Robert Whitaker at Gothenburg

So, I went to Gothenburg, Sweden, last month where Robert Whitaker was giving a talk about his latest book Anatomy of an Epidemic, a lecture arranged by the Family Care Foundation.

The point of departure in his book is Whitaker's puzzlement about, that despite the claim that pharmacological treatments have improved treatment options within psychiatry, and therefore the lives of “mentally ill” people, an increasing number of these “mentally ill” people become chronic, on disability pay, suffering through more and more serious “side”-effects, and exposed to a greater and greater risk of early death.

To find answers to his questions, Whitaker conducts a thorough review of the research in the field of psychopharmacology in its entirety, and concludes that the picture painted by this research is somewhat different than the one psychiatry has delivered to the general public.

Whitaker's book, like its predecessor Mad in America , is a disturbing read. One thing is to see how the actual science in the field clearly and unmistakably proves psychiatry's storytelling about biological brain diseases and the superiority of psych drugs in their "treatment" to the public over the past decades to be just that: storytelling, with no basis whatsoever in any scientific evidence. This is what everyone familiar with the scientific research has known for a long time. Another thing still is to see the suspicion, which even many critics will not dare to covet: that psychiatry – almost from the outset – has understood that its own tales of the wonders of  psychopharmacology are lies equal to the stories of biological brain illnesses, so unmistakably confirmed in Whitaker's book by quote after quote of “expert” statements about the matter.

Like most other critics, Whitaker ended his lecture with the inevitable, politically correct: "I do know, that many people feel they are being helped by psychiatric medications, so there is a place for these drugs in treatment."

In the discussion that followed, I asked him why, after just presenting the scientific data - which all state one thing: that if people feel helped by psych drugs, then this must be attributed to either a placebo effect, and/or simply the fact that their judgment is impaired due to the drugs' influence, so in actual fact, there is no place for the drugs in "treatment",  in as far as this "treatment" is meant to truly help people in crisis - he still decided to end his presentation with what could be described as an apology for said presentation.

In the last chapter of Anatomy of an Epidemic, Whitaker takes a thorough look at the Finnish Open Dialogue approach, which, with its well-documented effecacy, is an alternative to the current biomedical approach to emotional crisis. Yet even Open Dialogue uses psych drugs -- in a very limited capacity, especially when it comes to "anti"-psychotics, and only as a "last resort". In answer to my question, Whitaker said he would like to see projects like Open Dialogue initiated, but with just one difference: no use of psych drugs at all. I would really like to see that, too! Like  Whitaker says, mankind has survived for thousands of years on this planet, without these drugs, so…

 

 The slides for Whitaker's presentation are here.

Thanks to Paul Englar for his huge help with the translation of this blog post.

Healing Homes. A new film by Daniel Mackler

Yesterday morning, Daniel Mackler's new film Healing Homes. An Alternative, Swedish Model for Healing Psychosis was in my mailbox. I've watched it four times since then.

If you know Daniel's previous film, Take These Broken Wings, this one is different. Healing Homes is an informal, often contemplative, and also raw, and at the same time very intimate and personal film.

Instead of the carefully staged interviews we saw in Take These Broken Wings, in Healing Homes Daniel Mackler takes a step back as a director, and leaves the scene almost entirely to the participants in the film, joining them only as just one more participant himself. This allows him to capture the essence of what Familjevårdsstiftelsen, the Family Care Foundation, in Gothenburg, Sweden, is all about: fearless openness and authenticity. Take These Broken Wings showed us, in a very professional way, how full recovery from "psychosis"/"schizophrenia" without drugs is possible, even likely, with the help of a professional therapist. Healing Homes goes further, not only explicitly revealing a truth about the human being Carina Håkansson, founder of the Family Care Foundation, but indeed revealing the truth about crisis to be a state of being human to an extreme extent that can be understood and overcome with the help of other human beings who are not afraid to be extremely human themselves. This is what this film is about. The healing power of being oneself, genuinely, uncompromizingly. And not just behind the closed door of a therapist's office, but in all life situations, which is what the family home, "det utvidgade terapirummet", the extended therapy room, invites to.

Just like Daniel Mackler himself, I'm quite suspicious of professionalism in the field. As the Norwegian psychologist Christian Moltu wrote in his article "Det konkrete, mellommenneskelige" (The actual, interpersonal) in 2009, all too often therapists make use of therapy techniques, of their professionalism, as a kind of shield they can hide behind whenever they don't manage to stay present, and truly meet their clients where these are at. Healing Homes nevertheless has convinced me that professionalism can be of great value if it is used as a means to prevent exactly this distancing, alienating, the other dehumanizing use of itself, if it is used to help the therapist, and whoever else interacts with a person in crisis, stay present with the person in any given situation by being "professionally" human, conscious about and self-aware of one's own as well as the person in crisis' humanness.

"It's about people, and... people. Giving love to people", Therése says in the film about the Family Care Foundation. And it is what the film not only is about, but what it actually does, fearlessly and uncompromizingly with great respect and love allowing people to be who they are. I've watched Healing Homes four times now, each time discovering new, fascinating details. It's a film I'll watch again and again. For the details, but first and foremost for its love for people that is the magic behind the success of the Family Care Foundation as well as the magic of this film.



Order the film here: http://www.iraresoul.com/dvd2.html, and watch it, again and again.

Robert Whitaker, Keynote at Alternatives 2010

Robert Whitaker - Alternatives Keynote from National Empowerment Center on Vimeo.

The NEC apologizes to Will Hall

For whatever reason -- could it be the massive protest on Facebook?... -- the organizers of Alternatives 2010, the NEC, apologized to Will Hall, and restored his workshop in its original form. Will Hall has agreed to withdraw his cancellation, and to do the workshop as planned. Yay! Have a great conference, everybody!

http://www.madnessradio.net/update-coming-off-medication-workshop-restored

Alternatives 2010 censors Will Hall

Yup, first they try to keep Bob Whitaker from talking, and now they've decided that Will Hall may not include coming off drugs at his workshop. A workshop about choice in regard to drugs, where you may not talk about coming off?? Sounds sort of meaningless, I'd say. "Alternatives" my ass!

Here's the press release:

MENTAL HEALTH CONFERENCE CENSORSHIP

Coming Off Medications Workshop Censored at 'Alternatives 2010' Mental Health Conference

Alternatives, the mental health consumer/survivor conference with more than 1,000 participants annually, has withdrawn its previous approval for a workshop on coming off psychiatric medications.

The workshop, based in a pro-treatment choice, harm-reduction philosophy, was to share information about continuing, reducing, or coming off medications. After approving the workshop in June, the National Empowerment Center, which organizes the conference to be held in Anaheim California, made a last-minute decision to change the title and description to remove any reference to coming off medications. Will Hall, an internationally-recognized schizophrenia survivor and radio host who was set to lead the workshop, decided that he could not go along with the decision and will not be attending the conference. "Coming off medications is a topic vital to wellness and recovery, and should not be censored," he said.

The controversial move by the National Empowerment Center comes in the wake of a recent similar decision to bar Robert Whitaker, a Pulitzer finalist investigative journalist whose work spotlights medication dangers and growing evidence that non-drug alternatives work better for some patients. Whitaker was restored as a conference keynote speaker only after mental health advocates mobilized quickly on the internet to challenge the decision.

The annual Alternatives conference is organized by consumer/survivor groups and federally funded. With workshops ranging from wellness, youth, housing, employment, advocacy and diversity issues, Alternatives is the country's most prominent gathering for mental health consumers, who attend from all US states and as far away as Guam. Medication issues, however, have consistently been excluded from the program.

Hall, who works as a therapist, says he is not anti-medication and does not give medical advice, but instead educates individuals, families, and health care providers to make more informed choices. "People are caught between pro-drug marketing by pharmaceutical companies and the anti-drug message of some activists. We need honest and unbiased information about psychiatric medications, including assessing drug risks and discussing how to come off drugs safely when they aren't right for you. Many people find medications helpful, but there are huge dangers involved, and sometimes it's better to reduce medication or slowly go off."

After several hospitalizations and a diagnosis of schizoaffective disorder schizophrenia, Hall has been medication-free for more than 17 years. He says a combination of holistic health, support groups, and spiritual practice nurtured his recovery from mental illness, but believes that "each person's path to recovery is different. My work fills a great need for information, and it's a shame this topic is censored at a national conference that claims to be dedicated to
wellness and calls itself 'Alternatives.'"

