Emerging Roles for Psychiatrists in the Age of Radical Modernity
Unique Peoples Monogram
This paper discusses emerging roles for psychiatrists as contributors to social transforming action in the Age of Radical Modernity.
It outlines over fifty years of longitudinal action research in the Australasia Oceania East Asia Region providing evidence of processes that work:
a. That Patients and Outpatients of a particular kind of dense therapeutic community can re-constitute their lives individually and in community
b. That these Patients and Outpatients can:
I. Return to functioning well in wider society
II. Massively expand their family friend networks
III. That these network can network well with other resonant networks
c. That a sub-set of these Patients and Outpatients who have re-constituted themselves can go to another level - supporting the re-constituting of society while collaborating with other Patients and Outpatients in Nested Networks working alongside Therapeutic Community Professional Staff and other resonant people
d. That action towards re-constituting society extends beyond re-constituting the social life world to include reconstituting the political life world (including social policy and practice), the economic life world, and other life worlds on planet Earth (including the biosphere)
e. That this action is spreading towards the emerging of a new Epoch on Earth
Resource people are available to fast track these processes in other parts of the world. Examples:
a. In the UK where wellbeing data on Health and Mental Health Practitioners is both disturbing and a key indicator of serious problems; where there is anxiety about the erosion of professional roles in mental health in particular, and where government provision and funding is being cut and being replaced by private companies with increasingly stringent regulatory and contractual expectations on delivery with more and more of the available funding being diverted to administering the control apparatus. In this context, there is already a network of Therapeutic Communities and other resonant entities like Enabling Environments and GreenCare that may want to extend their range of cooperative action.
b. In Low and Middle Income (LAMI) parts of the world without adequate support to people with low mental health
The age of Radical Modernity is deemed by political scientists and others as the period from 1999 to the present. These years have seen the sudden emergence of a world that is radically different to the 19th and 20th Centuries. A quote from Dr Mark Triffett, Senior Lecturer, School of Social and Political Sciences, Melbourne University:
Transition to Radical Modernity has brought with it an intensifying pattern of deep dysfunction for the liberal order, highlighted by a series of financial and economic crises and escalating volatility within liberal markets, as well the deteriorating functionality and legitimacy of liberal democracies.
Pervasive features of Radical Modernity (1994-2014) are:
1. A fast changing world created by:
a. A combination of globalization,
b. The rapid rollout of the Internet, and
c. Associated virtual information and communication technologies (ICT).
2. Radical Modernity has also brought forward deeply de-linear, non-linear, inter-connected and inter-dependent, multi-causal environments which political and economic systems, in general, find increasingly difficult to decipher, order, and predict.
3. There are holistically integrated systems of systems; we need processes that work well holistically.
4. Linear assumptions and organizing principles get it wrong with large implications. The result is increasing unpredictability, disorder and crisis permeating society.
5. Legislators and regulators typical live in legal and regulatory realities divorced and remote from the realities of everyday life for people at large in radical modernity, and yet presume to control what is outside their experience domain.
Hence, radical transforming is on the table.
Governments at all levels in Australia and elsewhere still organize themselves on 19th Century assumptions. These 19th Century assumptions were stretched by Modernity and are failing under Radical Modernity. Politicians and commentators locked in these 19th Century assumptions have two standard responses:
1. What has happened is an outlier or anomaly
2. We need better leaders
Neither of these two responses address nor will ever resolve the issues raised by Radical Modernity. Refer Radical Modernity for a wider discussion.
One example of action research seeking to address the above issues may be found in the life-work of Australia futurist psychiatrist Dr Neville Yeomans (1927-2000). Yeomans began his life-long passion with action researching social processes contributing to epochal change. He sensed that the social life world was entering into an inter-epoch phase. As a futurist, Yeomans anticipated what has come to be termed ‘Modernity’ and ‘Radical Modernity’. He also sensed that social and cultural change would occur at the edges and margins of society – among the marginalised – the outsiders – those that had ‘society’ knocked out of them – and psychiatrists are one group who know some things about marginal people.
