A NEW BRIGHT EDGE
“Living utterance becomes an active participant in social dialogue. If we imagine such a word in the form of light, then the living and unrepeatable play of colors and light on the facets of the image that it constructs can be explained as the spectral dispersion of the ray word, in an atmosphere filled with the alien words, value judgments and accents through which the ray passes on its way to the object; the social atmosphere of the word, that atmosphere that surrounds the object, makes the facets of the image sparkle.” (The Dialogic Imagination: Four Essays by M.M. Bakhtin, M. Holquist (ed), tr.C. Emerson,Universityof Texas Press, 1981, p.277).
Introduction: The New Bright Edge
The image that propelled this title was given to me by Tom Andersen, who kept telling me that I must come to the North of Norway in the “Darktime.” So he invited me for the first day of spring, just as the sun was going to appear. The occasion was a meeting of Andersen’s “Northern Network,” composed of teams handling “acute” breakdowns from hospitals in countries all acrossEurope’s northern rim. Tom took me to his top floor office at theUniversityofTromsothe morning of the conference, and out the window I saw the first rays. They appeared in the cleft of two snow-covered mountains, then faded away, followed by colors of pink, mauve, and gold which lit up the edges of landscape and sky.
From time to time as I have passed through the history of this field, I have been given the chance to see such first rays. And I have in some way known or guessed which newcomer approaches would establish themselves and persist. One is taking shape now, like a ship hull-up on the horizon and coming closer. It has been referred to as the “Conversational Therapies,” a term used by Roger Lowe (2005) in an article in this May’s Family Process. Lowe distinguishes between the approaches that use “structured questions” like Narrative and Solution-Focused work, and what he calls, following John Shotter, the “striking moments” approach, which does not use pre-planned techniques. I am interested in establishing a train of forebears for this last effort, which is now branching off into the future in interesting ways but includes some distinguished ancestors.
The work of these forebears was foreshadowed by Gregory Bateson, who at the end of his life emphasized the indirect communication styles of what he called the “Creatura,”or the world of the living. Putting these ideas to work, Harry Goolishian and Harlene Anderson took a sharp turn away from causal interventions in their “not knowing” stance. Then Tom Andersen introduced the “reflecting process,” which pleased those of us like Peggy Penn and myself who were trying to work in a less instrumental way. More recently, some of these practitioners have introduced us to new philosophical resources based on the witings of Ludwig Wittgenstein and Mikhail Bakhtin. We have a new “in-house philosopher” in social thinker John Shatter, who has described how these writers can help us understand what Bakhtin calls “dialogicality.” We are beginning to have new terms for what we do, like Tom Andersen’s idea of “withness practices.” Finally, we have some novel examples of these ideas embedded in the work of innovators such as Jaakko Seikkula and his colleagues in Finland who have given us an approach called “Open Dialogue,” Mary Olson, who is teaching this dialogic method at the Smith School of Social Work, and Chris Kinman in Vancouver, who is experimenting with a Language of Gifts that is aimed at influencing entire communities and producing entire system change. But let me go back in time, and start with the early genius who (for me) started it all, Gregory Bateson.
Bateson and Syllogisms in Grass
There were several philosophical pioneers in the last century who made it their life’s work to study how the forms of Western discourse entangle us. The two most important ones, in my view, were Ludwig Wittgenstein and Gregory Bateson. In Wittgenstein’s famous book of arguments with himself, “Philosophical Investigations” (1953), he explores ways to get out of the invisible linguistic trap he called the “fly bottle.” His work has generated an industry of explainers. Bateson’s writings have not yet called forth such an industry, but he took on a similar charge in describing a style of prelinguistic communication that animals use and that is common to religion, humor, some forms of madness, playfulness, and art. This type of communication, Bateson held, applied specifically to what Jung called the “Creatura,” the world of the living, as opposed to the “Pleroma,” meaningNewton’s world of force and mass. The Pleroma has no mental process, no names, no classes. The Creatura, on the other hand, is founded on pattern and communicates through “as if” language, using similitude and metaphor in a variety of embedded and embodied ways.
