WEBVTT

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- Good evening everyone.

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We're gonna get started.

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As you all know, I'm Marianne Yoshioka,

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the new dean of the
School for Social Work.

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Yay!

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I could not, I have had
the most amazing first week

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on the job, and

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it is in no small part because
of the incredible pleasure

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I have gotten from meeting many of you.

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I've not met all of you
yet, but it really truly is

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my personal goal to meet
each and every one of you.

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An amazing time because of
this extraordinary event today.

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And having the opportunity
to meet our partners

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in field education, for whom
we are very very grateful

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for all that we have done.

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And so much of the importance
of this clinical training

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that you are receiving is
in part because of the work

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and dedication of those individuals

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at our many field partner
agencies and organizations

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around the country.

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So thank you again to
everyone in field education.

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And in particular, thank
you to our field work

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education department here at Smith,

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who does pretty well an amazing job.

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To Carolyn and Kaitlyn, and Maria,

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a big heartfelt thank you.

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I could not be more delighted
to preside over tonight

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and to welcome you all
to this important event.

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It's important to
celebrate the amazing work

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and the great opportunities
we have here at Smith College.

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And it's important to celebrate
it and to take moments

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to acknowledge both what
this experience here

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in the School of Social
Work has given people,

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and the many many ways
that people give back.

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Not only to the School of Social Work,

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but really to our profession
and the advancement

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of clinical practice.

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And it's important to take this moment,

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and I am happy to welcome our new provost

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for the university, as well,
to our proceedings tonight.

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And I will be welcoming her
to the podium in a moment.

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And then Carolyn du
Bois will be coming back

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to the podium to help
us through our program

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for the evening.

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Provost Katherine Rowe has also started

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her position here at the college

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along the same lines as I have,

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so it's been a marvelous chance
for me to get to know her,

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and I am greatly looking forward

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to a productive relationship
as we move forward.

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Provost Rowe holds degrees in English

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and American Literature
from Carleton College

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at the Bachelor's level,
and from Harvard University

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at the Master's and PhD levels.

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She is well-regarded and
well-known nationally

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and around the world as
a scholar of Shakespeare.

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And over recent years has
studied the role and impact

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of digital media on the
transformation of literature.

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She comes to us from Bryn Mawr
where she was the co-founder

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of Luminary Digital Media,
which is a reading platform

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that brings the works of
Shakespeare to our mobile devices.

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She brings a wealth of experience
in faculty development,

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academic priorities,
institutional governance,

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international initiatives,
and the effect of pedagogy

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for non-native English speakers.

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In addition, she's contributed

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to the college's visibility
and positions initiative,

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a depth of experience
that can only do us well.

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I think that many of you
may have heard, as well,

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that she brings another
very unique skill set

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that she probably does not
promote nearly as much,

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but she is a skilled ultimate
frisbee competitor and coach.

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I'm thinking there's ultimate
frisbee in our future.

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So without further ado, I'd
like to welcome Provost Rowe

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to the podium.

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(applause)

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- Thank you so much Dean Yoshioka,

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for that lovely, lovely introduction.

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I'm so thrilled to be here tonight.

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This is my first ceremonial duty at Smith,

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and it's very special that
it's one that celebrates,

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as this important event tonight does,

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Smith's long history of
commitment to service

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and excellence in service.

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I'm gonna begin by welcoming to the stage

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each of our awardees, and then
I'm gonna give them a moment

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to say a few words of their own.

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And I hope you will hold your applause,

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well you can do it at the beginning,

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but I hope you will give them a moment

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to stand up and collect
themselves to speak to you,

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'cause we really want to hear from them.

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It is my honor to welcome
to the stage tonight

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Josephine Tervalon.

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(applause)

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(laughter)

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I had that impression.

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I'll take a moment to be
serious in this honor, though.

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As an MSW graduate of Smith
College School for Social Work,

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an esteemed clinical
social work professional,

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you are a source of great
pride for the school.

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You are a gifted clinician,
teacher, and consultant.

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In a career that spans 50
years, you have made significant

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contributions to the field
of social work practice

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and clinical social work education.

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You graduated with honors from
Tuskegee University in 1961

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and headed north to
continue your education here

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at Smith College School of Social Work,

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earning your MSW in 1963.

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In the years that followed,
you worked in private practice

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both overseas in Italy and Texas,

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providing clinical
services to individuals,

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families, and groups.

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A consumate teacher and mentor,

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you have provided astute
social work supervision

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to generations of MSW students,

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and have served as a
member of the clinical

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and adjunct faculties at
Baylor College of Medicine,

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the University of Texas School
of Social Work at Austin,

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the Washington School of
Psychiatry in Washington DC,

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and here at your alma mater

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Smith College School for Social Work.

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Smith College is
particularly grateful to you

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for your work as a faculty
field advisor for students

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in the Texas area from 1985 to 2007.

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Over the course of those 22 years,

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you provided students
with an outstanding level

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of educational support that advisees

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have described as a gift.

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You are known, respected,
and loved for your clear,

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concise feedback, your
guidance around complex

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clinical issues, and
your unwavering support

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of the educational and
professional development

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of your students and advisees.

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In addition, you've provided
skilled consultation

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to agency-based supervisors
and have been a valued member

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of the field faculty,
providing wise and often witty

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counsel to your fellow
FFAs around the joys

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and the challenges of clinical
social work education.

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You are a role model,
mentor, teacher, supervisor,

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and leader who has
inspired the development

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of many colleagues, particularly
women in the practice

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of group psychotherapy.

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You've contributed to the
social work profession

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in so many ways, including,
but not limited to,

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your contributions as a
longstanding member and leader

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in the National Association
of Social Workers,

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Texas Society for Clinical Social Work,

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American Group Psychotherapy Society,

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and Houston Group Psychotherapy Society.

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You were nominated by
the YMCA of Houston Texas

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as one of the outstanding women
in the mental health field.

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In addition to your clinical practice,

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teaching, and supervisory work,

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you've conducted research, written papers,

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and presented extensively
on mothers and daughters

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and women in the profession.

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Josephine Tervalon, throughout the course

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of your extraordinary career,
you've contributed deeply

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to the lives of many, just
has Smith College has,

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in the words of Sophia Smith,
become a perennial blessing

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for the world, so too have your good works

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become a perennial
blessing for Smith College

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School for Social Work and the profession.

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It is with great pride
that we present to you

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the Day-Garrett Award.

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I'd love to welcome you to the podium here

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for a few words.

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(applause)

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(sighs)

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- Provost Rowe.

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Dean Yoshioka.

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Carolyn du Bois.

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And Josh Miller.

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I have to recognize all of these people

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for not only their positions,
but what it means for me today

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to be standing here before you.

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I was going to write a few words,

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and then I did write a few
and I didn't write any more.

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So I'd like to share a bit
of what this means to me.

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It is awesome.

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Overwhelming.

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A joy.

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To have your peers honor you in this way.

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There is nothing better.

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What's difficult is sitting in the chair

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while they're talking about you.

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I think there's more anxiety
in being seated there

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than if you're looking to get the Oscar

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and don't know if your
name is going to be called.

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To hear part of your life being

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repeated back to you and
how others have seen it

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and appreciated it.

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When I received the
call from Josh in March,

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I was in the kitchen with
my husband cooking soup

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for a small dinner party.

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And having a ball, heard
Josh's voice and I said,

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oh Josh, it's wonderful
to hear your voice.

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What's up?

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And he says, well, I
have some news for you.

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And he said that, I
thought, oh, maybe you guys

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want me to come up

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and do a little workshop
or something, right?

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In my head.

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And then when he told
me, you have been one

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of the selected nominees,
one of the selected people

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for the Day-Garrett Award this year

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and I said, What?

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Oh my God.

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Are you serious?

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He said, of course I'm serious.

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And then Albert stops what he was doing

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when I said oh my God.

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It is such an honor to
know that you see my work

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and know me in that way.

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It's been a blessing.

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This is also a significant
year for me in many other ways

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because you heard how many
years I've been graduated.

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And Smith gave me many gifts before this.

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This is the ultimate, but the
first one was the classmates

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and people that have been in my life

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since I came to Smith.

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And the fact that I came on a scholarship.

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I was ready to tell them, I
can't come because I only have

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$1000, which was a gift

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when I graduated undergraduate school.

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And they said, come, we'll
take care of the rest.

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In those days, that was truly
a blessing and I was here.

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I met a dear friend who is here.

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When I got the call, I thought,
how do I tell my friends?

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And who do I tell first that
I want to hear it from me?

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One is Zora Lusick, who's here with me

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and was my classmate.

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We have been friends all these years.

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In fact, we have many things alike.

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Like sons born on the
same day a year apart.

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That kind of thing.

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Cats that are named the same.

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Okay?

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I also met dear friends
and made dear friends

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in my second year placement,

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met a woman in Detroit
who has become a sister.

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She is here tonight from Detroit,

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and she was in social work and
in early child development.

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And her husband.

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And all my family, that
not all of them are here

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because they're seven grandkids

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and we're an abundant family
and there are lots of things

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always going on and they all
split between the coasts,

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but they are here in the front row.

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Our first granddaughter, who is wonderful

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and had to, had to practice

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because she does theater and is well known

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in Melrose, Massachusetts.

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But these are the people,

256
00:13:54.043 --> 00:13:58.175
and I have, oh, Shiva, okay?

257
00:13:58.597 --> 00:14:02.074
And my other daughter that I,

258
00:14:02.074 --> 00:14:06.191
who adopted me, and my
other two granddaughters,

259
00:14:06.191 --> 00:14:09.135
whom I'm very dear to are here,

260
00:14:09.135 --> 00:14:10.548
Helen Chung.

261
00:14:10.874 --> 00:14:13.039
And I've known her for years.

262
00:14:13.039 --> 00:14:16.548
And for your family, for your friends

263
00:14:16.548 --> 00:14:20.494
to be in awe with you when you
tell them what's happening,

264
00:14:20.494 --> 00:14:23.086
and immediately say, I'm coming,

265
00:14:23.086 --> 00:14:25.363
I'm going to be there.

266
00:14:25.550 --> 00:14:28.562
It doesn't get any
better than that in life.

267
00:14:28.664 --> 00:14:32.216
I truly love you all, I'm so
appreciative of this award.

268
00:14:32.216 --> 00:14:36.653
I'm so appreciative of the
school maintaining this award

269
00:14:36.653 --> 00:14:39.789
and honoring those of us who have worked

270
00:14:39.789 --> 00:14:42.296
not because we looked for an award,

271
00:14:42.296 --> 00:14:45.015
but because we truly believe in the work

272
00:14:45.015 --> 00:14:48.465
and give it our best, and
it's been my life work.

273
00:14:48.781 --> 00:14:52.604
Thank you so much for
this and keeping it going.

274
00:14:52.983 --> 00:14:55.782
(applause)

275
00:15:40.233 --> 00:15:43.171
(laughter)

276
00:15:47.593 --> 00:15:51.123
- It's my great honor to
invite to the stage now

277
00:15:51.123 --> 00:15:54.413
our second recipient of
the Day-Garrett Award,

278
00:15:54.462 --> 00:15:57.666
Chester Villalba, please join me.

279
00:15:57.832 --> 00:16:00.706
(applause)

280
00:16:14.450 --> 00:16:16.908
(laughter)

281
00:16:18.780 --> 00:16:22.221
This award was established in 1967

282
00:16:22.221 --> 00:16:24.962
to honor Florence Day and Annette Garrett,

283
00:16:24.962 --> 00:16:27.810
exceptional educators, who personified

284
00:16:27.810 --> 00:16:31.394
in their personal lives and
service to their communities

285
00:16:31.394 --> 00:16:33.879
the high purpose of professional service

286
00:16:33.879 --> 00:16:36.290
that has long distinguished
the Smith College

287
00:16:36.290 --> 00:16:38.001
School for Social Work.

288
00:16:38.775 --> 00:16:41.815
As a graduate of Smith
College School for Social Work

289
00:16:41.815 --> 00:16:45.111
and a distinguished social
work professional with 40 plus

290
00:16:45.111 --> 00:16:49.228
years of experience as
a clinician, scholar,

291
00:16:49.228 --> 00:16:53.494
educator, and leader in the
field of clinical social work,

292
00:16:53.494 --> 00:16:56.528
you are a source of great
pride to this school.

293
00:16:57.579 --> 00:17:00.790
Chester Villalba, you
have a Master's degree

294
00:17:00.790 --> 00:17:02.763
from Smith College School for Social Work

295
00:17:02.763 --> 00:17:04.736
and an honorary doctorate degree

296
00:17:04.736 --> 00:17:07.300
from the Sanville Institute.

297
00:17:07.328 --> 00:17:09.952
You are a member emeritus
of the National Academy

298
00:17:09.952 --> 00:17:12.671
of Practice in Washington DC,

299
00:17:12.671 --> 00:17:14.997
and for more than 30 years,
you have participated

300
00:17:14.997 --> 00:17:17.546
as a peer reviewer for the
Council of Accreditation

301
00:17:17.546 --> 00:17:21.034
for Social Service and
Mental Health Centers,

302
00:17:21.034 --> 00:17:23.700
and served as commissioner
to the National Council

303
00:17:23.700 --> 00:17:26.969
of Accreditation of Children
and Family Services.

304
00:17:27.465 --> 00:17:30.462
You have distinguished
yourself through your dedicated

305
00:17:30.462 --> 00:17:33.289
service to children and
families in the Bay area,

306
00:17:33.289 --> 00:17:35.731
working for 20 years as the CEO

307
00:17:35.731 --> 00:17:38.531
of Family Service Mid-Peninsula.

308
00:17:38.654 --> 00:17:42.206
Over those 20 years, you
expanded family services programs

309
00:17:42.206 --> 00:17:46.344
to include group therapy,
counseling for older adults,

310
00:17:46.344 --> 00:17:49.501
crisis hotlines for parents and teens,

311
00:17:49.501 --> 00:17:52.210
and public education
workshops while maintaining

312
00:17:52.210 --> 00:17:55.180
a private practice in Los Altos.

313
00:17:56.135 --> 00:17:58.674
You are a longstanding and honored member

314
00:17:58.674 --> 00:18:01.223
of the Board of Trustees
at the Sanville Institute,

315
00:18:01.223 --> 00:18:04.498
as well as chairman of
the Acknowledge Alliance,

316
00:18:04.498 --> 00:18:08.993
formerly the Cleo Eulau
Center, Board of Directors.

317
00:18:09.863 --> 00:18:12.209
At Acknowledge Alliance, you
have promoted the well-being

318
00:18:12.209 --> 00:18:15.878
and education of children
by helping to promote,

319
00:18:15.878 --> 00:18:18.598
support, and provide
validation for teachers

320
00:18:18.598 --> 00:18:19.995
and their good work.

321
00:18:19.995 --> 00:18:22.662
Your work with the agency has
helped to build more resilient

322
00:18:22.662 --> 00:18:26.389
and connected youth educators,
and school communities.

323
00:18:27.141 --> 00:18:30.736
You are co-founder of the
Palo Alto-based Adolescent

324
00:18:30.736 --> 00:18:33.498
Counseling Services,
an agency that provides

325
00:18:33.498 --> 00:18:35.472
three main counseling programs

326
00:18:35.472 --> 00:18:38.697
in Santa Clara and San Mateo counties.

327
00:18:39.375 --> 00:18:41.313
The bilingual On-site Individual

328
00:18:41.313 --> 00:18:43.105
and Family Counseling Program

329
00:18:43.105 --> 00:18:45.707
at eight public middle and high schools,

330
00:18:45.707 --> 00:18:49.099
the Adolescent Substance
Abuse Treatment Program,

331
00:18:49.099 --> 00:18:52.555
and the Affordable After
School Counseling Program,

332
00:18:52.555 --> 00:18:55.178
which offers assessment,
treatment, and education

333
00:18:55.178 --> 00:18:56.986
for the entire community.

334
00:18:58.080 --> 00:19:00.586
In addition, we are so grateful

335
00:19:00.586 --> 00:19:03.786
for your service at Smith
College School for Social Work.

