Let me introduce our project by telling you about our first article. In 2017 the Finnish journal Psykoterapia-lehti published ‘Psykoosi: Sosiaalinen destruktionismi’, which deals with the personal yet abstract nature of mental illness. We were very excited; it was our first academic article. We had originally drafted it in English and were planning a more ambitious version for the international readership, one that would more generally address the theory and practice of psychiatry. The result is now published on this site as well as on the excellent academia.edu, though we first tried the usual publishing route. Here is the cover letter I wrote for it:
This article introduces a new, comprehensive view of mental illness as a phenomenon intrinsic to human society. We use first-person accounts to illustrate our case because it is grounded in individual experience, and we address the psychiatric model of Open Dialogue because of the importance of human interactions. The article concludes by proposing a way forward for psychiatry in its relation to the behavioral sciences and philosophy.
Jose Maanmieli is originally from Spain. He has been living in Finland for over 10 years and is now a Finnish citizen. He has been able to contrast the different local conditions between Spain and Finland, primarily, thanks to his partnership with Karoliina Maanmieli, who has a long history in mental health. Since we met, Open Dialogue has been an important part of our research considerations. The model seems to be more popular abroad than here in Finland, where it originates, for its humanity and effectiveness. We believe that this is due to its existential, ideological basis, which clashes with the “coldness” that is predominant across countries today. Our article solves this problem, essentially, by identifying what those opposing views have in common as antagonistic, moral views that “fight for the client.”
As the conclusion reads, our proposed solution involves “elucidating the link between the abstract and the personal that is characteristic of mental illness.” In this way, we have tried to take what is good about both warm and cold perspectives. Our personal collaboration, ongoing publishing efforts, and friendship with people who have been hospitalized reflect this motivation to explain what is happening, and our conviction that mental illness has much to say about the human condition. We look forward to hearing what you think about the article.
Jose and Karoliina Maanmieli
We first tried sending this article to the journal Psychosis, which advertises itself as accepting all kinds of psychosocial approaches, single or combined. A lot of journals are multidisciplinary or integrative these days. Alas, the editor thought it was not a research article, but an opinion article. Certainly, it is not a research article in the sense that we do not follow a methodology that is currently accepted. Instead, we demonstrate the limitations of the current theoretical paradigm, let alone the methodological one, and we do that by presenting and discussing evidence.
Fair enough, we thought, we need to approach a more theoretical venue, even though our article is clearly also about the personal and the practical. Being familiar with the philosophy of psychiatry, we submitted to the journal Philosophy, Psychiatry & Psychology. Many months passed while the article was being sent to reviewers. This was a good sign, as the article was being considered. However, it has happened to us many times that our articles are considered for publication by important journals and then rejected with little or no justification. Luckily this time the journal did provide some sort of rationale. Let’s have a look at it.
I have pasted the comments from the two reviewers on the bottom of this post. As you can see, none of them have anything positive to say, even from their position of anonymity. This is an interesting response considering the psychological and human context of these enquiries. Generally, too, when providing a rationale for a rejection of any kind, it is a sign of fair judgement that something positive is said about what is being rejected. However, these reviewers clearly have a bad relationship with our paper. The article is “not original” but at the same time it is filled with “sweeping generalizations” which are unjustified. How can this be? Are those generalisations perhaps original?
It is impossible to present new ideas when they are received in this way, by taking them out of context when they are imprecise, and dismissing them as “strident” or “confused” when they are precise. Justification seems a matter of valuing the particular when we are putting forward a general idea and valuing the general when we are putting forward a particular idea, so that we simply cannot win. A good example of the latter is when one reviewer writes that “issues about scope are confused with issues about the nature of the positions in question” regarding my discussion of relativist versus absolutist meanings. If you take the time to read that brief discussion (in the last section of the article, before its conclusion) you will see that it is logical and very precise. The reviewer could address it directly, but has preferred to introduce the general concepts of “scope” and “nature of the positions”, leaving one guessing as to what the reviewer’s own justification might be for stating that my argument is confused.
