Recently I as Chairperson of Hearing Voices Network Ireland (HVNI) got to spend some time with Hearing Voices Network Athens (HVNA), in Athens. I received a warm and loving welcome from the Network there, participated in one group, would have liked to join a second, if not for an episode. We also played music—doura & guitar—ate together and hung out at the HVNA premises in Athens. There were lots of hugs and laughter, as well as the serious business of who we are.

The HVN Athens/Greece has approximately 60 members which, like HVNI hold a monthly steering Committee. They organise two self-help groups for voice-hearers in Athens City, also Herakleion, Chania, Agrinio, & Thessaloniki. There are two self-help groups for family and friends in Athens with potentially a third one to come. There is a group for collaborative practice and self-education for mental health professionals and trainees. There are 3000 people on the HVNG newsletter list.

The Athens network host many extracurricular social, arts, and café groups also. There is a yearly seminar. I was invited to be part of one, hosted by HVNA and the psychology department of the University of Thessaly. Other seminars of HVNA have been in mental health hospitals—including on the infamous psychiatric hospital on the island of Leros, which in 1989 became internationally known for the maltreatment of patients and embezzlement of funds. Also seminars have been held with user & family associations, NGOs, and universities.

HVNA have collaborated with Initiative for a Polymorphous Movement for Mental Health, family associations for mental health, collective worker’s publishing houses in Athens, city movements, events, discussions in organisations and political places, etc. They have published or intend to publish titles by Joanna Moncrieff, Lucy Johnstone, & others in the field of critical psychiatry.

The aims of Hearing Voices Networks worldwide are the same, that is to provide support, foster acceptance, meaning-making & metaphor to the condition of hearing voices, for voice-hearers and their family and friends. We prefer the term ‘voice-hearers’ rather than ‘psychosis’ or ‘schizophrenia’ as the former term is less stigmatising and more human,  common, and everyday.

As HVNA have said in their article for Asylum Magazine (Spring 2018, “Spreading the word—Eight Years of HVN Greece, Creating Space for Our Voices”) what the HVN do is “a vivid, autopoietic system that aims at producing meaning and therefore life”. It states that we as psych survivors “have been violently attacked from neoliberal politics that aim to destroy the community”. The HVN Movement aims to keep people connected. As the HVN have stated, “there is no life without connection, there is no life for human beings without meaning”. Voice-hearers participate at all levels of our actions, which empowers us. Voice-hearers challenge ourselves by exposing personal issues and, speaking through our experience, present a new perspective about ‘psychosis’ to professionals. A more human approach is adopted. Our community work brings us in touch with other social movements such as associations for human rights, antifascists movements, etc.

To quote: “a recovery movement incorporates pain, experiences significant turning points, and enjoys the benefit of companions who chart their own paths. The pain concerns more people than the person directly experiencing psychosis; included are also family members called to stand in support and manage an endless series of dilemmas, personal anxieties, fears and the duty for responsible action as prescribed by society. Also included is, the mental health professional, who is faced with the same endless series of dilemmas, personal anxieties, fears and the mandate for responsible action issued by society; and, last but not least the ordinary citizen-viewer, who is coming face-to-face with an unfamiliar condition usually stigmatised by fear, in response to which s/he is invited to reconsider ethical, ideological and personal self-evident beliefs in what is also a confusing challenge to overcome oneself.”

All HVN offer self-help groups. Those groups are not in themselves a form of therapy; rather they offer therapeutic support and education.

Experience shows that recovery is not feasible unless there are some important others available, those who will believe in the reality of the experience, who will feel the pain and suffering experienced and who will trust that recovery is possible despite the mythology about incurable schizophrenia and chronic neurodegenerative diseases that the medical gospel presents. To quote Marianna of HVNA, sister to a voice-hearer; ”things are more difficult for anyone who has suffered the disrespect and the irrational violence of a system that is unresponsive and places preconceptions, trade interests and insecurities and the contributions of insurance funds before human beings.”

The HVN Greece article in Asylum Magazine also includes a paragraph with the heading ‘The recovery of the Mental Health professional’ which quotes U. Galiberti, who points out that,  mental health professionals, deprived as they have been of their own humanity, attempt to explain man objectively like any natural phenomenon.

