An Australia Psychiatric Pioneer
The
Life Work of Dr Neville Yeomans
Written
2005. Last update April 2014.
A
Summary Paper derived from a PhD Dissertation
Abstract
The pioneering by Dr Neville Yeomans of community psychiatry, psychiatric nursing, psychiatric therapeutic
community, community mental health and other related practice in Australia is
outlined. Yeomans’ role as the founding director of Fraser House, a therapeutic
community based psychiatric unit in 1959 in North Ryde Psychiatric Hospital in
Sydney, Australia is detailed, along with his Fraser House outreach in
pioneering the application of psychiatry to social transformation towards a
more caring and humane global society. The adapting by Yeomans of his father PA
Yeomans’ Keyline sustainable agriculture practice (for working well with self
organising complex living systems) as Cultural Keyline, a model for psychiatry,
the psychological and social sciences, and the social life world is detailed.
Keywords:
‘Community, Keyline, Psychiatry, Therapeutic, Yeomans
Photo
One Neville and nurse at Fraser House in
1960 (Yeomans 1965a).
An Overview
This paper outlines psychiatrist Dr Neville Yeomans (1928–2000)
pioneering (Spencer 2006c) of psychosocial approaches in psychiatry (Engel 1977). Qualifying as a psychiatrist in the mid 1950s, Yeomans pioneered therapeutic community practice in 1959 as the founding
director of Fraser House, a therapeutic community based psychiatric unit in
North Ryde Psychiatric Hospital in Sydney, Australia. Yeomans also pioneered
community psychiatry, psychiatric nursing, community mental health, suicide/crisis
telephone services, psychosocial domiciliary care, small residential
therapeutic communities and dispersed non-residential therapeutic communities.
Yeomans adapted therapeutic community practice within civil society via
professional as well as peer-lead psychosocial self-help groups. These he
linked to social networking for psychosocial wellbeing. Yeomans further
explored civil society community enrichment via evolving public places and
villaging within cities, as well as via energising and enabling multicultural
festivals, gatherings and community based artistry.
I first met Yeomans in 1985. Thereafter he acted as my mentor for 13
years prior to my commencing research towards a PhD in July 1998, two years
before Yeomans’ death. During those 13 years we engaged in joint and separate
action research in over ninety different
contexts replicating all aspects of Yeomans’ earlier praxis (Spencer 2006b, Appendix 2)
Contexts and
Precursors
Yeomans’ first degree was in biology. He became a psychiatrist in the
mid 1950’s and completed other studies to become a sociologist and psychologist
in the early Sixties and a barrister in the early Seventies. Yeomans’ spoke of two major influences on his thinking and
acting, firstly, his early experience of personally receiving nurturing from
Australian Aboriginal and Islander women following two life threatening
traumas. Australian psychiatrist John Cawte (a friend of Yeomans) called this
indigenous social cohesion based healing ‘sociomedicine’ (Cawte 1974; Cawte 2001).
The second influence on Yeomans was his father Percival A Yeomans who
was recognised by the world famous English agriculturalist Lady Balfour in the
1970’s as the person making the greatest contribution to sustainable
agriculture in the world in the past 250 years. Yeomans worked closely with his
father and two brothers Allan and Ken on the family cattle farms West of
Sydney. The Yeomans family used nature as their guide in working with the
moment-to-moment context of the farm environment as an inter-dependent
self-organising complex living system. P. A. Yeomans called the processes he
developed with his sons ‘Keyline’ (Yeomans 1955; Yeomans 1958; Yeomans, P. A. 1971; Yeomans 1976; Yeomans
and Yeomans 1993).
PA Yeomans supported by Neville and Allan evolved ways
of being guided by context in working well with complex living systems,
especially their emergent and self-organising properties. Key concepts in PA Yeomans model are ‘Keypoint’ and ‘Keyline’. These
refer to specific features of land topography. The Keypoint is a specific place
just down from the main ridge in a primary valley. The Keyline is the contour
line through the Keypoint. Both of these features have very specific
implications for sustainable agriculture design (Spencer 2006b, Ch. 5). Keyline practice fosters nature’s
tendency for thriving.
Neville Yeomans adapted his father’s ‘Keyline’
sustainable agriculture practice as ‘Cultural Keyline’. Cultural Keyline is a
model for psychosocial psychiatric practice, the psychosocial sciences, as well
as the social life world. Cultural Keyline is also a way of perceiving,
sense-making and engaging with ‘the whole of it’ in social contexts. It is also
a way of working well with others in group contexts, and a way of enabling
system emergence, transition and evolution towards thriving.
The Yeomans particularly looked for the freely
available energy in the systems, for example, how to make maximal use of
gravity in distributing water, and how to maximise contexts for having massive
growth in soil biota for new soil generation. The free system energy is understood as the sum total of the potential
energies that are contained within the contextual resources. Cultural Keyline
is a method of employing this freely available potential energy, by processes
that increase the energetic resourcefulness of the contextual locality to
action sustainable wellness.
Neville Yeomans adapted PA Yeomans’ processes of
working with land topography to social and group topography. Just as the
Yeomans family was guided by nature on their farms, Neville Yeomans was
continually scanning the social environment and social topography for what to
do next. Yeomans found wisdom in the social milieu and was constantly guide by
that wisdom about what was fitting in the moment-to-moment unfolding context.
Method
This paper draws on the work of the PhD undertaken by
Spencer (2006b). The thesis used a
naturalistic inquiry based qualitative research approach. It used principles of emergent design (Lincoln and Guba 1985, p.208). To ensure
trustworthiness and following Denzin (1978), triangulation of data collection was used by simultaneously engaging
in in-depth interviewing, (1995, p. 81) prolonged action research, and archival research. Yeomans, and three
Fraser House ex-staff (a psychologist, a psychologist/ anthropologist and a
senior psychiatric charge nurse) were interviewed as well as a Fraser House ex-patient and an
ex-outpatient. Comments made by one interviewee
were crosschecked with the other interviewees.
