Can a Mind be Well?

[spiritual_emergency]

In the thread that Allen initiated, "Can a Mind be Sick?" we've had quite a lively discussion. I'm not sure if we fully addressed his opening query but we did examine it, in particular the possible role of Jungian-based methodologies as a means of interpreting and addressing the content that emerges from an individual in deep crisis whose psyche has collapsed/fragmented/shattered.

We also briefly looked at the role of medication (some of us more closely than others) and touched on the idea that collective bodies can also become ill: families, institutions, idealogies, cultures, even entire nations. In these cases, the individual in crisis may be expressing the crisis and dis-ease of the entire collective. Family systems therapy (thanks for bringing that up, finding my way), are probably some of the best examples we have for interpreting "not-wellness" within a collective group.

I had considered adding more to that thread but then I thought perhaps it would be better to spin off into a new one, hence the title of this thread: Can a Mind be Well?

In this topic, I thought I'd share some of the information I've gathered as related to treatment approaches that seem to have a very good success rate for helping people recover from the experience that is known as psychosis and/or schizophrenia in this culture.

[spiritual_emergency]

John Weir Perry (1914 - 1998) was a Jungian psychiatrist who founded an experimental residential facility called Diabasis, in San Francisco, California, during the 1970s. This was designed as a comfortable home where young adults, who were experiencing the initial days of their first "acute schizophrenic break", could live in and be empowered to go through their Apocalypse on the way to greater health and happiness.

The results were amazing: without any treatment by medication, electroshock or locked doors – but with opportunities for painting, dance, massage, meditation and conversation – full-blown "schizophrenics" were able to go through their ego-death and emerge on the other side, as Perry put it, "weller than well."

Instead of being sent to a mental hospital and/or being expected to take medication for the rest of their lives, these people would live at Diabasis for the first three months, spend three more months in a half-way home, and then return to the outside world, with few if any relapses of their "schizophrenia"!

Source: An Interview with John Weir Perry

"...85% of our clients (all diagnosed as severely schizophrenic) at the Diabasis center not only improved, with no medications, but most went on growing after leaving us."

- John Weir Perry

The Facility: Diabasis was an experimental project in San Francisco. It was a residence facility that lived through three years and more of inpatient work with acute "schizophrenic" episodes in young adults without the use of medications, always as part of the county's community mental health system. Its purpose was to provide a home in which clients might have the opportunity to experience with full awareness their deepest processes during this intense turmoil.

Staffing: The facility was staffed by twenty paraprofessionals who served not only the ordinary functions of attendants, but also provided psychotherapy as counselors. Some of these held fractions of our seven paid positions, while others were volunteers. Although this arrangement brought the secondary benefit of lower cost, it's primary purpose lay in selecting individuals by disposition rather than by professional category; we picked ones who by qualities of empathy and ease with psychic depth were particularly suited to this work, whom we could then educate and train on the job.

Theory and Method: The orientation ultimately derived out of a Jungian approach although not all staff were specifically given to that theory and method; instead, several modalities were drawn upon. There was a consensus on the basic viewpoint that the acute "psychotic" episode under discussion typically contains elements of a spontaneous reorganization of the self and that therefore, if handled well, may result in self-healing. The therapeutic aim was to avoid the damage of labeling and disqualifying attitudes and instead, to respond to all that happens intrapsychically with honest feeling; also it was to validate the efforts the psyche makes spontaneously to effect a transition from a poor state of organization of the self to one that is more suited to the nature of the particular individual's disposition. The processes expressed in the imagery and emotion frequently lead to profound changes in one's outlook and lifestyle, specifically in one's cognitive structures, value system and belief system.

Progress of Therapy: Our most surprising finding in the case of early acute episode was that grossly "psychotic" clients have usually come into a coherent and reality-oriented state spontaneously within two to six days, without need for medications. We have found that our work was most effective with those acute early episodes that were productive of imageful content. With clients who came to us in their third or fourth episode, we often found that their experience was beneficial but the outcome less striking. Chronicity was another matter and the chances of fruitful experiences more uncertain. A history of heavy medication usually made it difficult to do effective psychotherapeutic work.

Conclusions: Returning to the question of what alternative programs can be, we arrived at certain conclusions. Such a program can be much more than benign mileau therapy. It is possible to do effective psychotherapy in the acute episode, since the client's talk is clear and the material of dynamics active and ready to hand. The use of medications can be reserved for backup alone, for the rare times when behavior becomes too hard to handle and after other psychological means have been attempted. Therapy is best conducted in the spirit of nondoctrinaire openess to learn from the clients what the experience of their altered states is, and what it feels like to go through this process, and thus to be of help in facilitating its own aims toward reorganizing the self. When allowed to proceed, we find that a growth process is often underway that can be sustained, with consequent developments in one's system of meanings, value, beliefs and lifestyle. This treatment mode may then help avoid the devastating picture of incapacitation and recidivism that now prevails, and then becomes a burden to mental health systems. The cost-effectiveness of such a program depends entirely upon its use by the community to handle acute and early, if not first, episodes, with the prospect that these clients might be benefited in such a way that they would no longer remain indigents, dependant upon the county for aftercare.

Source: Trials of the Visionary Mind: Spiritual Emergency and the Self-Renewal Process

John Weir Perry is Former Assistant Clinical Professor at the University of California, San Francisco. He is the author of The Heart of History: Individuality in Evolution, published by SUNY Press; The Self in Psychotic Process: Its Symbolization in Schizophrenia; Lord of the Four Quarters: Myths of the Royal Father; The Far Side of Madness; and Roots of Renewal in Myth and Madness.

See also:

• Treatment or Therapy?

• Visionary Experience in Myth and Ritual

• The Inner Apocalypse: An Interview With Dr. John Weir Perry

• Diabasis - Prague, Czech Republic

[spiritual_emergency]

For over a decade Loren R Mosher, MD, held a central position in American psychiatric research. He was the first Chief of the Center for Studies of Schizophrenia at the National Institute of Mental Health, 1969-1980. He founded the Schizophrenia Bulletin and for ten years he was its Editor-in-Chief. He led the Soteria Project.

The Soteria research demonstrated that there is a better way: A better way to treat schizophrenia and other psychoses that destroy the lives of so many young people. The Soteria research showed that the prevalent excessive destructive psychiatric drugging of all these young people is a huge and tragic mistake. The psychiatric establishment was offended. Prestige and Money won. Truth and Love lost.

When Dr Mosher died he was Director of Soteria Associates, San Diego, and Clinical Professor of Psychiatry, School of Medicine, University of California, San Diego.

