Tag: Open Dialogue
As stories wove together, Ron turned to the son and said, “You know, I don’t think you were ever schizophrenic at all.” There was an extended silence as this statement sunk in and the group drew closer to hear what came next. But the rain fell harder until all sound was drowned out. We sat together, feeling the rain soak into our ears, our bodies, the ground; words were unnecessary.
Sandra Steingard, writing in the journal Psychiatric Services, reviews a recent article finding that the quality of the therapeutic relationship impacts the efficacy of medication treatment.
In a new report, the United Nations Special Rapporteur on the right to health, Dr. Dainius Pūras, calls for a move away from the biomedical model and “excessive use of psychotropic medicines.”
It is very encouraging to observe the spread of early psychosis programs to many states and communities throughout the United States. I hope that someday there are programs in all 50 states, not just 34, and that there are literally thousands of these programs not a hundred.
Over the past seven years, I have been teaching open dialogue principles and practices in a variety of settings. This blog will focus on the development of a training program, now based in Manhattan, and what I’ve learned from running this program and teaching this approach in the US.
Within days of announcing the webinar and providing the link to register, we were deluged with enrollments. It turns out that a great many professionals, advocates and clinical managers are interested in learning about Open Dialogue and its application to an American community.
Four years ago I dove into a deep and murky pond: the bottomless depths of medical databases that hold mental health research. After examining over 4000 studies, and hundreds of meta-analyses, I surfaced from my research and was hit with a startling “Aha” moment: non-drug approaches really work.
I have sometimes stopped en route to work, unsure how much longer I can continue. There is a sense of betrayal to my father and grandmother by working in a profession that failed them and is the only medical specialty to have its own survivor movement, not from the illnesses it hopes to treat, but from the ministrations of the profession itself.
In this second article, I will further analyze the reasons why the unevidenced biological-illness approach to “schizophrenia” has become so entrenched in our society. Most importantly, I will discuss hopeful alternatives.
As a psychiatric survivor who has personally experienced severe psychosis, my criticisms focus on the relative lack of attention to what psychiatric drugs actually are, and on the uncertain, contested nature of the supposed target of these drugs: “schizophrenia.” I will elaborate on each of these points with references, as well as highlighting alternative approaches to helping psychotic people.
In an article for Psychiatric Services, psychiatrist Christopher Gordon and his colleagues report on the results of a one-year feasibility study attempting to implement...
The Collaborative Pathway is a replication and adaptation of Open Dialogue at Advocates, Inc., a human services agency in Framingham, Massachusetts where I serve as Medical Director. Last week, our team published an article in the Best Practices column of the journal Psychiatric Services, describing the program and our results from the first cohort of young people and families experiencing a psychotic crisis. This is the first published adaptation of Open Dialogue in the U.S. and represents the culmination of several years of planning, training, and direct service.
For ABC’s All in the Mind, Lynne Malcolm and Olivia Willis report on the latest research showing that hearing voices may be far more...
In the past five years, there has been a dramatic explosion of interest in the Open Dialogue Therapy practiced in Tornio, Finland. It is a humanistic “treatment” that has produced five-year outcomes for psychotic patients that are, by far, the best in the developed world, and there are now groups in the United States, Europe and beyond that are seeking to “import” this care. However, the challenges for doing so are many and, last month, Open Dialogue UK - on the occasion of the first-ever fully recognized Open Dialogue training outside of Tornio - organized a conference in London to hold an open dialogue about Open Dialogue.
When people are “mad,” they are often insisting that certain things are so, and frequently seem unwilling or incapable of appreciating or learning from other perspectives. Yet when the supposedly “sane” mental health system approaches those who are mad, it typically does the same thing – it insists that its own view of what’s going on is correct, and seems incapable of appreciating or learning from others, whether they be the patient, the family, former users of services, or anyone who understands madness in a different way.
"Almost 30 years ago a group of clinicians in Finland decided to treat psychosis differently. Their approach, known as Open Dialogue, has impressive recovery...
Vermont Governor Shumlin recently suggested a change to state law that would accelerate the process under which a person could be forced to take antipsychotic drugs against her will. The House Human Services Committee reviewed this proposal and I was asked to testify. What follows are my comments.
Any attempt to establish an alternative diagnostic system to the predominantly biologic DSM-5 classifications or to initiate a transformation of the individually oriented mental health treatment systems needs to critically explore how, not only what, we think about health and healing, about mental and emotional suffering, about traumatic experiences and injustices, and the multiple forms of pain that are part of our human existence. The broad critique of the DSM-5 by so many national and international organizations and individual colleagues will in the end not be powerful and far reaching enough without this inquiry into the foundations of our thinking and without reflection about our ways of thinking.
We are profoundly social beings living not as isolated individuals but as integral members of interdependent social systems—our nuclear family system, and the broader social systems of extended family, peers, our community and the broader society. Therefore, psychosis and other forms of human distress often deemed “mental illness” are best seen not so much as something intrinsically “wrong” or “diseased” within the particular individual who is most exhibiting that distress, but rather as systemic problems that are merely being channeled through this individual.
Based on the Finnish Open Dialogue approach, the Parachute program is an alternative to current health care systems where a team of health care workers collaborate with families and those in distress to develop a path to recovery. The success of Parachute is now spurring the development of similar programs in the UK.
Results of a large government-funded study call into question current drug heavy approaches to treating people diagnosed with schizophrenia. The study, which the New York Times called “by far the most rigorous trial to date conducted in the United States,” found that patients who received smaller doses of antipsychotic drugs with individual talk therapy, family training, and support for employment and education had a greater reduction in symptoms as well as increases in quality of life, and participation in work and school than those receiving the current standard of care.
For the past four years, I have been deconstructing my views of my profession. My focus has been primarily in two areas: the efficacy and safety of the drugs I prescribe and the so-called “alternative” approaches (in this I include many things such as Open Dialogue, Hearing Voices groups, and Intentional Peer Support to name a few). I have shared much of this in the blogs I wrote during this time. I am also interested in how we can improve and reform the public mental health system since this is not only where I work but where most people seek services and help. I wonder where – if anywhere – psychiatrists fit in to a reformed system.
Writing for CounterPunch, Paris Williams writes that when an individual is experiencing what has been termed “psychosis,” it is important to recognize that this may also be the manifestation of a breakdown in their larger social groups, the family, society, and even the species.