On the occasion of the tenth anniversary of the closure of Henderson Hospital Democratic Therapeutic Community

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)

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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 …

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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) …

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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…

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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).

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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.

References/weblinks

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.

https://www.researchgate.net/publication/261759145_’On_agoraphilia_a_psychosocial_account_of_the_defence_and_negotiation_of_publicprivate_spaces’

https://en.wikisource.org/wiki/A_Dialogue_between_Alexander_the_Great,_and_Diogenes_the_Cynic

http://moderngov.southwark.gov.uk/Data/Health%20and%20Adult%20Care%20Scrutiny%20Sub-Committee/20080227/Agenda/Closure%20of%20HendersonHospital.pdf

https://www.independent.co.uk/life-style/health-and-families/health-news/mental-hospital-closure-plan-is-condemned-as-inhumane-765690.html

http://www.communitycare.co.uk/2008/05/27/henderson-hospital-staff-and-residents-fight-to-reverse-closure/

https://www.leighday.co.uk/News/Archive/2008/April-2008/Henderson-Hospital-closes-today—a-failure-by-the

http://news.bbc.co.uk/1/hi/health/7144686.stm

https://www.theguardian.com/society/2008/apr/16/mentalhealth

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“Nothing about us without us” – notes towards a draft manifesto for survivor-led emancipatory research

“The only true commonwealth is that which is as wide as the universe. I am a citizen of the world” – Diogenes of Sinope

“Education either functions as an instrument which is used to facilitate integration of the younger generation into the logic of the present system and bring about conformity or it becomes the practice of freedom, the means by which men and women deal critically and creatively with reality and discover how to participate in the transformation of their world.” – Paulo Freire, Pedagogy of the Oppressed

 

On a damp and foggy Paris day in December 2017, a small group of two survivor researchers, a philosopher, and a mental health practitioner (that last one was me) attended #ConfCap2017 to discuss and debate issues around the civic and legal and human rights of persons living with disability in the face of societal attempts, in certain circumstances, to restrict their liberty and to force treatment upon them.

We were invited to participate in a seminar/symposium in which we were asked to speak to this theme: ‘Exercice des droits et participation: entre contraintes et accompagnement: Recherche émancipatoire’. We began by considering the implications of Clause (o) from the Preamble to the UN Convention on the Rights of Persons with Disabilities:

“(o) Considering that persons with disabilities should have the opportunity to be actively involved in decision-making processes about policies and programmes, including those directly concerning them,” …

Some of the philosophical territory was set out and then we spoke about different ways in which our paths as users and/or as providers of mental health services and as activists, writers, researchers and consultants had intersected – how our ‘given’ roles had been creatively blurred in practices of equality in the field of mental health – how ’emancipatory research’ might be an organising idea for some of those practices and what the UNCRPD preamble’s ‘actively involved’ might mean in practice.

It’s these ideas of ’emancipatory research’, which I must confess I only first came across when I received this invitation, and the possible meanings of ‘active involvement’, that I wanted to write about here.

It’s in the very nature of the term ’emancipatory research’ that it would be a very bad idea to attempt to claim or define the term or to appropriate, colonise or enclose the open spaces the term evokes and signposts. Here I just want to see if there’s part of the map that’s not yet been fully charted…

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I didn’t know a lot about the terrain and so I poked around a little and had a couple of pointers from survivor researcher colleagues. I probably missed a whole chunk but here is some of what I found …

In a book published in 2000 called ‘Research and Inequality’, co-editors Humphries, Merten and Truman reviewed arguments for an emancipatory research paradigm and traced some of the theories and discourses interwoven under this heading. They began with the Enlightenment as a movement located in optimism about emancipation (from scholasticism and the tyranny of superstition and religious dogma). They noted the importance and influence of Marxism, feminism, post-structuralism and other similar discourses and they identified research models such as ‘participatory action research’ (whose lineage goes back to Paolo Freire), ’empowerment research’ and ‘collaborative enquiry’ as examples of emancipatory research practice.