336
00:19:03.786 --> 00:19:06.250
You served as an agency-based supervisor

337
00:19:06.250 --> 00:19:09.049
and then as a field
advisor for many years.

338
00:19:09.087 --> 00:19:12.820
Students described you as
clinically knowledgable,

339
00:19:12.820 --> 00:19:15.790
respectful, and understanding.

340
00:19:15.913 --> 00:19:18.206
A strong advocate for students' learning

341
00:19:18.206 --> 00:19:23.011
and "an enthusiastic and
spirited faculty field advisor."

342
00:19:24.499 --> 00:19:26.131
Furthermore, your work in our field office

343
00:19:26.131 --> 00:19:28.286
was instrumental in the
development of an expansion

344
00:19:28.286 --> 00:19:31.042
of our network of field
agencies in the Bay Area.

345
00:19:31.933 --> 00:19:34.205
Through your direct
service and leadership,

346
00:19:34.205 --> 00:19:36.211
you've touched the lives
of tens of thousands

347
00:19:36.211 --> 00:19:39.314
of teens and their families,
helping them find a way through

348
00:19:39.314 --> 00:19:42.450
and beyond the challenging
adolescent years.

349
00:19:42.450 --> 00:19:45.085
You've made exceptional
contributions to Smith,

350
00:19:45.085 --> 00:19:47.548
to the field of social work practice,

351
00:19:47.548 --> 00:19:50.119
and to the high purpose
of professional service,

352
00:19:50.119 --> 00:19:52.071
to which this school,

353
00:19:52.071 --> 00:19:54.646
for which this school is renowned.

354
00:19:54.951 --> 00:19:57.617
You are a blessing to the
school and the profession.

355
00:19:57.617 --> 00:19:59.900
It is with great pleasure
that we bestow upon you

356
00:19:59.900 --> 00:20:01.558
the Day-Garrett Award.

357
00:20:01.617 --> 00:20:02.918
Please come join me.

358
00:20:02.918 --> 00:20:05.856
(applause)

359
00:20:12.667 --> 00:20:15.063
- She knew more about myself than I do.

360
00:20:15.063 --> 00:20:17.084
(laughter)

361
00:20:18.113 --> 00:20:21.548
I really am in awe, as Josh phoned,

362
00:20:21.548 --> 00:20:23.126
when he phoned me,

363
00:20:23.126 --> 00:20:25.612
I said, there may be a mistake here.

364
00:20:27.137 --> 00:20:30.049
But I tell you, I'm just so grateful

365
00:20:30.049 --> 00:20:33.914
and honored to receive this award,

366
00:20:34.176 --> 00:20:37.590
particularly because two of my mentors

367
00:20:37.590 --> 00:20:40.725
in my professional life
received this award

368
00:20:40.725 --> 00:20:44.539
and they were Jean Sanville,

369
00:20:44.539 --> 00:20:46.949
who created her own school

370
00:20:46.949 --> 00:20:50.420
for doctoral MSWs

371
00:20:50.420 --> 00:20:52.889
in Berkeley, California,

372
00:20:52.889 --> 00:20:56.382
and Cleo Eulau was my mentor in Palo Alto,

373
00:20:56.382 --> 00:21:00.322
and she received this
award some years ago.

374
00:21:00.723 --> 00:21:04.072
To be in that company, I tell you,

375
00:21:04.072 --> 00:21:06.359
it fills my heart.

376
00:21:08.232 --> 00:21:11.080
I would like to tell you a story about

377
00:21:11.080 --> 00:21:15.276
my son, who graduated from Smith.

378
00:21:15.677 --> 00:21:19.026
But first, it's a story of how social work

379
00:21:19.026 --> 00:21:22.038
is in our family's DNA.

380
00:21:22.759 --> 00:21:25.729
My wife was a social
worker when I met her,

381
00:21:26.055 --> 00:21:30.769
and when I came to Smith,
I was placed in Rochester,

382
00:21:30.769 --> 00:21:35.238
and then, there we got
pregnant and we came back

383
00:21:35.238 --> 00:21:37.211
for the summer.

384
00:21:37.211 --> 00:21:39.242
Our son Greg was born.

385
00:21:39.579 --> 00:21:42.128
And one day he phoned me and said,

386
00:21:42.128 --> 00:21:45.051
Dad, you know, I'm not, I don't wanna be

387
00:21:45.051 --> 00:21:47.333
in political science anymore.

388
00:21:47.333 --> 00:21:49.424
And I've been doing some community work

389
00:21:49.424 --> 00:21:53.253
with Joan Baez Center for Humanitas,

390
00:21:53.253 --> 00:21:56.826
and I've been a case
worker for Tom Lantos,

391
00:21:56.826 --> 00:21:59.914
who is, was a congressman

392
00:21:59.914 --> 00:22:03.160
from San Mateo county district

393
00:22:03.160 --> 00:22:06.548
and was in Washington, and
Greg did an intern there.

394
00:22:06.548 --> 00:22:10.111
And he said, but I was
a migrant case worker

395
00:22:10.111 --> 00:22:12.703
for that office in San Mateo,

396
00:22:12.703 --> 00:22:15.209
and I really like talking to people.

397
00:22:15.209 --> 00:22:18.516
And, you know, I said,
he says over the phone,

398
00:22:18.516 --> 00:22:21.556
Dad, I said I might
think about getting a PhD

399
00:22:21.556 --> 00:22:26.039
in psychology, but you know,
I did send for the catalogue

400
00:22:26.039 --> 00:22:29.182
for the Smith School for
Social Work for where you went.

401
00:22:29.182 --> 00:22:31.016
For social work where you went.

402
00:22:31.016 --> 00:22:35.149
I'm thinking of becoming a social worker.

403
00:22:35.645 --> 00:22:38.610
And he said, but Dad, I
have a question to ask you.

404
00:22:38.610 --> 00:22:39.709
This was over the phone.

405
00:22:39.709 --> 00:22:41.202
And I said, sure, Greg.

406
00:22:41.202 --> 00:22:44.189
I said, that's wonderful
that you'd consider that.

407
00:22:44.189 --> 00:22:47.698
I'm really pleased, if
that's your decision.

408
00:22:47.698 --> 00:22:49.586
He said, but Dad, I wanna ask you,

409
00:22:49.586 --> 00:22:51.990
why did you complain so much?

410
00:22:53.180 --> 00:22:55.585
Did you like social work?

411
00:22:56.689 --> 00:22:59.260
And I said, I complained?

412
00:22:59.260 --> 00:23:01.510
I can't believe I would complain.

413
00:23:01.510 --> 00:23:02.865
I love this field.

414
00:23:02.865 --> 00:23:05.809
You know, social work is so amazing

415
00:23:05.809 --> 00:23:08.134
in that you can be a counselor,

416
00:23:08.134 --> 00:23:10.150
you can be a psychotherapist, you can be

417
00:23:10.150 --> 00:23:12.006
a community organizer.

418
00:23:12.006 --> 00:23:15.114
You can even be a CEO of an agency,

419
00:23:15.472 --> 00:23:19.317
and you can, like I was, or you
can have a private practice.

420
00:23:19.536 --> 00:23:21.765
And you can do anything
you want and you can move

421
00:23:21.765 --> 00:23:25.456
from medical social work
to group social work,

422
00:23:25.456 --> 00:23:29.146
and it's a field that you can
do so many different things

423
00:23:29.146 --> 00:23:32.158
and be a professional social worker.

424
00:23:32.399 --> 00:23:35.759
And I said, but I don't,
can't imagine complaining.

425
00:23:35.759 --> 00:23:38.948
And I said, but I'll think
about it and let you know.

426
00:23:38.948 --> 00:23:40.550
So I thought about it and I thought,

427
00:23:40.550 --> 00:23:43.013
I never complain, I love this field.

428
00:23:43.013 --> 00:23:46.523
It really, you really feel like
you're making a contribution

429
00:23:46.523 --> 00:23:49.266
and to work with people and groups

430
00:23:49.266 --> 00:23:52.721
on a one to one basis and
see communities change.

431
00:23:52.721 --> 00:23:56.764
I mean, it's a, it just
does something to the spirit

432
00:23:56.764 --> 00:23:58.481
and makes you feel whole.

433
00:23:58.481 --> 00:24:00.081
So I didn't understand it,

434
00:24:00.081 --> 00:24:03.787
and then I thought, ah, I know
what I was complaining about.

435
00:24:03.889 --> 00:24:05.627
So I phoned him up and I said, Greg,

436
00:24:05.627 --> 00:24:07.739
I never complained about the field.

437
00:24:07.739 --> 00:24:10.043
The only thing that I complained about

438
00:24:10.043 --> 00:24:11.344
was the money.

439
00:24:11.344 --> 00:24:13.477
There wasn't much money in it.

440
00:24:13.477 --> 00:24:15.451
But that didn't stop him.

441
00:24:15.451 --> 00:24:16.731
He came to Smith.

442
00:24:16.731 --> 00:24:20.741
In fact, he was born, as
I said, Carla was pregnant

443
00:24:20.741 --> 00:24:23.578
when we were in placement,
and I think he was

444
00:24:23.578 --> 00:24:27.792
the first baby on campus in 1968,

445
00:24:27.792 --> 00:24:32.751
and he's been a social
worker ever since his birth.

446
00:24:32.751 --> 00:24:35.339
Thank you very much for the award.

447
00:24:35.339 --> 00:24:37.216
It's really, I'm honored.

448
00:24:37.216 --> 00:24:40.015
(applause)

449
00:25:07.139 --> 00:25:08.702
- I feel like Vanna.

450
00:25:08.702 --> 00:25:11.795
So it's wonderful wonderful
to see you all here,

451
00:25:11.795 --> 00:25:15.134
and to welcome you to this lecture

452
00:25:15.134 --> 00:25:16.968
and to the annual conference.

453
00:25:16.968 --> 00:25:19.891
I want to thank, add my thanks

454
00:25:19.891 --> 00:25:21.704
to those that Marianne shared,

455
00:25:21.704 --> 00:25:24.264
as did the Provost, to all
of our field affiliates

456
00:25:24.264 --> 00:25:27.485
who are here, supervisors,
directors of training,

457
00:25:27.485 --> 00:25:29.736
faculty field advisors.

458
00:25:29.736 --> 00:25:32.530
I say it every single year,
I mean it every single year.

459
00:25:32.530 --> 00:25:35.116
We could not do this work without you.

460
00:25:35.965 --> 00:25:38.866
I also wanna add my
thanks to my field team,

461
00:25:38.866 --> 00:25:42.086
my administrative
support, and my very able

462
00:25:42.086 --> 00:25:44.071
associate and assistant
directors of field,

463
00:25:44.071 --> 00:25:46.929
Katelin Lewis-Kulin and
Maria Del Mar Farina.

464
00:25:46.929 --> 00:25:49.725
I'm also incredibly touched to see

465
00:25:49.725 --> 00:25:54.152
two of our long-time field
faculty receive this award.

466
00:25:54.152 --> 00:25:57.708
I think it's very fitting
and it's a great pleasure.

467
00:25:58.749 --> 00:26:01.447
It's also my pleasure to
introduce to you tonight

468
00:26:01.447 --> 00:26:05.857
Mary Olson, who is our keynote
speaker for this evening.

469
00:26:06.161 --> 00:26:10.582
Dr. Olson received her B.A.
from Wellesley College,

470
00:26:10.865 --> 00:26:15.089
an M.S., a Master's Degree
in English and Comp. Lit.

471
00:26:15.089 --> 00:26:18.502
from Columbia, then came here and did

472
00:26:18.502 --> 00:26:20.817
an MSW degree at the
School for Social Work

473
00:26:20.817 --> 00:26:24.123
and then got a PhD from the
Department of Communication

474
00:26:24.123 --> 00:26:26.534
at UMass in Amherst.

475
00:26:26.534 --> 00:26:29.829
She's a gifted clinician
who has over 30 years

476
00:26:29.829 --> 00:26:34.282
of clinical experience with
children, adults, and families.

477
00:26:34.981 --> 00:26:36.656
She maintains a private practice,

478
00:26:36.656 --> 00:26:39.141
and currently serves as
the executive director

479
00:26:39.141 --> 00:26:42.234
of the Institute for Dialogic Practice,

480
00:26:42.234 --> 00:26:44.250
which is work that we're
gonna have the privilege

481
00:26:44.250 --> 00:26:47.188
of hearing much more about this evening.

482
00:26:47.876 --> 00:26:50.841
She's wonderfully gifted teacher.

483
00:26:50.841 --> 00:26:54.276
She's taught clinical
practice, theory, and research

484
00:26:54.276 --> 00:26:57.177
at a number of institutions,
including Smith College

485
00:26:57.177 --> 00:27:00.334
School for Social Work, the
UMass School of Medicine

486
00:27:00.334 --> 00:27:02.472
and the Department of Psychiatry,

487
00:27:03.075 --> 00:27:05.379
the Family Institute of Cambridge,

488
00:27:05.379 --> 00:27:07.448
the University of Helsinki,

489
00:27:07.448 --> 00:27:11.453
and Jyväskylä, did I, I
didn't say it right, did I?

490
00:27:12.045 --> 00:27:13.411
Did I nail it?

491
00:27:13.411 --> 00:27:16.248
Jyväskylä University in Finland,

492
00:27:16.248 --> 00:27:18.594
where she served as a Fulbright Professor

493
00:27:18.594 --> 00:27:21.020
in the Department of Psychology.

494
00:27:21.047 --> 00:27:23.394
She's currently the
co-principal investigator

495
00:27:23.394 --> 00:27:25.922
for a project funded by the
Foundation for Excellence

496
00:27:25.922 --> 00:27:28.599
in Mental Health Care on adapting

497
00:27:28.599 --> 00:27:30.988
the Open Dialogue model in the US.

498
00:27:30.988 --> 00:27:33.868
And has served as
co-principal investigator

499
00:27:33.868 --> 00:27:36.566
on a number of other major
grant-funded projects

500
00:27:36.566 --> 00:27:39.788
including one from the
National Science Foundation

501
00:27:39.788 --> 00:27:41.814
on empowerment for the elderly

502
00:27:41.814 --> 00:27:44.197
through assisted technology.

503
00:27:44.918 --> 00:27:48.288
She's the author of numerous
articles and book chapters

504
00:27:48.288 --> 00:27:52.288
on family therapy,
anorexia, feminist practice,

505
00:27:52.288 --> 00:27:55.599
managed care, and of course Open Dialogue.

506
00:27:56.053 --> 00:27:58.165
She's a highly sought after speaker,

507
00:27:58.165 --> 00:28:00.277
both here in the States
and internationally,

508
00:28:00.277 --> 00:28:03.018
and we're delighted that she's
joining us here this evening.

509
00:28:03.018 --> 00:28:05.935
So please join me in
welcoming Dr. Mary Olson.

510
00:28:06.101 --> 00:28:08.559
(applause)

511
00:28:18.111 --> 00:28:21.385
- Well, it's a great honor
and privilege to be here.

512
00:28:21.385 --> 00:28:22.782
Can you hear me?

513
00:28:22.782 --> 00:28:24.563
Oh, I gotta stay by the mic, okay.

514
00:28:24.563 --> 00:28:26.494
It's a great honor and
privilege to be here,

515
00:28:26.494 --> 00:28:30.088
and I'm really delighted to
be able to talk to you tonight

516
00:28:30.088 --> 00:28:33.694
about Open Dialogue and
my experience in Finland.

517
00:28:33.694 --> 00:28:37.715
I really appreciate the
invitation from the faculty

518
00:28:37.715 --> 00:28:39.053
to do so.

519
00:28:39.688 --> 00:28:43.656
I graduated from this
program many years ago

520
00:28:43.656 --> 00:28:47.559
and it has provided a
wonderful foundation,

521
00:28:48.879 --> 00:28:52.924
which it continues to do
as I am able to wtiness,

522
00:28:52.924 --> 00:28:56.067
with my current students
and also graduates

523
00:28:56.067 --> 00:28:58.296
of this program who I
continue to work with

524
00:28:58.296 --> 00:28:59.474
in the field.

