What Soteria houses can teach us about psychosis, medication, and recovery
I first learned about Soteria houses when I stumbled upon the book Soteria: Through Madness to Deliverance on the book cart at a psychiatric hospital where I worked. I took it home, devoured it in a few days and returned it to the cart in hopes that it would inspire a hospitalized patient. The philosophy and approach of Soteria were entirely different from those of the hospital. Residents temporarily lived in a house that always had supportive people around. Meals were communal and as residents got better, they could participate in running the household and supporting their housemates. Residents at Soteria were treated more as friends or peers than disordered people who needed to be highly controlled.
Most residents entering Soteria were medication naive, and medication wasn’t required by the Soteria program. There’s a myth that psychiatric medication is required for the treatment of psychosis. It can be a big mindset shift for both people who experience altered states and mental health clinicians to understand that psychiatric drugs aren’t necessary for recovery and can even be a hindrance.
After leaving inpatient hospitals, I had the chance to work with a few clients in private practice that were medication naive. One client struggled with hostile voice hearing for about 15 years before we began working together. We explored voices, their meaning, and their relationship to the client’s past trauma. We carefully tracked outcomes to ensure the work was helping and in just 8 months, the client’s effect size was 1.5, almost twice what is considered a good outcome for therapy (0.8). It wasn’t just the numbers that told the success story, the client got a better job and told loved ones about the voices hearing so that they had enough support that therapy was no longer needed.
It can be hard for many people to believe these sorts of recovery narratives due to the misinformation about experiences often labeled schizophrenia or psychosis. However, the more I do this work, the more people I meet who have been able to recover better without medication. This is in sharp contrast to people I worked with in hospitals, who were often completely medication compliant but never recovered a life that I would want to live.
I work with many people who take psychiatric drugs and fewer that don’t. Some of my clients say that their experience is too overwhelming without drugs and they prefer to dampen the experience with medication. I totally respect that perspective, but I often wonder if some of those people would feel differently if they had a place like Soteria. A place that would give them the compassion and companionship needed to move through the full depth of their experience and come out on the other side feeling better.
This piece was inspired in part by videos from the Soteria Summit. The video below offers a lived perspective that deepens many of the themes in this post