Hall is the author of the Harm Reduction Guide to Coming Off Psychiatric Medications, published by mental health peer groups The Icarus Project and Freedom Center. The guide, available freely on the internet, has been distributed to more than 15,000 people and is available in Spanish and German translations.

http://theicarusproject.net/HarmReductionGuideComingOffPsychDrugs

--
http://www.willhall.net

http://www.madnessradio.net/coming-off-medications-workshop-censored

How to make a shrink shit his pants

Visiting David M. Allan, M.D.'s blog, your first impression might be a rather positive one. He seems to have got at least something. And yes, he has got something. But, alas!, when it comes to so-called "schizophrenia" the guy hasn't got a clue. No more than any other of the drug-pushers in the business. Watch this - the comments. Watch him get increasingly insecure, defensive, and eventually almost hostile *), although I'm really gentle with him, if I may say so myself.

Isn't it just mind-boggling? I mean, wouldn't you expect someone who has dedicated his professional life to helping people to be curious about different perspectives and opinions, instead of being this dismissive of them, and unwilling to give them a thought? Where's the problem, Dr Allen? Oh. I see, two main problems: 1. If I'm right, it means there would basically be no need for you as a shrink anymore. There would be no need for any shrink anymore. You would have to find yourself another job, maybe even give up on the "M.D." as other medical specialities have certain standards... And if you want to stay in the business, you'd have to start from scratch, as all you've been taught so far is how to help society - get rid of people in emotional distress, as discrete, fast and efficient as possible. You haven't been taught how to help people in emotional crises themselves. 2. If I'm right, and you want to stay in the business, you'd have to do something radical about your fear of yourself, your own "issues", or dysfunctionality... Ugh, yeah, that's tough! Especially the latter is a really nasty one. For any narcissist.
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*) Any resemblance with adjectives you might catch Dr Allen scribble down in his "patients'" charts is intentional. :D
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Oh and, note that in his last comment Dr Allen writes "True psychosis is never a normal variant of anything." This statement doesn't really make much sense, unless you take Dr Allan's at this point presumably rather "disturbed" state of mind ("disturbed" as in "psychosis", yup) into consideration. What he seems to try to say is that true "psychosis", that is being truly disturbed (by/about something)..., has got nothing to do with being human. So, when someone is "psychotic" (disturbed, by/about something, my or Dr Allan's statements for instance...) s/he is not really human. Aha. So much for seeing the person, and not the diagnosis. Thank you for clarifying this for us, Dr Allan!

"Are you riding yet, or are you still rolling?"

I found this at Wu Wei Verlag's website, a German publisher specializing in, among other things, publications critical of our culture's increasing violence and abusiveness in the field of equitation, which especially the "Rollkur" *) - which means forcing the horse to bend his neck to a point where his nose almost touches his chest, an unnatural position and extremely damaging especially to the horse's upper vertebrae (though in a broader sense damaging to his entire body and soul) - is an expression of.



The text says: "Are you riding yet, or are you still rolling?" It reminded me of what one of my trainers used to say, that the motto of dressage competitions should be "Look what I'm NOT able of!"

Any parallels to the mh system? Well, if you ask me, the whole mh system is an expression of what its professionals are NOT able of, and one could ask them: "Are you helping people yet, or are you still oppressing them?"

Via Camera-Obscura
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*)The English term is hyperflexion.

The OPUS Trials - comparing drug "treatment" to drug "treatment"

Here you can find an overview in English over the research I referred to in both yesterday's post and this one from March 16.

While you scroll down to the "Funding" section at the bottom - and I'll get back to why you might want to have a look at this section -, don't be fooled by the charts. It's the figures that count, not the bars or lines. And the figures tell us that OPUS indeed works significantly better than "treatment" as usual. Well, at least in regard to "treatment adherence", "compliance" that is, and in regard to indoctrinating parents/family - which, on its part, certainly contributes to the higher "treatment adherence" achieved in an OPUS-setting compared to "treatment" as usual. Otherwise, thus also in regard to outcomes, differences are rather insignificant.

As I suspected in my previous post, the research was only and solely designed to compare OPUS to "treatment" as usual, and thus did not follow up on people who decided to take another, potentially more promising, route to recovery, than OPUS or "treatment" as usual. While these people seem to make up a considerable amount in both groups. Almost half of the initial participants in the study did not respond to the five-year-follow-up interview. Some of them certainly because they've become wiser than to remain uncritically cheerful about the received "treatment" in the meantime.

Of course, it is very nice that the dosage of neuroleptics in an OPUS setting, presumably thanks to the massive indoctrination and rat training offered by OPUS, is kept about 20% lower than in a "treatment" as usual setting. Nevertheless, this still is no reason to get over-the-top enthusiastic about OPUS as people in "treatment" as usual settings often are senselessly overdrugged, meaning that people in OPUS settings are just a little less overdrugged, and, well, as there still is a looong way from a little less overdrugged to the barely drugged at all of alternatives like Soteria or Open Dialog.

Did you scroll down to the "Funding" section? If so, you'll maybe remember that I referred to Merete Nordentoft as the Danish Fuller Torrey. Yup, also The Stanley Medical Research Institute funded this research project. Is it any wonder that drug-free, non-medical alternatives were of no interest to the researchers, and that learning to live with a chronic illness through OPUS is hailed to be as good as it can get?...



Best buddies
(How I wish I had Photoshop!)

Why Merete Nordentoft's recent research showing "schizophrenics" to do better without drugs won't change a thing about treatment

Well, in short, because the 19% of study participants reported to be "fully recovered" aren't really fully recovered, but rehabilitated.

A follow-up article in the Danish journal Dagens Medicin portrays Mai Pedersen, a 30-year-old with a high school exam (it's the smart ones who do best, remember?), and with some of the most loving and supportive parents imaginable (it's the ones with a truly idyllic family background who do best, remember?), who was labelled "schizophrenic" seven years ago, put into OPUS (Merete Nordentoft's early intervention program) and on drugs, of course, both neuroleptics and "anti-depressants", and who decided to go off the drugs some time ago. The latter actually, and this is the really disturbing part as the article's title, which translates into "Went off medication - and didn't ask for permission before afterwards", indicates, without asking permission from her shrink. Imagine! She didn't ask her shrink before tapering off the drugs!! How incredibly cheeky!*)

Although Mai Pedersen doesn't take any drugs today, she is "symptom-free". So, according to the article, Mai Pedersen is "fully recovered". But is she really? Mai Pedersen has an enemy. The enemy is stress. And it still has that much power over her as to have her weigh everything she does in regard to how the enemy "stress" probably will react to it. Mai Pedersen has, certainly thanks to CBT-rat training (and yes, it may well make training progress come more swiftly and be more lasting if the rat has some brains), and thanks to her wonderfully supportive parents (yes, relatives can play a decisive role when it comes to "insight" and "compliance", the better they manage to hide their own dysfunctionality behind a facade of pure family idyl, the more of a "support" - for biopsychiatric "treatment" - they will be) learned to live as a victim of "schizophrenia", a slave of a chronic brain disease. She has accepted that nothing ever will come as easy to her as it does to her "normal" friends and acquaintances, that she will have to make sacrifices to the "illness" for the rest of her life, that the "illness" dictates what she can and can't do, and that she maybe even will end up in hospital again, and again, and again... - And btw, take a look at the photograph at the top of the article, and note how beautifully it communicates the heavy burden of suffering from "schizophrenia".

Mai Pedersen succeeded in becoming a licensed psychomotrician, and is a member of the OPUS-panel, which "tries to spread information in the community about the many success stories that show also patients with schizophrenia to be able to live rewarding lives." A real success story. Or, as Mai Pedersen puts it herself, "a lousy Danielle Steele novel". Indeed!

Well well, here it is that I ask, how about a panel to try and spread some information in the community about the many real success stories that show labelled people to be able to overcome their crisis, and live a life without "schizophrenia", without constantly having to be on their guard against an enemy called "stress", without massive limitations and sacrifices, and without having the spectre of returning "psychosis" and re-hospitalization hanging over their heads?? How about a panel to try and spread some information in the community about real recovery, real freedom, to be possible??

But alas, such a panel would probably not consist of a bunch of happy and grateful OPUS-patients (and Mai Pedersen is still a patient today, she still sees her shrink on a regular basis, apropos of "fully recovered"...), a bunch of Elyn Sakses, who identify as being "mentally ill", as suffering from a chronic brain disease by the name of "schizophrenia". So, it is rather unlikely that we will see such a panel initiated by the establishment anytime in the foreseeable future. Just as a paradigm shift in the definition and treatment of crisis is unlikely to happen as long as the Mai Pedersens and Elyn Sakses of this world aren't only made slaves of an alleged illness, but also, and even more important, of a system, that (ab-)uses them big time to sell its hopeless messages and harmful "treatment" to the community.

To get back to Merete Nordentoft's research, the rate of 19% "fully recovered" participants is obviously an error, resulting from an erroneous concept of "full recovery". The true figure probably is closer to 0%, as the study apparently was not designed to include participants, who dropped out of "treatment", but seems to exclusively have concentrated on individuals, who stayed in contact with the mh system throughout the entire five years during which they were monitored. If this is the case, and I have a very strong hunch that it is, not least because the article in Dagens Medicin otherwise probably would have portrayed someone else instead of Mai Pedersen, real full recovery of course is excluded in advance from figuring in the results as a possible outcome. I suppose, this is what is called "biased" then.

