Shirah Vollmer MD

The Musings of Dr. Vollmer

What Is Your Narrative?

Posted by Dr. Vollmer on January 22, 2015

How do we tell our story? Do we start with where we are born, the type of parents who raised us, our siblings, or do we start in the present and work our way backwards? Do we speak about our jobs, our kids, our friends, our hobbies? Do we spill the traumatic aspects first, or do we withhold them for fear of the listener’s reaction? Does our story depend on who is listening? Do we change narratives based on our audience or do we drone on regardless of the feedback we are getting? This was our discussion last night with my students, who, as I have been blogging about previously, mostly work in agencies which demand EBPs, or evidenced based therapies http://en.wikipedia.org/wiki/Evidence-based_practice which deny the possibility of a narrative. This is the tragedy of our time, that newly trained therapists are not learning to appreciate the patient’s narrative as a window into understanding their mental distress. Yet, I preach to the converted as my class is 8 students who are committing themselves to learning how to understand the narrative. Still, there is a collective sigh of familiarity when I remind them that EBPs not only superficially help patients, but they create superficial therapists as well. The depth of our work comes from listening to how the patient constructs his world, to listening to the meaning associated with his behaviors and his interactions.

Isabelle, fifty-five, comes to mind. She was an attorney, but hated her job. She developed fatigue, headaches, and joint pains, all non-specific symptoms which prompted her to believe that she had a fatal illness and that she must retire instantly because her days were numbered. She sought endless medical consultations and had expensive medical tests and procedures to prove her point, and yet all of the results turned out to be negative. Still, she could not take ownership of her desire to retire, but rather she had to construct a story in which she was on her death-bed, in order to give herself permission to start a new chapter. Money was not an issue, as she had saved enough over the years to comfortably retire, and her husband was still enjoying his work. Still, the guilt that she experienced when thinking about quitting work was enormous, but also unconscious. It was through our work together that she could come to associate that her guilt was transferred into somatic symptoms, resulting in her need to create a narrative of death in order to make the changes in her life that she felt to be necessary. She was raised to believe that work was the only meaningful way to contribute to the world. It took us a long time to see that that was a very limited world view which she adopted, unconsciously. Eventually, Isabelle was able to create a new narrative where she embraced life and developed insight into her previous behavior, such that going forward she could make decisions which were more linear, more in line with her passions, and so she gave herself permission not to work and to be healthy.

“That is how new narratives lead to mental health,” I explain to my students. “We do not have to tell people what to eat or when to exercise, but we do have to help them want to be healthy so they can figure that out. ” I continue with my mantra. We give people the opportunity to metabolize their childhood experiences and in so doing they are free to make new choices for themselves. With this freedom comes the birth of a human being, the birth of a person who wants to make a mark in the world, and with this desire, will come the behaviors of healthy living.

2 Responses to “What Is Your Narrative?”

  1. Shelly said

    What was Isabelle’s childhood narrative? She must have been raised that work was praised and worthwhile while leisure activities were a waste of time. Retirement, apparently, was not an option to her parents. “Work until you drop” must have been the mantra. Is work the only way people can make their mark on the world? Is it not through their children, the effect they have in their communities, philanthropy, excellence in sports or other activities?

    • Yes, work meant productivity, whereas leisure time meant waste, and to create waste was a terrible thing, and hence Isabelle was plagued with guilt at the thought of not working. Retirement was an option for her parents, but they were at loose ends during their retirement and hence Isabelle was also very afraid that if she opted to retire than that would be her fate, as well. Making meaning in life is the art of living, and each person has to navigate those waters in ways which make sense to them. As you say, some people find meaning through their children, their community work and/or their philanthropy. The question is how to people find meaning in those activities, and in particular, for those lost souls who are in a phase of life where they are searching for meaning, how do they do that? That is often the question which prompts people to initiate therapy and hence making new narratives is a path towards meaning making in one’s life. Thanks.

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