Robyn Fivush & Chikako Ozawa-de Silva
Narratives, Self-Transformation, and
Healing
In the third CMBC lunch in three weeks, Robyn Fivush
(Psychology, Emory University) and Chikako Ozawa-de Silva (Anthropology, Emory
University) offered differing, albeit complementary, perspectives on the role
that telling one’s story can play in healing psychological wounds.
Naikan and Narrative
Ozawa-de Silva spoke about the transformation that patients
undergo in Naikan, a Japanese therapeutic practice, which employs a method of
eliciting narrative reconstruction of past events. Naikan stands out from other forms of narrative-based
therapy in that it does not involve any active social interaction. It proceeds entirely between patient and
practitioner. “Naikan” means inner
looking or introspection. A therapeutic
session takes place over the course of a week, during which time the patient
undertakes an examination of past acts and deeds from the third-person
perspective.
The shift in perspective from the first- to the third-person
is the crucial component of Naikan therapy.
The shift is initiated by a series of structured questions designed to
help patients gain a better understanding of themselves, their relationships,
and the fundamental nature of human existence. The client is asked to choose a significant
person in their life to focus on (typically starting with the mother) and then
to record answers to the following three questions: (1) what did you receive
from this person? (2) what did you give in return? and (3) what trouble did you
cause this person? Note that there is
not a fourth question about how this person caused trouble for the client. That is because focusing on how we have been
troubled comes easily to most of us, and runs counter to the shift away from
the first-person perspective that Naikan intends to facilitate.
In order to foster deep introspection, during the treatment period
the client is not allowed to talk to anyone, read, or watch television. One signal of transformation over the course of
the week is the client’s increasing use of the passive voice. Instead of saying “I love…,” for example, the
client will begin to say “I am loved.”
This shift indicates that the client has become more reflective and
begun to think from the other person’s perspective. Although the shift in perspective does
nothing to alter external circumstances, it does alter how the client views
those circumstances, and can make them less painful. Ozawa-de Silva noted that for this reason
Naikan is described as a “cure without curing.”
Ozawa-de Silva identified three positive changes typically
undergone by the time Naikan therapy terminates. (1) Increased sense of connectedness with
others. Through their reflections on the
roles that other people have played in their lives, clients come to see that
they are not as “self-made” as previously thought. (2) Increased sense of self-acceptance. Many clients start Naikan therapy suffering
from low self-esteem. Naikan helps them
to gain a more balanced perspective on themselves. People start to accept their imperfections
more, because they feel relief that they have friends and relatives who accept
them for who they are. (3) Greater sense
of gratitude. This point is connected to
the first two. Naikan reflections highlight
the ways in which other people have played important parts in the client’s
life, leading to a sense of appreciation of others’ roles. According to Ozawa-de Silva, these upshots of
Naikan bear a close relation to the three main categories of positive mental
health: emotional well-being; psychological well-being; and social
well-being. The positive effects of
Naikan are measurable even months after the end of the therapeutic session.
Is Storytelling
Always Therapeutic?
Narrative clearly plays a central role in the therapeutic
successes of Naikan. In American
culture, too, it is widely held that talking through negative experiences can have
therapeutic import. Fivush’s
presentation sought to interrogate this widely held view and to highlight some
potential limitations of storytelling for therapy. She agreed that narratives are instrumental
in the formation of identity, but insisted that it should not be taken for
granted that storytelling is always therapeutic, especially when the subject’s
experiences were especially traumatic or stressful.
Fivush began by looking at some of the evidence in favor of
the therapeutic benefits of storytelling.
In the 1970s, David Spiegel (UCSF medical school) designed a study to
investigate the potential benefits of support groups for terminally ill
women. At the time it was believed that
talking about their symptoms and pain would merely create stress for patients
and their families. On the other hand,
there was a growing interest in how best to care for the “whole patient,”
including emotional and psycho-social well-being. In order to test his hypothesis that it would
be helpful for terminally ill patients to talk to and provide support to one
another, Spiegel assigned 50 or so women to support groups of 10-12 women each,
with 30 or so left out to serve as a control.
Initially, no differences in diagnosis or symptoms were detected. After a year, however, the women in support
groups reported doing better in quality of life measures (such as stress and
anxiety levels), even though there was no difference in their physical health
compared with the control group. More
strikingly, after 10 years, it was possible to conclude that on average women
in support groups survived a year and a half longer than those in the control. This suggested that the support groups worked
to increase longevity.
