Ακόμα τρελός μετά από τόσα χρόνια

San Diego Weekly Reader, Vol. 32, No. 2, Jan. 9, 2003

Ακόμα Τρελός

Μετά Από Τόσα Χρόνια

Jeanette De Wyze, reporter

Σύντομα μέσα στους επόμενους μήνες, το Journal of Nervous and Mental Diseases θα δημοσιεύσει ένα άρθρο, το οποίο περιγράφει ένα ασυνήθιστο πείραμα, με ανθρώπους που είχαν πρόσφατα διαγνωσθεί με σχιζοφρένεια. Αυτό το πείραμα κατένειμε τυχαία, σε δύο διαφορετικές μορφές θεραπείας, νέους ανθρώπους που είχαν λάβει αυτή τη διάγνωση. Κάποιοι από αυτούς εισήχθησαν σε ψυχιατρικό νοσοκομείο, όπου τους χορηγούνταν φάρμακα, για να ελεγχθούν οι ψυχωτικές τους κρίσεις. Οι υπόλοιποι πήγαν σε ένα άλλο μέρος, γνωστό ως Soteria House (Σπίτι Σωτηρία). Έζησαν εκεί για αρκετούς μήνες, μαζί με μια άλλη ομάδα σχιζοφρενών, καθώς και με μια ομάδα ανθρώπων γεμάτων κατανόηση (όχι επαγγελματιών της ιατρικής), οι οποίοι τους παρήχαν συναισθηματική υποστήριξη όλο το εικοσιτετράωρο. Η έρευνα παρακολούθησε την πορεία των υποκειμένων της, για δύο χρόνια. Σύμφωνα με την πιο πρόσφατη αναφορά, οι σχιζοφρενείς που έζησαν στο θεραπευτικό σπιτικό και δεν έπαιρναν φάρμακα, τα πήγαν καλύτερα από εκείνους που λάμβαναν φαρμακοθεραπεία στο νοσοκομείο. Επιπρόσθετα, «αυτοί που τα πήγαν καλύτερα από όλους, ήταν οι ίδιοι για τους οποίους είχε προβλεφθεί ότι θα έχουν τα χειρότερα αποτελέσματα», αναφέρει ο Loren Mosher.

Ο Mosher, ένας ψυχίατρος από το San Diego, ήταν ο βασικός αρχιτέκτονας του πειράματος Σωτηρία. Όσα εκτυλίχθηκαν κατά τη διάρκεια των ετών που κράτησε αυτό το πείραμα (από το 1971 έως και το 1983), διαμόρφωσαν τις ιδέες του για τη σχιζοφρένεια, μια κατάσταση που εκτιμάται ότι προσβάλλει έναν έως δύο σε κάθε εκατό Αμερικανούς. Αντίθετα με την πλειοψηφία των συναδέλφων του, ο Mosher ποτέ δεν πείστηκε ότι η ψυχωτική συμπεριφορά ήταν αποτέλεσμα εγκεφαλικών αποκλίσεων. Κατέληξε μάλιστα να πιστεύει ότι, αν η σχιζοφρένεια δεν είναι μια οργανική ασθένεια, τότε είναι λάθος να πιέζονται οι σχιζοφρενείς να λαμβάνουν φάρμακα που αλλάζουν το μυαλό τους. Αναγνωρίζει βέβαια ότι η φαρμακευτική αγωγή, με τα ισχυρά αντιψυχωτικά που συνταγογραφούνται στις μέρες μας, συχνά όντως ανακουφίζει τα συμπτώματα τις τρέλας και κάνει ευκολότερο τον έλεγχο των διαταραγμένων ατόμων. Ωστόσο, ο Mosher ισχυρίζεται ότι υπάρχουν καλύτεροι τρόποι για να βοηθήσει κανείς τους περισσότερους από τους σχιζοφρενείς να επανακτήσουν την υγεία τους – τρόποι φθηνότεροι, περισσότερο ανθρώπινοι και φιλελεύθεροι, λιγότερο ενοχλητικοί για το σώμα και την ψυχή των ανθρώπων.

Επειδή ακριβώς εμμένει στις πεποιθήσεις του, ο 69χρονος γιατρός δηλώνει: «Είμαι εντελώς περιθωριοποιημένος από την αμερικανική ψυχιατρική. Δεν με προσκαλούν ποτέ να δώσω grand rounds. Δε με προσκαλούν ποτέ να κάνω παρουσιάσεις. Δεν είμαι ποτέ προσκαλεσμένος σε συνέδρια ως κύριος ομιλητής, στις Ηνωμένες Πολιτείες. Ωστόσο, από το 1968 μέχρι το 1980, την περίοδο που πολλές από τις ανορθόδοξες πεποιθήσεις του βρέθηκαν στο επίκεντρο του ενδιαφέροντος, ο Mosher κατείχε μια διακεκριμένη θέση στην ψυχιατρική ερευνητική κοινότητα της Αμερικής. Υπήρξε ο πρώτος επικεφαλής του Κέντρου Ερευνών για τη Σχιζοφρένεια στο National Institute of Mental Health, της Washington, D.C. Ίδρυσε το περιοδικό Schizophrenia Bulletin στο οποίο διατέλεσε αρχισυντάκτης για δέκα χρόνια. Η ιστορία για το πώς και το γιατί έγινε ο παρίας του επαγγέλματός του, αποκαλύπτει πολλά για τους αθέατους τρόπους με τους οποίους άλλαξε η ιδέα της τρέλας στην Αμερική, στη διάρκεια των τελευταίων σαράντα χρόνων.

Τα ίχνη των μη-συμβατικών τάσεων του Mosher μπορούν να αναζητηθούν στην παιδική του ηλικία. Υπήρξε ένα ασθενικό αγόρι φορτωμένο με αλλεργίες και άσθμα και έχασε τη μητέρα του από καρκίνο του στήθους, όταν ο ίδιος ήταν εννέα ετών. Καθώς μετακόμιζε συνέχεια από συγγενή σε συγγενή, ο Mosher λέει ότι λίγο-πολύ ανέθρεψε ο ίδιος τον εαυτό του, από τα οχτώ έως τα δεκατέσσερά του χρόνια. Το 1949 είχε ήδη εγκατασταθεί με τον πατέρα του στην κομητεία Marin, ωστόσο συνέχισε να απολαμβάνει ασυνήθιστη ελευθερία ως έφηβος. Είχε άδεια και δίπλωμα οδήγησης από την ηλικία των δεκατεσσάρων. Τα καλοκαίρια εξερευνούσε την έρημο της Sierra Nevada πάνω σε ένα αράβικο στάλιον που του παραχωρούσε κάποιος θείος του. Πριν να περάσουν δυόμισι μήνες από την αποφοίτησή του απ’ το γυμνάσιο, έπιασε δουλειά ως εργάτης στις πετρελαιοπηγές της Montana και του Wyoming, χρησιμοποιώντας ψεύτικη ταυτότητα, για να αποδείξει ότι είναι πάνω από εικοσιένα χρονών. «Η ιστορία που έλεγα ήταν πως δούλευα μετά το κολέγιο για να μαζέψω λεφτά και να πάω στην Ιατρική.» Το ψέμα εκείνο τον μεταμόρφωσε, όπως διηγείται. «Απότομη αλλαγή. Ήμουν ο «Γιατρός». Η πρακτική μου ευτυχώς περιορίστηκε σε απλές πρώτες βοήθειες, συνήθεις ασθένειες όπως κρυολογήματα, και κάποιες σεξουαλικής φύσης ενοχλήσεις, όπως ψείρες των γεννητικών οργάνων και γονόρροια.» Ο Mosher πάντως είχε εκπλαγεί και κατενθουσιαστεί από το πόσο σημαντικός έγινε ξαφνικά στα μάτια των συναδέλφων του «επειδή φαινόμουν έξυπνος και «επρόκειτο να γίνω γιατρός»».

