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.
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.
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.