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
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’.
|
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.
A FOLLOW-UP SERVICE AND LIAISON WITH OUTSIDE
ORGANIZATIONS.
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 Subjugating 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
CATCHMENT AREAS
Fraser House was
the first mental institution in
NEVILLE’S ACTIONS
TO PHASE OUT FRASER HOUSE
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’.
THE DECLINE OF
THERAPEUTIC COMMUNITIES
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
FRASER HOUSE
EVALUATION
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).
FRASER HOUSE A
MODEL FOR AMERICAN RESEARCH
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.
ETHICAL ISSUES IN REPLICATING FRASER HOUSE
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
INMA AND FRASER HOUSE
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
NETWORKING
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.
EX
FRASER HOUSE PATIENTS AND 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).
FINDINGS
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
A POWERFUL INFLUENCE
Neville suggested
(Dec 1993, July 1998) that Fraser House became a powerful influence in closing
mental asylums within
SUMMARY
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.