Nick Putman on the history of Open Dialogue UK
In the past five years, there has been a dramatic explosion of interest in the Open Dialogue Therapy as practiced in Tornio, Finland. It is a humanistic “treatment” that has produced five-year outcomes for psychotic patients that are, by far, the best in the developed world, and there are now groups in the United States, Europe and beyond that are seeking to “import” this care.
However, the challenges for doing so are many and, last month, Open Dialogue UK organized a conference in London — “Toward Openness and Democracy in Mental Health Services” — in order to hold a public dialogue on how the progress of spreading Open Dialogue’s approaches to other countries is going, and to identify what is needed for this process to go well. More than 600 people attended the conference, from 20 or more countries, mostly from the U.S. and Europe but with attendees from further-flung areas such as Nigeria and Uganda.
Conference organizer Nick Putman, a psychotherapist who spent years living in therapeutic communities run by alternative-minded models such as the Philadelphia Association and Arbours, had traveled to Tornio to learn about the method. He then formed Open Dialogue UK in 2013 to promote and provide clinical services in the Open Dialogue model to families in the UK, as well as to provide the necessary training for clinicians. Said Putman;
“It has been a privilege to be part of the international Open Dialogue community over the past five years, and it felt important to organize this conference in order to bring together many of the people I have met during these years who are working hard to move our services in a more dialogical direction. Dialogue is at the heart of the approach, and so every opportunity to come together to share news of developments, and to think and dialogue together about the best ways of proceeding, is welcome.”
Open Dialogue UK Conference: A Sampler
Thirty people from six countries are enrolled in Open Dialogue UK’s three-year training program. While there have been open dialogical training programs in the United States and elsewhere, the Tornio clinicians — Mia Kurti, Jaakko Seikkula, and others — have recognized Open Dialogue UK’s program as the first to provide training equivalent to that which clinicians in Tornio undergo. “This is the very first training outside Finland to follow the criteria for professional competence in Open Dialogue,” said Seikkula. “We really need to be sure that the practice follows the Open Dialogue experience in Western Lapland when applying it in new contexts. I am very happy about the realisation of the training so far. Both the part of the Open Dialogue certificate, and the trainer-in-training part have been successful. According to the experiences in the UK we are now working to generate a world-wide Network for Open Dialogue education programs.”
Open Dialogue UK is also offering a one-year foundation program in Open Dialogue, as well as shorter seminars. (Applications are still open for the foundation training, and are welcome from those working in mental health services in the UK and internationally, as well as independent practitioners and peers.) Several clinicians from Tornio, along with long-time Open Dialogue teachers from elsewhere, have helped set up these training programs, and are teacher on them.
In his keynote, Seikkula — who has led the research into Open Dialogue outcomes — observed that the roots of this approach are found in philosopher Mikhail Bakhtin’s proposition that “dialogue is the basis of human life.” Following this principle, the conference was organized as a dialogue, with panels of clinicians and peers – and audience members – reflecting on each presentation.
A dominant theme of the conference was that the enthusiasm for Open Dialogue reflects an ever-growing dissatisfaction with the prevailing “medical model” of care, and the search for something better. Seikkula noted that while it was true that biological psychiatry had abandoned people with psychosis to drug-focused treatment, the field of psychotherapy had done so as well, and that it was this larger abandonment of the psychotic person that needs to be addressed.
Jaakko Seikkula: Open Dialogue UK Keynote Address
Discussion after Seikkula Presentation
While Open Dialogue originated in Tornio as an effort by clinicians to reform the municipal mental health system, much of the impulse to import it into other countries has come from the consumer/survivor/ex-patient and antipsychiatry movement in the rest of the world, whose leaders have looked to Open Dialogue as a corrective to the systems in place. Seikkula returned often to speaking of the necessity of working from within the system to correct it, rather than create alternatives entirely outside the system. While this is driven in part by the necessity of attending to potentially lethal medical conditions — such as eating disorders, as Seikkula noted, as well as the need for careful research to correct, validate and extend the practice — others, such as Werner Schütze of Germany spoke to the power of a grassroots movement that was creating Open Dialogue-like programs and trainings that are open to all — clinicians, non-clinicians, people with lived experience – who wish to build on the principles that Open Dialogue has validated as an effective alternative.
