Editor’s Note: Award-winning journalist Lisa Ling is the host and executive producer of the CNN Original Series, “This is Life with Lisa Ling” which airs Sundays at 10 p.m. ET/PT starting November 27. The views expressed in this commentary are her own. Read more opinion on CNN.
It’s hard to describe what it’s like when less than an hour after I meet someone, a person divulges a trauma, or some deeply held secret.
The scene often goes like this: We sit across from one another and our eyes meet. Our breathing slows, deepens to an audible level and our limbs begin to fidget. And then the tears start to flow.
At that moment a bond develops between the two of us that is different from the ones I have even with my close friends or family members. But it is a human connection that is special and, at times, even sacred.
For nine seasons, these are the moments I’ve shared with people whose lives have become part of the documentary series, “This Is Life.” They could not be more different from one another, or from me, but they share in common being people I might never have gotten the opportunity to meet if it weren’t for our show.
I can recall them each so clearly: The mother who avoided coffee and alcohol all of her life in deference to her Mormon faith’s Word of Wisdom, but who like so many in her community, had become addicted to the opioids that her doctor had prescribed to her and so many others for pain.
The former Colorado prosecutor who decided to undergo psychedelic therapy for a severe mental health crisis that was triggered by a home invasion.
The group of Chicago teenagers who told me that they were all eight or nine years old when they saw someone get shot in their neighborhood for the first time.
The couple in their 70s who I met at a swinger convention who explained how essential trust was in their relationship for them to be at such a lascivious event.
The graduates of a fatherhood program in jail who attended a father-daughter dance inside the facility where they were incarcerated.
Over the course of nearly a decade, we have embedded and immersed ourselves in communities big and small, throughout almost all of the 50 states. In all of our shows, we have sought out a deeper understanding of who people are and why they might do or think the way they do. And as diverse as our seasons are topically, the thread that ties all of our stories together has been the uniqueness of the American experience.
But these days, I find myself asking: What does the uniqueness of the American experience even mean at a time when our nation is deeply divided and the very notion of who gets to be American is in question? We have emerged from a global pandemic psychologically battered and emotionally bruised. We have endured lockdowns, protests, insurrection, sky-high inflation. Add to those things media and social media that are literally pushing people in opposite directions and the question of what it means to be an American has taken on a somber urgency.
Now more than ever, we are glued to devices and following only those who espouse the same things that we do. We are finding ourselves in bubbles that are becoming increasingly difficult to penetrate.
In the push to personalize our social media feeds, many of us have boxed ourselves into ways of thinking that are intolerant of dissent.
Most of the time, we’re not even thinking for ourselves anymore. When big tech collects data on our viewing and buying habits and delivers information to us individually that algorithms determine we might want to see or consume, it shuts us off from other ways of thinking and extrospection. And because our devices have been designed to inundate our brains with information, we’ve become numb to things that might ordinarily cause us to feel. We are momentarily tantalized by clickbait, then we just swipe to the next thing. And the cycle repeats.
The risk in all of this is that we don’t take time to understand context or think critically, because we’re too busy scrolling aimlessly without time to reflect on what it all means. This cycle is a phenomenon our show has looked at in detail: People, predisposed to feelings of paranoia who have been pushed to the extremes by media that caters to their preferences, or the information they seek out.
What we have tried hard to do over the years is get to know people beyond the surface level—or the headlines. What do the lives of the people who might be vulnerable to conspiracy theories and extreme media look like day to day? On what are their fears based? How might our own fears or concerns collide or intersect? I’ve never felt more strongly about the work that we do, the questions we ask and the conversations that we have on “This Is Life” than I do now, because it’s been, I have always believed, that the more we know about each other, the better we become. This show has given viewers a window into the private lives of people that you may have heard of or have an opinion about, but never really taken the time to get to know. Now is the time to get to know more intimately the lives of our fellow Americans.
