Some thoughts in the end of 2017

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Meetings of different kind, at our office and elsewhere have taken place during the year- some have been hard to deal with, but most of time it has been enriching and powerful to be a part of The Extended Therapy Room.

An increasing number of individuals and organizations are nowadays more critical to the use of psychiatric diagnosis and prescriptions of psycho pharmaceutical drugs than just some years ago when our organization started. Our purpose is shared with many others all over. It is indeed hopeful!!

An increasing number of individuals and organizations are asking for alternatives to the psychiatric paradigm when people experience life crisis, our organization is together with others trying to describe and mediate what matters and what is needed. Still there is a way to go….

I am happy and grateful for many things, but also worried – there are indeed things to be worried about, in the big world as in the small one. More than ever we need to remind each other about the importance of continuing the shared work for a better world.

BIG WORDS… Tom Andersen used to talk about big words and what it means in practice. I wonder what he would have said about the situation by today. Many words, many different concepts, diagnosis, terms and theories. But does it necessarily mean better meetings with one another?

I am not sure about that, most people tell about the essential meeting with another human being, especially when life is at stake. Very few, if anyone refer to theoretical concepts or methods when we describe what was important when hope was nearly gone or when it felt as if everything was lost. Rather we then describe the experience of caring, love and solidarity. To be met by another human in a dignified way.

Our feelings are essential, so is our thinking. Maybe more than ever right now. How do we – you and I think about life and other humans, how do we- you and I include others? How do we talk about one another and how do we solve dilemmas and conflicts in everyday life and in society?

A few days ago I watched a movie about the life of Hanna Arendt, a great philosopher and human being. I thought to myself that her thinking and deeds are missing today. What would she have said about the world and what would she had suggested us to do? I think she would have asked us to connect research and practice in a more direct way, and to never forget our own responsibility regarding the way we talk and behave towards each other. She would probably had been upset about the “nonsense research” which makes no sense and she would have asked for more actions…

Christmas appears, for some people it means a lot and for some people it means nothing. Whether we believe in the narrative or not, about a child being born in a stable many years ago, Christmas might remind about the importance of love and miracles happen. At least that is what Christmas means to me, and the darker it gets the more I need to hold on to the idea about the light and yes, miracles happen. What else to call that which happens when people come together and open up our hearts and minds… One of the Nobel prize winners talked about miracles happen, but it uses to be connected to hard work, he said. Might well be… Things happen we cannot always explain, life changing meetings and new discoveries.

Psychotherapy research tell us it is not possible to explain in detail what works and what does not work in the therapy room, the researchers claim it seems as if the meeting is essential between the therapist and the one called client. Those of us; professional helpers and family homes who have worked for many years know that the researchers are right – the meeting is essential – actually the most important. But not just the meeting, also the therapist and the client as those we are matters. How we talk, think and behave, towards each other, ourselves and others.

It is knowledge related to life itself, something human beings have experienced and still experience, no matter when and where on earth we are. My wish for years to come is that we will take care of this knowledge, and create organizations and contexts which hold essential knowledge, develop it and care for it.

I wish you All a peaceful, thoughtful and loving Christmas Holiday and a GOOD NEW 2018 to come!!!

With love and appreciation

Carina

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Visiting the medication free psychiatric ward in Tromsö

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Tromsö has a special place in my heart and mind ever since the very first time my former colleague Teo Keller and I attended a June seminar where we met with hundreds of other people, including Ann-Rita Gjertzén, Michael White, John Shotter, Harlene Andersen, Jaakko Seikkula, Magnus Hald, Lynn Hoffman and the one who made the very special meeting happen, late Tom Andersen.

I am not sure he would have liked to be mentioned as the one who made it happen, and of course it was a collaborative action, but he had a special gift in the sense, to create space for essential meetings to happen, either it took place in a psychiatric ward between just a few persons or during an international meeting.

Tom was in my mind and heart as the aircraft flew into Tromsö last Sunday and from the window I could see the spectacular view of the mountain and the sea as always is there. The purpose for my visit was to meet with staff and those here called patients at the newly opened medication free ward, which has been established thanks to many people´s visions and efforts led by Magnus Hald who is in charge of the clinic.

