This Chapter
discusses criticisms made in the Sixties about Neville and Fraser House and
provides some responses. Neville’s processes for extending Fraser House into
the local community are detailed. The Australian society’s processes and
sanctions for placing boundaries upon behaviour and for accommodating diversity
are detailed and these are contrasted with Fraser Houses and Neville’s use of
therapeutic community to fulfil the same functions. Neville’s setting up of
transitions to community self-caring is detailed, as well as Neville’s
intentional actions contributing to the phasing out of Fraser House. Research
on Fraser house evaluation is briefly outlined. The Chapter concludes with
ethical issues in replicating Fraser House and some conclusions about the
research questions.
As leader, two of the roles Neville used were ‘enabler’
and ‘orchestrator’ of self organizing action by others. For this, Neville was
accused of being irresponsible and not doing his job of leading - loosely
defined as, ‘telling everyone what to do’. Being the Director and Psychiatrist
in charge of the Unit, he was expected to do just that. In his profound love of
all involved, Neville said (Dec 1993, July 1998) he was accused of being, ‘too
emotionally close’. In his tight, tough, humane, meticulously specific, and
precise interventions in crisis contexts he was accused of being a
megalomaniac. Accusations would depend on which moment a critic happened to be
observing. The seeming conflicting roles of non-interventionist/interventionist
and uninvolved passive/totally involved tyrannical megalomaniac are fully
consistent with use of opposites and cleavered unities. Neville’s behaviour was
consistent with his behaviour being appropriate to each passing moment and
context.
There is another sense in which Neville used
control and abandon in his own functioning. It is resonant with what Castaneda (1974) wrote about the Yaqui Indian, Don Juan’s
way. Don Juan spoke of walking the path between control and abandon and how to
combine both of these in peak performing - to control oneself and at the same
time abandon oneself – to calculate everything strategically - that’s control,
then once this is done, to act, to let go; that’s abandon.
Neville could seamlessly slip between control
and abandon or use both simultaneously at differing levels of functioning. This
letting go and abandoning is resonant with Wolff’s writings in his book,
‘Surrender and Catch’ (1976). Even in surrendering/abandoning there is
keen sensing of what others may not sense.
The above accounts for seeming contradictions
in Neville’s behaviour. As for the efficacy and appropriateness of Neville’s
actual behaviours in context, that is outside the scope of this research.
Clark and Yeomans wrote that during the early
months of Fraser House Neville exercised tight control in supporting his staff
against the anxieties in the change-over from ‘old and trusted methods of
managing patients to new and unfamiliar techniques’ (1969, p.41-42). They mention that this function was
critical in the early days when situations occurred like patients being
arrested at a local hotel, violent quarrels breaking out between patients,
cases of window smashing, insubordination and outbreaks of panic. Clark and
Yeomans go on to say ‘however, as confidence was created in the new methods,
staff learned to meet and handle emergencies without the continual presence of
the director. As staff felt more confident, patients became more secure and the
frequency of emergencies decreased (1969, p.41-42).
The response to
Fraser House ranged from recommendation to condemnation. In their book about
Fraser House Clark and Yeomans report (1969, p.54):
Many professional workers, psychiatrists,
psychiatric workers, psychiatric nurses and clinical psychologists, have
expressed antagonism towards the practices of the Unit. They have claimed,
among other things, that the confidences and the dignity of patients are not
respected in the traditional way, and that the treatment is crude and
administered by unskilled personnel. They describe instances in which relatives
of a patient have been denied information about the progress of treatment, or
had pressure exerted upon them to attend group therapy meetings against their
own wishes.
At a more personal
level, charges of flamboyance and irresponsibility have been made against the
director of the unit (that is Dr. Neville Yeomans). Some practitioners have
refused to refer patients to Fraser House because of their feelings of disquiet
about its personnel and practices.
I will respond to the above criticisms;
firstly, the report that ‘relatives/friends of a patient had pressure exerted
upon them to attend group therapy meetings against their own wishes’. I have
discussed that ‘family and friends attending Big Group’ was a condition for
patient entry to the Unit. I have included a letter sent to friends and
relatives encouraging them to attend (refer Appendix 11). That letter said that
if requested, a group of patients could call on friends and relatives to
explain things, and answer questions. In respect of the claim that pressure was
being exerted against people’s wishes, Neville stated that this certainly
occurred fairly regularly as particular circumstances arose.
Some families went out of
their way to not cooperate with efforts to treat family members. Neville wrote:
Family inconsistency and conflict,
distrust of the hospital, etc is most commonly and in fact almost solely found
amongst the relatives of the most severely ill of all patients. It
characteristically arises with the relatives of severely schizophrenic and
major narcotic addicts, murderers, and violent patients; far more than in any
other group which is perhaps a reflection of the extreme tension and distortion
under which these families live, making them suspicious of any efforts to help
them (Yeomans, N. 1965a, Vol. 5, p. 44-45).