In our final season, we take a probative look at the future of humanity itself, focusing, for instance, on the long-term effects of isolation and mental health. As we spend more and more time on our devices and increasingly seek validation in the form of “likes,” from people (or bots) we may not even know, our in-person exchanges are decreasing. Parents are lamenting that their kids would rather be on devices than play with other kids, engage in physical activity or do just about anything else.
In one episode, we meet a teenager named Glenn who hasn’t had a meaningful face-to-face interaction with a human being in years. Instead, he spends countless hours in his bedroom wearing an Oculus headset and journeying to virtual worlds and meeting people in the metaverse. This young man has sought to avoid profound social anxiety and rejection, but in doing so, he has lost all meaningful in-person interaction. If more people like him start forgoing human relationships, we could start losing the ability to interact with one another. The potential of becoming desensitized to the human experience and emotions, while existing in a virtual world, could be very real.
By doing this, a young man who professes to have intense social anxiety, Glenn can avoid having to deal with the rejection that has plagued him his whole young life. But when legions of people start living without meaningful human relationships, what does that mean for our species?
As Dr. Bessel Van Der Kolk writes in the bestselling, “The Body Keeps Score,” “Being able to be safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.”
Get our free weekly newsletter
After an almost two-hour VR session in Glenn’s bedroom – I was the only person outside of his family who has ever been in his room – where we slayed dragons and took part in a speed dating game that, at times, tested Glenn’s anxiety, he told me of his deepest wish.
“I would really like to have a girlfriend one day,” he said, “a real girlfriend.”
No matter how “real” virtual reality becomes, once you take the headset off, you’re still alone. And nothing compares to human touch, comfort, vulnerability and emotion. Those are things that we are supposed to feel. The human connections I’ve made with everyone who has participated on our show over the years, have changed me. The depths of the stories people have shared with me, the vibration of their bodies as they’ve wept, at times, in my arms. Witnessing the joyful faces of those who’ve overcome seemingly insurmountable challenges.
It has been an honor and a privilege to share these human moments with so many over the years. I’ve become a better person as a result. And it’s these kinds of interactions that we need more of in America today. During these deeply divided times as we are being pushed further into extremes, we have to be proactive about exiting our bubbles and engaging. After all, THIS IS LIFE.
For updates on CNN’s Original Series and Films, sign up for our Keep Watching newsletter. Every week, you’ll receive insider information, including exclusive notes from the hosts and filmmakers of your favorite films and series.
“Dissociating” has become an internet buzzword, but what does it mean and how common is it really? A study published in the Journal of Psychiatric Research suggests that this mental disconnect may be very common among people with depressive symptoms.
Dissociation is a word used to describe a mental detachment or separation. It is a popular word on social media now, and it can be used to describe normal forgetfulness, daydreaming, or absent-mindedness. It also has a pathological definition, which can include amnesia, hearing voices, flashbacks, derealization, depersonalization, identity fragmentation and more.
These symptoms can be associated with experiencing trauma or significant stress. Depression, which many people suffer from and can be very difficult to treat, can encompass these pathological dissociative symptoms as well. This study sought to explore the relationships between dissociative symptoms, depression, trauma, and other potential mediating factors.
Hong Wang Fung and colleagues utilized 410 adult participants with self-reported clinically significant levels of depressive symptoms. Participants were recruited online and completed their survey on the web. Measures included questionnaires regarding sociodemographic information, depression symptoms, dissociative symptoms, trauma experiences, interpersonal stress, family support, and perceived benefits of psychiatric medication.
Results showed that the majority of participants reported experiencing clinically significant levels of dissociative symptoms. Some dissociative symptoms, such as disengagement and depersonalization, were very common and were found in over 70% of participants, while others, such as identity dissociation, were much rarer. This study found differences between participants who showed high versus low levels of dissociative symptoms.
