Ramped up

In his latest book, Anatomy of an Epidemic, Robert Whitaker looks at the Open Dialogue program in Western Lapland (Finland) and can't quite put his finger on why these group meetings generally in the person's home are so effective. (The number of new cases annually in this region show an astonishing 90% drop from the 1980s.)

Without knowing this program either, but having spent two years in another program in Europe which thought it was cutting edge, I will offer some thoughts. First of all, the initial Open Dialogue meeting takes place usually in the person's home within twenty-four hours of reported psychotic behavior. If the psychotic person jumps up and leaves the room, he is encouraged to listen in to the conversation even if not physically present in the room. (The open door policy.) Medication is not usually discussed in the first few meetings and often is not recommended at all.

Whitaker claims that the Open Dialogue concept of psychosis doesn't fit into either the biological or psychological category. It is familiar to me because it is very much like the Family Constellation Therapy that Bert Hellinger and others espouse. "Psychosis does not live in the head. It lives in the in-between of family members, and the in-between of people," Salo explained. "It is in the relationship and the one who is psychotic makes the bad situation visible. He or she 'wears the symptoms' and has the burden to carry them."

As a parent, would this concept of the origin of psychosis make me feel better or worse about the situation compared to the group meetings that I went to with the family in the psychiatrist's offices? There, psychosis was considered something foreign to everybody, family and patient included. It was something that just "happened," like becoming diabetic or discovering that your house was burgled. Medications were part of the deal, and were insisted on. I'll put my money on better outcomes in Lapland.

The program we were involved with made me feel anxious. I am sure that the families are anxious in Lapland, too, but it seems like the situation is diffused rather quickly within the privacy of the home. We suffered through the horror of thinking that my son's brain was inexplicably damaged, we were led to believe that the doctors held the key and that there was nothing that we could have done to prevent this or to get over this. (There's no cure, right?) We were also encouraged to attend meetings with other parents who, naturally, were worried about their children - and it showed. It was a climate of fear. Then the side effects of the drugs quickly became apparent - leading to more fear and a sense of doom.

The "problem" had been escalated by dragging it under a bigger spotlight instead of containing it and working through it where it arose - in the home. A massive case of over-reaction to a problem of living.