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Down the Rabbit Hole
Paul Kiritsis, PsyD candidate, DPhil., MA (Psychology), MA (History)

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The Role of Narrative in Psychotherapy and Healing

Paul Kiritsis - Sunday, May 24, 2015


“There is no greater agony than bearing an untold story inside you.” –Maya Angelou

 

Creative narrative and storytelling stands at an evolutionary junction reflecting the gradual emergence of semantic language, culture, and the social brain. They predate science, property rights, medicine, the consumer societies birthed by the Industrial Revolution, the religious work ethic, and anything else of worth ever invented by the human species. More importantly though, they allow for a constellation of individuals with identical or analogous moral ideals, ethical standards, religious beliefs, and cosmogonies to interweave, self-organize, and facilitate a context for personal movement to self-actualization and henceforth serve as collective repositories for the co-construction and transmission of culture. Desire for subsistence and inherent meaning is a driving force to be reckoned with, and its sheer value and aptitude in being able to relegate our perceived differences to the wastebasket of triviality is reflected in the cross-cultural immanence of oral and written myth in bygone civilizations and through Hollywood movies, television serials, genre fiction, and pop magazines in the contemporary developed world. At the very core of narrative gravity is self-identity (Dennett, 1991); it has occupied and continues to occupy so much subjective mental space because it is the principal mechanism through which all generations have recreated thyself. Without a doubt we come to know conscious and unconscious aspects of the self (Snyder, 1998), our competences and limitations, our motivations, and our aspirations through narrative.   

Save for reflecting the sociocultural milieus and encompassing blueprints for behavior, identity, and theoretical knowledge in all known cultures, narrative probably emerged, in part, as a mechanism of neural integration and coordination between the dominant and nondominant hemispheres of the brain (Cozolino, 2010). If this is indeed true, then a multilevel function of narrative is to facilitate neural connectivity in the brain, emotional stability, psychological flexibility, and psychosomatic health. Dan Siegel has much to say about this curious phenomenon. The integrative neural processes occurring during formative periods of development can be vertical, dorso-ventral, or interhemispheric (Siegel, 2012). The importance of the latter, according to Trevarthen, cannot be overstated because the anterior commissures and corpus callosum combined is, “the only pathway through which the higher functions of perception and cognition, learning and voluntary motor coordination can be unified (Siegel, 2012, pp. 341).” Associational neurons in the frontal, temporal, and parietal lobes are the modus operandi, linking intricate representational processes of the hemispheres together (Cozolino, 2010).

Concerning the importance of narrative in interhemispheric coordination, scientific treatises activate only the digital, temporal processes of the dominant left hemisphere whereas the combined visual imagery and linear storyline couched within real stories and fictional tales activate both the aforementioned and the holistic, analogic processes of the nondominant right hemisphere (Siegel, 2012). In light of this interdisciplinary schema, it appears that our genetic and neurological constitution come with in-built “attractions” for higher-order activities (i.e. reading and listening to stories or creating them) able to activate and hence integrate cortical and subcortical processing systems, the hippocampus and amygdala, and specific regions of the frontal lobes (Rossi, 1993). Moreover, creative storytelling stimulates denser connectivity between the language centers; the neural networks dedicated to memory, visceral, and emotional processing; and conscious awareness (Cozolino, 2010). Albeit unconscious, there’s a reason as to why we recourse to them when we’re suffering from self-perpetuated patterns of depression, anxiety, over-emotionality, or a sense of emptiness and meaninglessness in our suboptimal lives.

            Let’s attempt a substantiation of the abovementioned claim with some palpable examples from my own personal experience. In the last eight months the rigorous intellectual demands of gradual school inadvertently lead to the abandonment of hitherto present artistic endeavours like creating writing, reading novels, writing poetry, drawing, playing the keyboards, and doing jigsaw puzzles. Before I knew it I was meandering inside the labyrinth of syllogistic reasoning, cause-effect relationships, and interpretation, pumping out scholarly papers at an astronomical rate. Although unconscious of it at first, the biases patterns of left-right activation began cropping up in my subjective conscious experience as irritation, agitation, and a slight nervousness. Some basic feelings of emptiness and desolation associated with this lopsided life orientation were also present. Something didn’t feel “right” anymore; there was something missing.

