Meanderings and Soteria House

This is an edited version of something I posted the first month I wrote this blog about a year and a half ago. I’ve grown since I wrote this and learned more about treating mental health issues naturally, I’ve left most of this piece unchanged, even though there is much more to add on this topic:

Though I have serious questions about the nature of psychiatry, I cannot pretend to know what to do in all instances of supposed mental illness, most particularly how does one treat, if not through psychiatry, the acutely psychotic individual.

The only instances in which I became psychotic, as I’ve said many times now, was when I took hallucinogens. I was never violent and it’s questionable whether I was actually a danger to myself, but nonetheless I was forcibly hospitalized and medicated with first generation neuroleptics because I was not acting within the norms of society. People are afraid of psychosis so they lock us up if we become psychotic, regardless of whether we are actually a danger or not. (When someone is an outright danger to themselves or others it’s clear that this is an acute emergency and needs to be looked at in a different way than the typical non-violent psychosis–however, I also think that if people were properly trained in de-escalation, a lot of potentially violent people could be managed without drugs as well) In any case the question is what should be done if someone is simply psychotic and not a danger? I think the example of Soteria House and the programs it inspired are key here. Soteria House was a project that ran from 1971-1983. It “treated” people who were diagnosed schizophrenic and compared outcomes with the local psychiatric hospital. It was a drug free rehabilitation. (drugs were used in just 3% of cases and only very temporarily)


My neuropsychologist, who knows a hell of a lot more about the brain and mental health than any psychiatrist I’ve ever met, once told me while I was having a manic episode that in his experience manic episodes run their course. Whether you suppress with medication or just let it work itself out the time involved for it to come to resolution is the same. Testing this opinion, I did let a manic episode run it’s course without additional medication. I was none the worse for it and I’m sure better off since I did not get stuck on even higher doses of neuroleptics.

With this in mind I propose that had I had a place like Soteria House to recover when I first got psychotic, I would have never entered the psychiatric system and I would now be fully recovered and not have lived a blunted, numbed-out, cognitively impaired life for the past 15 years. Soteria house was created for those diagnosed as schizophrenic, but it’s progenies worked with all sort of people labeled “seriously mentally ill,” with similar startling results:

ABSTRACT: The author reviews the clinical and special social environmental data from the Soteria Project and its direct successors. Two random assignment studies of the Soteria model and its modification for long-term system clients reveal that roughly 85% to 90% of acute. and long-term clients deemed in need of acute hospitalization can be returned to the community without use of conventional hospital treatment. Soteria, designed as a drug free treatment environment, was as successful as anti-psychotic drug treatment in reducing psychotic symptoms in 6 weeks. In its modified form, in facilities called Crossing Place and McAuliffe House where so-called long-term “frequent flyers” were treated, alternative-treated subjects were found to be as clinically improved as hospital-treated patients, at considerably lower cost. Taken as a body of scientific evidence, it is clear that alternatives to acute psychiatric hospitalization are as, or more, effective than traditional hospital care in short-term reduction of psychopathology and longer- social adjustment. Data from the original drug-free, home-like, nonprofessionally staffed Soteria Project and its Bern, Switzerland, replication indicate that persons without extensive hospitalizations (less than 30 days)are especially responsive to the positive therapeutic effects of the well-defined, replicable Soteria-type special social environments. Reviews of other studies of diversion of persons deemed in need of hospitalization to “alternative” programs have consistently shown equivalent or better program clinical results, at lower cost, from alternatives. Despite these clinical and cost data, alternatives to psychiatric hospitalization have not been widely implemented, indicative of a remarkable gap between available evidence and clinical practice. J Nerv Ment Dis 187:142-149, 1999

More from the Soteria website:

Basically, the Soteria method can be characterized 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. The core practice of interpersonal phenomenology focuses on the development of a nonintrusive, noncontrolling but actively empathetic relationship with the psychotic person without having to do anything explicitly therapeutic or controlling. In shorthand, it can be characterized as “being with,” “standing by attentively,” “trying to put your feet into the other person’s shoes,” or “being an LSD trip guide” (remember, this was the early 1970s in California). The aim is to develop, over time, a shared experience of the meaningfulness of the client’s individual social context-current and historical. Note, there were no therapeutic “sessions” at Soteria. However, a great deal of “therapy” took place there as staff worked gently to build bridges, over time, between individuals’ emotionally disorganized states to the life events that seemed to have precipitated their psychological disintegration. The context within the house was one of positive expectations that reorganization and reintegration would occur as a result of these seemingly minimalist interventions.