Panelist Olga Runciman – who at one time was told she would be schizophrenic the rest of her life and was locked up in hospitals for many years, only to try quitting medication (rather than suicide) and go on to become a psychiatric nurse and clinical psychologist – told of a conversation with Seikkula:
“I said; ‘Oh, my gosh we’re seven people from Denmark. We have to go back, rent a place, and just start up shop.’ And Jaakko was saying, ‘well, you know, you can’t just…; to that. And I said ‘well, to be honest, it will be learning by doing and even if we make a pig’s ear of it, it will be better than psychiatry!'”
Former psychiatrist Volkmar Aderhold and Petra Hohn presented on their long collaboration training people in Open Dialogue, saying, “What is the right thing to help people in psychotic states? It’s this natural way of being together; the melting of psychotic experiences within these meetings. It’s amazing…. And network meetings are the single most effective intervention in psychiatry.”
Discussion following Volkmar & Petra
Runciman, Rachel Waddingham, and Jacqui Dillon, leaders in the Hearing Voices Network in Europe all of whom identify as psychiatric survivors), said that while they embraced Open Dialogue principles as consistent with the principles of the Hearing Voices network, they were concerned about peers being co-opted when a system adopts (or maintains that it is adopting) Open Dialogue principles. Said Waddingham;
“I think what drew me in was the philosophy behind it… there’s a real honoring of otherness, that we cannot claim or define or own someone else’s experience, all we can do is find some space between us to find a dialogue or some way of connecting to each other, and that feels so in line with my values from the Hearing Voices Network… That’s really profound and it’s so lacking in the current mental health system, where there’ s so much diagnosis… Whilst I was really attracted to it, I had reservations about whether I wanted to train as a practitioner or not, because it’s still a treatment system.”
Peter Kinderman spoke to this, saying
“There’s a little niggle in the back of my mind, which is that the peer trainer element maintains a ‘them and us,’ so; you can be part of the team, but you’re labeled as a peer. And basically, there’s a very slippery slope between saying that ‘you’re a valued member of the team, and part of the value that you bring is your lived experience. And that’s very, very close to saying ‘this is a woman that’s had lived experience, unlike me.'”
Amy Morgan, a clinician from Advocates in Framingham, Massachusetts reported that — distinct from the report of many at the conference — peers working at her agency had decided against training in Open Dialogue, fearful of being absorbed into a clinical role that would interfere with their ability to fully advocate for their clients. Morgan reported that Advocates found the presence of peers in Open Dialogue network meetings — solidly in their role of support to the person at the center of discussion — to be “invaluable.”
The discussion repeatedly alighted on an intriguingly complex question; does Open Dialogue represent a “radical” paradigm-shifting development in mental health care, or a return to age-old principles of caring for people who are struggling with uncomfortable emotions and difficult states of being? Several speakers noted that while Open Dialogue represents a radical shift within the context of the current system, it is essentially a way of “being” with people in distress that has always been (and continues to be) found in “less developed” societies.
Several speakers at the conference and in the training, including psychiatrist Russell Razzaque of the National Health Service at the conference, and psychiatric nurse Paul Ekwuruke and peer worker Flick Grey in the training that followed, noted that people in non-industrial, indigenous communities naturally do what Open Dialogue “teaches” people in industrial countries to do; to stay with people, work with their families, and keep the “disturbed” person within the community, rather than separating the person from the community, somehow having been designated aberrant, “broken,” or medically ill.
Indeed, the question of whether Open Dialogue is fundamentally concerned with dialogue at all was raised from the floor by one conference participant, who noted that in some cultures, ways of communication go far beyond spoken language. The sentiment was responded to by members of the panel. (See the conference sampler video at the end of this article.)
