“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.
In 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.