psychoanalyst author editor
Psychoanalysis and Therapeutic Communities
The Cassel Years
Although I had been drawn into this a bit at St Bernards, I applied and got a post as a Director of a sizeable unit. I moved jobs after a long and generally fertile time at St Bernards. This was the Cassel Hospital, arguable the first therapeutic community in the British civilian psychiatric services – or at least, it was developed in the 1940s by Tom Main who first employed the term ‘therapeutic community’, in a published paper in 1946. So, in 1993, moving a step away from direct clinical work in the public service, it seemed perhaps a bit like a swan song. There I immersed myself in the management culture and sought to explore the possibilities of using the experience, and the methods in the more human, democratised therapeutic community for the benefit of the new NHS culture. I was at first greatly assisted by the Chief Executive of the Trust, Chris Higinbotham, although when he left in 1995, I found the culture increasingly inclement, and ultimately felt my foray into management a failure.
British psychiatry had grown out of these large institutions (see Section 2). My job had ben to try to inspire an interest in the experiences of the people we cared for. It was not so much an intent to inspire an interest, because I fund in so many cases people had joined the staff precisely because they were concerned and sensitive to the suffering of their charges; so the job was to help to sustain that interest in the majority of the staff who had gone into the work. The job I moved to after St Bernard’s Hospital, in 1993, was different, an experiment on my part. It was to see how I would fare in a management role in the heart of bureaucracy, which had always been the kind of thing I’d carefully kept to the margins. I became Clinical Director of the Cassel Hospital, a prestigious position. By 1997, I had got the result of my experiment, and left, to become an academic. In fact it gave me an opportunity to reflect on a lot of issues and themes that I had puzzled over during my period in British psychiatry. I considered anew, and from a different perspective, notions of authority, and the dynamics of therapeutic communities, and institutions. There were colleagues at the Cassel with experience and a high calibre of thinking about therapeutic communities, and they were the real stimulus of the work – whilst the managerial chores became… well, just chores.
2001 (with Peter Griffiths) Enquiry into a culture of enquiry.
In Lesley Day and Pamela Pringle (eds) Reflective Enquiry into Therapeutic Institutions. London: Karnac.
In some ways the Cassel Hospital is a living fossil, since the average lifespan of a therapeutic community may be around 10-15 years. The Cassel had been organised by Tom Main as a therapeutic community in 1946, nearly 50 years previously. It held to the basics of the experiments in Military psychiatry, at Northfield Hospital in Birmingham during the wartime, whilst at the same time it appeared to me to be still at the sharp-end, forefronting the thinking that needs to be done on how an institution can in itself be, and remain, therapeutic. Perhaps constant enquiry means constant rejuvenation in terms of an organisation.
1998 (with Angel Santos) The use at the Cassel of the organisational dynamics to enhance the therapeutic work.
Therapeutic Communities 19: 29-39
I learned many things at the Cassel Hospital. One of which is the importance of applying the notions of intra-staff dynamics in the clinical cut-and-thrust of everyday work in a caring institution. The ability for staff to enact the inner world of patients who they become involved with is quite extraordinary when we have the chance to focus on it and think about it. But that chance is only given by the institution itself, and individuals cannot take it for themselves individually.
1996 (with Kingsley Norton) Severe personality disorder: treatment issues and selection for in-patient psychotherapy.
British Journal of Psychiatry 168: 723-731.
Republished 2008, in Adshead, Gwen and Jacob, Caroline Personality Disorder: The Definitive Reader. London: Jessica Kingsley.
This was one of the collaborative ventures between the Cassel and Henderson Hospitals; I and Kingsley were Clinical Directors of each. The paper intended to present to a psychiatric readership the possibilities of a social therapeutic approach to the behavioural and relational disturbances of personality disorders.
1996 Communities and their health
Therapeutic Communities 17: 173-182
This was an invited lecture that attempted to spell out an overview of therapeutic community dynamics that need following, as the various players manoeuvre in the social space either to easy their discontents, or to work through them.
1998 Psychoanalysis and therapeutic communities – The Cassel heritage and the culture of enquiry.
In Penny Campling and Rex Haigh (Eds.) Therapeutic Communities- Past, Present and Future (London: Jessica Kingsley).
When Penny Campling and Rex Haigh decided to do a ‘re-make’ of the book Nick Manning and I did in 1979, they commissioned a whole new series of Chapters nearly 20 years on. I was pleased to reflect on how the relations of psychoanalysis to the therapeutic community had evolved. Arising directly within the central thinking of psychoanalysis, therapeutic communities had emerged as a much more activist form of intervention than the purely reflective one psychoanalysis is. And it is of course appropriate that a community which is involved in all its self-sustaining activities should be more activist. So we seemed to need a new investigation of how reflection and enquiry might need to connect with activity.
1998 (with Wilhelm Skogstad) The hospital in the mind: The setting and the internal world.
In Julia Pestallozi (Ed.) Psychoanalytic Psychotherapy in Institutional Settings. London: Karnac.
Again reflections on the Cassel Hospital, this time with a colleague there, attempted to explore the important dynamics around prioritising the inner world within the pre-occupations and politics of an organisation.