Source: Dr. Mosher's Website

The Soteria Project (1971-1983)

This project's design was a random assignment, 2-year follow-up study comparing the Soteria method of treatment with "usual" general hospital psychiatric ward interventions for persons newly diagnosed as having schizophrenia and deemed in need of hospitalization. It has been extensively reported (see especially Mosher et al., 1978, 1995). In addition to less than 30 days previous hospitalization (i.e., "newly diagnosed"), the Soteria study selected 18- to 30- unmarried subjects about whom three independent raters could agree met DSM-11 criteria for schizophrenia and who were experiencing at least four of seven Bleulerian symptoms of the disorder (Table 1).

The early onset (18 to 30 years) and marital status criteria were designed to identify a subgroup of persons diagnosed with schizophrenia who were at statistically high risk for long-disability. We believed that an experimental treatment should be provided to those individuals most likely to have high service needs over the long term. All subjects were public sector clients screened at the psychiatric emergency room of a suburban San Francisco Bay Area county hospital.

TABLE 1: The Soteria Project: research admission/selection criteria

1. Diagnosis: DSM II schizophrenia (3 independent clinicians)

2. Deemed in need of hospitalization

3. Four of seven Bleulerian diagnostic symptoms (2 independent clinicians)

4. Not more than one previous hospitalization for 30 d or less

5. Age: 18-30

6. Marital status: single

Basically, the Soteria method can be characterized as the 24 hour a day application of interpersonal phenomenologic interventions by a nonprofessional staff, usually without neuroleptic drug treatment, in the context of a small, homelike, quiet, supportive, protective, and tolerant social environment.

The core practice of interpersonal phenomenology focuses on the development of a nonintrusive, noncontrolling but actively empathetic relationship with the psychotic person without having to do anything explicitly therapeutic or controlling. In shorthand, it can be characterized as "being with," "standing by attentively," "trying to put your feet into the other person's shoes," or "being an LSD trip guide" (remember, this was the early 1970s in California).

The aim is to develop, over time, a shared experience of the meaningfulness of the client's individual social context-current and historical. Note, there were no therapeutic "sessions" at Soteria. However, a great deal of "therapy" took place there as staff worked gently to build bridges, over time, between individuals' emotionally disorganized states to the life events that seemed to have precipitated their psychological disintegration. The context within the house was one of positive expectations that reorganization and reintegration would occur as a result of these seemingly minimalist interventions.

The original Soteria House opened in 1971. A replication facility ("Emanon") opened in 1974 in another suburban San Francisco Bay Area city. This was done because clinically we soon saw that the Soteria method "worked." Immediate replication would address the potential criticism that our results were a one-time product of a unique group of persons and expectation effects.

The project first published systematic I-year outcome data in 1974 and 1975 (Mosher and Menn, 1974; Mosher et al., 1975). Despite the publication of consistently positive results (Mosher and Menn, 1978; Matthews et al., 1979) for this subgroup of newly diagnosed psychotic persons from the first cohort of subjects (1971-1976), the Soteria Project ended in 1983. Because of administrative problems and lack of funding, data from the 1976-1983 cohort were. not analyzed until 1992. Because of our selection criteria and the suburban location of the intake facilities, both Soteria-treated and control subjects were young (age 21), mostly white (10% minority), relatively well educated (high school graduates) men and women raised in typical lower middle class, blue-collar suburban families.

Results - Cohort 1 (1971-1976): Briefly summarized, the significant results from the initial, Soteria House only, cohort were:

Admission Characteristics: Experimental and control subjects were remarkably similar on 10 demographic, 5 psychopathology, 7 prognostic, and 7 psychosocial preadmission (independent) variables.

Six-Week Outcome: In terms of psychopathology, subjects in both groups improved significantly and comparably, despite Soteria subjects not having received neuroleptic drugs. All control patients received adequate anti-psychotic drug treatment in hospital and were discharged on maintenance dosages. More than half stopped medications over the 2-year follow-up period. Three percent of Soteria subjects were maintained on neuroleptics.

Milieu Assessment: Because we conceived the Soteria program as a recovery-facilitating social environment, systematic study and comparison with the CMHC were particularly important. We used Moos' Ward Atmosphere Scale (WAS) and COPES scale for this purpose (Moos, 1974, 1975). The differences between the programs were remarkable in their magnitude and stability over 10 years. COPES data from the experimental replication facility, Emanon, was remarkably similar to its older sibling, Soteria House. Thus, we concluded that the Soteria Project and CMHC environments were, in fact, very different and that the Soteria and Emanon milieus conformed closely to our predictions (Wendt et al., 1983).

Community Adjustment: Two psychopathology, three treatment, and seven psychosocial variables were analyzed. At 2 years post-admission, Soteria treated subjects from the 1971-1976 cohort were working at significantly higher occupational levels, were significantly more often living independently or with peers, and had fewer readmissions; 571/16 had never received a single dose of neuroleptic medication during the entire 2-year study period.

Cost: In the first cohort, despite the large differences in lengths of stay during the initial admissions (about 1 month versus 5 months), the cost of the first 6 months of care for both groups was approximately $4000. Costs were similar despite 5-month Soteria and 1-month hospital initial lengths of stay because of Soteria's low per them cost and extensive use of day care, group, individual, and medication therapy by the discharged hospital control clients. (Matthews et al., 1979; Mosher et al., 1978).

Source: Soteria House

See also:

- Schizophrenia Bulletin: A Systematic Review of the Soteria Paradigm for the Treatment of People Diagnosed With Schizophrenia

- Lorne Mosher's Website

-

- Soteria - Alaska

[Born to Perish]

I suppose a mind cannot be well if it cannot be sick. What an interesting contradictory situation we have here.

[spiritual_emergency]

Jaakko Seikkula, Ph.D. is a professor at the Institute of Social Medicine at the University of Tromso in Norway and senior assistant at the Department of Psychology in the University of Jyvskyl in Finland. Between 1981-1998, he worked as a clinical psychologist at the Keropudas hospital in Finland where he and colleagues developed a highly successful approach for working with psychosis known as Open Dialogue Treatment (OPT).

Among those who went through the OPT program, incidence of schizophrenia declined substantially, with 85% of the patients returning to active employment and 80% without any psychotic symptoms after five years. All this took place in a research project wherein only about one third of clients received neuroleptic medication.

Dialogue Is the Change: Understanding Psychotherapy as a Semiotic Process of Bakhtin, Voloshinov, and Vygotsk

Introduction

My goal is to describe the foundations of dialogical psychotherapy and to demonstrate how the latter can treat even the most serious psychic problems (psychosis, schizophrenia). By presenting case examples, I hope to give readers some ideas for using dialogical conversation in their own clinical practices....

