By Sarah Phelan
Recently my PhD research into the twentieth century Scottish psychiatrist, Thomas Ferguson Rodger (1907-1978), has led me to explore the evolution of the therapeutic community model of psychiatric care. This investigation has been spurred by Rodger’s own comments on the formative influence of his own and his colleagues’ experiences as military psychiatrists in the Second World War. Upon their re-entry into civilian society, psychiatrists were driven by a fresh enthusiasm for what psychiatry could achieve: Rodger reflected that psychiatrists assumed their duties with “words like therapeutic community on their lips” and that they began to re-envision psychiatric care on a “non-authoritarian” model (DC081/4/2/18 13). This and similar expressions of psychiatrists’ altered post-war attitude which can be found within Rodger’s archive have compelled me to research further the beginnings and development of the therapeutic community within the twentieth century. Yet an exploration of the origin of the therapeutic community is not without its challenges; as John A. Mills and Tom Harrison caution, this genealogy is “complex and hard to elucidate” and these therapeutic initiatives were rooted in a “matrix of speculation about social control”, in particular British psychoanalysis of the 1920s and 1930s (23).
While Rodger’s account of military psychiatrists’ collective work in the Second World War will be explored more fully in a chapter of my PhD, here I recount in brief some of the interesting features of the therapeutic community model which I have come across in my reading of the literature on this topic and which illustrate its varied manifestation during the Second World War years.
Teri Chettiar captures the broad conceptual underpinning of most therapeutic communities in her article on the community at the Cassel Hospital overseen by the former military psychiatrist, Tom Main, in the period after World War Two (108). The therapeutic community began as “a movement away from conventional ‘custodial’ assumptions” within institutions of psychiatric care and evolved “out of a commitment to sharing therapeutic responsibility between patients and staff and to pre-serving patient’s pre-admission responsibilities and social identities” (Chettiar 108). Acknowledging its multifarious origin, Mills and Harrison posit that there is “reasonable case” for understanding the psychiatric innovations of Northfield Military Hospital in 1945 as the “first true therapeutic community”, and they situate Wilfred Ruprect Bion’s and John Rickman’s earlier experiment at Northfield as an important forerunner to this (22). Yet there were fundamental differences between these two initiatives, that is, between what was later deemed the First Northfield Experiment and the Second Northfield Experiment.
The First Northfield Experiment began in 1942 as a “controversial and radical” project initiated by Bion and Rickman (Jones, “War” 496, 497). Faced with a crowded ward of soldiers traumatised by the Second World War, Bion substituted the customary hierarchy of the doctor-patient relationship for a more militaristic system where patients were still “soldiers” and psychiatrists became “commanding officers” (Thalassis 357, 358). Befitting this atmosphere, Bion re-envisioned treatment as the encouragement of “morale” and this in time effected a reversal of this military ranking as the “military super-ego” was no longer cast onto higher authority, but was given back to the patients/soldiers who became responsible for their own welfare and surroundings (Main 7). However Bion employed a controversial understanding of cure: a return to normal functioning at Northfield involved the development of “self-respect” through “social adjustment” which was connected to “a willingness to accept the responsibility of active combat” (Thalassis 358). Nafsika Thalassis writes that this contributed to the end of the project as Bion’s belief that soldiers should be returned to the front to fulfil their military duty rather than being invalided out was not easily acceptable to his psychiatric colleagues at Northfield (360).
The Second Northfield Experiment differed from the First in that it developed “gradually” and through the inputs of a number of individuals including Sigmund H. Foulkes, Main and Harold Bridger (Harrison and Clarke 698). Bridger, who initiated the Second Experiment at Northfield from 1944-45 (75), identified “lessons” in the failure of the First Experiment in terms of the dissension between Bion and his colleagues surrounding the clash between military and medical aims (74). He believed that the ushering in of “changes” required “conditions and circumstances” which would facilitate “a common understanding of purpose and method” among the various divisions of the hospital (74). Therefore Bridger acted as “a social therapist” to the “hospital-as-a-whole” in order to develop the social relations of the institution (78).