What is most remarkable about this is that the staff were not afraid of psychosis. Psychiatry is fraught with fear. Fear of that which is not understood, and so, psychosis must be suppressed and in so doing so begins the oppression of those labeled with mental illness. It’s all a slippery slope from there. It’s additionally interesting that the staff at Soteria, were largely non-professional and therefore not brainwashed by psychiatry and psychology in school. They therefore had much fewer negative assumptions about the people they were helping and instead probably made the positive assumption that recovery was possible, something most mental health professionals don’t truly entertain.

Not just psychosis, but every less than pleasant feeling ends up medicated. We are all afraid of feeling. We are not taught to cope and we have the expectation that we should be “happy.” Normal causes of pain and suffering like grief and trauma are medicated instead of worked through. And natural alternatives are not even considered. This is in the truest sense inhumane. It is human to feel and yet we are more and more often told that “negative” emotions are a disease.

I wish to feel! Since coming off of meds I’ve slowly started to feel again. Often the feelings are unpleasant. Or because I’ve been blunted for a decade and a half, I get overstimulated sometimes. I feel too much. I need to remove myself from overstimulating situations sometimes. But this is common of everyone in withdrawal and it is also common to welcome feelings coming back with mixed emotions. Once the withdrawals are over we live fuller lives. Not perfect lives and not lives without difficult moments but we experience the full array of human emotions and celebrate them.

I don’t always feel good these days. Sometimes I feel downright shitty. But boy do I sure as hell feel empowered. I can’t begin to describe how wondrous of a feeling it is to take my mind and body back from psychiatry and to own them. To be responsible for them and to treat them with respect and wholesomeness. It is purely a joy. Even when I am feeling desperately awful I feel a sense of power I never have before. Everything is opening up ahead of me and for the first time in 15 years I feel the sense of possibility. No one should ever have that taken from them. And it’s stripped from millions of people with mental illness routinely on a daily basis. I, like many people diagnosed with “severe mental illness,” have been told, we will never function normally again, that we will be sick for the rest of our lives and that we will need to poison are bodies with toxic drugs for the rest of our lives. Well, I’ve now seen evidence of thousands of people who were told that and it was simply not true. How can psychiatrists be so damn cocky? How did we get here?

There are so many societal factors at play. Frankly I think capitalism is one of the roots of it, but I probably shouldn’t get that political on you and it certainly is not as simple as just that. But clearly the pharmaceutical companies have much to do with the agenda of pushing drugs at everything one feels as unpleasant or is perceived as abnormal by others, all in order to turn a profit.

Of course, the “abnormal” have been victims of human rights abuses for hundreds of years. So it’s a question of oppression by the “normal” as well–giant societal factors at play.

About Monica Cassani

Author/Editor Beyond Meds: Everything Matters

22 Responses

  1. I think, what “normal” people actually are most afraid of is not so much “psychosis” – or “mania”, or “depression”, or whatever “abnormal” behavior – in someone else as it is their own potential to experience extreme states of mind, and show extreme behavior. Everybody has this potential, and everybody knows it. Although most people don’t know it consciously. They live in denial: “This could never happen to me!” As Loren Mosher pointed out, the gene-story is an excellent way to keep your own fear at arm’s length. If only we could find the gene for “schizophrenia”, or “bipolar”, or or or, we would be safe: it couldn’t happen to the – genetically – “normal”. Until then, we create a pseudo-security by alleging the genes are there. So we can continue and deny our own potential for madness.

    Apropos of the “magic” six weeks, after which neuroleptics allegedly show to be most efficient: “psychosis” usually lasts for five – six weeks. With or without drugs. So, it’s not the neuroleptics starting to have an effect. It’s “psychosis” taking its very natural course

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  2. C

    I worked in a psychiatric hospital for about a year, and I read this book about Soteria recently. I believe that the phenomenological method should be explored, but the problem remains of how one would deal with someone who was violent and or self-destructive to themselves.

