Dialogue Is Just What the Doctor Ordered: Town Halls in a Time of Crisis

Kermit Cole
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Dear Fellow Dialoguers,

The success of Mad in America has, from the start, been connected with our ability to create a safe space for dialogue. MIA was, to be sure, carried into existence on a wave of response to Robert Whitaker’s books by people whose experience had been previously invalidated and whose voices had not been heard. But the ultimate success of MIA’s mission has to do with creating a safe space for a dialogue that includes everyone who has a stake in the narrative around the diagnosis of, and response to, human distress.

The surprising finding of the creators of “Open Dialogue,” the municipal response to “mental health crisis” that originated in Western Lapland, was that crises—including “psychosis”—tended to resolve when they shifted their focus from “treating” or “fixing” to simply fostering a safe space for dialogue. In a similar spirit, MIA has striven to provide a safe and welcoming space for for discussion of treatments that, at best, have not helped, and in many cases, caused harm. But we have also striven to change the narrative around how to respond to this pain and these crises.

At many points this has been a difficult and painful mission. However, it may be that in times of crisis such as this, when dialogue is arguably the hardest and likely the most painful, that it is also the most urgent and most beneficial. This, too, has been the experience of the Open Dialogue practitioners, and after nine years Mad in America has similarly made progress. Our purpose has begun to be accepted as valid; from the United Nations, to many individual nations, even to high levels of government as well as within the halls of psychiatry and medicine, it is acknowledged that the ways we have sought to redress human distress through narrowly medical treatments have not been working. These approaches are being re-assessed at human, economic, societal, or scientific levels.

Not only is dialogue necessary, it is happening. It may be that we find what some have said all along; that dialogue may be in the end be not only necessary, but possibly the best—and often sufficient—response to human distress at its deepest level.

The need for and benefits of dialogue have perhaps never been more stark on a global level than now. The response to the Town Halls and the Urgent Dialogue that MIA, HOPEnDialogue, and Open Excellence have convened so far seems to affirm that the time we have spent learning to make safe spaces for dialogue has been time well spent. We arrive at this moment well prepared and eager to build on that dialogue as we find our way together toward a future where the pain we all face is met by responses we all share in creating.

Our next Town Hall, on May 15th at noon Eastern U.S. time, will be a discussion between Russell Razzaque of London, Regina Bisikiewicz of Poland, Corinne Hendy of Nottingham, Rob Cotes of Atlanta, and Martijn Kole of Utrecht that begins with their experiences of fostering a dialogical perspective in systems of “mental health” care. Register here!

A part of this discussion may focus on the ways that peers have been so critical to bringing dialogicity to system change. Among the possible reasons for this that have come up in preparation for this meeting have been the need for the voice of people who have been and might be hurt by existing standards of care, and the need for questioning, dubious voices to continue the dialogue in the face of diagnostic or treatment-based authority. It may be that advocates are needed to stand apart from vested interests in ideology or outcome, and simply—as Martijn Kole, a peer advocate from the Netherlands, said—to “just be”, as dialogue swirls about but may not include the person at the center of concern. Whatever the reason, it seems inescapable that as people have sought to adapt the “Open Dialogue” that has been part of system change in Western Lapland, peers have proven to be integral to the effort to bring about grassroots cultural change to systems elsewhere.

More perspective on why this might be will likely come on June 5 with the dialogue between Caroline Mazel-Carlton, Cindy Marty Hadge, Chackupurackal Mathai, Clarissa Mendonça Corradi Webster, and Rufus May on historical and current efforts to bring the spirit of the Hearing Voices Network to both the “real” and “virtual” worlds.

I would like to thank the support the MIA team has given to make these dialogues possible. Shira Collings’ enthusiasm and skill, James Moore’s graciousness and problem-solving, and Miranda Moore’s speed and acumen have been invaluable. As is so often the case, the face that you see is just the beneficiary of so many who give so generously. We all share in our gratitude for the chance to join with all of you to build on the opportunity for dialogue that each new challenge we face—together—presents.

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

14 COMMENTS

  1. Kermit,
    NAMI elevates the voice of the family over the sufferer of mental distress from what I read on MiA. However, it is my experience that MiA elevates the voice of the sufferer over the family. Until true parity and dialogue occurs and is facilitated between the 2 parties most interested in this entire topic, I wonder how much progress will be made.