And in conclusion, it is important to remember that ”when the ruling psychiatric practice is dominated by one-way institutionalisation and suppression, the Network of Voice-hearing People in Greece Advocates alternative ways of dealing with mental discomfort through searching for meaning in the discomfort.”

“Overall, we strongly believe that the HVM offers a paradigm shift (in the Kuhnian sense) in the area of mental health, that it opens new horizons for a different and innovative understanding of people who have been diagnosed with schizophrenia; and most importantly: IT WORKS!”

Laugh, Love, Always.

The post When HVN Ireland Meets HVN Athens appeared first on Mad In America.

A pioneering community mental health service in West Cork has been shut down—even though a report obtained by Mad in Ireland found it should be upscaled across the Health Service Executive (HSE) at national level, as it has “the potential to improve the quality of life for individuals experiencing severe and enduring mental illness.”

The closure by the HSE of the West Cork Open Dialogue service is a retrograde step, as an independent expert report found it “ought to be considered alongside other and existing treatment options within West Cork mental health services with more training made available to staff across the service, to ensure that the underpinning of Open Dialogue evolves across the service.”

Expert report

The report, which has to date not been published by the HSE, was carried out by the National Suicide Research Foundation and a group of experts in mental health. An executive summary of the report has been obtained by Mad in Ireland and is published here for the first time. It is the first in-depth study in Ireland to explore and evaluate the tenets of Open Dialogue and its findings provide key insights into how the West Cork Open Dialogue service was experienced by service users, their families and clinicians and, according to the report’s authors, “serves as a marker in how mental health practices should be delivered.”

Executive Summary_Open Dialogue_

The report found that:

• Open Dialogue is considered both as a therapeutic approach to support people dealing with an acute mental health crisis and a way of organising clinical care in response to the mental health crisis. As a therapeutic approach, Open Dialogue places the person at the centre of their recovery, mirroring the values and principles of a recovery-oriented model of healthcare.
• Open Dialogue demonstrates that increased well-being is possible despite living with an enduring mental illness and that recovery is based not just on treating the symptoms but on empowering people, enabling them to be autonomous and self-directed, in pursuing their goals and dreams whilst providing tailored care and treatment.

• The dominant biomedical model of healthcare that currently exists within the HSE is inadequate to meet the complex needs of the individuals who present with an enduring mental illness and that a cultural shift is required across mental health services to ensure that services focus on the person through the lens of their whole life, and not just solely on symptom reduction.

In the report, service users and their families spoke of the inherent difference of working with a team of professionals that seemed to “truly care about their mental well-being and felt that compassion and humanity in which the network meetings were held was key to the recovery process. Of note was the shared sense of mutuality that peer support workers brought to the table in sharing their lived experience of living and managing to move forward whilst experiencing mental health difficulties.”

Dominance of the medical model

One of the barriers to recovery from mental health distress cited in the report is dominance of the medical model of mental health treatment that looks at people through a particular lens and mainly treats symptoms as biological rather than psychological. Service users expressed frustration at being prescribed psychotropic medication as the first or only alternative as opposed to other interventions.

One person said:

“When I attended my GP when I was going through quite bad depression, I was quite ill and all they wanted to do was give you antidepressants and that seems to be the same for pretty much for any (..) that just. Seems to be the first port of call to give you antidepressants. So it took me a long time to actually get to see anybody to talk to and I would like that to have been a lot quicker.”

In response to questions about the service closure, the HSE told the Southern Star newspaper in January that “a decision was made to not accept any new referrals to the Open Dialogue programme as this approach is integrated into the multi-disciplinary delivery of care.” The HSE statement called Open Dialogue “talk therapy” and said talk therapy is on offer in mainstream services.

Whilst talk therapy may be on offer in mainstream services, Open Dialogue as a systemic needs-adapted approach (as opposed to a talk therapy) is now not available in West Cork. Nor could it be integrated into a bio-psychiatric model given the clear philosophical and clinical contradictions between both models. The service was the first Open Dialogue service in Ireland, representing at the time of introduction an innovative progressive mental health service in West Cork. Ironically, whilst other mental health services around the country are only recently beginning to embrace Open Dialogue and other post-psychiatric contemporary best practices, we see an early innovator service in retrograde. Outside of the HSE’s statement, no other communique with people who would have been involved in any way with the service corroborates what it states in relation to service integration. On the contrary, the message is clear: Open Dialogue is gone from Cork.

