Appendices

 

 

 

 

Appendix 1. Obituary of Dr. Neville Yeomans Psychiatrist 1928 – 2000

 

 

 

Neville Yeoman's affection for and empathy with the original inhabitants of Australia began very early in his life when, at the age of 3, he was saved by an Aborigine after he had wandered off and become lost in the bush in far north Queensland. This rescue from certain death, laid the foundations for his later work with Indigenous communities as a carer, with an intense interest in the peoples and their cultures. He was a co-healer rather than a prescriber and believed in approaching the problems of mental health, alcoholism and drug addiction from a community perspective. He devoted much of his life to providing counselling and treatment to those most underprivileged and handicapped especially women, alcoholics and drug addicts. After 1975, he extended these activities to northern Australia, from the Atherton Tablelands to the Kimberleys, from Arnhem Land to Central Australia. In a sense it was a repetition of his childhood years when his family travelled like "gypsies" throughout the northern parts of Australia with his prospecting father.

 

Neville Yeomans was born in Sydney on 7 October 1928 to Percival Alfred ("P.A.") and Rita Yeomans. It was the depression and life was hard.  His father, "P.A." Yeomans, a mining engineer (who later became famous for his contributions to agriculture including Keyline Farming, City Forest, Shakaerator plough and other agricultural developments) took the family around northern Australia trying their luck at prospecting. These were important years for Neville Yeomans when many aspects of his character were moulded.       

 

The vagabond existence of the family meant that they were never in the one place for long. Experiences such as attending 13 schools in one 12-month period, taught him that friendships were ephemeral and superficial.

 

He completed his schooling at Scotts College in Sydney and then went to Sydney University from where he graduated as a Bachelor of Science (Biology) in 1948. He wanted to work with and heal people and he went on to obtain his Bachelor's degree in Medicine and Surgery in 1956. But it was people's minds that fascinated him most and he completed a Diploma in Psychological Medicine in 1959. In the same year he won an overseas scholarship that enabled him to meet with some of the World's leading psychiatrists. Neville Yeomans was a brilliant and sensitive man who understood things in their context, and he had an ability to see things from different perspectives to those commonly held.

 

He was appalled by the methods used at the time to treat psychiatric disease (especially shock treatment which he regarded as a crime) and on his return from overseas he established and became the Director of Fraser House at North Ryde Psychiatric Clinic, Australia's first family Therapeutic Community with accommodation for some 86 adults and children. It was a revolutionary contextual approach that treated psychiatric disease on a family and community basis instead of treatment of just the individual. Patients were able to be rehabilitated and return to society rather than being locked away out of sight and restrained with drugs and straightjackets. Many of his peers did not understand this radical approach to treatment and Neville was frequently vilified for being out of step with the main stream of things. It is interesting to note that 40 years later, his approach to psychiatric treatment has become the norm rather than the exception.

 

During the period from 1959 to 1972, he ran "healing community" courses for Aboriginal and Islander peoples in Sydney, in country New South Wales and at Alice Springs in Central Australia.

 

He was the Co-ordinator of Community Mental Health for New South Wales Health Department from 1965 to 1970.

 

He published many papers on psychiatric treatment (which are now held in the Mitchell Library in Sydney) and with a colleague, wrote a book "Fraser House: Theory Practice and Evaluation of a Therapeutic Community" published by Springer, New York (Clark and Yeomans 1969).

 

As his interest in community work developed, he completed a Diploma in Sociology at the University of New South Wales in 1963, to better understand the social aspects of human responses. He also broadened his interests to studying other cultures and their values and, among other things, joined the Australia Eurasian Association in the late 1960's, and followed his passion for multiculturalism. He regarded Australia as a "cooking pot" rather than a "melting pot" of cultures, cooking up a new and better culture for the future! It was on a platform of multiculturalism that he stood for the seat of Philip (Liberal, Sydney) in the 1972 elections and gained sufficient votes not to lose his deposit, but failed to gain the seat.

 

Not content with his already numerous qualifications he went on to complete a Bachelor of Law degree from the University of New South Wales in 1975 and was admitted to the Bar. In spite of this, he was more interested in mediation than litigation and closely studied the mediation systems used in China. He studied Japanese and Chinese languages and travelled overseas to Asia, Europe and the Americas on several occasions over the years. He was an avid supporter of Bliss Symbolics, an international sign language based on symbols.

 

Neville Yeomans was drawn more and more to the area he grew up in and in 1975 he moved back to north Queensland where he became engrossed in working with Aboriginal people. He conducted a private psychiatric counselling and family therapy practice, facilitated community support for Aboriginal and Ethnic groups, established "Healing Haven" houses in North Queensland and assisted in the creation of a black women's shelter in Cairns.

 

In the early 1980's he became interested in and a keen qualified practitioner of Neuro Linguistic Programming (NLP) which was a revolutionary way of treating emotional states and of helping people overcome psychiatric illness and addictions. He and a friend, Terry Widders, set up NLP Centres in Cairns, Townsville in Queensland and Bondi Junction in Sydney. Neville Yeomans continued to pay the price of being a pioneer of new ideas and was regarded as a pariah by many of his professional colleagues in the establishment, with many refusing to refer patients to him.

 

In 1987 he was a consultant to Petford Aboriginal Training Farm in far North Queensland and from 1989 to 1994 he facilitated camp-outs/Intercultural Healing Training festivals in the Atherton Tablelands and at the Petford Aboriginal Training Farm. In 1990 he was an Adviser to the Australian South Sea Islander United Council. He was on the Steering Committee for Training on Torture and Trauma in 1994 and conducted a three-day training course in Darwin. His working career came to an end in 1997 in Darwin where he was discovered sick with bladder cancer by his youngest son, and brought back to Sydney for treatment.

 

Neville Yeomans was a very intelligent, passionate and insightful person with a deep sense of purpose and an ability to focus absolutely on the job in hand, a characteristic that often made it difficult for those closest to him. He was also an introspective, artistic and aesthetic person who loved music (he played the clarinet) and art and he wrote poetry on a regular basis from the mid 1960's. Many of the poems demonstrate his sharp wit and sense of fun. The hundreds of poems he wrote, which give glimpses of the man within, will be published shortly. His passion was to treat people in need, his skill was his ability to engage with people and to make suggestions for change. His dying wish was to leave a legacy of clinics for Aboriginal people to enable them to help themselves. Neville Yeomans died in Brisbane on 30 May 2000 following a painful struggle with cancer. He spent his final days at home, surrounded by members of his family and friends. He is survived by his two brothers, two half-sisters, five children from two dissolved marriages, and eight grandchildren.

 

Peter N. Carroll

Leura, N.S.W.

 

 


 

Appendix 2. List of Neville’s Early Actions and the Isomorphic Social Action Neville had me Experience as an Action Researcher

 

 

 

Type

 

Examples of Neville’s Early Social Action

 

 

Isomorphic Metaphor

 

 

Therapeutic Community

 

Fraser House

 

Bondi Junction Network

Geoff Guest at Petford

Small Island Gathering

Jail Groups

 

Group Work

Fraser House Groups

Human Relations Groups

Bondi Junction groups

Petford Groups

Small Island Gathering

Jail Groups

Trauma Support Groups

ConFest Groups

Family Therapy contexts

Healing Ways:

 

Work Therapy

 

 

 

 

 

 

 

 

 

 

Cultural Keyline

 

 

 

 

 

Cultural Healing Action

 

 

 

 

 

 

Laceweb Healing Ways

 

 

 

 

 

 

 

 

Family therapy

 

 

 

 

Fraser House:

  Committee work

  Canteen

  Bowling Green

 Suicide Support

 Domiciliary visits

 

All of listed action

 

 

 

Fraser House

Fraser House outreach

Laceweb & INMA

 

 

 

Festivals, happenings, events, parties

 

 

 

 

 

Laceweb sharings

 

 

 

 

 

 

 

 

Fraser House; Small Therapeutic Community Houses; Laceweb action

 

 

 

Letters to global

   governance

Jail Groups

Networking

Internet

This PhD

 

All listed action

 

 

 

Sydney Gatherings;

All aspects of Laceweb Action Research and Networking; Psychnet Networking

 

Yungaburra New Years Eve Party; Rainforest campouts; At Small Island Gathering;

Psychnet networking; Tagaytay Gathering and Pikit visit in Mindanao in the Philippines; ConFest

 

Tapped me into Laceweb sharings in Qld. and Darwin Top End; Balmain Work-shops; other Sydney work-shops with Neville; Australian South Sea Islander Communities; personal co-learning

 

Engaging me in family therapy contexts

 

Festivals

 

Watsons Bay; Centennial Park; Paddington; ConFest; Cambelltown; Aquarius at Nimbin; Cooktown

 

ConFest; Aboriginal & Islander Therapeutic Community Gathering; Small Island Gathering;

 

 

Australian South Sea Islander gatherings

 

 

Community Markets

 

Paddington; Yungaburra

Rapid Creek

 

Paddington; Yungaburra; Rapid Creek;

St. Andrews (Vic); Channon (NSW)

 

 

Intercultural

 

Asia Club; Watsons Bay Gathering; Laceweb Networking; Rio Earth Summit

 

Small Island Gathering; Laceweb Networking among Aborigines, Torres Strait Islanders, Australian South Sea Islanders, Hmong, West Papuans, Bougainvillians, and East Timorese Communities; linking throughout SE Asia Oceania (Psychnet 2005a)

 

 

Networking

 

Fraser House Family Friendship networking; Self help Groups; Laceweb Action

 

 

Bondi Junction; Laceweb Action – Atherton/Cairns; Rapid Creek; Byron Bay; Small Island Gathering; Australian South Sea Islander Communities; SE Asia, Oceania, and Australasia networks

(Psychnet 2005a)

 

 

Functional Matrices/Self Help Groups

 

Mingles; Connexion; Inma Nelps; Nexus Groups; UN-Inma; etc.

 

Mingles; Inma Nelps; Nexus Groups; Funpo,

UN-Inma

 

Keyline

 

 

 

 

 

P.A. Yeomans action

Use of Keyline at Festivals

 

 

 

 

1992 Aboriginal & Islander Therapeutic Community

Gathering; visit to Nevallan and Yobarnie;

Interaction with Ken, Allan and Stephanie Yeomans

 

 

Interfacing with Dominant System

 

Fraser House; Community Mental Health; Psychiatric study group; Rio-Earth Summit

 

Global-local Realplay; Letters to Global governance bodies; RHSET, NACADA; Extegrity documentation;

Canberra briefings; mentoring of CEO’s and senior executive of multinational organizations;

Interfacing between UNICEF E-Asia Regional Office & Psychnet;

Dialogue with PNG & East Timor Parliamentarians

 

 

Interfacing with business

 

Asia link Business Group Study Group

 

 

Current versions of the Business Cultural Keyline Study Group: ongoing action research with CEOs

 

 

Everyday life action

 

 

 

 

 

 

 

Neem Production;

Tree Oil Extraction;

Horses; Laceweb action

 

 

 

 

 

Laceweb action Sydney, Melbourne, Byron Bay, Atherton and FNQ, Darwin Top End, Laceweb and

 

Psychnet Networking; other E. Asia and Oceania networking, especially Tagaytay Philippines gathering, and with muslim men’s group in the rice growing hamlet in Takepan in Mindanao; Jail Groups

 

 

 

Local Governance

 

Fraser House; Small Therapeutic Community Houses; Small Island Gathering; Aboriginal & Islander Therapeutic Community Gathering

 

 

Small Island Gathering; Aboriginal & Islander Therapeutic Community Gathering; ConFest; Jail Groups

 

Micro Gatherings/events

 

Fraser House

Blackmountain

Yungaburra

Asia Ball

 

 

Blackmountain rainforest party; Jail Groups Yungaburra new years eve party; ConFest Site Trips

 

 

 


 

Appendix 3. A Comparison of Goffman’s ‘Total Institutions and Fraser House

 

 

              Total Institutions                                   Fraser House

 

 

The key fact of total institutions is ‘the handling of many human needs by the bureaucratic organization of whole blocks of people’ (p18).