We are many who have followed the plans to create a medication free ward within the mental health care system in the North of Norway and I was excited and happy to be on my way, and also to meet with Robert Whitaker who would be there to examine how does the ideas and practice look like. Thanks to his relentless searching for facts and evidence regarding psycho pharmaceuticals many people have come to question the existing paradigm which is very focused on medication.

From the very first moment as entering the ward I felt a welcoming atmosphere, an openness and a respectful warmth. The ward is situated right in the middle of the hospital, and few things have been changed regarding how it looks like compared to a traditional ward, and still it is different.

Few things but essential ones, as for example the piano which is placed in the living room. Beautiful flowers, a basket full of colorful balls of yarn, and other small details made me feel at home in a way I usually don´t when visiting a psychiatric ward.

It made me think of Barbro Sandin and Walla where she together with others worked for many years. Walla was the name of the organization but it was also the name of the beautiful home like house where the work took place. Barbro used to say that the environment with its furniture, paintings and flowers is essential especially when life is hard and chaotic inside.

Well, beautiful things are important but as we know more important are the people around us, and so I wish to say something about the people I met. As always it is from a very subjective point of view and as always it will just capture some glimpses, but still…

Merete Astrup who is in charge of the ward seems to be surrounded by people whom like herself mediate warmth, calmness, trust and faith in what is happening and what will happen. This altogether with the respectful way the staff talk about and with those here called patients is as I think a guarantee for the work and shared mission.

By the way, it took me a long time to find out who is the one and who is the other. As for example, I asked one woman what is her profession and she smiled and said “I am a patient”. The tone in every conversation was respectful and as we all know that is of utmost importance when life is at stake. As it also is essential to let people be the way we are, without being met by interpretations and interventions we have not asked about.

This if I may say freedom is an important principle, as I understood it. To not let specific formulas or methods stand in the way, but to try to see each and every one and their needs and strengths. As for example there is no formula how many days the patients may stay at the ward, it might be a few days and it might be months.

There is a structure at the ward which include different activities and conversations, but the one here called patient does not have to participate if she or he does not want to do so. Many different professions are represented at the ward, but it did not seem to be crucial who is the one and who is the other, rather it seemed as if the relationship is in focus and to make use of many different perspectives and experiences.

A challenge since Northern Norway is a big area is to build sustainable networks in different parts of the area and to find people to cooperate with. When talking to Merete and the others it seemed as if they were well aware of this challenge and willing to take it on. I could not help myself from suggesting the staff to find some family homes who are willing to be part of their pioneer work. If something, that is missing so far, as I think.

It made me both hopeful and glad to meet with the people at the ward and to be invited the way we were. Robert Whitaker will write a more detailed article in MadinAmerica so please stay in touch and be connected.

The staff has taken on to a big and important challenge, we are many from all over who hope and wish their work and experiences will be followed by other psychiatric wards in the Nordic countries and elsewhere.

I wish all the people I met the very best, and I keep inside of me some strong and touching moments, in the kitchen, in a sofa and at a meeting that I was blessed to be part of.

Carina

Ps, I am sure Tom Andersen would have liked the work and the warmth at the ward.

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Perseverance, patience, dedication and the personal responsibility that we always carry with us

On Sunday I go to Tromsø to meet people at the newly opened pharmaceutical free department of psychiatry. I look forward to visit Tromsø again and I am happy that many years of dedicated preparation and planning among others by Magnus Hald, who is responsible for psychiatry in northern Norway, made this department possible. Magnus was a close friend and colleague of Tom Andersen’s who prematurely passed away almost ten years ago. Crystal clear is the memory of sorrow when the news of Tom’s death reached me, but also the confidence in being surrounded by many people who in different ways have carried on in his spirit.

Tom’s work was about creating space for meetings between people, both in the small and intimate context and on different continents. He had a strong belief in the ability of people and the importance of listening to both what is expressed verbally and what you feel in your body.

