Psychiatry in Scandinavia

By Marvin Ross

There must be something in the water in Scandinavian countries that produces some strange treatment modalities for serious mental illnesses. The latest is drug free units within psychiatric hospitals in Norway. Previously, we had (and still do) the open dialogue program in Northern Finland which claims to cure almost all of schizophrenia drug free.

This program has been touted for years by the anti-medication/anti-psychiatry proponents of the US journalist Robert Whitaker and his adherents in Mad in America. I wrote about this program in Huffington Post back in 2013 and pointed out that there is almost no research showing it to be effective. A Finnish psychiatrist confirmed that “most mental health professionals in Finland would agree with your view that Open Dialogue has not been proven to be better than standard treatment for schizophrenia. However, it is also a widespread view that the programme is attractive due to its client-centredness and empowerment of the service user, and that good studies are urgently needed to establish the effectiveness of the programme. Before it has been established to be effective, it should be seen as an experimental treatment that should not (yet?) be clinical practise.”

At the time, some of my critics on social media attacked me for actually asking a Finnish psychiatrist what mainstream shrinks in Finland thought of the program. Just recently, I received a message from someone on Linkedin asking me if I was still negative about Open Dialogue as there is now new research showing how good it is. I replied that I was negative but would love to seen the research. I never heard from her again.

More recently (in 2015), Dr Dawson also wrote about Open Dialogue in this blog. He commented that “Even if some form of two year intensive counseling/therapy/group therapy worked as well as four weeks of Olanzapine, what on earth would be the justification for withholding the Olanzapine?” And he pointed out that “the psychiatrist and director of Open Dialogue in Finland, in interview, acknowledged that she prescribes neuroleptic medication for “about 30 percent” of their patients.”

Now, Norway has added to this anti-drug position and “By 2017 all health regions in Norway have established medication-free treatment services in mental health care, following a direct requirement from the Ministry of Health and Care Services.” (from correspondence from the Norwegian health ministry).

What is being offered is that “All the drug-free units emphasize creating recovery processes based on patients’ own experiences and wishes. Most services create treatment plans in collaboration with patients. The treatment in Vestre Viken HF in the South-Eastern Regional Health Authority and Vegsund DPS in the Central Norway Regional Health Authority have fixed schedules. Common treatment approaches of the drug-free units are psychotherapy; both individual therapy and group therapy, environmental therapy, art therapy, Illness Management and Recovery (IMR),psychoeducation, physical and social activity, exposure therapy, and networking; both in regards to relatives and work/education.”

Even though this program was first introduced starting in 2015 at the insistence of “user organizations” (and what they are is not defined), no evaluations have been done comparing those who do not get medication to those who do. That research is just recruiting patients and is not expected to have results until 2023.

The issue to me is should this drug free experiment have ever been begun in the first place and the answer is no. The evidence based consensus guidelines for the treatment of schizophrenia all recommend that anti-psychotics should be used in the acute phase and that they should be used in order to prevent relapses once the patient is stable. Not using accepted treatment for serious mental illnesses is as stupid, in my opinion, of oncology centres forgoing standard cancer treatment and allowing patients to try the type of quack remedies you find in alternative medicine.

The one survey that has been done is of psychiatrists and their view of this experiment. The research conducted by a Norwegian hospital was reported on by Mad in America who said “The research, which was funded by a grant from the Stavanger University Hospital, found that psychiatrists carried negative opinions of this initiative. They understood the programs to be unscientific and rooted in the perspectives of dissatisfied service-users within a patient group that “lacks insight” into their problems. These recent findings were published in the Journal of Psychopharmacology.”

Needless to say that Mad in America disagrees with the criticisms and argue that :

“here exists substantial debate in the clinical and research literature over the long-term effects of antipsychotic drug treatment for psychosis and whether the significant safety risks outweigh any benefits. Also, critics have pointed to the impact of guild interests and institutional corruption on current guidelines recommending this treatment.”

Please not that the references they cite to demonstrate their points are all from Mad in America – a highly reputable source of all things scientific.

This entire situation is forcing me to go have a few pints of homeopathic lager!