Paul Ekwuruke, a London-based psychiatric nurse originally from Nigeria, spoke eloquently of the “irony” of people communicating poorly in the “so-called developed world,” noting how easily he finds people — including, sometimes, family members in extreme states — when he returns home;
“When I talk about inclusiveness I talk about comprehensive acceptance of difference. Because we are not the same. We are all different. And the only way we can work together and achieve a common goal is when we have acceptance irrespective of difference … Whenever there is separation it brings up aggression, because one thing I’ve understood in my work in psychiatry is that once people are isolated the feeling of marginalization comes in, the feeling of exclusiveness comes in, the feeling of wanting to be heard comes in, and that acting out – that is the madness – is a way of communicating, is communication itself … calling people to attention and saying ‘I exist, I am here, and want to be heard.’”
Australian trainee Flick Grey echoed this theme, saying;
“Someone actually said to me, ‘why are you off to learn this Finnish model when we have very similar practices in indigenous communities?’ Which I thought was a really interesting question — and that is a pattern within academia generally — that people go off and study white European thinkers, when actually there are a lot of people thinking on the planet. And whose ideas get taken up?”
Along with the question of whether Open Dialogue is simply a re-packaging of old, extant wisdom that is often to be found in “less developed” cultures, the question was posed of why people of color were almost completely unrepresented in both the conference and the training. The challenge posed by replicating Open Dialogue’s success while being respectful of local culture and wisdom and maintaining fidelity to Open Dialogue’s core principles was an active and fertile topic in both the conference and the training.
A key discussion point on the panel contemplated the nature of suffering; how it is held in our society and the challenge that psychiatry faces in dealing with discomfort, with psychiatrist Volkmar Aderhold noting that his transition into dialogical practice was precipitated by the depth of suffering he experienced in the practice of psychiatry, saying that “psychiatry itself is a battleground, and a bad one.” Panelists such as James Davies of the Council for Evidence-Based Practice called suffering “a call to change; actually it can bring about something positive” rather than “a useless encumbrance,” noting that this realization had come about as a result of suffering he had experienced in his own life.
The conference day took on a gathering sense of momentum and excitement, as clear evidence of a budding, transformative movement took hold; a movement that returns a troubled industry’s focus to principles of care that are powerful, universal, and enduring. Open Dialogue is about more than just talking; it is about a rediscovery and re-engagement of love in the clinical setting.
Some connected with Open Dialogue have described psychosis as the plight of a person or persons trapped in monologue; a description that goes some way toward explaining why Seikkula — a consummate scientist and researcher, it is well worth noting — summed up his keynote, as well as the essence of why dialogue is capable of ameliorating psychosis, with these words; “Love is the life force, the soul, the idea; there is no dialogical relationship without love, just as there is no love in isolation. Love is dialogical.”
The Open Dialogue UK conference and training presented an opportunity to witness this dialogue – and love – in action. We hope that presenting this report on Mad in America provides an opportunity for the vibrant discussion that began in London to continue. We invite you to contribute to this vital and challenging movement for change and renewal by adding your voice, and witnessing the voices of others. It is, after all is said and done, what Mad in America was — and is — all about.
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Jaakko Seikkula & Richard Armitage
…And every recovered “Schizophrenic” saves the UK at least £1 million….
This is really a good point. I believe that the Tornio crew did a cost/benefit analysis. I’ll try to get a hand on it.
Whilst no formal cost-benefit analysis of Open Dialogue has been published, there is some national Finnish data which shows that it costs less to provide services in Western Lapland than in the rest of Finland. And this is just when you look at the data for the mental health service offered. When you take into consideration the data from the research published to date from Western Lapland, such as lower relapse rates, higher employment, far lower use of long-term medication, lower use of disability benefits, etc., it is, for me, clear that, when you look at the bigger picture, the cost savings will be considerable.
Wow thank you Kermit. What a fantastic report. Your passion really shows through in this. I am with you; I love Open Dialogue’s approach and have been telling many people about it.
I think Seikkula’s 3 outcome studies are very convincing and the philosophy behind it is so right.
Also, think that most of Open Dialogue’s core principles are not so different from the core ideas behind depth psychoanalytic psychotherapy with psychotic people – respect for the individual, providing immediate help, honoring of otherness, focusing on intersubjectivity. Where OD differs is largely in the greater focus on the social network and the team.
It should work… showing someone love and using the strengths in a person’s social network should work anywhere. There is no reason it can’t work outside of Tornio.
Well done with the videos; it really brings the presentation to life.