Adrienne Murphy, who was an Open Dialogue practitioner with the West Cork team, confirmed to Mad in Ireland: “Open Dialogue was not integrated into any West Cork service once they stopped taking referrals and there appears to be no longer support for Open Dialogue in the services here.”

The Southern Star newspaper also quoted a healthcare professional, who was one of the founders of the service.

“It is very sad to hear that the clinic has been closed and difficult to understand when the research recommends for the expansion of the approach,” she said.

“Despite this very disappointing decision, I am extremely proud to have been involved in developing this service and to have worked with wonderful families and colleagues,” she added.

Progressive rights-based service

The West Cork Open Dialogue service, written about in detail here, was established in 2012, a progressive move at the time, under Dr Pat Bracken, psychiatrist, and co-founder of the Critical Psychiatry Network.

Open Dialogue is seen as an alternative to medical model treatments that are largely based on medication. It emphasises dialogue and shared understanding between service users and their support network and it was endorsed by the World Health Organisation’s Guidance on Community Mental Health Services: Promoting Person-Centred and Rights-Based Approaches report as an example of a service which engenders a human rights-based approach.

Internationally, Open Dialogue is increasingly gaining traction as a real alternative to the medical model in helping people recover from mental health difficulties.

Within Open Dialogue, psychiatric medication is used in a need-adapted manner. This means therapeutic activities are planned and carried out flexibly and individually in each case so that they meet the real and changing needs of the patients as well as of their family members. Medication is rarely initiated at the beginning of the treatment contact.

As reported by Mad in Ireland last month, new research from Finland has suggested that mental health services based on the Open Dialogue approach to mental health may reduce psychotropic drug treatment in young people.

The research suggests that the iatrogenic risks of long-term psychotropic treatment can be minimised by reducing the amount of medication prescribed, which may be a factor in the promising outcomes in treatment strategies such as the Open Dialogue approach.

The value-base and proven positive outcomes of Open Dialogue make it a unique project that needs to be expanded rather than closed under the pretext of ‘integration’.

The post Irish Open Dialogue Shut Down—Despite Expert Report Stating It Should Be Scaled Up appeared first on Mad In America.

The chemical imbalance theory of depression—what was once considered the gold standard reason for why people take antidepressants—was, apparently, “a figure of speech.”

This gobsmacking admission from The College of Psychiatrists of Ireland appeared on its website in what seems to be relatively new content to reflect the long-known reality: there is not, nor has there ever been, any scientific evidence to support the chemical imbalance theory.

Most people reading the Mad in Ireland website will have known for quite some time that the chemical imbalance theory was debunked. The reason we say “gobsmacking” is because it’s not something that Irish psychiatrists have said publicly before, although a representative for the College did say in a 2015 media article that people didn’t really believe it anyway.

This is simply not the case. Any wonder, when for decades, people have been deluged with information suggesting that depression is caused by a “chemical imbalance” in the brain—specifically, low levels of serotonin.

A survey indicates that actually more than 80% of the public blame a “chemical imbalance” in the brain for depression, so clearly it’s not enough to quietly retract something that’s been held up as the cause of depression, by simply saying it was a figure of speech.

The “figure of speech” phrase in itself is interesting. The chemical imbalance theory has in recent times been called things like a careless metaphor rather than the concrete fact it was communicated as for many years—for example, see Harvard Health. There are many other sites including the phrase or something similar, an attempt, perhaps, to rewrite history, now that the theory has been debunked.

According to well-known researcher and psychiatrist Professor Joanna Moncrieff in a National Post article:

“In the 1980s, when the first SSRI, Prozac, was launched, ‘the pharmaceutical industry knew it couldn’t market them in the same way (as benzos) because numbing someone’s unhappiness had got a bad rep with the benzodiazepines,’ Moncrieff said. ‘So, it had to convince people that they had an underlying disease and needed to take the drugs for an underlying disease.’”

Moncrieff has been instrumental in bringing to light the issues associated with psychiatric drugs and in stating why it’s so important that people know the truth. She says whether antidepressants work or not depends on how we “understand what they are doing.” And if they are not correcting a serotonin imbalance, or reversing some underlying mechanism of depression, “what are they doing?”

​​When people are taking mind-altering drugs that they believe corrects a chemical imbalance, you’d imagine it would be a priority to tell them if the science changes, or thinking shifts.

