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.
No comments:
Post a Comment