hi chee — you make some good points — about the dependency, etc. i appreciate what you say — thank you for posting. maybe it’s worthwhile to try some form of self-therapy? i am working on self-therapy myself! daniel
Hi Martin — it’s hard for me to know what the case is. It’s possible that they’re right (that you have to feel worse before you feel better) but it sounds unlikely to me. Maybe your therapists aren’t any good — or maybe they’re just a bad fit for you. Maybe there’s a good one out there for you. Or maybe there’s something else that you need to do that would be more helpful than therapy. I don’t know what that is. I thought I was a pretty darn good therapist but I didn’t help everyone I met. And I know things other than therapy helped me, and continue to — it’s just a question of finding out what those things are…. all the best, Daniel
hmm, i don’t really know much about prakash ellenhorn. i’ve never visited there. i seem to have some memory somewhere that one or more of their staff did the open dialogue training with mary olson. but i am not sure. i think of them as being one of the more progressive treatment centers in the USA, though often that doesn’t say too much, because for starters there’s not much that’s really progressive in the USA (or anywhere), and also many of these places try to be progressive (some do better than others) but still get very stressed out working within the confines of the super-screwed-up mental health system………. wish i had more for you. daniel
hi becky
i haven’t read my article in a while, so i don’t know if i said it there, but when i became a therapist at first (when i was 27) i was terrified of the things you mentioned. i also looked very young, younger than my years. and i was working with people older than i was — vietnam vets then in their 50s. i used to get down on my knees before sessions (early on) and just pray (i didn’t even believe in god) that i could make it through a session and keep my wits about me. then i’d just plunge in. there’s no way to get over the fear other than just doing it. that’s my experience. also, one thing i came to realize over time is that the people who are coming in for help, to talk, to reveal themselves and their deepest problems, are much more vulnerable, in most cases, than we are as therapists. so i think when we can empathize with the inherent anxiety that most people go through coming to a new therapist — so stressful — it can make it easier for us to calm down, be in our own skin, and listen to them…and be there for them. just thoughts… oh, by the way, don’t know if i said in the essay also, but i did from time to time have people comment that i was too young, and sometimes i got fired by clients over it. but others liked me looking young. they felt safer. also, i know some older therapists who get fired for looking too old. so it goes both ways. all the best! daniel
thanks for your comment michelle 🙂 and greetings! i wrote this article over two years ago, but it still holds true for me. all the best to you on your journey! daniel
Sera,
i have such respect for you and what you have written. i also have seen different incarnations of this “hot stove” film and i couldn’t stand it — for the reasons you described. i found the film, and the creators’ reactions to the criticisms of it, disingenuous. also, i wish the filmmaker, Sheryll Franko, were involved in this discussion. i do not know if she understands the subject matter well enough to realize what she got herself into, or if she actually believes that people like lieberman actually have something valuable to say. but i think it’s also not fair for alice maher to put some of the blame for the film on her being “young and inexperienced”. if i were Sheryll i would be troubled by this.
-Daniel Mackler
hi aminaoboe — greetings to you. thanks for you comment. at the risk of sounding cliche or simplistic, i would have to say follow your heart!! i was called to be a therapist — a calling from within — and my leaving being a therapist was a calling also……..a calling to a different life, which i’m still exploring. meanwhile, i think it’s great that you play oboe. what a wonderful instrument. i spent my day playing guitar and singing 🙂
daniel
thank you for this piece, Jay. I am appreciative of all you write. just today i quoted your work to someone. i consider your work very important, and i consider you a real original.
-daniel
hi mark,
well, i’m glad to hear you meet most of the criteria — sounds like we probably agree on a lot then! as for the parent one, i do have many friends who are therapists i consider pretty darn good who have kids. and i recognize that that criteria probably seems out of left field, especially since i didn’t explain my reasoning behind it that much. if you’re curious to hear more of my point of view on parents and parenting feel free to check out my website. ( http://www.wildtruth.net ) maybe my point of view would seem less bizarre then? all the best, daniel
greetings John — thanks for the comment — and the ideas in it. well….feeling better after each session…… in a way that makes sense, but also…..sometimes hell comes up in healing, in breaking dissociation, that is very painful……facing previously denied horrors……that could make people feel a lot worse, at least in the short-term. but even feeling those feelings makes some people feel more alive, more on the path to being integrated… daniel
hi alex,
i think we differ in opinion on mother teresa. but just because we differ doesn’t mean that i diagnosed her, at least diagnosed her in the psychiatric sense. i feel i am using my critical judgment about her, and i stand by that. i see nothing wrong with that. would i also be diagnosing hitler if i said he was a callous, out-of-control monster who never dealt with his childhood history of severe abuse and played it out in the most horrendous and brutal of ways? and i never met him either. and i don’t think it’s being judgmental either, rather, again, using my judgment.
all the best,
daniel
p.s. mother teresa’s rather uncritical biographer, by the way — someone who, from what i remember, really liked her — made many of the same points about her that i did (her inconsistency, hypocrisy, etc.). so i didn’t pull this out of nowhere.
thanks for your comment julie — wow! i agree with a lot of it, for sure. however, i don’t inherently see therapy as a form of prostitution, even if a lot of therapists are bad bad news and do prostitute parts of themselves in nasty ways. also, just to be clear, i didn’t say that all therapists who have kids are bad therapists. in the essay i wrote: “And there are some therapists who have kids whom I think are far better than average, even brilliant in some ways.”
greetings to you!
daniel
thank you for your comment, Uprising. the things i wrote in this article have not been abstract for me either, which is why i feel inspired to write about them. by the way, i also think it’s terrible to railroad someone into blaming someone for their problems — or railroading anyone into doing anything…
Hi Sharon,
i am curious about this comment, and i would be glad if you would elaborate more, because it seems basically impossible for a therapist who respects and understands the people he or she works with, listens well, develops a good relationship with them, cares about them, honors the pace of their growth process, and doesn’t force anything on them to turn therapy into a “god-forsaken, demeaning, horrifying” experience. Or did i misread what you wrote? the only way i could imagine such a therapy becoming a horrible experience for people is if the caring nature of the relationship somehow facilitated the eruption of so much buried, forgotten trauma in the client that it completely overwhelmed the person and retraumatized him or her. but even that wouldn’t likely make sense to me if the therapist was really good, because a good therapist (as i define a “good therapist”) would sense that possibility before it happened and would help the therapy go at a slower and thus non-retraumatizing pace.
wishing you the best,
daniel
hi Getitright —
just to be clear, i never said (much less assumed) that all childhood trauma “boils down to bad parenting”. that would be a very simplistic thing to say. there is too much evidence to the contrary. but a lot of it does, for sure. after all, parents wield more power and control over a baby’s and young child’s life than pretty much anyone can possibly wield over anyone else. and even if people who are not the parents are more clearly the traumatizers of a child, it’s often not that hard to see how parents had some (or a lot of) influence in setting up the dynamics that led to this abuse, through intent or neglect.
i see in our world, though, that there is often a big push to let parents off the hook, in one way or another, for the damages they cause either directly or indirectly.
daniel
Hi Alex and Getitright,
greetings! the coercion part is true — i’m definitely against people/therapists who pressure others to forgive, even subtly pressure it. i think that is very common. the deeper part of what i’ve observed, though, is that often forgiveness leads to a sort of pseudo-healing, more of a burying of the hurt, a burying of the grief process. it feels good, it makes people and families more comfortable, but it doesn’t really resolve the traumas. i’ve seen many people become comfortable in a state of what is known as forgiveness, very happy. it’s really a state that very much coincides with the ideals of normalcy. and i think the grieving process is much much less so.
as for mother teresa, i think she was a very disturbed woman. very split off from her feelings and her own healing process. i always felt this about her until i read her biography — not even a particularly critical biography — and saw how troubled, inconsistent, and even hypocritical she was. often the people who are very split-off, though, seem quite healthy. it was people like mother teresa who helped me see more clearly just how much being dissociated can mimic a state of self-actualization…
hi duane,
i don’t totally agree with what you wrote here (though thanks for the comment!), however, one part does resonate with me: the part of the massive responsibility that comes with being a parent. that’s a big part of why i think people, especially those who have young children, when the responsibility is greatest, shouldn’t be therapists, which bears a lot of similarity to parenting, with the devotion and responsibility required.
daniel
thank you. Interestingly, I’ve learned a lot about being a therapist since i formally quit being one. there are many things i wish i had done differently. i think i did a lot right, but some not. i basically had no great role models (and not for lack of trying to find them) and was following my heart — and also doing a lot of self-reflecting on the process. i also had some really good friends who were insightful who gave me good guidance. and i learned a lot from my clients. but what a tough job!!!
a quick addition: you wrote: “So I don’t agree that children/spouse suffer from a parent being devoted to his job, as long as it doesn’t go overboard. I would say the opposite – that it’s complementary.”
in most cases i agree with you, but i see the job of therapist as not a normal job. i think it’s more than a job. therapists who treat it as a normal job, and not a calling, well…i basically don’t see them as being much good.
hi ajewinisrael–
you wrote: “I would add that in my experience, having kids opens a person up to levels of compassion for others that people without children don’t easily access.”
i would actually agree with this. there are many things that that people don’t easily access — and i think i make this clear in the essay. i think for many people having children is simply the easier way. but that doesn’t, in my experience, mean that easier equates to better. i think the more difficult way is actually the much more real and honest way. i think for many people having children is like an addiction — like a drug. it’s an easy access a lot of feelings, but not a solution. the tough inner path, through healing traumas, resolving one’s own childhood dilemmas — not using having children of one’s own as props — that is the solution i’ve seen. that doesn’t mean that most people who don’t have children do this. from what i’ve observed most don’t. it’s too difficult.
daniel
hi duane,
this seems like an odd admission to me — odd in that you don’t see a problem with it. basically, you did little or no growth or recognized no growth in yourself until you had a child? that seems very unfair to your child.
i have heard similar things many times, though. people often say that they didn’t start getting their life together until they had a child. the subtext i read is that they’re using the child to provoke their own growth. often to me it’s a signal that a person doesn’t see a problem with using the child for his or her own purposes. much more fair is to grow up before having kids. people do this, after all.
all the best
daniel
hi bpdtransformation — thanks for the comment. i am serious about what i wrote about parents. and you’re right — i don’t see a large pool of potentially great therapists. but the therapists are not “tainted” by their offspring. better put would be “their potential quality as a therapy gets tainted or limited by the fact that they’ve had offspring”.
the evidence i’ve seen is my observation about people — that once people have children it locks in place a lot inside them such that there are many emotional places they can’t go…and things they can’t see. that of course is not to say that all people who don’t have kids can suddenly go to these places, because, as i suggested in the essay, this isn’t true either. that’s why i say having kids “stymies their potential” — blocks the possibilities of what they can do. that’s what i’ve seen.
hi frayed — alas, i think the therapist you described is all too common…..all that fakeness and fake empathy. i do know some therapists who are not like that — and some who i consider to be excellent. but not many!! that’s why i think trusting one’s gut is so important — it weeds out these creepy fake people pretty quickly. wishing you the best — daniel
dig it, sera. yes, and i have been to some conferences that moved me. however, even at the better or best ones my favorite time has always been the off-time, when people just hang out and talk….. i might someday like to create a conference with just a few speakers (ones who know how to give a good, unique talk, people with a dramatic flair) and the rest of the time just open for hanging out, talking, eating, getting to know…. just an idea…. always glad to see what you write —- daniel
nicely said, Sera. i think what you described is right on the money, and the way you described it is fair. as a slightly side note, i have pretty much grown to hate going to conferences, or at least most of them. all the fake hoopla, the “wow i learned so much” when i can’t quite figure out what was remotely new, and all the self-congratulatory pride that “we can all put aside our differences under this big tent.” i think there is something about coming together to fight a common enemy and stand up for a common cause, but i think a lot of times those are just surface efforts, and underneath it after the conference ends it’s just back to the same-old, same-old…….
greetings to you —- daniel
excellent article. thank you. scary that ISPS (the organization that first connected me with robert whitaker, back in 2005) wanted lieberman to be a keynoter at their big NYC conference last month…”to dialogue with him.” like that was ever going to happen… regardless, he dropped out before the conference. scary guy…but not coincidental that he rose to power in his field of choice, psychiatry.
cool sera. you guys really have created something special up there in western mass. to me it would be so backward if they slashed your budget. i can only imagine that the budget-making (and budget-cutters) really don’t have a clue of the REAL value in what’s happening with the Western Mass RLC.
cool to hear jaycee. i know less about what’s going on in the UK than in the USA. i do know some about the UK training, though. i would imagine they are certainly using some of the OD principles — and i really wonder how it’ll go with people going through a “first-episode.” if they’re really going for it that’s great news 🙂
great article, sera. it would be a disaster if the western mass RLC had this budget cut. i consider the western mass RLC a flagship community — one that does so much good on so many levels to so many people. i share about your work all over the world — as an example of what can be, and what can happen when people come together with strong common values and actually live them. the evidence i have is not in numbers and figures, it’s in getting to know the people involved, feeling the passion, and realizing that a whole new way is possible.
