Thursday, December 1, 2022

Comments by Daniel Fisher, MD, PhD

Showing 91 of 91 comments.

  • Having devoted 40+ years of my life to this struggle for respect and freedom for those of us labelled mentally ill I am beyond an either/or approach. I like to work on three fronts at the same time. I promote as many alternatives as the system will stand, such as peer-run respites, advance directives, peer-run state advocacy(such as On Our sown of Maryland), person-driven planning Warmlines etc through the National Coalition of MH Recovery and the Alternatives Conference and at the same time work towards deeper cultural change by connecting our struggle with the struggle of other oppressed groups through intersectionality such as the disability community by NCMHR’s membership in the National Disability Alliance for Mental Health, NDLA and the BIPOC and LGBTQ + communities. II also work within the system as a psychiatrist on the fringes of the system by my practice of open Dialogue and a developer of emotional CPR or eCPR. We need many avenues for change but we need to respect each other on the process. I have seen many positive changes in these 40 years but I know we have many miles to go before we are closer to a just and carrying society,

  • Thank you Bob for an excellent summary of working within the system for change. Our advocacy group National Coalition for MH Recovery plans to highlight these points.However, we equally need outside the system advocacy. We need to go directly to the the lay public, exposing the numerous lies made by mainstream psychiatry such as the chemical imbalance myth, the limited effectiveness and danger of medication, the need for alternatives to coercion and confinement etc. we will propose alternatives at the Alternatives Conference 2022, Nov 2,3,4. Go to

  • Dogworld, I agree with your statement and the perspective of this article. As part of my recovery of my humanity I decided to become a psychiatrist and correct the power imbalances created in the mental health service delivery world. Being too much of a task to take on individually I joined the consumer/survivor movement and co-founded the National Empowerment Center. Our Emotional CPR program is designed to rebalance power in every helping relationship within and outside the mental health system. Thank you Mad in America for highlighting the challenges of peers working as providers.

  • Kindred Spirit I am glad you found Emotional CPR useful. In eCPR, we are learning that hospitality can take the place of hospitalization. The Greeks knew the value of hospitality 3000 years ago as described in the Odessey by Homer. The Greeks tried to sit with a stranger and share a meal and wine with them as a form of diplomacy. This gave them a chance to be together without immediately labeling and treating them as an outsider needing to comply to their culture.

  • Rebel,I share your caution about a variety of therapies as you are right, many of them can be dehumanizing too. I had a negative experience with psychoanalysis in my 20’s. However, Emotional CPR is not a clinical technique but is based on a form of natural support. It is an approach based on the understanding that we all carry the capacity to heal within us, but at times we get stuck in old reactions of flight and fight to traumas. When we are stuck, another human being, being human can open us up to new perspectives and new hope. In the process, the person initially assisting often themselves further grow.

  • Thank you Bob for your excellent summary of the evidence that “antipsychotic” medications can often be harmful. However, I
    am a practicing psychiatrist, who has people contact me in all states, who have been through the worst experiences of the system. In fact, I have found that sometimes for these people, low doses of antipsychotics for limited periods, combined with Dialogical Practices, can be helpful. Even the practitioners of Open Dialogue in Tornio use antipsychotics for 30% of there individuals. I do believe though that if from the very start (before they see me) these young people were given hope and a holistic approach I would perhaps never need to prescribe a medication. Though a critique of over reliance on medication is critical, I would also suggest that we examine the host of other ways that conventional psychiatry interferes with recovery. For instance the pronouncements to persons in severe distress that they have life long diagnoses such as schizophrenia and bipolar disorder are intolerable and should be considered malpractice. This prophesy of doom, as Pat Deegan calls it, is still intoned in the most prestigious psychiatric hospitals. One day I hope that enough of us persons with lived experience can band together and create an AA type mutual support system practiced on a voluntary basis, with no payments or liability. We could use many of the approaches our movement has developed such as WRAP, Intentional Peer Support and Emotional CPR. We are starting to develop enough experience with eCPR Communities of Practice that I can see such a day coming.

  • Excellent article, and our retraining of professionals, families and community members at arge with Emotional CPR carried out these principles. Our C is for connecting in a respectful manner with our hearts. P is for emPowering by regarding the person as an equal human being with equal rights. As some comments point out, a crucial way to protect rights is to enhance the power and status of the person labeled with a MH condition. The micro and macro aggressions of the mental health system start with the concept that these conditions are due to chemical imbalances in the brain of the individual. Replacing the DSM 5 with the Power,Threat,Response framework would be much more in line with human rights.
    I would also insist that being treated for emotional distress did not diminish our rights under the Bill of Rights.

  • Ivor sounds like a kindred spirit in an oppressive world. I would love to be able to contact him. I, like Fiachra, was labeled with schizophrenia in my 20’s. I was so angry at the treatment I received that I decided to become a psychiatrist, to humanize care, especially for people who need to traverse to dreams in waking life, (so called psychosis) in order to heal. I too have been considered too radical for most of my professional peers. I can be reached at [email protected]

  • Thank you Sandy for this interesting review. I am not sure I would find that much new in the book and I am sorry that she was not more critical. It is tragic that our field pathologizes normal human suffering. In the process, hope is extinguished and opportunities for healing the person and their network are lost in mirage of medication fixes. The voice of those of us with lived experience are being silenced more than ever in this era.I too continue to integrate medication with Open Dialogue, peer support, and Emotional CPR. But the ideology surrounding medication privilege it in a manner that makes it difficult for the other approaches to have equal influence.

