The following excerpt comes from a fascinating book called Healing the Mind Through the Power of Story, by Lewis Mehl-Madrona. All people, he argues, are “narrative creatures … A developing body of evidence suggests that a default state of the brain is one of making up stories (part of what is called the theory of narrative generation).” In embracing story-writing as the default mode of the human brain, Mehl-Madrona has long advocated for a form of psychiatry which doesn’t try to construct a narrative for the patient but which surrenders to the narrative that the patient has already developed for him or herself.
This is something medicine is missing, he says, a “stillness and a willingness to listen.” The following is from a section called “The Meaning of Madness” (pp 345-346).
The meaning of “madness” cannot be found in chemicals or diagnostic nomenclature. No two mental illnesses are the same, despite DSM [The Diagnostic and Statistical Manual of Mental Disorders]. Each madness has its own unique meaning that can only unfold within the context of the person’s life who lives that madness and only becomes understandable by seeing the person against the backdrop of his family and community. Just as each woman gives birth in her own style, each individual recovers from insanity in her own manner.
This can be seen in the story of “Fran,” who was a thirty-five-year-old woman who had lived a fairly ordinary life (with the exception of what was called a manic episode that resolved in her twenties). Then, two years before I started working with her, she had abruptly ended a ten-year relationship to be with a man she had met on the Internet, who turned out to be married and have two children. The family’s story about Fran was that she realized too late that this man was unavailable and broke down over the pain of the simultaneous loss of her past relationship and anticipated future relationship. She had been hospitalized and diagnosed with bipolar disorder. She had been started on medications meant to “treat” this disorder, and none had worked. Fran’s psychiatrist sent her to me when she took maternity leave, but I gathered from subtle hints in her notes (between the lines, so to speak) that she was glad to pass Fran along, since Fran wasn’t responding to her ministrations.
At first, I liked the family’s interpretation of Fran’s story, but I slowly became aware that Fran detested this interpretation. She felt it trivialized her struggles and her pain. She believed that she had been meant to be the vampire queen, to ascend to sit at the right hand of God as his queen. When the time came to be called, she had been too selfish and had been tossed aside. She had been punished by being made to live among the undead (the rest of us). She was waiting for an angel to come to take her to her rightful place in the cosmos, which involved dying to eternal life….I tried [to bring this story around to one that was more ordinary], but Fran was insulted by [that approach] and accused me of conspiring with her family to torture her. That was when I realized that we had to respect and work within her story.
A colleague suggested that we begin with the notion of time. Perhaps Fran’s sense of time was off. Perhaps sitting by the front window, watching through the glass for the angel, was unrealistic. Perhaps she would have to busy herself to make her prison better since angels might not come for twenty years. Since she didn’t want to have an accidental death (to choke or drown or otherwise die through nonascension), she would have to give some care to her physical world for a while. This was a better strategy. It also revealed the family conflict. Everyone (including me at first) was trying to deny the reality of the “otherness” of Fran. We wanted to bring her down form her Wagnerian operatic world into our ordinary world of high school-ish dramas. She refused to be dislodged.
When we acknowledged Fran’s otherness, what emerged was the exhaustion of family members from the work of trying to change her. Within the consultation group in which this family presented itself, the recommendation was to surrender, to stop trying to change Fran…we were to accept her edict–that she was the queen and therefore in control of her destiny. Members of the consultation group offered to pray for Fran and for the family. A suggestion was made for everyone to write letters to God, that they could be given to Fran as origami hangings, like Sadako’s thousand cranes for world peace in Hiroshima, Japan. A member of the group told about praying for her daughter for twenty years before her daughter found a way out of alcohol and drug problems. “God works slowly,” she said. “Maybe twenty years is not long to God,” she added, reinforcing what we had told Fran–that she might need to revise her time frame for angelic ascension.
We encouraged the family to get their lives back and to acknowledge Fran’s fundamental differentness from them. She was not speaking in metaphor or parable. She was telling her story as she experienced it. This approach opened the door to change, which had hitherto been closed.
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