daniel
sandra — i’m with you — i like what you say. i also think what you write is so true: “we live in a world that wants evidence.” i think that is what makes me sad — that we have this real evidenced-based program in western lapland that demonstrates just how good therapy and minimal or no meds can be for folks in an initial major crisis, and yet it gets poo-pooed because in part because it hasn’t been replicated, yet the people who are on the front lines with the best ability to replicate it and help others replicate it (the open dialogue trainers and many of the trainees, etc.) aren’t taking a strong or smart enough stand. as an example of this, i read over that umass “adaptation” study and had to blink my eyes. it’s like, who designed that? and why? it’s like, finnish open dialogue created their famous study with people with first-episode psychosis — people who are a lot easier to help therapeutically than people who have been medicated for a long time. the umass study seemed to be all about the latter, not the former. that’s a totally different client base, people much much harder to help to “recover fully.” my two cents: if the goal is to get a strong evidence base for programs that can really help a high percentage of people “with psychosis” — a very important goal, to my mind — we should clearly be designing programs for the people who are the easiest to help — the people in a first-episode. and we should follow the finns and try to do it with little or no meds. and if it’s not political or hard to implement then i think we just need to try harder and work smarter and more creatively. it isn’t impossible. i’m all for trying to help everyone (and as a therapist i worked with many people who had been in the system for years), but i think the point here is to think with more of a long-range view — that is, more strategically. otherwise we’re putting in a lot of energy into programs that will add little or nothing to the evidence base and will do nothing to help change the system.
i find that disappointing. and it really brings many questions to the front of my mind. are the people who designed these adaptation studies naive? or are they just not so strong at the politics angle, and thus making compromises in the basic designs of the programs?
i remember when i screened my film open dialogue at Advocates, Inc. about four years back and i talked with chris gordon about an open dialogue study he wanted to spearhead. he asked me what i thought was the most important thing for the study in terms of making it valuable. i said: “insist on working with people in a first episode — and try like hell not to medicate them. and after that focus on all the open dialogue stuff.” but as far as i know it never happened. to me that’s sad.
to me the original soteria study from the 70s and early 80s still provides more of an important evidence base than any of the open dialogue adaptations.
but anyway, i’m babbling — it’s late for me. bedtime.
i thank you for participating in this dialogue — and i do wonder what you (and others) think of all this. i’m sticking out my neck to try to make these points as clearly as i can, and now my neck just needs to lie on a pillow for a few good hours.
hermes — yep, you put it simply and to the point. and when people—even progressive mental health folks—avoid what you’re saying it makes it easy to jump on the “open-dialogue-as-panacea” wagon train. but what kinds of results will “open dialogue” get if they do use neuroleptics a lot? not so hot. i simply cannot see it otherwise. yes, people like open conversations — and i believe they are a good thing — but i simply cannot see great hope and great outcomes à la Finnish Open Dialogue when people are more medicated. i thought this was rather obvious, but i guess, considering what’s been happening in the spread of open dialogue, that it’s not so obvious.
all the best to you,
daniel
hi alex —
thanks. but i don’t know that many others do agree that i’ve done so admirably by posting all this. from what i see, most of the response here to this essay has been silence — and a rather limited discussion about the points that i’ve made. basically no one directly involved in open dialogue work has commented at all here — aka no dialogue. one might say that’s because i’m a bit rude or something like that, but i think it’s because it’s too hot-button of an issue and they have their work to protect. easier to stay silent, keep on doing the same old limited thing, and not really fight to change the system. comfort rules. that’s my take on it. a big missed opportunity — a disappointment.
thanks for what you’ve shared — appreciated!!
daniel
hi ron,
i also like the idea of promoting open dialogue and bringing it into wider use. i’m all for that. but when some of the most known stuff with the new open dialogue studies don’t even primarily work with people with “first episode psychosis” — let alone “first episode” with minimal or no meds — then i think, what’s the point? also, i think the effect of this can be negative, because clearly they’re not going to get the great results they got in finland, which just leads more and more people to believe that the great results of open dialogue are just finland-specific. that’s a major missed opportunity.
daniel
nicely said, Alex. and i’m glad the discussion has been helpful to you. it has also been helpful to me — but stressful. yet worth it. i feel for me it is often easier to “call out” the big bad enemy — traditional psychiatry, big pharma, etc. i think this essay and discussion are a bit more nuanced for me. yes, of course i still think that the big bad enemy is still big and bad, but the stress for me is, to a degree, calling out our allies here — and ourselves. i have learned so much these past few years, after making my films. it has opened up a new world to me, and also thousands of people and their experiences and lives. but i guess what i’m coming to is that we — “the good folks” 🙂 — have to be smarter and wiser in moving forward. and i think sometimes that’s not easy. in fact, extremely difficult, given the challenges of changing a system. when i first became a therapist i was interested in working with individuals — and at times individual families. now that has shifted for me. yes, i still see the profound need that individuals and families have, but i’m more interested in changing systems — and so i’m interested in strategy also. i think that’s where this essay is coming from… what we might be doing that’s a bit off-track, and what we might also be doing better. i think it can be politically incorrect in a sense to critique or criticize our own allies — and that’s the stress for me — yet…..i think it’s a good thing. after all, the typical traditional psychiatric criticisms can be so stupid as to be useless. so…….i guess what i’m saying is that although this is stressful for me — writing this, reading some of the responses (as it kicks up stuff from my childhood — painful rejection for opening my mouth) — the fact that it is useful to some people makes it worthwhile. so…..thank you!! daniel
thank you Eugene for this post. you said many things that resonate with me. i would like to focus on one, because it (and others’ posts here) have help me clarify some ideas in my head. you wrote:
“Where things get difficult (if not impossible), is on the level of implementation and system change. The manifold efforts to transform psychiatric (revolving door) in-patient treatment as well as biologically oriented out-patient treatment have proved to be disappointing at best.”
yes, to me that is the big problem. and here is the idea that nags at me. as i see it, the real challenge in changing psychiatry for the better as regards Open Dialogue is to get it implemented at a systems level — with people in “first episode psychosis” with little or no meds. training individual clinicians to do better family therapy and to have more of a broader, needs-adaptive approach is nice and good and helps some individuals, but it doesn’t really do much to change the system at all, especially since most of these clinicians aren’t even from the same working system. the problem as i see it, and which in part has inspired this article, is that Open Dialogue has become a sort of fad, partially for some very well-deserved reasons. what i don’t like about this fad is that in the midst of the buzz one of the main points get lost — system change!! that is the great opportunity with open dialogue — an inspiration to change systems beyond western lapland, and ultimately to change the whole system. instead, though, more often open dialogue gets reduced to just minor system change and some hope for individuals who want help now for their families and their own individual selves. even some comments here in this comments section reflect that — and it makes sense. people want help now for themselves. i get that. i get emailed constantly by people who want this.
i think, though, that the people who bear the torch as Open Dialogue leaders (in the USA, those who have branded the phrase “Open Dialogue” for their own exclusive, proprietary uses) have an obligation to do more than just train a few clinicians and perhaps spearhead a rather weak pilot study here and there that can’t hope to get results anywhere near what they’ve gotten in Finland. to me anyone who wants to brand Open Dialogue has an obligation to do a lot more than this, and to be real leaders. otherwise, i believe, their use of the name Open Dialogue just becomes self-serving — and diminishes not just what Finnish Open Dialogue, on a systems level, is really about, but what Open Dialogue in general really could (and should) be.
thanks for giving me the opportunity to share this!!!
all the best — and greetings from rainy NYC,
daniel
greetings marina. yes, the finnish open dialogue therapists were lovely and to my mind their work is radical. but in some ways they are just a regular system, or were when i was there. there was no peer support when i was there, not even much or any knowledge of it from what i remember. and even though there was a flattered hierarachy of power in many ways, there still was a big difference between clinicians and so-called clients. also, the idea of filming clients, especially those in “extreme states” is a complex one everywhere. some places were okay with me doing it, others clearly not. perhaps if the folks who were the leaders of finnish open dialogue had gotten to know me better and trust me more they might have allowed me to ask people who were coming for help if they wanted to be filmed. but they didn’t know me well at all when i arrived — in fact, no one in western lapland knew me in person at all!! i had met jaakko seikkula a few times before i went there, but he wasn’t even in western lapland then, because he’s a professor in jyvaskyla (maybe 500km away). but i always appreciated him and the others welcoming me to western lapland at all, because i have some pretty antipsychiatry views, so that was a risk on their part. greetings from new york!
daniel
good question john. it bummed me out that i wasn’t allowed to interview families and people in crisis (aka clients) on camera when i was in finland. i was told i wasn’t allowed to do it, mostly for reasons of confidentiality, but also because they didn’t want people in crises or families to feel pressured to talk with me. basically, they didn’t give people the opportunity to say “no” to me. i can kind of understand it, but at the same time i much prefer to give people the option to decide for themselves. that said, i accepted the stipulation because i wanted to do my best to make a film that represented their work, and if i had fought on that issue there probably would have been no film…
greetings to you — and great article you just put up!
daniel
that’s part of my point, carina. the other part, ron, is i question how much of what gets legally brand-labeled as “open dialogue” really does emphasize some of the most important things that made finnish open dialogue famous — like not medicating folks (or seriously minimizing antipsychotics) who are experiencing a “first-episode”?
you wrote: “I think that having a conversation with family members and the distressed person when the family might have been abusive sounds potentially ok to me.”
i agree with that — as long as the person “in distress” wants that conversation with the family and it’s not being forced on them. i think those kinds of non-forced conversations can be very healthy and helpful. nice to hear from you, john — daniel
Susan and Matt — this is a beautiful piece. Susan, I am forever grateful for the opportunity you gave me to be a part of the Soteria-Alaska family, and Matt — it was wonderful to work with you. Thank you both.
Daniel
hey, dig it julie!!! good to hear what you have to say, and i’m really wishing you all the best on your journey. and i also admit, the idea of giving hurt kids an hour of respite a week is not all bad, that’s for sure!!!
happy new year,
daniel
greetings petra. having the boundaries the way i did it was tough — i’d probably be somewhat looser if i did it again. but also i needed some boundaries, and couldn’t just be regular friends with people. some formality was necessary, at least for me, especially just to help me organize my time and optimize the focus of the work. but it did make it kind of artificial, for sure. but i also think it’s kind of artificial to sit for forty hours a week and listen to so many people’s problems and healing processes — so maybe some of the artificial structure reflected that…hmm……not sure…. daniel
i see good therapy as a lot more than just doing meta-help and waffling and then collecting cash. that sounds like bad therapy to me. but i also don’t see therapists as “giving” people jobs and homes — though maybe good therapy could help people, even homeless people, attain those things. i’ve seen it.
i’m not sure how to weed out the quacks. maybe, for me, this whole mental health thing really isn’t even a field… i only refer to therapists or coaches i really trust. so it’s not about weeding out the bad ones — it’s hunting for the good ones and holding on to them!
hi sandra,
i so want to write more and more and more in response, and yet i have to go to bed and catch a plane in the early morning — and then i’m going off the grid for ten days!!!! i hope this isn’t seen as a hit-and-run blog piece by me — not intended that way at all. i will be back in ten days!!! what i want to say is this: i am VERY glad you posted what you did in this blog’s comments. i think you have dramatically improved the dialogue here, and in fact may even be responsible for it becoming a real dialogue. meanwhile, i had no idea what people would think of this piece i wrote. yes, i was mad when i wrote it. very mad. (that is part of my personality.) but what i figured was, “a piece i wrote when mad should somehow find a home on ‘mad in america.’ ” and it seems it has. i respect robert whitaker for letting it stay up. and i respect you for writing about your lack of indifference to it—and for taking what i perceive to be a leap into some pretty hot waters. and then returning to write some more. thank you.
well, i’m off to sleep—big day tomorrow! and i hope to connect with you more.
daniel
the “shutting down dialogue” thing is interesting…..considering how much dialogue has been going on here. i personally like the dialogue, especially when it gets controversial.
-daniel
Hi Sandra,
Hmm. I don’t really have a problem characterizing human distress as a biological phenomenon. I think everything related to humans or other living creatures could be characterized that way. I also think consciousness can be viewed, though not necessarily understood well, as a brain function. I just think it’s too simplistic of a lens. I think it’s much more realistic and helpful to view it through one of many of non-brain lenses. Just my preference. Thanks for your words.
