Monday, 4 January 2010

Open Dialogue - A critique in reply to Will Hall

Will Hall posted a piece on Open Dialogue - or Dialog as it spells in American English - at Beyond Meds today.

He writes that "[i]n discussions about open dialog, some have objected to inclusion of family members in the dialog process." One of these "some" am I. A couple of months ago, I posted my part of an extensive e-mail exchange with a friend here in Denmark who's made a couple of videos about the implementation of Open Dialogue elements some places in Danish psychiatry, on Facebook. So, if you're a Facebook-friend of mine, you can find it there in my notes. For everybody else, I will repost here in a slightly edited (I've no intentions to feed the Fullofits out there any arguments in favor of their agenda) version.

Will writes in his piece at Beyond Meds that he is "leaning towards championing open dialog alongside soteria as a viable model we all should learn from." Here is, in short, why I for one lean towards championing Soteria above Open Dialogue (for those of you who want the long and detailed version of my criticism, see my part of the e-mail correspondence below):

1. One of the "golden rules" of Open Dialogue is that there is no talking about anyone who isn't present. As far as the person in crisis is concerned, I regard this a matter of course. When it comes to others, like family members, I find it problematic. Especially people in a more or less emotionally vulnerable state of mind may find it difficult to talk about abuses they've experienced, and that probably lead to them being in crisis, with their abuser(s) present. The presence of the abuser(s) may very well make the environment where the dialogue takes place a lot less safe than it could and should be. Trying to persuade - or even coerce - a person in crisis into tolerating the presence of their abuser(s) while the pain the abuser(s) has caused is talked about by making the presence of the abuser(s) a precondition to any talk about them, seems almost abusive to me in itself.

2. In my opinion, a safe place for the person in crisis to stay at is one of the most important ingredients for healing to occur. Open Dialogue does not offer the person in crisis a truly safe place to retreat to, like Soteria does. Open Dialogue's aim is to preferably leave the person in crisis in her environment - which may for instance mean staying under the same roof as her abuser(s) - and doesn't offer anything but hospitalization as an "alternative". Hospitals are not safe places for people in crisis. They are no alternative. Even without medical "treatment" implemented, staying at a hospital makes the person who stays there a patient, pathologizes her. Open Dialogue here contradicts itself, when it is stated that "[w]hat we avoid: Diagnostic procedures; Medication; Control; The language of pathology;..."

3. Last but not least, Open Dialogue defines itself as a different kind of psychiatry, not an alternative to psychiatry. Psychiatry per se is a medical speciality. It is not a branch of sociology, psychology, philosophy, or whatever else along those lines. In the videos my friend has made, one of the "experts" working with Open Dialogue elements explicitly states that the "experts" still would be needed. Open Dialogue or not. My question in this regard is what the "experts" are needed for if not for "Diagnostic procedures; Medication; Control; The language of pathology"?? As far as I know, this is what the "experts'" training is all about. It is not about the sociology of interpersonal relationships, spiritual issues, trauma-related distress, or any of the other components of crisis.

Soteria has shown that there is one qualification that is more important than any ever so advanced, professional training or theoretical "knowledge" - actually, I don't think, there can be any such thing as true knowledge of crisis other than from first hand experience, or, at least, unreserved acceptance of the person in crisis - when it comes to the "staff": the ability to "be with" someone without reservations, without any fear, and no matter where this someone is at in terms of his/her state of mind. Professionalism in the field usually is (ab)used to create a safety distance, a power imbalance, between the person in crisis and the "staff", the support team. (Thus, the Norwegian psychologist Christian Moltu states that therapists have a tendency to hold up therapy techniques as a kind of "shield" between their clients and themselves whenever the client, respectively his/her experience, becomes too threatening to them.) Terms like "patient" and "staff" alone are enough to create this distance, or imbalance. Open Dialogue, at least partly in contrast to Soteria, and contradicting its own above-quoted statement, does make use of this professionalizing, pathologizing and alienating terminology.