In contrasting the truths of logic with the truths of metaphor, Bateson turns to a musty old philosophical artifact, the “syllogism in Barbara.” Classical logic has identified several syllogisms, or tautological word structures, and the Barbara one goes like this: “Men die, Socrates is a man, [therefore] Socrates will die.” Bateson explains that this sequence is built on classification. He says: “The predicate `will die’ is attached to Socrates by identifying him as a member of that class whose members share that predicate.” In other words, Socrates is in the box of things that die.
But there is another syllogism that seems to ignore the rules of classification, which Bateson called “Syllogisms in Grass.” It takes this form: “Grass dies, Men die, [therefore] Men are grass.” An English reviewer once pointed out that this was how Bateson himself did his thinking, and called attention to a 1944 book by an E. von Domarus which said that this was how schizophrenics thought too. Bateson agreed heartily with this opinion, and made Syllogisms in Grass a centerpiece of his descriptions about how things communicate in the natural world. He fires off this ringing salvo in Angels Fear:
“The whole of animal behavior, the whole of repetitive anatomy, and the whole of biological evolution – each of these vast realms is within itself linked together by syllogisms in grass – whether the logicians like it or not … In other words, it looks as though until 100,000 years ago… there were no Barbara syllogisms in the world, there were only Bateson’s kind, and still the organisms got along all right. They managed to organize themselves in their embryology to have two eyes, one on each side of a nose. They managed to organize themselves in their evolution…And it became evident that metaphor was not just pretty poetry, it was not either good or bad logic, but was in fact the logic on which the biological world had been built, the main characteristic and organizing glue of this world of mental process that I have been trying to sketch for you…” (pp. 26-30).
This statement thrilled me. It felt accurate, and it justified the enormous importance my community placed on sensory and emotional gesturing in the work we did. It also justified the efforts of philosophers like Wittgenstein, mentioned above, in not only searching out an alternative logic for communication but finding that it could be strikingly different from the classical logic that Western thinkers had come to see as the norm. The preverbal, analogical vision of Bateson seemed especially pertinent to the project of psychotherapy, because it indicated that advice and expertise were not enough; you had to reach for connection at levels that lay beyond the scope of words.
This idea took me back to my early English literature studies with F.O. Mathiessen at Harvard university. We were reading T.S. Eliot, and Mathiessen talked about Eliot’s concept of the “objective correlative.” This idea was close to what was then known as the “New Criticism,” which held that the poem or novel or play was organized around a symbolic offering that was the signature for the work’s larger meaning.
For instance, in the case of the novel “Moby Dick,” the White Whale was the stand-in for a more abstract idea – Ahab’s obsession, or a drama of revenge – it did not have to be fully spelled out because the White Whale said it for you. But there was plenty of work for literary critics in clarifying the link between the objective correlative and the meaning it stood for.
I felt that Bateson was saying something similar, that there is a hidden language known to Nature and animals and mad people and artists, but forgotten by the rest of us as our education proceeds. I was struck by current research in neurology that has pointed to a specific area of the brain – the amigdala, also called the “emotional brain” – saying that this is the brain’s “smoke alarm,” because this is where intense and early memories are stored. I believe that messages directed toward this area have to use Nature’s ancient grammar or they will not be received. When Bateson talked about syllogisms in metaphor, he didn’t mean that we should literally use figures of speech, but rather that this was a good example of the way sensory and felt-level channels can carry messages between people when attempts at logical explanation fail.
I also want to say that this kind of creatural grammar breaks through private walls so that connections can be found. Why is this emphasis on the wider web so important for a therapist? Because it turns us away from looking at individuals and their inner life, which is what modernist psychology trains us to look at, and points instead to the threads that link everybody to the social loom. If you stay with modernist psychology, you will forever be trying to see your job as a matter of building logging roads, putting up bridges, and various other engineering projects. If you move to a postmodern psychology, you have to jump, likeAlice, into the pool of tears with the other creatures. This situation is a great equalizer and carries some dangers, but it is the only source of information with the power to transform.
My Three Pillars of Wisdom
But let me move to what I call my Three Pillars of Wisdom, the three anchors of the kind of work I and my community do. These are the practices that have signalled the shift from a modernist view that sees emotional problems as within-person phenomena like medical complaints, and the postmodern view that they are relational and dialogic in nature. The first pillar is the idea of “not knowing” brought into the field by Harry Goolishian and Harlene Anderson. Based on practice, not theory, this concept pulled the rug out from under the scientific framework that upholds the dubious claims of most fields dealing with mental health, including family therapy.
