Editor’s Note: This article, written by Heidi Tommila, was first published on our affiliate site, Mad in Finland.
The title of this article is from Jaakko Seikkula’s book Dialogue Improves—but Why? One subheading in chapter seven: “Psychological behavior is part of dialogue, not pathology.” I read the book last winter, but I’ve skimmed through it again a bit now and thought I’d write a few words about it.
In the book, Seikkula emphasizes, through its many twists and turns, that the most difficult mental health problems should be seen as an active activity of the mind in insurmountable stressful situations.
“What if psychotic behavior is not a “pathological state of mind”? In terms of helping, a more constructive perspective is to look at all the activities of the human mind in response to life’s events. Also, psychological symptoms are responses to life, not signs of illness. Often even the opposite: they show the mind’s active ability to protect itself in stressful situations.”
“Dialogical practice makes it possible to understand psychotic behavior as one possible response to an extreme stressful situation. Psychosis is not a psychopathological condition or a disease, but an active act of the human mind in an extreme situation.”
“Instead of viewing psychotic behavior as an abnormality of the brain or other psychic structure, it can be viewed as an active attempt by the corporeal mind to cope with extreme stress.”
“This is not a psychiatric illness, but a possible and necessary way for all of us to defend ourselves if we are in a challenging enough high-pressure situation. It is the mind’s active way of defending itself against insurmountable pressure.”
“The basic condition for everything is that the person’s experience is not seen as an illness, but as his active attempt to function under extreme pressure.”
Well, this is of course something quite different from what we are usually told. When I now type “psychosis” into Google, the search results refer to an illness, a mental health disorder, a state where a person’s sense of reality is disturbed, there are hallucinations, difficulties in distinguishing what is real and what is not.
Of course, the possibility of delusions cannot be completely denied. On the other hand, what is delusion and what is not? What is true? It’s not always clear-cut either, especially in the way that the Health Library takes a stand on this:
“Philosophers argue about what is truth, and history has bad examples of how the authority of treatment systems has been misused. In modern psychiatry, the problem of truth is approached very practically. It is usually not unclear when a person’s sense of reality has been disturbed. A psychotic symptom is—to roughly generalize—a thought or sensation that feels real, which other people representing the same culture think is not true.”
And when I look at it from my own point of view, many of the concepts of prevailing psychiatry appear to be delusions, even with scientific grounds.
In dialogical practice, according to Seikkula, the narratives of a person who comes to treatment for psychotic symptoms, which appear to be delusions, are treated as experiences that could not be put into words due to the massive emotional upheavals contained in the experiences. And delusion as a word does not describe the matter at all, but instead we think that the person is talking about something important that really happened through them. The memories related to those experiences awaken with the experiences of this moment.
The stressful situation at this moment can remind you of the original terrifying experience to some extent, or the reminder can be from a very small clue, for example a similar emotional experience or the sensation of a smell or color. In this case, the body reacts according to some real traumatic event, but it manifests itself metaphorically as if it also happened in this moment. For example, a person may feel that someone close to him is threatening his life because he has a memory of an old experience of violence where someone really threatened his life.
However, this also gives me the idea that the possibility should be taken into account that someone’s life may have been threatened even closer to this moment, and not just in the past. This too could possibly appear as similar emotional experiences and reactions considered psychotic, as the reactions evoked by past experiences.
Seikkula writes that hallucinations have been said to be stories related to real events in life, which are accompanied by the perceived horror of death. And it would be very important to understand that the patient is talking, if sometimes more or less metaphorically, about real experiences, and not just consider them meaningless delusions. And through them, a person can get in touch with the traumatic experiences of the past for the first time; they allow these experiences to be put into words, perhaps for the first time in a person’s life. A person also has fewer opportunities to get to know their own experiences if their reality is not accepted. In addition, this weakens his chances of controlling his own behavior. Focusing on symptoms, seeing them as a disease or a disorder of brain function, and over-pathologizing problems often also weakens a person’s ability to manage their own life and integrate experiences.
I think it is quite aptly said when Seikkula writes:
“Respecting and listening to the other person becomes the main goal of dialogical work, while in psychiatric treatment the goal is often to find out ‘how crazy the other person is’ and what the family’s problems are, if there is any interest in meeting the family at all.”
For some reason, I think it wouldn’t be such a big change to start treating patients and their experiences like this. And what a big meaning that could have!
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.
Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.