The National Empowerment Center is promoting a new initiative called "Community Dialogues for Recovery and Wellness." These dialogues are designed to bring together people from diverse backgrounds, who share a common interest in building a loving society. The initial purpose of these community dialogues is to shift our understanding of mental health issues from the present, traumatic medical model to an empowering, loving recovery-based culture. This shift is vital to decreasing our damaging over-reliance on medications as the only treatment of mental health issues. In a deeper sense, the wellness of our society as a whole depends on shifting communication from an unemotional, dogmatic pattern to a dialogical, collaborative form.
Problem to be addressed:
I believe that we all struggle with the basic issues of "the human condition" such as why are we here, why do people die, and how can we truly connect at a heart-to-heart level with each other. We all know, at a deep level that we are missing some connection with each other which is more vital than oxygen. Our industrial culture, the culture of the blind-eyed buildings that Allen Ginsberg howled about, isolates and segregates people into electronic cells. Allen Ginsberg's poem Howl, an anthem of the Beat generation, warned us of a fascination with the machinery we create which he called Moloch, the god of fire from the old testament:
"Moloch whose mind is pure machinery...Moloch whose eyes are a thousand blind windows!"
This cold world of steel and concrete cuts us off from the spirit nourishing love we all need to be more whole. Psychiatry perpetuates that alienation by convincing everyone that any stress we experience is due to a chemical imbalance that should be diagnosed and medicated away. Dialogue gives us an evolving approach for valuing our differences so we can learn to love each other. I want to whisper these values of dialogue to each organizational level of our society to build communities of love and understanding that will enable each of us to reach ever greater capacity for creativity and fulfillment. Genuine dialogue can enable us as a human community to address this deep spiritual yearning which when thwarted leads to "symptoms" which are really attempts to solve the pain of the human condition in misguided ways. Our apparent symptoms of mental illness are vital calls to action to connect, empower, and revitalize our communities. If we do not heed the call of these symptoms; if we try to remove these symptoms by considering them an indication of individual pathology to be removed by drugs and hospitalization, we risk the further disintegration of our society. Removing people's cries of distress is like dismantling a smoke detector, which is sounding an alarm in a house. We are temporally relieved of the high-pitched whine of the smoke detector, and then the house burns down.
Our Vital Center Tells us How Alive We Are:
I believe that each of us carries a moment-by-moment awareness of how alive or dead we are. Our sense of life may be called spirit, soul, or vital center. When our vital spirit feels weak, we are gripped by a deep sense of dread. A sense that death is coming. We will do almost anything to relieve ourselves of this foreboding. We may try drugs to dull the pain. I used to smoke grass (and indeed did inhale). I loved the sense that time was extended, but then, as the grass wore off, time started rushing by again. I took mescaline, and loved seeing eidetic imagery of semi-frozen tableaus suspended in time, like Dali clocks. But then time rushed back. Later I slipped into my own world, but that led to other problems. At first being in a waking dream I felt liberated. But then I grew fearful; the world seemed to be dying around me. Another way to escape the sense of death is to cut ourselves because physical pain is often more bearable than psychic pain. I vividly recall a lonely woman in the emergency room holding her arm with its bright red blood flowing from her self-inflicted gash. I was incredulous and asked, "Why would you ever do that?" She smiled wryly, "This pain is minor compared to the pain I feel inside." We may see a psychiatrist and complain of feeling uncomfortable in our own skin and having a heavy heart. The psychiatrist administers a Beck depression inventory and the score indicates moderate depression. The psychiatrist records moderate depression in the consumer's record and following the standard of practice, prescribes an SSRI, such as Prozac. We walk away thinking we will feel better. But we only feel a little better if we can cling to the remaining image of the person who wrote the script. I have had clients who said they put their pill bottle beside their bed because then they felt my presence. This was only a temporary fix for the emptiness inside.
