Post by Admin on Jul 13, 2022 12:25:33 GMT
Dear members of ISPS and other friends,
Once again ISPS lost an important figure. We received the sad news that Johan Cullberg from Sweden passed away. He was an inspiring, hardworking psychiatrist / psychoanalyst not only for ISPS but for many mental health professionals, for people with psychosis and their families all around the world. When I was a young trainee in psychiatry, his book ‘Dynamic psychiatry’, first published in 1984, was a welcome ‘antidote’ to the DSM, the diagnostic system in psychiatry which labels people in an alienating way. Johan Cullberg always argued for a deeper integration of psychological and human values in the treatment of people with psychosis. In my opinion his book of 2006 ‘Psychoses: an integrative Perspective’, the first book in the ISPS series, is essential reading for every psychiatrist. Johan Cullberg was an international board member of ISPS from 1990 till 2003 and chair of the board from 1997 till 2000. In 1991 he was the host for the 10th ISPS international symposium in Stockholm, Sweden. This was a wonderful conference with a variety of challenging lectures and with more than 700 attendees. His warm but modest personality made a big impression on me. In the afterthoughts of this conference he cited ‘the nightmare of Per Vaglum from Norway: that the patients are given very good individual and family therapy, but since they live in a destructive institutional ot social milieu, the good effects of psychotherapy are destroyed by the environment. Be that large psychiatric wards, isolation in a lonely flat or being subjected to overmedication’. And he continued: ‘That must be another important challenge for ISPS: to help us create such milieus which are really therapeutic and to continue to show our interest in the therapeutic use even of the biological treatments and methods. After all we are treating a person, not a bunch of receptors’ (Cullberg, 2006). The economic surplus of this Stockholm conference was partly used to sponsor a national conference in Sweden which was the beginning of the later ‘Parachute project’ for persons with a first psychotic episode. The Swedish Parachute project became a worldwide example for good practice for treatment for psychosis. The project represents an effort to provide need adapted treatment on a large scale for all persons with first episode psychosis in a big area of the Swedish population. I am convinced that the world would be better if the six principles of this Parachute project would be used for everyone with acute psychosis: (1) intervention without delay by a competent and dedicated team, preferably in the patient’s home; (2) initial crisis intervention is structured according the patient’s needs; (3) immediate and recurrent family meetings, generally including the person with psychosis, intended to understand the strains and resources of the family and to provide a common understanding of the psychotic reaction; (4) accessibility and follow-up continuity provided by a specialised treatment team over a five-year period; (5) use of the lowest optimal dose of neuroleptic medication with an attempt to avoid antipsychotics during the first 1-2 weeks and (6) access to small-scale, home-like, low-stimulus overnight care when the stay in the home proved insufficient or negative during this period. The crisis home is preferably situated outside the hospital, in an apartment or a small house, and used only for 3-6 persons with a first psychotic episode. I will never forget the first ISPS conference in our country (Belgium) in 2003 where Johan Cullberg was invited to present the first results of this Parachute project. He did it in such an engaged and impressive way that he became an example for my future psychiatric work. My heart is full of gratitude for what he meant to me in the development of my further ideas. And I am sure that I am not the only one. I wish his family and his friends much warmth and support for the loss of their beloved person.
The use of a small-scale, home-like, low-stimulus overnight in an ordinary house for an acute crisis shows a lot of similarities with the Soteria houses of Mosher in San Fransisco and Ciompi in Bern. It reminds us to the revival of the therapeutic communities that grew in several regions in the world in the 1970 ’s, especially in Italy where under the influence of Basaglia big asylums were been closed. During the next ISPS conference in Perugia this year we will hear a lot about therapeutic communities and home-like places. I enjoy this movement away from the hospital but again to the community to make the treatment of an acute psychotic crisis more human and hopeful, less stigmatising and alienating and with more involvement of family members. Johan Cullberg would had been happy to hear on this conference that the nightmare of Per Vaglum from Norway changed in the fulfilment of his own dream for the future that he expressed in the following way: ‘I hope that ISPS thinking will penetrate deeper into psychiatric services. I hope that the struggle between biological and humanistic and between cognitive and dynamic will increasingly belong to history. We shall have to regard our task in a dialectical way. The risk for mistreatment will be diminished when we try to keep the three requirements of psychosis treatment in mind (a good milieu, reliable and constant therapeutic persons and -if necessary- pharmacological treatments at lowest effective doses) not monopolizing one of them’ (Cullberg 2006).
