Chapter Four

This Chapter is the first of four on Fraser House and commences with Neville’s adaptation of his father’s Keyline to Cultural Keyline within the context of evolving Fraser House, a psychiatric unit that opened in 1959 within North Ryde Hospital in Sydney, NSW. The Unit’s processes assuming a social basis of mental illness, and Fraser House locality, cultural locality, layout and sourcing of patients are discussed. An overview is given of the Unit’s milieu and Neville’s processes for evolving it as a therapeutic community. The Chapter concludes with a description of the Re-socializing Program entailing patient self-governance and law/rule making via patient-based committees. In the forward of Clark and Yeomans’ book about Fraser House, Maxwell Jones, the pioneer of therapeutic communities in the United Kingdom wrote, ‘Throughout the book is the constant awareness that, given such a carefully worked-out structure, evolution is an inevitable consequence’ (Clark and Yeomans 1969) (my italics). The reasons for this comment by Jones about Fraser House are discussed in the next four chapters.

A SOCIAL MODEL OF MENTAL DIS-EASE AND CHANGE TO BEING WELL

Window Of Opportunity

Neville had completed degrees in zoology, medicine and the further studies to become a psychiatrist in the mid Fifties. In 1956, three years prior to setting up Fraser House, Neville initiated the first group psychotherapy program for schizophrenics in Gladesville Hospital (Yeomans 1965, Vol. 12, p. 66-69). Neville recognized that, with considerable upheaval and questioning in the area of mental health in New South Wales, and a Royal Commission being mooted into past practices - there was a small window of opportunity for innovation in the mental health area. The New South Wales health department built the Fraser House residential unit especially for Neville. Neville was aged thirty-one when he obtained the go-ahead from the New South Wales Health Department to take in patients at Fraser House, a psychiatric Unit located in the grounds of North Ryde Hospital in Sydney, New South Wales - now called the Gladesville Macquarie Hospital. The Fraser House men’s ward was opened in September 1959 and the women’s ward in October 1960. Fraser House was a 78 bed and 8 cot short-term government hospital for voluntary severe psychiatric people; psychotics, schizophrenics, psycho-neurotics, and people with personality disorders. This Unit was established from outset as a therapeutic community, with Dr. Neville Yeomans as founding director and psychiatrist.

Photo 1 Neville and nurse at Fraser House

Assuming A Social Basis Of Mental Illness

Neville evolved Fraser House assuming a social basis of mental illness. Consistent with this, the treatment was sociologically oriented. It was based upon a social model of mental dis-ease and a social model of change to ease and wellbeing. Neville and Fraser House worked with the notion that the patients’ life difficulties were in the main, from ‘cracks’ in society, not them. Neville was familiar with twin sociological notions that people are social products and at the same time people together constitute their social reality (Berger and Luckmann 1967). Neville took as a starting framework that a person’s internal and external experience, along with interpersonal linking with family, friends and wider society all have connexity. Given this, Neville held to the view that pathological society, pathological community, and dysfunctional social networks give rise to criminality and mental dis-ease in the individual. As well, his view was that ‘mad’ and ‘bad’ behaviors emerge from dysfunctionality in family and friendship networks. Problematic behaviors may be experienced as feeling bad or feeling mad, or feeling mad and bad. For these people, life may be lived as unfathomable mess. While Neville recognized massively interconnected causal process were at work, he also recognized and emphasized this macro to micro direction of complex interwoven causal processes within the psychosocial dimension. Working with the above framework Neville set out to use the Keyline principle, ‘do the opposite’ to interrupt and reverse dysfunctional psychosocial and psychobiological processes.

Neville told me a number of times that the aim and outcome of Fraser House therapeutic processes was ‘balancing emotional expression’ towards being a ‘balanced friendly person’ who could easy live firstly, within the Fraser House community, and then in the wider community. The process doesn’t require or need ‘intellectual’ therapy. In this there is resonance between Nevilles and Assagioli’s thinking (Assagioli 1971). Neville’s view was that the intellect is the ‘servant of emotions’ and ‘servant of reproductive and survival instincts’. Many Fraser House patients returned to functionality with little by way of insight about what had happened to them. Neville said that what they were researching at the Unit was whether sharing everyday Fraser House milieu would lead to emotional corrective experience and a move to functional living in the wider society.

Neville wanted to create a special place where people could evolve their own way of life – their own culture – together; where they could evolve themselves as they evolved their shared reality. This follows from Neville’s ‘interconnected living system’ view on embodiment outlined in Chapter Three, namely that our ideas, processes and actions with others in constituting shared realities may sustain and change the way our body functions, and simultaneously the way our body functions may sustain and change our ideas, feelings processes and actions. While all manner of things were awry with patients – cognitively, mentally, physically, emotionally, and socially – within the Fraser house milieu, all structure and process framed and actuated the ‘community’ as the central transforming process in the therapeutic community, regardless of a patient’s presenting condition and conventional diagnosis.

LAYOUT, LOCALITY, AND CULTURAL LOCALITY

Locality and Layout

Fraser House was a set of buildings over a quarter of a kilometer long. The buildings were set in a long thin wiggly line along the contour line - refer map below. From my reckoning, the building is along a Keyline, and Neville’s office was at the Keypoint. I had already noted this when in 2001 Jack Wells, who is familiar with Keyline and worked at Fraser House in the early 1970’s after Neville had left, also pointed out to me the Keyline connection in the Unit’s layout. I met Wells through a conference festival that Neville helped evolve called ConFest. This Conference Festival is discussed in Chapter Eight.

Photo 2 Jack Wells at ConFest

Photo 3 Fraser House along Keyline where the convex curve becomes concave

The buildings were linked by enclosed walkways. While Fraser House was specially built for Neville, he had no say in aspects of the design layout. The Health Department ‘system’ required complete separation of males and females in different wards. A single story administration building was in the middle. At one end of the central administration section was a meeting room (approximately eight meters by sixteen meters) where the big meetings were held.

Diagram 1 Map of section of Gladesville MacQuarrie Hospital, (formerly North Ryde Hospital) showing Fraser House, made up of Wards 8 & 9, now called the Lachlan Center

At either end of the administration block there was a double story 39 bed ward, and there was a dining room at each end. There was a separate staff office in each ward. Most rooms were 4 bed dormitories. There were a few single rooms in each ward.

In Fraser House, the State system’s intention to have a division of sexes in separated wards would have been ‘shattering’ any chance of what Neville called ‘total community’, ‘transitional community’ and ‘balanced community’. Neville viewed the original planned (by the system) use of space as ‘schizoid’ - completely divisive, split - creating ‘them and us’ and ‘no go’ areas for both patients and staff. Neville saw this separation of the sexes as isomorphic with cleavered dysfunctional community. Warwick Bruen was a psychologist at Fraser House in the early 1960’s. In a 1998 interview, Bruen described the initial separation of sexes into different wards required by the Department as, ‘an extension of the medical infection model’.

Photo 4 One Wing of the Fraser House Dorms

The female ward opened in October 1960. Neville rearranged room allocation so there were no separate wards for males and females, although bedrooms remained same sex. This required some negotiating between Neville and the male staff and Unions as there was resistance to this change. After the Unit was running for a time, eight downstairs rooms were set aside for families-in-residence. The eight cots were also in these rooms. School age child patients at Fraser House attended local schools.

Neville arranged for the dining room at one end to be used by all patients. The other dining room was turned into a TV, games and recreation room. This created the necessity for patients and staff alike to walk more than quarter of a kilometer wending through each building and along winding covered walkways between buildings to go to these popular places. The dining room, the lounge room and the long corridor between them were all public spaces conducive to meeting and talking. Fraser House was a replication of the community space of the Tikopia Villages and trails.

Locality As Connexion To Place And Connexity With Place

The following is a synthesis of my crosschecked findings from interviewees and archival records. Neville created opportunities for Fraser House residents to respect and celebrate their diversity in creating social unity and cohesion as the Fraser House Community. While Fraser House was located in the grounds of the North Ryde Hospital, Neville was creating locality in the sense of ‘connexion to place’. He structured interaction such that the close communal living and the mores they evolved together helped constitute and sustain individual and communal psychosocial wellbeing among the residents. Neville also structured interaction during Fraser House events, and outdoor picnics and excursions (Fraser House Follow-up Committee of Patients 1963). Just as in Tikopia, Neville structured social exchange such that psychosocial wellbeing processes were woven completely into every aspect of their lives together. There was constant linking within and between people of differing generations, gender, ‘clan’ (family group), ‘village’, home locality, status and occupation (that is, differing sociological categories). Neville did this by cleavering the Big Group attendees into the Small Groups, each time using different sociological categories. This is discussed in Chapter Five.

