Meditations on an Expanded,Narrative Inquiry Methodology Combining Clinical Dynamic Understanding and Biography

Abstract

As a meditation on a method of narrative inquiry, this paper describes an ongoing project which integrates a narrative, portrait-based approach to clinical storytelling with a clinically-focused dialogical process. Expanding upon previous narrative work completed by Michael O’Loughlin and colleagues, this research is a single-case, longitudinal, qualitative exploratory study of an individual who has struggled with psychosis, been exposed to the psychiatric care system, and transmuted their life history through artistic sublimation. In addition to producing a biographical portrait, the purpose of this study’s expanded methodology is to invite a reflective, dialogical process that allows for autobiographical engagement, verification and co-construction of the emerging life story, and deepening conversations about the complexities of human struggle. It is my hope that, through a version of dialogical exchange and narrative practice in the tradition of Michael White, this research provides a way in which clinicians and researchers can facilitate curative, biographical spaces for those with painful lived experience and inherited trauma. By receiving, tracking, and validating human thought and experience, this work aims to combine the portraiture of rendering a life with an in-depth exploration of the complexities of and intersectionality between subjectivity, severe psychiatric distress, creativity, counter-storying, and narrative healing.

From bearing witness to psychiatric sufferers’ distress from their psychic difficulties and from the challenges imposed onto them by the psychiatric system itself, I have come to understand that the psychiatric care system is widely incapable of recognizing, receiving, framing, and understanding psychiatric struggles as human troubles. While pursuing my first master’s degree, I chose to gain both clinical and research experience outside of my academic program by working at a large, state-funded psychiatric hospital. It was these moments that solidified the trajectory of my future doctoral studies. Struck by the realities which psychiatric sufferers endure, I committed myself to doing my part to rectify the shortcomings of their care. Until recently, I did not fully understand why. I recognized parallel experiences of my voice being reduced, stifled, and overlooked in many—if not the majority—of the individuals who resided as inpatients. While I was not consistently silenced throughout my life, I was muted enough—especially at personally meaningful junctures in my development. My voice was significantly stifled in my former writing, for example, after being deemed “too loud.” I complied with the consistent recommendation given at that time, and I continually erased myself from my own work until my voice was virtually extinguished. It was these defining moments of suppression, minimization, and disregard that had molded the cores of my interiority, my self-confidence and, by extension, my abilities to own my narrative and to speak with authority. I recognize these inner conflicts as human struggles—or what André Green (1986) identified as “private madness”—that are shared by many others, including those whose life circumstances have caused them to seek refuge in psychosis. While I was previously unaware of my internalized conditioning to evade, pardon, and hide my voice, I became strikingly conscious of my wounded narrative power when I saw myself mirrored in those who found themselves as inpatients. Deeply moved by their stifled voices which reflected my own, I dedicated my work to examining why and how psychiatric sufferers are not afforded the privilege to speak their truths and, ultimately, I began advocating for and providing such latitude.

In my doctoral research, I explore the complexities of and intersectionality between subjectivity, experiences of severe psychiatric distress, creativity, narrative healing, and possible threads of counter-storying. More specifically, for my dissertation, I am conducting a single-case, longitudinal, qualitative exploratory study of an individual who has struggled with severe psychic suffering and who has transmuted their life history through artistic sublimation. In doing so, I aim to examine the relationship between creativity and so-called “madness,” as well as the power of biography and autobiography to illuminate human experience. This work, as a testimonial project involving deep narrative inquiry, can be viewed as a limit-case (Gilmore, 2001), focusing on receiving and retelling a person’s complex, constructed perspective of their self-story because of, rather than despite, certain life challenges. Taking from Mary Catherine Bateson’s (1989) idea of “life as an improvisatory art” (p. 3), this research aims to provoke what Bateson called “a dialogue of comparison and recognition, a process of memory and articulation that makes one’s own experience available as a lens of empathy” (p. 5).

As an extension of my ongoing dissertation work, this article aims to lay out my theoretical framework and methodology of my qualitative study. I continue to hold the same goal as I had alluded to in a recent article: Sharing the scope and procedure of my work may facilitate further research in “all fields that involve the remembering and narrating of human experience, especially that of psychoanalysis” (Kulsa, 2022, p. 1). The utility of this expanded methodology involves its capacities to not only enhance and to provide further insight into the phenomena of interest, but to also place the consideration of ethics, memory, language, the image, and the self at the center of the kinds of qualitative research with which these fields concern themselves. It can be argued that this work falls in the domain of what Joseph Featherstone (1989) called “people’s scholarship,” or a scholarship in which “scientific facts gathered in the field give voice to a people’s experience” (p. 375).

Roy Schafer (1980), an early advocate for the power and place of narrative in psychoanalysis, recognized that the “narrative choice” of a narrator is influenced and sometimes determined by power differentials and both conscious and unconscious impingements within the therapy room. “This choice,” he wrote, “dictates that the story of the dialogue and the events to which it gives rise be told in terms of a doctor’s curing a patient’s disease” (Schafer, 1980, p. 37). I, however, intend to be a dialogical partner with my participant in this work and to eschew the tendency to embody the conventional, so-called “inscrutable therapist” or “omniscient, impenetrable analyst.” As Catherine Mathelin (1999) captured in her writing, an observer cannot create or recreate another person’s life story; only the narrator is able to author their own narrative in their own time, as they see fit. Therapeutic work, therefore, is about meeting and receiving the other as they unfold their life story, which is admittedly a broad, multidimensional, existential phenomenon more so than a narrow, solely psychological one.

