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This chapter discusses the failure of the dominant paradigm in psychiatry, which assumes that mental illnesses are genetically influenced brain diseases. The failure of psychiatry is the consequence of erroneous assumptions about the nature of mental illness, and of ignoring the importance of warmth and kindness in promoting psychological healing. A recovery-orientated, autonomy-enhancing approach calls for the finding of ways to give more authority to the consumer. It seems that the greatest force for good in modern mental health care is the rise of an organized and increasingly vocal consumer movement. Organizations such as the Hearing Voices Network encourage patients to pursue avenues of recovery that they choose themselves, and offer protection against mental health professionals who fail to address their members' needs.

In practicing narratively, the doctor and patient can examine together what the doctor’s kit of psychiatry might have to offer in light of the values and preferences of the person seeking consultation, which authorizes the patient as the arbiter of what is helpful and what is not. Narrative psychiatry holds the perspective that while the doctor may have specialized knowledge about treatments, the patient is the expert on his or her life, and medicine or other treatments can be evaluated according to the values and preferences of the patient. In its nuanced approach to effective collaboration, narrative psychiatry offers ways to more fully manifest the intentions of the mental health recovery movement. This chapter will show how to collaborate with patients in considering and choosing among psychiatric resources such as psychotropic medications. In doing so, it will touch on the range of competing discourses about psychiatric treatments that may be influencing our patients and us. The story we have come to hold about who the patient is and what the problem is determines the therapeutic options we consider. All the skills described in the previous chapters—emotional attunement; developing a rich portrait of who the person is separate from the problem; clarifying the patient’s vision for his or her life; creating an externalized, experience-near description of the problem and its effects; and cultivating a narrative of how the person is resisting the problem and how that is linked to personal hopes and values—are prerequisites for being able to collaboratively consider which resources might best meet the patient’s needs. From our initial consultation on, we cultivate very different stories about the patient and the problem depending on the questions we ask—or don’t ask. Creating narratives that articulate our patients’ personal experiences of their problems and that honor their resiliencies, skills, and preferences sets the stage for considering treatments that will be most effective and life enhancing. When we have a collaborative therapeutic stance, we can look side by side with our patients at the wealth of treatment options that might be helpful and weigh the pros and cons together.