In Fraser House, everyone’s lives in the Unit’s space created public space. The Unit’s public space was community space - where people were in continual close social exchange - where friendships blossomed and were sustained by regular contact. Neville created Tönnies' ‘Gessellschaft’ (Tönnies and Loomis 1963). Like in Tikopia, with all of the constant social exchange, any strife soon became common knowledge and typically, it was interrupted before it could start. Within the wider civil society there is scant ‘public space’ as places that allow for, and foster people engaging in conversing and community building with friends, relatives and strangers. The shared community life in Fraser House ‘public space’ meant that people continually talked to and about each other, and hence, like on Tikopia, social news was continually circulating. In Fraser House this circulating of social news was encouraged by the slogan, ‘bring it up in a group’. At certain times of each day there was a mingling flow of females and males from one end of Fraser House to the other along a winding long passageway that mirrored the mountain trails between both sides of Tikopia Island. In Fraser House everyone was ‘contained’ within healing community space. Everybody was in every one else’s gaze, and audience to each other’s change work. Chilmaid made the observation in April 1999 that there was literally no place to hide in Fraser House. One swoop through the place would find someone if they were there.

Neville created a large community gathering place in Fraser House for Big Group Meetings and many smaller gathering places for Small Group meetings and re-creation, with the passages between these (and the dining room) mirroring Tikopia trails. In evolving Fraser House, Neville engaged in place-making and sub-place-making. For example, the room that Big Group was held in became a very special place.

Neville set up a process where there was always a support network to call on to resolve any issue. As necessary, a special support network would be temporarily created to surround one or more till an issue was resolved. For example, in Fraser House suicidal people would have a small 24 hour-a-day support group comprising patients and staff. The Unit’s evolving common stock of practical wisdom about what works was so readily passed on that this wisdom was widely held in the Fraser House community. Patients, Outpatients and staff who had been in Fraser House for a time knew ‘what worked’ in different contexts. These socio-healing actions were preventive. They sustained wellbeing. They were the norm. Social exchange that ‘worked’ constituted an integral part of the patients, outpatients and staff’s evolving good life together. Typically it was trivial ‘everyday stuff’ about how to live well together.

Like in Tikopia, within Fraser House Neville structured it so that people lived with those most different to themselves. The under-active over-controlled shared dorms with the over-active under-controls. As in Tikopia they lived with those most different in order to gain unity and strength together though regular contact in day-to-day life. All involved in Fraser House experienced inter-related cohesive factors of everyday operation, the use of a common understanding and experience of Fraser house routines and shared values, and the sharing of a common culture; the sharing of Community (with a capital ‘C’), - to paraphrase Firth - all that is implied by all involved in the Unit when they would speak of themselves as ‘being at Fraser House’, just as the Tikopian said ‘tatou na Tikopia,’ ‘We the Tikopia,’

Locality as ‘connexion to place’ became ‘connexity with place’ by Neville’s modeling and by osmosis as all aspects of Fraser House’s social forces naturally constituted interdependent, inter-related, interwoven, inter-connected, and interlinked experience and action. While I can write about this, to fully sense Fraser House we would have had to have been there; words are not up to the job – like attempting to convey with words the lived experience of listening to Bach’s Mass in B Minor. All the above is discussed in greater detail in this and later Chapters.

Cultural Locality

Crosschecked interview reports from all of my Fraser House interviewees and findings from a wide range of archival material (Yeomans 1965; Yeomans 1965; Yeomans 1966; Yeomans 1967) confirm that the Fraser House milieu became a community of people who were evolving their own sub-culture together. While all people do this all the time, Neville recognized that linking people together, and simultaneously linking them to a specific place, has potential. In the last Chapter I referred to this as creating ‘cultural locality’ (Kutena 2002). Neville used the word ‘culture’ as meaning ‘way of life together’. He used the word ‘locality’ having this meaning in his drafting of the Objects of the Keyline Trust mentioned in Chapter Eight. In specifying things being produced by the Keyline Trust Neville wrote:

(b) Such materials and productions to be Australian in origin and dominantly for the purposes of enhancing community cooperation and mutual support, locality, self respect, friendliness, creativity, culturally appropriate peaceful nationalism and multinational regional cooperation

Recall that ‘Cultural locality’ means ‘way of life together in this place’. ‘Cultural locality’ is derived from Indigenous sensitivities, wisdom and way. While Neville used the term ‘locality’ to mean ‘connexion to place’ I cannot recall him using the expression ‘cultural locality’, although I sense he would have had resonance with this expression. All people involved in the Unit belonged to and were together evolving the Fraser House cultural locality. The places and spaces in Fraser House became very familiar. They were intimately known. These spaces and places, as well as the staff, outpatients and staff in those spaces and places were all an integral part of it.

Once oriented participants in the Unit knew where they were within Fraser House. This was in a twofold sense, firstly, where they were in Fraser House space, and secondly, something far more challenging, where they were in relation with all the others in the Fraser House community. They also knew where they were in relation to other places and spaces in Fraser House. All of this was embodied. They had feeling and knowings and associated shared understandings of the past happenings in Fraser House places and spaces. Their mindbody ‘livingness’ – as in ‘the whole of it’ (Kutena 2002) responded to the re-membering of these happenings. All involved were living the physical embodiment of the Fraser House cultural locality. By arranging for all in Fraser House to attend Big Group meetings Neville was creating concentrated cultural locality. The vibrant cultural locality of Fraser House was vastly different to the anomic, displaced, normless, alienated, unconnected, meaningless, overwhelming, aggravating lives they had been leading.

EMBODYING KEYLINE

The Tikopia people, in communally walking against and with gravity as they walked over the ridges to an fro - passing those opposite to themselves in friendly banter - were embodying their way of life - a mindbody synthesis with their people, their place, and their world. Like the Tikopians, all in walking to and thro in Fraser House were embodying their way of life - a mindbody synthesis with their fellow Fraser house people, in their place and in their world of their co-reconstituting. For Neville particularly, ideas, feelings, bodily functioning – even down to the neuro-psychobiological dendritic and cellular level, as well as psychosocial processes and actions in everyday life are all interactive and co-constituting, that is, each part plays a part in maintenance and change processes. This is discussed in Chapter Six.

Resonant with Neville’s view on embodiment, Stephen Rose, author of the Conscious Brain (Rose 1976; Rose 2002) in a radio interview broadcast on the Australian ABC Science Show on Saturday 29 June 2002 said, ‘Changes in Society can change people’s nature, which in turn can change their biology’. Neville would have said that change in any of these three aspects might ripple through to change the others. This has important implications. Our ideas, processes and actions individually and collectively may sustain and change the way our body functions. The way our body functions may sustain and change our ideas, processes and actions. Another term for ‘embodying’ is ‘incorporating’ from the Latin ‘in corpus’ meaning, ‘in the body’. This embodying has been intimated a number of times already. Neville was constantly exploring how to foster and use this interactive embodiment happening within and between connected people who are connected to place – cultural locality. Fraser House people incorporated Fraser House Way.

This extends ideas discussed by Berger and Luckmann that society is social constituted and in this process - people are constituted as products of society, psychosocially, and psychobiologically (Berger and Luckmann 1967). Recent research into tensegrity (integrity through tension) (Buckminster Fuller 1961; Pugh 1976) and intercellular communication is resonant with this. The creative and strategic use by Neville of tension to enable integrating possibilities (tensegrity) in Fraser House will be introduced in Chapters Four through Seven. Neville’s use of ‘extegrity’ (Yeomans 1999), a term he used meaning ‘extensive integrity’ in Laceweb peacehealing for reconstructing collapsed societies is discussed in Chapters Nine and Ten.

SOURCING PATIENTS

Back Wards and Prisons

It was not commonly known in 1959 and through the Sixties that Neville set up Fraser House to be a micro-model of a dysfunctional world and more specifically, a micro-model of the alienated dysfunctional fringe of a dysfunctional world. This was the major first step in exploring epochal change. This was where Neville felt it was the best possible place to start. What’s more it was Neville’s view that together, this fringe had massive inherent potential to thrive. This was isomorphic with nature’s tenacity to thrive at the margins. Neville’s aim was to work with and tap this potency just as he and his father worked with the emergent potential of their farmland. His relation to the land and to this alienated dysfunctional fringe was one of love, care, respect and awe at their potential, rather than one of disdain, domination and control. Neville was mirroring Indigenous way. To approximate this alienated fringe, Neville arranged to populate the Fraser House with a balanced group of ‘mad’ and ‘bad’ people. To reiterate for emphasis, Neville was not just setting himself a big challenge in starting with the mad and bad of Sydney, he did so because he firmly believed that these, along with dysfunctional Aboriginal and Islanders were the best people to work with in evolving a new caring epoch

Fraser House accepted long-term chronic mental patients and other severely mentally ill people balanced with an equal number of criminals, alcoholics, delinquents, addicts, and according to the sexual mores of the Sixties, homosexuals, prostitutes and other sexual deviants (Yeomans 1961; Yeomans 1961; Clark and Yeomans 1969). There was a spread across the various diagnostic categories. The intake aim was to have a spread of categories present in the Unit. Appendix 3 shows the various categories of patients in Fraser House as at 30 June 1962. Note that there were an equal number of males and females. This was typical

From the outset Neville negotiated with the Office of Corrections that Fraser House would have twenty male and twenty female prisoners released on license to Fraser House at any one time. People were transferred straight from jail and signed on as voluntary patients. None of the Wards at Fraser House were locked. Few absconded. If they did, they knew that Neville would send the police after them. Upon their return to Fraser House they would face the possibility of not being able to stay and therefore the aversive possibility of being transferred to another hospital, or for ex-prisoners, being transferred back to jail with further charges against them. The prisoners selected to go to Fraser House typically had considerable psychosocial dysfunction that had been in no way addressed by incarceration. They were typically in the last months of their prison term. Typically, that some of them had to be soon released back into society was a worry to people at all levels of society.