Inspired by a Buddhist perspective on therapy (Epstein, 2013), I envisioned that the core premise of this project would be embodied as encounters, or existential meetings with another—meetings which are dedicated to fundamentally receiving and then representing that person’s narrative using as much of a personal framework as possible. In my effort to follow Wilfred Bion's (1962a, 1962b, 1967) recommendations of allowing for reverie, I endeavored to incorporate a more Lacanian way of working, which could facilitate a less restrictive, more conversational process between myself and my participant. I searched for a methodology which resonated with my research questions and my vision for this biographical study. More importantly, I aimed to incorporate a kind of dynamic methodology which could facilitate therapeutic conversations that allow for the emergence, verification, and expansion of a therapeutic narrative. Ultimately, with the guidance of my research mentor, Michael O’Loughlin, I was motivated to adapt my own methodological approach. While developing a framework for understanding and being mindful of both guiding principles and cautionary notes from an array of psychoanalytic, first-person narrative, portraiture, ethnographic, documentary, feminist theory, and creative arts readings, I found thinkers across these various disciplines whose writings resonated well. Among these were Deborah Britzman’s (2021) discussion of Marion Milner’s (2010) self-study On Not Being Able to Paint, Sara Lawrence-Lightfoot’s (1997, 2005) work on portraiture, Leigh Gilmore’s (1994, 2001) and Leonor Arfuch’s (2020) works on feminist, autobiographical writing, and, finally, Michael White’s (2007, 2011) dialogical notion of narrative practice.

These writers’ kernels of inspiration helped me think through the methodology of the kind of in-depth, narrative inquiry which I imagined for this biographical study. While this work is influenced by more multidisciplinary figures and theories than I can discuss in this space, the purpose here is to highlight the crux of the rationale behind and development of an expanded methodology which I believe this critical psychological inquiry—and therapeutic work, in general—calls for. There is a large body of work related to narrative not only in psychology and psychoanalysis, but also in other, interrelated disciplines (e.g., creative arts, gerontology, politics, forensic law, etc.). I recognize that, despite a phenomenological emphasis and the “narrative turn” (Meretoja, 2018, p. 1) evident in contemporary psychological research, there is a need for work that provides subjects themselves with the opportunities for their narratives to be heard, received, validated, fostered, and liberated on their own terms. This research, therefore, is my first substantial effort to provide and sustain a listening space for narrative healing—a space which can ideally allow for a kind of evolved, regenerative practice that is widely needed. ¹

Theoretical Framework

As mentioned earlier, the framework developed for this project draws from an array of domains: psychoanalysis, first-person narrative, portraiture, ethnography, documentary work, feminist theory, and creative arts. In consideration of the scope of and space for this article, I selected several theories, which have significantly influenced this research, to discuss here. To emphasize the connections between these ways of thinking and to relate these ideas to the purpose of this project, I envision these guiding principles as distinct, yet interconnected threads which coalesce to form a complex, illustrative tapestry—a metaphorical tapestry that is ultimately the completed clinical writing. I begin this theoretical discussion by describing both narrative theory and portraiture as well as by laying down the groundwork as to why narrating a life is essential in both the existential and clinical contexts. Next, I outline the concepts of reauthoring lives and counter-storying as the next major, intertwined threads in the tapestry. I then underscore the necessities of biographical space, situated subjectivity, and intersubjectivity before including a discussion of some psychoanalytic concepts which have distinctively colored this needlework, so to speak.

Narrative Theory and the Power of Portraiture

Since narrative theory serves as the core of the main thread in the tapestry that is a narrative approach, I present some of its primary notions first. Similar to other organizing principles like the use of heuristics in decision theory (Kahneman & Tversky, 1972), implicit personality theory to account for personality descriptions (Rosenberg, 1977), and macrostructure to give form to discourse processing (Kintsch, 1977/2013), narrative can be employed as an organizing principle to conceptualize the human condition (Sarbin, 1986). A leading thinker for the validity and value of narrative psychology, Theodore Sarbin (1986) argued for a revived psychology through the fundamental functions of creating, telling, and comprehending stories. He viewed “the story as a guide to living and as a vehicle for understanding the conduct of others” (Sarbin, 1986, p. x). Similarly, Jerome Bruner (1990) discussed how humans make meaning from experiences and, therefore, cannot be reduced to mechanistic computations. Summarizing this notion, William Randall (2016) noted that our lives are not storied in a vacuum. Providing an alternative to the positivistic paradigm which comes from a mechanistic worldview, Sarbin (1986) proposed that Stephen Pepper’s (1942) root metaphor method could be applied to contextualism so that narrative, as “a fruitful metaphor for examining and interpreting human action” (Sarbin, 1986, p. 19), leads to a better understanding of human experience.

Drawing from Michel Foucault’s (1969/2012) concept of discursive formation, Thomas Kuhn’s (1970) theory of paradigm shifts, and Paul (Ricoeur's 1991a) description of narrative identity, Bradley (Lewis 2011) wrote that “to understand new knowledge formations, one must also consider the social context of knowledge construction” (p. xi)—echoing Sarbin’s (1986) idea of each human experience being shaped by socially complex, intersecting narrative structures. Ricoeur (1977) used the term “metaphorical truths” to explain the various ways through which humans experience the world. Lewis (2011) reflected on this perspective of metaphorical process as it extends beyond concepts and that which is symbolizable in language. Narrative, therefore, is an interpretive construction of the self Lewis (2011). As (Ricoeur 1991b) noted, “Fiction, in particular narrative fiction, is an irreducible dimension of self-understanding” (p. 30, italics in original). Hanna Meretoja (2018), speaking of Ricoeur’s perspective, wrote that “only ‘a life narrated’ can be ‘a life examined’ and hence worth living” (p. 1, italics in original). Grounded in a postmodern epistemology, this view allows for the concept of selfhood to exist and develop in light of multiple, co-existing truths (Queler, 2017), and it is narrative—as “the privileged form for this interpretation” (Lewis, 2011, p. 47)—through which these truths may be invoked (Lawrence-Lightfoot, 2005).