An example of taking our statements out of context is when the first reviewer comments:
Consider the very first sentence of the introduction. It asserts that the world of psychiatry is divided between those that discriminate against people for their illness or accept them for their health. Actually I suspect most psychiatrists would claim to accept the person while acknowledging the reality of their illness. If one wants to allege that this third option is somehow disingenuous or incoherent, that must be argued, not just assumed.
Firstly, it is again not a sign of balanced judgement or consideration that an introductory statement is scrutinised in this manner. We have accompanied this statement with other statements that are well-known examples of dual positions in all kinds of fields. Our intention here was that the reader would interpret the concepts discrimination against and acceptance not in the personal context of how a psychiatrist feels toward patients, but in an ideological context, if you will. I believe this is very clear in the text. However, the reviewer has taken our statement out of context, as he (let us now discriminate against the opposite sex) is shocked that we have “just assumed” such a thing as a general distinction between two approaches in psychology or psychiatry, let alone politics. Why is the reviewer taking personally what is clearly a theoretical view, one that is key to the conceptual structure of our article? Does the biomedical model not involve some rejection of the patient compared to social approaches? Could his own expression “the reality of their illness” possibly involve some sort of discrimination against the patient? He also “suspects” that psychiatrists feel a certain way about patients, but I imagine he would have a hard time proving such a general statement by his own standards.
We make “sweeping generalizations about how psychotic persons feel in general, without any justification”. Indeed, we do not claim to have justified that mental illness involves family issues and existential challenges, if there is any sense to such a justification. We simply assumed that the journal Philosophy, Psychology & Psychiatry is receptive to these kinds of assumptions, which have been made by many philosophers of psychiatry and are very common among the profession. I do not believe that R.D. Laing, for instance, had to “justify” that schizophrenics experience what he called ontological insecurity. Those are introspective notions that are either accepted by other feeling persons or they are not.
Freud made a number of similar assumptions in connection with the idea of a Freudian slip, as did Laing, who was very conscious of language. Note that the reviewer writes they do add to.
The philosophical components of the paper are disappointing. There is a tendency to make unsubstantiated, and often superficially impressionistic, claims. Such claims are often decorative: they do add to, but rather detract from, the main line of argument.
At first glance, the idea of a Freudian slip is not very rigorous. However, when one gives Freud the kind of chance that we have not been given by these reviewers, the view appears to make sense. The reviewers make other kind of grammatical mistakes, and one wonders if these are the result of a poor education or, rather, that our words have upset something in them, something sympathetic even. Maybe, as they say, there are “frank contradictions” in our paper because we are indeed being frank:
their are frank contradictions that are not addressed. For instance, the second paragraph of the introduction says OD “is now regarded as one of the most effective clinical practices” whereas the third paragraph says that “the results of OD are generally limited, and there is little reason to expect this to change in the current theoretical paradigm”
Can the performance of a football team, say, be possibly regarded as one of the most effective, while at the same time be seen as limited? Or does whatever people regard as most effective represent an absolute limitation to its development? Again, the reviewer does not want to consider that we might be proposing a higher standard for dialogical practices (as the words in the current theoretical paradigm are supposed to mean) and is instead set to find contradictions in our grammar.
Interestingly, our article reads like “a manifesto for those who are already believers in the authors belief system”. However, the article is itself an introduction to a belief system, one that presents a number of arguments these reviewers ignore on the basis that we have not adhered to their own belief system about what constitutes philosophical argument. In other words, these persons are simply not ready to evaluate a number of fundamental ideas about philosophy and knowledge in and of themselves. This is, after all, understandable. It is precisely the crux of our argument, and why we are in the end relieved that all these academics have, indirectly, given us a chance to make our article freely available to all of you.
The icing on the cake of course came when the chief editor of this journal, having said nothing positive either, answered my arguments above by encouraging me to learn from those very constructive comments. He also wrote that I disqualified them. Perhaps indeed. I wish the reviewers had disqualified my paper in the same way as I did their comments. Instead, we are left mostly with, shall we say, adjectives written by some abstract beings, who continue their business somewhere in this ethereal realm of knowledge.
