Chris: Many thanks for agreeing to speak with the Phil SIG on your new book, Personally Speaking. Before we delve into the book itself, given its focus on personal narratives, it seems fitting to start by asking you to tell us a bit about your own story.
Glenn: Thank you for asking, I think the two are quite closely related, but like many, it has taken me many years to sympathetically understand the influence of my personal history upon my life and work: My parents grew up in the aftermath of the second world war, both came from poor, uneducated, working-class backgrounds, both lost their fathers in childhood. With few resources, they worked very hard to make a secure and outwardly successful home. I’m sure they loved their two boys, but my memory is mostly of an anxious and argumentative household from which I wanted to escape, albeit with a longing for belonging. I look back on a rather lost, lonely and troubled childhood. I was bullied and anxious around others. I struggled with learning to read and write but nonetheless found great comfort in books and stories, but was most at home wandering in Epping Forest, with nature for companionship. School was bit of a nightmare, but I was saved by being curious, intelligent and creative and able to rise to challenges when I needed. So, it was an improbable and rather bumpy path that led me to medical school in Bristol where I struggled to cope with the social challenges more than the academic, but really started to find my feet, for the first time, when I was introduced to psychiatry.
Chris: Could you say more about your clinical work, and how narrative and meaning-making influenced your practice?
Glenn: It’s nearly 50 years since I was on my student psychiatry placement, but I can still remember the enduring impact of two books. The team social worker gave me an anthology of carers stories from the National Schizophrenia Fellowship (NSF – now ‘Rethink’) and our teacher, who became a friend and mentor, introduce us to Anthony Clare’s ‘Psychiatry in Dissent’. The first vividly opened my awareness to the complex experience of living with psychosis as a family, and the second to how just about every aspect of psychiatric practice was contested – particularly by those on the receiving end. These were stimulating and confusing, in equal measure, but from the outset it seemed to me that psychiatry was all about engagement with life experience and personal meaning and there were no simple or universally applicable ‘answers’. On completing my training, I was drawn to work alongside Jeremy Holmes in North Devon and learned a great deal from his emphasis on psychotherapeutic psychiatry. I was later able to move to Exeter and develop the county-wide rehabilitation service, which focused on taking a positive long-term perspective and supporting people in their recovery through enabling relationships. It took me six years, alongside my NHS work, to complete my MD thesis, ‘On meaning and purpose in delusional belief systems’ but this prolonged biographically based study into the meaning of symptoms became a ‘royal road’ for me to develop a narrative approach to rehabilitation practice. It didn’t answer why people became psychotic, but it did make the content more intelligible and therapeutically approachable, as we became more able to understand and empathise with the life predicament of the people who became our patients.
Chris: Is there anything else you’d like to share about your own story?
Glenn: Well, life continues to have its complexity and shadows but I’m very pleased to be entering my 71st year, in a warm and secure relationship, as a father and grandfather, and with a dear doggie companion. And, having taken the ‘step-up’ into retirement, I’m mindful of Oliver Sacks’ final essay, ‘On gratitude’, and, overall, share his sense of deep appreciation for what has been possible to experience and achieve. I have known times of significant mental distress but I’m pretty sure that finding a way to survive and sit with those anguishing experiences, gave me confidence to sit alongside others in their darkness, without being frightened of despair, and hopelessness, and confusion. Learning from the ‘Recovery Movement’ was the most hopeful and helpful discovery in my personal / professional life and I had the good fortune to become the RCPsych’s lead on Recovery (2006-11) and many other opportunities. In later years I feel I’ve come home to a more secure and grounded way of being through meditation and contemplative studies. It has been a time of (re) integration and healing for much of what has gone before, which has led directly to the purpose and process of our book.
Chris: For those unfamiliar, could you explain what the book is about?
Glenn: In a simple sense it is richly illustrated anthology of intimate autobiographical stories, from well-known and well-respected colleagues, reflecting on what they have learned from their life experiences that has informed, influenced and inspired their work. It underlines how the interconnections between our personal and professional lives can be mutually supportive, on the life-long road to maturity. It is a rich resource that invites the reader to reflect on their lives and value their experience, but what it is ‘about’ is likely to be different for different readers as they engage in their own personal contemplations. In trying to summarise the book, various metaphors have come to mind … it is somewhat like a welcoming campfire: offering warmth and light, somewhere to gather in the dark and listen to stories that connect with the story you’re living. Or a buffet table: with a spread of narrative nourishment to which you can bring your plate and choose what you value or need. And I joke that it’s also ‘a bit of a mess’: in the old style of the doctors’ mess, a safe place where you could sit with colleagues, including elders, and hear them talk about life and work, what was going wrong, what mattered. In a way this is a ‘mess’ in a book.