Daniel
wow — this is intense. i just read the rest of the posts, including obert whitaker’s, and i’m not quite sure what to say. i will say this — a lot of people have entered this dialogue, people with differing points of view. i think that’s good. but i hear robert whitaker’s point that this might not be encouraging a bigger dialogue that Mad in America wishes to have. (i am wild, i admit that. i like to let that side of me be free.) on the other hand, i also noticed that robert did not suggest removing my blog piece, so that is a relief (for me as a writer, at least). past that, i’m not quite sure what to say. i want to think on it. on the other hand, this blog piece is pretty much in line with other work i’ve done over the years, like my youtube song “bullshit.” and this one is probably even a bit “safer” because it didn’t mention anyone by name. i just wrote more generally here.
haha — i can’t help but laugh at the intensity of what you write. you write in the same spirit in which i wrote that essay. it reads like poetry to me. thank you. thank you abbot, thank you stephen gilbert.
daniel
hi Sandra,
I just want to reply to one other thing in your comment — about the fact that you’re a psychiatrist, and that since you believe that we are biological beings that that makes you a biological psychiatrist. Hmm….. I just don’t see it that way — I was not a “biological therapist,” despite also seeing people as biological beings. to me a “biological psychiatrist” is a special type of psychiatrist who focuses on “treating” the human brain, not the human person, and when the human person gets in the way of that “treatment” then the “biological psychiatrist” uses force and pressure to position the person to be more amenable to brain treatment. from what i have read of your work and heard about you, i really don’t see you as a biological psychiatrist. i think some psychiatrists are partially biological psychiatrists and partially human psychiatrists, and some are hardly biological or not biological at all. and some are anti-biological psychiatrists — especially the ones who are good at using their powers and education and experience and licenses to help people get off the meds and out of the mental health system. just my two cents!! 🙂
daniel
Fiachra — yes — that makes sense to me. i am still considering the point Sandra Steingard made that my piece shuts down dialogue. I think the fact that several people are here commenting and discussing and exploring suggests to me that it doesn’t shut down dialogue. the intensity of my piece might make dialogue more difficult, but it opens up a different kind of dialogue, i think…. thanks for what you’ve shared.
daniel
hi Sandy — greetings. well, i’m glad you posted this. to me this is dialogue. i think in the greater context of my work this piece is just one facet of it, one facet of my point of view, of my feelings. it’s…an ode…a piece of poetry in a sense. i realize that it can leave out some people — even some biological psychiatrists who do not act in the ways i have described here. but….my best reply would be that there are so many people who have experienced biological psychiatrists in the way i described above, people i love, that…..i felt it’s worth it. and, sadly, it also expresses my experience at dealing with so many biological psychiatrists myself. i just decided to throw this piece into the mix. i’m actually a bit surprised mad in america published it. i didn’t expect it to be so popular overall. but i particularly love some of the comments about it so far — they have moved me and made me glad to put it up. hello from nyc—–daniel
hi anthony! sending you love and strength! i have personally seen what “aot” can do to people, and i think it’s a rotten program to the core. i think you are brave, very brave. wishing you the best — daniel
you’re welcome! i am so glad you posted this. telling the truth helps me keep my sanity too. sometimes i have to be harsher than at other times, aaaah!!!
well, some insurance companies are better than other, though some are simply a joke. more and more what i’ve seen is that insurance companies pay less–less–less and make therapists do a lot more bureaucratic work to get that decreasing money, and also, worst of all, reveal a lot more about their clients. also, it’s almost all diagnosis-based….which to me is farcical. but i guess i expressed all that already and am not answering your question!!!! (sorry.) if i were to go back to being a therapist i think i would not take insurance. the big advantage, of course, is that it can save clients some money. and it’s sad that people would have insurance and yet have to pay out of pocket, though of course co-pays for their insurance were sometimes more than what they paid me if we just worked on my sliding scale!! so….i’ll tell you how i worked with the insurance companies: i always worked to give milder diagnoses, because we had to diagnose. i also gave clients an option about not using their insurance and just paying a low-fee out of pocket instead. also, sometimes for people who had been diagnosed with serious things up the wazoo for years, the insurance could have a great advantage: i could use billing with a diagnosis as an opportunity to give them milder diagnoses than they’d ever had before, and thus, in effect, document their recovery from things like “schizophrenia” — into diagnoses like “PTSD” or “generalized anxiety disorder.” personally, though, what i’ve come to believe is that if you’re going to play ball with insurance companies then one will always have to compromise and work within their diagnostic system. ugh. i don’t want to do that anymore. it’s been a relief to be out of the system…. sorry if that’s a convoluted answer!!! –daniel
thanks kim. much appreciated. yes…….i do like humor, and i used it as a therapist a lot, because it is part of my personality. however, i was pretty careful in using it, because it could quickly alienate some people, as has even happened by posting this essay. that’s the risk, i guess. but sometimes i just……need to laugh!!!! 🙂 daniel
thank alix. yep — basically i wrote this essay not to critique individuals but to critique the whole diagnostic system. i see it as needing to be scrapped, and i chose to express that through humor….which has its risks!! i’ve written so many “straight” essays about this and usually they get a much more tepid response. humor — people either love it or hate it!! well, if it’s halfway decent humor….as i hope this was.
wow. can’t win ’em all. 🙁 i will say, though, that i certainly have met therapists and psychiatrists who have embodied the points of view expressed in this essay. i wish the field were healthier.
hey! that’s a cool comment. thanks. well, about copyrighting it…hmm…i also put it on my website, so in a way it is copyrighted. as for crowdsourcing….i don’t really even know what that is, but if you want to try that feel free to go for it. also, i “defined” another 10 or 15 diagnoses but chose the best for this essay……..i was going for brevity!! all the best, daniel
very cool, erin. it makes sense to me why you didn’t come. it’s not easy to be out and public about these things. becoming more public for me has been a big psychic shift…….. wishing you and your family the best,
daniel
hi fred. dig it! my film equipment for this film came to about $1350 i think. $800 canon camera (takes tapes, not memory cards), ~$300 beechtek audio adapter, and ~$250 boom mic. and that was it. pretty simple………and basically super-cheap as far as a camera set-up goes. i do have a light tripod but i didn’t need it for this project. i also have lavalier mics for indoor interviews but i didn’t use them here. they’re probably about $250 each, and i have two. then it also takes a computer for editing, and i have a 4-year-old mac book pro with an older version of final cut pro. probably a lot of this stuff could be purchased used. my stuff is all old and works fine. all the best to you fred,
daniel
thank you whoopsie. yes, the man who spoke about the effects of ECT……that was intense. i really don’t know how to reply to something like what he said. sending you the best!!! daniel
hi martin,
i don’t know if your therapist is good or not — i am skeptical of therapists in general. this could be an issue of your therapist’s quality, but it might also be the effects of the antidepressant and/or drug withdrawal. i’ve seen people who come off their medication (you were on it for a while too) and had withdrawal effects that lasted a lost time, and can be really debilitating — similar to some of the things you described.
meanwhile, while i can’t speak with assuredness about quality of your therapy, i still have some skepticism. i actually just recorded a couple of self-interviews for youtube on this subject. i put one up a couple weeks ago — you might like it.
very intense article, Michael. Scary stuff. Thanks for sharing this. And I particularly liked Tina’s comments. I remember once interviewing Joanne Greenberg and she said that after she was released from the mental hospital for the final time in the early 1950s they stamped “MP” on her Maryland driver’s license — for “Mental Patient.” I asked her how she got it off her license, and she said, “I moved to Colorado.”
hi nathan,
just a quick moment to write. well……..i think it’s pretty hard for people to tell if they have a good therapist or not. i’ve written a fair amount about this somewhere, i think on the web (i don’t know where the link is). the problem is that a lot of people who go to therapy are in a more-or-less vulnerable state, which doesn’t usually place them in a position to be the most discerning about the quality of the therapist they’re sitting with. so it’s pretty much a crapshoot for most people, and many times it seems they just stick with the therapist if they marginally like the person, which tends not to be a pretty good indicator of the therapist’s quality, especially if the therapist is the type to gratify the therapist. and of course there are lots of people who have little or no choice in the therapist to whom they’ve been assigned — take it or leave it… ideally they can spend a lot of time asking the therapist a lot of questions to try to best determine for themselves the therapist’s quality. and getting a referral from someone they really trust and know well helps — but is also far from giving top-notch assurance…hmm……
hi discussant—
yes, i do find interesting what you write. and i actually agree with a fair amount of it — considering i personally think most therapy and most therapists stinks. i think if therapy can be avoided it’s much better, which is actually why i very rarely recommend therapy. in fact, i really can’t think of situations where i have recommended it, especially in the last several years. i’m a major proponent of self-therapy, and write about it a lot. i think it’s preferable. i have a whole section of my website on self-therapy ( http://wildtruth.net/on-self-therapy/ ) and basically no essays that really promote therapy. (though i do make films that speak highly of some therapy.) one essay, though, might be considered rather positive on therapy, though: http://wildtruth.net/three-differences-between-therapy-friendship/
but i do think there are some situations where therapy (with a good therapist) can be very useful and healing for people. but personally i see therapy as much more of an art than a science. that’s why i don’t get into worry much about the statistics about therapy, positive or negative. but like good artists (worth their value) vs. bad/mediocre artists (not worth it), i think good therapists are rare, and bad/mediocre therapists are pretty common….in fact, very common.
but just because most artists don’t have great talent, that doesn’t mean that a michelangelo can’t occasionally shine through…..
anyway, good to read what you write — i’ll keep considering it.
Discussant,
i read the main-page essay on your website and i have mixed feelings about it. i found some of it okay — and good for discussion, but mostly what i felt was that you were accurately describing bad therapy. but i don’t see that what you write necessarily describes all therapy. perhaps, to one degree or other, it describes MUCH or MOST therapy, but not all…
hmm…i think there are several assumptions in what you’ve written, Discussant.
1) that i harmed people. did i? i don’t see the evidence from my essay above. maybe i was not an “optimal” therapist (whatever that might be), but as i see it i gave it my all and i think i was pretty useful to a lot of people. those whom i have had the chance to follow up with (and those ask while they were in therapy with me) said they found me useful, in a variety of ways.
2) that i wasted clients’ time and money. hmm, did i? i think i made my prices fair (as fair as i could), and that i didn’t want to work with people any longer than necessary. and i think i respect the people i worked with enough to recognize that they could decide for themselves if they were wasting their time and money, and from what i gathered from those that stuck around in therapy was that they didn’t feel they were wasting their time and money. i personally think people got a pretty good deal out of working with me. and no one was forced to come.
3) that i’m a hypocrite for thinking that the therapy i received was bad and the therapy i offered was pretty good. so is a baseball coach who himself had bad coaches necessarily a hypocrite? i don’t see the rub. i wouldn’t say that i learned about the value of therapy from being in therapy myself. i learned about it in lots of other ways — including from many facets of life itself.
i guess the troubling thing for me is that you read my essay and somehow determined that i was a bad, harmful therapist. it seems to me that you’ve really read into my essays things that i don’t think are there.
now i’m going to check out your website. i’ll admit that you haven’t offered the best intro to it for me, but i’ll try to read it with an open mind anyway.
hi Marc,
good to hear this. i have heard of marshall rosenberg and his work with nonviolent communication, but it’s been a while and i really can’t remember if i read anythign he wrote. i’ll have to see what i can find. thanks for sparking some ideas!
wishing you the best ——daniel
dig it john — thanks for your comment. i especially liked this part you wrote: “When it goes well you forget the role you are in, as either client or therapist, you are just human beings caring for each other and trying your best to understand each other in this rather fractured world.”
hi Tore,
thanks for sharing. interesting for me to hear this. i’ve actually spent a fair amount of time in sweden these past few years, but perhaps you knew that. (i made a movie in sweden 3 years ago.) i know 2 of the acronyms you share, but i don’t know what “BT therapy”. i’ll try to figure it out… all the best, daniel
hi Gloria,
well…….hmm…….how to respond. probably the simplest way to respond is to say that i just have found that i’m doing fine on my life’s path and haven’t felt any interest in seeing a therapist. i’ve become pretty good at doing self-therapy. and i have a lot of nice friends. so i’m contented about my life’s trajectory, even if my life is a bit tough at times — but that’s to be expected, all things considered. i have chosen a challenging path — or maybe it’s more accurate that a challenging path has chosen me…
that said, actually i am curious about what motivated you to write this comment. i’m all ears if you care to share.
all the best to you,
daniel
i agree, dorothy. but a very weird thing happened. i wrote the first draft of this article 3 days ago. later that evening i coming in the door of the building where i stay when i’m in NYC, and i ran into a woman who i knew years ago. she is Puerto Rican, and she is the grandmother of 2 boys who were in a pre-kindergarten class i used to play guitar for back before i became a therapist. they are both 19 years old now. (they were 4 then.) i see them on the street sometimes — they’re tough guys, one is a parent himself, and we still have a great rapport. they always give me hugs on the street. they’ve introduced me to their grandmother. she said to me, “you know, i want to invite you over to our house for dinner. i’ll have my grandsons come over, and i’ll cook us all a really nice spanish meal!” i couldn’t believe it!! and i said…….YES!! it was like magic. so maybe when i get back to NYC next week i’ll take her up on her offer. cool, eh?? i think there’s always a chance for redemption……
a hug to you, dorothy,
daniel
hi Nathan. thank you for sharing this. it’s sad to say, but two things helped me get through social work school, one bad and one good. the bad one was that i had to lie and hide my feelings throughout so much of my childhood, to survive in my family. it’s a skill — if you call it that — that i retained, and it occasionally comes in useful. the good reason i stayed in was because i was so passionate about my goal, and i wasn’t going to let anything stop me from achieving it. so i just restrained myself from lashing out at my superiors and supervisors as best i could. i really hated many of them — they were unethical, to varying degrees, and also many were very hurtful to me and to the others they had power over — but i just swallowed it, because i knew in our supposedly “open” relationships, where they were supervisors and i was supervisee, if i had done what they said was appropriate and really spoken my mind they would have destroyed me. so i kept quiet…..and bided my time. that hurt me too……but i didn’t know a better way….
sending you warm greetings — daniel
thank you Ted. Part of me was scared to share this essay, but another part of me, a growing-stronger part, said to myself, “go for it. the real fear is what i’ve been through — not being able to share my real experience for fear of offending….” it’s a gift to be able to write and share. and i thank you. it was a pleasure to meet you last year in alaska. and your story……….wow. just wow. talk about intense. i have such respect for you.
daniel
hey, Dig it mjk!!! so nice to hear from you again. i remember your moniker of mjk!! wishing you the best. by the way, i cried when i wrote that about not accepting that woman’s meal. it was good to cry about it. i think i wasn’t able to cry about it at the time.