Έπρεπε πρώτα να μπει στο κολέγιο. Είχε κερδίσει μια υποτροφία για το Stanford, που τότε ήταν γνωστό ως το σχολείο-πάρτι για λευκούς αγγλοσάξονες προτεστάντες. Η ιδέα των πάρτι του άρεσε, αλλά έπρεπε επίσης να δουλεύει για να βγάζει τα έξοδά του. Ο Mosher ήξερε ότι ο απώτερος σκοπός του ήταν το πτυχίο ιατρικής. Μικρός έτρεφε θαυμασμό για τη γιατρό που τον φρόντιζε σε καθεμιά από τις πολλές παιδικές ασθένειες που είχε περάσει και λέει οτι οι ικανότητές της και η κατανόηση που του έδειξε, τον έκαναν να θέλει να γίνει κι αυτός γιατρός. Αφού η Ιατρική Σχολή του Harvard τον απέρριψε, παρακολούθησε μαθήματα στο Stanford για δύο χρόνια και ύστερα έκανε διακοπή σπουδών για ένα χρόνο, ώστε να εξοικονομήσει χρήματα. Τότε τον δέχθηκε το Harvard για μεταγραφή. «Έτσι, το πτυχίο μου – με έπαινο – είναι από την Ιατρική Σχολή του Harvard. Πράγμα σημαντικό», λέει σα να έκανε καμιά σκανδαλιά. «Εξηγεί πολλά πράγματα τα οποία μπόρεσα να κάνω, ενώ άλλοι συνάδελφοι συναντούσαν κωλύματα». Ο Mosher συνδέει το πτυχίο από το Harvard με το ότι μπόρεσε να έχει μια «πολύ πολύ καλή φοιτητική ταυτότητα… Η ικανότητά σου να κάνεις πράγματα διευκολύνεται». Μετά την αποφοίτηση, μπήκε εσώκλειστος στο University of California, του San Francisco. «Κ έπειτα πήρα ειδικότητα ψυχιάτρου, πάλι στο Harvard.»

Γιατί ψυχιατρική; Ο Mosher εξαίρει αρκετές εμπειρίες στην ιατρική σχολή, που κίνησαν το ενδιαφέρον του για αυτό το πεδίο. Κάποια στιγμή αρρώστησε, «επρόκειτο για την περίπτωση της υποχονδρίασης που παθαίνουν οι φοιτητές ιατρικής» και ήταν αρκετά σοβαρή ώστε να τον αναγκάσει να ζητήσει ψυχολογική βοήθεια. «Στην ψυχοθεραπεία μου, που κράτησε πάνω από ένα χρόνο, έζησα από πρώτο χέρι τις θεραπευτικές δυνατότητες μιας υποστηρικτικής ανθρώπινης σχέσης.» H συμμετοχή του σε μια καλοκαιρινή ψυχιατρική κοινότητα, τον έφερε σε γνωριμία με εμπνευσμένους ψυχιάτρους, όπως ο Gregory Bateson και του παρήχε τη δυνατότητα να πάρει μια ιδέα για τις «ανθρωπιστικές δυνατότητες» της ψυχιατρικής, οι οποίες για τον Mosher έρχονταν σε αντίθεση με τις τεχνολογικές και μηχανιστικές όψεις πολλών από τις υπόλοιπες ιατρικές ειδικότητες. Έμοιαζε ότι όλοι οι φίλοι του θα διάλεγαν ψυχιατρική˙ ακολούθησε κι ο ίδιος.

Αναφέρει ότι εκείνος ο ένας χρόνος που πέρασε ως εσώκλειστος γιατρός, τον βοήθησε να διαμορφώσει μερικές από τις κεντρικές του στάσεις. Καθημερινά αντιμέτωπος με «την αρρώστια, την αδιαφορία και το θάνατο, καταστάσεις πάνω στις οποίες είχα πολύ λίγο έλεγχο ή επιρροή» , ο Mosher ένιωσε αποφασισμένος να μη βλέπει τους ασθενείς του σαν αντικείμενα, όπως έμοιαζαν να κάνουν πολλοί συνάδερφοί του. Έμπνευση βρήκε στα κείμενα σύγχρονων υπαρξιστών και φαινομενολόγων στοχαστών, όπως ο Rollo May, ο Soren Kierkegaard, ο Jean Paul Sartre, ο Maurice Merleau-Ponty και άλλοι. «Η κεντρική ιδέα τους είναι, βασικά, διασκέδασε τον εαυτό σου, γιατί μπορεί αύριο το πρωί να μην ξυπνήσεις», εξηγεί ο Mosher. «Και είχαν μια πολύ ευθεία αντιμετώπιση ως προς το να δέχονται τους ανθρώπους γι’αυτό που είναι, χωρίς να τους κρίνουν, να τους κατηγοριοποιούν και να τους ταιριάζουν σε κουτάκια. Απλώς προσπάθησε να είσαι εκεί, να είσαι το καλύτερο που μπορείς σε ό,τι κι αν κάνεις. Όταν έχεις γύρω σου ανθρώπους που πεθαίνουν και δεν υπάρχει τίποτα άλλο που να μπορείς να κάνεις, αυτό είναι τουλάχιστον μια ανακούφιση».

Το 1962 ο Mosher έφτασε στο Ιατρικό Κέντρο Υγείας της Μασσαχουσέττης (ένα ίδρυμα που για καιρό ήταν γνωστό ως «Psycho», χάρη στο προηγούμενο όνομά του: «The Boston Psychopathic Hospital»). Εκεί, ένας στρουμπουλός ασπρομάλλης, που έμοιαζε με τον Αη Βασίλη, «με έκανε να ξεφορτωθώ όποιες τάσεις μου είχαν απομείνει σχετικές με το να “θεραπεύω” ασθενείς», λέει ο Mosher. Αυτός ο άνθρωπος, που έγινε ο μέντορας του Mosher, παρακινούσε τους ψυχιάτρους να ξεχάσουν την ιδέα του να κάνουν πράγματα στους ασθενείς. Αντί για αυτό, τους ενθάρρυνε να είναι μαζί με τους ανθρώπους που υπέφεραν – να τους καταλαβαίνουν, να τους δέχονται και να χτίζουν σχέσεις μαζί τους. «Η ενθάρρυνσή του να σχετιζόμαστε με τους σχιζοφρενείς ως ανθρώπους με πολύ σοβαρά προβλήματα ζωής, να τους φερόμαστε με σεβασμό και αξιοπρέπεια και να προσπαθούμε να βλέπουμε τα πράγματα όπως εκείνοι τα έβλεπαν, ήταν ένα πολύ σημαντικό κομμάτι στη μετέπειτα εξέλιξής μου», τονίζει ο Mosher.

Όμως ο Mosher ήρθε αντιμέτωπος με καταστάσεις που έδειχναν ότι η κουλτούρα του ψυχιατρικού νοσοκομείου αντιστεκόταν σε τέτοιες συμπεριφορές. «Εκλογικεύονταν πιο άνετα οι αποφάσεις που έπαιρνε το προσωπικό, παρά οι ασθενείς˙ και σωματικές θεραπείες, όπως τα ηλεκτροσόκ, εφαρμόζονταν εκεί που υπήρχε πρόβλημα σχέσεων». Όταν έληξε η θητεία του, είχε αναπτύξει δύο αλληλοαποκλειόμενες στάσεις. Η πρώτη ήταν ότι «οι ανθρώπινες σχέσεις θα μπορούσαν να είναι θεραπευτικές, ακόμη και για αυτούς που η κυρίαρχη τακτική τους ήταν να αποστασιοποιούνται» - δηλαδή, για τους σχιζοφρενείς. Από την άλλη μεριά, θεωρούσε ότι η πραγματικότητα της ζωής μέσα στο ψυχιατρείο εμπόδιζε τη δημιουργία τέτοιου είδους σχέσεων.

Ο Mosher δεν είχε σκοπό να ξοδέψει την καριέρα του μέσα στα ψυχιατρεία. Οραματίστηκε ένα μονοπάτι, που θα μπορούσε να τον οδηγήσει σε διακρίσεις ως ψυχιατρικό ερευνητή˙ και σαν ένα πρώτο βήμα προς αυτή την κατεύθυνση κέρδισε μια θέση «κλινικού βοηθού» στο Εθνικό Ινστιτούτο Ψυχικής Υγείας (ΝΙΜΗ). Ξεκινώντας το 1964, δούλεψε στον τομέα των Μελετών για την Οικογένεια, εξετάζοντας οικογένειες που είχαν παιδιά με σχιζοφρένεια.

