Category : Guestblog

Intelligence Linked to Bipolar Disorder

Intelligence Linked to Bipolar Disorder

By Jane Collingwood

Research has indicated that bipolar disorder may be up to four times more common in young people who were straight-A students.

A link between high IQ and bipolar disorder has been proposed for many years, but the scientific evidence has so far been weak, say researchers from the Institute of Psychiatry, King’s College London, UK.

Collaborating with the Karolinska Institute in Sweden, they used information from the Swedish national school register on all 713,876 students graduating from compulsory education between 1988 and 1997, at age 15 or 16. This was cross-referenced with figures from the Swedish hospital discharge register on diagnosis of bipolar disorder between the ages of 17 and 31.

Excellent school performance was linked to almost four times the average risk of developing bipolar disorder among boys. The study is published in the British Journal of Psychiatry.

“We found that achieving an A grade is associated with increased risk for bipolar disorder, particularly in humanities and to a lesser extent in science subjects,” said Dr. James MacCabe, lead researcher. “These findings provide support for the hypothesis that exceptional intellectual ability is associated with bipolar disorder.

“A-grades in Swedish and Music had particularly strong associations, supporting the literature which consistently finds associations between linguistic and musical creativity and bipolar disorder.”

He believes that a mild form of mania can cause people to have greater stamina and concentration, and link ideas in innovative ways, as can unusually strong emotional responses, common in people with bipolar disorder.

“Although having A grades increases your chance of bipolar disorder in later life, we should remember that the majority of people with A grades enjoy good mental health,” Dr. MacCabe added.

A previous study also found a link between high test scores and a greater risk of bipolar disorder. Dr. Jari Tiihonen and colleagues at the University of Kuopio, Finland, looked at different aspects of intelligence among people who go on to develop bipolar disorder.

They analyzed test results from 195,019 apparently healthy males conscripted into the Finnish Defense Forces. In Finland, all men serve for 6, 9 or 12 months at around 20 years of age.

The 100 participants who went on to have bipolar disorder had significantly higher scores for “arithmetic reasoning.” A high score was associated with a more than 12-fold greater risk, report the researchers.

“The finding of an association between progressively increasing risk of bipolar disorder and high arithmetic intellectual performance is rather surprising,” they write. “The arithmetic test not only requires mathematical skills but also rapid information processing, since the limited amount of time for solving the tasks allows only a small percentage of subjects to finish the test.

“It is plausible to assume that subjects having the ability to rapidly process information may share the same neurobiological characteristics as subjects who develop mania, a state characterized by high alertness and psychomotor activity. It is tempting to speculate that good arithmetic or psychomotor performance may have contributed in human evolution to the persistence of bipolar disorder, which is strongly genetically transmitted and associated with a high mortality rate.”

Nevertheless, the majority of previous studies that have measured intelligence in relation to bipolar disorder have found no significant difference compared with the general population. In fact, “cognitive impairment consistent with deficits in IQ” has been reported during acute episodes of mania and depression, reports Dr. Katherine E. Burdick of the North-Shore-Long Island Jewish Health System, New York.

She writes, “There are a handful of studies that have reported impairment in current IQ performance in bipolar patients; however, when premorbid [before the illness] intellectual capacity has been evaluated, bipolar patients have consistently demonstrated performance comparable to control subjects.

“These data suggest that IQ deficits in bipolar patients are likely to reflect a decline in functioning due to the onset of the disease, and more specifically due to the onset of psychosis.”

Other studies indicate that a higher pre-illness IQ may be a protective factor against the psychotic form of bipolar disorder, whereas lower IQ is often associated with developing psychotic bipolar disorder. A great deal of research is being carried out in this area, with the aim of fully understanding how this illness is linked to intelligence.

Dr. Stanley Zammit of the University Hospital of Wales, Cardiff, UK, concludes, “Premorbid IQ is likely to be a risk factor for psychotic illnesses in general. However, it does not seem to have an effect on risk of developing bipolar disorder.”

He believes this indicates different pathways of causality for bipolar disorder to those for schizophrenia, psychoses, and severe depression.


MacCabe, J. H. et al. Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study. British Journal of Psychiatry, Vol. 196, February 2010, pp. 109-15.

Tiihonen, J. et al. Premorbid intellectual functioning in bipolar disorder and schizophrenia: results from a cohort study of male conscripts. The American Journal of Psychiatry, Vol. 162, October 2005, pp. 1904-10.