Appendix 21 contains a
relevant case involving a tangled inter-generational inter-family dysfunctional
group of six where considerable pressure was put on a dysfunctional person not
involved in Fraser House at the time though linked to a dysfunctional network.
Readers can draw their own conclusions about the efficacy of the pressure to
attend Fraser House in this case.
As for the claims that the treatment was
crude and administered by unskilled personnel, the reports of those I interviewed
was that patients and staff alike became extremely competent in a whole range
of processes outside of conventional mental health practice. The Unit became
the centre for teaching new psychiatrists ‘community psychiatry’. Fraser House
patients played the major role in training these new psychiatrists.
In respect of the criticism that confidences
and the dignity of patients were not respected in the traditional way, we have
discussed the often tough and provocative nature of Fraser House community process.
Neville described his way as being ruthlessly compassionate in intervening,
interrupting and sabotaging people who were adept at maintaining and sustaining
their own and/or others’ dysfunction.
In Fraser House people changed where nothing
else had worked in the other places they had been. Relatives and friends of a patient were
often denied information about the progress of treatment. It was regularly
found that many relatives and friends were very prepared to use information
about a patient’s progress to destructively sabotage that process.
It is to be expected
that what Neville was doing would create ‘peer disquiet’ about Fraser House
personnel and practices. Anything that turns a profession on its head and
strips away virtually every aspect of members of that profession’s traditional
power and authority as both individuals and as a profession would create
vehement opposition.
Each of my Fraser
House interviewees agreed that many newcomers to Big Group would have
had the following experience (Clark and Yeomans 1969, p. 54):
Some patients and
their relatives and friends have shown extreme fear of, and hostility towards,
the practices of the Unit. They describe vividly their feelings of horror and
helplessness when first exposed to the interrogation or verbal attack of a
group of grossly disturbed people. Frantically, they look towards the staff for
protection, but support is not forthcoming. The inescapable conclusion is
reached: staff and patients are united in their efforts to uncover innermost
secrets and to probe sensitive emotional areas without remorse.
Every Fraser House
interviewee said that Big Group was an extremely intense experience and in all of
this, there was profound framing compassion and a relentless drive for all
involved to be moving to being able to live well in the wider community. As for
being flamboyant, Neville was a chameleon who constantly changed to fit
context. In keeping Fraser House before the public of
Dr. N. M. Mitchell from Kenmore Psychiatric Hospital in
Goulburn was interested in setting up a 300 patient therapeutic community
(based on Fraser House) within Kenmore, a psychiatric hospital with over 1,800
patients (Mitchell 1964). A file note by an unnamed author in
Neville’s collected papers states:
Dr. Mitchell was sent to Fraser House for a week of
intensive training and received copies of Fraser House’s rules, administration
structure and committee organization. Neville had visits to Kenmore and visited
While their
therapeutic community had around 300 patients Neville ensured all involved
in Kenmore and the local hospital knew about this new Unit (Yeomans, N. 1965a, Vol. 12, p. 66-69).
Note the thoroughness
of Neville in ensuring every single patient and staff member, as well as the
local base hospital, were all thoroughly briefed on the new therapeutic
community unit at
Neville’s work with
Dr. N. Mitchell and Dr. J. Russell at Kenmore was featured in a newspaper
article on 19 June 1963 called, ‘Kenmore’s Group Therapy Plan – Leading
Psychiatrist Visits Kenmore’ (Evening Post 1963) (Photo 29 below). Dr. Mitchell is quoted in
the article as saying, ‘A large-scale community living or group therapy used at
This segment looks at Neville’s
contextual frames for positioning Fraser House praxis in fostering a transition
to a humane caring epoch. Neville spoke (July-Aug, 1998) of Western society
having four levels of functioning relating to regulating of conduct - namely,
values, norm, rules, and obligations.
Photo 1 Newspaper Clipping Neville placed in archive ‘Dr. Yeomans at
Figure 1 below shows Neville’s framework that he outlined
to me (Dec 1993) based on these four levels. It also shows the normal and
deviant behaviours associated with each of the four, and also the typical
societal ‘correcting’ agencies associated with each level. The criminally
insane are typically deviant on all four levels. Criminal people and the
socially dysfunctional may deviate at any level. Australian society’s
correcting agencies provide a ‘service’ role for the community at large. In
large part, level two and three service is provided by some level of government
- the public sector. Some private sector contracting-out occurs; for example,
private prisons. Private commercial practitioners (service providers) may be
supported by government funding arrangements; for example psychiatrists and
physicians in level four. Voluntary service providers also assist; for example,
church based social and counselling services and youth-outreach services in
level one and aspects of level four. Outside the massive service provider
arrangements is now an extensive network of self-help groups.