525
00:29:00.131 --> 00:29:01.287
So.

526
00:29:02.008 --> 00:29:05.538
Let me start by asking how many of you

527
00:29:05.538 --> 00:29:07.938
know something about Open Dialogue,

528
00:29:07.938 --> 00:29:09.596
are familiar with it.

529
00:29:10.018 --> 00:29:11.597
Okay, that's quite a bit.

530
00:29:11.597 --> 00:29:12.695
All right.

531
00:29:12.695 --> 00:29:16.732
Okay, Open Dialogue is an innovative,

532
00:29:17.410 --> 00:29:19.923
social network approach to

533
00:29:20.504 --> 00:29:23.384
the most severe psychiatric crises

534
00:29:23.384 --> 00:29:25.053
and conditions.

535
00:29:25.635 --> 00:29:30.232
It was developed by a team
led by Jaakko Seikkula,

536
00:29:30.232 --> 00:29:34.008
Birgittu Alakare, and Uka Altenin,

537
00:29:34.008 --> 00:29:37.933
at Keropudas Hospital in Tornio, Finland,

538
00:29:37.933 --> 00:29:39.991
which is in western Lapland,

539
00:29:39.991 --> 00:29:43.244
which is in the northwest
corner of Finland.

540
00:29:43.244 --> 00:29:46.679
It's a province of about 70,000 people

541
00:29:46.679 --> 00:29:49.019
on the Swedish border.

542
00:29:50.348 --> 00:29:53.420
Open Dialogue is both a system,

543
00:29:53.420 --> 00:29:56.129
a way of organizing a treatment system,

544
00:29:56.129 --> 00:29:59.632
and it's a form of therapy in that system.

545
00:30:00.961 --> 00:30:03.723
It has garnered international attention

546
00:30:03.723 --> 00:30:07.152
for its outcomes for first-time psychosis.

547
00:30:07.510 --> 00:30:10.112
There were two five-year studies,

548
00:30:10.112 --> 00:30:13.898
and 80% of Open Dialogue patients

549
00:30:13.898 --> 00:30:17.333
were working, studying,
or looking for a job

550
00:30:17.333 --> 00:30:19.931
at the five year marker.

551
00:30:21.046 --> 00:30:25.110
Integrating key insights
from psychoanalytic

552
00:30:25.110 --> 00:30:29.963
and psychodynamic approaches
to trauma and psychosis,

553
00:30:29.963 --> 00:30:34.720
Open Dialogue is rooted in, nevertheless,

554
00:30:34.720 --> 00:30:37.515
in the systemic family therapy tradition

555
00:30:37.515 --> 00:30:41.344
that descended from the
work of Gregory Bateson

556
00:30:41.344 --> 00:30:45.028
and made language and
communication central.

557
00:30:46.496 --> 00:30:50.677
It also benefits from the
influence on this tradition

558
00:30:50.677 --> 00:30:54.922
of the writings of Mikhail Bakhtin,

559
00:30:54.922 --> 00:30:59.913
who is mostly an incomprehensible
Russian philosopher,

560
00:30:59.913 --> 00:31:01.774
but nevertheless.

561
00:31:02.217 --> 00:31:05.790
But particularly his concept of dialogue

562
00:31:05.790 --> 00:31:08.920
as a model of the living world.

563
00:31:09.189 --> 00:31:11.589
Open Dialogue pioneer Jaakko Seikkula

564
00:31:11.589 --> 00:31:15.834
was the first to conceptualize
therapeutic conversation

565
00:31:15.834 --> 00:31:19.759
as dialogic in Bakhtin's sense.

566
00:31:19.759 --> 00:31:21.856
And we'll be, I'll be trying to clarify

567
00:31:21.856 --> 00:31:23.471
what that means.

568
00:31:24.085 --> 00:31:26.677
The unique geography of Finland,

569
00:31:26.677 --> 00:31:29.702
its position between Russia

570
00:31:29.702 --> 00:31:33.510
and the West has allowed for this

571
00:31:33.510 --> 00:31:36.549
idiosyncratic cross-fertilization

572
00:31:36.549 --> 00:31:40.752
of ideas and practices
from Russia, Europe,

573
00:31:40.752 --> 00:31:42.772
and the United States.

574
00:31:44.890 --> 00:31:47.077
So, here's a map.

575
00:31:47.077 --> 00:31:50.767
You can see that Tornio is right beneath

576
00:31:50.767 --> 00:31:52.681
the Arctic Circle.

577
00:31:53.018 --> 00:31:57.028
And there's been a lot
of cross-fertilization

578
00:31:57.028 --> 00:31:58.811
between the group in Tornio

579
00:31:58.811 --> 00:32:01.291
and one in Tromso,

580
00:32:01.291 --> 00:32:03.994
which is the northern rim of Norway.

581
00:32:04.994 --> 00:32:07.584
And the work of a person
named Tom Andersen

582
00:32:07.584 --> 00:32:11.392
who invented something
called the reflecting team

583
00:32:11.392 --> 00:32:14.437
and reflecting process work.

584
00:32:16.362 --> 00:32:19.588
But I'm really gonna start,

585
00:32:19.797 --> 00:32:21.749
the first part of this talk,

586
00:32:21.749 --> 00:32:26.158
by describing my own
connection to this work.

587
00:32:29.078 --> 00:32:33.369
As Gregory Bateson said, epistemology, or,

588
00:32:34.164 --> 00:32:36.020
which is a fancy work for the way

589
00:32:36.020 --> 00:32:39.843
that we think, our style of thinking,

590
00:32:40.030 --> 00:32:41.837
our rules for thinking,

591
00:32:42.238 --> 00:32:44.440
is always personal.

592
00:32:44.937 --> 00:32:48.350
The point of the probe
is always in the heart

593
00:32:48.350 --> 00:32:50.760
of the explorer.

594
00:32:50.771 --> 00:32:54.365
So I'm gonna tell how I
discovered Open Dialogue

595
00:32:54.365 --> 00:32:58.877
and the ways in which I
think it altered my practice

596
00:32:58.877 --> 00:33:01.260
starting 15 years ago

597
00:33:01.800 --> 00:33:05.053
when I encountered this
radically different

598
00:33:05.053 --> 00:33:06.828
kind of work.

599
00:33:07.069 --> 00:33:08.860
And then I'm gonna go on, the second part

600
00:33:08.860 --> 00:33:11.687
of the talk, I'm gonna talk about why now.

601
00:33:11.687 --> 00:33:15.964
Why is there a growing
interest in the United States

602
00:33:15.964 --> 00:33:17.697
in Open Dialogue.

603
00:33:19.121 --> 00:33:23.995
Project directors at Samsa and NIMH,

604
00:33:23.995 --> 00:33:28.358
these are the two major
federal funding agencies

605
00:33:28.358 --> 00:33:32.262
in the United States, have
expressed great interest

606
00:33:32.262 --> 00:33:36.048
in supporting an Open Dialogue initiative,

607
00:33:36.048 --> 00:33:38.299
hopefully they're gonna support ours,

608
00:33:38.299 --> 00:33:40.645
at UMass Medical School.

609
00:33:40.645 --> 00:33:43.941
I co-lead a research project there

610
00:33:43.941 --> 00:33:48.767
on the adaptation of
Open Dialogue to the US.

611
00:33:49.647 --> 00:33:53.647
But the question is why now
is there this keen interest,

612
00:33:53.647 --> 00:33:56.953
whereas several years ago, we were told

613
00:33:56.953 --> 00:33:59.791
that our work was just too different

614
00:33:59.791 --> 00:34:02.430
and that we would never
get funding for it.

615
00:34:03.940 --> 00:34:06.841
So, talking about this growing interest

616
00:34:06.841 --> 00:34:10.371
is gonna require my sketching

617
00:34:10.371 --> 00:34:12.814
the historical and cultural forces

618
00:34:12.814 --> 00:34:16.579
that are shaping the
introduction of Open Dialogue

619
00:34:16.579 --> 00:34:18.610
into the United States.

620
00:34:19.683 --> 00:34:22.424
Just briefly, let me say that,

621
00:34:22.424 --> 00:34:24.333
as you may well know,

622
00:34:24.333 --> 00:34:28.045
in the last two decades,

623
00:34:29.625 --> 00:34:32.013
the dominant discourse of psychiatry

624
00:34:32.013 --> 00:34:36.172
has been something called
biological determinism.

625
00:34:36.172 --> 00:34:41.172
That sees symptoms as
biochemical processes

626
00:34:41.177 --> 00:34:45.121
to be treated primarily with medication.

627
00:34:46.129 --> 00:34:49.003
In contrast to this perspective,

628
00:34:49.468 --> 00:34:53.467
Open Dialogue believes in responding

629
00:34:53.467 --> 00:34:56.064
to the whole person in a context.

630
00:34:56.859 --> 00:34:59.600
Now what's happening at
the various highest levels

631
00:34:59.600 --> 00:35:04.101
of academic research is
that there is recognition

632
00:35:04.101 --> 00:35:09.101
that biological determinism,
that this linear,

633
00:35:09.147 --> 00:35:13.988
decontextualized, simplified view

634
00:35:13.988 --> 00:35:17.118
of the brain as a thing

635
00:35:18.244 --> 00:35:20.910
has very many,

636
00:35:20.910 --> 00:35:23.667
has a great variety of problems.

637
00:35:24.654 --> 00:35:28.995
And what I'm sensing is that
there's a paradigm shift

638
00:35:28.995 --> 00:35:30.375
underway.

639
00:35:30.616 --> 00:35:34.599
And the interest in Open
Dialogue is reflecting that.

640
00:35:35.288 --> 00:35:37.581
I think that there is a shift toward

641
00:35:37.581 --> 00:35:41.410
reestablishing psycho-social care

642
00:35:41.410 --> 00:35:45.847
in the treatment of the
most severely troubled

643
00:35:45.847 --> 00:35:49.137
and distressed and disenfranchised people.

644
00:35:52.471 --> 00:35:53.787
So.

645
00:35:54.999 --> 00:35:57.942
And thirdly, at the same
time that I wanna describe

646
00:35:57.942 --> 00:36:00.502
this approach and why
I'm interested in it,

647
00:36:00.502 --> 00:36:04.214
I also want to state

648
00:36:04.214 --> 00:36:07.088
that there is a need for caution

649
00:36:07.232 --> 00:36:11.531
in bringing a method and a
system from another place,

650
00:36:11.531 --> 00:36:16.128
and that for this to really be
viable in the United States,

651
00:36:16.128 --> 00:36:20.090
there has to be extensive adaptation.

652
00:36:20.725 --> 00:36:25.551
Particularly because of our
diversity of population.

653
00:36:27.893 --> 00:36:30.489
So let me start with my own history.

654
00:36:35.700 --> 00:36:39.273
My discovery of Open
Dialogue was serendipitous.

655
00:36:39.273 --> 00:36:42.014
Now, people who know me
know that I love language

656
00:36:42.014 --> 00:36:43.668
and I love words, so,

657
00:36:43.668 --> 00:36:47.373
in preparation for this talk
I looked up serendipity,

658
00:36:47.795 --> 00:36:52.795
and Wikipedia says that
serendipity is the accident

659
00:36:52.904 --> 00:36:55.432
of finding something good and useful

660
00:36:55.432 --> 00:36:59.031
without specifically searching for it.

661
00:36:59.752 --> 00:37:04.232
It was coined by an art
historian named Horace Walpole

662
00:37:04.232 --> 00:37:06.647
who in 1754

663
00:37:07.389 --> 00:37:11.015
wrote a letter using this
word for the first time,

664
00:37:11.015 --> 00:37:13.842
basing it on a Persian fairy tale,

665
00:37:13.842 --> 00:37:16.561
the Three Princes of Serendip,

666
00:37:16.561 --> 00:37:20.625
whose heroes, he said, were
always making discoveries

667
00:37:20.625 --> 00:37:23.484
by accident or sagacity,

668
00:37:23.484 --> 00:37:26.102
of things they were not in quest of.

669
00:37:27.985 --> 00:37:32.144
Serendipity is based on
the Sanskrit serendip,

670
00:37:32.144 --> 00:37:34.645
which means golden island.

671
00:37:35.110 --> 00:37:37.456
Now, I think what I wanna make clear

672
00:37:37.456 --> 00:37:39.941
is not only was my
discovery of Open Dialogue

673
00:37:39.941 --> 00:37:43.866
marked by serendipity,
but Open Dialogue itself,

674
00:37:43.866 --> 00:37:46.960
by fostering a context for listening,

675
00:37:46.960 --> 00:37:50.970
emphasizes a more
collaborative, open-ended,

676
00:37:50.970 --> 00:37:54.692
and yes, serendipitous conversation,

677
00:37:54.692 --> 00:37:59.631
in which the aim is to
generate a common language,

678
00:37:59.631 --> 00:38:03.721
or dialogical dialogue,

679
00:38:04.441 --> 00:38:07.953
in contrast to trying to

680
00:38:07.953 --> 00:38:11.277
simply immediately eradicate

681
00:38:11.277 --> 00:38:14.447
symptoms based on an expert-driven

682
00:38:14.447 --> 00:38:18.921
or "monological" discourse.

683
00:38:20.175 --> 00:38:22.660
It was Foucault who best

684
00:38:24.810 --> 00:38:29.810
identified the political
nature of not having

685
00:38:29.956 --> 00:38:33.224
a common language in psychiatry.

686
00:38:34.073 --> 00:38:37.326
Foucault said that the
absence of a common language

687
00:38:37.326 --> 00:38:39.231
in psychiatry, in other words,

688
00:38:39.231 --> 00:38:41.140
a shared language,

689
00:38:41.140 --> 00:38:45.177
is a formula of social exclusion.

690
00:38:46.964 --> 00:38:49.145
He also said,

691
00:38:49.780 --> 00:38:52.440
and he wrote in Madness and Civilization,

692
00:38:53.193 --> 00:38:54.689
as for a common language,

693
00:38:54.689 --> 00:38:57.541
now he's talking about in psychiatry,

694
00:38:58.155 --> 00:39:01.211
there is no such thing any longer.

695
00:39:01.963 --> 00:39:05.323
The constitution of
madness as mental illness

696
00:39:05.323 --> 00:39:07.947
at the end of the 18th century

697
00:39:07.947 --> 00:39:11.546
affords evidence of a broken dialogue.

698
00:39:12.778 --> 00:39:15.584
The language of psychiatry,
which is a monologue

699
00:39:15.584 --> 00:39:19.231
of reason about madness,
has been established

700
00:39:19.231 --> 00:39:23.054
only on the basis of such silence,

701
00:39:23.231 --> 00:39:27.295
meaning the silence of
the voice of madness,

702
00:39:27.295 --> 00:39:30.452
the silencing of the voice of suffering

703
00:39:30.452 --> 00:39:34.851
from the perspective of
the person suffering.

704
00:39:38.249 --> 00:39:39.587
So.

705
00:39:40.595 --> 00:39:43.219
And by common language, I
wanna add something else,

706
00:39:43.219 --> 00:39:47.202
which is that we don't just mean words.

707
00:39:48.232 --> 00:39:50.792
I was really delighted to

708
00:39:50.792 --> 00:39:54.504
be and to hear the panel on Monday night

709
00:39:54.504 --> 00:39:56.200
talking about their work,

710
00:39:56.200 --> 00:39:59.197
and I thought to myself when
I heard about hip hop therapy,

711
00:39:59.197 --> 00:40:04.157
which uses rap music to engage urban youth

712
00:40:04.157 --> 00:40:06.834
who are turned off by talk therapy,

713
00:40:07.084 --> 00:40:11.958
as an example of a very
creative dialogic practice.

714
00:40:13.536 --> 00:40:15.904
So dialogue and engaging dialogue

715
00:40:15.904 --> 00:40:18.191
can take many many forms.

716
00:40:20.565 --> 00:40:22.965
So, my journey into Open Dialogue

717
00:40:22.965 --> 00:40:24.960
was through an unlikely door.

