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Soteria

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In "Soteria: Through Madness to Deliverance," Loren Mosher and Voyce Hendrix, with Deborah Fort, paint a vivid picture of the day to day life at Soteria-House, the Northern California alternative to psychiatric hospitalization that proved it is possible to help people through madness with kindness, empathy and validating people's experiences, and most importantly, by "being with" people, rather than "doing to" them. Due to his prolific writings, Dr. Mosher has presented many scientific papers on Soteria, but in this book, the program comes to life. The failures as well as the successes are described.

Only with this book has it been possible to get a sense of what it was like to be at Soteria. Through the truly dedicated and caring staff, such as the incredible Voyce Hendrix (and even the residents), people were allowed their madness and, through being allowed their madness, able to get through it and on with their lives. This book is a must read for anyone interested in alternatives to the prevailing pessimistic paradigm of psychiatric treatment. It is truly a story of hope. A story of a better path -- a path not currently taken.

Dr. Mosher, loved "being with" people who were psychotic. He called them "my most interesting customers." Dr. Mosher, passed away in July of 2004, at the age of 70, five months before the book was published. He must have written this book knowing that his personal efforts on behalf of providing a humane form of care was going to cease. Thus, "Soteria: Through Madness to Deliverance" must be seen as his final act of love to people experiencing disturbing psychosis by leaving a trail to follow for those who have the vision to see it.

Why read the book?
1..Buying it supports vital work.
2..Less than 1% of the book can appear here.
3..Change, action and recovery can replace hand-wringing.
4.."Understanders" are therapeutic for the seriously disturbed.

Soteria (Greek for deliverance) was a community-based, experimental, residential treatment facility in San Jose CA during 1971-1983, offering refuge mostly to young "schizophrenics." Would Soteria be as effective...as a nearby psychiatric ward where antipsychotic drugs were highly valued?

Focus: Given...that people labeled as "schizophrenic" often cannot develop or maintain close interpersonal relationships and supportive (non-family) network systems, Soteria believed these should comprise its focus.

The Moos Social Scales, which were heeded by Soteria, tallied staff's judgments about treatment areas, as they measured involvement, support, spontaneity, autonomy, practical orientation, personal problem orientation, tolerance of anger and aggression, order and organization, program clarity, and staff control.

Causation of Psychosis: More than half of adult admissions...to psychiatric hospital wards have histories of sexual and/or physical abuse. Also there may be parents' inability to focus and be clear, and parents' hostility toward their children... When someone goes "crazy," it's often in response to numerous problems, usually triggered by a particularly distressing event like a romantic rejection, the death of a parent, or excessive involvement with recreational drugs - - or inability to form social networks apart from families of origin.

Violence was much less than in hospital settings, but residents sometimes struck out at staff members who reminded them of their parents; and they also sometimes hit, kicked or bit or verbally abused others, because they felt defrauded, cheated, robbed, neglected, or otherwise treated unfairly.

Realizations and Incentives:
1..Elaborate institutions can impinge negatively on psychotically disorganized people. They often must be inflexible, must rely on authority, must institutionalize roles, and must rest decision-making power and responsibility in a hierarchy outside the client's control - staff and patients often feel powerless, irresponsible and dependent.
2..Jerome Frank's massive review of studies of therapy found, ...that therapist experience, duration of treatment, type of problem, patient characteristics, theory of intervention, etc., generally had no relation to patient outcome.
3..The World Health Org. has found that "schizophrenia" outcomes in poor countries like India, Nigeria and Columbia, where only a small percentage of patients are maintained on antipsychotic medications, are much, much better than in rich countries like the United States.
4..A massive 1979 World Health Org. study of "schizophrenic" outcomes correlated recovery with low reliance on neuroleptic medication...
5..The first case reports of tardive dyskinesia appeared in 1956. ...1:4 patients started on neuroleptics, will develop TD, a cosmetically disfiguring and untreatable condition...within five years...stigmatization is nearly inevitable.
6..The Germans who invented neuropathology, looked at the brains of thousands of "schizophrenics" before there were any neuroleptics and were unable to find any specific cellular pathology.