Burdick, K. E. et al. The role of general intelligence as an intermediate phenotype for neuropsychiatric disorders. Cognitive Neuropsychiatry, Vol. 14, July 2009, pp. 299-311.

Zammit, S. et al. A longitudinal study of premorbid IQ score and risk of developing schizophrenia, bipolar disorder, severe depression, and other nonaffective psychoses. Archives of General Psychiatry, Vol. 61, April 2004, pp.354-60.

P.T.S.D. Symptoms

P.T.S.D. Symptoms

By Mayo Clinic staff

Post-traumatic stress disorder symptoms typically start within three months of a traumatic event. In a small number of cases, though, PTSD symptoms may not appear until years after the event.

Post-traumatic stress disorder symptoms are generally grouped into three types: intrusive memories, avoidance and numbing, and increased anxiety or emotional arousal (hyperarousal).

Symptoms of intrusive memories may include:

  • Flashbacks, or reliving the traumatic event for minutes or even days at a time
  • Upsetting dreams about the traumatic event

Symptoms of avoidance and emotional numbing may include:

  • Trying to avoid thinking or talking about the traumatic event
  • Feeling emotionally numb
  • Avoiding activities you once enjoyed
  • Hopelessness about the future
  • Memory problems
  • Trouble concentrating
  • Difficulty maintaining close relationships

Symptoms of anxiety and increased emotional arousal may include:

  • Irritability or anger
  • Overwhelming guilt or shame
  • Self-destructive behavior, such as drinking too much
  • Trouble sleeping
  • Being easily startled or frightened
  • Hearing or seeing things that aren’t there

Post-traumatic stress disorder symptoms can come and go. You may have more post-traumatic stress disorder symptoms when things are stressful in general, or when you run into reminders of what you went through. You may hear a car backfire and relive combat experiences, for instance. Or you may see a report on the news about a rape and feel overcome by memories of your own assault.

When to see a doctor
It’s normal to have a wide range of feelings and emotions after a traumatic event. You might experience fear and anxiety, a lack of focus, sadness, changes in how well you sleep or how much you eat, or crying spells that catch you off guard. You may have nightmares or be unable to stop thinking about the event. This doesn’t mean you have post-traumatic stress disorder.

But if you have these disturbing thoughts and feelings for more than a month, if they’re severe, or if you feel you’re having trouble getting your life back under control, talk to your health care professional. Getting treatment as soon as possible can help prevent PTSD symptoms from getting worse.

In some cases, post-traumatic stress disorder symptoms may be so severe that you need emergency help, especially if you’re thinking about harming yourself or someone else. If this happens, call 911 or other emergency medical service, or ask a supportive family member or friend for help.

Warning Signs of Teen Violence

In 2007, approximately ten percent of American teens of both sexes reported that being physically hurt by a boyfriend or girlfriend sometime during the preceding twelve-month period, according to the Youth Risk Behavior Survey, a comprehensive statistical monitoring project conducted on a biennial basis by the Centers for Disease Control and Prevention (CDC). In the same survey, more than 11 percent of teen aged girls reported that they had, at some point, been forced to engage in sexual intercourse against their will. Other studies have shown that one in five girls in high school has suffered physical or sexual abuse at the hands of a boyfriend or intimate partners. Dating violence puts teens at greater risk of physical injury, up to and including death, as well as depression, suicide, drug abuse, unhealthy eating habits, and risky sexual behaviors that can lead to unwanted pregnancy, sexual violence, and serious illnesses, including HIV/AIDS.Information for Teens:The first stirring of romantic and sexual feelings can be an exciting time for an adolescent, and dating can be lots of fun. However, being intimate with another person can make a teen vulnerable to violence at the hands of his or her romantic partner. Teens who experience abuse, whether physical, sexual, or emotional, may find themselves feeling confused and ashamed and unsure of where to turn. It is important for any victim of abuse to understand that he or she is not at fault. It is also important for victims to seek out help. The best thing to do is to confide in a parent, teacher, or other trusted adult. If that is not possible, a teen who is experiencing dating violence should turn to her friends for support. Nonetheless, the reality is that many teens who are victims of abuse at the hands of a romantic partner tell no one. For teens who cannot bring themselves to tell anyone about what they are going through, there are many non-profit organizations and resource centers that are available to help.

