This is the first of five chapters on Fraser House researching the questions, ‘What change processes, innovations and social action evolved in and from Fraser House? How do these differ from other psychiatric therapeutic communities? What were the outcomes and effects of Fraser House?
This chapter gives an overview of Fraser House’s milieu and Neville’s processes for evolving it as a micro-model in exploring epochal transition. Neville’s assuming a social basis of mental illness is discussed along with his emphasis on and strategic use of locality, layout, and mix of patients. Chapter Seven discusses the Fraser House Re-socializing Program entailing patient self-governance. Chapter Eight discusses Fraser House Big Meeting of all staff, patients, outpatients and guests, as well as Neville’s group processes. Chapter Nine looks at the change processes evolved at Fraser House, and Neville’s evolving of Cultural Keyline from Keyline is analysed. Chapter Ten looks critically at Fraser House, and details ethical and other issues in replicating Fraser House. Neville’s actions in closing down Fraser House are outlined and the implications of locality and networks within Fraser House are discussed.
Neville set out to evolve a very rich inferential social place (Pinkard 1995, p. 115) at Fraser House approximating the richness of the family’s farms. Neville planned to gather marginalized dysfunctional people to his social place where they could sort out and re-constitute their own inferences together. Neville understood the potential of dysfunctional societal processes external to self, evoking mindbody disintegration and dysfunctional networks. Neville created a social place, space and climate whereby dysfunctional people could be energized to re-constitute themselves towards wellbeing, and to let go of dysfunctional tensions and contradictions permeating through them from prior struggles in socially toxic places.
Neville planned to take in people fractured by living in dysfunctional social contexts and places in society, whom society’s response was in Neville’s view (Dec 1993, July 1998) to place in even more dysfunctional anti-social contexts and places - asylum back wards and prisons. In contrast to these total institutions (Goffman 1961), Neville wanted to create a social space where people and their family and friends could ‘genuinely find themselves at home in it’, and be able to constitute their own inferential functional space of their own mutual making, and to reconstitute their social networks towards functionality, and take these functional networks out and create their own functional social spaces back in wider society. How Fraser House differed from other total institutions is detailed in Appendix 3).
During the years 1956
to 1959 Neville began laying the groundwork to set up Fraser House. The
commencing focus-of-action was to be a very innovative and iconoclastic
therapeutic community based psychiatric unit. Neville set up the unit as Fraser
House in 1959 within
That the Unit would engage in prolonged continual action research into epochal transition through re-constituting both people and people-in-community as they were evolving together shared everyday realities that fostered wellbeing.
Neville followed through on this intention - later describing Fraser House as, ‘the most significant psycho-social research institute in this State’ (Yeomans, N. 1965a, Vol. 4, p. 24).
Neville was familiar with Marx’s sociological writings about the interplay between concurrently re-constituting people and society – that societies are socially constituted realities, and that these realities concurrently fold back, as it were, to constitute people as varied constitutions of these realities. Comminel (1987, p.135) quotes Marx (1844) who wrote:
Thus the social character is the general character of the whole movement: just as society itself produces man as man, so is society produced by him.
Marx writes immediately after the above quote of the interplay of activity, enjoyment and nature:
Activity and enjoyment, both in their content and their mode of existence, are social: social activity and social enjoyment. The human aspect of nature exists only for social man: for only then does nature exist for him as a bond with man… Thus society is the complete unity of man with nature – the true resurrection of nature – the accomplished naturalism of man and the accomplished humanism of nature.
Neville was extending natural thrival processes in nature to exploring human nature emerging from communal bonding: the above interplay of action and enjoyment discussed by Marx.
Neville included the following diagram in his 1971 paper, ‘Mental Health and Social Change’ (1971c; 1971b) in succinctly specifying his view of epochal transition process.
Diagram 1. Neville’s Diagram
In describing the form of the shift Neville wrote:
The take off point for the next cultural synthesis, (point D1 in the above diagram) typically occurs in a marginal culture (1971, p. 1).
In my understanding in Cultural Keyline terms, Neville timed and positioned Fraser House at D1. In ‘Keyline form’, Fraser House was just below the steep fall off the main ridge (mainstream asylums in crisis) at a Keypoint in a ‘primary valley‘ on the margins of the decline of the old cultural synthesis and the first beginnings of a new cultural synthesis.
Diagram 2 Neville’s Diagram recast in Keyline terms
Neville chose to populate the Fraser House
enclave from the ‘marginal culture’ of the mad and bad from the dysfunctional
fringe of the old cultural synthesis in
It develops a relatively anarchical value orientation system (1971b, p. 1).
This aptly describes Fraser House; values oriented the unit. While the values were deemed anarchy by some in the health hierarchy, this was relative to their top down control of the disempowered. Neville evolved a patient self governance based value system energising patient empowerment. Neville then writes in his ‘Mental Health’ paper about the old cultural synthesis in decline becoming dedifferentiated (uniform and undifferentiated) with little innovation:
Its social institutions dedifferentiate and power slips away from them. This power moves into lower level, newer, smaller and more radical systems within the society. Uncertainty increases and with it rumour (1971b, p. 1).
Neville spoke (Dec 1993) of Fraser House being placed as one of the ‘lower level, newer, smaller and more radical systems within the society’ that he wrote about in his ‘Mental Health’ paper (1971c; 1971b). Also referencing the same paper,Neville ensured that ‘uncertainty and with it rumour’ abounded about how Fraser House mismatched the psychiatry of the old cultural synthesis. Another quote from Neville’s ‘Mental Health’ paper (1971c; 1971b):
Also an epidemic of experimental organizations develop. Many die away but those most functionally attuned to future trends survive and grow (1971b, p. 1).
Fraser House was just such an ‘experimental organization’. In terms of the old cultural system, these ‘experimental organisations’ are like an epidemic – spreading viral like; the Sixties and Seventies saw the emergence of all manner of interest in alternative living. Neville was constantly engaged in action research into how well Fraser House was ‘functionally attuned to future trends’ so it could ‘survive and grow.’