Concerning medications, that may be a short-term solution in some cases, it doesn't need an "expert" to prescribe them. Any GP can do the job.

Bottom line: Open Dialogue in my opinion has the potential to become an alternative alongside Soteria. Without doubt. As long as it involves "experts", hospitalization, the language of pathology, as long as it involves, instead of excludes, psychiatry, and as long as it does not offer really safe places for people in crisis to go, though, it is not nearly as acceptable to me as Soteria is.

Read Will Hall's comment on my reply, "More on Open Dialog", here.

These are my e-mails ("Vestlaplandsmodellen" is an alternative and widely used in Scandinavia term for Open Dialogue):

1. e-mail: Thanks for the links! I watched both programs - the first though had only about 15 minutes of the program - and they gave me an idea of the situation here in DK, which I'm - as I guess you know - not uncritical of.

[These are the links: TVGaderummet 23.sept.2009 (Danish)

1. (60 minutes)

2. (60 minutes)]

I'm actually not that much acquainted with the Vestlaplandsmodellen as I am with Soteria. I only know about the former what is available on the net, and that's not a lot. Well, of course it's great that some of the elements of the Vestlaplandsmodellen are employed at least in some few places in DK. Nevertheless, what strikes me watching the vids is, that, Vestlaplandsmodellen or not, people in crisis are still referred to as "patients" - I'm not very patient, and I never was :D - and the self-appointed "experts" are still referred to as experts. I'm a lot more radical than that. At one point there's someone who asks when there will be a shift in the power imbalance between "patient" and staff in the mh system. IMO it won't happen as long as "patients" are "patients", and "experts" are "experts". Open dialogue or not. The "experts" need to go. That is, the medical profession needs to go. In spite of a whole lot of talk about humility - very nice, indeed! - the "experts" still don't admit, that their "expertise" as members of the medical profession isn't of much use to people in crisis. Actually, at one point one of them explicitly states, that they are still needed. They are not. Unless of course, we keep on employing the medical model to one or another extent, and I don't know where the Vestlaplandsmodellen stands in that regard.

I had a quick look at Region Syddanmark's site:, and alone the "Ikke et enten-eller - men et både-og" (not an either-or but a both-and; meaning treatment options) somehow gives me the creeps. Another thing that gives me the creeps, time and again, and thus in the vids too, is the incessant yattering about how important it is to involve the relatives. Network yes, relatives rarely. Usually the person in crisis' relatives are their primary traumatizers - does the Vestlaplandsmodellen acknowledge this? Does it acknowledge the trauma-model at all? And if so, in how far? -, and I agree wholeheartedly with those, who rather want people in crisis to realize this, and distance themselves, actually break away, from their toxic relatives, than to try and "salvage" family ties at any cost. IMO acknowledging the trauma is extremely important, not only in an mh-context, but in regard to our culture on the whole.

What also strikes me, once again, is the politicians' ability to talk at length without saying much substantial. An awful lot of hot air... Well, and I wonder how anyone still can be the least in doubt about the efficiency of non-medical approaches to crisis. After I don't know how many years of success with alternatives, be it the Vestlaplandsmodellen, Soteria, or whatever of that kind.

2. e-mail: A while ago, I listened to some Norwegian radio broadcast by a psychologist, Grethe Nordhelle, about manipulation. She concluded, that only consciously deceiving people is true manipulation. I sent her an e-mail where I wrote how I'd experienced my mother to have been extremely manipulative, but nevertheless not in a fully conscious fashion. She replied, that there was a grey zone of helplessness, where the deceiver/manipulator is conscious about what s/he is doing, but since his/her ego's survival depends on doing it, s/he suppresses the awareness of his/her actions hurting others. It's the narcissist's way of surviving. And they haven't got any other way. - And I use the term "narcissist" acknowledging that we're all more or less "narcissists" in as far as we (almost) all have an ego that likes to take control. Which, if allowed, results in us needing and (ab-)using others for our own ego's benefit. What I mean by the term in this context is people, who are more or less completely identified with their ego, and thus unaware that they are not their ego. So, whatever these people do comes from the place of their ego. And the ego doesn't love or care for anything but itself.

