Dialogue as a Response to the Psychiatrization of Society? Potentials of the Open Dialogue Approach

Abstract

In recent decades, the use of psychosocial and psychiatric care systems has increased worldwide. A recent article proposed the concept of psychiatrization as an explanatory framework, describing multiple processes responsible for the spread of psychiatric concepts and forms of treatment. This article aims to explore the potentials of the Open Dialogue (OD) approach for engaging in less psychiatrizing forms of psychosocial support. While OD may not be an all-encompassing solution to de-psychiatrization, this paper refers to previous research showing that OD has the potential to 1) limit the use of neuroleptics, 2), reduce the incidences of mental health problems and 3) decrease the use of psychiatric services. It substantiates these potentials to de-psychiatrize psychosocial support by exploring the OD’s internal logic, its use of language, its processes of meaning-making, its notion of professionalism, its promotion of dialogue and how OD is set up structurally. The conclusion touches upon the dangers of co-optation, formalization and universalization of the OD approach and stresses the need for more societal, layperson competencies in dealing with psychosocial crises.

Trigant Burrow and the social world

“…In other words, the patient or client's “abnormality” is not and should not be seen as an individual pathology, but, rather, as a pathology in society―which is an example of what Bourdieu refers to as “misrecognition.” This has huge implications for how we understand pathology (and, therefore diagnosis and treatment); the patient/client; and the role of the psychoanalyst/psychotherapist, especially for those groups that have been pathologized and marginalized by psychoanalysis and psychotherapy (for a history of which, see Schwartz, 1999). Thus, we join the call for the de‐psychiatricization of society (von Peter et al., 2021).…”

“…As we become less ego‐centric and more contentive, a term Burrow coined to describe a pattern of more instinctive orthotonic responses, we give up our authoritarian position in the therapeutic relationship, and no longer attempt to manipulate our client into change. We let go of the medical model, adopt a growth model, and become more responsive to our clients (Drury, 2017; von Peter et al., 2021). We see this today in Seikkula's (2011) Open Dialogue , a most successful approach to psychosis, which Seikkula himself says he feels “uneasy to name as a therapeutic method ” (p. 191).…”

“…in 1952). Psychotherapy and psychoanalysis would look quite different if the root metaphor for the person was the organism (see, for instance, Tudor & Worrall, 2006), the default setting for therapy was group therapy (see Tudor, 1999), and therapists challenged “individual think.” This is the reason why mental health services in many countries are in such a mess (Drury, 2014; von Peter et al., 2021).…”

The Lost Social Context of Recovery Psychiatrization of a Social Process

“…Tolerance of uncertainty is emphasized in order to make possible a multi-voiced, transdisciplinary collaboration involving those concerned by the situation (Holmesland et al, 2010 ). In a recent paper it is explicitly argued that Open Dialogue Approach may offer a less psychiatrizing form of support through its potential to (1) limit the use of neuroleptics, (2), reduce the incidences of mental health problems, and (3) decrease the use of psychiatric services (Von Peter et al, 2021 ).…”

De-psychiatrizing our own research work

“…The contested presumption of the biomedical nature of madness and distress remains implicit in the work of many critical psychiatry scholars who seek to engage in “less psychiatrizing forms of psychosocial support” (von Peter et al, 2021 ) or routinely assume the existence of “apolitical or irreducible distress” (Logan and Karter, 2022 ). This kind of subtle but persistent othering subverts efforts to eradicate the psychiatrization of human experience as a matter of principle (LeFrançois et al, 2013 ; Burstow et al, 2014 ; Russo and Sweeney, 2016 ; Beresford and Russo, 2021 ), regardless of its spread—and despite circumstances that can turn “mental illness” into an acceptable explanatory framework that legitimizes medical “solutions” to the complexities of living.…”