Alexander Dost thou not know that I am able to give thee a kingdom?
Diogenes I know thou art able, if I had one, to take it from me; and I shall never place any value on that which such as thou art can deprive me of. …
Alexander … for which purpose thou hast forsworn society, and art retired to preach to trees and stones.
Diogenes I have left society, because I cannot endure the evils I see and detest in it.
From “A Dialogue between Alexander the Great, and Diogenes the Cynic” by Henry Fielding (1743)
On 23 April 2008 at 2.00pm, a certain NHS Mental Health Trust closed the Henderson Hospital Democratic Therapeutic Community on a ‘temporary’ basis – pleading or otherwise peddling the usual piddling managerialist alibis and nostrums.
Even if you weren’t there, you can guess the sort of thing they said. What’s a fellow to do, we were – and are still – invited to consider, when he runs a big business and he can’t secure his cash flow? Our hands are tied. It’s no longer financially viable … and so forth … (if you can bear to look, some of it is laid out in the southwark.gov weblink listed at the bottom here). It’s been the same old song, for many years now, and it never lets up (or lets on) (or lets anyone off) and at some point you just know you’re going to hear those two dread words – ‘luxury flats’ – and another expanse of the Attlee/Bevan post-WW2 welfare settlement will have gone down with all hands on deck and the officers in the lifeboat, to the sound of cash tills singing ‘ker-ching!’ and developers popping corks – and also, somewhere at the edge of audibility, the continuing suffering of the marginalised and traumatised and dispossessed and excluded …
I was there. A bit player: not one of the residents, or the residential team; not one of the potential candidates for admission suddenly denied an opening – but I was there through the death-throes of the community and I was there the day it was finally evacuated and boarded up. I was working for the Henderson Outreach Service team: it was my first NHS job. I started there in April 2001 and was there for seven eye-opening, humbling, almost overwhelming years that educated and moulded me as a person, as a citizen, as a mental health practitioner and as a psychotherapist. I then joined the massed ranks of the redeployed – an ongoing upheaval still playing out its consequences a decade down the line, in a minor but nonetheless sharply-pointed echo of and parallel process to the upheaval endured by those residents and candidates.
This is not all about me – but I do want to say how vividly I remember my first contact with the Democratic Therapeutic Community (DTC). As part of the interview process I was invited to attend the 9.15 community meeting. I was intensely anxious. Staff and residents congregated in this long rectangular space, dark in my memory but lit by windows and glass doors all along the long side facing the garden and full of assorted faded and shabby but snug and inviting furniture and fittings of the sort that nowadays would have the corporate drones diving for their alarm buttons on about 57 grounds of violation of health and safety edicts (NB this and other photos in this blog were taken the day the hospital closed, by the way) …
Visitors were participant observers in the community meeting but active verbal participation was strictly limited to stating one’s name and business when asked and otherwise to remain silent. It’s an old cliché of the DTC, but it was not an easy matter – and why should it have been? – to distinguish staff from residents by any visual cues, and this is one of the things I remember so well: the disorienting (transformative) almost visceral experience of stepping out of the world of vertical hierarchy and rigid structure and into a liminal space where everything seemed to be up for negotiation in a flattened (not entirely flat, but flattened) hierarchy. And the other memory I retain is how excluded I felt: I was wrong, somehow, wrong to the very core of me; I did not understand, there was a language and vocabulary whose key I did not possess; I felt received but not welcomed.
I quickly came to perceive that in this way some fragment of the experience of the residents had been located in me, or I had identified with, as though this community had a sign above the door that said “do not abandon hope, all ye who enter here, but check your privilege, interrogate the quality of your own hospitality and get your head around what it’s like to feel excluded and outcast, and that right speedily, because this is the emotional work we do here and it matters very much” – or something like that, and I’m sure that anyone who lived there for the allotted year would be able to come up with something decidedly more pithy and concise…
This is not about me and it is also not about recording a formal history of the unit: plenty of other places where that can be researched. But in case you don’t know what all this is about, I’d want to include you in! The Henderson DTC was in its sixty-first year of existence when it was closed. It therefore just pre-dated the inception of the National Health Service. It opened in 1947 essentially as a trauma unit, for ‘shell-shocked’ soldiers struggling to reintegrate back into civilian life after the end of World War Two. It went through changes of identity and changes of location over the years – and changes of funding, especially in the wake of the advent of the ‘internal market’ but if you want to know what people remember and mourn, when the Henderson DTC model is evoked, it is this:
- Staff had no control over admission and discharge of residents inside the maximum stay of one year
- Admission was by majority vote of a group of nine residents and three staff members – early departure from treatment depended on the vote of the whole community (in which residents always outnumbered staff)
- There was no use of psychotropic medication permitted or prescribed
- There was no coercive psychiatry or medico-legal technologies involved – no use of the Mental Health Act (or Probation Orders or conditions of residence or restriction orders of any kind) – no curfews, no restraints – as far as is possible to sustain in the UK of the late twentieth and very early twenty-first centuries, residents entered and stayed of their own free will
