A New Vision for Mental Health Care at Soteria Jerusalem

I didn’t know much about Soteria as I approached the entrance to the Jerusalem Soteria house. I had heard of the original Soteria project—an old California home that housed individuals experiencing psychosis—which was meant to be an alternative to psychiatric hospitalization. It was founded by psychiatrist Loren Mosher, who was the chief of the Center for Studies of Schizophrenia in the NIMH from 1968 to 1980. He spent his career studying schizophrenia and advocating for psychosocial treatment without the use of antipsychotic drugs, with Soteria being the culmination of his life’s work.

In the few years it operated, the Soteria house was highly successful at treating psychosis without the use of neuroleptic drugs, perhaps because the core principle of Soteria was being with residents—that is, staying present with them and listening to them in a non-judgemental manner, not treating their “illness”. Soteria staff—which consisted mainly of volunteers with no clinical experience—were there only to accompany residents undergoing a psychotic episode, offering them a safe space with no formal treatment plan. Although they dealt with acutely psychotic individuals, Mosher and his colleagues were able to create an environment that was primarily non-medical and non-professional, and this alternative environment, combined with the act of being with a supportive community, was likely what allowed residents to heal. Despite the success of Soteria, Mosher would eventually resign from the APA not long after the NIMH unexpectedly pulled the plug on his vision.

My first exposure to Soteria was in Robert Whitaker’s book Anatomy of an Epidemic, the same book that would ultimately lead me to the Jerusalem Soteria house. The book is largely about the use of psychiatric drugs and how they may do more harm than good in the long run—a controversial proposition, but one that is shared among a select few pioneers in psychiatry, including the late Loren Mosher. I picked up a copy of Anatomy of an Epidemic at a used bookstore in my hometown of Charlottesville, Virginia, and the content of the book dramatically changed my perspective on psychiatric drugs to this day. Over a year later, while visiting my family in Israel, I was quite surprised to come across a Hebrew translation left behind on a park bench in Tel Aviv.

Flipping through the pages, I came across the name Pesach Lichtenberg, who wrote the foreword to the Hebrew translation. Curious as to who this man was, I consulted the internet, and a quick search revealed an article linking Lichtenberg to the opening of Israel’s first Soteria house in Jerusalem. Despite living in Israel for five years, I had no idea that one of the few operating Soteria houses in the world was located only a short train ride away.

The entrance to the Jerusalem Soteria house is a work of art. Colorful stained-glass windows curve over a grand iron gate, all a part of a beautiful historic stone home in the heart of Israel’s capital. A handmade sign that reads “Soteria house” in Hebrew is the only indication that the building is not a fancy private residence, but a mental health facility.

As I stood for a moment admiring the entrance, two Arab-Israeli men came through the doors, talking and laughing in Arabic. Curious about their relationship to Soteria, and struggling to think of a good question to ask, I stopped them and simply asked “do you live here?” to which one man turned to the other, laughed, and said “of course! Can’t you tell we’re crazy?” A joke—probably.

I wasn’t intending to visit the Soteria house that day, nor was I supposed to be there. In fact, it was only a few days prior that I had even heard of the place, and I just so happened to be in the area. But, being the curious person I am, I knew I had to knock on the door—I was leaving Israel in a few weeks, and there wouldn’t be another such opportunity. I rang the doorbell—which felt very much like I was visiting any old family home—and a young woman came to the door. I explained my reasons for being there, which really came down to being a curious psychology student who wanted to see how a Soteria house operates. She told me that I was the first person to ever request such a thing, and that she wished she could let me in, but, as a volunteer, was not authorized to do so. I left the house with a phone number, which I texted later that day. After explaining in detail my reasons for wanting to visit the Soteria house, a few hours later, I received a very simple response: “want to come tomorrow?”

I had already returned to Tel Aviv, where I was staying, but I took a quick train to Jerusalem the next morning. After spending a few hours wandering around the city, I returned to the Soteria house, this time knowing I had a contact who would let me in. I once again rang the doorbell, and a young man answered the door. I asked for the name of the man I had been in touch with, and after taking a few minutes to find him, he came back to the door to welcome me in. The man I had talked to on the phone was there, and he shook my hand, told me to make myself at home, and—being a busy person—walked out the door and left.