718
00:40:26.450 --> 00:40:28.778
About 15 years ago, I was invited

719
00:40:28.778 --> 00:40:31.252
by the then dean for social work

720
00:40:31.252 --> 00:40:33.482
at Smith College, Anita Lightburn,

721
00:40:33.482 --> 00:40:36.063
to participate in a research study

722
00:40:36.063 --> 00:40:37.897
on the effects of managed care

723
00:40:37.897 --> 00:40:40.238
on children and families.

724
00:40:40.916 --> 00:40:45.022
I was part of a group that
included Phoebe Sessions

725
00:40:45.022 --> 00:40:48.435
and Allen Coffee Pulleyblank,

726
00:40:48.435 --> 00:40:51.987
and I was interested
in this because of what

727
00:40:51.987 --> 00:40:55.192
I was experiencing
professionally at the time.

728
00:40:55.987 --> 00:40:59.069
In the mid-90s, in the Pioneer Valley,

729
00:41:00.409 --> 00:41:03.506
there was a sea change when managed care

730
00:41:03.506 --> 00:41:07.479
started to come in and shape
the mental health field.

731
00:41:08.551 --> 00:41:11.495
Up until that point, family
therapy had flourished

732
00:41:11.495 --> 00:41:15.378
and there had been family therapy teams

733
00:41:15.378 --> 00:41:18.273
and family therapy training programs.

734
00:41:20.177 --> 00:41:22.460
After the arrival of managed care,

735
00:41:22.460 --> 00:41:24.518
family therapy teams started disappearing

736
00:41:24.518 --> 00:41:26.961
from ordinary clinics and agencies,

737
00:41:26.961 --> 00:41:29.307
and family therapy training programs

738
00:41:29.307 --> 00:41:31.317
started to shut down.

739
00:41:31.419 --> 00:41:33.670
The program that I had
spent five years building

740
00:41:33.670 --> 00:41:35.206
at Berkshire Medical Center

741
00:41:35.206 --> 00:41:38.544
was dismantled in five
weeks when we merged

742
00:41:38.544 --> 00:41:41.584
with another agency under the new,

743
00:41:41.584 --> 00:41:45.087
restrictive economic context.

744
00:41:45.530 --> 00:41:48.666
So, at that point I
thought that family therapy

745
00:41:48.666 --> 00:41:50.671
was facing extinction and I was wondering,

746
00:41:50.671 --> 00:41:52.154
are these just bad ideas?

747
00:41:52.154 --> 00:41:53.477
We were just mistaken?

748
00:41:53.477 --> 00:41:56.670
They don't make any sense, you know?

749
00:41:57.956 --> 00:42:01.839
What had drawn me to family
therapy in the first place

750
00:42:01.839 --> 00:42:05.199
with the idea of trying to
understand an individual

751
00:42:05.199 --> 00:42:06.963
in a context.

752
00:42:08.110 --> 00:42:13.006
So when Anita Lightburn
invited me to join this study,

753
00:42:13.006 --> 00:42:15.587
I leaped at the chance,

754
00:42:15.587 --> 00:42:19.672
and what I found was that
it began to shape an answer

755
00:42:19.672 --> 00:42:23.715
to what was happening and
why systemic practices

756
00:42:23.715 --> 00:42:26.770
were disappearing from public settings.

757
00:42:28.141 --> 00:42:31.352
We interviewed stakeholders

758
00:42:31.352 --> 00:42:33.788
in the northeast and

759
00:42:34.925 --> 00:42:37.133
we interviewed people in
community mental health,

760
00:42:37.133 --> 00:42:40.450
we interviewed administrators,
front line people,

761
00:42:40.450 --> 00:42:43.479
psychologists, social workers,

762
00:42:43.479 --> 00:42:46.513
insurance companies.

763
00:42:47.148 --> 00:42:50.928
And what we found was a virtual consensus.

764
00:42:51.606 --> 00:42:55.510
At that point, there was an ascendancy

765
00:42:55.510 --> 00:42:57.622
of psycho-pharmacology,

766
00:42:57.622 --> 00:43:01.771
and a downplaying of all
relational therapies,

767
00:43:01.771 --> 00:43:03.930
including family therapy.

768
00:43:04.448 --> 00:43:05.909
And in looking back,

769
00:43:05.909 --> 00:43:08.961
what we discovered was
a very important trend,

770
00:43:10.361 --> 00:43:13.408
which is that the insurance practices

771
00:43:13.408 --> 00:43:18.271
were the way that the new
biological determinism

772
00:43:18.431 --> 00:43:22.890
was established and became routine

773
00:43:22.890 --> 00:43:25.998
in ordinary clinics and practices.

774
00:43:26.442 --> 00:43:28.419
So not only was,

775
00:43:28.447 --> 00:43:30.281
were the insurance companies

776
00:43:30.281 --> 00:43:32.670
shaping reimbursement structures,

777
00:43:32.670 --> 00:43:36.334
they were shaping
clinical practice itself.

778
00:43:41.214 --> 00:43:43.368
The subtrends that we found.

779
00:43:43.368 --> 00:43:47.230
Now I also wanna say that
the managed care initiative

780
00:43:48.940 --> 00:43:52.296
was propelled by very legitimate aims

781
00:43:52.296 --> 00:43:55.080
and managed care is not a monolith

782
00:43:55.080 --> 00:43:59.948
and there were better managed
care companies than others.

783
00:44:00.071 --> 00:44:04.705
But in general, this was the
effect on public settings.

784
00:44:05.159 --> 00:44:07.431
Now the reason I'm gonna
go over these trends

785
00:44:07.431 --> 00:44:09.031
a little bit more is because

786
00:44:09.031 --> 00:44:12.182
they remain highly relevant today.

787
00:44:12.423 --> 00:44:15.761
There's a new book by
a woman, Sandra Bloom,

788
00:44:15.761 --> 00:44:20.411
called, a relatively new book
called Destroying Sanctuary

789
00:44:20.411 --> 00:44:24.913
in which she documents that
not only do these trends

790
00:44:24.913 --> 00:44:28.853
still operate, they've become amplified.

791
00:44:30.651 --> 00:44:34.591
So, what we found in addition
were these subtrends.

792
00:44:35.547 --> 00:44:38.485
There was an erosion of clinical practices

793
00:44:38.485 --> 00:44:42.185
and an emphasis instead on
productivity and procedures.

794
00:44:43.375 --> 00:44:46.234
There was the idea that
medication is really

795
00:44:46.234 --> 00:44:48.958
the only real thing that you can do.

796
00:44:50.458 --> 00:44:52.591
There is an emphasis on the individual

797
00:44:52.591 --> 00:44:56.025
and reinscribing the individual
as the locus of pathology

798
00:44:56.025 --> 00:44:58.995
even if that individual is a child.

799
00:45:00.932 --> 00:45:04.430
There was increased professional isolation

800
00:45:04.430 --> 00:45:07.758
and an absence of
collaborative arrangements.

801
00:45:07.758 --> 00:45:12.398
A flattening out of opportunities

802
00:45:12.398 --> 00:45:14.877
for training and supervision.

803
00:45:15.811 --> 00:45:19.682
And so there were reduced
contexts for creativity

804
00:45:19.682 --> 00:45:21.308
and innovation.

805
00:45:22.200 --> 00:45:24.631
And finally, the most important trend,

806
00:45:24.631 --> 00:45:27.330
which is kind of a trend
about all the other trends,

807
00:45:27.330 --> 00:45:31.708
is that there was a loss of
language of the living world.

808
00:45:32.247 --> 00:45:36.721
Dialogue, stories, metaphor,
ambiguity, mystery.

809
00:45:38.532 --> 00:45:39.980
Did I say dialogue?

810
00:45:39.980 --> 00:45:42.512
History, stories.

811
00:45:43.958 --> 00:45:48.438
Instead, there was this idea
that all human suffering

812
00:45:48.438 --> 00:45:50.294
could be comprehensively,

813
00:45:50.294 --> 00:45:52.715
there was an increasing disposition

814
00:45:52.715 --> 00:45:56.495
to see all human suffering
as comprehensively

815
00:45:58.475 --> 00:46:00.719
explained by

816
00:46:01.418 --> 00:46:03.428
a chemical imbalance.

817
00:46:05.013 --> 00:46:07.471
So this was pretty discouraging.

818
00:46:10.645 --> 00:46:13.599
I also wanna say that even though

819
00:46:13.599 --> 00:46:16.874
there were these trends,
there were and continue to be

820
00:46:16.874 --> 00:46:21.055
many people, many social
workers, particularly,

821
00:46:21.055 --> 00:46:24.393
doing wonderful wonderful work

822
00:46:24.393 --> 00:46:26.718
and helping people despite these

823
00:46:26.718 --> 00:46:29.517
less than optimal circumstances.

824
00:46:31.689 --> 00:46:34.547
Around this time when we
were doing this study,

825
00:46:34.547 --> 00:46:38.120
I happened to go hear Carlos Sluzki talk

826
00:46:38.120 --> 00:46:40.296
at the American Family Therapy Academy.

827
00:46:40.296 --> 00:46:43.223
He'd also been my boss
for about seven years.

828
00:46:43.763 --> 00:46:46.546
But he was one of the few psychiatrists

829
00:46:46.546 --> 00:46:48.477
and family therapists at the time

830
00:46:48.477 --> 00:46:52.769
who began to speak out
about what was happening.

831
00:46:53.255 --> 00:46:57.415
And he talked about the powerful economic

832
00:46:57.485 --> 00:47:02.485
and political interests that
were embedded in the decade

833
00:47:02.524 --> 00:47:04.043
of the brain.

834
00:47:04.423 --> 00:47:06.627
The interests of the
pharmaceutical companies

835
00:47:06.627 --> 00:47:08.739
and the insurance companies.

836
00:47:08.739 --> 00:47:11.363
And he also pointed out that the idea

837
00:47:12.833 --> 00:47:15.980
of reducing symptoms to biochemical events

838
00:47:15.980 --> 00:47:20.909
allows for the selective
inattention to inequality,

839
00:47:20.909 --> 00:47:25.102
poverty, racism, social injustices,

840
00:47:25.102 --> 00:47:27.531
as we look for

841
00:47:27.750 --> 00:47:31.105
the universal brain causes

842
00:47:31.105 --> 00:47:34.709
rather than looking at social
and political contexts.

843
00:47:35.110 --> 00:47:38.773
Now, I also wanna say that
I am not anti-medication.

844
00:47:39.035 --> 00:47:41.909
Medication is sometimes essential.

845
00:47:42.139 --> 00:47:44.976
But I think we need a much more subtle

846
00:47:44.976 --> 00:47:47.280
and integrative approach.

847
00:47:47.280 --> 00:47:50.618
That medication is not the
only real thing you can do.

848
00:47:50.618 --> 00:47:52.570
It's one thing you can do.

849
00:47:52.570 --> 00:47:55.934
But there are other things
that are helpful as well.

850
00:47:56.751 --> 00:48:00.900
So he also said, despite
his scathing critique,

851
00:48:00.900 --> 00:48:03.919
that in the midst of
all this grim picture,

852
00:48:03.919 --> 00:48:07.172
like in one of those doom and
gloom science fiction stories

853
00:48:07.172 --> 00:48:11.139
in which, to our relief,
in some remote crevices

854
00:48:11.139 --> 00:48:14.883
of the scorched earth, patches of flowers

855
00:48:14.883 --> 00:48:16.946
begin to bloom again.

856
00:48:17.112 --> 00:48:19.832
A variety of systemic practices inspired

857
00:48:19.832 --> 00:48:23.800
by the powerful ideas of
the field of family therapy

858
00:48:23.800 --> 00:48:26.264
were still growing here and there,

859
00:48:26.264 --> 00:48:28.162
posing new challenges,

860
00:48:28.162 --> 00:48:30.663
pushing new envelopes.

861
00:48:31.693 --> 00:48:33.308
So.

862
00:48:34.509 --> 00:48:38.455
The next leap in my life
I really can't explain.

863
00:48:38.455 --> 00:48:42.306
It's easier for me to say
that I had a fairy godmother

864
00:48:42.306 --> 00:48:46.529
that waved a magic wand than to explain

865
00:48:46.529 --> 00:48:49.089
how I got a Fulbright to go to Finland

866
00:48:49.089 --> 00:48:51.515
to study Open Dialogue.

867
00:48:52.108 --> 00:48:56.747
But, I came across Open Dialogue

868
00:48:56.747 --> 00:49:01.242
when I was doing this
research on managed care.

869
00:49:01.462 --> 00:49:06.095
And the contrast was astonishing to me.

870
00:49:06.613 --> 00:49:10.442
So in this remote corner
of western Lapland,

871
00:49:10.442 --> 00:49:14.048
they had a family-centered,

872
00:49:14.048 --> 00:49:18.175
network-centered approach
that was delivering care

873
00:49:18.175 --> 00:49:22.431
in the community and
achieving impressive outcomes

874
00:49:22.431 --> 00:49:25.230
with the severest problems.

875
00:49:25.706 --> 00:49:29.590
In contrast to the United
States where systemic thinking

876
00:49:29.590 --> 00:49:33.984
was vanishing, in Finland
it was being regarded

877
00:49:33.984 --> 00:49:37.355
as a serious agent in the treatment

878
00:49:37.355 --> 00:49:40.480
of the most severe conditions.

879
00:49:40.480 --> 00:49:43.434
And so I became very
very interested in this

880
00:49:43.434 --> 00:49:46.005
and when I had a chance to go to Finland,

881
00:49:46.005 --> 00:49:48.697
I leapt at that chance.

882
00:49:49.354 --> 00:49:53.375
So I went to the University of Jyväskylä

883
00:49:53.375 --> 00:49:56.810
Department of Psychology and
that's the beautiful bridge

884
00:49:56.810 --> 00:49:58.150
and river.

885
00:49:59.948 --> 00:50:02.433
It's a little murky, the photograph,

886
00:50:02.433 --> 00:50:05.377
but that's the psychology building, there.

887
00:50:05.377 --> 00:50:07.175
And I went there in 2001.

888
00:50:07.175 --> 00:50:10.930
And I was invited there,
actually, to talk about research

889
00:50:10.930 --> 00:50:13.095
I had done on anorexia.

890
00:50:13.095 --> 00:50:16.252
And I had done a series of case studies

891
00:50:16.252 --> 00:50:20.294
with women who had recovered at a time

892
00:50:20.294 --> 00:50:23.750
when recovery was a disputed concept

893
00:50:23.750 --> 00:50:26.417
in the eating disorders field,

894
00:50:26.417 --> 00:50:28.416
and it may be still today.

895
00:50:28.721 --> 00:50:31.366
But using a phenomenological approach,

896
00:50:31.366 --> 00:50:34.800
I came to understand anorexia,

897
00:50:34.800 --> 00:50:37.397
at least in the beginning phases,

898
00:50:37.563 --> 00:50:41.744
as something in which women

899
00:50:41.744 --> 00:50:46.224
draw on the language of food and body

900
00:50:46.224 --> 00:50:50.420
to express a dilemma that's unspeakable.

901
00:50:50.597 --> 00:50:53.956
In other words, food
and body is a territory

902
00:50:53.956 --> 00:50:57.209
that the culture gives to women,

903
00:50:57.209 --> 00:51:01.597
and women use that territory,
that symbolic language

904
00:51:01.988 --> 00:51:05.017
to convey unspeakable dilemmas,

905
00:51:05.017 --> 00:51:09.355
or inexpressible dilemmas
that are felt to be,

906
00:51:11.575 --> 00:51:14.098
that they otherwise can't express.

907
00:51:14.702 --> 00:51:18.286
So what struck me about what
was happening in Finland

908
00:51:18.286 --> 00:51:20.856
is that the Finnish team also

909
00:51:22.776 --> 00:51:27.708
conceptualized psychosis as
a crisis of inexpressibility.

910
00:51:28.109 --> 00:51:31.801
As also stemming from an inexpressible

911
00:51:31.801 --> 00:51:33.950
or unspeakable dilemma.

912
00:51:34.073 --> 00:51:37.209
And they were evoking a similar interplay

913
00:51:37.209 --> 00:51:41.010
of body, voice, and communication.

