“During the first couple of days of a crisis, it seems possible to speak of things that later are difficult to introduce … It is as if the window for these extreme experiences may only stay open for the first few days. If the team manages to create a safe enough atmosphere through a rapid response and by listening carefully to all the themes the clients speak of, then critical themes can find a space in which they can be handled and the prognosis improves.”
— Jaakko Seikkula, in “Open Dialogues and Anticipations” by Jaakko Seikkula & Tom Erik Arnkil
In the spirit of the quote above, Louisa Putnam and I put together the first “Dialogue in a Time of Crisis” town hall meeting in collaboration with Mad in America, HOPEnDialogue, and Open Excellence two weeks ago. We had heard many stories of friends and colleagues adapting their dialogical approaches during the COVID-19 crisis, and we wanted to create a space to gather and learn as we all find a path forward. Over 360 people from 33 countries* joined the panel of Jaakko Seikkula, Rai Waddingham, Andrea Zwicknagl, Richard Armitage, and Iseult Twamley. Since then over 1000 people have watched or listened on YouTube.
Many of those responding spoke of being touched by the respectful atmosphere, with space and time allowed for thoughts to form, and new meaning to arise. This, to me, is the essence of dialogicity: finding our way forward in uncertain times by opening up, not ending, the dialogue. It seems paradoxical that when we are most afraid we would let go of the desire for a quick fix. But perhaps the fact that we are relational, social beings means that crisis brings out the need to look to the collective. The fact that so many people found their way to this forum and found comfort in it was, for Louisa and I and all that gathered to participate, very fulfilling. Equally fulfilling as the discussion and the reaction to it was the lively exchange in the chat section, as people from around the world signed on to say hello, meet, comment, and exchange contact info. Similarly, the Q&A was rich with experience and poignant in its immediacy.
We will continue exploring the challenges and learnings of dialogues in times of crisis on the first and third Fridays of the month, at 12:00 pm EST (5:00 BST). This Friday, May 1, Jimmy Ciliberto, Charmaine Harris, Jasmin Ishaq, Ramune Mazaliauskiene, and Alita and Fletcher Taylor will discuss what they are learning in their respective systems. On Friday, May 15, Russell Razzaque, Regina Bisikiewicz, and others will discuss their efforts at systems change. On Friday, June 5, Caroline Mazel-Carlton and a panel including Cindy Marty Hadge, Chackupurackal Mathai, Rufus May, and others will discuss how the Hearing Voices Network has been bringing its spirit to the real world and online before and during the crisis. Please join us for any or all of these.
In putting together these panels, we have touched on the deep sorrow and learning we are all encountering. I heard of a father forced to decide whether to go to the hospital, given his poor prospects for treatment or cure, or to simply stay home rather than risk suffering and dying away from his family. This touched in me the awareness of aspects of this crisis that transcend physical safety. Without connection—and dialogue—there is a way we experience an existential loss of self. This central importance of dialogue and connection to the human experience helps to explain the difficult choice between physical comfort—even survival—and staying in meaningful relationship in times of crisis.
Jimmy Ciliberto said in a conversation about Friday’s panel “I realized that when I started offering my availability—like complete availability; every day, weekends—the family’s need diminished … When they feel you are available, they don’t feel they are alone.” Perhaps it is in crisis that we can begin to see that others seeing things differently is not necessarily a bad thing, and may in fact be good. We learn not only to tolerate uncertainty, we learn that it is preferable to the false sense of certainty that comes with being alone.
As I have studied the dialogical perspective, and tried to implement it, it has seemed to me that principles and skills that are hard to grasp in the abstract become clear and even obvious in crises. For instance, the skill of simply repeating a single word or phrase, without interpretation or analysis, taught as part of reflecting practice, feels awkward and artificial in ordinary conversation. When someone in deep crisis, however, strains to find the words that they—and then you—can connect with, gently touching each word as they find it feels as natural as touching a child learning to step on rocks across a stream; offering a soft voice of encouragement, saying simply, by repeating what you have heard, “You are not alone; it’s safe to keep trying.”
The response to the town hall gave me insight as well into “Tolerance of Uncertainty.” I have thought in the past that perhaps aiming past mere tolerance—to falling in love with uncertainty—might be the way. However, when participants appreciated the panel’s tolerance of uncertainty much more than any specific topic discussed, I wondered whether tolerance of uncertainty is not in fact a rational process, but a feeling; a quality of relationship that makes it possible to accept that though we may not have certainty about the future, we can be certain about the people with whom we will enter that uncertain future.
Dialogical practice can be described in many different ways; as a personal perspective and approach to the world, as a way of being, as a way of responding to people in crisis, and as a community’s collective response to people in crisis. For this moment, I will let Jaakko Seikkula’s observation from the first panel be the final word: “In this kind of practice I can be more human than I was before. And that is perhaps the most important thing of all. And if we can be more human, and if it is more helpful than any other way that I’ve been involved, it’s a good outcome.”
Please join us as we learn to be more human together, and in perhaps learning how to be more helpful in the process.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.