To protect Fraser House from attack, very few people knew of Neville’s epochal-transition agenda. This agenda and Neville’s adapting of Keyline and Indigenous way were never mentioned in any of Neville’s writings of the period. The only people I interviewed who knew of this agenda were Ken and Stephanie Yeomans, and his Fraser House personal assistant Margaret Cockett. Neville did have the support of people at the top of the Health Department who, I understand, also did not know of Neville’s wider agenda. It was commonly known that Fraser House would be an experimental unit and a therapeutic community. Initially only Neville knew how iconoclastic he intended it to become.
Neville had completed degrees in zoology, medicine and further studies to become a psychiatrist in the mid Fifties. In 1956, three years prior to setting up Fraser House, Neville initiated the first group psychotherapy program for schizophrenics in Gladesville Hospital (Yeomans, N. 1965a, Vol .12, p. 66 - 69). Similar to the mood change in psychiatry in England after the Second World War (discussed in Chapter Three), Neville recognized that, with considerable upheaval and questioning in the area of mental health in New South Wales, and a Royal Commission being mooted into past practices - there was a small window of opportunity for innovation in the mental health area. The New South Wales Health Department built the Fraser House residential unit especially for Neville. Neville was aged thirty-one when he obtained the go-ahead from the New South Wales Health Department to take in patients at Fraser House.
Photo 1 Neville and nurse at Fraser House in 1960 (Yeomans 1965a).
Fraser House was located in the grounds of
Fraser House was a set of buildings over a quarter of a kilometre long. The buildings were set in a long wiggly pattern along the contour line – refer Diagram 8 below.
From my reckoning, the building is along a Keyline, and Neville’s office was at the Keypoint. (I had already noted this when in 2001 Jack Wells, who is familiar with Keyline and worked at Fraser House in the early 1970's after Neville had left, also spotted the Keyline connection in the Unit's layout and told me about this. I met Wells through a conference festival that Neville helped evolve called ConFest - discussed in Chapter Eleven.
Photo 2 Jack Wells at ConFest – From DTE Archives
The buildings were linked by enclosed walkways. While Fraser House was specially built for Neville, he had no say in aspects of the design layout. The Health Department ‘system’ required complete separation of males and females in different wards. A single story administration building was in the middle. At one end of the central administration section was a meeting room (approximately eight metres by sixteen metres) where the big meetings were held.
Photo 3 A photo I took in June 1999 of Fraser House through the trees along Keyline
The diagram below shows
At either end of the administration block there was a double story 39 bed ward, and there was a dining room at each end. There was a separate staff office in each ward. Most rooms were 4 bed dormitories. There were a few single rooms in each ward.
In Fraser House, the State system’s intention to have a division of sexes in separated wards would have been ‘shattering’ any chance of what Neville called ‘total community’, ‘transitional community’ and ‘balanced community’. Neville viewed the original planned (by the system) use of space as ‘schizoid’ - completely divisive, split - creating ‘them and us’ and ‘no go’ areas for both patients and staff. Neville saw this separation of the sexes (with administration as a ‘wall’ between them) as isomorphic with dysfunctional community. Warwick Bruen was a psychologist at Fraser House in the early 1960’s. In a 1998 interview, Bruen described the initial separation of sexes into different wards required by the health department as, ‘an extension of the medical infection model’.
Diagram 3. Map of
The female ward opened in October 1960. Neville rearranged room allocation so there were no separate wards for males and females, although bedrooms remained same sex. This required some negotiating between Neville and the male staff and unions as there was resistance to this change.
Photo 4 Photo I took in June 1999 of one wing of the Fraser House Dorms
After the Unit was running for a time, eight downstairs rooms were set aside for families-in-residence. The eight cots were also in these rooms. School-age child patients at Fraser House attended local schools.
Neville arranged for
the dining room at one end to be used by all patients. The other dining room
was turned into a TV, games and recreation room. This created the necessity for
patients and staff alike to walk more than quarter of a kilometre wending
through each building and along covered walkways between buildings to go to
these popular places. The dining room, the lounge room and the long corridor
between them were all public spaces conducive to meeting and talking. Fraser
House was a replication of the community space of the
Neville evolved Fraser House assuming a social basis of mental illness. This has links to the important role social cohesion plays in preventing mind-body-spirit sickness in Australian Aboriginal culture (Cawte 1974; Cawte 2001).
Regardless of conventional diagnosis, in Fraser House it was assumed that dysfunctional patients would have a dysfunctional inter-personal family friendship network. This networked dysfunctionality was the focus of change.
Consistent with this, the Fraser House treatment was sociologically oriented. It was based upon a social model of mental dis-ease and a social model of change to ease and wellbeing. Neville said (July 1998) that he and all involved in Fraser House worked with the notion that the patients’ life difficulties were in the main, from ‘cracks’ in society, not them. Neville took this social basis of mental illness not out of an ignorance of diagnosis. Neville was a government advisor on psychiatric diagnosis as a member of the Committee of Classification of Psychiatric Patterns of the National Health and Medical Research Council of Australia.
Neville was familiar with twin sociological notions that people are social products and at the same time people together constitute their social reality (Marx 1844; Berger and Luckmann 1967). Neville said (June 1998), that he took as a starting framework that people’s internal and external experience, along with their interpersonal linking with family, friends, and wider society, are all interconnected and interdependent. Given this, Neville held to the view that pathological aspects of society and community, and dysfunctional social networks give rise to criminality and mental dis-ease in the individual. As well, his view was that ‘mad’ and ‘bad’ behaviours emerge from dysfunctionality in family and friendship networks. This was compounded by people feeling like they did not belong - being displaced from place (dislocated). Problematic behaviours may be experienced as feeling bad or feeling mad, or feeling mad and bad.