  • The Safe Space: The Safe Space bills itself as “the most comprehensive resource on the web to learn about dating violence.” This site offers educational resources for teens who suspect that they may be involved in an abusive relationship but do not know where to turn, as well as tips for staying safe when one has been a victim of dating violence. One entire section is devoted to the use by abusers of technologies such as texting and social media to harass, stalk, and threaten their victims and how to guard against it.
  • Dating Violence: A Dating Bill of Rights: This page from the website of the Alabama Coalition Against Domestic Violence offers information about teen violence, including signs that can serve to warn teens that a dating partner may become abusive, a sidebar that sets out a “dating bill of rights” and a section on safety planning that encourages teens to confide in adults about abuse and advises them to change lockers, phone numbers, and routes to school and keep numbers of trusted friends, adults, and community resources at the ready.

Information for Parents Who Fear Their Children May Be Victims of Dating Violence:

Before parents know it, their children are adolescents and demonstrating an interest in romantic relationships with their peers. Nearly three-quarters of students in the ninth-grade report that they are engaging, or have engaged, in dating behavior. Although dating is a natural and healthy part of growing up, the prevalence of violence in teen dating relationships is alarming. Because of the long-term effects of dating violence on victims, parents should be aware of the potential for abuse in teen relationships and the signs of an abusive relationship. One of the risk factors for being both a victim and a perpetrator of teen violence is inadequate parental supervision, involvement, and support. However, even attentive parents can miss the signs of dating violence, and victims are often reluctant to divulge the details of their intimate relationships with their families. Parents can address the problem head on by talking to their children about dating violence before it happens and getting involved with school and community efforts to reduce the incidence of abusive intimate relationships among teens.

  • Choose Respect: Choose Respect is an initiative co-sponsored by the Division of Violence Prevention, an office of the National Center for Injury Prevention and Control (NCIPC), which operates under the auspices of the CDC and the U.S. Department of Health and Human Services. The aim of Choose Respect is the prevention of dating violence through education and the fostering of healthy intra-family relationships. The Choose Respect website provides tips and resources for parents who wish to talk to their adolescent children about dating and dating violence.
  • Warning Signs: This page from the Choose Respect website offers parents a comprehensive list of warning signs, both signs that a teen is currently in an abusive relationship and signs of an abusive person who has the potential to perpetrate violence against an intimate partner.

Information for Educators on Dating Violence Resources:

Many victims of teen dating violence do not tell family and friends about what is happening to them. It is therefore imperative, given the deep and far-reaching consequences of dating violence, that educators recognize the signs of this form of abuse among their students and be prepared with resources for victims and thief friends and families. Although detecting dating violence and providing support to victims is vital, it is equally important that educators engage in prevention by implementing in the classroom educational tools and provided by various governmental agencies and advocacy groups. Preventing dating violence depends just as much upon recognizing in students the signs of a potential abuser as well as the signs of a potential victim.

  • National Youth Violence Prevention Resource Center, Teen Dating Violence: The National Youth Violence Prevention Resource Center is a federally sponsored and funded program for community members whose aim is to prevent violence among America’s youth. This page of the National Youth Violence Prevention Resource Center offers a comprehensive list of resources for educators, healthcare professionals, and activists seeking to prevent teen dating violence and intervene in abusive relationships between adolescents. Included are links to articles on confronting, treating, and responding to teens involved in violent dating relationships and screening teens for dating violence.
  • Teen Dating Violence Facts: This fact sheet, compiled by the National Teen Dating Violence Prevention Initiative of the American Bar Association, provides a comprehensive collection of facts and statistics gathered from numerous academic studies, federal and state agencies, and advocacy organizations regarding the incidence, cause, prevention, and consequences of teen dating violence.
  • Teen Dating Violence: A Closer Look at Adolescent Romantic Relationships: This article from the National Institute of Justice Journal, a publication of the National Institute of Justice, the research arm of the U.S. Department of Justice, provides a thorough analysis of the causation and dynamics of teen dating violence, drawing on federal research studies and statistics.
  • 2007 Youth Risk Behavior Survey Data: Health Risk Behaviors by Sex: Every two years, the CDC conducts a comprehensive survey of American youth, covering a wide range of behaviors that put teens at risk of death, disability, and other adverse consequences. The respondents are students in the ninth through twelfth grades in public and private high schools across the United States. This page breaks down responses by sex with respect to behaviors whose incidence varies significantly between males and females, including dating violence.
  • Physical Dating Violence Among High School Students–United States, 2003: This fact sheet issued by the CDC analyzes survey responses related to dating violence collected through the Youth Risk Behavior Survey administered in 2003. The authors conclude that the data reveal an urgent need for prevention programs aimed at children and teens as young as 11 years old with the goal of reducing the incidence of teen dating violence and associated risk behaviors, as well as of the adverse consequences that correlate with these behaviors.
  • Intimate Partner Violence: Dating Violence Fact Sheet: This comprehensive fact sheet issued by the CDC defines dating violence as “physical, sexual, or psychological/emotional violence within a dating relationship.” It includes a number of statistics on the incidence of dating violence among teens culled not only from CDC-sponsored surveys but also from other scholarly studies and provides a lengthy bibliography of sources, including articles from refereed journal articles.
  • Understanding Teen Violence, 2008: This CDC-authored fact sheet defines dating violence, explains why dating violence among teens is a serious public health issue, and identifies some of the risk factors for becoming a perpetrator or victim of dating violence, including low self-esteem, abnormally aggressive behavior towards others, anger management problems, poor social skills, inadequate parental supervision, and the occurrence of physical abuse or other violence in the home.