«Έρευνες σε διδύμους για τη σχιζοφρένεια γίνονταν από τις αρχές του 1900», αναφέρει. «Οι Γερμανοί ήταν οι πρώτοι που τις έκαναν». Μέχρι το 1960, σύμφωνα με τον Mosher, μερικές αυθεντίες δήλωναν ότι,στα δύο τρίτα περίπου των περιπτώσεων που το ένα ομοζυγωτικό δίδυμο είχε σχιζοφρένεια, το άλλο δίδυμο ήταν στην ίδια κατάσταση. Αν αυτό ήταν αλήθεια, θα αποτελούσε ένα ισχυρό στοιχείο ότι η σχιζοφρένεια έχει γενετική βάση , εφόσον τα ομοζυγωτικά δίδυμα μοιράζονται τον ίδιο γενετικό κώδικα. Ωστόσο, τον καιρό που ο Mosher έφτασε στο Ινστιτούτο, λέει ότι υπήρχαν κριτικές που είχαν αρχίσει να αμφισβητούν την αξιοπιστία των μελετών με δίδυμα. Νεώτερες και μεθοδολογικά σταθερότερες έρευνες έδειχναν πολύ χαμηλότερο βαθμό συσχέτισης.

Η ομάδα στην οποία συμμετείχε ο Mosher δεν μελετούσε τέτοιες στατιστικές συσχετίσεις, αλλά προσπαθούσε πιο πολύ να καταλάβει τι γίνεται στις περιπτώσεις των ασύμφωνων όμοιων διδύμων – δηλαδή αυτών εκ των οποίων το ένα είναι τρελό μα το άλλο όχι. «Φέρναμε τα δίδυμα και τις οικογένειές τους στο κλινικό κέντρο για περίπου δύο εβδομάδες και τους μελετούσαμε ως ομάδα». Το εύρημά τους, λέει ο Mosher, ήταν οτι σε αυτές τις οικογένειες, το δίδυμο που δεν κατάληγε σχιζοφρενές «ουσιαστικά είχε λάβει διαφορετική μεταχείριση από το αδελφάκι του, με διάφορους τρόπους».

Σήμερα

Two Alternative Viewpoints:
Psychotropic Drugs and Crises

A Response to Practical Questions Raised by this Web Site

I. The Use of Psychotropic Drugs:

The materials presented on this website make clear some of our views on the overuse and misuse of the psychotropic drugs, in particular the so called "neuroleptics" or "anti-psychotic" medications. These drugs, even the newer so-called "atypicals", have serious adverse effects and toxicities associated with their use. Some of their toxicities are life threatening (neuroleptic malignant syndrome), while others, like tardive dyskinesia and tardive dementia are usually cosmetically disfiguring, irreversible and result in seriously diminished overall functioning. Numerous other toxicities, both physical and cognitive, are associated with their short and long term use. Hence, if possible, it seems prudent to avoid or minimize (short term, low dose) their use.

As experience has accumulated with the newer anti-depressants (Prozac is the best known one, but there are a number of others) several important facts have emerged:

• They are only slightly more effective than placebos ("sugar pills").
• They cause, in a certain percentage of cases, a very disturbing form of agitation called "akathisia" that can produce violent behavior (suicidality or homicidality), especially when associated with another of their effects, "disinhibition" or emotional indifference.
• These drugs may also cause psychosis and/or mania severe enough to result in psychiatric hospitalization.
• They are all associated with withdrawal problems (see below) that are much more common and severe than has generally been acknowledged.

So, the high initial expectations of these "wonderful" anti-depressants (as widely heralded by their makers) are exaggerated. These problems with the anti-depressants should be taken in the context of the fact that there are numerous studies indicating that several types of psychotherapy are as, or more effective, and result in fewer relapses.

Unfortunately, many psychiatrists believe the myths that drugs are the only real treatment for "major mental illnesses" (they may give lip service to psychosocial interventions) and that they have improved the long-term outcomes of patients receiving them. Many studies show that these two beliefs are indeed myths. In fact, long term social, vocational and symptom outcomes for persons labeled as having "schizophrenia" are probably worse now than before the anti-psychotic drugs were introduced. However, since it does not fit the currently fashionable belief system this research is given little credence and is discouraged by funding sources and journal editors. Furthermore, 70-80% of persons taking anti-depressants report living unsatisfying lives. Suicide rates have not declined since the advent of these drugs.

Moreover, it is common (and in my opinion, questionable) practice these days to give many patients a "cocktail" of a combination of different types of drugs to try to treat the many different kinds of symptoms a single patient may present-independent of his/her actual problem(s). Hence, psychiatrist's tend to "cover all the bases" with their medication regimes. This practice has never been subjected to clinical trials and no credible scientific evidence exists that such drug cocktails produce better results in the treatment of psychotic symptoms. Each additional drug has its own set of adverse effects, toxicities and interactions with other drugs that result in exposing patients to an ever larger number of possible medication related problems.

In addition to their short and long term unwanted effects all psychiatric drugs have withdrawal reactions because of changes they cause in the brain. These reactions vary in time of onset, severity and type of symptoms experienced. There is also great inter-individual variability about if, when and how withdrawal is experienced. As a rule of thumb the longer a drug has been taken and the higher the dose the more severe the withdrawal reaction will be.

Do not stop your drug(s) suddenly or reduce your dose quickly, as this usually increases the chances of developing severe withdrawal reactions. Dose reduction and discontinuation should always be done slowly while in a relationship with a thoughtful and competent physician -- not necessarily a psychiatrist. You should be aware that it is generally considered to be malpractice for a physician to prescribe (this includes a withdrawal regime) for patients he has not seen. Hence, because I am not your doctor I am not able to give you specific advice about what to do about the drugs (if any) you are currently taking or being asked to consider.

I would counsel that you find a physician you like, trust and with whom you can form a collaborative relationship to discuss your concerns and wishes. It is the doctor's responsibility to provide you with the information you need to make an informed decision. Be very careful of information derived from pharmaceutical manufacturers, especially about their newest "breakthrough" product(s).

A fairly complete list of potential withdrawal reactions from neuroleptics, as well as a prudent withdrawal program to be undertaken in conjunction with your physician, are discussed in "Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications," by Peter Breggin & David Cohen (Perseus Books, 2000).

My own thinking about psychiatric drugs (especially the so-called "anti-psychotic"medications) is that they should be avoided if at all possible. My approach would be first to develop relationships with the persons involved and establish a safe and protective social context-preferably at a residence. Then I would take a relationship building therapeutic approach including the family if possible -- based on developing a joint understanding of, and finding meaningfulness in, the situation presented. This is easy to say but hard to do in the context of managed care and mental health practitioners who often lack training in basic listening skills.

In addition, a lack of non-coercive in-residence mobile crisis teams, communities lacking safe residential places (like Soteria House) and viable, involved support networks -- all of which can dedramatize crises -- makes the process even more difficult. If for some reason psychotropic drugs are necessary, and agreed upon by all parties, I recommend starting with the lowest dosage possible of the least toxic drug for the shortest period of time needed to address a specific behavior.

The most common reason I have found it necessary to use medications has been when it has not been possible to assemble enough caregivers to assure everyone's safety. Unfortunately, my views are not widely shared by my fellow psychiatrists or the drug companies.

There is an extensive discussion of why drugs should be avoided if possible and how they should be given when necessary in chapter 5, "Is Psychotropic Drug Dependence Really Necessary?" of Mosher and Burti's "Community Mental Health: A Practical Guide" NY. Norton, 1994. Norton's phone order number is 800-233-4830.

II. Dealing with Crises without Medicalizing Them

Remember, what follows are generic clinical guidelines about what to do in case of a severe personal/family emotional crisis (however defined). I cannot prescribe what to do because I am neither your doctor nor do I know you or the resources and options available in your area. In addition, such plans should be developed collaboratively with everyone involved. Prescription, by definition, is not usually a collaborative process. There are several generic principles that might be useful in your decision making:

1. Try to remain in as normal an environment as possible -- one that includes your usual relationships -- at home, at a friend's house, or at a residential setting that is home like -- even if staffed by paid caregivers. Try to engage natural resources like family, friends, clerics etc. to help by providing support, understanding and common sense advice within the context of their relationships with those involved.

If professional intervention is needed they should come to where you are. If possible use non-psychiatric mental health professionals, as they are more likely to address the situation from a psychosocial (rather than medical) perspective.