The second pillar is the practice originally called the reflecting team, contributed by Tom Andersen and his colleagues in Tromsoe. This was a deathblow to the formats favored by early family therapists , as it undermined the one-way screen and other devices that cut the family off from the professionals dealing with them. Asking a family to comment on the reflections of professional family therapists about their own situation was even more unheard of. In an interesting development here, Harry Goolishian who, together with Harlene Anderson, had become fascinated with postmodern ideas, suggested to Andersen that he broaden the term to “reflecting process.” He felt that to link this idea to a specific format or technique was unnecessarily limiting.
The third pillar is what I call, for a similar reason, “witnessing process.” There is some internal history of the field to report here. Soon after Tom Andersen shared his reflecting team format, Michael White adopted it too. In line with his preference for anthropological rather than psychological language, he used anthropologist Barbara Meyer’s term “definitional ceremony” to describe it. In pursuit of his efforts to help someone “reauthor” his or her story, White saw that having witnesses for this ritual was an strongly authenticating experience. It was clear that a reflecting group could further the creation of a more inspiring identity, and this led him to create what he called an Outsider Witness Registry, where persons who had already worked with him could be invited back to help someone else in a similar situation.
I myself, as soon as I began to use reflecting teams, was struck by the layering power of the many voices and groupings it put into play. It was a prismatic process, where one moment’s witnesser became another moment’s witnessee. But as with the reflecting team, I felt strongly that we needed a term that didn’t belong to any one person or school. “Witnessing Process” was a suitably large tent under which many of us could fit, regardless of our therapeutic allegiances. But let me go on to some of the novel ideas that are signaling us toward the future.
The Contribution of John Shotter
A primary source of this new bright edge I am talking about comes from John Shotter, a social psychologist whose writings on the nature of dialogical communication have become increasingly relevant to the relationship therapies. He has been creating a little intellectual whirlpool around the ideas of two philosophers in particular – Mikhail Bakhtin and Ludwig Wittgenstein, and applying them to relational therapy. He and Tom Andersen have been giving workshops together, and this has been a happy development. For my part, I felt that Shotter was our “in-house philosopher.” He was leading us away from the idea that had convinced us that we could change social reality by verbal means. In its place was a picture of communication as a more bustling, jostling enterprise. Shotter speaks of “embodied knowing” versus “language-based knowing” and describes it as “the sense that addresses itself to feelings of `standing,’ of ‘insiderness or outsiderness’ in any social group.” He says it’s not a skill or a theoretical knowing, but has to do with the anticipations we bring to a conversation, and the influence these impressions have on us and others.
This development seems to have led Shotter to move away from social constructionism, which was the theory we had given most space to. He feels it is lacking in any description of the constraints inherent in social exchange. In his view, communication is like a social weather. It fills our sails, becalms, or sometimes wrecks us. Sensing what is called for in a particular context, responding correctly to gestures like an extended hand, feeling a black cloud settling over a discussion, are all examples of a weather system that can impact us in concrete and material ways. Social constructionism has been described as a linguistic system, which is a more static image, and implies greater flexibility in what is and is not possible. This is the reason many people have accused it of being “relativistic,” if not morally depraved.
The truth is that the famous “linguistic turn”of postmodernism is more often conflated with words rather than gesture. People with emotional problems do a lot of gesture talk and often the problem itself is gesture talk. For this reason, Shotter is very keen on Wittgenstein’s appreciation of this more hidden realm. He quotes Wittgenstein as saying “The origin and primitive form of the language game is a reaction; only from this can more complicated forms develop.” He explains that by primitive, he means that “this sort of behavior is prelinguistic: that a language game is based on it, that it is the prototype of a way of thinking and not the result of thought.” In another of his famous notes, he says that language “is a refinement,” and quotes Goethe: “In the beginning was the deed.” (1980a, p. 31) In this respect, Wittgenstein’s and Bateson’s interests were very similar.