With ‘exploring epochal transition’ as a meta-frame, Dr Neville Yeomans was the founding director and psychiatrist of Australia’s first Therapeutic Community, Fraser House in Sydney NSW in 1959. Yeomans is recognised as one of the Pioneers of Therapeutic Community.
Yeomans set up Fraser House to be a micro-model of a dysfunctional world and more specifically, a micro-model of the alienated dysfunctional fringe of a dysfunctional world. This was the major first step in Neville’s exploring epochal transition; this was where Neville felt it was the best possible place to start – at the dysfunctional fringe. What’s more, it was Neville’s view that together, this fringe has massive inherent potential to thrive. This was isomorphic with nature’s tenacity to thrive at the margins. To approximate this alienated fringe, Neville arranged to populate Fraser House with a balanced group of ‘mad’ and ‘bad’ people – his terms. Neville was not just setting himself a big challenge in starting with the mad and bad of Sydney, he did so because he firmly believed that these, along with dysfunctional Aborigines and Islanders from NSW Mental Hospitals transferred to Fraser House, were the best people to work with in evolving a new caring epoch (Spencer, 2005, P.93).
Neville was familiar with William Gouldner’s book ‘The Coming Crisis in Western Sociology Neville was exploring the potency of folk on the margins of society relationally engaging together for constituting new social forms. Gouldner writes (1970, pp. 224):
Limited increases in the randomness of social systems – that is, growing anomie - may be useful for the human and the cultural system. In this view the ‘anomic’ person is not merely an uncontrolled ‘social cancer’ but may be a seed pod of vital culture which, if only through sheer chance, may fall upon fertile ground.
He contains within himself the ‘information’ that can reproduce an entire culture, as well as the energy that enables him to ‘imprint’ this information upon patterns of behaviour, and to strand these together into social systems.
If on the one hand, the individual’s extensive enculturation provides him with a measure of functional autonomy in relation to social systems, on the other hand, his capacity to create and maintain social systems provides him with a measure of functional autonomy from specific cultural systems.
Neville recognised both the potency of the individual and of the group. Gouldner (1970), in critiquing Talcott Parsons’ focus on inter-dependencies within social systems, was writing about the potency of the individual within social systems; something that tends to be left out of Parson’s analysis. In his section ‘Anomie as Dedifferentiation’ Gouldner (1970, pp. 224) writes:
When a social system has failed to solve its problems and is destroyed as such, the individuals do not, of course, disappear with it. The social system then dedifferentiates back into its more elemental components, into smaller primary groups or individuals, which can and frequently do survive. From the standpoint of that specific social system this is a period of ‘disorder’ or of anomic crisis. But from the standpoint of both the component individuals and the cultural system, this is a cutting of bonds that releases them to try something else that might better succeed. Anomic disorder may unbind wasted energies, sever fruitless commitments; it may make possible a ferment of innovation that can rescue the individuals, or the cultural system from destruction.
The embodied and socialized individual is both the most empirically obvious human system, and the most complex and highly integrated of all human systems; as a system, he is far more integrated than any known ‘social system’. In his embodiment, the biological, psychological, social, and cultural all conjoin (Gouldner, 1970, p 224).
Neville was keenly aware of Gouldner words and there resonance with Neville having residents and all involved in Fraser House learning about evolving their own personal agency through their embodied experience of their biologically flexible responding to their own moving, sensing, feeling, and verbalising in relational social engaging with others in evolving together a culture of their own making.
And a single creative individual, open to the needs of other and the opportunities of his time, can be a nucleus of spreading hope and accomplishment (Gouldner 1970, pp. 222).
This last sentence aptly describes Neville and his way and potential.
Neville evolved Fraser House assuming a social basis of mental illness. This has links to the important role social cohesion plays in preventing mind-body-spirit sickness in Australian Aboriginal culture. Regardless of conventional diagnosis, in Fraser House it was assumed that dysfunctional patients would have a dysfunctional inter-personal family friendship network. This networked dysfunctionality was the focus of change.