Self-help blossomed in
The social-pathology support framework of Fraser House and the Laceweb assumes that resident behaviour is a function of pathological social networks - a failure at the community level, and also assumes it is in part a function of pathology within the wider society. While Fraser House was a service provided by the NSW Health Department, life within Fraser House was pervasively self help.
Within
Fraser House there was no service based correcting agent - where
‘agent’ means someone who does something for you – rather, within Fraser
House the correcting, remedial and generative processes operating at all of the
four levels of functioning depicted above in Figure 1 becomes the therapeutic
community, which by its nature, is bracketed off, though embedded in local
community.
LEVEL |
NORMALITY |
DEVIANCY |
CORRECTING
PROCESS |
FRASER
HOUSE AND LACEWEB CORRECTING
PROCESS |
||||
1
Values |
Moral Ethical |
Immoral Unethical |
Priests Moral
leaders |
Therapeutic
Community |
|
|||
2
Norms (Legality) |
Legal Law-Observance |
Illegal Criminal |
Judiciary Police |
Therapeutic
Community |
|
|||
3
Rules (Efficacy) |
Loyal |
Disloyal |
Administrators |
Therapeutic
Community |
|
|||
4
Obligations (Capacity) a)
Role Performance b)
Task Performance |
Role responsibility (Competence) Ability |
Mental
Illness Physical
Illness (Disability) |
Psychiatrist Physician |
Therapeutic
Community Therapeutic
Community |
|
|||
Figure
1
Maintaining Conduct and the Correcting Processes
In Neville’s framework, the
notion of ‘service delivery’ by ‘expert’ ‘corrective agencies’ is replaced by
self-help, and mutual or community help by the therapeutic community. This is
resonant with Indigenous community sociomedicine for social cohesion. The
therapeutic community is supported by nurturing enablers as ‘resource people’.
The paper ‘Government and the Facilitating of Grassroots Wellbeing Action’ (Yeomans, Widders et al. 1993a; Yeomans, Widders et al.
1993b) suggests ways that self-help, and mutual or community
Grassroots wellbeing action may complement top-down service delivery.
In Fraser House, residents
explored, clarified, and developed their values and reciprocal obligations
together. They developed their own community lore, law, rules, norms and obligations.
They were living within Fraser House’s more functional value, rule, and norm
systems that they were evolving and continually reviewing together as a caring
community. This co-reconstituting of the rules and norms they lived by was
embedded within every aspect of communal life in Fraser House. The values,
lore, law, rules and norms embodied humane caring self-help and mutual-help.
These aspects were never reified – as if they were immutable and coming from
God. As Kuhn pointed out in his writings about the potency of paradigms (1962; 1996), the processes constituting and sustaining
societal paradigms are reified and rarely if ever noticed or questioned.
Neville created a context where the social constituting of the Fraser House
shared reality was made explicit and kept under continual review by the Fraser
House community. Goffman had written about various types of total institutions.
Neville fitted these total institutions into the above framework of values,
norms, rules, and obligations as depicted in Figure 2. (‘Comparison of
Goffman’s, ‘Total Institutions’ and Fraser House’ is Appendix 2)
Neville described Fraser
House as a ‘transitional community’ as it was continually adapting to meet
changing contexts and challenges. There was a culture of continual improvement
in being well – wellbeing. Neville described all this as ‘micro-processes’ that
may be used in returning a way of being and living together to wider society in
Australia – a culture that Neville described (Dec 1993) as been subject to the
cultural stripping by the Rum Corps at the very start of European settlement in
Australian - where in Neville’s terms,’ Irish and other settlers and local
Aborigines alike all had their culture stripped systematically from them and a
military culture imposed’.
LEVEL |
CAPABILITY AND NATURE |
INSTITUTION |
CONFORMING
PROCESS |
|
|
1
Values |
Capable
and in retreat |
Abbeys,
Monasteries, Convents |
Priests Moral
leaders |
|
2
Norms (Legality) |
Capable
and deliberate threat to society |
Jails,
Penitentiaries, POW Camps, |
Judiciary Police Guards |
|
3
Rules (Efficiency) |
Capable
and there for instrumental purpose |
Army
Barracks, Ships |
Administrators |
|
4
Obligations (Capacity) a)
Role Performance b)
Task Performance |
Incapable
and unintended threat to society Incapable
and harmless |
TB
Sanatorium, Mental
Hospital Blind,
Orphaned, Aged, Indigent |
Physician,
Psychiatrist Physician,
Carer |
Figure 2 Neville’s Four Levels and Total Institutions
Neville embedded the
framework depicted in the above table into the evolving Laceweb. The
distinction between mainstream ‘service delivery’ approaches and the self-help
Laceweb model is discussed in Chapters Twelve and Thirteen.
