Empowerment is Vital to Dialogical Recovery

Daniel Fisher, MD, PhD
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In my previous blog, I used a new term, Dialogical Recovery to describe the importance of dialogue to recovery. I and others in the recovery movement have been asking ourselves recently, “What is it about Open Dialogue that resonates with our lived experience of recovery?” There is emerging agreement among us that a dialogue approach is empowering, which is why it is very important to recovery. In fact, empowerment may be one of the most important elements of recovery.
To understand the importance of empowerment, we need to reconsider the nature of the emotional distress from which people are recovering. The present day mental health system calls these issues mental illness. This term is very jarring to most of us with lived experience. We do not want our lives reduced to a biochemical equation. This leaves many of us feeling hopeless and powerless. We are led to believe that all we can do is find the right doctor and the right medication to run our lives. The Open Dialogue practitioners use the term monologue to describe the state of psychosis. By monologue they mean there is only one version of reality and that it is not possible to revise that version. In fact, the medical description of mental distress is monological because it is imposed by authorities upon every person in distress. In addition this spell of the medical model of distress is cast upon every member of our society as the only version of reality. Society is told, without facts to back it up, that emotional distress is due to a chemical imbalance. I think our society’s narrow medical description of madness is actually trapping persons in monologue and therefore blocking recovery. I discovered that when I performed biochemical research and reduced human beings to a medical model I crossed over into monological madness. This imposition of one person’s reality on another person has been considered an impetus for the subjected person’s retreat into psychosis by Helm Stierlin. The consensus among those of us who have recovered from psychosis is that the way out of this madness is through self-determination and choice. Self-determination is an expression of each person’s voice as unique and important. This is an expression of dialogue. To run your life for yourself, however, requires one to be able to exercise power through being involved in empowering relationships. Unfortunately, the present system works to disempower persons when they are in greatest distress.
So if the chemical imbalance theory of emotional distress does not resonate with the lived experience of those of us who have recovered from mental health issues, what reality does? Many of us who have lived experience of recovery from emotional distress have concluded that trauma played a pivotal role in our later distress. For myself, being sexually molested by a 5th grade teacher left a lasting emotional scar. That experience reinforced my suspicion that I was defective and inferior. The abuse left me fearful and obedient to persons in positions of authority. I felt compelled to reflexively adopt their version of reality. I felt powerless to run my own life and looked outside myself for my plans and goals. For me that outwardly imposed life plan was to become a biochemist and discover the chemical imbalance causing my sister to be unhappy. When you have been traumatized every interaction carries a threat because we allow most people to tell us what to do. Well when you feel threatened by interactions and other person’s ideas, your safest response is to withdraw into your own monological world. This results in a person clinging to their view of reality. I, for instance, became convinced that everyone was a cleverly constructed robot. Many people would call this a delusion and dismiss it. Actually it is a creative protection, and should be respected and understood. I later understood that I thought the world was filled with robots because I could not express my own feelings.
The primary task of recovery from this monological state is to feel safe enough through trust to enter once again into mutually satisfying dialogical relationships. Empowerment is critical to regaining the ability to relate. Here are examples how a person can help co-create a dialogical space, which invites both themselves and others to experience their life more fully.:
Recently a mother and daughter came to see me. The daughter has been agitated for several years. She and her mother agreed that hospitalization made the daughter feel worse. The daughter sped through a litany of crises, and insisted that I had no idea of how much she was suffering. She stood up ready to leave, wondering if I really was a doctor. I pulled my diploma of board certification from hiding and she calmed down. She commented that she was glad I kept my documents off the wall. She then directed her anger towards her mother for imposing restrictions upon her. I then asked if she would listen while I interviewed her mother. The second time I asked she agreed that I could talk with her mother. I asked her mother to share difficulties she had encountered prior to her daughter’s troubles. Her mother shared her own distress and as she did so her daughter calmed down and listened. The more genuine the mother was about her own pain, the more her daughter was attentive and gained control of her own thoughts. The daughter was then able to stay another hour while we conversed and planned together their next day. ( It appeared that the critical moment came when the mother was able to disengage from her parental role and share from her own experience. This shift in power seemed to allow the daughter to assume greater control of her own thoughts and life. The two had been trapped in a monological engagement from which neither could escape. The mother’s need to be in charge combined with the daughter’s refusal to take responsibility blocked the capacity of both to step out of their roles. It was necessary for someone outside their dyad to engage the mother in a new conversation to enable her to unlock her role. This allowed them both to engage in a more dialogical relationship and experience the power that such freedom nurtures.)
Another example comes from my work in developing a public health approach for a lay person to help another person through a crisis. We call the approach emotionalCPR or eCPR. C is for Connecting, P is for emPowering, and R is for Revitalizing. (for more info visit: www.emotional-cpr). Recently I was observing two of our trainees practicing emPowering through a role play. The helper kept trying to be helpful, coming from the position of an expert. She kept saying, ” Why don’t you try…” These suggestions, though well meaning, were actually causing the person in distress to seem even more powerless to think of any ideas of her own. Then the helper started to share her own distress. I could see the person in distress listening attentively. She gained confidence and started to have more strength and conviction in her voice. She was able to come up with her own goals and plans. (Again, as with the mother and daughter, it seemed that when the person helping could express her own humanity through sharing some of her woes, the person in distress was more empowered.)
I believe one of the most healing aspects of Open Dialogue is the attitude of the practitioners. They sincerely live as real people trying to help other real people. They do not express themselves as experts. They respect the capacity of the persons they are helping to be the experts in their own lives. Also the lack of a prior agenda helps “equalize the playing field.” They believe and practice that every voice is important and needs to be heard. This is the essence of democracy.
In western society, we are all fundamentally challenged to recover our humanity. At times, it seems that the extreme emotional states we have experienced were an expression of our longing to live a more fully human life. I recall during my most prolonged period of muteness (one month), saying to myself, “I will only come out when I am sure that I can trust the people around me.” I think the most empowering dialogue occurs when a person helping me can share being themselves with me in such a way that it frees me to be more fully human and empowered. Carl Rogers called this way of being by the therapist congruence. I would call it being your genuine self. Mikhail Bakhtin says that the most devastating experience for a human being is the lack of a response by another person. This view is reinforced by Martin Buber’s description of the vital importance of one person truly being present with another person in an I and thou manner. Being around people who believe in our capacity to be more fully human is life affirming and empowering.