914
00:51:42.595 --> 00:51:45.709
So, what happened is that
these two research areas,

915
00:51:45.709 --> 00:51:48.419
one on larger systems and the other

916
00:51:48.419 --> 00:51:51.328
on embodied communication came together.

917
00:51:51.328 --> 00:51:53.762
Because as I said, Open Dialogue

918
00:51:53.762 --> 00:51:56.711
has this double helix structure.

919
00:51:56.717 --> 00:52:01.346
It's both a system and
it's a dialogical practice

920
00:52:01.346 --> 00:52:03.910
in open psychiatric meetings.

921
00:52:04.034 --> 00:52:06.502
So it has these two levels.

922
00:52:06.796 --> 00:52:09.441
So I decided that I wanted
to learn more about it

923
00:52:09.441 --> 00:52:13.366
and I arranged to go
to Keropudas Hospital,

924
00:52:13.366 --> 00:52:18.123
which is a six hour train
ride from the university

925
00:52:18.123 --> 00:52:21.543
where I was teaching,
so that I could learn

926
00:52:21.543 --> 00:52:26.119
more about it and I could
give a kind of living form

927
00:52:26.119 --> 00:52:29.270
to these statistics.

928
00:52:29.926 --> 00:52:31.811
So I went to Keropudas Hospital,

929
00:52:31.811 --> 00:52:34.823
and I went there in December.

930
00:52:35.362 --> 00:52:37.660
So this is the dark time.

931
00:52:37.912 --> 00:52:40.167
Below the Arctic Circle,

932
00:52:40.450 --> 00:52:44.508
where there was no sun,
but there was light.

933
00:52:45.719 --> 00:52:49.052
And I wanna tell you
about that experience.

934
00:52:49.175 --> 00:52:51.003
So here's the,

935
00:52:52.311 --> 00:52:55.515
a photograph from outside of my hotel.

936
00:52:55.564 --> 00:52:57.830
That's 8:30 in the morning.

937
00:52:58.326 --> 00:53:01.131
And I left that hotel

938
00:53:01.131 --> 00:53:02.454
and that's what it looked like.

939
00:53:02.454 --> 00:53:05.003
It looked like evening,
and it was quite lovely

940
00:53:05.003 --> 00:53:07.760
but nothing I'd ever experienced before.

941
00:53:08.160 --> 00:53:10.454
And I was picked, so I was picked up

942
00:53:10.454 --> 00:53:13.824
by the chief psychologist
at Keropudas Hospital,

943
00:53:13.824 --> 00:53:16.032
Kauko Haarakangas.

944
00:53:16.032 --> 00:53:20.271
And we were driving out to the hospital.

945
00:53:20.928 --> 00:53:23.871
And we tried to do small talk,

946
00:53:23.871 --> 00:53:26.826
although that wasn't
working because small talk

947
00:53:26.826 --> 00:53:29.354
is not a cultural practice in Finland.

948
00:53:29.354 --> 00:53:32.579
So even though we were both trying,

949
00:53:33.951 --> 00:53:37.520
Finnish silence quickly
descended on our conversation.

950
00:53:38.953 --> 00:53:41.929
And so I started looking out the window

951
00:53:41.929 --> 00:53:45.161
and looking at this winter landscape.

952
00:53:45.161 --> 00:53:49.704
And it was one monochromatic
field of whiteness.

953
00:53:51.614 --> 00:53:54.178
There were very few buildings.

954
00:53:54.760 --> 00:53:57.751
The river was frozen on our left.

955
00:53:58.056 --> 00:54:00.104
There was a cloudy overhang

956
00:54:00.104 --> 00:54:03.138
that fused the sky and the earth.

957
00:54:03.677 --> 00:54:06.354
And I thought about
something that Tom Andersen,

958
00:54:06.354 --> 00:54:09.394
this Norwegian psychiatrist
I mentioned earlier

959
00:54:09.394 --> 00:54:13.831
had said in a seminar that had been given

960
00:54:13.831 --> 00:54:17.852
earlier that summer in
Sollejellen, Norway,

961
00:54:17.852 --> 00:54:20.177
and I also had the
privilege of going to that.

962
00:54:20.177 --> 00:54:24.540
And Sollegjellen, Norway
is a desperately beautiful

963
00:54:24.540 --> 00:54:29.540
and barren mining town in northern Norway.

964
00:54:29.851 --> 00:54:33.001
And he started the conference by saying

965
00:54:33.001 --> 00:54:35.368
go to the margins

966
00:54:38.131 --> 00:54:40.296
if you wanna be creative.

967
00:54:40.296 --> 00:54:42.658
So, he said that,

968
00:54:43.240 --> 00:54:44.872
or maybe he said go to the margins

969
00:54:44.872 --> 00:54:46.888
and I added the part about creativity.

970
00:54:46.888 --> 00:54:51.888
But anyway, I was thinking,
this is where we must be.

971
00:54:51.901 --> 00:54:54.913
I am on the margins.

972
00:54:55.804 --> 00:54:59.446
So, this is also, kind of
what it looked like there.

973
00:54:59.548 --> 00:55:04.145
And so we got to the hospital
and I got out of the car

974
00:55:04.145 --> 00:55:08.689
and I really appreciated
the no holds barred effect

975
00:55:08.689 --> 00:55:11.366
of winter near the Arctic Circle.

976
00:55:11.366 --> 00:55:14.517
There was a dry and absolute cold.

977
00:55:14.843 --> 00:55:18.886
And we went into the hospital
and the morning was spent

978
00:55:18.886 --> 00:55:21.744
learning about Open Dialogue,

979
00:55:21.744 --> 00:55:24.112
Kauko did a PowerPoint presentation

980
00:55:24.112 --> 00:55:26.149
and talked about this work.

981
00:55:26.149 --> 00:55:29.477
But I was about to see it in action

982
00:55:29.477 --> 00:55:33.391
because the head
psychiatrist Birgittu Alakara

983
00:55:33.391 --> 00:55:36.527
had gotten a call from
a therapist that morning

984
00:55:36.527 --> 00:55:40.804
about a woman who was saying
that she was suicidal.

985
00:55:40.804 --> 00:55:45.657
And so Birgittu invited the woman,

986
00:55:45.657 --> 00:55:48.697
I mean, the therapist
called about this woman,

987
00:55:48.697 --> 00:55:51.182
invited the therapist, the woman,

988
00:55:51.182 --> 00:55:56.131
an outpatient nurse,
and this woman's partner

989
00:55:56.131 --> 00:55:59.033
to what's called a treatment meeting

990
00:55:59.033 --> 00:56:01.379
and I was offered a chance to participate

991
00:56:01.379 --> 00:56:03.016
in that meeting.

992
00:56:03.694 --> 00:56:07.971
So the treatment meeting is
the main therapeutic forum

993
00:56:07.971 --> 00:56:10.055
of Open Dialogue.

994
00:56:10.573 --> 00:56:14.584
Within 24 hours of the initial call,

995
00:56:14.584 --> 00:56:17.143
there is a meeting that's called,

996
00:56:17.143 --> 00:56:19.970
in advance of any hospitalization,

997
00:56:19.970 --> 00:56:23.948
that brings together the person
at the center of concern,

998
00:56:23.948 --> 00:56:26.753
any family members, any professionals,

999
00:56:26.753 --> 00:56:30.481
and anybody else closely
involved in the situation.

1000
00:56:31.511 --> 00:56:33.878
The treatment meeting then, thus

1001
00:56:33.878 --> 00:56:36.556
brings together the family.

1002
00:56:36.556 --> 00:56:41.072
The family is involved from the
very beginning of treatment.

1003
00:56:42.774 --> 00:56:45.835
And not only did this treatment meeting

1004
00:56:45.835 --> 00:56:49.184
reorganize the hospital admission process,

1005
00:56:49.184 --> 00:56:53.658
it also changed the
therapeutic enterprise itself.

1006
00:56:54.016 --> 00:56:56.501
Because professionals
were thrown in together

1007
00:56:56.501 --> 00:56:59.285
with families and people in trouble

1008
00:56:59.285 --> 00:57:01.252
from the very beginning.

1009
00:57:01.322 --> 00:57:04.708
And they began to change
their clinical philosophy.

1010
00:57:04.810 --> 00:57:07.594
Instead of thinking as old-style,

1011
00:57:07.594 --> 00:57:09.588
systemic family therapists that they

1012
00:57:09.588 --> 00:57:13.492
have to initiate change
and make interventions,

1013
00:57:13.492 --> 00:57:17.653
they shift it

1014
00:57:17.653 --> 00:57:20.810
to a very different kind of practice

1015
00:57:20.810 --> 00:57:24.042
influenced by the ideas of Bakhtin,

1016
00:57:24.042 --> 00:57:26.474
that their goal was simply

1017
00:57:26.474 --> 00:57:30.239
to foster dialogue and make sure

1018
00:57:30.239 --> 00:57:33.022
all voices were heard,

1019
00:57:33.022 --> 00:57:36.809
and to try to come up with
a more shared understanding

1020
00:57:36.809 --> 00:57:40.499
of the crisis, to try to help the person

1021
00:57:40.499 --> 00:57:43.496
at the center of concern find words

1022
00:57:43.496 --> 00:57:47.443
for what was frightening
and distressing them,

1023
00:57:47.443 --> 00:57:50.720
and that this social weaving

1024
00:57:50.720 --> 00:57:53.506
of this assembly of voices,

1025
00:57:53.506 --> 00:57:58.506
this polyphonic conversation,
to use Bakhtin's word,

1026
00:57:58.708 --> 00:58:02.563
became the basis of care.

1027
00:58:04.543 --> 00:58:07.956
So, when I walked into
the meeting after lunch,

1028
00:58:07.956 --> 00:58:12.686
there was a young woman sitting there,

1029
00:58:13.150 --> 00:58:15.849
and she was sitting next to the door,

1030
00:58:15.849 --> 00:58:17.795
and she was

1031
00:58:19.870 --> 00:58:21.587
not making eye contact.

1032
00:58:21.587 --> 00:58:25.256
She still had her white puffy parka

1033
00:58:25.256 --> 00:58:28.407
with its snowflake
pattern on it zipped up.

1034
00:58:28.808 --> 00:58:32.424
And the color was drained from her face

1035
00:58:32.424 --> 00:58:34.279
and her body seemed inert,

1036
00:58:34.279 --> 00:58:38.391
and her spirit seemed also absent.

1037
00:58:39.228 --> 00:58:41.942
And next to her was her partner.

1038
00:58:42.204 --> 00:58:44.007
So I'll call her Hannah,

1039
00:58:44.007 --> 00:58:46.545
and her partner, who I'll call Euke,

1040
00:58:46.545 --> 00:58:48.007
was the opposite.

1041
00:58:48.007 --> 00:58:53.007
He was dark-haired, he
was wiry, he was alert,

1042
00:58:53.020 --> 00:58:57.318
his body was turned toward
her in a protective way.

1043
00:58:57.318 --> 00:59:01.936
He was a social worker, he
was also completely fluent

1044
00:59:01.936 --> 00:59:03.445
in English.

1045
00:59:03.611 --> 00:59:05.904
He sensed my need for a translator

1046
00:59:05.904 --> 00:59:08.831
and he began to translate the session.

1047
00:59:09.808 --> 00:59:12.826
I had the counter-impression
that he was a caretaker

1048
00:59:12.826 --> 00:59:15.444
of the first order of magnitude.

1049
00:59:16.890 --> 00:59:20.975
Birgittu, the head psychiatrist
began the Open Dialogue

1050
00:59:20.975 --> 00:59:23.066
meeting in the way we begin,

1051
00:59:23.066 --> 00:59:27.311
which is to ask about
the history of the idea

1052
00:59:27.311 --> 00:59:29.054
to have the meeting.

1053
00:59:29.241 --> 00:59:31.311
Whose idea was it to have this meeting?

1054
00:59:31.311 --> 00:59:33.006
Who took the initiative?

1055
00:59:33.006 --> 00:59:35.492
And because the therapist is the one

1056
00:59:35.492 --> 00:59:38.685
who asked for the meeting,
she began speaking.

1057
00:59:38.926 --> 00:59:42.126
And she described how Hannah

1058
00:59:42.126 --> 00:59:44.632
had moved here from
another part of Finland.

1059
00:59:44.632 --> 00:59:46.264
She had grown up

1060
00:59:47.674 --> 00:59:50.563
in a family that had been very abusive.

1061
00:59:50.563 --> 00:59:52.952
She had fallen in love with this man.

1062
00:59:52.952 --> 00:59:56.578
He was from this area and
he was coming back here

1063
00:59:56.578 --> 01:00:00.103
for work, and she had come with him.

1064
01:00:00.471 --> 01:00:03.377
She knew no one else in the area.

1065
01:00:04.631 --> 01:00:07.330
And she had been seeing this therapist

1066
01:00:07.330 --> 01:00:10.003
in individual therapy, and she had been,

1067
01:00:10.003 --> 01:00:12.392
for several weeks, telling this therapist

1068
01:00:12.392 --> 01:00:15.058
that she did not wanna live anymore,

1069
01:00:15.058 --> 01:00:16.850
that she wanted to kill herself,

1070
01:00:16.850 --> 01:00:18.589
that she had a plan.

1071
01:00:18.589 --> 01:00:22.465
And the therapist was
becoming very very concerned.

1072
01:00:23.676 --> 01:00:27.228
So Birgittu listened and then asked

1073
01:00:27.228 --> 01:00:32.060
the fiance, what are your thoughts about

1074
01:00:32.060 --> 01:00:34.464
what the therapist had said.

1075
01:00:36.006 --> 01:00:38.438
And there was a silence.

1076
01:00:38.438 --> 01:00:41.627
There was a stillness, it
was completely concentrated.

1077
01:00:41.627 --> 01:00:45.222
Although, I must say that
I have never felt so calm

1078
01:00:45.222 --> 01:00:49.354
in any kind of meeting before.

1079
01:00:49.360 --> 01:00:51.120
I felt completely calm and safe.

1080
01:00:51.120 --> 01:00:52.991
It was really remarkable.

1081
01:00:53.563 --> 01:00:55.280
And I looked at Birgittu's face,

1082
01:00:55.280 --> 01:00:59.482
and I was really struck by
how open and intent it was.

1083
01:00:59.482 --> 01:01:02.170
That there was no suggestion in her face

1084
01:01:02.170 --> 01:01:06.164
that she was assessing or
scrutinizing this couple.

1085
01:01:07.748 --> 01:01:10.270
She was just waiting for an answer.

1086
01:01:10.511 --> 01:01:15.193
And the man looked at
her and he said something

1087
01:01:15.193 --> 01:01:17.337
that stunned all of us.

1088
01:01:17.337 --> 01:01:22.227
He said, I get drunk and I beat her.

1089
01:01:27.182 --> 01:01:29.923
I then was stunned

1090
01:01:29.923 --> 01:01:32.568
and, but I looked over at Hannah

1091
01:01:32.568 --> 01:01:34.605
and all of a sudden she

1092
01:01:34.605 --> 01:01:37.560
came back into the room

1093
01:01:37.560 --> 01:01:40.274
and started to look more alert

1094
01:01:41.133 --> 01:01:44.615
and the color started
coming back into her face.

1095
01:01:44.983 --> 01:01:47.601
It's as if she'd woken up from a dream.

1096
01:01:49.260 --> 01:01:51.884
And then, I too began to feel movement

1097
01:01:51.884 --> 01:01:55.063
and I turned to her and I said,

1098
01:01:55.063 --> 01:01:57.409
she also spoke English,

1099
01:01:57.409 --> 01:01:58.636
I said,

1100
01:02:01.825 --> 01:02:04.246
which is more dangerous to you?

1101
01:02:04.246 --> 01:02:07.301
Your thoughts of suicide or the beatings?

1102
01:02:08.214 --> 01:02:11.066
And she said instantly, the beatings.

1103
01:02:15.019 --> 01:02:18.613
So now it was really
easy to see her position

1104
01:02:20.149 --> 01:02:22.922
and to comprehend

1105
01:02:22.922 --> 01:02:25.589
what Mary Catherine Bateson has called

1106
01:02:25.589 --> 01:02:29.017
the whole contextual structure.