Through Tom and his work I became, in my work, a part of a large network that in its practice and vision reminds us of the importance of the perseverance, patience, dedication and personal responsibility that we always carry with us.

Especially in times like these – so marked by anxiety, inconsistencies and implausible statements – it is essential not to give in to despair and catastrophic fantasies. Even if it sometimes seems difficult, there is no alternative but to think that things will go well in the end, and that it matters what we each do and contribute with.

Suzanne Osten usually reminds me of this. She says that we always have a responsibility to let a small spark of hope exist, even when it’s at its darkest. I was thinking about this the other day when I was listening to a movie clip with the French psychoanalyst Francoise Davoine; she began her career more than thirty-five years ago by visiting the dayroom at a state psychiatric hospital in France only to be present if any of the patients would like to talk to her. She calls her patients researchers, because together with her, they research their lives and the surrounding world.

My thoughts are also with Barbro Sandin, who in the mid-1970s began her pioneering therapeutic work at Säters hospital. She showed that it is possible to understand psychotic conditions and that what is called schizophrenia is neither chronic nor impossible to comprehend. But the encounter with another human being is extremely important.

In a moment, one of “my people” will turn up, so I will end this text in a feeling of joy and gratitude of being part of a group made up of many people, both my dear colleagues that I meet every day and those I meet less frequently but who in their thought and deeds help me to be where I am.

Carina

 

 

 

 

 

 

 

 

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Some thoughts right before Christmas

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I’m gazing out over the square where people from all around the world hurry past. Actually not all of them are in a hurry. One young man just limped by on bent legs that were perhaps demolished in a war somewhere. Another young man is sitting on the sidewalk listlessly holding out a paper cup. I imagine that he is silent, that his cry for help was silenced long ago. So many people are feeling so hopeless these days. Sometimes I think twice before I turn on the radio. I don’t want to be reminded of all those being abandoned to their fate, in Aleppo and Mosul as well as other places ravaged by drought, famine and war.

My mother says I shouldn’t think so much, but do you do stop? And is it really preferable to turn your thoughts off? To not allow yourself to feel or be touched. There are moments when I’m going by tram and I want to get up and preach about everybody’s responsibility to intervene, to act and to thwart. But I don’t – at least I haven’t, yet. Maybe someday I will be big enough to stand up. Maybe someday I will be brave enough to do my part and do what I should have done a long time ago.

Amidst all the lights and tinsel, the presents and the aromas from bubbling pots my mind is needled by the unrelenting thought – does it really have to be like this?

In a world where we all should be able to help each other and join together loneliness is mushrooming accompanied by cynicism. Professional media pundits on TV talk about goodness as if it were ballast, as if there were an excess of it. At the same time these same pundits talk about drug addiction as if it were a sickness, without taking into consideration any kind of relationship or context. So random, so reckless, so dispiriting.

Suzanne says we can tell the darkest stories imaginable, to children and adults alike, as long as we always ensure there is a ray of hope at the end. A glimmer of light that makes it possible for us to go on, that helps us have the courage, the ability and the will to care about the essence of human beings and their conditions in the world.

From my window I can see people coming and going holding hands. There is a son full of trust with his hand in his father’s and three smiling, young women meeting the day arm-in-arm. I also see all the people who bend down and drop a coin into the worn paper cup. All the people who haven’t given up on the idea that it’s better to give than not to. All those who know it could have been them instead.

In a little while one of all the people I’ve had the joy of meeting in my work will arrive. Soon I’ll open my door to him.

On behalf of The Extended Therapy Room I wish you all MERRY CHRISTMAS and HAPPY NEW YEAR!

Carina

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A warm thank you …

… to All who attended our symposium Pharmaceuticals – Risks and Alternatives.

And to All of you who support us from near and far. It means so very much!!!

The symposium was also a starting point for the International Institute for Psychiatric Drug Withdrawal (IIPDW) which is now created. The faculty so far consists of Olga Runciman, Sami Timimi, Birgitta Alakare, Robert Whitaker, Will Hall, Carina Håkansson, Jaakko Seikkula, Volkmar Aderhold, John Read, Magnus Hald and Peter Götzsche.