The majority of society's helpers, especially in the mh system, are such narcissists. They're attracted to the helping professions because these are the professions where one can feel most needed, and successful at the same time, compared to the patient's/client's misery - as long as the patient/client remains miserable... The mh system is every narcissist's paradise, because it's about the only among the helping professions where one can get away with actively preventing people from recovering and becoming independent of the narcissist's help. In addition, no human being is as helpless and dependent as someone whom you can declare " insane" whenever you, the "expert", like, someone who, due to a brain disease, is not able to make any decisions on their own, and thus need the "expert" to run their life.

The point is, they know what they're doing. They know, they're deceiving, exploiting, manipulating, and actually harming others for their own benefit, but they suppress this knowledge, and make an effort to convince both themselves and everybody else of their actions to be necessary and even beneficial for their victims, because they're nothing, absolutely nothing, without or beyond their ego. That they act out of fear and helplessness doesn't excuse their actions. They're fully responsible. Just as a psychopath is fully responsible if s/he commits a crime. Or just like the oil industry is fully responsible for the environmental damage it causes, although it needs to cause this damage in order to survive.

You would have to enlighten these people to make them stop constantly looking for new objects ("patients") they can project their own profound insecurity and helplessness into. But enlightenment doesn't happen from without. It can only happen from within the person herself. And it only happens when there's enough suffering, which in the case of the narcissist means, that they can't find an object to satisfy their insatiable (!) need to be needed with.

The "revolution" has to start with the "patients" shedding the label of "patient", the identification as the helpless victim. Difficult. Very difficult. Especially when it comes to people in emotional distress, that more often than not is the result of never having been anything else but helpless victims. People who've been traumatized tend to repeat the trauma. Over and over again. Being the victim is the only way they know to survive. A perfect match for the narcissist. And gene-theories, biological determinism, if it's in regard to "mental illness", criminal, or whatever else kind of "abnormal" behavior, is the ultimate victimization. Designed by a thoroughly narcissistic culture to serve its narcissist-members' needs.

IMO, no one, neither the victim nor the perpetrator, is served by excusing the abuse, saying the perpetrator-abuser didn't know what s/he was doing. As long as we keep on and are afraid of blaming - i.e. holding accountable - the perpetrators, they will keep on abusing us. Nothing much will change. Anger can also be a good thing. I've tried not to be angry. I've tried to make myself believe the "they don't know what they do"-thing. Something inside me gets very very angry each time I try. Because it just isn't true, that they don't know, and therefor should be forgiven. I want to hold them fully accountable. That is what I can do by now without anger. It's not about revenge. I don't care if they pay for what they've done. The past doesn't interest me. It's about the truth to be said, and stop the abuse from continuing forever.

Long rant, one more thing: How does the Vestlaplandsmodellen handle situations where the abuser/relative is either dead or doesn't want to participate? The latter is a problem that I know both Bateson, Arbours Crisis Centre and similar approaches more often than not had/have. Even people, who initially agreed to participate, left offended and under protest at the slightest suggestion that they maybe were just a little responsible. Narcissists don't make mistakes. It's always everyone else's fault but theirs if anything goes wrong. Suggesting something else usually sends them right through the roof. Exactly because they know, they're to blame. And they rarely at all agree to participate in anything where they risk to be blamed. So, what does the Vestlaplandsmodellen do about that? Forgiveness? No blame?

I see some good things happening, me too. Things like the hearing voices network getting more and more attention, or like Daniel Mackler's film. I'm still a bit suspicious toward the Vestlaplandsmodellen. IMO, it's not both-and. It definitely is either-or. Whatever biological/genetic differences, they are symptoms - of abuse -, not causes.