In The Ethics of Storytelling, Meretoja (2018) discussed the tendency for narrative theorists to either argue for or against narrativity. A proponent of narrativity, specifically that which involves a critical subjectivity, Arfuch (2020) wrote that “language takes possession of experience, not the reverse” (p. 73). Similarly, Kenneth Gergen et al. (1996) noted that “[t]he describing and naming [of experience] makes it real” (p. 103). Others who argue against narrativity (e.g., Sartwell, 2000) may share the belief that “the more you recall, retell, narrate yourself, the further you risk moving away from accurate self-understanding, from the truth of your being” (Strawson, 2004, p. 447). I view the latter belief to be that which contributes to the ongoing narrow, skewed approach to how human beings are understood and treated clinically, socially, and culturally. More specifically, this line of thinking may coincide with individual and systemic resistances to addressing and processing what Christopher Bollas (1987) called the “unthought known.” As a result, the exquisite richness of complex, diverse life experiences may be minimized, impeded, and, in the most poignant of cases, disregarded or erased entirely.

In my effort to co-construct a portrait of a life through a process of restorying challenging experiences, I aimed for my participant to feel seen and received. In addition, I was concerned about embodying an engaging, pivotal role in capturing the parts and whole of their lived experience. I became inspired by Lawrence-Lightfoot’s (1997, 2005) writing on portraiture, which fuses art, social scientific inquiry, and phenomenology. In contrast to the formulaic structure of positivistic presentations of experience, portraiture is set apart by its capacity to utilize, hold, and maximize paradox. Documenting narrative, making meaning from disjointed components, re-examining and reshaping values and perspectives, as well as reconciling opposites are not only powerful, collective processes of human life, but these characteristics are mirrored in and cultivated by portraiture work. This research also draws from portraiture and, hence, can be characterized as “portrait-based” since it deliberately demands a discerning vigilance to empirical data, to crucial dynamics of documenting and presenting a shared narrative, and to highly creative expression from which a biographical portrait emerges.

Reauthoring Lives Through Narrative Practice and Counter-Storying

I, like White and David Epston (1990), embrace the text analogy, which could be viewed as the metaphorical darning tool that is used to weave the next two interlaced threads of reauthoring and counter-storying into the developing tapestry that is this research. As “‘performances’ of meaning rather than actually formulating meaning themselves” (Bruner, 1986, p. 25), texts specifically open up a space for the authoring of alternative lived experiences (White, 1990). Circumventing objective realities and improvement as prerequisites for our life trajectories, the text analogy allows us “to make sense of our lives and to express ourselves” through “storying that determines the meaning ascribed to experience” (White, 1990, pp. 9–10). The success of this kind of storying—where an individual develops a coherent account of their story or self-narrative (Gergen & Gergen, 1984/2014) by “arranging their experiences of events in sequences across time”—can provide one “with a sense of continuity and meaning” (White, 1990, p. 10) in life. Not only does the text analogy offer individuals a space to enter into their stories, but it also provides an “intertextual world” in two ways: a) “it proposes that persons’ lives are situated in texts within texts,” and b) it recognizes a reauthoring of lives where “every telling or retelling of a story, through its performance, is a new telling that encapsulates, and expands upon the previous telling” (White, 1990, p. 13).

Following White’s (1990) narrative practice, I chose to utilize the text analogy since it is this interpretive framework that honors the possibility of restorying one’s life history and, more broadly, human possibility. Reauthoring one’s experiences “necessitates the active involvement of persons in the reorganization of their experience” (White, 1990, p. 18), which invites “the free recombination of the factors of culture into any and every possible pattern” (Turner, 1974, p. 255). Narrative allows for the illumination and renegotiation of both identity and formless, unknown possibilities that constitute marginalized storylines which could then be articulated and shaped by and for oneself. Narrative, therefore, is a means through which we may restore authorship over our life stories.

As Arthur Frank (2013) argued, I believe that those of us who are not only wounded in body but also in spirit and in voice “need to become storytellers in order to recover the voices” (p. xx) which physical illness, psychiatric distress, interventional treatments, others’ ascriptions, and systemic constraints take away. Hegemonic narratives—influenced by the power of societal and systemic interests (Ehrlich & King, 1994)—can often be misrepresentative, trivializing, counterproductive, and even harmful (Lafrance & McKenzie-Mohr, 2014), resulting in “damaged identities” (Nelson, 2001, p. 112). The biomedical narrative, for instance, can be described as having “master status” as a dominating way of understanding (Frank, 2013) that can engender these negative identities.

However, through a restorative process of “narrative repair” (Nelson, 2001), individuals can address, dispute, and correct the distortion and depoliticization of the storying of their own life stories (McKenzie-Mohr & Lafrance, 2014). Alternative discourses can directly contest the power which society’s governing forces wield in order to typically shape and influence marginalized groups (Foucault, 1966/2002, 1976/1990). Discursive resistances have been called “‘counter-narratives’, ‘counter-discourses’, or ‘counter-stories’” which can “challenge and disrupt hegemonic framings of social realities” (Lafrance & McKenzie-Mohr, 2014, p. 7) for these oftentimes forgotten, oppressed, and maltreated populations. “Counter-storytelling,” similarly, “is […] a way for marginalized voices to be heard and new societal realities forged” (Vaccaro, 2010, p. 427). It is through counter-stories that these voices can develop a compelling, even revolutionary, power to refute misleading, grand narratives and, as a result, both alter the focus and understanding of the collective (Carney, 2001) while creating a reparative, necessary “counter-reality” (Delgado, 1989, p. 2412).

Foundations for Narrative Inquiry and Biography: Biographical Space as Healing Space, Situated Subjectivity, and Intersubjectivity

The weaving of “biographical space” (Arfuch, 2020), its facilitative capacity for narrative engagement, and the salient function of biography are the threads which are traced here. This project draws from the ethnographic tradition and biographical genres in that it is an attempt to not only develop and maintain a continuous, intimate involvement in an other’s internal world, but to also do so using the narrator’s own perspective. Inviting what Michael Holroyd (1999/2001) called “intimacy between strangers” (p. 13), this intersubjective work incorporates biography’s specific focus: to take on “the task of giving form to a life that didn’t exist before the narrative” (Arfuch, 2020, p. xxi, italics in original).