In working with Geertz’s concepts of ‘thick description’ (1973) and holographic generalization (Lincoln and Guba 1985, p.125) I used thematic analysis (also called Narrative Analysis). In this I was guided by Kellehear (1993, p. 38) and Miles and Huberman (1994). For analysis I drew on
Berger and Luckman’s notion of ‘typification’ (1967) in looking for what Eisner calls, ‘structural collaboration’ -
‘recurrent behaviours or actions, those theme-like features of a situation that
inspire confidence that events interpreted and appraised are not aberrant or
exceptional, but rather characteristic of the situation (1991, p. 101)’. As well Eisner’s (1991, p. 63) ‘connoisseurship’ was
used, defined by him as ‘the ability to make fine-grained discriminations among
complex subtle qualities’. Connoisseurship is ‘the art of appreciation’. A
fundamental aspect of connoisseurship is ‘allowing the situation to speak for
itself, that is, to allow for an emergent focus’ (1991, p. 176).
This method of analysis is resonant with both Yeomans’ Cultural Keyline
practice and his father’s Keyline, both of whom used an emergent focus on the
emergent tendencies of complex systems. Yeomans never mentioned either of the
terms ‘Keyline’ or ‘Cultural Keyline’ in any of his Fraser House writings.
While ‘Cultural Keyline’ is such a central concept to Yeomans and his way, I
have found no mention of this term in any of his other writing either. However,
Cultural Keyline is implicitly present throughout Yeomans’ writing and
action if one understands the term and how to discern it. Yeomans had not used
the term with Margaret Cockett or Stephanie Yeomans, the two he discussed most
things with.
Yeomans first mentioned the term ‘Cultural Keyline to me in Yungaburra
in December 1991 in the context of my starting a PhD on his work. When I asked
Yeomans to explain Cultural Keyline, Yeomans changed the topic saying that I
already knew all about it. This puzzled me as I had no idea what the term
meant. I again asked in December 1993 and he suggested that I read his father’s
Keyline writings. Then I may discover Cultural Keyline in my own actions. After
his death in May 2000 I realised that Yeomans was aware that through his subtle
modelling of his behaviour in my presence, I had absorbed aspects of his way
and regularly used Cultural Keyline in my action research in his presence, even
though I did not know my actions were consistent with Cultural Keyline. I sense
that Yeomans’ view was that head knowing alone will limit understanding of
Cultural Keyline – understanding has to emerge through the embodiment of
values-based relevant experience.
A challenge in researching Yeomans and his work is that his ways were
essentially inexplicable. Another complicating factor in this research was that
there were fractal forms to everything Yeomans and his father were engaged in,
although these are not immediately obvious. If this fractal quality and the
interconnected and inter-dependent nature of Yeomans praxis is not recognized,
as it was not recognized by me for halfway through my research, an inquirer
would miss the inter-related, inter-connected and inter-dependent essence and
potency of Yeomans (and his father’s) work. Any amount of analysis of the parts
that missed their inter-relatedness, or laboured to make links when they are
already pervasive, would again miss the essence.
Every aspect of the above research method is resonant with all aspects
of Neville Yeomans’ praxis. Cultural Keyline was found as a fractal-like
repeated pattern in Yeomans’ diverse psychiatric action.
Literature Review
This segment provides a brief literature review as
background to my research into Yeomans’ lifework.
Bloom (2005, p.77) identifies the rise
of biopsychosocial approaches in psychiatry in the 1920’s and also traces
the professional links made by psychiatrists to evolve their specialty in the
same decade. Colloquia were held in 1928 and 1929 under the auspices of the
American Psychiatric Association Committee on Relations with the Social
Sciences. As well as psychiatrists, the colloquia attendees were psychologists,
political scientists, anthropologists and sociologists.
These two colloquiums helped forged psychiatry’s links with the social
sciences. In the context of this reaching out to the social sciences and as an
indication of how psychiatry was viewed by the medical profession in the
1920’s, the APA chairperson White stated during the 1929 Colloquium:
The specialty of psychiatry is almost universally neglected by medical
education (White 1929, p. 136).
Bloom writes:
Collaboration between
sociology and psychiatry is traced to the 1920s when, stimulated by Harry Stack
Sullivan and Adolph Meyer, the relationship was activated by common theoretical
and research interests. Immediately after World War II, this became a true
partnership, stimulated by the National Institute of Mental Health, the Group
for the Advancement of Psychiatry, and the growing influence of psychoanalytic
theory.
Bloom continues (2005, p. 81):
One piece of evidence of this development was
the emergence of the new subspecialty of social psychiatry. Initiated in Great Britain,
it reflected the importance of broad environmental factors in the aetiology of
mental disorders.
Bloom (2005, p81.) quotes Grob (1991) writing that it was,
…..the triumph of the psychodynamic
approach….that set the stage for the collaboration and cross-fertilization of
psychiatry with the behavioural and social sciences in the 1950s.
Speaking of the 1950-1970 period Bloom (2005, p. 82) discusses important changes in psychiatric approach and educational method:
…the focus was on
human behaviour, and the theoretic model was psychodynamic. George Engel, in what
he called the biopsychosocial model, gave voice to this point of view more than
any other single voice.
Engel and others argued for both medicine and psychiatry to be modelled
on the biopsychosocial:
To provide a basis
for understanding the determinates of disease and arriving at rational
treatments and patterns of health care, a medical model must also take into
account the patient, the social context in which he lives, and the
complementary system devised by society to deal with the disruptive effects of
illness, that is, the physician role and the health care system’s. This
requires a biopsychosocial model (1977, p. 32).
Engel makes the point that:
Other factors may
combine to sustain patienthood even in the face of biochemical recovery.
Conspicuously responsible for such discrepancies between correction of
biological abnormalities and treatment outcomes are psychological and social
variables (1977, p.132).