While Neville recognized massively interconnected causal process were at work, he also recognized and emphasized this macro to micro direction of complex interwoven causal processes within the psychosocial dimension. Working with the above framework, Neville set out to use a Keyline principle, ‘do the opposite’ to interrupt and reverse dysfunctional psychosocial and psychobiological processes (biopsychosocial). That is, he would design social and community processes that would inevitably lead to Fraser House Residents re-constituting their lives towards living well together.
Neville told me (Sept, 1998) a number of times that the aim and outcome of Fraser House therapeutic processes was ‘balancing emotional expression’ towards being a ‘balanced friendly person’ who could easy live firstly, within the Fraser House community, and then in their new, expanded, and functional network in the wider community. The Fraser House process didn’t require or need ‘intellectual’ therapy. Neville’s view (Dec, 1993, June-August, 1998) was that the intellect is the ‘servant of emotions’ and ‘servant of reproductive and survival instincts’. Neville said (Sept, 1998) that many Fraser House patients returned to functionality with little by way of insight about what had happened to them. Neville said (Dec, 1993) that what they were researching at the Unit was whether sharing everyday Fraser House milieu would lead to emotional corrective experience and a move to functional living in the wider society.
Neville wanted to create a special place where people could evolve their own way of life (their own culture) together; where they could evolve themselves as they evolved their shared reality. While all manner of things were awry with patients – cognitively, mentally, physically, emotionally, and socially – within the Fraser house milieu, all structure and process framed and actuated the ‘community’ as the inevitable central transforming process in the therapeutic community, regardless of a patient’s presenting condition and conventional diagnosis.
Resonant with Tikopia, Neville created opportunities for
Fraser House residents to respect and celebrate their diversity in creating
social unity and cohesion as the Fraser House Community. While Fraser House was
located in the grounds of the
Neville created Tönnies'
small village community (Tönnies and Loomis 1963). Like in Tikopia, with all of the constant
social exchange, any strife soon became common knowledge and following the
Fraser House slogan ‘no madness and badness here’, typically, it was
interrupted before it could start. Patients had little or no such spaces and
places outside of Fraser House that allowed for, and fostered people engaging
in conversing and community building with friends, relatives and strangers. The
shared community life in Fraser House ‘public space’ meant that people
continually talked to and about each other, and hence, like on Tikopia, social
news was continually circulating. In Fraser House, this circulating of social
news was encouraged by the slogan, ‘bring it up in a group’. At certain times
of each day there was a mingling flow of females and males from one end of
Fraser House to the other along a winding long passageway that mirrored the
mountain trails between both sides of
All involved in Fraser House experienced inter-related cohesive factors of everyday operation, the use of a common understanding and experience of Fraser house routines and shared values, and the sharing of a common culture; the sharing of Community (with a capital ‘C’); to paraphrase Firth - all that is implied by all involved in the Unit when they would speak of themselves as ‘being at Fraser House’, just as the Tikopians said ‘tatou na Tikopia,’ ‘We the Tikopia’ (Firth 1957).
Within Fraser House, simple and profound changes occurred in people’s lives during, and as a function of mundane everyday life contexts – as people went about sharing food, getting dressed, engaging in idle chats and the like. Neville called this, ‘Everyday Life Milieu Therapy’ (Dec, 1993; July, 1994; Aug, 1998). For this, Neville drew upon his understandings and personal experiencing of Indigenous socio-healing, as well as from his reading the work of, and conversations with his colleague, psychiatrist Dr. John Cawte about Australian Aboriginal Sociomedicine (Cawte 1974; Cawte 2001).
Neville said (Dec, 1993; July, 1998) that a central component of Fraser House change was the freeing up of the emotional and gut feelings of all involved - while sharing in community as they went about mundane aspects of everyday life. While drawing on the above ways, Neville also applied from Taoism (June 1999) the idea that for all at Fraser house, healing came from ‘letting life act through them’ as they went about their shared life together in the daily routines of getting up, getting dressed, showering, and the like. Within Fraser House and the subsequent small therapeutic houses that Neville established, a change component was this persistent sorting out of how mad and bad people could live well with each other.
The Unit’s evolving common stock of practical wisdom about what works was so readily passed on, that this wisdom was widely held in the Fraser House community. Patients, outpatients and staff who had been in Fraser House for a time knew ‘what worked’ in different contexts. Social exchange that ‘worked’ constituted an integral part of the patients, outpatients and staff’s evolving good life together. Typically, it was trivial ‘everyday stuff’ about how to live well together.
By Neville’s modelling and by osmosis all aspects of Fraser House’s social forces naturally constituted interdependent, inter-related, interwoven, inter-connected, and interlinked experience and action. While I can write about this, to fully sense Fraser House we would have had to have been there; words are not up to the task – as I mentioned in my methods chapter, it’s like attempting to convey with words the lived experience of listening to Bach’s Mass in B Minor.
Neville (Dec, 1993) used the word ‘culture’ as meaning ‘way of life together’. Neville recognized that linking people together, and simultaneously linking them to a specific place, has potency. Zuzanka Kutena introduced me to the term ‘Cultural Locality’ in connexion with Indigenous sensitivities, wisdom and way (2002). ‘Locality’ is used as meaning ‘connexion to place’. ‘Cultural locality’ then means, ‘a way of life together connected to place’. Zuzanka - upon hearing about everything at Fraser House being densely interconnected, inter-related and interdependent - used the term ‘livingness’, as in ‘the whole of it’ (2002). In the same context, when Margaret Mead visited Fraser House (discussed in Chapter Nine) she used the term ‘total’ to convey the same thing.
In Fraser House, all patients and outpatients were involved in self governance as an aspect of constituting a way of life together connected to place. While Neville used the term ‘locality’ to mean ‘connexion to place’, I cannot recall him using the expression ‘cultural locality’, although I sense he would have had resonance with this expression. All people involved in the Unit belonged to, and were together evolving and embodying the Fraser House cultural locality.
