Jerry Dincin (1930 - 2013) worked at Fountain House from1958 to 1964. He was the first person charged with replicating the Fountain House model, developing two programs in New Jersey before moving to Chicago to become the Executive Director of Thresholds. The Fountain House communitiy offers sincere condolences to Mr. Dincin's family and friends.
The year I came to Fountain House, 1964, turned out to be Jerry's last year before taking the position of Executive Director of Thresholds, a new Clubhouse/Psychosocial Rehabilitation/Psychiatric Rehabilitation program in Chicago. During that year I didn't get to spend much time with Jerry, because he was out developing Friendship House and Prospect House, two new programs in New Jersey. (It seems that in this period the replication of the Fountain House model would be carried out, in a hands-on manner, by trained Fountain House staff.) Jerry was highly regarded by all and could or should have been the assistant director of Fountain House.
After Jerry moved to Chicago and sometime after I was appointed Program Director at Fountain House, then-Executive Director John Beard asked me to join him on a two-day trip to attend a conference in Chicago. The first evening after we arrived, we met Jerry for dinner. John and Jerry talked about many things, but I clearly remember their conversation about starting a professional organization made up of Psychosocial Rehabilitation programs. Jerry was very excited about the prospect of such an organization.
On the plane ride home, John appointed me as the Fountain House representative to help develop any formal professional organization. I should explain that from approximately 1972 to 1980 a group of programs identifying themselves as psychosocial rehabilitation programs were meeting annually to share theory, research and program innovations. The participants at these early meetings were made up of a small group of programs: Fountain House in New York, Thresholds in Chicago, Horizon House in Philadelphia, Hill House in Cleveland, Friendship House and Prospect House in New Jersey, Forward House in Montreal, and a few others made up the core programs that met in the early days.
As time went by the number of programs sending staff to these annual meetings grew until, at the urging of Jerry and Irv Rutman, the Executive Director of Horizon House, a working group was formed to plan the creation of a formal professional organization: the International Association of Psychosocial Rehabilitation Services (IAPSRS).
Once it became clear that an organization would be formed, John provided support by allowing for my involvement and participation. As a representative of Fountain House and later as the Director of The Club (in New Jersey), I socialized and worked with Jerry and the other founding IAPSRS members to create and grow the organization. Jerry and I also co-chaired some of the more exciting symposia in which we debated the importance of program cohesion and program diversity. Also, to my chagrin, we competed for a National Institute of Mental Health (NIMH) training grant that he won for Thresholds. In all my dealings with him, I came to know him as a creative and passionate soldier and advocate for people with mental illness with a fierceness and dedication that is hard to duplicate.
Julius Lanoil Consultant and former Program Director, Fountain House
Three modern day, strength-based theories are consistent with the Fountain House working community practices, in that they state or imply a need for places where people can build their motivation, self-efficacy, self-esteem, and ultimately their natural tendency for personal fulfillment.
In 1997, the psychologist Albert Bandura elaborated his concept of self-efficacy. Self-efficacy is an individual’s belief that he has the ability to accomplish a certain task; as a person’s self-efficacy increases, he is better able to deal with insecurities related to unsuccessful past efforts. According to Bandura, the best way to improve self-efficacy is through participation in real activities as opposed to simulated ones. It’s through this participation that a person can have a successful experience (mastery), observe others successfully participating in similar activities (vicarious experience), and be inspired by others in a significant relationship (verbal persuasion).
In Edward Deci and Richard Ryan's self-determination theory, intrinsic motivation - a prerequisite for self-actualization - requires a place: a social environment in which the nutrients for autonomy (the exercise of control and choice) relatedness (relationships with people who care) and competence (increasing self-efficacy) exist.
The third relevant incarnation is the advent of positive psychology in 2001 – a field that brings together theories and research that focus on what people need in order to live a "good life." According to positive psychology, the good life involves optimal functioning; subjective well-being; and a focus on human strengths, capacities, and resources rather than human pathology. As it relates to positive psychology and the need for supportive environments, Martin Seligman and Christopher Peterson wrote
"Using your signature strengths is concordant with your intrinsic interests and values; hence in a supportive environmental context the clients strengths will become evident. This does not typically happen in a prescriptive way such as having the client complete a strengths inventory, but it occurs spontaneously in the relationship."1
The Fountain House strength-based working community treatment approach predates these three modern theories, although it has in common with them all of the essential elements for human growth and development. They all state or imply the necessity of a relationship-rich place - a place that has values and offers a sense of belonging and the opportunity to model others, a place that has practices and activities that are real, not simulated, in which members can choose to participate, and - by that choice - experience success and the growth in their motivation and self-efficacy.
