I have just attended the 17th International Conference on the Treatment of Psychosis in Tornio, Finland. I am full of thoughts and I keep trying to figure out how I will explain this meeting to others. Tornio is the town where Open Dialogue was developed and studied. The attendees – mostly from northern Europe – include people who have been working for many years in what is more broadly called network approaches. This is all fairly new to me. I am far from an expert, in fact I am not sure I even understand. What seems clear is that this is fundamentally a humane approach to talking to people in distress. What was wonderful about this meeting is that these individuals seem to practice their ideas in the way they live. They are humane in their interactions with one another. They are respectful of their colleagues. The entire meeting was a reflection of their work and it was profoundly stirring to me.
I want to continue to learn more. I will try to discuss topics of interest as I find the words to articulate them in a manner that seems honest. My colleague, Chris Gordon, used the term “radical humility” to describe the attitude we need to have in our work and I am thinking of that term when I take the bold step of trying to share my experiences here. I want to try and record some of what I have learned. Writing helps me to remember and to think. I want to share this with those of you who are also curious. I am talking to the “me” of several months ago. I am thinking about what would have made sense to me then.
So what are we saying when we talk about dialogue and networks? One concept that was helpful was the notion of crisis perspective vs. illness perspective. When someone calls for help, the team who responds does so quickly. There is an effort to try to understand the crisis from as many perspectives as possible. Everyone’s experience and perspective is valued and important.
What I just wrote is not controversial and I imagine that if I talked about this in most psychiatric circles, no one would object to this. They might even say this is what they are already doing. However, in my current practice, this work is done in the service of classifying symptoms, arriving at a diagnosis, and then developing a treatment recommendation. In Open Dialogue, this work is done because this process in and of itself is what is most helpful.
This is important. Often, what clinicians do in order to do what is considered competent work leads us to have a breach of empathy with our patients. It is often at the point of labeling symptoms that we lose the connection. I have been in this situation and could not think of a way to avoid this. I am now beginning to conceptualize a system in which there are other options.
I hope there will be more to follow. In the spirit of Open Dialogue, there is no conclusion.