Nevertheless, a space for narrative development must first exist for any type of healing work—a transformative space which validates, strengthens, and uplifts, rather than delegitimizes, belittles, and ignores. The former approach inspires individuality, agency, self-expression, and the exploration and credibility of one’s inner world and voice, whereas the latter approach perpetuates misattunement, misrecognition, misunderstanding, and the suppression of one’s interiority and narrative development. Providing biographical space, or “the critical medium for self-representation” (Kulsa, 2022, p. 1), can be critical for individuals’ capacity for narrative development in the therapy room or research setting as well as, more broadly, navigating institutional systems and life as a whole. This space for narrative function and critical subjectivity allows for a “place where we can share pain and loss, whatever the motive for the suffering” (Arfuch, 2020, p. xx). My research embodies the “narrative function” which Arfuch (2020) discussed: This project endeavors to open up a biographical space in order to develop a deeper understanding of the immense, therapeutic nature of narrative inquiry.

In light of Arfuch’s (2020) writing on the power of biographical and autobiographical genres, I recognize that an interlinked thread in this work’s tapestry involves a kind of required relationality, or what Arfuch called “a situated subjectivity in aesthetic, ethical and political terms” (p. xix, italics in original). Seeing through the eyes of another and honoring that gaze, this kind of qualitative research allows for an immersion in the interiority of one’s existence, which is often shaped by fragmented and interrupted discourses of identity (Arfuch, 2020; Gilmore, 1994). I share Arfuch’s (2020) goal “of rescuing ‘personages insufficiently recognized or unjustly forgotten’ by means of biographies” (p. 27), and I argue that biography is a vehicle which fosters the needed, healing space which I call for in this work. Echoing White’s (1990) perspective on narrative practice and capturing the ultimate goal of this biographical inquiry, Arfuch (2020) wrote:

As in truth we always live in a routine of gestures, voices and journeys, with the whole of the past under our skin and on the surface of language, only to be suddenly woken for moments, perhaps by another voice, by some circumstance, by a meeting. And then what is spoken closes up again in order to live on, but changed. Every story transforms the lived experience, gives it further nuances. Maybe another meaning. Every story also notes a difference in the trajectory of the world. It inscribes something that was not there before. (p. xx)

I aim to be this other voice, hopefully giving additional meaning to another’s felt experience, providing the “further nuances” which Arfuch (2020) mentioned, and examining human suffering in a way which gives others access to receiving and knowing the unknown.

Research Aim and Psychoanalytic Influences

Echoing how many historically great psychoanalysts—who accomplished extraordinary work with those who were severely distressed (e.g., Searles, 2018; Sullivan, 1962; Will, 1975)—conceptualized psychosis, I believe that severe psychiatric distress is neither a disease nor a problem, but is invoked as a solution and serves as an inherent protection from that which is intolerable in the world. As a result, for many who experience socially and relationally complex, extreme emotional states or what is known as “psychosis,” the mechanism of symbolization may not exist or may be inhibited by others, trauma, and/or the system as a whole. Not dissimilar to what psychoanalysts do within the therapy room (O’Loughlin, 2020a), I seek to render catastrophic losses, or deep maladies of the soul, speakable or representable. Connecting a psychoanalytic perspective with Arfuch’s (2020) and White’s (2011) ideas, I endeavor to be an Other who, in collaboration with my participant, makes meaning from extraordinary subjective experience in a way which is both therapeutic and freeing.

I aim to produce a biographical portrait of one creative person’s life and artistic work after experiencing catastrophic life ruptures over a period of years. By tracking the complexities of human thought and experience, this writing combines the portraiture of rendering a life with a deep understanding of four major domains: psychological phenomena, the feminist tradition of discursive resistance, the connection between creativity and healing, and biography/autobiography. The lens for this work is predominantly informed by the well-established, psychoanalytic notion of bearing witness (e.g., O’Loughlin, 2007a, 2007b, 2013, 2018). Bearing witness is “a means of offering a receptive space where traumatized [and marginalized] individuals or groups might begin the process of examining and speaking through their own life stories” (O’Loughlin et al., 2019, p. 5). These narratives can often involve unbearable, unnameable, unspeakable, unsymbolizable personal truths which remain unheard. Speaking of how psychiatric sufferers’ life stories are characterized by dispossession, or the experience of non-being, Julie McNamara (2011) urged for hearing and valuing the stories of such disenfranchised, suppressed voices.

This writing is an effort to address this “call of stories” (Coles, 1989) by providing nuanced insights into severe psychiatric suffering, especially for a creative individual. I intend to widen the lens on this topic through this multi-leveled, multi-voiced project, which integrates various, critical discourses in order to bear witness to and map out a kind of life story that is too often written off as unintelligible, unrelatable, or unworthy. In her writing, Gilmore (1994) argued that “[t]hese discourses can be taken as different legends for a map that is still being drawn” (p. 13). This narrative project adds to the understanding of the human condition but, I argue, more importantly than that, it maps out a manner of receiving human experience.

The processes of metabolizing and transmuting trauma, according to Maud Mannoni (1999) and others (e.g., Lacan as discussed in O’Loughlin, 2013, 2020a, 2020b), can happen within the psychotherapeutic matrix that includes an Other. “The Lacanian solution, in therapy,” O’Loughlin (2013) wrote, “is precisely to get at the residue that resists symbolization” (p. 99), where “residue” refers to the “ancestral or inherited melancholic” (O’Loughlin, 2020b, p. 6) and spectral presences which remain unprocessed. Highlighting the importance of an Other in this restorative practice, O’Loughlin (2018) used the metaphor of darning to synthesize Lacanian theory with the notion of psychoanalysis existing as a means to restory traumatic life and ancestral experience. Referring to what Jacques Lacan (1966/2006) spoke of as “supplementation,” Bruce Fink (2014) also discussed this reparative process as a way of patching over voids of experience. These various ideas reflect the essence of restorying as a creative, discursive, psychological, and existential process: Restorying involves some way of collaborating with another person and/or using a medium in order to incorporate one’s lived experience of psychic rupture(s), which had foreclosed meaning-making at one point, and to then transform such experience into a newly crafted, retold life narrative (O’Loughlin et al., 2019).

