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Day 4 of the Australian Journey 2012

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Next I moved onto illnesses, discussing how narrative competence allows us to Use the different perspectives of storytelling to create a complete picture of the illness and its meaning to the patient.

The narrative of an illness needs to not only give the patient a voice, but also to re-present the dialogue between patient and caregivers, inclusive of the voice of the caregiver or health professional.   I gave the example of the story of the first encounter with the illness being named.   Mandy said, Linda: We fought for 6 hours that day because I fought back.   At one point I was slamming his head into my knee.   I went to the hospital and that's when I found out I was pregnant. That"s when they diagnosed me."   To her credit, Mandy had received every psychiatric diagnosis available from someone.   This is how she came to have a "complicated mind".    Mandy also told habitual stories that illustrate usual activities.   For example, she said, " I get so angry, I mean he would wake me up for no reason, and he knows I can never get to sleep and so I have a 3 hour panic attack because he needs $5, right now, so I would lock him in the basement.   I would just get so sad. I would take all my pills, whatever I had around. I'd still do it but my son put me right, he said he didn't want to be without me. They would call me from the other side, my best friend, my son's father. And he was really good looking."   Mandy was talking about her usual activity of taking all the pills at hand when she was upset.   She was however, entertaining a counter story during her time she had been in the Complicated Minds group -- that her son loved her and would miss her and needed her to stop overdosing on pills.   People also have "reported speech" narratives in which they describe important conversations with others.   Mandy said, "The doctors don't want to hear what I tell them.   They get really nervous when I come in the office. I made one of them brownies but it doesn't help."   Mandy's experiences with physicians were generally negative.   She made them uncomfortable and recognized it.   These stories are important.   During our interactions with health professions decisions are made about the management of the illness and the health practitioners story about the illness is transmitted to the patient. Interactions between patients and health care professionals thus play a major role in the social construction of illness narratives.   We rely upon physicians to tell us what we have and why we have it.   This generates "because narratives" in which we explain ourselves, often in reference and comparison to others, which are called narratives of comparison with others.


                We completed the workshop in Warburton with examples and exercises of people telling each other stories and listening for the smaller narrative units comprising the story, thereby recognizing points of potential intervention.   Then we went across the street to the Polish Jester for a wonderful Polish meal of pickled vegetables, smoked herring, and stuffed cabbage.   I fell asleep immediately upon returning to Karith.

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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
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