  • Annita, I am so impressed by your recovery of your life and your vivid writing about it. Dr Searles and your therapists were real enough to enable you to be real. It is like the Velveteen Rabbit. I too went through similar experiences including being diagnosed with schizophrenia when it was due to sexual abuse. I also wrote a book, “heartbeats of hope” about it and about ways I would like to humanize the systems. I look forward to meeting you one day.
    I am part of a team of persons with lived experience who have been developing a “training experience” called Emotional CPR which calls forth the soul of each person in society to heal and grow. You might find it resonates:

  • Though I did not know Janet well, I tremendously respected her work, her values and her presence. I am so sorry we did not work together more closely. I could have really used your help Janet, as an early leader and survivor. I feel that that there are few of the early pioneers left. Others who like Judi, Rae, Howie and Leonard saw through the BS so clearly and were free to say what they saw. One of my favorite moments with Janet was doing a workshop at NARPA with a couple of progressive shrinks, Peter Statsny and Ron Liefer, and one other. Though they were progressive they did not have their own lived experience, and they did not appreciate the importance on non verbal connecting, such as though a mutually consensual hug. Janet was in the audience and came up and sang a song she had, I think composed or at least recalled, “I just want a hug” written to commemorate a social worker who was dismissed because he offered hugs to his clients. Janet was just such a warm, thoughtful, supportive human being. A very rare combination on this cold, heartless planet.

  • Julie Green, you are right on about activism,
    . “I channel the anger into activism. It makes me a better activist for sure.” Activism heals two of the greatest wounds of trauma. The collective nature of activism overcomes the isolation and the empowering feeling that comes from being part a change that reversed the abuses overcomes helplessness. I still am fueled by the anger smoldering in my belly from the forces hospitalizations, the forced medications forced seclusion and forced labeling I went through. I hope to make the world safer for my children but we have a long ways to go.

  • Massachusetts c/s/x’s, members of the Mental Patient Liberation Front, brought a court case against the the DMH of Mass., in 1975, which was known as Rogers versus Commissioner Olin ( The plaintiff, Ruby Rogers and 7 others, petitioned the court to prevent forced treatment with antipsychotic meds. The case went to the US Supreme Court who referred it back to the Mass Supreme Court. The resolution was that a competent person in a psychiatric hospital or the community cannot be forcibly medicated until a special hearing has been held and they have been assigned a “Rogers guardian” who uses substitution judgement (decides for the person based on what their expressed wishes might have been before they we are that decision point) to decide on treatment. In theory, these Rogers Guardianship hearings should give a level of protection against forced treatment but because very few psychiatrists will testify against another psychiatrist, the judgements go against the labeled person 97% of the time.

  • Great analysis Bob. I too could see that a line was being drawn. The editors want the public to believe that psychiatry is basically good. Just don’t use as much medication for as long as is done and otherwise the great system of mental health care can continue. There are so many layers to psychiatric treatment that it will take more than one article to cause a tipping point of rejecting its fundamental belief. Many critiques from many directions need to continue. And we need to organize and collaborate, worldwide. The economic pressure to keep employment for all involved coupled with big Pharma’s immense interest will keep the struggle going. I believe in years we will slowly wake the public up and other means of assisting one another will take the place of psychiatry: Open Dialogue, Peer respites, eCPR ETC, but we cannot expect one or two articles to win the day. Come one come all to the new, Peoples’ alternatives in dC July 7-11 where we can continue strategizing in person.

  • Thank you Christian. I would love to contact the director of the program and see if there is any way I could assist in this historic effort. I am very interested in systems change aspects. We are using three elements of change towards a more recovery-oriented care system: Emotional CCPR, Recovery Dialogues(Dialogical practice applied to treatment staff) and “Finding Our Voice”
    Trainings to develop peer leaders for advocacy.

  • Another reason I believe for its success in Finland is that their society overall provides more social supports for those in need growing from greater social capital and greater sense of belonging to your community. It also helps that the area of Lapland where the best results are found is not under the sway of big Pharma or psychiatrists who are agents of big pharmaceutical companies who are invested in the chemical imbalance myth.

  • Thank you Walter Keim. I would answer your question about is a paradigm shift needed with a resounding yes. A shift from power over to collaboration is essential to the recovery paradigm and that shift in emphasis is what OD means when it emphasizes that every voice counts. When Daniel Mackler in his documentary on OD asked the late Maarko Seutala, an OD developer, “What is the essence of OD?” Maarko thoughtfully said,” Democracy.” Sadly we are witnessing the daily loss of our democracy here in the US. To me this is a central reason that we in the US have difficulty importing OD. The recovery paradigm is based on the essential inalienable rights embodied in our constitution’s opening “we hold these truths to be self evident, that all men are created equal” to persons labeled mentally ill.

  • I was in the first cohort of trainees in OD conducted by Mary Olson and Jaakko Seikkula. I have used it in my private practice for the last 6 years. I sometimes have a cotherapist or sometimes utilize a family member to reflect with, as I learned many years ago from Dr. Tom Andersen. I have found the approach very successful, and wrote up one of my family experiences in my book, “heartbeats of hope.” The OD approach is closest to a recovery-oriented practice as I have found. Its nonexpert, collaborative, person centered orientation, in which every voice is valued is what persons with lived experience have been advocating. I agree the task of retraining and shifting away from our brain-centic, individual-based perspective is daunting, but essential to try. In England, the NHS is testing OD in a carefully designed $2.6 million, multi year study. I think we should do the same. I also think we need an adaptation that engages more peers and at times can be practiced by peers themselves working in settings such as peer-run respites. I also have found that integrating OD with Emotional CPR is synergystic. I think a US adaptation could enhance OD by utilizing peers trained in eCPR to carry out initial engagement and then incorporate the peer into the team. Several years ago I accompanied a Finnish team working with a family. The parents were present, but not their son, the person of focus (as they call the person with a presenting issue). I participated in the meeting as a peer, revealing my own lived experience. The parents said that if there was a peer on the OD team their son would likely participate. In Poland, I also observed a family in which the person of focus only participated once a peer connected with him. I also find it very helpful to gives all family members assignments to read about eCPR between sessions. I realize there is a need in research to replicate original protocols but there is also a need for OD to evolve.

  • This study verifies what the c/s/x movement had discovered 40 years ago, i.e. that recovery of our lives depends upon self-chosen social connections and community-based activities in which we feel valued and loved, just like the rest of society. C/s/x run drop in centers sprung up in the 80’s to achieve this goal. Then the beauty of mutusl peer support got subverted by the professionalization of the peer role. We need to return to our roots and Alternatives 2018 hosted by National Coalition for Mental Health Recovery,( will offer such an opportunity.

