John Rickman, Wilfred Ruprecht bion, and the origins of the therapeutic community

History of Psychology

Volumn 10, Issue 1, 2007, Pages 22-43

  Mills, John A ^a,c   Harrison, Tom ^b  

^a UNIVERSITY OF SASKATCHEWAN   (Canada)

^b BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS FOUNDATION TRUST   (United Kingdom)

^c NONE   (Canada)

Author keywords

Bion; Community psychiatrty; Northfield; Rickman; Therapeutic communities

Indexed keywords

HISTORY; HUMAN; MENTAL HEALTH SERVICE; METHODOLOGY; PSYCHOANALYSIS; PSYCHOTHERAPY; REVIEW; THERAPEUTIC COMMUNITY; UNITED KINGDOM;

COMMUNITY MENTAL HEALTH SERVICES; ENGLAND; HISTORY, 20TH CENTURY; HUMANS; PSYCHOANALYTIC THERAPY; PSYCHOTHERAPY; THERAPEUTIC COMMUNITY;

EID: 33847607502     PISSN: 10934510     EISSN: None     Source Type: Journal    
DOI: 10.1037/1093-4510.10.1.22     Document Type: Review

References (76)

1. See Kurt Lewin, R. Lippitt, and Robert K. White, "Patterns of Aggressive Behavior in Experimentally Created 'Social Climates'," Journal of Social Psychology 14 (1939): 229-256.
2. Also see Lewin and Lippitt, "An Experimental Approach to the Study of Autocracy and Democracy: A Preliminary Note," Sociometry 1 (1938): 292-300. The studies revealed various differences between authoritarian and democratic groups, such as higher levels of intragroup aggression and of discontent in the former. We thank Hank Stam for providing us with the references cited.
3. Thus, writing of two of the earliest therapeutic communities, Maxwell Jones's unit at Mill Hill Hospital near London and Wilfred Bion's Training Wing at Northfield Military Hospital in Birmingham, England (both operating during World War II), Rex Haigh writes: "[both] made fundamental challenges to the nature of authority." (Rex Haigh, "The Quintessence of a Therapeutic Environment," in Therapeutic Communities: Past, Present and Future (London: Jessica Kingsley, 1999), 254.
4. See Tom Harrison, Bion, Rickman, Foulkes and the Northfield Experiments: Advancing on a Different Front (London: Jennifer Kingsley, 2000), 24-37.
5. For accounts of British psychoanalysis, see Judith M. Hughes, Reshaping the Psychoanalytic Domain: The Work of Melanie Klein, W. R. D. Fairbairn, and D. W. Winnicott (Berkeley, Calif.: University of California Press, 1989)
6. and Phyllis Grosskurth, Melanie Klein: Her World and Her Work (New York: Knopf, 1986).
7. The literature on community psychiatry is very large. The following bibliographic sources are useful: Robert N. Rapoport (1960), Community as Doctor: New Perspectives on a Therapeutic Community (London: Tavistock, 1960), Chapter 1, footnote 5;
8. Milton Greenblatt et al., Custodial to Therapeutic Patient Care in Mental Hospitals (New York: Arno Press, 1955), 433- 484 (especially 457- 462; most of the bibliography lists background sources in areas such as empathy, attitudes, and group dynamics);
9. Gerald Grob, From Asylum to Community: Mental Health Policy in Modern America (Princeton: Princeton University Press, 1991), 358 -359, notes 4 and 5;
10. Tom Harrison, Bion, Rickman, Foulkes and the Northfield Experiments (London: Jessica Kingsley, 2000), 287-308.
11. David Kennard, "The Therapeutic Community as an Adaptable Treatment Modality across Different Settings," Psychoanalytic Quarterly 75 (2004): 296. Haigh in "The Quintessence of a Therapeutic Environment" puts forward five principles that differ from Kennard's but overlap with them. They are: 1. Attachment: A culture of belonging. "[c]community members can clearly feel a sense of belonging - where membership is valued and where members themselves are valued." (247-248); 2. Containment: A culture of safety. Patients: "[have] the novel opportunity to have . . . powerful primitive feelings accepted and validated." (249); 3. Communication: A culture of openness, defined as the opportunity: "[to] make contact with others, enjoy mutual understanding of common problems and find meaning through this connection." (250); 4. Involvement: A culture of participation. Haigh comments: "Everything that happens in the community - from the washing up, to the board games, to the requests for leave - can be used to therapeutic effect." (252); 5. Agency: A culture of empowerment. Haigh comments: "[most] therapeutic impact comes from work the patient does, rather than the therapist." (254). In general, Haigh comments that only Principles 4 and 5 are truly specific to therapeutic communities.
12. Harry Stack Sullivan, Conceptions of Modern Psychiatry: The First William Alanson White Memorial Lectures (New York: Norton, 1940).