Fraser House patients were adults, teenagers and children of both sexes, mainly from middle and working-class backgrounds. Typically, around two thirds of Fraser House patients were referred from public agencies, especially state Psychiatric Services. Other institutional referrals came from courts, probation and parole services, and the narcotics and vice squads. Some admitted were referred by private individuals, doctors, patients and staff (Clark 1969, p.58-59). Some staff admitted themselves as voluntary patients.

In 1961, referrals were accepted from patients, and family and friends were admitted. In 1963 whole families were admitted. Desegregation of family units and single patients occurred in 1964. (Yeomans 1965, Vol. 4 p. 2-4).

During the development of Fraser House in 1959 the working name for the Unit was reported in the Weekender Newspaper as the ‘Neurosis and Alcohol Unit’. Neville was reported in the Sunday Telegraph Newspaper, 14 February 1960 as saying that he believed that Fraser House was the only clinic in the World where Alcoholics and Neurotics mingle 50% and 50 % (1960, February 14). The male Unit had both single and married men. Married men who were alcoholics could have their wives stay with them regardless of whether the wife was an alcoholic or not. The couple was the focus of change. This was the start of eight family suites. Whole families with two and three generations, from babes in arms to the elderly were involved in the suites. Neville pioneered family therapy and inter-generational therapy in Australia.

The focus of change at Fraser House for both the mad and the bad was ‘the patient in their family-friendship-workmate network’. In keeping with this, another condition of entry was that members of a patient’s family friend workmate network had to sign in as outpatients and attend Big and Small Groups on a regular basis. According to all of my interviewees, including a former patient and outpatient, the Fraser House outpatient sub-community was permeated with dysfunctional/problematic behavior, which was typically transformed to functionality by their involvement in Fraser House. It was regularly found that dysfunctional patients had dysfunctional family-friendship-workmate networks. The focus of change being the patients and outpatients and their respective networks made sense from the Fraser House experience.

In supporting mad and bad people to live well with each other, Neville’s view was that one of the primary healing processes that was both structured into and continually and pervasively at work within Fraser House, was the day-to-day lived-life dynamic healing interplay of social cleaving and unifying processes; the same processes that have been discussed in talking about Tikopia. Neville would set up scope for micro-experiences creating very strong forces cleaving pathological entanglements, as well as forging functional bonds within and between people - linking them back to their humanity.

Balancing Community

Resonant with Tikopia and as part of Fraser House’s Unity through Diversity, Neville arranged for Fraser House to be a ‘balanced community’. Neville endeavored to have equal numbers in each of a number of categories. Neville sought and obtained balance within the Unit population on the following characteristics:

· inpatients and outpatients

· mad and bad

· males and females

· married and single

· young and old

· under-active and over-active

· under-anxious and over-anxious

· under-controlled and over-controlled

Figure 1 Categories in which Neville sought to have equal numbers of Patients

Neville in his paper ‘Socio-therapeutic Attitudes to Institutions’ refers to the potency of community process in the ‘balanced community’ he had created. He speaks of a special kind of community as a therapeutic technique, where, ‘therapeutic techniques must aim at giving patients autonomy and responsibilities, and to encourage contrast with (the wider) community, the ‘balanced community’ aims for a mixture of patient types so that the strain is towards normality rather than the strain toward the mode of abnormal behavior of a particular section of the institution’ (Yeomans 1965, Vol 12. p. 49). The above quote is another example of the way change was structured into the Fraser House process. The emergent properties of social and community forces were recognized and harnessed.

In his monograph, ‘Social Categories in a Therapeutic Community’ (Yeomans 1965, Vol. 2 p. 1) Neville describes a number of processes used to allocate beds : age grading, marital status and social categories. Room allocation was never based on diagnosis. While there were same sex dorms (except in the family units) Neville ensured that the opposites were placed together in dorms, therapy groups, activities and patient-based committee work. An example of structured use of cleavage/unity processes in Fraser House was ~~the~~ allocating bedrooms such that two under-controlled hyper-actives (e.g. sociopaths) were placed in with two over-controlled under-actives (e.g. neurotic depressives). This became the main basis for room allocation.

Many interweaving processes, to be discussed later, ensured patient safety. Having opposites sharing the same dorm was based on the principle that the presence of opposites creates a metaphorical normal position in the middle. Fraser house research showed that there was a tendency towards the mean, with under-controlled becoming more controlled, and less active; the over-controlled became less controlled and more active.

Drawing 1 The metaphorical normal middle

A ‘glimpse’ of Neville’s use of the above two principles and Tikopia’s cleavered unities show up in the book, ‘Fraser House’ under the subheading ‘Cleavages’ (Clark and Yeomans 1969, p. 131).

‘The friendship patterns, and therefore the informal influence structure, reflected cleavages in social groupings according to status (patient or staff) and sex. This conclusion is based on a sociogram, figure 14.1 constructed from replies to the question’ ‘Who are your main friends in the Unit?’ ....’

Sociogram 1 This sociogram is Figure 14.1 from Clark and Yeomans, 1969 book depicting a sociogram of Mutual Choice Friendship Structure

‘In the sociogram, a horizontal line shows the cleavage between staff and patients, and a vertical line shows the cleavage between the sexes’ (my italics).

The authors summarize the sociogram data as follows,

‘In short, the genotypical structure of the community (my comment: ‘as a healing community’) is represented by the mutual ties that form a network which is both continuous and yet divided by sex and staff-patient status (my italics).’

One observation of the emerging community depicted in the above sociogram is the relationship between the informal and the formal social structure. Clark and Yeomans provide the following comment on this:

‘The individuals with the most formal power are the psychiatrist in charge (Neville) (40) and the medical officer (41), the male charge nurse (23) and the female charge nurse (11). Of these, the only one with a link, by means of a mutual tie, into the genotypical informal social structure was the psychiatrist in charge. This suggests that the main burden of influence and communication falls on the lower status individuals.’

This finding is fully in keeping with Neville’s notion of devolving responsibility and reversing the status quo. It was also in keeping with Neville’s hands-off though being profoundly and sensitively linked that he was enabler on the edge of the informal social structure.

Recognizing the inter-generational nature of dysfunction, Fraser house had three generations of some families staying in the family units or attending as outpatients.

There were three types of inpatient categories - firstly, inpatients who attended each day from 9A.M. to 9 P.M.; secondly, residential inpatients who went out to work full-time or part-time; and thirdly, full-time residential inpatients.

Fraser House was a huge endeavor. Once under way it was having around 13,000 outpatient visits a year. Big Groups and Small Groups were held twice a day on all weekdays with between 100 and 180 in attendance five days a week year round. Fraser House had more than 3000 small groups a year with between 8 to 12 people attending, i.e. between 24,000 and 36,000 people attendances (Yeomans 1965, Vol. 4 , p. 18)

For all of the unifying talk within Fraser House of, ‘we are all co-therapists’ - staff and patients alike - when a member of staff required treatment it was given in groups containing only staff members, or the treatment was given separately from the day-to-day functioning of the unit, or the staff member gave up the staff position and signed in as a patient. Some staff did do this.

Aboriginal and Islander Patients

In keeping with his (Yeomans 1965) interest, one of the early things Neville did was to invite Mental Hospitals throughout NSW to send any Australian Aboriginal and Torres Strait Islander patients that they had incarcerated to Fraser House. The 9 April 1962 Daily Mirror ran an article with the heading, ‘NSW Lifts the Aboriginal States – Freedom in Ryde Clinic’ (1962) wherein Neville is quoted as saying, ‘We have a plan to transfer to the Centre over a period of time all 50 Aboriginals who are now patients in NSW mental hospitals.’ Around Fifty Australian Aboriginal and Torres Strait Islander patients were sent to Fraser House, emptying all the other Mental Hospitals of patients with these backgrounds.

Apart from a few that needed full time care because of associated medical conditions, all of these Aboriginal and Islander people passed through Fraser House and were returned to their respective communities. Both Bruen and Chilmaid, as well as media reports (Yeomans 1965) confirmed that these patients blended into and participated in every aspect of the Fraser House healing milieu. The 9 April 1962 Daily Mirror article mentioned above also stated:

‘Aboriginals mix freely with white patients in a special unit at the North Ryde Psychiatric Clinic. It is the first time in NSW that Aboriginals have been accepted with equality in a psychiatric unit. They share the same wards and have the same privileges as white patients’.

Neville is reported as saying, ‘One Aboriginal patient at a mental hospital for 20 years had been completely rehabilitated after a few months at the center. He is now at home with his family.’