Shotter feels that the move toward embodied knowing also takes us away from Descartes and the Western tradition. The Enlightenment valued the objective eye of the observer. In contrast, dialogical reality is based on the shared subjectivity of the participants. Instead of a “representational” understanding, Shatter offers a “relational” one. Instead of seeking to be a master and possessor of nature, as Descartes described it, we have to respect its “shaped and vectored” qualities. Shotter further observes that in matters that concern the world of the living, many important things “occur in meetings of one kind or another.” All the more reason that we should scrutinize the kind of talking that goes on in them. Not all meetings make the kind of difference psychotherapists are looking for, and it behooves us to examine what is the special nature of those that do.
One of Shotter’s biggest contributions from this point of view has been to translate the lofty abstractions that Bakhtin and his colleagues have given us into more ordinary terms. I like particularly his turning the concepts of “Dialogical” vs. “Monological” conversation into “Withness Thinking” vs. “Aboutness Thinking.” According to Shotter: “Withness Thinking” is a dynamic form of reflective interaction that involves coming into contact with another’s living being, with their utterances, with their bodily expressions, with their words, their works.” In “Aboutness Thinking” he says, “the other person remains wholly and merely an object of consciousness, and not another consciousness.” He quotes Bakhtin: “Monologue is finalized and deaf to the other’s response, does not expect it and does not acknowledge it in any decisive force.”
The beauty of the notion of “dialogicality” or “withness” is that it addresses the crisscross of merging and overlapping voices, and their silences too, in normal everyday exchange. Instead of the “expert” individual being assigned the most influence in this activity, as usually happens in psychotherapy, a “withness” conversation allows voices to emerge that have often been stifled or withheld. Attempts to manage meaning may be the norm in our societies, and many psychotherapy models have been built on such attempts, but in these circumstances “withness” does not automatically occur. In fact, there are some who say it is more apt n to occur. When, in thinking back on an interview, the best outcome is that people would feel the conversation itself was the author of what was said.
The “Withness Practices of Tom Andersen
These ideas fed into my own belief that our theory had to take the mysterious world of the senses more into account. I was using the idea of “underground rivers” to depict the sensory channels that flow between people when they seem to be connecting. I also looked back at my own journey, from an emphasis on seeing in “The Art of Lenses,” to an emphasis on hearing in “Exchanging Voices,” to the current emphasis on touch and feeling. Andersen, of course, had always been persuaded of this emphasis. Influenced by the late Aadel Hansen and Gudrun Ovreberg, two well-known physiotherapists in Norway, Andersen has always placed the body at the center of his work As a result, he is attentive to breathing; to posture; to tone of voice, as well as to his own inner and outer voices and what is going on in his own body. He says:
“The listener (the therapist) who follows the talker (the client) not only hearing the words but also seeing how the words are uttered, will notice that every word is part of the moving of the body. Spoken words and bodily activity come together in a unity and cannot be separated … the listener who sees as much as he or she hears will notice that the various spoken words “touch” the speaker differently… Some words touch the speaker in such a way that the listener can see him or her moved.” (1996, p. 121)
In another article, Andersen follows the action in an interview he did inFinland. He first describes his talk with the host team, who tell him about a mother with two daughters, one of whom, age 19, was “hearing voices.” The team said they were worried because so many other persons in that family had been hospitalized for psychosis. Andersen said he could always meet with the team alone, if that was what they wanted to consult him about, but asked if it would not be better to find out from the mother and daughter directly what their own concerns might be. The team agreed.
After a short discussion with the translator, asking her what her preferred method of translating might be, Andersen went on to describe the body language of the mother and daughter as they came into the room and sat down. The mother seemed very preoccupied. After hearing about various concerns – the daughter’s refusal to go to school, the history of family members’ hospitalizations, the mother’s divorce from the father ten years before, the mother’s divorce from the father ten years before, Andersen asked the mother if she had any other children. She said yes, from a former husband, whose parents raised this daughter and kept her from her mother. She had become a street person, taking drugs. But now she had written to her mother, asking to come live with her. Andersen asked the mother if she thought the daughter had missed her, and was told yes. Did she in turn miss her? Yes. The sister nodded yes too.
