Friday 24 March 2017

Open Dialogue-a Contribution to a Healthier World: Threat or Chance?






In this article the dilemma of psychiatry as a medical science is outlined as well as options, where we as psychiatrists should turn to. Open Dialogue as a therapeutic approach to severe mental health crisis is introduced and described in its principles and elements. A case description illustrates how principles and elements are set to work. Connections to the upcoming Peer Movement are drawn as well as to EU-Legislation about Deinstitutionalisation and the UN-Convention of Civil Rights for People with Disabilities (UN-CRPD). Finally the difficulties in implementing such a comprehensive approach are outlined to get closer to an answer, whether this kind of change has more of a chance or tends to be a threat.

Since a couple of years it is obvious, that psychiatry as a science is facing a fatal crisis, but resistance to acknowledge some facts, that showed up, is strong within the profession, and that for many reasons. Still like in the middle ages the ambassadors of the new knowledge get kind of “burnt” on the bonfires of certain journals, as if to kill the messenger who brings in bad news. It looks like some facts are too disturbing to have a closer look at them. And we don’t have to name it a “Copernican Turn” what is happening, it is more that we gathered knowledge that does not fit the mainstream assumptions in psychiatry. In this I follow Pat Bracken, Bob Whitaker  and Peter Gøtzsche as well as some others, who have been dealing with different aspects (Joanna Moncrieff [5], Volkmar Aderhold, Stefan Priebe and P. Bracken  sum up what we gained through what is called scientific research in the last decades and it is very sobering to imagine the billions of Euros spent. What for? Yes, as much as nothing. They could not lift any secrets of the brain as much as to be helpful for our patients. 

The same is true forbrain imaging techniques and genetics. Robert Whitaker has had a closer look at the longterm outcome of different kinds of studies concerning different kinds of psychiatric treatment and comes to the conclusion that following the guidelines of medical – pharmacological treatment as usual leads to an outcome worse, than we would have expected and those patients who manage not to fall into the desired “compliance” and refuse to take long term medication, have better chances to recover and be included in more sufficient working and living conditions. He also revealed the way that business interests of the psychiatric profession and big pharma met in a fatal way for the benefit of the two, unluckily it turned out to be a disadvantage for the patients. He also revealed through epedemiological data in western countries a fourfold rise of disability allowances for mental health problems and connects it to the dominant treatment system. Peter Gøtzsche as head of the Northern European Cochrane Association investigated the scientific background of the admission of certain substances to the market and revealed criminal power behind it. Joanna Moncrieff managed to show, that theories about a chemical imbalance in the brain in the case of mental illness is nothing but a fairy tale, just a seemingly plausible invention. Stefan Priebe as a socially oriented psychiatrist has become the “mockingbird” of Psychiatry. He writes about the missing results of the investments in research over the last decades and its meaninglessness for the therapeutic endeavors. So we work in a mental health system that is built on wrong assumptions, produces more problems than it can solve, is more devoted to money and its implications than to those citizens, who are facing severe crisis and thus getting dependend on support. What a mess, we might say, and yes, it is. But the situation is far from being hopeless. 

Luckily we know a lot about how we could improve our attempts to offer help, that can be not only accepted but also helpful!! By now, we know from the experiences in the Soteria Movement,(Mosher Ciompi the results from longterm studies(Huber, Ciompi und Müller, Vermont Study, Harrows, Wunderinck, West- Lappland)the acknowledgement of human wisdom through philosophy, Buber  Bateson  Developmental Psychology (Trevarthen Stern [18] Reflective Processes and Open Dialogue (J. Seikkula, T. E. Arnkil enough to know, in which direction we should go. science made the race and we have to admit, they had and still have fantastic results in medicine as well as other disciplines. But then there came up the idea to apply this approach of looking at smaller and smaller parts of living organisms as human beings, first brain architecture, than nerves, followed by research on cells and synaptic connections, now on an intracellular level of mitochondria or membranes. 

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