 

 

 

The focus is the inmate (p 18).

 

 

In the three big chunks of life - work, play, and sleep - these happen in the same place, under a single authority. All phases of the daily round are done with a large group of the same people (p 17).

 

 

 

 

 

 

People are inmates and/or patients (p 17).

 

 

 

 

 

 

They are required to do the same thing together.

 

 

 

 

 

All are treated similarly (p 17).

 

 

 

All phases of the daily round are time bound and tightly scheduled (p 17).

 

 

This schedule of activities is imposed from above by explicit formal rulings by a body of officials (p 17).

 

 

 

 

 

 

The aim of this scheduling is bureaucratic convenience (p 17).

 

 

 

 

The key fact of Fraser House is the embracing and satisfaction of individual and the therapeutic community’s needs by the staff supporting and enabling residents taking responsibility for themselves.

 

The focus is the resident in his/her social (family and friends) network.

 

In the three big chunks of life - work, play, and sleep - these happen in the same place. Some residents went to outside work, Timing relating to work, play, and sleep was in part scheduled by staff and in part determined by committee process. Residents were constantly been rotated through various small and large groups and patient run/controlled committees having differing mixes of people.

 

People are termed patients, residents or clients. While conscious of the potency of terminology, within the wider hospital processes, residents were ‘patients’ and all the documentation designated them as

‘patients’.

 

Big and small groups and committee work was scheduled for people to do the same things together. There was some free time. Ward committee patients decide timing (lights out/on etc.)

 

Rather than being ‘treated’, people are ‘related to’ and each person is related to differently.

 

Spontaneous social interaction with aspects of Fraser House life tightly scheduled (e.g. groups and committee work).

 

While small groups and big group are required by officials, virtually every aspect of community life is determined by the residents via committee structures that are effectively run by the residents, sometimes with no staff as observers. A body of rules governs a large part of schedules and these are also determined by the residents.

 

The aim of the scheduling is to compel residents to enrich their psychosocial self and take responsibility for making decisions affecting the quality of their life and behaviour in community with others.

 

 

All the staff enforces the schedule of activities (p 17).

 

 

 

 

 

 

The schedule coalesces into a single rational plan designed to fulfil the official aims of the institution (the power of the fittest) (p 17).

 

 

There is a basic split between a large managed group (the inmates) and a small staff (p 18).

 

 

 

 

Both staff and inmates are in uniforms owned by the institution (p 18).

 

Staff work 8 hour shifts and are socially integrated into, and live outside (p 18).

 

Inmates live inside. Some may get passes (p 18).

 

 

 

 

Inmates have no contact with the outside world or have restricted supervised contact or non-contact visits (p 18).

 

 

 

 

 

Each group tends to see each other in ‘narrow hostile stereotypes’ (p 18).

 

 

 

 

 

 

 

Social distance is typically great and often formally prescribed (p 19).

 

Inmates are not given information about what is being discussed about them by staff (p 20).

 

Both residents and staff are responsible for ensuring adherence to the schedule. Issues relating to residents’ non-adherence to the schedule are resolved through resident committees and community processes, especially at Big Group.

 

The schedule coalesces into a single sensible plan (survival of the fitting) designed by the residents to support residents’ self-help and community help towards psychosocial wellbeing.

 

While staff and inmates are in different roles, there is closeness between them including strong friendships. More experienced residents share the enabling and support roles with the staff.

 

Some staff and all inmates wear their own casual clothes (some use of uniforms by staff – refer Photo 19).

 

As with Fraser House.

 

 

 

While inmates live inside, some go out to work; some attend from 9 AM to 9 PM; others typically can get passes; most go home for weekends; many attend as outpatients.

 

A condition of being a resident at Fraser House is that family and friends have to attend Big Group and small groups as ‘clients’. Whole families were in residence, so for them, there was constant contact. Visits by family and friends to Fraser House outside of big group visits were restricted.

 

The staff patient distinction is always maintained (cleavage) although residents and staff see each other as individuals with unique abilities and potential. Everyone in both groups is a potential resource for everyone else (cleavered unity). Staff seek to have residents build upon their ecological bits.

 

Social closeness is typical and encouraged.

 

 

Communication is very open; anything may, be brought up in Big Group. Reporting is controlled. Staff discussion regarding residents not shared with residents.

 

 

 

 

The Institution is deemed to belong to staff (p 20).

 

 

 

 

 

 

The self of inmates is systematically, if often unintentionally, mortified (p 24).

 

People are stripped on entry through a series of abasements:

(i)   degradation

(ii)  humiliation

(iii) profanation of self (p 24).

 

 

 

 

 

 

 

 

 

 

 

 

On arrival, inmates lose their clothes and end up nude, given identical issue (all uniform); stuff that never belongs to you (p 24).

 

The barrier between the inmate and the outside world marks the first curtailment of self (p 24).

 

 

 

 

 

 

 

 

The buildings and plant are designed to separate and control, and to segregate sexes (p 24).

 

 

 

 

 

 

 

 

In the outside world inmates may take a number of separate roles, and typically none will block their performance and ties in another role (role segregation). Being inside automatically disrupts role scheduling. Staff determines inmate’s roles (p 24).

 

 

 

 

 

Every behaviour encroaches on every role and will be used to curtail and mortify self (p 24).

 

Role dispossession occurs (p 24).

 

 

The capital infrastructure is state owned; however, Fraser House as community ‘belongs’ to the therapeutic community and all involved. Friends and relatives (attending as ‘outpatients’) are part of the therapeutic community.

 

The enrichment of self of residents is pervasively built into every aspect of the Unit.

 

Prospective inmates required to attend big group and small group twelve times with their family/friends network signed in as outpatients to assist their bonding with the community The initiation & admittance process was through the traditional North Ryde Hospital process. Once at Fraser House people are welcomed into the community through a series of bonding processes; examples:

 

Each person allocated buddies and room mates

Advised of Fraser House lore

Told slogans

 

Residents use their own clothes.

 

 

 

 

While being ‘inside’ and having friends and family required to visit, the absence of barriers in the therapeutic community makes enrichment of self through ecological interaction (almost) inevitable. Residents go on regular outside trips (as recreational activities and as domiciliary and crisis therapists). Some residents go to work. Most return home at weekends.

 

While the buildings and plant were a traditional design they were used in ways ensuring constant interaction between residents, between residents and staff, between residents and outpatients, and to integrate and foster interaction between the sexes. The Dining Room and recreation rooms were located so as to maximize mingling.

 

Virtually everything is known by everybody (especially through the ‘bring it up in groups’ protocol). Through the resident run committee process all residents help evolve the various roles within the community. Resident committees determine resident roles. People may volunteer for these roles, and all play a part in deciding who participates for a time in the roles. There is some role scheduling and some role spontaneity.

 

Every behaviour encroaches on every role and will be used to expand and enrich self.

 

Enriched and new role taking is encouraged and role flexibility occurs.

 

 

 

Because of the institutions pervasive intrusion into virtually every aspect of inmate’s lives, the admission procedures include obedience tests and will-breaking contests in order to compel co-cooperativeness from the outset (p 26).

 

 

Inmates are likely to be stripped of their usual appearance and their ‘identity kit’ (p 30).

 

Inmates subject to indignities - examples:

.  must use spoon

.  must beg/humbly

.  ask for little  things

. being teased,

.  sworn at and ignored (p 230)

 

The boundary individuals place between their being and the environment is invaded. The embodiments of self are profaned

(p 32).

 

 

 

 

Unavoidable contact with aliens (no choice) and contaminating of objects of self-feeling - such as one’s body, immediate actions, thoughts and possessions (p 36).

 

 

 

There is the violation of one’s informational preserve regarding self. During admission, information about past behaviour (especially discreditable facts) are collected and written up in dossiers available to staff (p 32).

 

 

 

 

While the schedule of activities is to be complied with, considerable freedom is given till the person is immersed in the community. Then tough constraints are placed on mad and bad behaviour by staff and other residents. Conditions may apply regarding re-entry if a resident elects to leave early.

 

Residents’ appearance is unchanged or they are encouraged to improve it.

 

 

Any staff or resident subjecting anyone else to indignities would be censured.

 

 

 

 

 

 

Boundaries between self and environment open to community view and may be perturbed and cleavered if deemed dysfunctional. Potential for all residents and staff being there to support residents’ self help. The embodiments of self are respected and celebrated.

 

Unavoidable contact with resident/staff enablers (no choice) and processes interrupting and sabotaging madness and badness towards decontaminating objects of self-feeling - such as one’s body, immediate actions, thoughts and possessions.

 

There is the ecological violation of one’s informational preserve regarding self. During admission, information about past behaviour (especially discreditable and creditable facts) are collected and made available to staff and residents as part of local knowings of everyone in the therapeutic community. Any non-ecological use of this information is interrupted and censured.

 

 

 

Inmates undergo mortification of the self by contamination of the physical kind - by forced interpersonal contact and social relationship (p 36).

 

 

 

 

 

 

Enforced public character of visits by friends and relatives (p 38).

 

Contaminative exposure by having mail and phone calls monitored, limited and censored (p 38).

 

Contaminative exposure by denouncing significant others, especially when others physically present (p 38).

 

 

 

 

The usual relationship between the actors and their acts is disrupted (p 41).

 

 

 

The above firstly by ‘looping’, where an agency creating a defensive response in inmates hones in on this response for its next attack. The reaction to the situation is collapsed back into the situation. Inmates can’t defend themselves by creating distance between the mortifying situation and themselves (p 41).

 

 

 

Another form of looping follows from the lack of role segregation (desegregation) allowing behaviour in one role/context to be brought into every other role/context (p 41).

 

 

Inmates undergo shifts within the self by being placed in dorms with one ‘mirror’ person and two ‘opposites’ (for example, two ‘under-controlled/ over-active’ residents with two ‘over-controlled/under-active’ residents - with forced interpersonal contact and social relationship compelling a shift to the psycho-socially functional middle ground.

 

This applies to visits by friends and relatives attending big group.

 

Typically no monitoring. Some contact restrictions and limits to contact with dysfunctional others.

 

Community based pressure to ‘bring it up in the Big Group’; concern about consequences for the community as a whole, and personally experiencing the results of the process ‘working’ had residents exposing others, especially significant others.

 

As for Fraser House, though the behaviour of residents and the outcomes of their behaviour are constantly a matter for group discussion towards functionality.

