Personal Stories and Psychotherapy
6.5 Therapeutic Care and Unappropriated Narratives
Typically, as patients’ accounts are polarized by their affliction, they certainly do not point to the prereflective meaning of their experience; on the contrary, it might be argued that they conceal it. For instance, in the case of that patient of ours who has described a detailed sequence of her cardiac difficulties, the “pathology” she is experiencing and relating is unconnected to the actual conditions within which it emerged and even more so to any historical origin. Failing to recognize the condi- tions triggering his disorder, a patient seeking therapeutic care “to straighten his life out with words” will produce an account of his own experience as though this had just sprung out of nowhere.
Evidently, this is the kind of patient who yearns for sense and hence easily falls prey to the soothing and reassuring effect achieved by the theoretical perspective of many forms of psychotherapy through the standardizing and anticipating ordering of the future. But this is also a particularly vulnerable patient, who can more easily be exposed to the charisma of the healer and hence to the kind of abuses perpetrated in the name of therapeutic care.
A “pointless” account of the sort just outlined hinders one’s understanding of the experience at its basis, since the verbal reconfiguration made of it by the patient loses any connection to the way in which meaning has prereflectively taken shape.
Hence, an account of this sort de facto prevents one from retracing the patient’s experience to its origin: to that context of circumstances in which the occurrence of ipseity became detached from its narrative reconfiguration, thereby leading to the formation of the symptom.
For instance, in the case under scrutiny, the description of cardiac difficulties that stands at the center of the accounts and everyday life of the patient certainly does not allow us to grasp the way in which the patient perceives herself when she feels without the other—nor does it allows us to understand within which existential horizon this perception fits; rather, the patient is simply reporting that in certain moments of the day or week she suffers from tachycardia.8 In this respect, the indi- cating meaning that the patient provides through her narrative is “pointless”: it does not lead the therapist to re-enact the situation and occasion of expression to which the meaning refers and hence does not orient him to a fulfillment of the experience indicated.
In everyday life an assertion conveys the way in which a certain concrete experi- ence is pointed out. By following the direction revealed by the assertion, it is pos- sible to distinguish that which is being indicated, what the assertion has in view. But while an assertion points to a given experience, and by grasping it freezes it within a certain linguistic meaning, so to speak, at the same time, it strips the meaning of its context and turns it into something present.
8 To simply dismiss incongruities of this sort as self-deception is to assume that the patient is imple- menting a maneuver (negation or rationalization) to avoid facing the element of truth in her account, as opposed to examining this personal history from the perspective of how the patient relates to her own past.
6.5 Therapeutic Care and Unappropriated Narratives
So while an assertion indicates how to grasp a certain experience, at the same time, it covers the field or web within which the experience in question took shape, thereby concealing the access to its modes of direct actualization. It may be argued that every assertion is nourished by its simultaneous and necessary capacity to veil the prereflective condition that anchors it and out of which it emerges. For instance, the act of mentioning a desk—the famous example provided by Heidegger in one of his early lectures—conceals the different meanings which this object has for the professor, his students, the cleaner, or someone who has never been in a lecture hall.9 In the case of symptoms, however, the patient’s account completely obscures that prereflective meaningful structure which at the same time it presupposes.
Nowhere does assertion prove more dangerous than in the production of symptoms (Caputo 1984, 1988). To quote John Caputo, “Interpretation is always threatened by the pull (Zug) of fallenness, the withdrawal (Entzug) of authentic self-understand- ing. The opposite pull (Gegenzug) of projection, which makes authentic interpreta- tion possible, is always liable to degenerate. It is just this threat that is posed when interpretation passes over into the ‘assertion’” (Caputo 1988 p. 73).