Figure 3 below is Neville’s
extension of Figure 1 and depicts the way society accommodates diversity
between people, socio-economic groups, ethnic groups and cultures. Societies
have varying degrees to which they will allow protest and dissent. The columns
are lists (rather than a table) of correcting processes for resolving deviancy
from within or from outside the society. The right-hand column gives the Fraser
House/Laceweb healing processes for healing deviancy in all its forms towards
having cleavered unities that respect and celebrate diversity.
Fraser House offered primary
patient care by skilled psychiatric nurses to many surrounding organizations. A
Fraser House social worker was based in the Hunters Hill Council Chamber’s
Administrative Office providing a service to the public half a day a week.
Neville was continually giving talks to church groups and other organizations
about Fraser House and its processes. Neville set up what was called the Sydney
Therapeutic Club on the veranda of Ward One at Sydney Hospital (Yeomans, N. 1965a, Vol. 5, p. 104). Neville worked closely with eight social
workers at
Level |
Normality |
|
Correcting Process |
Fraser House/ Laceweb Correcting Process |
Cleavage Diversity |
Current
way: Oppressor/ Oppressed Advantaged/ Disadvantaged Subjugator/ Subjugating Exploiter/ Exploiting Possible
way: Harmonious Unity |
Protest Disobedience Conflict Sabotage Insurrection War Terrorism |
Venting
energy Fines Compelling compliance Coercion
& sanctions Imprisonment
Warrior
system - yang Political
Mediators Negotiation Police/Military Para-military Militias Torture
& Trauma Shaming
& Maiming (Towards status quo
in current way) |
Cultural
Keyline Healing
nurturing – Yin Therapeutic
Community Mediation
Therapy Peacehealing Healing/Wellbeing
networks Festive, and
celebratory gatherings Everyday life
wellbeing processes (Towards possible
way of harmonious cleavered unity) |
Figure 3 Neville’s Figure Depicting
the Way Society and Fraser House/Laceweb Accommodate Diversity Among People,
Socio-Economic Groups, Ethnic Groups and Cultures
As
an example of linking Fraser House to the wider community and vice versa,
during 1965, assistance was given on an individual or workshop basis by members
of the Fraser House Research Group to thirteen organizations listed in Appendix
22 (Yeomans,
N. 1965a, Vol. 12, p. 94).
Seventeen people from the Parramatta Psychiatric Centre met monthly under
Neville’s chairmanship on eight occasions (Yeomans,
N. 1965a, Vol. 12, p. 85).
Members of the Salvation Army undertook training in group leadership at Fraser
House. Brief and extended training courses also included clergymen from all
Christian denominations. Also involved were family welfare agency counsellors,
parole officers, and nurses and administrators from private hospitals. Neville
also advised the Salvation Army on the development of hostels (Yeomans,
N. 1965a, Vol. 12, p. 72).
Neville was the Honorary Consulting Psychiatrist at Langton Clinic for
Alcoholics. He also guided that hospital on therapy, policy and research (Yeomans,
N. 1965h, Vol. 12, p.70).
In the above action Neville was providing support to each
of the mainstream institutions outlined in Figures 1, 2 and 3 who were
providing mainstream service delivery based correcting processes for people
deviating from society’s values, norms, rules and obligations. Neville also
linked with senior people in the criminal justice prison system through the Fraser
House Psychiatric Research Study Group. This linking is another example of how
Neville explored interfacing his ways with mainstream ways.
Neville
also gave many talks and interviews about Fraser House that were broadcast on
TV and radio. This was confirmed by Neville, Chilmaid, and Bruen (April 1998).
Neville was the Guest of Honour at the All Nations Club on 30 August 1963 (All Nations Club 1963). A draft of a speech on social problems to
the Ionian Club Sydney entitled, ‘Introduction on the Origins of the Ionians’
is included in Neville’s archived papers (Yeomans 1968a). On one occasion a TV crew from the ABC came
and filmed a section of Big Group. One of the intentions of these interviews
was to have the public know so much about what was happening at Fraser House,
that it would raise a hue and cry if there were any moves to close the Unit.
One of the things Neville
was exploring when he was away overseas for nine months in 1963 was the state
of the art in community based healing approaches in the
Upon his return Neville
wrote a report (1965a, Vol. 1, p. 70-80) recommending that community mental health
centres be attached to schools, because school counsellors meet the families.
Neville’s report recommendations were shelved. Neville energized the Paddington
Children’s’ Community Centre based in part on the Afro-American New Haven
Community School he visited in America (1965a, Vol. 1, p. 70-80). This linking of support to schools has some
resonance with what happened in the NSW town of
Fraser House was the
first mental institution in
Neville delivered a paper at
the Pan Pacific Rehabilitation Conference in 1968 called ‘The Therapeutic
Community in Rehabilitation of Drug Dependence’ wherein he wrote about steps he
was taking towards evolving community mental health.
