Kermit Cole: Dialogical Approaches to Extreme States


This week, we interview Kermit Cole. 

Kermit’s first career was in film and television, directing, amongst others, Living Proof: HIV and the Pursuit of Happiness in 1994.

Kermit has undergraduate and master’s degrees in psychology from Harvard and he has over two decades experience working with people in extreme states. He likes to say that he likes to work with trauma, especially when it’s being called something else – such as “psychosis”. Together with his partner Louisa Putnam, he works with couples and families with members who have been labeled as having a mental illness, seeking other ways to understand their struggles – ways that often lead to better outcomes.

Kermit has been part of the team at Mad in America since it was founded in January 2012.

I was keen to ask Kermit about what led to his interest in therapeutic work, his experiences of supporting those in extreme states and his thoughts on Open Dialogue and dialogical approaches in general.

In this episode, we discuss:

  • How Kermit came to be involved with a photo project that aimed to change the dominant image usually portrayed for those with HIV or AIDS and how that led to his 1994 film: Living Proof: HIV and the Pursuit of Happiness
  • How Kermit came to feel that a persons life should not be appraised based on its duration
  • How he went on to make the transition from film maker to supporting others with their mental health and wellbeing
  • That Kermit came to feel that having a camera got in the way of the connection that he wanted to make with people
  • How he went back to study and developed an interest in trauma and its impact on people and came to develop the skills necessary to be comfortable dealing with extreme states
  • His experiences working on a helpline for people experiencing suicidal thoughts and in a group home setting
  • How it felt to support those in distress without judgement or control, but just being with them and how not being alone sometimes makes a big difference
  • How sometimes supporting someone means not judging but also not colluding with beliefs that may come across as delusional, and how this is different to the approach of trying to medicate away behaviour that has been classified as aberrant
  • That Kermit feels blessed that he could choose between schooling and study or the risk of depression, diagnosis and hospital, but that many are not so fortunate
  • How Kermit and Louisa work together to support people struggling with their mental health through a family therapeutic approach and based on Open Dialog principles
  • That it is important to respond to a network that is in crisis, such as the family unit, rather than a single individual
  • That this approach used in Tornio, Finland resulted in excellent outcomes for patients and a lowering of municipal expenditure on mental health crises
  • How Louisa and Kermit approach working together in an open dialog model
  • How, if you can find a way for people to safely do what they would naturally want to do, then it can be helpful
  • How Kermit became involved with Mad in America after reading Robert Whitaker’s books
  • That taking medication could almost be viewed as an act of communion
  • That life, being human, hurts, but by learning to connect we can ameliorate the trauma

Relevant Links:

Kermit Cole, family therapist

From film director to group home director

Living Proof: HIV and the Pursuit of Happiness

Kermit and Louisa on the Dr. Peter Breggin hour podcast

Soteria Network UK

Open Dialogue

How to Listen:

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To get in touch with us email: [email protected]


  1. i don’t think saying / believing that aliens gave someone a cure for cancer is a delusion. i really don’t see a problem with someone holding a belief (maybe it’s knowledge) like that.

    first of all, humanity knows space aliens are genuine and they actually, physically exist. this is object fact but it’s shrouded in a conspiracy of denial and lies.

    if someone, the right sort of person or people, would have believed and received the messenger man humanity very well could have inherited a cure for cancer. it was worth indulging.

    missed opportunity.

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