Case: Lars

Lars was a severely psychotic young boy. He would sit in a corner of the ward and have no contact with anyone. After three months without any noticeable improvement in his condition, the therapeutic team decided to have a joint meeting to discuss the serious situation. The team invited all the professionals involved in his treatment, both from outpatient and inpatient care, and his family. At some point in the conversation Lars’ older sister said, “the last two weeks have been hard on the family”. When asked what was making things so hard, neither she nor any other family member answered. After a while, Lars’ brother replied that, “after hearing what the doctor said, it was tough”. He was asked what the doctor had said, and for a second time the conversation on this subject dried up. After a while, the sister, for a third time, took up the same issue by saying that “it has been a tough period for the family after hearing the doctors words”. She was asked to tell the group more about the situation and the doctor’s diagnosis. She said that the doctor had given his opinion about what was wrong with their brother, and his diagnosis was hard to bear. She was encouraged to repeat what the doctor had said. After a moment of silence, she answered in a soft voice, “the doctor said that our brother has schizophrenia”. Upon hearing this word, all the family members started to cry.

The team responded to this incident by sitting silently, thus making space for the emotional moment, after which the family members were asked to say what schizophrenia meant to each of them. They started to tell, at first hesitantly and then more and more straightforwardly, how their father’s mother was diagnosed as having schizophrenia and that she had been hospitalized for 35 years. The family had tried to have the woman live with them, but this always failed because she had strong delusions that they would either poison her or take control of her property in some other way. This history was traumatic for all the family members, and they never talked about it. It was a history without words.

The doctor who made the diagnosis was asked to describe the things that led him to view the problem as schizophrenia. He did so, and said that he wanted to start Lars on the best possible treatment. He did not think that Lars should stay in the hospital for the rest of his life. At this point, a new type of conversation emerged: one between the doctor and the family members. This helped everyone to see the seriousness of the situation. In the same conversation it became possible to talk in a new way of their experiences with the father’s mother (whom they began to speak of as “grandmother”) and to supply words for a narrative that previously had none.

Because the meanings of our acts and experiences are constructed in social relations, it is important for the social network to participate in meetings concerning a crisis. In the meaning-networks of social relations, the polyphony of life serves as the engine of psychotherapy. At the same time, this new reality is both experienced jointly, in a way not possible previously, and new words are created for those difficult experiences that as yet have none. In this way, new meanings and new understandings are constructed. The shared emotional experience opens up the monological impasse to dialogical reflection, which in turn obtains its meaning from the inner dialogue of the patient. The inner and outer dialogues are part of the same language; no sharp boundary divides them...

Reality is created on the boundary

Although we would suppose that each of us has an inner core that guides our behavior, we must also note that the meaning of our psychological acts is created on the boundary between inside and out, in social relations with other individuals or in our inner dialogue between different voices, which have their origins in our life experiences...

But in the joint meeting, this definition triggered an avalanche of new meanings, which opened up in the shared conversation and prompted new understanding between the discussants. In the meaning-network constructed between these individuals, the diagnosis of schizophrenia of course had its place, since it formed the theme of conversation. The talk, however, no longer focussed on the meaning of schizophrenia to the inner psychological or biological structure of the patient, but on the actual conversation then and there, on what “schizophrenia” meant to every participant. This led to a polyphonic deliberation of each one’s own experiences of schizophrenia and of matters related to the grandmother and to Lars’ future.

Originally one-voiced, monological words started to receive multi-voiced, dialogical aspects.In defining the difference between the meanings generated from structuralism and those derived from contextual meaning, Bakhtin says the following: “Contextual meaning is personalistic; it always includes a question, and address, and the anticipation of a response; it always includes two as a dialogical minimum. This personalism is not psychological, but semantic.” By contrast, structuralism seeks to describe the research problem by one exact definition, as is the case in the natural sciences. In the contextual definition of the psychological reality, on the other hand, conversation creates each research problem. Shotter calls this “knowing of the third kind”, and the observer him/herself is always included...

The basic elements of dialogue in psychotherapy

Based on the semiotic theory described above, a psychotherapeutic approach can be conducted that no longer focuses on changing the psychological or social structure by interventions nor by using questions as interventions. Rather, it focuses on constructing a joint dialogue between the participants in a treatment meeting in order to generate a new understanding of the circumstances related to the actual crisis. The basic elements of this procedure include the following:

(1) The therapeutic conversation should start with as little preplanning as possible, to guarantee that each participant has the same history in speaking of the actual issues.

(2) All courses of treatment should be organized when everyone is present – the patient, those nearest him/her, and all the professionals involved.

(3) Therapists should not be considered as experts who know all the answers to questions, and they should avoid giving ready-made responses and solutions to those in a “non-expert” position. Rather, therapeutic expertise should consist primarily in skill at generating dialogue.

(4) The best results in the most serious psychiatric crisis seem to presuppose immediate help, where the social network around the patient can, in a safe enough form, tolerate uncertainty and avoid premature conclusions and decisions. This includes especially the avoidance of starting the patient on large doses of anti-psychotic medication rapidly or impulsively, but only after several discussions of such medication and, if it is started, then in small doses.

(5) Promoting conversation is primary. Therapeutic “work” is to generate dialogue, not to draw conclusions and make decisions. All the participants should be heard, since being heard always improves one’s understanding of oneself.

(6) Open dialogue is a key factor. This includes openness in integrating different therapeutic methods as parts of the entire treatment process, since the patients can start to construct new words, and in many different ways, for experiences that till then they had none.

Source: Dialogue Is the Change: Understanding Psychotherapy as a Semiotic Process of Bakhtin, Voloshinov, and Vygotsk [PDF File]

See also:

- Dr. Jaakko Seikkula: Open dialogues with good and poor outcomes for psychotic crises: Examples from families with violence

- Dr. Daniel Fisher: Learning From Northern Europe

[spiritual_emergency]

In a post I made elsewhere I noted there is a reason I promote the work of clinicians who use minimal or no medications. It's because of things like this...

Risks Associated with Medication...

... The big finding is that people with schizophrenia are losing brain tissue at a more rapid rate than healthy people of comparable age. Some are losing as much as 1 percent per year. That’s an awful lot over an 18-year period. And then we’re trying to figure out why. Another thing we’ve discovered is that the more drugs you’ve been given, the more brain tissue you lose.

Q. WHY DO YOU THINK THIS IS HAPPENING?

A. Well, what exactly do these drugs do? They block basal ganglia activity. The prefrontal cortex doesn’t get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy.

Source: The New York Times > Log In

... researchers in Ireland reported in 2003 that since the introduction of the atypical antipsychotics, the death rate among people with schizophrenia has doubled. They have done death rates of people treated with standard neuroleptics and then they compare that with death rates of people treated with atypical antipsychotics, and it doubles. It doubles! It didn't reduce harm. In fact, in their seven-year study, 25 of the 72 patients died.

Source: Psychiatric Drugs: Chemical Warfare on Humans - interview with Robert Whitaker

... There is an excess of death from natural causes among people with schizophrenia. Aims Schizophrenia and its treatment with neuroleptics were studied for their prediction of mortality in a representative population sample ... During a 17-year follow-up, 39 of the 99 people with schizophrenia died. There is an urgent need to ascertain whether the high mortality in schizophrenia is attributable to the disorder itself or the antipsychotic medication.