Participants reporting higher levels of dissociation also reported higher levels of childhood and adulthood trauma, interpersonal stress, PTSD symptoms, and depressive symptoms. This leads to the idea that dissociative symptoms could potentially be one reason that depression can be difficult to treat. Additionally, emotional constriction, a dissociative symptom, was found to be related to decreased perceived benefits of psychiatric medication, which also has treatment implications.
This study took strides into better understanding the prevalence of dissociative symptoms in people with depression. Despite this, there are limitations to note. One such limitation is that the sample was recruited online and was not a clinical sample. With self-report symptoms, it is difficult to say if all participants would reach diagnostic criteria for depression or dissociative symptoms. Additionally, people going through more severe mental health problems were excluded, and due to the distressing nature of dissociative symptomology, it is possible this limited generalizability.
“This study contributes to the literature by systematically investigating the prevalence and correlates of dissociative symptoms in a sample of people with depressive symptoms,” the researchers concluded. “Dissociative symptoms were positively correlated with trauma, stress and trauma-related symptoms in our sample. People with depression should be screened for dissociative symptoms so as to ensure timely interventions for addressing trauma and dissociation and their related symptoms as needed.”
The study, “Prevalence and correlates of dissociative symptoms among people with depression“, was authored by Hong Wang Fung, Wai Tong Chien, Stanley Kam Ki Lam, Colin A. Ross.
Being a parent is a chaotic life, and there is really no saving you from that fact. However, that doesn’t mean that you can’t cut a few corners, so to speak, to make life with kids just a little bit easier.
While these tips and tricks likely won’t take away all of your stress, they can most certainly help you to alleviate some of it. Whether you are new to parenting, or even if you are a professional when it comes to parenting, at least a few of these tips are going to simplify your life immensely. Here are 5 tips seasoned parents swear by to make life with kids just a little simpler.
1. Commit to a bedtime routine.
It might sound like more trouble than it’s worth, but actually, not having a bedtime routine is what is more trouble than it’s worth. When your kids go to bed at the same time each night and have a routine in which every step is accounted for, they aren’t going to fight you when it comes time to go to bed, at least not as much as if their bedtime is always inconsistent.
2. Shop consignment sales for kids’ clothing.
Kids’ clothes can be super expensive, and at the end of the day, it is unlikely that their clothes or shoes will last very long before they outgrow them. So, purchase their clothes on consignment and when they are done, put them back up for sale.
3. Keep vinegar on hand at all times.
Vinegar is such a useful thing, it can be used to alleviate the pain of a burn, to clean just about anything, and it’s also convenient for cooking. Make sure you keep a bottle on hand just in case.
4. Stop folding newborn clothes.
Newborns do not care if their clothes are wrinkly. So keep them in a special basket that is mostly organized and call it a day.
5. Instead of birthday presents, ask for this.
Birthday presents are awesome, but do you know what is even more awesome? Having a night to yourself to eat your cake in peace. So, tell your friends and family that what you would like more than anything is to have someone watch your kid(s) for a few hours.
A third of people at risk of depression and anxiety could prevent it by getting enough exercise, a study suggests.
Exercise is a well-known treatment for those with depression, with doctors even prescribing it.
But moving more could prevent people becoming depressed and anxious in the first place, a study of more than 37,000 people suggests.
If everyone managed 75 minutes a week of vigorous exercise – which makes you breathe hard and includes running and swimming – it could prevent almost 19 per cent of cases of depression and anxiety, researchers concluded.
Research suggests regular exercise could reduce diagnoses of depression and anxiety
And if we all did between two-and-a-half hours and five hours a week of moderate activity – which makes you breathe faster and includes brisk walking, cycling and dancing – another 13 per cent of depression and anxiety diagnoses might never happen.
These findings suggest almost a third of cases of depression and anxiety, which affect one in five adults in the UK, might be preventable through exercise.
Dr Carlos Celis-Morales, senior author of the study from the University of Glasgow, said: ‘This is a very strong public health message, as exercise is free, and everyone can increase how much they do in a week.’