  • Good article Darby. It is important to distinguish between paid peer staff and mutual support peers. The basic function of the mental health system is of controlling the behavior of people not conforming to social norms. Cooptation is real because hiring peers to work in an untransformed system will inevitably lead to the peers carrying out that basic function of enforcing compliance. I have long struggled with how to change the basic culture of the mental health. I have carried out many fights from within, drawing on allies from outside. Our struggle to block the Murphy Bill was exhausting and frustrating. I still feel there is a role for organizing people with lived experience and hope that the new, non federally-funded Alternatives 2018 (July 29-Aug 3rd, in DC) can renew our efforts. We will have a preconference to discuss advocacy, our own day on the hill and then the conference to learn from each other. This certainly would be a great workshop topic. But ultimately we need allies from outside our field such as the disability, civil rights, and LGBTQ movements. I think our organizing is even more challenging than these others because we are the most dispised, most discriminated against group.

  • Miriam, Thank you for your excellent deconstruction of the mystification used by psychiatry. You. Point out that collaborative psychiatry is an oxymoron because of the power imbalance. As a person with lived experience who practices as a psychiatrist I practice emotional CPR and Open Dialogue to reduce this power imbalance, but it still exists. I acknowledge the imbalance but work with the person to realize their dreams with at times are to come off meds.

  • Thank you Peter. The truth is these SSRIs are addictive and dangerous especially for children. There is a possibility of informed choice for adults but with children none is possible. Every SSRI should have a black box warning for all age groups, but especially for children. But who will ensure such a warning is heeded? Our FDA whose officials drool over lucrative PHARMA jobs?

  • Dialogue helps both ways as meaning is being created. The way I distinguish between recovery and healing I feel is critical. To continue your tennis player analogy, I see recovery of full life as a sociopolitical term describing her position relative to other players and the association of tennis players with its rules whereas healing is a more psychophysiological description of her intrapersonal struggle. So using your tennis player analogy: she had a trauma to her arm and psyche and as a result she could not compete well enough to qualify for membership in the association of players who qualify for major tournaments any longer. With rehab, belief in her by others in the qualified group, and a brace she fully recovered her membership and once again qualified. Her arm continued to heal even after she had fully recovered her position as a member of the association. She became more sympathetic towards others who struggled to stay within the qualifying range, providing them peer support. During the healing she resorted to an earlier style of play but as her healing progressed she could return to developing new moves she never knew herself capable of. This was a trauma activated growth of her capacity.

  • Thanks Ron for great review of my book. Here are my thoughts about the question “can one have recovered completely and still be on medication?”
    First I know of a number of people who have recovered a full life though still take a smaller than usual dose of medication.
    My point is that recovery is defined by seven characteristics especially having control over the major decisions of one’s life and passing as no more disturbed than neighbors (see On page 130 I state:”The primary distinction between a person who is labeled ‘mentally ill’ and a person labeled ‘normal’ seems to be whether the person has experienced a major interruption in the development and life that resulted in others making decisions for them.” So by my paradigm of recovery of life, taking or not taking medication is not the main criterion of being labeled mentally ill. After all there are many in our society who take medication but maintained a major social role and therefore were never labeled “mentally ill.”
    As far as the title being sappy, as Ron points I have found that recovery of my life depended on my retiring my capacity to feel and experience my emotions.

  • In response to the article cited by klh above: George Kelly explained in his Personal Construct Theory (PCT)that we are all making up our best guess of reality as no one has access to all dimensions of greater reality. when our construct of reality is too different from the greater reality we often express hostility towards those who propose an alternative closer to the greater reality. This would explain why the majority of psychiatrists maintain the invalided beliefs that human suffering is primarily in our genes and chemistry and why the they are hostile towards those of us with lived reality of recovery, calling us names such as antipsychiatry and messengers of false hope. At times I am a particular lightning rod for such hostility perhaps because I am a card carrying member of of the psychiatric tribe and an experienced neurochemist who questions the evidence base of the dominant medical paradigm. Those of us who have recovered from the label of severe mental illness say ,”We are the evidence base” upon which a new approach of compassionate care should’ve developed. Our creation of Emotional CPR is a step we have made in that direction. I had to self publish my recent book, “heartbeats of hope” which can be obtained on NEC website,

  • Wow sounds like a great gathering and wish I could have been there to be transformed. On the discussion of recovery that Laurie Ahern and Others engaged in, I was also involved in the struggle to keep the funding for Alternatives and for all the SAMHSA funded c/s/x activities. It was and remains an annual battle, today more than ever and much of the controversy continues to be over the competition between the pathological medical model and recovery through empowerment paradigm. Recovery may seem like an overly clinical term and today it is used that way by the system, but as Laurie said the c/s/x movement has used it as “recovery of a full life after being marginalized by the label of mental illness which was really trauma” or for young people who have not yet been labeled recovery of life after trauma. Some of us still use it and it is still dangerous enough that the Murphy/Torrey axis wants the recovery of life movement crushed with the the take your pills and shut up medical model.
    I have just published a book on this topic called “heartbeats of hope” subtitled”the empowerment way to recover your life.” It’s available through NEC.

  • This is an amazing report. Wonder who he talked with because it is a pleasant surprise that a Medical doctor from Lithuania would come to these conclusions on his own. This report is calling for a massive and much needed shift at cultural, social, and political levels. Most of his suggestions such as empowerment, civil rights, replacement of medical model with a psychosocial/rights paradigm have been made by the consumer/survivor movement and even our White House Commission report. But hearing them from the UN is misic to my ears. Especially given that WHO is usually dominated by a colonization and medicalization approach to mental health. So, with all the continuing pressure to humanize the system, why does it remain so insistently coercive, medical and individual focused? Steve McRae above nailed it, the economic interests of big Pharma trumps all other considerations. I would add that big pharma thrives in our mechanized culture that see people as machines not autonomous members of a democratic community.