Source: Schizophrenia, neuroleptic medication and mortality.

... A study in France found that excess in mortality among patients with schizophrenia was, among all variables studied, most directly correlated with the dosages of antipsychotic medication received. In the United States, high rates of death, and especially of fatal injury, have also been reported in people treated with antipsychotics. Further, a study from Finland found that the number of antipsychotic drugs used correlated with mortality...

Source: http://publications.cpa-apc.org/media.php?mid=341 [PDF File]

... Both in vivo and post-mortem investigations have demonstrated smaller volumes of the whole brain and of certain brain regions in individuals with schizophrenia. It is unclear to what degree such smaller volumes are due to the illness or to the effects of antipsychotic medication treatment. Indeed, we recently reported that chronic exposure of macaque monkeys to haloperidol or olanzapine, at doses producing plasma levels in the therapeutic range in schizophrenia subjects, was associated with significantly smaller total brain weight and volume, including an 11.8–15.2% smaller gray matter volume in the left parietal lobe.

Source: Neuropsychopharmacology - Abstract of article: Effect of Chronic Exposure to Antipsychotic Medication on Cell Numbers in the Parietal Cortex of Macaque Monkeys

... Both typical (first generation) and atypical (second generation) antipsychotics are associated with an increased risk of stroke, Douglas said. ... The risk for stroke was slightly higher for people taking the newer atypical antipsychotics, compared with people taking the older typical antipsychotics. Atypical antipsychotics include drugs such as Abilify, Clozaril and Zyprexa. Typical antipsychotics include Thorazine, Haldol and Clopixol.

Source: http://www.nlm.nih.gov/medlineplus/news/fullstory_68678.html

Most Frequent Suspect Drugs in Deaths 1998 - 2005 [FDA Report]

Clozapine (Anti-psychotic): 3,277

Risperidone (Anti-psychotic): 1,093

Olanzapine (Anti-psychotic): 1,005

Source: FDA - Adverse Affects [PDF File]

When soldiers return from Iraq or Afghanistan, and they have suffered either emotional or physical wounds, especially Traumatic Brain Injury (TBI), they are sent to Warrior Transition Units (WTU’s). Some shocking news has come to light concerning the large numbers of deaths in these WTU’s. ... "suicide is not the major cause of death." That honor belongs to something being referred to as "sudden cardiac arrest." ... Naturally, these hundred of deaths are only the tip of the iceberg. Thousands of veterans return home on psychotropic drugs, and if they are not given psychotherapy or other non-drug interventions, we can only assume that this death toll will continue to rise.

Source: Soldiers are Dying and Not Just From Guns

RESULTS: Over the decade, 39 of the 88 patients (44%) died, with no instances of suicide. Reduced survival was predicted by increasing age, male gender, edentulousness and time since pre-terminal withdrawal of antipsychotics; additionally, two indices of polypharmacy predicted reduced survival: maximum number of antipsychotics given concurrently and absence of co- treatment with an anticholinergic...

CONCLUSIONS: Receiving more than one antipsychotic concurrently was associated with reduced survival, in the face of little or no systematic evidence to justify the widespread use of antipsychotic polypharmacy. Conversely, over-cautious attitudes to the use of adjunctive anticholinergics may require re-evaluation.

Source: Mortality in schizophrenia. Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study -- Waddington et al. 173 (4): 325 -- The British Journal of Psychiatry

... "there are studies that have shown that people treated with neuroleptics have changes in brain structure that are at least associated with drug treatment, dosage, and duration -- and have been shown to increase over time as drugs are given." He cites one "horrific study" of children between the ages of 10 and 15 in which the researchers measured the volumes of the kids' cortexes. "The cortex is what you think with, the part on the outside," Mosher explains. Over time, "They watched the cortical volume of these young people decline, while the cortical volume of the nonschizophrenic controls was expanding because they were adolescents and still growing." The researcher concluded that their schizophrenia had caused the decrease in the subjects. "And yet every single one was taking neuroleptic drugs"...

Source: http://laingsociety.org/colloquia/thercommuns/stillcrazy1.htm

I do think people should be able to make use of the tools they personally identify as helpful -- that includes anti-psychotic medication and even, highly controversial treatments such as ECT. But I also think they are entitled to full informed consent so they can determine if the potential benefits outweigh the risks. It also seems clear to me that if we can help people with minimal or no medication, we may be helping them best in the long run.

In order to adopt that standard of care we may have to:

- Recognize that medication has the power to help and the power to inflict grievious harm.

- Resist reaching for the easiest solution.

- Create safe containers where people can go to move through their crisis with emotional support.

- Learn to interpret and understand psychotic states of consciousness.

- Use medication only as absolutely necessary in the first several weeks of crisis. This may allow us to recognize those individuals who are capable of functioning well without medication.

- Maintain individuals on the lowest dose of medication as necessary to sustain function.

- Make use of therapeutic programs that will help individuals in crisis maintain or restore social roles and relationships that are so critical to rebuilding their sense of self-identity and thus, assisting them in their personal recovery.

[spiritual_emergency]

When I first came across the work of John Weir Perry (more than a year after my experience) and read about the Diabasis program I was somewhat surprised for the setting was very similar to the psychological space I had created for myself. That was a home environment with therapeutic care available around the clock, 24 hours a day, for about six weeks. If I needed to talk to someone, Gallagher was there. I experienced him as being completely separate from me at that time. He did and said things I never could have anticipated. Mostly, he listened. And sometimes, he held my hand. And when it was all done, we did something you're not supposed to do with your therapist but if your therapist is your Animus, you can probably slide your indiscretion past the ethics board.

Meantime, in spite of my fascination with Jung, spirituality and metaphoric modes of communication, I do believe I am well. I've noted that I have never seen a doctor, been hospitalized, recieved medications or formal therapy.

However, at the point my child was hospitalized I did speak candidly with one of their psychiatrists because I didn't want to hold back any information that might help my child. The expression on their psychiatrist's face grew quite concerned as I described what had happened to and with me. "That's schizophrenia," they said at one point. But when I explained that I'd not recieved any form of treatment, my relationships were healthy, I was working, etc., the expression on their face turned to puzzlement. "It couldn't have been schizophrenia then," they said, "because no one ever recovers from that."

Given that I was there to get help for my child and not for me, I didn't see the value in pressing the point. Nonetheless, I guess I can also say that at this point, I have seen a psychiatrist and they pronounced me well.

~ Namaste

See also:

- Schizophrenia & Hope

- What's Wrong With You?

- A Commentary on the Rosarium Philosophorum

Music of the Hour:

[spiritual_emergency]

Born to Perish: I suppose a mind cannot be well if it cannot be sick. What an interesting contradictory situation we have here.

Hello Born to Perish,

I missed your earlier comment but I have a little story that addresses the question you raise...