Chris: You describe the “heart, art, and soul” of psychiatry as fundamentally relational. What do you mean?
Glenn: I have struggled to summarise the book in a single sentence, but landed on: ‘Through intimate autobiographical stories, leading psychiatrists illustrate how the heart, the art, and the soul of psychiatric medical practice are fundamentally relational, starting with themselves.’ That “starting with themselves” matters. The stories repeatedly show that how we relate to our own experience informs how we relate to patients, and our colleagues and teams too. This doesn’t mean collapsing boundaries or assuming equivalence. It means recognising that psychiatry is dependant not only on technical competence but on personal connection and capability. Relationship-building is not “extra”; it is intrinsic and essential. The book is, in a sense, about re-visioning our professional identity as a relational identity: we are people before we are practitioners and our work is essentially that of seeking to form trusting and helpful relationships with those in great distress … we can call on many technical skills and resources too … but I’m with Irv Yalom in thinking that it’s the relationship that heals.
Chris: Was there a story that stood out for you personally?
Glenn: I’ve learned something important from all the stories but have a particular connection with Mike Shooter’s. I read an earlier version many years ago in a BMJ interview. He described his depression, suicidal thoughts, despair, and the sense of wasted years. When he stood for the presidency of the Royal College of Psychiatrists, he included his experience of depression as a qualification for high office. I read it while I was going through a very difficult patch myself, feeling depressed and fraudulent, struggling to reconcile being a patient and being a doctor. His story embodied the possibility that these are not two different species of human being. They are two aspects of one human life, and each can inform and support the other. It was a vision for how professional and personal maturity can be helpfully interconnected. And having been personally helped by his personal story, Mike was the first person I approached to contribute to this project, and I was delighted he accepted …
Chris: What is the importance of narrative in psychiatric theory, practice, and research?
Glenn: Valuing narrative is valuing meaning: meaning attached to experience, and experience as arising from trouble in life. A narrative perspective inherently humanises our understanding of distress. It situates difficulties within a life trajectory: one thing happens after another. It offers a different perspective on psychopathology and on formulation. Narrative also offers insight into painful or corrosive stories— stories people are told about themselves, or attach themselves to, which become toxic and destructive. People can live by painful meanings that shape identity: who they are, what they’ve been through, how they got here. Therapeutically, narrative work can involve story-making and story-breaking. Many people are confused about their life: what happened, what it means, where it came from. Sometimes we work to help them create a story to live in and live by. At other times, people are stuck in a story; constrained by it; fed indigestible meanings. Then we may help them to open meanings, let go of some of them, and see from another perspective, a more hopeful and healthy way of understanding that stands them in better service as a map to live by. The journey of personal recovery is often marked by a transition and transformation of the story people are living in as they come to understand what they’ve been through, where they are now, and where they’d like to be. This reauthoring of our lives and finding satisfactory meanings-to-live-by is personal work, but something that can be enabled by practitioners and peers.
Chris: Do you feel the culture of psychiatry values narrative more now?
Glenn: I can only offer a personal perspective, and it feels to me as though the ‘culture’ of psychiatry is significantly and unhelpfully divided, such that, depending on viewpoint, the answer could be both ‘yes’ and ‘no’. One division is between the psychotherapeutic and bio-medical camps, what Luc Ciompi referred to as ‘the disastrous split’, and which broadly mirrors our endemic cultural divide between science and the arts. Many forms of psychotherapeutic training and practice are deeply attentive to narrative awareness, but these are seldom the leading approach in our services. In my view, our therapeutic approaches need creative integration if we are to really to develop person-centred care. But a deeper and more disturbing division may be between the aspiration and culture of our training as Psychiatric professionals and the often conflicted and compromised reality of our employed roles in practice. It’s hard, very hard, to value and sensitively engage with personal meaning and intimate therapeutic relationships, if you are overworked, under supported, stressed and struggling yourselves. The stories in our book are set against the tensions of these uncomfortable realities, and I feel one of our overarching messages is of the need to find a practical way to reclaim, inhabit and embody the guiding narrative of our own profession as based on ‘holistic and person-centred care’ – including that for ourselves.
Chris: Although the book isn’t principally philosophical, there are philosophical implications. Did anything come out for you?