Information for Friends of Teens Who May Be Involved in Relationship Violence:

Teens who are victims of dating violence may be reluctant to confide in adults. They are often more likely to turn to a close friend for support. Even if a teen tries to conceal ongoing abuse from her peers, a close friend will often be the first to notice changes in the teen’s behavior and appearance that are the hallmark signs of dating violence. But the friends of a teen experiencing dating violence are still kids themselves. They may be unsure of how to help or what resources are available. The links below provide resources for teens who suspect that a friend is involved in a violent dating relationship or who want to address the problem of dating violence in the larger community.

  • Love is Respect: Support for a Friend: This page from the website for the National Teen Dating Abuse Helpline offers information for friends of victims of dating violence, including signs of dating violence and a list of do’s and don’ts for helping and responding to a friend who confides that she is a victim of abuse.
  • Talk to an Abusive Friend: This page from the website for the National Teen Dating Abuse Helpline offers guidance for teens for confronting friends whom they believe to be the abuser in a relationship marred by dating violence.
  • Break the Cycle: The mission of Break the Cycle is to empower youth to end domestic violence. Break the Cycle sponsors a youth activism program and offers training to young volunteers who seek to raise awareness of dating violence among fellow teens.
  • How Can I Help My Friend?: This page from the Alabama Coalition Against Domestic Violence offers tips and resources for friends of victims of dating violence as well as signs and symptoms that a friend is being abused.
  • Peer Ambassador Program: This page provides teens with information about joining the Love is Respect, National Teen Dating Abuse Helpline Peer Ambassador Program. Peer Ambassadors volunteer to serve as peer educators and resources for other young people in their schools and local communities. The National Teen Dating Abuse Helpline website provides links to an awareness toolkit that ambassadors and other teens can draw upon in their efforts to help friends who are victims of dating violence and address the problem of dating violence among their peers.
  • (source of this article)




Give the words life


Give the words life.

Come alive

Words flow through the streams of time landing upon the ears of those whom are willing to listen for them however the words are not alive.  I often see more people willing to leave behind money, personal items, and memento’s behind for their loved ones to cherish long after their last breath. What if they could leave behind words that have life filled within them that can last a thousand years or more?  Is that even possible?  Perhaps, one truly does not know the power of their own words leave upon the hearts of others.  When I was younger I never imagined just how much my words or lack of words would impact upon my life today.  I doubt any of us as a child would think that our own words would cause us to either walk life as a healed person or as a wounded one late in life.  Our youth gives us the impression we are tough and strong but in reality we are not strong or weak but both.

It recently dawns upon me that all my life I gave life to my words however that was a cruel life I gave them.  I’m facing a foe of jealousy and wanting recognition for which are not my friends.  Indeed I gave my words the wrong kind of life but even though it has done me harm there was good  that was also given to me.  It gave me the eyes to see myself in a more human light then I feel that most do not wish to see ourselves as.  I mean that we tend to not want to see the bad in our lives because we can end up always focusing on those negative things about us and life.  But what in life doesn’t have a good or bad within it?

