Soteria
Encyclopedia
Soteria is a community service that provides a space for people experiencing mental distress or crisis. Based on a recovery model
, common elements of the Soteria approach include primarily non-medical staffing; preserving resident's personal power, social networks, and communal responsibilities; finding meaning in the subjective experience of psychosis by "being with" clients; and no or minimal use of antipsychotic
medication (with any medication taken from a position of choice and without coercion).
Soterias were open — they had no restraint facilities for young psychotic patients, mostly at their onset. Loren Mosher
, who founded the Soteria experience, showed that treating psychosis also in the acute phase is possible without using restraint methods.
Soteria houses are often seen as gentler alternatives to a psychiatric hospital system perceived as authoritarian, hostile or violent and based on routine use of psychiatric (particularly antipsychotic) drugs. Soteria houses are sometimes used as "early intervention" or "crisis resolution" services.
Loren Mosher
,at 83 N. 13th street San Jose, Calif. 95112, "The original Soteria House opened in 1971. A replication facility ("Emanon") opened in 1974 in another suburban San Francisco Bay Area city. "This was done because clinically we soon saw that the Soteria method "worked." by psychiatrist
Loren Mosher
, who was influenced by the philosophy of moral treatment
, previous experimental therapeutic communities (such as the Fairweather Lodge
s), the work of Harry Stack Sullivan
, and Freudian psychoanalysis. The name Soteria comes from the Greek Σωτηρία for "salvation" or "deliverance" (see Soter
).
Mosher's first Soteria house specifically selected unmarried subjects between the ages of 18 and 30 who had recently been diagnosed as meeting the DSM-II criteria for schizophrenia. Staff members at the house were encouraged to treat residents as peers and to share household chores. The program was designed to create a quiet, calming environment that respected and tolerated individual differences and autonomy. There was also an ethos of shared responsibility for the running of the house and playing a part in a mutually-supportive community, with the distinction between experts and non-experts downplayed (similar to therapeutic communities). Psychotropic medication, including anti-psychotics, were not completely rejected and were used in some circumstances. The Soteria staff, compared to staff in other psychiatric services, were found to possess significantly more intuition, introversion, flexibility, and tolerance of altered states of consciousness.
The Soteria project was admired by many professionals around the world who aspired to create mental health services based on a social, as opposed to a medical, model. It was also heavily criticized as irresponsible or ineffective. The US Soteria Project closed as a clinical program in 1983 due to lack of financial support, although it became the subject of research evaluation with competing claims and analysis. Second generation US successors to the original Soteria house called Crossing Place is still active, although more focused on medication management.
A first European near-replication of the original Soteria approach was implemented in 1984 in Berne, Switzerland, on a somewhat different conceptual basis. Three Soteria-like environments focused on longer term rehabilitation were created in Sweden (Perris, 1989).
Writing in 1999, Mosher described the core of Soteria as "the 24 hour a day application of interpersonal phenomenologic interventions by a nonprofessional staff, usually without neuroleptic drug treatment, in the context of a small, homelike, quiet, supportive, protective, and tolerant social environment." More recent adaptions sometimes employed professional staff. The Soteria approach has traditionally been applied to the treatment of those given a diagnosis of schizophrenia
.
“Soteria Berne” located in the center of Berne started functioning on 1 May 1984 in a 12-room house surrounded with a garden. In the house, a maximum of six-eight patients and two nurses can be accommodated. Admitted patients had to meet the following criteria:
Research at Soteria Berne found that most acute schizophrenia patients can be as successfully treated as by standard hospital proceedings, but with significantly lower doses of anti-psychotics and without higher daily costs. In addition, the Soteria approach appeared to offer certain advantages mainly located at the subjective-emotional, familial and social level.
In the context of increasing interest in the Soteria approach in the United Kingdom, several European countries, North America, and Australasia, a review of controlled trials suggested the Soteria paradigm yields equal, and in certain specific areas better, results in the treatment of people diagnosed with first- or second-episode schizophrenia spectrum disorders (and with considerably lower use of medication) when compared with conventional, medication-based approaches. A reevaluation of the approach was called for.
Recovery model
The Recovery Model as it applies to mental health is an approach to mental disorder or substance dependence that emphasizes and supports each individual's potential for recovery...
, common elements of the Soteria approach include primarily non-medical staffing; preserving resident's personal power, social networks, and communal responsibilities; finding meaning in the subjective experience of psychosis by "being with" clients; and no or minimal use of antipsychotic
Antipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
medication (with any medication taken from a position of choice and without coercion).
Soterias were open — they had no restraint facilities for young psychotic patients, mostly at their onset. Loren Mosher
Loren Mosher
Loren Richard Mosher was an American psychiatrist, clinical professor of psychiatry, expert on schizophrenia and the chief of the Center for Studies of Schizophrenia in the National Institute of Mental Health...
, who founded the Soteria experience, showed that treating psychosis also in the acute phase is possible without using restraint methods.
Soteria houses are often seen as gentler alternatives to a psychiatric hospital system perceived as authoritarian, hostile or violent and based on routine use of psychiatric (particularly antipsychotic) drugs. Soteria houses are sometimes used as "early intervention" or "crisis resolution" services.