World War Two created a context that contributed to major change in the treatment
of the mentally ill towards using psychosocial approaches. By the end of the
Second World War both UK and the United States had large numbers of returning
soldiers and former prisoners of war suffering from what was called ‘war
neurosis’. Totally socially withdrawn, these people were being ‘warehoused’ in
the back wards of asylums - conditions replicating, and in some respects more
hopeless than their former prison camps where they could at least hope for the
end of the war. David Clark (1974) one of the pioneers of therapeutic community writes of the term
‘therapeutic community’ first being used in the United Kingdom in 1946 by Main
to describe the processes at Northfield Hospital, Birmingham.
Clark writes:
There, a group of
psychoanalysts and group therapists working with demoralized psychoneurotic
ex-soldiers developed a new pattern of institutional life (1974, p. 29).
In contrast to the conventional asylums, Jones writes of starting at
Belmont Hospital in 1941 to provide psychiatric support of a different kind to
returning soldiers:
By great good fortune
I was asked to organize a treatment unit for British ex-prisoners of war who
had just returned from the prison camps in Europe. We developed a ‘transitional
community’, which helped to rehabilitate men who had been shut away from
ordinary society for up to five years and who had to adapt to a world which had
largely forgotten them.
And so, almost
imperceptibly we moved from the idea of teaching with a passive, captive
audience, to one of social learning as a process of interaction between staff
and patients.
Maxwell Jones is recognized as the main developer of therapeutic
community in the UK (Jones 1953; Jones 1957). The therapeutic community process was
largely responsible for the return of war neurosis soldiers to mainstream
society. According
to Jones, at Fulbourn Hospital:
…the group that benefited most from the therapeutic
communities were the patients (and staff) trapped in long-stay wards. By 1980
most of those patients had left hospital (1996).
Sandra Bloom (1997) refers to Harry Wilmer’s development of therapeutic community in the
USA as having similarities to the UK treatment of war neurosis.
Bloom (2005, p81) quotes Grob (1991) writing that it was:
The effects of a
sociology that focused on issues of health and illness proceeded to grow in
medical education, research, and the treatment of mental illness until 1980,
when a distinct shift of emphasis in psychiatry occurred.
After the rise of biopsychosocial approaches
in the 1920’s there was a move away from the biopsychosocial to a
biopharmacological model in the 1980’s (Bloom 2005, p. 77):
In its role as educator of future physicians,
post-war psychiatry developed a paradigm of biopsychosocial behaviour but,
after three decades, changed to a biopharmacological model.
David Clark, in Chapter Eight of his book ‘The Story of a Mental
Hospital: Fulbourn, 1858-1983’ (1996) details his views about factors leading to the decline of therapeutic
committees in the UK National Health system. Clark’s observations can be seen
in the context of a psychiatric profession shifting to a biopharmcological
model around the 1980’s as discussed above.
In 1970, four wards in Fulbourn hospital had been therapeutic
communities and a number of hospitals had therapeutic communities. David Clark
writes of the UK experience:
During the 1960s
therapeutic communities had started in many psychiatric hospitals; Henderson,
Claybury, Littlemore, Fulbourn, Dingleton and Ingrebourne became well known. In
the 1980s therapeutic community wards stopped operating, units were closed,
hospitals famous for being committed to therapeutic community principles, such
as Claybury, dwindled in size and ultimately were being closed down (1996).
Clark (1996) suggests that in his opinion:
The root cause is the
incompatibility of an egalitarian, democratic ward culture with the
authoritarian, bureaucratic organization which the National Health Service has
gradually become.
… the hostility of
powerful senior doctors to a system that devalued their expertise and
challenged their power worked against it, and the National Health Service
Bureaucracy of the 1990s, with its emphasis on ‘business management’, strict
economy, and answerability upward could not tolerate a system so challenging,
so revolutionary and so irregular.
Enthusiasm and hope
do not appear in accounting systems.
Evolving
Community Psychiatry at Fraser House
Yeomans recognized that in 1957, with considerable upheaval and
questioning in the area of mental health in New South Wales and a Royal
Commission being mooted into past practices, there was a small window of
opportunity for innovation in the mental health area. Fraser House was purpose
built for Yeomans during 1968-1969 by the New South Wales Health Department as
an 80-bed residential unit on the grounds of North Ryde Psychiatric Hospital.
Yeomans was aged thirty-one when he obtained the go-ahead from the Health
Department to take in male patients at Fraser House in September 1959.
At either end of the administration block there was a double story 39
bed ward, and there was a dining room at each end. There was a separate staff
office in each ward. Most rooms were 4 bed dormitories. There were a few single
rooms in each ward. The female ward opened in October 1960. Yeomans rearranged
room allocation so there were no separate wards for males and females, although
bedrooms remained same sex. One dining room became the social and entertainment
lounge.
Yeomans evolved Fraser House as a short-term residential unit assuming a
social basis of mental illness. While maintaining balance between diagnostic
categories (Spencer 2006b, Appendix 5) Fraser House treatment was
sociologically oriented. It was based upon a social model of mental dis-ease
and a social model of change to ease and wellbeing. Regardless of conventional
diagnosis, in Fraser House dysfunctional patients typically would have a
dysfunctional inter-personal family friendship network. Yeomans took this
social basis of mental illness not out of an ignorance of diagnosis; he was at
the time a government advisor on psychiatric diagnosis as a member of the
Committee of Classification of Psychiatric Patterns of the National Health and
Medical Research Council of Australia (Yeomans 1965, Vol. 12, p. 96). This networked dysfunctionality among prospective patient networks was
the focus of change at Fraser House. Consistent with this, before admittance
was considered, a prospective Fraser House patient had to attend Fraser House
Big and Small groups twelve times along with members of his or her
family/friend network, with all of them signing in as outpatients.
Admittance was also dependent on the network members undertaking to
continue attending Fraser House groups as outpatients throughout a patient’s
stay. During the 1960s, Fraser House had around 13,000 outpatient visits per
annum. Fraser House patients arrived at Fraser House typically with a small
(less than six) dysfunctional family friendship network and left in twelve
weeks (the maximum stay) with a functional network of around seventy people,
most of whom lived in the same locality as the patient. Ex-patients could, by
arrangement, return three times for further stays at Fraser House. Fraser House
processes ensured these seventy-people networks were being linked into other
Fraser House based networks in an extended network of networks.