The title of the Perugia conference ‘Co-constructing healing spaces’ is promising. A healing space (be it at home, in a therapeutic community, in a Soteriahouse, a peer respite house or another place) has to be co-constructed with each other. For this we need a whole community. We learned from Italy that the closing of the big asylums was only successful when big networks for mental health work together to change mental health organisations. In the promotion film of the Perugia conference we learn that after 1965 Perugia was the setting for one of the most successful movements for the reform of the mental health care in the community. An alliance of politicians, nurses, patients and psychiatrists managed not only to transform Perugia’s huge asylum system but also to set alternatives to that system across the whole Umbrian region. I hope that many people will have the opportunity to come to this beautiful city with a long history, to attend the conference with a wonderful and large program. In this Newsletter you will read the latest information about the conference and you can register here
Besides regular news of the local networks you will find in this Newsletter the results of the elections for the new EC. This means that the current EC will remain active for only 2 more months. I had the enormous privilege of working with a fantastic team of the EC and I am very grateful for this. Each of them dedicated themselves in a very personal way to the goals they had set for themselves to serve ISPS and this with Antonia's ever-ready support. We have worked hard but we have done so with great pleasure and conviction. A summary of the activities over the past three years by the current EC will be send to our members in a few weeks. The circumstances were not favourable: the pandemic held the whole world in its grip and many people passed away in loneliness. Solitude was sometimes hard to bear with the rules of social distancing and the lockdowns. Moreover, since February 2022 onwards, a terrible war holds us captive. The EC expressed their statement against the invasion and violent action of Russia in Ukraine. We realise that this war has a disastrous impact on the mental health of many people, not only the people who are attacked but also people who are sent to the battlefields to attack, and their children and grandchildren on both sides of the conflict. However, in the circumstances of the pandemic and the war, ISPS showed great flexibility and creativity and certainly did not lose touch with its members also thanks to the passionate commitment of the regional chairs of the loca ISPSl networks. We discovered the power of online meetings and webinars and of increased internet communication through email discussion groups and social media. I would like to thank everyone for their contribution and commitment to bringing humane, psychosocial treatment for psychosis in this changing world that keeps on giving us new surprises.
Ludi Van Bouwel
ISPS Chair
Once again ISPS lost an important figure. We received the sad news that Johan Cullberg from Sweden passed away. He was an inspiring, hardworking psychiatrist / psychoanalyst not only for ISPS but for many mental health professionals, for people with psychosis and their families all around the world. When I was a young trainee in psychiatry, his book ‘Dynamic psychiatry’, first published in 1984, was a welcome ‘antidote’ to the DSM, the diagnostic system in psychiatry which labels people in an alienating way. Johan Cullberg always argued for a deeper integration of psychological and human values in the treatment of people with psychosis. In my opinion his book of 2006 ‘Psychoses: an integrative Perspective’, the first book in the ISPS series, is essential reading for every psychiatrist. Johan Cullberg was an international board member of ISPS from 1990 till 2003 and chair of the board from 1997 till 2000. In 1991 he was the host for the 10th ISPS international symposium in Stockholm, Sweden. This was a wonderful conference with a variety of challenging lectures and with more than 700 attendees. His warm but modest personality made a big impression on me. In the afterthoughts of this conference he cited ‘the nightmare of Per Vaglum from Norway: that the patients are given very good individual and family therapy, but since they live in a destructive institutional ot social milieu, the good effects of psychotherapy are destroyed by the environment. Be that large psychiatric wards, isolation in a lonely flat or being subjected to overmedication’. And he continued: ‘That must be another important challenge for ISPS: to help us create such milieus which are really therapeutic and to continue to show our interest in the therapeutic use even of the biological treatments and methods. After all we are treating a person, not a bunch of receptors’ (Cullberg, 2006). The economic surplus of this Stockholm conference was partly used to sponsor a national conference in Sweden which was the beginning of the later ‘Parachute project’ for persons with a first psychotic episode. The Swedish Parachute project became a worldwide example for good practice for treatment for psychosis. The project represents an effort to provide need adapted treatment on a large scale for all persons with first episode psychosis in a big area of the Swedish population. I am convinced that the world would be better if the six principles of this Parachute project would be used for everyone with acute psychosis: (1) intervention without delay by a competent and dedicated team, preferably in the patient’s home; (2) initial crisis intervention is structured according the patient’s needs; (3) immediate and recurrent family meetings, generally including the person with psychosis, intended to understand the strains and resources of the family and to provide a common understanding of the psychotic reaction; (4) accessibility and follow-up continuity provided by a specialised treatment team over a five-year period; (5) use of the lowest optimal dose of neuroleptic medication with an attempt to avoid antipsychotics during the first 1-2 weeks and (6) access to small-scale, home-like, low-stimulus overnight care when the stay in the home proved insufficient or negative during this period. The crisis home is preferably situated outside the hospital, in an apartment or a small house, and used only for 3-6 persons with a first psychotic episode. I will never forget the first ISPS conference in our country (Belgium) in 2003 where Johan Cullberg was invited to present the first results of this Parachute project. He did it in such an engaged and impressive way that he became an example for my future psychiatric work. My heart is full of gratitude for what he meant to me in the development of my further ideas. And I am sure that I am not the only one. I wish his family and his friends much warmth and support for the loss of their beloved person.
