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The 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.
Read MoreAnthropologists who study the psychiatric field recently had papers published in two highly influential journals. The New England Journal of Medicine featured a commentary by Gardner and Kleinman, “Medicine and the Mind — The Consequences of Psychiatry’s Identity Crisis” while “Merging Intensive Peer Support and Dialogic Practice: Implementation Lessons From Parachute NYC” by Hopper and colleagues was in Psychiatric Services.
Arthur Kleinman and Kim Hopper are leaders in their field. For this reason alone, these papers are worthy of review. While they both call for or describe reform initiatives, they point us in different directions with regard to the future role of psychiatrists.
Read MoreThis Continues the Spotlight on the Suicides series. Astonished by the conclusion of Stephen O’Neill’s inquest, I wrote to Northern Ireland’s Deputy First Minister, copied to the Ministers of Health in Ireland, Simon Harris, in Wales Vaughan Gething, and in England Matt Hancock, along with the Danish MEP, Margrete Auken, the European Ombudsman, Emily O’Reilly and Martina Anderson, a Northern Irish MEP.
Michelle O’Neill MLA
Deputy First Minister
Coalisland Sinn Fein Office
Co Tyrone BT71 4LN
Dear Michelle O’Neill
Re: Stephen O’Neill
I testified recently at Stephen O’Neill’s inquest. Concerned about the conclusion, I have since liaised with several lawyers, one of them a coroner, to explore what might be done to prevent an unfortunate inquest compounding an unnecessary death.
The options available to anyone unhappy with an inquest, primarily review whether there has been a breach of legal process. It is clear to the O’Neill family, and to me, there hasn’t been a breach of legal process, and even a judicial review at this point would be unlikely to contribute to the public safety in the manner the family had hoped for from an inquest.
This leaves the family in a situation resembling that of the relatives of those who died on the recent Boeing 737 Max flights. Had these deaths not been so public, a coroner would likely have concluded they were an unavoidable accident and his/her brief was just to record a death by plane crash. This verdict would have been supported on judicial review.
I am writing to you because there have been thousands of deaths like Stephen O’Neill’s and almost certainly will be thousands more – hundreds of Boeings – and, if a decent coroner like Mr McGurgan cannot see a way to make a difference, no-one will do anything to forestall these further deaths. The situation calls for a political rather than a judicial response.
Read MoreOne of the first things I do when returning home from a trip away is to stop by my local coffee shop and get my favorite iced tea. Do I go for the tea… well no, not really. No matter where I live, I have been doing this for years because it is not really about the beverage, it is about the people. The folks that work at my local coffee shop, whether it was when I lived in Pasadena, California, Rockville, Maryland or now in Hollywood, California, make the day just a bit brighter.
Black Girl Magic – London and Keris
This story isn’t about the iconic and ubiquitous coffee shop, coffee or tea. It is about “Connection”. Away for a week in Trieste, Italy, I return to my local coffee shop to be greeted by London – there we are – Black Girl Magic! She knows my name, I know hers.
Read MoreFor many years, mental disorders were simplistically understood as imbalances or deficits in the neurotransmitters in the brain. Recent research has debunked the “chemical imbalance” theory, and has given rise to more complex understandings around how the various systems of the body interact to influence physical and mental health. For example, many people are unaware that 95% of the “feel-good” neurotransmitter serotonin in the body is produced in the intestinal tract.
In recent years, scientists have begun to study what is known as the “gut-brain axis,” or the system of communication between the brain and the gut. Scientists have discovered what could be called “a second brain,” located in the walls of the digestive system. This “second brain” is referred to in scientific literature as the enteric nervous system (ENS), made up of two thin layers of more than 100 million nerve cells that line the gastrointestinal tract from esophagus to rectum. Increasingly, science is coming to understand that the ENS interacts in complex and significant ways with the central nervous system (CNS) via the vagus nerve and what is known as the “adaptive immune system.”
The recognition of the complex and delicate interactions between different systems in the body has given rise to a new field called “psychoneuroimmunology.”
Read MoreAs several authorities* over time have researched, documented, and reported, there is no “mental illness.” It is not an “illness”, as practitioners of psychiatry using the medical model, have long conjectured without evidence. There are no “them” with mental illness and “us” without. How we interact with the world does not conform to the construct of illness in physical health, nor can it be treated using that construct to intervene when life challenges arise.
Instead, as I have experienced personally, with family members, and with those I have served, there appears to be a continuum of emotional vulnerability in play daily for all of us, with each of us experiencing fluctuating manifestations of those vulnerabilities in our unique and individual ways. For example, some individuals can be seriously “thrown off” by a sequence of personal financial challenges; others by their spouses suddenly being inexplicably absent in the evenings from the home; or adolescents being bullied on social media, etc.
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