Andersen then said, “It sounds like your daughter is lonely.” When the mother confirmed this, he asked her if she too were lonely. At this point she said, “I have so much pain.” Andersen asked where in her body was the pain. In the heart and in the thoughts. If the pain found a voice what would it say? It would scream. With words or without words. The mother only looked at him. Andersen asked “Who would you like to receive your scream? She said, “God.” How should God respond to your scream? She said she hoped God could take care of her three daughters. A long pause followed, and a long silence. The audience seemed very moved, as was Andersen himself.
In the next part of the interview, Andersen found out that this mother had no adults in her life that she could talk to; she had no one else but her daughters. She had been close to her father’s parents, but they had died. If they had been here, might they have helped her? Might she have been able to scream to them instead of God? She began to weep, saying yes. Andersen asked if her grandmother had been here, what would she have said. The mother answered: Little girl, you have been so good to your daughters. What would you say back? Grandmother, I love you so much. And what would she then do? She would put her arms around me and I could smell her. She smells so good.” Many people in the audience were now openly weeping. Andersen asked the daughter what her thoughts were. She said she knew her mother had pain, but did not know anything about her grandparents. She said that she would rather hear about that pain than not hear.
Andersen closed the interview with a suggestion that the mother take her two daughters to the grandparents’ grave and talk to the girls about them. Andersen then asked the team and the audience to share their thoughts with him, while the mother and daughter listened. The team said they had been very moved by the mother’s feelings for her daughters. Andersen asked if there was a grandmother’s voice in the audience, and found one; then he asked for a grandfather’s voice. These persons said that they had also been moved, and the grandmother said how important it was for a granddaughter to have a grandmother and for a mother to have a mother. Mother and daughter left the meeting “with firm handshakes and firm looks,” and Andersen was told by a team member three months later that the daughter had no more fears or voices and was going to school in the fall.
In Andersen’s commentary on this interview, he describes his work as a communal enterprise rather than an individual-oriented one, and makes this very interesting point about language:
“Language is here defined as all expressions, which are regarded to be of great significance in the above-mentioned communal perspective. They are of many kinds, f.i. to talk, write, paint, dance, sing, point, cry, laugh, scream, hit, etc., are all bodily activities. When these expressions, which are bodily, take place in the presence of others, language becomes a social activity. Our expressions are social offerings for participating in the bonds of others.”
I like that idea, as it underscores the importance of the network aspect that we will be seeing in the work of Jaakko Seikkula which I will be describing next. But first, I want to comment on Andersen’s ability to connect on a deep and very personal level. The late (and much-missed) Gianfranco Cecchin used to mock me for my interest in the idea of “empathy.” “Why do you need empathy?’ he used to ask. “What is so important about this empathy?” I tried to tell him that this is a word I use interactively, which is why I call it “tempathy,” for “traveling empathy.” Recently I learned about the discovery of cells within the brain that researchers call “mirror neurons.” Scientists at the University of Groningen in the Netherlands (Science and Technology, The Economist, May 14 2005, p. 81) have found an action-sensitive type of cell that fires not only when a rhesus monkey reaches out for food, but in another rhesus monkey who sees the first one reaching out. Descriptive experiments with humans are finding the same thing, and researchers into autism say that autistic children strikingly lack these cells. So there is beginning to be some backing for the idea that empathy is not only a trait in the individual but is central in the formation of the social net.
The Open Dialogue Approach
Let me move on now and talk about “Open Dialogue. This term refers to the work of a group fromKeropudasHospitalin the North of Finland that has come up with a dialogic network approach to persons with first time acute psychosis. The group’s background philosophy was greatly influenced by the work of the Russian philologist Mikhail Bakhtin, and his circle. The Finnish group has published some papers on Open Dialogue in which they compare their outcome statistics during a five year study with those of what they called “treatment as usual,” meaning the hospitalization-plus-neuroleptic-medication which had become the accepted way to treat an acute breakdown in the North of Finland, and is standard issue at many other places as well.
This study raised many questions. Five years after it began, eighty percent of the Open Dialogue patients were working, studying, or training for a job. Only 20 percent were on neuroleptic medication. In the comparison group, by contrast, 80 percent were on disability and 80 percent were on neuroleptics. By design, hospitalization played a much smaller part in the Open Dialogue group than in treatment as usual, and often was avoided altogether. One had to ask: what is the secret of this approach, and how does it work?