Margaret Cockett would continually ask around the prison/court system for any Aboriginal and Islander people who could be transferred to Fraser House. Typically, the people involved in the prisons were pleased to let Aboriginal and Islander people transfer. One such Aboriginal prisoner was paranoid as the reason he was in jail was that whenever he was drunk he would go out of his way to punch policemen. He settled down in Fraser House and was released to more functional living with his family.

As an example of a back ward individual, Neville described the case of an isolate micro-encephalic Aboriginal person (born with a very small brain) who presented with few skills. He had the body of a twelve year old though he was an adult. He had no capacity for speech and would make aversive noises, for example, snarling and screeching. As well, he would get angry and bite. Within the Unit, at Neville’s instigation, this person was related to as if he was a ‘lovable little puppy dog’. This matched his optimal functioning. After this he soon became friendly, contented and easily fitted in to Fraser House society. Neville described his cries as:

‘…soon becoming harmonious and naturally expressive of mood - typically, contentment and happiness compared to the prior screeching. He had probably moved close to the optimum functioning of his mindbody. Thereafter he was attached to various factions. He was able to move back out into the community in a care-house and fit in with the house life as a normal micro-encephalic person rather than a dysfunctional abnormal one’.

Neville was fascinated that this person adjusted so well to social life and his change was a convincer for Neville that emotional freeing up is the core of all therapy. ‘With no frontal cortex to speak of, how else could he have changed?’

THE FRASER HOUSE MILIEU

Creating Whirlpools

Both psychosocial structure and processes where entangled in Fraser House just as the. whirlpool’s structure only exists as water in process in a vortex. Similarly Fraser House’s tenuous evolving psychosocial structure was constituted, reconstitured and sustained as self-organising human energy - as processes in action.

Being Voluntary

While many of Fraser House patients were people who had been committed to other asylums and required approval of the system to leave, a condition of entry to Fraser House was that patients voluntarily accept the transfer to Fraser House with some appreciation of what the Unit was like. Having all patients ‘voluntary’ was part of the self-help frame Neville set up at Fraser House. This ‘voluntary’ component was a crucial aspect of patient empowerment. Neville saw the Health Department stopping this voluntary requirement in the late Sixties as the single most important imposed change that ended Fraser House as self organizing Cultural Keyline in action. This is discussed further later.

Neville asked around Mental Asylums for people they had in their back wards. These wards were typically where ‘long term stays’ were kept who the system had given up on ever restoring to society. Eleven certified patients from Gladesville Hospital’s back wards were asked, and Neville described them as more in the ‘resigned to coming’ category. They were given ‘Special Care Leave" from their home hospital and signed on as patients at Fraser House. Neville said that apart for a couple who had serious medical problems who needed constant care, the rest of these moved through Fraser House and back to functional living in Society.

Re-Casting the System

There is present in society a caste system that says, ‘normals have to behave normally, criminals behave criminally and mad people are anticipated to behave madly’. One psychiatric nurse with experience outside of Fraser House said that in her experience of other mental asylums, both the patients and the staff will tolerate madness in other patients, ‘because the patients are ill’. However, they typically will not tolerate the slightest bit of inappropriate behavior in staff. This again reflects the caste system. When I mentioned her comments to Neville. his view was that while this ‘tolerance’ towards patients in other institutions in one sense is ‘showing consideration’, at the same time, this tolerance maintains the madness. In Fraser House there was relentless subversion of both madness and criminality, and rather than displaying a tolerance that maintained the status quo, fellow patients took the lead in this subverting. Some people in some categories of mental disorders were inept in picking pathology. Other patients and outpatients became very skilled at picking pathology or were already skilled at this and took the lead in pointing out, ‘that madness and badness are not tolerated here’.

In Big Group, and in other Fraser House contexts, people would be engaging in all the ‘natural’ dysfunctional roles of ‘helpless’, ‘hopeless’, ‘blamer’, ‘judger’, ‘condemner’, ‘distracter’, ‘demander’ and the like. For a discussion of these terms refer Virginia Satir’s books (Satir 1972; Bandler, Grinder et al. 1976; Satir 1983; Satir 1988). Typically, some of the patients using these behaviors would be withdrawn isolates. Anyone using any of these behaviors in Fraser House would have had it pointed out to them and typically, they would have been interrupted. If they persisted in the behavior this would have been reported to Big Group and Small Groups.

This is another example of Neville’s use of his father’s idea of using ‘opposites’ and ‘reversals to mainstream protocols. When madness or badness was subverted, all hell may break loose, and Fraser House had the processes to work with the corrective emotional outpourings and experience, and the support for people through this experience, towards functionality.

Getting On With It

Recall that from inception, Neville had teed up Fraser House as a ‘short term stay’ facility. For Neville, Fraser House was not an interim ‘holding place ‘ while a long term place could be found in other institutions. From the outset Neville had confidence that his ideas would work in getting people living functionally in the wider community. A rule was set up that patients could only stay at Fraser House for six months. This was later reduced to three months. After three months patients had to leave regardless of whether they had improved or not. This rule was to provide motivation to ‘get on with their healing’. The clear message of the rule in the vernacular was, ‘Don’t procrastinate. Get on with it.’ At one time the typical stay was six weeks (Yeomans 1965, Vol. 4 p. 2-4).

Another general rule on admittance was that patients could return to Fraser House three times. The break between returning was flexible. One patient said that he wanted a transfer to Gladesville Hospital. He was told that on leaving Gladesville he could not return to Fraser House for six months. He did go to Gladesville for a short time and then settled down and got on with his healing at home. This was reported to Neville by patients doing follow-up domiciliary work – (from conversation with Neville during Aug, 1999). This follow-up work is discussed later in this Chapter.

Fraser House As Therapeutic Community

In Neville’s paper, ‘The Psychiatrist’s Responsibility for the Criminal, the Delinquent, the Psychopath and the Alcoholic’ (Yeomans 1965, Vol. 12, p. 50) he wrote, ‘The community is allowed easiest into the hospital which treats the whole family and friendship group of the patient.’ Neville quotes from WHO Technical Report Series No. 208. 9^th Report of the Expert Committee on Mental Health 1961, p.15 in his paper, ‘Sociotherapeutic Attitudes to Institutions’ (Yeomans 1965): ‘In the opinion of the Committee, the importance of adequate training in medical sociology can’t be over estimated, particularly in connection with the teaching of mental health promotion.’ Neville wrote of that, ‘World Health Organization Report’ that enlarged upon the growing view that the recovery of mental patients depends less upon the specific therapeutic techniques than on the socio-psychological environment of the patients in the hospital’ (Yeomans 1965 Vol. 12, p. 46, 60-61). Consistent with creating ‘cultural locality’ Neville went on to say that Clinicians, ‘must aim at allowing the outside culture into the institution’.

The socio-psychological environment in Fraser House was central to the change process. As mentioned in the Chapter Three method section, it took me a long time to realize that the expression, ‘Therapeutic Community’ was not just a title. Fraser House was a therapeutic community - pervasively. Therapy was the function; Community was the process. The word ‘therapy’ was not used in the conventional sense of something done to someone by a psychotherapist, but in the sense of self-organizing self and mutual co-reconstituting of wellbeing.

The Fraser House milieu was like the soil on the Yeomans’ farm. It was complex, interwoven and maintained in a thriving state because of very strategic redesign features that Neville set up and sustained, fully consistent with thrival aspects within individuals as living system and between individuals as a Fraser House living system.

At Fraser House, other dysfunctional people were regularly arriving into a community of dysfunctional people in various stages of shifting towards being able to live well with others and return functionally to the wider community. It was not just a unit where everyone did their best to make it therapeutic. In the Unit, the community as ‘community’ functioned as therapy. In Fraser House thousands of people were coming and going with between ten and thirteen thousand outpatient visits annually. There was the therapeutic perpetual passing on by staff and patient alike of the ‘common stock of knowledge of how things work around here’ (Berger and Luckmann 1967) - individual quirks, where things were, who sits in that chair at that time, the little routines - all the little bits that make living comfortably with others possible.

All the members of the Fraser House therapeutic community – staff, patients and outpatients - as community, shared their lives with each other. In Fraser House the norm was created that there was never any blaming of any one. Anyone blaming himself or herself or anyone else would be immediately interrupted. If anything happened it was deemed to be a shortcoming of the total community. Neville said that every aspect of Fraser House was structured as a community system that overrode everything limiting change, even a doctor’s power of veto. Only Neville as director had the power of veto and he was always driven by context, and within that, the ecological part of the context; so he too fitted in with the fitting. Neville’s process is discussed further in Chapter Five. Any doctor breaking this veto rule would have his or her attention drawn to it by patients and staff, including the cleaners, and the matter would be a priority agenda item during the next Big Group. In a 30 June 1999 conversation with Neville he said, ‘Doctors working in Fraser House would have had their maximal sense of professional powerlessness in their careers. Doctors being authoritarian was not permitted. Most administrative things that doctors would decide as a matter of course in other medical contexts had to be brought to meetings where patients had a voice and were in the majority. If a life-threatening situation occurred where a doctor or other ‘professional’ felt the need to intervene, then a special committee of as many patients and staff as possible would be quickly convened. These temporary special committees would be typically reviewed at the next Big Group.’