In parallel with these innovations at Northfield, Maxwell Jones was realising similar ideas independently at Mill Hill Public School which was being used by the staff of the Maudsley Hospital (Manning 9). While both Jones and the Northfield psychiatrists sought to alter the traditional hospital structure in order to harness “unrealised positive therapeutic forces” therein, in Jones’s case this was propelled by “practical” reasons in contrast to the more “theoretical” orientation at Northfield (Social Psychiatry 9). In 1941, Jones was supervising a “psychosomatic unit studying effort syndrome” of one hundred soldiers suffering from uniform symptoms often relating to the heart and breathing, which were traced to a “psychological” rather than “physical” origin (Social Psychiatry 16). In order to explain this disorder to the patients, it was convenient for Jones and his colleagues to speak with them as “a body”, an occasion which acted as his introduction to “large group therapy” (Social Psychiatry 16). With the gradual realisation that patients’ insight grew through “a two way interaction”, Jones progressed from “didactic” talks before a “passive, captive audience to one of social learning as a process of interaction between the staff and the patients” (Social Psychiatry 16-17).
These are just some examples of the beginnings of the therapeutic community which illustrate the varied ways in which this model of psychiatric care emerged during the Second World War years. Tom Harrison’s book, Bion, Rickman, Foulkes and the Northfield Experiments: Advancing on a Different Front provides a very comprehensive and interesting discussion of the many more diverse influences which contributed to the intellectual climate out of which the therapeutic community grew at this time. These include, among others, the ideas of Ronald Fairbairn and object relations psychoanalysis (Harrison 38-44), the American psychologist, Kurt Lewin’s writings on “field theory” (Harrison 64-68) to the ideas of the educator Madam Montessori (Harrison 71). Yet in a sense the genealogy of the therapeutic community became even more diverse and interesting as time went on, especially when one considers its later association with anti-psychiatrists, such as the controversial Scottish psychiatrist, R. D. Laing.
Bridger, Harold. “The Discovery of the Therapeutic Community.” The Social Engagement of Social Science, A Tavistock Anthology 1 (1990): 68-87. Print.
Chettiar, Teri. “Democratizing Mental Health: Motherhood, Therapeutic Community and the Emergence of the Psychiatric Family at the Cassel Hospital in post-Second World War Britain.” History of the Human Sciences 25.5 (2012): 107-122. Print.
Harrison, Tom. Bion, Rickman, Foulkes and the Northfield Experiments: Advancing on a Different Front. Community, Culture and Change. Ed. Lees, Rex Haigh and Jan. London: Jessica Kingsley, 2000. Print.
Jones, Edgar. “War and the Practice of Psychotherapy: The UK Experience 1939-1960.” Medical History 48.4 (2004): 493-510. Print.
Jones, Maxwell. Social Psychiatry in Practice: The Idea of the Therapeutic Community in Practice. Harmondsworth, Middlesex: Penguin, 1968. Print.
Main, Tom. “The Concept of the Therapeutic Community: Variations and Vicissitudes.” Group Analysis 10.2 (1977): S2-S16. Print.
Manning, N. P. The Therapeutic Community Movement: Charisma and Routinization. London: Routledge, 1989. Print.
Mills, John A, and Tom Harrison. “John Rickman, Wilfred Ruprecht Bion, and the Origins of the Therapeutic Community.” History of psychology 10.1 (2007): 22. Print.
Thalassis, Nafsika. “Soldiers in Psychiatric Therapy: The Case of Northfield Military Hospital 1942–1946.” Social History of Medicine 20.2 (2007): 351-68. Print.
University of Glasgow Archives: Thomas Ferguson Rodger Archives DC081/4/2/18 – Typescript notes for a lecture given to Leeds Psychiatric Society titled ‘Psychiatry and the public health’ by Thomas Ferguson Rodger (c1960s)