1107
01:02:29.770 --> 01:02:32.063
So this man that she loved

1108
01:02:33.713 --> 01:02:37.044
also, and that had rescued
her from her family,

1109
01:02:37.044 --> 01:02:40.035
also was violent and abusive at times.

1110
01:02:40.297 --> 01:02:43.198
And yet, she was wholly dependent on him

1111
01:02:43.198 --> 01:02:45.289
and knew no one else in the area

1112
01:02:45.289 --> 01:02:47.949
and did not have a family to go back to.

1113
01:02:49.747 --> 01:02:53.896
My sense was that there was
something subtle and powerful

1114
01:02:53.896 --> 01:02:57.378
about the stance of the professionals.

1115
01:02:57.736 --> 01:03:01.421
John Shotter calls this withness.

1116
01:03:01.747 --> 01:03:04.898
As opposed to aboutness, thinking.

1117
01:03:05.202 --> 01:03:08.194
Being with rather than doing to.

1118
01:03:09.831 --> 01:03:12.850
Bakhtin has a fancy word, dialogicality,

1119
01:03:12.850 --> 01:03:16.140
to talk about this sense of being with.

1120
01:03:16.775 --> 01:03:19.164
And what happened,

1121
01:03:19.164 --> 01:03:21.511
even though this was
about something terrible

1122
01:03:21.511 --> 01:03:25.574
that was happening, there
was a common language forming

1123
01:03:25.574 --> 01:03:28.630
that gave this young woman a voice.

1124
01:03:30.193 --> 01:03:33.045
And so, you know,

1125
01:03:33.073 --> 01:03:36.176
I was really struck because
I'd worked in emergency rooms

1126
01:03:36.176 --> 01:03:38.523
and I don't think I'd ever experienced

1127
01:03:38.523 --> 01:03:41.749
such a rapid shift in perspective.

1128
01:03:43.003 --> 01:03:46.559
So after this experience I decided to do,

1129
01:03:46.608 --> 01:03:48.858
to learn more about it,
to do some research.

1130
01:03:48.858 --> 01:03:51.503
I did a very, sort of a, what
could be loosely described

1131
01:03:51.503 --> 01:03:53.669
as an ethnographic study.

1132
01:03:53.669 --> 01:03:56.847
I teamed up with Jaakko Seikkula

1133
01:03:56.847 --> 01:03:59.098
and we did writing together.

1134
01:03:59.098 --> 01:04:02.739
And then I came back to the United States.

1135
01:04:06.287 --> 01:04:08.494
So let me just quickly kind of review

1136
01:04:08.494 --> 01:04:10.227
before I go on,

1137
01:04:11.118 --> 01:04:14.830
and just kind of speak in a
little bit of a different voice

1138
01:04:14.830 --> 01:04:19.171
and give somewhat of a brief
overview of this approach.

1139
01:04:20.951 --> 01:04:22.861
There are these seven principles.

1140
01:04:22.861 --> 01:04:25.475
These are the principles
that Kauko had outlined

1141
01:04:25.475 --> 01:04:28.045
in his PowerPoint presentation.

1142
01:04:28.045 --> 01:04:31.789
Immediate help, the team
meets within 24 hours.

1143
01:04:31.789 --> 01:04:34.381
A social network perspective.

1144
01:04:34.381 --> 01:04:37.335
You can distill the aim of Open Dialogue

1145
01:04:37.335 --> 01:04:41.137
to reducing psychic and social isolation.

1146
01:04:41.442 --> 01:04:43.490
So bringing everyone together

1147
01:04:43.490 --> 01:04:45.414
to try to figure out what's happening.

1148
01:04:46.017 --> 01:04:48.247
Flexibility and mobility.

1149
01:04:48.247 --> 01:04:50.156
There's geographical flexibility,

1150
01:04:50.156 --> 01:04:52.566
there's clinical flexibility.

1151
01:04:52.566 --> 01:04:55.371
This is not an approach
that strives for theoretical

1152
01:04:55.371 --> 01:04:58.832
or clinical purity, so
it's very integrative.

1153
01:04:59.435 --> 01:05:01.131
It brings in ideas and insights

1154
01:05:01.131 --> 01:05:03.472
from various traditions.

1155
01:05:03.830 --> 01:05:06.219
The responsibility of the therapist,

1156
01:05:06.219 --> 01:05:09.536
the therapist is responsible
for organizing the services.

1157
01:05:09.536 --> 01:05:12.138
Psychological continuity,
meaning that the team

1158
01:05:12.138 --> 01:05:14.976
that comes together
within the first 24 hours

1159
01:05:14.976 --> 01:05:18.404
remains your team during
the duration of the crisis.

1160
01:05:19.061 --> 01:05:21.983
Tolerance of uncertainty means that

1161
01:05:23.913 --> 01:05:25.887
it's really a relationship to time,

1162
01:05:25.887 --> 01:05:29.097
that to try to develop
an organic understanding

1163
01:05:29.097 --> 01:05:32.095
of the situation, integrating the voices

1164
01:05:32.095 --> 01:05:36.852
of everyone present means
that you have to be able

1165
01:05:36.852 --> 01:05:39.689
to tolerate the uncertainties
so you can build

1166
01:05:39.689 --> 01:05:41.374
the plan and the decisions

1167
01:05:41.374 --> 01:05:43.262
based on an organic understanding.

1168
01:05:43.262 --> 01:05:45.790
So there's an avoidance of hasty decisions

1169
01:05:45.790 --> 01:05:47.832
and quick assessments.

1170
01:05:47.880 --> 01:05:51.112
And finally, dialogue, which
I'm gonna say more about

1171
01:05:51.112 --> 01:05:53.640
a little bit later, but
the aim of dialogue,

1172
01:05:53.640 --> 01:05:58.018
the aim of the meeting is
simply to create dialogue.

1173
01:06:01.215 --> 01:06:04.183
I also analyzed this practice using

1174
01:06:05.063 --> 01:06:09.121
these two levels of the
micropolitics and poetics.

1175
01:06:09.713 --> 01:06:12.540
The micropolitics being the
institutional practices,

1176
01:06:12.540 --> 01:06:15.046
and the poetics being the dialogue

1177
01:06:15.046 --> 01:06:16.934
and the language practices.

1178
01:06:16.934 --> 01:06:19.462
And what's happened over the last 10 years

1179
01:06:19.462 --> 01:06:23.686
is that the dialogic practice
has also been adapted

1180
01:06:23.686 --> 01:06:28.608
to more ordinary kinds of
couple and family therapy

1181
01:06:28.635 --> 01:06:31.269
So now we talk about dialogical therapy

1182
01:06:31.269 --> 01:06:34.960
that shares many of the same
psychotherapeutic principles,

1183
01:06:34.960 --> 01:06:39.647
but it's not embedded in
this overarching system.

1184
01:06:41.626 --> 01:06:44.613
Finally, just to highlight
two important key assumptions.

1185
01:06:44.613 --> 01:06:47.940
In contrast to traditional family therapy,

1186
01:06:47.940 --> 01:06:51.706
the Open Dialogue approach
and dialogical therapy

1187
01:06:51.706 --> 01:06:55.236
does not view the person or the family

1188
01:06:55.236 --> 01:07:00.040
as the cause of the psychosis
or the cause of the problem.

1189
01:07:00.644 --> 01:07:04.942
It really takes a kind of
ideological agnosticism

1190
01:07:04.942 --> 01:07:07.171
saying we really don't know what causes

1191
01:07:07.171 --> 01:07:09.742
these severe crises and conditions,

1192
01:07:09.742 --> 01:07:12.654
but that bringing people
together in a crisis,

1193
01:07:12.654 --> 01:07:15.928
not separating people
seems to be particularly

1194
01:07:15.928 --> 01:07:18.866
important in these severe situations.

1195
01:07:19.981 --> 01:07:22.818
The other is that it's a meaning-driven,

1196
01:07:22.818 --> 01:07:26.300
language-driven view, say, of psychosis.

1197
01:07:26.487 --> 01:07:29.687
That psychosis is a
terrifying, alienating,

1198
01:07:29.687 --> 01:07:33.548
temporary estrangement

1199
01:07:33.548 --> 01:07:36.561
from shared communicative practices.

1200
01:07:36.684 --> 01:07:38.636
It's a no-man's land where a person

1201
01:07:38.636 --> 01:07:42.064
has no genuine voice or agency.

1202
01:07:42.390 --> 01:07:45.569
So there's a great emphasis
in this way of working

1203
01:07:45.569 --> 01:07:50.352
on constructing voice,
constructing agency.

1204
01:07:50.593 --> 01:07:54.539
And in contrast to the way
we tend to work with people

1205
01:07:54.539 --> 01:07:58.240
in these states, they start
from the very beginning

1206
01:07:58.240 --> 01:08:02.298
in engaging a communicative process.

1207
01:08:03.573 --> 01:08:05.393
Here are the outcome
studies, which is I think

1208
01:08:05.393 --> 01:08:07.537
the whole reason we're here,

1209
01:08:07.537 --> 01:08:09.877
the whole reason we're talking about it.

1210
01:08:10.022 --> 01:08:13.286
So, in terms of medication use,

1211
01:08:13.286 --> 01:08:16.987
two-thirds of their
first-time psychosis people

1212
01:08:16.987 --> 01:08:21.087
are not put on anti-psychotic medication.

1213
01:08:23.689 --> 01:08:28.165
In terms of relapses, almost 70%

1214
01:08:28.165 --> 01:08:31.503
did not have a relapse
within the five years,

1215
01:08:31.503 --> 01:08:35.076
and these statistics are
pretty consistent for both

1216
01:08:35.076 --> 01:08:37.353
five year followup studies.

1217
01:08:38.266 --> 01:08:42.095
80% have very, have residual,

1218
01:08:42.095 --> 01:08:46.041
very light residual or
asymptomatic at five years,

1219
01:08:46.041 --> 01:08:48.249
and then the functional outcomes,

1220
01:08:48.249 --> 01:08:51.331
80% working, studying, looking for a job

1221
01:08:51.331 --> 01:08:54.504
and only 20% on disability.

1222
01:08:54.627 --> 01:08:57.390
The best longitudinal
research that we have

1223
01:08:57.390 --> 01:09:00.974
in the United States is
Martin Harrow's work.

1224
01:09:00.974 --> 01:09:05.677
And he has found that
a comparable statistic

1225
01:09:05.677 --> 01:09:10.418
in the U.S. would be 5% recovery rate.

1226
01:09:11.576 --> 01:09:15.042
So, for this reason, people
are trying to figure out

1227
01:09:15.042 --> 01:09:18.236
what are they doing right.

1228
01:09:22.284 --> 01:09:24.183
So, coming home.

1229
01:09:24.183 --> 01:09:25.851
So I came home

1230
01:09:26.017 --> 01:09:28.140
from this experience

1231
01:09:28.140 --> 01:09:32.207
and I found people

1232
01:09:32.207 --> 01:09:34.361
at Smith College School for Social Work

1233
01:09:34.361 --> 01:09:35.993
who were interested in Open Dialogue.

1234
01:09:35.993 --> 01:09:40.993
I found like-minded people
at UMass medical school.

1235
01:09:41.082 --> 01:09:44.707
But, as I said, we wrote
grant applications,

1236
01:09:44.707 --> 01:09:46.755
we did our best,

1237
01:09:46.755 --> 01:09:51.755
and we repeatedly did not get
funding for this research.

1238
01:09:53.304 --> 01:09:55.437
But at the same time, I began,

1239
01:09:55.437 --> 01:09:57.805
in my own clinical practice

1240
01:09:57.805 --> 01:10:00.359
to experience

1241
01:10:01.068 --> 01:10:04.037
startlingly positive outcomes

1242
01:10:04.037 --> 01:10:06.849
in working with young
women and their families

1243
01:10:08.699 --> 01:10:13.134
with eating disorders,
depression, cutting,

1244
01:10:13.134 --> 01:10:16.344
psychosis, and I think that,

1245
01:10:16.344 --> 01:10:18.915
though not in every case,

1246
01:10:18.915 --> 01:10:22.125
but what was different in my own practice,

1247
01:10:22.125 --> 01:10:24.856
I would say, is that

1248
01:10:24.856 --> 01:10:29.063
I started to drop the clinical gaze.

1249
01:10:30.733 --> 01:10:33.548
And even though I thought I
didn't have a clinical gaze,

1250
01:10:33.548 --> 01:10:36.098
'cause, you know, I was
feminist, I was systemic,

1251
01:10:36.098 --> 01:10:38.604
and social justice, and all this stuff,

1252
01:10:38.604 --> 01:10:40.251
but I did.

1253
01:10:40.695 --> 01:10:44.454
And I remember the
moment that it was gone.

1254
01:10:45.089 --> 01:10:48.897
And it doesn't mean that you
don't use your expertise,

1255
01:10:48.897 --> 01:10:52.602
you just use it much more lightly.

1256
01:10:53.440 --> 01:10:56.000
And instead of looking for the crazy thing

1257
01:10:56.000 --> 01:10:57.899
in the person and family,

1258
01:10:57.899 --> 01:11:01.701
I simply tried to make sure
that everyone was heard.

1259
01:11:03.189 --> 01:11:06.464
And the difference, I
think it created a kind of

1260
01:11:06.464 --> 01:11:08.277
openness of mind

1261
01:11:08.277 --> 01:11:12.153
that families, that people can sense.

1262
01:11:12.831 --> 01:11:16.750
And it's very subtle,
but it's very powerful.

1263
01:11:21.492 --> 01:11:23.273
There're two quotes

1264
01:11:23.273 --> 01:11:26.110
that tended to capture, I think,

1265
01:11:26.110 --> 01:11:30.963
the effect of this work
on my own practice.

1266
01:11:30.963 --> 01:11:34.334
One is by the architect
Christopher Alexander

1267
01:11:34.334 --> 01:11:38.157
who talks about aliveness in architecture,

1268
01:11:38.579 --> 01:11:43.389
and I felt there was a new
aliveness in my clinical work,

1269
01:11:43.389 --> 01:11:46.034
and I was struck with the idea that

1270
01:11:46.034 --> 01:11:49.490
the more we learn about this method,

1271
01:11:49.490 --> 01:11:52.231
and I would say this dialogic practice,

1272
01:11:52.231 --> 01:11:56.508
the more I found it doesn't so
much teach us new processes,

1273
01:11:56.508 --> 01:12:00.519
but rather opens up a process in us

1274
01:12:00.519 --> 01:12:03.723
which is already part of us.

1275
01:12:04.743 --> 01:12:06.806
And that was my experience.

1276
01:12:07.046 --> 01:12:09.457
And the other is Peter Rober

1277
01:12:09.457 --> 01:12:14.246
talking about dialogue is a space

1278
01:12:14.246 --> 01:12:16.885
where life can come.

1279
01:12:19.675 --> 01:12:22.118
Okay, so I said that I would talk

1280
01:12:22.118 --> 01:12:24.063
a little bit about.

1281
01:12:25.253 --> 01:12:26.992
Let me just say before I go forward,

1282
01:12:26.992 --> 01:12:29.914
the really, the ground of my
conviction about this work

1283
01:12:29.914 --> 01:12:33.264
is my own lived clinical experience

1284
01:12:33.264 --> 01:12:36.991
in tandem with what I saw in Finland.

1285
01:12:37.786 --> 01:12:40.964
But the shift in my own clinical practice

1286
01:12:40.964 --> 01:12:44.516
and the way my own clinical
work started to flourish

1287
01:12:44.516 --> 01:12:47.955
is what has kept me going.

1288
01:12:48.889 --> 01:12:50.670
But let's think now,

1289
01:12:50.670 --> 01:12:53.710
I wanna turn now to talk about

1290
01:12:53.710 --> 01:12:56.409
the cultural and historical factors

1291
01:12:56.409 --> 01:12:59.114
that are shaping this
interest in Open Dialogue

1292
01:12:59.114 --> 01:13:00.740
at the present time.