By arranging for all in Fraser House (all staff and patients) to attend Big Group meetings, Neville was creating concentrated cultural locality. The vibrant cultural locality of Fraser House was vastly different to the dis-placed, anomic, dis-located norm-less, alienated, unconnected, meaning-less, overwhelming, aggravating, isolated lives they had been leading.
Neville set up Fraser House to be a micro-model of a
dysfunctional world and more specifically, a micro-model of the alienated
dysfunctional fringe of a dysfunctional world. This was the major first step in
Neville’s exploring epochal transition. This was where Neville felt it was the best
possible place to start – at the dysfunctional fringe. What’s more, it was
Neville’s view that together, this fringe has massive inherent potential to
thrive. This was isomorphic with nature’s tenacity to thrive at the margins -
what the Yeoman’s were exploring on their farms. Neville’s aim was to work with
and tap this potency, just as he and his father worked with the emergent
potential of their farmland. Neville’s relation to the land and to the
alienated dysfunctional fringe that he brought into Fraser House was one of
love, care, respect and awe at their potential. To approximate this alienated
fringe, Neville arranged to populate Fraser House with a balanced group of
‘mad’ and ‘bad’ people – his terms (Dec 1993, June 1998). Neville was not just
setting himself a big challenge in starting with the mad and bad of
Fraser House accepted long-term chronic mental patients and other severely mentally ill people balanced with an equal number of criminals, alcoholics, delinquents, addicts, and according to the sexual mores of the Sixties, homosexuals, prostitutes and other sexual deviants (Yeomans 1961a; Yeomans 1961b; Clark and Yeomans 1969). There was a spread across the various diagnostic categories. The intake aim was to have a spread of categories present in the Unit. Appendix 5 shows the various categories of patients in Fraser House as at 30 June 1962. Note that there were an equal number of males and females. This was typical.
From the outset Neville negotiated with the Office of Corrections for Fraser House to take twenty male and twenty female prisoners released from prison on license to Fraser House at any one time. People were transferred straight from jail to Fraser House and signed on as voluntary patients. None of the wards at Fraser House were locked. Few absconded. If they did, they knew that Neville would send the police after them. Upon their return to Fraser House they would face the possibility of not being able to stay and therefore the aversive possibility of being transferred to another hospital, or for ex-prisoners, being transferred back to jail with further charges against them. The prisoners selected to go to Fraser House typically had considerable psychosocial dysfunction that had been in no way addressed by incarceration. They were typically in the last months of their prison term.
Fraser House patients were adults, teenagers and children of both sexes, mainly from middle and working-class backgrounds. Typically, around two thirds of Fraser House patients were referred from public agencies, especially state psychiatric services; other institutional referrals came from courts, probation and parole services, and the narcotics and vice squads. Some admitted were referred by private individuals, doctors, patients and staff (Clark 1969, p.58-59). Some staff admitted themselves as voluntary patients.
Neville was reported as saying that he believed that
Fraser House was the only clinic in the World where alcoholics and neurotics
mingle 50% and 50% (Sunday Telegraph Newspaper 1960). The Unit was referred to as the Alcoholics
and Neurotics Unit. The male Unit had both single and married men. Married men
who were alcoholics could have their wives stay with them regardless of whether
the wife was an alcoholic or not. The couple was the focus of change. This was
the start of eight family suites. Whole families with two and three
generations, from babes in arms to the elderly were involved in the suites.
Neville pioneered family therapy and inter-generational therapy in
In 1961, referrals were accepted from patients, and family and friends were admitted. In 1963 whole families were admitted. Desegregation of family units and single patients occurred in 1964 (Yeomans, N. 1965a, Vol. 4, p. 2 - 4).
In keeping with Neville’s interest, one of the early things he did was to invite Mental Hospitals throughout NSW to send to Fraser House any Australian Aboriginal and Torres Strait Islander patients that they had incarcerated (Yeomans, N. 1965a). The 9 April 1962 Daily Mirror newspaper ran an article with the heading, ‘NSW Lifts the Aboriginal Status - Freedom in Ryde Clinic’ (1962) wherein Neville is quoted as saying, ‘We have a plan to transfer to the Centre over a period of time all fifty Aborigines who are now patients in NSW mental hospitals.’ Around fifty Australian Aboriginal and Torres Strait Islander patients were sent to Fraser House, emptying all the other Mental Hospitals of patients with these backgrounds.
Apart from a few that needed full time care because of associated medical conditions, all of these Aboriginal and Islander people passed through Fraser House and were returned to their respective communities. Both Bruen and Chilmaid, as well as media reports (Yeomans, N. 1965a) confirmed that these patients blended into and participated in every aspect of the Fraser House healing milieu. The 9 April 1962 Daily Mirror article mentioned above quotes Neville as saying:
Aborigines mix freely with white patients in a special unit at the North Ryde Psychiatric Clinic. It is the first time in NSW that Aborigines have been accepted with equality in a psychiatric unit. They share the same wards and have the same privileges as white patients.
One Aboriginal patient at a mental hospital for 20 years had been completely rehabilitated after a few months at the Centre (ed. Fraser House). He is now at home with his family’ (Daily Mirror 1962).
Margaret Cockett, Neville’s personal assistant would continually ask around the prison/court system for any Aboriginal and Islander people who could be transferred to Fraser House. Typically, the people involved in the prisons were pleased to let Aboriginal and Islander people transfer.
A Case Study of the outcome of a back ward micro-encephalic Aboriginal person transferred to Fraser House is included as Appendix 6.
The focus of change at Fraser House for both the mad and the bad was ‘the patient in their family-friendship-workmate network’. Patients typically arrived at Fraser House being part of a small (2-6 people) dysfunctional family/friendship/workmate network. Neville said that the assumption and the experience of Fraser House people were that the individual patient was fundamentally a part of this dysfunctional social context.