This vital spirit is nourished by our deep spiritual connection with each other. When I was in my deepest distress, when my spiritual isolation was the most profound after my first marriage ended, I felt famished. I felt an empty feeling in my solar plexus. I tried to consume food, electronic goods, people, drugs almost anything to relieve that empty feeling. The solar plexus, a large area in the middle of my body, may be so named because it is like our internal sun. When I feel my relationships are fulfilling, my solar plexus radiates out from inside to warm my life and the lives of those around me. I feel the glow of spring and the growth of new leaves and flowers bursting forth. When my solar plexus is weak, life seems to drain from me. The leaves of my existence fall from my being to the cold frost of winter. Just like a person you love lights your fire.
People are More Important than Pills:
I now regard my lived experience of extreme mental states as the spiritual emergence described by Stanislaw Grof. From my lived experience and that of countless others, I have found that only a dedication to pursuing loving connecting at the most human level, in the present moment, can be an enduring balm for the existential pain of the human condition. This is a hard lesson to learn. Today, in the mental health system, one of the biggest barriers to learning is the distraction to our feeling and thinking created by so called panacea drugs. Recently a previous client of mine, M, told me that when she first met me as her doctor, she thought I was crazy.
"Why was that?" I ventured, feeling a little hurt.
"Well you kept saying that the medication did not really help us very much. Instead you said the greatest healing came from relationships. "
"So why did that make you think I was crazy?" I was curious to know.
" Before I met you, psychiatrists had always told me I had a chemical imbalance in my brain and only medication could help me by balancing those chemicals. But now I realize you were right," she said sweetly.
"How is that?"
"Now I realize that relationships are the most critical aspect of my recovery."
I asked her, "What do think helped you shift from thinking pills were most important to realizing people were most valuable in recovery?"
"The groups that we did on dialogue helped a great deal (she was referring to a series of weekly classes called "Voice and Dialogue Training," where we learned from each other the principles of dialogue.)"
Another example of such a shift in thinking occurred through a series of Open Dialogue sessions. Open Dialogue is a new form of network therapy developed in Finland which focuses on strengthening a person's relationships rather than focusing on the their brain chemistry. It works from the premise that the difficulties a person encounters are largely due to interruptions in the nourishing dialogue between them and significant persons in their network. Thus the problem is in the social network not within any one individual. It is the most successful form of therapy in the industrial world for first break psychosis. In a recent training session, we learned that a young man D had suffered psychosis for several years and had difficulty speaking, especially around his father, who was a better speaker than listener. The son often drifted into his own world of monologue. Medication had not been able to bring him out of his psychosis. His family had been told that D was mentally ill and it was due to his faulty brain chemistry. His family was in despair. They tried Open Dialogue. After several sessions, the son started speaking, making more sense, and connecting with his family. His father started listening and could see the importance of relationships in his son's recovery.
Just Hiring Peers is Not Sufficient:
There is a growing recognition that our present approach is not working. The New Freedom Commission for Mental Health stated in 2003 that the present mental health system is broken. The Commission, of which I was a member, recommended a consumer-driven transformation from symptom reduction to a recovery-oriented approach. To repair itself, the mental health system has been hiring peers in many settings. It is as if administrators are saying, "Just add a peer, stir, and the system will become recovery-oriented." That programmatic fix is not working. All over the country I hear the same litany from peers: "We feel under valued." "We are given the worst jobs and lowest pay." "We cannot use our lived experience of what works because we are told that is a boundary issue." " The system continues to only offer the medical model when I found a more holistic approach much better." The attempts to use person-centered planning have also fallen short. The problem is you cannot just change a protocol or hire a peer and expect that the whole system will change from its present way of treating people as isolated machines to one that sees the whole human and all their relationships as vital to their recovery and their life.
To transform the system and indeed the society in such a fundamental manner, we need to actually shift its basic values and culture. We need to find ways to help thousands of people go through the shift that my former client M and the father and son, D, in Open Dialogue experienced.