For Humphries et al., following Freire, emancipatory research is ‘research which has an explicit concern with ending inequality and taking the side of oppressed and marginalised groups…Knowledge is not just about finding out about the world but about changing it’ (Humphries et al, 2000: p.4.) And Humphries asks an important follow-up question (p. 186): “What does emancipatory research mean if researchers are inevitably implicated in power, so that our efforts to liberate perpetuate the very relations of dominance?”

‘Co-production’ was not so much of a buzzword at the turn of the century but that ethos also carries ’emancipatory’ connotations, at least in theory (instead of ‘us’ the experts by training producing knowledge for ‘them’ the experts by lived experience, let’s ‘we’ join to produce the knowledge ‘together’). Some other time I’ll share our co-produced critique of ‘co-production’ but for now let’s peg it as ’emancipatory lite’.

Jerry Tew (2003) shows how the conventional established discourses around the gold standard (an interestingly outdated term, this) in scientific/medical research paradigms are located in an excluding and objectifying value base and suggests emancipatory research would have as its task:

“To produce evidence and theory (concepts and frameworks) that can enable users and carers to:

  • have a greater awareness of their situation so that they can make informed decisions and choices;
  • have more control over their lives in areas where this may have been taken from them;
  • participate in areas of social, economic, and political life from which they may have been excluded;

and can enable communities and practitioners to:

  • challenge stigma, injustice, social exclusion…” (p. 24)

Emancipation, in any domain, is not a process of continuous progressive trajectory or a question of the quickest route from A to B. There are an increasing number of survivor researchers and experts by both training and lived experience who are making significant contributions in the field. The concept of ‘survivor researcher’ was news to the audience at Paris ConfCap, however, and as Diana Rose, Sarah Carr and Peter Beresford (2018) note: “service users, survivors and their organisations are pre-defined as consultants in research and knowledge-making and not positioned as leaders, knowledge-makers or researchers themselves. We do not appear to be permitted to enter the same terrain or space as ‘real’ researchers.”

There is some ‘active involvement’, in other words, within the possible meaning of the UNCRPD, but it’s the kind of involvement that mostly comes from being ‘included’ in someone else’s project…

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Here is possibly where the United Nations again comes in handy. Bear with me while I reproduce what they say a bit.

The ‘Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ (2017) proclaims (p. 6) that

“21. The promotion and protection of human rights in mental health is reliant upon a redistribution of power in the clinical, research and public policy settings.”

and goes on to recommend (p. 20):

“92. To address the imbalance of the biomedical approach in mental health services, the Special Rapporteur recommends that:

(a) States take immediate measures to establish inclusive and meaningful participatory frameworks in the design of and decision-making around public policy, to include, inter alia, psychologists, social workers, nurses, users of services, civil society and those living in poverty and in the most vulnerable situations;

(b) States and other relevant stakeholders, including academic institutions, recalibrate mental health research priorities to promote independent, qualitative and participatory social science research and research platforms, exploring alternative service models that are non-coercive;

(c) States partner with academic institutions to address the knowledge gap in rights-based and evidence-based mental health within medical education.”

So that’s a fairly clear rights-based mandate and indeed instruction to break up established monopolistic discourses determining research and knowledge production in the field of psychosocial disability (which term is broadly defined under the UNCRPD in a way that includes mental health issues and the contested domains of ‘personality disorder’, ‘eating disorder’, post-traumatic syndromes of various other kinds, etc).

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At ConfCap 2017 my colleagues and I looked back to the inspirational emancipatory pedagogy of Joseph Jacotot, concerning whom the contemporary French philosopher Jacques Rancière has written so eloquently. Jacotot, exiled to Flanders after the restoration of the French monarchy in 1815, discovered that he could teach French when speaking no Flemish even though his pupils spoke Flemish but knew no French.

Jacotot concluded from this experience that the role of the ‘master’ in relation to the ‘pupil’ needed to be entirely rethought and that “we are all equal in our intellect and common humanity”. Rancière critiques processes of social inclusion in which equality is constructed as a goal to be worked towards, arguing instead that we might simply assume equality from the outset and see how that changes our practice.

