Day 578

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This is the question : How can we Re-create Psychiatry?

How can we break down the“us” versus “them” approach?

How can we stop ourselves from putting people into neat little labelled boxes rather than perceiving each one as a unique individual with their own unique story and experience?

How can we communicate in a way where we respect boundaries but do not create barriers? How can we truly listen in a way that we can put ourselves in someone else’s shoes?

There is a hierarchy in knowledge. Intellectual knowledge is considered superior to emotional or experiential knowledge, which in turn is rated higher than seemingly irrational knowledge, which could come from ‘patients’ with seemingly little insight. Who makes these decisions? How come the power balance between psychiatrists(intellectual/clinical) and patients(experiential/seemingly irrational) is so extremely warped? Does looking at people through templates give us any idea of who they truly are?

The Open Dialogue approach is a philosophical/theoretical approach to people experiencing a mental health crisis and their families/networks, and a system of care, developed in Western Lapland in Finland over the last 25-30 years. In the 1980s psychiatric services in Western Lapland were in a poor state, in fact they had one of the worst incidences of ‘schizophrenia’ in Europe. Now they have the best documented outcomes in the Western World. For example, around 75% of those experiencing psychosis have returned to work or study within 2 years and only around 20% are still taking antipsychotic medication.

Working with families and social networks, as much as possible in their own homes, Open Dialogue teams work to help those involved in a crisis situation to be together and to engage in dialogue. It has been their experience that if the family/team can bear the extreme emotion in a crisis situation, and tolerate the uncertainty, in time shared meaning usually emerges and healing is possible.

This Open Dialogue training launches in London next month.

 

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