all the best to you,
daniel
hi NewPC,
thank you — and i feel you make good points. at the risk of sounding arrogant, though, i’d have to say that i’m pretty aware of my off-beat — and angry, troubled, frustrated, traumatized, “imperfect” sides — and one of the big problems i had with supervisors is that they couldn’t tolerate those “imperfect” sides in themselves. most were only minimally self-reflective, especially if they’d been in the field for a while. most of my supervisors were really incompetent — at least the supervisors i had formally when i had no choice in who to have. eventually i chose people to surround myself with who really were good, who related to me and related to themselves. real people!! but they were few and far between…
all the best,
daniel
hi altostrata and marian,
well, i’ve had various people tell me that short-term benzo use was helpful to them in getting off neuroleptics, and that they didn’t get hooked. i’ve also known a lot of people hooked on benzos — absolutely horrible. so basically my thought is that if the benzos are not used short-term or very scantily then they’re too risky. i’m curious what others think about this. perhaps there are a lot more people out there who feel that any benzo use (even very short-term) is just too risky.
all the best,
daniel
p.s. well, again, i hope people don’t take me as the b-all and end-all in neuroleptic withdrawal, because i’m not that! i just have some ideas based on my own experiences, and i wanted to take the risk of putting out those ideas — and to hear others’ feedback. i just think there’s not enough out there on this subject, so that anything that’s fairly well thought-out, however imperfect, would add something…because so much of what is actually being done in practice now is horrible!
good points. i like them. i also agree it’s good to jump beyond the hypothetical and theoretical. for me, now, though, in my life…i want to make sure i have my ducks lined up, which is why i put out this piece. also, i don’t have the energy to start a new program…….wish i did, but i don’t. i burned out on being a therapist…that and i was finding pleasure in doing other things (films, visiting other programs, etc.). actually, tomorrow will be three years since i closed my practice.
but i think it’s great to discuss this — especially with people like you who have clearly thought about it a lot and have a lot of experience. and by no means would i say my experience is the b-all and end-all. that’s why i looked forward to discussions about this piece…though i admit, i was nervous to put the piece up because this stuff can REALLY anger people, and i felt that no matter what i said i would step on someone’s toes, which i didn’t want to do.
thanks for what you’ve shared, and for the links.
daniel
you wrote: “Your assumption that ‘tapering is a given’ is incorrect, and that you can simply get a psychiatrist on staff who knows how to do it — problem solved.”
hmm…..i never said that you’d simply get a psychiatrist on staff who knows about tapering and everything will be okay. if i had said that i’d be criticizing my writing too.
also, when i said that i take “tapering as a given for most people,” i mean in the hypothetical “good” program which i’m exploring, not in already existing programs in general.
i like the points you make, however, i think you may have somehow gotten the idea that i disagree with what you’re writing. i agree with it, but take tapering as a given for most people, and for that reason perhaps did not emphasize it enough.
all the best,
daniel
p.s. i checked out your website. i’d never seen it before. looks like a very good resource. thanks.
hi altostrata — i actually did mention tapering twice in my article, but could have given it more attention. of course tapering is, in many cases of coming of neuroleptics, vital.
i do challenge you on the following:
I wrote: “helping people withdraw from neuroleptics in a systematic way is largely unexplored territory.”
my thought: i agree with what you’re saying, but the only thing i think that’s unexplored is helping people withdraw in a “systematic” way. yes, there’s tons of info out there on withdrawal, but not enough of it has been systematically collected. it would be nice to have it collected systematically.
hi Sandra,
good questions. hmm……well, i don’t think there should necessarily e a goal in what the supporters would be attempting to accomplish in terms of what will happen to the person reducing meds, instead, i see the role of the supporter as simply to be supportive of what the person himself or herself wants. basically, i see a supporter as a caring, mature, real, open person…
i liked what john said about the pain that some people feel when they come off. maybe i’d add that some people find the process simply torturous: physically … mentally … emotionally… that’s what i’ve heard.
i also like what you wrote about being more explicit about it being a harm reduction approach. and i’d also add that in this hypothetical program there were be tons of free copies of will hall’s “harm reduction guide” for everyone to have.
hi PC — good points. you actually help clarify some of what i tried to express. by no means should the psychiatrist be the only one to have many of the skills on his or her skill set. many of those skills should simply be common knowledge. i think part of the reason that i listed many of the skills i think a good psychiatrist should have is that almost none i know possesses them, much less many of them…
but, there are some real benefits of having a trained medical professional as an ally in the tapering process…if only, at the very least, because the drugs cause actual medical problems!
and i also think of grace jackson, m.d. i’ve had some great conversations with her, and they always leave me feeling humbled. she’s a psychiatrist who really knows a lot!
hello jonah. i’m enjoying reading these comments. in reply to your comment about my wording of “advance directive notwithstanding”: i guess i mean that if someone puts something in their advance directive that allows for force or even requests it in certain circumstances, and then later changes their mind, then their later decision would trump their advance directive. don’t know if that came across clearly… but this is tricky stuff — it wasn’t easy for me to word it right. personally because i have a lot invested in this subject emotionally. –daniel
hi Philroy,
From what I have seen and heard possibilities for tapering slowly were definitely discussed and encouraged, but many of Soteria-Alaska residents just came off however they wanted, and that mostly meant cold turkey.
hi Anonymous — I like many of the points you make. One thing I will say is that Soteria has tried to do its best to create a real and viable alternative to the traditional psychiatric and forced drugging system — and to try to help people get away from that system and avoid it if at all possible. That’s its basic reason to be. It’s just been very tough to implement. As to the idea of Soteria working with the traditional system: yes, that has its drawbacks, but if it didn’t it wouldn’t exist as a program at all, at least at this point. I myself prefer to work outside the system — but that has its drawbacks too….at least at this point as well.
About government funding: well, I don’t see that as inherently bad (though of course it can be very bad in many or most cases). But if government funding were inherently bad then that would invalidate some programs I really like in Europe, like Open Dialogue and the Family Care Foundation. And doesn’t the Hearing Voices Network get government funding in some places?
About the shooting death: yes, I probably erred (without realizing it) on the side of being euphemistic in my language. But the story is also quite public, and all over the internet, so I guess I figured most readers already knew about it or could easily find out more if they wished, and because it was such a horror. Meanwhile, because I spend a lot of time at Soteria, where that horror happened and where it remains a quite sensitive subject, I have fallen into what some might call the trap of using more gentle language… There was certainly no intention on my part to deceive. It’s just very complex to write about any of this at all — anything about this program. I hesitated for a while to write this piece, and would have found it easier to write nothing and just keep the knowledge I had about Soteria-Alaska private. But I decided instead to go for it, to the best of my ability.
One other thing: few people at Soteria (residents/staff) talk about “first breaks” and the like — frankly I don’t think they care about this at all in their day-to-day work, or use this kind of language. To them people are people, no matter what they’re going through. I just chose to use that “medical” language for the sake of keeping continuity with the language of people like Robert Whitaker, Loren Mosher, Jaakko Seikkula, etc. — but I see how it leaves me open to some very valid criticism.
hi Steve — very interesting points. And definitely worth considering. One thing, though, that is greatly advantageous about Soteria over Open Dialogue is that Soteria is much easier to set up — Open Dialogue practitioners requires tons of professional training, whereas Soteria uses almost exclusively nonprofessionals.
Also, I do think there is some truth to the idea of stigma being attached to living in a house like Soteria, and less so about Open Dialogue (of the Finnish variety).
Yes and no….. There was one being conducted but it was curtailed over a year ago, but it looks like it’s starting up again. Results are preliminary so far….. My observations came from talking in depth with the staff, listening to the residents, making my own observations, talking with former residents, etc.
hi Yana —
great to hear from you, and I look forward to hearing more and more about the original Soteria. Actually, I’m only filling in for Susan for a total of 3 months — a short sabbatical for her!! And for me it’s ALMOST over — just another week of work, and then I’m moving onward. It’s been an amazing three months (actually it will be 4 months in Alaska in total). Great learning opportunity for me — and I have incredible respect for everyone at Soteria-Alaska. The dedication and talent is stunning.
Hi Michael —
yes, an ironclad agreement with the pysch emergency room would have been fantastic. No doubt about that! Who knows — maybe such things will become possible in the future. Until you wrote this post I never really thought about the concept of an ironclad agreement……it almost seems like fantasy to me……….a good fantasy. Maybe someday!!
Thanks for your sharing—–
Daniel
right on, Marian — I agree with what you write. As you say, a big part of Open Dialogue is working with social networks, and so many people I’ve seen who have been in (and out and in and out) of the system for a while have lost a lot of their social networks.
—Daniel
thanks Darby — much appreciated! One program I love that has focused on helping people come off the drugs is the Family Care Foundation in Gothenburg, Sweden. I’ll actually be visiting there in two weeks. Perhaps you saw them in my film “Healing Homes.” I made that film to contrast their work with a program like the Open Dialogue Project in Finland, which just focuses their research on people experiencing “first breaks.”
What I like about the Family Care Foundation is that they provide a lot more intensive, long-term support for people coming off the drugs than do programs like Soteria. As I see it, this support provides better “shock absorbers” — or more cushion — so that people don’t end up leaving the program so precipitously when the going gets rough…..
Soteria-Alaska has two paid staff on at any given time. From what I have observed raising kids is quite different from being a staff member at Soteria — basically not comparable, in my opinion. The intensity level is often radically higher at Soteria.
Meanwhile, very cool about you coming off psych drugs. But I don’t think for one second that I have dismissed or given up on “chronics.” I just was trying to make the point that, from what I’ve observed and studied, Soteria is not the best place for people who have been in the system and on psych drugs for a long time. There are programs that are better set up to work with people who have been in the system longer. Soteria wasn’t set up for that, and basically hasn’t gotten good results with these kinds of folks.
As for me personally giving up: NEVER. I just think it’s important for me to share what I observed, and have been observing a lot in the world.
This is not, however, to say that Soteria couldn’t help some people in very “chronics” situations — in fact, they have helped some people in these situations a lot — and I said this in the article. It’s just they haven’t helped people recover fully — according to Mosher’s definition of recovery.
all the best — and thanks for the thought-provoking comment!
Daniel
Thank you for this excellent interview.
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Excellent article, Jay. Thank you. I love your logic and the style with which you present your arguments.
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hi chee — you make some good points — about the dependency, etc. i appreciate what you say — thank you for posting. maybe it’s worthwhile to try some form of self-therapy? i am working on self-therapy myself! daniel
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glad to hear that you found the article useful. wishing you the best on your journey ——- daniel
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excellent article, Noel. Daniel
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great article, ron — well-written and well-argued. daniel
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nice to hear, candice——–thanks 🙂 !! daniel
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greetings and thank you!! i appreciate what you’ve written 🙂
daniel
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Hi Martin — it’s hard for me to know what the case is. It’s possible that they’re right (that you have to feel worse before you feel better) but it sounds unlikely to me. Maybe your therapists aren’t any good — or maybe they’re just a bad fit for you. Maybe there’s a good one out there for you. Or maybe there’s something else that you need to do that would be more helpful than therapy. I don’t know what that is. I thought I was a pretty darn good therapist but I didn’t help everyone I met. And I know things other than therapy helped me, and continue to — it’s just a question of finding out what those things are…. all the best, Daniel
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hmm, i don’t really know much about prakash ellenhorn. i’ve never visited there. i seem to have some memory somewhere that one or more of their staff did the open dialogue training with mary olson. but i am not sure. i think of them as being one of the more progressive treatment centers in the USA, though often that doesn’t say too much, because for starters there’s not much that’s really progressive in the USA (or anywhere), and also many of these places try to be progressive (some do better than others) but still get very stressed out working within the confines of the super-screwed-up mental health system………. wish i had more for you. daniel
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which treatment center are you talking about? i’m not sure…. maybe i know it… all the best! daniel
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hi becky
i haven’t read my article in a while, so i don’t know if i said it there, but when i became a therapist at first (when i was 27) i was terrified of the things you mentioned. i also looked very young, younger than my years. and i was working with people older than i was — vietnam vets then in their 50s. i used to get down on my knees before sessions (early on) and just pray (i didn’t even believe in god) that i could make it through a session and keep my wits about me. then i’d just plunge in. there’s no way to get over the fear other than just doing it. that’s my experience. also, one thing i came to realize over time is that the people who are coming in for help, to talk, to reveal themselves and their deepest problems, are much more vulnerable, in most cases, than we are as therapists. so i think when we can empathize with the inherent anxiety that most people go through coming to a new therapist — so stressful — it can make it easier for us to calm down, be in our own skin, and listen to them…and be there for them. just thoughts… oh, by the way, don’t know if i said in the essay also, but i did from time to time have people comment that i was too young, and sometimes i got fired by clients over it. but others liked me looking young. they felt safer. also, i know some older therapists who get fired for looking too old. so it goes both ways. all the best! daniel
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thanks for your comment michelle 🙂 and greetings! i wrote this article over two years ago, but it still holds true for me. all the best to you on your journey! daniel
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Sera,
i have such respect for you and what you have written. i also have seen different incarnations of this “hot stove” film and i couldn’t stand it — for the reasons you described. i found the film, and the creators’ reactions to the criticisms of it, disingenuous. also, i wish the filmmaker, Sheryll Franko, were involved in this discussion. i do not know if she understands the subject matter well enough to realize what she got herself into, or if she actually believes that people like lieberman actually have something valuable to say. but i think it’s also not fair for alice maher to put some of the blame for the film on her being “young and inexperienced”. if i were Sheryll i would be troubled by this.
-Daniel Mackler
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sure, it’s possible! glad my article was of some value to you. wishing you the best on your journey!!!
