Recovery From Schizophrenia: Psychiatry And Political Economy

230 TREATMENTauthors point out that their sample of patients was not composed of particularlygood-prognosis cases—they selected individuals who were young and single,generally considered indicators of poor outlook. All patients, however, were at avery early stage of their illness. Patients with the fewest relapses in both treatmentprograms tended to have good prognostic features (better prior social competenceand a later age of onset), but there is no indication that good-prognosis patientsdid better in drug-free care. 30Soteria BerneSoteria Berne, a therapeutic household for the treatment of schizophrenia, borrowsmany ideas from Mosher and Menn’s Soteria Project. Established by psychiatristLuc Ciompi in a 12-room house in the middle of Berne, Switzerland, theprogram can accomodate up to eight patients and two nurses. Like the CaliforniabasedSoteria, the household in Berne aims to manage people with schizophreniain a small supportive environment using neuroleptic medication in low doses andonly in unusual circumstances. Young people with a first episode of schizophreniaare selected fairly randomly for admission (very agitated or involuntary patientsare excluded) from among cases presenting to the local emergency services. Somepatients with longer-lasting illness and poor-prognosis features are also admitted.Twenty-five people treated at Soteria Berne were compared with a matchedgroup of 25 similar patients treated at conventional local hospitals. When the twogroups were followed up after two years, conventionally treated and Soteriapatients had similar levels of pathology and functioning. Soteria-treated patients,however, had used much lower doses of antipsychotic medication—one quarteras much during the acute treatment phase, half as much overall. Thus the resultsat Soteria Berne are very similar to those at Soteria in California. 31Lehtinen and associatesA recent Finnish immediate assignment study confirms the good outcomesachieved by Soteria and Soteria Berne with minimal use of medications inschizophrenia-like psychosis. In this study progress was assessed over two years for106 patients admitted to treatment for a first episode of psychosis (excludingaffective psychosis like bipolar disorder) in 1992–93 at one of six differenttreatment centers around Finland. All the patients were provided individual andfamily treatment, but at three centers the patients received only minimal doses ofantipsychotic medication and nearly half received no antipsychotic medication atall over the two-year period. At the other three centers usual antipsychotictreatment approaches were used. The outcome for patients in the minimalmedication group was equal to or superior to that of patients treated with usualdoses of medication. 32