CHAPTER SEVEN – CRITIQUING AND REPLICATING

This Chapter discusses criticisms made in the Sixties about Neville and Fraser House and responses to these criticisms are made. Neville’s processes for extending Fraser House into the local community are detailed. Wider society’s processes for placing boundaries upon behavior and for accommodating diversity is detailed and these are contrasted with Fraser Houses and the Laceweb’s use of therapeutic community to fulfill the same functions. Neville’s setting up of transitions to community self-caring is set out, as well as Neville’s intentional actions contributing to the phasing out of Fraser House. Research on Fraser house evaluation is briefly outlined along with a discussion of American research using Fraser house as a model. The Chapter concludes with ethical issues in replicating Fraser House.

CRITIQUE OF FRASER HOUSE IN THE SIXTIES

In summing up Fraser House, the response of those involved in Fraser House ranged from rapturous commendation to rapping condemnation. In their book about Fraser House Clark and Yeomans report (Clark and Yeomans 1969):

‘Many professional workers, psychiatrists, psychiatric workers, psychiatric nurses and clinical psychologists, have expressed antagonism towards the practices of the Unit. They have claimed, among other things, that the confidences and the dignity of patients are not respected in the traditional way, and that the treatment is crude and administered by unskilled personnel. They describe instances in which relatives of a patient have been denied information about the progress of treatment, or had pressure exerted upon them to attend group therapy meetings against their own wishes.’

‘At a more personal level, charges of flamboyance and irresponsibility have been made against the director of the unit (that is Dr. Neville Yeomans). Some practitioners have refused to refer patients to Fraser House because of their feelings of disquiet about it’s personnel and practices.’

‘Some patients, also and their relatives and friends, have shown extreme fear of, and hostility towards the practices of the Unit. They describe vividly their feelings of horror and helplessness when first exposed to the interrogation or verbal attack of a group of grossly disturbed people. Frantically, they look towards the staff for protection, but support is not forthcoming. The inescapable conclusion is reached: staff and patients are united in their efforts to uncover innermost secrets and to probe sensitive emotional areas without remorse.’

Some of these charges were also made against Neville’s father. He was described as being unprofessional, unskilled in agricultural science and with being too forthright. Similar charges of being unprofessional and unskilled are made against Laceweb people.

A RESPONSE

I will respond to these criticisms; firstly, the report that ‘relatives/friends of a patient had pressure exerted upon them to attend group therapy meetings against their own wishes’. We have discussed that ‘family and friends attending Big Group’ was a condition for patient entry to the Unit. We have also seen a letter sent to friends and relatives encouraging them to attend. That letter said that if requested, a group of patients could call on friends and relatives to explain things, and answer questions. In respect of the claim, ‘that pressure was being exerted against people’s wishes’, Neville stated that this certainly occurred fairly regularly as particular circumstances arouse.

Some families went out of their way to not cooperate with efforts to treat family members. Neville wrote, ‘Family inconsistency and conflict, distrust of the hospital, etc is most commonly and in fact almost solely found amongst the relatives of the most severely ill of all patients. It characteristically arises with the relatives of severely schizophrenic and major narcotic addicts, murderers, and violent patients; far more than in any other group which is perhaps a reflection of the extreme tension and distortion under which these families live, making them suspicious of any efforts to help them (Yeomans 1965, Vol 5, p. 44-45)’.

The following is an example Neville recalled - a tangled inter-generational inter-family dysfunctional group of six. Firstly, two of the group were attending Fraser House - a brother and sister in their early twenties. After a time they brought along a fourteen-year-old friend of the sister who revealed she had been living in a criminally exploitative sexual relationship with a man in his fifties for many months. He had also being taking illegal photographs of this fourteen year old. She had moved in with this fellow, a mate of her father, after the father had been sexually abusing her. The fourteen year old had confided all this to the brother and sister.

