This paper uses Dostoevsky s Notes from the Underground as the starting point for a critique of the assumption that engaging with narratives enhances well-being. While the limits of narrative have long been an object of critique by scholars in the medical humanities, the question of limits has been posed primarily in terms of whether ... nar-rativity can be considered an anthropological universal, and in terms of what (or whom) a privileging of narrativity might exclude. Through Dostoevsky, we reframe this problem by asking whether the construction of selves through narrative can and should be regarded as a healthy norm, even for those in whom this activity ap-pears to come naturally. Dostoevsky identified a dark side to the heightened con-sciousness associated with supposedly enlightened modern individuals. He critiques a tendency towards ever increasing abstraction from concrete existence and embodies this critique in the character of the underground man, a man plagued by sickness and distress, partly because he can only conduct his life on the basis of what he has read. The paper urges those working in the medical humanities today to formulate an adequate response to the paradoxes exhibited in Dostoevsky s great novel.