1293
01:13:01.162 --> 01:13:04.458
So as I said, you know,
biological determinism

1294
01:13:04.458 --> 01:13:07.455
has shaped the mental health field,

1295
01:13:07.455 --> 01:13:10.079
but now, at the highest levels,

1296
01:13:11.389 --> 01:13:14.932
there's the recognition
that this way of thinking

1297
01:13:14.932 --> 01:13:17.513
has some serious problems.

1298
01:13:17.513 --> 01:13:19.849
And here are, I think,

1299
01:13:19.849 --> 01:13:23.789
the various reasons why

1300
01:13:24.147 --> 01:13:27.810
this perspective is being rethought.

1301
01:13:28.232 --> 01:13:31.805
The first is that, as
has been brought forward

1302
01:13:31.805 --> 01:13:34.519
by the work of Robert Whitaker,

1303
01:13:35.112 --> 01:13:37.448
U.S. psychiatric disabilities

1304
01:13:38.941 --> 01:13:41.426
have increased, actually,
they've skyrocketed

1305
01:13:41.426 --> 01:13:45.164
for children and adults
over the past 20 years.

1306
01:13:45.820 --> 01:13:49.068
The reasons for this
are not well understood.

1307
01:13:50.439 --> 01:13:54.918
Whitaker's perspective is
that the medications over time

1308
01:13:54.918 --> 01:13:58.940
tend to chronify sever difficulties.

1309
01:13:58.940 --> 01:14:01.489
It's probably more complex than that

1310
01:14:01.489 --> 01:14:05.627
because there have been profound
changes in work patterns,

1311
01:14:05.627 --> 01:14:07.110
in welfare reform.

1312
01:14:07.110 --> 01:14:09.685
I think it's a much more complex picture.

1313
01:14:09.894 --> 01:14:12.475
But this has been well-documented,

1314
01:14:12.475 --> 01:14:14.981
that psychiatric disability rates

1315
01:14:14.981 --> 01:14:19.434
have increased exponentially
in the last 20 years.

1316
01:14:20.325 --> 01:14:24.901
The other influence is the
rise of the recovery movement

1317
01:14:24.901 --> 01:14:28.282
and the testimonies of
psychiatric survivors

1318
01:14:28.282 --> 01:14:31.764
and mental health consumers

1319
01:14:34.211 --> 01:14:38.276
who have really formed
a world wide movement

1320
01:14:38.276 --> 01:14:41.619
that has been propelled by the internet.

1321
01:14:41.646 --> 01:14:46.009
So psychiatric survivors in
Germany can compare experiences

1322
01:14:46.009 --> 01:14:48.530
with people in the United States.

1323
01:14:48.590 --> 01:14:51.352
So this has become a very powerful lateral

1324
01:14:51.352 --> 01:14:53.624
social and political movement,

1325
01:14:53.624 --> 01:14:56.797
and they have testified to

1326
01:14:57.645 --> 01:15:00.824
what they feel are dehumanizing practices,

1327
01:15:00.824 --> 01:15:05.596
hasty insurance-driven
treatment decisions,

1328
01:15:06.274 --> 01:15:09.265
and an over-reliance on medication.

1329
01:15:11.970 --> 01:15:15.223
Their power and their
influence is important.

1330
01:15:15.223 --> 01:15:17.228
I think that this is probably one

1331
01:15:17.228 --> 01:15:19.916
of the most important
things that has come out

1332
01:15:19.916 --> 01:15:22.715
of the mental health field
in the last 20 years.

1333
01:15:23.212 --> 01:15:27.350
But it also means that if somebody wants

1334
01:15:27.350 --> 01:15:29.878
to do research,

1335
01:15:29.878 --> 01:15:34.198
it's now impossible to do
research without including,

1336
01:15:34.198 --> 01:15:37.472
and I think this is a very
important ethical shift,

1337
01:15:37.472 --> 01:15:41.141
without including the
voice of the consumer,

1338
01:15:41.141 --> 01:15:43.802
the voice of the psychiatric survivor.

1339
01:15:44.757 --> 01:15:47.082
And psychiatric survivors and consumers

1340
01:15:47.082 --> 01:15:49.237
have embraced Open Dialogue.

1341
01:15:49.237 --> 01:15:53.631
They see it as the one clinical approach

1342
01:15:53.631 --> 01:15:56.415
that is consistent with
the values and principles

1343
01:15:56.415 --> 01:15:58.873
of their movement.

1344
01:16:00.404 --> 01:16:04.067
I think the third factor is that

1345
01:16:04.724 --> 01:16:08.190
genetic researchers and
psychiatric epidemiologists

1346
01:16:08.190 --> 01:16:11.838
are now inferring social factors,

1347
01:16:11.838 --> 01:16:15.425
say in the study of people

1348
01:16:16.039 --> 01:16:18.193
diagnosed with schizophrenia.

1349
01:16:18.193 --> 01:16:22.112
The diagnosis of schizophrenia
is also being deconstructed.

1350
01:16:22.310 --> 01:16:27.163
Understood not as a
discrete disease entity,

1351
01:16:27.163 --> 01:16:29.963
but as a cluster of symptoms.

1352
01:16:30.502 --> 01:16:33.120
But I don't wanna get into that right now.

1353
01:16:34.288 --> 01:16:37.904
But, for example,
psychiatric epidemiologists

1354
01:16:37.904 --> 01:16:41.877
have shown that if
you're a person of color,

1355
01:16:42.618 --> 01:16:46.128
your chances of being
diagnosed with schizophrenia

1356
01:16:46.128 --> 01:16:50.516
increase greatly the whiter
your neighborhood becomes.

1357
01:16:53.306 --> 01:16:57.060
The diagnosis of schizophrenia
is also corollated with

1358
01:16:57.060 --> 01:17:01.470
disruption of social
network and immigration.

1359
01:17:01.913 --> 01:17:04.424
There is an enormous literature on that.

1360
01:17:05.753 --> 01:17:08.857
Genetic researchers also
have failed to produce

1361
01:17:08.857 --> 01:17:13.309
any kind of single gene
for, say, schizophrenia.

1362
01:17:13.870 --> 01:17:16.942
Now there may well be
a genetic contribution,

1363
01:17:16.942 --> 01:17:21.831
but there's so many genes that
are involved, it's dizzying.

1364
01:17:23.693 --> 01:17:28.060
So the idea that it could
be distilled to one gene

1365
01:17:28.429 --> 01:17:31.911
is really a hypothesis that has failed.

1366
01:17:32.919 --> 01:17:36.354
And finally, it's become
clear that these medications

1367
01:17:36.354 --> 01:17:39.298
have very serious side effects.

1368
01:17:39.298 --> 01:17:41.964
They affect brain tissue,
they're associated

1369
01:17:41.964 --> 01:17:46.964
with metabolic syndrome, and
people who are longterm users

1370
01:17:46.988 --> 01:17:51.787
of anti-psychotic medications,

1371
01:17:51.787 --> 01:17:55.435
it's been shown that their life expectancy

1372
01:17:55.435 --> 01:18:00.427
is 25 years less than people

1373
01:18:00.427 --> 01:18:03.002
who do no take these medications.

1374
01:18:03.680 --> 01:18:06.901
So it would have been really wonderful

1375
01:18:06.901 --> 01:18:10.058
if we could do research and
come up with medications

1376
01:18:10.058 --> 01:18:13.583
that could cure the human suffering.

1377
01:18:13.781 --> 01:18:18.073
But it's turned out to
be much more complicated.

1378
01:18:18.186 --> 01:18:22.026
And as I said, this is well
known at the highest levels

1379
01:18:22.026 --> 01:18:23.764
of academic research.

1380
01:18:23.764 --> 01:18:26.388
And the highest levels
of academic research,

1381
01:18:26.388 --> 01:18:30.328
no one believes in the chemical
imbalance theory anymore.

1382
01:18:33.769 --> 01:18:37.272
There's also some other troubling trends.

1383
01:18:37.715 --> 01:18:40.990
The use of anti-psychotics
in children with Medicaid

1384
01:18:40.990 --> 01:18:44.563
is four times that of
children in the private sector

1385
01:18:44.563 --> 01:18:47.159
and for less serious conditions.

1386
01:18:48.403 --> 01:18:53.181
13 to 15% of foster kids
are prescribed psychiatric

1387
01:18:53.181 --> 01:18:57.196
medications compared to
4% of non-foster kids.

1388
01:18:57.597 --> 01:18:59.869
So these medications,
the other troubling trend

1389
01:18:59.869 --> 01:19:03.207
is these medications are
being used disproportionately

1390
01:19:03.207 --> 01:19:07.527
with the most vulnerable
and the most disenfranchised

1391
01:19:07.527 --> 01:19:09.916
population, so why is that?

1392
01:19:09.916 --> 01:19:14.422
If this is an objective disease.

1393
01:19:17.585 --> 01:19:18.667
So.

1394
01:19:20.742 --> 01:19:22.896
The other part of this

1395
01:19:22.896 --> 01:19:25.222
is that neuroscience is beginning

1396
01:19:25.222 --> 01:19:28.974
to show that the brain

1397
01:19:28.974 --> 01:19:32.221
really does not operate like a thing.

1398
01:19:32.600 --> 01:19:36.803
Its logic is not linear,
it's not cause and effect.

1399
01:19:36.803 --> 01:19:39.843
It's dialogical, it's systemic,

1400
01:19:39.843 --> 01:19:41.538
there are feedback loops.

1401
01:19:41.538 --> 01:19:43.687
It's much more like a network.

1402
01:19:43.928 --> 01:19:46.647
There's a group in
Switzerland that's mapping

1403
01:19:46.647 --> 01:19:49.218
the architectural and
functional principles

1404
01:19:49.218 --> 01:19:52.055
of the brain, and the
metaphor that they use

1405
01:19:52.055 --> 01:19:54.577
is the brain is like a symphony.

1406
01:19:55.959 --> 01:19:58.999
Of course, it's also a chemical entity.

1407
01:19:58.999 --> 01:20:02.508
But its organizing logic
is probably musical

1408
01:20:02.508 --> 01:20:04.240
and communicative.

1409
01:20:05.473 --> 01:20:08.325
So, and this is not to say,

1410
01:20:08.331 --> 01:20:10.443
at the same time, that these medications

1411
01:20:10.443 --> 01:20:12.858
aren't necessarily helpful.

1412
01:20:13.302 --> 01:20:15.947
As I said, for come
people they're helpful.

1413
01:20:15.947 --> 01:20:19.381
Why they're helpful is not
really well understood.

1414
01:20:19.381 --> 01:20:22.351
It's more empirical
rather than theoretical.

1415
01:20:22.987 --> 01:20:26.816
And it also may be, like
many things in medicine

1416
01:20:26.816 --> 01:20:30.431
and many things in the
biological living world,

1417
01:20:30.431 --> 01:20:34.730
that these medications have time factors.

1418
01:20:34.730 --> 01:20:38.239
In other words, if you go on
prednisone for your asthma

1419
01:20:38.239 --> 01:20:40.393
you can't stay on that indefinitely.

1420
01:20:40.393 --> 01:20:44.734
So this is being understood
and there's a rethinking

1421
01:20:44.734 --> 01:20:48.990
of this simple idea that a severe symptom

1422
01:20:48.990 --> 01:20:52.425
is a biochemical event, it's a brain,

1423
01:20:52.425 --> 01:20:57.278
it's a chemical imbalance
that can be repaired,

1424
01:20:57.278 --> 01:21:01.607
like insulin is to diabetes,
with the right medication.

1425
01:21:01.607 --> 01:21:06.423
And that really, we have ben
in the grip of a false idea.

1426
01:21:07.656 --> 01:21:11.617
So what's changing is, and
I think one of the reasons.

1427
01:21:12.391 --> 01:21:15.346
Now again, I don't what
you coming away from this

1428
01:21:15.346 --> 01:21:18.172
thinking Open Dialogue
means no medication.

1429
01:21:18.172 --> 01:21:20.754
Because medication is used, but it's used

1430
01:21:20.754 --> 01:21:24.561
in a pragmatic way.

1431
01:21:24.561 --> 01:21:29.297
It's used to facilitate
social participation,

1432
01:21:29.297 --> 01:21:34.123
rather than in a theoretical
way to fix an imbalance.

1433
01:21:36.241 --> 01:21:38.843
I think over time, the paradigm shift

1434
01:21:38.843 --> 01:21:40.816
that we are going to be seeing

1435
01:21:40.816 --> 01:21:44.827
is a shift from biological reductionism

1436
01:21:44.827 --> 01:21:48.752
that treats symptoms as
biochemical processes,

1437
01:21:48.752 --> 01:21:50.917
the brain as a thing,

1438
01:21:50.917 --> 01:21:55.141
to a dialogical approach that
responds to a suffering person

1439
01:21:55.141 --> 01:21:59.796
in a context, and that the
mind is a relational process.

1440
01:22:00.474 --> 01:22:04.766
This has enormous implications
for the social work field.

1441
01:22:05.519 --> 01:22:09.647
Open Dialogue is a more
collaborative, egalitarian,

1442
01:22:09.647 --> 01:22:13.625
less hierarchical way
of organizing a system,

1443
01:22:13.625 --> 01:22:16.665
and I think clinical social workers

1444
01:22:16.665 --> 01:22:20.334
are poised to be leaders
in bringing forward

1445
01:22:20.334 --> 01:22:24.082
this new way of thinking
and this new practice.

1446
01:22:24.910 --> 01:22:27.576
I wanna just say a little bit more

1447
01:22:27.576 --> 01:22:29.031
just to,

1448
01:22:31.693 --> 01:22:33.570
so there's truth in advertising.

1449
01:22:33.570 --> 01:22:34.770
I, so.

1450
01:22:35.426 --> 01:22:38.487
So this is the project
that I'm working on.

1451
01:22:38.487 --> 01:22:42.178
I hope I mentioned that
I'm working together

1452
01:22:42.178 --> 01:22:47.178
Jaakko Seikkulak, who
telecommutes from Finland,

1453
01:22:47.265 --> 01:22:49.053
Skype commutes, and also comes here

1454
01:22:49.053 --> 01:22:52.231
once or twice a year,
and also Doug Ziedonis,

1455
01:22:52.231 --> 01:22:54.205
who's working with us, and he's Chairman

1456
01:22:54.205 --> 01:22:56.871
of Psychiatry at UMass Medical School.

1457
01:22:56.871 --> 01:23:00.988
So this is really remarkable
that a Chairman of Psychiatry

1458
01:23:00.988 --> 01:23:04.743
of a major medical school
would be working with us

1459
01:23:04.743 --> 01:23:09.547
to try to bring forward
this Open Dialogue approach.

1460
01:23:10.150 --> 01:23:13.009
And one of the things
that we've done so far

1461
01:23:13.009 --> 01:23:15.633
is we have done what you need to do

1462
01:23:15.633 --> 01:23:16.891
in order to do research.

1463
01:23:16.891 --> 01:23:19.728
we got funded by the
Foundation for Excellence

1464
01:23:19.728 --> 01:23:23.056
in Mental Health Care and
we spent the last two years

1465
01:23:23.056 --> 01:23:26.629
doing the preliminary work, developing

1466
01:23:26.629 --> 01:23:29.594
the research protocols and
materials you need to do

1467
01:23:29.594 --> 01:23:31.796
for clinical study.

1468
01:23:32.528 --> 01:23:34.821
We have, if you're interested,
I'm not gonna go over this

1469
01:23:34.821 --> 01:23:37.263
right now, but if you're
interested, there is something

1470
01:23:37.263 --> 01:23:40.655
that we've, we have a finished
product that you can download

1471
01:23:40.655 --> 01:23:43.183
from our website called the 12 elements

1472
01:23:43.183 --> 01:23:44.623
of dialogic practice.

1473
01:23:44.623 --> 01:23:47.780
Like, 12 is I guess a mystical number.

1474
01:23:47.780 --> 01:23:50.404
I don't know why we came up with 12, but.

1475
01:23:51.514 --> 01:23:54.344
But this will soon be
available on our website.