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hi aminaoboe — greetings to you. thanks for you comment. at the risk of sounding cliche or simplistic, i would have to say follow your heart!! i was called to be a therapist — a calling from within — and my leaving being a therapist was a calling also……..a calling to a different life, which i’m still exploring. meanwhile, i think it’s great that you play oboe. what a wonderful instrument. i spent my day playing guitar and singing 🙂
daniel
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thank you for this piece, Jay. I am appreciative of all you write. just today i quoted your work to someone. i consider your work very important, and i consider you a real original.
-daniel
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glad to read this christian horse gal!!! – thanks!! daniel
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thanks David! much appreciated 🙂 daniel
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thank you Emily. and all the best to you in your upcoming practicum — and also your broader journey through life! 🙂 daniel
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hi mark,
well, i’m glad to hear you meet most of the criteria — sounds like we probably agree on a lot then! as for the parent one, i do have many friends who are therapists i consider pretty darn good who have kids. and i recognize that that criteria probably seems out of left field, especially since i didn’t explain my reasoning behind it that much. if you’re curious to hear more of my point of view on parents and parenting feel free to check out my website. ( http://www.wildtruth.net ) maybe my point of view would seem less bizarre then? all the best, daniel
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thanks Duane 🙂
–daniel
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hi duane,
you wrote: “I’ll take a good close friend over a licensed therapist almost every time.”
in a nutshell, i agree!!!
daniel
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thank you plebtocracy for your insightful comment. greetings, daniel
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thank you Richard — daniel
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Thanks Truth! daniel
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thanks Alex — i’ve enjoyed it too — the differences of opinion, the agreements, all of it — daniel
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greetings John — thanks for the comment — and the ideas in it. well….feeling better after each session…… in a way that makes sense, but also…..sometimes hell comes up in healing, in breaking dissociation, that is very painful……facing previously denied horrors……that could make people feel a lot worse, at least in the short-term. but even feeling those feelings makes some people feel more alive, more on the path to being integrated… daniel
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hi Kim — thanks for your thoughtful comment. daniel
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hi alex,
i think we differ in opinion on mother teresa. but just because we differ doesn’t mean that i diagnosed her, at least diagnosed her in the psychiatric sense. i feel i am using my critical judgment about her, and i stand by that. i see nothing wrong with that. would i also be diagnosing hitler if i said he was a callous, out-of-control monster who never dealt with his childhood history of severe abuse and played it out in the most horrendous and brutal of ways? and i never met him either. and i don’t think it’s being judgmental either, rather, again, using my judgment.
all the best,
daniel
p.s. mother teresa’s rather uncritical biographer, by the way — someone who, from what i remember, really liked her — made many of the same points about her that i did (her inconsistency, hypocrisy, etc.). so i didn’t pull this out of nowhere.
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thanks for your comment julie — wow! i agree with a lot of it, for sure. however, i don’t inherently see therapy as a form of prostitution, even if a lot of therapists are bad bad news and do prostitute parts of themselves in nasty ways. also, just to be clear, i didn’t say that all therapists who have kids are bad therapists. in the essay i wrote: “And there are some therapists who have kids whom I think are far better than average, even brilliant in some ways.”
greetings to you!
daniel
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thank you for your comment, Uprising. the things i wrote in this article have not been abstract for me either, which is why i feel inspired to write about them. by the way, i also think it’s terrible to railroad someone into blaming someone for their problems — or railroading anyone into doing anything…
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Hi Sharon,
i am curious about this comment, and i would be glad if you would elaborate more, because it seems basically impossible for a therapist who respects and understands the people he or she works with, listens well, develops a good relationship with them, cares about them, honors the pace of their growth process, and doesn’t force anything on them to turn therapy into a “god-forsaken, demeaning, horrifying” experience. Or did i misread what you wrote? the only way i could imagine such a therapy becoming a horrible experience for people is if the caring nature of the relationship somehow facilitated the eruption of so much buried, forgotten trauma in the client that it completely overwhelmed the person and retraumatized him or her. but even that wouldn’t likely make sense to me if the therapist was really good, because a good therapist (as i define a “good therapist”) would sense that possibility before it happened and would help the therapy go at a slower and thus non-retraumatizing pace.
wishing you the best,
daniel
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hi Getitright —
just to be clear, i never said (much less assumed) that all childhood trauma “boils down to bad parenting”. that would be a very simplistic thing to say. there is too much evidence to the contrary. but a lot of it does, for sure. after all, parents wield more power and control over a baby’s and young child’s life than pretty much anyone can possibly wield over anyone else. and even if people who are not the parents are more clearly the traumatizers of a child, it’s often not that hard to see how parents had some (or a lot of) influence in setting up the dynamics that led to this abuse, through intent or neglect.
i see in our world, though, that there is often a big push to let parents off the hook, in one way or another, for the damages they cause either directly or indirectly.
daniel
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Hi Alex and Getitright,
greetings! the coercion part is true — i’m definitely against people/therapists who pressure others to forgive, even subtly pressure it. i think that is very common. the deeper part of what i’ve observed, though, is that often forgiveness leads to a sort of pseudo-healing, more of a burying of the hurt, a burying of the grief process. it feels good, it makes people and families more comfortable, but it doesn’t really resolve the traumas. i’ve seen many people become comfortable in a state of what is known as forgiveness, very happy. it’s really a state that very much coincides with the ideals of normalcy. and i think the grieving process is much much less so.
as for mother teresa, i think she was a very disturbed woman. very split off from her feelings and her own healing process. i always felt this about her until i read her biography — not even a particularly critical biography — and saw how troubled, inconsistent, and even hypocritical she was. often the people who are very split-off, though, seem quite healthy. it was people like mother teresa who helped me see more clearly just how much being dissociated can mimic a state of self-actualization…
all the best,
daniel
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hi duane,
i don’t totally agree with what you wrote here (though thanks for the comment!), however, one part does resonate with me: the part of the massive responsibility that comes with being a parent. that’s a big part of why i think people, especially those who have young children, when the responsibility is greatest, shouldn’t be therapists, which bears a lot of similarity to parenting, with the devotion and responsibility required.
daniel
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thank you. Interestingly, I’ve learned a lot about being a therapist since i formally quit being one. there are many things i wish i had done differently. i think i did a lot right, but some not. i basically had no great role models (and not for lack of trying to find them) and was following my heart — and also doing a lot of self-reflecting on the process. i also had some really good friends who were insightful who gave me good guidance. and i learned a lot from my clients. but what a tough job!!!
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p.s. hi ajewinisrael.
a quick addition: you wrote: “So I don’t agree that children/spouse suffer from a parent being devoted to his job, as long as it doesn’t go overboard. I would say the opposite – that it’s complementary.”
in most cases i agree with you, but i see the job of therapist as not a normal job. i think it’s more than a job. therapists who treat it as a normal job, and not a calling, well…i basically don’t see them as being much good.
daniel
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hi ajewinisrael–
you wrote: “I would add that in my experience, having kids opens a person up to levels of compassion for others that people without children don’t easily access.”
i would actually agree with this. there are many things that that people don’t easily access — and i think i make this clear in the essay. i think for many people having children is simply the easier way. but that doesn’t, in my experience, mean that easier equates to better. i think the more difficult way is actually the much more real and honest way. i think for many people having children is like an addiction — like a drug. it’s an easy access a lot of feelings, but not a solution. the tough inner path, through healing traumas, resolving one’s own childhood dilemmas — not using having children of one’s own as props — that is the solution i’ve seen. that doesn’t mean that most people who don’t have children do this. from what i’ve observed most don’t. it’s too difficult.
daniel
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duane,
not exactly. i’m fathering myself. and have been for a long time.
daniel
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hi duane,
this seems like an odd admission to me — odd in that you don’t see a problem with it. basically, you did little or no growth or recognized no growth in yourself until you had a child? that seems very unfair to your child.
i have heard similar things many times, though. people often say that they didn’t start getting their life together until they had a child. the subtext i read is that they’re using the child to provoke their own growth. often to me it’s a signal that a person doesn’t see a problem with using the child for his or her own purposes. much more fair is to grow up before having kids. people do this, after all.
all the best
daniel
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hi bpdtransformation — thanks for the comment. i am serious about what i wrote about parents. and you’re right — i don’t see a large pool of potentially great therapists. but the therapists are not “tainted” by their offspring. better put would be “their potential quality as a therapy gets tainted or limited by the fact that they’ve had offspring”.
the evidence i’ve seen is my observation about people — that once people have children it locks in place a lot inside them such that there are many emotional places they can’t go…and things they can’t see. that of course is not to say that all people who don’t have kids can suddenly go to these places, because, as i suggested in the essay, this isn’t true either. that’s why i say having kids “stymies their potential” — blocks the possibilities of what they can do. that’s what i’ve seen.
daniel
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hi frayed — alas, i think the therapist you described is all too common…..all that fakeness and fake empathy. i do know some therapists who are not like that — and some who i consider to be excellent. but not many!! that’s why i think trusting one’s gut is so important — it weeds out these creepy fake people pretty quickly. wishing you the best — daniel
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dig it, sera. yes, and i have been to some conferences that moved me. however, even at the better or best ones my favorite time has always been the off-time, when people just hang out and talk….. i might someday like to create a conference with just a few speakers (ones who know how to give a good, unique talk, people with a dramatic flair) and the rest of the time just open for hanging out, talking, eating, getting to know…. just an idea…. always glad to see what you write —- daniel
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nicely said, Sera. i think what you described is right on the money, and the way you described it is fair. as a slightly side note, i have pretty much grown to hate going to conferences, or at least most of them. all the fake hoopla, the “wow i learned so much” when i can’t quite figure out what was remotely new, and all the self-congratulatory pride that “we can all put aside our differences under this big tent.” i think there is something about coming together to fight a common enemy and stand up for a common cause, but i think a lot of times those are just surface efforts, and underneath it after the conference ends it’s just back to the same-old, same-old…….
greetings to you —- daniel
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tis true! screw all the liars, manipulators, and jerks!!!
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Another excellent article, Sera — thank you. It’s quite informative on a lot of levels. Much appreciated!
Daniel
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i heard it was because of “scheduling conflicts.” maybe he had a “date with the devil”? lol.
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excellent article. thank you. scary that ISPS (the organization that first connected me with robert whitaker, back in 2005) wanted lieberman to be a keynoter at their big NYC conference last month…”to dialogue with him.” like that was ever going to happen… regardless, he dropped out before the conference. scary guy…but not coincidental that he rose to power in his field of choice, psychiatry.
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thanks manchu — and i checked out your website — nice!
all the best to you!
daniel
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cool sera. you guys really have created something special up there in western mass. to me it would be so backward if they slashed your budget. i can only imagine that the budget-making (and budget-cutters) really don’t have a clue of the REAL value in what’s happening with the Western Mass RLC.
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cool to hear jaycee. i know less about what’s going on in the UK than in the USA. i do know some about the UK training, though. i would imagine they are certainly using some of the OD principles — and i really wonder how it’ll go with people going through a “first-episode.” if they’re really going for it that’s great news 🙂
thanks 🙂
daniel
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nicely said, Alex.
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great article, sera. it would be a disaster if the western mass RLC had this budget cut. i consider the western mass RLC a flagship community — one that does so much good on so many levels to so many people. i share about your work all over the world — as an example of what can be, and what can happen when people come together with strong common values and actually live them. the evidence i have is not in numbers and figures, it’s in getting to know the people involved, feeling the passion, and realizing that a whole new way is possible.
daniel
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sandra — i’m with you — i like what you say. i also think what you write is so true: “we live in a world that wants evidence.” i think that is what makes me sad — that we have this real evidenced-based program in western lapland that demonstrates just how good therapy and minimal or no meds can be for folks in an initial major crisis, and yet it gets poo-pooed because in part because it hasn’t been replicated, yet the people who are on the front lines with the best ability to replicate it and help others replicate it (the open dialogue trainers and many of the trainees, etc.) aren’t taking a strong or smart enough stand. as an example of this, i read over that umass “adaptation” study and had to blink my eyes. it’s like, who designed that? and why? it’s like, finnish open dialogue created their famous study with people with first-episode psychosis — people who are a lot easier to help therapeutically than people who have been medicated for a long time. the umass study seemed to be all about the latter, not the former. that’s a totally different client base, people much much harder to help to “recover fully.” my two cents: if the goal is to get a strong evidence base for programs that can really help a high percentage of people “with psychosis” — a very important goal, to my mind — we should clearly be designing programs for the people who are the easiest to help — the people in a first-episode. and we should follow the finns and try to do it with little or no meds. and if it’s not political or hard to implement then i think we just need to try harder and work smarter and more creatively. it isn’t impossible. i’m all for trying to help everyone (and as a therapist i worked with many people who had been in the system for years), but i think the point here is to think with more of a long-range view — that is, more strategically. otherwise we’re putting in a lot of energy into programs that will add little or nothing to the evidence base and will do nothing to help change the system.
i find that disappointing. and it really brings many questions to the front of my mind. are the people who designed these adaptation studies naive? or are they just not so strong at the politics angle, and thus making compromises in the basic designs of the programs?
i remember when i screened my film open dialogue at Advocates, Inc. about four years back and i talked with chris gordon about an open dialogue study he wanted to spearhead. he asked me what i thought was the most important thing for the study in terms of making it valuable. i said: “insist on working with people in a first episode — and try like hell not to medicate them. and after that focus on all the open dialogue stuff.” but as far as i know it never happened. to me that’s sad.
to me the original soteria study from the 70s and early 80s still provides more of an important evidence base than any of the open dialogue adaptations.
