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.
The 1920s saw the development of the residential living and learning communities such as Father Flanagan’s Boys’ Town in the USA, Homer Lane in England, and Aicorn in Austria. In England, these programs for disadvantaged youth were called Q Camps (for Quest and Query) and practiced “Planned Environmental Therapy” developed by the psychiatrist Marjorie Franklin. This therapy was based on identifying the healthy aspects of a person in an attempt at restructuring attitudes and functioning in a residential social and community environment. (Wills, W. D., The Hawkspur Experiment, London, George Allen & Urivin, 1941).
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.
Consultant, Education and Wellness Consultant, Fountain House