Philosophy, Psychiatry, & Psychology

Philosophy says that life must be understood backwards. But . . . it must be lived forward. . , , It is more and more evident that life can never be really understood in Time.

(Kierkegaard; quoted in Cappelørn 2002, 47)

It was a pleasure to read Jason Thompson’s serious and thought-provoking piece, and I am grateful to the editors for giving me a chance to comment. The idea that the self is revealed in narrative is a popular one among different schools of psychotherapy, both in terms of technique and theory; and my response addresses both these issues in turn.

As a clinician, I have always liked people’s stories. As a junior psychiatrist, I used to love the moment when I first met someone and could say to them, ‘You were born; and then what happened to you?’ Now, a little wiser, I usually ask, ‘Where does your story start? How do you come to be sitting here with me now?’ What I have learned is that what I usually hear first is the speaker’s account of how they see themselves at this moment; what I have come to think of as ‘the cover story.’ Such a story has elements of fact and fiction, blended into one; it may have greater or less degrees of ‘truthiness.’ In the therapeutic context, of course, it also (consciously and unconsciously) is part of a social interpersonal transaction, one that involves dependence and need.

Now autobiography does not have this social element (which might also be thought of as an attachment discourse). The work exists without a reader; the autobiographer does not ask for a reader, or demand anything of the reader, and will never know what others make of his story. It may be written with a hoped for reader in mind; and in that sense it may be relational. But the autobiography is not intersubjective, whereas the process of therapy engages with and explores the social space between therapist and patient (or patients, as in group therapy, to which I shall return).

In the therapeutic space, the narrator of a life story has an audience; furthermore, an audience with their own set of responses. What the autobiographer sees of himself is not necessarily what the therapist sees. This is the first step in the slow process of dismantling the cover story, to reveal a more complex story, where the other characters in the history begin to emerge in more detail, and, quite literally, the plot ‘thickens.’ Equally, the ‘problem’ that the narrator has identified may recede, and quite another problem moves into the foreground (Garland 1982).

This process of revelation can be distressing for the narrator patient. It is often not appreciated that many, if not most people, who come for therapy do so precisely because they are uncomfortable with their self-experience. The development of the sense of self in childhood is hugely dependent on the feedback from others, especially attachment figures (i.e., the people who cared for us as we grew [End Page 251] up). Disturbing and frightening experiences with careers result in narratives of attachment that are often fragmented and incoherent (Hesse 2002).

It is the job of the therapist (and other group members in group therapy) to examine the incoherence in a narrative, and try and pull the fragments together. It is important to emphasize that ‘incoherence’ here does not mean unintelligible, garbled, or silly. Incoherence is defined by attachment theorists (see Hesse 2002) using linguistic maxims described by the philosopher Paul Grice (1989); and it involves violations of rules of discourse. Take the Maxim of Quality (p. 26), which requires that speakers are truthful and have evidence for what they say, a patient may say in therapy that he had ‘a golden childhood’ with kindly parents who took care of every need. However, later in his narrative, he may recount an episode of cruelty or lack of care, which contradicts his previous assertion. If he does not correct himself, or reflect on the discrepancy, then this is an indication of a lack of operation around this contradiction, which suggests an internally incoherent narrative...