Unfortunately, these results were a fluke. Hundreds of similar studies have since been
carried out, and none has generated Spiegel’s results. This is a case, Fivush explained, where a
sensational finding that has failed to replicate has become entrenched in the
public mind anyway. Even though there is
no good evidence for the claim, it is widely believed that support groups
enhance survival rates. Even if they
have no effect on survival, however, it is
true that support groups improve quality of life.
What is it about being in a support group that improves
quality of life? According to Spiegel,
there is something critical about sharing your story. Social psychologist, James Pennebaker, knew
about Spiegel’s study and undertook to investigate further the therapeutic
power of storytelling. In particular,
Pennebaker was interested in the effects that “expressive writing” might have
on well-being. He randomly assigned a
group of college freshmen to an expressive writing assignment where they were
asked to write their deepest thoughts and feelings for twenty minutes a day for
three days in a row. Another randomly assigned
group of students was given a non-emotional writing assignment, and another
group wrote nothing. At the end of the semester,
Pennebaker took base-line measures of psychological and physical health. Freshmen involved in expressive writing were
found not only to report higher levels of psychological well-being (less
stress, anxiety, etc.), but also had higher GPAs. Since Pennebaker’s study, the effects of
expressive writing have been widely studied, and the general findings are
robust. Even improvements in physical
health, such as t-cell functioning, have been correlated with expressive
writing. Such studies provide strong
evidence that talking about our experiences is good for us.
Fivush cautioned, however, that while storytelling is
therapeutic on average, there are
some individuals who actually get worse when they share their story. For many people, storytelling contributes to
cognitive processing of negative experiences.
It is not that such individuals learn to see their negative experience
as a good thing, but rather, as in Naikan, it enables them to take a different
perspective on their life, and provides for a sense of growth. But Fivush stressed that narrative does not
facilitate cognitive processing in everyone.
She gave the example of 9/11 first responders, who were required to talk
about their experiences as a way of dealing with the trauma they experienced in
order to keep their jobs. For many of
these individuals, sharing their stories did not help them at all; on the
contrary, it served merely to re-open their wounds. Certain individuals do not show signs of
cognitive processing when reconstructing the story of a traumatic event. Rather they exhibit what is called
“rumination.” Instead of processing what
happened to them in a productive way, narration leads some people to dwell on
the negative experience in a counter-productive way. They wonder, for instance, why it had to
happen, or even come to the conviction that life is awful and can never be the
same again.
Although there is solid evidence that storytelling helps
most people in most scenarios deal with negative experiences, Fivush’s main
point was that this should not be taken for granted in all cases. For some people, sharing their stories may
even have a detrimental effect on their well-being. It is not clear why some tend to engage in
rumination rather than cognitive processing.
It may be that those with worse childhoods tend to be more
ruminative. Whatever the reason, such
counter-examples to the benefits of narration need to be taken into
consideration. They indicate that there
is more to learn about exactly who benefits from narrative therapy and
why.
On this question of who benefits and why, an interesting
discussion ensued in the Q&A on gender differences and the benefits of
narrative. Fivush pointed out that
expressive writing has been shown to be more effective in improving the
well-being of males. The reason for this
is interesting: females tend to be much more naturally emotionally expressive
than males, so the exercise in expressive writing does not have as sharp an
effect for them as it does for males, who tend to lack outlets for emotional
expression. In our culture, more value
is placed on talking about past experiences if you are female. By adolescence, girls begin to co-ruminate
with girlfriends. This can actually lead
to negative consequences for health, however, since rumination, as indicated
above, is a risk factor for depression.
Conclusion
Ozawa-de Silva and Fivush addressed the question of the role
of narrative in therapy from very different perspectives, and emphasized
contrasting points. On one hand, Ozawa-de
Silva talked about the successes of a very specific form of narrative therapy –
Naikan. On the other, Fivush raised
questions about the benefits of narrative in therapy from a general standpoint. Nevertheless, there was no disagreement about
the fact that by and large storytelling is a powerful therapeutic technique. It is just that, for some people,
reconstructing the story of a traumatic event can lead to unhealthy rumination
rather than to healthy cognitive processing.
Ozawa-de Silva suggested that the specific focus in Naikan on fostering
cognitive processing may therefore be an important factor in its success. The need to be sensitive to this distinction
between situations where narrative leads to unhealthy rumination, and
situations where narrative leads to healthy cognitive processing was perhaps,
then, the chief take away from the lunch.