Thank you. I used to work in film. It’s nice to unpack the ‘Mad Max’ footlocker for something I really care about.
I’ll stick to my B3, thank you.
? is right… what are you talking about…
It’s interesting to note that the one way that Open Dialogue differs from psychoanalytic psychotherapy (at least in today’s world) is that Open Dialogue IS the approach to mental health care in Tornio. The clinicians of Tornio transformed the system over the decades that they have been in charge of it. Elsewhere, as Jaakko noted several times, it wasn’t just that psychiatry’s influence grew, it was that psychotherapy in general abandoned “psychosis” to it.
We could look at many reasons for this, including a general societal shift that made it difficult to do otherwise. But what was demonstrated in Tornio isn’t simply a superior “technology” of mental health care. It is a demonstration of what happens when the overarching ideology that Open Dialogue rests upon IS the system of care.
So the challenge isn’t merely to adapt or import it; it is to follow the example in reconstructing our cultures and communities. That could be the civil services, but the model holds in whatever network you we working with, down to our families, significant others, and people we meet on the street: try very hard to hear – completely – what they are saying (or not saying), and ideally to feel and understand what feelings they have that are driving them to say (or not say) it, BEFORE you make any decisions about whether what they are saying is right or wrong, good or bad. Focus on feeling with them, and perhaps the sense of what they are saying will change – for you, at least, and perhaps (almost certainly, I’d say) for the collective.
That can be done whether or not we manage to change the world, or society, or psychiatry. It can be done today. It has been done throughout the world and throughout history by healthy communities, healthy families, and healthy couples. To the extent that psychoanalytic psychotherapy was – and is – successful, it could be argued, this (your point) is why.
What Open Dialogue proves is that ‘psychotherapy’ works very well for ‘psychosis’ (something a lot of people don’t know).
This article is a gift. Thank you so much. Your description of this event sent goose pimples down my spine and almost as if I was in attendance myself, experiencing the excitement of being one of the six hundred in attendance. I am so glad that your radar was on high alert, picking up on so many important questions that were asked such as ” Why weren’t there many people of color at the conference?: ” What wisdom traditions and voices from indigenous cultures could be providing additional models for healing and restoration?” “What about other forms of language?” “Is the spoken word considered by western people to be the only form of communication available to man/humankind?” Also, there are restorative justice projects and non-violent language training projects that are accomplishing some of the same goals as Open Family Dialogue but the applications are not limited to the “mental health” field. they deal with healing with healing from racism, victims of violence, homophobia, etc. Finally, when I attended the Economics of Happiness conference in Portland last year, I found that there were many, many potential overlapping areas where the movement for justice in the mental health field overlaps with the environmental/peace/justice/occupy movements. Although many activists and leaders in those justice movements do not identify as being survivors/consumers/ex-patients, many of them are feeling overwhelmed and despairing and in need of comfort, consolation, healing, and restoration. Why should they have to wait for a personal crisis for our community to offer them mental, emotional, and personal, financial support? I highly agree with the Peter Kinderman’s remark:
“”There’s a little niggle in the back of my mind, which is that the peer trainer element maintains a ‘them and us,’ so; you can be part of the team, but you’re labeled as a peer. And basically, there’s a very slippery slope between saying that ‘you’re a valued member of the team, and part of the value that you bring is your lived experience. And that’s very, very close to saying ‘this is a woman that’s had lived experience, unlike me.'” I too, feel that creating sharp divisions between peers and non peers creates an out for people. I believe that madness is a universal human experience and the only way for so called professional healers to make a positive impact is for them to acknowledge their darkest, most wounded aspects. Having divisions between peers and non peers is a slippery slope indeed.
But the thing is Open Dialogue is proven to work (longterm).
Yes; what Open Dialogue did was document its approach and outcomes. Many people have done good work; they proved the value of what they were doing. Others can follow the example, in their lives and in their work, without necessarily having to revamp their whole system.
On the other hand, Open Dialogue also provides tools for revamping a whole system, which is also a good thing.