Staff Relating

The nurses and doctors within mainstream never fraternized in each other’s tea-room; they did in Fraser House. The mainstream way at the time was that a nurse would always stand if a Doctor entered a room. Nurses new to Fraser House would be tugged back down on to their chairs when they stood when a Doctor entered the room. ‘None of that necessary here!’ It took a time for this big change to settle in. In Fraser House, the shared norm was that ‘the voice of the newest nurse was just as equal as any one else’. At Fraser House Nurses worked as a team (Yeomans 1965, Vol. 4 , p. 17). One of the nurse roles was that of educator (Yeomans 1965, Vol. 4 , p. 20-23).

Neville’s view was that the power – the healing wisdom, psychosocial and emotional energy, and creativity of the Fraser House community was infinitely greater than anyone, including himself. According to Neville during an August 1999 conversation, ‘the staff were astonishingly loyal, and acted with inspired devotion’. Neville gave all concerned almost absolute freedom except in times of crisis. As a by-product, staff fostered their new profession and won a new award rate in creating a new role for themselves as nurse therapists. Fraser House psychiatric nurses were the first ones to achieve a professional award salary in Australia. Such was the passion and commitment within the staff that Neville would often have to order them to go home. Consistent with Neville’s Way discussed in Chapter Three, he would leave almost total freedom to the community so that it could evolve itself (emergent and self organizing process).

For and Against

While Fraser House had the support and backing of the Head of the Health Department, the second string people of the Health Department were bitterly opposed to every aspect of Fraser House as it challenged every one of their beliefs about psychiatry, psychiatric nursing, nursing, as well as about hospital governance, structure, administration and practice.

While operating ‘within’ a ‘government service delivery’ frame, Neville set up another frame, namely, ‘folk self-organizing self-help action in community’. Mainstream ‘health’s, ‘we do it for you because we know’ ‘servive delivery’ people had little or no sense of this new form of ancient wellbeing action.

The Far-From-Equilibrium Learning Organization

In complexity terms, every aspect of Fraser House was structured by Neville and others to maintain the Unit in a far from equilibrium state. Living systems that are adaptive and thriving well while being provoked and challenged by the surrounding ecosystem are usually in far from equilibrium states (Capra 1997, p. 85-94, 102, 110, 175-178, 187). When situations within Fraser House became stuck, Neville would intentionally provoke it and then use the evoked heightened emotional contagion as emotional corrective experience. Some examples of this are given later in this Chapter and later Chapters.

Neville created a community which was what Senge called thirty three years later a ‘learning organization’ (Senge 1992). The Unit had a culture of continual review, innovation and openness to try new ways, leading to sustained negentropy (the opposite of entropy). Neville was decades ahead of business cultural change practitioners in introducing what has since being called, ‘a culture of continual improvement’. Many examples of how Neville sustained this culture are given later. In the business world this culture of continual improvement is often talked about, but not easily achieved, as conservative forces constantly subvert the novel in a myriad ways to maintain near equilibrium conditions. Business leaders are now beginning to realize that equilibrium in a fast changing world is a dangerous state that impoverishes an organization’s adaptive capacity (Davis and Meyer 1999; Pascale, Millemann et al. 2000).

The Use Of Slogans

Neville and staff made extensive use of simple slogans to pass on to newcomers how the place worked. To have staff, patients, and outpatients embody the values, ideology and practices of the Unit, simple slogans were restated over and over. For example, the Unit’s social basis of mental illness perspective was expressed by the slogan, ‘Relatives and friends cause mental illness’. The idea of potential for change and using existing internal resources for change was supported by the slogan, ‘No one is sick all through’. The best advice that could be given a patient was, ‘Bring it up in a Group’. In the early days of Fraser House, permissiveness within the staff-patient relation was embodied in the slogan, ‘We are all patients here together’. The self and mutual help focus was supported by the slogan, ‘We are all co-therapists’. However, recall that boundaries were maintained between staff and patient, in that any staff needing psychosocial support would either receive this within an all-staff support group, or if the situation warranted it, the Staff member would enter Fraser House as a voluntary patient. Some staff did this. The requirement that patients and outpatients get on with self and mutual healing and interrupt any mad or bad behavior in self and others was reinforced with the mantra, ‘No mad or bad behavior to take place at Fraser House’.

Rules/slogans for use by the staff were mentioned in a document called, ‘How to administrate in Fraser House’(Yeomans 1965, Vol. 4 , p. 24). Some examples:

‘Know what to leave undone in an emergency’

‘Frequent rounds are a necessity’

‘Combine the weak with the strong’

All of the above slogans and rules became a simple shared language and set of beliefs that were easily taught to new arrivals.

I found the same practice of using simple slogans used informally among prisoners in my prison work in a 63 bed medium security special protection unit to sustain a smooth running people system. One example that was repeatedly used by prisoners was, ‘You either do it (time) easy or you do it hard’, and another was, ‘You do the crime; you do the time’. These simple notions linked to spontaneous renouncing of the world outside the prison in many respects made prison life much easier for many inmates and contributed to their psychosocial surviving. This happened spontaneously.

Socio-Medicine For Social Cohesion - Everyday Life Milieu Therapy

Within Fraser House simple and profound changes occurred in people’s lives during, and as a function of mundane everyday life contexts – as people went about sharing food, getting dressed, engaging in idle chats and the like. Neville called this, ‘Everyday Life Milieu Therapy’. For this, Neville drew upon his understandings and personal experiencing of Indigenous socio-healing way, as well as from his reading the work of, and conversations with his colleague, psychiatrist Dr. John Cawte about Australian Aboriginal Sociomedicine (Cawte 1974; Cawte 2001, (First edition - 1996)).

Paul Wilson, a noted Australian criminologist and a past head of the Australian Institute of Criminology and current Dean of the School of Humanities at Bond University, writes of this learning how to ‘live well with each other’ in describing his experience of living in a therapeutic community Neville modeled on Fraser House in Mackay some years after leaving Fraser House (Wilson 1990, p.79-80). The Mackay Therapeutic House was far from being a typical boarding house. Neville told me that he had incorporated and adapted Fraser House Way to that small Mackay therapeutic community house. Wilson was having psycho-emotional difficulties in his life at the time and used his stay in this therapeutic community house to sort out his life. The following quote is Paul Wilson’s experience of everyday-life milieu therapy:

‘Neville Yeomans created a community free of doctrinaire principles. The Mackay setting successfully created a sense of belonging. Most people who have experienced deep personal distress have lacked, in my opinion, any sense of residing in a group or clan. They, like I, have lived their lives constructing walls around themselves, to protect themselves from other people. In the process, they have lacked the knowledge and experience of living in a community’.

‘There was nothing magical in the process of achieving this sense of belongingness..... Our day-to-day activities were almost mundane. I would wake up in the morning and help whoever was up to get breakfast ready.

Then as people came in to the kitchen, we would talk about all sorts of things people talk about over breakfasts. Marion would ask one of us to collect some groceries, or to cut the lawn, or help with the laundry.’

‘Most importantly, there were always people around you who you felt cared for you as a human being. This interconnectedness of person with person was the thread that bound the community together and gave us a sense of ‘family’ - a unit that many of us had ignored or not had before.’

This passage resonates with the Fraser House milieu, highlighting the point that everyday life contexts can provide opportunities for one-trial learning about how to live together. This links to what Neville called, ‘caring and sharing the Aboriginal way’ – ‘home, street and rural Mediation Therapy’ and the relating potency of Neville’s ‘mediation counseling’.

Neville had drawn from his experiences with Aboriginal and Islander nurturers an extensive array of micro-experiences and simple processes that foster social cohesion, family friend networking, relationship building, and healing happening between people in conflict, within a relational mediating healing frame.

As an aspect of sociomedicine Neville used what he termed, ‘conversational change’. With this, everyday conversation has potential for reconstituting people’s being and behavior. In exploring ‘conversational change’ processes, Neville also evolved a set of micro-experiences that may allow the enabling of healing action to take place ‘on the run’ as it were, as one goes about relating with other people in day-to-day contexts. These are resonant with the Milton Erikson’s therapeutic use of language in everyday life (Bandler, Grinder et al. 1979; Hanlon 1987) and the similar subtle language Eleanor Porter wrote for her character Pollyanna in the book of the same name (especially Chapters Eight to Ten) – now available on the internet (Porter 1913). Neville passed these ways on to me in action research contexts. Neville also used what he called ‘context healing, street mediation and group story performance’. These draw on Indigenous healing process, cultural action and cultural healing action (Yeomans and Spencer 1993; Queensland Community Arts Network 2002), corroboree, therapeutic communities, dance movement and Keyline organic farming concepts and processes. This action uses natural and evolving contexts as healing possibilities. It also uses what Neville called mediation therapy and mediation counseling for strengthening healing, relationship and community. These ways are discussed later.

A central component of Fraser House change was the freeing up of emotional and gut feelings of all involved while sharing in community as they went about mundane aspects of everyday life. While drawing on the above ways, Neville also applied from Taoism the idea that for all at Fraser house, healing came from ‘letting life act through them’ as they went about their shared life together in the daily routines of getting up, getting dressed, showering, and the like. Within Fraser House and the subsequent small therapeutic houses that Neville established, a change component was this persistent sorting out of how mad and bad people could live well with each other.