For unfolding context - Fraser House residents would typically arrive with a dysfunctional family friend network of five or less and leave within three months with a functional family friend network of between 50 and 70.
All of the Fraser House Staff, patients and outpatients I interviewed spoke of the dense holistic inter-related ‘total’ nature of Fraser House. Yeomans collected papers contain the Report:
Dr. Margaret Mead, world famous anthropologist who visited Australia last year attended a meeting of the Psychiatric Research Study Group (refer below) and also stated that she considered Fraser House the most advanced unit she had visited anywhere in the world. (Yeomans, N. 1965a, Vol. 12, p. 69)
Neville told me that Mead also stated that Fraser House was the only therapeutic community she had visited that was totally a therapeutic community in every sense. Mead described Fraser House, as ‘Total’. By this term, I sense she was endeavouring to convey the pervasively complex inter-connected, inter-related denseness of the interwoven processes simultaneously happening within the Fraser House community, where for examples, residents and their family friend network members as outpatients were trained in both quantitative and qualitative research method and actively participated in designing and testing research instruments and carried out and evaluated theirs and others’ research – research as therapy.
Residents and outpatients were receiving the strong positive emotional experience that what they thought and felt about things mattered and was of value. Having come from conflicted family environments where contradictory communication was the norm, doing reality testing and checking the practical usefulness, validity and relevance of their observations was valuable – forming relational wellbeing. Patients and outpatients would start discussing a very diverse range of topics and in the processes evolve their capacities in forming, expressing and evaluating opinions and making insightful and useful observations about human interaction. Yeomans was using research by patients and outpatients as an integral aspect of therapy (research therapy). Within Neville’s Meta-Frame this was preparing folk to be capable, able and active with others in re-constituting society as they re-constituted themselves as individuals, community and networks of networks. And in all of this, every aspect of Fraser House was so extremely tight on being socially ecological, such that Maxwell Jones recognises this about Fraser House in the forward of Clark and Yeomans’ book about Fraser House. ‘Throughout the book is the constant awareness that, given such a carefully worked-out structure, evolution is an inevitable consequence’ (Clark and Yeomans 1969, Forward, p. vi).
Consistent with this framing, the 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. Neville said that he and all involved in Fraser House worked with the notion that the patients’ life difficulties were in the main, from ‘cracks’ in society, not them. Neville took this social basis of mental illness not out of an ignorance of diagnosis.
Neville was 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. Neville was familiar with twin sociological notions that people are social products and at the same time people together constitute their social reality. Neville said that he took as a starting framework that people’s internal and external experience, along with their interpersonal linking with family, friends, and wider society, are all interconnected and interdependent. Given this, Neville held to the view that pathological aspects of society and community, and dysfunctional social networks give rise to criminality and mental dis-ease in the individual. As well, his view was that ‘mad’ and ‘bad’ behaviours emerge from dysfunctionality in family and friendship networks.
This was compounded by people feeling like they did not belong - being displaced from place (dislocated). Problematic behaviours may be experienced as feeling bad or feeling mad, or feeling mad and bad.
While Neville recognized massively interconnected causal process were at work, he also recognized and emphasized this macro to micro direction of complex interwoven causal processes within the psychosocial dimension.
Working with the above framework, Neville set out to use a principle, ‘do the opposite’ to interrupt and reverse dysfunctional psychosocial and psychobiological processes (biopsychosocial). That is, he would design social and community processes that would inevitably lead from the micro to the macro towards Fraser House Residents re-constituting their lives towards living well together. Neville told me a number of times that the aim and outcome of Fraser House therapeutic processes was ‘balancing emotional expression’ towards being a ‘balanced friendly person’ who could easily live firstly, within the Fraser House community, and then in the wider community.