I agree about the intersectionality of liberation movements that include all of us humans, animals, and planet. It is the values and philosophy underlying Open Dialogue that is most significant. When the “othering” and the “us/them” identifications are structured in, then we lose sight of the basic values underpinning liberation for us all, regardless of roles. We need to identify as humans and create compassionate communities where there is greater justice, equality, learning, growing, and celebration of difference. Rai Waddingham is a great example as are others working towards restoring values of mutuality and love. These can’t be patented, mass produced and marketed, regardless of how hard western countries led by the USA attempt. The values and principles of the Hearing Voices Network, Open Dialogue, Intentional Peer Support, Black Lives Matter, and learning from Paulo Freire, Bell Hooks, and other liberation leaders are congruent with a movement I rejoice to count myself among.
” …..when we have very similar practices in indigenous communities?…” In all communities not just indigenous – the only people telling us that the expression of normal distress (though bottled up) is abnormal are the professionals.
Depression also as an illness is now diagnosed hundreds of times more than it was a few decades ago with 10 per cent of the British population addicted to anti depressants (just like the “schizophrenics”).
Certainly true. There have always been good people who did good work, quietly, modestly, and divesting themselves of glory, power or reward.
I view what we are engaged with here as a perennial effort against the temptations of glory, power, “efficiency,” “effectiveness,” and “certainty.”
Good parenting and good society has always been about the cultivation of a tolerance for uncertainty, and resilience against stress and pain (rather than hoping for its elimination). Open Dialogue is one more good example of the success of cultivating that on a community-wide level.
Over 40 years ago, in an old mental hospital in Melbourne Australia, we set up a program to attempt just this. We worked with families, kept the drugs low to non -existent, spent hours in 1:1 talking and listening. We called it Crisis Intervention. It was killed by institutional psychiatry, (very few were permitted to work there), drugs and ECT. I believe that movements like Open Dialogue grow from existing sources. That this kind of thing grows normally from society where people are not overwhelmed by `glory, power, “efficiency,” “effectiveness,” and “certainty”, (status), and that there have always been people doing this, quietly, out of the public eye, a kind of `village’ care, if you like. But when powerful institutions such as the church, medicine intervened, this `pastoral’ care was lost. I guess I call it caring. I think we must be very careful that a) Open Dialogue does not become corrupted by psychiatry wanting to control it; b) psychiatry doesn’t shut it down (as in Soteria House). Because right now it is a threat – where the leader of a team could be non-medical, one can see trouble ahead. Already one such program has been corrupted by the continued use of medication as the core of treatment, and the doctor as head of the team brooking no true negotiation. It will be very hard for them to let go for the sake of the patient, because the patient has, traditionally, held the lowest place on the totem pole. Still, we can hope.
Kermit, this is true that a primary danger to Open Dialogue is institutional psychiatry infecting it in various ways, for example by insisting that medication be tried in every case, and remained on in many. This would ruin the results most likely and promote the delusion that trauma-informed, low-drug care is no better than “treatment as usual”.
Open Dialogue is obviously the most cost effective treatment approach available because people get cured, or better than cured – but how is it faring outside of Tornio in the rest of Finland?
Good question. From what I understand, not so well. Finland at large is relatively medical model and antagonistic. Open Dialogue is about how the clinicians in the Tornio catchment area have transformed their own practice and community. I think this suggests that if its to be adopted, it’s a community-by-communuty proposition.
My point. See Deeeo42.
It’s very frightening to think – that you have an approach within a country that can deal with a problem, and the people within the country that really need help, can’t access it.
I remember the first time I was told that it was possible to recover without medication – I was astonished. But it was the same as anything else.
To give some idea, I’m a Finn, and I only heard about Open Dialogue after reading Whitaker’s book. It’s a small country too. I also kind of think it has been even over-sold in international groups like this. My experience with the public mental health care was that it was very low quality and abusive. I even had as my psychiatrist someone who had been working in the Open Dialogue group in Tornio, I think. I think there has been some interest in the approach lately, largely because of the international interest.
OK. So individuals who take part in the “open dialogue” experience may sometimes, maybe often, benefit from what they do. This is not something I have the information to agree with or challenge.
However, this seems to be a quasi-medical model approach, which still uses diagnostic terms and makes obvious distinctions between staff and clientele, and which seems void of political context to a large degree. It remains a program for “those” people.