Today words flowed hitting their target making it hurt and cracking this heart of mine because the one whom threw them was suffering also.  They were leashing out at some whom they felt had hurt them but hurting another because you are hurt doesn’t make it right in fact it makes you appears worse then the person whom harmed you.  I awoke to a world this morning where people’s words made me feel like the simple right I have is slowly fading into oblivion and that theirs was still in tact.  My words shall not die because you wish to not hear them nor shall I kill off my own words just because I do not wish to hear them either.  Life is a world full of words that show whom we are on the inside and if you kill those words off then you reject me without giving me a fair chance to see whom I am.

Words should fly free but note that one should always take the responsibility of giving those words life for whom those words land upon.  I shall continue to walk using my words and try to release those words that I keep locked within due to lack of courage but I am tired of my words dying within my own soul.  So I set my words free to fly upon the world to touch a person whom may need to hear them as I listen to hear their words that I too need to hear.


“Depression: So many people around the world have depression. Some severe and some
moderate. We need to raise awareness for the dangers of depression. Some people cut
or even burn themselves to relieve pain. People all around the world commit suicide
because of being so depressed that they feel as though they can’t live any longer.
People need to be aware of depression.” – Tyler Parlow

We Are the Ones We Have Been Waiting For

Guest Blog: Dr. Dan Fisher, M.D

We Are the Ones We Have Been Waiting For


I had a dream several years ago:
I was sitting in a circle with others with lived experience of extreme mental states. (a term we prefer to mental illness). We might have been in a self-help center. We were intensely sharing, listening, commenting, supporting and being with each other as we have been learning is so vital.

Gradually I started to notice that all around us the “normals” were running about helter skelter, looking wilder and wilder and more and more distracted. From time to time they would stop and stare. Then they started to ask us what we were doing to stay so centered and calm when they were feeling so distracted by fear, doubt and insecurity. We said we were having our weekly self-help group. They wanted to know what drugs we were taking, and we shared that actually most of us were off all drugs and medication.

Then they brought TV cameras and said they wanted to film us so they could learn what our program was. We welcomed their filming us, but we said they might be disappointed to learn that we are not practicing a program but in fact were just practicing self-help and mutual support, without a program.

We also said that we did not have a clear leader, because we all had internalized the comfort agreement, which we had constructed years before at the start of our group. They just shook their heads in disbelief because they had never heard of any group getting together without a clear leader, without a program, and with medications or drugs.

The Mental Health Crisis in Our Society: I believe that dream was predictive of the world we live in today. We are experiencing a mental health crisis in this country. As Robert Whitaker pointed out in Anatomy of an Epidemic, the use of psychiatric drugs has skyrocketed in the US in the last 20 years.

Far from bringing relief, this over-reliance on medications and the medical model have been accompanied by a staggering 300% increase in the rate of persons being declared psychiatrically disabled. We are witnessing and ever greater widening of the diagnosing of behaviors once thought to be within normal range, in the impending release of DSM V.

This new bible of the mental health system will contain a new category of prepsychosis. This diagnosis could potentially be given to everyone, since given sufficient trauma, anyone can experience extreme mental states, which are called psychotic. In fact, it is often necessary to experience extreme mental states to reorganize ones sense of self at a deep level (Perry, 1989).

By labeling these states as prepsychotic, they will be treated with medications, which most likely will interrupt a potential growth experience. We badly need a new paradigm and new approach to emotional distress. I believe our consumer/survivor/ex-patient movement has developed the understanding and the tools needed to save all our people: both those of us labeled and those not yet labeled. We have discovered that just as my dream described, we can recover our lives, our humanity, and our sense of purpose through self-help and mutual support.

I and many people with lived experience have been establishing and participating in these self-help groups for 30-40 years. My first experience of such a group was in 1978, with the Mental Patient Liberation Front, in Boston. It was at my first MPLF meeting that I met two of my life-long mentors in this movement, Judi Chamberlin and David Oaks. Judi through her example, through her writings, and through her brilliance showed me never to be afraid of anything. She was as fearless as they come.

Her book, On Our Own: Ex-patient controlled Alternatives to the Mental Health System, showed me and my generation that we could and in fact had to learn to help each other. Though she did not use the word recovery, she pointed out that our lived experience enables us to help each other in ways that people who have not experienced extreme states cannot understand.

This was a principle similar to the AA principle that a fellowship of persons with similar experience can help us recover in ways much more profound than any professional without such experiences could understand. Judi died in Jan. 2011, but I and all in our movement carry her in our hearts every day. Her heart continues to pump energy and hope within our movement. David Oaks has similarly moved mountains for all of us with lived experience. He inspires me every day with his clear vision and outrage at the injustices we suffer. He started the international organization, Mind Freedom, led a hunger strike to demonstrate that the APA could not prove that there is a chemical basis of extreme mental states, builds bridges with the larger disability community, and is working to get the UN Convention on Rights of Persons with Disabilities ratified.

