Chapter Six - Fraser House Milieu
ORIENTATING
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.
INTRODUCING FRASER
HOUSE
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[1]
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.
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.
Window of Opportunity
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
LAYOUT, LOCALITY, AND CULTURAL LOCALITY
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 section 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
ASSUMING A SOCIAL
BASIS OF MENTAL ILLNESS
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.
LOCALITY AS CONNEXION TO PLACE
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.
CULTURAL LOCALITY
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.
SOURCING PATIENTS
Back Wards and
Prisons
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).
ABORIGINAL AND
ISLANDER PATIENTS
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.
FAMILY- FRIENDS-WORKMATE NETWORK AS FOCUS OF CHANGE
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).
BALANCING
COMMUNITY
Resonant with Tikopia and as part of Fraser
House’s unity through diversity, Neville arranged for Fraser House to be a
‘balanced community’. Neville 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.
BEING VOLUNTARY
While many of
Fraser House patients were people who had been committed to other asylums and
required approval of the system to leave, a condition of entry to Fraser House
was that patients voluntarily accept the transfer to Fraser House with
some appreciation of what the Unit was like. Having all patients
‘voluntary’ was part of the self-help frame Neville set up at Fraser House.
This ‘voluntary’ component was a crucial aspect of patient empowerment. Neville
saw the Health Department stopping this voluntary requirement in the late
Sixties as the single most important imposed change that ended Fraser House as
self organizing Cultural Keyline in action. This is
discussed further later.
Neville asked
around Mental Asylums for people they had in their back wards. These wards were
typically where ‘long term stays’ were kept who the system had given up on ever
restoring to society. Eleven certified patients from
RE-CASTING THE
SYSTEM
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.[2]
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.
FRASER HOUSE AS
THERAPEUTIC COMMUNITY
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.
STAFF RELATING
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
in
FOR AND AGAINST
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.
THE
USE OF SLOGANS
Neville and staff made extensive use of simple slogans to pass on to
newcomers how the place worked. To have staff, patients, and outpatients embody
the values, ideology and practices of the Unit, simple slogans were restated
over and over. For example, the Unit’s social basis of mental illness
perspective was expressed by the slogan, ‘Relatives and friends cause mental illness’. The idea of potential for change and using 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.
FRASER HOUSE
WELLNESS NORMS
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).
Another 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.
HANDBOOKS ON
FRASER HOUSE STRUCTURE AND PROCESS
Neville gave patients and
outpatients the task of becoming so familiar with Fraser House structures and
processes, including the processes Neville and others used 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 THERAPY
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.
DRUG USE
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.
SUMMARY
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.