Sourcing Patients and
the Fraser House Milieu
Yeomans sustained Fraser House as a balanced community in a number of
respects. Half the patients at any one time were from asylum back wards and half
were from prisons. Half were male and half were female. Half were under-active
and half were over-active. Half were under-controlled and half were
over-controlled. Half were under-anxious and half were over-anxious. Having
opposites sharing the same dorm was based on the principle that the presence of
opposites creates a metaphorical normal position in the middle. Fraser house
research showed that there was a tendency towards the mean, with the
under-controlled becoming more controlled, and less active; the over-controlled
becoming less controlled and more active.
Yeomans was quoted as saying, ‘We have a plan to
transfer to the Centre over a period of time all fifty Aborigines who are now
patients in NSW mental hospitals (Daily Mirror 1962).’ This
happened and apart from a few that needed full time care because of associated
medical conditions, all of these people passed through Fraser House and were
returned to their respective communities.
Like Maxwell Jones in the UK (Clark, 1974, p. 29) Yeomans evolved Fraser
House as a transitional community. In Fraser House everything was in constant
change and flow – staff, patients, outpatients, processes, policies, and
procedures. Like the water in motion in the whirlpool, in Fraser House,
structure was process in action. Every aspect of Fraser House process supported
the emergence and growth of functional nested networks of around seventy
people.
It is possible that in 1960 Fraser House was the only clinic in the
World where alcoholics and neurotics mingled 50% and 50%. In 1960 the Unit was
referred to as the Alcoholics and Neurotics Unit. The male Unit had both single
and married men. In 1960 married men who were alcoholics could have their wives
stay with them regardless of whether the wife was an alcoholic or not. The
couple was the focus of change. This was the start of eight family suites.
Whole families with two and three generations, from babes in arms to the
elderly were involved in the suites. Yeomans pioneered family therapy and
inter-generational therapy in Australia. In 1961, referrals were accepted from
patients, and family and friends were admitted. In 1963 whole families were
admitted. Desegregation of family units and single patients occurred in 1964.
Big and Small Group Process
The Fraser House Handbook refers to audience and crowd
behaviour, especially contagion, being a central aspect of Big Group (Yeomans,
N. 1965a, Vol. 4, p. 18-20, 50-54). In Yeomans’ paper, ‘Collective Therapy –
Audience and Crowd’ (1966) he wrote, ‘the skilled use of collective forces is
one of the paramount functions of the socio-therapist and such skills are
defined by the team as ‘Collective Therapy’. In Yeomans paper,
‘Sociotherapeutic Attitudes to Institutions’ he wrote, ‘Collective therapy,
both audience and crowd, utilizes social forces in the patients’ primary group
(Yeomans, N. 1965a, Vol. 12, p. 46, 60-61).’ Yeomans engaged all involved in
Fraser House (staff, patients and outpatients) in recognizing, understanding
and utilizing these social forces.
In Fraser House, it was not just ‘therapeutic
community’ in name - Community was the
therapy. Big Group utilised both crowd and audience effects. The Big Group room was rather small for the numbers that crammed into it
- around 8 metres by 16 metres. So that everyone could see everyone at Big
Group, moveable wooden tiers were set up along each of the long sides of the
Big Group room. Staff, patients and outpatients were all mixed together in a
self-organising process. A raised podium was set up at the far end for the two
recorders who kept a transcript of the proceedings. Yeomans as well as ex-staff
members Bruen and Chilmaid (April 1999) confirmed that typically, the attendees
sat in two rows along both of the long sides. Attendees were all jammed in
shoulder to shoulder. When the numbers exceeded 180, there would be three rows
along one or both of these long sides.
A half hour break followed Big Group where staff reviewed the Big Group
chairperson’s use of theme, and his or her modes of interacting with the
attendees, as well as group mood and values. During this review other attendees
of Big Group took refreshments in another room.
After the half hour break, staff and attendees were split up into many
small groups where group membership was based on a
revolving set of sociological categories. The
composition of small groups varied daily. All the small groups at any one time
were based on the same category. The social categories were:
o
age
o
age and
sex
o
kinship
o
locality
o
married/single
status, and
o
social
order (manual, clerical, or semi-professional/professional).
Friday’s Small Groups
were made up according to both age and sex for both staff and patients. This
was the one exception to the non-segregation policy. Often inter-generational
issues, including sexual abuse issues, were the focus of these Friday groups. Age grading was deemed very important, as it is one of the
basic divisions in society. Age grading allowed space for sorting out
inter-generation pathology that was very prevalent. People in
pathological social networks would be all together with everyone else in Big
Group. However, because of the
continual changing composition in small groups, the members of these
pathological networks were regularly split up (cleavered) for the small group
sessions.
Any
visitor coming regularly on certain days of the week would find that they would
be attending groups based on differing categories. For the small groups based
on locality, Sydney was divided into a number of regions. In most cases, groups
of people came regularly on the same trains, buses and each other’s cars so
they all got to know each other. Patients and Outpatients would attend the
small groups allocated by locality for their region of normal domicile. The
Unit’s aim was to increase the patients’ role-taking functionality and
psychological comfort towards their returning to functional life in their local
community with an extended and functional family/friendship/
workmate network, typically of around seventy people. This meant that
people who arrived with a social network that was smaller than typical in
society, ended up having one that was typically larger in terms of the number
of people in the ‘closely known and regularly interacting’ part of their social
network.
After a
time at Fraser House these individual patient family/friendship networks would
expand to have members with cross-links to other patient’s networks, and with a
continual changing Unit population, with overlap in stays, these nested
patient-networks became very extensive. As well, all these people had Fraser
House experience in common, and a common set of mutual support skills.
Both Big
and Small Groups were run like meetings. Typically, one staff person ran the
Small Group and another staff person was a process observer, on-sider and
trainee. The nurses mainly conducted Small Groups. The Fraser House Handbook
written by a group of patients specifies the nurse therapist role in Small
Groups:
The role of the Small Group therapist and observer has
always been the province of the nurse in Fraser House, and represents part of
the rise in therapeutic status. Nurses have become therapists in their own
right.
