Soteria House reflections from a former staff member: What is psychosis? Altered states? Extreme states? And why psychiatry is failing to support people during these challenging times.
After 40 years of working in the mental health field, I reflect on the beginning of my career in a National Institute of Mental Health–funded research project called “Soteria House.” I moved on to work in the public sector from crisis worker, to supervisor, to program manager, to Chief of Adult Outpatient services for the public mental health system in Santa Cruz County, California. I have come full circle, back to the lessons learned at Soteria House in the mid-1970s.
It is from this work experience that I learned about “extreme states”, aka persons labeled with psychosis and schizophrenia. As a 23-year-old undergraduate student working on my own major, art therapy, at University of California Santa Cruz, I was offered a field placement assignment at Soteria House.
My background was primarily art, but I was being encouraged to explore a new field called “art therapy.” This brought me to Soteria in San Jose, California. I arrived at Soteria, my first day on the job to find a Victorian-style large home in the heart of San Jose.
I was given very little background information, just so that I might be able to do “art therapy” with the residents. I didn’t know what the word schizophrenia meant, except maybe what I’d heard on TV, “a split personality.” My orientation was to a typical home environment, social introductions were made, and my volunteer job assignment was to simply “hang out and be with people.” After 6 months, a full-time paid staff position opened up, and I was asked to come work full time.
I never felt like I was “working,” and honestly, I loved being at Soteria so much that it wasn’t till the end of my employment that I even took note of how much I was being paid. There’s something about being with people when they are going through a difficult time that is such a privilege and truly an honor to be a part of this intimate journey. I was there because I chose to be and loved the “scene.”
There were times of deep pain, tears, screaming, throwing things, and no sleep for days on end, but always something would emerge and a calm would eventually arrive, you really had to have faith in the process. When sleep would finally come, often the resident would sleep for days and emerge as a totally different person. Quite, shy, a bit uncomfortable, and a curiosity to find out what had been happening . . . these were the times for putting the pieces of the puzzle together.
The residents chose to be at Soteria; I slowly learned that this was a federal research project, funded by the National Institute of Mental Health. The project director was the director of the schizophrenia division, Dr. Loren Mosher. Dr. Mosher and John Bola both wrote papers on Soteria, Mosher on the clinical program and design and Bola as the program evaluator (Bola & Mosher, 2003).
The residents were screened by psychologists at the local locked psychiatric inpatient hospital, Valley Medical Center, a Hospital in San Jose. They needed to fit the DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria for “schizophrenia,” and it needed to be their “first break.” They were given the choice of staying at the hospital or coming to Soteria.
All six residents were given their own private room and had the freedom to do what they felt like. This might include staying in their bedroom, sleeping all day, or hanging out in the living room and listening to music or chatting with whomever was around. Relationships developed naturally, and we all got to know one another to various degrees, no different than how we develop friendships. This was not a therapist-patient relationship but rather a sort of social relationship.
As a staff member I had some responsibilities—going to the market and preparing dinner. Everyone was on their own for breakfast and lunch and could help themselves to whatever they might like. Grocery shopping was often an outing to the market. Usually, one or two residents would accompany me to the store. When we returned home, I would ask for help prepping the meal. It was all quite informal. The house was often a bit of a mess, but then, we’d all get together and decide it was time for a quick house cleaning and again, whoever wanted to join would do so.
Late night is when there was the most connection. We typically would stay up until at least 2 or 3 a.m., and it wasn’t unusual to be up all night talking in the living room. Being a young woman in my 20s, this was a time of life when I really thrived on intensity and deep conversations. Soteria was the perfect place for this! I believe that my own personal experience experimenting with psychedelics during the 1970s actually contributed to my ease and comfort with people who often were in extreme states or as I would think of it “altered states.”
Even though I was aware that the people I was with had been labeled with “schizophrenia,” that label meant nothing to me. So I found out that the altered realities were much easier to relate to, and this became the “frame” I operated in while “at work.” In some ways, one could think of my role as a guide for someone on a psychedelic journey, at least this is how I framed my work.