 

Within pervasive frames of ‘self help’ and ‘therapeutic community’, looping occurs where the full range of resident’s responses, (especially defence and avoidance responses to the therapeutic community), may be reflected back to them and be the subject of discussion and action. Typically, any distancing of themselves from their acts and the consequences of their acts is challenged.

 

As for Fraser House, although within a context of enabling self-help and mutual-help.

 

 

 

 

In mental asylums, a permissive environment entraps inmates to ‘project’ or ‘act out’ their typical difficulties, which they are then confronted with during therapy sessions (p 42).

 

 

 

Inmates are regimented and tyrannized in that within civil society, the issue of ‘correctness’ rarely arises. Inmates have to constantly look over shoulders to see if criticism or other sanctions are coming. Minute matters, usually those of personally taste and choice in the outside world, are prescribed by authority (p 42).

 

Each specification robs the individual of an opportunity to balance needs and objectives in a personally efficient way and opens up lines of action to sanctions by staff (p 43).

 

 

The autonomy of the act is violated (p 43).

 

 

 

Economy of action is disrupted by being required to ask permission for supplies for minor activities; adults placed into suppliant submissive roles unnatural for adults; allowing ‘interception’ by staff, (being put off, teased, denied, questioned or ignored) (p 45).

 

Regimentation by being required to perform regulated activity in unison with others (p 46).

 

 

 

Use of an echelon form of authority in that any member of staff has certain rights to discipline or impose sanctions on any member of the inmate class (p 46).

 

As for Fraser House, though within a context of enabling self help. Permissiveness continues till the person is enamoured and imbedded in the community. Things may then get humanely and ecologically tight and tough and dysfunctional behaviour interrupted.

 

‘Enabling wellbeing of self and others’ is the standard for both residents and staff in relating with and intervening in the life of others. Some minute matters are pre-scribed by decision of resident committees.

 

 

 

 

 

Specification is decided by residents and staff in daily group and social interaction, providing an opportunity to balance needs and objectives in both a personal and community sensible way and opens up lines of action to enhancement by all.

 

The autonomy of the act is supported at the individual and community levels, with scope to explore fit in both sectors.

 

Economy of action is facilitated by residents being in charge of supplies for minor activities. This places adults into active responsible roles natural for adults and allows ‘enabling support’ by staff.

 

 

 

Some regimentation by being required to perform regulated activity in unison with others within a context where residents have established most of the ground rules.

 

Use of a communal form of communal empowerment in that any resident or member of staff may provide enabling support to another resident or member of staff. The Ward Committee has authority to enforce sanctions for breach of rules.

 

 

 

Echelon authority and strict enforcement of regulations may result (especially in new arrivals) in living with chronic anxiety about consequences of breaking rules (p 46).

 

 

 

 

Loss of self-determination through having no capacity to decide certain bodily comforts such as soft bed and quietness at night (p 47).

 

 

 

 

Even the capacity for self determination by the mode of response given back to authority may be denied or discounted by staff ignoring the response and reframing the response as a symptom of pathology (p 47).

 

 

 

Curtailment of self may be almost total (p 49).

 

 

 

It is largely the privilege system that provides the framework for personal reorganization (p 51).

 

 

Firstly, proscriptive and prescriptive house rules layout required conduct (p 51).

 

Secondly, there are a small number of clearly defined rewards or privileges held out in exchange for obedience.

 

 

 

The inmates’ world is built around these minor privileges - e.g., a coffee and a smoke. These are akin merely to the absence of deprivations one normally expects not to sustain (p 51).

 

Release is elaborated into the privilege system (p 53).

 

Community, Family and individual empowerment and strict enforcement of healing ways may result, especially among new arrivals, in living with ecological levels of anxiety, e.g. overactive/under-controlled may use-fully have more anxiety, and under-active/ over-controlled may usefully have less anxiety.

 

As for some aspects of Fraser House (such as the ‘soft bed’). However, residents have full control of regulations and involvement in the therapeutic change processes, ensuring things like a quiet nights sleep.

 

The capacity for self-determination. Ecological responses given back to authority would be supported by staff at every opportunity; residents would be encouraged to explore the con-sequences of non-ecological responses to other residents and staff. Staff denying or discounting responses would be censured.

 

Virtually everything fosters enriching the self towards self determining action and sociable relating with other selves in community.

 

Every aspect of the values based caring therapeutic community provides the framework for personal re-organization.

 

In Fraser House the bulk of proscriptive and prescriptive rules are decided by the residents.

 

Residents evolve their own lore and rules. They have free access to their own canteen. Privileges are generally a right for all, though the Ward Committee could withdraw rights for a breach of rules.

 

Non-ecological behaviour may see a withdrawal of some privileges.

 

 

 

 

 

Release not linked to privileges; rather based on ecological functioning and capacity to fit into outside community - though required to leave after six months stay. This was reduced to three months to foster change.

 

 

 

Thirdly, there are the punishments including withdrawal of privileges (even small privileges) and these assume great/terrible significance (p 51-2).

 

Rewards and punishment received by inmates are only received by children and animals in outside world (p 53).

 

Rewards and punishment woven into the residential work system with certain places, roles, and perks associated with reward (p 53).

 

There is among inmates an informal system of what Goffman calls ‘secondary adjustments’ - practices that don’t directly challenge staff, but allow inmates to obtain forbidden satisfactions (‘the angles, deals, ‘knowing the ropes’)

(p 56).

 

An informal inmate system ensures that no inmate informs on others’ ‘secondary adjustments’; violators defined as ‘finks’ ‘squealers’, and ‘rats’ (p 56).

 

Inmate support groups developing in opposition to the system (p 56-57).

 

 

 

 

Typically, inmates find out that fellow inmates have all the properties of ordinary, occasionally decent human beings worthy of sympathy and support. Past offences cease to be an effective means of judging personal qualities (p 57-59).

 

In therapeutic institutions, the inmates become less able to protect their ego by direct hostility towards the institution (p 59).

 

The rules for sanctions were evolved and administered by the patients and outpatients. Sanctions have significance.

 

 

Rewards and punishments were not imposed top down. Sanctions were context and age relevant.

 

 

Consequences flowed from context and everyday life milieu.

 

 

 

The everyday life milieu worked its constituting potency. Anyone seeking ‘advantage over’ and ‘egocentrically working the system’ would be confronted with this by patients, outpatients and staff.

 

 

 

The oft-invoked slogan and practice was, ‘bring it up in the group’.

 

 

 

 

Support groups fostered and linked to the to Fraser House community. There were functional and dysfunctional factions and cliques forming and disbanding regularly. Dysfunctional ones were cleavered.

 

The same. Developing resident support groups as an integral part of the system.

 

 

 

 

 

 

The Fraser House system enhances ego, identity and mindbody integrity and support of the Unit as a functional community.

 

 

 

Secondary adjustments and adapting:

 

Firstly, by using regression (situational withdrawal) as a defence;

 

Secondly, flagrant non-cooperation;

 

Thirdly, colonization, fitting in and ‘doing it easy’;

 

Fourthly, conversion - becoming the perfect inmate;

 

Fifthly, playing it cool by a combination of the above. (p 61-64).

 

Typically, neither ‘stripping’ processes nor reorganizing processes seem to have lasting effect, partly because of secondary adjustments, counter mores and playing it cool (p 64).

 

The presence of release anxiety due to disculturation and stigmatisation (p 69-71).

 

 

 

 

 

 

 

Inmate’s families have little understanding of the institution and can cause major embarrassment to inmates (p 123-135).

 

 

 

 

Some, because of prior experience of traditional hospitals, may set out to make use of secondary adjustments, though such behaviour would be challenged and immediately brought up in a group. Being involved in Fraser House minimizes the necessity to resort to these ‘secondary adjustments’.

 

 

 

 

 

 

 

 

 

 

 

Reorganizing and re-constituting pro-cesses had lasting effect. All involved are vigilant in stopping processes that may strip.

 

 

 

Processes foster residents expanding and enriching their culture (as ‘way of life’). Close involvement of family and friends being in therapy themselves minimizes resident stigma as does domiciliary care visits by those who are about to be released. Typically, residents leave with a functional supportive network of around seventy.

 

Dysfunctional family and friends who are sabotaging a resident would be confronted and possibly isolated. Resident’s families typically have intimate understanding of the institution and are actively involved in resident healing (and typically, self healing) as well as potential for involvement in the unit’s committees.

 

 

 


 

 

 

Appendix 4. Neville’s Forward to his Father’s BookCity Forest

 

 

FORWARD

A major change in values and in behaviour is beginning to occur in Australia. For too long we have been exploiting both our continent and each other. Patterns of human living based on selfishness and ruthless competitiveness are becoming self-destructive. A new era is dawning--equality between the sexes, generosity in human relationships and honesty in negotiation. With this goes a respect for the environment that sustains us.

Humankind is a bio-social species. His biological survival depends on harmonious working with Nature. Harmony comes only when we give as well as take.

The world has paid a terrible price for the Industrial Revolution and the advance of science. We had to be ruthless to control and harness the forces of Nature; to become machine-like, to make machines and to think like computers, to conquer ignorance. But the battle is won. Now we must re-humanise ourselves and share the fruits of our labour. The swing away from the mistakes of the chemical solution of biological problems is beginning. Natural food movements suggest we are searching for a healthier way. The growth of community groups in ecology, welfare, education and the arts suggest we want to become better and happier humans.

Australia is the only continent on earth never split by warring nations or states. We are fortunate in being unimportant in the great power competition. As inheritors of the industrial era we are on the periphery of both European and Asian civilizations.

We alone are in a position to accept the best from all continents in ideas, people and ways of living.

History took humanity from the tribe to the City State, to the Nation State. The next step is the Continental Nation at peace with itself and with its neighbours. It is our unique opportunity and duty to become the example to the rest of the world for that next step. In this process the Machine City must be replaced by the Human City. The exploited landscape must be husbanded with loving care. The soil which gives us life must be developed in its own living processes so that it grows richer year by year rather than poorer. The beauty and freedom of personal space depends on caring for the integrity of all our environment. We may not be the most varied and beautiful continent on earth, but we can and must be the most human.

My father's work and the contributions of all Australians is needed for the task ahead (Blumer and Shibutani 1970).

Neville Yeomans.