A high school exam, the ability to think clearly, and a supportive network, family or other, are without doubt useful in the recovery process. But there is one more important thing , maybe the most important of them all, in terms of recovery that isn't mentioned anywhere in context with Merete Nordentoft's research, and that thing is what Al Siebert termed "resilience". The ability to "resile", or resist (without breaking your neck over it), for instance the massive indoctrination labelled people usually face in the mh system. The ability to preserve one's integrity in an environment designed to strip you entirely of it. Mai Pedersen had the high school exam, but unfortunately she didn't have the amount of resilience necessary to achieve real full recovery, and I also wonder if she would have had her family's support in case she had had the necessary amount of resilience, and had chosen to opt for freedom, instead of for slavery.
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*) The title of the article caused some indignation among consumers/survivors, and gave rise to an interesting discussion at a Danish mainstream forum. - Of course I simply had to set the cat among the pigeons... :D - I will write about my thoughts on the matter in a future post here.

Bye bye, Merete! - Some final thoughts about Merete Nordentoft's study on "schizophrenia" outcomes

Bottom line: if people weren't doped up over their eye balls with consciousness reducing, brain damaging drugs, if they weren't told depressing, demoralizing and pacifying lies about a chronic, biological brain disease, but encouraged to look for the existential, spiritual meaning of their personal crisis, there'd be a lot more than 19% who'd recover fully. It's still a long way from these 19% to the 85% of alternatives like Soteria.

Merete Nordentoft wants the period people are "treated" under the OPUS project to be extended from two to five years. Half of the participants in the study were "treated" under OPUS during the first couple of years. The article doesn't say anything about these participants doing better than the other half, on the contrary: "We don't know to what extent the prognosis depends on the treatment, even if some individuals certainly have improved thanks to the treatment." -Merete Nordentoft, in perfect self-contradiction, as well as in perfect contradiction to her own research results.

I'd say, what we'd really need isn't more OPUS, but to have the Danish Fuller Torreys (yes, Merete Nordentoft really believes there's something to Fuller Torrey's cat poop nonsense... ) replaced by Loren Moshers. The whole incompetent (they can't even interpret their own research results) bunch of them. Merete first.
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Related: "New Danish research shows that 'schizophrenics' do better off drugs"

"More about Merete Nordentoft's surprising (NOT!) research results on 'schizophrenia'"

More about Merete Nordentoft's surprising (NOT!) research results on "schizophrenia"

The main emphasis of the article, whose title translates into: "High school certificate a good weapon against schizophrenia", is on the role of education in terms of recovery from so-called "schizophrenia".

The researchers followed 547 people labelled with "schizophrenia" over a 5-year-period.

Results: 19% achieved full recovery, most of them, as mentioned in my previous post, were not "treatment compliant", respectively didn't use psych drugs at all. 15% achieved significant improvement. 53% didn't achieve lasting improvement, but are able to live independently, and without longer hospitalizations. 13% are dependent on assisted housing, or need long-term hospitalization.

Among those who achieved full recovery or significant improvement, a higher education is prevalent, most of them are women, and most of them come from a family background with both parents living together. On the other hand, "negative symptoms" like social withdrawal and passivity indicate a less favorable outcome.

Education: the so far only comment on the article at Dagens Medicin (the journal only allows professionals to comment... ) concludes that a higher education equals to a higher IQ which equals to more benefit from CBT - "something we've known for a long time".

In my opinion, a higher education equals to the ability to search for information on one's own, if necessary - and when it comes to "mental illness" it is necessary, since true information in Danish is thin, to put it mildly - also information in foreign languages like English. Information that may have the individual choose to, by and large, do without neuroleptics, that may have him/her question the (Danish) mh system's messages about a chronic, biological brain disease, and that may have him/her investigate into alternative views of the experience. A higher education often equals to a stronger belief in one's own intellectual capacities, "intellectual self-reliance", so to speak, and thus to less blind confidence in others' - the "experts' - authority.

A higher education often provides tools to think analytically, critically and independently. Invaluable tools when it comes to finding meaning with one's experience, and become an expert on one's own behalf: "I know what's good for me." It's called empowerment, and it's decisive in the recovery process.

Drugs: well, I'd say, it's self-evident that substances which interfere with and reduce cognition, memory, self-/consciousness, etc., which in fact often render researching, googling, reading and understanding unsurmountable challenges, are not helpful in the process of resolving crisis.

Women: in general, women are more socializing than men, and don't have the same reservations against opening up and talking about personal problems. And if people who experience crisis need anything, it is the possibility to communicate their experience to someone they can trust unconditionally.

Family: a somewhat well-functioning family can be a valuable resource of support. Especially if family members are minded to resolve problems rather than to just brush them under the carpet, or run from them.

It doesn't look like the researchers have done much else than gathered statistics about "symptoms" experienced, hospitalizations, education, family background, and whatever else can be observed from the outside. Also this study seems to be a shining example of the lack of empiricism in psychiatric "research" in general. Participants obviously were not asked what in detail was helpful for their individual recovery. As a result, the researchers stand with a bunch of data they, due to their preconceived idea of the nature of "schizophrenia" - it's still referred to as an "illness", of course -, and the resulting preconceived idea of what kind of treatment is indicated, don't really know what to make of.

Probably, their reasoning will not go beyond conclusions like the one mentioned above, that CBT is the decisive factor, while they just as probably will be unlikely to admit the quite logic causality between "treatment" with consciousness reducing, and in the long run brain damaging substances and long-term outcomes. Actually, the article explicitly states, that "antipsychotics" are effective treatment for "psychosis": "Don't draw the 'wrong' conclusions from the research results! Take your meds!" Also, an undertone can be traced in the article that clearly emphasizes that "full recovery" doesn't mean "cured". "Schizophrenia" still is a chronic brain disease: "You're still ill! Don't you dare to believe anything else! You're only as lucky as to be in remission!" So, it is unlikely that this study will change anything about how "schizophrenia" is perceived by the "experts", or how it is being treated. Concerning the fact that most of the fully recovered participants either went off neuroleptics, or never used them, this is probably not interpreted as a precondition for their recovery ("remission"), but rather as a result of it. Just as the article doesn't mention the connection between "negative symptoms" like social withdrawal and passivity on the one hand, and the these "negative symptoms" increasing effects of neuroleptic drugs on the other, with one word.

If at all this study makes it to one of the major journals in the field, I suspect it will suffer the same fate as other long-term outcome studies, and soon be buried in the archives, under a load of crap like Thomas Werge's eugenic "research", that allegedly found the genetic cause of "schizophrenia" to be chromosome mutations which are found in 60 - 90% of the general population... (Can't recall whether I wrote about it here, but well, now you know: 60 - 90% of the general population are genetically predisposed to develop "schizophrenia". In other words: to be a human being predisposes you for "schizophrenia". LMAO.)

BTW: the article calls OPUS a "psycho-social" project. Not by any stretch of imagination can I find much "psycho-social" about a project that explicitly promotes " - psycho education with weight on a biological model (guilt reducing)", and "antipsychotic medical treatment" as "indicated" for "most of the patients".

New Danish research shows that "schizophrenics" do better off drugs

Oh really?! You don't say! Yup. And Merete Nordentoft who led the research, is dumbfounded with this result: "Most of the participants who achieved full recovery, didn't take medication after five years. Some of them actually managed entirely without medication. I didn't expect this."

Well well, what did you expect, Merete?? Merete Nordentoft is the Danish "expert" when it comes to "schizophrenia". How is it that the Danish "expert" on "schizophrenia" seems to never have heard of any long-term outcome studies like Harding, et al., 1987, or Harrow, Jobe, 2007, of the WHO-studies, of Soteria, Open Dialog, and and and?! Maybe she doesn't speak English? I mean, we all know that shrinks usually are not the sharpest tools in the shed among medical professionals... Which leads me to another interesting result of the study. But since it's really late: more on it, link and so on, tomorrow.

Open Dialogue - A critique in reply to Will Hall

Will Hall posted a piece on Open Dialogue - or Dialog as it spells in American English - at Beyond Meds today.

He writes that "[i]n discussions about open dialog, some have objected to inclusion of family members in the dialog process." One of these "some" am I. A couple of months ago, I posted my part of an extensive e-mail exchange with a friend here in Denmark who's made a couple of videos about the implementation of Open Dialogue elements some places in Danish psychiatry, on Facebook. So, if you're a Facebook-friend of mine, you can find it there in my notes. For everybody else, I will repost here in a slightly edited (I've no intentions to feed the Fullofits out there any arguments in favor of their agenda) version.