Since September 1965, Fraser
House has been innovating a community psychiatry service for approximately
300,000 population. This programme aims at intense contact with government
public servants, community aid services and all other relevant community
leaders including police, ministers of religion and all those depended upon by
large groups (Yeomans, N. 1965a, Vol. 1, p. 267-289).
In a document marked ‘confidential’ called, ‘A Community
Developers Thoughts on the Fraser house Crisis’ (1965a, Vol. 2, p. 46-48), Neville writes of actions that would lead
to the phasing out of Fraser House.
Over the last couple of years the Unit
Director and developer (Dr. Yeomans) has been increasingly involved in
strengthening the organizational preparedness of the outside community, aimed
at the relative devolution of Fraser House and the development of an external
therapeutic (welfare) community.
Neville does not expressly
state what the ‘crisis’ was that was implied in the title of the article. In
terms of attack from psychiatrists and other health professionals opposed to
Fraser House process, the Unit had been ‘in crisis’ from inception.
A shift to a ‘community
mental health’ focus and a further widening of focus to embrace ‘community
health’ via ‘strengthening the organizational preparedness of the outside
community’ was hinted at in the forward to the second edition of ‘Introducing a
Therapeutic Community for New Members’ (Yeomans, N. 1965a, Vol. 4).
The major changes in the programs of the
Fraser House Therapeutic Community in the past 20 months (1965/1966) have been
the development of an intense Community Psychiatry Programme, first in Lane
Cove municipality in September 1965, and more recently in the
The Fraser House handbook
for new staff has a segment on the Nurses Role:
Nurses are assigned in teams to regional
areas at the moment; Lane Cove, Ryde, the rest of
In September 1965 the Lane
Cove Community Psychiatry Programme began. In June 1966 a similar programme
began in Ryde (Yeomans, N. 1965a, Vol. 4, p. 2-4).
In discussion with Neville
(Nov 1998) about Figures 1 and 3 above he said that while Fraser House had been
a seminal step, it was still a State run enclave. Kenmore Therapeutic
Community was another State run enclave. Ex-staff member Dr. Madew was replicating
Fraser House at
Neville wanted his ideas
spreading outside of State control. His next step was to move Fraser House way
out into the community and slowly move community-centred action away from
service delivery and towards grassroots self-help and mutual-help. Neville
spoke (Dec, 1998) of this as, ‘returning wellbeing processes back to grassroots
folk’.
In 1993, Neville engaged me
in writing with him and Terry Widders about the gulf that exists between
Grassroots self-help and Government (1993a; 1993b). In that paper Neville describes the
fulfilment of his aspirations in the Sixties when he was shutting down Fraser
House as a Government Institution embedded within an expert service delivery
tradition.
Across Northern Australia
influences are being generated that are placing the impetus for nurturing
cultural action for wellbeing back at the place it breaks down - with local
people as they go about their lives. It is a lateral and bottom-up action.
Small groups engage in action and keep using practices that work for them.
Others become involved and initiatives, starting 'at the bottom', work their
way 'out' and 'up' to include more of the wider community.
To have Fraser House process
start to move out into civil society and then into grassroots self-help
networks Neville sensed it was best to let Fraser House be re-absorbed by
mainstream and disappear. He did not want Fraser House remaining as a
government administered service delivery entity that was a mere shadow of how
it was when he was there, and for this ‘atrophied anomaly’ to be presented as
‘Dr. Neville Yeomans’ Therapeutic Community’.
Neville told me (Dec 1993,
June-July 1998) that he had predicted in the 1960’s that therapeutic
communities in psychiatric hospitals in
Neville said (Dec 1993, July
1998) that within Fraser House, psychiatrists experienced their maximum career
disempowerment. Neville held the forces that wanted to annihilate all trace of
Fraser House at bay for nine years.
Neville had intentionally
positioned Fraser House in the ‘declining old cultural system at the margins’
to research both the internal and external process of setting up an
organisation deemed ‘radical’ and ‘anarchic’ by the old cultural synthesis.
Neville in 1967 and 1968
arranged for opponents of Fraser to get their way after he had achieved
everything he wanted at Fraser House. He then wanted to move the Units
processes into civil society in
A cost-benefit analysis
designed by Neville revealed the Unit to be the cheapest and most effective
compared to a traditional and to a very new ‘eclectic’ unit (Yeomans 1980a; Yeomans 1980b).
Chilmaid (Sept 2004) said:
Fraser House costs matched
the two admission units but had many more outpatient numbers, both attendees
& assertive outreach (follow-up visits) and groups, so cost per patient day
must have been lower; due to length of stay, patient throughput was also lower.
Treatment results were
followed for up to five years and this research showed that improvement results
were maintained (Clark and Yeomans 1969).
Madew, Singer & MacIndoe
(1966) conducted controlled research in Sydney at
Bayview House Therapeutic Community[1]
within Callan House. They found that the therapeutic community was
significantly better at returning patients to the community. The therapeutic
community costs were also significantly lower than the control group.