In July 1971, Dr Neville Yeomans indicated the above themes in choosing the title in a paper about Epochal Change - Mental Health and Social Change:
The so called Decline of the West is purely relative in the technological sense. In the cultural sense its decadence may be actual. The take off point for the next cultural synthesis, typically occurs in a marginal culture. Such a culture suffers dedifferentiation of its loyalty and value system to the previous civilization. It develops a relatively anarchical value orientation system. Its social institutions dedifferentiate (a reference to Gouldner’s writing referred to above) and power slips away from them. This power moves into lower level, newer, smaller and more radical systems within the society.
Uncertainty increases and with it rumour. Also an epidemic of experimental organizations develop. Many die away but those most functionally attuned to future trends survive and grow.
Fraser House and Fraser House Outreach was one of these ‘experimental organisations’ mentioned above. Yeomans work at Fraser House in many ways mirrored similar pioneering work being done by Maxwell Jones, Dennie Briggs, Thomas Main and Harry Wilmer. The work of these therapeutic community pioneers evidenced the transformative potential of a particular kind of community experience for supporting at risk people to re-constitute and re-socialise their lives through relating better with themselves and others.
With the same ‘Exploring Epochal Transition’ meta-frame, Yeomans set up the Psychiatric Research Study Group in the early 1960s on the grounds of the North Ryde Hospital adjacent Fraser House. This Study Group’s public framing was as a forum for the discussion and exploration of innovative healing ideas (‘healing’ as in ‘making whole again’) relating to evolving cultural localities (people connected together connected to place), enabling environments, .relational wellbeing, reconnecting with nature and the like,
Neville and the Study Group networked for, and attracted very talented people; students of psychiatry, medicine, psychology, sociology, social work, criminology and education attended from the University of NSW and University of Sydney and other places. The Psychiatric Research Study Group became a vibrant therapeutic community in its own right with a close working relation with Fraser House. Prison officers and parole officers with whom Neville had been working within the prison and corrective system also attended the Study Group. The Psychiatric Research Study Group provided a space where ideas were enthusiastically received and discussed.
Some participants had been finding it hard to get an audience for their novel ideas within the climate of the universities of the day. Anything raised in the Study Group that seemed to fit the milieu in Fraser House was immediately action researched and tested by Yeomans in Fraser House. In trying something to see if it worked, Yeomans spoke of ‘the survival of the fitting’. At one time there were 180 members on the Psychiatric Research Study Group mailing list.
The Study Group ‘represents every field of the social and behavioural sciences and is the most significant psycho-social research institute in this State (NSW). The Psychiatric Research Study Group maintained a central file of research projects underway throughout NSW and acts in an advisory and critical capacity to anyone planning a research project’. Meetings were held monthly at first at Fraser House and then elsewhere (Yeomans N. 1965. Collected Papers vol. 4, p. 24).
Neville took this one step further. He demonstrated that not only could resident and their family and friends regularly visiting as outpatients re-constitute themselves, he energised them such that many of them also took on the task with others of re-constituting wider society.
During the 1960s around Sydney there was great energy and passion for re-constituting society, and ex-residents and ex-outpatients of Fraser House were active in this process.
In 1968 Yeomans left Fraser House to take up the new role of being Australia’s first Director of Community Mental Health in NSW. He also simultaneously became Australia’s first Director of Community Health in NSW. In these roles he helped energise over 25 self-help and mutual-help groups – what may be termed Local Area Mutual Providence Societies (LAMPS). Networks of networked ex-residents and ex-outpatients of Fraser House were also very active in these groups.
After leaving these Government roles Neville returned to private practice to provide time and scope to extend the Epochal Transformational processes into wider society. He rented his double story House in Bondi Junction where he had established a psychiatric practice and moved up along the coast of Far North Queensland establishing psychiatric clients and engaging in psychiatric consultations with individuals and families. He did this in Mackay, Townsville, Cairns, and Yungaburra. At each location he strategically bought a house that he used as a psychiatry Clinic and also established it as a Small Residential/Outpatient Therapeutic Community. Each time Neville moved on, therapeutic community member tenants’ rent paid the mortgages. An example of daily life in Neville’s Mackay TC has been written by psychologist Professor Paul Wilson, who became a resident for a time (refer Whither Goeth the World of Human Futures, page 737.) Where Neville could he linked up his clients into self-help and mutual-help networks. He ended up with a network of networks up the East Coast of Far North Queensland.