Patients, outpatients and staff became skilled as co-therapists during their respective stays at Fraser House and would engage in ‘everyday life’ therapy as they engaged in social interaction with each other. Some adopted Neville’s conversational change processes by absorbing them into their mode of being, typically without noticing that they were doing this. ‘Therapy’ wasn’t a mantle that people put on - it was not a ‘chore’ – it was there as a hardly noticed aspect of being.

Clark and Yeomans’ book contains a segment of a young male patient’s diary (Clark and Yeomans 1969). The earlier section has entries where the patient writes of his confusion and tentativeness about his life and Fraser House. His dysfunction is implicit in his writing. As his diary entries proceed, he records things indicating that he is shifting to functioning well without giving any indication that he even notices that he is changing. Here is an excerpt from early in this patient’s personal account:

‘I am sitting beside Jane in the male group room, holding her bandaged hand. She is very tense. ‘Please help me’, she says. ‘What is the matter with me?’ ‘I feel frustrated. I don’t know what to do. I tell her that there must be a reason for her tension and that she should talk about what bothers her to me or in the groups. But she says that she never knows what to say.’

He is out of his depth though he reiterates the Fraser House mantra, ‘Bring it up in a group.’ A little later:

‘I catch John on the verandah and when I have told him about what bothers me he asks me: ‘Have you talked to Jane about it?’ ‘No I have not.’ ‘Why don’t you?’ he says then. ‘She has been leaning on you for so long now, why not turn the tables for a change and let her help you?’ I haven’t thought of it, but it sounds logical enough.’

This is an example of self-help through mutual-help. While these exchanges seem trivial, Neville and the other interviewees said that time and again the Fraser House experience was that trivial exchange was potent.

At the end of this patient’s diary he has been assessed as ready to leave Fraser House and return to the wider world. Nowhere does he give any indication that he has any insight into the process whereby change to wellbeing and functional living is occurring in his life, or that such change is even occurring. He was not engaging in any intellectual sabotage of his changework – behaviors like faultfinding, judging, blaming, and condemning.

Fraser House Social Ecology

The total Fraser House process curtailed any physical violence. Any newcomers were assigned a buddy for sometime who tagged them so they were never alone. A ‘contract’ was made that everyone at Fraser House, staff, patients and outpatients alike, were to watch out for violent situations and to restrain and interrupt people, preferably before problematic situations even got under way. No informant had any knowledge of any staff member ever been seriously hurt. Fraser House was a relatively big place - around 250 meters long. Outside of Big and Small Groups and the intervening tea break, people were always spread throughout the buildings or on the move. Some fights did break out between patients and were typically interrupted quickly. Any unusual noise would immediately attract a crowd. The energy and ethos of the Unit was always to respond immediately to disturbance and interrupt, rather than to encourage fighting, as more typically happens in wider society. Typically, if something happened say, late at night, any patient or staff member spotting it would immediately get everyone who was up and about to form a group (often a fair size group - as many as they could get) to go to the ‘disturbance’. If someone was doing an ego trip, he or she would be ‘dumped on big time’.

Other mitigating factors were the continual presence of an audience, the presence of females and children, and knowing that violence, or threats of violence would be brought up in Big Group with around 180 mad and bad people present to focus on the perpetrator(s) of violence. Violence and other unacceptable behavior would also be invariably discussed in small groups. Typically, there was commitment to healing in patients and outpatients. All knew that the very strong expectation within the Unit’s milieu was that, ‘here people change and return to the wider society well’. There was also a continually reinforced mantra, ‘no mad or bad behavior to take place at Fraser House’. Crazy behavior was expected and accepted at every other mental hospital in Australia – after all, the reasoning went, ‘Patient are crazy, so what else would you expect’. In stark contrast, new arrivals would have a settling in period where their mad and bad behavior would be pointed out to them. Increasingly, mad and bad behavior would be interrupted in ways discussed later.

Patients also knew that violence could mean their treatment could be terminated. Recall that another pressure to change was a time limit on a stay at Fraser House of six months. Recall that during 1965 the common limit rule for staying at the Unit was five months This was later tightened to three months and the average length of stay was six weeks (Yeomans 1965, Vol. 4 p. 2-4). After leaving, people could return two more times by arrangement. These limits reinforced the, ‘you will return to the wider community’ framing that was pervasive at Fraser House. After leaving Fraser House people could stay in ‘contact’ with the Fraser House milieu because they had this sustained in their reconstructed family-friend network

Handbooks On Fraser House Structure And Process

Neville gave patients and outpatients the task of becoming so familiar with Fraser House structures and processes including the processes Neville and others used to enabling Big and Small groups that they could and did write extremely well written and succinct handbooks for use by new staff, patients, outpatients and guests (Yeomans 1965, Vol. 4).

Neville wrote the introduction section of a Handbook called, ‘Fraser House Therapeutic Community’. This was one of a number prepared at different times specifying the Unit’s structure-process. Two other statements about Fraser House structure and process was the February 1965, ‘Introducing a Therapeutic Community for New Members by the Staff of Fraser House (Yeomans 1965, Vol. 4). A 1966 draft of the Second Edition of the above document was a complementary document to the document, ‘Staff Patient Organization in Fraser House and was largely written by patients (Yeomans 1965, Vol. 4).

In March 2003 Chilmade wrote to me saying that there were handbooks (roneoed typed sheets) both for patients and relatives. The staff handbook was for longer term staff. ‘I did`t get one in my first stay of 3 months in 1962, but did get one (borrowed & not returned) in 1966 when I spent a full year there. Patients did not get access to the staff handbook.’

SELF-GOVERNANCE AND OTHER RECONSTITUTING PROCESSES

The Resocializing Program – Using Governance Therapy

Neville set up a process whereby patients evolved response abilities by taking responsibility for their own democratic self-government. Neville referred to patient-based rule making as creating ‘a community system of law’ (Yeomans 1965, Vol. 3). Law evolved out of evolving Fraser House lore. The Fraser House vehicle for evolving democratic self-governance initially was a committee that decided the ground rules for ward life called appropriately the Ward Committee. Eventually many committees were established.

Patients outnumbered staff on all committees. Each committee member had one vote. This meant that patients could always out-vote staff. This often happened. Neville set the committee ground rules such that he always had a power of veto. Dissenting people who felt strongly enough about a decision could take it before Neville and the decision would be held over till he attended the particular committee where people would present their views.

Neville rarely overturned a decision made by patients where staff dissented, as by Neville’s reckoning after due consideration, the patients generally held the better stance. In his paper, ‘Sociotherapeutic Attitudes to Institutions’ and consistent with creating ‘cultural locality’ Neville wrote, ‘Patient committees formalize the social structure of the patients’ sub-community (Yeomans 1965 Vol. 12, p. 46, 60-61). Neville being ‘dictator’ satisfied the Health Department’s requirements for Top-Down control. However, in practice, Neville was a benevolent dictator’ and the patients and outpatients effectively ran the place – and by all accounts, they ran it effectively.

Chapter Ten discusses Neville’s using his patient self governance processes as a model for post war reconstruction of decimated societies.

The Ward Committee

Patients were voted on to the Ward committee by their peers and readily participated. This first of many committees decided matters such as when lights went on and off, and patient conduct within the wards. The Ward Committee evolved to be the main process for evolving the Unit’s rules and disciplinary process in ensuring compliance with the rules.

The Ward Committee membership was typically isomorphic with the ward’s mix relating to the merging of opposites. Typically, diabolically autocratic people served along side people who displayed extreme tolerance and passivity. Criminals often with a tough ‘no mercy’ attitude would serve with the anxious over-controlled. This was another social context for working out how to work together, and working this through created potential for all involved to catch glimpses of a metaphoric normal person somewhere in the middle. And then, ‘Yeh! I can do that!’ ‘We can work this out!’

Patient Administration

The other early committee was a Parliamentary Committee that grew to be a committee that governed the work of all other committees. Every member in every other committee was automatically a member of the Parliamentary Committee. The Pilot Committee was a ‘Committee of Review’ of the Parliament Committee. Within a very short time, a number of patient-run committees and work groups were set up that involved the patients themselves being actively involved in making decisions and taking actions on every aspect that normally would be the role of Fraser House administration people. Neville evolved the Fraser House committee process so that eventually the committees involved the Committees taking on aspects of all of the roles normally undertaken by staff.

Imagine psychiatric patients returning to everyday life with finely honed practical skills in administering a complex organization having for example, over 13,000 outpatient visits a year. This is what happened. When they were back in their community and learning to interact with people at say, the counter in their local Child Endowment office, the patients typically had some understanding about how bureaucracies worked through personal experience.

The structures and process of the committees were being continually fine-tuned. Chapters 8 and 9 of Clark and Yeomans book (Clark and Yeomans 1969) contain a detailed description of the patient committees at one point in time. Figure 04 below shows a diagram from Clark and Yeoman’s book depicting Patient Committees and the staff devolving their traditional roles to become healers.