but anyway, i’m babbling — it’s late for me. bedtime.
i thank you for participating in this dialogue — and i do wonder what you (and others) think of all this. i’m sticking out my neck to try to make these points as clearly as i can, and now my neck just needs to lie on a pillow for a few good hours.
warm greetings,
daniel
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hermes — yep, you put it simply and to the point. and when people—even progressive mental health folks—avoid what you’re saying it makes it easy to jump on the “open-dialogue-as-panacea” wagon train. but what kinds of results will “open dialogue” get if they do use neuroleptics a lot? not so hot. i simply cannot see it otherwise. yes, people like open conversations — and i believe they are a good thing — but i simply cannot see great hope and great outcomes à la Finnish Open Dialogue when people are more medicated. i thought this was rather obvious, but i guess, considering what’s been happening in the spread of open dialogue, that it’s not so obvious.
all the best to you,
daniel
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“For a human being there is nothing more terrible than a lack of response.” – Mikhail Bakhtin
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hi alex —
thanks. but i don’t know that many others do agree that i’ve done so admirably by posting all this. from what i see, most of the response here to this essay has been silence — and a rather limited discussion about the points that i’ve made. basically no one directly involved in open dialogue work has commented at all here — aka no dialogue. one might say that’s because i’m a bit rude or something like that, but i think it’s because it’s too hot-button of an issue and they have their work to protect. easier to stay silent, keep on doing the same old limited thing, and not really fight to change the system. comfort rules. that’s my take on it. a big missed opportunity — a disappointment.
thanks for what you’ve shared — appreciated!!
daniel
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hi ron,
i also like the idea of promoting open dialogue and bringing it into wider use. i’m all for that. but when some of the most known stuff with the new open dialogue studies don’t even primarily work with people with “first episode psychosis” — let alone “first episode” with minimal or no meds — then i think, what’s the point? also, i think the effect of this can be negative, because clearly they’re not going to get the great results they got in finland, which just leads more and more people to believe that the great results of open dialogue are just finland-specific. that’s a major missed opportunity.
daniel
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nicely said, Alex. and i’m glad the discussion has been helpful to you. it has also been helpful to me — but stressful. yet worth it. i feel for me it is often easier to “call out” the big bad enemy — traditional psychiatry, big pharma, etc. i think this essay and discussion are a bit more nuanced for me. yes, of course i still think that the big bad enemy is still big and bad, but the stress for me is, to a degree, calling out our allies here — and ourselves. i have learned so much these past few years, after making my films. it has opened up a new world to me, and also thousands of people and their experiences and lives. but i guess what i’m coming to is that we — “the good folks” 🙂 — have to be smarter and wiser in moving forward. and i think sometimes that’s not easy. in fact, extremely difficult, given the challenges of changing a system. when i first became a therapist i was interested in working with individuals — and at times individual families. now that has shifted for me. yes, i still see the profound need that individuals and families have, but i’m more interested in changing systems — and so i’m interested in strategy also. i think that’s where this essay is coming from… what we might be doing that’s a bit off-track, and what we might also be doing better. i think it can be politically incorrect in a sense to critique or criticize our own allies — and that’s the stress for me — yet…..i think it’s a good thing. after all, the typical traditional psychiatric criticisms can be so stupid as to be useless. so…….i guess what i’m saying is that although this is stressful for me — writing this, reading some of the responses (as it kicks up stuff from my childhood — painful rejection for opening my mouth) — the fact that it is useful to some people makes it worthwhile. so…..thank you!! daniel
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thank you Eugene for this post. you said many things that resonate with me. i would like to focus on one, because it (and others’ posts here) have help me clarify some ideas in my head. you wrote:
“Where things get difficult (if not impossible), is on the level of implementation and system change. The manifold efforts to transform psychiatric (revolving door) in-patient treatment as well as biologically oriented out-patient treatment have proved to be disappointing at best.”
yes, to me that is the big problem. and here is the idea that nags at me. as i see it, the real challenge in changing psychiatry for the better as regards Open Dialogue is to get it implemented at a systems level — with people in “first episode psychosis” with little or no meds. training individual clinicians to do better family therapy and to have more of a broader, needs-adaptive approach is nice and good and helps some individuals, but it doesn’t really do much to change the system at all, especially since most of these clinicians aren’t even from the same working system. the problem as i see it, and which in part has inspired this article, is that Open Dialogue has become a sort of fad, partially for some very well-deserved reasons. what i don’t like about this fad is that in the midst of the buzz one of the main points get lost — system change!! that is the great opportunity with open dialogue — an inspiration to change systems beyond western lapland, and ultimately to change the whole system. instead, though, more often open dialogue gets reduced to just minor system change and some hope for individuals who want help now for their families and their own individual selves. even some comments here in this comments section reflect that — and it makes sense. people want help now for themselves. i get that. i get emailed constantly by people who want this.
i think, though, that the people who bear the torch as Open Dialogue leaders (in the USA, those who have branded the phrase “Open Dialogue” for their own exclusive, proprietary uses) have an obligation to do more than just train a few clinicians and perhaps spearhead a rather weak pilot study here and there that can’t hope to get results anywhere near what they’ve gotten in Finland. to me anyone who wants to brand Open Dialogue has an obligation to do a lot more than this, and to be real leaders. otherwise, i believe, their use of the name Open Dialogue just becomes self-serving — and diminishes not just what Finnish Open Dialogue, on a systems level, is really about, but what Open Dialogue in general really could (and should) be.
thanks for giving me the opportunity to share this!!!
all the best — and greetings from rainy NYC,
daniel
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greetings marina. yes, the finnish open dialogue therapists were lovely and to my mind their work is radical. but in some ways they are just a regular system, or were when i was there. there was no peer support when i was there, not even much or any knowledge of it from what i remember. and even though there was a flattered hierarachy of power in many ways, there still was a big difference between clinicians and so-called clients. also, the idea of filming clients, especially those in “extreme states” is a complex one everywhere. some places were okay with me doing it, others clearly not. perhaps if the folks who were the leaders of finnish open dialogue had gotten to know me better and trust me more they might have allowed me to ask people who were coming for help if they wanted to be filmed. but they didn’t know me well at all when i arrived — in fact, no one in western lapland knew me in person at all!! i had met jaakko seikkula a few times before i went there, but he wasn’t even in western lapland then, because he’s a professor in jyvaskyla (maybe 500km away). but i always appreciated him and the others welcoming me to western lapland at all, because i have some pretty antipsychiatry views, so that was a risk on their part. greetings from new york!
daniel
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thanks fred 🙂
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maybe someone else could film people—”clients” and families—over there. it would be a worthwhile project, i believe.
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good question john. it bummed me out that i wasn’t allowed to interview families and people in crisis (aka clients) on camera when i was in finland. i was told i wasn’t allowed to do it, mostly for reasons of confidentiality, but also because they didn’t want people in crises or families to feel pressured to talk with me. basically, they didn’t give people the opportunity to say “no” to me. i can kind of understand it, but at the same time i much prefer to give people the option to decide for themselves. that said, i accepted the stipulation because i wanted to do my best to make a film that represented their work, and if i had fought on that issue there probably would have been no film…
greetings to you — and great article you just put up!
daniel
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that’s part of my point, carina. the other part, ron, is i question how much of what gets legally brand-labeled as “open dialogue” really does emphasize some of the most important things that made finnish open dialogue famous — like not medicating folks (or seriously minimizing antipsychotics) who are experiencing a “first-episode”?
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cool carina — and yes, i am curious how people more connected with Finnish Open Dialogue will respond. all the best — daniel
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🙂 you’re welcome.
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you wrote: “I think that having a conversation with family members and the distressed person when the family might have been abusive sounds potentially ok to me.”
i agree with that — as long as the person “in distress” wants that conversation with the family and it’s not being forced on them. i think those kinds of non-forced conversations can be very healthy and helpful. nice to hear from you, john — daniel
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Susan and Matt — this is a beautiful piece. Susan, I am forever grateful for the opportunity you gave me to be a part of the Soteria-Alaska family, and Matt — it was wonderful to work with you. Thank you both.
Daniel
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interesting comment — i relate to what you write —
daniel
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hey oice — that’s a cool comment — thank you!!
daniel
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hey, dig it julie!!! good to hear what you have to say, and i’m really wishing you all the best on your journey. and i also admit, the idea of giving hurt kids an hour of respite a week is not all bad, that’s for sure!!!
happy new year,
daniel
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greetings petra. having the boundaries the way i did it was tough — i’d probably be somewhat looser if i did it again. but also i needed some boundaries, and couldn’t just be regular friends with people. some formality was necessary, at least for me, especially just to help me organize my time and optimize the focus of the work. but it did make it kind of artificial, for sure. but i also think it’s kind of artificial to sit for forty hours a week and listen to so many people’s problems and healing processes — so maybe some of the artificial structure reflected that…hmm……not sure…. daniel
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Thanks for this piece, Deron. It’s excellent.
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best of luck to you, yesenia 🙂 daniel
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thanks Alex.
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i see good therapy as a lot more than just doing meta-help and waffling and then collecting cash. that sounds like bad therapy to me. but i also don’t see therapists as “giving” people jobs and homes — though maybe good therapy could help people, even homeless people, attain those things. i’ve seen it.
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lol.
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i’m not sure how to weed out the quacks. maybe, for me, this whole mental health thing really isn’t even a field… i only refer to therapists or coaches i really trust. so it’s not about weeding out the bad ones — it’s hunting for the good ones and holding on to them!
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cool reply — thank you. — daniel
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thank! 🙂
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hi sandra,
i so want to write more and more and more in response, and yet i have to go to bed and catch a plane in the early morning — and then i’m going off the grid for ten days!!!! i hope this isn’t seen as a hit-and-run blog piece by me — not intended that way at all. i will be back in ten days!!! what i want to say is this: i am VERY glad you posted what you did in this blog’s comments. i think you have dramatically improved the dialogue here, and in fact may even be responsible for it becoming a real dialogue. meanwhile, i had no idea what people would think of this piece i wrote. yes, i was mad when i wrote it. very mad. (that is part of my personality.) but what i figured was, “a piece i wrote when mad should somehow find a home on ‘mad in america.’ ” and it seems it has. i respect robert whitaker for letting it stay up. and i respect you for writing about your lack of indifference to it—and for taking what i perceive to be a leap into some pretty hot waters. and then returning to write some more. thank you.
well, i’m off to sleep—big day tomorrow! and i hope to connect with you more.
daniel
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thanks!
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🙂
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the “shutting down dialogue” thing is interesting…..considering how much dialogue has been going on here. i personally like the dialogue, especially when it gets controversial.
-daniel
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intense. very intense.
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nice post!! i very much found value reading it. but i wish it weren’t true. it’s very painful.
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right on, John.
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thank you Steve. i like what you wrote.
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erg, yes. though i don’t believe in these diagnoses….
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you’re welcome!!
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i actually think this has been a pretty good dialogue here!
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so nice to read. thank you, Khursheed!
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thank you for this, too, B — i agree!
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thank you, B!
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lovely, chaya!
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thank you!
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i like what you say, Stephen. thank you.
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good point, AA.
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Hi Sandra,
Hmm. I don’t really have a problem characterizing human distress as a biological phenomenon. I think everything related to humans or other living creatures could be characterized that way. I also think consciousness can be viewed, though not necessarily understood well, as a brain function. I just think it’s too simplistic of a lens. I think it’s much more realistic and helpful to view it through one of many of non-brain lenses. Just my preference. Thanks for your words.
Daniel
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wow — this is intense. i just read the rest of the posts, including obert whitaker’s, and i’m not quite sure what to say. i will say this — a lot of people have entered this dialogue, people with differing points of view. i think that’s good. but i hear robert whitaker’s point that this might not be encouraging a bigger dialogue that Mad in America wishes to have. (i am wild, i admit that. i like to let that side of me be free.) on the other hand, i also noticed that robert did not suggest removing my blog piece, so that is a relief (for me as a writer, at least). past that, i’m not quite sure what to say. i want to think on it. on the other hand, this blog piece is pretty much in line with other work i’ve done over the years, like my youtube song “bullshit.” and this one is probably even a bit “safer” because it didn’t mention anyone by name. i just wrote more generally here.
