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November Edition 2020 I NPN O N A N A T November Edition 2020 I NPN O N A L P A R A N O I A Limbrick Centre, Limbrick Road, Sheffield, S6 2PE, Tel: 07590837359 Email: [email protected] N Website: www.nationalparanoianetwork.org E [email protected] The articles are the views of the contributors and not T necessarily those of NPN W O R K 1 The Soteria Approach The history of Soteria as an approach dates back to 1971 when Dr. Loren Mosher of the National Institute for Mental Health opened the first “Soteria House” in Santa Clara, California. Although Dr. Mosher’s radical ideas led to a resignation from the NIMH, his work has expanded across the globe, with houses in Hungary, Vermont, and Israel, to name a few. Soteria is well known for its non-medical approach, providing first experiencers of acute psychosis a “safe haven” during such difficult extreme states. This non- medical approach includes a comfortable and home-like residence, layperson staffing, and involvement in everyday life relationships and activities as opposed to the artificial situation of a psychiatric ward. Research from the original Soteria House pointed to positive outcomes, such as benefits related to psychopathology, work, social functioning, and discontinuation of psychiatric medication. Soteria‘s core principles were developed by Loren Mosher and Luc Ciompi over 30 years and include: 1. “The provision of a small, community-based therapeutic milieu (akin to a living community). 2. A significant proportion of layperson staff. 2 3. The preservation of personal power, social networks, and communal responsibilities. 4. A “phenomenological” relational style which aims to give meaning to a person’s subjective experience of psychosis by developing an understanding of it by “being with” and “doing with” the clients. 5. No or low-dose antipsychotic medication, with all psychotropic medications being taken by choice and without coercion.” The current article uses phenomenology and an analysis of the social environment of the Soteria house to uncover the healing mechanisms of the treatment model. Many of the authors’ insights are derived from experience with the Soteria House Reichenau in Germany, as well as previously published accounts of the Soteria model. The authors describe a phenomenological understanding of schizophrenia, followed by an analysis of how the Soteria environment provides an opportunity for individuals to recompose a disordered sense of self safely. Dr. Nischk and Dr. Rusch begin by explaining that some professionals view schizophrenia as a “disorder of the minimal or core self.” In other words, the underlying sense of being an “I” who is capable of thinking, feeling, and acting on one’s own is disturbed. This leads to a chaotic organization of reality, from fluctuating self- awareness to difficulty navigating a shared social world 3 with others. Anomalous psychotic experiences, such as delusion and paranoia, are described as an attempt to make sense of this fundamentally disordered self-and- world awareness. “From these basic disturbances, a host of consequential and compensatory experiential alterations may develop, including an abnormal sense of consciousness and presence, altered bodily experiences, and a fragile self- other distinction.” They also link this disturbed core self to social life, stating that the confusion of psychosis coincides with an inability to judge the boundaries between self and other. The core self is not merely “inside” but is related to difficulties establishing an “I-Thee” relationship that would allow an understanding of oneself as an “I” in the first place. “The therapeutic challenge may thus consist in providing a social milieu that considers the fragile interpersonal boundaries while offering opportunities for engagement.” One of the effects of this core self-disturbance is difficulty navigating complex environments. The authors explain that conventional psychiatric wards often have strange and alienating lists of rules and social demands, which can confuse people experiencing psychosis. The Soteria house, on the other hand, establishes a 4 “normal” environment. This can be as simple as a coffee machine, a table with chairs, and a deck of cards, all situated within a small and “cozy” setting with carpet to dampen excess noise. Social roles are also well-defined, such as “guest” and “host” rather than the complex hierarchy of a psychiatric hospital. The authors argue that this “normal” kind of environment is less confusing and can allow a more relaxed and familiar world for individuals to navigate, ultimately reducing emotional tension. One of the pillars of the Soteria model is what the authors call “being-with.” This is described as similar to the original caretaker-infant relationship, out of which the core self is established developmentally. Because psychosis is marked by difficulties with the self-other relationship, it is believed that sharing space with individuals experiencing psychosis can help them begin to develop a sturdier core self. This is achieved through a