Narrative Medicine & Psychiatry, Dr Scott Von

Recent interest in the relation between science and narrative has sparked some expression in me. As someone who began as a psychoanalyst and later came to practice medicine and psychiatry I took an unorthodox path, and I take a radical stance in this area. Not only do I see psychiatry but also physical medicine itself as embedded in an analytic or narrative science. The more radical end of psychoanalysis has always taken the symptom as a narrative. In fact the whole project from Freud on was to envelop “disease” in the narrative of human culture. So for me the radical psychoanalytic ethic had to be extended to psychiatry and medicine as well. No symptom of the body can be left out of this equation.

Most of my non-psychoanalytic colleagues – psychiatrists, psychologists, and psychotherapists (and all too many analysts as well) – like to make a Division between everyday neurotic problems that can be solved with therapy and some realm of “disease” that they consider biological or genetic which basically includes more extreme and non-normal states that they do not understand or are frightened by. Which is not to say that biology and medicine are not sciences in themselves with practical use. But the project from the renaissance enlightenment to the modernist effect of psychoanalytic and phenomenological psychiatry was to embed this natural science into a larger human or spiritual science of the cultural and linguistic narrative that we are enmeshed in.

I know that most people in the alternative or anti psychiatry realms would share my resistance to this Division. But I wonder how many would follow me a step further into questioning the concept of disease even in physical medicine as ever separable from its narrative creation and interpretation. This requires stepping deeper into physiology and further out into the spiritual, philosophical, and poetic simultaneously. It is not only a matter of applying medical technology within a narrative relationship. It is a matter of understanding how all science, medicine, and “disease” always already is a semiotic, linguistic, narrative process intertwined with the human narrative.

I wanted to learn to practice a form of physical medicine and psychiatry which could work within a psychoanalytic, phenomenological, humanist, narrative approach. And what I found in researching, learning, and practicing medicine and psychiatry from diverse cultures is that there never was this artificial Division that exists today. Not in Traditional Chinese Medicine, Ayurvedic Medicine or other ancient sciences that are having a resurgence today, nor in alternative forms of modern scientific medicine such as Homeopathic, Naturopathic, and Osteopathic Medicine and Psychiatry which were only marginalized recently through political means and are now gaining in popularity again with the limitations of the allopathic materialist model more apparent.

The fact is that what we need is a truly Integral Medicine and Psychiatry that can apply technology only with a greater understanding of where that fits in to the larger picture of human freedom. We can only nourish destiny: help support the vehicle and arena of body and earth for the unfolding of Psyche – an infinite number of individuating beings and their paths of destiny which we cannot pretend to understand – only bear witness to and co-create with.