In 1985, Yeomans returned to Bondi Junction in NSW for five years re-establishing his psychiatric practice. During this time he re-established the Psychiatric Research Study Group with 25 members based at his house in Bondi Junction, NSW. He used this Group to evolve a Dispersed Therapeutic Community of 180 people over an 18 month period. Some participants of the Psychiatric Research Study Group as well as members of the Dispersed Therapeutic Community supported Neville in his Epochal Transformational Action Research in Far North Queensland. Around 1990, Neville returned to Yungaburra, Queensland and resumed action research. In each of the next three years Neville energised Gatherings around Yungaburra, examples:
As well, Neville was very active in networking – refer One Fortnight’s Laceweb Action In The Atherton Tablelands In Jan. 1994.
In 1994, Neville moved to Darwin in the Northern Territory to energise Epochal Transformational Action at that locality. Neville had identified the Australia Top End as the best place to energise Epochal Transformational Action in his paper Mental Health and Social Change. In Darwin he energised the Rapid Creek Project.
While Neville devoted much of his time to locating and working with clients and setting up psychiatric practices, he did accumulate an extensive portfolio of properties as a legacy to his family. For context, in the 1970s psychiatrists were light on the ground in the far North. Neville arranged to have all of this action research written up and place in an Archive.
Two portals to this Archive are:
Neville set up a rich network of networks that has the feature of mimicking complex systems in nature in being a self-organising phenomenon. Action in these networks continues after his death in 2000. Action has spread throughout the Australasia East Asia Oceania Region and wider afield. The Archive in the past year has been linked to with over 230,000 hits by people in 140 counties with over 11,000 down loads of E-Book resources.
Neville had been involved in inter-disciplinary studies in the fields of psychiatry, sociology, biology and psychology. He involved people with academic studies and experience from right across the human and social sciences as enabling support of local people on the margins engaged in mutual help in re-constituting themselves as they re-constituted wider Society. Dr Neville Yeomans has set up a model of practice for any psychiatrist passionate about therapeutic environments, relational health and social policy, as well as re-constituting health and wellbeing not only in the social life sphere, also in the political, economic and other vital spheres of life experience on Planet Earth towards a new epoch for all.
This paper has set out a model of praxis that has been delivering on the claims made at the outset of this paper, namely that in the context of Radical Modernity where current assumptions inevitably lead to failures, Patients and Outpatients of a particular kind of dense therapeutic community can re-constitute their lives individually and in community. A sub-set of these with enabling support can go on to support the re-constituting of society.
The processes Neville started evolve people able to work well with de-linear and non-linear processes. They can sense the pervasively interlinked, interconnected, inter-dependent holistically integrated nature of system of systems and engage holistically. They have evolved processes that can react fast and transform experience and behaviour.
Folk in these networks of networks in the Region are continually evolving competences in inter-relating as an essential feature of relational forms of knowing. Folk involved work well with contexts that are inherently unpredictable. Folk are being evolved with the experience and capacity to use relational knowing and with capacities to go outside the square and relate well interculturally, recognizing that people live in differing realities.
Given that much of politics, economics, institutionalized life and other aspects of Radical Modernity are beyond people’s capacity to use reason and comprehend, folk in the networks of networks may engage well with folk whose mode of engagement is not based on rationality and reason; engaging in contexts where rationality itself is ‘mad’ and reason is unreasonable.
Given funding, experienced people with process resources are available to fast track these processes in other parts of the world.
Yeomans, N. (1965a). Collected Papers on Fraser House and Related Healing Gatherings and Festivals - Mitchell Library Archives, State Library of New South Wales.
Neville Yeomans Houses
Bondi Junction, NSW
 From Latin de- "apart" + cadere "to fall" - hence ‘to fall apart’