We launched Mad in America Continuing Education (MIACE) in 2014 with a specific goal: providing an alternative to CEU and CME presentations, many funded by pharmaceutical companies, that promoted the merits of psychiatric drugs and the disease model that psychiatry had adopted when it published DSM-III. Bob Nikkel, who had been Oregon’s commissioner for both mental health and addictions from 2003-2008, launched this effort for us and served as MIACE’s executive director until his retirement last summer.
You can see that under his leadership, MIACE presented courses by psychiatrists, psychologists, and leaders in the peer community that told of a need to rethink the disease model and embrace alternative models of care.
In the last two years, we also hosted a series of “town halls” on dialogical therapies, which were co-sponsored by several other organizations. Kermit Cole and Louisa Putnam, who are founding MIA board members and trained in Open Dialogue therapy, took a lead role in developing these town halls. We also developed a town hall related to withdrawal from psychiatric drugs in concert with the International Institute for Psychiatric Drug Withdrawal.
These two efforts—webinars and town halls—have a different focus. The continuing education courses were designed as “educational” presentations, with CEU credits offered. The dialogical town halls were designed to stir a discussion about the subject. With this experience as a guide, we are now moving forward with webinars that combine both elements: educational aims combined with a discussion that emerges from a panel presentation. On Wednesday, we will host a zoom webinar with that dual purpose titled: What is “Peer-supported Open Dialogue”?
However, as we have “marketed” this first program, we failed in one notable way. We failed to emphasize that this webinar was designed to be the first in a series on this topic. As a result, we have been criticized for the fact that the first panel is comprised of the developers of a “peer-supported Open Dialogue” effort in the UK, without a peer on the panel. This is an understandable criticism, and thus I thought it was important to present our larger aims with this series. Hence, this blog.
First, a bit of personal background.
In my book Anatomy of an Epidemic, I wrote of how there was a long line of evidence showing that over the long-term, the regular use of antipsychotics increased the chronicity of psychotic disorders (and led to other harms), and that a best-use model would involve selective use of the drugs, with two principles guiding that selective use: no immediate use with first-episode patients in order to see who could recover without exposure to the drugs, and for those who were exposed to the drugs, an effort to minimize their long-term use.
As part of my research for the “solutions” chapter, I came upon research published by Jaakko Seikkula regarding outcomes in northern Finland for patients treated with Open Dialogue therapy, which involved a selective-use model of antipsychotics. Their results stood as a “proof of principle” that could be gleaned from 50-plus years of scientific studies: This was a use of antipsychotics that produced markedly better outcomes.
Since then, Open Dialogue approaches have been developed and adapted to local environments in the United States, the United Kingdom, and numerous other countries. I confess a personal disappointment with one element of this adaptation, as the focus often has been on “dialogical” practices, with much less emphasis given to selective use of antipsychotics. In fact, in many adaptive practices, the selective use of antipsychotics has been ignored and left out of the equation.
Another adaptive element—but this one is happily so—has been “peer-supported Open Dialogue,” with peers an integral part of the dialogical team. There was no active peer movement in northern Finland when the Open Dialogue practice was developed. Incorporating the expertise of peers into the dialogical mix was new to the practice and, one could argue, essential to its effective adaptation into current systems of care in the United States, the UK, and elsewhere.
The Parachute Project in New York, which was launched in 2012, created mobile response teams who were trained in both Open Dialogue and Intentional Peer Support, with the teams composed of both mental health professionals and those with lived experience. That program, unfortunately, has ceased to operate.
However, in the UK, the development of peer-supported Open Dialogue has continued, and there is ongoing research, known as the ODESSI trial, of the effectiveness of these services within several of the UK’s National Health Service Trusts.
Kermit Cole, who was the founding editor of Mad in America, is now taking over as director of our MIA webinars, and he envisioned our presenting a series of presentations that would “explore how POD (peer-supported Open Dialogue) principles and practices are essential to implementing Open Dialogue’s inspiration to an intrigued but skeptical—and increasingly desperate—world.” Kermit feels that POD may even inspire and enable social networks to meet crises dialogically without needing to access the psychiatric system.
