The History of the Open Dialogue Approach in the United States
Presented at the World Open Dialogue Conference, Tokyo and Kyoto, Japan, February 2019.
I wish like to thank Nazlim Hagmann MD for her invaluable feedback on an earlier draft of this essay.
“Open Dialogue”—a network approach to severe psychiatric crises developed at Keropudas Hospital in Tornio, Finland–first began to attract notable attention in the United States a decade ago, although many ideas and practices that influenced its evolution in Finland actually came from the US. In particular, the Finnish team refined and advanced elements of US family therapy. Among these US linkages are Gregory Bateson’s Palo Alto research on family communication (1952-1962); Ross Speck and Carolyn Attneave’s network therapy for schizophrenia that flourished in the late sixties at the Philadelphia Child Guidance Clinic, and Harry Goolishian and Harlene Anderson’s collaborative-language approach that emerged in the eighties at the Galveston Institute in Texas. While holding in mind that Open Dialogue is indebted to these and other US ancestors, this brief essay will focus on the recent wave of interest in the Finnish approach.
There have been almost 900,000 views of Julia Rucklidge’s 2015 TEDx talk on nutrition and mental health, with many complimentary viewer comments.
Last week, however, the TED organization has inexplicably “flagged” the video with the following comment:
“NOTE FROM TED: We’ve flagged this talk, which was filmed at a TEDx event, because it appears to fall outside TEDx’s curatorial guidelines. There is limited evidence to support the claims made by this speaker.”
Julia has attempted to educate TED staff regarding the fact that over 35 peer-reviewed publications could hardly be described as “limited evidence,” and that her interpretations do not go beyond the data. But so far they are not interested in her evidence.
The whole thing seems so strange: isn’t TED supposed to be all about innovation? But clearly, some lobbyist has convinced them that a non-pharmaceutical treatment should not be respected.
I am asking you to help make this video go viral. That seems to be the only response we can make to such an inappropriate move on TED’s part.
Share it with others, through Facebook or email or Twitter
Ask your friends and colleagues to do the same
Let’s see if we can quadruple the views to 5 million or so.
Dr. Bonnie Kaplan, PhD is the fund advisor of the Nutrition & Mental Health Research Fund and a member of the new International Society for Nutritional Psychiatry Research (ISNPR). For many years, she studied developmental disorders in children, especially ADHD and reading disabilities (dyslexia). Dr. Kaplan was part of a team from University of Calgary and University of British Columbia which helped in the search for genes that predispose children to dyslexia. Also, with her students, she investigated the characteristics of adults with ADHD. Such work led her to further investigations of the role of nutrition. Another interest has been the mood symptoms that accompany ADHD and learning difficulties, and the role of micronutrient treatment of mood, aggression and explosive rage. This progression of topics has resulted in a research program focused on the role of nutrition in brain development and in brain function, especially the use of broad spectrum micronutrient treatment for mental disorders.
Kaplan, B. J., Simpson, J. S. A., Ferre, R. C., Gorman, C. P., McMullen, D. M., & Crawford, S. G. (2001). Effective mood stabilization with a chelated mineral supplement: An open-label trial in bipolar disorder. Journal of Clinical Psychiatry, 62(12), 936-944.
Popper, C. W. (2001). Do vitamins or minerals (apart from lithium) have mood-stabilising effects? Journal of Clinical Psychiatry, 62(12), 933-935.
Kaplan, B. J., Crawford, S. G., Gardner, B., & Farrelly, G. (2002). Treatment of mood lability and explosive rage with minerals and vitamins: two case studies in children. Journal of Child and Adolescent Psychopharmacology, 12(3), 205-219.
Kaplan, B. J., Fisher, J. E., Crawford, S. G., Field, C. J., & Kolb, B. (2004). Improved mood and behavior during treatment with a mineral-vitamin supplement: an open-label case series of children. Journal of Child and Adolescent Psychopharmacology, 14(1), 115-122.
Simmons, M. (2003). Nutritional approach to bipolar disorder. Journal of Clinical Psychiatry, 64(3), 338.
Frazier, E.A., Fristad, M., Arnold, L.E. (2009). Multinutrient Supplement as Treatment: Literature Review and Case Report of a 12-year-old Boy with Bipolar Disorder. Journal of Child and Adolescent Psychopharmacology.19:453-460.
Rucklidge, J. J., & Harrison, R. (2010). Successful treatment of Bipolar Disorder II and ADHD with a micronutrient formula: A case study. CNS Spectrums, 15(5):289-295.