The brother was incensed about this fellow exploiting the 14 year old as he knew his sister, the one attending Fraser House with him, had been sexually abused by their father. The brother and the fourteen year old stole the man’s expensive photographic equipment as payback for exploiting the girl. Because of this they had been charge by the police. All this was revealed to everyone in Big Group. The Big Group decided that six of the competent mature-aged patients (none of those involved in the focal group, and some who had themselves been exploiting children) would confront this fifty year old. The fourteen year old moved all her gear out of the man’s house in his absence and she shifted in to Fraser House. Around 8:30PM on a dark night this fellow answers a knock on the door to find five psychiatric patients on his doorstep. Neville told me that the spokesperson said words to the effect, ‘We are all friends of the young girl you have had her living with you, and we know everything, and it is in your interest to let us in come in and talk with you’. He let them in. The spokesperson continues, ‘We are all patients at Fraser House. Do you know Fraser House?’ He did.

‘One hundred and eighty people in a Big Group talked about you and the 14 year old girl at length today. You can go to jail for a long time for what you have been doing. It is very much in your interest to attend Fraser House reception at 9:20 A.M tomorrow morning for a meeting starting sharp at 9:30 A.M.’ He was there.

Apart from anything else, this fellow had been placing his own wellbeing in extreme danger without a single thought of consequences for him. He needed help, though at first he did not know it. The man attended Fraser House Big Group and Small Groups processes regularly thereafter. Initially, the brother and sister, the 14 year old, and the fifty year old were allocated to different Small Groups. After a time, two or more would attend the same Small Groups. Ultimately the brother and the fourteen year old faced court where their reason for taking the photographic equipment, the older man’s exploiting the fourteen year old, and the fact that the two of them and the fifty year old had been attending regular therapy groups at Fraser House, were all taken into account as mitigating circumstances. Because of their evidence in their trial, the fifty year old was taken into custody by police and let out on bail. He continued attending Fraser House as an outpatient and this was put forward as something in his favor and taken into account in his sentencing. Readers can draw their own conclusions about the efficacy of the pressure to attend Fraser House in this case.

As for the claims that the treatment was crude and administered by unskilled personnel, the reports of those I interviewed was that patients and staff alike became extremely competent in a whole range of processes outside of conventional mental health practice. The Unit became the center for teaching new psychiatrists ‘community psychiatry’. Fraser House patients played the major role in training these new psychiatrists. In respect of the criticism that confidences and the dignity of patients were not respected in the traditional way, we have discussed the often tough and provocative nature of Fraser House community process. Neville described his Way as being ruthlessly compassionate in intervening, interrupting and sabotaging people who were adept at maintaining and sustaining their own and/or others’ dysfunction.

In Fraser House people changed where nothing else had worked in the other places they had been. Relatives and friends of a patient were often denied information about the progress of treatment. It was regularly found that many relatives and friends were very prepared to use information about a patient’s progress to destructively sabotage that process.

It is to be expected that what Neville was doing would create ‘peer disquiet’ about Fraser House personnel and practices. Anything that turns a profession on its head and strips away virtual every aspect of members of that profession’s traditional power and authority as both individuals and as a profession would create vehement opposition.

Each of my interviewees agreed that the following quote encapsulates the experience of many newcomers to Big Group.

‘Some patients and their relatives and friends have shown extreme fear of, and hostility towards, the practices of the Unit. They describe vividly their feelings of horror and helplessness when first exposed to the interrogation or verbal attack of a group of grossly disturbed people. Frantically, they look towards the staff for protection, but support is not forthcoming. The inescapable conclusion is reached: staff and patients are united in their efforts to uncover innermost secrets and to probe sensitive emotional areas without remorse (Clark and Yeomans 1969).’

