Tag: Open Dialogue

I was never anti-recovery. I will admit, however, that when the recovery movement first came to my attention in the 1990s, I was not drawn in. In recent years, this is another area in which I have needed to re-examine my assumptions.

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.

On a beautiful Vermont summer week-end, about 40 people – social workers, psychologists, psychiatrists, administrators, and people with lived experience among us – gathered together. Our purpose: To come together and model what many of us had experienced in Europe at the International Meetings for the Treatment of Psychosis.

It has been five years since I traveled to Western Lapland in Finland to film my documentary “Open Dialogue” on their Open Dialogue Project—the program, as I stated in the film, presently getting the best long-term statistical results in the world for the treatment of first-episode psychosis. My film came out four years ago, and since then I have been screening it around the world, giving lectures about Open Dialogue and my experience in Finland, participating in regular conferences and Q&A sessions about it, receiving daily emails, Facebook messages, blog and Youtube comments about it (as it’s now been free on Youtube for a year), and keeping in regular contact with some of the folks who work there. But I haven’t shared many of my updated opinions in writing, so I wish to do so now.

Those of us with lived experience, here in the US and now around the world have discovered that most mental health professionals have little understanding of what extreme mental states are like. They think those states are a sign of illness. They think that hearing voices and having vivid dreams are symptoms of those illnesses. We who have been through our own recovery know that we are all basically healthy people who have experienced a variety of traumas.

When I first entered a state of altered reality (called psychosis) at the age of 25, I was exhilarated. Then, when I could not...

The Collaborative Pathways project at Advocates, Inc. in Framingham, MA has received an FEMHC grant to develop and evaluate their highly innovative new program....