There are landscapes that seem to ask you to stop and look more closely, rather than simply pass through them. Iceland is a land that carries with it a paradoxical image: that of an untouched, distant, separate place. But perhaps “untouched” is a word that does not really exist. No land is ever completely separate from what surrounds it. Iceland too, despite its geographical distance and distinct identity, seems to be crossed by exchanges, relationships, and influences. And perhaps it is precisely this tension between the desire to preserve what one is and the need to enter into relationship with what is different that makes it so interesting.
At first glance, I felt as though I were moving through an austere, at times almost barren land. A vast expanse of lava, rocks, moss and mountains, with few traces of human presence, where the landscape seemed to have remained frozen in a primordial time. Yet it only took a moment of stopping to realise that this land is anything but still. Water flows everywhere, in streams crossing the rocks, heat rises from beneath the ground, geothermal areas constantly remind us that beneath an apparently silent surface there is an energy that continues to move.
It was here that the 30th International Meeting on Dialogical and Reflective Approaches to Psychosis took place. Perhaps this is because Open Dialogue itself now finds itself in a land of transition, on a surface upon which many things have been built and consolidated, while beneath it questions, energies and possibilities continue to move. Thirty years are long enough to look back, recognise a journey, take stock of what has been built, and ask ourselves in which direction this movement is heading.
When Open Dialogue was first conceived, the question was how to meet a person in crisis and their network in a different way. From that question emerged a way of working that challenged many of the certainties of psychiatry and mental health services: the idea that a crisis must immediately be reduced to a diagnosis, that the response must necessarily be individual, that the professional must be the one who knows, and that the family and social network is, at most, merely a backdrop.
Open Dialogue introduced another possibility: meeting the person within their relationships, making space for different voices, tolerating uncertainty, and creating a shared language when a shared explanation does not yet exist. Above all, it recognised that a crisis does not belong solely to the individual, but takes place within a network of relationships and can also be navigated through that network.
The risk after thirty years, is that what began as a transformation in the way we look at things may gradually be turned into a method. A set of procedures, tools and competencies. I believe that today the point is not simply to “do dialogue”, but to continue questioning the way we think about crisis, suffering, care and relationships.
Perhaps the question today is not only how we can respond to crisis dialogically, but also what kind of society makes dialogical care possible. This question shifts our perspective, because Open Dialogue cannot simply be a technique added to services that continue to operate according to fundamentally different logics.
If dialogue requires time, listening, multiple voices, tolerance of uncertainty and attention to relationships, then it necessarily also calls into question the organisation of services, the way we understand professional responsibility, the relationship between institutions and communities, and the way we imagine care.
It asks us what kind of services, communities and relationships we want to build, because dialogue needs time, people who are willing to listen without already knowing where they will arrive, places where uncertainty is not immediately experienced as a failure, and networks.
The point, therefore, is no longer only how we respond to crisis, but how we create contexts in which people can move through a crisis without being immediately transformed into diagnoses, cases or service users.
During the meeting, Icelanders were being asked to express their views on whether negotiations for European Union membership should be reopened. The choice was not to reopen that process. Beyond the political dimension, I was struck by the possibility of seeing this decision not simply as a search for isolation, but as a question about how to remain in relationship with what is different from oneself: how close to come, how much to belong, and how much of one’s own identity to preserve.
The idea of an “untouched” land can therefore also be looked at differently. Perhaps what we call untouched is not something that never enters into relationship with what is other, but something that manages to preserve its own identity while continuing to be traversed by other influences.
And what about Open Dialogue? I find myself wondering how much of its identity it needs to preserve in order not to become simply one of many methodologies available.
For a long time perhaps, we thought of Open Dialogue as something that had to be preserved in its authenticity, as though it were necessary to protect certain original principles from the risk of being diluted. But a living practice cannot remain unchanged. In order to continue generating something new, it must enter into relationship with other forms of knowledge, other cultures, other experiences, and other ways of understanding care.
To become influenced by others means allowing ourselves to be changed by encounters, but it does not necessarily mean losing ourselves. On the contrary, perhaps it is precisely through our relationship with what is different from us that we can better understand who we are.
Perhaps this is one of the passages that Open Dialogue is being called upon to navigate today: not choosing between purity and contamination, between identity and openness, but learning how to be influenced without dissolving.
Open Dialogue was born within a specific historical, cultural and institutional context. Over thirty years, it has travelled across countries, healthcare systems, professional cultures and very different communities.
I like to think that the word “open” can have an even broader meaning: being open does not mean having no boundaries, nor does it mean giving up what identifies us. To me, it means accepting that boundaries can be crossed and that encounters with others can transform us.
Perhaps the challenge for Open Dialogue today is to remain sufficiently grounded not to lose its identity, while remaining sufficiently open to be transformed. An equilibrium within tensions, rather than definitive answers.
Beneath the surface, something is always moving. And one of the questions I carry with me is: what energy do we want to continue flowing through Open Dialogue?
I returned from Iceland with the feeling that thirty years of Open Dialogue represent a threshold, a place where we might pause for a moment and listen.
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