 

Appendix 5. Diagnosis of Fraser House Population as at 30th June 1962

 

Reference (Clark, A. & Yeomans, N., 1969 Page 56)

 

 

                                                                               Male   Female  Total

    Disorders Caused by or Associated                                                        

    With Impairment of Brain Tissue

 

1.    Acute and Chronic brain disorders                 0          0          0

2.    Mental deficiency, mild with epilepsy             1          0          1

 

TOTAL                                                                      1           0          1

 

Disorders of Psychogenic Origin

 

Psychotic Disorders

Affective Reactions:

Manic Depressive reaction depressive type        1          1          2               

Schizophrenic Reactions:

Schizophrenic reaction, simple type                     3          8       11

Schizophrenic reaction, hebephrenic type           0          3          3

Schizophrenic reaction, catatonic type                2          2          4

Schizophrenic reaction, paranoid type                 3          6          9

Schizophrenic reaction, acute                                         

undifferentiated type                                             1          2          3

Schizophrenic reaction, schizo-affective type     2          0          2

 

TOTAL                                                                       12       22       34

 

Psychoneurotic Disorders

        

Psychoneurotic Reactions

Anxiety reaction                                               0          1          1

Conversion reaction                                         0          1          1

Obsessive - compulsive reaction                     1          1          2

Depressive reaction                                         2          2          4

 

TOTAL                                                                       3          5          8

 

Personality disorders

         

Personality Pattern Disturbances:

Inadequate personality                                    0          1          1

Schizoid personality                                        1          0          1

Sociopathic Personality Disturbances

Anti-social reaction                                         3          2          5

Dyssocial reaction                                          1          2          3

Sexual deviations:

homosexuality                                     4          0          4

pedophilia                                            2          0          2

prostitution and beastiality                   0          1          1

Personality Trait Disturbances

Compulsive personality                                  1          0          1

Addiction:

alcohol                                                 4          2          6

drugs (bromides; amphetamines;

narcotics)                                            1          1          2

Both alcohol and drugs                       4          1          5

TOTAL                                                                       21        10        31

___________________________________________________________

 

COMPOSITE TOTAL                                               37        37        74


 

 

Appendix 6. A Case History of an Aboriginal Micro-Encephalic Aboriginal Person Transferred to Fraser House

 

 

A Case Study synthesised from discussions with Neville (Dec 1993, July, 1998)

 

As an example of an asylum back ward Aboriginal 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 socialised, became friendly, contented and easily fitted in to Fraser House society.

 

Neville (Dec 1993, Aug 1998) 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. To quote Neville (July 1998), ‘With no frontal cortex to speak of, how else could he have changed?’


 

Appendix 7. The Roles of Fraser House Nurses

 

 

Reference – (Yeomans, 1965a, Vol. 4)

 

 

THE ROLES OF FRASER HOUSE NURSES

(From the Fraser House Staff Handbook)

 

Preamble

 

As with all new work situations, so to working as a new nurse in this community means coming to grips with a degree of initial stress.  The job is not easy at first, and one thing is certain - it can only be done well by all staff members seeing themselves as members of a TEAM.  Only then can new tasks become tolerable and the difficulties surmountable.  This is the first and most important working rule to be learned, and with the acceptance of it everything else will tend to fall into place.

 

This basic point can’t be stressed too much, and new nurses are advised to lean heavily on the team in the first few weeks in particular. By communicating difficulties, responsibilities will be spread out and training will continue. Nothing has to be faced alone.

 

The staff team gives the example on which the patients will perforce model themselves. It has been a lesson well learned here, as in other therapeutic communities all over the world, that when the staff team pulls together the patients tend to do likewise, and from this comes the amalgamation of true community effort that results in success all along the line in the treatment program.

 

Perhaps the most immediate observation made by a nurse coming to work in this therapeutic community for the first time, is that the patients themselves have had a great deal of authority delegated to them. Indeed, in some matters they are virtually the sole authority. At first glance it will seem fantastic that patients assess and admit new patients; review progress and institute treatment procedures; make new rules and alter old ones; mete out discipline, etc.

 

To many new nurses and doctors as well, and particularly to those whose previous experience was connected with the physically ill in the general hospital field, or who come from psychiatric settings more formalized in approach, all of this will be right out of line with their training and role appreciation. Adjustment will have to be made, and acceptance that this is necessary is the first and most important step towards fitting into the altered (and ever changing) role required.

 

In sum, nurses here at Fraser House are not so much doing FOR the patients as working WITH and SHARING an experience. This is basically what is expected.

 

Understanding the reason behind the differences in work standards and altering roles helps - no one would be willing to change his work pattern in, or the why he sees himself in work without reasonable explanation.  If the therapeutic community can be viewed as necessary evolution change towards democratic self-discipline, and if the nurses’ role can be seen as becoming more therapeutic as it moves away from that of custodian towards autonomy for the patients, then the first step is made.

 

CONCEPT

 

The basic role of the nurse in Fraser House is that of therapist and this means accepting the patients as worthwhile and worthy of help and so, aiming to change their deviant behaviour and the deviant ways they see themselves or others.  The nurse also is a representative of society, and becomes involved with patients in order to return their neurotic, psychotic or other deviant behaviour to the norm of this society.

 

The nurse remains as much a therapist in being with one patient or with an informal group of patients as in formal group therapy.  To be a therapist means to express real caring and at times, discipline about patients.  Training in psycho and socio-therapeutic techniques is a continuing process and the nurse enters into research work and the domiciliary field as well.  The nursing staff makes up the largest portion of the staff team and has 24-hour close interpersonal contact with the patients.  The role is vital, and in many ways is the most important.

 

ROLE

 

Nurses are assigned in teams to regional areas at the moment - Lane Cove, Ryde, Rest of North Shore, other areas.  Each regional team is expected to be responsible for knowing their area, its problems and helping agencies etc..  Moreover nurses in each team are expected to come to know all in-patients and outpatients 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; be part of both for medical officer and follow-up committee planning for the patients of their region.

 

Nurses working in community and social psychiatry ‘steal’ many of the roles of psychiatrists, psychologists, medical offices, sociologists and social workers.  This gives the nurse much more power to initiate and decide and also the accompanying responsibility.

 

So the role of the nurse in Fraser house is seen as complex and wholly therapeutic, using a team approach in a therapeutic community to set the climate for personality change and social reorganization.

 

The new nurse will at first learn various areas, and these will be filled in to fit into shape as the tour of duty lengthens. An hour or so will be spent with a senior staff member on the first day for initial induction discussions, and the newcomer is paired off to work with a nurse who is versed in Unit procedure. Experience has shown how the patients actually give a great deal of help to new staff in aiding in their orientation. The new nurse will receive plenty of support to fit into the community. Fraser House traditions are now well established. There are no great dissatisfactions to overcome.

 

Nurses are on the staff to work as members of a therapeutic team, and to receive a training that has profitable personal and career rewards. Better training and greater work satisfaction for staff are basic aims in therapeutic communities.

 

GROUP THERAPY

 

The significance of group therapy in Fraser House may be gauged by the fact that there are about three thousand groups structured in a year involving twice this number of man-hours by the nursing staff. Reporting sessions, attended by nursing staff follow each of these groups, also consume more man-hours devoted to analysis and interpretation of each group, and exchange of information brought out by these groups. These reporting sessions are also for continuous training in all aspects of community and social psychiatry

 

Small groups are made up of from eight to twelve people, and are allocated daily. These allocations are made to conform to different patterns according to age and marital state, according to social class and marital state, according to sex and marital state. Also, there are intergenerational groups consisting of patients and their families, of each medical officer attached to the Unit, and groups made up of ‘withdrawn’ patients.

 

The unstructured groups are special groups held for particular patients for various reasons, e.g., they may be planned and scheduled for certain times during the day or night when a patient’s relatives arrive from the country. Or they may be spontaneous, when a relative arrives unexpectedly. Or they may be held as and when a particular patient, or patient family becomes disturbed over some crisis which arises.

 

THE THERAPIST IN SMALL GROUP THERAPY

 

The role of small group therapist and observer has always been the province of the nurse in Fraser House, and represents part of the rise in therapeutic status. Nurses have become therapists in their own right.

 

The first essential in taking a group is to see it as a meeting, and like all meetings, there is a need for a chairman to conduct affairs and keep issues to the point.

 

The initial function of the therapist is to see that the group functions as a group. It may be necessary for him to be quite directive in order to achieve this in some groups, but on the other hand it may just happen anyway even if he adopts a completely passive and wordless role. How active or passive, directive or non-directive the therapist is or chooses to be, may be influenced by many things – e.g., the attitude or mood of the group itself and tensions built up prior to and during its running; the type of group and purpose, or the themes introduced during the group. The therapists own personality is a basic factor which determines handling, and this may vary from day to day depending on the therapist’s mood, and also on his attitude to the type of group or even some of the people contained in it.

 

It should be said here that, whilst one might be influenced to some extent by the way certain therapists conduct the group, it is inadvisable and unwise, and indeed well nigh impossible for one therapist to copy another, for the previously stated reason that the therapist’s own personality is a basic factor in determining the handling of groups. So that even if one decided on a particular therapist as ones ‘idol’, one should not attempt to emulate too closely. Because of this ‘personality’ factor and other rather intangible factors, there are not many rigid rules which can be generalized to apply to all groups, but the following can be applied to most:

 

THEMES

 

If a theme is introduced, and it is considered to be not too superficial or inappropriate, the group should pay some attention to it, and not change the theme to another without good reason. If an attempt to change the theme is made, it may be done deliberately by a patient for a fairly obvious reason (such as a personality clash with someone involved in the previous theme), or a less obvious reason such as an unconscious identification and a consequent wish to avoid the theme. It may also be done through plain insensitivity on the part of the person making the attempt at the change. There are many reasons for these moves, and it is the therapist’s role to decide on the dynamics of the situations and then to make use of them by feeding them straight back into the group at the time, and if necessary, to make an interpretation of the dynamics operating in the events and occurrences.

 

It is also in the province of the therapist to direct the group away from superficial themes or from discussing themes in a superficial manner. The therapist, in order to discourage superficiality, may find it necessary to commence the group immediately he enters the room, by physically structuring the group in such a way that he gains attention, establishes some kind of control, and incidentally builds some initial tension within the group. This, of course is not always necessary or desirable, but is often helpful in dealing with groups of teenagers who tend to spread themselves around the room, put their feet up on chairs, and throw matches and cigarettes about. These practices in themselves are quite harmless, but in group are often used as avoiding tactics, and are apt to wreck and render valueless the group itself. So the therapist can avert these disruptions when he enters the room by making everyone get up and draw their chairs into a tight circle in the centre of the room and disallowing feet up on chairs.

 

In general, the therapist should make use of what is going on in each particular group at the time it is taking place. He has first to be able to recognize what is going on and he can only do this through observation and experience. The way he uses these things which are going on within the group depends to a large extent on the therapist himself – again the personality factor. Even though a therapist is inexperienced, and perhaps not very confident, he should keep in mind that he brings something very valuable to the group with him – something which no one else can do in the same way – the sum total of his own unique life experience. When used with confidence, this is a very powerful force which all nurses have at their disposal.


INTERACTION AND INTEREST

 

If most of the group is involved in interaction, it goes without saying that they are also interested. However, interest can be very high even though there is not much interaction. Look at their faces, their feet, their hands, their respiration, the way they sit, and it will be known if they are interested or not. Interaction may not be high if the therapist has found it necessary to be active or directive. This sometimes must be the case.

 

TENSION

 

There will usually be varying amounts of tension as the group progresses, both from the group as a whole, and from individual members. Silences usually build up while tension is mounting, and the best way to use this tension is not to break these silences; let the members of the group do it as they will when they can no longer stand the tension – and then see what is released with the tension and make use of it.

 

MOOD

 

The mood of a group is sometimes sustained throughout, but more often it changes, ranging through many emotions and frequently depending to some extent on the build up and release of tension, the themes discussed and the manner of the discussion, the interaction and the interest, and the cross-identification of those who interact. The role adopted by the therapist is also important here. Once again, the emotions which set the mood for the group are used.