An assertion completely loses the disclosiveness of the original understanding to which it refers, amplifying the patient’s unfamiliarity with his or her own experi- ence—which is therefore suffered—through the establishment and endurance of a vicious circle between the actual happening of experience and its symbolic repre- sentation. This difficulty of accessing personal experience therefore manifests itself in the form of a symptom, which—as the Greek etymology of the word suggests—
occurs together with the activation of the mechanism (i.e., the triggering of the vicious circle).10 On the other hand, a symptom indicates that the motility of life has come to a halt: through the repetition of a mechanism, it reduces the possibilities of signifying that which the individual encounters, and hence to access a shared world, thereby hijacking the person’s freedom and opening up the domain of suffering.11
Most of the problems that lead patients to undergo treatment revolve around the subtle and constantly ongoing interplay between prereflective meaning and its lin- guistic appropriation. In the footsteps of Aristotle’s Poetics, Ricoeur (2010) empha- sizes how the construction of a plot—which combines a range of different factors (agents, aims, means, situations, outcomes, expectations, etc.) into an intelligible whole—constitutes the mediating element between the need for concordance in one’s narrative and the acknowledgment of discordances. Through its reconfiguring power, language makes it possible to compose, and hence also to reinforce or ignore, the congruence between different experiences, thereby creating the possibility to alter the dynamic between experience and its symbolic reconfiguration.
In the case of the aforementioned cardiac symptoms, then, the prereflective expe- rience at their basis, instead of being revealed and appropriated through an adequate
9 Consequently, the analysis of meaningfulness, which is to say of how the desk is understood by each person, coincides with the study of the access to it, which is achieved by re-enacting it.
10 Etymologically, “symptom” describes a fact that coincides—and occurs together with—another fact that is its effect or marker.
11 It is on the basis of this that psychopathology structures itself as a science.
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narrative, is only reconfigured on the basis of a sense that excludes it. As already noted, the account loses its reference to living meaning and through a vicious circle engenders an experience that produces the same account again and again, amplify- ing the distance with the meaningful structure which it presupposes in a self-refer- ential and recursive fashion.
On the other hand, the reconfiguring of events may force the unstable structure of discordant concordance which distinguishes the narrative plot, creating concor- dance where discordant elements are present. In this case the narrative invents a new meaning, de facto allowing the experience at its basis to remain unappropriated. In other words, the distance between experience and its narrative appropriation is pro- duced through the weaving of a narrative that is so incongruous—or perhaps oblique, one might say—with respect to prereflective meanings that, although it does not explicitly manifest a symptomatology in itself, it may engender other con- ditions of malaise. Hence, it represents a different form of impediment compared to the simple production of a symptom.
This is, for instance, the case with patient X, who after a 7-year conjugal rela- tionship and three children born 2 years apart finishes weaning her newborn and finally gets back to work, only to discover that she has never really loved her husband.
This discovery marks the beginning of a marital crisis, which the patient attributes to her husband’s behavior, his everyday attitude toward her, and his having forced her to marry, undergo three pregnancies, quit university, etc.
Some time after the beginning of the crisis, the woman falls for a married col- league of hers and begins an affair made up of sporadic encounters that com- pletely take over the patient’s sense of her own life. The dilemma which leads the patient to seek treatment is whether she should leave her husband or not—a nagging doubt, accompanied by constant anxiety, with fluctuating behavior toward both partners.
The patient, who has turned to therapy to resolve her dilemma, perceives this experience as being completely unrelated to the situation in which it took shape, namely, the glaring fact that she got back to work. Returning to work after 6 years and three pregnancies totally changed the patient’s existential horizon and sense of her everyday life; her condition as a woman, wife, and mother; her perception of her own femininity and capacities; and her way of relating to her own family of origin, money, everyday things, and stage of life.
It is within such a context that the patient falls in love with a colleague she has known for years.
Equally unrelated to this transformation of the patient’s life is her repro- cessing of her personal life. This revolves around a narrative of self whose protagonist is the patient herself, a young, fragile, and inexperienced victim who has fallen prey to an attractive man—her husband—and is forced to quit
6.5 Therapeutic Care and Unappropriated Narratives
Through the new mode of access to the past that emerges together with the transformation of her existential conditions, the patient rearranges her own mem- ories into a new narrative yet does not appropriate them or engage with their sense. Hence, she fails to grasp the fact that, now as much as in the past, she is always making her life choices in opposition to someone, or at any rate in view of someone, rather than in view of herself. In other words, the patient does not grasp the fact that when she is required to decide for herself, she searches for a support and center of gravity because she feels at a loss. Hence, the woman’s narrative reconfiguration of the past in the light of the new possibilities opened up by her affair with a colleague does not lead her to investigate what significant factors are driving her in that direction (motivation) and thereby to renew her present ipseity by appropriating this perception of herself (her feeling disoriented when required to decide for herself); rather, this narrative reconfiguration redefines the web of events to the point of obscuring it and removing it from the domain of the proper.