  • Tabita, I love your advice to parents. Especially for parents and the young person to know they are not broken or defective. I agree that what are described as symptoms are communications about a young person’s world. This description of the challenge as an issue between the young person and their environment gives hope for healing. Pronouncements of defective brains (for which there is no evidence ) rob the person and their family of hope.
    I gave a talk about my own recovery of my life in Oregon. A 13 year old boy attended with his mother. I asked his mother at lunch if her son benefitted from my talk. She said I may have saved his life. She said that when he was 10 he had been diagnosed with bipolar disorder and was told it was a permenant condition for which he would need a lifetime of services. This pronouncement caused him to lose hope and he has been suicidal ever since. She said,”Today was the first time he had heard that there was hope that he could have a full life and it was the first day he has not felt suicidal!”

  • Sera, I am impressed you keep after the spotlight team. I have been putting more of my energy into creating a changed culture, even on a small scale, that is why I work with a team to do emotional CPR. In small ways, in localized areas, people, even chronically normal ones, are able to experience a more authentic, noncoercive way of being together.I also applaud Hearing Voices network in that direction as well as peer run respites. I just want to keep my eyes on the prize, a transformed society and say f*** to the rest.

  • You clearly point out that the Spotlight team lives in a hopeless universe where the state has an endless obligation to control inherently defective people. I am sure such a pessimistic view increases the prejudice and discrimination they claim they want to aleviate. But, do they even care or do they just want to be a National Inquirer? What will it take for them to see the universe we live in, where we frequently take charge of our lives. In addition to to the Hearing Voices Conference, I hope they also come to the Alternatives Conference following it in Boston Aug 18-21.

  • Great news from Trømso. I agree with Steve Spiegel that the adaptation of Open Dialogue and reflecting processes in the US is hampered greatly by our insistence that these are medical problems, by our continued use of hospitalization, and the professional resistance. I also agree with Diane Engster that we could learn much from work with persons with dementia. I would hope that in addition to professionally directed treatments there would be more use of peers, more emphasis on recovery and trauma informed orinciples, as well as introduction of trainings inspired and created by peers such as Emotional CPR, intentional peer support and WRAP. I would love to go back to Trømso and teach Emotional CPR for their medication free unit. In my experience the best alternative to medication is building respectful, empowering relationships based on heart-to-heart connections.

  • Stephen, I agree with your frustration. It is indeed nearly impossible to change the system from within. In fact, it may be a rule of systems theory that by their very nature systems cannot produce the second order change, the transformational change, from within. Then it becomes a question of the best strategy. At NEC we have been pushing the envelop for some time, by going outside the mental health system to reach less trained persons who deal with issues of emotional distress by teaching emotional CPR to the lay public. Also, Oryx Cohen’s film Healing Voices” reaches out to the public at large.

  • Yes I did get through about 6 years of life changing experience with every type of therapy and three hospitalizations better than I was before. Though I am critical of the over reliance on meds and a medical explanation of human woes and trauma, I do find therapy,with a caring humanistic person can help. Meds and hospitals are last resorts but sometimes are all we can do, and people should not be shamed or ashamed for using them. Mostly I want people to hear at the start of their journey that extreme emotional distress can be healing, it is not an illness but it is important to get help, in a respectful, empowering, and hopeful setting.

  • Having spent 40 years trying to use the power of the label psychiatrist to undo the system, at great hardship, I would agree with Bean. The systemic change needed must come from outside the system. Media? Perhaps as we are doing here, social media; gatherings also in the form of teachins as we did to counter the Vietnam war; I also have confidence that Emotional CPR can restore the natural healing capacity which is inside of each of us.

  • Katie, I am very sorry to hear about your coworker and the MHFA treatment you received. Actually I joke that the only good thing about MHFA is that made me and a group of people with lived experience so mad we decided to create an alternative to it, eCPR. I have been asked to do an “environmental scan of peer support, the challenges and opportunities. I would like to use your story to describe the challenges, without your name, OK ? It is for SAMHSA not the public.

  • Katie, Thank you for your well written, soulful sharing. I worked for 30 years in the system as a psychiatrist who disclosed I had recovered from schizophrenia(whatever that is). Probably because I entered high in the food chain I was not directly attacked but I experienced many of the micro aggressions of mentalism you chronicle. At my retirement the truer attitudes emerged when the company newsletter referred to me as a”peer psychiatrist.” I give talks and write to counter the avalanche of negativity and prejudice we face. But I agree it is a thankless task. I totally understand your wanting to work outside the field. I now focus my attention on Emotional CPR for everyone and getting out my book, “heartbeats of hope.” My best to you.

  • Excellent article Sera. Dorothy’s story is heart breaking and yet her therapist, a young psychiatrist, Lee Macht, was able to help her save her life and raise a terrific family. Lee was a teacher of mine who was truly a visionary. When he learned that I had been hospitalized and diagnosed with schizophrenia prior to entering the Cambridge Hospital Department of
    Psychiatry, of which he was director, he said my experience could be an asset. He warned me however, not to reveal my history to other members of his department, as they would not be so accepting. I also had a psychiatrist, George, who never insisted I stay on mind numbing antipsychotics and let me out of seclusion and a hospital I felt was killing my spirit. There are so many ways that the the system “beats humanity out of people” but there are a few brave souls like Lee and George who defy the ethos of slow death. They should not be the exception. We should have a Yelp system of grading mental health workers for all to see. We also need humanistic training designed and carried out by persons with lived experience. Though discouraging our resistance gives me heart. Let’s keep at it. What choice do we have to do otherwise?

  • Good job Sera. Some of you may know that a group of us with lived experience originally created Emotional CPR as an alternative to MHFA. We now just try to create alternative ways that anyone can help anyone through distress or just communicate to lessen the distress of living in such an oppressive world. We avoid all references to diagnostic or other mental health terms other than saying we hope eCPR will help prevent people being labeled and processed by the system.