More information will soon be available….

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Reply to an article in Socialpolitik

In their article Pebbles Karlsson and Martin Ambrose Schalling suggest that “antipsychotics and lithium should be made free” (Socialpolitik, 3, 2016).

At first, we believed that we have misinterpreted them – do they really mean that psychotropic drugs should be made even more available on the market? This despite the fact that we in Sweden and other parts of the Western world have been able to record an almost exponential increase in the use of such drugs, while the number of people who are forced into early retirement due to mental disorders at the same time has increased significantly?

Research demonstrates that people do not have a better recovery rate when using antipsychotics, but rather the opposite (Seikkula 2006, Harrow 2012, Wunderink 2013 Aderhold,2014 Whitaker, 2016, Gøtzsche,2016).

Karlsson and Ambrose Schalling state in their article that people with severe mental illness have up to 20 years shorter life expectancy than the average citizen. This is a fact that also we, unfortunately, are familiar with, but we do not share the view of the reasons behind this, nor the notion that the best solution would be even greater access to antipsychotics. Studies show that treatment with antipsychotics is a contributory factor to the short life span of these patients (Gøtzsche 2016).

We would have wished that Schalling, as chair of Psykiatrifonden, instead had drawn the readers’ attention to the non-functioning psychiatric care system, that still in 2016 to an appallingly high degree lacks alternative to hospitalization with early diagnosis and prescription of psychotropic drugs as almost the only action.

We still lack, with very few exceptions, early psychotherapeutic interventions, continuity, availability, time, sustainable thinking and action, contact with networks and, more than anything, a focus on the person involved and his or her experiences and needs.

We also would have wished that the writers had noted that strong drugs are prescribed without a rigorous, continuous follow-up and without a plan on how these drugs should be cut down and ultimately removed from the treatment. This is actually one of the major differences between diabetes and psychosis: the former is a chronic disease (where insulin has a specific action), but this is not the case with the latter and it should therefore not be treated as such.

The authors refrain (apart from half a line in the article) from discussing all the side effects that are associated with antipsychotics and most likely are a significant reason why people stop taking them.

Proven experience and international research report severe side effects, both physical and mental, of these drugs. This huge problem deserves more attention and more research, independent of the psychotropic drugs industry and not as today, closely linked to it (Whitaker and Cosgrove 2015).

Much remains to be done to alleviate human suffering and prevent people from getting caught up in a psychiatric dependency. As humans we are social and relational beings, and we need to adapt healthcare institutions and organizations accordingly.

We welcome the authors and not least the organization Schalling represent, Psykiatrifonden, to future talks and a joint action to create alternatives to the currently highly dysfunctional psychiatric health care in our country.

Carina Håkansson, PhD, founder of the Foundation Extended Therapy Room, Sweden
Birgitta Alakare, psychiatrist, Finland
John Read, professor of psychology, UK
Olga Runciman, psychologist, Denmark
Peter Gøtzsche, professor, Cochrane Institute, Denmark
Jaakko Seikkula, professor of psychotherapy, Finland
Hanna Lundblad, social worker, Sweden
Will Hall, research student, USA

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Little seed and large oak

Just recently, our group spent a day with P. Tudor-Sandahl and C. Sandahl talking about our work, its practices and visions. We mentioned the people we meet daily, and also all those we don’t meet so often but who are included in different ways. We talked about our dreams, about why we do what we do and about the joy of being part of something that very much is “for real”. We also talked about rules and regulations, formalities and financing – all the short and long term obstacles and difficulties we have to cope with. We put words on our fatigue, frustration, resignation and those brief moments of powerlessness. But even more we spoke about joy, meaningfulness, context, participation and the importance of being there.

Someone reminded us of the little seed in the soil and how it silently grows, branches out and finds its basis. The seed that is dependent on light, hope – and someone else’s participation and presence.

We didn’t find it hard to identify with the seed and its conditions, but the parable wasn’t totally accurate. Is what we do akin to a seed, Hanna asked and then suggested that we rather bear the semblance of a large oak tree with bushy and “experienced” branches. It was suddenly very quiet in the room, as if each one of us had to cover the gap between the small seed and the big oak. We realized that it is in that gap we find ourselves, both as individuals and as an organization.

