The person as whole - A Holistic Perspective on Humanity as the Foundation of Mental Health Work

The person as whole - A Holistic Perspective on Humanity as the Foundation of Mental Health Work

Author: Tomi Bergström, PhD, Psychologist, Adjunct Professor of Clinical Psychology

In holistic thinking, the whole is perceived to possess qualities that cannot be reduced to its individual components. Thus, the whole is greater than the sum of its parts. For instance, the concept of a mental health problem refers to various human characteristics, emotions, thoughts, and behaviors that someone finds problematic in a given situation. Because the problematic nature of such psychosocial phenomena depends on the context and the meanings attributed to them, they cannot be reduced merely to the characteristics of an individual. Therefore, categorizing perceived or experienced psychosocial challenges into diagnostic categories or using predefined treatment methods can unduly narrow the approach to encountering and treating individuals. Instead, it is important to create a safe space where a new understanding of the current life situation can be collaboratively built. Based on this understanding, helping efforts can be tailored more individually and appropriately.

An Alternative to Reductionism

A holistic perspective on humanity offers an alternative to the prevailing reductionist view of mental health (Bergström, 2023). In reductionism, the aim is to understand the whole by breaking it down into simpler components. For instance, certain problems are assumed to indicate a specific disorder, which is believed to stem from specific causal factors such as life events, psychological processes, or bodily functions like brain activity. Consequently, mental health care seeks to identify and treat these causal factors using predefined methods.
However, diagnoses describing psychosocial problems do not actually reveal what causes the observed or experienced problem. Psychiatric and neuropsychiatric diagnoses are based on agreed-upon symptom descriptions, essentially serving as synonyms for observed problems. Even similar psychosocial problems cannot always be traced back to recurring causal factors, just as human experiences, thoughts, or behaviors cannot. Additionally, whether a particular trait, emotion, thought, or behavior is considered problematic depends on the context and cultural attitudes towards such traits and societal expectations.

Reductionist views on mental health present several challenges (Bergström, 2023; van Os et al., 2019). Firstly, classifying psychosocial problems as medical disorders can lead to the perception that these agreed-upon symptom descriptions are actual illnesses causing the observed problems. This can result in people explaining their issues as being due to a psychiatric or neuropsychiatric diagnosis, which is essentially a self-perpetuating circular argument. This narrows the understanding of normalcy, medicalizing human traits and life problems and placing them under the authority of mental health experts. Demand for services increases, and treatment begins to emphasize symptom relief using predefined methods rather than considering individuals' unique life situations and the bodily, psychological, and social factors maintaining the challenging situation.

According to the holistic view, complex phenomena like psychosocial issues are not entirely reducible to their components, nor is such reduction necessary for understanding or helping people (Rauhala, 1986). For example, the human body and its biological functions are essential for psychological and social phenomena, but these phenomena cannot be reduced to their biological components because their manifestations and meanings are context-dependent. Thus, psychosocial phenomena labeled as mental health problems or disorders contain qualities not present in their individual components, making it impossible to fully understand or treat them solely through their parts. For example, feeling uneasy and struggling with daily tasks, concentration, or social interactions cannot be traced back to a single life event, psychological function, gene, or neuron but result from complex interactions that are always individual and context-specific.

A holistic view helps explain why phenomena diagnosed as mental health disorders have not been reducible to psychological or biological components, despite repeated attempts, such that they can be verified through laboratory tests or other independent methods. It also clarifies research findings indicating that, regardless of the method or problem, effective mental health care shares common factors such as the individual characteristics of service users and therapists, the quality of the therapeutic relationship (Wambold, 2015), and the general effects of psychotropic medication on universal human thought and emotional processes (Moncrieff, 2018).

Open Dialogue as an Example of a Holistic Mental Health Care Model

The Open Dialogue approach, developed at Keropudas Psychiatric Hospital, is a family- and network-centered mental health care model (Seikkula & Alakare, 2004). Approach is based on systematic service system research indicating that predefined psychotherapies and other treatment interventions often did not function appropriately in the context of everyday mental health work due to the inherently complex and interpretative nature of people's challenges. Surprisingly, treatment efficacy improved when workers approached treatment situations without predefined goals, roles, or tasks. Instead, they sought to create a safe space using a curious attitude, active listening, open-ended questions, and various techniques to ensure all voices were heard equally. This approach led to more dialogical, reciprocal encounters, with involved parties considering and understanding the situation from different perspectives.

