[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

[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

[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

[costello]

Good to hear from you, s_e. I'm impressed with Open Dialogue too. I wish it were more widely available.

I've been thinking about a career change and have considered training as a therapist. Open Dialogue is one of approaches I'd love to train in, but you can't really do it as an individual, can you? It's like the whole system around the client - including the other professionals - would have to participate. How would it be practiced in the U.S.? When I was trying to get help for my son through the mental health center here, I met the most rigid, unimaginative, controlling individuals I've ever had the misfortune to encounter in my life. They'd made up their minds on my son's dx and what to do for him (really do to him!), and they weren't going to give an inch. How do you make systems like that change?

My relationship with the mental health people and the institutions is; them, or the streets or jail. That is how it seemed to me.

I recognize that modern medicine is kinder than the Church would be, in regards to treating the mentally ill.

Still, the English language is inadaquete for describing how it feels to be labeled, shunned then humiliated. I forgive, but I can't forget.

I appreciate your efforts, they ARE making a difference and you deserve divine Love as a result, if I had my way in that area. I, unfortunately, have, seemingly zero connections, there. Someone once told me, "The tragedy is, there is no tragedy."

This was my experience.

I improved my life, but many are still "there"

I can't forget them.

I will never forget them.

gracias

[costello]

Originally Posted by brookwest

Still, the English language is inadaquete for describing how it feels to be labeled, shunned then humiliated. I forgive, but I can't forget.

This makes me very sad. I can't speak for my son, but I suspect he feels the same way.

Open Dialogue is a mental health therapy that originated in Finland and shows a great deal of promise in helping people, especially those having their first psychotic break. From what I understand, it's more respectful that the "traditional" kinds of mental health therapies provided in the U.S.

One thing I really like about it is that there is no discussion of the person at the center of concern outside of his presence. Everything is discussed in the team.

Another thing I like is that there is an assumption that the problem is between people, rather than inside the person who is showing symptoms.

IMO it's a very promising and innovative approach which should be given a chance here in the U.S. But, of course, if it works, it would cut into drug company profits. God forbid people start getting well and going on with their lives!

Will Hall has an interview with Mary Olson at Madness Radio: http://www.madnessradio.net/madness-...on-open-dialog.

Hahaha ****. I might as well move to Finland & learn the language!! Perhaps not in that specific order... : )

[costello]

Originally Posted by Shayatanica

Hahaha ****. I might as well move to Finland & learn the language!! Perhaps not in that specific order... : )

They do pretty well with English. Maybe you could get an all English team.

Oh, then that settles it. I'm totally relocating to Finland. Time to find some fuzzy sweaters & a viking hat! XD

[costello]

Originally Posted by Shayatanica

Oh, then that settles it. I'm totally relocating to Finland. Time to find some fuzzy sweaters & a viking hat! XD

Sounds fun!

[spiritual_emergency]

Hello costello,
I've been busy and quiet. I popped in for a bit last night though and managed to catch up a little on what's been happening with your son.

Meantime, I've read that an Open Dialogue clinic will soon be opening in the US. Here are the details...

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/

The clinic is associated with Mary Olson, who worked with Seikulla in Finland.

Opportunities for training have also begun to open up in America...

Source: Open Dialogue Training - Beyond Meds

~ Namaste

[costello]

She's too far away to benefit me. I've heard her interviewed on two different programs, and she sounds like a kind, gentle, and empathetic person. I'm sure her clients are lucky to have a chance to work with her.