    It appears Open Dialogue takes that more balanced approach though I have no personal experience with it (wish I did!). I hope some day MiA can move thru (and beyond) the pain and trauma of the sufferers to see that the families are suffering as well (from the fallout of the trauma and distress of the sufferer and not only from the effects of psychiatry) and healing will only come when all parties are brought together and learn how to love and create safety for everyone involved.
    Respectfully,
    Sam

  2. Hi Kermit,
    I am so thankful for MIA as well, not for myself (only) but as the educational and supportive platform they are, along with all of the commenters.
    I will say that I never read one book regarding “MI”, or it’s “treatments” before I became suspicious.
    In fact, it was some “self-help” books, that were the catalyst, er, or, perhaps they just “helped” lol.
    Process

    In fact I was thinking about Robert Whitaker yesterday, fondly and thankfully. I know he contributed greatly in getting people to think, to be critical.
    Which led to me being able to read so many enlightening comments from members.

  3. “I would like to thank the support the MIA team has given to make these dialogues possible. Shira Collings’ enthusiasm and skill, James Moore’s graciousness and problem-solving, and Miranda Moore’s speed and acumen have been invaluable. As is so often the case, the face that you see is just the beneficiary of so many who give so generously. We all share in our gratitude for the chance to join with all of you to build on the opportunity for dialogue that each new challenge we face—together—presents”

    Thank you for bringing attention to these wonderful dedicated and skillful people. My thanks as well.
    Jim

      • I’m MUCH more worried about “helpers” selling their secrets to psychiatry.
        I noticed someone sold them “mindfulness”. I also know, other merchandise is being shared in “good faith”.
        I get it. I get the civility, but it JUST DON’T WORK, being nice.
        It does not work for the indigenous to strike up deals. The land is almost gone.

        • Thanks Sam. I freaked a little the first time I tried to register and decided not to attend… then figured out the CODE and…

          Part of me wants to shake people and part of me feels really sorry for them. It’s a beautiful and weird thing these town halls. I appreciate the emotion from panelists, but also feel a bit hopeless by the “yes, but” fear of action. I quit peer support before the trial period ended because I was asked to do things that went against my values, like charting and policing and dumbing down my story so no one would get any ideas and try to come off meds too. If I can take a stand surely someone with more hiring potential could too.

          7 years too late, after my med withdrawal, an RT apologized to me. She said I had asked her for help as a patient, told her I was overmedicated, but she didn’t do anything because blah blah blah hierarchy, not my place, kids to put through college. It hurts to know that my life was not worth the risk to comfort level or college fund.

          Losing everything to do the right thing is not the worst that could happen. I don’t know how to get that across. I just get told I don’t understand or it’s different for me. Easier. Ha ha.

          So I’m experimenting with being less of a thistle. Professionals can be super sensitive. SUPER delicate. Higher the earning potential the easier fruit to bruise it seems. I’m not sure if it’s working, but it’s something to try. I really enjoy the town halls. Helps me be more fuzzy, less prickle.

          • Then again I heard meditation practice in the wrong hands could also be used as a form of social control. Maybe the government funded mindfulness CBT thing I just started is working. hmmmmm.

          • I get it. I know I can be “prickly”, which I try to control, but at the same time, I don’t want to keep opinions in, opinions that might offend people.
            Sure there are times that I do not say things that are on my mind 🙂 I wish psychiatry used that same approach. Perhaps when they “know” someone “fits” their “criteria”, they could just shut up.

            I often meet people and don’t tell them what I think of or about them. And yet I could, because what I say or think, does not affect them in every nook of their life.

            I think Town Hall has it’s own beauty, and I’m so happy to see you there….happy to see and feel a few people with the same concerns.. a different gathering… but I’m afraid of cross contamination with psy.
            But then again, I realize there are greater stories within each speaker, greater than my thoughts. It’s not so easy for them either. And of course I form opinions lol.

            I’m just certain of one thing. I doubt I can be friends with Psy.
            We can call that prickly, or we can call it insight, based on history and the continuation of that system. They keep borrowing, yet will not let go of the things that do not work.
            I see it as being busy trying to hold something up, which I hope those who get borrowed from, realize.

  4. quit peer support before the trial period ended because I was asked to do things that went against my values, like charting and policing and dumbing down my story so no one would get any ideas and try to come off meds too.

    Any “peer support” run by shrinks or their surrogates is by definition bogus. This is a concept that was stolen from the movement in the 80’s and is now in service of everything we opposed back then. The idea of mh pros of any kind presuming to set standards for “peers” should be seen as repulsive. The late great Stephen Gilbert, who worked as a “peer” at Arkansas State Hospital, has left behind a wealth of testimony as to the futility of trying to help people this way, check his MIA comment history.

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