    In this book, the authors describe a man who set himself on fire using lighter fluid and matches, apparently because of a delusion. How would you say that the staff could protect a person like him? Do you think the house should have been more stringently guarding against self-harm or violence?

    I would say that in contrast, the hospital I worked at was fairly safe. People I know who have been in hospitals for psychatric reasons would always say that you can always hurt yourself in the hospital, even kill yourself, but I think that at least this hospital was much more careful about that.

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  3. Froscha

    This is a great post, particularly your observation that psychosis should not be feared in most cases; that the professionals operate from a basis of fear, and approach their patients’ recovery with negative assumptions.

    Fear. I remember watching Six Feet Under with my roommates at the first place I lived after my one psychotic experience. There was that scene where the ‘bipolar’ brother attacks his sister in a fit of mania — trying to remove the tattoo on her back with a knife — and later, a very creepy display of obsession over one of the other female characters.

    I remembered thinking, of my diagnosis, “They must never know!” I lived in dread of how abnormal they must have already thought I was, which, if you can imagine, made me act more neurotic. Had the fear not been put in my head by the medical establishment — “this will happen again unless…” — I could have continued on the road of genuine recovery I had started immediately after my crisis. (I know, I’m starting to sound like a broken record on this point!)

    Down to only one drug, I now finally feel what you expressed, Gianna, that sense of the world opening up to us again.

    The flip side: I’m now experiencing delayed grief and guilt over things that happened when I had more meds coursing through me, but you know what? I write it out. And this process helps more than those drugs. I feel stronger afterward, not weaker, not afraid of the next wave of feelings.

    I agree with you, Marian; people know on a subconscious level that they too could be susceptible. It’s a quiet, drawn out kind of hysteria maybe. They only consciously recognize the acute kind when it’s safely external to them.

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  4. Froscha

    Wow, you are quick on the draw! Thanks.

    I should write more too–besides my long comments here, I mean (ahem). I tend to wait until the feelings get too acute and the regular modes of escapism are no longer distracting enough.

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  5. Have to admit, that I haven’t read the whole thing (Soteria) yet, but I read the chapter “Some problems and some solutions” where, among other things, violence is mentioned. The solution is pretty simple: when first you have established a basis of mutual trust, people will tell you, when they feel like getting violent. No matter how “psychotic” they are at the moment. You then can talk about it, de-escalating the situation, or, if that doesn’t work out, get the person to take some medication (Soteria staff never medicated anyone forcibly).

    The problem with conventional psych wards is, that the atmosphere there usually is dominated by fear, and that you can’t trust anyone who fears you, or whom you fear. Fear excludes trust.

    Not so long ago, the Danish media reported about an increasing number of suicides at psych wards. Both the “experts”, politicians, and the public agree, that the “solution” is to have people more closely monitored, “tightened observation”, which in plain English means more restraints, more locked doors, more forced drugging etc. More fear, that is.

    The Norwegian psychologist Arnhild Lauveng writes in her book I morgen var jeg alltid en løve, that she immediately smashed everything breakable, she could get her hands on, in order to use the pieces to cut herself. She once was allowed to go and visit her mother – accompanied by a hospital staff – who’d set the table with her finest china, although the hospital had advised her to get plastic cups and paper plates. Nothing happened. “I couldn’t betray my mother’s trust in me”, Lauveng writes. Trust breeds trust. Fear breeds fear.

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  6. Oh, and: “psychotic” crises are more often than not the result of an existential/spiritual/emotional insecurity. How could inducing more insecurity ever be a solution to that?

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  7. Just came to think of something else (where do all these words suddenly come from? strange): Steven Morgan mentioned in one of his comments on the NYT-bipolar-thing, that we often end up becoming afraid of ourselves (our brains, our minds), because of all these warnings we get to hear all the time, that actually only reflect others’ fears. Someone who’s afraid of him-/herself is maybe the easiest to control for others. So, by frightening us out of our wits they manage to keep us, whom they projected their own fears into, under control. Which gives them a – false – feeling of being in control of their own fears/themselves.