The study, in the journal BMC Medicine, looked at people aged 37 to 73 who had not anxiety. They were given fitness trackers to monitor physical activity.
When they were followed up, for almost seven years on average, around 3 per cent had developed depression or anxiety.
Based on the results, researchers calculated that sedentary people who switched to 75 to 150 minutes a week of vigorous activity would be 29 per cent less likely to develop depression or anxiety.
Doing 150 to 300 minutes a week of moderate physical activity would reduce the risk of becoming anxious or depressed by 47 per cent.
More research is needed, as the study authors do not yet understand if it is the exercise itself making the difference.
Although physical activity does flood the brain with reward chemicals, the benefits may be more about exercising with other people and the boost we get from socialising.
Share or comment on this article:
A third of people at risk of mental health issue could avoid it with regular workouts, study shows
The views expressed in the contents above are those of our users and do not necessarily reflect the views of MailOnline.
Add your comment
By posting your comment you agree to our house rules.
Do you want to automatically post your MailOnline comments to your Facebook Timeline?
Your comment will be posted to MailOnline as usual.
Do you want to automatically post your MailOnline comments to your Facebook Timeline?
Your comment will be posted to MailOnline as usual
We will automatically post your comment and a link to the news story to your Facebook timeline at the same time it is posted on MailOnline. To do this we will link your MailOnline account with your Facebook account. We’ll ask you to confirm this for your first post to Facebook.
The issue of mental health featured prominently in a recent survey of members from Nautilus’s Netherlands branch, with some feeling dissatisfied with elements of their work. Linde de Visser and Sascha Meijer examine the outcomes of this survey and look at what Nautilus is doing to make sure members can ‘sail with satisfaction’
Disillusioned with sailing
More than a quarter of our working members who participated no longer enjoy sailing due to the Covid-19 pandemic and Ukraine war. Of the 161 working members that completed the survey, more than half indicated that they find sailing less enjoyable due to recent developments.
Lack of communication
The survey also indicates that contact with shore organisations has deteriorated since the start of the pandemic, whilst workload has increased.
In 2018, the research report ‘Seawater through the veins’ also showed that factors like human contact in communication between shore and ship, as well as targeted career conversations, are important to seafarers.
In times of war and pandemic, seafarers have experienced their HR and crewing departments more as ‘crew change departments’.
Almost half of the respondents stated that they want to stop working early, but for the most part it is not financially feasible.
‘Sailing with satisfaction’
The rather shocking results of the survey prompted Nautilus to give its annual symposium in June 2022 the theme of ‘safe sailing with satisfaction’, and to put ‘sailing with satisfaction’ on the agenda in the maritime sector.
A previous Telegraph article reported on input from Nautilus members and industry representatives on this topic. During the symposium the initiative was supported by the public, with almost everyone present agreeing that ‘yes, I find safe sailing with satisfaction important’.
More than half of the seafarers who completed our survey think their current mental health is fine, but this is still a concerning figure. Internationally there are studies that raise serious concerns about the mental health of seafarers. Insomnia, depression and even suicide are alarmingly common. Much more attention should be paid to this subject, to make sure that the industry remains attractive to Dutch seafarers.
The European Transport Workers Federation (ETF) organised a symposium on mental health on 16 September. Sascha Meijer, the vice-chairman of Nautilus’s Netherlands branch, took part due to her Union position and her as chair of the EU consultation between unions within ETF maritime transport. Nautilus member Captain Rudolf Roozendaal started off the conversation with a video message about his time as a captain onboard a Dutch merchant vessel.
There were various speakers from across the maritime sector, ranging from doctors to employers. Belgian medical examiner Rob Verbist said one problem is that seafarers with mental health issues are not always seen by doctors with maritime knowledge. As a result, it takes longer to develop standard protocol for helping seafarers. Speakers emphasised that there is still a taboo about mental health problems and that some seafarers are even afraid of blacklisting.