We are not one or the other, but both. Or maybe neither one nor the other, but something else. Something that cannot be defined or limited, but that we know needs air and light to grow, take hold and develop a solid crown with strong branches.

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A view from my window

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I love the view from my window at our new office Järntorget 4; trams, people from all over the world, bikes, cars, balloons, children, teens, old women and men, cherry trees, beautiful houses, less beautiful houses, dogs, some cats who maybe have lost track… shops, restaurants, bars, and some flowers.

Especially I love to watch the people walking back and forth, it is such a variety of colors, styles, mood, temperament, ages… I know nothing about the people I watch, some of them I will never see again, others will walk across the square often, some might be known to me, and I will be known to them…

The square reminds me of the extended worldwide network we are part of, all the people who in one way or another are connected to each other, most of us do not know each other personally, but sometimes we meet, for a short while or for a longer period of time. Experience is exchanged, so are thoughts, wonderings, feelings and dreams. Sometimes the meeting becomes life changing. Sometimes we get to know about it, and sometimes we don’t. It happens in silence and beyond words.

Life changing meetings also happens in daily work where I am blessed to be part of a group who know each other and who trust each other. Some days ago Hanna, Alexandra and I met with a bunch of family homes here in our office, and the conversations were amongst other things about life changing meetings, for ourselves as well as for those who we sometimes call clients.

Now it’s time for me to leave the computer for a while and to do some practical preparations for the party which will be held in a couple of hours, to celebrate our extended work together with lots and lots of people all over the globe.

Carina

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Welcome to the Extended Therapy Room

Last Sunday we were at the gala premiere of Suzanne Osten’s movie “The girl, her mother and the demons.” Important and shocking – and reminiscent of how life conditions all the way from the start have a significant importance. But also about the power of the impermanent, the importance of having people around us, that we are not separate islands. That life is constant movement!

UKON has written a new book, “Glömskans bibliotek”(The library of oblivion), which is a must for all of us who in our life and work meet other people. His book also reminds us of life’s conditions, its whimsical nature and all that we cannot know with certainty. But we can listen, we can try to be there.

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Yesterday Elinor Hägg, our communicator who among other things will help us with the website, started her work. She walked around here at Järntorget 4 and photographed, and some of the pictures we want to share with you. We also want to share the passion, thoughtfulness, excitement, joy – and our quiet everydayness – with you. We want our place to be open, inviting and challenging. At the same time. Or a little of each. At least sometimes.

On Monday, April 18 we are visited by Lois Holzman us, and we still have a few seats left … Do not miss this unique meeting with a passionate woman full of knowledge and experience.

A lot has happened since last we wrote. We’ve had a meeting with Space For Change, initiated by John Holmberg, Göran Carstedt and Martin Sande. We’ve met several new clients, young and adults. Contacts with psychiatry have been taken, and we have had a meeting with Social Resurs here in Göteborg. And we’ve bought stationary, bookcases, desks, biscuits, coffee and other necessities.

We are right in the middle of designing a knowledge seminar – International Research and Practice of Psychiatric Drug Risk and Withdrawal, which will be held in Göteborg on 15 October. Among the invited speakers are Sami Timimi, Olga Runciman, Jaakko Seikkula, Volkmar Aderhold, Carina Håkansson, Robert Whitaker, Will Hall, John Read and Joanne Moncrieff.

Invitation and information on how you register will be published by the end of May, but reserve 15 October already today. On April 29, we have a housewarming party and two days before that, on April 27, we have a first meeting with the familjehem (“family homes”) that in one way or another will be an important part of our work. Their everyday knowledge, together with psychotherapeutic knowledge, form the basis our work with the extended therapy room. It is not simplistic approaches, diagnoses or technologies that are essential when meeting a person whose life is at stake. It’s about something else: using you own and other people’s significant life experiences in a sufficiently safe and holding structure, and being there with the Other.

Welcome to us at Järntorget 4!

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