Every interviewee, including the ‘ex North Shore Bus Depot Gang’ leader and the outpatient I met in Yungaburra said that Big Group was an extremely intense experience and in all of this, there was profound framing compassion and a relentless drive for all involved to be moving to being able to live well in the wider community. As for being flamboyant, Neville was a chameleon who constantly changed to fit context. In keeping Fraser House before the public of Sydney, Neville was very prepared to be a flamboyant celebrity. Later, when he was quietly evolving networks among Indigenous people and wanting to minimize interference from dominant elements, he went out of his way to be invisible. In chasing up some people in Sydney in 1998 and 1999 who knew Neville in the Sixties, a number said they thought he had died years before.

REPLICATING FRASER HOUSE IN STATE RUN ENCLAVES - KENMORE HOSPITAL’S THERAPEUTIC COMMUNITY

Dr. N. M. Mitchell from Kenmore Psychiatric Hospital in Goulburn was interested in setting up a 300 patient therapeutic community (based on Fraser House) within Kenmore, a hospital with over 1,200 patents (Mitchell 1964). A file note in Neville’s collected papers states, ‘Dr. Mitchell was sent to Fraser House for a week of intensive training and received copies of Fraser House’s rules, administration structure and committee organization. Neville had visits to Kenmore and visited Goulburn Base Hospital and developed liaison between Goulburn Base Hospital and Kenmore. Neville engaged in four days of continual supervision at Kenmore during one phase when he ran small and large groups in every ward of the hospital and delivered talks to all members of both staff and patients throughout the entire hospital’ (over 1800 people). He also supplied Kenmore with research instrument to act as case history records. While their therapeutic community had around 300 patients Neville ensured all involved in Kenmore and the local hospital knew about this new Unit (my italics) (Yeomans 1965, Vol. 12, p. 66-69). Note the thoroughness of Neville in ensuring every single patient and staff as well as the local base hospital all were thoroughly briefed on the new therapeutic community unit at Kenmore.

Photo 1 Dr. Yeomans at Kenmore - Goulburn Evening Post, 19 June 1963.

Neville’s work with Dr. N. Mitchell and Dr. J. Russell at Kenmore was featured in an article in the Goulburn Evening Post on 19 June 1963 called, ‘Kenmore’s Group Therapy Plan – Leading Psychiatrist Visits Kenmore’ (1963). Dr. Mitchell is quoted as saying, ‘A large-scale community living or group therapy used at Kenmore since late last year has proved an unparalleled success. Kenmore modeled their Committee structure/process on the one then in use within Fraser House.’

FRASER HOUSE AND TRANSITIONS TO COMMUNITY SELF CARING

This segment looks at Neville’s contextual frames for positioning Fraser House praxis in fostering a transition to a humane caring epoch. Neville spoke of Western society having four levels of functioning relating to conduct - namely, values, norm, rules, and obligations. Figure 1 shows firstly these four levels, secondly, the normal and deviant behaviors associated with each of the four, and thirdly, the typical societal ‘correcting’ agencies associated with each level.

Typically, criminal people are deviant at levels one, and three in addition to level two. The criminally insane are typically deviant on all four levels. The mentally ill may deviate at level one and three as well as level four.

Note that these mainstream agencies provide a ‘service’ role for the community at large. In other words, they ‘do it for us’. In large part, level two and three service is provided by some level of government - the public sector.

Some private sector contracting-out occurs; for example, private prisons. Private commercial practitioners (service providers) may be supported by government funding arrangements; for example psychiatrists and physicians in level four. Voluntary service providers also assist; for example, church based social and counseling services and youth-outreach services in level one and aspects of level four. Outside the massive service provider arrangements is now an extensive network of self-help groups.