  • These are dark times. The forces of darkness, such Lieberman, Torrey, PHARMA, and Murphy are tasting blood. We need to keep countering their claims. I would only have added to your argument that Dr. Insel and NIMH have admitted they have found no biological basis for any of the forms of mental distress labeled mental illness. We need media outlets to get our ideas out to the public. Here we are mainly speaking to each other. It will be in the court of public opinion that these questions will be acted upon.

  • Great blog Mary. It is important to counter critiques of Open Dialogue based on false assumptions and bias. Speaking of bias, I am struck by Marvin Ross’s statement that Open Dialogue is antipsychiatry. I think this is a false claim. Having taken your two year course and having accompanied the Finnish Open Dialogue teams for two days in Tornio, I can attest that Open Dialogue is not antipsychiatry.A psychiatrist, Dr. Brigitte Alakare, is a prominent member of each team, and a developer of the approach. I myself, working as a psychiatrist, have used this approach in my clinical practice. I find that Open Dialogue actually allows the psychiatrist to participate as a team member in a way that standard clinical practice in the US does not allow. When I worked in an outpatient clinic in the US my primary role was as a prescriber of medication. I was not paid to attend team meetings and was not trained to participate in the network dimensions of therapy. Open Dialogue provides a set of values that allow for the interaction of persons working from a variety of perspectives. As a psychiatrist, I interact in a dialogical manner with the network and then can also monologically give my recommendation for medication. I find that this involvement with the person’s personal network and the other members of their team allows me to more sensitively calibrate an optimal dose of medication. I then can feel more comfortable with increasing or decreasing medication knowing that I will soon find out the outcome. I actually find that far from antipsychiatry, Open Dialogue provides a setting in which the psychiatrist’s expertise can be appreciated more than in the standard US setting. Part of our work at U Mass will be to detail the role of the psychiatrist within Open Dialogue.

  • This is an exciting, informative exchange which should be sent to the FDA. In Jan. 2011, several avid advocates, critical of ECT braved a snow storm to testify before the FDA Neurology Scientific Advisory Com. Though there were pro ECT testimonies contending that the ECT machines should be down graded to category II level (the same as a syringe), the Advisory Com. voted to keep ECT machines classified as category III devices (their classification during the last 25 years). FDA still has not given its final ruling. As a category III device the manufacturers of them would need to prove they are safe and effective. To date, as Dr. Hickey points,out the evidence is that ECT is unsafe and ineffective when compared with placeboes. I urge readers to pressure the FDA to follow the advice of its Advisory Board, and confirm that the ECT machine is a category III device, and it’s use should be suspended until it is proven to be effective and safe

  • We developed emotionalCPR, to combat isolation and give everyone the skills and confidence to be with people in distress, without feeling they immediately need to refer them to professional help. We find that when we can be with a person in distress, in the present moment, new life emerges for both persons. I and others who have taken the 2-day certification or 4-day train-the-trainer course, find it improves our day-to-day communication and thinking as well. Thus one participant said,”EmotionalCPR is a way of life.” Our next training will be Dec. 2 and 3rd, just prior to Alternatives in Austin,Texas. To sign up, go to our website,

  • Thank you Michael and all these thoughtful comments. We are clearly facing perilous times
    Each of us needs to push back against these reactive forces of fear in the best way we can.
    Please know we do all we can do given our circumstances. In fact we do
    enough that we ourselves are targeted by reactive forces. We need to reduce the fear that
    parents face that their son or daughter will not respond to a police order and be
    shot. I agree that white cards of diagnosis are misguided, but we need to work with
    Police such as training them in emotionalCPR. so they can communicate with
    anyone who is upset, labeled or not.

  • I want to respond to these very thoughtful responses. Yhis response, over a month later may not be read, but I need to say a few things.
    In response to David Bates, I appreciate the time you spent in reviewing a variety of studies on trauma. I am sure that trauma has an affect on the brain and every other part of us and our relationships. I, however, would like to make a disctinction between the affects of trauma, and the capacity for us each to exercise agency. When I hear pharma and their minions say that those of us labeled at one time have broken brains, I hear a voice with that statement whisper, “and you will never lead a full life, because the very essence of being you is forever broken. Therefore, you will forever need professionals and medication to correct this intinsic brokenness, though at best they will splint it together in an imperfect manner.”
    This leads to Susan’s request, that NEC lead the recovery movement to understand that full recovery is possible and regularly occurs. Susan, I agree, NEC should resume the leadership we established 10 years ago to make this point clearly. I agree we have allowed SAMHSA to water it down in the interest of having it reachna wider audience. The truth is, as you imply, I never left this conviction, I just have found it is a concept too different for many people to hear. In fact makes many people angry when I say that complete recovery is real. They feel, like David above that they have a permanently altered brain and they will never fully recover.mI am inspired to write more on this question. I think we are confused between the life ending description of mental illness and the fact that we have, as the autism self advocates say, neurodiversity or we might say mental diversity. If we can distinguish between recovery as a regaining of a full and meaningful life on the one hand, and differences in ways to living that life which to varying degrees we all share, we might be able to resolve this debate. The NEC paradigm of Recovery and Development, which you can find in several of my papers and PACE on our website,, clearly makes this distinction. We separate recovery from what is called “mental illness” from healing from trauma. We are all healing from traumas, but only those of us who are labeled “mentally ill” go through recovery of our life in society.

  • As a psychiatrist who worked for three years in a state hospital and 25 years as a public sector community psychiatrist, I can attest to the accuracy of Sera’s assertions. The fact is,p there are in the US, and all industrial countries, two systems of law. There is the law of the land, the civil law and then there is psychiatric law. The law of the land applies until a person is psychiatrically labeled. Once labeled, a person is no longer under the protections of civil law, which in the US is derived from the Constitution, but the labeled person comes under psychiatric law. Psychiatric law is sanctioned by judges who defer to expert opinion of the psychiatrist. In so doing, the psychiatrist becomes the judge and jury of the decisions regarding the interventions ordered. Therefore, it is not surprising that the person psychiatrically labeled rarely wins their case. For instance in Massachusetts, in hearing regarding forced medications, the labeled one only wins 3% of the time. So, as Sera points out, diagnosis, the basis of labeling is the basis for the deprivation of rights. This means we must be very diligent to safeguard against any undue diagnosis. Unfortunately, diagnosis is also the basis for benefits. So there is a trade off, your rights for your benefits.