As I’ve mentioned before, the “TM” often appearing after “Open Dialogue” is indicative of a corporate mentality which underlies it. It reminds me of when FOX “News” tried to trademark the phrase “fair and balanced.” Any time someone take basic human characteristics or capacities and try to put their corporate stamp on them it should be seen as a “red flag.” It also makes me recall the Who’s rock opera Tommy, who after childhood trauma finds enlightenment via the zen of pinball, then ends up running a neo-fascist summer camp based on pinball in which legions of followers learn to follow his every command.
I had reservations about whether I wanted to train as a practitioner or not, because it’s still a treatment system.
Glad others have this reaction as well. (This doesn’t mean I would advise anyone not to participate.)
Having been immersed in Open Dialogue for the past five years I have to say that my overriding impression has been that it is far from a quasi medical model approach. Yes, similar language to the medical model is used in some of the research/literature, but this is not a reflection of the daily work, where ordinary language is used and the emphasis is on connection and meaning, a far cry from the culture that the medical model tends to engender. Based on a number of conversations I have had with the founders of the Open Dialogue approach, I think that where similar language to the medical model is used, there are a number of reasons for this – to some extent I think that something has been lost in translation, but probably more pertinent is that there has been a deliberate attempt to speak the language of psychiatry in order to connect, and in the hope that interest in more dialogical approaches will develop within this field. In Open Dialogue network meetings you stay close to the language of the family/network, in order to further connection and understanding, and so it is only natural for those involved in Open Dialogue research to use a similar approach in attempting to connect with those using more conventional approaches. We can reason as to whether this is the best way of proceeding, and I myself have mixed feelings about this, but there can be no question that Open Dialogue is starting to make a difference to a good number of psychiatric services around the world, and most probably the language used has been significant in this regard.
In addition to this it is important to remember that the Finns are passionate about public services and democracy – about the availability of high quality services to all. This is why Jaakko Seikkula speaks of the value of public services, and even of a ‘medical’ treatment system. I have never got a sense of ‘them’ and ‘us’ from the Finns who work in this way. Rather they would say that any of us could experience ‘psychosis’ given enough stresses/trauma in our lives. They want to be of service to others in a time of crisis, but right from the start they are seeking to empower the other, not themselves. They are not the experts, but rather the facilitators of a process, and if only a light touch is needed, this is all that will be offered. Having said this, I think that there is a good deal of skill/experience involved in such facilitation, so cannot agree that what we are seeing/involved in is a corporate stamping of “basic human characteristics or capacities” (though humanity is indeed at the heart of the approach).
As the interest in Open Dialogue develops around the world it naturally engages those in grass roots movements, activists, peers, etc., who will have their own views about the relative benefit of a system of care over more informal networks of people coming together in the service of healing and growth. I have been inspired by many such networks, but I do also think that there is a place for a properly funded public services run along Open Dialogue lines. Put more simply, there is a role for healers in society, so I don’t think we should apologise for this – this is not necessarily a violation of the other. One of the reasons why Jaakko Seikkula and his colleagues advocate for public services is that, in responding to the other, to the needs of the family/network, it is important that we have a comprehensive range of practices, so that our response can be swift, flexible and sufficient. There is great responsibility in our responding, and we need to ensure that we have adequate resources. As someone working independently (with others) in the UK (whilst also working with those within the National Health Service), I am all too aware of the importance of this.
With regard to the TM (or SM, ‘Service Mark’), the only place where this has been used is the US, and my understanding is that there are particular reasons for doing so in this context, which I am not party to, so can’t comment – it is not a feature of the development in any other country. Whenever an approach is being developed in a new context, I think there is a need to be protective of it, otherwise it can all too readily be eroded by the forces that be (I have seen this happen too often). Such protectiveness does of course need to be balanced out with an openness to local/cultural factors, but as I believe that Open Dialogue is at heart a cross-cultural approach (the affinity with many indigenous community based practices has already been mentioned), the emphasis for me will I think always be on trying to protect the integrity of an approach which makes so much sense to me. Having said this, Open Dialogue is a living organism, rooted in a wide range of practices. It has evolved over 30+ years in Western Lapland, and continues to do so, and as it starts to develop internationally this evolution will take many forms. I for one am excited to both witness and participate in the unfolding.
