From the forthcoming book Fountain House: Creating Community in Mental Health Practice by Alan Doyle, Julius Lanoil, and Kenneth Dudek. Columbia University Press, November 2013.
A working community assumes a place.A working community assumes place. Location and space are the necessary prerequisites of an association where face-to-face collaboration among participants is paramount. John Beard [Fountian House Executive Director 1955 - 1981] intuitively understood the imperative of having a place of one’s own for his vision to materialize. Because the conditions he envisioned differed so radically from the culture and practices of the hospital ward with its fixation on illness, he located an empty storeroom in Eloise as a “place” where he and his patients were free to set up a social space that would relate to the healthy interests of his patients and enable him to pursue what amounted to a different role as therapist. Ultimately he knew that the hospital environment was limited. So when the opportunity presented itself to build his own program at Fountain House, he took it.
It is critically important to people suffering from mental illness to have a place for association in society (Carolan et al., 2011; Whitley, Strickler, & Drake, 2011). The notion of place holds an existential quality, such that the associations that occur within that space become rich in meaning and memory. Augé (1995) defined places as “relational, historical, concerned with identity” (p. 77). They are spaces filled with emotion and meaning. Place then represents a welcome harbor for a population whose place in society is filled with stigma and embarrassment. Since deinstitutionalization and the loss of a special place for people suffering from mental illnesses—however ill-conceived and experienced—Fountain House represents one such niche where they can anchor to find meaning and stability and foster relationships with others.
Place can also have a salutary effect upon people. In the words of Relph (1976), “A sense of place can sustain identity, provide connection to a personal and collective past thereby offering an emotional center which is rooted and anchored in meaning and value” (p. 141). In this way, place, with its bonds of emotional and social supports, provides a “pathway for negotiating the complexities of living” (Casey, 1997, p. 448). March et al. (2008), analyzing place and its association with the etiology of severe mental illness, consider place to function as a reservoir of risk or resilience: “As a reservoir, place consists of the natural and built environment, physical structures, and material resources that shape experience within a designated geographic location. The physical and social architecture of place both shapes and reflects relationships among individual inhabitants, social groups and social structures and institutions” (p. 96).
We agree that the social processes found in a place can be both protective and curative for those stricken with mental illness. And we intend to pursue this line of thought in further detail in the epilogue, considering how the place Fountain House as a practice and message of hope can provide clues that assist in the amelioration of the problems faced by people with severe mental illness in an era of deinstitutionalization.
Finally, control over space and time is essential in order to sustain the full effects of the Fountain House approach. We now know, after years of attempts to replicate the experience of Fountain House, that spatial independence is a necessary precondition for the working community model to reach its potential in meeting the recovery goals of its membership. It requires a space uninhibited by the rules and mores of a traditional mental health setting. It requires new roles for members and staff so that they can work together in a sympathetic environment. Specifically, such a place requires an independent board of directors at its core who will work to realize the Fountain House mission of member empowerment over the long term and promises that the effort spent on building the program will not be lost. In their own building with their own name, and with an unlimited future, independent working communities can foster a message of hope and demonstrate a sustainable approach to recovery.
Alan Doyle, Julius Lanoil, and Kenneth Dudek