Education And Debate Narrative based medicine

A narrative approach to mental health in general practice

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7176.117 (Published 09 January 1999) Cite this as: BMJ 1999;318:117
  1. John Launer (johnlauner@aol.com), senior lecturer in general practice and primary care.
  1. Child and Family Department, Tavistock Clinic, London NW3 5BA

    This is the second in a series of five articles on narrative based medicine

    There is a tension between the complex narrative that a patient brings into the consulting room and a doctor's understanding of what is really going on as formulated in a diagnosis or an idea about pathology. Which is a “truer” account of reality: the patient's or the doctor's? Can both be true? If so, how?



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    These questions are particularly relevant in mental health care for a number of reasons. Firstly, sociology and ethnography have identified psychiatry alone among the medical specialties as peculiarly culture bound. 1 2 Secondly, psychiatry lies in an uncomfortable no man's land between conventional medical science and the search for meaning which may extend into political and religious domains.3 Thirdly, mental health professionals often use confusing and contradictory language to describe their observations. When compared with the babel of explanatory models which often seem to disqualify each other or which may simply be a way of asserting the therapist's power, the patient's own story may gain in authority and seem saner than the professional's version.4 Finally, psychiatry is the only area of specialist medicine in which talking and listening are explicitly understood to be therapeutic.5

    Summary points

    • The success of “talking cures” depends on their ability to give coherence to the client's experience of physical or mental illness and to enable the construction of a narrative of healing or coping

    • The narrative approach to mental health is concerned with the question of how a patient and clinician working together can construct a story that makes sense

    • In general practice doctors may make useful contributions to patients' stories although these contributions should not be seen as a superior “truth”

    The narrative approach in mental health

    In a book on the use of narrative in family therapy, Papadopoulos and …

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