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
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,
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
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,
During
the period from 1959 to 1972, he ran "healing community" courses for
Aboriginal and Islander peoples in
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
Not
content with his already numerous qualifications he went on to complete a
Bachelor of Law degree from the
Neville
Yeomans was drawn more and more to the area he grew up in and in 1975 he moved
back to north
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
In
1987 he was a consultant to Petford Aboriginal Training Farm in far
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
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 Jail
Groups |
Group
Work |
Fraser
House Groups Human
Relations Groups |
Bondi
Junction groups Petford
Groups 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 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 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 Tapped
me into Laceweb sharings in Qld. and Darwin Top
End; Balmain Work-shops; other Engaging
me in family therapy contexts |
Festivals |
Watsons
Bay; Centennial Park; Paddington; ConFest; Cambelltown; Aquarius at Nimbin;
Cooktown |
ConFest;
Aboriginal & Islander Therapeutic Community Gathering; Australian
South Sea Islander gatherings |
Community
Markets |
Paddington;
Yungaburra Rapid
Creek |
Paddington;
Yungaburra; Rapid Creek; |
Intercultural |
Asia
Club; |
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; Interfacing
between UNICEF E-Asia Regional Office & Psychnet; Dialogue
with PNG & East |
Interfacing with business |
|
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 Psychnet
Networking; other E. Asia and Oceania networking, especially Tagaytay |
Local
Governance |
Fraser
House; Small Therapeutic Community Houses; |
|
Micro
Gatherings/events |
Fraser
House Blackmountain Yungaburra |
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 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 Book
‘
FORWARD
A major change in values and
in behaviour is beginning to occur in
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.
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
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
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
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
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
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.
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.
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
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).
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
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)
1963. Some Detail of
Patient Government - 13 May 1963 (Yeomans 1963b)
1964. An Alcohol
Treatment Program in Australia – A Paper Presented at the 27th
International Congress on Alcohol and Alcoholism – 11 Sept 1964 (Yeomans 1964, Vol. 1, p.91)
1965. Post Graduate
Psychiatry and the Social Sciences. In Kiloh, L.C.
& Andrews, J.G. (eds.). Undergraduate and Post Graduate Teaching in
Psychiatry. University of NSW Press Sydney (Yeomans, N. 1965q, Vol 12. p.
77)