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Peter Lehmann: The Particular Elements of Soteria from t. file:///D:/MyFiles/documenten/soteria/literatuur/soteria.htm Lecture at the congress "Soteria and No Restraint", Merano, Peter Lehmann
The Particular Elements of Soteria from the Perspective of (ex-) Users and Survivors of Psychiatry
For the majority of (ex-) users and survivors of psychiatry the particular elements of Soteria are their central positions andinterests, which are included in the Soteria approach: Abstinence from psychiatric violence, abstinence from any kind ofillness and disorder models, abstinence from "expert"-arrogance, critique of Big Pharma, critical attitude toward neuroleptics,delivery of humane support along with the integration of the treasure of experience (ex-) users and survivors of psychiatry.
In 1995, when I (P.L.) was a member of the board of the German Association of Users and Survivors of Psychiatry (BPE),we were asked by the journal Sozialpsychiatrische Informationen (Social Psychiatric Information) whether we would bewilling to participate in a survey on the subject of improving the quality of psychiatric treatment. We agreed to take part butchanged the questions, as the board members could not agree on whether any type of psychiatric treatment could beconsidered "quality." The following are some of the questions we put to 665 members of the association—(ex-) users andsurvivors of psychiatry who were more or less critical of psychiatry: Did the psychiatrists address the problems which led to your admission? Was your dignity respected at alltimes? Were you fully and comprehensibly informed of the risks and so-called side effects of treatmentmeasures? Were you informed about alternative treatments? What was lacking to the detriment ofqualitatively good psychiatric care? Over 100 members of the association (BPE) responded to the survey. The result: only 10 percent of those who answeredsaid that psychiatry had helped them find a solution to the problems that had led to their psychiatrisation. Ninety percentsaid that their dignity had been violated. In response to the question of whether they had been informed about the risks and"side effects" of treatment measures, not one single person replied with "yes." For being able to talk of a qualitativelyacceptable psychiatry, the following fundamental criteria have to be fulfilled: Observance of the dignity of (wo)man, warmthand human bestowal, individual company, a relation full of confidence instead of fear. There are many useless things inpsychiatry: for many (ex-) users and survivors of psychiatry the whole institution together with the psychiatrists is useless. Ingeneral, the following factors were found to be useless: violence, the use of psychiatric drugs, coercive measures,electroshocks, fixation. Medical (wo)men who believe that they know more about their patients than they themselves areuseless. Alternatives are important for giving options to choose on. Concerning the question what these alternatives shall belike, the following suggestions were made: alternative drugs, e.g. homeopathic remedies, self-help, runaway houses,alternatives according to Mosher and Laing, soft rooms à la Soteria (Peeck, et al., 1995; see also Lehmann, 1998).
What is Particular about Soteria?
The essence of Soteria is its basic humanistic antipsychiatric approach along with its independence from the medical modeland all its consequences. Volkmar Aderhold et al. describe it in the book Alternatives Beyond Psychiatry (2007): Mosher had a life-long scepticism vis-à-vis all models of "schizophrenia," primarily because they would standin the way of an open phenomenological view. He saw the phenomenon, which is usually called "psychosis,"as a coping mechanism and a response to years of various traumatic events that caused the person toretreat from conventional reality. The experiential and behavioural attributes of "psychosis"—includingirrationality, terror, and mystical experiences—were seen as extremes of basic human attributes (Aderhold, etal., 2007, p. 146).
Consequence 1: Abstinence from "experts"-arrogance
This consequence is described at the same place: Soteria offered a homelike environment in a 12-room house with a garden in a fairly poor neighbourhood ofSan José, California and intensive milieu therapy for six to seven individuals. About seven full-time staffmembers plus volunteers worked there, selected for their personal rather than formal qualifications, andcharacterized as psychologically strong, independent, mature, warm, and empathic.
Soteria staff members did not espouse an orientation that emphasized psychopathology, deliberatelyavoided the use of psychiatric labels, and were significantly more intuitive, introverted, flexible, and tolerantof altered states of consciousness than the staff on general psychiatric inpatient units. These personalitytraits seem to be highly relevant for success in this kind of work. Former residents became staff members onseveral occasions (ibid., p. 147).