Emotional/psychological crises are very perplexing, frightening and distressing. Never-the-less try, at all costs, to avoid medicalization of whatever the "problem" is. Remember that crises are not life threatening "illnesses" -- people don't ordinarily die as a result.

If violence is a part of the crisis it can usually be managed by sheer force of numbers of persons present. Also, even though you may not know exactly what to do -- do not let mental health professionals take away your power to control your own life by the use of coercion. The use of coercion usually means that the professionals don't want to take the time to understand the problem and its context. They then provide a pseudosolution with the use of force that has serious long-term consequences: institutionalization, labeling, discrimination and marginalization.

Once you have been diagnosed, it will be impossible to remove a diagnosis from your medical records, regardless of the haste with which it was applied, or regardless of whether the diagnosis may be even remotely considered "correct."

What I am saying -- try to stay away from emergency rooms and hospitals unless it is clear to someone that the problem probably has a physical origin. It should be possible to determine this by a call to your primary care doctor.

A well organized, assertive family and support network can control professional involvement -- both the timing and quantity -- if it remains in its own residential context. This should be the goal.

2. Most crises arise in a family and its historical context. Hence, the focus of the relationally oriented intervention usually should be the family.

Given this conceptualization it becomes very difficult to decide whom, if anyone, should be medicated. I would not object personally to a sedative medication being given to all those who have been sleep deprived as a result of the crisis. The drug of choice for such situations is Benadryl, available without a prescription. Other sedatives would need to be prescribed by your physician. Sedatives have been shown to be as helpful as the anti-psychotic drugs in the de-escalation of severe ("psychotic") crises and have fewer short term adverse effects.

Restoration of the sleep-wake cycle and "tincture of time" (with the passage of time a much clearer perspective often emerges and what had appeared to be a very difficult problem is self-healing or not really so difficult after all). These are two important clinical concepts that are too often overlooked. Unfortunately, psychiatry and hospitals are under too much economic pressure to allow the operation of tincture of time's natural curative potential. These pressures are not present if "treatment" takes place in a residence with plenty of concerned and involved persons present.

3. Within the context of a relationship interventions should focus on the life events that are temporally related to the beginning of the crisis -- e.g. loss of a job, breakup of a relationship, a death, failure at school, leaving home etc., etc.

Each situation is unique so there is no one answer to what went wrong and how it might be best dealt with. However, it is good to remember that the more normally people are treated the more normally they will behave. In addition, crises offer opportunities for growth and change in a positive direction and are usually self-limited if not dealt with in a way that prevents their resolution.

A major objection to the use of the anti-psychotic drugs in acute crisis situations is that because they are such powerful central nervous system suppressants they may well have the effect of preventing crisis resolution. They are powerful enough to abort a psychological process, which if supported and understood, would resolve itself in the context of a relationship.

It may not be easy to follow the generic principles outlined above. They should be regarded as guidelines that will likely have to be compromised. But remember -- it is your (or a loved one's) psychological life -- that needs a very thoughtful, careful, unhurried and empathic approach.

Guard against unquestioning acceptance of authority -- especially medical -- even when you are nervous, perplexed and the situation feels chaotic and out of control. Psychiatry's track record in providing non-harmful answers to serious psychological crises has not been admirable. The adverse consequences of institutionalization -- its customary response -- have been detailed in #1 above.

Soteria Associates
Loren R. Mosher M.D.- Psychiatrist, Director
Mental Health, Research and Forensic Consultation
2616 Angell Ave., San Diego, CA. 92122
Phone 858-550-0312 Fax 858-558-0854
E-mail MosherSchreiber@compuserve.com

---

Posted on web site www.moshersoteria.com June 30th, 2003

Soteria Associates:
Mental Health Consulting
from an Alternative Viewpoint

What We Are About

Our mission is to provide evidence based alternative (to the currently dominant biomedical model) explanatory concepts and practices for the mental health community. We offer educational materials, lectures, seminars, consultations, support groups, advocacy, and expert testimony.

Our name has its origin in the Soteria project. In a random assignment study the Soteria Project demonstrated that acute psychosis could be treated successfully in the context of caring human relationships without the use of anti-psychotic drugs. Soteria is a Greek word meaning salvation or deliverance. For more information about the Soteria Project see the articles on this website.

The alternative evidence we present stands in contrast to the currently dominant biomedical hypotheses about the nature of major "mental illness". The alternative practice we espouse is not based on the medical model that treats nearly everything with psychotropic drugs. Rather, our model is voluntary, need and problem focused, relationship based, holistic, consumer (including families and social networks) driven and recovery oriented.

While we may offer various drugs (including dietary supplements and herbal remedies) they are viewed as adjunctive and used in as low a dose as possible for the shortest period of time that will allow evaluation of their usefulness.

There is no methodologically sound scientific data that what is labeled "serious mental illness" is genetically determined, is the result of identifiable biochemical abnormalities, is associated with specific brain lesions or is due to known etiologic agents (see bibliography on this site). Basically, the current hypothesis that "mental illness" is a "brain disease" is unsupported by data, making its continued propagation as "true" a myth or a delusion or a fraud. As such, we are in the realm of religious dogma -- not science. Pity the non-believers, for they shall be punished as deviants.

We do know that there are a number of psychosocial factors associated with the development of problematic behaviors:

• poverty
• childhood sexual and /or physical abuse
• parental neglect
• dysfunctional family behaviors such as the inability to communicate clearly and cogently, a pervasive family context of hostility and criticism, serious addictions, parental emotional divorce, high levels of stress secondary to chronic intra-familial conflict and an absence of a supportive social network.

Fortunately, by being able to understand the relationship of problematic behaviors to these psychosocial factors the kinds of interventions most likely to ameliorate their impact on those embedded in these psychonoxious contexts can be defined and implemented. Basically, being able to define the nature of a problem makes it possible to develop a potential solution. For example, if family conflict seems to be the main issue, it can be dealt with in family therapy specifically focused on reduction of conflict.

We believe that operating within a psychosocial paradigm can avoid many of the problems associated with the medicalization of what is labeled as "mental illness".

As we see it, the downside of the biomedical model of treatment is:

• A labeling process that does not allow for unlabeling and hence, almost inevitably, produces marginalization and discrimination
• Institutionalization that disrupts family and social network relationships and does little to help find meaningfulness in relation to crises, further escalating anxiety and perplexity in all those who care
• The introduction of the current (but erroneous) biomedical view of serious "mental illness" as being "incurable", "chronic", and/or "deteriorating". Maintenance is possible but-hope-so necessary for recovery, is nearly impossible in this conceptualization
• Medication, viewed by most as a required part of treatment, may actually impede or prevent recovery by aborting a potentially helpful psychological process that needs to be related to and understood rather than suppressed. It has, for example, been shown that the use of the anti-psychotic drugs, at least for what is called "schizophrenia", has resulted in poorer long- term outcomes than was the case prior to their use. In addition, suicide rates have not been reduced as a result of the use of the anti-depressant medications
• In violation of the Hippocratic dictum to "above all, do no harm", excessive reliance on medications has produced enormous rates of iatrogenic (doctor induced) diseases such as tardive dyskinesia and dementia, neuroleptic malignant syndrome, akathisia, suicidality, obesity, reproductive difficulties, and addiction- to name but a few
• The model has induced a sense of powerlessness in individuals, families and social networks because of its ability to use coercion in the name of providing "medical treatment"
• Medicalization has produced a psychiatric/drug company/hospital industrial complex that has such power and control over theory and practice as to make a change to a humanistic, psychosocial paradigm virtually impossible.

Many mental health professionals -- especially psychiatrists -- will attempt to invalidate and refute this argument -- while defending the status quo -- by referring to the "miraculous" effects of drug treatment. In addition they will contend that clinical practice is actually based on a "biopsychosocial model." It takes a very serious case of denial not to see what is before your eyes: Mental health treatment for the so-called "seriously mentally ill" is centered on medication with lip service at best being given to the "psychosocial" part of the model.

Consider these questions: How many adult mental health consumers in the mental health systems you know about are not being prescribed medications? What percentages are receiving regular psychotherapy of any type? How many are regularly able to access peer support groups? Is client input into program planning and development real -- or is it just tokenism? Are there client run programs? Are the expressed needs of clients taken seriously?

