An Australia Psychiatric Pioneer
Written 2005. Last update April 2014.
A Summary Paper derived from a PhD Dissertation
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.
‘Community, Keyline, Psychiatry, Therapeutic, Yeomans
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)
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.
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.
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).
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.
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.
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.
Therapeutic communities in the UK and USA had periodic whole ward meetings with up to 80 patients and thirty staff present. In Fraser House, total community Big Groups (staff, patients and outpatients attending) were held twice a day on all weekdays, with up to 180 in attendance five days a week, year round. The following terms were used in referring to the whole community meeting – ‘Collective Therapy’, ‘Big Group Therapy’, ‘Big Meeting’, ‘Big Group’, ‘Community Meeting’, and ‘Large Group Psychosocial Therapy’.
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 and sex
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.
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.
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.
Yeomans spoke (Dec 1993, Aug 1999) of three levels of governance at Fraser House – local, regional, and global. Patient with their family-friendship networks were engaged in their own local self-governance. The committee for locality-based transport called the Outpatients, Relatives and Friends Committee (one of the Fraser House Committees) was engaged in ‘regional’ self-governance. The parliamentary-pilot committees, in association with the other sub-committees of the parliamentary committee were engaged in ‘global’ self-governance of the Fraser House ‘global commons’. The committee structure was essentially bottom-up with committees reporting to the parliamentary committee to keep this wider committee of committees informed. This three-fold governance model involved everybody in a cross linking network of governance. All were involved at their local level. All were involved at their regional level. And they were all linked into global governance level process as a serving committee person, or being engaged by, and by interfacing with the global governance (by for example being assessed by the patient-based patient assessment committee).
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.
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.
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.
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.
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).
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.
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.
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).
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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