1476
01:23:54.819 --> 01:23:57.369
I call it, it's an anti-manual manual,

1477
01:23:57.369 --> 01:23:59.555
because I couldn't tolerate,
as an English major,

1478
01:23:59.555 --> 01:24:01.923
the idea of writing a
manual about something.

1479
01:24:01.923 --> 01:24:04.131
So instead of writing a manual,

1480
01:24:04.131 --> 01:24:06.744
we tried to distill what the elements were

1481
01:24:06.744 --> 01:24:09.415
and then give examples
from our own practice.

1482
01:24:09.603 --> 01:24:12.711
It's not a cookbook, it's not a how-to.

1483
01:24:14.509 --> 01:24:17.687
Finally, though, I said
that I wanted to also

1484
01:24:17.687 --> 01:24:21.020
give a word of caution.

1485
01:24:22.562 --> 01:24:25.254
And that is to say that

1486
01:24:26.044 --> 01:24:30.977
I think, despite the great
appeal of Open Dialogue,

1487
01:24:30.977 --> 01:24:33.264
the promise of Open Dialogue,

1488
01:24:33.761 --> 01:24:34.918
that

1489
01:24:35.660 --> 01:24:40.140
it's an idea that we really
need to understand more deeply

1490
01:24:40.140 --> 01:24:42.113
and how it would actually work

1491
01:24:42.113 --> 01:24:45.158
in our own context, in our own society.

1492
01:24:46.965 --> 01:24:49.803
You know, for example, I
think one of the things

1493
01:24:49.803 --> 01:24:53.686
that has allowed Keropudas Hospital

1494
01:24:53.686 --> 01:24:56.864
to achieve the outcomes it has achieved

1495
01:24:56.864 --> 01:24:58.880
is that it has a very good relationship

1496
01:24:58.880 --> 01:25:01.829
with the Rural County Employment Office.

1497
01:25:02.155 --> 01:25:05.269
So they're able, because
of this relationship,

1498
01:25:05.269 --> 01:25:07.631
to get people back to work.

1499
01:25:08.522 --> 01:25:09.743
Now,

1500
01:25:10.304 --> 01:25:12.693
how can that be replicated.

1501
01:25:12.693 --> 01:25:14.325
If you get people back to work,

1502
01:25:14.325 --> 01:25:15.690
that's a self esteem issue,

1503
01:25:15.690 --> 01:25:17.364
you're gonna manage your symptoms,

1504
01:25:17.364 --> 01:25:20.244
you got a job, you're
in a natural network,

1505
01:25:20.244 --> 01:25:22.307
so there're all these benefits.

1506
01:25:22.495 --> 01:25:25.172
So I think we really
have to think carefully

1507
01:25:25.172 --> 01:25:27.646
and think about how we're gonna adapt this

1508
01:25:27.646 --> 01:25:30.345
and be cautious about the claims we make.

1509
01:25:30.345 --> 01:25:32.787
I think there's a danger, also,

1510
01:25:32.787 --> 01:25:36.009
in saying, you know, Open
Dialogue is this new,

1511
01:25:36.009 --> 01:25:39.027
magical, miracle cure,

1512
01:25:39.027 --> 01:25:42.434
because everything is contextually shaped.

1513
01:25:44.253 --> 01:25:46.973
You know, maybe the
outcomes that they got,

1514
01:25:46.973 --> 01:25:49.298
you know, sometimes
they use the analogies,

1515
01:25:49.298 --> 01:25:50.600
like the Beatles, you know.

1516
01:25:50.600 --> 01:25:53.693
You had this particular
idiosyncratic group

1517
01:25:53.693 --> 01:25:55.837
of therapists working together,

1518
01:25:55.837 --> 01:25:58.711
and how do you replicate that?

1519
01:25:59.943 --> 01:26:03.954
So I wanna quote Gregory Bateson and say

1520
01:26:03.954 --> 01:26:06.695
behind every scientific advance,

1521
01:26:06.695 --> 01:26:09.969
there's always a matrix,
a mother load of unknowns

1522
01:26:09.969 --> 01:26:14.123
out of which the new partial
answers have been chiseled.

1523
01:26:15.035 --> 01:26:18.651
He advises us to be
careful, not to rush in

1524
01:26:18.651 --> 01:26:21.504
where angels fear to tread.

1525
01:26:23.878 --> 01:26:25.429
So with that,

1526
01:26:28.389 --> 01:26:29.983
I'll end my talk.

1527
01:26:30.448 --> 01:26:33.300
(applause)

1528
01:26:58.403 --> 01:26:59.961
Should we take a few questions?

1529
01:26:59.961 --> 01:27:00.826
Yeah?

1530
01:27:00.826 --> 01:27:02.853
- [Voiceover] We have time for a few.

1531
01:27:02.853 --> 01:27:04.329
- Okay.

1532
01:27:08.239 --> 01:27:09.513
Yeah.

1533
01:27:10.351 --> 01:27:12.790
- [Voiceover] It's an observation.

1534
01:27:12.955 --> 01:27:17.414
So I was just struck in your case example,

1535
01:27:17.414 --> 01:27:21.776
when you spoke of speaking to the fiance

1536
01:27:21.776 --> 01:27:25.776
and you said that in
reference to the woman,

1537
01:27:25.776 --> 01:27:29.759
but my reaction was to the man,

1538
01:27:30.096 --> 01:27:32.922
before the woman, the man had spoken,

1539
01:27:32.922 --> 01:27:36.751
and when I think about it, I think

1540
01:27:36.751 --> 01:27:41.636
it's a tribute to the approach being

1541
01:27:41.636 --> 01:27:44.361
not just a focus on prior expectations.

1542
01:27:44.655 --> 01:27:48.367
But this then allowed him, also,

1543
01:27:48.367 --> 01:27:51.662
to think about where he was going wrong.

1544
01:27:51.662 --> 01:27:54.212
- Absolutely, I couldn't
agree with you more,

1545
01:27:54.212 --> 01:27:55.449
I couldn't agree with you more.

1546
01:27:55.449 --> 01:27:57.465
Absolutely, absolutely.

1547
01:27:57.465 --> 01:28:00.537
He spoke the unspeakable,
and then that allowed

1548
01:28:00.537 --> 01:28:02.890
for her to acquire a voice.

1549
01:28:02.890 --> 01:28:06.445
So even though he was
doing something terrible,

1550
01:28:06.445 --> 01:28:09.389
he also had the humanity
to throw her a lifeline.

1551
01:28:12.369 --> 01:28:14.136
- [Voiceover] He needed help as well.

1552
01:28:14.136 --> 01:28:15.448
- And to find him,

1553
01:28:15.448 --> 01:28:17.133
yeah and so, and so

1554
01:28:17.133 --> 01:28:19.949
they define, so instead of being alone,

1555
01:28:19.949 --> 01:28:22.295
he was defining himself now

1556
01:28:22.295 --> 01:28:26.332
as somebody who was in need of help.

1557
01:28:26.572 --> 01:28:28.407
And I don't know if I mentioned this,

1558
01:28:28.407 --> 01:28:30.583
I meant to, but I may have forgotten it,

1559
01:28:30.583 --> 01:28:32.550
being a little nervous.

1560
01:28:32.791 --> 01:28:35.649
They referred him to a program,

1561
01:28:35.649 --> 01:28:37.089
they have very good programs,

1562
01:28:37.089 --> 01:28:39.617
they were starting to
have good programs then

1563
01:28:39.617 --> 01:28:41.963
for men who are violent
toward their partners,

1564
01:28:41.963 --> 01:28:44.645
so he accepted that referral.

1565
01:28:45.536 --> 01:28:49.477
So it really made the
situation much less dangerous.

1566
01:28:53.173 --> 01:28:54.703
Yeah.

1567
01:28:54.716 --> 01:28:56.348
- [Voiceover] Can you say
a little bit more about

1568
01:28:56.348 --> 01:28:59.686
the way that you can see
adaptations to the model

1569
01:28:59.686 --> 01:29:02.315
(mumbles)

1570
01:29:03.729 --> 01:29:05.617
- Well, I mean, I think that

1571
01:29:06.977 --> 01:29:09.168
the next step is that we are gonna see

1572
01:29:09.168 --> 01:29:12.304
and this is, we just wrote another grant

1573
01:29:12.304 --> 01:29:15.760
in which we're gonna try to see if we can,

1574
01:29:17.600 --> 01:29:19.578
there isn't a lot of money,

1575
01:29:19.578 --> 01:29:21.925
but we're gonna try to see if we can

1576
01:29:23.589 --> 01:29:26.106
organize treatment meetings in the UMass

1577
01:29:26.106 --> 01:29:27.839
Emergency Room.

1578
01:29:28.698 --> 01:29:33.150
And to see if we can have three meetings.

1579
01:29:34.116 --> 01:29:36.484
We have two people in the Emergency Room.

1580
01:29:36.484 --> 01:29:40.334
We also, Peter Rober and
I and Jaakko Seikkula

1581
01:29:40.334 --> 01:29:42.841
have been running training seminars

1582
01:29:42.841 --> 01:29:45.486
and we have people come
from different agencies

1583
01:29:45.486 --> 01:29:47.987
to train with us and
to learn this approach.

1584
01:29:48.643 --> 01:29:51.992
And we have two people
in the Emergency Room now

1585
01:29:51.992 --> 01:29:55.427
who have been through two
years of our training program.

1586
01:29:55.427 --> 01:29:58.147
And so we're very fortunate
to have a nurse practitioner

1587
01:29:58.147 --> 01:30:00.930
and a clinical social worker who

1588
01:30:00.930 --> 01:30:05.090
now are two of the 50
people in the country

1589
01:30:05.090 --> 01:30:07.245
who are trained in this way of working.

1590
01:30:07.245 --> 01:30:09.655
And so we're gonna see
if we can launch this

1591
01:30:09.655 --> 01:30:11.490
with 10 families and see,

1592
01:30:12.900 --> 01:30:14.594
see if it's feasible.

1593
01:30:14.594 --> 01:30:15.980
You know, can we do it?

1594
01:30:15.980 --> 01:30:17.495
Do the families accept it?

1595
01:30:17.495 --> 01:30:18.657
Do they come back?

1596
01:30:18.657 --> 01:30:20.689
Is it possible within the Emergency Room?

1597
01:30:23.041 --> 01:30:24.400
Yeah.

1598
01:30:24.662 --> 01:30:26.753
- [Voiceover] In some ways, the model,

1599
01:30:26.753 --> 01:30:29.398
the very systems are not foreign,

1600
01:30:29.398 --> 01:30:32.310
it seems to me, in terms of social work.

1601
01:30:32.310 --> 01:30:36.314
- Absolutely, absolutely.

1602
01:30:36.651 --> 01:30:40.224
- [Voiceover] We're probably
one of the professional groups

1603
01:30:40.224 --> 01:30:45.224
that has looked at the total
arena of the individual.

1604
01:30:45.237 --> 01:30:46.172
- Absolutely.

1605
01:30:46.172 --> 01:30:49.884
I feel that and I also
feel that the curriculum

1606
01:30:49.884 --> 01:30:52.956
at the Smith College
School for Social Work,

1607
01:30:55.096 --> 01:30:58.022
this, you know, the
excellent clinical training,

1608
01:30:58.022 --> 01:31:00.966
the ability to zoom in on the individual,

1609
01:31:00.966 --> 01:31:03.867
but also to look at the wider environment,

1610
01:31:03.867 --> 01:31:07.120
I mean, this is exactly the curriculum,

1611
01:31:07.120 --> 01:31:11.418
exactly the training that prepares people

1612
01:31:11.418 --> 01:31:13.594
to do this kind of work.

1613
01:31:13.594 --> 01:31:15.599
And we've had extraordinary graduates

1614
01:31:15.599 --> 01:31:18.895
in our program come through
our training program

1615
01:31:18.895 --> 01:31:22.447
and they're like ducks to water.

1616
01:31:22.447 --> 01:31:24.559
And I think you need both,

1617
01:31:24.559 --> 01:31:26.436
you know, one of the things about Finland,

1618
01:31:26.436 --> 01:31:29.517
it hasn't kind of divided
the psychoanalytic

1619
01:31:29.517 --> 01:31:32.196
and the systemic in the way
that it's been divided here,

1620
01:31:32.196 --> 01:31:35.699
so they draw fluidly
form both sides of that.

1621
01:31:36.057 --> 01:31:39.929
And I think it's very important to be able

1622
01:31:39.929 --> 01:31:43.971
to do that and to have as
broad a perspective as possible

1623
01:31:43.971 --> 01:31:48.306
when you're confronting
these great challenges.

1624
01:31:51.918 --> 01:31:53.117
Yeah.

1625
01:31:53.240 --> 01:31:55.640
- [Voiceover] I've come to
be inspired by your vision

1626
01:31:55.640 --> 01:32:00.555
of a coming paradigm shift away
from the biochemical model.

1627
01:32:01.165 --> 01:32:04.162
At the same time, I
wonder what it will take

1628
01:32:04.162 --> 01:32:07.500
for these dialogic
concepts to take purchase

1629
01:32:07.500 --> 01:32:12.283
in the minds of big pharma or
insurance company executives.

1630
01:32:12.609 --> 01:32:16.332
- Well, you know, I just
was in Nashville, Tennessee,

1631
01:32:16.332 --> 01:32:19.094
I've never been there before, talking to

1632
01:32:20.594 --> 01:32:22.992
managed care executives,

1633
01:32:23.723 --> 01:32:27.109
many of whom are also
fundamentalist Christians.

1634
01:32:27.318 --> 01:32:31.333
And a couple of 'em said,
you're doing the Lord's work.

1635
01:32:37.120 --> 01:32:39.599
So maybe, who knows?

1636
01:32:44.597 --> 01:32:46.169
Okay, one more.

1637
01:32:46.964 --> 01:32:48.490
- [Voiceover] Yes I'm also cautious

1638
01:32:48.490 --> 01:32:50.574
with the paradigm shift
that you had mentioned.

1639
01:32:50.911 --> 01:32:53.236
Would you say in juxtaposition to this

1640
01:32:53.236 --> 01:32:55.487
that there's also a paradigm shift

1641
01:32:55.487 --> 01:32:57.460
that at least we feel this in Canada

1642
01:32:57.460 --> 01:33:00.297
where people are wont to
do more natural things,

1643
01:33:00.297 --> 01:33:04.190
looking at all the things
that new immigrants

1644
01:33:04.190 --> 01:33:06.846
things that they used in their country,

1645
01:33:06.846 --> 01:33:09.651
and so this then, in
essence, will be helpful

1646
01:33:09.651 --> 01:33:11.400
to you to make this shift.

1647
01:33:11.400 --> 01:33:13.271
- Absolutely, absolutely.

1648
01:33:13.555 --> 01:33:14.973
Absolutely.

1649
01:33:14.973 --> 01:33:17.554
Yes, I think it resonates with something,

1650
01:33:17.554 --> 01:33:19.784
I think people feel, it's not that,

1651
01:33:19.784 --> 01:33:22.802
you know, again, it's not
to be anti-medication.

1652
01:33:22.802 --> 01:33:26.813
It's just, it's not sufficient to address

1653
01:33:26.813 --> 01:33:29.180
these problems and difficulties,

1654
01:33:29.180 --> 01:33:32.033
and I think people intuitively know that.

1655
01:33:32.754 --> 01:33:33.735
Yeah.

1656
01:33:33.735 --> 01:33:35.591
Okay, well you've been a wonderful group

1657
01:33:35.591 --> 01:33:36.849
and thank you for coming.

1658
01:33:36.849 --> 01:33:39.232
(applause)

1659
01:33:47.014 --> 01:33:48.849
- Thank you all so very much.

1660
01:33:48.849 --> 01:33:50.619
Mary, that was an absolutely wonderful,

1661
01:33:50.619 --> 01:33:52.059
wonderful presentation.

1662
01:33:52.059 --> 01:33:52.987
Thank you.

1663
01:33:52.987 --> 01:33:55.829
And I have someone's cell
phone from the dinner.

1664
01:33:55.931 --> 01:33:57.307
If anybody's missing one.

1665
01:33:57.307 --> 01:33:59.147
Thank you.