Rucklidge, J. J., Gately, D., & Kaplan, B. J. (2010). Database Analysis of Children and Adolescents with Bipolar Disorder Consuming a Micronutrient Formula. BMC Psychiatry, 10, 17.http://www.biomedcentral.com/1471-244X/10/74
Frazier, E.A., Fristad, M.A. & Arnold, L.E. (2012). Feasibility of a nutritional supplement as treatment for pediatric bipolar spectrum disorders. Journal of Complementary and Alternative Medicine, 18:678-85.
Frazier EA, Gracious B, Arnold LE, Failla M, Chitchumroonchokchai C, Habash D, et al. Nutritional and safety outcomes from an open-label micronutrient intervention for pediatric bipolar spectrum disorders. J Child Adolesc Psychopharmacol2013; 23(8): 558-67.
Retallick-Brown, H., Rucklidge, J. J., & Blampied, N. (2016). Study protocol for a randomised double blind, treatment control trial comparing the efficacy of a micronutrient formula to a single vitamin supplement in the treatment of premenstrual syndrome. Medicines, 3, 32. http://www.mdpi.com/2305-6320/3/4/32
Kimball, S., Mirhosseini, N., & Rucklidge, J. J. (2018). Database Analysis of Depression and Anxiety in a Community Sample—Response to a Micronutrient Intervention. Nutrients, 10(2):152. http://www.mdpi.com/2072-6643/10/2/152
Rucklidge, J. J. (2009). Successful treatment of OCD with a micronutrient formula following partial response to CBT: A case study. Journal of Anxiety Disorders, 23: 836–840.
Rucklidge, J. J., Johnstone, J., Harrison, R., & Boggis, A. (2011). Micronutrients reduce stress and anxiety following a 7.1 earthquake in adults with Attention-Deficit/Hyperactivity Disorder. Psychiatry Research, 189, 281-287. doi:10.1016/j.psychres.2011.06.016
Rucklidge, J. J., Andridge, R., Gorman, B., Blampied, N., Gordon, H. & Boggis, A. (2012). Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human Psychopharmacology: Clinical and Experimental, 27(5), 440-454. https://www.ncbi.nlm.nih.gov/pubmed/22782571
Rucklidge, J. J., Blampied, N., Gorman, B., Gordon, H., & Sole, E. (2014). Psychological functioning one year after a brief intervention using micronutrients to treat stress and anxiety related to the 2011 Christchurch earthquakes: A naturalistic follow-up. Human Psychopharmacology: Clinical and Experimental, 29(3), 230-243. https://www.ncbi.nlm.nih.gov/pubmed/24554519
Sole, E. J., Rucklidge, J. J., & Blampied, N. M. (2017). Anxiety and Stress in Children Following an Earthquake: Clinically Beneficial Effects of Treatment with Micronutrients. Journal of Child and Family Studies, 1-10. doi: 10.1007/s10826-016-0607-2 https://link.springer.com/article/10.1007%2Fs10826-016-0607-2
Kaplan, B. J., Rucklidge, J. J., Romijn, A. R., & Dolph, M. (2015). A randomized trial of nutrient supplements to minimize psychological stress after a natural disaster. Psychiatry Research, 228, 373-379. http://www.ncbi.nlm.nih.gov/pubmed/26154816
Mehl-Madrona, L., Leung, B., Kennedy, C., Paul, S. & Kaplan, B. J. (2010). A naturalistic case-control study of micronutrients versus standard medication management in autism. Journal of Child and Adolescent Psychopharmacology, 20(2):95-103. https://www.ncbi.nlm.nih.gov/pubmed/20415604
Rucklidge, J. J., & Harrison, R. (2010). Successful treatment of Bipolar Disorder II and ADHD with a micronutrient formula: A case study. CNS Spectrums, 15(5):289-295.
Rucklidge, J. J., Taylor, M. R., Whitehead, K. A. (2011). Effect of micronutrients on behaviour and mood in adults with ADHD: Evidence from an 8-week open label trial with natural extension. Journal of Attention Disorders, 15(1), 79-91.
Rucklidge, J. J., Johnstone, J., Harrison, R. (2011). Effect of micronutrients on neurocognitive functioning in adults with ADHD and Severe Mood Dysregulation: A pilot study. Journal of Complementary and Alternative Medicine, 17(12), 1-7. https://www.ncbi.nlm.nih.gov/pubmed/22112202
Rucklidge, J. J., & Blampied, N. M. (2011). Post earthquake functioning in adults with Attention-Deficit/Hyperactivity Disorder: Positive effects of micronutrients on resilience. New Zealand Journal of Psychology, 40(4), 51-57.