Hope, I don't come off too harsh. It's just that it really gets me to watch these people get away with their actions again and again and again, because we can't let go of being the victim and feeling guilty about speaking the truth.

3. e-mail: Another rant:

We're all responsible. For ourselves as well as for the community. Not ever holding anyone accountable for their actions equals to telling them it's ok to act irresponsible. If no one ever is going to be held accountable, nothing will change. The world, humanity, is in the mess it is today, because no one is willing to take responsibility, and because no one is willing to ask others to take responsibility, because that then would mean they'd have to take it themselves.

I'm sorry, my parents were responsible. They screwed up. They did as good as they could, but that doesn't change the fact, that it wasn't good enough. Taking responsibility means accepting that fact. Without acceptance no change. BUT: my parents' responsibility also ends where my own starts. "Mental illness" is not being given the opportunity to know. Today I know. So, I can't be "mentally ill" anymore without being responsible for it myself. It's my own choice, and so it will be my own fault, if ever I suffer in the irresponsible way of "mental illness" again.

I'm an existentialist, yup.

"It's ok to make mistakes. But it's unforgivable to make a mistake, and then claim it to have been the right thing to do, while you know, it was a mistake." (Ewa Jälmbrant)

Something else: Hammersley and Read: about 70 % of all people labelled "sz" have been abused physically and/or sexually during childhood. Add to that psychological/emotional abuse/neglect and get 100 %. I think it is obscene to expect a 17-year-old to sit in the same room with her father and talk about having been repeatedly raped by him from an age of, let's say, five or six years old, while the fact that she was so, and that she can't talk about it, rendered her "psychotic". What do we do? Forgive and forget without ever really talking about it? Won't work, I fear. Not in the long run.

In this context: shame - people feel shame because they were/are victims of abuse and are asked to keep silent about it: "It's your fault. You made me do this to you. So, don't blame me." And so they continue their business, the abusers.

If they just do what they're trained to do, unconsciously, irresponsibly, how come there are quite a lot who leave the system, disgusted by it, because they, in spite of all training, are able to see its harmfulness? How come, Loren Mosher was able to see, but not Merete Nordentoft? The scientific evidence is there, for all to see. They know it. They CHOOSE to ignore it.

4. e-mail: I don't want to fight them. I know, that it only would/will make them strike back even harder. - And that's actually what I see also is going on today, as alternatives, like for instance the hearing voices network, get more and more attention, and as there are more and more research findings that question the biological model. They feel threatened and strike back harder: assisted outpatient treatment, Thomas Werge's eugenic "research", re-establishment of padded "quiet rooms", i.e. isolation, etc. - And I absolutely agree to your point concerning primal therapy and the like.

But, on the other hand, when I have a problem, and ignoring, suppressing it makes me sick, I need to come to terms with it. Consciously. Even if that means, that I have to blame someone. - And although the term "blame" has a somewhat negative connotation, it only means "holding accountable". It doesn't mean "attack", "fight". Why does our culture regard holding someone accountable as a negative thing?... - So, basically, what it means is that I express what someone else's actions do or have done to me. Then, it is up to that someone whether they want to take my words as a personal attack - and a narcissist will do so - or whether they take them simply as feedback, allowing them to reflect their actions - which is what a responsible person does.

My responsibility is to separate my emotions from my words, and not to call someone names, for instance. Which IS a personal attack. Of course. That doesn't mean that I may not tell someone, that their actions made or make me feel angry. Or sad, or confused, "psychotic", "schizophrenic", "manic", "depressed", or whatever. If I'm not allowed to tell them, they'll carry on with their destructiveness, their abuse, and nothing is ever going to challenge the delusion of their own infallibility they've constructed for themselves and everybody else. If I'm not allowed to tell them, what we've got is exactly Laing's "Don't" again. Back to square one. The elephant in the living room, no one is allowed to see. And then my unconscious, seeing the elephant, doesn't leave me any other option than to resort to its own language: "insanity". The way to enlightenment goes through suffering - feeling and acknowledging, accepting, the emotions that were suppressed or denied. If I don't allow myself to experience that step, I won't get to the next.