In such a way, this mode of being continues to determine the patient’s orientation.
The motility of life is here suspended at a different level from that of the mecha- nism of the symptom. The distance from oneself is created and maintained through an unappropriated narrative: a narrative, that is, which does not thematize the mode of being that lies at its basis so as to make it its own, but which rather conceals it. In the particular case under consideration, the fact that the patient portrays herself as the victim of a charming and overpowering husband prevents her from dealing with her difficulty of taking charge of herself in the first person. This distance from one- self can be generated again and again over the course of one’s life, through the creation of different narrative reconfigurations that repeat the same underlying motif while continuing to conceal the experience that determines them, without ever remobilizing and taking charge of it.
All this is clearly visible in the case of our patient, who articulates the same dif- ficulty of taking charge of herself in different ways at three different stages of her life: she chooses to marry against her parents’ advice, to have three children against her husband’s will, and to leave her husband while blaming him for the separation.
In such a way, the patient remains distant from herself, so to speak: she does not deal with herself; she does not appropriate herself by establishing her own existence
her studies and job in her father’s company in order to conceive three children against her will. The patient no longer realizes that she chose to get married despite the opposition from her parents, who had advised her to wait, given her young age. The patient has forgotten that it was she who urged her hus- band to have some children, while he would have waited longer. The patient also misses the fact that it was her own choice to quit her studies and job with her first pregnancy. Memories, then, instead of being appropriated are resigni- fied according to the perspective provided by the ongoing circumstances.
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according to the repetition of the same dominant mode of self-perception. In our works on neurotic psychopathology (Arciero 2002, 2006; Arciero and Bondolfi 2009), we have distinguished different personality styles marked by particular ten- dencies, identifying the rules governing their manifestation on the basis of recurrent traits that, aside from accounting for the repetitive stabilization of given modes of being and related personality disorders, link them to the emergence of different neurotic configurations.12
When one is confronted with such recurrent modes of reconfiguring life events, as is often the case in clinical practice, it is tempting to extend them to mankind as a whole, and hence to scientifically interpret man according to a psychopathologi- cal model, in terms of causal invariants: in terms, that is, of recursive patterns for the ordering of personal experience, patterns which remain unaltered over the course of one’s life and thus lend a sense of stability and continuity to one’s experi- ence. This permanence may be seen to extend to symptoms.13 The origin of these invariants will then be sought in processes of development, including early forms of reciprocity. This is the burdensome legacy which, in various forms, has been dominating the world of psychotherapy since Freud. Those therapists who embrace this legacy in their practice explain life histories in terms of recurrent patterns. In doing so, they make a destiny of recursiveness and the non-appropriation of the reconfiguration that accompanies it. In other words, they freeze the patient’s life in an endless repetition, with each therapist accounting for it according to his own theory.
On the other hand, an approach that is the exact reverse of the one just illustrated, and which is adopted by narrativist therapies in particular, consists in envisaging the treatment as a “re-authoring” of the patient’s personal story, accomplished together with the therapist. Treatment, in other words, consists in transforming the patient’s narrative in such a way as to create new identities through the resignifying of the experiences it reconfigures, as though it were enough to alter the patient’s narrative to change his or her personal story. The distance between the two—which is brought into relief by MacIntyre (1981) when he states that stories are lived before they are told—becomes apparent in the case of hysterical fugue states. These are character- ized by the fact that instead of reconfiguring lived experience, the narrative is pro- duced as though it were a film starring the patient in the lead role, a film disconnected from the person’s actual life. It goes without saying that this way of crafting experi- ences coincides with a pathological condition.
As in the case of therapies of natural-scientific inspiration, the outcome of this rhetorical operation carried out by the narrativist therapist is always the same: to distance the patient from his own experience, preventing him from dealing with it.
But how can language have such power?
12 Our aim was to grasp the connection between normalcy and psychopathology by showing how the various neurotic syndromes may be traced back to the fossilization of modes of experiencing.
13 In Kraepelinian biological psychiatry, this perspective is pushed so far that symptomatology is reduced to chromosomic determinism.
6.5 Therapeutic Care and Unappropriated Narratives