David and I did not always see eye to eye. After all, though I served my time in 3 psychiatric hospitals, I went on to become a psychiatrist. But we have come to deeply respect each other and recognize that we both play important roles. His is more as an outside advocate and mine is as an inside advocate.

Our Movement’s Accomplishments: Recently, at a BRSS TACS (Bringing Recovery Services to Scale TAC) leadership conference, Dr. Ron Mandersheid, Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD), stated that every significant advance in the mental health field in the last 10 years has been conceived of and promoted by persons with lived experience.

He cited the advent of recovery as a unifying force. I too am convinced that our movement has played the most significant role in inspiring the field to embrace recovery. I and other persons with lived experience were able to establish recovery as the vision of the New Freedom Commission. This spring, at another BRSS TACS conference on policy development, a senior administrator from Massachusetts stated that stigma and discrimination would only be reduced when persons with lived experience run the mental health system.

The appointment of Paolo Delvecchio to Director of the lead government agency on mental health, the Center for Mental Health Services is a move in that important direction. Persons with other disabilities and with addiction disorders have for many years played leading roles in their fields. Another very important accomplishment has been the growing roles for peers in the areas of Services and supports, Training and Education, Evaluation and research, and Policy and planning. I call these contributions: STEPS to recovery.

New Direction for Our Movement: Implementation of Recovery Components through Dialogue: Until recently, our movement has primarily created and run recovery-centers or respite centers which are separate from the system. We have advocated for a mental health system to be run according to the principles of recovery. In 2006, SAMHSA published 10 components of mental health recovery and more recently, released a joint set of recovery principles for substance use disorders and mental health (

However, the lead decision makers in the system have not supported the concept of recovery. In fact, when SAMHSA first tried to release their 10 components of recovery, a senior official at NIMH stated that persons with severe mental health issues will never be self-determining and therefore can never recover. The system has tried to give the appearance of implementing recovery by only hiring peers. These peers, numbering in the thousands, have become frustrated and angry because they are expected to work in an untransformed system.

They are told not to share their recovery stories. They are told to keep such strong boundaries that the human touch they can supply is extinguished. When they complain they are reminded that they are at the bottom of the mental health food chain. Until the system transformation to recovery occurs at a much faster rate, peers will continue to be frustrated and feel under valued.

During the last 30 years, parallel to the recovery movement, there has been a dialogue movement. In the US, this movement was started by physicist David Bohm (Bohm, 1996), and organizational development leaders Peter Senge and William Isaacs. These Bohm Dialogues have been used for team building and conflict resolution in business and government.

At the same time, In Finland, psychologist Jaakko Seikkula and social scientist Tom Arnkil have applied dialogical principles to therapy (Open Dialogue) and multi-helper teams (Anticipation Dialogues)(Seikkula and Arnkil, 2006). I am in my second year of a course in Open Dialogue taught by Mary Olson, a professor of Social Work at Smith College. I think Open Dialogue can greatly transform clinical practice from symptom management to promotion of recovery.

But to transform the system as a whole, we will need to reach all the players who are presently involved. The major decision makers need to become convinced that Open Dialogue is a valuable clinical approach. There are many providers, administrators and family members who are hungry for a new way to approach these phenomenon, but don’t know what that might be.

They therefore cling to the medical model and medications, ineffective though they are. I believe that learning to practice the principles of dialogue in the community, advocates will convince the decision makers that the system would work much better if it was based on the recovery of a full life in the community instead of being locked inside of diagnostic labels and the expectation of life-long illness.

In fact, the National Empowerment Center and National Coalition for Mental Health Recovery have been developing dialogical training programs during the last 4 years. Together they form the beginning of a comprehensive set of trainings and consciousness raisings we are calling Dialogical Recovery.

They represent a synthesis of the Recovery Components and Dialogical Principles:
1. Introduction to Dialogical Recovery: an introduction to the components of recovery and principles of Dialogue as illustrated in Open Dialogue, Anticipation Dialogues, and Bohm Dialogues. This is a training under development. It will be based on the blogs that I have posted on Mad in America.