Consequence 2: Avoidance of violence and overwhelming abstinence from neuroleptics
Aderhold et al. write about the use of neuroleptics in the Soteria House: Neuroleptics were considered as problematic due to their negative impact on long-term rehabilitation andtherefore used only rarely. Specifically, during the first six weeks at Soteria these drugs were only givenwhen the individual's life was in danger and when the viability of the entire project was at risk. However,benzodiazepines were permitted. If there was insufficient improvement after six weeks, the neuroleptic drugchlorpromazine was introduced in dosages of about 300 mg. Basically, any psychiatric drugs were supposedto remain under the control of each resident. Dosages were adjusted according to self-observation and staffreports. After a two-week trial period, a joint decision was taken whether it made sense to continue the"medication" or not (ibid.).
Consequence 3: Availability of positive approaches
Without complying with mainstream psychiatric beliefs, positive perspectives, such as a readiness to deliver humanesupport, respect for the Hippocratic Oath and human rights can become reality. General guidelines for behaviour,interaction and expectation: Treat everyone, and expect to be treated, with dignity and respect.
Peter Lehmann: The Particular Elements of Soteria from t. file:///D:/MyFiles/documenten/soteria/literatuur/soteria.htm Guarantee asylum, quiet, safety, support, protection, containment, interpersonal validation, food and shelter.
Expect recovery from psychosis, which might include learning and growth through and from the experience.
Provide positive explanations and optimism.
Identify plausible explanations: emphasis on biography, life events, trigger factors instead of vulnerability; promotingexperiences of success.
Encourage residents to develop their own recovery plans; consider them the experts (adapted from Mosher &Hendrix, 2004).
Pat Bracken, Consultant Psychiatrist and Clinical Director in Ireland, shows in his paper "Beyond models, beyondparadigms: The radical interpretation of recovery": I believe that the medical model is only one manifestation of a more fundamental problem: the tendency tosee human problems as technical difficulties of one sort or another. I call this the "technological paradigm."(…) In this technological paradigm, issues to do with values, meanings, relationships and power are notignored but they are always secondary to the more important technical aspects of mental health. In thisparadigm, the technical aspects are primary. Furthermore, this paradigm underscores the centrality of"experts": professionals, academics, researchers, codes of practice, training courses and universitydepartments. Service users might be consulted and invited to comment on the models and the interventionsand the research, but they are always recipients of expertise generated elsewhere.
For me, the recovery agenda and the emergence of a mental health discourse that is user/survivor ledpresent a radical challenge, not just to the medical model, but to the underlying technological paradigm. Thisuser/survivor discourse is not about a new paradigm or a new model, but reorients our thinking about mentalhealth completely. It foregrounds issues to do with power and relationships, contexts and meanings, valuesand priorities. In the non-psychiatric literature about recovery, these become primary. As I read it, thisliterature does not reject or deny the role of therapy, services, research and even drugs but it does work torender them all secondary. For example, when it come to drugs and their use, the literature emerging fromindependent users and survivors of psychiatry seeks to prioritise access to information about the mode ofaction, the unwanted effects and debates about efficacy. It also works to ensure that psychiatric drugs areonly administered with consent and has exposed the profits made by Big Pharma in the area ofpsychotropics. (…) In my opinion, we should judge how much the recovery agenda is being accepted bylooking at how much prominence is afforded this user/survivor discourse in the training of professionals andacademics. The most radical implication of the recovery agenda, with its reversal of what is of primary andsecondary significance, is the fact that when it comes to issues to do with values, meanings andrelationships, it is users/survivors themselves who are the most knowledgeable and informed. When it comesto the recovery agenda, they are the real experts (Bracken, 2007, pp. 400-402).
Consequence 4: Leaving the American Psychiatric Association
In a letter to Rodrigo Munoz, President of the American Psychiatric Association, on December 4, 1998, Loren Mosherexplained his discharge of the APA: In my view, psychiatry has been almost completely bought out by the drug companies. The APA could notcontinue without the pharmaceutical company support of meetings, symposia, workshops, journaladvertising, grand rounds luncheons, unrestricted educational grants etc. etc. . What we are dealing withhere is fashion, politics, and money . I want no part of a psychiatry of oppression and social control(Mosher, 1998).
Psychiatry has been corrupted by drug company money, so Mosher in another paper: In my view American psychiatry has become drug dependent (that is, devoted to pill pushing) at all levels—private practitioners, public system psychiatrists, university faculty and organizationally. What should bethe most humanistic medical specialty has become mechanistic, reductionistic, tunnel-visioned anddehumanising. Modern psychiatry has forgotten the Hippocratic principle: Above all, do no harm (Mosher,undated).
