|Lecture at the congress "Soteria and No
Restraint", Merano, Italy November 21-23, 2007
Judy Schreiber Mosher
Does Soteria Have Future?
First I would like to thank the organizers of this meeting for including Soteria in this program and recognizing the important work of Dr. Mosher. I personally feel privileged and honored to be a speaker.
As many of you know, the concept of Soteria has been around since 1971. Several
months before Loren was diagnosed with the cancer that ended his
life, he looked up from something he was reading and said in an
excited, animated voice: "Judy, I think it's going to happen;
I think the concept of Soteria is catching on." What incredible
dedication and hope he displayed after all those years
still fighting for the right to alternative treatment for those
labeled with a diagnosis of schizophrenia; a treatment free of
restraints, both literally and pharmaceutically.
When Dr. Toresini asked me for a tentative title for my talk I quickly responded "Does Soteria Have a Future?" It was one of those lazy, sunny California days when the present seems endless and the future distant. The fact that I would actually have to present a paper with that title was furthest from my mind I just wanted to answer his email as quickly as possible and go back outside.
Several weeks ago, when the definitive Soteria Programme came,
I realized with a start that I had to present a professional paper
with that title. The enormity and grandiosity of my topic hit
me. After all, I was married to Loren
R. Mosher, with all the accompanying pleasures and burdens,
but I am not he, and I am clearly not a fortune teller, for if
I were, I would not be here, but in an extravagantly beautiful
office, filled with candles and incense, making millions of dollars
predicting the future for those who were interested.
As I thought about my topic and looked at the program, I realized that there are many competent presenters who can tell you about Soteria: Dr. Aderhold will talk about Soteria in the Literature, Dr. Bola will talk about Soteria and Economics, Dr. Burti will talk about Soteria as a teaching opportunity, and so on with the other excellent presenters. My unique vantage point, I realized, is as the wife and colleague of Loren Mosher. I strongly believe that in order to understand whether Soteria has a future, it is first important to understand something about Loren's dedication to his work and something about Loren's trials, tribulations and conquests. Nothing and no one exists in a vacuum, and, as he used to point out context is everything. The future, as we all know, is built on the past. So let me take you on a short journey, back in time.
Loren Mosher was born in Monterey California on Sept. 3rd 1933. His birth certificate
lists his father as a teacher and his mother as a housewife. The
world little noticed his birth. On that day one of the headlines
of the NY Times was a story about a new 700 horsepower Transcontinental
Airplane that would fly 208 mi. an hour and hold 14 passengers.
There was another headline which talked about the approaching
end of prohibition in America and yet another headline under a
picture of Franklin Delano Roosevelt talking about the crises
in Europe. One of the advertisements of the day stated, "Please
Your Wife by choosing a low-priced car between $445.00
565.00. It was not a particularly auspicious time to be
born but not bad either particularly because it was the
end of the prohibition of alcohol. For sure, for Loren, that was
an auspices start.
When Loren was young he had his first experience with hallucinations his own. He was desperately ill with some kind of encephalopathy, ran high fevers and saw and heard things that others did not experience. Luckily his pediatrician, the first female to graduate from Johns Hopkins Medical School, was kind and careful and did not overreact to these experiences. Was this one of the seeds of the future Soteria concept?
Loren's mother died when he was eight. He was in a military boarding school at the time she was in a hospital dying of breast cancer. His father was in the Navy. He told me that he knew the exact moment she died, even before he was told. He had some existential feeling and premonition and he simply knew, and he was right. Was it this experience that made him believe in the value and uniqueness of each person's experiences and perceptions?
Dr. Mosher developed his maverick tendencies after his mother died. Between the ages of eight and 14 he was shunted from grandmothers to uncles and, as he used to tell me, "I basically raised myself during those years." Even when he started living with his father he had extraordinary freedom. He obtained his driver's license when he was 14 and learned how to fly small airplanes when he was 15. His father was busy marrying and burying his second and third wives, or as Loren put it, "I never quite knew who was going to be my mother when I walked into the house, there were so many." Were these the experiences that added to Loren's belief in the need for consistency?
