Dialogical Recovery of our Minds

Daniel Fisher, MD, PhD
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I think that our mind and our capacity to use it to think clearly depends on our inner and outer dialogue. When we become too narrow in our thinking, which can be intensified by emotional disconnection from others and ourselves, we lose our minds. Makhail Bakhtin, a Russian philosopher,  calls this form of narrow thinking, finalized and monological. Here is my understanding of this concept from my own life experience with altered thought.

In a previous blog, “Dialogical Recovery of Life,” I described six principles of dialogue. I asked Belgian psychotherapist,  Dr. Peter Rober, one of my Dialogical Practice teachers, to comment on the blog. He said overall he liked it, but the idea of principles of dialogue troubled him. He said that principles can lead to ideals, which lead to ideology, which lead to violence because most people can never fulfill the expected level of compliance to ideology. At first, I was taken aback by the intensity of his response. But knowing that the inspiration for dialogical practice, Bakhtin, said there is nothing more distressing than no response, I responded. I told Peter I thought his critique was not a dialogical one. Instead of opening a place for new life and new thoughts, I felt closed down. Then I read what Bakhtin had said about these matters and more deeply understood Peter’s utterance. I am finding that indeed Bakhtin was very suspicious of theories and ideology. Theories have a way of closing down dialogue by concluding that there are answers when only possibilities exist. He argued for the concept that thoughts should not have a final conclusion, but instead need to be “unfinalizable.” He believed that there is, in life, a greater importance of the little details than in the grand scale generalizations such as of science. He called this “the prose of everyday life.” In explaining unfinalizability, he states, ” Nothing conclusive has yet taken place in the world, the ultimate word of the world and about the world has not yet been spoken, the world is open and free, everything is still in the future and will always be in the future.” He uses the term unfinalizability to mean openness, creativity and surpringness. I can give three examples of the dangers of some finalizable thoughts based on past monological thinking of my own. In the first example, I failed to pull out my monological thinking, and was hospitalized, while in the other two instances I found my way out once by self-help and once by peer support:

In my first episode of altered thinking, I had a meal with my roommates, which did not settle well with my stomach. I tried to sleep, but my stomach discomfort kept me awake. Then I started to feel weak and my heart started to beat faster and faster. My mind raced searching for an explanation. Ah ha, I reached a conclusion,” My roommates had actually poisoned me.” This thought was terrifying. I felt I couldn’t ask them because I could not trust them. They wouldn’t tell the truth. I had come to a final, irrefutable conclusion because of my monological thinking. Unfortunately there were no peers for me to share my fears with and I had not gained the experience of re-establishing my inner dialogue on my own. So my family, being helpless to do anything, took me to a psychiatric hospital where I was given an injection of Thorazine. It did stop the pattern of thought but did little for my habit of withdrawal at times of fear.

Five years later, when I was in my darkest hour, I felt I had to face my demons alone and without sleep. I was freshly out of my third hospitalization. I returned to my apartment and was greeted by my cat Nosey (who somehow survived the 2 weeks I was away), the stray cat who had adopted me. Night fell hard. My muscles were twitching from withdrawal from Thorazine. After all I had left the hospital without meds or a script. I had no intention to start the meds again. My mind was twitching too.

I spent 6 painful days not sleeping and not sure of the future. One night I became all too sure of my future. I could see no way out of the psychic pain I fallen into. I was sure I needed to end my life to end the pain. I lay in the tub in despair. I thought to myself, “What possible reason do I have to continue living? ”  Two thoughts kept me alive. First I was curious what would happen next. It still seemed that something new and unexpected might happen. Then even more fervently I said to myself, “I can’t kill myself, who would take care of Nosey?” I couldn’t think of anyone else. So I decided I had to go one living to take care of the cat who had adopted me.   I then said to myself, “I am going to say yes to life.”  Later I realized I must have been saying no to life for a long time prior to that. “Yes, life was worth living,” I affirmed to myself.  I think a large part of experiencing my humanity, since that moment, has been saying yes to life. Freud would say I went from Thanatos to Eros. I was experiencing my deepest spirit. It had left me and now was back. It seems I had to reach deep inside to my most essential level of life and death to rediscover my deepest spirit. That seems to be the moment when my maelstrom of despair turned into a tornado of hope. I felt like Dorothy, kicking the heels of her ruby red slippers and saying “there is no place like home,” to return myself to the home inside myself. The home of my spirit. And the whole sequence of leading back to life started with my letting go of the finalizability of my thinking. My future opened up when I re-experienced my curiosity. Saying yes to life is welcoming in new experiences and new people.