In 1993, Alfred Clark
published his book, ‘Understanding and Managing Social Conflict’. In this book
Clark specified the 1959-66 ‘Fraser House’ model as being still ‘state of the
art’ as a process for intervening and resolving social conflict within any
context around the Globe (1993).
Neville was delighted
to discover that Fraser House was one of the models used in comparative
research by Paul and Lentz in their 1968 research based in Illinois, USA (1977, p. 432). Paul and Lentz used Fraser
House as one of their models in developing their milieu therapy program.
However, many of the unique features of Fraser House were not used by the
American researchers. The researchers had also used a ‘poor cousin’ of Fraser
House model in their social-learning program as well. The American researchers
used a token economy. Neville set up a small actual economy within
Fraser House (for example, the canteen, the bowling green and packing light
globes).
The American research strongly
supported the efficacy of the Fraser House model. Over the four and a half
years of the American research and the next 18 months follow-up, the
psychosocial change programs were significantly ahead of the hospital group on
all measures, with social learning emerging as the treatment of choice.
While
Paul and Lentz’s clients had been chronic mental patients who had had long-term
hospitalisation, with the social-learning group fewer than 3% failed in
achieving ‘significant release’, defined as being longer than 90 days in
outside extended-care facilities. 10.7% of the original social-learning group
and 7.1% of the milieu group were released to independent functioning,
without re-institutionalisation. None of the original hospital group had been
released to independent functioning.
A cross comparison
between structures, processes, actions and underlying theory within Fraser
House and Paul and Lentz’s psychosocial programs shows that Fraser House
contained the aspects that constituted the effectiveness of both their
milieu and social learning programs. Some of the features of the American
models were present within Fraser House in a more advanced form. Fraser House
also had a large number of features that were not present or referred to by the
American researchers. To demonstrate the
‘total’ nature of Fraser House, the Unit’s features that were neither present
in the Paul and Lentz’s American research (1977) nor referred to by the American
researchers are listed in Appendix 23. Consistent with opposition to Fraser
House, Paul and Lentz’s treatment unit was closed by authorities shortly after
they published, notwithstanding their excellent results.
It is possible that
psychosocial change may be implemented in incompetent, inappropriate and
unethical ways. Attempts to set up psychosocial change programs may go
seriously astray to the point where people may be harmed or killed. We have
seen that the Fraser House therapeutic community psychosocial programs were, at
various levels, both simple and complex in their structure and processes. Both
highly specific and very non-specific change actions were used. Many of the
structures and processes were not obvious. Many were very subtle. Incompetent
people with the best intentions in the world may seek to establish psychosocial
change programs. They may operate under a belief in the ‘magical’ quality of
the approaches used - that you set a unit up and ‘let the magic happen’.
The consistent feedback from
all my Fraser House interviewees was that Fraser House was a ‘massive amount of
very tight and difficult work’. As mentioned, in Fraser House detailed
attention was focused on being extremely flexible within extremely tight
psychosocially ecological boundaries. One of these frames was safety at all
levels - physical, emotional, psychosocial, ethical, moral and spiritual.
Meticulous and constant attention was also focused on staff teamwork with team
building, team-maintenance and teamwork under continual review. The staff were
so dedicated and committed to each other and the community, Neville had to
constantly insist that they go home after their shifts ended instead of staying
on to do things to support. Recall that the groundwork laid down by Neville
allowed him to be away overseas for nine months in 1993 with Fraser House
thriving in his absence.
Neville was adamant that for any cloning of Fraser House
to be ecological, it would have to grow naturally and be context and local
place dependent; this included how it was embedded within the local suburbs to
ensure the natural evolving of strong functional local patient networks. An
important issue in replicating Fraser House was that Neville was a very skilled
and very charismatic person and there are few ‘Neville’s around (given his
Keyline and Indigenous precursors). As an example of his total completeness
Neville spoke to all 1800 (plus) staff and patients at
Dr. Mitchell’s Kenmore Therapeutic Community and Dr. Madew’s
One attempt at setting up a therapeutic community was the
Ward 10B unit set up by Dr. John Lindsay at the Townsville General Hospital
Psychiatric Unit (1992). Some years before, Dr. Lindsay had
requested permission to be, and had been an observer at Fraser House for three
weeks. Neville told me in 1992 in Yungaburra that Lindsay believed that he
‘slavishly’ copied aspects of Fraser House in establishing and running Ward
10B. In doing this, Neville said that, ‘Lindsay did not allow for the structure
of the city of
Neville told me (Dec 1993) that after Neville visited
Ward 10B he completely dissociated himself from having anything to do with it.
Neville said (Dec 1993) that this was because he sensed that Dr. Lindsay had
‘too faithfully followed Fraser House in a different State, political and
metropolitan context’. As well, there was evidence that the Ward 10B staff were
far from being an effective team. Ward 10B was in no way encapsulating the
Fraser House processes.