I, like others (e.g., Schafer, 1980; White, 2011), advocate for narrative work and storytelling as vehicles for healing. Moreover, I argue that the crux of psychological healing, or working through what Ronald Dworkin (1993/2011) called a “narrative wreck” (p. 211), is twofold: a) understanding the psychosocial context and background of a person, and b) narrating life stories outwardly to an Other—more specifically, “an empathic and interested Other” (O’Loughlin, 2020a, p. 6). Paraphrasing Frank (2013), I propose that life stories may be wrecked because the past has led to an unrecognizable present which may impinge upon human possibility and, subsequently, inhibit a foreseeable future. For various culminating psychosocial (i.e., circumstantial) and relational (i.e., intersubjective) reasons, the sense of self may become stunted, frozen in time, or stuck in what Ronald Laing (1972) called “knots.”

Echoing Laing (1970), Bollas (2013) asserted that devastating crises, such as what are commonly referred to as “mental breakdowns,” are not only inherently profound, human experiences, but they also hold the potential for what he identified as “a renewal of the self” (p. 8). What happens during and after such life ruptures—in other words, whether a person and their life narrative progress—can lead to “potentially liberation and renewal” or “enslavement and existential death” (Laing, 1970, p. 110). The obstruction of one’s being and life story from “narrative foreclosure” (Freeman, 2000), however, can be remedied through a dual affirmation process, where the telling of a self-story is narrated to both oneself and to others. Through narrative development, the “wounded storyteller” can reaffirm their existence as well as the value of the ongoing life history (Frank, 2013).

Consistent with Bollas’s (2013) premise, I argue for bearing witness to the cores of others’ psychic suffering while simultaneously offering the time which they need to generate meaning from their experiences. By being provided actualizations of Donald Winnicott’s (1960) seminal ideas of a holding environment and “a good-enough other” (Bollas, 2013, p. 27) as well as psychoanalytically-informed care, distressed persons may then engage in making meaning from their “private mental pain” (p. 1). Using Bollas’s (2013) words, “it is not the content of the past which is therapeutic at this point, but the act of history-making that is generative and transformative” (p. 70, italics in original). Like altered states of consciousness, extreme emotional states, or psychosis, suffering is nuanced and diverse; however, it is through articulating our individual stories that life can continue onwards.

Method of Narrative Inquiry

Research Overview and Positionality Statement

In essence, this research involves a type of self-representational, narrative engagement that focuses on the multifaceted social, psychological, and creative forms which can emerge from inherited and experienced trauma (Gilmore, 2001). I am interested in listening to another person, receiving what they lay out as their life story, and joining them in walking a piece of the symbolic road of life. It is important that I acknowledge my positionality as a student of psychodynamic and psychoanalytic thinking—a theoretical orientation which undoubtedly influences my frames of reference, approach to, and focus of this work. I discuss how my being impacts the work below.

Expanding Narrative Methodology

I include a narrative, portrait-based approach and a clinically-focused dialogical process in order to expand on the clinical dynamic interviewing methodology used previously in related research (Charles & O’Loughlin, 2012; O’Loughlin & Charles, 2012; O’Loughlin et al., 2014; O’Loughlin et al., 2019)—works which have origins in J. Christopher Fowler and J. Christopher Perry’s (2005) interview protocol. As mentioned earlier, these methods are impacted by readings across a variety of disciplines; however, White’s (1990, 2007, 2011) narrative practice was particularly influential in the development of the methodology for this biographical study. Expanding upon previous narrative work completed by O’Loughlin et al. (2019), this research is a study of one creative person who has struggled with psychiatric troubles, has been exposed to the psychiatric care system, and who has endured crises through artistic creativity and through a process of restorying their experiences of and related to psychiatric ruptures. Ultimately, I aim to fashion a portrait, or a clinical piece of writing which may be characterized as a “life drawing” (Lawrence-Lightfoot, 1997), of the participant’s life and artistic work because of, rather than despite, experiencing major life ruptures due to severe psychiatric distress.

O’Loughlin has spent years further developing Fowler and Perry’s (2005) research methodology, as well as viewing and studying interviews that were completed at the Austen Riggs Center in Stockbridge, Massachusetts, United States of America (Charles & O’Loughlin, 2012; O’Loughlin & Charles, 2012; O’Loughlin et al., 2014). Whereas O’Loughlin et al.’s (2019) methodology involved three semi-structured interviews with 13 participants each, I have the opportunity to incorporate many curative dynamics into this project that involves a series of deepening, fully collaborative conversations with one participant over a prolonged period of time. How can a spiral effect of depth be created in and from such meetings? Drawing from Bruner’s (1986) usage of the “mapmaking” analogy, White (2011) achieved what he called a process of “reauthoring conversations” with his patients. By encouraging people to examine their life events and to draw new conclusions, he invited therapeutic generation of counter-stories, alternative themes, or counter-plots with which people could then characterize their lives. Moreover, through his usage of memos and reflections, White (2007, 2011) prompted dialogical exchanges which functioned as a means to recruit rich descriptions of lived experience and to deepen his conceptualization of the reauthoring conversations.

Inspired by White’s (1990, 2007, 2011) therapeutic method of recreating lived experience via shared exchanges of understanding, I allow for a dialogical space in which the participant and myself can reflect honestly about each of our meetings. To do so, after meetings, I write a reflective letter that includes my thoughts about the participant’s disclosures. The participant then has the opportunity to either respond verbally during our next meeting and/or in writing during the interim between meetings should they choose to do so. The purpose of this consistent interchange of ideas is to extend the methodology further into a new area so that I am not only taking a portraiture approach, but also purposefully integrating a dialogical, narrative practice. My aim is that, by adapting White’s (2007, 2011) approach to reauthoring conversations, my work is grounded in a narrative approach—one that psychologists can relate to because of the long traditions of reflecting and receiving in the history of therapeutic work.