Five years later, as a board member of MindFreedom International he also supported hunger strike in Pasadena, California,that won international media publicity. The demand to the psychiatric system, especially the APA, was: Produce scientificevidence about why a single model—the medical theory of 'chemical imbalances' and pills—ought to so overwhelminglydominate mental health care as it does today. A team of 14 mental health academics and practitioners, MFI board memberLoren Mosher included, was reviewing the APA response to MFI's open letter from August 16, 2003, and said: Perhaps the treatment is worsening the disorder. At best, the treatment is not helping: researchers nowrecognize that the most popular psychiatric drugs, the SSRI antidepressants, rate only slightly better thaninert placebos. In addition, negative research findings (sponsored by industry) are commonly suppressed,and adverse drug effects are massively under-reported in psychiatric journals and to the Food and DrugAdministration. These dubious but tolerated practices create an enormously misleading view of the actualimpact of drug treatments. (…) In sum, the APA's statements reflect less the "pace of science" than the paceof commerce: they blur with the pharmaceutical advertising themes saturating our media. This is because theAPA is not an independent organization. One third of its operating budget comes from the drug industry.
Drug companies dominate its professional meetings to advertise drugs. In addition, the drug industry funds,directs, and analyses many drug studies, and psychiatric journals publish so-called scientific reports of thesedrug studies that are ghost-written by industry employees or marketing firms. Psychiatric drug experts withno significant ties to industry can hardly be found. Industry largesse binds many psychiatric practitioners tothe industry (cited in MindFreedom International, 2003).
Consequence 5: Supporting the withdrawal from psychiatric drugs
Do no harm is also the basis, on which Mosher supported the report "Coming off psychiatric drugs", a book with first-handreports of (ex-) users and survivors of psychiatric drugs from all over the world and additional articles of psychotherapists,physicians, psychiatrists, natural healers and other professionals helping to withdraw. In his preface Mosher addressedmind- and body-altering psychiatric drugs and withdrawal symptoms: Most had never been warned that the drugs would change their brains' physiology (or, worse yet, selectivelydamage regions of nerve cells in the brain) such that withdrawal reactions would almost certainly occur. Norwere they aware that these withdrawal reactions might be long lasting and might be interpreted as their Peter Lehmann: The Particular Elements of Soteria from t. file:///D:/MyFiles/documenten/soteria/literatuur/soteria.htm "getting sick again." … However, because the drugs were given thoughtlessly, paternalistically and oftenunnecessarily to fix an unidentifiable "illness" the book is an indictment of physicians. The HippocraticOath—to above all do no harm—was regularly disregarded in the rush to "do something." How is it possibleto determine whether soul murder might be occurring without reports of patients' experiences with drugs thatare aimed directly at the essence of their humanity? Despite their behaviour, doctors are only MD's, notMDeity's. They, unlike gods, have to be held accountable for their actions. This book is a must read foranyone who might consider taking or no longer taking these mind altering legal drugs and perhaps evenmore so for those able to prescribe them (Mosher, 2004, pp. 16-17).
Consequence 6: World wide appreciation by (ex-) users and survivors of psychiatry
I suppose Loren Mosher and his original Soteria approach are linked to each other inseparably. Soteria has given evidence,that The avoidance of psychiatric violence is possible even for a psychiatrist and even from the psychiatricperspective—not surprisingly—has better results than the use of typical psychiatric measures.
Staying away from illness and disorder models of any kind—not surprisingly—brings better results than the use oftypical psychosocial constructs.
The abstinence from "experts"-arrogance opens the view on the real problems of the people and promotes theco-operation with users and survivors of psychiatry.
The criticism of Big Pharma is appropriate and overdue.
The overwhelming avoidance of neuroleptics is more than useful.
The delivery of human support by integrating of the treasure of experience of (ex-) users and survivors of psychiatrycoincides with the interests of people with mental problems of a social nature.
Even with a psychiatric education, a humanistic philosophy of life is possible—not only in words, but also in practice.