(In contast, Fraser House staff rapport process was
described in the following terms:
The emotional comfort and satisfaction of the
Unit staff is one of the most significant features of the (Fraser House)
therapeutic program. The numerous staff meetings aim to foster this.
Specifically their role is to prevent the development of covert, hidden conflict
between staff members about patients. Such conflicts are proven to result in
overt patient disturbance. The staff remains the most powerful members of a
therapeutic community and their welfare and comfort are of paramount importance
(Yeomans, N. 1965a, Vol. 4, 50-54).
Following many complaints, Ward 10B was closed and became
the subject of a Commission of Inquiry that reported in 1991. This inquiry
sought to find out if negligent, unsafe, unethical or unlawful acts had taken
place. The conclusions of the report (Queensland Commission of Inquiry 1991, p. 461) were in part:
Clause 20.4 The primary lesson to be learned from the
findings of the Commission of Inquiry is that what happened in Ward 10B between
March 1975 and May 1987 must never be allowed to be repeated in this or any
other psychiatric unit in any hospital in the State.
Clause 20.5 The mentally ill population deserves expert
care, compassion and solicitude, not abuse and rude confrontation, and above
all they deserve to be spared from the excess of those who would wish to impose
upon them eccentric and idiosyncratic treatment philosophies. Even more so,
they deserve to be treated with all of the skill and learning which the caring
professions can offer them.
Dr. Lindsay gave his version of events at the Townsville
Unit in his book, Ward 10B - The Deadly Witch-Hunt (1992).
I sense that Ward 10B can stand as a warning to anyone
who may want to implement ideas culled from this thesis without allowing for
the interwoven richness of Neville’s way and value underpinnings.
It would be useful research to compare differences
between Fraser House and Ward Ten, especially between:
·
the
roles of the respective directors
·
the
respective director’s relationship with the respective staffs, and
·
the
respective treatment philosophies
Neville’s poem ‘INMA’ (included at the start
of this thesis) is about social networking in Far North Queensland and the
Darwin Top End in what Neville Termed an INMA or Intercultural Normative
Model Area. As I stated in Chapter Two, it was some time
before I started to see the fractal quality in everything Neville was doing and
how all the diverse bits were parts of the whole. It was not until May 2004
that I suddenly realized that Fraser House process was isomorphic with the INMA
poem.
Extracts from the poem:
It believes in the coming-together,
the inflow of alternative human energy, from all over the world (2000a).
Neville first created the
coming-together of ‘alternative energy’ – people he termed ‘the mad and bad of
It believes in an ingathering and a
nexus of human persons’ values, feelings, ideas and actions (2000a).
As
for an ‘ingathering and an nexus’, Neville first created the ingathering
into Fraser House from the NSW psychiatric hospital back wards and prisons. The
Fraser House community created the nexus and it was a nexus of ‘human
persons’ values, feelings, ideas and actions. This links with Neville having
the staff meetings to review themes, mood, values and interaction during big
and small groups.
Inma believes in the creativity of
this gathering together and this connexion of persons and values (2000a).
The Fraser House ethos and experience
was that the creativity and wisdom was in the community coming together and
consequent nexus of persons and values.
It believes that these values are
spiritual,
moral and ethical, as well as humane, beautiful, loving and happy (2000a).
The Fraser House evolved value
system shared all of the above values.
Inma believes that persons may come
and go as they wish, but also it believes that the values will stay and
fertilize its area, and it believes the nexus will cover the globe (2000a).
Fraser House patients could come and go as
they wish and the values of Fraser House did stay and were spread into the
wider
Bloom (1997) quotes Abroms who describes
milieu therapy (community therapy) as a ‘treatment context rather than a
specific technique…a metatherapy.’ Neville’s process created a very special
context whereby every aspect of social interaction was re-constituting people.
Neville demonstrated that dysfunctional people can provide mutual help
in evolving a reconstituting, self-governing, functional, transitional
community that could continually take in dysfunctional people and their
networks, and constantly generate and disperse them within a three month or
less time frame as ‘‘functional family-friendship seeding networks’ into wider
society.