Why does this matter? 

This matters because research shows that people who have biological explanations for mental illness tend to be more stigmatising toward themselves and others, and this belief can leave people feeling pessimistic about their chances of recovery.

A study published in the Journal of Affective Disorders found patients who believe that a chemical imbalance in the brain causes depression to have worse treatment outcomes.

Mad in America covered the results: “The results of the study, which included a sample of 279 persons attending an intensive behavioral health program in the United States, found that the endorsement of the chemical imbalance theory of depression was associated with poorer expectations of treatment and lower perceived credibility. Additionally, the researchers found that a belief in biological causes for depression was predictive of a greater presence of depressive symptoms at the end of treatment.”

It matters because the media and even many people who work in mental health continue to believe in the chemical imbalance theory of depression. This makes it hard for the media to challenge the mainstream narrative around a biomedical approach to mental health and it makes a culture shift within mental health itself harder to achieve.

It’s more clear than even that prescribers need to talk honestly with patients, explaining that it is unclear how antidepressants “work,” even for “depression,” and that using them to disrupt serotonin in the body has multiple effects on all physiological systems, as well as on feelings of overwhelm, hopelessness, and “depression.” These effects can include paradoxical suicidality, sexual dysfunction, blunted emotions, digestive problems, fatigue, weird dreams, and compulsions—among other side effects that affect mood.

What are the drugs doing?

The World Health Organization (WHO) guidelines on depression treatment are clear: “Antidepressant medications are not needed for mild depression.”

Multiple studies have found that even for severe depression, adding antidepressants to cognitive behavioral therapy does not result in better outcomes—psychotherapy alone is just as good in the short term. And therapy alone beats the drugs when it comes to long-term outcomes.

Prof Moncrieff has written several excellent papers outlining what she calls the drug-centred model of drug action.

She argues that…“Unlike the current disease-centred model, which suggests that psychiatric drugs work by correcting an underlying brain abnormality, the drug-centred model emphasises how psychiatric drugs affect mental states and behaviour by modifying normal brain processes. The alterations produced may impact on the emotional and behavioural problems that constitute the symptoms of mental disorders.” (See Table 1)

In other words, just like any other drug, psychiatric drugs have mind- and behaviour-altering properties.

As it becomes more apparent that the medical model needs to change but that vested interests are very reluctant to be open and honest about how and why it needs to change, professional activism is becoming more commonplace and important.

Published in the British Medical Journal (BMJ), 30+ prominent figures called on the UK government to acknowledge the evidence that antidepressants are no better than placebos for most patients and to increase funding of social and psychological interventions while decreasing drug prescriptions.

“Multiple meta-analyses have shown antidepressants to have no clinically meaningful benefit beyond placebo for all patients but those with the most severe depression,” they said.

“Our findings are in line with accumulating evidence that some biogenetic beliefs, like the chemical imbalance belief, are linked with poorer expectations for improvement, especially among those with the most troubling symptoms.”

As reported by Mad in Ireland last year, there is also advice in the UK around tapering, with pharmacists in England being urged to assist people who want to stop antidepressants.

Honest conversation needed

Given all of this, it really is long past time for an honest debate in Ireland around these issues. While in the past there has been backlash for professionals seen not to be toeing certain lines, surely with all of the research and information out there, this concern doesn’t apply anymore?

Some immediate questions arise from the CPI’s admission that the chemical imbalance theory of depression was just “a figure of speech,” namely:

• Has the concept been removed from training materials and replaced with all of the new science and studies around antidepressants and other psychiatric drugs?
• Is there a programme of work to inform various sectors such as social workers, pharmacists, and GPs, as a starting point?

GPs in particular should be given up to date information ensuring that informed consent is always the goal. Media should be informed and a public service campaign should be considered. For example, in other areas of health promotion, good information (e.g. FAST in relation to stroke) is important to have in the public domain.

If the chemical imbalance theory is still what a large swathe of the public believe, don’t researchers, mental health practitioners, and people who are responsible for mental health policies have an ethical responsibility to ensure that the public has the most up-to-date and evidence-based facts? This news might be upsetting for people, but it’s morally wrong not to tell them.

Only then can informed consent about medication become a reality rather than an abstract theoretical “figure of speech.”

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