Sailing with satisfaction in CBAs
We are also making sure sailing with satisfaction is on the agenda in collective bargaining agreement (CBA) negotiations. In 2019, in addition to a scheme for early retirement, provisions were included in the merchant shipping CBA about the additional factors that make jobs sustainable. For example, flying with as few stressful stopovers as possible, and holding career conversations with seafarers.
For the 2023 CBA, we are now discussing with our members what they would like to see in terms of help. Members have indicated that messages of appreciation – and being properly rewarded for good work – are major issues for them.
Jaakko Seikkula, along with Markku Sutela, created the Open Dialogue approach to acute crises in Finland. Jaakko is a clinical psychologist, a researcher and a professor of psychotherapy at the university of Jyväskylä, Finland. For more than 40 years, Jaakko has been developing the human practice of working with the most severe kinds of psychological and emotional distress. His work has gained interest worldwide, and his books have been translated into 15 languages. Lately, his main interest has been in organising a world-wide network of training in Open Dialogue to support its development. So far, this has taken place in more than 30 countries, which has included several important research projects.
—Interviewed by James Barnes.
JB: Many thanks for agreeing to this interview, Jaakko. I’m really very interested in Open Dialogue—and your work especially—as I think many others are, and increasingly so. It seems to have profound implications for care, and how care is structured, especially for those who experience more extreme and distressing states of mind. Just to start us off, would you give our readers a brief introduction to Open Dialogue and how it differs from psychiatric treatment as usual?
JS: Open Dialogue differs in many ways from common psychiatric services and the ideology that it involves. Treatment as usual targets the ‘symptoms’ of people in need of help. It is often organised around diagnostic categories and the main aim is to offer interventions for those ‘symptoms.’ Medication is seen as the primary option, especially in the most severe crisis such as ‘psychotic’ problems. Treatment as usual emphasises the individual, and if the family is seen as important in some cases the family is invited to think about ‘the illness’ and how to prevent it. Services most often do not have any continuity; rather, each distinct service is giving their own packet of care and it is the task of the clinicians to decide what methods are used and in what diagnostic category.
The idea of Open Dialogue, by contrast, is to meet with the full human being in their relational context, in which the specific ‘symptoms’ are secondary. All the decisions about the care are made in a shared process between the clinicians and the clients—the one in the centre of crisis, the family, and the rest of social network, if seen as important.
Open Dialogue organises services in an optimal way to support dialogue among the people who participate in the meetings. In this way, it involves two issues at the same time: organising services and generating dialogue. The optimal way has proved to include guaranteeing the immediate start of the process after coming into contact to services; always including the perspectives of the family and the rest of the person’s social network; integrating different methods of care based on the unique needs of each person; guaranteeing the continuity of the team in charge of the care; increasing safety and emphasising a capacity to tolerate the uncertainty included in crisis; and, in the end, to have the primary focus on generating dialogue instead of aiming to change the people in need of help. As a paradox, not focusing on symptom interventions seems to remove the ‘symptoms’ most effectively, as we have repeatedly seen in several studies.
JB: I wonder if you could briefly explain how working ‘dialogically’ helps the person in the crisis. You say in one of your papersthat it is a “voice-making, identity-making, agentic activity occurring jointly ‘between people.’” Could you break that down a little for us?
JS: Well, the main idea is to listen carefully to each participant in the conversation, accepting their comments without exceptions or conditions. Within this unconditional respect for their voices, people start to listen to themselves. They learn more about their own story. This is why, in the dialogical approach, we do not look to find some right story, or some right commentary on the story of the person in crisis. Really, what is most important is the response in the here-and-now while speaking about the important issues of one’s life.
The most difficult and most important experiences most often do not have any words, such that it would be possible to have an explicit narrative about it. They emerge in being moved, e.g. in an emotional reaction, by the things being told. This is the most important moment for a dialogical practitioner. Many times, I myself, for instance, notice this in repeating word for word what a person says and asking them to say more about the issue. In this way, the story starts to emerge and the one speaking becomes more of an author of her/his life again.