Will writes in his piece at Beyond Meds that he is "leaning towards championing open dialog alongside soteria as a viable model we all should learn from." Here is, in short, why I for one lean towards championing Soteria above Open Dialogue (for those of you who want the long and detailed version of my criticism, see my part of the e-mail correspondence below):

1. One of the "golden rules" of Open Dialogue is that there is no talking about anyone who isn't present. As far as the person in crisis is concerned, I regard this a matter of course. When it comes to others, like family members, I find it problematic. Especially people in a more or less emotionally vulnerable state of mind may find it difficult to talk about abuses they've experienced, and that probably lead to them being in crisis, with their abuser(s) present. The presence of the abuser(s) may very well make the environment where the dialogue takes place a lot less safe than it could and should be. Trying to persuade - or even coerce - a person in crisis into tolerating the presence of their abuser(s) while the pain the abuser(s) has caused is talked about by making the presence of the abuser(s) a precondition to any talk about them, seems almost abusive to me in itself.

2. In my opinion, a safe place for the person in crisis to stay at is one of the most important ingredients for healing to occur. Open Dialogue does not offer the person in crisis a truly safe place to retreat to, like Soteria does. Open Dialogue's aim is to preferably leave the person in crisis in her environment - which may for instance mean staying under the same roof as her abuser(s) - and doesn't offer anything but hospitalization as an "alternative". Hospitals are not safe places for people in crisis. They are no alternative. Even without medical "treatment" implemented, staying at a hospital makes the person who stays there a patient, pathologizes her. Open Dialogue here contradicts itself, when it is stated that "[w]hat we avoid: Diagnostic procedures; Medication; Control; The language of pathology;..."

3. Last but not least, Open Dialogue defines itself as a different kind of psychiatry, not an alternative to psychiatry. Psychiatry per se is a medical speciality. It is not a branch of sociology, psychology, philosophy, or whatever else along those lines. In the videos my friend has made, one of the "experts" working with Open Dialogue elements explicitly states that the "experts" still would be needed. Open Dialogue or not. My question in this regard is what the "experts" are needed for if not for "Diagnostic procedures; Medication; Control; The language of pathology"?? As far as I know, this is what the "experts'" training is all about. It is not about the sociology of interpersonal relationships, spiritual issues, trauma-related distress, or any of the other components of crisis.

Soteria has shown that there is one qualification that is more important than any ever so advanced, professional training or theoretical "knowledge" - actually, I don't think, there can be any such thing as true knowledge of crisis other than from first hand experience, or, at least, unreserved acceptance of the person in crisis - when it comes to the "staff": the ability to "be with" someone without reservations, without any fear, and no matter where this someone is at in terms of his/her state of mind. Professionalism in the field usually is (ab)used to create a safety distance, a power imbalance, between the person in crisis and the "staff", the support team. (Thus, the Norwegian psychologist Christian Moltu states that therapists have a tendency to hold up therapy techniques as a kind of "shield" between their clients and themselves whenever the client, respectively his/her experience, becomes too threatening to them.) Terms like "patient" and "staff" alone are enough to create this distance, or imbalance. Open Dialogue, at least partly in contrast to Soteria, and contradicting its own above-quoted statement, does make use of this professionalizing, pathologizing and alienating terminology.

Concerning medications, that may be a short-term solution in some cases, it doesn't need an "expert" to prescribe them. Any GP can do the job.

Bottom line: Open Dialogue in my opinion has the potential to become an alternative alongside Soteria. Without doubt. As long as it involves "experts", hospitalization, the language of pathology, as long as it involves, instead of excludes, psychiatry, and as long as it does not offer really safe places for people in crisis to go, though, it is not nearly as acceptable to me as Soteria is.
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Read Will Hall's comment on my reply, "More on Open Dialog", here.
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These are my e-mails ("Vestlaplandsmodellen" is an alternative and widely used in Scandinavia term for Open Dialogue):

1. e-mail: Thanks for the links! I watched both programs - the first though had only about 15 minutes of the program - and they gave me an idea of the situation here in DK, which I'm - as I guess you know - not uncritical of.

[These are the links: TVGaderummet 23.sept.2009 (Danish)

1. http://tvgaderummet.info/Links%20til%20tvg-film/tvg214-abendialog-23sept09-laplandsmodelen-paul36.mpg.avi.wmv.html (60 minutes)

2. http://tvgaderummet.info/Links%20til%20tvg-film/tvg215-81paneldiskusion-23sept09-paul37.wmv.html (60 minutes)]

I'm actually not that much acquainted with the Vestlaplandsmodellen as I am with Soteria. I only know about the former what is available on the net, and that's not a lot. Well, of course it's great that some of the elements of the Vestlaplandsmodellen are employed at least in some few places in DK. Nevertheless, what strikes me watching the vids is, that, Vestlaplandsmodellen or not, people in crisis are still referred to as "patients" - I'm not very patient, and I never was :D - and the self-appointed "experts" are still referred to as experts. I'm a lot more radical than that. At one point there's someone who asks when there will be a shift in the power imbalance between "patient" and staff in the mh system. IMO it won't happen as long as "patients" are "patients", and "experts" are "experts". Open dialogue or not. The "experts" need to go. That is, the medical profession needs to go. In spite of a whole lot of talk about humility - very nice, indeed! - the "experts" still don't admit, that their "expertise" as members of the medical profession isn't of much use to people in crisis. Actually, at one point one of them explicitly states, that they are still needed. They are not. Unless of course, we keep on employing the medical model to one or another extent, and I don't know where the Vestlaplandsmodellen stands in that regard.

I had a quick look at Region Syddanmark's site: http://www.regionsyddanmark.dk/wm232390, and alone the "Ikke et enten-eller - men et både-og" (not an either-or but a both-and; meaning treatment options) somehow gives me the creeps. Another thing that gives me the creeps, time and again, and thus in the vids too, is the incessant yattering about how important it is to involve the relatives. Network yes, relatives rarely. Usually the person in crisis' relatives are their primary traumatizers - does the Vestlaplandsmodellen acknowledge this? Does it acknowledge the trauma-model at all? And if so, in how far? -, and I agree wholeheartedly with those, who rather want people in crisis to realize this, and distance themselves, actually break away, from their toxic relatives, than to try and "salvage" family ties at any cost. IMO acknowledging the trauma is extremely important, not only in an mh-context, but in regard to our culture on the whole.

What also strikes me, once again, is the politicians' ability to talk at length without saying much substantial. An awful lot of hot air... Well, and I wonder how anyone still can be the least in doubt about the efficiency of non-medical approaches to crisis. After I don't know how many years of success with alternatives, be it the Vestlaplandsmodellen, Soteria, or whatever of that kind.

2. e-mail: A while ago, I listened to some Norwegian radio broadcast by a psychologist, Grethe Nordhelle, about manipulation. She concluded, that only consciously deceiving people is true manipulation. I sent her an e-mail where I wrote how I'd experienced my mother to have been extremely manipulative, but nevertheless not in a fully conscious fashion. She replied, that there was a grey zone of helplessness, where the deceiver/manipulator is conscious about what s/he is doing, but since his/her ego's survival depends on doing it, s/he suppresses the awareness of his/her actions hurting others. It's the narcissist's way of surviving. And they haven't got any other way. - And I use the term "narcissist" acknowledging that we're all more or less "narcissists" in as far as we (almost) all have an ego that likes to take control. Which, if allowed, results in us needing and (ab-)using others for our own ego's benefit. What I mean by the term in this context is people, who are more or less completely identified with their ego, and thus unaware that they are not their ego. So, whatever these people do comes from the place of their ego. And the ego doesn't love or care for anything but itself.

The majority of society's helpers, especially in the mh system, are such narcissists. They're attracted to the helping professions because these are the professions where one can feel most needed, and successful at the same time, compared to the patient's/client's misery - as long as the patient/client remains miserable... The mh system is every narcissist's paradise, because it's about the only among the helping professions where one can get away with actively preventing people from recovering and becoming independent of the narcissist's help. In addition, no human being is as helpless and dependent as someone whom you can declare " insane" whenever you, the "expert", like, someone who, due to a brain disease, is not able to make any decisions on their own, and thus need the "expert" to run their life.

The point is, they know what they're doing. They know, they're deceiving, exploiting, manipulating, and actually harming others for their own benefit, but they suppress this knowledge, and make an effort to convince both themselves and everybody else of their actions to be necessary and even beneficial for their victims, because they're nothing, absolutely nothing, without or beyond their ego. That they act out of fear and helplessness doesn't excuse their actions. They're fully responsible. Just as a psychopath is fully responsible if s/he commits a crime. Or just like the oil industry is fully responsible for the environmental damage it causes, although it needs to cause this damage in order to survive.

You would have to enlighten these people to make them stop constantly looking for new objects ("patients") they can project their own profound insecurity and helplessness into. But enlightenment doesn't happen from without. It can only happen from within the person herself. And it only happens when there's enough suffering, which in the case of the narcissist means, that they can't find an object to satisfy their insatiable (!) need to be needed with.