We believe the alternative voice provided by Soteria Associates and other similar organizations that provide accurate information (that is, with no conflict of interest) and education about the realities of today's mental health context -- via critical examination of current research on mental illness -- is much needed. Without critical dissident voices the real recovery oriented needs of persons with complex and recalcitrant problems will never be addressed.

There are many, many consumers and families coming to the realization that today's treatment landscape is desolate of any real understanding, help or hope for them. Soteria Associates hears from these dissatisfied persons daily by phone, email and regular mail. Among the many issues they raise, the following are common themes:

• They inquire whether there are any treatment centers that do not use psychotropic drugs routinely -- at present there are five in the entire country.
• They ask to be withdrawn from psychotropic drugs because of the terrifying and painful effects they have experienced from them -- but there are no doctors or facilities willing to take on the arduous task of withdrawing these drugs. Many report that the drugs have not really helped them -- only caused them problems. Many of those who have tried to withdraw experienced very frightening and unpleasant withdrawal reactions -- often of sufficient magnitude to make them restart the medication.
• They seek to understand and deal more effectively with their experiences but can not find persons willing to join with them in this difficult collaborative endeavor. Basically, no one wants to hear them out. Psychiatric residents (trainees) are taught that you "can't talk to disease" (ie, "schizophrenia" and severe depression or mania).
• They wonder why it is so difficult to find decent affordable housing with interpersonal support, if needed, in such an affluent country.
• They seek almost any alternative way of dealing with their problems but there are few professionals willing to offer anything outside the current dogma. Even asking, or questioning, may be viewed as non-compliance, further damaging their reputations.

The list goes on, but these are representative examples of what is wrong with the system. We find ourselves empathizing with their powerlessness and hopelessness.

It would be delusional to believe that Soteria Associates, a very small voice in a vast wilderness, can, by itself, address these needs. What is required is the formation of many communities of persons (and their friends) who have been failed by biomedically focused mental health treatment, the formation of groups demanding an alternative: Interventions that are humane, focused on understanding the meaningfulness of subjective experience, and on filling legitimate needs is what we espouse. Soteria Associates will be glad to be facilitators in so far as our resources allow.

However, the system will not change without the mobilization of many voices of angry, disaffected consumers -- and those who care about them -- collectively directed to changing the status quo and replacing those perpetuating it.

Soteria Associates
(Loren R. Mosher M.D.- Psychiatrist, Director)
Dr. Mosher is dead. His widow and co-worker,
Judy Schreiber, may be reached at this address
Mental Health, Research and Forensic Consultation
2616 Angell Ave., San Diego, CA. 92122
Phone 858-550-0312 Fax 858-558-0854
E-mail

Posted on web site www.moshersoteria.com June 30th, 2003;
revised April 8th, 2005

The Particular Elements of Soteria from the Perspective of (ex-) Users and Survivors of Psychiatry

Lecture at the congress „Soteria and No Restraint“, Merano, Italy
November 21-23, 2007
______________________________________________________________________

Peter Lehmann
The Particular Elements of Soteria from the Perspective of (ex-) Users and Survivors of Psychiatry

For the majority of (ex-) users and survivors of psychiatry the particular elements of Soteria are their central positions and interests, which are included in the Soteria approach: Abstinence from psychiatric violence, abstinence from any kind of illness and disorder models, abstinence from “expert”-arrogance, critique of Big Pharma, critical attitude toward neuroleptics, delivery of humane support along with the integration of the treasure of experience (ex-) users and survivors of psychiatry.

In 1995, when I (P.L.) was a member of the board of the German Association of Users and Survivors of Psychiatry (BPE), we were asked by the journal Sozialpsychiatrische Informationen (Social Psychiatric Information) whether we would be willing to participate in a survey on the subject of improving the quality of psychiatric treatment. We agreed to take part but changed the questions, as the board members could not agree on whether any type of psychiatric treatment could be considered “quality.” The following are some of the questions we put to 665 members of the association—(ex-) users and survivors of psychiatry who were more or less critical of psychiatry:

Did the psychiatrists address the problems which led to your admission? Was your dignity respected at all times? Were you fully and comprehensibly informed of the risks and so-called side effects of treatment measures? Were you informed about alternative treatments? What was lacking to the detriment of qualitatively good psychiatric care?

Over 100 members of the association (BPE) responded to the survey. The result: only 10 percent of those who answered said that psychiatry had helped them find a solution to the problems that had led to their psychiatrisation. Ninety percent said that their dignity had been violated. In response to the question of whether they had been informed about the risks and “side effects” of treatment measures, not one single person replied with “yes.” For being able to talk of a qualitatively acceptable psychiatry, the following fundamental criteria have to be fulfilled: Observance of the dignity of (wo)man, warmth and human bestowal, individual company, a relation full of confidence instead of fear. There are many useless things in psychiatry: for many (ex-) users and survivors of psychiatry the whole institution together with the psychiatrists is useless. In general, the following factors were found to be useless: violence, the use of psychiatric drugs, coercive measures, electroshocks, fixation. Medical (wo)men who believe that they know more about their patients than they themselves are useless. Alternatives are important for giving options to choose on. Concerning the question what these alternatives shall be like, the following suggestions were made: alternative drugs, e.g. homeopathic remedies, self-help, runaway houses, alternatives according to Mosher and Laing, soft rooms à la Soteria (Peeck, et al., 1995; see also Lehmann, 1998).

What is Particular about Soteria?

The essence of Soteria is its basic humanistic antipsychiatric approach along with its independence from the medical model and all its consequences.

Mosher had a life-long scepticism vis-à-vis all models of “schizophrenia,” primarily because they would stand in the way of an open phenomenological view. He saw the phenomenon, which is usually called “psychosis,” as a coping mechanism and a response to years of various traumatic events that caused the person to retreat from conventional reality. The experiential and behavioural attributes of “psychosis”—including irrationality, terror, and mystical experiences—were seen as extremes of basic human attributes (Aderhold, et al., 2007, p. 146).

Consequence 1: Abstinence from „experts“-arrogance

Soteria offered a homelike environment in a 12-room house with a garden in a fairly poor neighbourhood of San José, California and intensive milieu therapy for six to seven individuals. About seven full-time staff members plus volunteers worked there, selected for their personal rather than formal qualifications, and characterized as psychologically strong, independent, mature, warm, and empathic.

Soteria staff members did not espouse an orientation that emphasized psychopathology, deliberately avoided the use of psychiatric labels, and were significantly more intuitive, introverted, flexible, and tolerant of altered states of consciousness than the staff on general psychiatric inpatient units. These personality traits seem to be highly relevant for success in this kind of work. Former residents became staff members on several occasions (ibid., p. 147).

Consequence 2: Avoidance of violence and overwhelming abstinence from neuroleptics

Neuroleptics were considered as problematic due to their negative impact on long-term rehabilitation and therefore used only rarely. Specifically, during the first six weeks at Soteria these drugs were only given when the individual’s life was in danger and when the viability of the entire project was at risk. However, benzodiazepines were permitted. If there was insufficient improvement after six weeks, the neuroleptic drug chlorpromazine was introduced in dosages of about 300 mg. Basically, any psychiatric drugs were supposed to remain under the control of each resident. Dosages were adjusted according to self-observation and staff reports. After a two-week trial period, a joint decision was taken whether it made sense to continue the “medication” or not (ibid.).

Consequence 3: Availability of positive approaches

Without complying with mainstream psychiatric beliefs, positive perspectives, such as a readiness to deliver humane support, respect for the Hippocratic Oath and human rights can become reality. General guidelines for behaviour, interaction and expectation:

• Do no harm.
• Treat everyone, and expect to be treated, with dignity and respect.
• Guarantee asylum, quiet, safety, support, protection, containment, interpersonal validation, food and shelter.
• Expect recovery from psychosis, which might include learning and growth through and from the experience.
• Provide positive explanations and optimism.
• Identify plausible explanations: emphasis on biography, life events, trigger factors instead of vulnerability; promoting experiences of success.
• Encourage residents to develop their own recovery plans; consider them the experts (adapted from Mosher & Hendrix, 2004).