Once upon a time, way back in Greece, the word psyche meant soul. Then, much later, someone decided that word was too fuzzy, too imprecise so it was decided that the word psyche should mean mind. (Which people further associated with the word brain.)

The root iatry refers to the healing of and the root ology refers to the study of. Thus, psychiatry was the field for healers of the soul and psychology was the field for students of the soul. But then, all that changed and this is how healers and students of the soul became healers and students of the mind.

Do these questions sit differently if we ask:

Can the psyche be sick?

Can the psyche be well?

If so, what is the most effective healing agent?

[Guy Out There]

Is too forget, an act of ignorance or liberation?

I mention this quote (from my own deep thoughts) in the context that perhaps forgetting that you have a mental illness can liberate you, forget that it's an illness, it's not.

Can a mind be well?

What is well? That term is almost as ugly as 'normal'. There is no such thing as well or unwell in terms of the mind, compare me with a guy who has no mental health record, is he 'well' compared to me?

My mind simply has 'extra features' that help define me. I like the label 'me' because that is exactly who i am and you can diagnose and argue and label me all you like i'll never change, i'll never stop being me.

This is what happens when i get thinking, a splat all over these lovley forums.

[spiritual_emergency]

Guy Out There: I mention this quote (from my own deep thoughts) in the context that perhaps forgetting that you have a mental illness can liberate you, forget that it's an illness, it's not.

Here's the interesting thing... if schizophrenia is a disease, it doesn't behave like one in all people. If it did, no one could ever recover without the medications and we have data from numerous studies now that demonstrate that people do. What does strike me as remarkable is that so few people are aware of that.

[Guy Out There]

Guy Out There: I mention this quote (from my own deep thoughts) in the context that perhaps forgetting that you have a mental illness can liberate you, forget that it's an illness, it's not.

Here's the interesting thing... if schizophrenia is a disease, it doesn't behave like one in all people. If it did, no one could ever recover without the medications and we have data from numerous studies now that demonstrate that people do. What does strike me as remarkable is that so few people are aware of that.

Yeah sorry about my post, it doesn't make any sense at all, i wrote it when my mind was ('not functioning properly').

That's an interesting point you make also that schizophrenia doesn't behave like an illness in all people.

If it's not an illness then what can we call it? I don't think there is any one answer to that question, I guess everyone will have their own answer based on their own experiences for what some people see as an illness others see as 'the way they are' and others see it as a 'psychological problem' etc.

[finding my way]

Hi SE:). I just wanted to let you know there is Family Systems Therapy and there is Internal Family Systems Therapy. My last therapy was with the latter.

[spiritual_emergency]

GRAD STUDENT IN CLINICAL PSYCHOLOGY: "Dr. Laing, I still don't understand the theoretical basis of your therapeutic approach to schizophrenia. Could you please explain it?"

R.D. LAING: "Certainly. The basis is love. I don't see how you or I can be of any help to our clients in a visionary state unless we are capable of experiencing a feeling of love for them. Therapy, as opposed to mere treatment, requires that we have a capacity for loving kindness and compassion."

GRAD STUDENT (perplexed): "But Dr. Laing, what is your clinical methodology for developing this approach?"

Overheard at a talk given by R.D. Laing in New York

[spiritual_emergency]

A friend shared a link that I've been enjoying. It features Seikkula's Open Dialogue approach. I've spoken of this program up above. Those who passed through the program had very high rates of recovery with 85% working or going to school in a full-time capacity and 80% no longer experiencing psychotic symptoms after five years. Only 1/3 were ever medicated.

In the Open Dialogue approach, when a person or family in distress seeks help from the mental health system, a team of colleagues are mobilized to meet with the family and concerned members of the family’s network as promptly as possible within 24 hours, usually at the family’s chosen familiar location. The team remains assigned to the case throughout the treatment process, whether it lasts for months or for years.

No conversations or decisions about the case are conducted outside the presence of the network. Evaluation of the current problem, treatment planning, and decisions are all made in open meetings that include the patient, his or her social relations, and all relevant authorities. Specific services (e.g., individual psychotherapy, vocational rehabilitation, psychopharmacology, and so on) may be integrated into treatment over the course of time, but the core of the treatment process is the ongoing conversation in treatment meetings among members of the team and network.

... The drama of the process lies not in some brilliant intervention by the professional, but in the emotional exchange among network members, including the professionals, who together construct or restore a caring personal community...

CASE ILLUSTRATION: FROM FLASHBACKS TO LOVE

This single meeting ... embodies much of what we seek to explore in the dialogical treatment process. The network meeting was organized for Ingrid, a resident in a sheltered psychiatric residence. Her difficulties had emerged 9 years ago in reaction to an assault that she and her boyfriend had suffered on the street when three men, friends of Ingrid’s brother, had tried to rob Ingrid’s boyfriend. Ingrid had been injured when she tried to defend her boyfriend. She began to experience flashbacks of the assault and sought psychiatric treatment.

Quite soon after the assault, she disconnected from both father and mother, who had earlier divorced. Nothing seemed to help. The flashbacks, in the form of painful nightly dreams, came to invalidate her entire life. Ingrid was a pleasant woman, and everyone eagerly wanted to help her. Two contact nurses were responsible for her treatment and rehabilitation, working in collaboration with other social and health-care professionals.

Early in her career as psychiatric patient, Ingrid’s treatment team had tried to organize family meetings, which turned out to be unsuccessful because of the strong emotions involved. After many years of treatment, the team arranged a network meeting to plan for Ingrid’s treatment and future. The meeting, included Ingrid, her current boyfriend (not the one assaulted), her mother and father, her social worker, the two contact nurses, and her doctor. Although invited to the meeting, her brother did not appear.

The consultant asked the team members about their ideas for the meeting. They said that they wanted to reconnect the family relationships and discuss the future. The consultant offered open-ended questions to Ingrid and her family, wondering how they wanted to use the meeting time. Ingrid said that she was very tense and wanted to hear from her parents. They in turn said that they wanted to hear about Ingrid’s current life. Her boyfriend accused Ingrid’s parents of failing to support her rehabilitation by not being in any contact with her. The meeting was tense; Ingrid and her parents avoided looking directly at each other.

Ingrid’s mother began to talk about the assault, coming to tears as she spoke of feeling guilt about the event. She said that when she spoke with Ingrid’s brother, he blamed Ingrid’s boyfriend for what had happened. The consultant moved carefully to ensure that everyone had opportunity to express his or her concerns, aiming to move neither toward conclusions nor toward treatment planning decisions. One of the contact nurses burst into tears as she described her difficulties trying to help Ingrid without any remarkable success. The mood of the meeting became progressively sadder. Ingrid’s mother spoke of pining for the daughter she had loved so much when she was a child.