  • Metal Rabbit, I would be glad to speak in your area of the country. I wonder if you could share where that might be? How do you know how much medication is used in your region? That would be a useful stat to keep track of.
    Your dream is intriguing. Interpreting the infectious diseases as mental health conditions is likening the them to the dominant medical model of life.

  • David, I admire your attempt to distinguish between the power structure’s description of distressed people as having a broken brain from which they will never recover and your more nuanced description. I agree we should pick from science what we feel can assist us in our journey . However, I feel uncomfortable with the idea that trauma causes chemical changes that lead to bipolar disorder, characterized by “affect dysregulation and disorders of the self.” There was a time when I spoke and thought like that. It may work for you, but not for me. That line of thinking still removes me a step or two from the immediate experience of my self in relation to other people.

    If I find myself slipping back into patterns of destructive thoughts/feelings, such as “best not to trust anyone”, or “my body is just a sophisticated machine, devoid of a spirit, as portrayed in the ‘Matrix,'” I call on all the ways I have dealt with those periods before.I need to think with my most expansive self in the here and now. I need to listen to all my inner voices and make sense of them. I also find it very helpful to talk with someone, heart to heart. I try to express my inner pain with my authentic voice. For me, I find that the secondary process thinking involved in considering the role of my nervous system, separates me from my authentic voice and blocks my integration.

    As I write this I think, “David finds solace in such a description of his issues and his journey.” I am glad it has worked for you. At stake though are the millions of lives of those who are deeply troubled.I feel a need to raise my voice in their behalf.

  • Very valuable conversation. Recent calls for draconian laws to further shackle us, following the recent tragedy in Conn. point out just how othered we are. It seems our society needs some group to scapegoat and we seem to be it. All the fears and alienation people feel, end up heaped upon us. Then I agree with Sera, it doesn’t matter what name we are called, the main thing is we are the ultimate other. We are each person’s shadow, their most unexplored unknown. The words stigma and discrimination do not come close to describing the devaluing, disrespecting, and dehumanizing that we are subjected to. Small wonder few people want to declare they recovered, for to do so means they have to admit they also were part of the other.

  • Thank you Bob. So wonderful that you followed up on his challenge. I met David in 1978 at the Mental Patient Liberation Front. I have been inspired by him ever since. He is in my heart and I hope he will return in full force. In the meantime, I feel renewed urgency to carry forward our important work, with as he and Martin Luther King called us, the creatively maladjusted. We love you David.

  • Jack, I live in Boston, hot bed of protest and also of conventional psychiatry. I run the NEC and we are connected to advocates all over the country and world. We should think, I believe of stages. The National Federation for the Blind just staged a boycott of Amazon for not making their Kindles accessible to blind students. I will see what their steps were and see if we can adapt. I think it would be helpful to get some statistics on the APA, such as how much of its budget comes from Pharma, how much money it makes on DSM sales.
    I am a great believer in Coalitions. I have reached out to the Humanistic Psychologists, and think we should reach out to Paula Kaplan and her protesters.
    First step might be to call a planning meeting by teleconference,the kind where everyone calling in pays.

  • Dr. Brogan, How inspiring to read your post. I have been sounding warnings about medications, but have not coupled those warnings with the need to constantly expand our knowledge about all the chemicals we take into our body. My wife is in public health, where they practice the precautionary principle. The problem you must run into is that the research on medications is almost always carried out by the pharmaceutical companies (an exception being the CATIE study, which debunked the hype that atypical “antipsychotics” were superior to the typicals). We should insist that NIMH carry out independent testing of any new medication and that all the results be part of any paper.

  • Jack, I completely agree with your assessment of DSM 5. In fact, I and many other members of the consumer/survivor movement are fed up with the whole diagnostic reductionism approach. The perpetuation of the medical model greatly depends upon the idea that life issues can be reduced to as diagnosis, like any other illness. That is ridiculous, as the BMJ article of Bracken et al point out.
    I agree we should mobilize all the critics of DSM 5 and begin a informational boycott of the APA leading to a boycott of the DSM 5. We could start by a boycott on the sale of all APA products. We could also critique the publications of the APA. We should point out that as long as the APA receives money from big pharma and any of the sale of its DSM products and publication of information about medications are a violation of conflict of interest ethical guideines.

  • Lisa, I am in DC often and will connect there. I am so glad you found me again. If life coaching is mostly focused on planning, we need a different name for the type of coaching a person can enter into when they need to restore hope and feeling they have a future. Maybe hope cultivators? Our emotionalCPR is very much about restoring hope which is what the R is:revitalization

  • Lisbeth, This is a terrific post, and a vitally important one. I know for myself I was so fortunate that my friends always held hope. In fact, one friend gave my wife to be great hope. I had been going out with Tish for about a year. She knew I had a history of extreme mental states, which psychiatry calls psychosis. I was very stressed by medical school and started to retreat again into my own reality. My young girl friend was terrified, having never seen me in that condition. We were so fortunate, a good friend, who had seen me go through such periods before told her, “don’t worry he comes out of these states better than when he went in.” Those words of hope enabled her to stay with me, which enabled me to come through the extreme state. We have been married 34 years and have two wonderful daughters. I never retreated like that since, and we have my friend’s hopeful statement to thank.

  • Alice, I would love the name of the nurse you
    Mention and/or the study . In Mass we are looking
    For some early indicators of recovery and locus
    Of control may be an excellent one. We keep
    Returning to agency, efficacy and empowerment
    As the most critical determinants of recovery.

