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December 14, 2016 by Christopher Gordon, MD

Finding our way together

A doctor-patient relationship that calls out the best in each other

Several years ago, a person whom I was serving as a psychiatrist changed my life. This man had been a participant for some years in the services of the non-profit where I work, Advocates in Framingham, Massachusetts.

He had spent years going in and out of hospitals, for what doctors called bipolar disorder, but what he himself experienced as periods of great spiritual elation (which clinically looked like mania) alternating with what he described as “spiritual hibernation” (which looked like severe depression).

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December 13, 2016 by Bob Nikkel, MSW

A Foundation of Professional Education for Now and the Future


For its first year and a half, the Foundation for Excellence in Mental Health Care nurtured a fund supporting an on-line continuing education service developed by Robert Whitaker called the Mad in American Continuing Education Project.

This initiative now has 12 courses and lectures taught by internationally recognized researchers and clinicians. These offerings have been accessed by over 1,500 mental health professionals as well as persons with lived experience and family members. We have also reached a far broader geographical audience than originally anticipated–from Canada, the UK, Australia and New Zealand.

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December 7, 2016 by Sandra Steingard, MD

Vermont Collaborative Network Approach Launched

vermont_b-nikkelI 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.

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November 4, 2016 by Kermit Cole

Exploring Psychiatry’s “Black Hole”: The International Institute on Psychiatric Drug Withdrawal

Anyone who has found themselves in the universe of psychiatry knows that it contains some of the “black holes” of science.  There is little reliable science on how medications are supposed to ‘work,’ less on what a psychiatric illness is, and none on how to withdraw from the medication. For many, escape from diagnosis and medication is daunting if not impossible. Those who succeed do so for the most part on their own initiative, and therefore any information is anecdotal.

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October 26, 2016 by Bob Nikkel, MSW

Antidepressants and Pregnancy: The Risks and Potential Harm to Normal Fetal Development

bnikkel_miaceFor the past several months, Mad In America Continuing Education has been working with a small online education company,, to remake our CME/CEU lectures into full-bodied courses. Our first such course is on the risks that antidepressant use during pregnancy pose to the developing fetus. We think it covers a subject of utmost importance to our society.

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July 31, 2016 by Amy Beausang, PharmD

Did I choose the wrong profession?


One of the Most Trusted and Respected Professions
After 7 years of university (5 in pharmacy school), and just 6 months after passing my pharmacy board exams, the sickening realization that had been creeping up out of my gut–the one that I kept trying to hide from my brain and my heart–could be repressed no longer.

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July 28, 2016 by Christopher Gordon, MD

6 Lessons on Open Dialogue in the U.S.

Takeaways from The Collaborative Pathway experiment



The Collaborative Pathway is a replication and adaptation of Open Dialogue at Advocates, Inc., the human services agency in Framingham, Massachusetts, where I serve as Medical Director. Last week, our team (Chris Gordon, Vasudha Gidugu, Sally Rogers, John DeRonck, and Doug Ziedonis) published an article in the Best Practices column of the journal Psychiatric Services, describing the program and our results from the first cohort of young people and families experiencing a psychotic crisis.

This is the first published adaptation of Open Dialogue in the U.S. and represents the culmination of several years of planning, training and direct service. None of it would have been possible without generous initial funding from the Foundation for Excellence in Mental Health Care.

We provided our services to 16 young people and families over a period of one year. Most have continued to receive services after the study period, so we have more substantial follow-up data than was published in this initial paper. It’s hard to draw many conclusions about Open Dialogue from such a small sample, but I would like to share some of the promising lessons we’ve learned along the way:

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May 9, 2016 by Beatrice Birch

A Recipe for Life After Benzodiazepines

Inner Fire-Guides-Therapists-and-Seekers-4-10-16-074Vermont healing community successfully supports those tapering off of benzodiazepines and other drugs

Inner Fire, Inc. is a proactive healing community, offering striving individuals the choice to recover from debilitating and traumatic life experiences, (which often lead to addiction and mental health challenges), without the use of psychotropic medications. We opened our doors in Brookline, near Brattleboro in southern Vermont, on September 8th, 2015, welcoming six seekers to our yearlong intentional, therapeutic and farm based day program. Once the Inner Fire Home has been built, our intention is to become a therapeutic residential community.

Seven months later, all but one of the seekers who arrived on psychotropic medications have tapered safely off, having balanced the sometimes incredibly difficult withdrawal process with the empowering, proactive therapies and the practical work. A seeker, proven innocent after twenty-six years in prison, has withdrawn from a crack cocaine habit he developed while homeless during the first years after incarceration.

Another seeker will soon be off a very powerful benzodiazepine. “Hell warmed up” is the expression used describing the withdrawal process from this benzodiazepine; however, it has been everyone’s experience that by staying engaged in the program, surrounded by encouraging and loving people who believe in them as a creator and not a victim, that the withdrawal symptoms have not been as debilitating as expected.

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May 4, 2016 by Bob Nikkel, MSW

Reflections on Saks Institute Discussions of the Movies and “Mental Illness”

bnikkel_miaceOnce again this year, I was fortunate to attend the annual Saks Institute symposium held at the University of Southern California’s Gould School of Law.  The topic, fittingly enough in L.A., was mental illness in the movies.  Several filmmakers were in attendance, as were a variety of others–some academics, some attorneys, some mental health professionals, and a variety of others, including family members and some NAMI advocates.  My observations in this blog are made with the belief that those who participated in the symposium were some of the “best and the brightest” and in no way do I mean to be critical of their aspirations or devotion to the cause of helping move us beyond stigma and discrimination.

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April 18, 2016 by Sandra Steingard, MD

My Journey of Recovery

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.

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