The first panel—this is the Wednesday presentation—was initially composed of three people who have been leaders in creating this UK effort: obtaining funding, developing training protocols, and assessing its effectiveness. We believed that having these three—psychiatrist Russell Razzaque of NELFT, family therapist Val Jackson, and Professor Mark Hopfenbeck—to discuss POD’s origin in the UK, development, and future would be a good way to kick off the series.
The subsequent panels in this series will present teams—largely peers—from the UK and the Parachute Project that will talk about their experiences, and their perspective on POD’s future.
With this plan for a series in mind, we did not think to include a peer on this first panel, but rather decided to present the institutional origins of the UK effort. We have since heard from a number of people who signed up for the webinar, and others, that this was a glaring mistake on our part.
Personally, I think the mistake we made was not making it clear that this was a first in a series, and that the series would follow a chronological path, one that told of how the UK effort took root and grew, and that subsequent panels would feature the perspectives and expertise of peers.
Perhaps even that plan was flawed. However I hope that this blog will make our intentions clear, and MIA readers will now see the larger plan and join us in this exploration of peer-supported open dialogue. We are pleased to announce that Charmaine Harris, who is a part of the POD team, will join the panel on Wednesday as a co-host.
After the webinar, the zoom meeting will remain open for anyone who wants to come onscreen and chat. Several members of the panel will stay on during this time as well.
Please sign me up for each and every one of them.
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Good idea.
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I need to be on my way now. I have such a lot to do. Practical things. I keep hearing a phrase….
“The Walls of Jerico”.
I think it is a portent of some city somewhere globally that may be defeated by weaponized sonic machines. Globally the calander IS going to change.
I could be incorrect about all of that but as with the Hoover Dam, if it all comes true then it probably vouches for the rest of the content of some of my comments. Click my name. I hope none of it does come true. And we must always regard tomorrow as blissfully unknowable. I just give my oevre as if weather reports. That ancient preoccupaton with star and cloud.
Somebody knows a “Lesley” at MIA. Possibly a spirit now.
But I must go and sit on a hilltop and make my comments to the high, carousel spin of sea breezes.
Love and light,
From Diaphanous Weeping.
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I am grateful that you have organised this event. The benefits of open dialogue need to be demonstrated and shared
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I actually wonder about the miracle of dialogue.
In my magical mystery tour of my planet “dialogue” often poses a bar to understanding deep feelings. Animals dispensed with dialogue in the Triassic and simply learned to hum. Babies have been trying to teach us how to forgoe bombastic verbosity for aeons. We never listen to babies and animals because we think they have nothing to say to us…but that is the point…their nothing to say is the same poetry as a sunset or a river.
Open Humming project sounds effective.
I am muddled today so forgive my annoying foraging for acorns of truth. With respect, dialogue, in my experience, is a perfector and utilizer of so much “logic”…dia-logic-gue…given that sentences are logical…that it becomes a tidying up of feelings while pretending to locate them.
Who is Lesley?
A spirit of someone called Lesley keeps bursting into song.
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I am not demoting any choices. The more the merrier. Open Dialogue is a winner. Ditto Soteria House. Bear Grylls, the S.A.S action man, took people to impossible landscapes to get their survival mechanisms kick started. The people were always a wreck of powerful emotions on the edge of life or death. Who you really are surfaces up from layers and sediments of heavy rational thought. You ditch those stifling layers to travel light across a brittle rope, a vine strung between a branch of wizen thorns and a dusty pinacle.
Our juggling, precarious lives are often barely clinging on.
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Bob,
don’t forget family like me who have the lived experience of walking thru everything my wife experienced, at times carrying her thru it, until she could make sense of things and heal and integrate it back into her own narrative. You’ve got to expand the circle because there are few ‘peers’, probably, who would be committed day in and day out, 15 years and counting like me and other family members who are in a lifetime commitment…I know there are many family members who fall far short of the ideal and are even part of the problem and abuse…but I still believe there are others out there like me, who if they were supported and trained could learn to do the things I have.
Sam
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The event has been and gone and I remain profoundly moved every time Open Dialogue enthusiasts get together and talk about what it is that they do. To think that how we talk to one another, listen and relate would be so hugely influential in our well being.
