Psychosis and the limits of dialogue
|– We introduce a view of mental illness as a conflict with society|
– Psychiatry also reflects a conflict between worldviews
– The existence of ‘society’ is questionable
– Therefore, we should understand those who cannot adapt to it
Abstract: Some words have the power to define what is real. This article introduces a comprehensive view of mental illness as an inner conflict with those words. We suggest that individuals are sometimes unable to assimilate the narratives most human beings live by because the social realities they portray are abstract, incoherent and conflicting. We do this through a constructive criticism of Open Dialogue, an innovative, celebrated approach to mental health care that resembles family therapy. Open Dialogue is important due to its situated focus on human relationships. However, the approach adheres to the metaphysical narrative of social constructionism, which we argue is but another form of rationalism that competes with the rationalism of the biomedical model. Both approaches effectively disregard embodied experience, individual decision-making and the sciences of behaviour because they have a basis in societal norms. We illustrate our case through the psychosis stories gathered in a unique, minimally edited book, which we contrast with case examples of Open Dialogue. Our analysis shows that epistemic and therapeutic value should not be seen as opposites. Questioning our most fundamental assumptions reveals that the person in crisis has a lot to say about life’s biggest questions, and opens the door to a genuinely open dialogue.
Keywords: morality, psychiatry, Open Dialogue, decision-making, family, rationalism, social realities
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