I was surprised by how easily I was able to enter the house. There was no security, no I.D. check, and nobody really questioned who I was. The environment felt very free—people were simply hanging around chatting, the bedrooms were all unlocked with the doors wide open, and the decor reminded me of a hostel I had once stayed at in Vienna. But, as I wandered through the house, the stone walls and mosaic tile on the floor at times made me feel like I was in an ancient temple, and I remembered I was in the heart of the holy land.

I sat down on the old and worn-out—but surprisingly comfortable—couch, right next to an old and worn-out dog, who was fast asleep on the floor. Multiple guitars were mounted on the wall in front of me. Below them, a piano keyboard, surrounded by books, board games, and a single IDF shirt attached to a hanger. The bookshelves held an interesting selection of books ranging from Harry Potter to the Hebrew translation of Robert Whitaker’s Anatomy of an Epidemic, as well as an entire shelf dedicated to religious Jewish texts. Next to the shelf was a bag containing tallit, a prayer shawl often worn by religious Jews. The house felt like a conglomeration of many things, but not once did it feel like a mental health facility.

The kitchen was attached to the main living area, and I immediately took notice of a man chopping bright orange carrots. I was surprised to see large and sharp kitchen knives in a place that housed people experiencing acute psychosis, knowing how strict conventional institutions are when it comes to sharp objects. But I was even more surprised to see a man cooking a real meal in a real kitchen stocked with fresh produce and a variety of Middle Eastern spices. Looking to start a conversation, I asked if he was a volunteer, to which he responded: “Sometimes I work here, sometimes I live here. I’m not sure anymore”.

Indeed, with few exceptions, it was surprisingly difficult to tell who was a volunteer and who was a resident, and perhaps by secretly wondering who the residents of the house were, I was missing the point. Soteria, unlike conventional psychiatric institutions, was never supposed to have an “us” and “them” distinction, something that became clear as everyone in the room sat down at the same table to eat the same meal, a large plate of scrambled eggs and Israeli salad.

As part of the group ate their lunch, I talked with one man who told me that the group had recently returned from a multi-day excursion to the Negev desert—hiking being one of many group activities the house would do together. As we discussed his experience volunteering at the house, I noticed he had a copy of Loren Mosher’s Soteria: From Madness to Deliverance in his hand. “I believe in this project”, he said. “It could be the future”.

Not long after my visit to the Jerusalem Soteria house, I returned home to the States to finish my undergraduate studies in Psychology, where I hoped I could learn more about the enigma of schizophrenia. I had already been told many things from my professors—that schizophrenia is a genetic degenerative brain disease—thought to be caused by an imbalance of dopamine—from which few people recover. But also that it is manageable, so long as appropriate antipsychotic medication is used. Second-generation antipsychotics, I was told, are free from the nasty side effects that the old drugs carried, and should be taken for life to manage the disease. These are things I was inclined to believe, yet Soteria challenged all of them.

I would eventually come to realize the unfortunate truth: the biological model of schizophrenia touting dopamine dysfunction as the cause has no conclusive evidence to support it, genetic research has failed to locate a “schizophrenia gene”, and even the new generation of antipsychotics cannot treat schizophrenia—and may even worsen the prognosis.

Perhaps psychiatry’s commitment to the biomedical model of mental illness is the reason these myths have persisted. Alternative paradigms that take a more holistic view of mental illness are not respected, even when they lead to successful treatment models like Soteria. Yet, although it is unlikely that we will see a radical paradigm shift in the near future, hope for a more humane schizophrenia treatment is not lost. As of 2023, there are 18 operating Soteria houses around the country of Israel—a striking rate of growth considering the first house in Jerusalem was only established in 2016. Perhaps even more surprising is the nation’s full embrace of Soteria houses, which are now funded by the Ministry of Health under the name “stabilizing houses”.

No radical change was necessary for this to happen, and no existing psychiatric system had to be overthrown. In fact, the major factor in the success of Soteria in Israel was the increasing awareness of abuses occurring in psychiatric establishments, as the Jerusalem Soteria founder Pesach Lichtenberg details in his 2017 article. It is remarkable that radical alternatives like Soteria can gain traction so fast when the climate is right, and can thrive despite conflicting with mainstream psychiatry. The implementation of Soteria in Israel really is an incredible feat, and if Loren Mosher were alive today, he would be thrilled to witness the successful implementation of his life’s work.