The machine lay dormant
It’s parts jammed, frustrated, cogs stuck, wires hanging loose disconnected
The power was on but pulsing in pain rather than delight
Circuits were stuck in a continuous loop with no hope of change
Then came the lube
A new lease of life
The grinding noises quietened, the pain, the tension abated
And the machine lurched into motion, it’s old smiley self revitalised
The machine is still the machine, it puffs, it pants, it squeals, sometimes in pain
At others in delight
But it’s running better now, it cares for itself, a new lease of life hope and love.
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A concern I have is this.
Schizophrenics have been easy to malign by society.
Schizophrenics are where society hurls its trash, its fear and embarrassment, its inferiority and terror of going mad.
So schizophrenics are easy to harass and intimidate and school by society.
Things have improved gradually. Although I am not in favour of medication unless vital and short term, I think the medicalizing of schizophrenia has held off the superstitious braying mobs. Calling schizophrenia an illness is less of an ordeal than screaming at them for being posessed with a devil and hounding that poor person out of the parlour.
Nowadays we do not talk about posession but it is still there. The new form of posession is illuminated by psychotherapy. Schizophrenics are the way they are because of being “posessed” by dimmly recalled “trauma”. That trauma has caused the schizophrenic to look raving. All that “has to” occur is that the schizophrenic is made clean again or purged. This is done by purging them of their half forgotten yet still possessing “devil of a trauma”. Enough therapy should expunge that devil and cure the schizophrenic back to being a pillar of the establishment. It will prove how horrid “trauma” is, ģiven that it can cause the terrible affliction of schizophrenia. But thereafter “trauma therapy” must be seen to be working at getting rid of schizophrenia or that becomes a disappointment to “utopians”.
Utopians get disgruntled at “utopia resistant” schizophrenics, as if their dogged decision to stay ill is an insolent selfish prioritizing of who they are.
But this disgruntlement by society then looks no different to how schizophenics used to be viewed as “treatment resistant”. When madness declines the offer to be sane, all the sane “fixed” people regard the ill one as a traitor.
Society will always loathe the traitor.
A regime is coming in future. It will make Hitler look fond. This new regime will stop EVERYONE from choosing their own choices.
The choice to read a book.
The choice to choose a doctor.
The choice to go for a walk.
The choice to call the police.
The choice to cry about such a regime.
The choice to retaliate.
The choice to take pills.
The choice to refuse to take pills.
The choice to enjoy learning new things of individual interest.
The choice to say you are sick.
The choice to say you are not sick.
The choice to love the wrong person.
The choice to love the right person.
The choice to not want to know how brutal the regime is.
The choice to turn to another faith.
The choice to regard women as good people.
The choice to set up your own kiosk or marquee.
The choice to paint portraits.
The choice to live in your own home.
The regime is global and is going to make EVERYONE feel like they HAVE TO ask PERMISSION to choose ANY choice AT ALL.
I am in a psychiatric hospital out of my free choice. But it deals with the topic of walks by giving what it calls tickets of time. Thus I can go for a thirty minute stroll if I get from staff a ticket of time. We could argue about how infantilizing that permission to take a wander is, but in future EVERYONE will want to be in a psychiatric hospital because in the outside world EVERYONE sane will be on tickets of time for doing shopping and salt mining and visiting and praying.
All of my comments have been about getting people ready to discern what are their own heartfelt free choices as opposed to indoctrinated “consensus opinion”. You can still have the same opinion as the “consensus opinion”, an opinon is harmless enough. The “consensus” bit though is what the regime will be busy enculturating their beliefs into.
Regimes can make fathers sell their daughters. Regimes can make shopkeepers betray their neighbour shopkeepers. Regimes can blast a hole in a city with no thought for the babies or the elderly.
The disabled, the schizophrenics who still hallucinate after trauma therapy and who are no longer called ill or are called nothing but ill will be the first to get called “lazy”.
I am not sure if the mentally ill will get marched off for forced medicating or whether they will be scapegoated or whether they will be beautifully left in peace.
But I do know that because the mad seldom bother with “logic” they will be immune from the way the regime infiltrates universities with twisted logic of its own.
Emotional intelligence is more far reaching. It is better to grab onto this sort of knowing via gut intution whilst forced to agree to logic and nod like a puppet on a string.
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