In keeping with this, another condition of entry was that members of the prospective patient’s family friend workmate network were required to first sign in as outpatients and attend Big and Small Groups with the prospective patient on a regular basis for twelve visits. This rule ensured that prospective patients and their families and friends knew that regular attendance by them all was a requirement. Additionally, this rule had the effect of having people absorbed into the Fraser House community before becoming residents or outpatients - with all the advantages flowing from this close fit. Attendance of a patient’s family, friends and workmates as outpatients at the Unit’s Big Group and Small Groups was called Family-Friends-Workmate Therapy.
In Neville’s paper, ‘The Psychiatrist’s Responsibility for the Criminal, the Delinquent, the Psychopath and the Alcoholic’ (1965a, Vol. 12, p. 50) he wrote:
The community is allowed easiest into the hospital which treats the whole family and friendship group of the patient.
According to all of my interviewees, including a former patient and outpatient, the Fraser House experience was that:
1. Among patient’s networks, inter-generational dysfunction was common.
2. That people within ‘pathological families’ were often being rewarded for deviance.
3. Patient pathology was inter-related, inter-connected and inter-woven with the pathology of the social (family/friendship) network in which the patient was enmeshed.
4. People’s behaviours in these dysfunctional networks were typically transformed to functionality by their involvement in Fraser House.
The focus of change being the patients and their family-friends-workmates as outpatients made sense from the Fraser House experience.
This focus on the patient’s network was called ‘Family-Friends’ Therapy, ‘Primary-Group’ Therapy and ‘Household’ Therapy. Given that the patient and his family-friend-workmate network was the focus of change, Primary-Group Therapy was fundamental.
According to Chilmaid (Aug, 1999) there was not so much a ‘treatment program’, more that everyone knew who had what problems and ‘treatment’ tended to be context driven and informal rather than formal and planned. Notwithstanding this frame, both the Admissions Committee and the Progress Committee (made up of patients – refer Chapter Seven) did identify the ‘big’ and ‘small’ things that needed resolving and these were made known to the community-as-therapist.
In Neville’s paper, ‘Sociotherapeutic Attitudes to Institutions’, and consistent with creating ‘cultural locality’, he wrote that mental health professionals:
…must aim at allowing the outside culture into the institution (Yeomans, N. 1965a, Vol. 12, p. 46, 60-61).
One of Neville’s monograph’s reports that, ‘relatives routinely attended groups in 1961; it also mentioned that relatives friends and workmates attended the Unit (1965a, Vol. 4, p. 2 - 4).
Resonant with Tikopia and as part of Fraser House’s unity through diversity, Neville arranged for Fraser House to be a ‘balanced community’. Neville endeavoured to have equal numbers in each of a number of categories consistent with evolving a complex balanced, though diverse social system. Neville sought and obtained balance within the Unit population on the following characteristics:
· inpatients and outpatients
· mad and bad
· males and females
· married and single
· young and old
· under-active and over-active
· under-anxious and over-anxious
· under-controlled and over-controlled
Neville in his paper ‘Socio-therapeutic Attitudes to Institutions’ refers to the potency of community process in the ‘balanced community’ he had created. He speaks of a special kind of community as a therapeutic technique, where:
…. therapeutic techniques must aim at giving patients autonomy and responsibilities, and to encourage contrast with (the wider) community, the ‘balanced community’ aims for a mixture of patient types so that the strain is towards normality rather than the strain toward the mode of abnormal behaviour of a particular section of the institution (1965a, Vol. 12, p. 49).
The above quote is another example of the way transformative change was designed and structured into the Fraser House process. Mirroring Neville’s farm experience, the emergent properties of social and community forces were recognized and harnessed.
In his monograph, ‘Social Categories in a Therapeutic Community’ (1965a, Vol. 2, p. 1) Neville describes a number of processes used to allocate beds : age grading, marital status and social categories. Room allocation was never based on diagnosis; people would have been mirroring and modelling each other. While there were same sex dorms (except in the family units) Neville ensured that the opposites (resonant with Tikopia) were placed together in dorms, therapy groups, activities and patient-based committee work. An example of structured use of cleavage/unity processes in Fraser House was allocating bedrooms such that two under-controlled hyper-actives (e.g. sociopaths) were placed in with two over-controlled under-actives (e.g. neurotic depressives). This became the main basis for room allocation.
Many interweaving processes, to be discussed later, ensured patient safety. Having opposites sharing the same dorm was based on the principle that the presence of opposites creates a metaphorical normal position in the middle. Neville said (Dec 1993, Sept 1998) that Fraser house research showed that there was a tendency towards the mean, with the under-controlled becoming more controlled, and less active; the over-controlled becoming less controlled and more active.
Recognizing the inter-generational nature of dysfunction, Fraser house had three generations of some families staying in the family units or attending as outpatients.
There were three types of inpatient categories – firstly, inpatients who attended each day from 9 AM to 9 PM; secondly, residential inpatients who went out to work full-time or part-time; and thirdly, full-time residential inpatients.
For all of the unifying talk within Fraser House of, ‘we are all co-therapists’ - staff and patients alike - when a member of staff required treatment it was given in groups containing only staff members, or the treatment was given separately from the day-to-day functioning of the unit, or the staff member gave up the staff position and signed in as a patient. Some staff did do this.
While many of Fraser House patients were people who had been committed to other asylums and required approval of the system to leave, a condition of entry to Fraser House was that patients voluntarily accept the transfer to Fraser House with some appreciation of what the Unit was like. Having all patients ‘voluntary’ was part of the self-help frame Neville set up at Fraser House. This ‘voluntary’ component was a crucial aspect of patient empowerment. Neville saw the Health Department stopping this voluntary requirement in the late Sixties as the single most important imposed change that ended Fraser House as self organizing Cultural Keyline in action. This is discussed further later.