Unable to isolate and scrutinize these at the time, I continued spiralling into a lamentable lapse of discontentment until my very conscientious and astute psychotherapist reorientated me to the inner world of images, symbols, and heroic journeys, the same plane the storytelling process appropriates for the sake of recommencing dialogue between the value-laden ego and the rich tapestry of archetypal content irrupting from the unconscious (Snyder, 1997). Done in a context-appropriate manner, my therapist’s solicitation to create self-narratives in a personal journal by combining creative storytelling with the writing process occasioned in emancipation from emotional arousal and stress and increased feelings of exuberance, contentment, and wellbeing. This creative project evolved into something much more powerful and profound during Expressive Arts Therapy class, examining existential, spiritual, and metaphysical themes via the integration three different modalities–drawing, poetry, and prose. Another more reductive mode of expressing this would be to say that the creative processes unleashed led to a readjustment of right-left balance.     

On a similar note the consensus amongst neuroscientists is that the corpus callosum, the bundle of nerve fibres interconnecting and coordinating the two hemispheres, doesn’t reach full maturity until early teenagehood (Galin, Johnstone, Nakell, & Herron, 1979). From about twelve onwards, I became fascinated with genre fiction, especially drama, thriller, and horror, petitioning my parents for books written by Richard Laymon, Dean Koontz and Stephen King. Being firm believers in education and intellectual stimulation, they complied with every request and so instead of engaging in activities more pertinent to my age group (i.e. playing make-believe), I devoured suspenseful and stimulating narratives from the opulent comfort of my cerulean-tinted room. By the time I’d reached sixteen I’d read about a hundred and fifty fiction books. Deliberating on the progression of my own development, it recently occurred to me that this early passionate and sometimes pathological fixation with the artificial worlds of genre fiction may have not been a random epiphenomenon of innate curiosity per se, but a necessary catalyst for enhanced metabolic activity and right-left neural integration.

A still deeper exploration of cerebral pathways illuminates narrative and storytelling as the fundamental catalyst of neural integration. In circumstances where an individual is relaxed and composed, affective processes mediated by dense bidirectional connections between the orbitomedial prefrontal cortex, amygdala, anterior cingulate, and right hemisphere are encumbered, manifesting as the direction of focal awareness to stimuli of the external environment. This connotes increased prosocial behavior and contentment, for the most part. Psychological stress, anxiety, and negative affect are detrimental because they increase levels of cortisol in the bloodstream, activating the amygdala’s fight-flight-or-freeze response which leads to inhibition of the cortical networks (specifically the orbitomedial cortex) regulating bottom-up survival processes like emotions, drives, impulses, and so forth (Kern et al., 2008). When the amygdala is allowed to disrupt homeostatic balance of emotional arousal and focal attention over sustained periods of time, symptoms of depression and psychotic features may arise (Cozolino, 2010).

Gradually, the mutual effects of antisocial behavior and atypical intrusions into conscious awareness from deviant, invasive, and ego-dystonic voices breed fallacious interpretations known as delusions which disconnect the individual from consensus reality. Now our phylogenetic history shows that perceived detriments connected with impositions of primary process thinking and implicit memory from the right hemisphere do not outweigh the benefits, otherwise natural selection would have propelled it the way of the dinosaurs some time ago. Whatever the reasons for evolutionary retainment, the former permit direct access to archetypal contents and mythic images from whence a more resilient contextual self may be wrought and a more goal-directed movement to self-definition cognized (Snyder, 1997). More and more, it seems as though narrative and creative storytelling activate a particular pattern of dynamic unconscious processes able to yield all-powerful revelation from archetypal content saturation in the subjective mental sphere, and reintegration of left-right processing systems after their provisional dissociation in the more objective neural sphere. Based on the aforesaid theoretical and experimental research, one should surmise that narrative is an extremely compelling form of expressive arts therapy and can be applied as an adjunct to a miscellaneous range of clinical populations.

Creative storytelling and writing can be applied to a wide array of clinical populations, including individuals suffering from anxiety and depression, bipolar disorder, and psychosis (Mehl-Madrona, 2010). Anxious and depressed people suffering from emotional dysregulation would best benefit if we first identify their underlying psychological trigger and then co-create a narrative that transforms the perceived nature of the stressor from arbitrary and detrimental to essential and temporary, imbuing the client’s life with richness, empowerment, and meaning. For a depressed parent who has lost her only child, for instance, we might suggest co-creation of a memorial project binding together the latter’s stories, milestones, and interests into a personal myth that places an otherwise nonsensical participatory event into a meaningful context. Similarly, a bipolar sufferer who is demotivated and depressed and won’t leave the house can be inspired with the co-creation of narratives whereby the detrimental voices and characters pervading the inner world can be made conscious, dialogued with, and transformed into less maladaptive, irrational, and self-defeating ones. On the other hand a psychotic self can build meaningful stories around its aberrant, disturbing, and ego-dystonic experiences for how to better function in consensus reality. A belief that aliens are inserting microchips into one’s cerebral cortex or that aliens have bugged one’s house might be therapeutically countered through the active co-creation of stories in which aliens have either become trapped in another dimension or forgotten how to reach Planet Earth.