And, btw, that's exactly what psych drugs are designed to do. Preventing people from recognizing the truth by throwing them back into a state of dissociation. It's not a historical mistake. From the ego's point of view it's the only right thing to do. If the self becomes conscious, the ego is no longer in control. Our culture is a culture of the ego. It's not a mistake. It's premeditated, and it serves a purpose.

I doubt, they feel compassion. Maybe they tell themselves, and everybody else, that it's compassion, but narcissists don't feel compassion, or have empathy. What they feel writing prescriptions is a momentary satisfaction of their ego's need to be needed.

5. e-mail: I see one advantage in having family involved to the extent that they need to be present when they're talked about: I would have loooved to tell my dear mother in detail, without her interrupting me a dozen times, telling me how terribly wrong I am to feel that way, and completely matter-of-fact, no emotions taking over, how her actions had influenced me, i.e. had messed me up. BUT: 1. I wouldn't have been able to stand as much as the sight of her during the first three or four months (at least). (...) Alone mentioning her made "symptoms" intensify remarkably. My no.1 trigger. (...) IMO, it was crucial, that I had the opportunity to talk about my relationship with her without her being present. 2. It would have taken me one single session to tell her the above mentioned stuff. I dare say, I know what her reaction would have been... And no matter how gentle, calm, reasonable, whatever, I'd worded it. With the best will of the world I can't see why anyone would want to, at any cost, salvage a "relationship" like the one I had with my mother. One thing's for sure: I would have been the one, who'd paid for that.

Of course everybody, even someone like my mother, deserves a chance. However, my mother would have blown that chance, no doubt. And then? Then I wouldn't have been given the opportunity to talk about my no.1 trigger? That really pisses me off. Who's side are these guys on? (side: Yes, our "relationship" basically was that of enemies. It was war. But it wasn't me, who'd made her my enemy.)

More bitching: Somehow this no talking about anyone who isn't present to me smells a bit of blackmail. Quite similar to "Take your meds, or we won't pay for therapy (or even worse: we'll withdraw your SSI)." - It's illegal, nevertheless it happens. And often enough they get away with it, because people don't know their rights. The no meds no therapy-thing for instance, my therapist told me about a client of hers who'd been threatened with it. - Make that: "If you don't agree to meet your family/parents, we can't help you." And then what? The back ward? I see why they focus on young people, first "episode" - BTW: People in their late teens or early twenties usually are somewhat more easy to "influence", oh well, threaten, than a thirty- or forty-year-old. Drugs or not, if it really is categorically enFORCEd (like in "coercion", yup) that you have to communicate with your abuser(s), or you won't get help, these people aren't much better than the abuser(s) themselves. What people in crisis need is UNconditional support and accept. Not more and even more of the emotional blackmail, that got them into crisis in the first place.

Geez, I would like a word with this Jaakko! :D

Ask people what was helpful during crisis and recovery. More often than not they'll mention time away from their family/parents, among the most important things.

It's really nice that they don't use more drugs than they do. Still, Soteria seems a lot more attractive and desirable - and, indeed, the person in crisis respecting - to me.

6. e-mail: "Certainly, when meeting with people who are acutely mentally ill and those who love them, we can feel compassion for their determination to stick to the predictability of monologic positions." (from the article) []

Well, I stick to my positions: 1. I was not "mentally ill", period. (cf. Pernille in the vid stating she was ill. What did she suffer from? The flu?... Sorry for the sarcasm, it just really bugs me.)

2. My mother didn't love me. (As devastating as it was at first, it was one of the most important insights to reach. "I Never Promised You a Rose Garden" - the title was chosen for a reason.)