Five more years later, just after I had returned from an exciting trip to California, I felt freer and more buoyant than usual. Then I became frightened as the feeling was so unfamiliar. I started to believe that I was experiencing less of the force of gravity. This thought led to worries that actually gravity was much more variable than we had been taught. I thought, “Gravity must be pushing up on me, not pulling down. O my all the scientists have been lying to us!” Then my whole belief structure started to crumble. If “the men of science” had lied to us about gravity, what else had they lied about. My fear was growing to terror, as my mind fell into a narrow, familiar groove of linear thinking, if A was true then B then… leading to a state of extreme suspiciousness, some call paranoia. This extreme was allowing my thoughts to become finalized with one conclusion, i.e. that there was no real pull of gravity, only a pushing up by the earth. However, this time was different. Instead of letting my thoughts merely consumer themselves by twirling into a whirlpool of monologue and fear, I had learned the value of peer support. So I called a reserved, thoughtful practitioner of the Alexander technique. I felt I could trust him, as he seemed very accepting of unusual thoughts. I told him of my experience with traveling, lightness etc. and concluded with my worst fear, “Richard, I am worried that there may be no gravity!” I fairly screamed. Richard remained calm, acknowledged my agitation and then thoughtfully, and believably replied, “Well no one really knows what gravity is, but it is a useful hypothesis.” With those few words and his caring attitude, my mind became freed from that deadly death spiral groove it was careening into. ” Hypothesis, of course, not absolute reality, but a human construct to describe reality for our convenience,” I thought to myself.

So upon reflecting on these three pivotal events in my recovery of my life, I now can frame them with an understanding that feels very satisfying. In all cases, my thinking had become calcified. I had become trapped in the certainty that I could explain my life and all of life around me by linear logic. I was looking for a set of laws to explain all of life. This attitude worked well in the Lab. of Neurochemistry of NIMH where my boss said he only believed the reality that could be written as a chemical formula. My thoughts had become finalized and my thinking monological. They had become as final as a chemical formula. Thank heavens in the last two cases there was a part of me that refused to believe that I had all the answers in my immediate conscious conclusions. How exciting it is now to have discovered Open Dialogue and its inspiration Makhail Bakhtin. It explains to me how overly certain thoughts, combined with monological thinking which result from emotional isolation lead to the altered thinking called psychosis. It makes sense then to understand recovery as the combination of an inner and outer capacity to reestablish dialogue, especially on an emotional level.

 

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25 COMMENTS

  1. Wow! A beautiful essay Dan, deeply revealing of actual experience and the self-discovery, recovery journey.

    I hope people take the time read and re-read your hard earned wisdom, and come to question the avoidance of self-awareness inherent in our rationalizations, and also some of the timely metaphors in their meaning?

    I was struck by “This extreme was allowing my thoughts to become finalized with one conclusion, i.e. that there was no real pull of gravity, only a pushing up by the earth.”

    It reminded me of this;
    “The apparent opposition and dominance by the military order of the intricate six-layered cerebral cortex, over the messy anarchistic networks of the “simple-minded” brain stem, was upset by the great neuropathologist Paul Ivan Yakovlev.

    Yakovlev challenged the hierarchical (top down) Cartesian worldview (I think therefore I am) and proposed that our increasingly complex behaviors have evolved from within to outward, from “below to above.”

    “Out of the swamp of the reticular system, the cerebral cortex arose, like a sinful orchid, beautiful and guilty.” _ Paul Yakovlev.”

    Exerts from “In an Unspoken Voice” by Peter Levine, PhD.

    The experiential writing of people like yourself and Michael Cornwall and others, is desperately needed to help people free themselves from the jargon of mechanically minded intellect’s, and learn to question our “I think therefore I am,” cultural paradigm.

    Be well:))

    • David, Descartes has bothered me for a long time and I find myself often wanting to turn him on his head with other alternatives such as “I am therefore I think,” which reminds me that we need to exist to think or the black English, “I be thinking” which reminds me that there are times when thinking and existing are experienced together rather than in sequence.
      In terms of the cerebral cortex, I agree that it is over- rated. To have a rich inner dialogue no one part of onesself should dominate to such a degree that the person loses autonomy. I use meditation to equalize the voices which is vital to outer

      • oops, …out involvement with others in way that is fulfilling. Instead of chemical imbalance I think i needed to go through a lived experience of recovery from an imbalance of parts of myself. I tried to have my highly rational thinking self control my emotional side rigidly. I could only reset this imbalance by drastic means of nearly completely reversing the imbalance. So for a while I had to go into altered states where I could fully experience my emotions. Then I had to find a way to balance the two sides. Recently, with my mother’s death I have been tested in that regard, to feel the sadness and not be overwhelmed by it is a challenge. Friends and family help as well as music and sharing with you all my blog friends.