It is not only sharing with the clinician, but sharing with the rest of the family or other members of the social network. The extra power in Open Dialogue comes from the most important people in the person’s life being present and sharing this moment. Everything shared and said receives its meaning in the relational context of the one in crisis. Thus, the resources to survive and find a perspective in one’s life are multiplied.
The voices are present in two forms. Firstly, the voices of those persons present in the dialogue and their points of view, which are respected without any conditions. And secondly, the inner voices of the participants and their points of view. These inner voices may be actualised, for instance, in conversation when speaking about experiences that move both the one who is speaking and those listening. The inner voice should be respected also without conditions.
This means that to get help you do not need to have the capacity to describe in explicit words what has happened and what that means to you. It is enough to share the experiences of becoming moved. Also, the inner voices may appear in many different forms and sensations. One does not need to have a particular kind of reaction; all reactions are respected. This is important when we meet with a person with ‘psychotic’ experiences. At one point they may talk as any other might about the occasions of their life. In the next moment, all of a sudden, they may start to speak in ways that are incomprehensible, or may start to act in unanticipated ways. All are accepted forms of participating in the dialogue and are not considered as ‘illness’ or ‘strange.’
JB: Much appreciated. So, I wanted now to ask you specifically about how Open Dialogue views the ‘psychotic’ experiences that it often works with. Mainstream psychiatry views such experiences as expressions of neurological/neurocognitive disease processes, heavily linked to ‘faulty genetics.’ The American Psychiatric Association, for example, terms schizophrenia a “chronic brain disorder.” In what way do you understand it differently and what is your view of the mainstream model?
JS: As in any other phenomenon of human life, there are many different ways to understand the problem. One of them is the medical model that you refer to. The medical model, unfortunately, has taken over the field over the last 30 years, which has caused a lot of harmful effects on the practice. In one of the long-term follow-up comparisons between Open Dialogue and treatment as usual in Finland, it appeared that there has been no development in practise over the last 25 years. I think that one reason for this is the emphasis on ‘psychosis’ as primarily psychopathology—that it really is a brain disease and consequently the intervention needed is medication to the brain. This view is very one sided, as it does not take into account all of the other elements of the person and their family’s life, and by so doing it has been very harmful to the development of new practices.
In my mind, a much more effective way is to think about ‘psychotic’ behaviour as an embodied psychological response to extreme stress. ‘Psychotic’ experiences are one form of defence that the embodied mind uses to protect itself against a total disaster. They are not pathological, nor signs of an illness, but necessary survival strategies that everyone of us may need in an extreme situation. The extreme situation may be something that is occurring in the present, or it may be drawing on earlier experiences in a person’s life. In hallucinations, the person is most probably speaking about real incidents that have happened, but which they do not yet have any other words, other than ‘psychotic’ ones, to express it with.
Following this way of thinking, it really is not the aim to try and get rid of ‘symptoms,’ because they seem to include the most essential parts of the painful experiences. In focusing on getting rid of them, the ‘brain disorder’ model is actually destroying a lot of the potential and possibility of regaining authority in one’s life. We, as professionals, have to be ready to tolerate the situation without words and start to listen carefully to what the other one is saying, although it may sound totally un-understandable in the beginning.
JB: Open Dialogue pulls on a rich academic and psychotherapeutic history including Gregory Bateson’s famous ‘double bind’ hypothesis of schizophrenia and the ‘Milan school’ of family therapy for psychosis among others. These approaches—like Open Dialogue—understand communication and interpersonal relationships to be at the heart of the ‘psychotic’ processes. Firstly, what is the reason, in your view, that these ways of understanding and responding to such experiences were marginalised and dismissed for so long? And, secondly, how has Open Dialogue built on these approaches?