 

 


 

Appendix 8. Fraser House Big Groups

 

 

Reference - (Yeomans, N. 1965a, Vol. 5, p. 34)

 

 

Fraser House Big Groups

 

Whereas much has been achieved over the years in the way of explanation and handling of individual and small group difficulties, little is to hand to clarify the acknowledged emotional forces and the psychotherapeutic techniques of large community groups.

 

Most individual maladjustments can be readily recognized by seeing a personality at conflict with himself and his environment. Small groups portray the ‘family’ setting and inter-personal interaction. But ‘Big Groups’ forming as they do the backdrop to all therapy in this Unit, are not explainable adequately in the term of psychology or psychiatry previously applied to the individual patient or even to the classical group situation.

 

The sciences of sociology and social psychology, with their study of whole collections of people and the interplay of these groupings within entire societies, are used to explain both these dynamics of the Big Groups and the therapeutic directions of the whole community. Theories of behaviour of crowds and audiences apply to the Big Groups in particular.

 

The techniques used in handling these meetings are principally our own and have evolved through testing and retesting of basic theories by adoption and ‘trimming’ of those found successful by some leaders, and by constant discussion and evaluation of the problems these community groups pose.

 

The community meetings held at Fraser House are of two main types and a third is gradually evolving. Morning community groups have two main therapeutic functions; personality change is the aim of four meetings, while social control is the focus of the Thursday morning administrative group. Evening Big Groups, though not compulsory, are invariably well attended by in-patients. But by far, the majority attending can be classified as outpatients and these receive the bulk of the attention. With family therapy as a principle, the projective interplay of the various families present characterizes these meetings to such a degree as to almost typify the aim of the evening Big Groups.

 

The setting is a large hall (the Centre Block) in which clear speaking is adequate, central to both wings of the building. Seating is in two rows at the sides and one end with a single row at the end nearest the entrance door. The group leader usually sits in the centre of this row, but is free to move according to his or her dictates. All of the chairs face centrally so that, as much as possible, everyone is in view and speakers can face each other. But principally the people are shoulder-to-shoulder as in an audience as well as being members of a single crowd - usually numbering about one hundred persons.

 

Two members of the nursing staff (one male - one female) observe and record the meeting from a detached point behind the back row.

 

Other staff members (medical, nursing, research, etc) intersperse themselves among the patients, paying particular attention to the three inner corners (notorious geographically for the most destructive and resistive sub-groups) but leaving the doorway clear of staff. Portion of a row is reserved here to lessen the interruption made by latecomers.

 

It has become traditional that the four ‘therapeutic’ Big Groups commence with a reading of the ‘Ward Notes’ by one of the patients. On Thursdays this is deferred till after the various committee reports and elections. In essence these ward notes serve the purpose of an informal Unit newspaper and comprises all manner of notifications from grouches about yesterday’s foodstuff to staff warnings against suspected ‘conmanship’.

 

Usually the therapist then allows the group to enter into spontaneous ‘free floating’ discussion until a general interconnecting theme is apparent. This may then be pursued with promptings towards interaction between different generations or social classes or psychiatric opposites – or perhaps to tie in together for mutual support those with similar difficulties, personally or because of family or life-crisis situation.

 

At times the focus might fall on one particular patient or family to highlight a special need, and it is quite common for sub-groups or cliques to merit attention. These latter are constantly forming, breaking and re-forming, and the group leader much of the time finds it impossible to be aware of these changes and undercurrents. The interspersing of staff members throughout does much to obviate this as these moves can be discussed later in the reporting session, or if urgent, brought to the attention in the group by the staff member aware of the moves. Most meetings see the group as a whole reacting much like an audience to a few main actors. This can be constructive as an insight-gaining process as the personal, intra and inter-family or sub-group projections are portrayed and leadership values rise or fall. At other times when matters affecting the internal security of the community arise or pressures are brought to bear from outside sources, interpersonal differences are dropped for combined feeling and action and the Unit becomes united as its projection against threat is shown. So the audience-type reaction displaces to behaviour more attributable to that of a crowd. When these crowd-like emotional forces move the whole community, the opportunity is presented to harness these towards a therapeutic goal which can do more in a single hour towards personality change for more people than many months of other therapy. Herbert Blumer (1970) says of these forces:

 

People become aroused and more likely to be carried away by impulses and feelings; hence rendered more unstable and irresponsible. In collective excitement, the personal make-up of individuals is more readily broken and in this way the conditions prepared for the formation of new forms of behaviour and for the re-organization of the individual. In collective excitement, individuals may embark on lines of conduct which previously they would not have thought of, much less dared to undertake. Likewise, under its stress and with opportunities for the release of tension, individuals may incur significant re-organization in the sentiments, habits and traits of personality.

 

When both the staff and patients are working well together in the Unit, a peak of enthusiasm is reached at times when everyone sees almost any move at all as being gainful. New enterprises are embarked upon with an eagerness that is almost inspired and success is a certainty. Whereas perhaps a month earlier the same move would have met an equally certain failure. All improvements in expanded therapy services and the patient-government structure (and the recent acquisition of the Unit vehicle) have been adopted at such times.

 

The opposite of gain is loss and this is felt most acutely in a feeling-wave by the entire community at a time of bereavement, deprivation or mourning – when a fellow-patient’s close relative dies; rejecting parents spurn pleas for help; or there has been a serious or fatal attempt at suicide. Here the all-pervading shared sadness can give rise to depressives becoming overwhelmed with emotional forces of loss and breaking into bitter tears as a sign of externalising their feelings of aggression and loneliness. The sincere sympathy given by fellow-patients and therapist at these times can do much to consolidate future lessening of inhibition while false exaggeration of hope is avoided.

 

Again, when as a whole the Big Group is swayed by frustration, contagious aggression and excitement result; just as contagious as the feelings of fear and panic experienced due to a shared threat anywhere.

 

The recognition and use of these crowd feelings by the therapist are usually intuitive. The leader must ‘feel’ these and employ them – they are of the greatest value when utilized therapeutically towards corrective emotional experience. This can be rated as either an individual, a family, the whole group, or any combination of these being helped in this direction.

 

Community meetings are followed by a report by the two official observers, and comment by all staff members present, including the therapist who took the group. Points assessed are:

 

·         Mood

·         Theme

·         Value and interaction

·         Therapist’s role

·         Techniques employed

 

From these ‘post-mortems’ comes much of the knowledge needed. At the moment this seems by no means exhaustive. The aim must be always to look at the community in the ‘BIG’ – as a whole and this certainly is no easy matter.

 

FURTHER THEORY AND EXAMPLE

 

The Fraser House Therapeutic Community is a sub-community of Lane Cove and Ryde aimed at all the different social problems of these areas. There is an inherent movement towards change resulting from the emotional contact of people with different problems.  This change is a therapeutic change if the atmosphere is one of help, respect for the worthwhileness of each person, and discipline where necessary. A professional man, father of a schizophrenic girl, once abused the patients and the Unit, because he was sick of people of lower education etc. telling him what to do. His education and professional knowledge were not in doubt, but his capacity as a loving trusting father was. Those like him in age and education had tried and failed to change him in the past. Those unlike him could do so with much more effect.

 

This therapeutic community attempts to reproduce normal life in many ways, particularly in allowing the development of emotional storms (as they occur in families) and in not enforcing overly good behaviour, as is the usual hospital pattern. Like normal life too, there are limits and so effective discipline is a major part of the program, especially for those with antisocial or hostile problems.

 

The process of change for the disturbed patient and family may be described in many ways. One is that the Unit attempts to provide emotionally corrective experiences in the conflict area. This can be seen in the spreading of a theme within a group or in the contagion of feeling within the Unit that always most deeply affects those with the problems in the area of conflict which set off the emotion. When sexual interference becomes an emotional topic, the experienced therapist can tell at a glance all those women and girls who have had a similar experience - it screams from their faces. They can then be helped to face this and all the covering up about it, in them and in their family.

 

Success for a therapist is now known to depend very much on how much the patient realizes that the therapist cares. This cannot be acted by the therapist – and here lies the importance of learning to relax and be oneself and express oneself in the therapeutic situation

 

Caring for the patient does not mean loving and accepting everything he does. You don’t care for someone if you let them wreck themselves or harm others. It means coming to see and feel that the patient is a person worth helping and changing. It means to accept the person, but reject their deviant problems (e.g., love a depressed person, but NOT their depression – want to change their depression). Particularly it means rejecting abnormal behaviour, particularly that which is harmful to others. So here caring will mean love and discipline.

 

There are some points which help in the therapeutic approach to whole families in groups:

 

1.    Aim to help the whole family

2.    Help them not to push the most deviant member down when they are under tension

3.    Encourage parents of the presenting patient to talk about their difficulties with their own parents, and each other

4.    If the presenting patient has improved more than the rest of the family, suggest they forget his problems and talk about their own

5.    Make sure the different generations in the family attend different small groups much of the time

6.    The overt symptoms in the presenting patient usually indicate the key conflict for all the family

7.    Suggest family members who insist they have no problems, that you would like them to be more selfish and talk about themselves anyway

8.    Don’t reject the parents because of what you see they have done to their child – find out what he has done to them

9.    No parent ever purposefully wrecks his or her child. They should not be blamed for a tragedy they were caught up in

10.  Don’t adopt any of the above techniques unless you feel it

 

The emotional comfort and satisfaction of the Unit staff is one of the most significant features of the therapeutic program. The numerous staff meetings aim to foster this. Specifically, their role is to prevent the development of covert, hidden conflict between staff members about patients. Such conflicts are proven to result in overt patient disturbance. The staff remains the most powerful members of a therapeutic community and their welfare and comfort are of paramount importance.


 

Appendix 9. The Case of the Insightful Cleaner

 

 

 

A case study synthesised from discussions with Neville (Dec, 1992, Aug 1998)

 

 

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 (Dec, 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 coloured 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 placed beside her. After a time a set of poster colours 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. At one stage she was running out of walls to paint and this coincided with word being received on the grapevine that a fund cutting inspection team would arrive that might recommend closing the Unit if it was deemed too alternative. 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 they found all the staff 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 ‘catatonic artist’ was able to return to living in society.


 

Appendix 10. Case Study - The Canteen as Work Therapy

 

 

 

A case study synthesised from discussions with Neville (Dec, 1992, Aug 1998)

 

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, N. 1965a, 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. 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.


 

Appendix 11. A Copy of a Letter Drafted by Resident Members of The Parliamentary Committee

 

 

 

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

 

 

 

Fraser House

The Psychiatric Centre

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 9:30 A.M. each morning and at 6:30 P.M. 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


 

Appendix 12. Notes on Fraser House in the Media

 

 

 

Notes synthesised from discussions with Neville (Aug 1998) and archival research.

 

As one aspect of ensuring Fraser House’s continued existence, Neville was constantly seeking and gaining media attention focused on Fraser Houses value to the community. Neville placed a large collection of media clippings and other Fraser House archival material in the Mitchell Library within the NSW State Library (von Sommers 1960).