When I left Soteria House, I was asked by a local therapist in my community if I’d come to work on the county’s Crisis Team for the local community mental health agency. This therapist knew about Soteria and assumed that if I could work with people who were in a “psychotic” state, unmedicated, that I could work on the crisis team. So began my work for the traditional mainstream system.
I was the “gatekeeper” for the locked psychiatric hospital. I would perform the assessments, give a working diagnosis, and decide if one needed to be admitted to the hospital or not. Given my Soteria background, I clearly had a strong bias NOT to admit if at all possible. The challenge was that there was not a Soteria House to send someone to who was in a vulnerable state.
I often would spend hours with individuals and their families to create a “safety net” so that they might go home. This safety net really consisted of what I had learned at Soteria. I would merely pass this knowledge on to others. The basic instructions would be to have a team of family and friends who would stay with the person of interest 24/7. I emphasized compassion, nonjudgment, and that the goal was to make a human connection while holding a “safe” space.
I’ve worked in the public mental health sector for more than 30 years, finally terminating my career in the clinical area as the chief of adult outpatient services.
I spent almost 40 years working with people who have been diagnosed with various types of psychotic disorders. What I’ve witnessed is that we still don’t know what causes these states. The medical model has not been successful in fulfilling their promise of “recovery.” In fact, my view tells me that people get worse, much worse than those who were the lucky ones to be at Soteria. The high numbers of people considered to be “chronically mentally ill” is a sad statement of our currentsystem. This often is what is considered “recovery”: stabilization on medications and a lifetime on state disability. Is this recovery? Or is this the result of a broken and misguided system?
So what is psychosis? I believe that psychosis is an amazing and powerful defense mechanism, a mode of survival when something in one’s life is simply intolerable. This more often than not stems from a trauma.
Trauma is different for each individual. What one considers traumatic another may not. Therefore, it requires a deep sensitivity and understanding, listening, and “being with” to learn about what might have triggered this response of psychosis. It is only from the “being with,” that is, with the development of a true relationship—that will allow for the story to unfold and understanding and human connection to set in. This is where “recovery” happens.
I do not believe that we can say that psychosis is a biologically induced state. Maybe there is a small percentage of people for whom one day science will discover a link in their DNA, but I believe that the majority of our friends and family who are deemed “mentally ill” have been diagnosed without any scientific evidence to support this hypothesis.
What can a caregiver do to be helpful during a psychotic state?
Be real, be yourself, and develop a true human connection based on honesty and your own inherent ability to be with another human being who is in distress. This may include talking, listening, or the act of “being with.” Your presence will be felt, and this creates a sense of safety and being known and knowing the other. Trust in the process of human connection and that understanding and healing will emerge from these connections.
Today there are groups meeting to have Soteria like homes in their country, the UK meets through the Soteria Network. Berne, Switzerland has had a Soteria House opened since 1984. Soteria Israel was recently opened and you may read more about it here.
|Bola, J. R., Mosher, L. R. (2003). Treatment of acute psychosis without neuroleptics: Two-year outcomes from the Soteria Project. Journal of Nervous and Mental Disease, 191, 219–229. Google Scholar, Crossref, Medline, ISI|
Yana Jacobs, LMFT, is currently chief development officer at the Foundation for Excellence in Mental Health Care, a nonprofit community foundation with a mission to bring alternatives into the mainstream public and private sectors. She began her work at Soteria House as a staff member in the mid 1970s, mentored by Loren Mosher, MD. Soteria House became her clinical foundation as she moved into other areas of employment within the mental health world. Yana spent more than 30 years working both in private practice as a therapist and in the public sector at Santa Cruz County Mental Health in California. She first worked with their crisis team and later became the Chief of Adult Outpatient/Recovery services. As an ally to people with lived experience, she implemented a Peer-Run Respite House, funded by a federally funded SAMHSA Transformation Grant. Yana believes that we must work both as activists on the outside and with our allies on the inside if we are to bring about real change. She teaches about “being with” people who are in extreme states, based on her work and life experience at Soteria House.
Re-used with permission from SAGE Publishing.
Soteria: Reflections on “Being With” finding ones way through psychosis. Yana Jacobs. Journal of Humanistic Psychology. First Published March 19, 2018