The use of a small-scale, home-like, low-stimulus overnight in an ordinary house for an acute crisis shows a lot of similarities with the Soteria houses of Mosher in San Fransisco and Ciompi in Bern. It reminds us to the revival of the therapeutic communities that grew in several regions in the world in the 1970 ’s, especially in Italy where under the influence of Basaglia big asylums were been closed. During the next ISPS conference in Perugia this year we will hear a lot about therapeutic communities and home-like places. I enjoy this movement away from the hospital but again to the community to make the treatment of an acute psychotic crisis more human and hopeful, less stigmatising and alienating and with more involvement of family members. Johan Cullberg would had been happy to hear on this conference that the nightmare of Per Vaglum from Norway changed in the fulfilment of his own dream for the future that he expressed in the following way: ‘I hope that ISPS thinking will penetrate deeper into psychiatric services. I hope that the struggle between biological and humanistic and between cognitive and dynamic will increasingly belong to history. We shall have to regard our task in a dialectical way. The risk for mistreatment will be diminished when we try to keep the three requirements of psychosis treatment in mind (a good milieu, reliable and constant therapeutic persons and -if necessary- pharmacological treatments at lowest effective doses) not monopolizing one of them’ (Cullberg 2006).
The title of the Perugia conference ‘Co-constructing healing spaces’ is promising. A healing space (be it at home, in a therapeutic community, in a Soteriahouse, a peer respite house or another place) has to be co-constructed with each other. For this we need a whole community. We learned from Italy that the closing of the big asylums was only successful when big networks for mental health work together to change mental health organisations. In the promotion film of the Perugia conference we learn that after 1965 Perugia was the setting for one of the most successful movements for the reform of the mental health care in the community. An alliance of politicians, nurses, patients and psychiatrists managed not only to transform Perugia’s huge asylum system but also to set alternatives to that system across the whole Umbrian region. I hope that many people will have the opportunity to come to this beautiful city with a long history, to attend the conference with a wonderful and large program. In this Newsletter you will read the latest information about the conference and you can register here
Besides regular news of the local networks you will find in this Newsletter the results of the elections for the new EC. This means that the current EC will remain active for only 2 more months. I had the enormous privilege of working with a fantastic team of the EC and I am very grateful for this. Each of them dedicated themselves in a very personal way to the goals they had set for themselves to serve ISPS and this with Antonia's ever-ready support. We have worked hard but we have done so with great pleasure and conviction. A summary of the activities over the past three years by the current EC will be send to our members in a few weeks. The circumstances were not favourable: the pandemic held the whole world in its grip and many people passed away in loneliness. Solitude was sometimes hard to bear with the rules of social distancing and the lockdowns. Moreover, since February 2022 onwards, a terrible war holds us captive. The EC expressed their statement against the invasion and violent action of Russia in Ukraine. We realise that this war has a disastrous impact on the mental health of many people, not only the people who are attacked but also people who are sent to the battlefields to attack, and their children and grandchildren on both sides of the conflict. However, in the circumstances of the pandemic and the war, ISPS showed great flexibility and creativity and certainly did not lose touch with its members also thanks to the passionate commitment of the regional chairs of the loca ISPSl networks. We discovered the power of online meetings and webinars and of increased internet communication through email discussion groups and social media. I would like to thank everyone for their contribution and commitment to bringing humane, psychosocial treatment for psychosis in this changing world that keeps on giving us new surprises.
Ludi Van Bouwel
ISPS Chair