We also thought about the Democratic Therapeutic Community tradition in the UK since World War Two, beginning with a famous experiment in which Wilfred Bion, then an army psychiatrist in charge of the rehab wing of a military psychiatric hospital full of shell-shocked ‘soldiers who happen to be patients’, decided that his unit was in disarray and that the rehab task was hopeless unless the ailment could be displayed to the group as a group problem.

Bion formed an experimental therapeutic community centred around a daily parade ground meeting and invited the men to investigate their problems of discipline in wartime themselves, declining to exercise in any predictable way the medical or military authority vested in his role. The direct descendant of this approach was the Henderson Hospital Democratic Therapeutic Community, founded in 1947, which was the treatment centre in and around which, much later on, the paths of my colleagues and I converged.

At ConfCap 2017 we put the question whether this tradition of emancipatory practices of equality could be maintained and developed and we listed some of the ways in which we might be understood in different ways to have succeeded in producing knowledge together under this rubric and how this process has arguably become more emancipatory over time, at least in certain dimensions.

By this I particularly mean, that I was fairly clearly self-defining as project leader in my own early forays into research alongside survivors, whereas the roles have become gradually more ‘blurred’ (in therapeutic community terminology) to the point that recent and planned future ‘productions’ are either located in a practice of equality or may be understood as survivor-led.

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What then do I think I am doing, writing this blog and (for example) not even naming my colleagues? Well let me say first of all that I have not mentioned names because I am not assuming agreement with the train of thought I have set out here although I am very conscious of how strongly influenced it is by the collaborative work and I am not at all claiming thoughts as ‘mine’.

I also began by saying I was not going to make the mistake of staking out territory for myself or for my definitions of anything. Emancipatory research is a broad field and there might be something about this blog that justifies inclusion under that broad head, even if I am writing as expert by training.

What I want to do by way of conclusion is to jot down a few notes towards a manifesto or charter of some kind that might help to identify and mark ‘Survivor-led emancipatory research’ as an important and valued and differentiated subset of ’emancipatory research’ generally … and then see where it goes …

So – in that spirit – survivor-led emancipatory research is or might be understood:

(1) to be survivor led in design, implementation and publication
(2) to be embedded in flattened hierarchies and practices of equality that value expertise by lived experience
(3) to be concerned with, and to uphold a free and open and fearless culture of enquiry into, inequalities and dynamics of force within the system of care
(4) to renounce diagnostic models and categorisations that objectify the person in distress and not to objectify its own research subjects
(5) to place a value on deploying the self of the researcher
(6) to value communities of learning and to enlist experts by training in various fields as and when this may be helpful
(7) to value and privilege rainbow literature over grey literature

(8) to be understood as an anti-colonial practice and to resist and oppose discourses that would seek to ‘include’ it

(9) to be and to be recognised to be a form of knowledge production on equal terms with other such forms

(10)…..?

 

References

Paolo Freire ([1970] 1996) Pedagogy of the Oppressed. London: Penguin.

Jacques Rancière ([1987] 1991) The Ignorant Schoolmaster: Five Lessons in Intellectual Emancipation. Stanford, CA: Stanford University Press.

Diana Rose, Sarah Carr & Peter Beresford (2018): ‘Widening cross-disciplinary research for mental health’: what is missing from the Research Councils UK mental health agenda?, Disability & Society. DOI: 10.1080/09687599.2018.1423907

Jerry Tew (2003) Emancipatory research in mental health, in “Where you stand affects your point of view. Emancipatory approaches to mental health research. Notes from Social Perspectives Network Study Day 12 June 2003” pp. 24-28

Carole Truman, Donna Mertens, Beth Humphries (eds) (2000). Research and Inequality. London: UCL.

Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (2017) UN General Assembly – A/HRC/35/21 https://documents-dds-ny.un.org/doc/UNDOC/GEN/G17/076/04/PDF/G1707604.pdf?OpenElement

UN Convention on the Rights of Persons with Disabilities (2006) https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html