Thanks for taking the time to spell some of this out. I just read it again more thoroughly and a lot of it makes a lot of sense. The concept is excellent for the most part, I’m all for support networks and context. If the practice comes anywhere close to matching the theory it can only be on the whole a good thing, at least at this point in history. That said, I have a few (now slightly more educated) thoughts about, mainly, language and politics. (Actually this is my second reply, the first one below was inadvertently posted without hitting “reply.”)
there has been a deliberate attempt to speak the language of psychiatry in order to connect, and in the hope that interest in more dialogical approaches will develop within this field
If the “open dialogue” approach (which I find to be more credible uncapitalized) is primarily about the well being of those participating I don’t understand why a priority would be to “sell” the concept to the field of psychiatry. For one, as someone else mentioned, the game of psychiatry is control, and their instinctual response will be to coopt it, regulate it and slip more drugs into the mix. Something which is truly valuable and really “works” doesn’t need psychiatry to legitimize or advertise it; people will beat a path to your door and psychiatry will be left out in the cold holding out its hand. Where it should be left. (Right?)
I also sense that in a place such as Finland certain terms like “psychosis” may have a slightly more populist connotation and carry somewhat less potential for abuse, as the lines between the interests of the people vs. the state are not as sharply drawn as they are here in the heart of the imperialist beast. Though a Finnish proletarian may perhaps rightly take me to task for saying this, I think that in a modern neo-fascist state such as the U.S., which is home to and primarily controlled by giant corporations, the slightest lip service given to the medical model will ultimately be used to rationalize more drugs and coercion. Maybe I’m being stereotypical, but my image of life in Finland compared to that here is one of less general stress and more community, all of which has long been undermined here by corporate rule (and psychiatry). In a more rational society it would be possible to occasionally use even such phrases as “mental illness” and understand that one is using a figure of speech, not talking about an actual disease. But there’s no telling how long it may take us to get to that point, and for now it should be a priority to eliminate disease terms like “psychosis” altogether.
It sounds like a number of steps are being taken in the right direction, which is great. Whether or not the medical model terms are merely vestiges of the past or more ingrained than some believe is not something I have the info to opine on at the moment.
Putting a corporate stamp on such a process is still a problem, as we’re primarily dealing with basic human capacities from which we have become alienated. Empathy and compassion are not products. As I mentioned elsewhere, it’s comparable to putting a trademark on the teachings of the Buddha. What will truly replace psychiatry will be our collectively reclaiming these aforementioned human capacities; this would not be a profit-making venture. I also think that without having a sense of the political context of one’s suffering it cannot be fully or permanently resolved. But there are positive trends developing here. Thanks for your response.
Remember psychiatry is an extremely lucrative `profession’. Here is a conservative estimate for one reasonably successful psychiatrist, Check it out: 2 patients per hour @ $400 each = $800 per hour; 6 hour day = $4,800 per day; 4 day week = $19,200 per week; 40 week year -= $768,000 per year. Add ECT fees for 20 treatments per week @ $500 each = $10,000 per week; ECT engagement for 30 weeks per year = $300,000; speaker/research fees from big pharma = $50,000 per year; TOTAL: $1,118,000 per annum. Do you really think psychiatry will let this go? The reason open dialogue happened in the remote North is because establishment Finnish psychiatry banished it! If psychiatry are talking about embracing it now, there are certain to be very good reasons that don’t necessarily anything to do with the open dialogue team’s or the patient’s best interests. Some other major factors. There is a huge industry of private psychiatric hospitals across the world, all aimed at profit. The aim and achievement of open dialogue is to make people well so that they don’t NEED hospitals. Hospitals NEED sick people for profit. Private and public hospitals employ large numbers of specialist psychiatric and auxiliary staff. Governments are answerable to the electorate for employment rates. Losing large numbers of jobs, particularly in government facilities, is not good for politicians. Psychiatrists are aware enough of human fears and close enough to politicians to encourage discomfort and create at least ambivalence in public officials and politicians whose jobs might be threatened if too many people get well. It also goes without saying that drug companies, whose aim is to at least maintain `illness’ and, wherever possible, to encourage it, will be less than impressed with programs such as open dialogue. Remember Germany and Sweden refused to authorise Prozac? It’s amazing, or is it, what a few billion dollars can achieve. Not every man has his price, but most do. Please forgive my cynicism but as I said, I’ve been through this already. Good, even great, programs have disappeared again and again. Maybe the answer would have been for everyone to move to West Lapland and just get well. For I’ll bet open dialogue will sink beneath the $$$$ of Big Psychiatry, unless we are VERY, VERY careful.