After the reflective dialogue, the consultant asked the family members if they wanted to comment on what they had heard. Ingrid’s mother had been listening to the team’s conversation in tears. Her father spoke of being moved by the dialogue and was especially touched by their affirmation of the family despite his own feeling that he had not done enough to reconnect. Ingrid’s mother said that she loved her daughter very much.

From my perspective as the consultant, I had been tracking verbal and gestural signs of emotional expression throughout the meeting, my own feelings resonating to the feelings in the room. I was moved by Ingrid’s mother’s expression of love and by the signs that the others in the room were deeply touched by her words. Ingrid and her mother took each other’s hand.

In a follow-up 1 year later, Ingrid remembered the meeting well. She said that it was one of the most powerful experiences of her life. She did not have a single flashback for 4 months following the meeting. Although the dreams of the assault occasionally recurred thereafter, she had managed to start vocational school with team support. She was no longer in a relationship with her boyfriend but was in contact with her mother and had visited with her father and his new family. She had met with her brother on one of her visits with her mother. They had had a couple of family meetings with the team as well.

THE SHARED EXPERIENCE OF EMOTION

Committed to responding as fully embodied persons, team members are acutely aware of their own emotions resonating with expressions of emotion in the room. Responding to odd or frightening psychotic speech in the same manner as any other comment offers a ‘‘normalizing discourse,’’ making distressing psychotic utterances intelligible as understandable reactions to an extreme life situation in which the patient and her nearest are living. ... In the case illustration, it was important that the emotions of the family members connected to the ‘‘not-yet-spoken’’ experience of Ingrid’s assault were expressed openly in the meetings in the presence of the most important people in Ingrid’s life...

The most difficult and traumatic memories are stored in nonverbal bodily memory. Creating words for these emotions is a fundamentally important activity. For the words to be found, the feelings have to be endured.

Employing the power of human relationships to hold powerful emotions, network members are encouraged to sustain intense painful emotions of sadness, helplessness, and hopelessness. A dialogical process is a necessary condition for making this possible. To support dialogical process, team members attend to how feelings are expressed by the many voices of the body: tears in the eye, constriction in the throat, changes in posture, and facial expression. Team members are sensitive to how the body may be so emotionally strained while speaking of extremely difficult issues as to inhibit speaking further, and they respond compassionately to draw forth words at such moments. The experiences that had been stored in the body’s memory as symptoms are ‘‘vaporized’’ into words.

... Before the meeting, network members may have been struggling with unbearably painful situations and have had difficulty talking with each other about their problems. Thus, they have estranged themselves from each other when they most need each other’s support.

In the meeting, network members find it possible to live through the severity and hopelessness of the crisis even as they feel their solidarity as family and intimate personal community. These two powerful and distinct emotional currents run through the meeting, amplifying each other recursively. Painful emotions stimulate strong feelings of sharing and belonging together. These feelings of solidarity in turn make it possible to go more deeply into painful feelings, thus engendering stronger feelings of solidarity, and so on. Indeed, it appears that the shift out of rigid and constricted monological discourse into dialogue occurs as if by itself when painful emotions are not treated as dangerous, but instead allowed to flow freely in the room.

Observing and reflecting on his experience participating in scores of network meetings, the first author began to recognize an emotional process that, when it emerged in a treatment meeting, signaled a shift out of monologic into dialogic discourse and predicted that the meeting would be helpful and productive. Participants’ language and bodily gestures would begin to express strong emotions that, in the everyday language used in meetings, could best be described as an experience of love.

As in the meeting with Ingrid and her social network, this was not romantic, but rather another kind of loving feeling found in families absorbing mutual feelings of affection, empathy, concern, nurturance, safety, security, and deep emotional connection. Once the feelings became widely shared throughout the meeting, the experience of relational healing became palpable...

Read more: Healing Elements of Therapeutic Conversation: Dialogue as an Embodiment of Love[PDF File]

Music of the Hour:

[IrmaJean]

R.D. LAING: "Certainly. The basis is love. I don't see how you or I can be of any help to our clients in a visionary state unless we are capable of experiencing a feeling of love for them. Therapy, as opposed to mere treatment, requires that we have a capacity for loving kindness and compassion."

Overheard at a talk given by R.D. Laing in New York

Wow. I am really liking that quote. Beautiful and powerful stuff...and undoubtedly true as well.

[spiritual_emergency]

RD Laing seems to be considered a scamp by many in the psychiatric community but I consider him to be one of the pioneers of the critical psychiatry movement.

Meantime, I came across a very good resource and collection of links for any who are looking for more information on the Open Dialogue approach, either as a form of treatment for themselves or a loved one.

The Open Dialog method has the best reported outcomes for any method of assisting those who are beginning to show “psychotic symptoms.” Rather than relying primarily on medications, it aims to facilitate dialog throughout a person’s close social network. You can find out a lot about it just by clicking on the links below.

- “Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies” Psychotherapy Research, March 2006; 16(2): 214_/228 http://psychrights.org/research/Digest/Effective/fiveyarocpsychotherapyresearch.pdf

- “Healing Elements of Therapeutic Conversation: Dialogue as an Embodiment of Love” Fam Proc 44:461–475, 2005 http://taos.publishpath.com/Websites/taos/Images/ResourcesManuscripts/seikkula-HealingElementsofTherapeuticConver.pdf

- “Open Dialogue Approach: Treatment Principles and Preliminary Results of a Two- year Follow-up on First Episode Schizophrenia” Ethical and Human Sciences and Services, 2003, 5(3), 163-182. http://psychrights.org/research/Digest/Effective/OpenDialogue2yfollowupehss0204.pdf

- “Open Dialogue in Psychosis II: A Comparison of Good and Poor Outcome Cases” Journal of Constructivist Psychology, 14:267-284, 2001 http://psychrights.org/research/Digest/Effective/OpenDialoguejoconstrudial2.pdf

- “The Open Dialog Approach to Acute Psychosis: It’s Poetics and Micropolitics” Family Process, Vol 42, No 3, 2003 http://www.theicarusproject.net/files/OpenDialog-ApproachAcutePsychosisOlsonSeikkula.pdf

- “Inner and outer voices in the present moment of family and network therapy” Journal of Family Therapy (2008) 30: 478–491 http://www.theicarusproject.net/files/OpenDialog-InnerOuterVoicesFamilyNetworkDialogSeikkula.pdf

- “Open Dialogues with Good And Poor Outcomes For Psychotic Crises: Examples From Families With Violence” Journal of Marital and Family Therapy July 2002 Vol 28 No 3 263-274 http://taos.publishpath.com/Websites/taos/Images/ResourcesManuscripts/seikkula-OpenDialoguesWithGoodAndPoorOutcomes.pdf

- Family and Network Therapy Training for a System of Care: “A Pedagogy of Hope:” [in Lightburn, A. & Sessions, P. (Editors). (in press). The handbook of community-based clinical practice. New York: Oxford University Press.] http://www.theicarusproject.net/files/OpenDialog-PedagogyOfHopeFamilyNetworkCurriculumOlson.pdf

