From Stigmatic Silence to Open Dialogue Approach: Mapping the possibilities of Dialogic evolution in Mental Health




By Naagha Shyamala R

“Crucial Conversations” by Joseph Grenny, Kerry Patterson, Al Switzler, Ron McMillan1 is a NewYork Times bestseller on the importance and effectiveness of dialogues in different situations. One of the community-based examples from the book that showcases the effect of lack of dialogue relates to individual mental health issues which, in turn, become a public safety issue. The example states that more than half of the people who are convicted of violent crimes are first time offenders who committed crimes against friends or loved ones.2 These perpetrators could be our neighbours or acquaintances who, just before the day of committing the crime, had a regular job, acted as a responsible family member, paid their bills, enjoyed an ice cream and so on. But, what made that person an offender is possibly the absolute lack of dialogue, which would have let their emotions build up, till they express their frustration in the only way they know – unfortunately often violently. This is a serious mental health issue which can turn into a grave public safety issue.

When we talk about Mental Health, self-care is seen to be an important aspect.The famous saying that comes to mind is “You can’t pour from an empty cup”. Another dimension of the analogy is that it can be equally futile and destructive when the cup is overflowing, especially with contents that are suppressed negative emotions.

Dialogic Method as a way to Address the Causes of Mental Ill-being

Trigger Warning: Suicide references

In my personal experience, I have come across the suicides of some friends. In most cases,it was evident that everyone had an untold story which came out posthumously in fragments. The common factor was not just that the story was untold, but that the fragments were never brought together until the person resorts to an extreme decision like suicide. Dialogue could have been the tool to bring the fragments together and enable the characters to see the bigger picture. After all, having access to a locked door and having the willingness to knock on it is better than looking only at a dead end.

The dead ends are often a result of bouncing off of too many locked doors and tiring efforts to knock on and unlock them. These locked doors could be several factors, ranging from personal and micro blocks like dysfunctional families, workplace stress, isolation, to macro and systemic blocks like discrimination, systems that are unfair and unjust to marginalised groups and, most importantly, the cultural stigma surrounding mental health.. When it comes to the causes of mental health issues, these have been seen as an individualistic and lonely, untethered concept. Often, very few strings of the causes are pulled back to the nodal points of the contexts mentioned above. And, if we group all these factors that cause the mental health issues into an umbrella called “problems” or “conflicts”, a lack of dialogue, especially, a lack of dialogue among all the stakeholders together prolongs the impact of these factors. The Dialogic Method becomes a powerful tool in resolving such conflicts, through a non-binary approach that can bring all the stakeholders involved to ensure that everyone sees and gets value in the resolution.

For example, the secularism of certain countries is currently threatened by religious differences and polarisations. The outlook that often comes out is the unequal levelling of the different factions of the society. A dialogue can bridge the gap between these levels and – as in William Isaac’s definition of dialogue3 in “Dialogue and the Art of Thinking Together” suggests – dialogue lifts people out of polarization and channels the energy of their differences into coordinated powers.

Dialogue is not only a potential way to address the symptoms of mental health issues but also the underlying causes.

Dialogic Method in Mental Health Treatments

India is a community-oriented country unlike its Western counterparts which are more individualistic. Many studies suggest that connecting with people and developing a sense of belonging in a larger community is a major factor that aids our mental health and boosts happiness. Ironically, India is also a country where depression and suicide rates are high. When we explore the Whys, we can clearly see that India may be a community-oriented country but the community is not dialogue-oriented. It is hierarchy-oriented, with importance given to the positions occupied in and by various social and political institutions.

Bruce Mallory and Nancy Thomas, in their paper “When the Medium is the Message: Promoting Ethical Action through Democratic Dialogue”4, highlight the need for dialogue, which ensures equal voice for everyone regardless of their formal status and, most importantly, sufficient time for everyone to interrogate, deliberate and communicate. This, however, is often not the case in India. The hierarchy in Indian communities demands submissiveness, produces judgments, and drives gossips and assumptions, all of which are disablers of an effective dialogue. In this way, the positive outcomes of a community-oriented society are sometimes negatives, perhaps making such a society even less conducive to well-being than an individualistic society. However, as Mallory and Thomas have mentioned, dialogue can be the tool that can remove the shackles of hierarchy and actually activate the positive effects of community. 5

The Dialogic Method invites all the stakeholders of a situation to participate in the dialogue with the complete awareness that it is important for a sustainable outcome. Re-emphasising the fact that India is a community-oriented society, the need for dialogue among the different stakeholders of the community or society to address the challenges faced by any one person is crucial.