In addition to offering adults with serious mental illness a sense of belonging, the Fountain House treatment approach breaks new ground by creating a situation in which they are needed to participate in all of the essential practices and activities of the community. When you relate to a person’s need to be needed, you celebrate humanity, confer dignity, and emphasize belonging. It both supports and fosters self-respect, and because of the mutual need and mutual gratitude expressed, produces equity in the professional relationship.
1 Seligman, M.E. Positive Psychology: Fundamental Assumptions. The Psychologist 16, p. 126-127.
Julius Lanoil Education and Wellness Consultant, Fountain House
In addition to the settlement house movement and milieu therapy, John Beard – the innovative social worker and former executive director who developed the Fountain House strength-based treatment approach - may have been influenced by his contemporaries, the Humanist psychologists of the 1950s.
How did therapeutic communities also influence Fountain House? In the ten years I worked closely with John, I never heard him mention Maslow, Rogers, Fromm, Horney, or Jung, or for that matter, any ideas he labeled as humanistic; nevertheless he believed that staff must be genuine and offer members basic acceptance and a significant relationship - beliefs consistent with Rogers’s client-centered therapy. John also felt strongly that all people need relationships, a feeling of rootedness, the opportunity to be creative, a sense of identity and a frame of orientation: the list of necessary human needs proposed by the famous Humanist Erich Fromm and prominently represented in the Fountain House community.
In general, Humanism in the 20th century was a reaction to the pessimism and lack of human choice embedded in both psychoanalytic and behaviorist theory. It optimistically speaks to our inherent potential as human beings. The concept dates back to Aristotle who stated 1) the individual is constantly trying to realize positive values from a core of human nature that moves from simple to complex 2) relationships should be concerned with sharing, giving, and taking care of each other and 3) people act from both self-benefiting and other-benefiting virtues. (Peterson and Seligman, Character Strengths and Virtues: A Handbook and Classification, 2004, pp. 22-25).
Nevertheless, as Rogers explained, there are negative events which can thwart a person’s natural upward movement and create pathology. As a result, this deep yearning for positive fulfillment can become weak and difficult to hear, but it can be stimulated to an increasingly noisy level by a social environment that supports it by focusing on people’s strengths. This idea of belonging to a social environment that supports self fulfillment is echoed by Maslow, who believed that belonging is a prerequisite to the development of a person’s self-esteem and self actualization.
In Karen Horney’s Neurosis and Human Growth, the client has a built-in propensity for self- realization. This hopeful notion is also consistent with Carl Roger’s Organistic Valuing Process, (1959), Abraham Maslow’s Self-Actualization (1968), Jung’s Concept of Individualization, as well as John Beard’s "need to be needed " conceptualization. The real need for member assistance in the Fountain House community creates a focus on members' strengths, as opposed to a focus on their pathology, an operational necessity. Other strength-based approaches utilize verbal analysis and social persuasion to build confidence but we believe, like Bandura, that talk alone cannot achieve the consistent changes in human behavior that build self-efficacy and esteem. Also this need for member participation in all of the activities of the Fountain House community destroys the traditional hierarchical relationship between staff and members and paves the way for significant, authentic relationships.
While observing the treatment of the physically disabled at the Rusk Institute in New York City, Beard became interested in the use of supports, like prosthetic devices and ramps, to create a hopeful reality for the disabled. This is manifest in his concept of “invisible social ramps” - the invisible supports built into programs and practices in the Fountain House community that make the larger community more accessible to members.
John Beard never formally identified himself as a Humanist, but these humanistic principles formed the basis of the treatment approach he developed at Fountain House:
an optimistic belief in human potential
the importance of relationships and belonging to a supportive community as prerequisite to self actualization
his two groundbreaking contributions to social theory and practice: his conceptualizations of his "need to be needed "and "invisible social ramps."
Had he been prone to writing, I believe John would be recognized as one of the leading humanistic practitioners of the 20th century.
Finally, the ideas of the Humanist psychologists, which include an optimism about the capacity of people and hopeful expectations for their future prospects, come to life in the Fountain House community, because as John Beard taught, our function is to help facilitate a member’s movement toward self-actualization by strengthening and building upon his or her existing strengths.
The next and final element in this series looks at today's strength-based treatment theories, which provide frameworks for the ideas we share and predate.
Julius Lanoil Education and Wellness Consultant, Fountain House
The strength-based approach to treatment originated in the writings of Aristotle, but its more modern development began in the 17th century. Moral treatment, as it was called, was supported by John Locke and other early Humanists. Humanism - with its emphasis on the worth and dignity of all people, the commonality of all human experience, the rejection of inappropriate authority, and optimism about the capacity of people - can be seen as the first context in which a focus on human strength building occurred.