When he was in the eighth grade he was doing so poorly in school that the school system wanted to put him in a vocational/trade school because they believed that would be the limit of his abilities. His father, a carpentry teacher, went to the school and argued on behalf of his son's abilities and convinced the school board that he should follow the usual academic tract. Was this the seed of Loren's belief in the power of families and context?
Loren successfully graduated from high school and was accepted to Stanford
University. For those who don't know, since he was not borne to
privilege or money, he had to work his way through college and
subsequently medical school. During the summer prior to his first
year in college he faked his ID and worked as a roughneck on an
oilrig. He told them he needed money to go to medical school.
The lie was so successful that the other men started calling him
"doc" and asking him to treat their ailments. Luckily,
Loren once told me, the complaints were limited to the need for
simple first aid, common cold ailments and sexual complaints and
diseases. He said it was there that he learned the power of being
called a doctor. He had already planned to pursue medicine but
this convinced him even further. He completed his Bachelor's Degree
He attended Stanford University Medical School for two years and then transferred to and graduated form Harvard University Medical School. He once told me that he applied to Harvard because he was so angry that they rejected him the first time he decided to try again. As he used to say, "I had the best of medical schools on both coasts east and west in U.S.
During his psychiatric residency at Massachusetts General Hospital he met, and was supervised by, Elvin Semrad, who had an enormous influence on his beliefs and career. It was from Dr. Semrad that Loren first heard and learned of the concept of being with rather than doing to a central tenet of Soteria.
"His encouragement to relate to schizophrenics as people with very serious
life difficulties, to treat them with dignity and respect, and
to attempt to see things as they saw them was a critical piece
of my subsequent development," Loren once told an interviewer.
It was during this experience, at Massachusetts Mental Hospital,
that he began to realize psychiatric hospitals and good treatment
were not synonymous.
In 1964 he was accepted to the National Institute of Mental Health as a Clinical Associate. As he put it to me "I was a golden boy, on the track to becoming a department head some day." There he studied twins who were discordant for schizophrenia. Although he later acknowledged the sample was small and there were selection problems, the results, which showed that the twin who had schizophrenia was treated differently by the parents, influenced his later thinking.
On the track to becoming a golden boy...but something happened. He convinced the NIMH to send him to London in 1966, where he studied at the Maudsley, did couples' therapy at the Tavistock Clinic and spent time with Ronnie Laing and at Kingsley Hall, the latter leaving the biggest impression on Loren as a budding young psychiatrist. Of course the cultural revolution that brought the Beatles, mini skirts and drugs to London, and subsequently to the world, also impacted his free spirit. Loren decided at that time "that madness need not be and is probably better not treated in a hospital."
He was able to test his theories when he came back and worked at Yale University Hospital for a year. He was put in charge of a 20-bed ward, which he ran in a very open and free manner. After a year it was clear that the administrators at Yale were not happy with this experiment and Loren agreed to move on. He returned to the National Institute of Mental Health where he became the first Chief of the Center for the Study of Schizophrenia and founded, and was first editor of, the Schizophrenia Bulletin.
Loren had been honing his theoretical beliefs and observing the upsurge in the use of drugs as the treatment of choice for schizophrenia when he wrote a grant and obtained research funding for a house in the community to treat those persons newly diagnosed with schizophrenia. His original grant request was slashed and he was given funding for only 18 months rather than the five years that he requested. The proposal funded a house, called Soteria, meaning Salvation in Greek. Soteria opened in 1971. Another house, Emanon no name spelled backwards, was opened in 1974.
During the years that followed when Loren was constantly fighting the system, being vilified and marginalized by his colleagues, I can still hear him saying that his study, and the subsequent positive results, went against the major four tenets of psychiatry it was anti hospital, anti medication, anti professional and anti medical model.
Years of turmoil followed and Loren met Dr. Burti who told him about "new law" in Italy that closed the front doors of the mental hospitals. Loren went to Verona for a year, in 1980, to learn more about this new and revolutionary concept. He hoped to influence policy and treatment in the United States. However, when he returned from Italy in 1980 he was told that his position at the National Institute of Mental Health no longer existed; someone else was appointed to the position.