- There were no ‘one to one’ psychological therapies available but a range of therapy groups, work groups and community meetings, which latter could be called at any time, day or night, if an issue affecting the whole community demanded the community’s whole attention
The American social anthropologist Robert Rapoport studied the Henderson Hospital in the 50s and in 1960 reported that four key characteristics defined the therapeutic milieu of the then twelve-bedded unit (when I joined in 2001, there were 27 beds as well as two other ‘replicated’ communities of similar size, in Crewe (Webb House) and in Birmingham (Main House)). These four characteristics Rapoport identified as democratisation, communalism, permissiveness, and reality confrontation. Transposed to the late period Henderson DTC model, these four ideas relate to major decisions all being taken by majority vote; to the ethos (‘communalism’) of staff and residents sharing with one another all the tasks and processes of daily living in a flattened hierarchy, with conventional roles consciously blurred; to the principle (‘permissiveness’) that there were no transgressions but only enactments, in that there were plenty of ‘house rules’ prohibiting all kinds of violence but it was understood that residents were not expected immediately or magically to relinquish safety practices (such as practices of self-injuring) that had got them to the door; and finally (‘reality confrontation’), to the principle that permissiveness did not preclude challenging the individual to understand that within the communal frame his or her actions had an impact on the rest of the community – and that by engaging in a given safety practice (slamming a door in frustration, for example) it was understood that distress had been expressed but that the individual had still placed themselves thereby outside the (conceptual) boundary of the community and would need to ask the community’s blessing to ‘come back in from the cold’ and to continue their emotional work (again, others may be able to put this into words better than can I who worked mostly at the edge of this system).
Elsewhere, I have written in perhaps more moderate and balanced tones about the demise of Henderson Hospital and looked at some of the ways in which the DTC in its defiant persistence may ultimately have contributed to its own dénouement:
“The Henderson DTC … not only represented an affront as well as a reproach to the over-use and abuse of medico-legal technologies deployed by the conventional psychiatric services for trauma and social exclusion that surrounded it: it also rather enjoyed actively poking its thumb in that system’s eye and should not perhaps have been so surprised when it eventually got thumped for its pains.” (Adlam, article in preparation)
“The Henderson’s own fraught relationship with the system of care … perhaps meant that it found itself too closely identified and ‘damned by association’ with the troubled, anti-social outsiders and misfits who were its client group.” (Adlam and Scanlon, 2013)
But what is a blog for, if not for engaging in familiar safety practices – which, in my case, right now, may well mean slamming a door, or even breaking a window or two? In the permissive culture of the therapeutic milieu, it’s understood one can’t be, would not want to be ‘reasonable’ all the time. Confront me, o reader, with reality – but not just yet, if that’s okay … because it’s ten years since Henderson was closed, and I am still influenced and shaped and inspired by my experience then and in the aftermath of its closure and I’m still mourning its loss but most of all at this the tenth anniversary (give or take a week or two of assembling my thoughts) I am really very deeply furious that it was shut down. I read through contemporaneous accounts of the closure process (some of which weblinks I’ve included as references below) and it still makes me furious. And I’m furious to feel that, provocative, even Diogenesque, though we may have been, nonetheless, some of the Alexanders of the field (not those many allies who stood alongside us, but those arbiters and authorities who stood by) did not come to our aid, or came too late, or came with weasel words, when eventually they rocked up outside our barrel…
Most of all, I’m angry because I keep encountering people who I feel would have found hope in the idea of the availability of the Henderson Hospital Democratic Therapeutic Community as a national specialist resource for traumatised and dislocated souls – and for whom that hope has simply not been available. That door has closed – like so many other doors.
People have died.
Who knows if they would still be alive, if they’d made it into the DTC? No-one can know this. And not everyone who did spend time at Henderson felt helped by it. But austerity and managerialism are violent and mendacious discourses and so let’s not get confused. Of course we could afford to keep the Henderson open. We could then and we could now. Spare me all that crap about cross-subsidies. The annual budget of the Henderson was about a third the cost of a Challenger tank (well, I’m approximating this detail off the top of my head, but that’s the joy of a blog, and you get the point I’m making).
In 2001 the Taliban dynamited the Buddhas of Bamiyan in central Afghanistan. They felt, so it seems to me, that the Buddhas constituted the wrong sort of evidence base and they hated how much those giant artefacts were revered by those whose hearts and minds they were determined to dominate. The closure of the Henderson was, on a much smaller scale, an analogous act of irrevocable cultural vandalism. I sympathise then with Fielding’s Diogenes, who forswears society because he cannot abide the evils he perceives in it.
We can’t just start up a campaign to re-open the Henderson. It’s gone. It leaves a hole in the fabric of the body politic that can never be repaired.
Adlam, J. & Scanlon, C. (2013) ‘On agoraphilia: a psychosocial account of the defence and negotiation of public/private spaces’, Forensische Psychiatrie und Psychotherapie, 20 (3), 209-227.