No wonder, that the Soteria approach was receipted positively and integrated into further approaches like the BerlinRunaway-house (Wehde, 1991, pp. 46-50). Kerstin Kempker, (former) leading worker in this well-known project, explainedwhy Soteria and comparable approaches have been so important for creating alternatives beyond psychiatry: Without the Dutch runaway-houses and Uta Wehde's intensive engagement with their concept and practice,the Berlin Runaway-house would not exist. Without the antipsychiatry from the early 70s, Laing's KingsleyHall and its "children" Soteria, Emanon and Diabasis we would miss the evidence, that the abstinence frompsychiatric measures and—instead of them—the life in an awake and warming community with equal rightsis at most helpful (Kempker, 1998, p. 66).
And no wonder, that the membership assemblies of the European Network of (ex-) Users and Survivors of Psychiatry(ENUSP) and the World Network of Users and Survivors of Psychiatry (WNUSP) in July 2004 conjointly mourned the deathof Loren Mosher: We express our deep sorrow at the loss of our dear friend Loren Mosher.
Loren cared passionately about our human rights, our freedom, and our ability to lead self-determined lives.
His pioneering work at Soteria House proved that humane, non-medical support is the best way to helppeople undergoing severe emotional distress.
His bravery in publicly resigning from the American Psychiatric Association called to public attention the wayin which Big Pharma and bio-psychiatry have allowed profits to overrule human needs.
Loren's warmth and caring touch so many of our lives, and he will be deeply missed (Chamberlin &Lehmann, 2004).
Aderhold, V., Stastny, P., & Lehmann, P. (2007). Soteria: An alternative mental health reform movement. In P.
Stastny, & P. Lehmann (Eds.), Alternatives beyond psychiatry (pp. 146-160). Berlin / Eugene / Shrewsbury: PeterLehmann Publishing.
Bracken, P. (2007). Beyond models, beyond paradigms: The radical interpretation of recovery. In P. Stastny, & P.
Lehmann (Eds.), Alternatives beyond psychiatry (pp. 400-402). Berlin / Eugene / Shrewsbury: Peter LehmannPublishing.
Chamberlin, J., & Lehmann, P. (2004). Message on behalf of WNUSP / ENUSP. 5. Congress of the EuropeanNetwork of (ex-) Users and Survivors of Psychiatry (A joined congress of ENUSP and the World Network of Usersand Survivors of Psychiatry—WNUSP): Networking for our Human Rights and Dignity. July 17-21, 2004 in Vejle(Denmark) Kempker, K. (1998). Vergleichbare Projekte. In K. Kempker (Ed.), Flucht in die Wirklichkeit—Das BerlinerWeglaufhaus (pp. 66-70). Berlin: Antipsychiatrieverlag.
MindFreedom International (2003, December 15). Reply by Scientific Panel of the Fast for Freedom in Mental Healthto the 26 September Statement by American Psychiatric Association Mosher, L. R. (1998, December 4). Letter of resignation from the American Psychiatric Association. Written toRodrigo Munoz, M.D., President of the American Psychiatric Association.
Mosher, L. R. (2004). Preface. In P. Lehmann (Ed.), Coming off psychiatric drugs: Successful withdrawal fromneuroleptics, antidepressants, lithium, carbamazepine and tranquilizers (pp. 15-17). Berlin / Eugene / Shrewsbury:Peter Lehmann Publishing.
Mosher, L. R. (Undated). How drug company money has corrupted psychiatry Mosher, L. R., Hendrix, V. with D. C. Fort (2004). Soteria: Through madness to deliverance. Philadelphia: XlibrisCorporation.
Peter Lehmann: The Particular Elements of Soteria from t. file:///D:/MyFiles/documenten/soteria/literatuur/soteria.htm Peeck, G., von Seckendorff, C., & Heinecke, P. (1995). Ergebnis der Umfrage unter den Mitgliedern desBundesverbandes Psychiatrie-Erfahrener zur Qualität der psychiatrischen Versorgung. SozialpsychiatrischeInformationen, 25(4), 30-34. Retrieved November 17, 2007, from www.bpe-online.de/umfrage.htm; for more details,see Lehmann, P. (1997). Variety instead of stupidity: About the different positions within the movement of (ex-) usersand survivors of psychiatry Wehde, U. (1991). Das Weglaufhaus—Zufluchtsort für Psychiatrie-Betroffene. Berlin: Antipsychiatrieverlag.
Address for correspondence
Peter Lehmann, Zabel-Krueger-Damm 183, 13469 Berlin, Germany, Tel. +49-(0)30-85963706, e-mail: mail lehmann.de, Internet: www.peter-lehmann.de/inter

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