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ISSN 0964-1886

VOLUME 24 NUMBER 3
Autumn
2003


CONTENTS

163 Editorial
John Gale

Social ecology
167
Private spaces, open spaces and asylum
Bill McGowan

Abstract: This paper addresses the theme of Social Ecology and Mental Health by attempting to bring together a range of concepts and ideas from health, social and urban geography, social ecology urban sociology, architecture, psychoanalysis, and public health.
The concept of ‘social space’ is used as an organising framework to illuminate the ways in which the built environment, and the wider social, economic and political structures may support or inhibit the ‘expressive’ function of asylum and the implications of this for our health and social wellbeing in our everyday lives in western urban cities. Concepts drawn from psychoanalytic literature are used to highlight the relationship between the internal world of the individual and the external environment through a discussion of the spatial anti psychological significance of a range of public amenities i.e. housing, open green spaces, transport systems etc.
The work of Anthony Giddens is used to set this discussion within a wider sociological context and a number of his ideas are used to locate and identify the therapeutic community as an important health promoting ‘locale ‘within the context of the wider neighbourhood locality. A plea is made for the recognition and advancement of the therapeutic community as an important health promoting intervention within the field of public health.

Horticulture and psychotherapy
187
The healing fields
Jenny Grut

Abstract: This paper was presented at CHT's annual conference, at the Royal College of Psychiatrists in 2001. The author is a psychotherapist who coordinates the work of the National Growth Project set up by the Medical Foundation for the Care of Victims of Torture. It is a unique project which works with refugees and asylum seekers in a long term rehabilitation programme using a combination of horticulture and psychotherapy on two allotment sites and in a remembrance garden. Here the author describes her work with 30 torture survivors and their families in what one client has called "hospital with a blue sky."

Architecture and psychotherapy
193
Finding a place for our soul: working in participatory design
Teresa Howard

Abstract: This paper describes a theoretical perspective and example of practice, developed by the author as a result of working in two professions concurrently; one dealing with the outer physical world: architecture and the other with the inner emotional world: psychotherapy Two short case studies are used as examples to demonstrate how working with unconscious modes of communication enables a more complete response to the problem of designing a more soulful environment; one that begins to meet some of our most difficult to express, inner needs.
Unconscious messages coming from the deepest recesses of our soul are always present but they usually get ignored, leading to impoverished communication and impoverished design solutions. Taking account of this delicate relationship leads to a form of participatory design that makes it possible for the end user to feel heard and involved. Consequently, an upward spiral from apathy to creative involvement is generated which significantly changes what is built, and how it is used and viewed.

Philosophical perspectives on nature
205
The natural environment as an element in a therapeutic community treatment programme
John Gale

Abstract: This paper the author outlines the ambiguous relationship which man has with the natural world, as well as some of the particular ways in which psychotic clients experience nature. He explains the philosophical basis for the way CHT works with nature, ddrawing on Heidegger an dLacon. Direct experience of the natural environment is built into the therapeutic programme, as is time for talking and thinking about the connection and alienation which we experience in relation to the earth. Together with an attentive reflection, provoked by the silence found in the countryside, these elements in the therapeutic treatment programme are aimed at helping clients gain greater self understanding, a sense of belonging and an ability to enjoy the world around them.

Case study: Summer Camp
217
A report on a therapeutic summer camp for residents of mixed diagnosis from four therapeutic households run by Community Housing and Therapy
Terry White, Kate Brown and Nicholas Wolff

Abstract: This paper is an account of a camp run for clients with a mixture of psychiatric diagnosis, which was held last summer. Initially inspired by research by a team of Polish psychiatrists, on a community programme for in-patients diagnosis with schizophrenia, a group of staff and clients set a theoretical basis for the project and planned a clinical framework on which the camp was run. There were excursions into the countryside and communal activities focused on cooking around a campfire. It is CHT's aim to develop these five-day camps as an extension of its existing therapeutic programmes. Clients and therapists will be able to connect with the natural environment as part of a team, working on basic tasks together. It is hoped that will give them an experience of being part of community-forming and highlight the ambiguous character of their relation to the natural world.

Archive Articles: Richard Crocket (1972, 1973)
227
Introduction
Craig Fees

232 Notes on the architectural requirements of the therapeutic community approach to psychiatry in district general hospitals
Richard Crocket

236 Therapeutic community adaptation of standard plans for district general hospital psychiatric units
Richard Crocket


GUEST EDITORIAL

It was said of Graham Greene that what interested him was the plight of decent men in foreign parts and the foreign parts in decent men! (The Daily Telegraph, 16th July 1999.) This may serve as a useful analogue for us in our consideration of the place of nature in a therapeutic community, because we might seriously conceive mental illness and psychosis in particular as a foreign land, a wilderness, a terra aliena. But we are also now much more aware than ever before that questions of ecology, of how we treat the earth, of green issues and of the tension between the city and the countryside are political concerns as well as having relevance for our mental well being.