In the world of mental illness, moral treatment - represented by, William Battie, William Tuke, Benjamin Rush and Philippe Pinel - was the first approach created on the belief that patients had skills and abilities that could be utilized in their treatment. For example, in England, William Tuke founded York Retreat where he created a family-style ethos. Patients performed chores to give them a sense of contribution, and there was a daily routine of both work and leisure. In the United States in the late 18th century, Benjamin Rush, eminent physician and humanitarian, developed humane approaches to treatment. He required hospitals to hire intelligent and sensitive attendants to work closely with patients, reading and talking to them and taking them for walks.
Also in the 1920s, the settlement house movement in the USA was another strength-based movement that influenced the Fountain House treatment approach. Similar to Fountain House-model programs, it related to the concrete needs of people in the local communities. Its emphasis on helping people fulfill the American dream through self-help, empowerment, family, community, support, training, social services and recreational activities had a powerful effect on John Beard through his social work training.
In 1945, in order to treat the so-called shell-shocked soldiers who had served in World War II, two hospitals were set up in England – Northfield Hospital in Birmingham and Mill Hill in London. Under the leadership of Dr. Main at Northfield and Dr. Maxwell Jones at Mill Hill, the strength-based ideas embodied in these hospital-based therapeutic communities gained full expression.
Stuart Whitely summarizes some of the tenets of this treatment in his article The Evolution of The Therapeutic Community. (Italics mine.) “When the leader interacts at the level of the group, his power can be magnified rather than dissipated.” At Fountain House, we call this working side by side. “It is not so much the occupation of the group but the participation in the group activity which is the curative factor.” It’s not the work but the therapeutic processes the work engenders. “Responsibility-sharing and mutual self-help lead to a decrease in passivity and dependence and to the abandonment of the sick role.” Members are asked to help themselves and others and to make choices. “Negative sanctions are less effective than positive reward in changing behavior.”
Unfortunately, the ideas developed in the therapeutic community movement failed to gain full realization because of conflicts between proponents of a strength-based treatment approach and the proponents of the psychotherapeutic treatment approach. Later, an offshoot of the therapeutic community, called milieu therapy, would have a powerful effect on Dr. Arthur Peirce - John Beard’s supervisor at Wayne County hospital in Eloise, Michigan. There, in 1950, they practiced AGT, the immediate forerunner of the Fountain House strength-based treatment approach.
The next element in this series looks at the influence of the Humanist Psychologists of the 1950s on the evolution of the Fountain House strength-based treatment approach.
Julius Lanoil Consultant, Education and Wellness Consultant, Fountain House
Julius Lanoil Wellness and Education Consultant, Fountain House
Fountain House is the name of a private nonprofit organization that started over sixty years ago to help men and woman released from psychiatric hospitals readjust to community life. The Fountain House treatment model is called the “Working Community,” a method developed as a direct result of the Fountain House experience.
Although the basic theory and underlying beliefs of the Fountain House program have not changed over the years, the nom de plume, like hair and clothing fashion, has.
From 1948 - 1968 Fountain House was called a day program. From 1968 – 1972, a number of day programs that espoused different methods but shared the goal of community integration for men and woman released from psychiatric hospitals started meeting to share experiences and information. Fountain House in NYC, Horizon House in Philadelphia, Hill House in Cleveland, Thresholds in Chicago, Fellowship House in Florida, Portals in Los Angles, and Forward House in Montreal were all included. These meetings formed the basis of IAPSRS (International Association of Psychosocial Rehabilitation Services), and Fountain House became known as a psychosocial program.
A little later, when the Community Mental Health Centers Act began to include partial hospitalization and other services for discharged psychiatric clients and IAPSRS became USPRA (United States Psychiatric Rehabilitation Association), the Fountain House program changed its designation again, becoming known as a psychiatric rehabilitation program.
In 1977 as a result of the replication efforts at Fountain House, the term Clubhouse Model began to gain parlance. In the ten years that followed, hundreds of Clubhouses were developed in the United States and around the world. These Clubhouses followed a model that was developed at Fountain House and was reflected by the International Standards, a series of declarative statements written in 1981 to guide new programs and to protect the rights of their memberships.
These standards, actualized by Fountain House and all other certified Clubhouses, are comprehensive in terms of member rights and organizational structure, but they say very little about treatment modalities or the therapeutic role of staff. As such, we felt that a book describing the role of community as treatment and the therapeutic role of staff in that community would be helpful to those interested in the work. All of this was undertaken and well described in a soon-to-be published book by Alan Doyle, Kenneth Dudek and me.
