Soteria (psychiatric treatment)

Last updated
Soteria house, Zwiefalten, Germany (2011) Soteria-Zwiefalten.jpg
Soteria house, Zwiefalten, Germany (2011)

The Soteria model is a milieu-therapeutic approach developed to treat acute schizophrenia, usually implemented in Soteria houses. [1]

Contents

Based on a recovery model, the common elements of the Soteria approach include the use of primarily nonmedical staff, who do not prescribe or administer antipsychotic medication to patients, and the preservation of residents' personal power, social networks, and communal responsibilities. [2]

Soteria houses provide a community space for people experiencing mental distress or crisis and have no restraint facilities. Loren Mosher, founder of the first Soteria house, believed that people with schizophrenia did, in fact, recover from the illness without the use of neuroleptics in a supportive home-like environment. [3]

Soteria houses are often seen as gentler alternatives to the psychiatric hospital system, which is perceived as authoritarian, hostile, or violent, and overly reliant on the use of psychiatric (particularly antipsychotic) drugs. [4]

Some psychiatrists contest the Soteria model's validity due to a perception that it diverges from the widely accepted biopsychosocial model, as well as research quality concerns. [2] [5] [6]

Theoretical model

Traditional psychiatric wards function according to the medical model, [7] : 113  in which physicians have considerable authority, and in which they rely heavily upon medications to treat or cure what those physicians view as patients' mental illnesses. Critics of this model have pointed out that its reliance on labeling inevitably produces consequences, namely stigmatization and objectification. [7] : 113 

Soteria emerged as a response to former psychiatric patients who said that they needed "love and food and understanding, not drugs", [8] by providing an alternative centered on development, learning, and growth, [7] : 113  and by comparing its results to those of the traditional model. [8]

History

The original Soteria Research Project was founded by psychiatrist Loren Mosher in San Jose, California, in 1971. A replication facility ("Emanon") opened in 1974 in another suburban San Francisco Bay Area city. Mosher was influenced by the philosophy of moral treatment, previous experimental therapeutic communities (such as the Fairweather Lodges), the work of Harry Stack Sullivan, [9] and Freudian psychoanalysis. The name Soteria comes from the Greek Σωτηρία for "salvation" or "deliverance" (see Soter). [10]

Mosher's first Soteria house specifically selected unmarried patients between the ages of 18 and 30 who had recently been diagnosed with schizophrenia according to DSM-2 criteria. 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 in running the house and in playing a part in the mutually-supportive community, where the distinction between experts and non-experts was downplayed (similar to therapeutic communities). Though the model calls for no use of psychiatric medication, in practice, they 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. [11]

However, the Soteria Research Project was also the subject of much controversy. [5] One of the main critiques was that the project was withholding evidence-based treatment as it was based on invalid anti-medication and anti-disease models, which went against the widely accepted biopsychosocial model of disease. [6] [12] Some also questioned the reported efficacy of the treatment, noting that Mosher's definition of patient recovery was staying off of drugs, with no assessment of their symptoms. [6]

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. [13] Second-generation US successors to the original Soteria house called Crossing Place are still active, although more focused on medication management.

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." [10] More recent adaptions sometimes employed professional staff. [14] The Soteria approach has traditionally been applied to the treatment of those given a diagnosis of schizophrenia. [7]

Current implementations

Soteria-based houses are currently run in Sweden, [15] Finland, [16] Germany, [17] [18] [19] Switzerland, [20] Hungary, [21] the United States. [22] [lower-alpha 1]

A first European near-replication of the original Soteria house was implemented in Bern, Switzerland, on May 1, 1984. However, the Bern approach differs from Mosher's original project in that it does not adopt the same anti-medical stance, using a consensual low-dose anti-psychotic treatment and including psychiatric staff.

