Others' Contributions to an Individual's Narrative Identity Matter

AJOB Neuroscience, 2017

Nancy Jecker and Andrew Ko (2017) wish to present an account of personal identity which captures what matters to the patient and places the patient at the center of medical decisions. They focus particularly on medical interventions in the brain that can cause drastic changes in personality; under what circumstances should we say the patient has 'survived' these changes? More specifically, how can we best understand the notion of survival in a way that captures what is of concern to the patient? This goal is laudable, however, their chosen account of narrative identity is ill-suited to this task for one reason in particular; it does not give sufficient guidance in predicting which medical decisions are likely to be experienced as disruptive to identity.

Person Centered Medicine, 2023

This chapter reviews the key principles of narrative medicine and its central importance for person centered medical care. The last two decades have seen the emergence of narrative medicine as a complement to biomedical approaches. Narratives are the vehicles through which patients understand and communicate their health problems, past history, and current concerns. Clinicians, in turn, offer narrative accounts of the nature of symptoms and illness that make sense of patients’ suffering, clarify its potential course and outcome, and provide a rationale for specific treatment interventions. Narrative medicine gives explicit attention to the ways that people convey their symptoms, predicaments and concerns and how the meaning of these experiences is interpreted and understood. Close reading or unpacking of the origins, meaning and significance of the narratives of patients and clinicians can inform person centered care. Narrative understanding can contribute to more accurate and complete characterization of patients’ needs, a stronger clinical alliance and more effective interventions.

Theoretical Medicine and Bioethics, 2017

An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve 'mismatches' between one's beliefs about one's health status on the one hand, and bodily sensations or past experience on the other. Patients' attempts to integrate these diagnoses into their self-narratives often involve either forming inaccurate beliefs about bodily sensations and/or past experience, or coming to believe that feelings and experience do not necessarily track or predict health status, leading to an ongoing sense of vulnerability to ill health. These resulting alterations in selfunderstanding can sometimes be considered harmful, in view of their implications for ascriptions of responsibility and ongoing anxiety.

2012

Excerpt from the Introduction to the collection: "Angela Woods critically examines Arthur Frank’s account of illness narratives as emblematic of the enthusiastic adoption of narrative as core to illness experience by some of those working in medical humanities. She suggests that this positive embrace of narrative as pivotal to the project of (re)humanizing medicine should be tempered by a more critical view of narrativity. Using Galen Strawson’s article, “Against Narrativity”, she argues that it is not at all obvious that we are “‘narrative selves”’ and that the best or most healthy way to respond to illness is through narrative. However, Woods also discusses the limitations of Strawson’s approach that can be revealed by taking a phenomenological approach. She concludes by suggesting that alternative approaches to narrative medicine, such as phenomenology, may be useful for understanding the experience of illness. Woods finally proposes that a closer look not at narrative but at its opposite, silence, may also provide an alternative to the emphasis on narrative in medical humanities."

2002

Journal of Neuro-Oncology, 2017

Journal of Systemic Therapies, 2016

This article compares and contrasts two different postmodern therapeutic orientations in terms of the way they approach issues of identity, agency, and therapeutic change. The author invited James Hibel, a narrative therapist, and Douglas Flemons, a hypnotherapist and relationally oriented brief therapist, to discuss differences and similarities in their respective approaches to these issues. The article includes an edited transcript of portions of the dialogue. My interest in what is common across relational models of therapy led me to set up a conversation between two practitioners with different therapeutic orientations: James Hibel, PhD, a narrative therapist, and Douglas Flemons, PhD, a hypnotherapist and relationally oriented brief therapist. They have been working collaboratively for over two decades in the Department of Family Therapy at Nova Southeastern University. As their student, interested in both of their approaches, I became curious about what they considered their differences and commonalities. Although the conversation was wide ranging, this article limits the scope of this comparison to three issues: identity, agency, and therapeutic change. To set the context for the conversation, however, I will first note some underlying assumptions and practices of their respective approaches, Narrative Therapy and Relational Brief Therapy. NARRATIVE THERAPY Narrative therapy is a non-normative psychotherapeutic approach that aims to "decenter the voice of the therapist" (White, 2011, p. 3) while privileging the voices of clients. Narrative therapy's underlying assumptions and presuppositions were inspired, initially, by White's interpretation of Gregory Bateson's communicational theory and, later on, by White's reading of social constructionist and post-structuralist ideas, mainly Foucault and Derrida.

Journal of Personality, 2013

An integrative model of narrative identity builds on a dual memory system that draws on episodic memory and a long-term self to generate autobiographical memories.Autobiographical memories related to critical goals in a lifetime period lead to life-story memories, which in turn become self-defining memories when linked to an individual's enduring concerns. Self-defining memories that share repetitive emotion-outcome sequences yield narrative scripts, abstracted templates that filter cognitive-affective processing.The life story is the individual's overarching narrative that provides unity and purpose over the life course. Healthy narrative identity combines memory specificity with adaptive meaning-making to achieve insight and well-being, as demonstrated through a literature review of personality and clinical research, as well as new findings from our own research program. A clinical case study drawing on this narrative identity model is also presented with implications for treatment and research.

Narrative and the cultural construction of illness and …, 2000