Dialogue as a Unifying Philosophy for Transformation:
For many years, I and other leaders of the c/s/x movement have been advocating to shift the system to recovery. However, we have lacked a consensus of how to implement recovery. We have advocated for hiring peers, but as pointed out, the system just teaches them to support the existing structure. We have promoted person-centered planning. But without a shift in the culture, the planning remains professionally centered. Then at an intersection of two dialogue approaches, I discovered a way to shift the very culture of groups. The first form of dialogue is the Bohm Dialogues, as developed for business at MIT. The second form of dialogue is Open Dialogue, used in treatment.
In addition to giving a vehicle to implement a recovery and wellness-based service, dialogue also is a trauma-informed, culturally-attuned approach.
Community Dialogues for Recovery of Wellness Campaign:
NEC is calling for a community dialogue campaign to bring recovery and wellness to the mental health system and society at large through learning the principles of dialogue:
- Respecting the whole person with their differences by
- Suspending one's own beliefs through
- Listening deeply together and
- Voicing one's authentic thoughts and feelings on the
- Heart-to-heart basis of
- Sharing our equality as humans in the present moment
Dialogue is an effective means of building loving, wellness communities at all levels. Learning to participate in genuine dialogue is a profound act of understanding and caring at the deepest spiritual levels.
Actions: NEC will develop Community Dialogues to Recover Wellness which will connect people and build physical, interpersonal, and spiritual wellness through:
- EmotionalCPR (eCPR): all stakeholders learning emotional dialogue from persons with lived experience: Connect, emPower, and Revitalize [eCPR is a program of the National Coalition for Mental Health Recovery, with workbook and train the trainer guide,www.emotional-cpr.org]
- Open Dialogue for Families and small groups before they experience distress so they can utilize this approach when experiencing trauma [being used in Tornio, Finland]
- Recovery Dialogues at organizational levels conducted by persons with lived experience who have been trained in Voice and Dialogue [already being successfully piloted at a community mental health center]
- Wellness Dialogues at Community level to improve the health of everyone's mind, body and spirit across the community. These might be called Wellness Villages [being done in Ireland under the name Trialogues]
Conclusion: What will society look like in 20 years?
I had a dream that a group of those of us with lived experience were sitting in a circle, sharing, and emotionally supporting each other. All around us, members of society who had not yet been labeled were frantically rushing about, each trapped in their own world. Occasionally some member of the "normal" world would peer into our group and ask us why we were so calm. They would bring TV cameras to record what we were doing. They would urgently quiz us, "What is your program? What drug are you taking? Is it a special diet? Is there a manual we can follow?" At first they could not believe that what enabled us to be calm despite the helter skelter they were experiencing was that we were being together and with ourselves in a new way. We explained that our centeredness was emanating from our being there for each other in a dialogically-based manner. Gradually the "normal" ones asked us to teach them how to be together in such a manner.
The world needs those of us who have lived through such deep, life changing experiences. Far from being cast to the margins, our wisdom is needed to help society gain a center and way of being not only to sustain us but to thrive. In past societies, our visions were sought after by those who had not directly experienced the break-throughs we have experienced. John Weir Perry, a Jungian therapist, stated that, "periods of rapid, acute culture change require people with a new vision to step forward."
I see a society in the future when all members feel that the community has a life, which needs to be nourished by collaborative, loving relationships. Where each member will be able to fulfill his/her potential to lead a meaningful life. Where we each will be mindful of the connections between us all and recognize that, "I can only be well if my community is well and my community can only be well if I am well."
Notes: * Refers to Allen Ginsberg's poem Howl, an anthem of the Beat generation :
"Moloch [god of fire in bible] whose mind is pure machinery...Moloch whose eyes are a thousand blind windows!"
Recovery Through Voice and Dialogue: Co-founder of the National Empowerment Center, Daniel Fisher, a psychiatrist, writes on alternatives to the medical/institutional model of distress and healing. In particular, he tells of the Empowerment Paradigm of Development and Recovery.