LEVEL

NORMALITY

DEVIANCY

CORRECTING PROCESS

FRASER HOUSE AND LACEWEB

CORRECTING PROCESS

1 Values

Moral

Ethical

Immoral

Unethical

Priests

Moral leaders

Therapeutic Community

2 Norms

(Legality)

Legal

Law-Observance

Illegal

Criminal

Judiciary

Police

Therapeutic Community

3 Rules

(Efficacy)

Loyal

Disloyal

Administrators

Therapeutic Community

4 Obligations

(Capacity)

a) Role

Performance

b) Task

Performance

Role responsibility

(Competence)

Ability

Mental Illness

Physical Illness

(Disability)

Psychiatrist

Physician

Therapeutic Community

Figure 1 The Four Levels for Maintaining Conduct and the Correcting Processes

They blossomed in the Seventies and Eighties, in large part because of the enabling impetus of Neville in the Sixties and early Seventies. This is discussed later in this Chapter. An example is the extensive directory of the Coalition of Self Help Groups in Victoria (COSHG) (Coalition of Self Help Groups 2002). A board member of COSHG accompanied me from Melbourne to Yungaburra in Far North Queensland in 1993 to stay with Neville and experience Laceweb action. This is discussed later in this Chapter and in Chapter Eight.

The social-pathology support framework of Fraser House and the Laceweb assumes that resident behavior is a function of pathological social networks - a failure at the community level, and also assumes it is in part a function of pathology within the wider society. While Fraser House was a service provided by the NSW Health Department, life within Fraser House was pervasively self help.

Within Fraser House there was no service based correcting agent - where ‘agent’ means someone who does something for you’ – rather, within Fraser House the correcting, remedial and generative processes operating at all of the four levels of functioning depicted above in Figure 06 becomes the therapeutic community, which by it’s nature, is bracketed off, though embedded in local community. In Neville’s framework, the notion of ‘service delivery’ by ‘expert’ ‘corrective agencies’ is replaced by self-help, and mutual or community help by the therapeutic community. This is resonant with Indigenous community sociomedicine for social cohesion. The therapeutic community is supported by nurturing enablers as ‘resource people’.

In Fraser House, Residents explored, clarified and developed their values and reciprocal obligations together. They developed their own community lore, law, rules, and norms. They were living within wider and more functional rule and norm systems that they were evolving and continually reviewing together as a caring community. This co-reconstituting of the rules and norms they lived by was embedded within every aspect of communal life in Fraser House. The lore, law, rules and norms embodied humane caring self-help and mutual-help. These rules and norms were never reified – as if they were immutable and coming from God. As Kuhn pointed out in his writings about the potency of paradigms (Kuhn 1962; Kuhn 1996), the processes constituting and sustaining societal paradigms are reified and rarely if ever noticed or questioned. Neville created a context where the social constituting of their shared reality was made explicit and kept under continual review by the Fraser House community. Goffman had written about various types of total institutions. Neville fitted them into the above framework of values, norms, rules, and obligations as depicted in Figure 07.

LEVEL

CAPABILITY AND

NATURE

INSTITUTION

CONFORMING

PROCESS

1 Values

Capable and in retreat

Abbeys, Monasteries, Convents

Priests

Moral leaders

2 Norms

(Legality)

Capable and deliberate threat to society

Jails, Penitentiaries, POW Camps,

Judiciary

Police

Guards

3 Rules

(Efficiency)

Capable and there for instrumental purpose

Army Barracks, Ships

Administrators

4 Obligations

(Capacity)

a) Role

Performance

b) Task

Performance

Incapable and unintended threat to society

Incapable and harmless

TB Sanatorium,

Mental Hospital

Blind, Orphaned, Aged, Indigent

Physician, Psychiatrist

Physician, Carer

Figure 2 The Four Levels and Total Institutions

My ‘Comparison of Goffman’s, ‘Total Institutions’ and Fraser House’ is in Appendix 10.

Recall that Neville described Fraser House as a, ‘transitional community’ as it was continually adapting to meet changing contexts and challenges. There was a culture of continual improvement in being well – wellbeing. Neville described all this as a ‘micro-process’ that may be used in returning a way of being and living together to wider society in Australia – a culture that has been subject to the cultural stripping by the Rum Corp at the very start of European settlement in Australian - where in Neville’s terms,’ Irish and other settlers and local Aborigines alike all had their culture stripped systematically from them and a military culture imposed’. Neville embedded the framework depicted in the above table into the evolving Laceweb. The distinction between mainstream ‘service delivery’ approaches and the self-help Laceweb model is discussed in Chapter Nine.