It was then that I heard that Mary Olson, a colleague of mine who was teaching at Smith School of Social Work, had been asked to apply for a Fulbright atYvaskylaUniversityinFinland. Tom Andersen had invited me to come to another of his conferences, and I asked if Olson could come with me. Since she was a good writer, as well as a good teacher and therapist, I wanted her to meet the Norwegian and Finnish researchers whose work I had been following for so many years. So I was able to introduce her to Andersen’s acute team atTromsoeHospital. She did get the Fulbright and taught for six months inYvaskylaUniversity, where she met Jaakko Seikkula, who was on the faculty. The result was an article describing the Open Dialogue approach (Seikkula, J. and Olson, M., 2003). She and Seikkula have applied for an NIMH grant to set up a pilot program using the Open Dialogue method with children admitted to the Emergency Room at the Community Services Program atUMassWorcesterMedicalSchool. As with theKeropudasHospitalstudy, it will compare the outcomes of the research group’s children with those of children who are admitted in the ordinary way.
Networks talking with Networks
Seikkula puts great importance on the meshing between the treatment team from the parent hospital and the social network of the afflicted person. This ad hoc team is the intertwined group that meets as soon as possible, preferably on the client’s own home ground. Since all staff in Keropudas is required to take a three year course in family therapy, regardless of discipline, it is possible to pull out at short notice a team that is on the same page. Because these early contacts are preferably held at home, hospitalization is often avoided, and so are the heavier drugs, although of course they are available. The network meets daily, as often as needed, until the disturbance has died down. Later, individual or family therapy might be offered, but the hospital team continues to monitor the situation.
Another important feature is an aspiration that the conversation be “without rank.” This is a concept offered by Bakhtin, who in his description of dialogicality talks about “the development of familiar and intimate forms of address … more or less outside the framework of the social hierarchy and social conventions, `without rank,’ as it were.” (1986, p. 97) What makes Open Dialogue of interest to researchers in Therapeutic Discourse and Conversation Analysis is the stated hope to create a common language. This means never challenging the strange words of the patient, no matter how irrational, but continuing to mull them over in the belief that over time a more mutual way of wording the situation will evolve. This forestalls the traditional effect of family therapy meetings, which is often to highlight the gap between the “sick” and “well” members of the family. or the similar gap between the patient and the professional. The end of such disparities would be a key characteristic of speaking together “without rank.”
Seikkula says that in its early days, their team followed previous methodologies like the Milan Systemic approach, but found that they failed to generate the hoped-for engagement between the team and the family. Seikkula says: “We early realized that it was no longer posssible to have control over the treatment processes by treatment plans or by family therapy.” Then they heard that Yrj Alanen inTurkuhad started to organize open treatment meetings which included the patient in every meeting about his or her problem, as well as automatically inviting the family in as well. At this point, the group also found that the ideas of dialogism proposed by the Russian philologists Mikihail Bakhtin, Lev Vygotsky and Valentin Voloshinov allowed them to create a description of the open treatment process. Seikkula puts the matter pungently:
“Coming into engaged meetings or dialogical meetings (as we started to call them), means giving up the idea of primarily having control over things and, instead, jumping into the same river or rapids with our clients and trying to survive by taking each others hands.”
In their article, Seikkula and Olson make an important contribution by tying the Open Dialogue format to Bakhtin’s concept of “polyphony.” Bakhtin lays out the difference between a writer like Tolstoy, who wrote from a God’s Eye View, with Dostoievsky’s ability to move in and out of the lives of his characters and speak with their voices. Bakhtin goes on to talk about the presence in social life of “a universe of innumerable consciousnesses, each with its own world.” A conversation that expresses these different possible worlds Bakhtin called “polyphonic.” This seems like an important value if one is hoping for a language to emerge that all have participated in making.
The Meaning of Chronification
The most startling impression I got from the articles members of the Keropudas team have written about their work was the fact that the aim of the treatment group was not so much to alleviate symptoms but to prevent chronicity. First of all, each situation was attended to as quickly as possible. As soon as an intake was done, an ad hoc team from the hospital would go out to wherever the afflicted person’s network was convening. The idea was to meet daily with the family until the anxiety about the situation had died down. Once a mutually understood view of the situation evolved, this would lessen the danger of isolation and chronicity, at which point individual, couple or family therapy might be added.