3. No one, not wild horses, and not even Jaakko Seikkula himself, would have been able to make my mother engage in a dialogue, unless she'd been guaranteed in advance, that she wouldn't have to accept any criticism of her person, and that it would be all about me being the one (and only) to blame.

The philosophy I see Open Dialogue employ - and I may be wrong, but so far it's my strong impression - is the usual, so to speak: It's the person in crisis, something's wrong with, she's the "patient", the "mentally ill" individual. Pernille for instance says at one point in the first vid: "...ud fra det, der fejlede mig..." (...on the basis of what was wrong with me...) So, something was wrong with her? I don't agree. At least, nothing more was wrong with her than what was wrong with everybody else... But of course, SHE got singled out, the spotted mental patient, because it was HER behavior that didn't fit the cultural norm... It isn't as pronounced as in conventional settings, still it's there. Why on earth can't we just get rid of this patronizing, devaluing (even if it's to a somewhat lesser extent in Open Dialogue) language entirely?? Makes me feel sick (haha...).

A little more respect for the person in crisis isn't enough. She has to be respected fully. It's not both-and. It's either-or. Or: you can't have your cake and eat it. You can't define someone as "mentally ill" and at the same time claim to respect them. You can't hold on to being the needed "expert", and at the same time claim to see the person, not the diagnosis. It's scary for someone who identifies as "expert", "mentally ill" or just "formerly mentally ill" to imagine having to let go of that identification. But it's the only way. IMHO.

"Psychiatry" by definition is a medical speciality. Open Dialogue defines itself, as far as I have understood, as a slightly different kind of psychiatry. As a medical speciality psychiatry pathologizes people's thought processes, emotions and behavior (if it didn't pathologize it wouldn't be a medical speciality, psychiatrists wouldn't be required to have studied medicine to enter the field; at some point Karen Klindt uses the term "klinisk psykiatri" (clinical psychiatry) in the first vid; "klinisk psykiatri" is a tautology; practised psychiatry is by definition clinical). That is, people in crisis' thought processes, emotions and behavior are not respected fully. Emphasis on "fully". To achieve that people in crisis are respected fully, psychiatry has to vanish from the surface of this planet. Psychiatry is an anti-democratic, totalitarian entity. It is symptomatic of our anti-democratic society (have a look at or and compare them to Folkeskolen (the Danish primary school), or any other official school system in any other "democracy"; it's everywhere, in every single one of society's institutions, the totalitarianism, more or less; in psychiatry it is pure). It has always been, it will always be.

And again: why on earth is the idea that there may be parents who do not love their kids sooo unacceptable?? It's a reality, for chrissake! Most people in our culture actually have no clue what love really is. They aren't capable of true love, because they themselves never experienced it. So they don't love their kids, they need them (which is about the opposite of love). Neither do they love themselves, they are in love with themselves. Quite a difference. You can't love anyone else if you don't have selflove. - Well, it's unacceptable because if we accepted it, we'd have to accept the fact, that these people, make that about 90 % of humanity, if not more, altogether are traumatized... by our culture, by modern western civilization. "Don't". Because if we do accept it, it's the end of modern western civilization. And we don't want that, do we??

It was only through the insight that my mother didn't love me, that I came to understand that she couldn't love me - and forgive her. This is different from the usual "forgiveness". It allows the whole process, it allows anger and grief, sorrow,... all that messy stuff, that people are so damn afraid of, they can't for anything in the world accept it in its entirety. Not even Open Dialogue.

Now, I've been highly critical. Don't get me wrong. I appreciate the advantages of Open Dialogue for the individual compared to conventional psychiatry very much. However, IMO Open Dialogue is still somehow stuck in certain very conventional thought patterns that I'd like to see abandoned. Because I regard them to be rather destructive on an overall perspective.