Diagram 2 Patient committees and the staff devolving their traditional roles to become healers (Clark and Yeomans 1969)

The respective roles that were devolved to the committees were, psychiatrist, charge nurse, nurse, occupational therapist, social worker, and administrator; these are depicted by the darker boxes. The various committees that took on aspects of the foregoing roles are shown in the lighter boxes.

All of the above committees were isomorphic with mainstream administrative cleaving; even following the Federal Government’s Parliamentary Review Committee (the Fraser House Pilot Committee) and using the term ‘Parliamentary’ Committee’. This reframed matching by Neville of mainstream structures and processes was a precursor of Neville’s 1999 Extegrity Program documentation specifying frameworks for bottom-up grassroots self-organizing mutual-help towards reconstituting decimated societies. This is discussed in Chapter Nine.

Another snapshot of the committee structure and process is in the Fraser House Staff Handbook (Yeomans 1965). A further view is in Dr. N. M. Mitchell’s monograph on the Committee Structure at Kenmore Hospital Therapeutic Community in Goulburn (Mitchell 1964) held at the Kenmore Hospital Museum. Kenmore’s Therapeutic Community was modeled on Fraser House. This is discussed in Chapter Seven.

The New Role For All Staff

In this devolving, staff took on the enabling/mentoring roles in respect of the patients taking over the staff’s administrative duties. This freed up all the staff including the cleaners to be also supporters of self-healing and mutual-healing by the patients and outpatients. The patients did the cleaning, with cleaners in mentoring roles. Because the cleaners were constantly present in the community during day work hours, they saw most of what was going on. Aided by this, and by common agreement of patients and staff, the cleaners were the most insightful community therapists after the patients. This skilled therapeutic role of the patients and cleaning staff was reported in the research, writing, and archives, and collaborated by interviewees.

Recall all staff attended Big Group – including the cleaners. Some cleaners became very insightful therapists - the ‘onlooker seeing most of the game’. On one occasion, mentioned by Neville in a conversation we had in Yungaburra Queensland during December 1992, a cleaner spotted that a catatonic women had drawn a beautiful horse in a moment of lucidity. The cleaner mentioned about the catatonic’s drawing skills during a Big Group and suggested that a drawing pad and colored pencil-set be left beside her so that she may be prompted to stay lucid longer. This was done and the catatonic patient did start to draw. To encourage her further, a full painting kit was arranged to be place beside her. After a time a set of poster colors in pots were set up and a nearby wall was designated as the ‘mural space’ and mentioned her name. In the end this patient came out of her catatonia and painted beautiful big murals over a section of the Unit and largely from this work. At one stage she was running out of walls to paint and this coincided with word being received on the grapevine that a’ razor gang’ would arrive that might recommend closing the Unit if it was deemed to ‘way out’. After discussion in Big Group about this impending inspection it was agreed that everyone would help in painting over the murals and returning the unit to white. When the inspectors arrived the staff where in their white uniforms in a white unit. The inspectors saw little that was out of the ordinary and okayed the Unit. After they left the mural painting resumed and after a time this person was able to return to living in society.

All of the staff were entering into new territory at Fraser House. No one, including Neville, had any prior experience of facilitating the collective action therapy of patient self-governance, or any of the other evolving aspects of Fraser House. No one had had prior experience with Big Group, where all patients and outpatients at Fraser House (around 180) joined with all staff on duty for one hour community meetings (held twice a day on weekdays). Neville and none of the staff had prior experience in therapeutic communities, or in being healers within daily community life. Neville was one of the few on staff to have prior small group therapy experience. Recall that he had been running groups for schizophrenics in 1956. As stated previously, Fraser House was continually involved in action research into its own unfolding processes. What worked was repeated. What did not work so well was adapted, or dropped. There was a climate of continual experimentation. No one outside of Fraser House had experience in the above processes either.

Balancing Governance

In maintaining balance, the aim was to have equal numbers of females and males on each committee. Endeavor was made to maintain an inter-generational mix. Isolates were learning to re-socialize and form relationships with other patients and outpatients. The Committee work required acquiring and using a wide range of personal and interpersonal communicating skills. Participants were encouraged to recognize and respect their own needs and those of others. This is a reason why the committee work was called the ‘Re-socializing Program’. Fraser House became a major center for learning group skills with people from many Government, Academic and Non Government organizations attending. Much of the training was done by patients. This is discussed in Chapter Six.

Endeavor was also made firstly, to maintain a balance on Committees between under-controlled/over-active people and over-controlled/under-active people, and secondly, to include outpatients within the various committees. At one stage their were eight patients and four outpatients on committees, that is, twice as many patients (Yeomans 1965, Vol 2. p. 12). Also, patients were encouraged to have balance between committee work and self-healing. Any person ‘hiding’ from their own change-work by being too busy in committee work soon had other patients pointing this out to them. If patients put themselves forward for elections too earlier in their stay, patients and staff alike would be suspicious of them being on a power trip or avoiding personal change work and would challenge them about this or raise the issue in Big or Small Groups. The same thing would apply to a person seeking to serve on many committees.

Flexible Rigidity

Paradoxically, through the patient and outpatient Governance Programme the Unit became increasingly flexible, although simultaneously, there was the making of tightly detailed microscopic rules. In a 13 July 1999 conversation with Neville, he stated that rules kept changing by refinement as necessary, although often a set of rules would be collectively dumped if they turned out to be non-functional. This paradoxical ‘increasing flexibility within tightly detailed microscopic rules’ mirrored Neville’s ‘non-interventionist/interventionist and uninvolved-passive/totally involved’ leader stance. Action was a function of context. When things flowed, the people involved engaged in the flow. When there were ‘hiccups’ or strife, then rules would be swiftly invoked. As on the Yeomans’ farms, all action was context driven, and what aspect, of what were often polar opposites, came into play, was a function of the unfolding moment. The nanno-rules (very detailed) were there constantly as a guide to action.

Patient Treatment And Training

In 1965/6 it was reported that patients were engaged in the following:

‘Assessing and admitting new patients, reviewing progress, instituting treatment procedures, making new rules and altering old rules and meting out discipline (Yeomans 1965, Vol. 4 p. 17)’.

The archival material, especially the Fraser House Handbook written by patients to train new staff (Yeomans 1965, Vol. 4 p. 17-20, 50-54) and the research interviews all support the view that patients became highly skilled in carrying out their committee and other work. I have access to embargoed Fraser House records that include some of the reports of the Initial Assessment Committee. They read like they were written by an extremely skilled, insightful and psychosocially-emotionally wise and discerning psychiatrist. As the saying goes, ‘It takes one to know one’. A number of case records were available for perusal along with the patient committee’s initial assessment on the patient. It was also apparent that the insights in the initial assessment were congruent with the dynamics that unfolded for particular patients.

Committees of patients prescribed treatment. At first this may sound a bizarre and dangerous notion. And yet all the reports in archival material and from interviews with the psychiatrist, psychologists and a senior charge nurse said the same thing - the patients quickly emerged as the most skillful in community therapy. Collectively they were way ahead of the professionally trained psychiatrist, the trainee psychiatrists, the psychologists and ahead of the nurse therapists. None of their professional training had in any way prepared them for community therapy enabling; in fact Fraser House became the center for training psychiatrists in community psychiatry, with the patients as the primary source of training.

The Domiciliary Care Committee

Members of the Domiciliary Care Committee started to do domiciliary visits on ex-patients and outpatients, and to go on suicide crisis calls into the community often late at night (Clark 1969, p. 69). Domiciliary Care is discussed in Chapter Five. Typically, five patients would support each other in making visits to potential suiciders on a twenty-four hour call-out basis. They would travel in the little red van funded through the patient run Canteen – discussed below.

This capacity was made known to the wider community and this outreach was frequently used by residents at the Gap on South Head in Sydney. Regrettably this spot is frequently used by suiciders who jump from the high cliffs onto the wave smashed rocks below. Once these residents knew of Fraser House Suicide Outreach, they would phone Fraser House for assistance. A potential suicider would suddenly be surrounded by five mental patients who were very skilled in therapeutic social intercourse. They had an excellent track record in getting potential suiciders to come back with them to Fraser House. This is discussed further in Chapter Five.

The following letter was drafted by resident members of the Parliamentary Committee as an aid to increasing involvement by family and friends. Neville arranged for a copy to be placed in his collected papers in the Mitchell Library (Yeomans 1965, Vol. 2, p. 11).

Fraser House

The Psychiatric Center

Cox Road

North Ryde

Dear

As your relative or friend is now a patient at Fraser House, it is now our common purpose to do what we can towards the restoration of full mental health.

We invite you to come as often as you can to the groups, the function of which are to enable all of us to find out the reasons why the breakdown has taken place, so that we can all assist.

There are in the hospital a number of committees, because it is believed that the patients and their relatives and friends can do most towards solving each other’s problems.

Groups are held at 9:30AM each morning and at 6:30PM each evening. Tuesday and Thursday groups are set aside for parents and relatives of the patients and Friday morning for general business.