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Daniel Fisher, MD, PhD
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.

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23 COMMENTS

  1. Thanks for your informative post Daniel and the storytelling. It’s caused me to reflect on personal situations and have more understanding.

    Being with another person and alongside them is what it’s all about. We have a saying in Scotland “we’re a’ Jock Tamsin’s bairns”, to demonstrate our solidarity and relationship.

    The psychiatric system in my experience is always trying to be paternalistic and keep the distance between professional and patient/carer. In my present engagement with the system, as a carer, I am doing what I can to level the playing field. It’s been a battle and a journey. It helps to know that we are not alone.

    Regards, Chrys

  2. I like the concept of Open Dialogue, Daniel. I wonder if it has something to do with that confusion of roles, where we can either act in a childish way, on the one hand, or act very paternalistically on the other, yet find it really hard to respond to our partner in the dialogue on a truly equsal basis i.e. adult to adult?

    • Dr. Fisher,

      I especially enjoy your words of encouragement on the subject of friendship… The value of finding a good friend, and how one good friend can make all the difference in recovery.

      Your work at the National Empowerment Center reminds me of the story of Noah and the Ark… You’ve built a ship to protect others from a great storm… You’ve saved lives… countless lives by what you’ve been able to construct.

      Thank you, sir.

      Duane

  3. “Mikhail Bakhtin says that the most devastating experience for a human being is the lack of a response by another person. ”

    Absolutely. The reason we talk, share & communicate (especially while experiencing distress & troubles) is precisely because we need Vital Information and FEEDBACK.

    We need to hear, and we need to hear in a very specific language and in a specific way. This brings the word, “response ABILITY” into focus.

    Who truly has the ability to respond? Who truly has the right voice and the right words to say? Who knows how to speak to us, in the way we so need and long to be spoken to?