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haha — i can’t help but laugh at the intensity of what you write. you write in the same spirit in which i wrote that essay. it reads like poetry to me. thank you. thank you abbot, thank you stephen gilbert.
daniel
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hi Sandra,
I just want to reply to one other thing in your comment — about the fact that you’re a psychiatrist, and that since you believe that we are biological beings that that makes you a biological psychiatrist. Hmm….. I just don’t see it that way — I was not a “biological therapist,” despite also seeing people as biological beings. to me a “biological psychiatrist” is a special type of psychiatrist who focuses on “treating” the human brain, not the human person, and when the human person gets in the way of that “treatment” then the “biological psychiatrist” uses force and pressure to position the person to be more amenable to brain treatment. from what i have read of your work and heard about you, i really don’t see you as a biological psychiatrist. i think some psychiatrists are partially biological psychiatrists and partially human psychiatrists, and some are hardly biological or not biological at all. and some are anti-biological psychiatrists — especially the ones who are good at using their powers and education and experience and licenses to help people get off the meds and out of the mental health system. just my two cents!! 🙂
daniel
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Fiachra — yes — that makes sense to me. i am still considering the point Sandra Steingard made that my piece shuts down dialogue. I think the fact that several people are here commenting and discussing and exploring suggests to me that it doesn’t shut down dialogue. the intensity of my piece might make dialogue more difficult, but it opens up a different kind of dialogue, i think…. thanks for what you’ve shared.
daniel
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hi Sandy — greetings. well, i’m glad you posted this. to me this is dialogue. i think in the greater context of my work this piece is just one facet of it, one facet of my point of view, of my feelings. it’s…an ode…a piece of poetry in a sense. i realize that it can leave out some people — even some biological psychiatrists who do not act in the ways i have described here. but….my best reply would be that there are so many people who have experienced biological psychiatrists in the way i described above, people i love, that…..i felt it’s worth it. and, sadly, it also expresses my experience at dealing with so many biological psychiatrists myself. i just decided to throw this piece into the mix. i’m actually a bit surprised mad in america published it. i didn’t expect it to be so popular overall. but i particularly love some of the comments about it so far — they have moved me and made me glad to put it up. hello from nyc—–daniel
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thanks boans — i’ll check it out. i haven’t heard of it. greetings! daniel
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hi anthony! sending you love and strength! i have personally seen what “aot” can do to people, and i think it’s a rotten program to the core. i think you are brave, very brave. wishing you the best — daniel
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you’re welcome! i am so glad you posted this. telling the truth helps me keep my sanity too. sometimes i have to be harsher than at other times, aaaah!!!
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thank steve!
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yes!
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right on, greg! 🙂
daniel
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right on, “Someone Else” and Jonathan!
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thanks Jen! i’m glad to hear what you write……..though i wish it weren’t true…..aaaaaah!!!!!! sadly it’s all too true…… daniel
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ugh, stephen — what you describe is what i have seen as well, so so so often. i wish it weren’t so…. thanks for sharing! daniel
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yep!
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yep. that’s it, B. that’s what i was trying to say. that and that the whole diagnostic system is ludicrous. 🙂 daniel
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🙂
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kafka nailed it with that book!
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well, some insurance companies are better than other, though some are simply a joke. more and more what i’ve seen is that insurance companies pay less–less–less and make therapists do a lot more bureaucratic work to get that decreasing money, and also, worst of all, reveal a lot more about their clients. also, it’s almost all diagnosis-based….which to me is farcical. but i guess i expressed all that already and am not answering your question!!!! (sorry.) if i were to go back to being a therapist i think i would not take insurance. the big advantage, of course, is that it can save clients some money. and it’s sad that people would have insurance and yet have to pay out of pocket, though of course co-pays for their insurance were sometimes more than what they paid me if we just worked on my sliding scale!! so….i’ll tell you how i worked with the insurance companies: i always worked to give milder diagnoses, because we had to diagnose. i also gave clients an option about not using their insurance and just paying a low-fee out of pocket instead. also, sometimes for people who had been diagnosed with serious things up the wazoo for years, the insurance could have a great advantage: i could use billing with a diagnosis as an opportunity to give them milder diagnoses than they’d ever had before, and thus, in effect, document their recovery from things like “schizophrenia” — into diagnoses like “PTSD” or “generalized anxiety disorder.” personally, though, what i’ve come to believe is that if you’re going to play ball with insurance companies then one will always have to compromise and work within their diagnostic system. ugh. i don’t want to do that anymore. it’s been a relief to be out of the system…. sorry if that’s a convoluted answer!!! –daniel
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thanks kim. much appreciated. yes…….i do like humor, and i used it as a therapist a lot, because it is part of my personality. however, i was pretty careful in using it, because it could quickly alienate some people, as has even happened by posting this essay. that’s the risk, i guess. but sometimes i just……need to laugh!!!! 🙂 daniel
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thank alix. yep — basically i wrote this essay not to critique individuals but to critique the whole diagnostic system. i see it as needing to be scrapped, and i chose to express that through humor….which has its risks!! i’ve written so many “straight” essays about this and usually they get a much more tepid response. humor — people either love it or hate it!! well, if it’s halfway decent humor….as i hope this was.
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wow. can’t win ’em all. 🙁 i will say, though, that i certainly have met therapists and psychiatrists who have embodied the points of view expressed in this essay. i wish the field were healthier.
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cheers! daniel
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yep!!! it’s bonkers, that’s what it is. but worse than bonkers…..psychiatric diagnosis is unhelpful…….no…..it’s hurtful. it’s just hurtful.
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haha. it’s all absolute silliness!
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hey! that’s a cool comment. thanks. well, about copyrighting it…hmm…i also put it on my website, so in a way it is copyrighted. as for crowdsourcing….i don’t really even know what that is, but if you want to try that feel free to go for it. also, i “defined” another 10 or 15 diagnoses but chose the best for this essay……..i was going for brevity!! all the best, daniel
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adjustment disorder is another junk/joke diagnosis. everyone qualifies for it…well, if they have any feelings at all.
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you’re welcome, Olga!!
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thank you both for sharing this. –daniel
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thanks Chrys.
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thanks! it was great there, true!
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cool! thanks. sorry for the delay in my reply! daniel
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thanks Francesca!!
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very cool, erin. it makes sense to me why you didn’t come. it’s not easy to be out and public about these things. becoming more public for me has been a big psychic shift…….. wishing you and your family the best,
daniel
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dig it, AC400. wishing you the best–daniel
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hi fred. dig it! my film equipment for this film came to about $1350 i think. $800 canon camera (takes tapes, not memory cards), ~$300 beechtek audio adapter, and ~$250 boom mic. and that was it. pretty simple………and basically super-cheap as far as a camera set-up goes. i do have a light tripod but i didn’t need it for this project. i also have lavalier mics for indoor interviews but i didn’t use them here. they’re probably about $250 each, and i have two. then it also takes a computer for editing, and i have a 4-year-old mac book pro with an older version of final cut pro. probably a lot of this stuff could be purchased used. my stuff is all old and works fine. all the best to you fred,
daniel
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very cool, Donna. thank you — much appreciated!! daniel
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thanks!
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thank you whoopsie. yes, the man who spoke about the effects of ECT……that was intense. i really don’t know how to reply to something like what he said. sending you the best!!! daniel
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thank you Dorothy!!
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hi martin,
i don’t know if your therapist is good or not — i am skeptical of therapists in general. this could be an issue of your therapist’s quality, but it might also be the effects of the antidepressant and/or drug withdrawal. i’ve seen people who come off their medication (you were on it for a while too) and had withdrawal effects that lasted a lost time, and can be really debilitating — similar to some of the things you described.
here’s a website you might find helpful:
http://survivingantidepressants.org/index.php?/forum/14-tapering/
meanwhile, while i can’t speak with assuredness about quality of your therapy, i still have some skepticism. i actually just recorded a couple of self-interviews for youtube on this subject. i put one up a couple weeks ago — you might like it.
http://youtu.be/G2-p4A7Bl6s
all the best
daniel
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great article, Lisa. i learned a lot from it and found it superbly written.
daniel
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i agree, it doesn’t have to be that way — but it so commonly is, especially for people who are more independent thinkers.
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good to hear what you write! yes, i surely do relate. i’ll send you a backchannel email. all the best to you.
-daniel
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dig it Sassy — i’ll drop you an email!! all the best, daniel
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i think these are some very good points, Tina.
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very intense article, Michael. Scary stuff. Thanks for sharing this. And I particularly liked Tina’s comments. I remember once interviewing Joanne Greenberg and she said that after she was released from the mental hospital for the final time in the early 1950s they stamped “MP” on her Maryland driver’s license — for “Mental Patient.” I asked her how she got it off her license, and she said, “I moved to Colorado.”
Wishing you the best—
Daniel
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Excellent article, Jay. I admire you and your work so much.
Daniel
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good to hear what you say, John!
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hi nathan,
just a quick moment to write. well……..i think it’s pretty hard for people to tell if they have a good therapist or not. i’ve written a fair amount about this somewhere, i think on the web (i don’t know where the link is). the problem is that a lot of people who go to therapy are in a more-or-less vulnerable state, which doesn’t usually place them in a position to be the most discerning about the quality of the therapist they’re sitting with. so it’s pretty much a crapshoot for most people, and many times it seems they just stick with the therapist if they marginally like the person, which tends not to be a pretty good indicator of the therapist’s quality, especially if the therapist is the type to gratify the therapist. and of course there are lots of people who have little or no choice in the therapist to whom they’ve been assigned — take it or leave it… ideally they can spend a lot of time asking the therapist a lot of questions to try to best determine for themselves the therapist’s quality. and getting a referral from someone they really trust and know well helps — but is also far from giving top-notch assurance…hmm……
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hi discussant—
yes, i do find interesting what you write. and i actually agree with a fair amount of it — considering i personally think most therapy and most therapists stinks. i think if therapy can be avoided it’s much better, which is actually why i very rarely recommend therapy. in fact, i really can’t think of situations where i have recommended it, especially in the last several years. i’m a major proponent of self-therapy, and write about it a lot. i think it’s preferable. i have a whole section of my website on self-therapy ( http://wildtruth.net/on-self-therapy/ ) and basically no essays that really promote therapy. (though i do make films that speak highly of some therapy.) one essay, though, might be considered rather positive on therapy, though: http://wildtruth.net/three-differences-between-therapy-friendship/
but i do think there are some situations where therapy (with a good therapist) can be very useful and healing for people. but personally i see therapy as much more of an art than a science. that’s why i don’t get into worry much about the statistics about therapy, positive or negative. but like good artists (worth their value) vs. bad/mediocre artists (not worth it), i think good therapists are rare, and bad/mediocre therapists are pretty common….in fact, very common.
but just because most artists don’t have great talent, that doesn’t mean that a michelangelo can’t occasionally shine through…..
anyway, good to read what you write — i’ll keep considering it.
all the best,
daniel
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Discussant,
i read the main-page essay on your website and i have mixed feelings about it. i found some of it okay — and good for discussion, but mostly what i felt was that you were accurately describing bad therapy. but i don’t see that what you write necessarily describes all therapy. perhaps, to one degree or other, it describes MUCH or MOST therapy, but not all…
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hmm…i think there are several assumptions in what you’ve written, Discussant.
1) that i harmed people. did i? i don’t see the evidence from my essay above. maybe i was not an “optimal” therapist (whatever that might be), but as i see it i gave it my all and i think i was pretty useful to a lot of people. those whom i have had the chance to follow up with (and those ask while they were in therapy with me) said they found me useful, in a variety of ways.
2) that i wasted clients’ time and money. hmm, did i? i think i made my prices fair (as fair as i could), and that i didn’t want to work with people any longer than necessary. and i think i respect the people i worked with enough to recognize that they could decide for themselves if they were wasting their time and money, and from what i gathered from those that stuck around in therapy was that they didn’t feel they were wasting their time and money. i personally think people got a pretty good deal out of working with me. and no one was forced to come.
3) that i’m a hypocrite for thinking that the therapy i received was bad and the therapy i offered was pretty good. so is a baseball coach who himself had bad coaches necessarily a hypocrite? i don’t see the rub. i wouldn’t say that i learned about the value of therapy from being in therapy myself. i learned about it in lots of other ways — including from many facets of life itself.
i guess the troubling thing for me is that you read my essay and somehow determined that i was a bad, harmful therapist. it seems to me that you’ve really read into my essays things that i don’t think are there.
now i’m going to check out your website. i’ll admit that you haven’t offered the best intro to it for me, but i’ll try to read it with an open mind anyway.
yours,
daniel
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hi Marc,
good to hear this. i have heard of marshall rosenberg and his work with nonviolent communication, but it’s been a while and i really can’t remember if i read anythign he wrote. i’ll have to see what i can find. thanks for sparking some ideas!
wishing you the best ——daniel
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dig it john — thanks for your comment. i especially liked this part you wrote: “When it goes well you forget the role you are in, as either client or therapist, you are just human beings caring for each other and trying your best to understand each other in this rather fractured world.”
right on!
greetings from new york!
daniel
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hi Duane,
that is very kind of you. i appreciate it. sending greetings from florida, where i am today!
daniel
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thanks marian!