Figure 3 is an extension of Figure 1 and depicts the way society accommodates diversity between people, socio-economic groups, ethnic groups and cultures. Societies have varying degrees to which they will allow protest and dissent. There are correcting processes for resolving deviancy from within or from outside the society. The right-hand column gives the Fraser House/Laceweb healing processes for healing deviancy in all it’s forms towards having cleavered unities that respect and celebrate diversity. All of the above was continually discussed within the Fraser House community. Patients would typically leave Fraser House with a large family friendship network, competencies in administering a substantial organization, and have a functional practical knowledge of sociology and competency in community therapy. It was little wonder that shortly after leaving Fraser House in 1968, Margaret Cockett was finding ex-patients popping up around Sydney engaged in local self-help action. Typically, she found that ex-patients were very effective in group process and action as they had had excellent experience and grounding during their Fraser House stay. When the going got turgid and emotions heated up in these action meetings it was nothing that these ex-Fraser House residents and outpatients had not already experienced in Fraser House.

Level

Normality

Deviancy

Correcting

Process

Fraser House/

Laceweb

Correcting

Process

Cleavage

iversity

Current way:

Oppressor/

Oppressed

Advantaged/

Disadvantaged

Subjugator/

Subjugating

Exploiter/

Exploiting

Possible way: Harmonious

Unity

Protest

Disobedience

Conflict

Sabotage

Insurrection

War

Terrorism

Venting energy

Fines

Compelling compliance

Coercion & sanctions

Imprisonment

Warrior system

- yang

Political Mediators

Negotiation

Police/Military

Para-military

Militias

Torture & Trauma

Shaming & Maiming

(Towards status quo in current way)

Cultural Keyline

Healing nurturing – Yin

Therapeutic Community

Mediation Therapy

Peacehealing

Healing/Wellbeing networks

Festive, and celebratory gatherings

Everyday life wellbeing processes

(Towards possible way of harmonious cleavered unity)

Figure 3 A Table Depicting the Way Society and Fraser House/Laceweb Accommodate Diversity Between People, Socio-Economic Groups, Ethnic Groups and Cultures.

Margaret recalled one Fraser House ex-patient as been a very angry person at Fraser House. When this person was leaving Fraser House, Margaret thought that he had a ‘long way to go’ in being ‘functional’. She met and talked to him at a social action meeting. Margaret told him that she was surprised to find him there and said she thought he would be ‘railing against the government’ rather than being involved in this self-help action. Margaret said he replied words to the effect, ‘You have it all wrong. Change is happening at the everyday life level. It is useless trying to change the Government and the large power processes.’ This response was in fact resonating fully with Margaret and Neville’s view. It also resonates with Rowan Ireland’s “Sitting on Trains” article regarding social movements in Brazil (Ireland 1998). Irelands paper is discussed in Chapter Nine.

Professor Ross Thorpe, the Head of Social Work at James Cook University when I started this research project in 1998, told me in November 1999 that when in the mid Seventies she was a new arrival in Sydney from the UK, social workers were continually talking about what happened in Fraser House in the early 1960’s.

During mid 2002 Alex Dawia - one of my Bougainvillian friends- and I had been invited down to Hobart to link and share with Tasmanian wellbeing networks. A series of gatherings were held involving healing ways sharings including Bougainville traditional Ways and Cultural Healing Action. These networking ways are discussed further in Chapters Nine and Ten. A casual conversation with a woman giving me a lift to the airport in Hobart, Tasmania after these gatherings revealed that she and many of the friends in Tasmania, especially Hobart in the late Sixties and early Seventies closely followed Neville and Fraser House developments and used these as inspiration to push for all manner of changes in that state’s Community and Family Affairs departments. She said that they had many successes and that they evolved very effective wellbeing networks throughout Tasmania.