The entire mental health care system in Keropudas's operational area was reorganized to support reaching the dialogical spaces, regardless of the problem. According to the holistic view and common effective factors in mental health care, reaching such a space is itself therapeutically effective (Bergström, 2023); psychosocial problems are subjective and interpretive, with multifactorial and context-specific backgrounds, but people benefit from being taken seriously and actively understood, regardless of the situation. The shared understanding emerging from dialogue can also be used to more individually apply need-specific helping and treatment practices.

Practical Application of the Open Dialogue Model

Independent cohort studies have linked the Open Dialogue model to better long-term treatment outcomes and cost savings, especially in acute and youth psychiatry contexts (Bergström et al., 2018; 2022; 2023; Buus et al., 2019; Kinane et al., 2022). However, since it is not a precisely defined method that excludes other treatments, it has not been studied using the same experimental designs typically used for medical treatments (Freeman et al., 2019). Consequently, it has not been promoted or trained within our service system, which is based on a reductionist view of mental health, and the current service system does not inherently support reaching a dialogical space. Implementing comprehensive and appropriate dialogical practices at the system level may require structural changes and specific training for healthcare personnel. There are emerging signs of such development globally, but in Finland, the time may not yet be ripe for systematically developing holistic practices across the entire service system.

However, individual mental health professionals can already develop their work towards a more dialogical approach using certain basic principles, regardless of whether they work in the public, private, or third sector. The key is to maintain a curious and interested basic attitude and, instead of problem definitions or treatment methods, to follow the themes raised by the involved parties in a good cooperative relationship, always responding to what has been previously said. It is important to trust that open dialogue carries and creates a sense of "we" that research indicates best predicts the effectiveness of mental health treatment, regardless of the method or problem. Additionally, a rich and shared overall understanding of the current situation is created to support both the helping party and the individual's self-understanding, providing a foundation for planning and implementing more specific help if needed.

For Whom is Dialogical Work Suitable?

Engaging in reciprocal linguistic or non-linguistic dialogical relationships is natural for humans from birth. Psychosocial challenges are fundamentally tied to the relationships in which individuals live and have lived. Thus, creating a dialogical space can be fruitful regardless of the problem, particularly in the early and transformative stages of the helping process when the main goal is to form a new understanding of the current situation. This approach is not a method but a foundation for helping work upon which the practice can be built or reorganized.

The dialogical helping process does not necessarily require a problem definition or even a clear identification of who the client or patient is. Reaching open dialogue is facilitated when the observed or experienced psychosocial problem and related difficult emotions, such as worry or distress, are currently prominent. It also helps when everyone affected by the situation participates in the meetings. Different perspectives and ways of thinking are also important for generating polyphonic dialogue.

However, one can also come to a dialogical helping process alone, for example, when concerned about oneself or a loved one, or if reciprocal discussion is needed on current issues. The dialogical helping process does not offer quick or ready-made answers and may not always suit rapid decision-making sometimes required by the system. Most often, answers and solutions emerge during the dialogical process, and these solutions may ultimately be more functional than those provided externally.

The dialogical helping process progresses one meeting at a time, with meeting compositions and locations varying according to the involved parties' wishes and needs. The dialogical process can also combine various psychotherapy and other treatment methods as needed once the dialogical space has been reached. Regardless of the problem or meeting composition, the professional's primary task throughout the process is to maintain a functional and trusting cooperative relationship.

Author: Tomi Bergström, PhD, Psychologist, Adjunct Professor of Clinical Psychology [Book an appointment with Tomi]

Tomi Bergström has worked as a clinical and head psychologist at Keropudas Psychiatric Hospital. He has over ten years of experience in psychiatric specialized care, coordinating network-psychotherapeutic and dialogical treatment processes for psychoses and other severe mental health disorders at the hospital-outpatient care interface. Alongside his clinical work, he has researched holistic mental health care models, such as the Open Dialogue approach, in both national and international research projects. Tomi has been involved in the WHO’s writing and evaluation group, drafting guidelines for implementing holistic mental health care models globally.

Tomi has recently moved back to Southern Finland with his family and continues to research holistic approaches and explore their development possibilities as a postdoctoral researcher at the Department of Psychology at the University of Jyväskylä and as an adjunct professor of clinical psychology at the Faculty of Education and Psychology at the University of Oulu. Alongside his research, he maintains a part-time private psychology practice at Mielipalvelu's Helsinki office.

Include Tomi in your support network by booking an appointment here. If no suitable time is available in the booking calendar, you can contact him directly to arrange a time and place for the meeting:

Remote appointments are also possible. Tomi conducts sessions in either Finnish or English.

For more information about Tomi and his work, visit: www.tomibergstrom.com

References:

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