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A ‘meaning-centred approach’ to patient consultation is the same as spirituality and psychiatry

Published online by Cambridge University Press:  02 January 2018

Temi Metseagharun*
Affiliation:
Robertson Centre, Kidderminster General Hospital, Bewdley Road, Kidderminster DY11 6RJ, email: drtemi2008@gmail.com
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © Royal College of Psychiatrists, 2010

I commend Paul Wallang's excellent piece, Reference Wallang1 which is as brilliant as it is relevant. I cannot agree more with the contents of his narrative reflected in his write up although, like everybody else, I have my own.

There is an old wine in a new bottle in all these discussions and narratives. The old wine is what prehistoric man and ancient civilisations perceived as ‘spirit’, as it is not difficult to imagine that a ‘spirit’ or anything ‘spiritual’ must reflect a story or narrative, the beginning of which must have a purpose (known or unknown) and the end a meaning that ‘loops back’ onto the purpose at the beginning. Everything about the human mind will be pointless, as some intellectuals say about the universe, unless it is centred on ‘meaning.’ There is no need to bring in Wittgenstein's legacy since we can figure this out ourselves from scratch. The ongoing recording or tape of our individual experiences (consciousness) is what forms our memory, which itself determines all future thinking and moment-by-moment definition of reality. The process of our minds determining or defining reality on a moment-by-moment basis is what we call (ordinary) perceptions. What is significant about this old wine, however, is that these recordings or narratives are intergenerational, ancestral and ultimately biological (DNA-based). Therefore even emotions and instincts represent forms of narratives, because they are the stories and instruction our ancestors continue to tell us that allow us to perceive without previous individual experience of what we ‘just know’ or feel. In response to Jeremy Holmes's letter, ‘What about psychodynamics?’, Reference Holmes2 I suppose it is now obvious that Freudian psychoanalysis and whatever psychodynamic psychotherapy and interpretations that we come up with can only represent the individual and/or culturally shared narrative. To the average Itsekiri (my fellow tribesman), psychoanalysis would be meaningless unless this Itsekiri person is tutored in Western culture and psychoanalytic narratives. For education and training purposes it is important, as stated in the adult psychiatry curriculum of the Royal College of Psychiatrists, 3 that trainees should be ‘able to appreciate the “scientific unknowns” in the relevant field of psychiatric practice’. To be able to do this the trainee needs to be encouraged to see the movie (narrative or story) on the DVD and not the chemical constituents of the DVD, the mechanism of the DVD player or description of its casing. Here is the secret of the so-called ‘mind–brain problem’ resolved in part. Each new generation comes with a new narrative worth listening to as part of the clinical encounter. It is unlikely that the impersonal biological DVD player (the brain) and its mechanisms, like those of other animals, will physically change much over a generation, but the narratives (the movies or stories held on the DVD or tape) that give meaning to people's lives –their spirituality – will continue to change and evolve for as long as the species exists.

In our consensus approach to patient consultation, the word ‘narrative’ may be more acceptable than ‘spirituality’ as it has no direct association with religion (something that one should rightly be suspicious of), but if ‘meaning’ is what we aim to centre consultations on, then it is important to understand that underneath the various terms we use, a ‘meaning-centred approach’ must be the same as spirituality and psychiatry.

References

1 Wallang, P. Wittgenstein's legacy and narrative networks: incorporating a meaning-centred approach to patient consultation. Psychiatrist 2010; 34: 157–61.CrossRefGoogle Scholar
2 Holmes, J. Meaning centred approaches: what about psychodynamics? Psychiatrist 2010; e-letter (http://pb.rcpsych.org/cgi/eletters/34/4/1579964).Google Scholar
3 Royal College of Psychiatrists. A Competency Based Curriculum for Specialist Training in Psychiatry: Specialist Module in Adult (General and Community) Psychiatry. Royal College of Psychiatrists, 2009 (http:/www.rcpsych.ac.uk/PDF/Adult_(GeneraLand_Community)_Feb09.pdf).Google Scholar
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