NEVILLE ACTIONS TO PHASE OUT FRASER HOUSE

In a paper called ‘The Therapeutic Community in Rehabilitation of Drug Dependence’ that Neville delivered at the Pan Pacific Rehabilitation Conference in 1968, Neville wrote about steps he was taking towards community mental health. ‘Since September 1965, Fraser House has been innovating a community psychiatry service for approximately 300,000 population. This programme aims at intense contact with government public servants, community aid services and all other relevant community leaders including police, ministers of religion and all those depended upon by large groups (Yeomans 1968, Vol. 1, p. 267-289).

In a document marked ‘confidential’ called, ‘A Community Developers Thoughts on the Fraser house Crisis’ (Yeomans 1965, Vol. 2, p. 46-48), Neville writes of actions that would lead to the phasing out of Fraser House.

‘Over the last couple of years the Unit Director and developer (Dr. Yeomans) has been increasingly involved in strengthening the organizational preparedness of the outside community, aimed at the relative devolution of Fraser House and the development of an external therapeutic (welfare) community’.

This ‘strengthening the organizational preparedness of the outside community’ was hinted at in the forward to the second edition of ‘Introducing a Therapeutic Community for New Members’ (Yeomans 1965, Vol. 4).

‘The major changes in the programs of the Fraser House Therapeutic Community in the past 20 months (1996) has been the development of an intense Community Psychiatry Programme, first in Lane Cove municipality in Sept 1965, and more recently in the Ryde Municipality. The major Therapeutic function of Fraser House will now be as the center for an intense Regionalized Community Psychiatric Programme. This programme is aimed at reducing the rates of mental and social illness in this part of Sydney as a pilot programme and involves a vast increase in the outward orientation and responsibility of the Unit. Groups of nurses were allocated localities in the suburbs surrounding Fraser House and supported patients and outpatients from their areas’.

The Fraser House handbook written by patients for new staff has a segment on the Nurses Role:

‘Nurses are assigned in teams to regional areas at the moment; Lanecove, Ryde, the rest of North Shore, and other areas. Each regional team is expected to be responsible for knowing its area, its problems and helping agencies etc. Moreover, nurses in each team are expected to come to know all in-patients and out-patients of that area; to be specially involved in the appropriate regional small groups, both in the community and in the Unit; to record progress notes on their regional patients; to be part of both medical officer and follow-up committee planning for the patients of their region (Yeomans 1965, Vol. 2, p. 18).’

In September 1965 the Lane Cove Community Psychiatry Programme began. In June 1966 a similar programme began in Ryde (Yeomans 1965, Vol 4. p. 2-4).

In discussion with Neville about Figures 06 and 08 in November 1998 he said that while Fraser House had been a seminal step, it was still a State run enclave. Kenmore Therapeutic Community was another State run enclave. Ex-staff member Dr. Madew was replicating Fraser House at Callan Park.

Neville wanted his ideas spreading outside of State control. His next step was to move Fraser House Way out into the community and slowly move community-centered action away from service delivery and towards grassroots self-help and mutual-help. Neville spoke of this as, ‘returning wellbeing processes back to grassroots folk’. For this to happen Neville sensed it was best to let Fraser House be re-absorbed by mainstream and disappear. He did not want Fraser House remaining as a government administered service delivery entity that was a mere shadow of how it was when he was there. Glendon Prison in the UK is a highly successful prison that is a therapeutic community. Neville said that after having excellent recidivism rates, way ahead of traditional maximum security prisons for over thirty years, there has never been any attempt to replicate Glendon Prison. Neville did not want Fraser House to become an isolated curiosity like Glendon. Laceweb people generally know little or nothing about Fraser House.

FRASER HOUSE EVALUATION

A cost-benefit analysis designed by Neville revealed the Unit to be the cheapest and most effective compared to a traditional and to a very new ‘eclectic’ unit. (Yeomans 1980; Yeomans 1980). Treatment results were followed for up to five years and this research showed that improvement results were maintained (Clark and Yeomans 1969).