The first essential in taking a group is to see it as
a meeting, and like all meetings, there is a need for a chairman to conduct
affairs and keep issues to the point.
The initial function of the therapist is to see that
the group functions as a group (Yeomans, N. 1965a, Vol. 4, p. 18).
Cultural Keyline and Group Process
In Keyline the three
features of the topography, main ridge, primary ridge and primary valley all meet
at the Keypoint (Spencer 2006b, Ch. 5). The three features are information
domains with different energies involved in linking to the Keypoint. There is
only one Keypoint per primary valley. In both
Big and Small Groups, interaction was based on themes that emerged from the audience. The themes chosen had the particular quality
of being conducive to coherence. The above was documented in a staff
handbook written by a group of patients (Yeomans 1965, Vol. 4, p. 1-54). Isomorphic with Keypoint, a theme conducive to coherence selected as a
Big Group focus became a Keypoint for discussion and would generate Keylines of
discussion (again isomorphic with his father’s Keyline). Where the attendees
were located in the social topography would be a function of the thematic
Keypoint. With one particular theme, say domestic violence, some would be on
‘the high ground’ on the ‘main ridge’ others would be on the sides on one or
other of the ‘primary ridges’ (each with a different kind of energy) and others
would be in the ‘valley’ (again, with a different kind of energy). A theme
change to say incest may change people’s place in the social topography.
Yeomans used Cultural
Keyline perception to determine when and if to change theme (a new Keypoint) as
this was very significant. A change
in theme was a change in Keypoint and hence a change to another ‘primary
valley’. This may alter people’s place in the social topography. How the use of
theme, mood, values and interaction are isomorphic with Yeomans father’s
concepts of ‘Keypoint’ and ‘Keyline’ are detailed in the related PhD (Spencer 2006b) and on a series of radio programs (Spencer 2006d). Yeomans was using Cultural Keyline perception in leading Big Group. He
was continually monitoring, theme and theme change, mood and interaction. In
having these aspects as discussion themes during review sessions, Yeomans was
inducting staff into Cultural Keyline perception and practice.
Protecting the Unit
Yeomans had the support of people at the top of both
the Health Department and North Ryde Hospital. This was crucial to getting
Fraser House started and surviving as many key people in the department wanted
it closed for the same reasons mentioned above by David Clark (1996). Yeomans protected Fraser House through setting up both internal and
external Fraser House research programs. Student’s degrees would have been
placed at risk if the Unit was closed. Alfred Clark, a psychologist from the University of
NSW headed up the External Fraser House Study Team. Clark‘s PhD was on Fraser
House (Clark 1969) and Clark and Yeomans wrote a book
together on the Unit (1969). Staff and Patients were also involved in research as a therapy
process.
To
further protect the Unit, Yeomans regularly gave public addresses about Fraser
House. He wrote many press releases and had the media attend groups at the
Unit. People from religious, business, academic, non-government and government
organizations including the Federal Government Foreign Affairs Department
attended Fraser House groups. Requests to attend were typically granted and
Fraser House became a major centre for learning group skills.
Governance Therapy – The Fraser House Committee Process
Within Fraser House Yeomans pioneered psychiatric patient committees in
Australia. He set up a process whereby patients and their family-friendship networks,
as outpatients, were massively involved in meetings and committee work. Members
of patients’ family friendship networks were required to sign on as Fraser
House outpatients and to attend Big and Small Groups as well as to offer
themselves for election to serve on committees. Fraser House patients and
outpatients progressively took on responsibility for their own democratic
self-governance. Patients and Outpatients effectively became responsible for
the total administration of Fraser House.
Yeomans referred to patient-based rule making as
creating ‘a community system of law’ (Yeomans, N. 1965a, Vol. 4). Fraser House
law evolved out of the evolving shared life experience together – their local
lore. The initial vehicle for evolving the Fraser House democratic
self-governance was a committee that decided the ground-rules for ward life
called appropriately the Ward Committee. Other committees were added to the
Governance process so that eventually the committees mirrored the roles of
every section of the Unit’s administration. The
respective roles that were devolved to the committees were psychiatrist, charge
nurse, nurse, occupational therapist, social worker, and administrator.
Every committee member had one vote. Patients and
outpatients outnumbered staff on all committees by design. This meant that
patients and outpatients together could out-vote staff. This often happened.
Neville set the committee ground rules such that he had a power of veto.
Dissenting people (staff, patients and outpatients) who felt strongly enough
about being out-voted could take the decision before Neville and the decision
would be held over till he attended the particular committee where people would
present their views.
This
three level (local, regional, and global) governance at Fraser House is a
micro-model of the ‘local regional global self-governance’ model that Yeomans
detailed in his paper called ‘On Global Reform’ (1974) setting out how
community psychiatry and Cultural Keyline (for those who know how to discern
it) may contribute towards societal transition to a more caring and humane
world – Epochal Shift. Only Margaret Cockett his personal assistant at Fraser
House, and Stephanie Yeomans (who worked as a psychiatric Nurse up the hill at
North Ryde Hospital) (his younger brother Ken’s first wife) knew that Yeomans
was using Fraser House as a model for the re-constituting of a collapsed
society and epochal shift.
Work as Therapy
It was commonly acknowledged by my interviewees and within archival
records that psychiatric patients and outpatients became the most skilled in
the emerging new field of community psychiatry – even ahead of the Fraser House
psychiatric staff whose prior education and training had in no way prepared
them for the Fraser House milieu. Fraser
House became the centre for training psychiatrists in community psychiatry,
with the patients as the primary source of training (Yeomans, 1989, 1992, 1993,
1997, 1998; Bruen, April 1999; Chilmaid, April 1999). Three years after the Unit started the Australian and
New Zealand College of Psychiatry co-opted Fraser House patients as trainers of
trainee psychiatrists in the new area of community psychiatry.