    In a way that HEALS.

    We seek to UNDERSTAND. If people want “peace”, they have to know WHAT THAT IS. Understanding is what peace is / peace is Understanding.

    Understand?

    Cool.

    Peace of mind = Understanding.

  4. “I, for instance, became convinced that everyone was a cleverly constructed robot. Many people would call this a delusion and dismiss it. ”

    Actually, it is a precise observation. Many people are automatic, mechanical, systematic, programmed – yes, in a word – “robotic”.

    Yup.

    And anyone who responds to you in a negative way (“delusion”) and then dismiss you – they were irresponsible; they lack the ability to respond to you accurately, healthfully and appropriately.

    Like music? Sure ya do. TV on The Radio: Robots (caution, explicit).

    Anyhoo – it’s just another opportunity to feel compassion for humanity, since so many people aren’t as healthy as they’d like themselves, and each other, to be. We got a hurt, injured, a bit “lost” and “talk sick” (toxic) society. Hopefully, *miracles* this year: as predicted. Yay!

    • Very insightful! Your cleverness like “talk sick” for “toxic” is great and makes me laugh at its astute social criticism delivered with amazing, amusing, surprising wit!!

      Thank you. Look forward to reading more of your witticisms!

  5. Dr. Fisher,

    Your story and work are very inspiring. I identified a great deal with your story of abuse related trauma immensely. I did not have so called “delusions” about seeing other people as robots, but they sure appeared that way. Due to interrelated work and domestic abuse, bullying and mobbing, I saw that when people became part of a vicious mob orchestrated by a psychopath, they lost much of their humanity. I think your seeing certain people as “robots” was very accurate in your own way and putting evil human behavior kindly. Dr. M. Scott Peck, Psychiatrist, talks about individual and group human evil/cruelty in his book, THE PEOPLE OF THE LIE. He wrote the bestseller, THE ROAD LESS TRAVELLED. When I was being tormented by group evil, I did tons of reading about evil, its causes and consequences and how one can understand and overcome/recover from it. At times, when the cruelty of the “mob” became especially vicious causing me great emotional distress, I felt that they were forcing me to try to be a robot to survive. There are many books and web sites on these topics on the web.

    Anyway, though I never lost touch with “reality” since it is well known depressed people have a far greater grip on reality having been robbed of all their POSITIVE ILLUSIONS (name of book), I certainly used your metaphor of robots with regard to myself and others a great deal as is the case with many so called sci fi movies like TERMINATOR, TRANSFORMERS and many others to warn us of our increasing loss of humanity. I have read that so called schizophrenics’ “delusions” usually have much to do with the reality of the situation and I think you really hit the nail on the head with your own robot metaphor for the evil you suffered, which ultimately made you “strong at the broken places.”

    Overall, your article is beautiful, inspiring, caring and wonderful. I feel those patients who encounter you and those you’ve mentored are very lucky indeed to have someone who has not only suffered and recovered from abuse related trauma, but used that experience to become a “wounded Healer” per Henri Nowen to practice an enlightened, empathetic, holistic trauma model to guide others on their path to recovery from traumatic experiences.

    Thank you so much for sharing this. Your story and is truly an inspiration for anyone.

  6. Dan–

    It really helps me -again- to hear you express things I also feel–especially in the middle of the night when I am supposed to be joining the rest of the world in “normal” sleep hours that have never felt “normal” to me. You have always been an inspiration for me– having been honored with some contact with you on and off over the years.

    I was “incested”–as in- done TO me–by my father when I was a few months old till 5. Of course, this would cause anyone to get profoundly depressed and feel like no one was smiling and they moved in mechanical ways…that’s the way the therapists seemed when I was a “receiver” in a day treatment program. It would also make one feel like not talking too when there were no smiles, no one sharing what they did on vacation, their middle name or any other revelation of themselves as fellow human beings. A wall of Power between the “Provider” and the “Provided for”.

    Later, as a day treatment “counselor” myself, they said I had “boundary issues” because I could so easily have empathy with the people I was supposed to “help” and felt so free and open about sharing anything with them. Yet I felt selfish giving my love to others because I felt so very joyful being with other people with whom I could truly understand–because I was/am there. Coming “out of the closet” as one of “them” was perhaps one of the most significant steps I have ever taken on this road to Recovery.