Theoretical model
Functioning of most psychiatric wards is principally based on medical model. Doctors possess decision-making powers and final authority; primary therapeutic value is attached to drugs used extensively; patients are considered as having an illness, with concomitant disability and dysfunction which should be “treated” and “cured”; labeling and its consequences, namely stigmatization and objectification, are almost inevitable. At Soteria, in contrast, the primary focus was on development, learning, and growth.History
The original Soteria Research Project was founded by psychiatristPsychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
Loren Mosher
Loren Mosher
Loren Richard Mosher was an American psychiatrist, clinical professor of psychiatry, expert on schizophrenia and the chief of the Center for Studies of Schizophrenia in the National Institute of Mental Health...
,at 83 N. 13th street San Jose, Calif. 95112, "The original Soteria House opened in 1971. A replication facility ("Emanon") opened in 1974 in another suburban San Francisco Bay Area city. "This was done because clinically we soon saw that the Soteria method "worked." by psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
Loren Mosher
Loren Mosher
Loren Richard Mosher was an American psychiatrist, clinical professor of psychiatry, expert on schizophrenia and the chief of the Center for Studies of Schizophrenia in the National Institute of Mental Health...
, who was influenced by the philosophy of moral treatment
Moral treatment
Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns...
, previous experimental therapeutic communities (such as the Fairweather Lodge
Fairweather Lodge
The Fairweather Lodge Program is a psychosocial rehabilitation model combining congregate living with collaborative employment.The Fairweather Lodge Program was developed by psychologist George Fairweather in California in 1963. Dr...
s), the work of Harry Stack Sullivan
Harry Stack Sullivan
Harry Stack Sullivan was a U.S. psychiatrist whose work in psychoanalysis was based on direct and verifiable observation .-Life and works:Sullivan was a child of Irish immigrants and allegedly grew up in an...
, and Freudian psychoanalysis. The name Soteria comes from the Greek Σωτηρία for "salvation" or "deliverance" (see Soter
Soter
Soter derives from the Greek epithet , meaning a saviour, a deliverer; initial capitalised ; fully capitalised ; feminine Soteira...
).
Mosher's first Soteria house specifically selected unmarried subjects between the ages of 18 and 30 who had recently been diagnosed as meeting the DSM-II criteria for schizophrenia. Staff members at the house were encouraged to treat residents as peers and to share household chores. The program was designed to create a quiet, calming environment that respected and tolerated individual differences and autonomy. There was also an ethos of shared responsibility for the running of the house and playing a part in a mutually-supportive community, with the distinction between experts and non-experts downplayed (similar to therapeutic communities). Psychotropic medication, including anti-psychotics, were not completely rejected and were used in some circumstances. The Soteria staff, compared to staff in other psychiatric services, were found to possess significantly more intuition, introversion, flexibility, and tolerance of altered states of consciousness.
The Soteria project was admired by many professionals around the world who aspired to create mental health services based on a social, as opposed to a medical, model. It was also heavily criticized as irresponsible or ineffective. The US Soteria Project closed as a clinical program in 1983 due to lack of financial support, although it became the subject of research evaluation with competing claims and analysis. Second generation US successors to the original Soteria house called Crossing Place is still active, although more focused on medication management.
A first European near-replication of the original Soteria approach was implemented in 1984 in Berne, Switzerland, on a somewhat different conceptual basis. Three Soteria-like environments focused on longer term rehabilitation were created in Sweden (Perris, 1989).
Writing in 1999, Mosher described the core of Soteria as "the 24 hour a day application of interpersonal phenomenologic interventions by a nonprofessional staff, usually without neuroleptic drug treatment, in the context of a small, homelike, quiet, supportive, protective, and tolerant social environment." More recent adaptions sometimes employed professional staff. The Soteria approach has traditionally been applied to the treatment of those given a diagnosis of schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
.
Current Soteria work
Soteria or Soteria-based houses are currently run in Sweden, Finland, Germany, Switzerland, Hungary and some other countries.“Soteria Berne” located in the center of Berne started functioning on 1 May 1984 in a 12-room house surrounded with a garden. In the house, a maximum of six-eight patients and two nurses can be accommodated. Admitted patients had to meet the following criteria:
- aged 17–35;
- a recent onset of schizophreniform or schizophrenic psychosis defined by using DSM-III-R criteria, not more than one year before admission;
- at least two of the following six symptoms within the previous four weeks: severely deviant social behaviors, schizophrenic disorders of affect, catatonia, thought disorders, hallucinations, delusions.
Research at Soteria Berne found that most acute schizophrenia patients can be as successfully treated as by standard hospital proceedings, but with significantly lower doses of anti-psychotics and without higher daily costs. In addition, the Soteria approach appeared to offer certain advantages mainly located at the subjective-emotional, familial and social level.
In the context of increasing interest in the Soteria approach in the United Kingdom, several European countries, North America, and Australasia, a review of controlled trials suggested the Soteria paradigm yields equal, and in certain specific areas better, results in the treatment of people diagnosed with first- or second-episode schizophrenia spectrum disorders (and with considerably lower use of medication) when compared with conventional, medication-based approaches. A reevaluation of the approach was called for.
External links
- Video of Robert WhitakerRobert Whitaker (author)Robert Whitaker is an American journalist and author, writing primarily about medicine, science, and history.- Early career :He was a medical writer at the Albany Times Union newspaper, in Albany, N.Y., from 1989 to 1994. In 1992, he was a Knight Science Journalism fellow at MIT. Following that...
and Loren Mosher discussing the evidence for the Soteria model. - Website on Soteria started by Loren Mosher.
- Soteria Foundation A Hungarian Soteria organization that provides multiple services to people with mental health problems and their families and communities.
- UK Soteria Network planning Soteria houses in the UK.
- Alaskan Soteria Network established a Soteria house.