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From 2012 to 2018, Parachute NYC offered a “soft landing” for people experiencing psychiatric crisis in New York City. Along with a respite center, Parachute mobile teams consisted of teams of health care professionals, including peer specialists, psychiatrists, social workers, and family therapists, who were each trained in the principles of Open Dialogue and Intentional Peer Support. Open Dialogue, developed in Western Lapland in Finland, espouses a practice of healing through polyphonic (many voices) dialogue within a non-hierarchical network, tolerating uncertainty, and treating every utterance as meaningful and rational. Intentional Peer Support, developed by and for peer specialists, embraces crisis as opportunity, mutual accountability within partnerships, and trauma-informed care. Parachute represented the first instance in which peer specialists were integrated into the Open Dialogue model.
Read MoreThe voices that I hear were very amped up before our historic first facilitator training in Florida. Like a lot of voice-hearers when I experience something new, my experiences can become louder or more intense.
My Voices had questions about whether what we were about to try was going to work. Whether the two-track training we had recently developed, honoring the different needs of groups for voice-hearers and groups for their family members could have the same transformative power as the other trainings we had held across the country.
I decided to visit a peaceful place before the training began and headed to a nearby Japanese garden. As I bought my ticket to the garden, something caught my eye.
Read MoreThe Hearing Voices movement began in Europe in the late 1980s when Marius Romme, a psychiatrist, realized that his training and therapeutic techniques were not helping one of his patients to manage the voices in her head. In listening to Patsy Hage, Romme began to wonder if maybe other voice-hearers might be in a better position to help her than he was. His hunch turned out to be correct, and the Hearing Voices Network (HVN) was co-founded by Romme and Hage in 1987.
The HVN is a peer-to-peer, nonclinical support group based on the radical idea that voice-hearing is not automatically a sign of pathology. Unlike traditional methods that encourage voice hearers not to engage with or listen to their voices, the HVN takes the opposite approach: voice-hearers are encouraged to explore and discover for themselves what their voices mean. The groups also provide social support and acceptance– something that is vitally important given the social distancing and isolation often reported by voice hearers. And the groups offer practical strategies for living with and managing voices.
Read MoreIn the United States, media representations of voice-hearers are rare and mostly negative. When our stories *are* shared, we are often portrayed as one-dimensional, irrational, violent or unable to contribute to our communities. Research indicates that one in ten people hear voices at some point in their adult lives, however; negative media representation leads many to stay silent about these experiences. We now know that that silence and isolation can make an experience of hearing voices more distressing and harder to navigate.
With the Hearing Voices approach, we create space for voice-hearers to share their experiences in all their individual complexity. We see over and over the healing value of articulating what our voices say, how long they have been in our lives, and what life events they might relate to. We have seen the importance of making room for trauma-informed and culturally-competent understandings of both why voices/visions occur and what healing practices are available.
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Is diagnosing a person and labeling them as mentally ill truly helpful? Ironically, when I first entered therapy it was because I feared mental illness. I did my best going to therapy for over 16 years, but to no avail. I received not one diagnosis but four of them. I finally realized that the mental health system is designed primarily to diagnose and place labels on human beings. These diagnoses or labels not only deem people to be mentally ill or defective, they also often prevent people from reaching their true potential.
Read MoreThe written interview transcript is below, edited for clarity:
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Damon Winter/The New York Times
In the largest newspaper in the world this week, one of the largest problems in the world was proposed as having a very simple solution.
There are few problems more heartbreaking and excruciating than the growing epidemic of youth (and adults) taking their own precious lives. And so, it’s understandable that great attention continues to go towards solutions that can make a difference.
In response to this urgent challenge, psychiatrist Richard A. Friedman asked in a New York Times op-ed: “How is it possible that so many of our young people are suffering from depression and killing themselves when we know perfectly well how to treat this illness?”
Do we? That’s certainly a widely shared perception among many in the general public today. But is the answer really this clear?
Read MoreI recently submitted a recommendation to Oregon’s mental health officials as they consider revising their clinical standards. My recommendation for these clinical practice standards has to do with providing true informed consent for prescribing psychotropic medications. If it were adopted, it would threaten to bring down a kind of “house of cards” that is the centerpiece of the mental health system.
The state is asking for feedback on what they call administrative rules for behavioral health. These rules provide the practice standards required of service providers.
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Open Dialogue is alive and well in Massachusetts. Since 2011, when Advocates was the first recipient of funding support from the Foundation for Excellence in Mental Health Care, Advocates has been providing Open Dialogue services in two programs based in Framingham, Massachusetts.
Advocates is a full-service, not for profit provider of services and supports to people with psychiatric conditions, developmental and other cognitive disabilities, substance use conditions, and other life challenges, offering residential supports, outpatient and emergency services, among other supports, all dedicated to the idea that everyone, regardless of diagnosis or disability, can live a full, challenging and rewarding life of their own design, given the right supports.
With the initial support from the Foundation for Excellence in Mental Health Care, and with additional support, particularly from the Department of Mental Health, Advocates was able to train 35 staff members at the preeminent training site for Open Dialogue in the US, the Institute for Dialogic Practice under the direction of Dr. Mary Olson, currently affiliated with Yale University.
We then launched two programs – one for young people experiencing early episode psychosis, called The Collaborative Pathway; the other for people receiving services from the Department of Mental Health, whose difficulties had become or were at risk for becoming more chronic, called Open Dialogue in Behavioral Health Services. With support from the Cummings Foundation, and ongoing support from the Department of Mental Health, both programs have been delivering Open Dialogue Services for nearly ten years.
Read MoreOne month ago I suddenly found myself in a very dark place where I felt vulnerable, raw, naked, humble, confused yet seeking to understand the social interaction dynamics that had triggered this journey into a seemingly bottomless pit. It’s been well over 10 years since I’ve been in such a solitary space, feeling alone, unsupported, disconnected from myself and from others.
I slowly began to emerge from the darkness 10 days ago and now I am completely out.
Going into the darkness, I remember telling people I am going through a big shift in my life. It was clear that something significant, transformational was happening. I came back with deeper feelings of connection, and a deeper sense of belonging to something much bigger than myself and a more profound sense of meaning and purpose. One lesson was about a deeper understanding of who I am separate from ego, that is, the identity I was taught and the social conditioning that has so brainwashed my thinking. And I might add the thinking of everyone around me. It’s grip on me is looser.
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