The academia was created by Plato against the teachings of Socrates. It is a possibility that Socrates never existed and was, in fact, Plato’s written idealisation of his own secret desire for genuine knowledge. With the academia, Plato wanted to institutionalise knowledge, to domesticate and deprive it of the freedom it necessitates, for power. These are old enough issues that continue to this day, be it in the institutions of knowledge, politics or the mental hospital. None of them is probably going to change without the others.
There certainly is a need to appreciate that psychotic communications often carry meanings that are important to the person and can contain valuable perspectives and alternative interpretations of reality. The attempt to do justice to this dimension in working with psychotic individuals is not new, going back at least to early work in the psychoanalytic tradition. The concern with this paper is that assertions are made in a strident and polemic manner without careful consideration of more nuanced options or providing a careful justification for positions that are far from self evident. Philosophical jargon is not a substitute for argument. Consider the very first sentence of the introduction. It asserts that the world of psychiatry is divided between those that discriminate against people for their illness or accept them for their health. Actually I suspect most psychiatrists would claim to accept the person while acknowledging the reality of their illness. If one wants to allege that this third option is somehow disingenuous or incoherent, that must be argued, not just assumed. Similarly, their are frank contradictions that are not addressed. For instance, the second paragraph of the introduction says OD “is now regarded as one of the most effective clinical practices” whereas the third paragraph says that “the results of OD are generally limited, and there is little reason to expect this to change in the current theoretical paradigm” Furthermore, while the paper is quick to condemn others for not letting the patient speak for herself and imposing an interpretation on her communications, the authors’ own interpretations are asserted with little argument as to why we should accept these. For example: Those who have experienced psychosis usually see the family as a repressive, anxiety-producing institution” Or, “These are feelings of existential despair”. Or, “Psychosis stories begin to make sense when one sees the person as writing about societal roles that are unintelligent and oppressive, not about real people and their ethical sense.” In such cases, highly inferential interpretations are being asserted without a rationale provided. Also the are often offered as sweeping generalizations about how psychotic persons feel in general, without any justification. In short, this paper reads like a manifesto for those who are already believers in the authors belief system, not a philosophical discussion of the position.
The main thrust of the paper is to establish that the open dialogue approach to therapy risks overlooking non-narrative, non-discursive ways of being that are rooted in more embodied modes of experience. Essentially, the paper tries to make the case that psychotic individuals may, for various reasons, may not be in a position to enter into dialogue with others in ‘the space of reasons’ on anything like an even footing.
The paper uses a bit of philosophical analysis and draws on a handful of unique Finnish case studies to establish its conclusions.
The paper also makes very heavy, perhaps overly heavy, reference to one author – Seikkula. A more balanced and wider set of references would be needed to make a firmer case for the paper’s conclusions.
The paper is not fit for publication as it stands.
The main idea of the paper is interesting and important, but – apart from being tied to the Open Dialogue approach to therapy specifically – it is not original. Discussing cases of psychosis in relation to the Open Dialogue approach give some specificity to the paper. Bu how does the main point differ, say, from Galen Strawson’s famous work “Against Narrativity”, where he argues that some people experience the world episodically and in non-narrative, non-discursive modes? Strawson’s work has been at the center of these discussions for years: why is it not mentioned?
The philosophical components of the paper are disappointing. There is a tendency to make unsubstantiated, and often superficially impressionistic, claims. Such claims are often decorative: they do add to, but rather detract from, the main line of argument. At other times they are simply confused – as in the discussion of absolutist versus relativist theories of truth, where issues about scope are confused with issues about the nature of the positions in question.
“The approach adheres to the metaphysical narrative of social constructionism, which we argue is but another form of rationalism …”. In what way, if any, is social constructionism a narrative? In what way, if any, is it metaphysical.
What are “experience experts” and how are they trained?