Glenn: I have no specialist training but have always been drawn to philosophical perspectives. I really appreciate how the etymology of ‘Philosophy’ unpacks as, ‘the love of wisdom’, and that our college motto is, ‘Let wisdom guide’ … I’ve sometimes thought our work could be reframed as ‘clinical philosophy’. But, what is ‘wisdom’? For me it is about knowledge, understanding and skill in learning how to be well and live well … it’s about life and living. Over a lifetime I’ve dabbled with many perspectives and have come to see what is of value as arising from many convergent streams of culture and contribution. For some years now I’ve been learning from secular Buddhist teachings which are psychological and philosophical, rather than religious, in nature, and observe many overlaps with early Greek philosophy. The Buddhists call their teaching ‘Dharma’ which is substantially focused on meditation and ethics and seeking to realise the fundamental nature of things … but with a clear focus on practicality, learning how to be well and live well, here and now. But I take this Buddhist dharma to be part of a much broader accumulation of human wisdom – what Jon Kabat Zinn refers to as ‘universal dharma’ … and from that viewpoint I consider our book of stories to be ‘dharma tales’ – whose guiding purpose lies in fulfilment of our College motto to, ‘Let Wisdom Guide’ … our stories being focused on the experiential wisdom of learning about life through open and honest contemplation of experience. And I think it’s important to emphasise that the ‘guidance’ here … is not something offered by the storytellers so much as something the reader is invited to discover for themselves in the context of reflecting upon their own lives.
Chris: One philosophical debate that comes to mind when thinking about narratives, concerns Karl Jaspers’ idea of the experiential aspects of schizophrenia as being inherently “un-understandable”. Is there a need to be mindful of the potential limits to the ‘understandability’ of some people’s personal stories?
Glenn: This is an important question. I think Jaspers’ views on ‘un-understandability’ has been substantially misunderstood to suggest that everything about psychosis is beyond the grasp of understanding – and therefore people experiencing psychosis are nonsense speakers – which, historically, has led to tragically depersonalised treatment, stigma and othering, the shadows of which affect us still. Wisdom is also defined in relation to ‘truth seeking’, but I believe ‘truth’ can be apprehended symbolically or metaphorically as well as through verifiable facts. I’ve explored this in some detail in my writing on, ‘Narrative approaches to psychosis’ in Healing Stories (1999) and that on ‘Understanding madness’ in Enabling Recovery (2006). In short, I really value the distinction Jaspers made between ‘understanding’ and ‘causal explanation’ and particularly his assertion that, ‘understanding proceeds by way of empathy’, which I see as enabled by narrative perspectives. (Note: I needed to look this up after our conversation but I was pleased to remember that Jaspers also said, ‘extreme psychotic states offer a human parable … patients see into depths that do not belong so much to their illness as themselves as individuals with their historical truth … in psychotic reality we find an abundance of content representing fundamental problems of philosophy’ (1963, p309)) And if I understand the spirit of your question correctly … there is a need to be careful and cautious in how we relate to the ‘truth’ of any particular story … stories are meaningful and motivated constructions of meaning, not read-outs from reality … but similarly there are also truths revealed and evoked by stories that can never be accessed through facts alone. This is very important in our therapeutic work as well as in living our lives.
Chris: Any specific advice, and any changes you hope to see in training and practice?
Glenn: There is work involved in turning experience into expertise, sometimes hard work. Our book suggests this (self) work could be a key aspect of both training and practice in support of our personal and professional maturation. Our book opens with an invitation to spend time with these authors, listening to their stories and reflecting on how that connects with the stories we are living in. I advise readers to read slowly, one story at a time. Don’t try to squeeze the juice out of it as you would a paper, looking for facts. Sit with an awareness of the author’s presence, really listen. And rather than ask, ‘what are they saying?’, ask yourself, “what does this have to say to me?” This is a book with a job to do, and putting the book to work offers opportunities for coaching, mentoring, supportive contemplation and personal reflection. I hope that groups of colleagues may like to read and discuss these stories together and perhaps be encouraged to find and offer one another stories of their own. My hope, our hope, is that our ‘gift of stories’ will be a supportive contribute to re-visioning psychiatry, based on person-centred and relational training and practice … but just how, is a question for our profession as a whole to consider.
Interview by Dr. Christopher Meechan Edited by Dr. Conor McAvoy Many thanks to Dr Glenn Roberts for sharing his time and wisdom.
