Paper short abstract:

This paper discusses advocacy for Open Dialogue, a model of psychiatric care that is often framed as a more ‘human’ alternative to conventional treatment. It explores how supporters of this approach have embraced human limitations – vulnerability, fallibility – as conditions of effective caregiving.

Paper long abstract:

Open Dialogue is an innovative model of psychiatric crisis response informed by systemic family therapy and service user/survivor movements. It strives to upend entrenched hierarchies within the clinical encounter, placing the client in the driver’s seat of a transparent, non-pathologising, and dialogical therapeutic process. In recent years, Open Dialogue has captured the imaginations of activists, clinicians, and people using services in the UK, where it is currently subject to a randomized controlled trial. Those advocating for the approach consistently describe it as a more ‘human’ alternative to conventional mental health services. This paper draws on 16 months of clinical ethnography to explore the multivalent notion of the human that is mobilized in such claims. It considers how human care came to be defined in relation and juxtaposition to anonymous and bureaucratic regimes of care within the UK’s National Health Service. Yet whereas anthropologists have often highlighted the social capacities of human beings (e.g., empathy, connection) relative to impersonal bureaucracies, Open Dialogue supporters frequently emphasized human limitations. The human, in this context, was fallible, uncertain, and, often, wounded. Interestingly, these qualities were construed not as barriers to high-quality service delivery, but as preconditions to high-quality therapeutic relationships that made space for clients’ own expertise and agency. In this way, I suggest, Open Dialogue advocates encourage a radical rethinking of caregiving that has implications both for anthropological theory and for a public mental health system in crisis.