We all have stories to tell: our own stories, stories we have heard, stories of what we have seen, stories of what we imagine or dream. The telling of stories, and listening to them, seems to be a fundamentally human activity. It is not necessarily the case that happy stories are better than sad stories, and any story can be told well, or badly. But some stories are important and, in some way, they need to be told and listened to. Among these are stories of difficult, traumatic and emotional experiences, stories of life and death, stories of illness. Storytelling is thus at the heart of both medicine and pastoral care. The doctor, like the priest, needs to be good at listening to stories.

If stories are important, the word ‘narrative’ might immediately appear to be an unhelpful synonym. It sounds more technical and, being employed frequently in academic discourse, could easily be seen to distance the everyday telling of stories from serious academic or professional work. Conversely, it might be understood as a technical term which cuts across various professional and academic disciplines, use of which demonstrates that stories are taken seriously by professionals and academics. This ambiguity is perhaps not unhelpful, for it turns out that narratives, stories, can be told and heard in importantly different ways, some of which are creative and can bring healing, and some of which are harmful and destructive.

Narrative in medicine and psychiatry

Trisha Greenhalgh and Brian Hurwitz (1998) identify a number of important features of a narrative:

I read this book with fascination and interest, and it confirmed my feeling that storytelling is central to psychiatric practice, alongside a deep respect for the patient's own spiritual journey. Two contemporary themes have been employed by the editors to enable psychiatrists better to understand – and therefore be more effective in the treatment of – their patients. First, the spiritual and religious concerns of patients, after years of neglect by psychiatry, have now been accepted as an integral part of psychiatric assessment and care. Second, there has been much recent interest from many quarters, including psychiatry, in the nature and application of narrative – what it is, how it affects the relationship with, and between, our patients, and how it makes for better treatment. These dual themes are maintained throughout this book, which is written for mental health professionals, hospital chaplains and others interested in the relationship of mental health to spirituality. The practical rather than theoretical is underscored, emphasising how users, carers and relatives can all enlist spirituality and narrative for their well-being.

The fourteen chapters range widely over different areas of psychiatric practice and theoretical viewpoint. Most are written by psychiatrists whose primary role has been the care of patients. Transcultural psychiatry is shown to be intimately involved with both narrative and the person's spiritual and religious convictions. Descriptive psychopathology depends entirely on the patient's story, which often includes their spiritual and religious understanding. Psychotherapy is greatly enriched by taking into account the spiritual aspects of life; story is pre-eminent, with narrative an essential aspect of therapy. Other chapters discuss the core psychiatric problems of depression, anxiety, psychosis, psychiatry of old age and mentally ill offenders, in all of which the interweaving themes of narrative and spirituality are prominent. There are moving stories from both a service user and from people seeking help from a mental health chaplain that show the significance of their beliefs in aiding the recovery process.

In Chapter 1, ‘Narrative in psychiatry, theology and spirituality’, it was suggested that narratives have a beginning and an end. Stories continue, of course, yet at a given point the narrator will have to identify a place to start and a place to stop telling the story. The choice of the beginning and of the ending will significantly frame the narrative and thus influence its impact, meaning and scope. This has been evident throughout the book, with some authors offering narratives that go back to childhood, or narratives that end with a death, but with none that attempts to tell the story of a whole life from birth to death. This is partly due to limitations of space, but it is also because the narratives included have focused primarily on matters of spiritual interest. Of course, if these narrators were to tell the story again after a period of time, they might have more to say, as in the case of a patient who is asked by their doctor ‘How have things been since your last appointment?’ Each ending of each narration is thus, at least potentially, the beginning of another narrative still to be told.

Importantly, in the present context, every human life must have a beginning and an ending, reflected in its unique narrative, and usually beginning with an account of the family into which a new human life is born. An autobiography generally concludes in the present moment, since the author cannot write, although they may speculate, about what is yet to happen. A biography concludes with a death, and perhaps with a reflection of the enduring impact on the lives of others of a life lived well – or badly.

Each clinical encounter is a privileged opportunity given to the clinician to share in an autobiographical narrative. It usually begins (if told chronologically – which it may well not be) with a history of the family of origin and the personal life history. It must of necessity end in the present moment and it is in the nature of the clinical encounter that both patient and doctor are likely to be speculating about what might happen next.

Spirituality and Psychiatry was published by RCPsych Publications in 2009. As editors of that volume, we have been gratified to note its warm reception and that the book was felt to have made a constructive contribution to the debate about the place of spirituality in contemporary clinical practice. So why, 6 years on, might it be timely for a further volume on the topic?

First, we are aware that there were gaps and omissions in Spirituality and Psychiatry. For example, it did not have much to say about affective disorders or about forensic psychiatry, and it did not have an author who wrote as an identified user of mental health services.

Second, while Spirituality and Psychiatry sought to be relevant to clinical practice and included a series of case histories, we realised in the course of our work as editors that it presented more questions than answers in relation to good practice in this newly developing field. Issues raised by spirituality in mental healthcare continue to be the subject of controversy, and we therefore felt that a second volume, with a different approach, could helpfully further the debate.

Third, while the evidence base has continued to grow steadily over the past 6 years, an important theme to emerge concerns the management of professional and ethical boundaries relating to spirituality and faith in clinical practice. There is therefore a need for a book that is cognisant of recent research literature, but which is also anchored in the realities of clinical practice. The present volume does not seek to review the recent quantitative research literature, although most contributors have made at least some reference to it. It does seek to address the realities of clinical practice in the context of the ongoing professional debate.

Fourth, for service users, spirituality and faith are closely connected with questions of relationship, transcendence and finding meaning and purpose in life – all of these questions being often best explored by way of narrative (or story). Narrative has provided an important theme in recent years in both medicine (Greenhalgh & Hurwitz, 1998; Roberts & Holmes, 1999; Engel et al, 2008) and theology (Loughlin, 1999).