 

In 1959 the Weekender reporter Green tells of a dedicated telephone number for Fraser House being SUI, similar to 011 today (1960); telephones in those days had alpha and numeric numbers. People-at-risk and their family and friends could attend Fraser House as outpatients and at-risk people could become inpatients. After only four months in operation, Fraser House had a five-month waiting list of people wanting to get in

 

Within the first nine months, Fraser House had hundreds of calls on their suicide hotline as reported in the Sun Newspaper, June 23 1960 (1960). Other Newspaper articles had headings like ‘Suicide Urge – Clinic Saves Lives  - The Neurotic and Alcohol Unit of the New Psychiatric Centre at North Ryde’ (1960), ‘Pulled From the Brink Suicide Clinic’ (1960), ‘Dial the Club and Talk it Over – Men Who Stop Suicides’ (von Sommers 1960), ‘Alcoholics V Neurotics’ (1960), ‘880281 – A Phone Number That Saves Lives’ (Kelly 1962), and ‘Why do People Commit Suicide’ (1962). The Readers Digest ran a story called, ‘Love From a Stranger’ in May 1960 (1960). The Pix Magazine ran a special report on 14 October 1961 called, ‘Are You a Potential Suicide’ (1961).

 


 

Appendix 13. The Roles of the Fraser House Patient/Outpatient Committees

 

 

 

A statement of the roles of the Fraser House Patient/outpatient committees showing the staff who devolved their role. This role structuring was being continually being modified and adjusted (Yeomans, 1965, Vol. 4)

 

 

Admitting Committee (devolved from the psychiatrist)

 

Roles:

·         Interviewing people seeking admittance

·         Identifying problems and problem areas

·         Specifying the type of treatment

·         Specifying period before review

·         Specifying conditions of admission

·         Ensuring prospective patients know the requirement for both patients and their families and friends to attend 12 groups before the patient’s admission

·         Making a record of all the above details which is presented at the following Thursday’s Administration Big Group.

 

Membership:

 

Residents eligible for election upon being six weeks in the Unit.

 

The split between residents and outpatients is unavailable.

 


Staff present:           

 

Medical officer and members of the nursing staff

 

 

Progress Committee (The senior committee - devolved from the psychiatrist)

 

·         Discussing and assessing individual patients and families

·         Discussing problem areas

·         Suggesting treatment procedures

·         Confirming, altering or changing treatment

·         Maintaining close liaison with Rehabilitation Committee

 

Membership:

 

Residents eligible for election after being two months in the Unit.

The Split between residents and outpatients is unavailable.

           

Staff present:           

 

Senior male nurse and senior female nurse

 

 

Pilot Committee (devolved from director/psychiatrist)

 

Roles:

·         Attending all other committees

·         Investigating all other committees

·         Reporting to Progress, Parliamentary or Big Group on irregularities or failing activities

 

(Formed March 1965)

 

Membership:

 

Residents who have considerable functionality and a hence likely to be leaving the Unit in the next few months.

 

The Split between residents and outpatients is unavailable.

 

Staff present as representatives:  

 

Senior and Junior charge nurses

 

 

Parliamentary Committee (devolved from senior charge nurse)

 

Roles:

·         Liaising between residents and staff

·         Sustaining paramount emphasis on democratic government, rights, dignity and freedom

·         Presenting staff with a uniform view of resident feelings about the Unit’s functioning

·         Airing criticisms of the efficiency and policy of any committee

·         Hearing applications of resignation from any committee.

·         Holding elections for vacant positions on any committee at start of Thursday Administration Big Group

 

Membership:            

 

All residents on structured committees.

 

The Split between residents and outpatients is unavailable.

 

Staff present as representatives:  

 

Senior and junior charge nurses

 


Ward Committee (devolved from nursing staff)

 

Roles:

·         Maintaining discipline

·         Ensuring ward cleanliness (as adjunct to domestic and maintenance staff)

·         Being responsible for patient cleanliness and welfare

·         Discussing treatment procedures with the Progress Committee

·         Meting out justice when rules are broken

·         Drawing up work rosters

·         Ensuring cleaning duties done

·         Monitoring resident’s behaviour

·         Permitting or denying weekend leave based on behaviour

·         Instilling responsibility, initiative and independence

 

Membership:                                    

 

Residents who have considerable functionality and a hence likely to be leaving the Unit in the next few months. The split was 8 residents and 4 outpatients.

 

Staff present as representatives:  

 

Nurses

 

 

Teenager’s Committee

 

Roles:

·         Promoting a spirit of friendship amongst teenagers in the Unit

·         Organizing a program of group outings and activities

·         Enforcing peer discipline

·         Assuming a group parenting role

·         Liasing with Ward Committee re inter-generational issues

 


Membership:                                    

 

Restricted to members under 20 years of age

Split between residents and outpatients unavailable.

 

Staff present as representatives:  

 

Nurses

 

Outpatients, Relatives and Friends Committee (devolved from Social Worker)

 

Roles:

 

·         Supporting the evolving of local psycho-social support networks

·         Maintaining locality based card index with names and addresses and typical travel modes

·         Providing a coordinated transport system to enable more regular attendance at groups

·         Providing assistance to outpatients within their own district

·         Providing relatives and outpatients with a voice in Unit management

·         Liasing with Follow-up Committee

 

Membership:                                    

 

Family and friends of inpatients, and inpatients. Split - 2 outpatients

 

Staff present as representatives:  

 

Social worker

 

Rehabilitation Committee (devolved from Social Worker)

 

Roles:

·         Assisting discharged patients finding work

·         Arranging accommodation

·         Liasing with the Progress Committee re progress and employment prospects

 

Membership:

 

Residents who have considerable functionality and a hence likely to be leaving the Unit in the next few months. Split between residents and outpatients unavailable.

 

Staff present as representatives:              

 

Social worker

 

 

Follow-up Committee (devolved from Social Worker)

 

Roles:

·         Establishing close liaison between inpatients and their relatives and friends

·         Organizing and financing home visits by resident domiciliary group members and searches for AWOL residents

·         Administering emergency aid

·         Liases with Outpatients, Relatives and Friends Committee

 

Membership:

 

Residents who have considerable functionality and a hence likely to be leaving the Unit in the next few months. Split - 4 residents and 2 outpatients

 

Staff present as representatives:              

 

Social worker

 

Activities Committee (devolved from Occupational Therapist)

 

Roles:

 

·         Arranging individual, small group or whole community occupational therapy for therapeutic and disciplinary purposes; examples: pantry duty, assisting the librarian, collecting workers meals, emu parades - a line swoop through the Unit picking up rubbish as everyone walks through; a tender was won by the residents to build a bowling green at the unit; in 1964 a contract was obtained to pack light globes.

·         Liaison with the Progress, Rehabilitation and Ward Committees and staff relating to appropriate occupational therapy

 

Membership:            

 

After resident has made considerable move to functionality. Information on split between residents and outpatients unavailable

 

Staff present as representatives:  

 

Nurse/occupational therapist

 

Finance Committee (devolved from Administration - accounting, banking and welfare)

 

Roles:

·         Holding surplus funds

·         Allocating these funds as necessary to other committees

·         Monitoring all committee funds and recalling funds surplus to need

·         Safeguarding the Units patient welfare funds

·         Inspecting cash records and cash balances of all committees at weekly meeting

·         maintaining Fraser House Finance Committee bank account

·         Being the Unit’s accountant, banker and internal Welfare Officer in respect of money

·         Assisting people who mishandle money towards greater responsibility while in office

 

Membership:

 

The treasurers of all of the other Committees

 

Staff present as representatives:

 

Administrative staff involved in accounting, banking and internal welfare; nurses.

 

At one stage the rule regarding the split was 3 residents and 3 outpatients

 

 

Canteen Committee - devolved from Administration (accounting, banking and welfare) and Occupational Therapist

 

Roles:

·         Contacting goods suppliers and ordering

·         Receiving goods from sales/delivery people

·         Serving patients, staff and visitors

·         Maintaining coin-in-the-slot soft drink machine

·         Supporting fellow Canteen Committee members who are isolates (e.g. depressed or schizophrenic residents)

·         Providing public relations role

·         Tallying up daily takings

·         Presenting weekly report at Administration Big Group

·         Generating surplus used to purchase van used in domiciliary visits and supplying petrol and maintenance

 


Membership:                        

 

Restricted to members under 20 years of age. The split was 6 residents and 2 outpatients

 

Staff present as representatives:  

 

Nurse/occupational therapist

 

 

Social Committee (devolved from the Social Worker)

 

Roles:

 

·         Arranging social activities both inside and outside the unit

 

Membership:                                    

 

Residents who had been 6 weeks or more in the Unit. The split was 3 female residents, 3 male residents, and 3 outsiders

 

Staff present as representatives:  

 

Social worker/Nurse/occupational therapist

 

Notes:

 

The Social Committee was disbanded a couple of times when there was no residents with flair for being on this committee. When some ‘live wires’ turned up as residents it would get restarted again.

 

Notice that the membership split ensured that outpatients were also represented and involved in the committee process with all of the benefits flowing from this in emerging them in the healing community process.


 

Appendix 14. Case Study - On Going Berserk

 

 

 

A case study synthesised from discussions with Neville Dec, 1993, Oct, 1998, Mar, 1999) as well as with Warrick Bruen (Oct, 1998; March & April 1999) as well as archival material.

 

Neville spoke of four major themes stirring emotions being gain, loss, threat and frustration. Neville would expressly make strategic use of incidents with a high probability of heightening emotional arousal associated with these four themes within Big Group.

 

Below is an example of how Neville intentionally heightened the group’s emotional arousal during a Big Group meeting. Neville spoke about a key point in the life of Fraser House; on one occasion after Fraser House had been going for around three and a half years, and as soon as Big Group started, Neville went berserk. All present thought Neville was having a mental breakdown. At first, Neville was just screaming and yelling. Then he conveyed that he was sick of everything. This raised everyone’s emotions. Threat was a dominant theme. After a short time the nub of Neville’s outburst was revealed. Neville was going on extended leave and the Health Department had not arranged a replacement psychiatrist. This was a serious matter. Neville’s (Yeomans, N. 1965a, Vol. 5, p. 1-14)  file note at the time about going berserk in Big Group’ said in part:

 

With my impending holiday today I allowed my aggressive frustration full play in the community meeting this morning. The meeting began by John asking me if I was really going on holidays. I said I was even if the bloody place fell down. I then berated the Division and the fact that Dr ----- or some other Doctor should have been here at least two weeks ago.

 

I took a most regressed and childish aggressive view against the department and in support of Dr Barclay (head of North Ryde Hospital) and my own efforts, pointing out that both of us were letting them down because of the department’s incompetence.

 

Dr. Barclay was very supportive of Neville and Fraser House.

 

Recall that the Keypoint in Keyline was where all the essential features of the topography merge and reveal the contextual connexity and concentrate the information distributed in the system. In Chapter Four it was suggested that keypoints occur in many contexts. I am suggesting that Neville’s outburst made the Keypoint, ‘I am leaving and there is no replacement!’ This keypoint was at the junction of every aspect of the Fraser House social topography. This keypoint also condensed all of the information distributed in the Fraser House System. Through this keypoint ran the keyline. In this context the keyline became the theme(s) for discussion. The first theme was ‘threat and anger through loss’.

