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[1]
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.
Yeomans wrote:
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:
1992.
Developing Aboriginal and Torres Strait Islander
Drug and Substance Abuse Therapeutic Communities
1993.
Lake Tinaroo Mediation Gathering
1994.
The Asia
Pacific Small Island Coastal and Estuarine Waters People Gathering
Celebration in NE Australia
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:
Processes for Transforming Action
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.
Summary
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.
References
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
Cairns, Queensland
Yungaburra, Queensland