13. Sullivan delivered the lectures in 1939, 232. We thank Craig Fees, who drew our attention to this passage. From other passages in Sullivan's writings, it seems that he was willing to extend a concept akin to the therapeutic community fairly broadly within mental hospitals. For example, he wrote: "The mental hospital is a community characterized by a strong interest in human behavior and an alertness to personality characteristics." (Sullivan, "Psychiatric Training as Prerequisite to Psychoanalytic Practice" in Sullivan, Schizophrenia as a Human Process: The Early Work at Sheppard-Pratt. [New York: Norton, 1962], 308-318 [a reprint of a paper Sullivan delivered in 1934]).
14. Earlier, Sullivan had written passages suggesting even more strongly that he was thinking along the same lines as those who created the first therapeutic communities. For example, he had suggested that: "[the] locus of psychobiological events is in a nexus of persons and their relations . . ." and that: "[not] sick individuals but complex, peculiarly characterized situations were the subject-matter of research and therapy." With respect to therapeutic potential, he claimed that there was an interaction between ward personnel and patients, while, even in diagnosis, clinicians' propensities and nosological categories interact. Even more specifically, he had written: "I refer to experience in dealing with young male patients by deliberate and rather thoroughgoing modification of the personal social and cultural environment in and within which they continued their being during the earlier stages of hospitalization." In a further passage, he had written: "[it] dawned on me that in personal interaction - even though it occurs extraconsciously - there is a valid, even if recondite, field for observation, classification, and induction." (All passages quoted from Sullivan, "Socio-Psychiatric Research: Its Implications for the Schizophrenia Problem and for Mental Hygiene," American Journal of Psychiatry 87 [1931]: 982-983).
15. Harrison, Bion, Rickman, Foulkes and the Northfield Experiments, 215.
16. Craig Fees points out that the term "therapeutic community" also occurred in the title of an article by Elizabeth Eells ("From the Sunset Camp Service League: Camp as a Therapeutic Community" in the Nervous Child, 6 (1947) and suggests that: "[it] was in general circulation at an oral level among psychiatrists and other mental health professionals in 1930s and 1940s who were exploring and discovering the influence of environment and community on health, mental health and behaviour, and that [Sullvan's and Eell's] happen to be the first known settings into print." (Therapeutic Community Open Forum, posted on 16 January 2006). Fees also suggests that the term could have been in widespread casual use among the medical community from the early 20th century onward and that Sullivan, Eells, and Main merely happened to be among those who first used it in published works.
17. For a list of some of those institutions see Kennard, "The Therapeutic Community as an Adaptable Treatment Modality across Different Settings," Psychiatric Quarterly 75 (2004): 297.
18. For an overall account of such work in Britain, see Maurice Bridgeland, Pioneer Work with Maladjusted Children: A Study of the Development of Therapeutic Education (London: Staples Press, 1971).
19. For an account of Lane's work, see W. David Wills, Homer Lane: A Biography (London: Allen & Unwin, 1964).
20. For an account of Aichorn's work, see August Aichorn, Wayward Youth (New York: Viking Press, 1935).
21. This is a translation of Verwahrloste Jugen. 2nd. Ed. (Vienna: Internationaler Psychaltyischer Verlag, 1931).
22. For accounts of Klein's and Fairbairn's theories, see Harrison, idem, 38-49 and Hughes, Reshaping the Psychoanalytic Domain. For an excellent treatment of Klein, see Grosskurth, Melanie Klein.
23. When speaking or writing of infants, Klein typically used the dichotomy "good breast" versus "bad breast." However, in that she believed that the phantasized dichotomy was the progenitor of later adult emotions she also, albeit more loosely, also spoke in terms of love and hate. See Grosskurth, Melanie Klein, 441 and 445 and various passages in Hughes, Reshaping the Psychoanalytic Domain, 44-88.
24. For a short review of her theory, see "Love, Guilt and Reparation" in Melanie Klein and Joan Riviere, Love, Hate and Reparation (New York: Norton, 1964), 57-119.
25. Klein presented the theoretical and empirical basis for her position in her "A Contribution to the Psychogenesis of Manic-Depressive States" (especially on 305-310) and "Mourning and Its Relation to Manic-Depressive States," in Klein, Contributions to Psycho-Analysis, 1921-1945 (London: The Hogarth Press, 1950), 282-310 and 311-338, respectively.
26. "Love, Guilt and Reparation," 65-66.
27. The belief that all children pass through psychotic stages is perhaps limited to those who follow Klein very strictly. Others would prefer to call such stages "infantile neuroses" or merely "bizarreness." See James S. Grotstein, Building on Bion: Roots. Origins and Context of Bion's Contributions to Theory and Practice (London: Jennifer Kingsley, 2003), 24, Note 7.