This did not stop him from talking and writing about his beliefs
and the Soteria model. He then worked as a professor, and vice
chairman of psychiatry, at a school that trained doctors for the
uniformed military services. When he did grand rounds for the
students, they would always bring him what they considered to
be the most psychotic persons and were always surprised when Loren
could talk to them. To him, it was simple as he once said: "It's
just a matter of how you approach people. If you treat them with
dignity and respect and want to understand what's going on, want
to really get yourself inside their shoes, you can do it."
While teaching at USUHS he was a consultant to a halfway house in Washington, D.C. and, with the staff, started Crossing Place, a house similar to Soteria in its smallness, and openness and staffing, but different in several ways: it was part of the public system and the length of stay was restricted to one month. Crossing Place also took in all kinds of patients, which meant as Loren said "black, lower class, homeless, fucked-up multi-drugged individuals." Also because the clients were heavily dependent on drugs no one made a big deal about medications. However, the general model of running the house and hiring staff was that of Soteria and like Soteria it was very successful 95% of those admitted were successfully discharged back to the community within the month. I know that Dr. Aderhold came to Washington, D.C. to study with Loren and worked at Crossing Place for 6 months, or maybe longer; I'm not sure.
I also had the honor and privilege of working at Crossing Place for a year and I can tell you from first hand experience that it was great, not only for the clients but for the staff as well. It provided me with a unique experience to learn what "being with" really meant. I would sit for hours with my assigned folks and just let it happen. My most memorable experience was when a client named Judy, the same name as mine, was lying with her head on my lap. After about 30 minutes Judy looked up at me, and with a twinkle in her eyes said, "look at this, Judy has her head in her own lap."
After the eight years at USUHS Loren became head of mental health for Montgomery County, a district in Maryland where he, with the late Dr. Fenton, opened up MacAuliffe House and researched the economic gains of such a crisis house. Again positive results a day in the crisis house cost less than a day in the mental hospital. In addition there was a comparison customer satisfaction sheet and the folks at MacAuliffe House expressed much more satisfaction than those who were in the hospital.
And of course I suspect you are all familiar with Dr. Mosher's famous letter of resignation from the American Psychiatric Association that he called the American Pharmaceutical Association.
You can agree or disagree with Dr. Mosher but one thing you have to say is that he was a courageous man who followed his beliefs, no matter where they led. There were many nights when he would rant against the system, his lips trembling and his eyes filling with tears. But he continued, not a Don Quixote going after windmills, but a dedicated warrior following his self assigned path.
Loren and his co-authors wrote approximately 40 articles on the success of the Soteria experiment, yet he continued to be marginalized throughout his lifetime, at least in the United States. I believe what kept his hope alive and fed his vision were the many centers in Europe, like this one, interested in learning more about Soteria so they could start one.
So I come full circle, does Soteria have a future? The answer is in the soul
and energy of the people in this room. If you believe, as Loren
did, in being with and not doing to, in minimal use of medication
and in the dignity of the human being, even if he or she carries
a label of schizophrenia, and most importantly if you are willing
to fight for your beliefs then yes, I believe Soteria has a future.
If you can say as he did.
"The most fun I have had in my life was just sitting, talking for hours
to people who were out of their minds."
Then yes, Soteria has a future.
However, if you are one of the establishment who will go along with your superiors,
not think independently, and are merely interested medicating
your clients and receiving a paycheck, then no, Soteria does not
have a future. Only you can decide that.
I would like to conclude by reading to you a quotation that I discovered several weeks ago:
There are stars whose light reaches the earth only
They themselves have disintegrated and are no more.
And there are people whose scintillating memory
Lights the world after they have passed from it.
These lights which shine in the darkest night
Are those which illumine for us the path.
Hannah Szenes (translator unknown)
I believe Loren was one of those people whose lights shine in
the darkest night and illumine for us the path. Whether you decide
to follow this path will decide if Soteria has a future.
Thank you very much. I look forward to two days of exciting talks and even some fun. After all, what would a meeting be in Italy without good wine, good talk and good food?
And oh yes, a bit of salesmanship if you are interested in purchasing the
book whose cover has been displayed on the screen in back
of me I have brought some and will be happy to sell them
during the break.