 

Big and Small Groups had a themes based open agenda. In the Big Group ‘Going Berserk’ context, the Unit would be without a doctor/psychiatrist. Some replacement was coming in two or three weeks, but in the meantime, they were ‘on their own’. Even when the replacement got there, he or she would have no experience or pre-briefing of ‘the Fraser House’ way. There was the major uncertainty of what changes a new psychiatrist would make in Neville’s absence. Neville was scheduled to be away for up to nine months. Neville’s behaviour and this news of no replacement being available heightened emotional arousal to fever pitch in everyone - a combination of anger, rejection, abandonment, confusion, anxiety, panic, frustration and fear. Neville then suddenly switched themes and slammed the Health Department as the ‘culprit’.

 

Both patients and staff’s emotions were, by this shift in thematic focus, directed into anger at the Department. Then Neville refocused theme and thinking again to ‘everyone taking responsibility for Fraser House and each other’. Again, patient and staff emotions were directed into this new theme – of ‘self-help and mutual-help’; another mixture of emotional energy - panic, concern, uncertainty, questions of being up to the task, to name a few. Then Neville shifted theme yet again and drew everyone’s attention to the suicidal nature of one of the patients present in the room, and laid it on the line that this person’s wellbeing - his very life - was in everyone’s hands. This was the next shift in emotional focus. Here the focus was on gain in the face of loss and threat, and how to get gain safely. Neville’s big picture thematic meta-interaction with staff and patients was all about engendering communal cooperation towards safety and gain in the face of danger and loss.

 

Neville’s constant changing of the group’s thematic focus during his ‘going berserk’ episode was an example of using Cultural Keypoints and Keylines (themes) of discussion. At the same time Neville used crowd synchrony and contagion in the context of energizing emergent self-organizing properties in the inter-mix of psychosocial and psycho-biological (emotional upheaval) systems in all present. Within Big Group, Neville used provocation and crowd contagion as change process.

 

Neville arranged for eight separate people’s reports of the particular Big Group meeting where he went berserk to be placed in the archives at the Mitchell Library (Yeomans, N. 1965a, Vol. 5, p. 1-14).

 

Every one of these reports similarly confirmed that Neville had intentionally mobilized and used group emotional energy towards group cohesiveness in caring for itself, and that this shifting around of emotional contagion was a crucial aspect of the Unit functioning extremely well during the ensuing nine months while Neville was on his (working) holiday.

 

One staff member’s report of the above incident ended with, ‘This story has no end because we still continue to function as a unit’ (Yeomans, N. 1965a, Vol. 12, p. 2). Another staff member wrote a file note saying:

 

I have no vivid recollections of the first week of Dr. Yeomans absence except that the nursing staff occasionally seemed surprised that the ward was still running and that we were able to get through staff meetings without Dr. Yeomans’ (Yeomans, N. 1965a, Vol. 5, p. 15).

 

Warwick Bruen also recalled Neville’s behaviour in going berserk in Big Group and collaborated the above material.

 

Placing eight separate staff member’s reports along with his own report of the ‘going berserk’ incident and its sequalae for me and others to find in his archives is another example of Neville, ‘the researcher strategist par excellence’. I suspect that he did this expressly for the likes of me to find them all nearly forty years on!

 

As an indication of the efficacy of using high expressed emotion in major crises as a keypoint for key lines of thematic action for system change, Phil Chilmaid mentioned one Fraser House research project that demonstrated that there was a consistent pattern that significant ‘breakthroughs’ tended to follow about 6-7 days after some major crisis (Cockett and Chilmaid 1965).


 

Appendix 15. Two Case Histories Showing Glimpses of Neville’s Process and the Fraser House Model in Action

 

 

The following case was synthesised from discussions with Neville (Dec, 1992 and July 1998). Bruen also confirmed the details (Oct 1998).

 

Case One - The Nurturing Mother

 

A mother was serving twelve years for the murder of two of her three very young children. Right through the mother’s prison term she had repeatedly stated that she was waiting for the day she gets out of jail to kill the remaining child who was a baby in someone else care at the time of the killings. This remaining child had been looked after by foster parents for eleven years and was twelve years of age. When the mother was within a few months of release she was still threatening to kill the child. There was a lot of pressure from the prison authorities on the Parliament of the day to pass special legislation to ensure this woman was never released. Prison governors and warders alike were concerned for the safety of this remaining child. Upon learning of the fears about the mother and her pending release, Neville suggested to the authorities that the mother be allowed to request a transfer from prison to attend Fraser House on a voluntary basis and if she agreed, to grant her request. In process of setting up this possibility, the foster parents of the surviving child, along with the child in question were invited by Neville to attend Fraser House Big and Small Group meetings for a number of months while the mother was still in prison. Neville fully briefed the foster parents and child on Big and Small Group process so that they all knew what to expect. The Foster parents and the child agreed to attend. There were other children present, as was the custom - up to eight families were in residence at any one time. As well, families and friends visitors included children. The safety of children and everyone was always of paramount concern. As for high expressed emotion and children, typically, in these families children already had been living with it from birth.

 

This attending of Big Group was for the foster parents and the child firstly, to decide whether to be present in Big Group if and when the mother arrived, and secondly, so that they could all get a sense of how Fraser House ‘operated’ on dysfunctionality, and thirdly, so that they could potentially - if the mother was released into Fraser House - have some clarity about where the mother was at. The alternative was for the child and foster parents to live, knowing the mother was possibly to be released, and then at large, ‘somewhere out there’, and knowing she was still threatening to kill the child. After regular attendance at Big and Small Groups, the foster parents and the daughter agreed to be present if and when the mother arrived at Fraser House. Given the circumstances, this says a something about Fraser House.

 

Also saying something about Fraser House and the spirit of the times, it was agreed by the Authorities that the mother be given an ultimatum - ‘be escorted from prison directly to Fraser House and admit yourself voluntarily or we will pass legislation to keep you in prison indefinitely’. She accepted the Fraser House alternative. The foster parents and child agreed to leave it up to Neville firstly to get a feel for the mother’s state of mind and secondly, as to whether or not to introduce them to the mother, and when. That the child and Foster parents were attending Fraser House groups, wanted the mother at Fraser House, and that the three of them would be there when the mother arrived was made known to the various interested parties determining the mother’s release. However, the maternal mother was given no information of the intention to have her daughter and the foster parents present on the day she arrived. When the mother was ushered into Fraser House she had little idea where she was or what sort of place Fraser House was - all she knew was that it was a psychiatric hospital where she would have a better chance of release compared to staying in prison where she was facing the possibility of an indefinite prison term. The members of the small assessment group who interviewed the mother upon her arrival were all patients who had killed or seriously injured members of their own families - it takes one to know one. As per the current practice at the time, this assessment was by members of the Admitting Committee made up of patients and was a regular feature of Fraser House. They did not declare they were patients and that they had all murdered or had seriously injured their family members.

 

The maternal mother had had no information at all about her sole surviving daughter for the eleven years she had been in jail. She had no knowledge of her daughter’s current whereabouts and that she would potentially meet her daughter in a Big Group setting. The maternal mother was left in the care of a staff member while the assessment group briefly gave their initial assessment of her state to the waiting Big Group. The mother was then taken down the short (soundproof) passageway and into this rather small room crammed to capacity. Around 180 people were in two tight circles and all eyes were on the mother. She was totally unprepared for this. She searched the room for familiar faces and found the members of the Assessment Group. She was directed to a spare chair and hardly noticed that she was sitting between two very powerfully built men. With their casual clothes, she had no way of knowing they were nurses who had been placed either side of her to prevent her reaching and harming her daughter. Beside one of the men was a female nurse. Unknown to the mother these three were on constant alert to stop her approaching her daughter. Directly opposite less than three steps away sat her daughter flanked by her foster parents, who in turn were flanked by people also on constant preparedness to move together and forward to block the mother being able to reach the daughter.

 

Neville spoke up and asked members of the Assessment Group in turn to give the newcomer their backgrounds. Each spoke briefly of assaulting/killing members of their families. After the overwhelming confusion and emotional flooding from this introduction to Fraser House Big Group, Neville caught the mother’s attention and said words rather quickly and matter of factly to the effect, ‘and....by the way....over there is your daughter... mentioning her name.’

 

Already in overload from the weird context, this sudden potent unexpected revelation put the mother into massive overload. The mother now had the opportunity to have a shot at killing her daughter in front of the group. This had been her fantasy obsession for eleven years and here was her daughter in the flesh in front of her - just a few steps away! After a very short time in the room the mother suddenly made a dash towards the girl and the male nurses, on razor alert for just such an occurrence, grabbed the mother. She immediately went into an almighty struggle with super-human emotional energy. The female nurse grabbed the mother’s hair and pulled this to restrain the mother from her attempts at biting bits off the two male nurses’ heads and shoulders. There were others prepared on either side of the foster parents and child (in the middle) that headed towards the mother blocking her path to the foster family. When she was restrained the meeting resumed. After a time when she had calmed a little, the restraining hands left her. She made a couple of other dashes and the same process returned her to her chair. The mother, daughter and foster parents were the group focus for the balance of the hour. The mother was probed relentlessly to determine where she was at.

 

Nothing, absolutely nothing, altered Fraser House routines. The Big Group meeting always lasted sixty minutes - exactly. The four key people in this case, sometimes separately, sometimes in different combinations attended the regular and special small groups that occurred throughout the day. They were again the focus of these groups. The maternal mother was not left alone with the daughter. All four participated in the evening Big Group. It emerged that at the time of committing the offences until she arrived in Big Group, the mother had had a delusional belief that all her children had a disease that would blind them. This delusional belief was unravelled and dispensed with. After everything that had happened that day, at the end of the evening Big, Small and special Group meetings there was consensus among everyone present, including the daughter and her foster parents, that the mother was now ‘safe’. She had had an absolutely sustained nourishing and corrective emotional experience throughout the day. Neville had plotted and planned for Fraser House to be at its healing best. The whole community had been in large part focused on this challenge for weeks.

 

The maternal mother and the daughter stayed together alone in a bedroom that night!

 

The following day a staff member wanted to know who the wonderful new nurturer was, and where was the new ‘murderess’. It was pointed out that the ‘nurturer’ and the ‘murderess’ was ‘one and the same person’. Neville describes having an overwhelming love for this mother during the whole hour of Big Group, during the balance of the day and thereafter.

 

 

The following case was synthesised from discussions with Neville (Dec, 1992 and July 1998). Bruen confirmed that this case is consistent with Neville’s way (Oct 1998).

 

 

Case Two - Jab the Wife

 

In the early Sixties Neville was called to a crisis in an upstairs dorm in Fraser House. Recall that the protocol was to never take unilateral action and get as many staff and patients as available involved as quickly as possible and practical. Neville was called on this occasion though the process was not based on calling the boss or based upon seniority. When Neville rushed in, an outpatient wife, who had no authority to be in Fraser House outside of big and small groups - especially not in the upstairs dorm - was pleading with her husband (a patient) with ‘caring concern’ to calm down. The husband was facing the corner stabbing the wall with a large knife (which he should not have had) yelling he was going to kill her (the wife). On either side of the husband were staff with knockout injections ready to jab him. The staff yelled to Neville, ‘Do we jab him’. Even in these dramatic contexts, consistent with protocols, staff sought confirmation from others for action, if possible. Neville sized up the situation in a flash and said, ‘Jab the wife!’ Neville was guided by the free energy in the system. The husband had his back to the wife. He was stabbing the wall, not the wife. She was, for Neville, the dysfunctional ‘driver’ of the husband’s behaviour. Neville intervened so that Neville became the ‘context driver’. The husband froze. The two staff were confused. Immediately Neville said ‘Jab the wife’, the wife turned into a rage and screamed obscenity at Neville revealing a side of herself that she had never revealed at Fraser House before.

