Academic journal article The International Journal of Narrative Therapy and Community Work

Re-Contextualising Conversations and Rich Story Development

Academic journal article The International Journal of Narrative Therapy and Community Work

Re-Contextualising Conversations and Rich Story Development

Article excerpt

My work as a member of the Narrative Therapy team within Country Health SA's Rural and Remote Mental Health Service provides me with opportunities to consult with people who have been admitted to an adult psychiatric ward and, upon discharge, have returned to their local rural community where they continue to be supported by a community mental health team. People are referred to our team by psychiatrists or community workers, and our service mandate is to provide narrative therapy for people who have been given diagnoses of depression, anxiety, post-traumatic stress disorder, or some sort of personality disorder diagnosis, and who have been subjected to childhood sexual abuse, sexual assault, domestic violence, or other trauma.

Discou rses of biomedicine

In this context, biomedical discourses dominate understandings of mental illness and therefore shape and are shaped by the vast array of structures and practices that are in place to attend to people's experiences of mental illness. These biomedical discourses reflect notions of mental illness as being firmly located in the human mind and body as naturally-occurring entities which can be discovered with appropriate scientific methods, instruments, and knowledge (Epstein, Wiesner, & Duda, 2013). Claiming scientific neutrality and objectivity in these practices, this discourse elevates the importance of skilled practitioners ascribing the correct diagnosis so that the right evidence-based treatments can be administered, frequently including medication regimes (Cosgrove & Wheeler, 2013; Strong, 2012; Tomm, 1990).

The Diagnostic and Statistical Manual of Mental Disorders (DSM), currently in its fifth edition, is a key text of this biomedical discourse and since its first publication over sixty years ago it has grown in size, complexity, and influence (Simblett, 2013). This influence has been carried by pop psychology, the media, public health and humanitarian campaigns to extend well beyond the boundaries of the professional disciplines to permeate everyday life and language in contemporary Western societies and beyond, including responses to wars and natural disasters (Epstein et al., 2013; Pupavac, 2001; Simblett 2013).

Over the past five decades, the biomedical discourse of psychiatry, its DSM and accompanying practices, have faced substantial critiques from a range of perspectives, albeit with little effect on the expansion of its influence (Harper, 2013; Lafrance & McKenzie-Mohr, 2013). This history includes examinations by feminist writers of the truth claims of the biomedical discourse and the subsequent obscuring of patriarchy (Swartz, 2013), including psychiatry's participation in the pathologisation of femininity, the medicalisation of women's misery, and the regulation of 'difficult' women (Ussher, 2010). As White (1995a) observes, this obscuring of the unequal power relations of culture enables people's problems to be regarded as aberrations, which enables us all to avoid facing our complicity in the maintenance of these structures of inequality. By locating problems within the individual and neglecting societal, cultural, and historical perspectives (Epstein et al., 2013), the attention of policy makers is also shifted away from attending to issues of inequality and injustice (Harper, 2013). This also evokes a historical perspective that the DSM, psychiatry, and biomedical discourses are predated by patriarchy and its oppressive social practices in relation to women's bodies, sexuality, and reproduction (Swartz, 2013).

Discourses of hu manism

Biomedical discourses rely on, among other things, dominant humanist discourses for the legitimacy of their truth claims about mental illness. These discourses draw on the notion of human nature, which is said to determine how people live and act in the world. Although the 'nature' of human nature varies between philosophies, it commonly 'presupposes an essence at the heart of the individual which is unique, fixed, and coherent and makes her what she is' (Weedon, 1997, p. …

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