Parameters of Collaboration and Procedure

I recognize that my participant’s story, as represented in this research, would not be the same if it were captured by any other person. Using Mikhail Bakhtin’s words, this dialogic project “is precisely the product of the reciprocal relationship between speaker and listener, addresser and addressee” (quoted from Vološinov, 1986, p. 86, ² italics in original). This research, therefore, specifically entails my participant’s narrative that I receive because of who I am, my background, theoretical orientation, and frames of reference, as well as my capacities to receive and represent (i.e., how I have prepared myself to meet with, accept, and ultimately present their story).

I considered a range of entry points as I aspired to cultivate a listening space which allows my participant to access their life story, to inscribe themselves in the biographical space, and to use that space to locate themselves in their narrative. One approach to the formulation of my participant’s narrative could be to have no entry point at all, but rather to merely invite my participant to begin narrating. This, I realize, reflects the clinical approach which many psychotherapists implement in their therapeutic work with patients. A second approach could be for the receiver to assume a more active role in influencing and guiding the development of the unfolding storyline (cf. O’Loughlin et al., 2019). By communicating prompts and parameters to govern the conversation at every juncture (e.g., “I wonder if we can begin with your earliest memories” or “I wonder if you could tell me about your experience with psychiatric struggles”), the narratee provides a self-imposed intervention to direct the narrator’s account. Each posture depends on the focus of the work, would offer a different framing of the writing, and would inherently result in a distinct shaping of the participant’s narrative.

While an argument could be made for each of these approaches and for any other entry point which may exist between the two extremes mentioned, I was inclined to pursue the first, nondirective approach. I am interested in receiving my participant’s narrative as “a good-enough other” (Bollas, 2013, p. 27) or, more accurately, as a disinterested, “good-enough listener” (Gilmore, 2001, p. 31). Considering the aims of this narrative engagement, my positioning to the development of the work, and the elements of the projected conversations (i.e., how and where I would enter the conversations with the narrator, what kind of role I would take during the meetings, what kind of listener I would be, etc.), I merely invite my participant to illuminate their story as they intend. I predominantly follow my participant’s natural narrative and do not determine how and when particular, relevant domains emerge in the conversational timeline. Nevertheless, I am cognizant of the various areas of narrative inquiry which I hypothesized would be crucial components of the narrator’s life experience: early life history, formation of their subjectivity and sense of self, experiences of psychiatric distress, as well as creative and artistic processes. If and when these domains arise, I express interest and explore them with my participant in an engaging, collaborative way that allows for further, deeper reflection.

After contacting potential participants who were referred by prominent figures in the fields of psychology and psychoanalysis ³ , I initiated preliminary conversations with each interested individual. I had initial, frame-setting conversations over the course of two separate meetings to assess each potential participant’s receptivity to and degree of suitability for this project. During the first conversation, I discussed this study’s purpose, elucidated the parameters of the conversations, and invited the interested person to receive overall details of the project. While I laid out my visions of this work at that time, I also presented points of negotiation and assessed how receptive the potential participant was to the frame-setting. During the second initial meeting, I presented the informed consent, the support system in place (i.e., my research mentor monitoring both the participant’s clinical safety and the progress of the research), the dialogical process, and a discussion about the risks and safeguards against these risks in regards to confidentiality and anonymity. This work, therefore, calls for an ethically attuned understanding between the different roles of researcher and clinician as it draws from the traditions of clinical psychology and psychoanalysis as well as narrative methodology that value a depth approach to human suffering. As a clinical researcher in this work, I would like to clarify that this is clinical research, not clinical work, and that the intentions of each are different: “Clinical work”—as it is widely conceptualized in psychology and psychoanalysis—involves using a therapeutic relationship to assist people in improving their lives, whereas “clinical research” uses the same tools to understand the psyche and to elicit similar narrative but for research purposes only. I would like to be clear that, for this project, I am not a clinician doing research, but rather I am a clinical researcher. While the roles of clinicians and researchers can be integrated [i.e., clinician-researchers (Yanos & Ziedonis, 2006) or scholar-practitioners (Wasserman & Kram, 2009)], these roles can, alternatively, be mutually exclusive. For this work, I am not a clinician-researcher (i.e., I am not conducting research on a therapy patient with whom I am engaged in clinical work) and, therefore, do not contend with competing ethical issues and complications involved with balancing the roles between clinician and researcher. ⁴ I am, however, a clinical researcher who uses clinical tools in order to conduct my research. In order words, clinical researchers apply the frameworks of understanding as well as skills within a field to inform the research on the phenomena of interest. With respect to this kind of research discussed here, clinical researchers in the field, including myself, apply the skills of clinical psychology in order to understand the psyche through research.

After discussing these preliminary, frame-setting conversations with my research mentor, I selected one person who met the following inclusion criteria: a) has experienced severe psychiatric distress during their lifetime; b) is in a creative profession (e.g., writing, painting, drawing, sculpture, or the performing arts); c) does not experience significant memory difficulties and is not verbally inhibited (i.e., someone who does not have a difficulty with verbalizing thoughts, emotions, and experiences); d) is willing to articulate their life story and life experiences while meeting with me periodically over an extended period of time; and e) consents to the study and agrees that I may be the storyteller of their life narrative. The first two inclusion criteria were included to target the phenomena of interest in this research. The third and fourth criteria aimed to facilitate data collection and the projected longitudinal nature of this study, respectively.

I asked my participant to facilitate this project—one that reflects the goal of psychotherapy and artistic expertise as vehicles through which new narratives are actively cultivated. I hoped that this individual would philanthropically allow me to listen, receive, and record their life over a series of encounters in an effort to be the storyteller of their purpose. Since obtaining written consent for this study, I am meeting with my participant for 10 months through a series of weekly, recorded interviews, each one lasting approximately 1 hour via Zoom—an online, video-conferencing platform which is compliant with the Health Insurance Portability and Accountability Act (HIPAA). I initially framed my collaboration with my participant by offering the following invitation: “I open this space up for you to lay out your story as you see fit—both how and when you would like over the course of our meetings together, and I am glad to hear it and listen to it and join you in walking a piece of the road with you.” This person and I then entered into a compact, which honors and centers on the existential notion of journeying together.

