Mediacal insignia“What brings you in today?” you ask after a new patient sits down in your office. The first order of business is a chronology of the present illness. Precisely when did the problem start? What was happening both at that moment and more generally in his/her life? Then the present illness prompts targeted questions about the patient’s life history, so the narrative of the present illness is placed into a wider narrative. As the patient talks, you attempt to link the sequence of events into a narrative caused by several possible diagnoses. To me this fascinating exercise never gets old.

Narrative truthIn his important book, The Why of Things (2013), Johns Hopkins psychiatrist Peter Rabins states that “Causal narratives seek to knit together disparate observations, facts, and events into a coherent and inclusive whole that convincingly links later events to prior events.” Rabins calls this “narrative truth,” which is obtained by the “empathetic method.” In medicine, after arriving at several possible diagnoses by the empathetic method, the empirical certainty of the scientific method is martialed by obtaining lab tests to settle on a single diagnosis. However the value of a given test is called into question if it is not consistent with the history—maybe it was the wrong test. In the mental health field, we are almost entirely dependent on narrative truth obtained by the empathetic method—as is this entire project. Dr. Rabins goes on to point to evidence that the ability to construct causal narratives has been physically evolved into our brains:

For me, though, the most convincing evidence that the distinction [of the narrative method] has value and says something about the structure of knowledge [italics added] is the fact that the narrative approach is present in all cultures and used by all individuals, whereas the methods of science are a relatively recent invention.

Studies carried out by the neuroscientists Roger Sperry and Michael Gazziniga offer further support for this view. They examined patients who had previously undergone “split brain” surgery—that is, had had the large fiber bundle that connects the two hemispheres of their brain severed in an attempt to stop the spread of seizure discharges from one side to the other—and they found evidence that there is a “center” in the brain, near or overlapping the language area in the left hemisphere, that “makes” connections between disparate pieces of evidence. This strongly suggests that the human brain is constructed to carry out narrative reasoning and that the linking of facts into a narrative causal web is innate.

Narrative Truth

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2 Comments on “Narrative (vs empirical) Truth”

  1. John, I think the concepts of “narrative truth” and “empathetic method” are shaky concepts. They ignore the distinction between the patient and the psychiatrist. As a patient, I might have one explanation (i.e., one narrative truth) that helps me understand my problem. The psychiatrist might construct another narrative truth based on his selective focus on certain statements made by the patient. Furthermore, both the patient and psychiatrist are dependent on what the patient is able to recall, or chooses to recall, about his past. The notion of “empathetic method” is even shakier. Empathy, virtually by definition, is subjective and can vary from one psychiatrist to another. By contrast, science seeks to be objective; one measure of scientific objectivity is inter-observer reliability. Causality is also a tricky concept. I subscribe to it, but existentialists/absurdists believe that we live in a world without inherent meaning; and if that’s the case, there’s no inherent causality in the world or human nature.

    1. Mark, Thanks so much for your response. I don’t see the narrative method and the scientific method as being at odds. The narrative method is also called the historical method because the British historian Edward Hallet Carr (What is History?–1961) described it as what historians do: historians rely on facts but the collection of facts is not their main function. Rather, the primary attribute of well-respected historians is how well they put the facts together and how they interpret them. Factual knowledge can change over time, as new information is unearthed (new documents or witnesses can be found, for example). This new information might or might not change the interpretation of the facts that were already known. The central and distinguishing act of the historian, however, is the linking and interpreting of the known facts.
      Taking a patient’s history is similar in that there are virtually an infinite number of facts in a given patient’s history, and an infinite number of scientific tests you could perform, but it is our innate ability to sift through all of this information and accumulate a limited number of causal linkages which then can be tested empirically. Artificial intelligence is beginning to be able to do this, but that is not science either, but the brute assembly of possible causal linkages.
      For me there is no getting around believing in causality, because, as you say, we descend into meaninglessness.

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