The following criteria were required for patients to be admitted:

Research at Soteria Berne found that the majority of acute schizophrenia patients could be treated as successfully by this paradigm as by standard hospital proceedings, but with significantly lower doses of anti-psychotics and at similar daily costs. [1] Some advantages of the Soteria model may be found at the subjective-emotional, familial, and social level. [1]

In the context of increasing interest in the Soteria model in the United Kingdom, several European countries, North America, and Australasia, a review of controlled trials was conducted in order to evaluate the efficacy of the approach in the treatment of people diagnosed with schizophrenia. The results indicated that the Soteria paradigm yields similar – and in certain cases better – results than standard treatment. However, as noted by the authors, the review was based on a limited number of studies of questionable quality, and more research is needed in order to form a better consensus. [2]

See also

Notes

  1. ↑ Soteria-Alaska operated from 2008 until 2015 when it closed due to insufficient funding. [23] [24] [25] [26] [27]

Related Research Articles

<span class="mw-page-title-main">Psychiatric hospital</span> Hospital specializing in the treatment of serious mental disorders

Psychiatric hospitals, also known as mental health hospitals, or behavioral health hospitals are hospitals or wards specializing in the treatment of severe mental disorders, including schizophrenia, bipolar disorder, eating disorders, dissociative identity disorder, major depressive disorder, and others.

Anti-psychiatry, sometimes spelled antipsychiatry without the hyphen, is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients, highlighting controversies about psychiatry. Objections include the reliability of psychiatric diagnosis, the questionable effectiveness and harm associated with psychiatric medications, the failure of psychiatry to demonstrate any disease treatment mechanism for psychiatric medication effects, and legal concerns about equal human rights and civil freedom being nullified by the presence of diagnosis. Historical critiques of psychiatry came to light after focus on the extreme harms associated with electroconvulsive therapy or insulin shock therapy. The term "anti-psychiatry" is in dispute and often used to dismiss all critics of psychiatry, many of whom agree that a specialized role of helper for people in emotional distress may at times be appropriate, and allow for individual choice around treatment decisions.

A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research.

<span class="mw-page-title-main">Fluphenazine</span> Typical antipsychotic medication

Fluphenazine, sold under the brand name Prolixin among others, is a high-potency typical antipsychotic medication. It is used in the treatment of chronic psychoses such as schizophrenia, and appears to be about equal in effectiveness to low-potency antipsychotics like chlorpromazine. It is given by mouth, injection into a muscle, or just under the skin. There is also a long acting injectable version that may last for up to four weeks. Fluphenazine decanoate, the depot injection form of fluphenazine, should not be used by people with severe depression.

<span class="mw-page-title-main">Typical antipsychotic</span> Class of drugs

Typical antipsychotics are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis. Typical antipsychotics may also be used for the treatment of acute mania, agitation, and other conditions. The first typical antipsychotics to come into medical use were the phenothiazines, namely chlorpromazine which was discovered serendipitously. Another prominent grouping of antipsychotics are the butyrophenones, an example of which is haloperidol. The newer, second-generation antipsychotics, also known as atypical antipsychotics, have largely supplanted the use of typical antipsychotics as first-line agents due to the higher risk of movement disorders in the latter.

<span class="mw-page-title-main">Perphenazine</span> Antipsychotic medication

Perphenazine is a typical antipsychotic drug. Chemically, it is classified as a piperazinyl phenothiazine. Originally marketed in the United States as Trilafon, it has been in clinical use for decades.

Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behavior and psychopathology. Biopsychiatry is the branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.

<span class="mw-page-title-main">Insulin shock therapy</span> Psychiatric treatment

Insulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. It was introduced in 1927 by Austrian-American psychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs in the 1960s.

<span class="mw-page-title-main">Emergency psychiatry</span> Clinical application of psychiatry in emergency settings

Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior.

<span class="mw-page-title-main">Silvano Arieti</span> Italian psychiatrist (1914–1981)

Silvano Arieti was a psychiatrist regarded as one of the world's foremost authorities on schizophrenia. He received his M.D. from the University of Pisa and left Italy soon after, due to the increasingly antisemitic racial policies of Benito Mussolini.

The biopsychiatry controversy is a dispute over which viewpoint should predominate and form a basis of psychiatric theory and practice. The debate is a criticism of a claimed strict biological view of psychiatric thinking. Its critics include disparate groups such as the antipsychiatry movement and some academics.