Rucklidge, J. J. (2013). Could yeast infections impair recovery from mental illness? A case study using micronutrients and olive leaf extract for the treatment of ADHD and depression. Advances in Mind-Body Medicine, 27(3), 14-18. https://www.ncbi.nlm.nih.gov/pubmed/23784606
Rucklidge, J. J., Johnstone, J., Gorman, B., & Boggis, A., & Frampton, C. (2014). Moderators of treatment response in adults with ADHD to micronutrients: demographics and biomarkers. Progress in Neuro-Psychopharmacology and Biological Psychiatry,50, 163–171. https://www.ncbi.nlm.nih.gov/pubmed/24374068
Gordon, H. A., Rucklidge, J. J., Blampied, N. M., & Johnstone, J. M. (2015). Clinically Significant Symptom Reduction in Children with Attention-Deficit/Hyperactivity Disorder Treated with Micronutrients: An Open-Label Reversal Design Study. Journal of Child and Adolescent Psychopharmacology, 25(10), 783-798. doi: 10.1089/cap.2015.0105 https://www.ncbi.nlm.nih.gov/pubmed/26682999
Rucklidge, J. J., Eggleston, M., Johnstone, J. M., Darling, K., & Frampton, C. M. (2017). Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: A fully-blinded, randomized, placebo-controlled trial. Journal of Child Psychology and Psychiatry.http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12817/full
Kaplan, B. J., Isaranuwatchai, W., & Hoch, J. S. (2017). Hospitalization cost of conventional psychiatric care compared to broad-spectrum micronutrient treatment: literature review and case study of adult psychosis. Int J Ment Health Syst, 11, 14. https://link.springer.com/article/10.1186/s13033-017-0122-x
Harrison, R., Rucklidge, J. J., & Blampied, N. (2013). Use of micronutrients attenuates cannabis and nicotine abuse as evidenced from a reversal design: A case study. Journal of Psychoactive Drugs, 45(2), 1-11. https://www.ncbi.nlm.nih.gov/pubmed/23909004
Popper, C. W. (2014). Single-Micronutrient and Broad-Spectrum Micronutrient Approaches for Treating Mood Disorders in Youth and Adults. Child and Adolescent Psychiatric Clinics of North America, 23(3), 591-672. doi: 10.1016/j.chc.2014.04.001
Sarris, J., Logan, A. C., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., Hibbeln, J., Matsuoka, Y., Mischoulon, D., Mizoue, T., Nanri, A., Nishi, D., Ramsey, D. Rucklidge, J. J., Sanchez-Villegas, A., Scholey, A., Su, K. P., Jacka, F. N. (2015). Nutritional Medicine as Mainstream in Psychiatry: A Consensus Position Statement from The International Society for Nutritional Psychiatry Research (ISNPR). Lancet Psychiatry, 2, 271-274. http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/abstract
Sarris. J., Logan, A. C., Akbaraly, T. N., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., Hibbeln, J., Matsuoka, Y., Mischoulon, D., Mizoue, T., Nanri, A., Nishi, D., Parletta, N., Ramsey, D., Rucklidge, J. J., Sanchez-Villegas, A., Scholey, A., Su, C., Jacka, F. N. (2015). The International Society for Nutritional Psychiatry Research (ISNPR) Consensus Position Statement: Nutritional Medicine in Modern Psychiatry (letter to editor). World Psychiatry, 14(3), 370-371. http://onlinelibrary.wiley.com/doi/10.1002/wps.20223/abstract
A study investigating the safety and toxicity of this product shows that, as studied to date, it has not produced any serious adverse effects:
Simpson, J. S. A., Crawford, S. G., Goldstein, E. T., Field, C., Burgess, E., & Kaplan, B. J. (2011). Systematic review of safety and tolerability of a complex micronutrient formula used in mental health. BMC Psychiatry, 11(62). http://www.biomedcentral.com/1471-244X/11/62
So What’s This About Another Webinar Series on Psychiatric Drug Withdrawal?
Some people are asking me, “Why another series of webinars on withdrawing from psychiatric drugs?” That’s a reasonable question given that our first series, Withdrawal from Psychiatric Drugs, covered a lot of territory. We presented general information as well as more specific subjects like wellness, personal experiences, research findings, and the evidence base for drug withdrawal.
But this subject is a complex one, and our first course was just our start in exploring this topic. With this second course we are focusing on the challenges that drug withdrawal presents to prescribers.
As many have noted, prescribers may have extensive experience getting patients on psychiatric medications and then managing their drug use, but little or no experience helping patients taper off the drugs. As some have quipped, prescribers have learned to fly the plane but not land it.
