This book describes current trends in the therapeutic community movement for psychosis, which was most active from the 1960s to the 1980s, in the years of social psychiatry, psychoanalysis, psychotherapy, patients' rights and participation, and even antipsychiatry. The movement's heyday was before the switch to the current dominant paradigm of biological and evidence-based psychiatry, and also preceded the widespread programme of closure of, or cut-backs to, the large psychiatric hospitals and asylums. In this book, 29 authors from 14 countries describe their work.

Therapeutic community models and practices have been in a critical phase of development and even existence during the last two decades. Are they needed or not; what are their special advantages or disadvantages; what is the best way to organize and manage them; are they cost-effective; and the most important: what are their results?

One basic cornerstone behind the therapeutic community model is humane and democratic: avoidance of coercion, promotion of patient and family participation and democracy, multidisciplinary team work, democratic leadership style, basic human respect for users, interaction and positive experiences in community life, learning by doing and through conflicts; at least not harming sensitive people with psychoses in the institutional environment.

These old humane and democratic ideas are also described in this book, and they are still valid – but alone, they not good enough reasons to adapt these models in clinical practice. Since those early days of enthusiasm (at least among a rather small group of activists), we have quite a lot of experiences, models, and prophecies on the adaptation of therapeutic community theories and practices for psychoses. However, we still miss a second cornerstone necessary for today's evidence-based medicine: systematic reviews on existing literature, as well as meta-analyses and controlled or at least naturalistic studies. Whilst we lack this hard scientific evidence (however difficult its generation is), the adaptation of therapeutic community methods remains limited and these models are not included in current care guidelines.

Evidence-based medicine de-emphasizes intuition, unsystematic clinical experience and even common-sense rationale as sufficient grounds for clinical decision-making and treatment practices. When searching for evidence, the first step is to use bibliographic databases for finding good-quality information. This kind of systematic description of the existing scientific study of the therapeutic community is minimally presented in this book. This book lacks hard medical evidence, facts on efficacy, and systematic data on existing (or missing) scientific research results. There is no synthesis of what is known and what not known, even though there are, elsewhere, some elements for such facts. However, last chapter of the book, by Gale and Espana presents some evidence for the effectiveness of therapeutic community treatment of psychosis but the results are vague. Review of the literature is non-systematic and most studies presented were conducted in the 1990s or earlier.

Psychoses are still a major mystery and enigma – and a large, partly unmet challenge to treatment, and to the therapeutic community model which is not a panacea. Schizophrenic psychoses are a major public health problem among the leading unsolved diseases, afflicting about 1% of humans. They are ranked fourth to sixth among causes of disability, begin early in adult life, and their prognosis is often poor. They cause excess co-morbidity, both psychiatric and somatic, around a 20% increase in mortality, as well as extensive negative social, familial and personal consequences. Neither cure nor prevention is yet in sight, and their causes and development remain poorly understood. Antipsychotic drugs relieve symptoms and relapses but have limited efficacy and harmful side-effects. In this book, some important hypotheses are presented, e.g. the very important idea that the therapeutic community model may reduce antipsychotic drugs doses. However, these ideas are not tested here. Not even the few existing studies are presented, e.g. Loren Mosher's views on drug-free treatment in Soteria (www.moshersoteria.com) or even my own study (Isohanni, Reference Isohanni1983) where it was possible to reduce extensively the dose of antipsychotic drugs by adapting the therapeutic community model in a ward for acute psychosis patients.

Psychoses stimulate speculations, phantasies – and serious experiences and clinical innovations; so too does this book. It gives many ideas and practical treatment models. However, scientifically valid, evidence-based facts are not presented here, nor is there any systematic review on earlier study of the treatment process or outcomes in therapeutic community models for psychoses. This lack prevents or limits the extensive rebirth or rediscovery of the therapeutic community model in treating psychoses.