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 and
interests, which are included in the Soteria approach: Abstinence
from psychiatric violence, abstinence from any kind of illness
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 be willing to
participate in a survey on the subject of improving the quality
of psychiatric treatment. We agreed to take part but changed the
questions, as the board members could not agree on whether any
type of psychiatric treatment could be considered "quality."
The following are some of the questions we put to 665 members
of the association(ex-) users and survivors 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 all times? Were
you fully and comprehensibly informed of the risks and so-called
side effects of treatment measures? Were you informed about alternative
treatments? What was lacking to the detriment of qualitatively
good psychiatric care?
Over 100 members of the association (BPE) responded to the survey.
The result: only 10 percent of those who answered said that psychiatry
had helped them find a solution to the problems that had led to
their psychiatrisation. Ninety percent said 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 qualitatively acceptable psychiatry,
the following fundamental criteria have to be fulfilled: Observance
of the dignity of (wo)man, warmth and human bestowal, individual
company, a relation full of confidence instead of fear. There
are many useless things in psychiatry: for many (ex-) users and
survivors of psychiatry the whole institution together with the
psychiatrists is useless. In general, 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
are useless. Alternatives are important for giving options to
choose on. Concerning the question what these alternatives shall
be like, 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 model and
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 stand
in 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 to retreat from conventional reality. The experiential
and behavioural attributes of "psychosis"including
irrationality, terror, and mystical experienceswere seen
as extremes of basic human attributes (Aderhold, et al., 2007,
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 of San José,
California and intensive milieu therapy for six to seven individuals.
About seven full-time staff members plus volunteers worked there,
selected for their personal rather than formal qualifications,
and characterized as psychologically strong, independent, mature,
warm, and empathic.
Soteria staff members did not espouse an orientation
that emphasized psychopathology, deliberately avoided the use
of psychiatric labels, and were significantly more intuitive,
introverted, flexible, and tolerant of altered states of consciousness
than the staff on general psychiatric inpatient units. These personality
traits seem to be highly relevant for success in this kind of
work. Former residents became staff members on several occasions
(ibid., p. 147).
Consequence 2: Avoidance of violence and overwhelming abstinence
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 and therefore used
only rarely. Specifically, during the first six weeks at Soteria
these drugs were only given when 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 drug chlorpromazine
was introduced in dosages of about 300 mg. Basically, any psychiatric
drugs were supposed to remain under the control of each resident.
Dosages were adjusted according to self-observation and staff
reports. After a two-week trial period, a joint decision was taken
whether it made sense to continue the "medication" or
Consequence 3: Availability of positive approaches
Without complying with mainstream psychiatric beliefs, positive
perspectives, such as a readiness to deliver humane support, respect
for the Hippocratic Oath and human rights can become reality.
General guidelines for behaviour, interaction and expectation:
Do no harm.
Treat everyone, and expect to be treated, with dignity and
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; promoting
experiences 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, beyond paradigms:
The radical interpretation of recovery":
I believe that the medical model is only one manifestation
of a more fundamental problem: the tendency to see 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 not ignored but they are always secondary to the more
important technical aspects of mental health. In this paradigm,
the technical aspects are primary. Furthermore, this paradigm
underscores the centrality of "experts": professionals,
academics, researchers, codes of practice, training courses and
university departments. Service users might be consulted and invited
to comment on the models and the interventions and 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 led present a radical challenge,
not just to the medical model, but to the underlying technological
paradigm. This user/survivor discourse is not about a new paradigm
or a new model, but reorients our thinking about mental health
completely. It foregrounds issues to do with power and relationships,
contexts and meanings, values and priorities. In the non-psychiatric
literature about recovery, these become primary. As I read it,
this literature does not reject or deny the role of therapy, services,
research and even drugs but it does work to render them all secondary.
For example, when it come to drugs and their use, the literature
emerging from independent users and survivors of psychiatry seeks
to prioritise access to information about the mode of action,
the unwanted effects and debates about efficacy. It also works
to ensure that psychiatric drugs are only administered with consent
and has exposed the profits made by Big Pharma in the area of
psychotropics. (…) In my opinion, we should judge how much the
recovery agenda is being accepted by looking at how much prominence
is afforded this user/survivor discourse in the training of professionals
and academics. The most radical implication of the recovery agenda,
with its reversal of what is of primary and secondary significance,
is the fact that when it comes to issues to do with values, meanings
and relationships, it is users/survivors themselves who are the
most knowledgeable and informed. When it comes to 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 Mosher explained his discharge
of the APA:
In my view, psychiatry has been almost completely bought
out by the drug companies. The APA could not continue without
the pharmaceutical company support of meetings, symposia, workshops,
journal advertising, grand rounds luncheons, unrestricted educational
grants etc. etc. ... What we are dealing with here 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 levelsprivate
practitioners, public system psychiatrists, university faculty
and organizationally. What should be the most humanistic medical
specialty has become mechanistic, reductionistic, tunnel-visioned
and dehumanising. 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 scientific evidence about
why a single modelthe medical theory of 'chemical imbalances'
and pillsought to so overwhelmingly dominate mental health
care as it does today. A team of 14 mental health academics and
practitioners, MFI board member Loren Mosher included, was reviewing
the APA response to MFI's open letter from August 16, 2003, and
Perhaps the treatment is worsening the disorder. At
best, the treatment is not helping: researchers now recognize
that the most popular psychiatric drugs, the SSRI antidepressants,
rate only slightly better than inert 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 Drug Administration. These dubious
but tolerated practices create an enormously misleading view of
the actual impact of drug treatments. (…) In sum, the APA's statements
reflect less the "pace of science" than the pace of
commerce: they blur with the pharmaceutical advertising themes
saturating our media. This is because the APA 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 these drug studies that are ghost-written
by industry employees or marketing firms. Psychiatric drug experts
with no significant ties to industry can hardly be found. Industry
largesse binds many psychiatric practitioners to the industry
(cited in MindFreedom International, 2003).
