This auto-ethnographic study describes the changes in the author's thinking and clinical work connected to her first-hand experience of Open Dialogue, which is an innovative, psychosocial approach to severe psychiatric crises developed in Tornio, Finland. In charting this trajectory, there is an emphasis on three interrelated themes: the micropolitics of U.S. managed mental health care; the practice of "dialogicality" in Open Dialogue; and the historical, cultural, and scientific shifts that are encouraging the adaptation of Open Dialogue in the United States. The work of Gregory Bateson provides a conceptual framework that makes sense of the author's experience and the larger trends. The study portrays and underscores how family and network practices are essential to responding to psychiatric crises and should not be abandoned in favor of a reductionist, biomedical model.

Open Dialogue is a recovery-oriented psychosocial approach that has been found to be effective with persons in acute psychiatric crisis. Drs. Douglas Ziedonis and Mary Olson are leading a multi-disciplinary team at the University of Massachusetts Medical School / UMass Memorial Health Care to develop implementation tools (manuals, fidelity scales, etc.) that are needed to implement and evaluate the Open Dialogue approach in the United States. A Spanish translation of this publication is available for download.