Divided City/Divided Selves: Negotiating Schizophrenia under Healthcare Reform in East and West Berlin

Lauren Cubellis

My dissertation research looks at the implementation of an alternative treatment model for psychosis in Berlin, Germany. A local community health organization is experimenting with dialogic practice that includes network therapy, home visits for clients, and the inclusion of peer specialists (individuals with lived experience as patients in the mental health system who have been trained to support others). The model aims to reduce dependence on, and over-prescription of, antipsychotic drugs, to keep people out of hospital emergency rooms and in-patient clinics, and to strengthen ties between clients and their social and familial networks. 
According to dialogic practice, the self is always answering to and being addressed by co-existents with whom he/she reciprocally constitutes the world (Bakhtin 1981; Holquist 1990). Dialogic practice in psychiatry harnesses these principles in order to deconstruct and rebuild social roles and relationships, validating the history and experience each person brings to the group. Thinking and acting in this way creates relationships of care that are emergent, flexible, and intersubjective. In contrast to a standard biomedical approach in which doctor-patient hierarchies and medical authority structure vectors of care and the psychopharmacological manipulation of the self, dialogic treatment necessitates a collaborative self-making that is deeply rooted in the tolerance of uncertainty and a persistent open-endedness. 
"Care"My preliminary research has shown that a changing economic landscape is forcing this group of dialogic practitioners into morally tenuous relationships of care. These tensions take shape within the history of a divided city, with clients living in the former East demonstrating social and therapeutic experiences distinctly different from their counterparts in the former West (Borneman 2015; Evans 2011; Lindy and Lifton 2014). The lingering effects of the East/West divide are thrown into relief by initiatives leveraging notions of social solidarity, of which reform in mental healthcare is one (Bauer 1994; Mossialos and Le Grand 1999). Whereas care in Germany, as elsewhere, was once the purview of informal kin networks, today it is often mediated by public institutions and third party payers (Brown 1989; Estroff 1981; Stone 2000). The influence of evidence-based medicine in research and practice adds to the pressures of funders to standardize therapeutic forms. In the context of postsocialist Berlin, this transition marks more than the neoliberalization of carework, in that it indexes a remaking of the social solidarity principles differentially experienced across eastern and western parts of the city (Borneman 1991; Boyer 2006; De Soto 1996; Hinrichs 1997; 2002). In light of this, the attention to the social forwarded by dialogic practice allows it to serve as a lens for examining the ways lingering East/West divisions, newly refracted through changing structural pressures, shape the sociocultural dimensions of psychotherapeutic experience and practice in Berlin.