Chapter
Ten – Critiquing and Replicating
ORIENTATING
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.
CRITIQUE OF FRASER
HOUSE IN THE SIXTIES
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.
A RESPONSE
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
REPLICATING FRASER
HOUSE IN STATE RUN ENCLAVES - KENMORE HOSPITAL
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
FRASER HOUSE AND TRANSITIONS TO COMMUNITY
SELF CARING
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