JS: It is not only these relational methods, but psychotherapy overall! For me, it seems that, since the early ‘90s, many sections of psychotherapy, including family therapists, have abandoned working with ‘psychotic’ patients. It seems as if the neurobiological brain disease explanation was adopted also in the psychotherapy field, with the exception of some parts of cognitive behavioural therapy, some psychodynamic therapists, and Open Dialogue folk.
Sorry for my emotional reaction! I really feel sad and mad when I think about the reactions of psychotherapists. Coming back to your question about Bateson and the Milan model in relation to Open Dialogue, they were—as you said—markers of the field to us, and to me personally. The Milan model brought us the importance of working as a team and understanding the importance of the family. At the same time, however, we realised the limitation of the family system approach’s idea that the problem behaviour was only a function of the family system. So, for instance, ‘psychotic’ behaviour was seen as a functional way of increasing family coherence. One part of that continues to look for the pathology in the family and thinks it necessary to analyse the family system in order to understand the functions of the ‘symptomatic’ behaviour.
One of the essential steps in developing Open Dialogue was to give up pathological thinking altogether, and start to work with all the families in crises without any question as to whether there is a need to change the family system. In doing so, families became allied to us in severe crises and were no longer targets of our therapeutic interventions. It may be that this is one of the reasons for the Milan model losing its power. It proved to be very challenging and difficult to put into practice, whereas dialogical practice was easier in the sense that it does not presuppose a specific explanatory model of the problem. Working in a dialogical way was very relieving to us as professionals, because we respect, without conditions, the different perspectives of family members.
JB: Great, thanks for that. I want now to ask you more about some of the specifics of Open Dialogue if that’s ok. Firstly, about the principle of ‘tolerance of uncertainty.’ In the same paper mentioned above, you say that this principle is “the opposite of the systemic use of hypothesising or any other kind of assessment tool.” As I understand it, Open Dialogue invites an almost antithetical kind of approach and activity to psychiatric diagnosis. It seems to me that the psychological and sociological act of psychiatric diagnosis is, at least in part, a defence against the anxiety, powerlessness, and overwhelm that one can experience when faced with, and tasked to help, someone in an extreme state of mind or deep distress. It’s a sort of concrete solution that provides a way of (at least temporarily) having some control over these feelings. I wonder what your thoughts are, and if you could speak a little bit about the principle?
JS: Yes, I agree with you. I think that the main thing to do, in terms of helping people in their crises, is to share their experience, which is what tolerating uncertainty is all about. We do not have responses or solutions to give to the family. Instead, we share in their desperation and hopelessness. This can only be done if we receive their emotional experience and start to live in and with the very same desperation that they are expressing in their words and—mostly—in their emotional embodied reactions. We, as professionals, need to learn to live in the uncertainty together with the family, or single client, and in this way it really involves both parts—the people and the professionals.
So long as one aims at making the right diagnosis of the person or of the family system, the risk increases of being outside as an observer in the professional—expert—frame, which may restrict the capacity to be present in the moment and share in the most essential experiences that do not have words.
JB: Another specific principle I wanted to ask about is the focus on consistency and ‘psychological continuity,’ and, relatedly, the central importance of safety, trust, and ‘containment.’ Again, I think it’s fair to say that these principles have been somewhat neglected by institutional psychiatry in its preoccupations with biomedical explanations and solutions. It strikes me, though—as I’m sure you are aware—that these principles are in fundamental alignment with humanistic, ‘trauma-informed’ and relational psychotherapies—though these are usually individual psychotherapies. I wonder how you see the overlap?
JS: Well, you are listing the main elements of any type of human meeting with people in crisis, regardless of whether that meeting is with one person by one practitioner, or if it is a meeting of a team with a single person or a family. In a multi-actor setting—family meetings with a team—there are at least two specific elements, which actually in my mind increases the resources to survive. The first element is that if the family is present, every conversation, every word, every utterance receives its meaning not only in the speaker but at the same time among all the listeners. Everyone participates in the dialogue openly, or in their inner dialogue. Repeatedly, I hear that the utterance of one family member surprises other family members and this experience already increases the polyphony within the family. This is enough in the sense that the need to try and give meaning by giving some interpretation decreases.