Neville asked around
Mental Asylums for people they had in their back wards. These wards were
typically where ‘long term stays’ were kept who the system had given up on ever
restoring to society. Eleven certified patients from
Neville (Aug 1999) spoke about there being present in society a caste system that says, ‘normal people have to behave normally, criminals behave criminally and mad people are anticipated to behave madly’. A psychiatric nurse whom I met on my visit (August 1999) to the Lachlan Centre (formerly Fraser House) with experience in Asylums (other than Fraser House) said that in her experience, both the patients and the staff of asylums will tolerate madness in other patients, ‘because the patients are ill’. However, they typically will not tolerate the slightest bit of inappropriate behaviour in staff. This again reflects the caste system. When I mentioned her comments to Neville his view (Aug 1999) was that while this ‘tolerance’ towards patients in other institutions in one sense is ‘showing consideration’, at the same time this tolerance helps maintain the madness. In Fraser House there was relentless subversion of both madness and criminality, and rather than displaying a tolerance that maintained the status quo, fellow patients took the lead in this subverting. Some people in some categories of mental disorders were inept in picking pathology. Other patients and outpatients became very skilled at picking pathology or were already skilled at this, and took the lead in pointing out the Fraser House slogan that ‘madness and badness are not tolerated here’.
In Big Group and in other Fraser House contexts, people would be engaging in all the ‘natural’ dysfunctional roles of ‘helpless’, ‘hopeless’, ‘blamer’, ‘judger’, ‘condemner’, ‘distracter’, ‘demander’ and the like. Typically, some of the patients using these behaviours would be withdrawn isolates. Anyone using any of these behaviours in Fraser House would have had it pointed out to them and typically, they were interrupted. If they persisted in the behaviour this would be reported to Big Group and Small Groups.
This is another example of Neville’s use of his father’s idea of using ‘opposites’ and ‘reversals to mainstream protocols. When madness or badness is subverted, people may become very aroused. Fraser House had the processes to work with the corrective emotional outpourings and experience, and the support for people through this experience towards functionality.
The socio-psychological environment in Fraser House was central to the change process; it took me a long time to realize that the expression, ‘Therapeutic Community’ was not just a title. It was not just a unit where everyone did their best to make it therapeutic. In the Unit, the community as ‘community’ functioned as therapy. Fraser House was a therapeutic community - pervasively. Therapy was the function; Community was the process. The word ‘therapy’ was not used in the conventional sense of something done to someone by a psychotherapist, but in the sense of self-organizing self and mutual co-reconstituting of wellbeing.
Neville quotes from WHO Technical Report Series No. 208. 9th Report of the Expert Committee on Mental Health 1961, p.15 in his paper, ‘Sociotherapeutic Attitudes to Institutions’ (Yeomans, N. 1965a):
In the opinion of the Committee, the importance of adequate training in medical sociology can’t be over estimated, particularly in connection with the teaching of mental health promotion.
Neville wrote of that:
World Health Organization Report that enlarged upon the growing view that the recovery of mental patients depends less upon the specific therapeutic techniques than on the socio-psychological environment of the patients in the hospital (Yeomans, N. 1965a, Vol. 12, p. 46, 60-61).
Neville set up Fraser House as a transitional community. At Fraser House, new dysfunctional people were regularly arriving into a community of dysfunctional people in various stages of shifting towards being able to live well with others and returning functionally to the wider community.
In Fraser House thousands of people were coming and going with between 10,000 and 13,000 outpatient visits annually. There was the therapeutic perpetual passing on by staff and patient alike of the common stock of knowledge of how things work around here - individual quirks, where things were, who sits in that chair at that time, the little routines - all the little bits that make living comfortably with others possible.
Both psychosocial structure and processes where entangled
in Fraser House. This is similar to the whirlpool’s structure only existing as
water in process in a vortex. Similarly, Fraser House’s tenuous ever changing,
ever evolving psychosocial structure in transition was constituted,
reconstituted and sustained as self-organising human energy - as processes in action.
In Fraser House everything was continually up for review. Therapeutic Community
was a new concept in
All the members of the Fraser House therapeutic community – staff, patients and outpatients - as community, shared their lives with each other. In Fraser House, the norm was created that there was never any blaming of any one. Anyone blaming himself or herself or anyone else would be immediately interrupted. If anything happened it was deemed to be a shortcoming of the total community. Neville said that every aspect of Fraser House was structured as a community system that overrode everything limiting change, even a doctor’s power of veto. Only Neville as director had the power of veto, and he said (July 1998) he was always driven by context, and within that, the ecological part of the context; so he too fitted in with the fitting. Any doctor breaking this veto rule would have his or her attention drawn to it by patients and staff, including the cleaners, and the matter would be a priority agenda item during the next Big Group.
Neville said (30 June 1999):
Doctors working in Fraser House would have had their maximal sense of professional powerlessness in their careers. ‘Doctors being authoritarian’ was not permitted. Most administrative things that doctors would decide as a matter of course in other medical contexts had to be brought to meetings where patients had a voice and were in the majority. When a life-threatening situation occurred where a doctor or other ‘professional’ felt the need to intervene, they were not to take unilateral action, rather a special committee of as many patients and staff as possible would be quickly convened.
These temporary special committees would be typically reviewed at the next Big Group.
Neville said (July 1998) that the nurses and doctors within mainstream never fraternized in each other’s tea-room; they did in Fraser House. The mainstream way at the time was that a nurse would always stand if a doctor entered a room. Nurses new to Fraser House would be tugged back down on to their chairs when they stood when a doctor entered the room; ‘none of that necessary here!’ It took a time for this big change to settle in. In Fraser House, the shared norm was that ‘the voice of the newest nurse was just as equal as any one else’. At Fraser House, nurses worked as a team (Yeomans, N. 1965a, Vol. 4, p. 17). One of the nurse roles was that of educator (Yeomans, N. 1965a, Vol. 4 p. 20-23). A paper (Appendix 7) about the role of the psychiatric nurse in Fraser House emphasized the need for teamwork. Neville’s view was that the power – the healing wisdom, psychosocial and emotional energy, emergent potential and creativity of the Fraser House community - was infinitely greater than anyone, including himself.