Consequence 5: Supporting the withdrawal from psychiatric
Do no harm is also the basis, on which Mosher supported
the report "Coming off psychiatric drugs", a book with
first-hand reports 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 addressed mind- and
body-altering psychiatric drugs and withdrawal symptoms:
Most had never been warned that the drugs would change
their brains' physiology (or, worse yet, selectively damage regions
of nerve cells in the brain) such that withdrawal reactions would
almost certainly occur. Nor were they aware that these withdrawal
reactions might be long lasting and might be interpreted as their
"getting sick again." … However, because the drugs were
given thoughtlessly, paternalistically and often unnecessarily
to fix an unidentifiable "illness" the book is an indictment
of physicians. The Hippocratic Oathto above all do no harmwas
regularly disregarded in the rush to "do something."
How is it possible to determine whether soul murder might be occurring
without reports of patients' experiences with drugs that are aimed
directly at the essence of their humanity? Despite their behaviour,
doctors are only MD's, not MDeity's. They, unlike gods, have to
be held accountable for their actions. This book is a must read
for anyone who might consider taking or no longer taking these
mind altering legal drugs and perhaps even more 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,
The avoidance of psychiatric violence is possible even for
a psychiatrist and even from the psychiatric perspectivenot
surprisinglyhas better results than the use of typical
Staying away from illness and disorder models of any kindnot
surprisinglybrings better results than the use of typical
The abstinence from "experts"-arrogance opens the
view on the real problems of the people and promotes the co-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 psychiatry coincides
with the interests of people with mental problems of a social
Even with a psychiatric education, a humanistic philosophy
of life is possiblenot only in words, but also in practice.
No wonder, that the Soteria approach was receipted positively
and integrated into further approaches like the Berlin Runaway-house
(Wehde, 1991, pp. 46-50). Kerstin Kempker, (former) leading worker
in this well-known project, explained why Soteria and comparable
approaches have been so important for creating alternatives beyond
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 Kingsley Hall and its "children" Soteria, Emanon
and Diabasis we would miss the evidence, that the abstinence from
psychiatric measures andinstead of themthe life in
an awake and warming community with equal rights is 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 death of Loren Mosher:
We express our deep sorrow at the loss of our dear friend
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 help people undergoing
severe emotional distress.
His bravery in publicly resigning from the American
Psychiatric Association called to public attention the way in
which Big Pharma and bio-psychiatry have allowed profits to overrule
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: Peter Lehmann
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 Lehmann Publishing.
J., & Lehmann, P. (2004). Message on behalf of WNUSP /
ENUSP. 5. Congress of the European Network of (ex-) Users
and Survivors of Psychiatry (A joined congress of ENUSP and
the World Network of Users and Survivors of PsychiatryWNUSP):
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 WirklichkeitDas Berliner Weglaufhaus
(pp. 66-70). Berlin: Antipsychiatrieverlag.
MindFreedom International (2003, December 15). Reply
by Scientific Panel of the Fast for Freedom in Mental
Health to the 26 September Statement by American Psychiatric
Mosher, L. R. (1998, December 4). Letter
of resignation from the American Psychiatric Association.
Written to Rodrigo Munoz, M.D., President of the American
L. R. (2004). Preface. In P.
off psychiatric drugs: Successful withdrawal from neuroleptics,
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: Xlibris
Peeck, G., von Seckendorff, C., & Heinecke, P. (1995).
Ergebnis der Umfrage unter den Mitgliedern des Bundesverbandes
Psychiatrie-Erfahrener zur Qualität der psychiatrischen Versorgung.
Sozialpsychiatrische Informationen, 25(4), 30-34.
Retrieved November 17, 2007, from/www.bpe-online.de/infopool/recht/pb/umfrage.htm;
for more details, see Lehmann,
P. (1997). Variety instead of stupidity: About the different
positions within the movement of (ex-) users and survivors
Wehde, U. (1991). Das
WeglaufhausZufluchtsort für Psychiatrie-Betroffene.
Copyright by Peter Lehmann 2007
Address for correspondence
Tel. +49-30-85963706, E-mail: mail[at]peter-lehmann.de