But what stood out for me so sharply was the fact that in the sample group treated atKeropudasHospitalsuch a large percent ended up functioning within, rather than outside, the ordinary world. Seikkula admitted that not every strange behavior might be suppressed, but they were pleased if their people did not go on to become chronic. The last time he came to theU.S.a month ago, I asked him if he were still working with so-called “schizophrenics” and he said, “I can’t find any.” He had shifted to working with depressed people instead. When I expressed surprise, he said that in the 12 years sinceKeropudasHospitalin the North of Finland began working so differently, the percentage of the population with chronic mental illness had declined – from 13 per cent of 100,000, to 8 per cent, to 3 percent, and so forth. He said that it possibly took this long for the effect of a method based on interrupting chronification to show up in a larger population.
Then I myself had an “arresting moment.” I began to ponder on the idea of preventing chronicity, and reviewed my own struggles with psychiatry over the years. My first disastrous encounter was with a country psychiatrist who dealt with my post-partum depression by putting put me on the just-discovered drug reserpine. The drug itself induced extreme agitation and made my condition worse. Luckily my husband won an award in drama criticism which brought us toOxford. Once there, my prescription ran out, and I got well. Ever since then I made every effort to stay clear of psychiatry, despite suffering from most of the symptoms of the “worried well.” I believe it was my search for a process that would feel more human, more accepting, that has colored my trajectory in this field.
In light of my own experience, thinking about what Seikkula had told me made enormous sense. It was a short step to propose to myself “What if we all decided that the purpose of therapy of any kind was to prevent chronification?” It then occurred to me that the term “calcification” might be a more general metaphor. How often we have used the word “stuckness” to describe a family’s difficulties? How often have the problems people come in with developed a thick, isolating carapace that hardens with time, entrapping not only other family members within it but also the treating professionals? This effect seemed to be one of the most striking discoveries of the family therapy movement, even though family therapy per se seemed unable to combat it.
Perhaps we are getting close to understanding why. The dialogic process I have been describing seems to dissolve this carapace. Andersen’s deeply gestural work is one example of countering calcification, as are Harlene Anderson’s collaborative practices, Peggy Penn’s creation of letter writing networks, and the dialogic teams of Jaakko Seikkula and Mary Olson and their colleagues. Harry Goolishian used to call the carapace phenomenon a “problem-defined system.” The main idea here is that one type of discourse can dissolve another. Perhaps the clearest example of this is the way Open Dialogue works to create a common language and endeavour that knits people together, and prevents the isolation that sets in when hospitalization and medication are routinely over-used.
To summarize, the secret of talk that unblocks the underground channels between people is that it operates on an underground felt-sense level, rather than following codified rules for change. A recent article by Roger Lowe compares what he calls the “structured question” approaches, used by Michael White and Steve de Shazer, with the collaborative extemporaneous style that Tom Andersen, Harlene Anderson, Peggy Penn and many others like myself prefer. Lowe comes up with two terms for this style of working: “dialogic” or “conversational.” I like the term “conversational.” It suggests a quality of open-endedness together with a groping, just-discovered effect, more like the way a creative artist operates than a trained professional. Andersen ends the article I drew from above by saying: `My wish is at this moment that we stop talking about therapy and rather talk of it as human art; the art to participate in the bonds with others.”
Whatever we call this new big tent, it seems obvious to me that we have gone beyond social constructionism’s “linguistic system” idea with its emphasis on the malleability of meaning. Instead we are looking for “withness practices.” These entail a special kind of conversation. They bypass the hierarchy implicit in most social interaction. They do not lead to some pre-determined goal or depend on a pre-arranged technology. If a sense of having “got there” occurs, it must come spontaneously, much as Wittgenstein suggests when he says that the aim of philosophy is to help us “know how to go on.” Above all, they operate on a gut level, which is the field where goods are struggled for and contests go on, and where a sense of justice is a constant living thing. If we can’t find a way to block the usual maneuvers, at least we can create a small temporary space where lions and lambs can sitdown to talk and listen.