    • Hi mjk:))

      “Christ on a cross: “it is done”

      Its a symbolic image that has haunted my life, no matter how many times I’ve wished it would leave me alone. Yet, just as Harry Chapin’s famous song suggests “someone keeps calling my my.”

      For those of who go through “psychosis” it seems to me that something keeps calling our name? And the experience is purposeful for the individual, their group & our species.

      I used to have all the typical self referential ideation, common to bipolar type 1’s mania, and the “savior syndrome,” yet after allowing the process to unfold three times in last three years, the savior notion has become a species metaphor, beyond my “I” need.

      Some see a transcendence process from a physically embodied sense of “self/soul”, which peaked about 5000 years ago, towards a cycle of “headonic” sense of self, which is peaking now, or has peaked already and then a pendulum shift back towards awareness of an embodied self/soul, which will take us to new heights of body/mind perceptual capacities.

      These days “Christ on a cross,” has morphed from my earlier “I am Christ” to a metaphor symbol of how awareness of the body is sacrificed to “sanctify” the mind.

      I used to wonder about the Israelite’s as the chosen ones, until I stopped reading metaphor and mythology as history and came to understand metaphor as a species existential interpretation.

      How does the Universe safe itself from becoming a silent place of dark matter/energy, if not by evolving into a form which can act upon itself?

      Why an epidemic of mental illness, at this time in the 21st century A.D. Do we need to look at the experience of psychosis with less fearful eyes, and to quick, instinctive assumptions about a “negative” process?

      Eisenstein, is said to have hoped we will come to understand that the Universe is a friendly place. Perhaps we need to stop “projecting” our fearful survival instincts onto it?

  2. Thank you for your article: it gives me a new slant and understanding into what is happening when my son gets stuck into “linear thinking” driven by anxiety. I think I will be better able to help him after reading what you are saying.
    Personally I like the “I think therefore I am” assertion by Descartes. The mind making sense of ones instinct, overruling it if necessary, understanding, taking charge, accepting responsability etc

    • I am glad my reflections can help you communicate better with your son. That is one of the major reasons I share my understanding, so it might help others in ways that I wish I could have been helped during my darkest hours. Always let him know you are there and that you will respectfully respond when he expresses he needs you. Recently my younger daughter, who will soon turn 28 shared a heart warming message. We were looking out on our backyard where my wife and I had fashioned theme birthday parties. I said, ” As a parent I never am sure if I am being helpful.” She gently replied, ” You gave me the best gift, you allowed me to become the self I wanted to become.” As she drives out for a new life in LA , far from our home and backyard, I carry those words as a consolation. When you have had lived experience there is always a fear that one’s children might have to go through a similar tribulation, so I was doubly reassured by her sentiment.

  3. Beautiful blog. Dr. Fisher. I wonder, do you think we are having a dialogical sort of discussion on these blogs and their comments? Seems to me there is usually complete agreement or complete disagreement, but not a move to new understanding of matters that you described.

    • Steve, though electronic media has limitations, as does written word in general, I am impressed that this blog comes closer to the dialogical connections I think are the healing our community and world need. We all I feel carry a part of the wisdom that we all need to lead a more fulfilling life. The more we learn to share that wisdom the more we will rebuild our fractured communities and all recover our humanity together.

  4. Dan, I have thoroughly appreciated your sharing your unfolding understanding of the dialogical process and the potential it holds for healing self and others in relationship.

    I am a former devotée of Bahktin’s carnivalesque approach to life as well as the other philosophical fathers (why all men?) of postmodernism including Derrida and Foulcault to name a few. Life is often a pastiche that cannot be understood without an intimate understanding of the contextual moment in which and experience is, well, experienced. I suspect the meme is another revival of postmodernism and, perhaps, a more helpful one.

    At some point, however, deconstructionism seemed to lose its allure. I think that happened around the time I became a mother and realized that structure could be a “good thing” for organizing behavior. But structure that included freedom within structure. Structure that isn’t calcified but grows and expands as responsibility and understanding grows and expands.

    As a parent and a working mother, I am constantly having to revisit, redefine and recommit to a set of guiding values and principles. And, I’m okay with that. I do hold a healthy relativistic stance towards others’ values and principles and I reserve the right to allow mine to evolve as I encounter new information and experience (perhaps the “takeaway” from my deconstructionist days).

    When I read your blog post, I felt your shut down-ness. What immediately came to mind was Vietnamese Zen teacher, Thich Nhat Hanh’s, caution that we not mistake “the finger for the moon.” This alludes to the relationship between principles and absolute or pure experience.