The "revolution" has to start with the "patients" shedding the label of "patient", the identification as the helpless victim. Difficult. Very difficult. Especially when it comes to people in emotional distress, that more often than not is the result of never having been anything else but helpless victims. People who've been traumatized tend to repeat the trauma. Over and over again. Being the victim is the only way they know to survive. A perfect match for the narcissist. And gene-theories, biological determinism, if it's in regard to "mental illness", criminal, or whatever else kind of "abnormal" behavior, is the ultimate victimization. Designed by a thoroughly narcissistic culture to serve its narcissist-members' needs.

IMO, no one, neither the victim nor the perpetrator, is served by excusing the abuse, saying the perpetrator-abuser didn't know what s/he was doing. As long as we keep on and are afraid of blaming - i.e. holding accountable - the perpetrators, they will keep on abusing us. Nothing much will change. Anger can also be a good thing. I've tried not to be angry. I've tried to make myself believe the "they don't know what they do"-thing. Something inside me gets very very angry each time I try. Because it just isn't true, that they don't know, and therefor should be forgiven. I want to hold them fully accountable. That is what I can do by now without anger. It's not about revenge. I don't care if they pay for what they've done. The past doesn't interest me. It's about the truth to be said, and stop the abuse from continuing forever.

Long rant, one more thing: How does the Vestlaplandsmodellen handle situations where the abuser/relative is either dead or doesn't want to participate? The latter is a problem that I know both Bateson, Arbours Crisis Centre and similar approaches more often than not had/have. Even people, who initially agreed to participate, left offended and under protest at the slightest suggestion that they maybe were just a little responsible. Narcissists don't make mistakes. It's always everyone else's fault but theirs if anything goes wrong. Suggesting something else usually sends them right through the roof. Exactly because they know, they're to blame. And they rarely at all agree to participate in anything where they risk to be blamed. So, what does the Vestlaplandsmodellen do about that? Forgiveness? No blame?

I see some good things happening, me too. Things like the hearing voices network getting more and more attention, or like Daniel Mackler's film. I'm still a bit suspicious toward the Vestlaplandsmodellen. IMO, it's not both-and. It definitely is either-or. Whatever biological/genetic differences, they are symptoms - of abuse -, not causes.

Hope, I don't come off too harsh. It's just that it really gets me to watch these people get away with their actions again and again and again, because we can't let go of being the victim and feeling guilty about speaking the truth.

3. e-mail: Another rant:

We're all responsible. For ourselves as well as for the community. Not ever holding anyone accountable for their actions equals to telling them it's ok to act irresponsible. If no one ever is going to be held accountable, nothing will change. The world, humanity, is in the mess it is today, because no one is willing to take responsibility, and because no one is willing to ask others to take responsibility, because that then would mean they'd have to take it themselves.

I'm sorry, my parents were responsible. They screwed up. They did as good as they could, but that doesn't change the fact, that it wasn't good enough. Taking responsibility means accepting that fact. Without acceptance no change. BUT: my parents' responsibility also ends where my own starts. "Mental illness" is not being given the opportunity to know. Today I know. So, I can't be "mentally ill" anymore without being responsible for it myself. It's my own choice, and so it will be my own fault, if ever I suffer in the irresponsible way of "mental illness" again.

I'm an existentialist, yup.

"It's ok to make mistakes. But it's unforgivable to make a mistake, and then claim it to have been the right thing to do, while you know, it was a mistake." (Ewa Jälmbrant)

Something else: Hammersley and Read: about 70 % of all people labelled "sz" have been abused physically and/or sexually during childhood. Add to that psychological/emotional abuse/neglect and get 100 %. I think it is obscene to expect a 17-year-old to sit in the same room with her father and talk about having been repeatedly raped by him from an age of, let's say, five or six years old, while the fact that she was so, and that she can't talk about it, rendered her "psychotic". What do we do? Forgive and forget without ever really talking about it? Won't work, I fear. Not in the long run.

In this context: shame - people feel shame because they were/are victims of abuse and are asked to keep silent about it: "It's your fault. You made me do this to you. So, don't blame me." And so they continue their business, the abusers.

If they just do what they're trained to do, unconsciously, irresponsibly, how come there are quite a lot who leave the system, disgusted by it, because they, in spite of all training, are able to see its harmfulness? How come, Loren Mosher was able to see, but not Merete Nordentoft? The scientific evidence is there, for all to see. They know it. They CHOOSE to ignore it.

4. e-mail: I don't want to fight them. I know, that it only would/will make them strike back even harder. - And that's actually what I see also is going on today, as alternatives, like for instance the hearing voices network, get more and more attention, and as there are more and more research findings that question the biological model. They feel threatened and strike back harder: assisted outpatient treatment, Thomas Werge's eugenic "research", re-establishment of padded "quiet rooms", i.e. isolation, etc. - And I absolutely agree to your point concerning primal therapy and the like.

But, on the other hand, when I have a problem, and ignoring, suppressing it makes me sick, I need to come to terms with it. Consciously. Even if that means, that I have to blame someone. - And although the term "blame" has a somewhat negative connotation, it only means "holding accountable". It doesn't mean "attack", "fight". Why does our culture regard holding someone accountable as a negative thing?... - So, basically, what it means is that I express what someone else's actions do or have done to me. Then, it is up to that someone whether they want to take my words as a personal attack - and a narcissist will do so - or whether they take them simply as feedback, allowing them to reflect their actions - which is what a responsible person does.

My responsibility is to separate my emotions from my words, and not to call someone names, for instance. Which IS a personal attack. Of course. That doesn't mean that I may not tell someone, that their actions made or make me feel angry. Or sad, or confused, "psychotic", "schizophrenic", "manic", "depressed", or whatever. If I'm not allowed to tell them, they'll carry on with their destructiveness, their abuse, and nothing is ever going to challenge the delusion of their own infallibility they've constructed for themselves and everybody else. If I'm not allowed to tell them, what we've got is exactly Laing's "Don't" again. Back to square one. The elephant in the living room, no one is allowed to see. And then my unconscious, seeing the elephant, doesn't leave me any other option than to resort to its own language: "insanity". The way to enlightenment goes through suffering - feeling and acknowledging, accepting, the emotions that were suppressed or denied. If I don't allow myself to experience that step, I won't get to the next.

http://www.youtube.com/watch?v=KorhMAsE3nU

http://www.youtube.com/watch?v=pwCUzV3izAI

And, btw, that's exactly what psych drugs are designed to do. Preventing people from recognizing the truth by throwing them back into a state of dissociation. It's not a historical mistake. From the ego's point of view it's the only right thing to do. If the self becomes conscious, the ego is no longer in control. Our culture is a culture of the ego. It's not a mistake. It's premeditated, and it serves a purpose.

I doubt, they feel compassion. Maybe they tell themselves, and everybody else, that it's compassion, but narcissists don't feel compassion, or have empathy. What they feel writing prescriptions is a momentary satisfaction of their ego's need to be needed.

5. e-mail: I see one advantage in having family involved to the extent that they need to be present when they're talked about: I would have loooved to tell my dear mother in detail, without her interrupting me a dozen times, telling me how terribly wrong I am to feel that way, and completely matter-of-fact, no emotions taking over, how her actions had influenced me, i.e. had messed me up. BUT: 1. I wouldn't have been able to stand as much as the sight of her during the first three or four months (at least). (...) Alone mentioning her made "symptoms" intensify remarkably. My no.1 trigger. (...) IMO, it was crucial, that I had the opportunity to talk about my relationship with her without her being present. 2. It would have taken me one single session to tell her the above mentioned stuff. I dare say, I know what her reaction would have been... And no matter how gentle, calm, reasonable, whatever, I'd worded it. With the best will of the world I can't see why anyone would want to, at any cost, salvage a "relationship" like the one I had with my mother. One thing's for sure: I would have been the one, who'd paid for that.

Of course everybody, even someone like my mother, deserves a chance. However, my mother would have blown that chance, no doubt. And then? Then I wouldn't have been given the opportunity to talk about my no.1 trigger? That really pisses me off. Who's side are these guys on? (side: Yes, our "relationship" basically was that of enemies. It was war. But it wasn't me, who'd made her my enemy.)

More bitching: Somehow this no talking about anyone who isn't present to me smells a bit of blackmail. Quite similar to "Take your meds, or we won't pay for therapy (or even worse: we'll withdraw your SSI)." - It's illegal, nevertheless it happens. And often enough they get away with it, because people don't know their rights. The no meds no therapy-thing for instance, my therapist told me about a client of hers who'd been threatened with it. - Make that: "If you don't agree to meet your family/parents, we can't help you." And then what? The back ward? I see why they focus on young people, first "episode" - BTW: http://www.miwatch.org/2009/10/upcoming_conference_focuses_on.html#comments. People in their late teens or early twenties usually are somewhat more easy to "influence", oh well, threaten, than a thirty- or forty-year-old. Drugs or not, if it really is categorically enFORCEd (like in "coercion", yup) that you have to communicate with your abuser(s), or you won't get help, these people aren't much better than the abuser(s) themselves. What people in crisis need is UNconditional support and accept. Not more and even more of the emotional blackmail, that got them into crisis in the first place.

