Apr 9, 2018
This week, we interview Dr Russell Razzaque. Dr
Razzaque currently works as a consultant psychiatrist and associate
medical director in east London and, together with colleagues, he
is leading a pioneering multi-centre Open Dialogue pilot in the UK
National Health Service.
In 2014 he released his book ‘Breaking
Down Is Waking Up’ in which he explores
alternative views of mental distress, their relationship to
consciousness and comparisons to forms of spiritual awakening.
In this interview, we discuss the relationships between
mindfulness, Acceptance and Commitment Therapy and Open Dialogue
and how the UK NHS is approaching the worlds first randomised
controlled trial of Open Dialogue interventions for people
struggling with emotional or psychological distress.
In this episode we discuss:
- What led Dr. Razzaque to his interest in psychiatry and in
particular some of the more unconventional aspects of the
- How beginning to practice mindfulness nearly 20 years ago led
to Russell starting to feel an incongruence between the dominant
philosophy in psychiatry and what he was learning from his own
- That the dominant philosophy is one of trying to help people
remove their pain and remove them from difficult and uncomfortable
experiences, but in his own personal development, he was learning
to sit with the pain and finding that valuable.
- How this led to an interest in novel therapeutic approaches
like Acceptance and Commitment Therapy, originally pioneered by
professor Stephen Hayes.
- That Russell felt disillusioned with the way that UK mental
health services and systems were organised and realised that
creating better outcomes for people would require system-wide
- How Russell came to be one of the leading figures in the worlds
first multi-centre, fully randomised Open Dialogue Trial which
seeks to establish the evidence base for Open Dialogue.
- That the trial involves eight NHS Trusts across the UK and that
several hundred practitioners have already been trained in Open
- That during the trial there will be randomly selected postcodes
receiving Open Dialogue interventions compared with randomly
selected postcodes receiving treatment as usual and that the
results will be compared after three years.
- That this trial will allow us to answer questions about the
efficacy of Open Dialogue because we will have built a strong
- How colleagues have reacted to the Open Dialogue trial and why
some might be threatened by the need to change.
- That Open Dialogue is a need adapted approach, so it is not
fundamentally against any of the conventional interventions, but it
encourages people to make their own choices, so medication use
tends to significantly reduce.
- That it is necessary to change the power dynamic in current
systems and approaches because the current methods lead to
dependency, whereas Open Dialogue is about empowering and
liberating the individual.
- That Russell is encouraged to find that many psychiatrists are
willing to open up to new ways of thinking about mental and
- How spirituality and psychiatry can work hand-in-hand and how
accepting spiritual explanations can sometimes lead to better
understanding of personal experiences.
- That, in future, the system needs to change such that
interpersonal relationships are put first and are seen as the key
to successful outcomes.
- That we also need to adapt so that clinicians are trained to be
present with distress and not just try to remove it.
- How people can hear Russell speak at the upcoming Compassionate Mental Heath
event in South Wales, being held on April 25th and
Breaking Down is Waking Up
Open Dialogue trial
Compassionate Mental Health