Again, whatever establishment psychiatry is saying about open dialogue, their leaders are still pushing long term use of psychotropic drugs and appear to be embarked on a campaign to vastly increase the use of Electroshock across ALL diagnoses across the world. They are also pushing for greater power and facilities to force treatment because of the `dangerousness’ of psychiatric patients. Nowhere, in everyday psychiatric circles, is there any dialogue apart from this. That psychiatry is an elaborate sand castle is well known, that the tide is coming in is also well known, but it remains a formidable,powerful and unrelenting force, at least until it collapses and will do almost anything to maintain itself. Like Ron Pies and Allen Frances, it will pay lip service to innovation while undermining everything that even remotely threatens it. Remember a cornered rat will fight as dirty as it needs to, to survive, because it must stay a rat to the end.
Well put, except for
Remember a cornered rat will fight as dirty as it needs to, to survive, because it must stay a rat to the end.
What’s wrong or dirty about any creature fighting to survive? Let’s not trash rats by comparing them to institutional psychiatry!
My sincere apologies to the rat, but we all fight to survive, even psychiatrists and they will destroy more and more people in that fight, to prove they were right, if nothing else. How else will they keep the power they have, pay the college fees, the new house, car and the travel? – oops! Big pharma will pay for that. They’ve had 40 years to get it together, they’re VERY strong and they’re smart, not intelligent in the true sense but devious. The crash will be huge let’s hope it doesn’t bury us.
The harder they come…
Perhaps the chance for these approaches and there are many pockets, including the Soteria house movement, around that have quietly gone about their business for along time, is that they all `come out’. If the public, advocates, friends, and families know about them they can go there and cut out the psychiatrists. This could have the effect of people beginning to demand financial support for alternative programs. Well researched cost effectiveness documentation could have an impact if politicians hear about it. There are serious problems in health funding and while drugs are at the forefront of this, assisted housing, welfare for life, hospital beds all cost a fortune. If we can point out financial benefits, we’ll have some chance of getting around the likely frenzied attacks of organised psychiatry who will then have to explain WHY they want to keep the expensive, low-performing staus quo.
This is correct. Economic arguments are crucial. And economic arguments will almost certainly favor approaches like Open Dialogue which use a non-medical low-drug approach. This should be a primary focus of researchers doing pilot studies of Open Dialogue, to track reduction in hospitalization/costs to taxpayers in the years following intervention. This could be a powerful weapon against establishment psychiatry.
I forgot to mention the government subsidised psychiatrist’s fees and hospital treatments including ECT, at least in Australia, New Zealand, UK and other publicly funded health systems. A program that gets people back to work will also cut welfare payments, reduce government subsidised housing and the need for staff, or may re-educate and direct those staff into open dialogue type programs instead of just acting as supervisors of drug compliance. (Increased job satisfaction = lower burn-out & work cover payments). What about the insurance companies that pay psychiatrists and ongoing hospital costs? Psychiatric patients are an enormous drag on them because under current practices they are virtually `sick for life’. One company here tried to organise a kind of support system to stop the constant re-admissions to psych hospitals. They might be interested in funding open dialogue and other similar support programs if better outcomes could be forecast. The government might be interested in encouraging that because if costs were lowered, insurance companies might be able to lower premiums (?) and more people would be able to afford cover, which in turn would take some of the pressure off public funds. The rationale to the insurance companies would be that lower premiums = more customers,and healthier, reduced numbers of chronically sick people means overall profits would probably increase. Overall, doing away with expensive doctors who create more problems than they ever solve is the cheapest and most effective way to sort out the mental health debacle. Vale psychiatry.