Geez, I would like a word with this Jaakko! :D

Ask people what was helpful during crisis and recovery. More often than not they'll mention time away from their family/parents, among the most important things.

It's really nice that they don't use more drugs than they do. Still, Soteria seems a lot more attractive and desirable - and, indeed, the person in crisis respecting - to me.

6. e-mail: "Certainly, when meeting with people who are acutely mentally ill and those who love them, we can feel compassion for their determination to stick to the predictability of monologic positions." (from the article) [http://findarticles.com/p/articles/mi_qa3658/is_200207/ai_n9086188/]

Well, I stick to my positions: 1. I was not "mentally ill", period. (cf. Pernille in the vid stating she was ill. What did she suffer from? The flu?... Sorry for the sarcasm, it just really bugs me.)

2. My mother didn't love me. (As devastating as it was at first, it was one of the most important insights to reach. "I Never Promised You a Rose Garden" - the title was chosen for a reason.)

3. No one, not wild horses, and not even Jaakko Seikkula himself, would have been able to make my mother engage in a dialogue, unless she'd been guaranteed in advance, that she wouldn't have to accept any criticism of her person, and that it would be all about me being the one (and only) to blame.

The philosophy I see Open Dialogue employ - and I may be wrong, but so far it's my strong impression - is the usual, so to speak: It's the person in crisis, something's wrong with, she's the "patient", the "mentally ill" individual. Pernille for instance says at one point in the first vid: "...ud fra det, der fejlede mig..." (...on the basis of what was wrong with me...) So, something was wrong with her? I don't agree. At least, nothing more was wrong with her than what was wrong with everybody else... But of course, SHE got singled out, the spotted mental patient, because it was HER behavior that didn't fit the cultural norm... It isn't as pronounced as in conventional settings, still it's there. Why on earth can't we just get rid of this patronizing, devaluing (even if it's to a somewhat lesser extent in Open Dialogue) language entirely?? Makes me feel sick (haha...).

A little more respect for the person in crisis isn't enough. She has to be respected fully. It's not both-and. It's either-or. Or: you can't have your cake and eat it. You can't define someone as "mentally ill" and at the same time claim to respect them. You can't hold on to being the needed "expert", and at the same time claim to see the person, not the diagnosis. It's scary for someone who identifies as "expert", "mentally ill" or just "formerly mentally ill" to imagine having to let go of that identification. But it's the only way. IMHO.

"Psychiatry" by definition is a medical speciality. Open Dialogue defines itself, as far as I have understood, as a slightly different kind of psychiatry. As a medical speciality psychiatry pathologizes people's thought processes, emotions and behavior (if it didn't pathologize it wouldn't be a medical speciality, psychiatrists wouldn't be required to have studied medicine to enter the field; at some point Karen Klindt uses the term "klinisk psykiatri" (clinical psychiatry) in the first vid; "klinisk psykiatri" is a tautology; practised psychiatry is by definition clinical). That is, people in crisis' thought processes, emotions and behavior are not respected fully. Emphasis on "fully". To achieve that people in crisis are respected fully, psychiatry has to vanish from the surface of this planet. Psychiatry is an anti-democratic, totalitarian entity. It is symptomatic of our anti-democratic society (have a look at http://www.dendemokratiskeskole.dk/ or http://www.summerhillschool.co.uk/ and compare them to Folkeskolen (the Danish primary school), or any other official school system in any other "democracy"; it's everywhere, in every single one of society's institutions, the totalitarianism, more or less; in psychiatry it is pure). It has always been, it will always be.

And again: why on earth is the idea that there may be parents who do not love their kids sooo unacceptable?? It's a reality, for chrissake! Most people in our culture actually have no clue what love really is. They aren't capable of true love, because they themselves never experienced it. So they don't love their kids, they need them (which is about the opposite of love). Neither do they love themselves, they are in love with themselves. Quite a difference. You can't love anyone else if you don't have selflove. - Well, it's unacceptable because if we accepted it, we'd have to accept the fact, that these people, make that about 90 % of humanity, if not more, altogether are traumatized... by our culture, by modern western civilization. "Don't". Because if we do accept it, it's the end of modern western civilization. And we don't want that, do we??

It was only through the insight that my mother didn't love me, that I came to understand that she couldn't love me - and forgive her. This is different from the usual "forgiveness". It allows the whole process, it allows anger and grief, sorrow,... all that messy stuff, that people are so damn afraid of, they can't for anything in the world accept it in its entirety. Not even Open Dialogue.

Now, I've been highly critical. Don't get me wrong. I appreciate the advantages of Open Dialogue for the individual compared to conventional psychiatry very much. However, IMO Open Dialogue is still somehow stuck in certain very conventional thought patterns that I'd like to see abandoned. Because I regard them to be rather destructive on an overall perspective.

I think what we'd need to survive, humanity as a whole I mean, is a far more radical change of our entire culture than what Open Dialogue represents in the mh field, I'm not too optimistic when it comes to our future as a species. I don't see it happen. Partly also because I see people uncritically cheering for "changes" that aren't really changes, on an overall perspective. Open Dialogue - this is probably as good as it gets. It's not good enough, IMO. It's still limited, by it's conditions for instance: you have to interact with your abusers because this is what we do in modern western civilisation. We have such great compassion with the abusers, we can't do without having the abused forgive the abuser. BS, IMHO.

Open Dialogue is a method. methods are always limited. And limiting. There's a lot of room for improvement if you think beyond the limits of methods. Also of this method, as good as it may be compared to conventional "treatment". People just don't realize. So they cheer, uncritically. And history repeats itself...

What we see is people recovering, becoming independent of the system, able to support themselves, working, well-adjusted contributing to society. Great. Really. But they're well-adjusted contributing to a profoundly sick society... These people grow, yes. Great. Really. But they could grow even more. Far beyond the limits of this profoundly sick society. So that they'd never call themselves "mentally ill", "schizophrenic", past or present, anymore, for instance.

7. e-mail: Of course, like every human being, my mother too had the potential to love. She just couldn't make use of it, and although she never talked much about her own childhood/upbringing, I know enough to know why she wasn't able to give love. I do see her, now. And I do love the part of her, that never was allowed to come into being, so to speak. That doesn't mean, that I would have to, at any cost, keep on interacting with her, the person, the individual, she was, for the rest of my life, just because she happened to be my mother.

And: it was crucial, that I was given the opportunity to talk about her and my relationship with her without her being present at the time. "There is no one size fits all" also applies to Open Dialogue. For some it may be ok to have their abusers present from day one. For me it wasn't. I needed physical distance to be able to, at my own pace, have the courage and explore my emotions towards her, and integrate them.

I disagree, that Open Dialogue is the best. It's good, yes. Much better than those crappy pills. Without the least doubt. And it is, also without doubt, wonderful, awesome, absolutely out of this world, that Open Dialogue elements are integrated into the system some places. But why are we, almost exclusively, focussed on Open Dialogue here in DK, when there are more "open", less systematic, rigid, alternatives out there. Soteria, yes. I don't say that Soteria is perfect. But it offers more room for true respect. It works outside of psychiatry, not inside of it. It's (at least) one step ahead of Open Dialogue. Why? Because it demonstrates that "experts" aren't needed. That all that is needed is being consciously in touch with yourself, being a conscious human being. And it demonstrates that crisis is - being human. It existed. It exists, in Alaska, Bern, Munich. The Weglaufhaus in Berlin works according to Soteria principles. There's a Soteria "movement" in the Netherlands. It's not a mere fantasy. Why not broaden the horizon, skip this Open Dialogue is the only alternative-tunnel vision?

I'd just wish there was just a little more focus on the fact, that Open Dialogue is not the one and only solution. (There is no one and only solution...)

But, well, yes, right now, we're light years from acknowledging that crisis is being human. So, of course, Open Dialogue is/would be a huge step in the right direction.

Some thoughts about A Beautiful Mind and I Never Promised You a Rose Garden

Usually, I'm not a big fan of filmatizations. Especially when I've read the book before I watch the movie, and when the book's emphasis is about more complex psychological contexts watching the movie often has been a bit of a comedown. An example of such a, in my opinion, somewhat failed adaption is A Beautiful Mind with its rather exaggerated and twisted presentation of "hallucinations", meant to help the audience understand the phenomenon, but actually more fit for obtaining the very opposite effect. And indeed, some stylistic faux pas, one would think directors like Bergman and Tarkovsky for instance had taught the cinema to avoid a long time ago. But, well, on the one hand we have Bergman's and Tarkovsky's feel for subtle nuances, on the other Hollywood's preference for broader strokes of the brush. Like comparing apples and oranges.

