Competing Responsibilities and the Distribution of Outcome through Dialogic Practice

ABSTRACT

Crisis intervention teams in Berlin, Germany use a form of dialogic practice – a therapeutic approach based on the relational meaning of language – to develop an alternative means of negotiating risk and evaluating “outcome” in psychiatric experience. These clinicians bring familial networks into the process of crisis management, revealing meaningful “outcomes” regarding crisis care to be tethered to local concepts of chronicity and responsibility. To conceive of outcome in this context requires attention beyond the individual, and instead the consideration of a distributed outcome, in which living with risk, and its consequences, is bound to the collective experience of the network.

RÉSUMÉ

Kriseninterventionsteams in Berlin nutzen eine Form der dialogischen Praxis als alternatives Verfahren zur Aushandlung von Risiken psychiatrischer Erfahrungen. Die Teams beziehen das familiäre Netzwerk und soziale Umfeld des Einzelnen in den Prozess der Krisenbewältigung ein und zeigen, dass Krisenversorgung und die Frage nach sinnvollen Ergebnissen von dieser an lokale Konzepte von Chronizität und Verantwortung geknüpft sind. Um den Begriff “Ergebnis” in diesem Kontext zu verstehen, muss dieser über das einzelnen Individuum hinaus gedacht und stattdessen als verteiltes Ergebnis gedacht werden, bei dem das Leben mit dem Risiko und seiner Folgen an die kollektiven Erfahrungen des Netzwerks gebunden sind.

KEYWORDS:

• Medication
• risk
• outcome
• responsibility
• dialogic practice

Acknowledgments

This study was approved by the IRB at Washington University in St. Louis.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The study resulting in this publication was assisted by a fellowship from the Berlin Program for Advanced German and European Studies at Freie Universität Berlin, the German Academic Exchange Service (DAAD), the National Science Foundation under Grant NSF 1756620, and the Society for Psychological Anthropology/Lemelson Foundation. However, the conclusions, opinions, and other statements in this publication are the author’s and not necessarily those of the sponsoring institutions.

Notes on contributors

Lauren Cubellis

Dr. Lauren Cubellis is a Volkswagen Postdoctoral Fellow at the Carl Friedrich von Weizsäcker-Zentrum at Universität Tübingen and an affiliated researcher at the Robert K. Merton-Zentrum at Humboldt Universität zu Berlin.