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

Walking Away from 'Illness Fears': Glimpses of a Narrative Journey towards Personal Agency and Justice

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

Walking Away from 'Illness Fears': Glimpses of a Narrative Journey towards Personal Agency and Justice

Article excerpt


I was telling you the three elements in my morals. They are: (1) the refusal to accept as self-evident the things that are proposed to us; (2) the need to analyze and to know, since we can accomplish nothing without reflection and understanding - thus, the principle of curiosity; and (3) the principle of innovation: to seek out in our reflection those things that have never been thought or imagined. Refusal, curiosity, innovation. (Foucault, interviewed by Bess, 1988, p. 1)

If I had to summarise the elements that inspirit each narrative conversation I embark on, I would use the words proposed by Foucault: refusal, curiosity and innovation. Refusal is present in externalising conversations. These conversations address and resist, among other things, the dominant discourses and practices of power of Western psychologies that confine people's identities. Curiosity, engendered by the 'narrative mode of thought' (Bruner, 1986), leads to exploration - not of certainties and truths, but of a variety of perspectives and possibilities. Finally, innovation emerges when we engage creatively with people and stay open to a diversity of ways to co-construct preferred stories.

It is my intention in this paper to show how refusal, curiosity and innovation informed my work with a client to whom an illness identity was assigned through a psychiatric diagnosis of hypochondria. This illness identity was ingrained through institutional practices that dispossessed him of personal agency and recruited him into oppressive thoughts and practices. I hope to portray the ethical understandings, conversational maps and documents that provided a context in which Manuel1 could reclaim his dignity from the injustice of pathologisation.

An identity confined by mental health discourses and practices

When Manuel first came to my office, he was overcome by subjugating words that defined him as mentally ill and a hypochondriac. He felt stigmatised and marginalised by the medicalisation of his identity, which had resulted from particular practices of power operating within the medical and psychiatric fields (Madigan, 1992; White, 1995a).

This subjugation had begun during Manuel's psychiatric hospitalisation two years before he came to my office. During the last stretch of his doctoral studies in Germany, fears about acquiring an incurable disease had visited Manuel for the fourth time in his life. With the intention of finally bringing the fears to an end, protecting his relationship with his wife and finishing his PhD, Manuel decided to ask for psychological assistance through the German government health system. This was where he got the suggestion to go to a psychiatric ward.

I decided to go to the hospital since I had been taught from childhood that doctors heal. During my three previous fear periods, doctors reassured me, confirming that I did not have a physical disease. This was enough for my illness fears to disappear. Nevertheless, last time this did not happen. I thought I was going to be cured at the hospital since I was attending the place where the experts in emotional problems help people.

Manuel's hope that the hospital would help him get well disappeared little by little. It was replaced by self-blame about having a psychiatric illness that, according to mental health discourses, was incurable. During this period, pathologising stories found an open door to sneak into Manuel's life. When Manuel shared the fear that was convincing him he had throat cancer, the therapist silenced him, saying, 'that is not true, you can never forget you are a hypochondriac'.

In order to be heard and viewed as credible by doctors, Manuel was subjected to daily saliva testing. When a test showed there was blood in his saliva ('real evidence' that he may in fact be ill), the doctors sent him to an ear, nose and throat specialist. After this, saliva tests came to dominate Manuel's life, relentlessly torturing him along with illness fears. …

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