Contribution short abstract:

Drawing on long-term fieldwork with Open Dialogue projects in New York City and Berlin, this paper examines what happens when a marginal politics of psychic life -- one tethered to the social polyphony of language -- must contend with the rational demands of local economies and politics of care.

Contribution long abstract:

The Open Dialogue model is a need-adapted approach to psychiatric crisis that originated in Finland (Alanen 2009; Olson et al. 2013). Today, practitioners across the world who find themselves frustrated by what they perceive to be the limits of biomedical psychiatry join this community to learn about a different way of understanding schizophrenia: one that is intersubjective and embedded in language, rather than an imbalance in the brain that can be repaired with medication and hospitalization. These practitioners turn to Bateson (1972) and Bakhtin (1984) to frame schizophrenia as something embedded in social networks, and they understand their therapeutic endeavor to be the stitching together of traumatic experiences for service users who have found themselves lost in a terrain of the unspeakable (Lester 2013; Seikkula and Trimble 2005). The Open Dialogue community proffers a radical and humanistic approach to psychiatry -- but it is a practice that lacks the evidence-base and replicability of standardized global health models; it has yet to be sustainably implemented beyond the original Finnish context (Freeman et al. 2019; Mueser 2019; Rose 2005). Drawing on long-term fieldwork with Open Dialogue projects in New York City and Berlin, this paper examines what happens when a marginal politics of psychic life -- one tethered to the social polyphony of language -- must contend with the rational demands of local economies and politics of care.