  • Thank you Gilbert, Yes we indeed need a large number of peers to help people reduce their mind numbing drugs. It is a horror to mankind that this goes on in the name of treatment. I am not totally opposed to medications, but we have to turn this Titantic of a psychopharmaceutical complex around so that other means of treatment and support that are empowering can be developed.
    Alice, you really hit the nail on the head. The issue of control and power is central. In fact that army of peers Gilbert wants to engage in detox will only be effective if the paradigm changes to put people back in control of their lives.

  • Great response. I too have been attacked by Dr. Torrey. He has saId I give people false hope.
    When he he says people labeled with psychosis lack insight, I say we are showing good judgement
    After all who should accept the false predictions of conventional psychiatry that we have a life-
    long brain defect for which we need life- long meds and life-long supervision. Fortunately
    neither I nor my family or DC-trained psychiatrist believed such pronouncements. I am happy to report that I went on to become a psychiatrist and I M proud of my 30 years of work as a
    psychiatrist. I am not anti-psychiatry, I admire many psychiatrists, it’s just sad
    The profession has lost its heart and reason.

  • Sabine, I too sat in such sad team meetings for many years, missing
    the essential ingredient you cite, people who believe in us when we had
    lost belief in ourselves. I believe there is increasing awareness that
    Recovery or discovery is real and will increasingly reach to each person.

  • Paris, Thanks, very interesting and I look forward to reading your book.
    My other question: have you cnnected to our consumer/survivor movement. California
    Has a long tradition of speaking up to the abuses the system perpetrates
    ThNks especially to the persistence of the false medical model.
    Your insights could help in our historic struggles. I can connect you
    As far as other research I am referring to the interviews we carried out
    at the the NEC which we used to explore the factors essential to recovery.
    We incorporated them into our recovery training project, Personal
    Assistance in Community Existence (PACE). It was published and is
    On our website. Mainly though we used the data to advocate for
    Recovery and establish the concept in the New Freedom Commission
    Report. The rest of our research has been in personal stories of
    recovery as we want to give hope and counter hopelessness.

  • I have been told by other readers that our perspective is in harmony and I can see from reading this op-Ed and the comments following it that indeed it is true. I am only sorry that as far as I know, and judging by your references, that you have not referenced the most important recovery research, by our recovery movement. I do not say this to detract from your important contributions. I say it more from the hope that you can join with our movement in its need to deeply question the dominant paradigm.
    One note about the first existential dilemma you state , the need to balance between autonomy and connection. I have come to realize this may be based on a false dichotomy. The longer I live and experience the more I find that it is precisely deep, loving connection which makes autonomy possible. As my two daughters move great distances from our home, I believe it is because they feel securely rooted in the love that my wife and I have given and continue to give, and receive from them. I have also concluded that most deep emotional distress is based on failures to achieve the security of love which I feel supersedes most cognitive paradigms. Pierre Tielhard de Chardin posited love was the source of all life and I would agree.

  • Taconic, Thank you for your insights and sensitivity. Your life is a testament to the power of even one kind, compassionate person when we are deep inside our own well defended self. Your remaining so long inside due to rage points to the two faces of altered states. They can be a life saver or if experienced in a hostile environment they can be an existence of no exit. Hopefully we can find ways that people can access the wisdom and healing of those altered states without getting trapped in rage or fear.
    As far as Open Dialogue for monological families, I too share concerns.Perhaps the families in Finland are not as rigid, nuclear, and hierarchical as many families such as yours and mine are here. One way to modify work with such a family might be the addition of a peer to the Open Dialogue team. They have not done that in Finland, but it may be an important adaptation here, both because of the rigidity of some of our families and the eagerness of peers here to assist in such situations?

  • Dear Beyond Labels, There is much wisdom in your post. First of all, though I want to be sure I understand your perspective. So I will restate each point as I hear it and then comment on it.
    You first of all state that I over generalize from my own experience and therefore most of what I say is projection.
    My comment: I would agree that I am putting much weight on my personal experience, and should have made that caveat. However, I have presented this perspective to many audiences and it often resonates. Furthermore, I have interviewed over a hundred other persons with lived experience as well as treated perhaps thousands.
    The point about whether psychosis is a state of a split between mind and heart. You state that is a very old concept, and that for you there was blending of mind and body.
    Comment:I think both of these states may occur in monologue. I think that my diagram is simplistic. It is merely a snapshot in time, and neglects to show different phases of monologue, fails to show the internal dialogue or monologue going on inside. I do recall in the early stages of my passing into my own world of monologue, I experienced elation. There was a flood of inner, very private dialogue, which was a period of great insight. This might have corresponded to your description of blending mind and heart. But then I became frightened, and then I became the frightened figure in the diagram. Then my inner dialogue broke down into a flood of one directional frightening thoughts for which I had no answer. I had loud thoughts (which could be called voices) convincing me that everyone else was a robot, and I lost in the inner voice to answer them back.
    You are concerned that my not depicting the family in the diagram and using the parallel with polio are too medical.
    Comment: I am trying to move our thinking away from medical descriptions, and to that extent the question of where is the person’s family in the diagram is good. Your questions about the family raise a question about the person showing distress for the network, not being pathologized. I will need to check with the Open Dialogue practitioners. I have seen that they work to improve the dialogue within the family as much as between the person showing distress and the family. Perhaps parents have adapted to their own monologue in a way that there children cannot, luckily, do.
    As far as the polio analogy, it was raised more as a caution against over treating symptoms rather causality. Instead I hoped it would show the extent to which the medicalized treatment immediately with medication actually made the problems much worse.

  • Thank you for your thoughtful reply. I will look up your references. The interplay of the different levels of the nervous system and their role in the sleep-wake cycle is very relevant to these altered states of reality. It seems that we need to be more aware of our emotional/social dimension of life. If we are not, individually and collectively, as is happening in today’s world, it bursts through as states of altered reality, waking us up to that deeper reality. Perhaps we are asleep when we are awake and truly awake to our true selves when we are dreaming. Certainly the Buddhists would say that.