There is a short-hand view of the problem of nature and mental life that gets wheeled out from time to time, particularly by psychoanalytic commentators on literature. The short-hand view runs something like this. Nature is seen and thus experienced, either as a wild and dangerous place or as a relaxing and harmonious place. How you conceive it will effect how you experience it and it all depends not on the countryside per se but on the subjective world of your feelings which are projected onto the tabula rasa of nature. Although this view fits conveniently with some ways of reading psychoanalysis, it is a misleading and facile view which tells us little about the natural environment. Usually this view makes great play of some ideas in Rousseau, without doing much justice to that over-sensitive and emotional political philosopher. His idea of the noble savage, Romanticism’s natura mater and psychological conceptions of instinct and adaptation often permeate this view.

There is, however, a longer literary and philosophical history to the relationship between man and nature than that, particularly among the Stoic writers, with their preoccupation for living in harmony with nature which might practically be called the foundational idea of Stoicism (Long, 2001, 1971; Sandbach, 1994). Certainly by Xenophon’s time "countrified" had come to mean uneducated and uncultured. Xenophon was inclined to rusticity and it is in his Qeconomicus that an entirely new spirit emerges (Marchant, 2002). Here, probably for the first time in literature, the full impact of the conflict between city and country, between culture and nature is made explicit and his love for the country which comes out has little in common with the sentimentality of Aristophanes. Xenophon’s book shows the land to be the imperishable root of all human life.

The rift between man and nature lies at the core of every human community in the sense that human society rests on what was known in the classical world as paideja (Jaeger, 1971). It is a difficult word to translate. Modern expressions like civilization, tradition, literature and education do not really cover it and yet they all refer to aspects of it and it is only when we apply them together that we get near to it. These words need to be taken as a unity and possibly ‘culture’ is the nearest we can get to express this unity. Not in the simple anthropological sense in which it is most frequently used today, to denote the entire complex of all ways and expressions of life which characterize any and every nation, even the most primitive. Paideia means culture in the sense of value. It is an ideal pursued by a community, self-consciously and I think comes fairly near to what Lacan meant by the symbolic.

Architecture — the way we organise space — is one of these cultural forms and one which has an immediate resonance with our internal world. The interplay between the external and internal location runs through many of the papers in this issue of the Journal, which is concerned primarily with the relationship between people and places in TCs. The paper by Teresa Howard discusses her attempts to take the unconscious into account in architectural design over a 25 year period. Although not referred to explicitly, her approach resonates with some of the notions about architecture as a way to "organise emptiness" that Lacan discussed in his Ethics. Two of the papers, those by Bill McGowan and Jenny Grut, were originally given at the Annual Conference of Community Housing and Therapy (CHT) held at the Royal College of Psychiatrists in February 2001 and entitled Ecology and Therapeutic Communities.

Jenny Grut’s paper is very much in the form of a talk and describes her work as a psychotherapist with victims of torture. When she delivered the paper it was accompanied by a number of slides showing her working with patients on the allotment and it was extremely moving. It is a personal account and I think Jenny’s passionate commitment to the work comes through in the text. Jenny’s work mirrors that of a TC because she is not seeing patients in a consulting room, but outside, working alongside them growing fruit, vegetables and flowers — and she runs therapy groups, so there is a lot of overlap with TC work. We have also included a review of a book about Jenny’s work which she co-wrote with Sonja Linden. Bill McGowan’s paper on social ecology is an erudite review and commentary on the way in which notions of space and location have been understood in different societies, with particular reference to issues of public health. He develops this by introducing concepts from Bion, Winnicott, Laing and others which connect our interior world with the environment.

The Conference and these papers contributed to a small group of staff and clients from CHT organising a camp for themselves and Terry White and his colleagues have written an account of the camp, more or less in the form of a diary, which we have included. I was struck by the way in which staff tensions about the raison d’etre of the camp came to the fore. I think readers who work as TC practitioners will be interested in hearing how the thing got organised, and it would be wonderful if other communities were inspired to follow suit or indeed, join in with future camps which Terry will be running.

We are particularly pleased to be able to publish, in this edition, two short pieces from the PETIT Archive and Study Centre by Richard Crocket, with a truly fascinating introduction by Craig Fees. These are important from an historical point of view. The two pieces are in the form of memoranda, written when Dr Crocket was Director of the Ingrebourne Centre in the early 1970s. The memoranda were sent in response to a national programme to build new psychiatric units within District General Hospitals. Although the programme did not go ahead, these memoranda initiated a dialogue with the architects.

In my own paper I have tried to explore some 1of the ways in which ecology brings us back again to the theme of language and thus has relevance for TCs, as they above all else take seriously the notion of community. All the papers published here remind me of the amusing rhetorical question posed by Lacan: "Do bees know geometry?" It is a question I often ask our staff, in order to stimulate the little grey cells! Recently, one bright spark came back to me, quick as a flash with the reply, "Only those who have been in group analysis!"

John Gale
Guest Editor

References

Jaeger, W. (1971) Paideia, The Ideals of Greek Culture Vol III (trans.) G. Highet, New York, Oxford: OUP

Long, A.A. (1971) Problems in Stoicism, London: The Athlone Press

Long, A.A. (2001) Stoic Studies, Berkeley: University of California Press

Marchant, EC. (trans.) (2002) Xenophon, Oeconomicus The Loeb Classical Library, Cambridge, Mass, London: Harvard University Press.

O’Hagan, A. The Daily Telegraph of 16th July 1999

Sandbach, F.H. (1994) The Stoics, London: Gerald Duckworth

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