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The following is a brief excerpt from a recently released study that sought to re-examine the "Soteria paradigm" -- a model of treatment for schizophrenia developed by Dr. Loren Mosher and colleagues.
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For over a decade Loren R Mosher, MD, held a central position in American psychiatric research.
He was the first Chief of the Center for Studies of Schizophrenia at the National Institute of Mental Health, 1969-1980. He founded the Schizophrenia Bulletin and for ten years he was its Editor-in-Chief. He led the Soteria Project."
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A Systematic Review of the Soteria Paradigm for the Treatment of People Diagnosed with Schizophrenia
Schizophrenia Bulletin Vol No. 1 pp 181-193
2008
Background: The "Soteria paradigm" attempts to support people diagnosed with schizophrenia spectrum disorders using a minimal medication approach. Interest in this approach is growing in the United Kingdom, several European countries, North America and Australasia.
In the late 1960's and early 1970's, a number of attempts were made to create therapeutic community alternatives to hospitalization for people diagnosed with schizophrenia. These tried to understanding schizophrenia not as an illness needing medical intervention but rather as an important aspect of an individual's life history. Rather than use antipsychotic medication as a first course of treatment, such initiatives emphasized the need to allow individuals to go through their experience of psychosis with minimal interference and high levels of support.
UK based initiatives included Kingsley Hall, associated with Laing and collegues in the Philiadelphia Association, and Villa 21, associated with David Cooper. Perhaps less well known is the "Soteria paradigm" which was developed by Mosher and colleagues in the United States. Over the course of its 30 year history, the therapeutic and structural features considered specific to the paradigm have been elucidated in some detail, with the so-called "Soteria critical elements" being disseminated to help inform the development of further Soteria projects. These core principles include
- the provision of a small, community-based therapeutic mileua with significant lay-person staffing
- preservation of personal power
- social networks
- communal responsibilities
- a "phenomonelogical" relational style which aims to give meaning to the person's subjective experience of psychosis by developing an understanding of it
- "being with" and "doing with" the clients
- no or low-dose antipsychotic medication with all psychotropic medications taken from a position of choice and without coercion.
Future Research and Ethical Considerations:
The Soteria paradigm remains an intriguing example of medical parsimony in the treatment of schizophrenia, via its use of significant numbers of nonmedically indoctrinated staff and minimal use of medication. The studies included in this review suggest that the Soteria paradigm yields equal (and in certain specific areas, better) results in the treatment of schizophrenia when compared with conventional, medication-based approaches.
The full article can be purchased here: [b]
Schizophrenia Bulletin
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Those who may not be able to purchase the article cited above can find more information about Loren Mosher and the Soteria project via the following links.
- Soteria Network
- Dr. Loren Mosher & Soteria House
- Still Crazy After All These Years
- Soteria: Through Madness to Deliverance [Book]
- Loren Mosher's Letter of Resignation from the APA
The following discussion may also be of interest because it highlights the work of other clinicians who operated from a similar alternative paradigm:
85% Recovery Rate