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hi Tore,
thanks for sharing. interesting for me to hear this. i’ve actually spent a fair amount of time in sweden these past few years, but perhaps you knew that. (i made a movie in sweden 3 years ago.) i know 2 of the acronyms you share, but i don’t know what “BT therapy”. i’ll try to figure it out… all the best, daniel
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hi alex,
yes, good to hear. and thank you!!
daniel
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thanks Steve. i appreciate what you say. and i look forward to returning to your website. all the best, daniel
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hi russerford — wow!! how nice to hear from you!! it’s a real pleasure to read your words, and i am wishing you the best from afar! a hug—-daniel
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hi Gloria,
well…….hmm…….how to respond. probably the simplest way to respond is to say that i just have found that i’m doing fine on my life’s path and haven’t felt any interest in seeing a therapist. i’ve become pretty good at doing self-therapy. and i have a lot of nice friends. so i’m contented about my life’s trajectory, even if my life is a bit tough at times — but that’s to be expected, all things considered. i have chosen a challenging path — or maybe it’s more accurate that a challenging path has chosen me…
that said, actually i am curious about what motivated you to write this comment. i’m all ears if you care to share.
all the best to you,
daniel
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hi Deron,
cool! looking forward to seeing you at NARPA too. thanks!
daniel
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hmm…….yes………….i wish it weren’t so true……
daniel
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i agree, dorothy. but a very weird thing happened. i wrote the first draft of this article 3 days ago. later that evening i coming in the door of the building where i stay when i’m in NYC, and i ran into a woman who i knew years ago. she is Puerto Rican, and she is the grandmother of 2 boys who were in a pre-kindergarten class i used to play guitar for back before i became a therapist. they are both 19 years old now. (they were 4 then.) i see them on the street sometimes — they’re tough guys, one is a parent himself, and we still have a great rapport. they always give me hugs on the street. they’ve introduced me to their grandmother. she said to me, “you know, i want to invite you over to our house for dinner. i’ll have my grandsons come over, and i’ll cook us all a really nice spanish meal!” i couldn’t believe it!! and i said…….YES!! it was like magic. so maybe when i get back to NYC next week i’ll take her up on her offer. cool, eh?? i think there’s always a chance for redemption……
a hug to you, dorothy,
daniel
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hi Nathan. thank you for sharing this. it’s sad to say, but two things helped me get through social work school, one bad and one good. the bad one was that i had to lie and hide my feelings throughout so much of my childhood, to survive in my family. it’s a skill — if you call it that — that i retained, and it occasionally comes in useful. the good reason i stayed in was because i was so passionate about my goal, and i wasn’t going to let anything stop me from achieving it. so i just restrained myself from lashing out at my superiors and supervisors as best i could. i really hated many of them — they were unethical, to varying degrees, and also many were very hurtful to me and to the others they had power over — but i just swallowed it, because i knew in our supposedly “open” relationships, where they were supervisors and i was supervisee, if i had done what they said was appropriate and really spoken my mind they would have destroyed me. so i kept quiet…..and bided my time. that hurt me too……but i didn’t know a better way….
sending you warm greetings — daniel
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thank you Ted. Part of me was scared to share this essay, but another part of me, a growing-stronger part, said to myself, “go for it. the real fear is what i’ve been through — not being able to share my real experience for fear of offending….” it’s a gift to be able to write and share. and i thank you. it was a pleasure to meet you last year in alaska. and your story……….wow. just wow. talk about intense. i have such respect for you.
daniel
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Thanks Michael!! this means a lot to me, coming from you! a hug—Daniel
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love to you too, Dorothy!!!
i’ve been thinking of you too today, Dorothy, down here in Florida!!! sending a hug! daniel
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hey, Dig it mjk!!! so nice to hear from you again. i remember your moniker of mjk!! wishing you the best. by the way, i cried when i wrote that about not accepting that woman’s meal. it was good to cry about it. i think i wasn’t able to cry about it at the time.
all the best to you,
daniel
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dig it Steven — thanks for sharing! i appreciate it. Daniel
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hi NewPC,
thank you — and i feel you make good points. at the risk of sounding arrogant, though, i’d have to say that i’m pretty aware of my off-beat — and angry, troubled, frustrated, traumatized, “imperfect” sides — and one of the big problems i had with supervisors is that they couldn’t tolerate those “imperfect” sides in themselves. most were only minimally self-reflective, especially if they’d been in the field for a while. most of my supervisors were really incompetent — at least the supervisors i had formally when i had no choice in who to have. eventually i chose people to surround myself with who really were good, who related to me and related to themselves. real people!! but they were few and far between…
all the best,
daniel
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I think your work and your writing is simply great, Jay. Thank you, as always. —Daniel Mackler
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hi altostrata and marian,
well, i’ve had various people tell me that short-term benzo use was helpful to them in getting off neuroleptics, and that they didn’t get hooked. i’ve also known a lot of people hooked on benzos — absolutely horrible. so basically my thought is that if the benzos are not used short-term or very scantily then they’re too risky. i’m curious what others think about this. perhaps there are a lot more people out there who feel that any benzo use (even very short-term) is just too risky.
all the best,
daniel
p.s. well, again, i hope people don’t take me as the b-all and end-all in neuroleptic withdrawal, because i’m not that! i just have some ideas based on my own experiences, and i wanted to take the risk of putting out those ideas — and to hear others’ feedback. i just think there’s not enough out there on this subject, so that anything that’s fairly well thought-out, however imperfect, would add something…because so much of what is actually being done in practice now is horrible!
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good points. i like them. i also agree it’s good to jump beyond the hypothetical and theoretical. for me, now, though, in my life…i want to make sure i have my ducks lined up, which is why i put out this piece. also, i don’t have the energy to start a new program…….wish i did, but i don’t. i burned out on being a therapist…that and i was finding pleasure in doing other things (films, visiting other programs, etc.). actually, tomorrow will be three years since i closed my practice.
but i think it’s great to discuss this — especially with people like you who have clearly thought about it a lot and have a lot of experience. and by no means would i say my experience is the b-all and end-all. that’s why i looked forward to discussions about this piece…though i admit, i was nervous to put the piece up because this stuff can REALLY anger people, and i felt that no matter what i said i would step on someone’s toes, which i didn’t want to do.
thanks for what you’ve shared, and for the links.
daniel
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nice points marian. i agree.
altostrata:
you wrote: “Your assumption that ‘tapering is a given’ is incorrect, and that you can simply get a psychiatrist on staff who knows how to do it — problem solved.”
hmm…..i never said that you’d simply get a psychiatrist on staff who knows about tapering and everything will be okay. if i had said that i’d be criticizing my writing too.
also, when i said that i take “tapering as a given for most people,” i mean in the hypothetical “good” program which i’m exploring, not in already existing programs in general.
daniel
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i like the points you make, however, i think you may have somehow gotten the idea that i disagree with what you’re writing. i agree with it, but take tapering as a given for most people, and for that reason perhaps did not emphasize it enough.
all the best,
daniel
p.s. i checked out your website. i’d never seen it before. looks like a very good resource. thanks.
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hi altostrata — i actually did mention tapering twice in my article, but could have given it more attention. of course tapering is, in many cases of coming of neuroleptics, vital.
i do challenge you on the following:
I wrote: “helping people withdraw from neuroleptics in a systematic way is largely unexplored territory.”
you replied: Excuse me???? I’ve got hundreds of pages of information about tapering here http://tinyurl.com/42ewlrl and symptoms here http://tinyurl.com/3hq949z Journal articles are here http://tinyurl.com/aqg3bjo
my thought: i agree with what you’re saying, but the only thing i think that’s unexplored is helping people withdraw in a “systematic” way. yes, there’s tons of info out there on withdrawal, but not enough of it has been systematically collected. it would be nice to have it collected systematically.
but everything else you say i agree with.
all the best,
daniel
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great piece, jay. your work is excellent. thank you! –daniel
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thanks duane!
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yes!
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good points. and good to hear from you, John!
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thanks, diana!
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hi Sandra,
good questions. hmm……well, i don’t think there should necessarily e a goal in what the supporters would be attempting to accomplish in terms of what will happen to the person reducing meds, instead, i see the role of the supporter as simply to be supportive of what the person himself or herself wants. basically, i see a supporter as a caring, mature, real, open person…
i liked what john said about the pain that some people feel when they come off. maybe i’d add that some people find the process simply torturous: physically … mentally … emotionally… that’s what i’ve heard.
i also like what you wrote about being more explicit about it being a harm reduction approach. and i’d also add that in this hypothetical program there were be tons of free copies of will hall’s “harm reduction guide” for everyone to have.
cheers!
daniel
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hi PC — good points. you actually help clarify some of what i tried to express. by no means should the psychiatrist be the only one to have many of the skills on his or her skill set. many of those skills should simply be common knowledge. i think part of the reason that i listed many of the skills i think a good psychiatrist should have is that almost none i know possesses them, much less many of them…
but, there are some real benefits of having a trained medical professional as an ally in the tapering process…if only, at the very least, because the drugs cause actual medical problems!
and i also think of grace jackson, m.d. i’ve had some great conversations with her, and they always leave me feeling humbled. she’s a psychiatrist who really knows a lot!
all the best,
daniel
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thanks!
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hello jonah. i’m enjoying reading these comments. in reply to your comment about my wording of “advance directive notwithstanding”: i guess i mean that if someone puts something in their advance directive that allows for force or even requests it in certain circumstances, and then later changes their mind, then their later decision would trump their advance directive. don’t know if that came across clearly… but this is tricky stuff — it wasn’t easy for me to word it right. personally because i have a lot invested in this subject emotionally. –daniel
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hi Philroy,
From what I have seen and heard possibilities for tapering slowly were definitely discussed and encouraged, but many of Soteria-Alaska residents just came off however they wanted, and that mostly meant cold turkey.
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thanks for the support, Duane!
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hi Anonymous — I like many of the points you make. One thing I will say is that Soteria has tried to do its best to create a real and viable alternative to the traditional psychiatric and forced drugging system — and to try to help people get away from that system and avoid it if at all possible. That’s its basic reason to be. It’s just been very tough to implement. As to the idea of Soteria working with the traditional system: yes, that has its drawbacks, but if it didn’t it wouldn’t exist as a program at all, at least at this point. I myself prefer to work outside the system — but that has its drawbacks too….at least at this point as well.
About government funding: well, I don’t see that as inherently bad (though of course it can be very bad in many or most cases). But if government funding were inherently bad then that would invalidate some programs I really like in Europe, like Open Dialogue and the Family Care Foundation. And doesn’t the Hearing Voices Network get government funding in some places?
About the shooting death: yes, I probably erred (without realizing it) on the side of being euphemistic in my language. But the story is also quite public, and all over the internet, so I guess I figured most readers already knew about it or could easily find out more if they wished, and because it was such a horror. Meanwhile, because I spend a lot of time at Soteria, where that horror happened and where it remains a quite sensitive subject, I have fallen into what some might call the trap of using more gentle language… There was certainly no intention on my part to deceive. It’s just very complex to write about any of this at all — anything about this program. I hesitated for a while to write this piece, and would have found it easier to write nothing and just keep the knowledge I had about Soteria-Alaska private. But I decided instead to go for it, to the best of my ability.
One other thing: few people at Soteria (residents/staff) talk about “first breaks” and the like — frankly I don’t think they care about this at all in their day-to-day work, or use this kind of language. To them people are people, no matter what they’re going through. I just chose to use that “medical” language for the sake of keeping continuity with the language of people like Robert Whitaker, Loren Mosher, Jaakko Seikkula, etc. — but I see how it leaves me open to some very valid criticism.
all the best,
Daniel
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hi Steve — very interesting points. And definitely worth considering. One thing, though, that is greatly advantageous about Soteria over Open Dialogue is that Soteria is much easier to set up — Open Dialogue practitioners requires tons of professional training, whereas Soteria uses almost exclusively nonprofessionals.
Also, I do think there is some truth to the idea of stigma being attached to living in a house like Soteria, and less so about Open Dialogue (of the Finnish variety).
all the best,
Daniel
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Rock on, Ted! I love reading what you write—–Daniel
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Yes and no….. There was one being conducted but it was curtailed over a year ago, but it looks like it’s starting up again. Results are preliminary so far….. My observations came from talking in depth with the staff, listening to the residents, making my own observations, talking with former residents, etc.
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hi Yana —
great to hear from you, and I look forward to hearing more and more about the original Soteria. Actually, I’m only filling in for Susan for a total of 3 months — a short sabbatical for her!! And for me it’s ALMOST over — just another week of work, and then I’m moving onward. It’s been an amazing three months (actually it will be 4 months in Alaska in total). Great learning opportunity for me — and I have incredible respect for everyone at Soteria-Alaska. The dedication and talent is stunning.
Hope to see you soon,
Daniel
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Hi Michael —
yes, an ironclad agreement with the pysch emergency room would have been fantastic. No doubt about that! Who knows — maybe such things will become possible in the future. Until you wrote this post I never really thought about the concept of an ironclad agreement……it almost seems like fantasy to me……….a good fantasy. Maybe someday!!
Thanks for your sharing—–
Daniel
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very cool, Rigel — thanks for sharing. Quite interesting.
Daniel
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right on, Marian — I agree with what you write. As you say, a big part of Open Dialogue is working with social networks, and so many people I’ve seen who have been in (and out and in and out) of the system for a while have lost a lot of their social networks.
—Daniel
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thanks Darby — much appreciated! One program I love that has focused on helping people come off the drugs is the Family Care Foundation in Gothenburg, Sweden. I’ll actually be visiting there in two weeks. Perhaps you saw them in my film “Healing Homes.” I made that film to contrast their work with a program like the Open Dialogue Project in Finland, which just focuses their research on people experiencing “first breaks.”
What I like about the Family Care Foundation is that they provide a lot more intensive, long-term support for people coming off the drugs than do programs like Soteria. As I see it, this support provides better “shock absorbers” — or more cushion — so that people don’t end up leaving the program so precipitously when the going gets rough…..
all the best to you!
Daniel
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Soteria-Alaska has two paid staff on at any given time. From what I have observed raising kids is quite different from being a staff member at Soteria — basically not comparable, in my opinion. The intensity level is often radically higher at Soteria.
Meanwhile, very cool about you coming off psych drugs. But I don’t think for one second that I have dismissed or given up on “chronics.” I just was trying to make the point that, from what I’ve observed and studied, Soteria is not the best place for people who have been in the system and on psych drugs for a long time. There are programs that are better set up to work with people who have been in the system longer. Soteria wasn’t set up for that, and basically hasn’t gotten good results with these kinds of folks.
As for me personally giving up: NEVER. I just think it’s important for me to share what I observed, and have been observing a lot in the world.
This is not, however, to say that Soteria couldn’t help some people in very “chronics” situations — in fact, they have helped some people in these situations a lot — and I said this in the article. It’s just they haven’t helped people recover fully — according to Mosher’s definition of recovery.
all the best — and thanks for the thought-provoking comment!
Daniel
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