Managing schizophrenia without medication? A look into the Soteria model
Schizophrenia is traditionally managed and monitored by psychiatrists, social workers, doctors, and nurses. The most common treatment is drug therapy. Some do well on medication, while others have difficulty. That raises the question of whether managing schizophrenia is possible without medication. Enter The Soteria Project. Created by Loren Mosher, a psychiatrist who was head of schizophrenia research at the National Institute of Mental Health in the 1970s, the project aimed at treating individuals with schizophrenia without the use of medication. Did it work? Read on!
What was the Soteria Project?
The Soteria House mode of treatment is based on a world view that sees all human beings as worthy of respect. Psychosis is viewed as a human experience, albeit an extreme one, and effective treatment involves the creation of a warm, safe, and respectful holding environment within the community. The Soteria Project took place in the 1970s in California, with one facility in San Jose and another in San Mateo. Loren Mosher explained that individuals recently diagnosed with schizophrenia were placed in a ‘community home’ where they were treated by non-professional staff who were supervised by professionals.
The non-medical approach focused on providing participants with a comfortable living space that felt like home, with a focus on everyday life relationships and activities, as well as working on the core-self. The Soteria model placed great importance on experiencing extreme states in a safe environment, free from judgement and filled with support. Participants were not treated with neuroleptic drugs, unless it was an absolute necessity, and even then with a very minimal amount of medication. Mosher said that most participants did not take any medications for the first six weeks in the program.
What were the results of the study?
The participants in the Soteria House were compared to a group of participants who received traditional, medication-based treatment. The majority of the Soteria House residents saw an improvement in their symptoms within the first six weeks without the use of medication. After the first six weeks, the medication-based treatment group showed similar changes in symptoms. Mosher and his colleagues were surprised by the quick results achieved through the psychosocial approach used in the Soteria House; they expected it would take much longer than the drug treatment to reduce the symptoms experienced by the participants.
Two years later they followed up on the participants of both groups. Soteria House participants who were treated without medication were doing significantly better than those treated in the hospital with neuroleptic drugs. Individuals who were predicted to have the worst outcomes gained more in the Soteria House than those in the hospital program. In the end, 43% of the Soteria participants never received neuroleptic drugs in the last two years of the experiment and were doing better than those who had received drugs during that period.
What worked with the Soteria model?
Mosher and his colleague Lorenzo Burt described twelve characteristics that could help explain why the Soteria model worked:
- The Soteria home had to be small and feel like home, having no more than 10 people, including staff.
- There were two staff members on duty, a man and a woman, who would work in 24-to-48-hour shifts.
- The staff and program director had to have a flexible ideology, making sure there would be no “failures of fit”.
- Peer and fraternal relationships were considered important.
- The open social system in the Soteria home allowed participants to easily access, leave, and return to the home if needed.
- Everyone contributed to the maintenance and daily running of the house to the extent possible.
- Roles were not heavily differentiated to encourage flexibility amongst the housemates.
- The hierarchy was minimal and there was no rigid structure.
- The home needed to be integrated in the local community.
- Relationships after discharge were encouraged.
- No traditionally defined therapy was given in-house.
Instead of traditional therapy, participants in the home were provided with services such as meetings that would allow them to deal with interpersonal problems as they came up, family mediation sessions if needed, and activities such as yoga, massage, arts in different forms, outings, and shopping. Additionally, there were four rules that Mosher and Burti say contributed to the success of the Soteria model. First, no violence to the self or to others was tolerated. Next, visitors could not come unannounced. Illegal drugs were not tolerated at the home, and sexual relations between clients or staff were taboo.
Eventually, the two houses used in the experiments were closed because funding dried up; a few Soteria Houses were replicated in Netherlands, Sweden, Germany, Japan, France, Hungary, the USA and Israel. As of the publication of this article, there are no Soteria houses in Canada. Do you think a treatment model like Soteria should be offered in Canada? What do you think of the results of Mosher’s study? Should professionals pursue this form of treatment more vigorously?
From Share&Care Spring 2023
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