Pat Bracken, Consultant Psychiatrist and Clinical Director in Ireland, shows in his paper “Beyond models, beyond paradigms: The radical interpretation of recovery”:

I believe that the medical model is only one manifestation of a more fundamental problem: the tendency to see human problems as technical difficulties of one sort or another. I call this the “technological paradigm.” (…) In this technological paradigm, issues to do with values, meanings, relationships and power are not ignored but they are always secondary to the more important technical aspects of mental health. In this paradigm, the technical aspects are primary. Furthermore, this paradigm underscores the centrality of “experts”: professionals, academics, researchers, codes of practice, training courses and university departments. Service users might be consulted and invited to comment on the models and the interventions and the research, but they are always recipients of expertise generated elsewhere.

For me, the recovery agenda and the emergence of a mental health discourse that is user/survivor led present a radical challenge, not just to the medical model, but to the underlying technological paradigm. This user/survivor discourse is not about a new paradigm or a new model, but reorients our thinking about mental health completely. It foregrounds issues to do with power and relationships, contexts and meanings, values and priorities. In the non-psychiatric literature about recovery, these become primary. As I read it, this literature does not reject or deny the role of therapy, services, research and even drugs but it does work to render them all secondary. For example, when it come to drugs and their use, the literature emerging from independent users and survivors of psychiatry seeks to prioritise access to information about the mode of action, the unwanted effects and debates about efficacy. It also works to ensure that psychiatric drugs are only administered with consent and has exposed the profits made by Big Pharma in the area of psychotropics. (…) In my opinion, we should judge how much the recovery agenda is being accepted by looking at how much prominence is afforded this user/survivor discourse in the training of professionals and academics. The most radical implication of the recovery agenda, with its reversal of what is of primary and secondary significance, is the fact that when it comes to issues to do with values, meanings and relationships, it is users/survivors themselves who are the most knowledgeable and informed. When it comes to the recovery agenda, they are the real experts (Bracken, 2007, pp. 400-402).

Consequence 4: Leaving the American Psychiatric Association

In a letter to Rodrigo Munoz, President of the American Psychiatric Association, on December 4, 1998, Loren Mosher explained his discharge of the APA:

In my view, psychiatry has been almost completely bought out by the drug companies. The APA could not continue without the pharmaceutical company support of meetings, symposia, workshops, journal advertising, grand rounds luncheons, unrestricted educational grants etc. etc. ... What we are dealing with here is fashion, politics, and money ... I want no part of a psychiatry of oppression and social control (Mosher, 1998).

Psychiatry has been corrupted by drug company money, so Mosher in another paper:

In my view American psychiatry has become drug dependent (that is, devoted to pill pushing) at all levels—private practitioners, public system psychiatrists, university faculty and organizationally. What should be the most humanistic medical specialty has become mechanistic, reductionistic, tunnel-visioned and dehumanising. Modern psychiatry has forgotten the Hippocratic principle: Above all, do no harm (Mosher, undated).

Five years later, as a board member of MindFreedom International he also supported hunger strike in Pasadena, California, that won international media publicity. The demand to the psychiatric system, especially the APA, was: Produce scientific evidence about why a single model—the medical theory of 'chemical imbalances' and pills—ought to so overwhelmingly dominate mental health care as it does today. A team of 14 mental health academics and practitioners, MFI board member Loren Mosher included, was reviewing the APA response to MFI’s open letter from August 16, 2003, and said:

Perhaps the treatment is worsening the disorder. At best, the treatment is not helping: researchers now recognize that the most popular psychiatric drugs, the SSRI antidepressants, rate only slightly better than inert placebos. In addition, negative research findings (sponsored by industry) are commonly suppressed, and adverse drug effects are massively under-reported in psychiatric journals and to the Food and Drug Administration. These dubious but tolerated practices create an enormously misleading view of the actual impact of drug treatments. (…) In sum, the APA's statements reflect less the "pace of science" than the pace of commerce: they blur with the pharmaceutical advertising themes saturating our media. This is because the APA is not an independent organization. One third of its operating budget comes from the drug industry. Drug companies dominate its professional meetings to advertise drugs. In addition, the drug industry funds, directs, and analyses many drug studies, and psychiatric journals publish so-called scientific reports of these drug studies that are ghost-written by industry employees or marketing firms. Psychiatric drug experts with no significant ties to industry can hardly be found. Industry largesse binds many psychiatric practitioners to the industry (cited in MindFreedom International, 2003).

Consequence 5: Supporting the withdrawal from psychiatric drugs

Do no harm is also the basis, on which Mosher supported the report “Coming off psychiatric drugs”, a book with first-hand reports of (ex-) users and survivors of psychiatric drugs from all over the world and additional articles of psychotherapists, physicians, psychiatrists, natural healers and other professionals helping to withdraw. In his preface Mosher addressed mind- and body-altering psychiatric drugs and withdrawal symptoms:

Most had never been warned that the drugs would change their brains' physiology (or, worse yet, selectively damage regions of nerve cells in the brain) such that withdrawal reactions would almost certainly occur. Nor were they aware that these withdrawal reactions might be long lasting and might be interpreted as their "getting sick again." … However, because the drugs were given thoughtlessly, paternalistically and often unnecessarily to fix an unidentifiable "illness" the book is an indictment of physicians. The Hippocratic Oath—to above all do no harm—was regularly disregarded in the rush to "do something." How is it possible to determine whether soul murder might be occurring without reports of patients' experiences with drugs that are aimed directly at the essence of their humanity? Despite their behaviour, doctors are only MD's, not MDeity's. They, unlike gods, have to be held accountable for their actions. This book is a must read for anyone who might consider taking or no longer taking these mind altering legal drugs and perhaps even more so for those able to prescribe them (Mosher, 2004, pp. 16-17).

La maggior parte dei pazienti non è stata avvertita del fatto che i farmaci possono modificare il cervello (o che, ancor peggio, possono sopprimere alcuni centri nervosi), e che quindi l'insorgenza di problemi di astinenza è praticamente inevitabile. E tanto meno sanno che questi possono durare a lungo e possono essere interpretati come una "ricaduta". (…) Siccome i farmaci sono stati somministrati con leggerezza, con modi paternalistici e spesso quando non necessari, al fine di curare una non ben precisata "malattia", il libro costituisce anche un'accusa contro i medici. Il giuramento di Ippocrate – di non procurare innanzitutto del male – non viene, di solito, nella fretta "di fare qualcosa", tenuto in considerazione. Come è possibile arrivare a stabilire se c'é stata morte dell'anima, se non si vogliono ascoltare gli effetti che i pazienti raccontano in merito ai farmaci, farmaci che agiscono direttamente sull'essenza intrinseca dell'uomo? Anche se vogliono darsi ad intendere in altro modo: i medici sono solo dottori in medicina, non semidei della medicina. Al contrario dei veri dei i medici devono accettare di dover rendere conto delle loro azioni. Leggere questo libro è un obbligo per tutti coloro che sono sfiorati dall'intenzione di assumere o di non più assumere queste medicine che, legalmente, modificano la personalità e, forse, è ancor più un obbligo per coloro che hanno il potere di prescriverle (Mosher, 2008).

Consequence 6: World wide appreciation by (ex-) users and survivors of psychiatry

I suppose Loren Mosher and his original Soteria approach are linked to each other inseparably. Soteria has given evidence, that

· The avoidance of psychiatric violence is possible even for a psychiatrist and even from the psychiatric perspective—not surprisingly—has better results than the use of typical psychiatric measures.

· Staying away from illness and disorder models of any kind—not surprisingly—brings better results than the use of typical psychosocial constructs.

· The abstinence from „experts“-arrogance opens the view on the real problems of the people and promotes the co-operation with users and survivors of psychiatry.

· The criticism of Big Pharma is appropriate and overdue.

· The overwhelming avoidance of neuroleptics is more than useful.

· The delivery of human support by integrating of the treasure of experience of (ex-) users and survivors of psychiatry coincides with the interests of people with mental problems of a social nature.

· Even with a psychiatric education, a humanistic philosophy of life is possible—not only in words, but also in practice.

