What Makes Soteria Work? On the Effect of a Therapeutic Milieu on Self-Disturbances in the Schizophrenia Syndrome

Soteria represents an alternative approach to the treatment of acute psychosis providing a community-based social milieu, personal relationships (“being-with”), and meaningful shared activities (“doing-with”) along with minimal neuroleptic medication. In this review article, we analyze Soteria’s potential to adapt to and restore self-disturbances, a central element of phenomenological conceptions of the schizophrenia syndrome. Based on typical difficulties of psychotic patients in responding adequately to situational demands, in relating to others, and in utilizing skills, we analyze how the architectural and social context, being-with, and doing-with take account of self-disturbances. The central elements of the Soteria approach all appear to carry the potential to adjust to self-disturbances and even offer opportunities for their relief. We suggest that it is precisely this property of the Soteria paradigm that induces sustained relaxation in patients, allowing for symptom relief, thereby specifying a central claim of “affect-logic” to explain the antipsychotic effect of Soteria.