Madew, Singer & MacIndoe (Madew, Singer et al. 1966) conducted controlled research in Sydney at Callan House therapeutic community that was modeled on Fraser House. Coincidently, Professor Peter Singer was my Behavioral Science (psychology) tutor at La Trobe University. They found that the therapeutic community was significantly better at returning patients to the community. The therapeutic community costs were also significantly lower than the control group.

In 1993, Professor Alfred Clark published his book, ‘Understanding and Managing Social Conflict’. In this book Clark specified the 1959-66 ‘Fraser House’ model as being still ‘state of the art’ as a process for intervening and resolving social conflict within any context around the Globe (Clark 1993).

FRASER HOUSE A MODEL FOR AMERICAN RESEARCH

Neville was delighted to discover that Fraser House was one of the models used in comparative research by Paul and Lentz in their 1968 research based in Illinois, USA (Paul and Lentz 1977, p. 432). Paul and Lentz used Fraser House as one of their models in developing their milieu therapy program. However, many of the unique features of Fraser House were not used by the American researchers. The researchers had also used a ‘poor cousin’ of Fraser House model in their social-learning program as well. The American researchers used a token economy. Neville set up a small actual economy within Fraser House.

The American research strongly supported the efficacy of the Fraser House model. Over the four and a half years of the American research and the next 18 months follow-up, the psychosocial change programs were significantly ahead of the hospital group on all measures, with social learning emerging as the treatment of choice.

While Paul and Lentz’s clients had been chronic mental patients who had had long-term hospitalization, with the social-learning group fewer than 3% failed in achieving ‘significant release’, defined as being longer than 90 days in outside extended-care facilities. 10.7% of the original social-learning group and 7.1% of the milieu group were released to independent functioning, without re-institutionalization. None of the original hospital group had been released to independent functioning. After four and a half years of results demonstrating that the two psychosocial programs were clearly superior to the comparison hospital’.

A cross comparison between structures, processes, actions and underlying theory within Fraser House and Paul and Lentz’s psychosocial programs shows that Fraser House contained the aspects that constituted the effectiveness of both their milieu and social learning programs. Some of the features of the American models were present within Fraser House in a more advanced form. Fraser House also had a large number of potent features that were not present or referred to by the American researchers. Features of Fraser House that were neither present in the Paul and Lentz’s American research nor referred to by the American researchers are listed in Appendix 11 (Paul and Lentz 1977).

The American social learning treatment was highly structured and very detailed. ‘Today we all learn how to undo buttons and tie shoe laces.’ The Fraser House social-learning processes were organically and natural linked into the community lived life experience of togetherness. The Fraser House process had patients learning by being responsible for rule making, decision making and action relating to large sections of community life, via the extensive system of client run committees and client tasks. The Fraser House model was to have life teaching them in an individualistic way rather than, ‘all individually doing the social learning course’, as in the American model.

Heinrichs’ 1984 review of developments over the previous twenty years in the psychosocial treatment of long term chronic psychotic patients, identified Paul and Lentz’s research as a remarkable study, especially it’s outcome of having over 92% of the patients in the social learning program released, with community stay without rehospitalisation, for the minimum follow up period of 18 months (Heinrichs 1984). Heinrichs’ identified another ‘source of great promise’ for psychosocial strategies. This was the extension of the strategies from the treatment of the ‘patient’ to the treatment of the whole family. Neville had pioneered full family residential therapeutic community over twenty years earlier and had family and friends therapy as an integral part of the sociotherapy of Fraser House since inception in 1959.

ETHICAL ISSUES IN REPLICATING FRASER HOUSE

It is possible that psychosocial change may be implemented in incompetent, inappropriate and unethical ways. Attempts to set up these programs may go seriously astray to the point where people may be harmed or killed.