No wonder, that the Soteria approach was receipted positively and integrated into further approaches like the Berlin Runaway-house (Wehde, 1991, pp. 46-50). Kerstin Kempker, (former) leading worker in this well-known project, explained why Soteria and comparable approaches have been so important for creating alternatives beyond psychiatry:

Without the Dutch runaway-houses and Uta Wehde’s intensive engagement with their concept and practice, the Berlin Runaway-house would not exist. Without the antipsychiatry from the early 70s, Laing’s Kingsley Hall and its “children” Soteria, Emanon and Diabasis we would miss the evidence, that the abstinence from psychiatric measures and – instead of them – the life in an awake and warming community with equal rights is at most helpful (Kempker, 1998, p. 66).

And no wonder, that the membership assemblies of the European Network of (ex-) Users and Survivors of Psychiatry (ENUSP) and the World Network of Users and Survivors of Psychiatry (WNUSP) in July 2004 conjointly mourned the death of Loren Mosher:

We express our deep sorrow at the loss of our dear friend Loren Mosher.

Loren cared passionately about our human rights, our freedom, and our ability to lead self-determined lives.

His pioneering work at Soteria House proved that humane, non-medical support is the best way to help people undergoing severe emotional distress.

His bravery in publicly resigning from the American Psychiatric Association called to public attention the way in which Big Pharma and bio-psychiatry have allowed profits to overrule human needs.

Loren's warmth and caring touch so many of our lives, and he will be deeply missed (Chamberlin & Lehmann, 2004).

Sources

• Aderhold, V., Stastny, P., & Lehmann, P. (2007). Soteria: An alternative mental health reform movement. In P. Stastny, & P. Lehmann (Eds.), Alternatives beyond psychiatry (pp. 146-160). Berlin / Eugene / Shrewsbury: Peter Lehmann Publishing.
• Bracken, P. (2007). Beyond models, beyond paradigms: The radical interpretation of recovery. In P. Stastny, & P. Lehmann (Eds.), Alternatives beyond psychiatry (pp. 400-402). Berlin / Eugene / Shrewsbury: Peter Lehmann Publishing.
• Chamberlin, J., & Lehmann, P. (2004). Message on behalf of WNUSP / ENUSP. 5. Congress of the European Network of (ex-) Users and Survivors of Psychiatry (A joined congress of ENUSP and the World Network of Users and Survivors of Psychiatry – WNUSP): Networking for our Human Rights and Dignity. July 17-21, 2004 in Vejle (Denmark). Retrieved November 17, 2007, from www.enusp.org/congresses/vejle/lorenmosher.htm.
• Kempker, K. (1998). Vergleichbare Projekte. In K. Kempker (Ed.), Flucht in die Wirklichkeit – Das Berliner Weglaufhaus (pp. 66-70). Berlin: Antipsychiatrieverlag.
• MindFreedom International (2003, December 15). Reply by Scientific Panel of the Fast for Freedom in Mental Health to the 26 September Statement by American Psychiatric Association. Retrieved November 17, 2007, from www.mindfreedom.org/kb/act/2003/mf-hunger-strike/hunger-strike-debate/mfi-2nd-reply-to-apa/
• Mosher, L. R. (1998, December 4). Letter of resignation from the American Psychiatric Association. Written to Rodrigo Munoz, M.D., President of the American Psychiatric Association. Retrieved November 17, 2007, from www.peter-lehmann-publishing.com/articles/mosher_resign.htm.
• Mosher, L. R. (2004). Preface. In P. Lehmann (Ed.), Coming off psychiatric drugs: Successful withdrawal from neuroleptics, antidepressants, lithium, carbamazepine and tranquilizers (pp. 15-17). Berlin / Eugene / Shrewsbury: Peter Lehmann Publishing. Retrieved November 17, 2007, from www.peter-lehmann-publishing.com/withdraw/prefaces.htm#loren
• Mosher, L. R. (2008). Prefazione. In P. Lehmann (Ed.), Liberarsi dagli psicofarmaci. Riuscire con pieno successo a liberarsi da neurolettici, antidepressivi, stabilizzanti dell'umore, Ritalin e tranquillanti (in preparazione). Retrieved November 17, 2007, from www.peter-lehmann-publishing.com/liberarsi.htm#loren
• Mosher, L. R. (Undated). How drug company money has corrupted psychiatry. Retrieved November 17, 2007, from www.peter-lehmann-publishing.com/articles/mosher_corrupted.htm.
• Mosher, L. R., Hendrix, V. with D. C. Fort (2004). Soteria: Through madness to deliverance. Philadelphia: Xlibris Corporation.
• Peeck, G., von Seckendorff, C., & Heinecke, P. (1995). Ergebnis der Umfrage unter den Mitgliedern des Bundesverbandes Psychiatrie-Erfahrener zur Qualität der psychiatrischen Versorgung. Sozialpsychiatrische Informationen, 25(4), 30-34. Retrieved November 17, 2007, from www.bpe-online.de/umfrage.htm; for more details, see Lehmann, P. (1997). Variety instead of stupidity: About the different positions within the movement of (ex-) users and survivors of psychiatry. Retrieved November 17, 2007, from www.peter-lehmann-publishing.com/articles/variety.htm.
• Wehde, U. (1991). Das Weglaufhaus – Zufluchtsort für Psychiatrie-Betroffene. Berlin: Antipsychiatrieverlag.

Copyright by Peter Lehmann 2007

Address for correspondence

Peter Lehmann, Zabel-Krueger-Damm 183, 13469 Berlin, Germany, Tel. +49-(0)30-85963706, e-mail: mail@peter-lehmann.de, Internet: www.peter-lehmann.de/inter

Όχι στην καθήλωση - Ναι σε τί ; Εναλλακτικές προτάσεις στην άσκηση βίας στην ψυχιατρική

ΟΧΙ ΣΤΗΝ ΚΑΘΗΛΩΣΗ – ΝΑΙ ΣΕ ΤΙ;

Εναλλακτικές προτάσεις στην άσκηση βίας στην ψυχιατρική

Βασικές θέσεις για την πίστη στο εφικτό μιας ψυχιατρικής χωρίς βία

Ø Η βία παράγει βία και παράγεται από βία.

Ø Η βία δεν είναι μόνο φυσική. Η αδιαφορία, η ανωνυμία, η υπεροψία, η γραφειοκρατία, η κωφότητα απέναντι στις προσωπικές ανάγκες, αποτελούν μορφές βίας.

Ø Και ως τέτοιες μπορούν να παράγουν βία.

Ø Σ’ όποια θέση του κύκλου κι αν βρίσκεσαι: ως ασθενής ή ως εργαζόμενος.

Ø Σ’ αυτήν την περίπτωση είναι λογική και ηθική αυθαιρεσία να ταυτίζεται η εκδηλωθείσα βία με στοιχεία της προσωπικότητας του ανθρώπου που την ασκεί ή με συμπτώματα της αρρώστιας του ψυχιατρικού ασθενή.

Ø Ένα μη βίαιο πλαίσιο προσαγωγής, υποδοχής και αντιμετώπισης του ψυχικά πάσχοντος ανθρώπου θα παρήγαγε αυτόματα λιγότερη βία προς και από όλα τα εμπλεκόμενα πρόσωπα.

Ø Αυτό θα είχε άμεσες συνέπειες στη εξέλιξη της ψυχικής κατάστασης του πάσχοντος προσώπου, αλλά και των εργαζομένων, που εμπλέκονται στην ψυχιατρική του εισαγωγή και φροντίδα.