    I don’t say, they do this deliberately. It just happens. Out of unawareness. (Now I’ll keep my mouth shut. Have to go to sleep anyway)

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  8. RE C “the problem remains of how one would deal with someone who was violent and or self-destructive to themselves”

    The problem remains shoot first , ask questions later. Mental patients are assumed violent. The justice system works that a person has to have commited a crime, in psychiatry the patient is a crime. If those in power treat people like animals and they behave like animals. This is shown in numerous experiments with a famous one being the Stanford prison experiment.

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  9. Sloopy Cowbell

    Interesting posting and comments!

    Psychiatry does tend to attract the authoritarian sociopaths. Many of those working in psychiatry have personality issues. For that reason they find themselves rejected by the respectable branches of medicine. Psychiatry, however, accepts any old chaff. It serves as the toxic wasteland for rogue medics.

    I remember one particularly aggressive psychiatric nurse admitting he was bored with his work on an acute mental ward. There wasn’t enough “challenge” to it, apparently. I figured he was frustrated by the checks on the violence he could use against the patients. Unable to relieve his tensions through his fists, he moved on to work in the prison sector. I couldn’t help pitying the inmates.

    While some sociopaths pull the wings off flies, others seek work in psychiatry.

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  10. Jan

    I’ve been reading these blogs, and one of the things that sticks in my mind is what Marian says at the end of a blog: Trust breeds trust. Fear breeds fear. How very succinctly and appropriately put. Thank you, Marian!

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  11. the problem is if i need to go to the hospital, i end up not in a safe place…the hospitals in arizona are not safe.

    i am down to only xanax now, got off abilify as it messed up my blood sugar, and i have tried most meds and seem to not tolerate any of them. i have been court ordered before and get very scared of the hospitals here.

    i think meds should only be used in acute crises…only after everything else was tried. i am not ok right now but overall i do better on amino acids and fish oil than the medication because i may have a chance to heal my body again.

    i lacked sleep for four years on the abilify and got very sick. i am finally able to sleep more now. the doctors do not listen to us enough. i would see them ten minutes every three months. how can this be a safe situation?

    i really like this blog, thank you.

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  12. Gene

    Dear Ginna,
    I just happened upon your blog today, 7/01/09.
    I was on the staff at Soteria and at Emanon. Much of what I have just read brings back a lot of memories. I would like to just briefly address some of the discussion between you and Marian.
    There was fear at Soteria, at times a lot. I think the main difference between Soteria and a ward was how it was addressed. First and foremost we had to acknowledge the fear in ourselves. You couldn’t just dump it onto the resident. You would mention it openly in conversation and see how many shared it with you. The majority of times that in itself would lead to a discussion, either in the kitchen or the living room, that would identify and deflate it. It was the willingness of staff to talk about their own sense of fear without “freaking out” that helped to develop that necessary trust from the residents that allowed them to put words to some of their awful fears. It was the willingness to speak the unspeakable or even to be able to eavesdrop while others spoke it that deflated so much potential paranoia back into the normal.
    I don’t know if this blog is still active since the last date in October 2008 but it does make me feel a little vindicated that people are still talking about Soteria. It was, along with my marriage and the birth of my children, one of the richest experiences of a fairly rich life.
    thanks for the air time

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  13. Gene

    Dear Gianna,
    My appologies for mispelling your name. One should, at least, get that right. Loren was an excellent spokeperson for the Soteria project and Alma M. still is. That was appropriate to their positions from the start. But I see the role of the on-site staff as a bit different. Our committment was and should always be to the residents. We acted as companions, guides and, when neccessary, protectors to the residents. To reduce what we went through together to a series of annecdotes in a public forum, I think, would be a dishonorable breach of the trust that was implicit and permanent. If you ever have points of contention or confusion regarding Soteria that I might help with please feel free to ask.
    The social instutionalization of any philosophy quickly devolves into dogmatic protectionism and that is true of American Psychiatry. While there are many excellent, caring and humane psychiatrists, most of them have to develop in semi-isolation. I think web sites like yours are essential in assiting them and so many others to consider alternatve frames of referrence. Keep the faith.

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  14. Gene: One of my riding instructors used to say: “Institutionalization suffocates the art.” Well, he aimed at the Spanish Riding School in Vienna, but I think, this is true for almost everything in life.

    You bet, I talk about Soteria on any given occasion, and I won’t stop until the day I die!

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