81% Recovery from Psychotic Breaks? Psychiatrist Reflects on Open Dialogue Method

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Psychiatrist Tom Stockman has been posting a series of articles on his blog Mandala, reflecting on the Open Dialogue method for intervening in psychiatric crises. Stockman recently participated in an Open Dialogue training program, and discusses the history and research behind the method as well as current developments around the world to investigate and practice it more.

“Open Dialogue was developed in Finland in the 1980’s for the treatment of acute mental illness, such as psychosis,” writes Stockman. “It involves a consistent family/social network approach to care, in which the primary treatment is carried out via meetings involving the patient together with his/her family members and extended social network. Since its original inception in Western Lapland, Open Dialogue has spread across much of Scandinavia, as well as Germany, Poland, and several US States. New York recently invested $50 million in an Open Dialogue service, and Massachusetts Medical School has established a Masters degree in Dialogic Practice. The variant used in New York integrates peer workers into the model, and has come to be known as Peer-supported Open Dialogue (POD).”

“Open Dialogue has been found to be significantly superior to normal treatment of acute psychosis,” writes Stockman. “After 5 years (1992 – 1997) of Open Dialogue treatment in Tornio, Lapland, 81% of people had no remaining psychotic symptoms and 81% had returned to full employment. Only 35% had used antipsychotics (Seikkula et al., 2006). In the UK, only 20% of people with ‘schizophrenia’ would be expected to be symptom free after 5 years, with close to 100% of all patients with psychosis receiving antipsychotics.”

On Open Dialogue Part 1: Introduction (Mandala, December 6, 2014)

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5 COMMENTS

  1. It seems a shame to ruin lives at a huge expense when there are good solutions available.

    “…In the UK….100℅ …receiving anti psychotics…”
    At a cost to the UK of: £60,0000 per “schizophrenic” per year (London School of Economics)
    and below:
    http://www.bbc.co.uk/news/uk-england-norfolk-25915457
    £168,000+ per person per year.

    Evidence says most psychosis comes to an end by itself anyway. My experience is that psychiatric drugs cause disability and create longterm illness through withdrawal syndromes; and that basic psychotherapy like CBT (or Buddhist philosophy) works well, and can keep problems in proportion.

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  2. I’ve been a part of an Open Dialogue dialogue, it’s makes a lot of sense. It is pretty much the opposite of what mainstream psychiatry is doing today – it’s about showing care, compassion, and respect to the patient. Because of this, it will likely be very difficult for psychiatrists to do, but it’s common sense for a good mom.

    And, as a person who experienced my first “psychosis,” just two weeks after being put on an antipsychotic (exactly when my doctor told me the drug would “kick in”). I’m quite certain the reason the recovery rates for those put on the antipsychotics is so low is because the drugs can actually cause “psychosis” in people inappropriately put on them (like those who had the adverse effects of an antidepressant misdiagnosed as bipolar).

    It is a shame the psychiatrists are ruining the lives of so many, and have no idea what the actual effects of their drugs are, while claiming to “know everything about the meds.”

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  3. “New York recently invested $50 million in an Open Dialogue service, and Massachusetts Medical School has established a Masters degree in Dialogic Practice.”
    Let’s see how that one works… But my feeling is that it is not enough – one has to acknowledge the crucial part of the stressful life circumstances that contribute to any “mental illness” and offer additional support for issues of unemployment, poverty, racism and so on.

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  4. “Significantly superior” is kind of a gross understatement! How about “dramatically superior,” and that’s without even the consideration of bothersome “side effects” like diabetes, heart disease, permanent neurological damage and early death.

    I’m glad to hear the news is spreading, though. It seems like the availability of an MS in Diologic Practice seems to legitimize the enterprise. But it never ceases to amaze me how mainstream folks can see these dramatic differences (80% vs 20% recovery) and be skeptical, when they accept a 10% difference between placebo and a drug as legitimate support for effectiveness.

    Of course, the answer lies in profitability and ego…

    —- Steve

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