Another thing that can give me a kind of comedown experience is when the movie consciously twists the text's "message", exploiting the book's, author's or protagonist's popularity in order to get its own "message" out. This too, A Beautiful Mind is an outstanding example to illustrate, abusing John Nash's celebrity status, letting his character state, that he takes the "newer medications", while we all know that the real John Nash didn't take neuroleptics other than when he was forced to, like during hospitalizations, and never after 1970.

The producers excused their distorting the historical facts, and said they didn't want people to toss out their drugs. In the meantime, the movie doesn't at any point directly state that John Nash didn't take drugs over longer periods. Thus there should be no need to mention the matter at all. Unless the idea was to exploit John Nash's popularity for the benefit of the psych drug industry. On the contrary, I'd say. Given the fact, that Nash did recover, while recovery on neuroleptics virtually never occurs, the truth should have been mentioned.

So, all in all it was with reservations that I ventured into watching the filmatization of Joanne Greenberg's novel I Never Promised You a Rose Garden the other day.

Except for in a single sequence, the visualization of Deborah's "hallucinations" is created in a more subtle way than John Nash's in A Beautiful Mind, and thus more endurable and credible. Never mind that it left me with vague associations to Timothy Leary and Woodstock, just as the decorations, costumes and requisits represent a somewhat strange blend of the 1950ies and the late 1970ies.

Although the movie's last sequences seem a bit rash - and it has to be considered that the standard length for movies, that rarely was exceeded, was 90 minutes back in 1977, the movie's production year - and, compared to the novel, a little superficially happy-ending-like, the movie manages to avoid the all too broad strokes of the brush, and, and this is really an achievement the subject taken into account, it avoids to descend into the melodramatic.

Based on a novel as complex as Joanne Greenberg's, a filmatization can hardly be anything but fragmentary. Nevertheless, the movie succeeds to make the best of its 96 almost-standard minutes, both because it focusses on some of the most essential themes of the novel, and not least because of the actors' brilliant performance (Kathleen Quinlan, Bibi Andersson - oh well, a Bergman-trained actress...), and I was positively surprised to see the novel's basic "message" unchanged.

A comment at YouTube says what the novel teaches us is "to have COMPASSION with the mentally ill". I replied: "What both the book and the movie teach us is that so-called "mental illness" is a choice (out of necessity though). Not a chronic brain disease. And they both teach us that we should make it possible for people to choose freedom, like Frieda Fromm-Reichmann made it possible for Joanne Greenberg. Instead of indefinitely locking them up in helplessness and dependency with toxic chemicals and hopeless messages about defective genes and chronic brain disorders."

I was surprised, but I'd also forgotten all about the movie's production year, 1977, that is about the fact that the movie was shot at a time in history when psych drugs didn't yet play the everything else overshadowing role they do play today, and when psychological and psycho-social causes still were considered. Interesting and refreshing in this context is that the dialogue doesn't get stuck in diagnoses and other crudenesses. Although "psychotic" appears from time to time, "schizophrenia" for instance isn't mentioned one single time throughout the entire movie. Probably also this a 1977-phenomenon.

Although it can by no means replace reading the novel itself, a filmatization of Joanne Greenberg's autobiographic novel that is well worth watching.

I Never Promised You a Rose Garden at YouTube.

Beyond redemption? - Critique of an article by Peter Stastny on treatment for first "psychotic episodes".

Via Gianna's blog, Beyond Meds, I just came across an interesting article by Peter Stastny on MIWatch.org. Although I widely agree to Peter Stastny's observations, two things bother me about his article. One of them is the misconception I see also Peter Stastny obviously holds, that Scandinavia must be paradise when it comes to services offered by the mh system. This is not so! I left the following comment at the post:

Peter Stastny here makes it sound like living in Scandinavia almost is a guarantee for more humane and recovery-oriented care to be provided when a person goes through a "psychotic" crisis. Nothing could be more wrong. "Need adapted treatment", also called the "Vestlapland's model", is, as the name suggests, restricted to a region in Finland, namely Vestlapland. There have been other recovery-oriented treatment approaches that were inspired by the Vestlapland's model, respectively by Soteria and similar projects. For instance the Swedish Parachute Project. All of them have been geographically restricted to more or less minor areas, and many of them are not employed anymore today.

It is true, that community care widely has replaced especially long-term hospitalizations. However, a closer look at how this community care does - NOT - work, shows that it is in fact nothing but what you might call "hospitalization in the community", or, more precisely, on the margins of community. Today, the biological model and thus the almost exclusive reliance on psychotropic drugs as "treatment" dominates psychiatric "care" in Denmark and Norway entirely. In hospital as well as in the community. People aren't warehoused behind the brick walls of a locked ward. They are chemically restrained warehoused in halfway houses respectively in an assisted living facility - more often than not of poor quality; there have been numerous scandals about gross overmedication as well as intolerably filthy and run-down environments here in Denmark over the past years - or, if they're lucky, in their own apartment and at the nearest drop-in center.

About 90 per cent of those who enter the system and receive a "psychosis" or "schizophrenia" label end up as revolving door patients, and on disability.

De-institutionalization has widely failed in Denmark, because it was (mis-)used in order to save the state money, not in order to provide more recovery-oriented services to people in crisis. In the meantime, the overall failure of community mental health care has Danish politicians ask for the re-establishment of hospital beds on locked and secured wards, for the implementation of AOT-laws, as well as for several other initiatives, such as the re-establishment of seclusion rooms, that inevitably will bomb mental health services in this country back to the good old asylum-days. It doesn't occur to anyone that the problem may not be the form - community instead of hospitalization - but the contents - recovery-oriented services instead of drugs, drugs, and even more drugs.

The situation in Norway, Sweden, and as far as I am informed also in Iceland is that AOT-laws already do exist, and are excessively used, and that at least the mh system in Norway has hospitalization facilities at its disposal so as to be able to incarcerate a vast number of people long-term. Norway also is the European country with most incidents of involuntary hospitalization and "treatment", as far as I know, Denmark holds a sad third or fourth position on this list.

By and large, also the psychiatric establishment in Scandinavia has been successful defending a purely biological, and in addition widely on coercion based, "treatment" model, and preventing alternatives from as much as being publicly discussed, or even becoming known to a broader public. IMHO, our system is anything but a model system. And it looks like it will be even less so in the future.
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The other disagreement I have concerning Peter Stastny's article is that also he, as most professionals, seems to believe that when people first had their second, third, or umpteenth "psychotic break" they're beyond redemption. Why his article entirely focusses on alternative treatment options for first "psychotic episodes". I can't tell you exactly how many times I had a "psychotic break" before I eventually received the guidance that made it possible for me to, I dare say once and for all, resolve crisis, but this last of my crises certainly wasn't my first one.

I have no doubt that crisis is "addictive", and habit-forming. The longer and more often someone employs a certain pattern of behavior, certain coping strategies, the more ingrained, probably also neurologically, it becomes. On the other hand, my compared to a teen or twenty-tear-old relatively more extensive life experience also was a huge advantage to me throughout the process of working things out. I'd say, all in all, my chances to recover were maybe different in kind but no smaller than any "first psychotic break" individual's.

No one should ever be regarded "beyond redemption". Recovery is possible and should be aimed at, no matter how many "psychotic breaks" someone has experienced. The services Peter Stastny, and others, are so eager to make available to people who experience their first crisis ought to be available to everyone, disregarded whether they're going through their first, second, or umpteenth crisis.

Who needs shrinks?

From The Last Psychiatrist's blog: "However, most of these 'patients' do not need these medications, most do not need psychiatry at all.  Of course many do, they are truly sick and but for psychiatry their lives would be chaos."

I'd say, the only reason why the lives of those "many" and "truly sick" people he obviously refers to here, and of whom I'd have been one myself, aren't chaos is that psychiatry has, successfully, destroyed these lives. Not perhaps because it has helped the people sort things out.

But well, he's a psychiatrist, right? And he's no Loren Mosher...

BTW: Last time I was "truly sick" was in 1999, when I'd caught the flu.

"Search inside your heart..."

Facebook group "The incarceration of John"

Conference "Recovery: A Human Right"

My YouTube-comment: "What is traumatizing to human nature? The very normal though also very unnatural circumstances, that alienate it from itself. Unfortunately, violence is just all too normal in our culture. Biopsychiatry being a kind of meta-violence, as it violates those, who react to our culture's violence. (...)"

Beyond Belief

Beyond Belief. Alternative Ways of Working with Delusions, Obsessions and Unusual Experiences, by Tamasin Knight, with a preface by Rufus May, is now available as a free download at peter-lehmann-publishing.com.



