in a story, hindering the development of process narratives and understandings. In order to cover such information gaps, students and patients construct and display grey boxes. In addition to talk and text, these consist of various actions and resources specific to a local discourse framework such as pointing at graphics, tabular information, and symbols. Grey boxes satisfy the organizational constraints of time, resources, and task structure that affect interaction related to understanding concepts and procedures, but their connection to a particular discourse framework restricts the transfer of knowledge between settings. The power of medical practitioners and teachers to enhance or restrict understandings relates to the ways that they accommodate the use of grey boxes during interactions with clients and students. Professional frames of reference that teachers or practitioners apply to task interactions may constrain the ways students or clients apply grey boxes and process narratives. Awareness of the functions of process narratives and grey boxes presents opportunities to modify local discourse frameworks and increase understandings of concepts, medical conditions, and treatment options. (shrink)