    Principles, values, spiritual practices are like the finger pointing to the moon. They can be helpful for guiding us to the truth of experience. But ultimately, principles, values and spiritual practices are not the truth in and of themselves. They are guides that should be ultimately abandoned to present moment experience and understanding.

    I see your dialogical principles in this light, and would honor your response to their critique as equally valid as the insights you gained from “trying on” your constructive critic’s perspective.

    Principles, compassionately and spaciously held alongside respect for individual choice, can facilitate dialogue rather than shutting it down. Right up there alongside the mighty question mark and a commitment to openmindedness. At least that has been my experience. Thank you for sharing yours. I find your perspectives, grounded in your rich experience, to be invaluable.

  5. Dan, thank you so much for sharing your beautifully written blog. I was once able to pull myself away from the act of suicide by thinking of something Camus wrote: “Within the depth of my winter I found that there was within me a spring.” I had gone out to the woods with a gun when I noticed the winter grow on a tree and thought of Camus. Prior to that, I painted a picture of myself painted into a corner. The winter growth on that tree and Camus…it was all sort of mystical. That was decades ago and to this day that moment in the woods saves me still.

  6. Dan, I like you and have admired your work for years. I still remember your kindness when we were working on the Paul Henri Thomas case and you gave us quotes to use.

    Nonetheless, for me, this is simplistic. It is unquestionably true that chemical formulas impact thought, as in exposure to Pb or Hg or innumerable organic molecules; hey did you know that thorazine can be used as a pesticide?

    Anyhow, I find a functional self-monologue or dialogue or simply a listening to my power animals is enormously functional. Like you, my panic response and my reaction to precipitously discontinuing meds I never consented to results in alarming mental scripts which can take on a life of their own.
    I feel so fortunate that I can have a good self-talk at present but I recognize it as a good fortune that is partly born of a calmer chemical reality as well as a spiritual and energetic relationship with the world.

    We will heal up this mind/body split somehow, I am certain of it.

  7. PS — There was once a family court which attempted to keep me from parenting. Two kids; one in Tufts School of Engineering, one studying healing at the Center for Natural Wellness; neither one labelled (after 3 generations of psych incarceration on my side of the family). It can be done. Keep telling the kids they are perfectly capable.

  8. Thank you for touching me right with your Blog and replies. While my begining of 18 psychiatric hospitalizations happened in a crisis, it happened in a life that often felt alone. I was Brook’s Fever on the playground. Someone would touch me and then chase most of my classmates who ran away in terror. There had been intimaces and dialogue, but much isolation and monologue. My life has much more dialogue today.

    I paid especial attention to Nosey, your mother and the youngest daughter. I remember how happy you said your mother was when your father saved your life with penecillan. I hope that which comforts you will.

    I want to congratulate you on your daughter. You and your wife must have been such good parents.

    I want to say my husband, Roger Armstrong and our children Jennifer Marie, Laura Elizabeth and Michael David are the closest to me. I also have a persistaant cat named Alister.

    Dan I appreciate your sharing with people and for some of that having come my way. You influence me.

  9. Dan,
    I appreciate your sharing of personal experience and reflecting how relationship and communication with people, animals and ourselves are all important. I think it’s beautiful and true what you are sharing. In moments of fear and desperation it helps to question our conclusions. It also helps to question our conclusions when we are certain that we are right. This is interesting because there are also times when it is helpful to trust ourselves and allow ourselves to be confident in our conclusions even if we are certain. I like a healthy balance of confidence and humility. It’s ok to be wrong and it’s ok to be right

    I look forward to seeing you in the near future.

    Chris Camilleri, MD
    Psychiatrist
    Peer

  10. New Identity

    I remember, therefore I am:
    Erase my memories and I cease to exist.
    I am what I was, what I have always been,
    So how can I change my personality?

    Reinvent myself, write an alternative biography,
    Plant the seeds imaginatively,
    Visualise my history on a grand scale:
    Colourful, loud, tangible and in good taste.

    Suppress the superego,
    and encourage the alter ego;
    Release the potential, realize the dream;
    Become what you could have been:
    Future recordings of pictures and sounds
    Triggered by post-hypnotic suggestions
    In a post-avant-garde world,
    Where only inanimate objects return
    To their original shape.

    This poem is my own solution to my mental breakdown: jettison the baggage and start afresh. I do not think there is any merit in revisiting past experiences over and over again as this only tends to project you into a downward spiral.

  11. Dan: I liked this a lot and it made me think of one of the tools I consider useful for ‘grounding’ my thought process. Namely, particpating in Socratic Dialogue at a meeting for Socrates Cafe. These dialogue sessions though helpful in keeping open-minded may sometimes challenge one’s patience and explore biases and tolerances…