I set out to follow Bion’s (1967/2013) clinical suggestions by approaching each meeting with an intent to listen and receive “without memory, desire, or understanding” or an aim to interpret. Rather, I allow my participant to guide me through their narrative and to provide the understanding themselves. The focus of our meetings is not on my understanding since that is not the key to this kind of work (Fink, 2014), but on my participant telling me about their lived experience and my receiving of their story on their own terms. Our conversations remain nondirective, thoroughly collaborative, and predominantly guided by my participant’s unfolding of their narrative as they desire.

To describe the procedure related to integrating the dialogical process mentioned earlier, I opened up narrative, autobiographical engagement with my participant by stating the following:

After each time we have a conversation, I will give some thought to what you said and send you my thoughts as an abstraction of that meeting. My letters will come from a place of reflection so, for example, I might say, “You know, I was listening to you last week and it made me think of …” My reflective letter will respond to our meeting so that you can think about it and, if you wish, reply back via writing in between our last conversation and our next one. During the next meeting, we will both discuss my reflection together—particularly what parts of my understanding resonates well or not—so that we can both process to a new place and continue the conversation from there.

By allowing my reflections to become the subject of dialogue, I become a dialogical partner with my participant. My participant subsequently has the opportunity to engage with my unconscious and understanding related to their narrative, all of which come to the fore. This multidimensional methodology, therefore, generates a rich platform for dialogue while eliminating the constrictive pressure to accomplish all the desired work in the meeting itself or within a limited number of meetings. By extending the dialogical process beyond the meeting, our conversations also continue and evolve over time. The actual meetings then become reflective spaces which engender the capacity to rotate deeper and deeper into material, guided by the feedback and reauthoring which my participant offers.

Our conversations have taken the form of three phases over the course of our meetings: a) my participant lays out their life story as they see fit while I receive their narrative; b) we discuss my participant’s creative process more explicitly through the exploration of their produced creative works; and c) I will then engage my participant in member validation and checking both the fidelity of my writing as well as their comfortability with the included material in the analysis. Regarding the data analysis, I chose to conduct an interpretive phenomenological analysis (IPA) of this qualitative research for multiple reasons. First, IPA is appropriate since it facilitates the purpose of qualitative research which, as Alan Kazdin (2017) wrote, “is to understand, elaborate meaning, and to uncover the experience of the participants” (p. 239). Second, IPA draws from narrative theory as it specifically offers a richness in developing subjective insights into a particular subject matter. Third, this kind of analysis maintains this study’s aim to facilitate a symbiotic process where both parties involved contribute to the emerging narrative. IPA warrants an intimate, collaborative effort as researcher and participant actively engage in making meaning from the data, privileging the participant’s narrative of their world. Fourth, because it is an immersive data analysis, IPA also reflects the purpose of this methodology in obtaining a greater depth from the gathered clinical material. After completing the open inquiry with my participant, I will watch the recordings of completed meetings and reread their respective transcripts several times. Through this sustained, personal immersion in the data, I will then identify themes in the collected narrative which intend to provide unique insights into a person’s life. Fifth, in this work, IPA is interconnected with psychoanalytic/clinical frameworks and narrative theory; the work of O’Loughlin et al. (2019) illustrates the integration of psychoanalytic understanding of the psyche, narrative process, and interpretive phenomenology. I am building on this body of work which has sought to combine psychoanalytic and clinical understanding, narrative theory, and interpretive phenomenology as a mode of analysis.

Ensuring the Quality and Fidelity of the Work

Although Institutional Review Board (IRB) approval was not required for this research since it involves biographical or oral history,^5,6 I take careful steps throughout this work to provide support and to safeguard confidentiality and anonymity in order to neutralize the inherent, relative risks of this research as much as possible. Multiple measures (e.g., thorough de-identification to protect the participant’s privacy and member checking, or a process of participant validation in order to enhance the fidelity of the produced narrative) are taken to ensure that the nature, development, and writing of this work remains ethical, confidential, and as authentic as possible. My reflective letters and probing, open-ended questions during meetings have the dual function of checking my understanding—or, more accurately, my receptivity—with my participant and of communicating and then negotiating my narrative framing of the work. As I develop my analysis of the collected data, I will offer interspersed meetings so that my participant could provide verbal and/or written feedback on the drafts which illustrate how I lay out their narrative and the trial interpretations (Fowler & Perry, 2005) which I offer. Therefore, although there is no direct compensation for participation, my participant has the rightful agency to decide whether they would like to participate in both the dialogical process and the literary editing of the work as I develop drafts of writing, if they are open to that kind of autobiographical engagement at the time.

In addition, the quality of the work is reviewed by and discussed with my research mentor who, again, oversees the clinical safety, data collection, analysis, and presentation of this research. Besides engaging in participant validation, I also record my countertransferential experiences, or my internal reactions, to the emerging content and dynamics of the conversations. By maintaining this meditative log, which I also share with my research mentor, I not only thoroughly review the audio- and video-recordings and their transcripts, but I also utilize my own sense of what occurred relationally, what was communicated, and what was left unspoken as data from the meetings. I would like to emphasize that I defer to my participant’s perceptions and understanding, which serve as the privileged account in this work. These discussed checks on the veracity and quality of the data are in place to avoid privileging my interpretations over the lived experience which my participant shared.