It will be for anyone who has experienced extreme mental states, their families, their friends, healthcare workers and anyone who has or might in the future come in contact with someone in such a state. In other words, since we believe that anyone can experience extreme mental states, it will be for everyone. For those who wish, this introduction to Dialogical Recovery can be followed by any selection of the other trainings listed below.
2. EmotionalCPR or eCPR: this is training program to teach all members of society how to help each other through emotional distress. It has been developed by 20 persons with lived experience and is primarily based on what we most wanted when we were in crisis. It is also based on a number of other programs, such as crisis counseling and psychological first aid to assist the public after disasters, recovery components which as the basis of mutual assistance, trauma-informed care, and suicide prevention. eCPR is a form of heart-to-heart dialogue, which through Connecting and emPowering restores a person’s vitality. We have trained hundreds of persons representing all stakeholders, in this country, Singapore and Australia.
3. Finding our Voice and Using it in Dialogue: this is a form of empowerment training developed by Judi Chamberlin, Sally Zinman, myself, and many other peers. It is based on 12 P’s of empowerment as demonstrated by effective peer advocates. The most important P is Passion. Those of us who have been effective all agree that a critical internal development in becoming an advocate is learning to transform our anger to passion. Gandhi understood this point very well for he said: “I have learnt through bitter experience the one supreme lesson: to conserve my anger, and as heat conserved is transmuted into energy, even so our anger controlled can be transmuted into a power which can move the world.” The goal of this training has been to develop more peer advocates to play an active role in the formation of public policy. With the resurgence of activity around healthcare reform, the participation of peers will be vital to ensure that the perspective of recovery is embodied in all the new policies and financing implemented.

4. Recovery Dialogues: For the last 4 years, I and staff at Riverside Community Care in Massachusetts have been engaged in a direct application of the Bohm Dialogues in a community mental health center. We now have three monthly recovery dialogues being carried out in three different locations of Riverside CC. A recent testimonial by a director of a clubhouse who attends a recovery dialogue beautifully describes why I feel these are an excellent means to shift the culture of the system to recovery:

“The day was no different than others; a hundred things to do and not enough time to do them. In my rapid step, I said my ‘good mornings’ heading for my office; as I turned the corner I saw Steve Goldman, Riverside Community Care Peer Specialist, preparing the circle of seats. It was in that moment that I stopped; I breathed deep letting out a huge sigh of relief, and a huge smile took over my face. Today we hosted the Recovery Dialogue and I was going to be there. While it may sound simplistic in the concept, discussing recovery, it is so much more.

It is an opportunity to leave your hat at the door regardless if you a provider or individual receiving services, a place to actively listen; sometimes challenging your way of thinking or validating the complexity of your experiences. It is a place to share struggles and strategies; honestly and from the heart without judgment. At the end it always gives me a renewed sense of hope that we all are people first and we are truly never alone. We have come so far in seeing the ‘whole person’ in the holistic approach of recovery. Recovery Dialogue is the catalyst needed to evolve our mental health system further and to have participants that are not just those who provide or receive direct services but to those that hold the powers to reform the policies and challenge the archaic systems that still exist.”

We are the Ones We Have Been Waiting For: Those of us with lived experience, here in the US and now around the world have discovered that most mental health professionals have little understanding of what extreme mental states are like. They think those states are a sign of illness. They think that hearing voices and having vivid dreams are symptoms of those illnesses. We who have been through our own recovery know that we are all basically healthy people who have experienced a variety of traumas.

We have different constitutions. In fact, every person in this world has a different constitution. Each of us needs to face the tasks of development, which involve finding the best fit between our gifts and the offerings of the world. At times we believe that persons go through extreme mental states in order to reorganize at a deep level. We who have gone through such a recovery of our true life can be guides both individually and collectively in leading the system to a truly recovery-based system as envisioned in the New Freedom Commission.

The time is short, and too many of our brothers and sisters are suffering. Let us dialogue together so our society can emerge from the darkness of the trees of neurotransmitters so we can all experience the world of a full and meaningful life.


Bohm,D. (1996). On Dialogue. Routledge Classics, London, England.
Chamberlin,J. (2012). On Our Own. National Empowerment Center, Lawrence, MA.
Perry,J.W. (1989). Far Side of Madness. Spring Publications. . Dallas, TX.
Seikkula, J. and Arnkil, T. (2006). Dialogical Meetings in Social Networks. Karnac, London, England.
Whitaker, R. (2010). Anatomy of an Epidemic. Crown Publishers, New York.





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