28. Bion was among those, such as Sullivan and Freda Fromm-Reichmann in the United States, who engaged in psychotherapy with psychotics. By the 1950s, he was giving long-term psychotherapy to such patients (a 5-year course of therapy to at least 10). His aim was not to cure conditions like schizophrenia but to enable schizophrenics to recognize for themselves the severity of their condition and thereby live some semblance of a normal life. He claimed that two thirds of his psychotic patients were earning a living. He rigorously eschewed any form of physical intervention, writing: "The analyst ought to expect concern for the patient's welfare to drive the family to intervene and he must be prepared to explain an alarming situation to them. He should strive to keep at bay surgeons and shock therapists alike while concentrating on not allowing the patient for a single moment to retreat either from his realization that he is insane or from his hatred of the analyst who has succeeded, after so many years, in bringing him to an emotional realization of the facts that he has spent his whole life trying to evade" (Bion, Second Thoughts (London: Heinemann, 1967), 34).
29. For a discussion of the "invisible college," see H. V. Dicks, Fifty Years of the Tavistock Clinic (London: Routledge and Kegan Paul, 1970), 107-109
30. and the numerous references to the group in Harrison, Bion, Rickman, Foulkes and the Northfield Experiments, especially 86-87.
31. For another fictional portrayal of psychiatric illness resulting from battlefield experience, see the account of the experiences and suicide of Septimus Warren Smith in Virginia Woolf's Mrs. Dalloway. For a portrayal of someone who learned to live with battlefield neurosis, see Inspector Ian Rutledge in Charles Todd's series of mystery novels, starting with Test of Wills.
32. We are relying almost totally on Sylvia Payne's obituary in the International Journal of Psychoanalysis,
33. republished as the Foreword to John Rickman, Selected Contributions to Psychoanalysis (London: Hogarth Press, 1957), 9-16.
34. See Harrison, Bion, Rickman, Foulkes and the Northfield Experiments, 38
35. and Harrison, "Northfield 50 Years On," (lecture, The Sutherland Trust, November 16, 2001).
36. Rickman, "The Individual and the Group," (lecture notes, Rickman Papers, Archives of the British Psycho-Analytic Society, Box 4, Folder 2, May 2, 1939). Inserts in square brackets added to create a grammatical sentence.
37. Rickman, "Uniformity or Diversity in Groups," (Paper based on two published lectures delivered in March of that year to the Institute of Psychoanalysis, 1958). We used an unpublished, transcribed copy in the possession of Pearl King and Tom Harrison.
38. Malcolm Pines, "The Influence of John Rickman and Melanie Klein on Wilfred Bion," (unpublished MS, 1998). We thank Dr. Pines for making it available to us.
39. From an abstract of Rickman's article in Psychoanalytic Quarterly, (1952): 21, 452. We thank John Forrester for bringing that quotation to our attention.
40. See Rickman, "Uniformity or Diversity in Groups."
41. James S. Grotstein, "Introduction: Early Bion," in Building on Bion: Roots, 9.
42. Eric Trist commented: In conjunction with [his analysis] he got out of his doldrums, entering on a late first marriage, publishing a late first paper (on psychological "asepsis") and beginning for the first time to reveal some of his immense powers of insight and intellect. Past the age of 40, he was beginning to find himself. (Eric Trist, "Working with Bion in the 1940s: The Group Decade," in M. Pines [ed.], Bion and Group Psychotherapy, [London: Routledge and Kegan Paul, 1958], 3).
43. See F. Kräupl Taylor, "A History of Group and Administrative Therapy in Great Britain," British Journal of Medical Psychology 31 (1958): 154-155, for an analysis of the degree of success and the validity of leaderless group tests. Kräupl Taylor maintains that the WOSB leaderless group tests owed their undoubted success to their indirect effects on morale rather than on their capacity to select the cognitive and personal characteristics required for leadership.
44. See Bion, Experiences in Groups and Other Papers (London: Tavistock, 1961), 83, Note.
45. Harold Bridger, "Northfield Revisited," in Bion and Group Psychotherapy, 92.
46. J. D. Sutherland, "Bion Revisited: Group Dynamics and Group Psychotherapy," idem, 49. Bion's beliefs in the socially based nature of personality and of human beings' openness to and awareness of the feelings of others appear, as suggested by one of the referees of this article, to bear some resemblance to Sullivan's. For example, in writing of the emergence of the capacity to love, Sullivan wrote: "Whereas previously, one may have learned to say the right things to one's companions, to do the right things, now those sayings and doings take on a very special significance. One's security is not imperiled by one's love object. One's satisfactions are facilitated by the love object. Therefore, naturally, for the first time one can begin to express oneself freely. If another person matters as much to you as you do to yourself, it is quite possible to talk to this person as you have never talked to anyone before."