Perhaps the most important ethical consideration when applying creative storytelling in psychotherapy is the characterological disposition of the client herself. One cannot truly benefit from creative-oriented endeavors when self-perception is riddled by serious doubt and uncertainty surrounding the ability to deploy imagination, to actively create and recreate in the service of valuated action and goal attainment, and to express the landscapes of the inner world. Some individuals just aren’t open to working with the imaginal plane. Another caveat for the expressive arts therapist concerns the client’s familiarity with the approach itself; individuals schooled in the arts, particularly in creating fiction, may really struggle with spontaneous expression because entrenched deep in their cognitive machinery is the belief that the emergent creative product must adhere to learned techniques and conventions. As we know setting concrete rules and boundaries encumbers the teleological propensities of process work. Hence the modality may not be nearly as effective when it constitutes one’s profession.

In cases where narrative is a co-creation between the therapist and client, the former should always be mindful of the latter’s participatory level with mythological, folkloristic, and idiosyncratic aspects of their own culture. Therapy can go a little awry, resulting in annihilation of the dyadic container of safety and trust if the therapist unwittingly recourses to certain symbols, images, and leitmotifs which are taboo and carry negative intimations and undertones. Similarly, the therapist should remain ‘sensitized’ to contextual information because the unconscious irruptions facilitated through these techniques may in fact be proto-scripts for premeditated actions like suicide attempts, homicide, and other malicious behaviors. There’s nothing more lamentable than feeding the fantasies of a criminal or psychopath with homicidal impulses. Over and above all, the approach must be self-directed, meaning that it must somehow be congruent with the client’s own needs and objectives as they stand in the present moment. Phenomenological experience seems to be the best yardstick in ascertaining whether or not creative storytelling is a viable medium for personal transformation; therapists know they’re on the right path when their clients utilize the imaginative process to actively and fluently connect with hitherto untapped aspects of their own selves in reparative ways.

On reflection creative storytelling is a universal phenomenon, transcending epoch, place, sex, religious and spiritual orientation, and sociocultural milieu. Long before the emergence of semantic language, our ancestors congregated about fireplaces to listen to engaging narratives about mass migration, the far-reaching consequences of the world flood, and the seemingly insurmountable quest of a heroic ancestor to undermine the forces of evil. Their pre-eminence in our phylogenetic history is explicable within both cultural and neural contexts: they contribute to the co-construction and transmission of culture from generation to generation whilst concurrently fashioning and maintaining sophisticated integration of left-right hemisphere and cortical-subcortical neural circuitry (Rossi, 1993). Narratives ground our experience in ways that allow for goal-directed action and progression to self-definition; they link our individual selves into a group mind like beaded pearls of a beautiful necklace; and they support the complexity and self-organization of brain function.

Because the therapeutic and cathartic qualities of creative narrative are neither arcane nor empirically sketchy, a psychotherapist who deems themselves competent, conscientious, and versatile would do well to apply them in the treatment of numerous clinical populations including the anxious and depressed, the manic depressive, and the psychotic. Certainly there are important caveats to be heeded when one meanders along that path. Therapists troubled by the question of whether to ‘story or not to story’ should look to the phenomenology of experience for their answer: a client’s receptivity to the imaginal world and willingness to create proactively in the service of self-definition and personal identity are two of the best measures in determining whether the approach will be efficacious or not. We are more than just a bundle of psychobiological compulsions strung together by habit, we are our therapeutic narratives. Nonetheless, we must own and become them if we are to heal.

 

 

Bibliography

 

Cozolino, L. (2010). The Neuroscience of psychotherapy: Healing the social brain (Norton Series on Interpersonal Neurobiology). WW Norton & Company.

Dennett, D. C.(1991) Consciousness explained. Boston: Little, Brown.

Galin, D., Johnstone, J., Nakell, L., & Herron, J. (1979). Development of the capacity for tactile information transfer between hemispheres in normal children. Science, 204(4399), 1330-1332.

Kern, S., Oakes, T. R., Stone, C. K., McAuliff, E. M., Kirschbaum, C., & Davidson, R. J. (2008). Glucose metabolic changes in the prefrontal cortex are associated with HPA axis response to a psychosocial stressor. Psychoneuroendocrinology, 33(4), 517-529.


Mehl-Madrona, L. (2010). Healing the mind through the power of story: the promise of narrative psychiatry. Inner Traditions/Bear & Co.

 

Rossi, E. L. (1993). The psychobiology of mind-body healing: New concepts of therapeutic hypnosis. WW Norton & Company.

 

Siegel, D. J. (2012). The developing mind: How relationships and the brain interact to shape who we are. Guilford Press.

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