So as not to have her provoke the husband to actually harm her, Neville immediately yelled again, ‘Jab the Wife!’ A staff member did jab the wife while the other one stayed ready to jab the husband. She collapsed unconscious immediately. The husband, who had not turned round, immediately put the knife down and started sobbing and stammering that she was goading him to sneak out of Fraser House and do house robberies.

He had arrived as a patient at Fraser House some weeks before from Long Bay Jail where he was a frequent inmate on robbery charges. On his last offence he had uncharacteristically harmed an elderly couple who surprised him during a robbery. It was this that was the reason for the authorities suggesting he be transferred to Fraser House for the last months of his term. It turned out that the demanding wife had been the catalyst for all his crime. Only the husband and wife knew this was the case. After being in Fraser House he wanted to break free of this cycle, though he loved his wife.

Neville described this man as ‘obsessed’ with his wife and ‘addicted to what was for him toxic’ (and could not tell anyone that she was the relentless driver of his criminality, and it was this double bind  - that he could not betray his wife and this was for him undiscussable - that Neville spotted when he entered the room. Till now, the patient had never found his voice to say anything about the wife. Neville spotted the metaphorical communication of stabbing the wall as meaning, ‘someone shut my wife up’. From this frame of meaning Neville could sense that stabbing the wall was functional in the context. It was this functionality as ‘free energy’ in the dysfunctional husband-wife relation that Neville supported. The wife’s response was to be for the first time honest in revealing her true nature – and this was also functional in the context – in confirming to Neville that his reading of the context was correct. In being honest she was tapping into her own ‘free energy’.

 

As the wife was signed on as an outpatient, Neville had every right to administer drugs to her. She slept and then slipped off sheepishly. The next day she fronted Big Group and one of the Small Groups and her dysfunctional behaviour was stopped.

 

All of what had happened in that upstairs dorm had happened extremely quickly. States can change very quickly. Learning can take place very quickly. Neville had acted in the upstairs dorm with high-speed precision. Neville reframed the context for each of the four in the upstairs dorm by yelling, ‘Jab the wife’. By saying these three words twice Neville created a context where major change occurred with ripple-on effects.

 

Neville’s response, ‘Jab the wife’ had a very different effect on each person present. It increased the arousal in the Wife, decreased the arousal in the husband and had the staffers go into curious confusion, typically an ideal learning state. Neville, in repeating the command, ‘Jab the Wife’ interrupted the staff members’ state and got action, reinforced the husband’s less aroused state, and removed the wife from the context. Once the wife had revealed her true role, Neville had to ensure that she was ‘removed’ quickly in case the husband did turn and hurt her given that the undiscussable had now been revealed. With her removed and her role in his criminality out in the open he immediately found his voice.

 

Neville could affect everyone differently and appropriately because he continually attended to the unfolding context as an inter-dependent, inter-related, interconnected living system. Neville looked for the free energy. A typical mainstream system response would have been to see the husband as ‘the problem’ and that this ‘problem’ had to be ‘eliminated’ (rather than resolved). The husband would have been jabbed as a matter of course, the wife would have been sent home and nothing in the husband-wife dynamic would have changed. The husband would have been put in the ‘difficult case’ basket while the wife as ‘unknown source of dysfunction’ would have sustained his dis-integration.

 

 

Appendix 16. Research on Patient Participation and Improvement

 

 

 

One example of involving Fraser House residents in research focused on patient participation and improvement. This was a consensual technique that involved patients rating patient participation and improvement. Patients were asked to nominate which patients were the ‘most’ and ‘least’ in various categories for questions like those below (Yeomans, N. 1965a, Vol. 12, p. 69):

 

·         Who are most involved in therapy sessions?

·         Who are least involved in therapy sessions?

·         Who think that being in the Unit is least worthwhile for them?

·         Who think that being in the Unit is most worthwhile for them?

·         Who get on well most with staff?

·         Who get on well least with staff?

·         Who join in least on social and recreational activities?

·         Who join in most on social and recreational activities?


 

Appendix 17. A List of the Questions That Were Asked in Neville’s Values Research.

 

 

 

The following questions were asked in Neville’s values research (Yeomans, 1965a, Vol. 7):

 

·         The nature of the universe

      (In the range ‘is basically good or makes sense’ through to ‘is

      basically bad or pointless’)

·         Human nature

      (In the range ‘good or sensible’ through to ‘bad or senseless’)

·         Can mankind change itself or be changed?

      (Yes, Perhaps or No)

·         Man-nature - what matters

·         Activity – Who do you take notice of

·         Direction –

 (Self, Others, What fits)

·         Degree –

Unimportant, moderate importance, important

·         Time important 

(Future, present, past)

·         Verticality place

(Above, level, below)

·         Horizontality place

(Centre, between edges, out one edge)


 

Appendix 18. Research Questionnaires and Inventories - Neville Yeomans Collected Papers

 

 

 

Reference - Neville Yeomans Collected Papers 1965a, Vol. 11.

 

 

A list of the many of the surveys and questionnaires that patients and outpatients were asked to complete. The page reference relates to Volume 11 of Neville Yeomans Collected Papers in the Mitchell Library –NSW State Library, NSW.

 

 

p. 175      

p. 183      

p. 193      

p. 197      

p. 207      

p. 213      

p. 221      

p. 237      

p. 245      

p. 251      

p. 265      

p. 271      

p. 271      

p. 277     

p. 283      

p. 291     

p. 317      

p. 331      

p. 329

      p. 337

      p. 355

     

      p. 366

      p. 365

      p. 367

     

      p. 399

      p. 399

           

 

Emergency Services Survey

Research Study Group Student Opinion Record

Course Assessment Record

Counsellor Opinion Record

Social Organization Study

Child Parent Group Reporting

Total Care Adjustment Record

Group Reporting Record

Landscape Planning Attitudes Questionnaire

Attitudes Towards Overseas Trade

Crime Attitudes

International Studies on Drug Dependence

Alcohol Attitudes Questionnaire

Personnel Study – Social Problems Record

Group Description Record

Follow-up Questionnaire

International Study on Family Planning

Attitudes Questionnaire

International Study on Handicapped Children

Patient and Family Questionnaire

Fraser House Opinion Survey – Psychiatric Research   Study Group

      Elderly Peoples Attitudes Questionnaire

Attitudes to Mental Illness

      Opinion Leaders Inventory – Fraser House

        Questionnaire

      Opinion Leader Record

     Migrant Attitudes Questionnaire

 

 

 

 

 


Appendix 19. Further Inventories Developed and Used at Fraser House

 

 

Reference - (Yeomans, N. 1965a, Vol. 4 , p. 43)

 

 

 

Personal Adjustment Record

Social Health Record

General Adjustment Record

Child Adjustment Record

Family Adjustment Record

Group Reporting Record

Follow-up Record

Social Problem Record

Social Value Record

Opinion Leader Form

 

 


 

Appendix 20. A Partial List of Research by Dr. Neville Yeomans And Other Research with Colleagues During the Years 1959-1965

 

 

 

This Appendix contains Tables 2, 3 and 4 listing fifty-seven of the extensive body of Neville’s research papers and monographs mentioned in his collected papers in the Mitchell Library. Many are undated though come from the 1959-1965 period. Table 4 lists Neville’s research in association with others.

 

 

 

The Unit Career of Staff Members (Yeomans, N. 1965g, Vol. 2, p. 38 - 40)

 

Whisperer’s Relationship - a Collusive Liaison (Yeomans, N. 1965~, Vol 5 p.38)

 

A General Theory of Welfare Functions (Yeomans, N. 1965g, Vol . 2, p. 38 - 40)

 

File Note - Reference to a Suicide in Fraser House (Yeomans, N. 1965e, Vol. 2, p. 43.) 

 

Network Therapy (Yeomans, N. 1965l, Vol. 5, p.40)

 

Abotat - A Modification of the Thematic Apperception Test for Administration to Aborigines (Yeomans, N. 1965a, Vol. 5, p.52 - 54)

 

The Problem of Taking Sides – Taking the Side of or Supporting the Healthy Component (Yeomans, N. 1965u)

 

Power in Collective Therapy (Yeomans, N. 1965s, Vol. 5, p.52 - 54)

 

Sydney Therapeutic Club (Yeomans, N. 1965{, Vol. 5, p.104)

 

Follow-Up Committee (Yeomans, N. 1965f, Vol. 5, p.106)

Personal Adjustment Record (Yeomans, N. 1965o)

 

Personal Information Record (Yeomans, N. 1965p)

 

Early 1960’s Social Values (Yeomans, N. 1965y)

 

The Psychiatrist’s Responsibility for the Criminal, the Delinquent, the Psychopath and the Alcoholic (Yeomans, N. 1965v, Vol. 12, p. 50)

 

Research on Alcoholism – Theory and Administration – A Paper for the National Committee on Alcoholism – Adelaide Meeting of Medical Sub-Committee (Yeomans, N. 1965w, Vol. 1, p.183 - 185)

 

Collective Therapy – Audience and Crowd. Australian Journal of Social Issues 2. & 4. (Yeomans 1966,Vol. 1, p,187-188, Vol.12, p. 77, 87)

 

The Role of Director of Community Mental Health (Yeomans, N. 1965x, Vol. 12, p. 66)

 

Culture, Personality and Drug Dependence - The Problem of Drug Abuse in NSW. The Institute of Criminology, Sydney University Law School.  Seminar Working Paper No. 3 (Yeomans, N. 1965d) 

 

Social Categories in a Therapeutic Community (Clark and Yeomans 1965)

 

Mental Health in the Office - Institute of Administration - University of NSW (Yeomans, N., Vol.1 p.203-213)

 

The Sociology of Medicine 1967 - Synopsis of Community Health Services and Informal Patterns of Care (Yeomans 1967b, Vol. 1 p. 215)

 

Incontinence Research (Yeomans 1965a, Vol. 12, p. 67-69)

 

The Nurses Self Image and its Implications - The Australian Nurses Journal Vol. 61 No. 4., April 1963 (Yeomans, N. 1965m, Vol. 12, p. 94)

Table 1 Neville’s Research Papers and Monographs

 

 

The following Table 3 lists further research and papers by Neville in the 1960’s.

 

1961. Treatment of Alcoholics and Drug Addicts in Fraser House Neurosis and Alcohol Unit (Yeomans 1961c,  Vol. 2, p. 45)

 

1963. Sociotherapeutic Attitudes to Institutions - Paper Presented at the State Psychiatric Services Clinicians’ Conference - 22 April 1963 (Yeomans, N. 1965z, Vol. 12, p. 46, 60-61 )

 

1963. Letter of Congratulations to Fraser House Patients Regarding Patient’s Rules for Committees – Jan 1963 (Yeomans 1963a)