I think what we'd need to survive, humanity as a whole I mean, is a far more radical change of our entire culture than what Open Dialogue represents in the mh field, I'm not too optimistic when it comes to our future as a species. I don't see it happen. Partly also because I see people uncritically cheering for "changes" that aren't really changes, on an overall perspective. Open Dialogue - this is probably as good as it gets. It's not good enough, IMO. It's still limited, by it's conditions for instance: you have to interact with your abusers because this is what we do in modern western civilisation. We have such great compassion with the abusers, we can't do without having the abused forgive the abuser. BS, IMHO.

Open Dialogue is a method. methods are always limited. And limiting. There's a lot of room for improvement if you think beyond the limits of methods. Also of this method, as good as it may be compared to conventional "treatment". People just don't realize. So they cheer, uncritically. And history repeats itself...

What we see is people recovering, becoming independent of the system, able to support themselves, working, well-adjusted contributing to society. Great. Really. But they're well-adjusted contributing to a profoundly sick society... These people grow, yes. Great. Really. But they could grow even more. Far beyond the limits of this profoundly sick society. So that they'd never call themselves "mentally ill", "schizophrenic", past or present, anymore, for instance.

7. e-mail: Of course, like every human being, my mother too had the potential to love. She just couldn't make use of it, and although she never talked much about her own childhood/upbringing, I know enough to know why she wasn't able to give love. I do see her, now. And I do love the part of her, that never was allowed to come into being, so to speak. That doesn't mean, that I would have to, at any cost, keep on interacting with her, the person, the individual, she was, for the rest of my life, just because she happened to be my mother.

And: it was crucial, that I was given the opportunity to talk about her and my relationship with her without her being present at the time. "There is no one size fits all" also applies to Open Dialogue. For some it may be ok to have their abusers present from day one. For me it wasn't. I needed physical distance to be able to, at my own pace, have the courage and explore my emotions towards her, and integrate them.

I disagree, that Open Dialogue is the best. It's good, yes. Much better than those crappy pills. Without the least doubt. And it is, also without doubt, wonderful, awesome, absolutely out of this world, that Open Dialogue elements are integrated into the system some places. But why are we, almost exclusively, focussed on Open Dialogue here in DK, when there are more "open", less systematic, rigid, alternatives out there. Soteria, yes. I don't say that Soteria is perfect. But it offers more room for true respect. It works outside of psychiatry, not inside of it. It's (at least) one step ahead of Open Dialogue. Why? Because it demonstrates that "experts" aren't needed. That all that is needed is being consciously in touch with yourself, being a conscious human being. And it demonstrates that crisis is - being human. It existed. It exists, in Alaska, Bern, Munich. The Weglaufhaus in Berlin works according to Soteria principles. There's a Soteria "movement" in the Netherlands. It's not a mere fantasy. Why not broaden the horizon, skip this Open Dialogue is the only alternative-tunnel vision?

I'd just wish there was just a little more focus on the fact, that Open Dialogue is not the one and only solution. (There is no one and only solution...)

But, well, yes, right now, we're light years from acknowledging that crisis is being human. So, of course, Open Dialogue is/would be a huge step in the right direction.


Mark p.s.2 said...

Great post!

Marian said...

Thanks Mark. I must admit though, that Rossa has a point when she writes that to label family members "abusers" can make it difficult to engage them in a dialog, and thus to change attitude. Probably it would be better to talk about responsibility, and not to label the person as such, but focus on her actions instead. A person's actions can be abusive. That doesn't make the whole person an abuser.

MindFreedom Virginia said...

Good points, Marian.

Seems like I was rash in mentioning Open Dialogue in my response to your comment on my blog. You apparently have had some experience with this approach to "treatment".

1. The experts made the need for alternatives in the first place with the horrible sort of disservice they established. Imprisonment and torture are not the way to treat people you care about. These experts won't even hold themselves accountable for their own failures, instead they are going to blame the victim patient.

2. Abusive situations exist, and excusing the abusers, or drawing them into the treatment process can definitely exasperate the situation, and can't be assumed to be the right course of action to take.