The second special element is the team itself. The team is working together by openly sharing their feelings and thoughts and by so doing they are ‘containing’ the suffering of the family within their communication and at the same time creating new resources. For the family, this seems to be mostly a very interesting experience because they hear so many perspectives about their dilemmas, and thus, in the many voices and perspectives they have new resources to deal with it. Many times, the conversations among the team members demystify the problem, and challenging issues become more normal and possible to deal with in everyday life.
JB: Much appreciated, Jaakko. I would like now to turn to a quote from one of your papers. You say, “It is its very simplicity that seems to be the paradoxical difficulty. It is so simple that we cannot believe that the healing element of any practice is simply to be heard, to have response, and that when the response is given and received, our therapeutic work is fulfilled.” Very elegantly worded, and I think this again very much aligns with the approaches above. It also reminds me a lot of the kind of ‘un-learning’ that one does training as a psychotherapist. The paradox seems to be that fending off the desire to provide an explanation, a cure, a solution to a person’s distress, is what ultimately makes real healing possible. Mainstream psychiatric interventions essentially do the exact opposite. To what extent do you think that it is this dialogical, intersubjective process that is ‘doing the work’ in Open Dialogue?
JS: In my mind, it is the dialogue in multi-relational settings that makes the difference. As I already said, I don’t think that the meanings that we find in the conversations are so important. What is much more important is to participate in the dialogues with our entire bodies, with our affects and sensations. This is the healing process. It is not to know the exact diagnosis—although I think it is important to recognise that we meet with people who may have ‘psychotic’ reactions—and neither is it the skilfulness of the therapist in giving good interpretations at the right moment. It is the sharing of the situation with our clients. This seems to be challenging to adopt because we practitioners are so used to thinking that it is our interventions that make the difference.
JB:I’d really like to get your thoughts on psychiatry’s interest in Open Dialogue. It seems to me that there are some psychiatrists who are genuinely interested in embracing a different paradigm. There are others, though, who more or less want to subsume it into psychiatry. A fairly well-known psychiatrist said to me that what’s important about Open Dialogue isn’t the dialogical philosophy and approach, but just how it engages families and social networks and minimises power differentials. That struck me as a little conceited and a problematic stance to take. Would you comment on what you think about these kinds of attitudes, and on the relationship you see it having with the institution of psychiatry going forward?
JS: Well, I think that people need to make strange things—like Open Dialogue—more familiar to themselves by thinking within more familiar frames, which they are used to. Perhaps in this way the challenge of the dialogical approach does not seem so big. I find some part of the comment very true: we really need to find ways to mobilise the social network into the healing processes. And there we need practical guidelines. But it is only partly true. The other part really is the dialogical philosophy: how to learn to respect the other without any conditions and how to realise this in the meetings with our clients. How do we dissolve the expert role and come to the similar level with our clients? That is the challenge, and I think that one cannot resolve that challenge without deep dialogical training. It is good to remember that the results of the Open Dialogue outcome studies were of studies conducted by practitioners with the highest training in Open Dialogue.
JB: That makes a lot of sense, thanks. Finally, I wanted to take a quote from a paper you co-wrote along with former UN special Rapporteur Danius Pūras among others: “Such an approach [Open Dialogue] exists in agreement with a post-psychiatric perception of mental health care epistemology and practice, which prioritises basic human values and everyday relationships, context-bound understandings, and local belief systems over symptoms and clinical diagnostics.” I think many people feel that in-patient psychiatric facilities have been and still are at odds with human rights. It seems to me that Open Dialogue provides a solution to this. Do you agree?
JS: Thank you for that thought. I really think that Open Dialogue respects human rights as an attitude, fulfils it in each new situation with the people who need help and in every single meeting with them thereafter.