Vermont Turns to Open Dialogue, Less Medication for Psychosis

Kermit Cole
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Psychiatrist (and MIA blogger) Sandra Steingard leads a team from Vermont in replacing antipsychotic medication with dialogue between patients, family members, and others. Steingard, concerned since the 1990s about the overselling of antipsychotics and understating of their risks – and patients’ refusal to take them – “didn’t really know what else to do. I didn’t see any other path” until learning about Open Dialogue, which originated in Finland. “They’re not really seeing schizophrenia in Finland. They’re seeing the same number of people coming in with acute psychosis,” Steingard says, “but people are getting better.”

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

11 COMMENTS

  1. BRAVO!!!!! I realize this is just beginning, but this is wonderful. We need demonstrations right here in the U.S. that Open Dialogue and other programs like it work. It seems Americans are insular and are somehow able to dismiss it from their minds when something in Europe or elsewhere works (like the resounding lack of interest in the provocative WHO study findings). Great thanks to Sandy Steingard, and to others in the US who are backing Open Dialogue, Soteria and other programs.

    This has made my day – make that week, possibly month.

  2. Sandy,

    Thanks for this encouraging news.

    I was describing the Open Dialogue Program to family members and their criticism was it was too costly.

    I responded by stating that drugs didn’t work long term and essentially we couldn’t afford not to try this program. But somehow, I think there is a better response.

    What would be a quick and to the point rebuttal when people raise the cost issue?

    Thanks!

  3. Sandy, according to Whitaker (p.343), spending on psychiatric services, in the region where Open Dialogue is the first line treatment, dropped 33% from the 1980s to the 1990s, and costs less per-capita than the other districts in Finland where O.D. is not practiced.

  4. I would like to clarify what I belive is an (inadvertent) misconception of this article. I do not want to leave the impression that I have an Open Dialogue program. I am interested in learning about Open Dialogue. I suspect this will take years.
    The program we have – called START – allows us to go to people’s homes at a time of crisis. We try to engage and listen. We try to involve the family and others in the social support system. We include peers who have been wonderful. Some of us are getting training in Open Dialogue but we do not claim to be trained at this time. We do not call our program an Open Dialogue program. I prescribe drugs in a manner that is in my opinion judicious and cautious and with what I consider full informed consent. Given the many side effects associated with most drugs I prescribe, I am understandably curious about any kind of way I can minimize their use.
    I did not seek out this article although I am grateful for the kind way in which my work was portrayed. I appreciate your kind words but I do not want anyone to be misinformed about the work we are trying to do.