- Book chapter on Scandinavia/Finland approach to psychosis: http://www.theicarusproject.net/files/OpenDialog-KjellbergChildAdolescentPsychiatryNorthernSweden.pdf

- “A TWO YEAR FOLLOW-UP ON OPEN DIALOGUE TREATMENT IN FIRST EPISODE PSYCHOSIS: NEED FOR HOSPITALIZATION AND NEUROLEPTIC MEDICATION DECREASES” Published in Social and Clinical Psychiatry. 2000, 10(2), 20-29. http://www.talkingcure.com/docs/jaako_seikkula_paper.rtf

- “Dialogue Is the Change: Understanding Psychotherapy as a Semiotic Process of Bakhtin, Voloshinov, and Vygotsk” http://spiritualrecoveries.blogspot.com/2006/05/dr-jaakko-seikkula-dialogue-is-change.html

- Madness Radio: Open Dialog Alternative, interview with Mary Olson http://www.madnessradio.net/madness-radio-mary-olson-open-dialog

- Mary Olson on VoiceAmerica http://www.voiceamerica.com/voiceamerica/vepisode.aspx?aid=44519

- A PowerPoint: http://www.health.bcu.ac.uk/ccmh/2008update/JS.pdf

Source: Recovery From Schizophrenia and Other Psychotic Disorders

[spiritual_emergency]

This program is out of Sweden.

[spiritual_emergency]

"All of us could have psychotic problems. It's an answer to a very difficult life situation. It's in a way, a kind of metaphorical way to speak of things that beforehand did not have anywhere they could be spoken of."

-- Jaakko Seikkula, clinical psychologist/founder of Open Dialogue Treatment

This is the land of open dialogue where for more than twenty years, they've been documenting their results which are the best in the western world, to the extent that schizophrenia is now disappearing from their region.

They're down to 2 cases per 100,000. A 90% decline in schizophrenia! And why? Because their first-episode cases are not becoming chronic.

- Robert Whitaker, author of Anatomy of an Epidemic

Video Trailer: Open Dialogue Treatment:

[spiritual_emergency]

Thoughts from Daniel Mackler, the film-maker of the Open Dialogue Documentary...

My Reflections on the Finnish Open Dialogue Project

Daniel Mackler

In June of 2010, I visited Western Lapland in Finland for two weeks. My goal was to make a documentary film on the Open Dialogue project. Although the film is now complete, and I feel it tells their story fairly well, there remains a lot that I left out — things I somehow, for one reason or another, couldn’t capture on camera.

I want to share a few of those missing things here. I first want to share my impressions of arriving at the Keropudas Hospital in Tornio, Finland, which is the nerve center for Finnish Open Dialogue. It all began there, almost thirty years ago. I actually stayed on the hospital grounds for my two weeks in northern Finland, so I had a lot of time to spend wandering around the hospital, talking with patients, and just watching how life unfolded on a day-to-day basis, and in the evenings too. Because of the Finnish confidentiality rules, however, I was not allowed to film patients — which was very disappointing and frustrating for me — but the administrators did let me talk with whomever I wanted, ask whatever questions I wished, walk freely inside the hospital without a pass or escort, and even visit their locked ward whenever I wanted, which I did often. Oddly, no one seemed to mind what I did there, or where I went — they really let me go free. I also sat in on many Open Dialogue therapy sessions, which, again unfortunately, I couldn’t film, but I did come away with impressions. Many.

Meanwhile, my first impression of arriving at the hospital: it was shocking. The reason: the first people I saw when I arrived at the hospital were several — maybe six or eight — very troubled looking, middle-aged or elderly men and women shuffling around outside the hospital entrance and inside the hospital lobby looking quite drugged, and some seeming to be experiencing serious long-term neurological side-effects from anti-psychotic drugs. Also, some were mumbling to themselves, and a few immediately recognized me as a new visitor, approached me, and begged for cigarettes.

What shocked me was that I had trouble believing that this was Open Dialogue, the place supposedly getting the best results in the world for the treatment of psychosis. To be frank, this looked like one of the worst hospitals I’d ever been to!

Interestingly, I’d come to Finland armed with questions and criticisms, and ready to really “get to the bottom” of Open Dialogue — to find out, at some level of confidence for myself, if they were really any good, or if their great results and reputation were really all a fantasy. But I certainly wasn’t expecting this. I thought I was going to have to dig, and dig hard. Instead I found the criticisms right on the surface. ...

What I found out later, however, was fascinating, and quite the opposite of my first impression. These folks had been long-term hospital patients at Keropudas Hospital back from the days prior to Open Dialogue. Some of them had been around since the 1970s — back when Western Lapland, I have since been told, was getting some of the worst outcomes for schizophrenia in Europe, back when there was no Open Dialogue, and back when everyone with issues labeled as psychotic was getting heavily medicated. These folks I met were the people who didn’t recover — and hadn’t been able to integrate living in the community. These were the people labeled as “failures” of a failing and quite traditional psychiatric system.

I also learned that in recent years, since the development of Open Dialogue, the therapists and psychiatrists had tried, sometimes several times with different people, to help these long-term patients taper off their neuroleptics, with often terrible results. They simply were too neurologically impaired by the drugs themselves, over too many decades, to be able to get off them. So presently they were on the lowest doses they could tolerate.

That was the first point: that these people were actually no reflection whatsoever on the success of Open Dialogue, but instead reflected the horror of the previous system. ... Doing a little digging, I asked the clinicians if they felt any motivation to keep these folks out of the public eye, and they looked at me horrified. “Why would we do that?” they replied. “They have as much right to be here as anyone else!”

I smiled. I agreed.

A second key thing I learned about Keropudas Hospital, which, like most mental hospitals, is placed on the far outskirts of town (in their case, on the edge of the forest), is that it’s a rather large hospital that is relatively unused. There are one or more whole wards that are unused. I remember visiting one. It looked like an average, spacious hospital unit, but it was silent — and empty. It was dusty. Nothing was happening there. And the reason: they no longer have patients for them. They’ve developed such an effective system of helping people get well from psychosis, and get permanently out of the psychiatric system, that they no longer need so many beds. (No wonder they have some of the lowest per capita spending for psychosis anywhere in Finland — at least that’s what I’ve heard. When people get fully well, and are able to get off all their psychiatric drugs, they save the system a lot of money.)

Also, much of the work they do helping people with psychosis, most of it, in fact, has nothing to do with the hospital itself. In most cases they don’t prefer that people in crisis come to the hospital, and they don’t even do much therapy in the outpatient clinic that is located at the hospital. In fact, their hospital outpatient clinic has only one therapy room — one therapy room to serve a population of around 70,000 people!