47. (Sullivan, Conceptions of Modern Psychiatry: The First William Alanson White Memorial Lectures [New York: Norton, 1940], 43.) We are not saying that Bion believed that officers should love those under their command, but we are saying that he believed that only those who had insight into and respect for their subordinates' feelings were worthy to command.
48. For a brief but sympathetic review of the First Northfield Experiment, see Kräupl Taylor, "A History of Group and Administrative Therapy in Great Britain," 153.
49. For a detailed analysis, see Harrison, Bion, Rickman, Foulkes and the Northfield Experiments.
50. Wilfred Bion and John Rickman, "Intragroup Tensions in Therapy," Lancet 2 (1943): 678-681
51. and Bion, "The Leaderless Group Project," Bulletin of the Menninger Clinic 10 (1946): 77-81.
52. The first article was republished in Bion, Experiences in Groups and Other Papers (London: Tavistock, 1961).
53. Bion's phraseology is an instance of the downward imposition of democratic values so characteristic of his generation and the one preceding it. Thus, Beatrice Webb, a leading Fabian, combined pervasive snobbery with deeply felt and genuine socialism.
54. Rickman, "Group Therapy Applied to the Rehabilitation Wing of a Psychiatric Hospital and to Ward Treatment," (Rickman Papers, Archives of the British Psycho-Analytic Society, 1943).
55. Ibid, 3. Italics added.
56. Jason S. Grotstein, "Introduction: Early Bion," in Building on Bion: Roots, 13. Grotstein also wrote: "[Bion] states that there is such a thing as the psychology of the group but that the origins of the psychology lie solely with the individuals comprising the group, but he also seems to believe that the potential group-relating aspect within the individual is activated by the group. . ." (ibid, 14).
57. D. W. Millard comments: "[the] important lesson, taken over into the second Northfield Experiment, concerned failing to involve the wider environment (in this case the whole hospital community and its administration), which came to be seen as a necessity if an unconventional therapeutic regime was to become established and survive." (Millard, "Maxwell Jones and the Therapeutic Community", in 150 Years of British Psychiatry [Vol. II], edited by George E. Berrios and Hugh Freeman [London: Athlone, 1996], 588.)
58. G. Bléandonnu (1994). Wilfred Bion: His Life and Works, 1879 - 1979. (London: Free Association Books), 63.
59. See Harrison, Bion, Rickman, Foulkes and the Northfield Experiments, 203. Bradbury himself refused to categorize his work as "art therapy."
60. Harrison, Bion, Rickman, Foulkes and the Northfield Experiments, 215.
61. Idem, 208.
62. Idem, 209-210. Emphasis added.
63. Bulletin of the Menninger Clinic, 10 (Spring), 1946.
64. Kräupl Taylor, "A History of Group and Administrative Therapy in Great Britain,"153.
65. Millard, "Maxwell Jones and the Therapeutic Community," 590.
66. Alexis Brook, "The Impact of Tom Main," Therapeutic Communities 14 (1993): 205-212.
67. See Bion, Experiences in Groups and Other Papers.
68. See R. J. Corsini, Methods of Group Psychotherapy (New York: McGraw Hill, 1957), 77.
69. For an account of Jones's work, see Millard, "Maxwell Jones and the Therapeutic Community."
70. For accounts of their work see: Dennis V. Martin, Adventure in Psychiatry: Social Change in a Mental Hospital (Oxford: Bruno Cassirer, 1962);
71. David H. Clark, Social Therapy in Psychiatry. (London: Churchill Livingstone, 1981),
72. and "The Therapeutic Community," British Journal of Psychiatry 131 (1977): 553-64;
73. and Duncan Macmillan, "An Integrated Mental Health Service: Nottingham's Experience," The Lancet November (1956): 1094-1095.
74. In his "The Therapeutic Community - Concept, Practice and Future," British Journal of Psychiatry 111, 947-949, Clark (1965) gives a concise account of the origins of the therapeutic community. Although most of his discussion deals with Northfield, he assigns Maxwell Jones a foundational role (but without discussing the theoretical origins of Jones's ideas or comparing his work with that done at Northfield).
75. Bridger, "Northfield Revisited," 100.
76. Our principles are similar to those listed by Kennard in "The Therapeutic Community as an Adaptable Treatment Modality across Different Settings," which we have quoted previously. Since we arrived at our principles independently of Kennard, we have chosen to use ours at this point in the article.