In a Fraser House staff handbook it was reported that
patients were engaged in doing the following work:
Perhaps
the most immediate observation made by a nurse coming to work in this
therapeutic community for the first time, is that the patients themselves have
had a great deal of authority delegated to them. Indeed, in some matters they
are virtually the sole authority. At first glance it will seem fantastic that
patients assess and admit new patients; review progress and institute treatment
procedures; make new rules and alter old ones; mete out discipline, etc.
(Yeomans, N. 1965a, Vol.4, p. 17).
Committees of patients prescribed community non-drug
based treatment. At first this may sound a bizarre and dangerous notion. And
yet all the reports in archival material and from interviews with the
psychiatrist, psychologists - and a senior charge nurse said the same thing -
the patients quickly emerged as the most skilful in community therapy.
According Yeomans and the ex staff members Warwick Bruen, and Phil Chilmaid, none
of the professional training of the Unit’s staff had in any way prepared
them for engaging in community therapy. Patients had the advantage that they
lived therapeutic community every day in the Fraser House milieu. They were
emersed in it.
Patients who became experienced in community
psychiatry were elected as members of the
patient assessment committee. The
archival material, especially the Fraser House Handbook written by patients to
train new staff (Yeomans, N. 1965a, Vol. 4, p. 17-20, 50-54), and the research
interviews all support the view that patients became highly skilled in carrying
out their committee and other work That
handbook included succinct sections firstly on the role of the psychiatric nurse
at the Unit, and secondly, on the processes for leading Big and Small Groups at
Fraser House.
I have access to embargoed Fraser House records that
include some of the reports of the Initial Assessment Committee made up of patients.
I have read restricted material including case records and the patient-run
Assessment Committee’s initial assessment on the same patients. It was apparent
that the insights in the initial assessment were congruent with the dynamics
that unfolded for particular patients. The assessments by patients read like an
extremely skilled, insightful and psychosocially-emotionally wise and
discerning community psychiatrist wrote them. This is consistent with the
expression, ‘It takes one to know one’.
As an indication of the staff, patient and outpatient
competence, they effectively self-organised and ran the Unit during Yeomans
absence overseas for nine months in 1963. For a numbers of weeks after Yeomans
left there was no replacement psychiatrist (because of no replacement being
found in time by the Health Department) and things went smoothly in the Unit.
Linked to this involvement in Fraser House governance was the use of
work as therapy. Progressively, all staff roles were taken on by patients with
support. The principle was ‘give the job to those who can’t do it, with support
so they learn to do it through experience’. To provide refreshments between Big
and Small Groups the patients sought and got permission from the North Ryde
Hospital Director to set up, own and operate their own canteen. Patients with
low social skills were assigned by patients in the Canteen Committee to
purchase stock for the canteen and sell goods. Patients lacking integrity were
put in charge of the money - to learn ethical behaviour. There was plenty of
therapeutic strife. At one time the
Fraser Canteen was staffed only by residents less than twenty years of age.
This would have created scope for sustained inter-generational relating with
suppliers and customers.
As another example of work as therapy, Fraser House patients tendered
for a public contract to build an outdoor bowling
green in the grounds of Fraser House. They won the tender and built the
bowling green. It is still functional to this day.
Photo Two Patients
Building the Fraser House Bowling Green in the Sixties with a Dormitory in the
Background
A Photo from
the Sydney Morning Herald (11 April 1962)
Fraser House pioneered home visits and domiciliary care by psychiatric
nurses and patients. A Fraser House monograph reports that follow-up groups to
homes became routine in 1962 (Yeomans, N. 1965a, Vol. 4, p. 2-4). Patients, who
had substantially changed to being psychosocially functional, and had been
assessed as being proficient as co-therapists, and were anticipating leaving
the hospital themselves, would call on ex-patients and their families and
friends to assist and resolve difficulties (Yeomans, N. 1965a, Vol. 5, p. 63).
Fraser House, patients were helping ex-patients settle back into the community before
they became ex-patients themselves. Patient members of the Domiciliary Care
Committee started to go on suicide crisis calls into the community often late
at night (Clark and Yeomans 1969, p.69-70). This service was the precursor to today’s crisis telephone line
services.
The patients used canteen’s profits to purchase and run a little red van
that the patients used for domiciliary care and suicide crisis calls. A group
of patients would often go, without staff, on these domiciliary visits. The
Follow-up Committee would also be continually requesting the visitors,
relatives and friends for patients to be able to use their cars and petrol to
conduct domiciliary visits (Yeomans, N. 1965a, Vol. 5, p. 63).
Yeomans wrote that these patients involved in domiciliary care work and
crisis support were very skilled (Yeomans, N. 1965a, Vol. 5, p. 106).
Participating in Domiciliary Care was not time based - ‘so many months prior to
leaving’ - rather ‘psychosocial health and competency’ based. After a time it
was decided to keep activity records and during the first nine weeks of
activity recording (1 July 1963 to 6 Sept 1963) there were 71 group activities
to homes. The average was just under 8 visits per week with a range of 5 to 12
per week.
Expecting Change
Unlike jails and lunatic asylums where inmates are expected to be mad
and/or bad, no badness or madness was tolerated at Fraser House. Both patients
and outpatients knew that the very strong expectation within the Unit’s milieu
was that, ‘here people change and return to wider society well’.
In the Unit there were many continually repeated simple slogans
reinforcing values based behaviours. The requirement that patients and
outpatients get on with self and mutual healing and interrupt any mad or bad
behaviour in self and others was reinforced with the mantra, ‘No mad or bad
behaviour here’. The expectation of change was conveyed by, ‘You can only stay
three months, so get on with your change.’ New arrivals would have a settling
in period where their mad and bad behaviour would be pointed out to them.
Increasingly, mad and bad behaviour would be interrupted.
Psychiatric Research Study Group
Yeomans set up the Psychiatric Research Study Group that met monthly on
the grounds of the North Ryde Hospital adjacent the Unit. The Group was a forum
for the discussion and exploration of innovative healing ideas.