I don't like "mental health" treatment. I'm not looking for holistic alternatives or eastern religion. I'm perfectly content not to have all that "mental health treatment" baggage to haul around with me everywhere I go. I have no regrets about leaving it behind me, in the past, where it belongs. I often wonder about the reasoning of those people who find it so difficult to do the same sort of thing.

I do feel nobody should be mistreated the way so many people have been mistreated in the name of "mental health care". This is why alternatives need to be developed to the "treatment" that the state provides, to the "treatment" so many people find themselves stuck with.

Nuff said.

Marian said...

MFV: I agree. All this "mental health care/treatment"-stuff talk that in fact, let's face it, more often than not is talk about nothing else than illness, illness, and even more illness, sickens(!) me too, and I certainly don't want ever more of it. Ultimately, I'd love to see the entire mental health - or rather illness - industry, mainstream and alternative, vanish from the surface of the planet, and be replaced by an understanding of crises as a natural part of being human, not an illness needing treatment. I think, Open Dialog has a potential here, because even if people don't need treatment, all human beings need the possibility to communicate in order to come to an understanding of themselves and the world - and mostly crisis is a question of being able to make sense of the world, and oneself in it - and what Open Dialog offers is primarily communication. Unfortunately, it's still offered as treatment, not as a possibility to have one's basic human need for communication met. Much would be won if we could get entirely rid of pathologizing professionalism, if Open Dialog cut all ties to psychiatry, employed peers instead of professionals, and freed itself entirely from any medical terminology and thinking. If we were to do without any kind of organized help for people in emotional crises, though, we would have to bring about radical change in society first.

Buteyko_Man said...

IN the 60s and forward, M. Scott Peck, M.D. was able to keep many persons from having to go into the hospital by getting the family to gather around 40 people in a space and then Peck and his assistant would come in and do his community building sessions. They came together because of the breakdown of the person and in the process, there was a transformation of the entire community around this person. You can still see some of this in the films of Bob Roberts who created the program in Prison called Project Return. An amazingly humanizing program. It is possible to work with the toxic community around the person, however safety is essential and so if the community cannot protect members from some abuser who tends to split the community, that person is worked with outside of the community until such time as they can be integrated in some way. That can only happen when they too are assisted in their healing as their wounding of others comes always and I mean always from their having been previously wounded. In psychodrama of the reject, this also occurs as it does in the work of Systemic Constellation work begun by Hellinger and perfected by many others and still growing.

Marian said...

Hi Buteyko_Man, thank you for your comment!

Just a few years ago, it was rather difficult to find more detailed information about Open Dialogue on the net or elsewhere, except for the books (that I hadn't read) written or co-authored by Jaakko Seikkula. That has since changed, thanks to the growing international interest in the approach, so I got many of the questions I had about it answered -- not least by Daniel Mackler's film, and by talking to him and others who have a more profound knowledge of Open Dialogue -- and I'm a lot less critical toward it today than I was two years ago.

I learned for instance that Open Dialogue, too, arranges for separate meetings, if there's a family member who acts abusive toward the others, and is unwilling to end the abuse immediately, and also that, if ever there's any doubt, any conflict, they usually side with the person in crisis.

My only criticism today would be that they still make use of the term "psychiatry", and that they, although on very rare occasion, send people into a hospital, instead of to some kind of crisis respite house. But those are basically formalities, and more important, I'd like to see them make even less use of psych drugs, preferably none at all. Especially when you can make contact with people as early as they do it in Western Lapland, I think it is absolutely possible to avoid drugs entirely.

However, I am and will always be highly critical of "certain elements implemented" in a conventional context, and then renaming this still fundamentally pretty much bio-medical oriented approach "Open Dialogue", just because both the "patient" and their entire network is invited to join the "experts" in their discussion of the "illness" and "treatment". Open Dialogue without a radical change away from a bio-medical view of crisis, and toward a psycho-social one is not Open Dialogue. Unfortunately, it is what Open Dialogue, or "certain elements implemented", looks like in the conventional Danish system.