    I am Recovering from the trauma of being over-powered by labels and medications. The incest trauma was just the beginning of the power others had over me all my life. Having become empowered by myself by giving myself permission to take back the power I did not have over myself, I am “going back”, perhaps all the way to the womb, to rewrite a script others wrote for me–a script I am writing in my own words now. In this way, I am taking responsAbility for determining my choice about who I am and how my life shall be.

    Thank you for sharing your “script”–before and afterward. You are such an impressionable role model for me and many many others.

    Nice to hear your thoughts once again!

    -Lisa

  7. I’ve found another instance of recognition: the “robotic” conditioning of persons within our one human body of life.

    The paragraph that contains the vital information, within this article, is “Removing Mind Locks and Mind Slides”:

    http://spiritlibrary.com/energetic-synthesis/how-much-are-you-willing-to-know#comment-40337

    The great “marriage” between psychology & spirituality can be TRULY, WONDERFULLY TRANSFORMATIVE. Where WORDS are our greatest tool, let us now see and understand the following RULE:

    The RULE is the word, “FORM”:

    Inform
    Misinform
    Conform
    Uniform
    Deform
    Malform

    Highlight: Transform

    In part, psychiatry’s KEYWORDS are “treatment” and “care”. We each and all know and understand that something is mistaken, where psychiatry has formed a CONTROL, which is NOT proper “treatment”, nor is it any sense of genuine “care”.

    How then does the industry (inorganic body of life, known as psychiatry) relinquish it’s CONTROL in order to establish a TRUE path of HONEST, PROPER “care and treatment”?

    The answer is in the “marriage” between PSYCHOLOGY & SPIRITUALITY.

    It is a matter that requires agreement. Keyword of the day has long been “greed” – and now is the time when we agree to cease using the term. There can be no Health in a world that has A-GREED to GREED. Of all things that ought to Thrive, with Vitality and absolute gratitude and pleasure of our very existence, we must agree to TERMS (words, which shape and FORM us) for our CONDITIONS:

    And there are many “robots” who are lost, and require our Love to want to TAKE CARE OF THEM and bring them into BEAUTIFUL HEALTH.

  8. MJK

    Love your latest word play around the word “form.” The spiritual article you cited had a lot of truth and wisdom in it too in my opinion providing many of the insights of spiritual leaders like Eckhart Tolle with his best selling book, THE POWER OF NOW, with a focus on letting go of the ego and the “pain body” that it creates to become spiritually enlightened and able to live in the NOW or PRESENT (Because life is a GIFT–See my own word play of the day?).

  9. Clearly, the hunger for dialogic healing is great given your blog responses!

    When you come to NC, would love to share with you the Insight Dialogue practice, which may be interesting to incorporat with eCPR trainings.

    The practice, rooted in Buddhism, but accesible to all (culturally and spiritually sensitive, no pedagogy) has six steps. It was powerful to practice them on retreat for a week. Here are the six steps employed in the dialogue, which is defined as a meditation in relationship,

    Pause—Relax—Open

    Pause—take a few moments as a dyad or tryad in mindful meditation, quiet the mind and affirm intention to listen deeply.

    Relax—settling into the quiet, releasing expectations or internal scripts for dialogue.

    Open—to the other person, their wisdom, and the ambiguity of how the dialogue will unfold.

    Trust Emergence

    Acknowlege that the dialogue is emerging and being shaped in response to what is arising in the present moment. Neither party knows where it may go as new information and truths are being shared. Trust that insight will emerge in this process.

    Listen Deeply—Speak the Truth

    Listen Deeply—get out of self and be wholly receptive to what is being shared. No need to act or fix. Seeking to understand, be receptive and attuned.

    Speak the Truth—about what you have heard and how it has moved you. When speaking truth with integrity and care, the other person feels truly heard (which is tremendously healing) and you discover your own truths.

    The goal of this process is mutual empowerment and insight. It is also humbling and engenders a great deal of compassion and respect for all willing to engage in this process!