Granted, the Open Dialogue clinicians do have an outpatient therapy clinic in each of their catchment area’s two largest towns (Tornio and Kemi), but they even prefer to avoid using these clinics for therapy, if at all possible. Their best preference is to meet in people’s homes. The therapists, usually a team of two or three trained family therapists, travel to the homes of the people in crisis. The clinicians made a point of telling me repeatedly that they saw no value in having people come to the hospital for therapy, because of the stigma. They felt that if they could help people get better at home, in their natural environment, then it was all for the good. Also, the clinicians told me repeatedly that they learned far more from people by seeing them in their homes than they could ever learn by seeing them in such an artificial place as a hospital or clinic. ...

What I heard from the Finnish people seeking help was that they felt the Open Dialogue system was fair — and honest. They also told me repeatedly that it felt “normal” to them. They used those words repeatedly. Interestingly, most of them seemed to have no idea that psychiatry was commonly hated and mistrusted in many other parts of the world, and even in parts of their own country. In fact, when I explained this to them many were genuinely surprised, as it contradicted their experience. This led them to tell me other things they liked best about their system. And they liked many things.

They liked the openness and frankness of the therapists. They liked it that above all else their own voices were heard and valued. They liked it that they had a key say in the decision about whether or not psychiatric drugs might be of benefit to them or not. They liked it that they had alternative options to drugs presented to them. They liked it that when they were in crisis they could invite their family and friends and other important people from their lives into therapy meetings — if they wished.

They also liked it that the therapists worked in teams, right in session — because they liked listening to what the therapists had to say to each other, in the middle of session. They told me that they felt they deserved to know what the therapists were thinking! And doesn’t it make logical sense?

They also told me that they liked it that their therapists met with them immediately in their crises, and didn’t put them off for months on endless, bureaucratic waiting lists. They liked it that therapists gave them the choice of meeting in their own homes or in clinics. They liked it that hospitalization was only used in cases of dire safety issues, and that hospitalizations were generally quite short. And they also liked it that visitors like me were so interested in what was going on with Open Dialogue — and were also interested in their lives. Many of them wanted to know what I myself thought of their lives, their situations, and of their therapy too. And, because it was Open Dialogue, and because I felt safe there, I shared my opinion. And they valued it. And it even felt therapeutic — which felt good to me. ...

Read the full interview here: Beyond Meds: Open Dialogue Treatment

[spiritual_emergency]

They're down to 2 cases per 100,000. A 90% decline in schizophrenia! And why? Because their first-episode cases are not becoming chronic.

- Robert Whitaker, author of Anatomy of an Epidemic

I'd been curious about that quote of Robert Whitaker's. I wanted to know what the rate of schizophrenia was before because I recalled that it was considered to be quite high. I found some information on that tonight...

The province of Western Lapland (72 000 inhabitants during the study periods, 1992-1997) lies to the north of the Gulf of Bothnia and shares a border with Sweden. The southern part of the region, where most of the population lives, is industrialized. Linguistically, ethnically and in religion the population is homogenous; over 90% are Finnish-speaking Lutheran Finns and live within 60 kilometers of Keropudas hospital.

The incidence of schizophrenia has been extremely high: in the mid 1980s, for example, an annual average of 35 new schizophrenia patients per 100,000 inhabitants, average being 13/100,000 in the rest of Finland (Salokangas et al., 1991)\

Source: Open Dialogue Approach: Treatment Principles and Preliminary Results of a Two-year Follow-up on First Episode Schizophrenia [PDF File]

[spiritual_emergency]

A treatment facility offering the Open Dialogue approach will be opening soon in the US. I'm told this is affiliated with Mary Olson, who worked with Seikkula in Finland.

Welcome to

www.opendialogueapproach.com

Mill River Institute

Our site is under construction and will be available soon.

We can be reached by phone at 413-237-2528

or by email at: brassworks.millriver@gmail.com

http://www.opendialogueapproach.com/

I imagine they'll have more business than they can handle.

[Sissagwaad]

Wow. I am really liking that quote. Beautiful and powerful stuff...and undoubtedly true as well.

Absolutely the key to efficasy in fascilitating an explorer to plumb themselves for the answers they have within.....is the safety of knowing one is authentically loved, loveable and acceptable.....it provides a safe place to begin the exploration, discovery and reclamation of self... This efficasy is what works for the Option Process in Sheffield Mass. It is also 'the stuff' of which Patch Adams illuminates and shares with his vision and passion.

[Sissagwaad]

the quote we're both replying to is:

R.D. LAING: "Certainly. The basis is love. I don't see how you or I can be of any help to our clients in a visionary state unless we are capable of experiencing a feeling of love for them. Therapy, as opposed to mere treatment, requires that we have a capacity for loving kindness and compassion."

[Born to Perish]

The most effective healing agent when it comes to things like: Anger and depression is LOVE. Anything else is a "physical" not "mental" problem. Example: Brain abnormally produces certain things or doesn't get enough of this or that.-Physical illness. Mental- "Not brain related", but mental as in: "Within the imagination".

[spiritual_emergency]

Some additional information that has come to me tonight regarding Open Dialogue Treatment in the US.

The writer of this piece, incidentally, is Daniel Fisher. Dan Fisher was diagnosed with schizophrenia as a young man. He then went on to make a full recovery and to train as a psychiatrist. In addition, he runs the National Empowerment Center which hosts a website with many informative articles and resources on recovery.

Open Dialogue has created a great stir since its public introduction to the United States two years ago through Robert Whitaker’s book, Anatomy of an Epidemic, and Dan Mackler’s film, “Open Dialogue.” This enthusiasm has been particularly marked in Massachusetts. This is partly due to the presence of Professor Mary Olson of Smith College.

Prof. Olson is the only certified trainer of Open Dialogue in the US. In 2001, she spent a year as a Fulbright Scholar at the University of Jyvaskyla where she met Jaakko Seikkula, one of its developers and a faculty member. Already teaching dialogic-systems ideas, she teamed up with Jaakko to do a study of Open Dialogue (Seikkula and Olson, 2003). They have continued to collaborate since (Olson, Laitila, Rober & Seikkula, in press). She is planning a pilot study of this new approach at U. Mass. Medical School.

Further, this past year, Mary established The Institute for Dialogic Practice in the Pioneer Valley (with Jaakko Seikkula, Marku Sutela, and Peter Rober) and began teaching a yearlong course on Open Dialogue to 28 peer and non-peer providers. Advocates, a community mental health center in Massachusetts, is sponsoring 15 of its staff to attend the training.

In addition, the peer-run Recovery Learning Community of Northeastern MA has been conducting introductory workshops. Though developed and practiced by professionals in Finland, this approach is extremely appealing to peers with lived experience of recovery here in the US (in our movement, there is growing dissatisfaction with the term “consumer,” because of its passivity and commercial connotation, so we are using “peer” or “person with lived experience”).

Source: Dialogical Recovery from Monological Medicine

See also: National Empowerment Center