The recent approach that has emerged in the mental health field is the Open Dialogue Approach6, pioneered by a clinical psychologist Jaakko Seikkula and now widely used in Scandinavian countries. It levels the space between the patient and the stakeholders connected with them by bringing everyone together to create a peer-led support system while ensuring equal space to dialogue, where everyone’s perspectives and thoughts are given equal importance. This approach, rather than talking about the symptoms of the person, talks about the strengths and the diverse energy the support system holds for the patient. In fact, we find parallels to elements of the Dialogic Method being used in the therapy setting as principles of Open Dialogue Approach, such as participation of family and networks to ensure everyone is involved, asking open ended questions to create a space for everyone to voice their emotions, feelings and perspectives, not just accepting but eliciting multiple viewpoints with an aim to channel the strength and support in diversity, emphasising the client’s own words and stories to show empathy and validate their thoughts and feelings make sure that the therapy and treatment results in holistic and sustainable healing. The studies post the Open Dialogue Approach also show similar results.

7Other variants of traditional mental health support which involve peer support systems like the Alcohol Anonymous groups, group therapy sessions for various mental health issues are also driven by the principles and elements of the Dialogic Method, such as looking into multiple perspectives, deriving strength from the differences, co-creating value and support sustainably.

Another developing field of Positive Psychology emphasises on a model called PERMA, which expands to Positive Emotions, Engagements, Relationships, Meaning and Accomplishments. Patricia Romney, in her paper “The Art of Dialogue”,8 emphasizes that dialogue focuses on the relationship rather than the theme or the topic which gives us the openness to modify some deeply held convictions. Building or maintaining the relationships also require engagements without judgements and assumptions. Diana Chapman Walsh, in her article “Trustworthy Leadership,”9 puts it beautifully, that when we let our guards down and allow our differences and doubts to surface and interact, something authentic and original can begin to emerge. This is the basis of engagements which lead to healthy and sustainable relationships. While the Dialogic Method is built upon and drives these principles, it not only becomes a significant but an inevitable part of maintaining and improving mental health.

As mentioned above, the causes of mental health can be tied back a lot to the external environment and in a country like India, individual therapy can overlook the negative impacts of the pervasive cultural factors in the external environment that affect a person’s mental health and the treatment. The lack of mental health professionals to address these mental health issues also invites a focus on Community Mental Health. Here again, the Dialogic Method becomes a powerful tool in bringing the community together and helps build a pool of shared meaning which leads to co-creating value together for a community to thrive collaboratively. The intervention will also have impacted the individuals and the community by introducing them to the Dialogic Method, which they can use sustainably.

Dialogic community interventions can also address the systemic causes of mental health issues not only in a country like India but in other countries too, which have their own challenges in the field. As Psychologist and Harvard Professor Dr Shekhar Saxena rightly remarked “When it comes to mental health, all the countries are still developing countries.”10


1 Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2002). Crucial conversations. McGraw-Hill Contemporary.

2 Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2002). Crucial conversations. McGraw-Hill Contemporary. (p-14).

3 Isaacs W. (1999). Dialogue and the art of thinking together : a pioneering approach to communicating in business and in life (1st ed.). Currency.

Dialogue: a conversation with a center, not sides. It is a way of taking the energy of our differences and channeling it towards something that has never been created before.

4 Mallory, B. & Thomas, N. (2003). When the Medium is The Message Promoting Ethical Action Through Democratic Dialogue. Journal of College and Character, 4(9), 1-9.

5 Mallory, B. & Thomas, N. (2003). When the Medium is The Message Promoting Ethical Action Through Democratic Dialogue. Journal of College and Character, 4(9), 1-9. (p. 5-7)

6 Olson, M, Seikkula, J. & Ziedonis, D. (2014). The key elements of dialogic practice in Open Dialogue. The University of Massachusetts Medical School. Worcester, MA.

7 Bergström, T., Seikkula, J., Gaily-Luoma, S. et al. A 5-Year Suicide Rate of Adolescents Who Enrolled to an Open Dialogue-Based Services: A Nationwide Longitudinal Register-Based Comparison. Community Ment Health J 59, 1043–1050 (2023).

8 Romney, Patricia. (2005). THE ART OF DIALOGUE.

9 Diana C Walsh (2005) Trustworthy Leadership, Journal of College and Character, 6:5, DOI: 10.2202/1940-1639.1458