If you would like a group from here to call on you to advise or help you in any way, to indicate what Hospital Benefits or social services are available, to explain the groups to you, or to be of any other assistance you have only to ask and a group of patients will be at your service.

Will you please write to me if there is anything we can do or any information we can give.

If you are in distress about anything, would you ring Fraser House, phone 880 281 and ask the charge nurse to give me your message.

The President

Patients’ Parliamentary Committee.

Notice that this letter was sent by the patient who was the President of the peak committee. Also note the inclusiveness of community therapy conveyed in the second paragraph, and that support was readily available, ‘by a group of patients’. They would come in their own red van.

The Outpatients, Relatives And Friends Committee

Shared travel was fostered by a committee called the Outpatients, Relatives and Friends Committee, one of the patient-run committees under the Fraser House Governance therapy/Resocializing Program. This Committee would arrange the matching up of attendees at Big and Small Groups to maximize car-pooling and people traveling together. Often people with very small family friendship networks and poor social skills would be voted on to the Outpatients, Relatives and Friends Committee to provide experience in social interaction.

As a consequence, these visitors and their associated Fraser House patient(s) tended to obtain, through their involvement in Fraser House, a completely revised and extended functional suburban friendship/support network composed typically, of up to seventy people who they met through Fraser House. Recall that typically, patients arrived at Fraser house having from two to seven dysfunctional members of their family and ‘friends’ in their lives. Some who had jobs had a workmate or two they had some social contact with.

Constituting Rules And Constitutions

In involving patients and outpatients in self governance Neville had them devise their own, ‘Patient’s Rules for Committees’ (Yeomans 1965, Vol. 2, p.6-12). Neville sent a letter of congratulations to patients and outpatients on 17 Jan 1963 when they produced this document, giving them ‘100% for effort’ (Yeomans 1965, Vol. 2, p. 13). A monograph prepared by patients and outpatients was, ‘The Constitution of the Fraser House Relatives and Friends Group’ (Yeomans 1965, Vol. 2, p. 50-60). Patients and outpatients in other Committees devised their own constitution. All of this was for Neville, part of the Communities creating a social system of law for the Unit from within the lore of their own constituting.

The Roles of the Patient Committees

Appendix 4 outlines all the various patient committees at a particular point in time. They were constantly being reviewed/changed, including which staff function was devolved to each committee, the roles of each committee, the membership of each committee, including membership criteria, the split between in-patient and outpatient membership, and the staff present at each committee meeting. Reading Appendix 4 now may give a feel for the totality and completeness that Margaret Mead, the anthropologist, spoke of when describing Fraser House as the most Total therapeutic community she had ever been to.

Patients were very mad and bad. In going onto committees they could be moving in and out of their dysfunction(s) (psychosis or episodes of schizophrenia and the like). Patients did what they could, depending on the state of their being-in-the-world on the day. We return to this later.

The Canteen And The Little Red Van

The idea of having a patient run canteen was first discussed by the Ward Welfare Committee in July 1960. This was reported in a Unit File Note now contained in Neville’s Collected papers (Yeomans 1965, Vol. 5, p. 30). The possibility of a canteen was raised because of the news that the Female Ward was about to open. This meant that extra funds would be needed to meet the expanding welfare needs of patients. As well, the canteen could provide snacks for the breaks between Big Groups and Small Groups. The only way to meet welfare needs up to this time had been by way of raffles. However, insufficient money was being raised. In September 1960 a definite decision was made by the Ward Committee to approach the patients on the idea of a canteen. The proposal was placed before all the patients of the whole Male Ward during Big Group. It was passed with unanimous approval. Dr. Barclay the head of North Ryde Hospital was approached. He approved the idea with the following provisos. All goods received had to be on a C.O.D basis. There was to be no long-standing accounts. A bookkeeping system had to be set up. Finally, the canteen would possibly have to cease if there were any major troubles, or if a hospital canteen opened. These conditions were accepted. In fact, each of these provisos had therapeutic value. The canteen was fully owned and controlled by the patients and the profits could be used at their discretion. Patients involved in running and administrating the canteen learned valuable life and social skills and response abilities. It provided a number of opportunities for ‘work as therapy’. It meant that patients learned responsible financial and other management skills. None of the administration money of the hospital was used. It was totally set up and funded by the patients.

The canteen was opened with £12 from funds available in the patient welfare kitty and a £53 loan from a patient committee member. Profits of the canteen funded the purchase of a little red van and money for fuel and maintenance. With between 10,000 and 13,000 outpatient visits and many hundreds of guests a year, the canteen had a steady stream of customers. As mentioned, the van was used by the patients in their suicide and crisis call out actions. Additionally, the patients used this van to go on domiciliary visits to ex-patients and outpatients. This will be discussed below.

It was generally understood in the mainstream system that the administration of a mental hospital could have detrimental effects, and to counter this, in mainstream hospitals some attempts would be made to ‘make things nice’. As we have seen above, in the devolving of administration to the patients in Fraser House, Neville used the patients’ involvement in administrating and organizing the Unit as an opportunity for them to learn by living and surviving all the work that this entailed. Fraser House ‘Administration therapy’ as the name implies used learning how to administer a major hospital as a therapeutic process. Patients and Outpatients also had opportunity to learn that fault, if it be called that, was not theirs, but a part of a ‘disorganized’ and ‘conflicted’ Fraser House system. For example, the Canteen was ‘delegated’ - through voting by patient and staff, and by common understanding - to those who were not able to do it, though capable of learning - so everyone could support them till they could learn to do it.

Photo 5 Allocating the job to those who can’t do it

Photo 6 Increasing confidence

The two photo above were taken at ConFest – discussed in Chapter Eight.

The canteen was a continual source of claims and counter-claims about theft and mismanagement. The mess was therapeutically valuable and this was commonly understood by all involved in Fraser House. It is another example of P. A. Yeomans use of opposites and reversals.

As mentioned, Neville and others called this committee related activity by the patients and outpatients, ‘governance therapy’. This participation in democracy is resonant with aspects of the worker participation and worker democracy of E. L. Trist and Fred Emery of the Tavistock Institute in the United Kingdom (Emery, Thorsrud et al. 1969). Alfred Clark the head of the Fraser House External Research Group went and worked with Trist at the Tavistock Institute after leaving Fraser House (Brown 1960; Emery 1966).

Saying ‘No’ And Undercontrolled Auditors

As an example of governance therapy in action, a person who had been elected to work in the canteen wanted to resign because some patients were asking him to break the rules and he could not say ‘no’ (Yeomans 1965, Vol. 5, p. 34). At the same time he would get very disturbed and angry. The consensus in the group discussion about this was that it was very much in his interest to learn to say ‘no’ without becoming disturbed. It was in his interest to stay working in the canteen and face this problem. He did stay on. He worked through this issue in group discussions and in his canteen work experience till it was resolved.

In a similar vane, an embezzler was knowingly elected to the Canteen Committee and, true to form, embezzled money. His actions, and their consequences for everyone provided a potent context for change work during both Big Group and Small Groups. I do not know the circumstances, however imagine having an under-controlled auditor who was a homicidal maniac supported by a few who could restrain the auditor when he was making his points to the embezzler too strongly! Matters to do with the canteen were a constant generator of extreme emotional passion in Big Group. It was well known that this continual therapeutic struggle amongst canteen workers was also the source of funding for the patients’ domiciliary and other outreach work which patients and outpatients were committed to, and highly valued.

Letting Life Act Through Them

Neville set up processes whereby responsibility for, and the activity of healing was taken on by the Fraser House community as a whole - that is both staff and patients. Patients had to regularly make choices and decisions and carry the responsibility that this entailed. Neville set up highly specified, though very flexible processes and practices that the community as ‘community’ then evolved together. A central component was freeing up emotional and gut feelings while sharing community. The healing came from ‘letting life act through them’. It was the persistent sorting out of how mad and bad people could live well with each other.

Traces of the Social Activities Committee’s energy is contained in their set of accounts which includes expenditure for boat hire during a picnic, taxis to the picnic, cartoon hire, rail freight for film, and cake mix. They sold the cakes and made a small profit (Yeomans 1965, Vol 2 p. 79). Each committee handling money was required to keep financial accounts, records and to present these accounts regularly to the Parliamentary Committee. This activity enabled patients to gain experience in budgeting and financial management of their own finances.

Neville pioneered patient committees in the mental health context within Australia; while patient committees are frequently used today, this was unheard of in 1959. Neville did have the support of a person high in the Health Department who helped Neville survive when psychiatrists and others questioned what he was doing. This will be discussed later.

REFLECTIONS

This Chapter has discussed Fraser House locality, cultural locality, layout and sourcing of patients. The Unit’s milieu as a Therapeutic Community was discussed and patient self-governance and law/rule making via patient committees was outlined. In the Fraser House Governance Therapy, Neville was evolving praxis towards folk community reconstituting their local lore and law as a vital aspect of reconstituting collapsed societies and evolving folk based transitions towards a caring new epoch (Yeomans 1971b; Yeomans 1974; Yeomans 1999). This is discussed in Chapter Ten.

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