Steven Morgan, Project Director of the Vermont Soteria Project, Reflects on Working With Psychosis


Soteria Vermont is a project of the Vermont state government, which seeks to be a leader in mental healthcare. When Hurricane Irene washed away Vermont’s state mental hospital, Vermont’s government chose to replace it with a network of smaller, community-based and alternative approaches to mental health care. Citizens of Vermont are legally entitled to alternatives to psychiatric medication; Soteria Vermont will be the second replication in the  United States (after Alaska’s) of Loren Mosher’s Soteria project which demonstrated in the 1970’s the efficacy of housing people experiencing first psychotic breaks with sympathetic non-professionals as housemates, in the style of R.D. Laing’s Kingsley Hall. The original Soteria was dedicated to using little or no psychiatric medication, and to using that only in the short term to stabilize a crisis. Repeated analyses of its records show extremely robust and long-lasting recovery from even the most extreme psychotic states.

Here, Steven Morgan, the project’s director, gives a short history of the project’s origins. Beginning this fall, Steven will be seeking a site for the house and creating a training program for the staff with the goal of opening the house’s doors in the fall of 2013. Vermont has dedicated $1 million per year to the project.

Mad in America will be following the project, through video interviews and documentaries, as well as Steven’s blogs (when his schedule permits).

9 COMMENTS

  1. I agree with you Steven that if caregivers are in their heads, running their experience of being with someone in madness through their theoretical/idealogical “black box” whether that intellectualy ingrained or “downloaded program” be Jungian, Langian, Buddhist or Dialogic, then we miss providing the necessary emotional immediacy and receptiveness of ‘being with’ the persosn and being able to “follow their path.”

    That reminds me that I recently was with a young man who was in a very active madness process. He invited me to walk with him. For 40 minutes I followed where ever he led, one step behind, leaning forward so I could hear his every word as his pent-up non-stop outpouring of metaphorical and emotional truth came out. In those 40 minutes,I never interrupted him once, never asked a question. He has been in the mental health system for several years. I would bet my life savings that that was the first time anyone had not played therapist or expert and just listened without any pre-conceived notions and welcomed whatever he said in open hearted and respectful silence.

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    • Hi Michael:))

      Perhaps we are seeing a new paradigm emerge and I hope this project does come to fruition, although I note that its a future possibility, rather than a current reality?

      In terms of paradigm shifts taking place beyond the obvious, in mainstream media focused attention, I’d like to point you and others in a position of influence, towards the kind of pure untainted science discovery, which gives much validity to a person centered approach.

      Both you and Steven comment on the real-life need to NOT bring any kind of preconceived ideology to the encounter with psychosis? As you say;

      “leaning forward so I could hear his every word as his pent-up non-stop outpouring of metaphorical and emotional truth came out.”

      The paradigm shifting discovery of a polyvagal control of the heart, explains just how, those of us suffering from unresolved trauma experience, become locked out of the social system of group survival, by our inability to regulate unconscious survival reflexes? The theory shows just how normal “spontaneous social reflexes,” are inhibited in those of us struggling to cope with past traumatic experience, which remains unresolved?

      In a computer analogy, its like having two distinctly different operating systems, (1) survival, (2) social, “the two vagal systems.” If our spontaneous social reflex functioning is “turned off,” by unresolved trauma experience, we cannot form healthy human relationships, no matter what cognitive constructs of ideology, we place our faith in.

      It seems to come down to understanding that physiological processes are primary, and the cognition of ideology is a secondary process? This new discovery does change everything, because it explains the very roots of “spontaneous” human behaviors, like never before in our history.

      Healthy spontaneous, physiological function, lies at the “heart” of human vitality and health, and Porges, shows the hidden plumbing, (so to speak) which stimulates what others have called “flow,” or being in the moment, or the care free joy of being alive. This is the essence of “two vagal systems,” in this new discovery.

      No matter our individual ideas, we all have the same human heart and the same nervous control of its unconscious, “autonomic” functioning, beneath all our ideological differences?

      Polyvagal theory is about the heart, not ideology? The human heart upon which the whispering muse of creative intuition and inspiration, plays her silent chords?