James Barry "Jim" Gottstein is a mostly retired Alaska based lawyer who practiced business law and public land law, and is well known as an attorney advocate for people diagnosed with serious mental illness. Gottstein has sought to check the growth in the administration of psychotropics, particularly to children.

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 (1968–1980). Mosher spent his professional career advocating for humane and effective treatment for people diagnosed as having schizophrenia and was instrumental in developing an innovative, residential, home-like, non-hospital, non-drug treatment model for newly identified acutely psychotic persons.

The management of schizophrenia usually involves many aspects including psychological, pharmacological, social, educational, and employment-related interventions directed to recovery, and reducing the impact of schizophrenia on quality of life, social functioning, and longevity.

The Critical Psychiatry Network (CPN) is a psychiatric organization based in the United Kingdom. It was created by a group of British psychiatrists who met in Bradford, England in January 1999 in response to proposals by the British government to amend the Mental Health Act 1983. They expressed concern about the implications of the proposed changes for human rights and the civil liberties of people with mental health illness. Most people associated with the group are practicing consultant psychiatrists in the United Kingdom's National Health Service (NHS), among them Dr Joanna Moncrieff. A number of non-consultant grade and trainee psychiatrists are also involved in the network.

<span class="mw-page-title-main">Luc Ciompi</span>

Luciano "Luc" Ciompi is a Swiss psychiatrist. He was professor of psychiatry, medical director of the University Social Psychiatric Clinic and co-director of the Department of Psychiatry of the University of Berne/Switzerland from 1977 to 1994. He is the founder of the concept of Affect-logics, an interdisciplinary theory of the rules of interaction between emotion and cognition, and the founder of Soteria Berne, He also proposed a conceptual framework towards an integrative, psycho-socio-biological understanding of mental illnesses, and promoted community-based halfway institutions for crisis intervention and social reintegration of the mentally ill.

Affect-logics or Affect logic is a biopsychosocial notion, introduced in 1988 by Swiss psychiatrist Luc Ciompi, relating initially to schizophrenia and other mental conditions, and later elaborated into a general meta-theory on the interactions between emotion and cognition, expanding from the individual level to collective phenomena.

The following outline is provided as an overview of and topical guide to the psychiatric survivors movement:

The following outline is provided as an overview of and topical guide to psychiatry:

<span class="mw-page-title-main">Antipsychotic switching</span> Process of transferring between antipsychotics

Antipsychotic switching refers to the process of switching out one antipsychotic for another antipsychotic. There are multiple indications for switching antipsychotics, including inadequate efficacy and drug intolerance. There are several strategies that have been theorized for antipsychotic switching, based upon the timing of discontinuation and tapering of the original antipsychotic and the timing of initiation and titration of the new antipsychotic. Major adverse effects from antipsychotic switching may include supersensitivity syndromes, withdrawal, and rebound syndromes.