Precedents in Theory and Facility:
1..Soteria embraced elements of practice from the era of "moral treatment" (J. Sanbourne Bockoven's description of America's mental health practices in the 1700's.)
2..Sullivan used nonprofessional personnel to achieve a 75% success rate (12 of 16 individuals) in the 1920's. Professionals got 25-30% success rate.
3..The healing potential of human relationships was drawn from psychoanalytical pioneers, Frieda Fromm-Reichmann (1948) and esp. Henry Stack Sullivan (1962); but also therapists who have described growth from psychosis (John W. Perry, 1953, 1962; Karl A. Menninger, 1959); a group of psychiatric heretics (Thomas S. Szasz, 1961; Ronald D. Laing, 1967); and chroniclers of the development of psychiatric disorder in response to life crisis (George W. Brown and James L. T. Birley, 1968.)
4..Soteria's phenomenologic stance...from a long-standing European philosophic tradition...was practiced by Laing (1960, 1967), David Graham Cooper (1967), Medard Boss (1963), others.
5..Soteria was...a response to...critiques of psychiatric institutions, most notably Erving Goffman's Asylums (1961).
6..Soteria tried to...test the validity of the critiques of the "anti-psychiatrists," such as Laing, Cooper, and Franco Basaglia (1987)
7..Psychosis as growth has been referred to by Menninger, Perry, and Laing and others.
8..Some members of Soteria's founding group had worked on the rather similar Silverman-Rappaport study based in San Jose in ~1966-1974
9..A Soteria progenitor was The Philadelphia Association's Kingsley Hall commune in London.

Five characteristics of a functional milieu (setting) defined.
1..Control of stimulation.
2..Provision of respite or asylum...
3..Containment of poorly-controlled behaviors engendered by psychosis.
4..Support for the person's immediate experience.
5..Early-on validation of the person's hallucinations etc as real.

Using the 1972 principles of Jerome Frank:
1..Presence of perceived healing context.
2..Development of a confiding relationship with a helper.
3..Evolution of a plausible causal explanation for the development of the problem.
4..Generation of positive expectations by the therapist's personal qualities
5..Provision of opportunities for success through therapeutic processes.

Some of Soteria's successful ingredients:
1..Understanding that psychosis (and regression) could be positive learning processes.
2..Maintaining flexibility via ill-defined roles and relationships.
3..Learning of coping by imitating and identifying with staff, volunteers and other residents.
4..Non-understanding of a given psychotic experience was deemed a staff shortcoming.
5..BEING WITH residents and protecting from harm comprised staff's dominant responsibilities.
6..Accepting "crazy" behavior if it wasn't dangerous.
7..Avoiding psychiatric jargon.
8..Providing physical contact, especially to severely regressed residents.

What set Soteria and Emanon apart?
1..Avoiding codified rules, regulations and policies.
2..Minimizing basic administration time and maximizing undifferentiated time.
3..Limiting intrusion by outsiders.
4..Working out social order on an emergent, face-to-face basis.
5..Following a non-medical model that did not require symptom suppression.

Due to Soteria's success, replications have already been operating in Switzerland and Germany; and more are developing in Hungary, Germany and New Zealand.

Books I have read which variously support Soteria's theory and practice:
1..Thomas Szasz' The Myth of Mental Illness
2..William Glasser's 1. Reality Therapy, 2. Choice Theory
3..Edward Podvoll's The Seduction of Madness
4..Richard Moskovitz'Lost in the Mirror

Presumably "Soteria's" could never be prevalent in the US, because the needs for professionals and drugs would dramatically decrease. Nevertheless, inspiration and hope remain.

Hopefully the waywardness of mainstream psychiatry as seen in the Soteria contrast will lead the young toward greater integrity in their choosing of careers.

Thanks for reading!

Bill Norwood

Soteria is the exposition of a grand experiment in the holistic treatment of schizophrenia and is recommended reading for anyone who has an interest in mental illness. When one applies outcomes criteria to the Soteria program, it holds up as equally effective to any of today's drug therapies.
I applaud the authors for their very accessible and important work.

A very useful book for those who have been victims of the mental health system in the USA. It gives you hope and insight into alternative treatments without medication. I wish the place was still open....I hope someone would take this vision and build upon it!!

Gives the reader a thorough look at what truly productive mental health care looks like. It also becomes obvious to the reader that this method is not used today because it is not supporting the drug and psychiatric industry. If anyone wants true healthy recovery and their life to be productive this project reveals the way it was supposed to be.

If you want to know what really happened at Soteria House in San Jose, don't read this book - read the local police reports. This place was NOT shut down because the psychiatric profession didn't want to accept that you could treat schizophrenia without drugs, nor did what happened in this place support that conclusion.