According to Neville (August 1999):
Fraser House staff members were astonishingly loyal, and acted with inspired devotion. They were totally devoted to patients’ healing, and patients experienced this emotionally on a daily basis.
Neville gave all concerned almost absolute freedom except in times of major crisis. As an aspect of Cultural Keyline, Neville would leave almost total freedom to the community so that it could evolve itself (emergent and self organizing process).
As an example of giving freedom the Staff Handbook includes the following comment about the nurse role at Fraser House:
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 (Yeomans, N. 1965a, Vol. 4).
As a by-product,
staff fostered their new profession and won a new award rate in creating a new role
for themselves as nurse therapists. Neville said (Dec 1993) Fraser House
psychiatric nurses were the first ones to achieve a professional award salary
While Fraser House had the support and backing of Dr. Barclay, head of the North Ryde Hospital as well as the Head of the Health Department, other senior people at North Ryde Hospital and the top layers of the Health Department were bitterly opposed to every aspect of Fraser House as it challenged their beliefs about psychiatry, psychiatric nursing, nursing, as well as about hospital governance, structure, administration and practice.
While operating ‘within’ a ‘government service delivery’ frame, Neville set up another frame, namely, ‘folk self-organizing self-help and mutual help action in community’. Mainstream health’s, ‘we do it for you because we know’ ‘expert service delivery’ people had little or no sense of this. It was all new to the Health Department, though very ancient from Indigenous perspectives.
Neville and staff made extensive use of simple slogans to pass on to newcomers how the place worked. To have staff, patients, and outpatients embody the values, ideology and practices of the Unit, simple slogans were restated over and over. For example, the Unit’s social basis of mental illness perspective was expressed by the slogan, ‘Relatives and friends cause mental illness’. The idea of potential for change and using one’s existing internal resources for change was supported by the slogan, ‘No one is sick all through’. The best advice that could be given a patient was, ‘Bring it up in a Group’. In the early days of Fraser House, permissiveness within the staff-patient relation was embodied in the slogan, ‘We are all patients here together’. The self and mutual help focus was supported by the slogan, ‘We are all co-therapists’. However, recall that boundaries were maintained between staff and patient, in that any staff needing psychosocial support would either receive this within an all-staff support group, or if the situation warranted it, the staff member would enter Fraser House as a voluntary patient. The requirement that patients and outpatients get on with self and mutual healing and interrupt any mad or bad behaviour in self and others was reinforced with the mantra, ‘No mad or bad behaviour to take place at Fraser House’. The expectation of change was conveyed by, ‘You can only stay three months, so get on with your change.’ Community self-governance was conveyed by the slogan ‘patients together decide the rules’. The egalitarian ethos was conveyed by, ‘Here everyone has an equal voice’.
Rules/slogans for use by the staff were mentioned in a document called, ‘How to administrate in Fraser House’ (Yeomans, N. 1965a, Vol. 4, p. 24). Some examples:
Know what to leave undone in an emergency
Frequent rounds are a necessity
Combine the weak with the strong
All of the above slogans and rules became a simple shared language and set of beliefs that were easily taught to new arrivals.
All of my Fraser House interviewees confirmed that Fraser House staff, patients, and outpatients became co-therapists. They would engage in ‘everyday life’ therapy as they engaged in social interaction with each other. Some adopted Neville’s conversational change processes by absorbing them into their mode of being - typically without noticing that they were doing this. ‘Therapy’ wasn’t a mantle that people put on - it was not a ‘chore’ – it was there as a hardly noticed aspect of being.
Clark and Yeomans’ book contains a segment of a young male patient’s diary (1969, p. 230). The earlier section has entries where the patient writes of his confusion and tentativeness about his life and Fraser House; his dysfunction is implicit in his writing. As his diary entries proceeds, he records things indicating that he is shifting to functioning well without giving any indication that he even notices that he is changing. Here is an excerpt from early in this patient’s personal account:
I am sitting beside Jane in the male group room, holding her bandaged hand. She is very tense. ‘Please help me’, she says. ‘What is the matter with me?’ ‘I feel frustrated. I don’t know what to do. I tell her that there must be a reason for her tension and that she should talk about what bothers her to me or in the groups. But she says that she never knows what to say (1969, p. 230).
He is out of his depth, though he reiterates the Fraser House mantra, ‘Bring it up in a group.’ A little later:
I catch John on the veranda and when I have told him about what bothers me he asks me: ‘Have you talked to Jane about it?’ ‘No I have not.’ ‘Why don’t you?’ he says then. ‘She has been leaning on you for so long now, why not turn the tables for a change and let her help you?’ I haven’t thought of it, but it sounds logical enough (1969, p. 231).
This is an example of self-help through mutual-help. While these exchanges seem trivial, Neville and the other interviewees said that time and again the Fraser House experience was that trivial exchange could be potent.
At the end of this patient’s diary he has been assessed as ready to leave Fraser House and return to the wider world. Nowhere does he give any indication that he has any insight into the process whereby change to wellbeing and functional living is occurring in his life, or that such change is even occurring. He was not engaging in any intellectual sabotage of his change-work – behaviours like faultfinding, judging, blaming, and condemning. Clark and Yeomans had not commented on the above features of the young mans diary.