Yeomans and the study group networked for, and attracted very talented
people. Students of psychiatry, medicine, psychology, sociology, social work,
criminology and education attended. The Psychiatric Research Study Group became
a vibrant therapeutic community in its own right and had a strong relation with
Fraser House. Yeomans described it as the premier
social science research group in Australia at the time. Yeomans would
immediately test anything raised in the Study Group that seemed to fit the
milieu in Fraser House in the Unit. At one
time there were 180 members on the Psychiatric Research Study Group mailing
list. Neville wrote that the Study Group:
…represents
every field of the social and behavioural sciences and is the most significant
psycho-social research institute in this State.
The
Psychiatric Research Study Group maintains a central file of research projects
underway throughout NSW and acts in an advisory and critical capacity to anyone
planning a research project’ (Yeomans, N. 1965a, vol. 4, p. 24).
The paper Realising Human
Potential refers to the action research of the Psychiatric Research Study Group
and a sister group started by Dr Yeomans in the 1980s. Realising Human Potential explores the rollout from Neville’s work
in the 1960s towards consciousness raising and better global futures.
Margaret Mead Visits
Fraser House
Margaret Mead the anthropologist and
Co-Founder (1948) and ex-President (1956/7) of the World Federation for Mental
Health (Brody 2002) visited Fraser House in the early Sixties. She
described Fraser House as the most total and the most complete therapeutic
community she had ever visited anywhere in the world. Margaret
Cockett, herself an anthropologist, recalled Margaret Mead saying during her
visit that she was very taken with the concept of therapeutic community and had
visited many such communities in different places. Mead ably conducted the
morning Big Group and ran a Small Group (from discussions with Yeomans, April
1999 and Cockett April 1999). Cockett described Mead as being highly skilled in
the role of leader of both Big Group and one of the Small Groups. Margaret Mead
also took the regular half hour staff group meeting that followed the Big
Group.
Yeomans writes of Margaret Mead ‘heaping praise on
every aspect of the Fraser House therapeutic community’ in talking with a
number of senior people from the Health Department who joined Margaret Mead for
lunch at the Unit, (Yeomans 1965, Vol. 12, p. 68). A Fraser House staff
file note states:
Dr Margaret Mead,
world famous anthropologist who visited Australia last year attended a meeting
of the Psychiatric Research Study Group and also stated that she considered
Fraser House the most advanced unit she had visited anywhere in the world (Yeomans 1965, Vol.
12, p. 69).
Phasing Out Fraser House
Yeomans had supported the successful replication of Fraser House at the
Kenmore Therapeutic Community, a 300 bed Unit set up by Dr N. Mitchell and Dr J. Russell on the grounds of Kenmore Psychiatric Hospital, a large 1800 bed Lunatic
Asylum at Cambelltown, South of Sydney (Evening Post 1963). A Fraser House ex-staff member Dr Madew also replicated Fraser House
at Callan Park - another large Lunatic Asylum where the therapeutic community
was called Bayview House. Both Kenmore and Bayview house therapeutic communities
were state run enclaves like Fraser House. Yeomans wanted
his ideas spreading outside of State control. His next step was to move Fraser
House process way out into the community and to slowly move community-centred
action away from service delivery and towards grassroots self-help and
mutual-help (Yeomans, Widders et al. 1993). Yeomans spoke (Dec, 1998) of this as, ‘returning wellbeing processes
back to grassroots folk’.
It is one thing to evolve therapeutic community within an enclave;
Yeomans wanted to action research processes for evolving mutual help processes
in civil society. His Big Picture was global societal change by innovation at
the margins (Yeomans, N. 1971). In discussion with Yeomans (Nov 1998) about his
leaving the Unit he said that while Fraser House had been a seminal step, it
was still a State run enclave. In a document marked ‘confidential’
called, ‘A Community Developers Thoughts on the Fraser House Crisis’ (1965, Vol. 2, p. 46-48), Yeomans writes of actions that he had set in motion 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.
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 1965, 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 Ryde Municipality. The major Therapeutic function of Fraser House will
now be as the centre for an intense Regionalized Community Psychiatric
Programme. This programme is aimed at reducing the rates of mental and social
illness in this part of Sydney as a pilot programme and involves a vast
increase in the outward orientation and responsibility of the Unit.
The Fraser House handbook for new staff has a segment on the Nurse’s
Role:
Nurses are assigned
in teams to regional areas at the moment; Lane Cove, Ryde, the rest of North
Shore, and other areas. Each regional team is expected to be responsible for
knowing its area, its problems and helping agencies etc. Moreover, nurses in
each team are expected to come to know all in-patients and out-patients of that
area; to be specially involved in the appropriate regional small groups, both
in the community and in the Unit; to record progress notes on their regional
patients; to be part of both medical officer and follow-up committee planning
for the patients of their region (Yeomans 1965, Vol.
2, p. 18).
Yeomans next exploration was the evolving therapeutic community in civil
society, and exploring possibilities whereby therapeutic communities may
self-organise like natural systems on their farms. Yeomans left Fraser House in 1968 and devoted himself to extending the
transformative ways evolved at Fraser House into wider society.
Extending Fraser House Way into Civil Society
While still at Fraser House Yeomans had written the job description then
applied for, and then became the first NSW Director of Community Mental Health.
He started Australia’s first Community Mental Health Centre at Paddington in
Sydney. Yeomans also started Paddington Bazaar, Sydney’s iconic Saturday
community market to surround his first community mental health centre with a
small village atmosphere. Paddington Bazaar continues to this day as a Sydney
icon (Mangold 1993, p. 4).
In the ensuing years Yeomans used his Cultural Keyline model in
pioneering family therapy, suicide-crisis telephone services as well as
counselling and family therapy within family law. Yeomans also evolved a number
of psychosocial self-help groups (Spencer 2006b, Appendix 30). Another focus was multicultural festivals as contexts for action
researching the self organising emergence and strengthening of social networks
among nurturers (Laceweb-Homepage 1995a). Networking naturally occurs at these festivals in a self-organising
way. Yeomans first gathering was the Watsons Bay Festival in 1968. He also
organised the Centennial Park Festival covering 540 acres, described by the
media as Australia’s first hippy Festival (Sydney Morning Herald 1969). With support Yeomans energised other festivals leading to the large
Aquarius Festival in 1973 in Nimbin, NSW. Along with Australia’s Deputy Prime
Minister Jim Cairns and others, Yeomans evolved ConFest (Mangold 1993, p. 4) an alternative
lifestyle bush-land campout conference festival that commenced in 1976.