caring, attentive form of relating, corresponding to what the authors call “synchrony” or “intercorporality,” explained as the natural rhythm of “gazes, gestures, and affective responses.” Individuals with a disturbed core self can begin to safely probe and test against the boundaries of the people spending time with them, leading to a stronger ability to self-reflect and see oneself as an individual. This may 5 look like the natural engagement of sitting and talking, taking walks together, or performing mutual tasks. “This may prepare the ground for other acts of selfhood, such as exchanging first- and second-person accounts, distinguishing fantasies from perceptions, verbalizing diffuse self-disturbances, or contextualizing experiences with respect to time and place, again approximating the corresponding process during infancy and childhood. Eventually, a third-person perspective may re-emerge, from which the individual can reflect on his or her assumptions and experiences.” A second pillar is called “doing-with.” This is described as an extension of “being-with” in the context of the Soteria social environment. Cooking, cleaning, and other mutual tasks provide an opportunity for further social engagement and consolidation of a stronger core self, in addition to building essential life skills which are often impaired in individuals who have a schizophrenia diagnosis. The effects of “doing-with” cover everything from strengthening these necessary social and life skills to building a more coherent “motor schema,” as individuals experiencing psychosis often struggle with a sense of fragmented body and mind. Bodily repetition and problem-solving, grounded in a safe social environment, can provide a healing space for this fragmentation. These tasks can help to re-train 6 concentration and memory skills, rebuilding the social, cognitive, emotional, and bodily foundation of the core self. “Therefore, doing-with as a holistic way of mutually assigned communal responsibilities offers multiple pathways of promoting the restitution of a vast array of aspects of selfhood underlying many higher skills, both motor and social,” the authors write. “Within a broader context, this daily collective practice might support people with the schizophrenia syndrome in re- establishing commonsensical ways of interacting and thereby in re-inhabiting their social world Peter Bullimore the Co-founder of the National Paranoia Network With Loren Mosher in Bradford in 2003 7 Psychosis as a developmental disorder: Dr Bob Johnson Everyone is born with a healthy mind. For some, a ‘catastrophe’ happens, and a brick is thrown into the works, which then stops the sufferer thinking straight. Being prevented from ‘thinking straight’, allows this ‘catastrophe’ to persist – but only in the sufferer’s mind in the real world, it’s long gone, it’s over. Therefore, the remedy is to gain the person’s trust, so as to bring their thinking up to date. Whatever this ‘catastrophe’ might have been – it could have been anything from a misplaced frown, through abuse, to parental death the key fact is that it’s now over. This is simple to say, if it weren’t, I couldn’t understand it but hard to do trust can take decades to build. Once trust is broken, it can be exceedingly hard to restore, and that is the crux of the matter. It pays the infant to not-think-straight – something which only trustworthy support can even begin to repair. Drugs prolong it, encouraging zombified withdrawal, ever further from reality. Adult emotional requirements differ radically from a child’s. Parenting keeps infants alive and adults insane. Let’s take two examples. A dad is away from home on business for a week or so. On greeting him on his return at the airport, his 2-year-old daughter runs across to greet him, “Daddy, daddy” she says. But then she stops abruptly, halfway. A ‘catastrophe’ has intervened and 8 so prevents her delivering her warm emotional welcome. The dad brushes this off, the child buries it. It doesn’t matter what the ‘catastrophe’ was, what matters is that it has thrown a brick into her emotional life – a brick that then becomes too painful to contemplate, to think about, and so to see it’s out of date. Which is tragic, because while parental love and support are vital in infancy, and were probably never absent in this case, some sort of miscommunication has gummed up the works. Something and I’m no longer interested in what, stops the child running towards what she desperately wants, and in infancy cannot survive without. Thinking straight would have allowed her to continue running gleefully towards dad, who was absent before, but now returned. This is the reality, the not-thinking-straight distorts that reality, a distortion which the individual sufferer is quite unable to correct, precisely because, you’ve guessed it, and it’s the one topic they cannot think straight about. This is such a grievous ‘injury’ to our mental world that all sorts of misapplications can follow, including, in worst cases, the incredibly painful symptoms of psychosis.
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