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Paper short abstract:

Can psychiatry democratise knowledge, embrace multiple truths and place non-expert dialogue at the heart of clinical decision-making? A multi-discipline team ethnography of Open Dialogue in the NHS as a complex polyphony of ambition and practice raises methodological and ethical challenges.

Paper long abstract:

As an approach to mental healthcare services that is gaining worldwide interest, Open Dialogue is often presented as a response to the ‘epistemic and hermeneutical injustice’ of which psychiatry stands accused. Open Dialogue aims and claims to demote psychiatry’s expert interpretations and give central place to dialogue among clients, family members and clinicians; to displace the usual diagnosis-treatment nexus into a wider relational field and to reshape professional and patient roles and hierarchies. Its commitment to polyphony implies recognition of different knowledges around mental healthcare. How are such goals realised when Open Dialogue is provided within public healthcare systems constrained, among many things, by the specific demands of clinical governance, patient record systems, performance indicators, graded posts and understaffing? This paper, by an anthropological research team (whose members include clinicians, and individuals with lived experience as service users and carers) draws on on-going ethnographic research with an Open Dialogue (OD) community mental health team in inner London to address varied and sometimes conflicting truths around mental health care. From fieldwork as OD practitioner-ethnographers, the authors describe diverse truth claims that surround things like diagnoses, medication, trauma narratives, the meanings of Open Dialogue itself, and methodological challenges and strategies of knowledge production/writing by an internally diverse team holding the tension between the dialogical refusal to interpret and anthropology as an interpretive discipline.