      If you get the time, please watch this video presentation of the theory, which helps so much in relating to being with someone, in a first episode psychosis? Its about the art of “in the moment,” presence and body language communication, affected by the heart? Perhaps in leaning forward, with an open body posture, you were listening with your heart, Michael?

      http://columbiapsychiatry.org/videos/polyvagal-theory-neural-mechanisms-mediating-social-behavior-emotional-regulation-and-health

      Warm regards.

      David Bates.

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  3. It seems that we are on the right track we still do not understand consiousness in our culture. All states of mind from what we call mad to normal are a source of suffering. What suffering do I speak of the pain/suffering of separation. We are all on a continuim so to speak of identifying with a separate sense of self but what if this is not who we are at all, what if this can been seen directly in the moment and all identies merge in the moment. We identify oueselve’s as belonging to a relious order or spiritual order, we identify our selve’s with gender, sexual identities, culture identities, history, community, race, creed, ethnic back ground, etc. on and on but what if we were to drop all of this to see that there is not separation at all, you are myself, to hate you is to hate me to love you is loving me. Once we see how the [I sense] seems to appear and the grasping that occurs to create separate identities along with the suffering we are free to be with each other as each other, you are me, how could I become other, Iam you, here true love exists unconditional.

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  4. I would add that just being silent takes restraint and practice. Sometimes, when one is fortunate, one’s filter either malfunctions or dissolves. In that split second, one may gain creative new insights about oneself, not insights about the person who is in an active madness state; and this can make the boundaries fuzzy but more enjoyable.

    My natural inclination as the parent of a person in a state of madness is to think like a sleuth or a reporter, attempting to piece together the racing and fragmented thoughts of my daughter, looking for evidence of a past trauma, or ways to piece everything into a logical narrative, all while considering the complex responses inside my own head. Even if I listen patiently and I don’t say a word, I am thinking thoughts: “This is hopeful.” …”This has meaning”…”This makes me angry or hurt”

    Sometimes my brain wants to burst from the exertion of processing the enormous volume of information when ‘listening’ and the effort to restrain my emotional responses is considerable.

    Occasionally, I can relax and enjoy the narrative, focusing instead on her positive attributes and winsome spirit in general, or the appropriateness of her emotions including rage, or how proud I am of her courage and integrity, even if I can’t put her thoughts/emotions immediately into a context that makes sense to me.

    Recently, I surprised myself by not taking a hurtful comment personally. Like a lightbulb going off, it occurred to me in a flash that a random, negative comment was not necessarily about me. Instead, I considered that it was evidence of new boundaries developing and I complimented her on the considerable work it must have taken, even though I didn’t understand the intended audience or context. Maybe she was just using me to bounce something off and gain confidence. Maybe I tend to over-react? Maybe the most disconcerting thing about my daughter’s madness is not how different she is from me but how similar she is to me. This has become a source of pride. maybe one day, this pride will be mutual.

    Mystery, secrecy, and unknowing is a type of boundary. As a mother, naturally I want to protect my daughter from harm and engage with her on every level and know about every single facet of her life, even to the point of meddling. Often it backfires.

    Even if my motive is to protect my daughter, and I am outraged by her involuntary hospitalization I’m not helping matters when I pry and exhaust myself trying to understand this madness. It is bad enough that she is under scrutiny, 24-7 by mental health workers. Doesn’t it make make more sense for me to encourage the two of us to spend our precious visits in merriment and folly, painting nails, laughing, making up silly songs, and sharing funny stories>? Maybe we can create a new shared madness, after all, unlike mental health care providers, I am not getting paid to spend time with my daughter; therefore, I may as well as enjoy our spent time together, not play therapist.

    My daughter is actually teaching me the more pleasant aspects of madness and the deeper I explore madness simply by spending time with her, the more I enjoy spending time with mad people in general including that mad part of myself. The difficulty is switching gears and returning to the sane community, in my household, church, and work, dealing with individuals who self identify as being perfectly sane. How does one bridge this gulf? I find myself longing less for my daughter to become ‘normal’ and more for other people to become like my mad daughter.

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