Το πρόγραμμα «Σωτηρία» και οι επίγονοί του

Το πρόγραμμα «Soteria» γεννήθηκε στην πρώτη του μορφή το 1969 στο San Francisco από τον ψυχίατρο L. Mosher, σε μια προσπάθεια οικοδόμησης ενός μη βίαιου και λιγότερο ιατρικοποιημένου μοντέλου αντιμετώπισης οξέων ψυχωσικών κρίσεων. Ο ιδρυτής του επηρεάστηκε από την προσπάθεια του R.Laing στο Λονδίνο και σχετικές φαινομελογικές και υπαρξιστικές θεωρίες γύρω από το θέμα της ψυχικής νόσου. Η ιδέα της Σωτηρίας γνώρισε αρκετές εφαρμογές και παραλλαγές στην πορεία των χρόνων, διατηρώντας ωστόσο πάντα το χαρακτηριστικό της μη βίαιης αντιμετώπισης ψυχωσικών διεγερτικών συμπεριφορών. Στις αρχές της δεκαετίας του 1980 μεταφυτεύτηκε στην Ευρώπη, στη Βέρνη της Ελβετίας, από τον Luc Ciompi, διαγράφοντας από τότε μια δική της ευρωπαϊκή πορεία. Από τα μέσα της δεκαετίας του 1990 έως και σήμερα αναδύονται με σημαντική ταχύτητα εφαρμογές της Σωτηρίας στη γερμανική ψυχιατρική, υποσχόμενες μια εναλλακτική πρόταση στην κλασική ψυχιατρική αντιμετώπιση διεγερτικών καταστάσεων, που κατατάσσονται στο πλαίσιο της ψύχωσης. Οι περισσότερες αμερικανικές όσο και η ελβετική «Σωτηρία» αποτελούν μικρές «κλινικές»-κοινόβια, που λειτουργούν σε τοπική απόσταση από το συμβατικό σύστημα ψυχιατρικής περίθαλψης, ακόμα και όταν εντάσσονται θεσμικά στην αλυσίδα της δημόσιας περίθαλψης. Ο συγκριτικός νεωτερισμός των Γερμανών συναδέλφων, ακολουθώντας και επεκτείνοντας κάποια πειράματα στην Αμερική, είναι ότι σε πολλές περιπτώσεις προσπαθούν να εφαρμόσουν το μοντέλο της Σωτηρίας μέσα σε συμβατικά ψυχιατρικά νοσοκομεία, και ως εκ τούτου αποτελούν μια ενδιαφέρουσα εμπειρία και ερέθισμα για τα ελληνικά δεδομένα.

Τι είναι η «Σωτηρία»

Η «Σωτηρία» αποτελεί μια φιλοσοφία και μια πρακτική αντιμετώπισης οξέων ψυχωσικών κρίσεων και διεγερτικών καταστάσεων με τα εξής χαρακτηριστικά.

· Μια μικρή μονάδα με περιορισμένη χωρητικότητα κλινών (στην πρώτη Σωτηρία 8 φιλοξενούμενοι με δύο άτομα προσωπικό. Στην πορεία η αναλογία ποικίλει ανάλογα με τις εκάστοτε μορφές του προγράμματος).

· Ήρεμο, φιλικό, «σπιτικό» περιβάλλον, με ήπια αισθητική, μεγάλη ανεκτικότητα στη διαφορά και υποστηρικτικό συναισθηματικό κλίμα προς τους φιλοξενούμενους.

· Απόλυτη απουσία φυσικής και άλλης βίας ή πειθαναγκασμού προς τους φιλοξενούμενους.

· Παρουσία σε 24ωρη βάση προσωπικού, που στην πλειοψηφία του δεν αποτελείται από επαγγελματίες θεραπευτές.

· Φιλοσοφία του «προσώπου αναφοράς»: ένα μέλος της ομάδας βρίσκεται σε κύρια επαφή με ένα φιλοξενούμενο πρόσωπο.

· Κατά το δυνατόν μειωμένη χρήση ψυχοφαρμάκων.

· Απουσία κλασικά εννοούμενου θεραπευτικού προγράμματος

· Έμφαση σε διαπροσωπικές φαινομενολογικές παρεμβάσεις.

· Σύνδεση με την οικογένεια και φιλικά πρόσωπα των φιλοξενούμενων.

· Συστηματική φροντίδα προς τους εργαζομένους στη μονάδα: επαγγελματική εποπτεία, κατάλληλα ωράρια και μεγάλα «ρεπό» για ανάκτηση των δυνάμεών τους.

Αντιμετώπιση διεγερτικών κρίσεων – Το «Ήσυχο Δωμάτιο»

Κρίσεις υπερδιέγερσης, τάσεις για άσκηση βίας στον εαυτό ή τους άλλους ή ακραίες συμπεριφορές, που ενοχλούν τους υπόλοιπους φιλοξενούμενους αντιμετωπίζονται στο «Ήσυχο Δωμάτιο», έναν αισθητικά φροντισμένο, ήπιο χώρο, όπου μπορεί ο φιλοξενούμενος υπό διέγερση να αποσυρθεί για το διάστημα της κρίσης του και να τη ζήσει σε όλες της τις μορφές χωρίς να ανατρέψει το συνολικότερο πλαίσιο. Σε τέτοιες περιπτώσεις συνοδεύεται από μέλος του προσωπικού, που βρίσκεται στον ίδιο χώρο μαζί του και τον συνοδεύει στην πορεία του με τρόπο ανάλογο με τις ανάγκες του φιλοξενούμενου προσώπου (συμμετέχοντας με διάλογο ή σιωπώντας κλπ), για όσο χρόνο χρειαστεί και μπορεί να αντικατασταθεί από άλλον εργαζόμενο, σε περίπτωση που ο ίδιος-ια έχει ανάγκη να αποσυρθεί. Τα γεύματα και ο ύπνος του φιλοξενούμενου μπορούν να λάβουν χώρα στο «Ήσυχο Δωμάτιο», εάν αυτός-ή το επιθυμεί. Μετά την αποκλιμάκωση της κρίσης το ενδιαφερόμενο πρόσωπο επιστρέφει στο δωμάτιό του και στο κανονικό του πρόγραμμα.

Αποτελέσματα

Ενδεικτική έρευνα αξιολόγησης σχετικά με μια 20ετή (1977-1997) εφαρμογή της «Σωτηρίας» στην Ουάσιγκτον (με το όνομα “Crossing Place”) έδειξε τα παρακάτω.

Ø 90% των φιλοξενουμένων μπόρεσαν να επιστρέψουν στην κοινότητα μετά από το πολύ 30 μέρες φιλοξενία στη «Σωτηρία» έχοντας υπερβεί την ψυχωσική κρίση, χωρίς να χρειαστεί να νοσηλευτούν σε ψυχιατρικό νοσοκομείο.

Ø Κανείς από τους φιλοξενούμενους στη «Σωτηρία» για την παραπάνω 20ετία δεν αυτοκτόνησε κατά τη διάρκεια της παραμονής του στο πρόγραμμα.

Ø Κατά την 20ετή λειτουργίας της μονάδας δεν παρατηρήθηκε κανένας αξιοσημείωτος τραυματισμός εργαζόμενου στη μονάδα.

Οι φιλοξενούμενοι στο CrossingPlace δεν επιλέχθηκαν με κανένα κριτήριο για την εισαγωγή τους στο πρόγραμμα, αλλά αποτελούσαν τυχαίες εισαγωγές στο ευρύτερο δημόσιο ψυχιατρικό σύστημα περίθαλψης. H ίδια η μονάδα ήταν ενσωματωμένη στο δημόσιο σύστημα περίθαλψης, χωρίς κανένα διακριτικό σημάδι προς τα έξω.

Η κατάσταση σήμερα

Η ιδέα της «Σωτηρίας» βρίσκει αυτή τη στιγμή εντυπωσιακή διάδοση ιδιαίτερα στη γερμανόφωνη Ευρώπη, σαν μια ευκαιρία για μη βίαιη και θεραπευτικά αποτελεσματική αντιμετώπιση οξέων ψυχωσικών περιστατικών. Οι διάφορες εφαρμογές της «Σωτηρίας» έχουν δικτυωθεί μεταξύ τους σε μια διεθνή ομοσπονδία, η οποία παρακολουθεί στην πράξη, μελετά επιστημονικά και επιδιώκει τη διάδοση της ιδέας της «Σωτηρίας».

Ηλεκτρονικές διευθύνσεις επαφής με προγράμματα «Σωτηρία»:

www.moshersoteria.com, www.soteria.ch, mosherschreiber@compuserve.com, sozialpsychiatrie@mh-hannover.de.

ΠΡΩΤΟΒΟΥΛΙΑ ΕΝΑΝΤΙΑ ΣΤΗ ΒΙΑ και ΤΗΝ ΚΑΤΑΠΙΕΣΗ ΣΤΑ ΨΥΧΙΑΤΡΕΙΑ

Tηλέφωνα επαφής με την Ομάδα Πρωτοβουλίας: Κέντρο Αποκατάστασης Θυμάτων Βασανιστηρίων και άλλων μορφών κακομεταχείρισης: κα Γαλατσοπούλου Φανή. Β. Λαζαρίδης: τηλ. 6938786793.