Commentary on the Soteria project: misguided therapeutics.

In The Divided Self (1965), R.D. Laing made an important contribution to phenomenology and inspired a generation of wrongheaded thinking about the treatment of schizophrenia. The Soteria House project, initiated by Loren Mosher on his return from a visit to Laing's Kingsley Hall, was based on a concept of schizophrenia as an existential crisis to be resolved at a personal and interpersonal level. Disease models and antipsychotic medications were considered impediments to the creative resolution of a psychotic episode, although it was acknowledged that they were sometimes necessary for management It was an interesting and daring approach to schizophrenia, most constructively construed as a psychosocial restitutive alternative to traditional hospitaiymedical treatment However, in sentiment and presentation, the Soteria House model eschewed the medical model and expressed ideology-based negativity toward the use of antipsychotic medications. Previous reports have shown that the Soteria House model can serve as an alternative to hospitalization in selected patients (Mosher et al. 1975; Mosher and Menn 1978; Mosher et al. 1995), but the risks and benefits compared with traditional care are very difficult to evaluate. Bola and Mosher (this issue) present a new analysis of old data. They interpret this analysis to substantiate the view that a minority of persons who are early in their course of schizophrenia can recover without medication. Putting aside the definition of recovery for a moment, substantial improvement and favorable course of illness off medication was noted by Bleuler (1978) in his long-term followup study and was also observed on a research unit with off-medication protocols (Carpenter et al. 1977), in the Chestnut Lodge long-term followup studies (McGlashan 1987), and more recently in the Finnish "need specific" treatment model (Lehtinen et al. 2000). More remarkable is the Bola and Mosher conclusion that the quality of the recovery is superior to on-medication recovery. These data are relevant to current issues in schizophrenia treatment, but the interpretation and conclusions are flawed. We present an alternative interpretation.