There have been some experiments around the world done regarding alternative treatment for psychosis. One of these is Soteria House in San Francisco, which was led by Lauren Mosher between 1969-71.
In general, psychiatric hospitals rely on drug treatment, psychosis is seen as an illness that needs to be “treated”, and doctors have decision-making power instead of the patient. At Soteria, psychotic patients were primarily treated without medication, in a home-like environment, and the psychotic process was seen as an opportunity for growth and learning.
The staff and patients at Soteria
The patients were selected from a group whose criteria were 16-30-year-old, unmarried, first-time hospitalized persons with a diagnosis of schizophrenia. There was also a comparison group of patients who were treated at the municipal hospital. Patients arriving for treatment and meeting the criteria were randomly assigned to either Soteria or the municipal hospital.
Various tests were performed on the patients: psychiatric assessment, nursing staff assessment, family assessment, and patient assessment. Patients were followed up every 6 months for two years.
At one time, there were 6 patients and 2 nursing staff per shift in Soteria. The shifts were long, 36-48 hours so that it would be easier for patients in a confused state to establish contact with the nurses. The nurses were untrained volunteers who shared the view that psychosis is an altered state of consciousness that causes a temporary crisis in a person’s life, but which can have positive effects if it is not forcibly interrupted or forced into a certain pattern. The nurses treated the patient’s experiences as “real” and the patient’s irrational behavior was seen as part of the process. The lack of training was seen as an advantage in that the nurses did not have any ready-made operating models or theoretical approach to patients, but were “being themselves” in the care relationships.
The nurses’ task was to be present during the process and share the patients’ experiences, instead of treating or guiding them. Nurses and patients were seen as equals, for example, there were no meetings intended only for nurses and everyday chores were shared equally among all those who could participate in them.
Patients were not given any antipsychotic medication for the first 6 weeks. If there was no change in the patient’s condition within this time, chlorpromazine 300 mg or more was given. Only 10% of Soteria’s patients needed medication.
Psychosis was viewed with positive expectations
Soteria’s program included 7 important criteria: (1) positive expectations of psychosis as a learning experience, (2)
flexibility in roles, relationships, and attitude, (3) sufficient time in treatment so that identification with the nursing staff could take place, (4) accepting and acknowledging the psychotic person’s experience, (5) the nursing staff’s responsibility for being present with the patient, and understanding that he does not have to “do” anything, (6) the ability to accept strange behavior without anxiety or the need to control it, (7) the normalization of the psychotic experience.
37 patients at Soteria and 42 patients in the municipal hospital participated in the experiment. Some of them withdrew or otherwise disappeared from the project’s follow-up, so the data was collected from 26 patients in Soteria’s experimental group and 23 patients in the comparison group.
None of the patients in Soteria’s experimental group received antipsychotic medication for the first six weeks, after which 3 patients received medication. In the control group, all patients received antipsychotics. In the two-year follow-up, 43% of the control group took medicine continuously, while the figure was 4% in the experimental group. Totally without medication was 57% in the experimental group and 0% in the comparison group.
Soteria’s patients were treated significantly longer than the patients in the comparison group. At the two-year follow-up, the comparison group had more new episodes of hospitalization, but the difference was not significant. The patients in the comparison group used more other mental health services than the experimental patients, 40% of whom did not need any kind of mental health services.
There were no notable differences between the groups in work situations, except that the patients in the experimental group had jobs with a higher educational level. In terms of living arrangements, patients in the experimental group lived independently more often than the control group and had more social contacts and friends.
Both forms of treatment were almost the same price per treatment day. The result of the experiment seem to be that psychotic patients could be treated without drugs and trained nursing staff at the same cost in home-like conditions and the results of the treatment would be slightly better than the results offered by hospital treatment.
The Soteria model gives us valuable guidelines for how friends and family can help a loved one who is going through psychosis. Validating the experience and seeing it as a process that can have a positive outcome, can help the person feel understood and supported, and reduce fear and anxiety.
“The prerequisite for treatment is that the psychotic experience is not invalidated. Often the systematic and comprehensive invalidation of the experience by the patient’s family and environment only drives the person further into madness.”
L. Mosher