Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 85In 1949 Dr George Bell unlocked the doors of all the wards of DingletonHospital in Melrose, Scotland. In earlier decades physician superintendents ofother hospitals had made similar attempts—Rutherford at Lenzie Asylum in 1881,for example, and Saxtby Good at Littlemore Hospital, Oxford, in 1935—butpublic pressure had always forced the doors closed again. Bell’s success, however,heralded an Open Door Movement in psychiatry which swept the Western worldin the years that followed. Mapperley Hospital opened its doors in 1953 andWarlingham Park, South London, soon after. Day hospitals for patients sufferingfrom psychosis were used in Great Britain in the 1940s and 1950s, and inAmsterdam, Holland, a comprehensive program was developed for the treatmentof the mentally ill in their own homes. Not until 1958, when drug treatment waswell established, did St Lawrence Hospital, New York, become fully opendoor. 14 Within the European hospitals, other changes were taking place.Beginning in 1946, British psychiatrists developed new patterns of institutionalliving. Termed “therapeutic communities” by Dr Tom Main, groups of therapistsand patients worked together to create a hospital environment where traditionalmodels of institutional authority were broken down, patients participated in thegovernment of their hospital community, staff and patient roles were blurred andopen communication was highly valued. Initially, this type of treatment settingwas not available for patients with psychosis. Tom Main worked withdemoralized ex-soldiers at Northfield Hospital, Birmingham, and Maxwell Jones,foremost in developing the therapeutic community concept, worked withunemployed drifters and, later, patients with character disorders at the HendersonHospital in South London. 15 In due course the therapeutic community idea wasintroduced into wards for patients with psychosis. At the Littlemore Hospital,Oxford, throughout the 1960s, there were therapeutic communities in threedifferent treatment units—for the elderly, for brain-damaged patients and foradult psychiatric patients. The programs, radical in concept, were established by DrBen Pomryn, who had worked with Maxwell Jones at the Henderson Hospital.On the general adult unit—the Phoenix Unit—staff and some 60 acute andchronic psychiatric patients (i.e. 70 or more people) participated in dailycommunity meetings that established ward policy, evaluated new admissions, heldinterviews with patients’ families, prescribed treatment (including drug treatmentand electro-convulsive therapy) and authorized discharges. Maxwell Jonesintroduced similar changes to Dingleton Hospital and turned it into an innovativemodel drawing staff and visitors from many parts of the world.The new hospital activity and therapeutic optimism were geared to earlydischarge, rehabilitation, and treatment in the community. Chronicallyinstitutionalized patients developed social competence and were placed insupervised hostels, returned to their families, or were set up in houses of theirown, living together in family-like groups. Psychiatrists and nurses left the wardsto see patients in their homes and in outpatient clinics and to consult with familyphysicians and community mental health workers. Sheltered workshops prospered,especially in Holland and, after 1960, in Britain, and pro-duced goods