References

  1. 1 2 3 Ciompi L, Hoffmann H (October 2004). "Soteria Bern: an innovative milieu therapeutic approach to acute schizophrenia based on the concept of affect-logic". World Psychiatry. 3 (3): 140–146. PMC   1414694 . PMID   16633478.
  2. 1 2 3 Calton T, Ferriter M, Huband N, Spandler H (January 2008). "A systematic review of the Soteria paradigm for the treatment of people diagnosed with schizophrenia". Schizophr Bull. 34 (1): 181–92. doi:10.1093/schbul/sbm047. PMC   2632384 . PMID   17573357.
  3. ↑ Bola, John; Mosher, Loren (April 2003). "Treatment of acute psychosis without neuroleptics: Two year outcomes from the Soteria Project" (PDF). The Journal of Nervous and Mental Disease . 191 (4): 219–229. CiteSeerX   10.1.1.564.2860 . doi:10.1097/01.nmd.0000061148.84257.f9. PMID   12695732. S2CID   1095393.
  4. ↑ "Soteria Programme – International Mental Health Collaborating Network" . Retrieved 2023-06-28.
  5. 1 2 Stupak, Radosław; Dobroczyński, Bartłomiej (2019-12-31). "The Soteria project: a forerunner of "a third way" in psychiatry?" (PDF). Psychiatria Polska. 53 (6): 1351–1364. doi: 10.12740/PP/OnlineFirst/91731 . ISSN   0033-2674. PMID   32017822. S2CID   55230325.
  6. 1 2 3 Carpenter, William T.; Buchanan, Robert W. (1 January 2002). "Commentary on the Soteria Project: Misguided Therapeutics". Schizophrenia Bulletin. 28 (4): 577–581. doi: 10.1093/oxfordjournals.schbul.a006965 . PMID   12795492.
  7. 1 2 3 4 Mosher, Loren R. (1995). "The Soteria Project: The First Generation American Alternatives to Psychiatric Hospitalization". In Richard Warner (ed.). Alternatives to the Hospital for Acute Psychiatric Treatment. Washington DC: American Psychiatric Pub. pp. 111–132. ISBN   978-0-88048-484-8.
  8. 1 2 Whitaker, Robert (2002). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Philadelphia: Basic Books. pp. 220–26. ISBN   9780465020140.
  9. ↑ Sullivan HS (1962) Schizophrenia as a human process. New York: Norton.
  10. 1 2 Mosher L.R. (March 1999). "Soteria and other alternatives to acute psychiatric hospitalization: a personal and professional review" (PDF). Journal of Nervous and Mental Disease. 187 (3): 142–149. doi:10.1097/00005053-199903000-00003. PMID   10086470. Archived from the original (PDF) on 2012-02-29.
  11. ↑ Hirschfeld RM, Matthews SM, Mosher LR, Menn AZ (April 1977). "Being with madness: personality characteristics of three treatment staffs". Hosp Community Psychiatry. 28 (4): 267–73. doi:10.1176/ps.28.4.267. PMID   844816. Archived from the original on 2012-02-12.
  12. ↑ Fava, Giovanni A.; Sonino, Nicoletta (2008). "The Biopsychosocial Model Thirty Years Later". Psychotherapy and Psychosomatics. 77 (1): 1–2. doi: 10.1159/000110052 . ISSN   0033-3190. PMID   18087201.
  13. ↑ Mosher, Loren (2000-08-29). "Soteria-California and Its Successors". psychrights.org. Retrieved 2023-08-05.
  14. ↑ Ciompi L (1997). "The Soteria-concept. Theoretical bases and practical 13-year-experience with a milieu-therapeutic approach of acute schizophrenia". Seishin Shinkeigaku Zasshi. 99 (9): 634–50. PMID   9396381.
  15. ↑ Perris, C.M. Cognitive Therapy with Schizophrenic Patients. Guilford, New York, NY, 1989.
  16. ↑ Soteria - kristillinen terapiakeskus
  17. ↑ Allgemeine Psychiatrie I / Soteria
  18. ↑ Toll – Haus
  19. ↑ Soteria
  20. ↑ Soteria Bern
  21. ↑ Soteria Alapítvány
  22. ↑ Pathways Vermont Soteria House
  23. ↑ "Lessons from Soteria-Alaska". 29 June 2015.
  24. ↑ "Soteria Alaska opening in the fall—Staff needed". 20 September 2008.
  25. ↑ "Some Observations of Soteria-Alaska". 28 September 2012.
  26. ↑ "Soteria-Alaska, Inc. - Facility Repairs". Archived from the original on 2022-10-05.
  27. ↑ "Soteria-Alaska". soteria-alaska.com:80. Archived from the original on 27 September 2012. Retrieved 12 January 2022.
  28. ↑ Ciompi, Luc; Dauwalder, Hans-Peter; Maier, Christian; Aebi, Elisabeth; Trütsch, Karl; Kupper, Zeno; Rutishauser, Charlotte (October 1992). "The Pilot Project 'Soteria Bern': Clinical Experiences and Results" (PDF). British Journal of Psychiatry. 18 (Supplement): 145–153. doi:10.1192/S0007125000297183. PMID   1356365. S2CID   40933685.[ permanent dead link ]
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.