From inception Neville had constituted Fraser House as a ‘short term stay’ facility. For Neville, Fraser House was not an interim ‘holding place’ while a long term place could be found in other institutions. From the outset Neville had confidence that his ideas would work in getting people living functionally in the wider community. A rule was set up that patients could only stay at Fraser House for six months. This was later reduced to three months. After three months patients had to leave; this was regardless of whether they had improved or not. This rule was to provide motivation to ‘get on with their healing’. The clear message of the rule in the vernacular was, ‘Don’t procrastinate. Get on with it.’ At one time the typical stay was six weeks (Yeomans, N. 1965a, Vol. 4, p. 2-4).
general rule on admittance was that patients could return to Fraser House three
times by arrangement. These limits reinforced the, ‘you will return to the
wider community’ framing that was pervasive at Fraser House. The break between
returning was flexible. Neville told me (Aug 1999) that one patient said that
he wanted a transfer to
There were instances of violence and insubordination shortly after Fraser House started though these were reduced after normative processes were established and staff acclimatised to new ways (Clark and Yeomans 1969, p.41-42). The total Fraser House process tended towards curtailing physical violence. Any newcomers were assigned a buddy for some time. This buddy tagged them so they were never alone. A ‘contract’ was made that everyone in Fraser House, staff, patients and outpatients alike, were to watch out for violent situations and to restrain and interrupt people, preferably before problematic situations even got under way. None of my informants had any knowledge of any staff member ever been seriously hurt. Fraser House was a relatively big place - around 250 metres long. Outside of Big and Small Groups and the intervening tea break, people were always spread throughout the buildings or on the move. Some fights did break out between patients and were typically interrupted quickly. Any unusual noise would immediately attract a crowd. The energy and ethos of the Unit was always to respond immediately to disturbance and interrupt, rather than to encourage fighting, as may happen in wider society. Typically, if something happened say, late at night, any patient or staff member spotting it would immediately get everyone who was up and about to form a group (often a fair size group - as many as they could get) to go to the ‘disturbance’.
Other mitigating factors were the continual presence of an audience, the presence of females and children, and knowing that violence, or threats of violence would be brought up in Big Group, with around 180 mad and bad people present to focus on the perpetrator(s) of violence. Violence and other unacceptable behaviour would also be invariably discussed in small groups.
Typically, there was commitment to healing in patients and outpatients. All knew that the very strong expectation within the Unit’s milieu was that, ‘here people change and return to the wider society well’. There was also a continually reinforced mantra, ‘no mad or bad behaviour to take place at Fraser House’. New arrivals would have a settling in period where their mad and bad behaviour would be pointed out to them. Increasingly, mad and bad behaviour would be interrupted.
Neville gave patients and outpatients the task of becoming so familiar with Fraser House structures and processes, including the processes Neville and others used in enabling Big and Small groups, that the patients and outpatients could and did write extremely well written and succinct handbooks for use by new staff, patients, outpatients and guests.
Neville wrote the introduction section of a handbook called, ‘Fraser House Therapeutic Community’. This was one of a number of handbooks prepared at different times specifying the Unit’s continually transforming structure/process. Two other statements about Fraser House structure and process was the February 1965, ‘Introducing a Therapeutic Community for New Members by the Staff of Fraser House’ (Yeomans, N. 1965a). A 1966 draft of the Second Edition of the above document was a complementary document to the document, ‘Staff Patient Organization in Fraser House’. This was largely written by patients (Yeomans, N. 1965a, Vol. 4).
The patients rich sense and appreciation of the nurse role at Fraser House is evidenced by the introduction to a section on the Fraser House Nurse Role in the Fraser House Staff Handbook: written by a of group patients:
So you have decided to take up a job as a nurse at Fraser House. Great career move (Yeomans, N. 1965a).
An Example of the section on the Nurse Role from a Staff Handbook is in Appendix 7.
In March 2003, Phil Chilmaid wrote to me saying that there were handbooks (roneoed typed sheets) both for patients and relatives. The staff handbook was for longer-term staff.
I did not get one in my first stay of 3 months in 1962, but did get one (borrowed by someone else and not returned) in 1966 when I spent a full year there. Patients did not get access to the staff handbook.
Family units were set up early in Fraser
House’s history. As far as I could ascertain, Fraser House was the first
psychiatric unit in
Fraser House experience was that independent of genetic bio-psychosocial pathology (inheritance), aspects of the patterns of daily interaction (heritage) were helping to constitute and sustain pathology, often among three and more generations. This evidence was consistent with Neville’s requirement of having a patient’s multiple-generation family-friendship network attend the Unit as outpatients.
As for Neville’s view on drug based therapy, licit Drugs were used, but as a ‘last option’. In Fraser House there was no drug-induced oblivion for containment as occurred in the back wards of other institutions. The head charge nurse/sister was authorized by Neville to sedate patients, and was quite prepared to do so if patents or outpatients were a definite danger to themselves and/or others, and the timing and circumstances warranted it, rather than using other more preferred interrupt strategies.
Stephanie Yeomans (July, 2002) said that in her experience there was no culture of illicit drugs use in Fraser House and this would not have been permitted by Neville.
This chapter has introduced Neville’s setting up of Fraser House as a micro-model exploring epochal transition. It has detailed Neville’s assuming of a social basis of mental illness and has given an overview of the Unit’s milieu. The next chapter introduces the Fraser House Re-socializing Program entailing patient self-governance as another aspect of Neville’s exploring of epochal transition.
 At the time I did not make sense of this talk of epochal change and did not take it seriously.
 For a discussion of these terms refer Virginia Satir’s books Satir, V. (1967). Conjoint Family Therapy; A Guide to Theory and Technique. Palo Alto, Calif, Science and Behavior Books, Satir, V. (1972). Peoplemaking. Palo Alto, Calif., Science and Behavior Books, Bandler, R., J. Grinder, et al. (1976). Changing With Families : A Book About Further Education for Being Human. Palo Alto, Calif., Science and Behavior Books, Satir, V. (1983). Conjoint Family Therapy. Palo Alto, Calif, Science and Behavior Books, Satir, V. (1988). The New Peoplemaking. Mountain View, Calif., Science and Behavior Books..