Psychiatry likes to portray itself as a scientific discipline, and indeed there is a lot of useful science to draw on when evaluating the evidence base connected to mental health problems, its causes and treatments. Sadly, most of the mainstream psychiatric literature of recent decades has shown a marked preference for rhetoric over scientific accuracy. Research and discourse in psychiatry are now dominated and infected by scientism — the promotion of a belief, sometimes intentionally, sometimes not, that because what you do and talk about sounds and looks like ‘science,’ it is ‘scientific’ — rather than a rational engagement with the nature and consequences of the actual scientific findings.
This scientism has sometimes scared critics from engagement with the actual science in preference of critiquing the suitability of using scientific reasoning to understand what we today define as ‘mental health.’ Opening the lid on both issues (the lack of engagement with the actual scientific findings and the suitability of using particular scientific methods for all knowledge generation) is important. We must endeavour to make transparent the grand deception that organisations such as the one I belong to (the British Royal College of Psychiatrists) are selling to the public about the nature of what we have come to call ‘mental illness,’ its causes, its treatments, and the way we should organise services to help those who become mentally unwell.
At its best, motherhood is a bittersweet agony of self-sacrifice and letting go. At its worst, her child dies and a mother enters a new world of never letting go, carrying the weight of an unrightable wrong. The miracle of beauty from ashes comes when her love grows up through the grief and continues to give life.
In 1956, Alice Bolstridge gave birth to a beautiful, joyful boy she named Alan. In 2015, she laid him to rest. In between, they walked together through the trauma of a prolonged childhood illness and a lifetime of seemingly intractable mental and emotional challenges that grew from it.
#3 in the series An Affirming Flame: Veterans’ Journeys from Trauma to Healing
Because of the gravity of the war-related experiences many veterans face, one struggle for veterans living with PTSD is the willingness and/or ability to tell their own story. To tell the story means to face it again, and that can be terrifying. But from Washington, DC, to Seattle, Washington, to the Navajo Nation in the southwest United States, story-telling is proving to be a key means of healing from the very trauma the memories of which veterans have strived to keep at bay.
Mad in America to Host Webinar On Oregon’s Innovative Early Psychosis Programs
On Friday, April 28th, from 1-2:30 pm Eastern time (10-11:30 am Pacific), Mad in America Continuing Education will be host a webinar on the Early Assessment and Support Alliance, a one-of-a-kind early intervention project in Oregon for youth experiencing psychosis. The EASA projects are unique in that they build on nearly 2 decades of outcome research and represent a pragmatic blend of models from Australia, Open Dialogue, and others.
April 10, 2017 by Gina Nikkel, PhD, President & CEO
Hearing Voices Network USA training in Atlanta
Gina Nikkel, PhD and Gail Hornstein, PhD in Atlanta at the April 5 panel discussion “What can we learn from people who hear voices?”
As President and CEO for The Foundation for Excellence in Mental Health Care (FEMHC) I have to admit that I get to participate in some life changing meetings and meet extraordinary people. This past week was no exception.
Farewell Mickey Nardo, 1 (not very) Boring Old Man
About five years ago, as my own blogging life was beginning, I found John M. Nardo’s outstanding blog, www.1boringoldman. His focus was on the poor quality of studies that formed the evidence base of modern psychiatry. In a painstaking way, he dove into study after study and pointed out their flaws. His outrage was apparent but couched in a graceful eloquence.
There was a comment section and I eventually jumped in. I had some communication with him outside of the blog, but mostly our communication was in the comments. At the beginning, I did not know his name or much about him. Over time, he shared a bit of his story.
Committed: The Battle Over Involuntary Psychiatric Care
Dinah Miller and Annette Hanson are two of the three psychiatrists who blog at Shrink Rap. After I started blogging, I began to search out other blogging psychiatrists and I found them. They also have articles published in Clinical Psychiatry News. My impression is that they are decent, well-meaning, and thoughtful psychiatrists (not unlike most of the psychiatrists I know) who want to demystify our profession. Their writing is clear, straightforward, and accessible. Like me, they are all practicing psychiatrists and they deal with the pragmatic challenges we face in our daily work. They offer critical views but they overall seem proud of their profession and their careers. While I respect their work, in that area we seem to differ; they do not seem to be burdened by the professional existential angst that besets me.
On one topic we agree — the subject of involuntary care is the most vexing, contentious, and troubling topic for psychiatry. To their great credit, they have directed an enormous amount of attention and effort to this subject in their latest book, Committed: The Battle Over Involuntary Psychiatric Care.