We have seen that the Fraser House Therapeutic Community psychosocial programs were, at various levels, both simple and complex in their structure and processes. Both highly specific and very non-specific change actions were used. Many of the structures and processes were not obvious. Many were very subtle. Incompetent people with the best intentions in the world may seek to establish psychosocial change programs. They may operate under a belief in the ‘magical’ quality of the approaches used - that you set the unit up and ‘let the magic happen’.

The consistent feedback from all my Fraser House interviewees was that Fraser House was a ‘massive amount of very tight and difficult work’. As mentioned, in Fraser House detailed attention was focused on being extremely flexible within extremely tight psychosocially ecological boundaries. One of these frames was safety at all levels - physical, emotional, psychosocial, ethical, moral and spiritual. Meticulous and constant attention was also focused on staff teamwork with team-building, team-maintenance and teamwork under continual review. The staff were so dedicated and committed to each other and the community, Neville had to constantly insist that they go home after their shifts ended instead of staying on to do things to support. The groundwork laid down by Neville allowed Neville to be away overseas for nine months with Fraser House thriving in his absence.

Neville was adamant that for any cloning of Fraser House to be ecological, it would have to grow naturally and be context and local place dependent; this included how it was embedded within the local suburbs to ensure the natural evolving of strong functional local networks. An important issue in replicating Fraser House was that Neville was a very skilled and very charismatic person and there are few ‘Neville’s around. As well, as detailed in this thesis, many of Neville’s Ways were not obvious.

One attempt at setting up a therapeutic community based on the Fraser House psychiatric unit was the Ward 10B unit set up by Dr. John Lindsay at the Townsville General Hospital Psychiatric Unit (Lindsay 1992). Some years before, Dr. Lindsay had requested permission to be, and had been an observer at Fraser House for three weeks. Neville told me in 1992 in Yungaburra that Lindsay believed that he ‘slavishly’ copied aspects of Fraser House. In doing this, Neville said that, ‘Lindsay did not allow for the structure of the city of Townsville’. In Ward 10B there was no evidence of locality or cultural locality. Neville visited Ward 10B and sensed that Dr. Lindsay had too faithfully followed Fraser House in a different state, political and metropolitan context. There was evidence that the Ward 10B staff were far from being an effective team. After visiting Ward 10B Neville completely dissociated himself from having anything to do with it. Ward 10B was in no way encapsulating the Fraser House processes. Following many complaints, Ward 10B was closed and became the subject of a Royal Commission. Dr. Lindsay gave his version of events at the Townsville Unit in his book, Ward 10B - The Deadly Witch-Hunt (Lindsay 1992). Dr. Mitchell’s Kenmore Therapeutic Community and Dr. Madew’s Callan Park were successful examples of cloning Fraser House. Dr. Madew was on staff at Fraser House prior to heading up Callan Park. As mentioned, Neville worked closely with Dr. Mitchell in setting up Kenmore Therapeutic Community.

REFLECTING

This Chapter commenced with some criticisms made of Fraser House in the Sixties and responses were given to these criticisms. Replicating Fraser House in Kenmore and Callan Park Hospitals was discussed. Material was provided contrasting wider society’s processes for placing boundaries upon behavior and for accommodating diversity, and Fraser Houses and the Laceweb’s use of therapeutic community to fulfill the same functions. The steps taken by Neville to set up transitions to community self-caring was set out as well as Neville’s actions contributing to the phasing out Fraser House. Research on Fraser house evaluation was briefly outlined along with a discussion of American research using Fraser house as a model. The Chapter concluded with ethical issues in replicating Fraser House.

Chapter Eight documents the various outreaches from Fraser House that Neville set up and enabled, and discusses how these fit into Neville’s frameworks for evolving a social movement fostering humane epochal transition.

REFERENCES

(1963). Kenmore's Group Therapy Plan - Leading Psychiatrist Visiting Kenmore. Evening Post. Goulburn.

Clark, A. W. (1993). Understanding and Managing Social Conflict. Melbourne, Swinburne College Press.

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