I've only had a short glimpse at Rufus May's preface so far, but the book certainly looks like great reading. Here's the description from Peter Lehmann's website:


"Tamasin Knight's first book Beyond Belief explores ways of helping people who have unusual beliefs. These are beliefs that may be called delusions, obsessions, or another kind of psychopathology.
• Psychiatric treatment attempts to remove these beliefs by medication and other methods. The new approach described in Beyond Belief is different. It is about accepting the individual's own reality and assisting them to cope and live with their beliefs.
• Beyond Belief explains the new approach in a very readable format.
• Many psychological techniques to cope with unusual beliefs are described. These include strategies to reduce fear, strategies to increase coping and problem solving techniques.
• Ideal for mental health professionals, service users/survivors and carers.
"Beyond Belief offers us a ground-breaking way of helping people deal with unusual beliefs. In Bradford we have found this publication it to be extremely helpful to service users, workers and as the inspiration for a new self help group. I am sure that this publication will enable more people to benefit from this knowledge and approach and help us change the way we as a society approach beliefs we find unusual." (Rufus May; Clinical Psychologist, Centre for Citizenship and Community Mental Health, Bradford University, England)"

Another reply to Will

Here's another reply to Will at WillSpirit:

My way to union with the great consciousness... I'm still on my way, Will. I haven't arrived there yet. Like you, I've had certain experiences, epiphanies, peak experiences... I've even spent longer periods of time in a state of inner peace. But I've not attained that state of mind once and for all. I know, that such a place exists, because I've been there. But if being there was a constant thing, at least my Danish blog would look a lot different from what it does. Probably also this one, although it usually isn't quite as pugnacious as the Danish one.

This is something, I thought I'd write a post on its own about, but I may as well at least mention it here and now. For a long time, I've felt sort of an obligation to frequently comment on news articles and stuff on my Danish blog. There are no other blogs commenting critically on what's going on specifically in the field of psychiatry in Danish. And surprisingly many people have told me, they have difficulty navigating and reading sites in English or American. The mh system in this country hasn't only a monopoly when it comes to treatment, but also in regard to which information gets out, and which doesn't... To a far greater extent than in English -speaking countries. Go figure...

One aspect of this is that I found myself constantly confronted with lies, prejudice, ignorance, cynicism, ... in short: violence, exhibited by the news articles etc. I had to read in order to comment on them. Another is that the same violence regularly tried to make it to my comment field, respectively made it to my mail inbox. It is toxic, and it is extremely contagious. It goes straight for the ego, and if you don't watch out, the ego will take control and start a war. Especially if you've been a victim of violence before. You can observe it all over the mh blogosphere. Egos trying to get at each other, acting out their personal trauma. And repeating it, over and over again. Guess, who gets hurt...

I'm certainly no saint. I've engaged in several wars lately. Increasingly belligerent. Acting out and repeating past trauma. It gives a very short-lived, superficial satisfaction to make someone one's enemy and bash them, with some scathing irony for instance. But when the moment of satisfaction is over, it does nothing but hurt. And then you need another moment of satisfaction. And another one, and another one... I've actually suffered a whole lot, recently. Enough to have me reconsider the future of my blogs, and my engagement in the mh-debate on the internet in general. That's what suffering is good for. To bring about change.

Well, drugs. Drugs certainly can open some doors. Hallucinogens especially. And they don't altogether have the sedating, deadening effect that neuroleptics have. However, they altogether alienate oneself from oneself to a certain extent. Watch this: http://www.youtube.com/watch?v=TiRvnfrs8UM - BTW a channel I recommend, SFJane.

As for me, I didn't have to clear my brain of pharmaceuticals. I spent my youth moving in what you might call "alternative" circles, where natural drugs like marijuana etc. weren't regarded a big problem, while everybody was highly suspicious of any kind of chemicals. In addition, psychoanalytical theories were the thing. I didn't even know, that psychiatry - or rather: the pharmaceutical industry - had come up with a concept of emotional distress being brain diseases, before I saw myself confronted with the "news" in context with my last crisis in 2004. It had always been a matter of fact to me, that whatever the problem, it certainly was a reaction to one's environment. The massive propaganda everywhere of course had me doubt this matter of fact for a while. It just didn't add up, it made no sense. What made sense, was reading Laing's The Divided Self, and what I remembered from Joanne Greenberg's I Never Promised You a Rose Garden, which I'd read as a teen.

Well, and then add to that the controlled and oppressed individual's pronounced desire for freedom and self-determination on the one hand, and her just as pronounced suspiciousness towards any authority that tries to take control and oppress on the other. Of course my reaction was: "I alone know what's best for me. No one and nothing messes with my mind but I myself." Luckily, this was respected. So, the only drugs I still will have to clear my brain of are caffeine and nicotine...

I've tried a benzo, once (apart from a suicide attempt that involved valium, but that's a different story). Nasty. Very very nasty. And it would have been even more nasty to experience that amount of loss of control, if it had happened during crisis. That is, during a period of time, where my true self openly rebelled against being controlled and oppressed. - Does psychiatric "treatment" worsen "symptoms"? It certainly does. Maybe not always, but often enough. Involuntary "treatment" by definition.

Last but not least, I was sort of intuitively convinced, that taking anything to numb out the pain would be extremely counterproductive, as I was determined as hell to find out, what the meaning was. And how were I supposed to figure out the meaning, when the pain was gone?


"A major objection to the use of the anti-psychotic drugs in acute crisis situations is that because they are such powerful central nervous system suppressants they may well have the effect of preventing crisis resolution. They are powerful enough to abort a psychological process, which if supported and understood, would resolve itself in the context of a relationship," Loren Mosher says here. 

The "symptoms" I experienced were indeed signposts, that showed me, clearly and unmistakably, whenever I was on the right track, trying to figure out what had caused what was going on. Without having them show me the way, the whole therapeutic process would have been a grope in the dark, unlikely to lead anywhere, since I was the only one who had the answers to all of my questions. In spite of what many people seem to expect, therapists obviously aren't there to know and tell their clients all the answers. Their only task is to suggest different angles from which to look at the questions, so that one of these angles hopefully may reveal the answer.

Numbing "symptoms" with neuroleptics leaves the client dependent on the therapist coming up with the answers, which actually is, what I see happen all over the place. - A Norwegian blog-neighbour of mine once was told by her therapist: "You know, the problem with you is that you resist being formed." Of course, my Norwegian blog-neighbour did the only reasonable thing, and ended the relationship with this "therapist". - Very convenient for society. But it won't do for the client, as it doesn't provide anything but, at best, just another false ego-identification.

So, in fact I embraced my "symptoms", because I knew, they were showing me the way out of my suffering.

I understand, that not everybody at any time has the opportunity to do as I did. The circumstances were without doubt in my favor. I had the space around me, that allowed me to "freak out" whenever I needed to, and I had someone, who supported me (almost) unconditionally. Most people unfortunately don't have that today. But that does far from mean, that they shouldn't have it. If I say, drugs are okay to use, I indirectly approve of the current paradigm of "care". I can't do that.

Basically, what I would like people to realize is that it doesn't matter what kind of label, how "serious" the problem, drugs simply aren't the answer, other than as a very short-term emergency solution, and never against the will of the person in crisis. I'd like to see the very common misconception eradicated, that there would be people, whose suffering is too severe to be met other than by (massive and long-term) drugging. There aren't. Everybody has the potential to recover, and no one should ever be prevented from it. Actually, it is often those, who suffer the most, and who seem to be "lost cases", who make the most remarkable recoveries. Given they get the right support. Because their extreme suffering also means an extreme incentive to change, and extremely clear signposts on the way to change. This is, what I reacted the most to in your initial post. That some people would need to be drugged. They don't. This, and the idea that all someone would be able to achieve, was learning to live with a chronic illness. It is not a chronic illness.

Compared to what is perceived as "normal" - and "normal" does not equal to "natural", "normal", in contrast to "natural", is a cultural construct - I certainly have "issues", still today. I'm still sensitive to noise, "noisy" visual perceptions, I still hear voices, I haven't abandoned but re-interpreted my "delusions". Does that make me an ill person? I don't think so. I think, it actually makes me more natural, so to speak, than I would be if I were perfectly adjusted to our normality. To me it's a strength, not an illness. Although it also is a lot more challenging to live in our "normal" and increasingly alienated from (human) nature world, and be naturally sensitive, than I imagine it to be for someone, who's sufficiently alienated from their own human nature and nature in general to be regarded well-adjusted to society, I wouldn't want to trade off that sensitivity for any amount of well-adjustment. I wouldn't want to trade off my true self, my true nature, for just another false ego-identification, that inevitably would lead to crisis again and again. In the end, if people think, I'm "weird" because I hug a tree, or have conversations with garden spiders, that's their problem, not mine.

I do understand and respect people who choose long-term medication when indeed they don't have a choice. That people aren't given a choice, is what I can't and won't condone.