I have had the great privilege and pleasure of working with a group of colleagues in Vermont who share my interest in bringing the humble and democratic ways of working developed in northern Finland and Norway to our state. Many of us were introduced to this work by Robert Whitaker’s description of Open Dialogue in Anatomy of an Epidemic and Daniel Mackler’s documentary Open Dialogue, and some of us worked with Tom Anderson, who came to Vermont in the 90s.
Some had traveled to Europe to attend the annual meeting of the International Network for the Treatment of Psychosis, the group of clinicians who had been working in this way for the past two decades. Others had the opportunity to train with Mary Olson, PhD at the Institute for Dialogic Practice. We have formed study groups and developed small teams who are beginning to introduce this way of working to our clinics.Read More
The Foundation for Excellence in Mental Health Care was founded in 2011 with the hope of expanding what many had come to believe was a narrow and faulty understanding of psychiatric conditions.Read More
I was recently asked to write an article for SAMHSA’s Recovery to Practice newsletter. This is a slightly edited version of that post.
Let me be clear: I was never anti-recovery. I will admit, however, that when the recovery movement first came to my attention in the 1990s, I was not drawn in. Whenever I attended a presentation on the topic, rather than being able to listen openly to the speaker, I felt defensive. At the time, I was working in a state that was pushing hard to close its state psychiatric hospital. While the mantra was of recovery, it seemed to be promoted by fiat. Since people were expected to recover, therefore, we did not need a state hospital.Read More
Vermont is a wonderful state and I am privileged to call it my home. We are known for our progressive ways, and this extends to our mental health care system. However, there are intense disagreements here – as there are everywhere – and I have learned in recent years about how changes that seem positive can have unexpected consequences.
In 2011, our state hospital closed suddenly over the course of a 24 hour period when it was flooded during Hurricane Irene.Read More
Psychiatrists around the world are currently engaged in efforts to critique the profession. Concern about the expansion of diagnostic terminology, the overly zealous use of pharmacotherapy, and the incursion of commercial interests – specifically by the pharmaceutical industry – into the workings of the profession are among the areas of concern.
Many psychiatrists have come to a critical stance after years in practice. But each year, newly minted doctors join the profession. They are trained in a system that tends to reify concepts that demand more critical scrutiny. It is a challenge to formulate a way of educating them about the generally accepted body of knowledge of the field while simultaneously instilling a critical appreciation of the limits of our understanding and therapeutic capabilities.
Hugh Middleton, the co-founder of the Critical Psychiatry Network, has written a remarkably eloquent yet concise book that fills this niche. “Psychiatry Reconsidered: From Medical Treatment to Supportive Understanding.”Read More
This month, a study of the treatment of young people diagnosed with schizophrenia attracted a good deal of attention. The headlines on my various internet feeds read “Talk therapy helps schizophrenia” and hailed a new treatment that includes listening to young people’s concerns and helping them find their way back to school or work. I often wonder what others make of my profession. What happened to render the notion that talking to people about their experiences and helping them find jobs or go back to school is something novel?
I was a psychiatrist who participated in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP). Although I welcomed the headlines, the reports left me with mixed feelings. While I celebrate the attention given to this study, I did not find the news reports to be entirely accurate. Several issues were raised, so to speak, that I want to address in this post:Read More
For the past four years, I have been deconstructing my views of my profession. My focus has been primarily on two areas: the efficacy and safety of the drugs I prescribe and so-called “alternative” approaches (in this I include many things such as Open Dialogue, Hearing Voices groups, and Intentional Peer Support to name a few). I have shared much of this in the blogs I wrote during this time. I am also interested in how we can improve and reform the public mental health system since this is not only where I work but where most people seek services and help. I have wondered where – if anywhere – psychiatrists fit in to a reformed system. I choose to post on some websites that are filled with deep criticism of my profession. I take it in and ponder in an Hamletian way if it is ethical to continue to practice given the serious problems in my field. I have come to an idea about how we can use our medical expertise to contribute something meaningful while acknowledging the value of non-medical thinking and remaining honest about the profound limitations of our knowledge. What follows is an attempt to articulate these ideas.Read More
On a beautiful Vermont summer week-end, about 40 people – social workers, psychologists, psychiatrists, administrators, and people with lived experience among us – gathered together. We hailed from Vermont, Massachusetts, and New York.
Our purpose: To come together and model what many of us had experienced in Europe at the International Meetings for the Treatment of Psychosis. These are the meetings where clinicians who work with the models of Open Dialogue, reflecting therapies, Needs-Adapted Treatment (NAT), or the variations of these practices that have evolved over the past two decades gather to discuss and share their work.Read More
In their new book, Psychiatry Under the Influence, Robert Whitaker and Lisa Cosgrove detail the ways in which economies of influence lead institutions to act in ways antithetical to their stated mission. They use this overarching framework to examine the actions of the America Psychiatric Association and academic psychiatry. Their convincing argument is that the actions of the institutions strayed towards the protections of the institutions and organizations at the cost of their stated mission to further the understanding of psychiatric disorders and improve treatment.Read More
On May 18, I had the pleasure and privilege of chairing a workshop at the American Psychiatric Association’s annual meeting in Toronto. The pleasure was in getting to meet two psychiatrists I have admired from afar, my co-presenters, Hugh Middleton and Joanna Moncrieff of the Critical Psychiatry Network. The privilege was in sharing the stage not only with my UK colleagues but with our discussant, Stephen Marder, a professor from UCLA who is one of the world’s preeminent schizophrenia researchers, and our co-chair Carl Cohen of the Radical Caucus of the APA.
The topic: Rethinking the Long-Term Use of Antipsychotics in Schizophrenia: For Everyone, No one or Some?Read More