Patients typically finally left Fraser House
with a network of around seventy people. Upon leaving, these networks would be
made up of current and former patients and outpatients. Within a few weeks of
leaving, network members would be primarily ex-attendees of Fraser House. Upon
first leaving, patients could return and stay as patients three times with the
members of their growing family friendship network. These return visits were
opportunities to increase functionality and importantly, to strengthen the
experience base within their networks. As some of these returning outpatients
may be members of a number of Fraser House connected networks - with members
in, or returning to Fraser House - ongoing links back to Fraser House could be
sustained for some time. Most of these networks were integrated networks
(discussed in Chapter Thirteen), with nodal people as links to other integrated
or network fragments and dispersed networks (also discussed in Chapter
Thirteen). Nodal people would have links into other Fraser House integrated and
dispersed networks. Within these networks were subsets of people who were
closely known and regularly connecting. Others were linked with less
frequently, though available as resource and support people. This all has
implications. One is that after Fraser House had a number of months of regular
outpatient attendances, Fraser House Big Groups began to be comprised of a
substantial and influential number of ‘seeding’ patients among those about to
leave, along with visiting outpatient members of their expanding functional
network. These people all had experience in working at the edge in Big Group,
as well as experience in training new psychiatrists in community psychiatry,
engaging in Domiciliary care and Committee work, and being a member of a
functional network supporting self and others. Having this core of people in
Big Group (and disbursed through small groups) supported by Neville and the
other staff, increased the capability of the whole group as crowd and audience
to hold interest and stay at threshold. There was critical catalytic mass.
During the early to mid Sixties Fraser House
was continually evolving functional networks of up to seventy people and having
them separate off from Fraser House into wider society - somewhat like meiosis
in human cells splitting to multiply. Wider society would have little knowledge
of this seeding process for community change. Neville, staff and patients in
domiciliary care roles remained potential and actual nodal persons into these
networks.
After Neville and Margaret left Fraser House
they both re-linked with some of the members of these networks in the late
sixties and seventies. Neville and Margaret worked with ex-Fraser House patients
and outpatients on community health initiatives when they found these people
active in community innovation, change and enrichment, discussed in the next
chapter.
The next segment explores the role of ex Fraser House patients in
energizing local self help action.
Neville said (Aug 1998) that patients would
typically leave Fraser House with a large family friendship network, as well as
experience in helping administer a substantial organization. They would also
have experienced the practical application of psychosocial research and have
competencies in community therapy process.
It was little wonder that shortly after
leaving Fraser House in 1968, Margaret Cockett was finding ex-patients around
Margaret recalled one Fraser House ex-patient
as been a very angry person at Fraser House. When this person was leaving
Fraser House, Margaret thought that he had a ‘long way to go’ in being
‘functional’. She met and talked to him at a social action meeting. Margaret
told him that she was surprised to find him there and said she thought he would
be ‘railing against the government’ rather than being involved in this
self-help action. Margaret said he replied words to the effect, ‘You have it
all wrong. Change is happening at the everyday life level. It is useless
trying to change the Government and the large power processes.’ This response
was in fact resonating fully with Margaret and Neville’s view and draws
attention to the profound difference between service delivery by experts (who
do things for people) and self-help/mutual-help in modulating social relations.
Neville wrote about this difference and how his way may be interfaced with
mainstream way (Yeomans, N. 1971c; Yeomans, Widders et al.
1993a; Yeomans and Spencer 1999).
Elshtain asked the question (1995, p.91):
If one cherishes and champions
individuality and community, diversity and commonalities, what resources are
available in our contemporary civic repertoire that push in this complex direction?
Neville was evolving psychosocial
resources cherishing and championing individuality and community, diversity and
commonalities in the NSW civic repertoire.
I have been exploring the
research 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?
The above four chapters have
document how Fraser House entailed structures and processes that far exceeded
other therapeutic communities outlined in Chapter Three, hence Margaret Mead’s
‘total’ descriptor. Neville introduced behaviour to community psychiatry that
involved:
·
thinking and acting as a personal eco-system
·
being a conscious extension of the eco-social system we are
imbedded in
·
engaging in interacting with wider eco-social systems
Neville evolved processes for
being a social catalyst for self-organising personal, family and community
transition. He evolved the following as Fraser House change structures and
processes:
·
Cultural Keyline
·
Total therapeutic community
·
Comprehensive community governance
·
Full family networking
·
Family-friendship networking
·
Intergenerational networking
·
Local and phone-based crisis and suicide support
·
Domiciliary care
·
Catchment areas
·
Big Group crowd and audience processes
·
Social category based small groups
·
Work as therapy
·
Psychosocial research as therapy
·
Values and moral vocabulary and dialogue
·
Values guided everyday life interacting
·
The weaving together of all of the above
Neville evolved a substantial body of
biopsychosocial praxis that may be used by both professionals in service
delivery and lay people in self-help in everyday life. The praxis also includes
processes for useful interfacing between professional and lay people in
supporting people towards increasing wellbeing. As such, Neville’s work is
fundamental for the likes of Workcover in
Neville suggested (Dec 1993, July 1998) that
Fraser House became a powerful influence in closing mental asylums within
This chapter commenced with criticisms made of Fraser
House in the Sixties and some responses to these. Replicating Fraser House in
Kenmore and
This concludes the set of
chapters on Fraser House. The following chapter documents the various
outreaches from Fraser House that Neville set up and enabled, and discusses how
these fit into Neville’s frameworks for evolving a social movement fostering
humane epochal transition.