The book is a description of the Fountain House model which could differ in practice from other programs calling themselves clubhouses. The authors felt that their writing should reflect the Fountain House program, in particular, not the clubhouse movement in general. Hence, Working Community became the new and current description of the Fountain House program model.
A 63-year old organization, Fountain House has a rich archive. For several months, I’ve been organizing and cataloguing these old documents and photographs in a database. I want to share a letter that predates even our formal beginnings as the W.A.N.A.Society. It's from a former Rockland State patient whose idea it was to create the W.A.N.A Society in the first place.
First, let me offer you some context.
Dr. Hiram Johnson was a psychiatrist who worked at Rockland State Hospital in 1942 and was interested in self-help models of treatment. He was invested in connecting patients to one another to cultivate friendships between people who had similar problems, could understand each other, and could form a support network after leaving the hospital.
Elizabeth Kerr Schermerhorn was a woman of privilege who became interested in psychology and studied with Carl Jung. She had her own theories about treating mental illness, and in 1942 she took a job at Rockland State Hospital as a Psychiatric Aide. She held a strong belief that there could be an integration of people with mental illness with people in so-called “normal society.”
I don’t know exactly how the work of Dr. Johnson and Mrs. Schermerhorn was sparked, but it really is the furthest back that you can trace the roots of the group we call the origins of Fountain House. Out of their efforts came something very, very simple that would lead to something very, very big.
This simple something was known plainly as “Self Help.” It was a small group of Dr. Johnson’s patients that started meeting in 1943 at Rockland State. It was inspired by the principle that motives, processes and needs basic to human beings outside of the hospital, also pertain to people inside the hospital. There aren’t many descriptions of this group, but one describes ten or so patients meeting in the hospital for activities like reading, singing, painting and discussions. Another recounts that Dr. Johnson sometimes gave lectures and that the group tried to put together a magazine.
Unfortunately, because of illness, Mrs. Schermerhorn had to leave her position at Rockland State in the summer of 1943, but many patients stayed in contact with her. This is where Michael Obolensky’s letter comes in. Michael Obolensky was a patient of Dr. Johnson’s at Rockland State and was also one of the first members of the group "Self Help.” On November 11th, 1943, he wrote to Mrs. Schermerhorn.
In the beginning of the letter he mentions “Self Help" and states that the group had helped him, and he knew it had helped others, regardless of fights they had often gotten into. He writes about his desire to be psycho-analyzed and says that he would be endlessly grateful if it could be arranged because he feels that, if someone got at the root of his illness, he would no longer have to return to Rockland “for which,” he writes, “believe me I have not the slightest desire.”
He tells Mrs. Schermerhorn about his life after getting out of the hospital; he returned to work at the same laboratory where he had worked before he was hospitalized. He made $30 a week working for 40 hours, and he rented a small room for $3.75 a week. He also mentions his family.
At one point in the letter he says that he wishes to have a heart to heart; he particularly wants to talk to her about his idea to organize a new group outside the hospital based on “Self Help.” He describes this association of former grads of Rockland as an annex of the society for improving conditions within hospitals of mental hygiene.
I find this letter to be important, because it goes back as far as you can in terms of Fountain House’s origins - a group of people gathering together as a community. Being a community is obviously one of the main threads that hold Fountain House together today. The other thing I like about going back to this letter is seeing how the original hospital group, combined with Michael's idea of establishing a group outside the doors of Rockland State, led to the W.A.N.A Society. Although W.A.N.A. ended up having a very different purpose than what Michael originally proposed, I think it was just as important and may have been what he really wanted in the first place.
I think Michael may have been held down by the fear of recurrence of his illness and, as a result, wasn’t daring to dream big enough. I do think that Michael sincerely cared about improving conditions in hospitals, but he also makes it clear that, in a perfect world, he would rather not be hospitalized in the first place, and I’m sure he wishes the same for his peers. The W.A.N.A. Society, eventually Fountain House, was that source that helped to keep people out of hospitals. In fact, later studies that I’ve read in the archives demonstrate that the clubhouse model not only lowered the number, but also the length, of hospital stays.
Michael, like most of us here at Fountain House, was trying to move on with his life after being released from the hospital. He was trying to live independently, work, and maintain ties with family and friends - things that those of us who struggle with mental illness are still doing today. However, unlike those of us in the present day who are lucky enough to have a place like Fountain House to go to, he had nowhere to turn. Michael was so desperate to find this place that he led the way, along with others, to create it from the ground up.