Ethical Considerations and Limitations

Researchers, such as anthropologists and other social scientists, are often concerned with doing harm to others when they engage in activities, such as qualitative research or documentary work, that subject human experience to methodical theorization. Referring to Arthur Kleinman’s (1995) viewpoint, Michael Jackson (2005) noted that we can “do violence to others, not only in the ways we act toward them but in the ways we speak and write about them” (p. 153). What ought to be the experiences of being with somebody and of the narrator themselves as they share their suffering? Whose story is actually being told in the work presented? How can this kind of work be done in respectful and helpful ways for both parties involved? And how can the work be presented “in a way which honors and is therapeutic for the narrator” (Kulsa, 2022, p. 1)? These are some of the considerations which concerned me during my preparation and which I continue to be mindful of during the realization of this project. Jackson (2005) asked, “Whose experience is to be prioritised – the sufferers or ours? And do we privilege what is at stake for the liberal spectator or what is at stake for the sufferer – for the issues are seldom the same?” (Jackson, 2005, p. 153, italics in original). To address this ethical dilemma, I endeavor to bracket my positioning, keep this writing as authentic as possible by focusing on the material presented, check my understanding with my participant after meetings, and discuss the fidelity of my interpretations as I produce writing that is infused with a clinical understanding.

That being said, there are limitations to acknowledge and to be mindful of in this work. As mentioned earlier, there are consequences related to the researcher’s role as co-constructor in the narrative process: Again, the work is shaped by the researcher’s background, theoretical orientation, frames of reference, and capacities to receive and represent. There is the additional complexity and ethical dilemma—as with all forms of research—related to the ethics of representation (Behar, 1996; Patai, 1987): How much of the data and what specific content does the researcher decide to include in the final version of the project’s writing? In other words, which pieces of the story are told? Conversely, which pieces are left on the cutting room floor? Moreover, while there were particular characteristics that I had searched for in a participant due to my dissertation’s focus (i.e., that they have a history of severe psychiatric distress and be an established creative professional), this study included a person who demonstrated sufficient capacities to remember and narrate their lived experience. In addition to this study’s generalizability being limited due to its single-case study design, this inclusion criterion related to memory and articulation abilities also limited this research in that it excluded a particular subset of individuals and their unique experiences.

Concluding Remarks

While this research is in progress, I hope that it will deepen the understanding of and discourse about severe psychiatric suffering and its connection with artistic expression and narrative healing. It is also my hope that, through my expansion of narrative methodology, my doctoral research helps to provide a way in which clinicians and researchers across various disciplines can facilitate and preserve curative, biographical spaces for all—particularly those with unmetabolized, painful lived experience and inherited trauma.

I would like to emphasize the dyadic, humanistic value of this kind of narrative work. The aim of this study and its methodology is not, in a detached and dehumanizing way, to gain knowledge of and objectify another and their life story, but to explore the experience of being together instead. Rather than a reductionistic process, this research is a collaboratively relational process—a principle which the whole theory of narrative centers around. This narrative inquiry, with its particular integration of dialogical exchange and autobiographical engagement, involves the essence of psychodynamic work: The clinician or researcher being in relation with another human being and looking at ways in which conversations can be useful to both the narrator and narratee in understanding themselves in the world. This research, therefore, endeavors to capture the experience of being in relation—how both my participant and myself, in bringing our own object-relational presences to the space, change from our relational connectivity. Ultimately, my participant and I will discuss whether and to what extent our conversations for this biographical, narrative project are facilitative of such growth.

This work, as an extensive exploration of an individual’s life, offers the capacity to achieve something which resembles a therapeutic relationship, not unlike the kind which develops and draws from the intersubjectivity and receptivity within a therapy room. While this work does not follow all of the conventions of therapy, it does have a frame which is largely similar to therapeutic work, as discussed earlier. I argue that my goal can be seen as analogous to that of a therapist’s primary goal for a patient: Our goal with patients is to help them to better understand their location in the world so that they can engage with living in ways which are more conducive for them. This is not different from my research goal here and that, as proponents of narrativity point out, is the beauty of biographic work.

Michael White’s (2007, 2011) work is proof of this in a way since it captures how therapeutic narrative emerges and how intensifying therapeutic conversations can yield therapeutic narrative. The methodology I employ here is essentially a variation of White’s (2011) narrative practice approach, and I am bringing to bear on that my knowledge of psychoanalytic, clinical technique—the clinical dynamic method—and my knowledge of the psychosocial nature of many psychic struggles. White (2011) brought his experience to bear on the narrative approach in the same way. Though his knowledge base was a little different in that he did not utilize a psychoanalytic notion of depth, this work here has the same fundamental idea of pursuing psychological healing through narrative engagement.

Using Frieda Fromm-Reichmann’s words to establish a common space that fosters the emergence of possibility and experience, I continually invite my participant to “[t]ake me along” (Hornstein, 2000, p. 228) and allow me to accompany them on their journey. Drawing from the words of my mentor, my participant and I walk a part of life’s path together. For that, I am forever grateful. It is a profound privilege of unimaginable proportions for my participant to share their life story with me so that this project develops as I initially envisioned. It is not lost on me that my participant endows me with an invaluable gift by sharing their testimony, agreeing to allow me to walk a piece of the road with them, and then tell their story. I also acknowledge that their participation and collaboration have embedded this work with a kind of exquisite depth and power which it would not have otherwise.

Like in many forms of research, thinking of a manner through which I may return some value to my participant has always been a crucial and meaningful factor in this work. As we conclude this project, I will open up a space to discuss how I may recognize my participant in a way which they deem of some value (e.g., a gift card for a store of their choosing or their favorite restaurant). I hope that an additional way to respond in kind is by offering this research as an effort to shift the pervasive, biomedical narrative that dominates the fields of psychology and psychiatry: from one of misrecognition, dehumanization, and marginalization—which commonly intersect with unspeakable suffering and psychiatric distress—to one of survival, transformation, regeneration, and emancipation. The latter of which, in my opinion, allows for narrative development that is more ethically attuned, empowering, inclusive, boundless, and humanizing. As a final thought that continues to motivate my work, I have faith that this research serves as a way to do some good in this world, and I am enormously indebted to my participant for the power and value of their contribution to this effort.