‘ConFest’, meaning ‘Conference Festival’ continues twice yearly to this day run
by Down To Earth Victoria Inc. (DTE). A core group of around 100 ensure that a
place is available in the Australian bush with pit toilets and a water supply.
Around 3,500 people attend and over 350 workshops, concerts and events emerge
through a spontaneous self-organising process (Spencer 2006a).
Photo 3 ConFest on Gulpa Creek– Photo from
DTE’s Archive
The preparation of the festivals and gatherings created rich contexts
laden with possibilities for community to emerge and opportunities for
integrated and dispersed social networking to occur. Other processes Yeomans
pioneered in Australia were cultural healing action (Yeomans and Spencer 1993), as well as mediation and mediation therapy (Carlson and Yeomans 1975).
During 1971 to 1973 Yeomans led three Gatherings in the Armidale Grafton
Area in Northern New South Wales called ‘Surviving Well in a Dominant World’
attended by Aboriginal and Islander and other marginal people from around
Australia reported by psychiatrist Max Kamien (1978) and Sociologist Margaret Anne Franklin (1995). Outreach by Yeomans and others linked to these gatherings supported
the evolving of therapeutic community based networks among Australian
Aboriginal and Islander nurturers. From 1972 onwards, Yeomans evolved a number
of small therapeutic community houses in North Queensland in Mackay (Wilson 1990, Ch 6), Townsville, Cairns, and Yungaburra, and in the Darwin Top End.
Micro-Models Towards
Evolving Global Futures
Yeomans evolved what he termed ‘International Normative Model Areas’ or
‘INMAs’ in Northern Australia that continue as a micro-model exploring linked
local, regional and global governance as an aspect of epochal transition
towards a more humane caring world respecting diversity and all life forms (Yeomans 1980).
In Fraser House, Yeomans was evolving a local regional global holistic
bottom-up folk-model for re-constituting collapsing and collapsed societies.
Patients and outpatients in the Unit were evolving their lore and law in
self-governance. They were mutually supporting each other in re-constituting
themselves, as together they constituted their Fraser House social reality.
Yeomans’ paper ‘On Global Reform’ (1974) outlining a 250 year epochal change process places his process as an
applied micro-model in the context of theoretical models evolved through a
network of academics and others called World Order Model Project (WOMP) (Falk 1975).
An outcome of Yeomans action research has been the emergence of an
informal lace-web of networks amongst Indigenous and other marginalized
intercultural natural nurturers in Northern Australia and in the East
Asia-Oceania-Australasia Region (DeCastro, 2002, pdf thumbnail 98; Laceweb-Homepage 1995b; Psychnet
2005b; Psychnet 2005a; Psychnet 2005c). These networks, as self-organising dispersed therapeutic communities
are evolving and supporting self-help and mutual-help amongst Indigenous/Oppressed
trauma survivors in the Region.
Assessing
Outcomes
All of my interviewees and others reported that Fraser
House practice established that extremely dysfunctional people could be the prime source of their own
reintegration and move to wellbeing functioning (Yeomans 1961a; Yeomans 1961b; Madew, Singer et al.
1966; Clark 1969; Clark and Yeomans 1969).
Research comparing Fraser House with a traditional admission
unit and a newly constructed admission unit found that Fraser House was more
effective and less costly (Yeomans 1980).
Psychiatry
and Global Futures
Yeomans derived Cultural Keyline from over 40 years of action-researched praxis.
Cultural Keyline is potent, dense and multifaceted; it is concurrently a model
for community psychiatry sustaining wellbeing based inter-relating and
interacting, a concept for the psychosocial sciences, a folk concept for
enriching everyday life interaction, a worldview, a mode of being, a mode of
sensing, and a mode of values based personal and social interacting. The concept is more fully developed in the PhD (Spencer 2006b).
I have given an overview of the evolving
of biopsychosocial approaches in psychiatry and Yeomans contribution to that,
and presented evidence that Yeomans evolved many psychiatric and social
innovations that have been adopted and adapted in Australian society. Yeomans
evolved a viable, effective and cost-efficient complementary biopsychosocial
model and complementary alternative to the current expert delivery of
psychiatric and somatoform drug centred treatments (Yeomans, Widders et al. 1993).
Fraser House’s transforming of the
dysfunctional people at the margin of the dominant society was in the context
of Yeomans sensing that these people were the very best people to
explore how to reconstitute societies and evolve human caring global futures (Yeomans, N. 1971). Consistent
with Cultural Keyline, everything Neville did in and following Fraser House was
designed to fit with everything else naturally, what Yeomans called ‘the
survival of the fitting’. Everything complemented and supported other aspects.
Things that did not work were fine-tuned or discarded. Issues that arose in one
context were resolved, or passed on to other contexts. In Fraser House, what
worked (as well as problematic aspects) was discussed with everyone in Big
Group. Issues not resolved in Big Group were passed on to Small Groups and vice
versa. Issues within Committees were resolved, or passed on to the
Parliamentary Committee. The Pilot Committee reviewed issues within the
Parliamentary Committee.
This pervasive
inter-connected weaving of everything with everything contributed to Margaret
Mead describing it as the most complete and most total therapeutic community
she had ever seen, and why Maxwell Jones said in the forward to Clark and
Yeomans’ book that all participants in Fraser House had to change
(1969). Within an academic paper I have
endeavoured to provide a feel of Fraser House so that what Mead and Maxwell
Jones sensed may become more widely known towards better futures.
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Other links:
Cultural Keyline - The Life Work of
Dr. Neville Yeomans - Research towards a PhD thesis
A complete PDF version of the above
document.