  • Appreciate the comments, though I would, along with Mary Ellen Copelend and Michael Cornwall agree that the choice is not shock or neuroleptics. The major alternative is the type of respectful, empowering relationships that occur in peer-run respites,WRAP, Open Dialogue, and Soteria Houses. We urgently need to transform the way we think of periods of emotional distress and see the healer within each person striving to become whole rather than view these periods as pathological symptoms of illnesses to be removed.

  • Jonathan, What a beautiful, imaginative comment. You touch on many themes,such as how to see beyond what you see first, and ACCEPT whatever experience you have.I am glad you expanded the Pink Floyd album. You are, I believe spot on. I agree that the standardization of our education leads standardized culture with standardized behavior. Lewis Mumford pointed this out several years ago in his book “The Pentagon of Power”

  • Stephen, Thank you for your deeply spiritual response. Though I cannot place you exactly, I feel your spirit.
    So you think I may be a mystic, I remember in college being very moved by the writings of mystics. I think I may have some of that in me. The ineffable quality of a mystical experience may be called a delusion today, because it causes such discomfort among those who are still out of touch with that dimension of their existence. In doing so we negate such a rich source of wisdom in ourselves and in each other. I do feel that creatura is one description of the language of altered states that are called psychosis. I also think it is a language we all carry inside us, not just when people are considered psychotic. When we dream are we not entering that creatura realm. It is I feel through uncovering this language, as you did, we can communicate with persons in altered states, thereby encouraging them to rejoin the rest of us, as the corpsman did for me. Relearning this language also allows our society to be one that supports recovery and wellbeing. It seems recovery is really recovery of our ability to speak creatura and in so doing to rebuild our crumbling communities. I also like you connection between mythos and creatura.I will need to learn more about mythos, it seems close to Jung’s achetypes.

  • Mary Ellen, What a wonderful, moving story, told with such love and caring. I too am glad you are blogging here. Your work has helped so many people around the world. I can see that you received a special gift of inspiration and of understanding from your mother. I agree with Mike Cornwall that the most important element in recovery is deep, empathetic listening with one’s heart. We with lived experience of recovery have a special gift of having been there which we can use to turn this uncaring, disempowering culture around.

  • First, you tell me, when will I come to NC? Find a group to invite me and I will come.
    I love this description of insight dialogue. I would love to read more about it. We actually encourage inner dialogue as a preparation for eCPR, which we call IeCPR. It seems that there is something very basic about dialogue. I am working on another essay about how dialogue opens and nourishes life. I was conducting a dialogue today between persons with lived experience working in the system and persons presently recovering in the system. The biggest concern of everyone was the attitude of professionals. It was an attitude that came with degrees and position. An attitude of superiority. Just when we are most in need of someone boosting our self-esteem, and empowering us, we enter a system that further reduces our sense of self. Then our sense of existing diminishes. My humanity depends on your humanity. We are as Martin Luther King Jr. said all part of a single fabric of humanity, interconnected in this mysterious web of life.I love an Ionesco quote I just read:” Ideology separates us, dreams and anguish bring us together.” and

  • MJK, I also enjoyed the spirituality article. I agree, not a greed, that the spiritual path is away to go beyond the material preoccupation of this world. I would bet that the adoption of spiritual practice would greatly reduce the amount of medication people felt they needed. I feel as though I reached a new, freer level of existence as a result of my lived experience. My withdrawal from the world of people gave me a lengthy period of retreat from day to-day noise and robotic messages. Since I came back from that other world experience I have had little interest in fame, power, or more money. I became a psychiatrist to humanize not to dominate. Just seems I came to the field a little late.

  • Donna and Lisa, Thank you for your comments.
    Donna for your perspective on the symbolic nature of my delusion of people being robots. Indeed I wish then I had someone like yourself validate that you had that way at times, that indeed at times it is as if people are robots, but people are not literally robots. This shows the power of peer support: validation that you are not alone, validation that there is an element of reality in the concept, but also helping to remind the person in distress of the need to communicate in consensual reality , especially with chronically normal people, so as not to burst their bubble of protection.
    Lisa, I glad I have in some way helped you and others towards recovery. That warms my heart and reinforces why I do this advocacy. Sounds like my message of the need to regain power in one’s life among the important people in it was important to you. It seems there are two major routes for gaining power in one’s network: either gaining a sense of personal power relative to the network one has and/or changing your network, to add more people who are validating (peers can be very valuable in this regard) and reducing the number who are invalidating. By the way, I prefer the term invalidation to stigma because it even more vividly illustrates the depth of the oppression we suffer. When we are labeled and inducted into the system as a consumer, our very being in its most human elements is rejected and dismissed. Irving Goffman so perfectly described it in Asylums as a degradation ceremony. We are subjected to degradation of our humanity.

  • Chrys, Glad my piece resonated. Might you translate the Scottish? It does give me a familiar feel about Jock and a way of being with rather than doing to or for someone. Being with rather than over scares us all, but especially if we do not want to look at our self. For when I am truly present with another person, I will experience my feelings and theirs more deeply. If they are frozen in fear because of their uncertainty about their grasp on reality,it is invaluable for me to recall similar periods I experienced and show that I am confident their life will continue and even flourish through such feelings. This is part of the unique contribution of persons with lived experience.

  • Mike, Thank you for your support. I feel that human caring and compassion are the basis of my work and yours. Though the forces of greed and coercion are strong, I agree with Martin Luther King, Jr., who said he could see over history that the arc of humanity was moving towards justice. We need to keep strengthening the bonds between those of us who can see the life force grow within our dialogue of caring and compassion. Then we can truly weave a bright tapestry to embrace our children and grandchildren. I believe, that within each human being, there is a need and a wish to grow a fuller life. This is the part that I try to resonate with, even in those whose fear constrains their life and causes them to constrain those close to them.

  • John, Thank you for your interest. Yes we want to enable peers to learn the most respectful, least stigmatizing approach to mental health I have found, instead of being trained in the medical model. The IPS model of Sheri Mead shares some principles with Open Dialogue, such as mutuality and sharing of power.