| KINGLSLEY
HALL
DIABYSIS
SOTERIA
BURCH HOUSE
CURRENT PROGRAMS
While support for persons experiencing spiritual
crises is not well developed in Western culture, some
residential treatment centers have attempted to provide
therapy based on an alternative perspective that psychosis
is potentially a "breakthrough rather than breakdown." Kingsley
Hall in England was the first alternative nonmedical
model residential treatment, and it inspired the development
of several others that are described below.
KINGLSLEY HALL
R.
D. Laing, MD, psychiatrist and author of numerous books on mental
health, argued that mad people have lost their conventional social
filters, and have regressed to a level of experience that precedes
the acquisition of rudimentary distinctions between inner and outer,
past and present, real and imaginary, good and bad, etc. But he argues
that their anguish and confusion may herald an inner voyage — termed
metanoia — which under optimal circumstances, can result in the
emergence of a more authentic and integrated way of being-in-the-world.
While in training as a psychoanalyst, Laing came across instances of
spontaneous remission in which subjects were not merely restored to
their premorbid condition, but emerged more integrated, insightful
and grounded than before — at least by their own reckoning.
Based on numerous case histories and first person accounts,
and on the reports of friends and former patients who
had metanoia-type experiences, Laing concluded that in
optimal circumstances, a psychotic episode can have a
positive outcome. To wrestle a redemptive measure of
freedom and insight from a psychotic interlude, and to
prevent the dreaded decline into chronicity, the disordered
person needs a safe, non-coercive environment and the
supportive and non-intrusive presence of others who have
also made this perilous inner journey, and can act as
guides, facilitators and protectors. Laing's enthusiasm
for the metanoia concept was such that during most of
the 1960s, he proposed that most psychotic disturbances
would follow this pattern, if the requisite conditions
were provided. Accordingly, Laing was also categorically
opposed to drugs, shock treatments, or any surgical interventions
that might cause the metanoia process to abort or misfire — in
short, to almost all of mainstream psychiatry.
If the human race survives, future men will, I suspect,
look back on our enlightened epoch as a veritable Age
of Darkness. . . .They will see that what was considered
'schizophrenic' was one of the forms in which, often
through quite ordinary people, the light began to break
into our all-too-closed minds. (The
Wing of Madness: The Life & Work of R.D.Laing)
Laing never claimed that the onset of acute psychosis
always heralds a metanoic journey. He merely said that
it usually would, or could. After 1969, however, Laing's
attitude was decidedly more cautious. When asked about
this in the 1970s, he estimated the odds of spontaneous
recovery, even in optimal circumstances, were 50% or
less.
In 1965, Laing, Esterson, Cooper and a small group of
friends and supporters founded a charitable foundation
for the creation of therapeutic communities for people
suffering from mental and emotional crises. The Philadelphia
Association was committed to the idea that a psychotic
breakdown is an existential crisis, and therefore, potentially,
an attempt to reconstitute the self in a more authentic
and integrated way. Professional and patient roles, as
implemented and understood in mainstream psychiatry,
are not conducive to genuine cure. In fact, they often
preclude a genuine understanding of the psychotic as
a person, and tend to exacerbate patients' sense of powerlessness
and isolation.
To remedy this situation, Laing and associates set up
therapeutic households that provided those suffering
acute distress and disorientation asylum from the world
outside, free from the stigma of diagnosis and the traumas
of involuntary treatment. The most famous of these households
was Kingsley Hall, in London's East End, which ran from
1965 to 1970. As his first marriage disintegrated, Laing
himself moved in there. He said about Kingsley Hall,
One of the problems is this: as soon as we have "professionals" we
have expectations that they should be "doing something." People
didn't have to do anything. They were living under
the same roof, and making a life together, on an ad
hoc day-by-day basis. There were no formal duties.
Simply sharing the same situation, sharing a kitchen,
sharing the arrangements to buy food (The
Wing of Madness: The Life & Work of R.D.Laing).
It closed in May of 1970 as a result of the neighbors
reactions to behavioral disturbances and lack of maintenance
of the facility, but is widely considered a noble experiment
that spawned other attempts to create non-medical approaches
to residential treatment of psychosis.
DIABYSIS
The Jungian analyst John
Perry, MD established a residential facility, Diabysis, in San Francisco
in 1974 that serves as a model for the environment most therapeutic for spiritual
emergencies, especially for persons in an acute psychotic crisis. Diabysis
created a homelike atmosphere where diagnostic labels were not used, and staff
members were selected who were comfortable with intensive inner processes.
Training in the mental health professions was not a requirement for staff although
many interns were used. Perry emphasized that when a person's psyche is energized
and activated, what is needed isn't "treatment" but contact with
a person who empathizes, who actively encourages the process, who provides
a loving appreciation of the qualities emerging through the process, and who
facilities the process rather than attempting to halt or interfere with the
process. Medication, he believed, only inhibits a person's ability to concentrate
on the inner work and it mutes the psychic energy needed to sustain the effort
to move the process forward. Perry describes it as follows:
What we did at Diabysis was specifically
to set up what we hoped would be the most ideal, least
toxic (smile), least damaging environment for a person
in the visionary state. First off, this means a home.
You need a place with friendly, sympathetic individuals
who live there. These people have to be companions,
have to be willing to listen and not be frightened
and not be judgmental about it, and not try to do anything
to anybody.
One has to let the visionary process
unfold itself spontaneously. Under such conditions,
to our surprise, we found that our clients got into
a clear space very quickly! We had started out with
the notion that we would surely be in for a lot of
bedlam with all this "madness" going on,
but actually the opposite was true! People would come
in just a crazy as could be on the first day or two,
but they'd settle down very soon into a state of coherency
and clarity. Often, when I would come in for a consultation
at the end of the week, I would see someone who had
been admitted in a completely freaked-out state just
a few days before, sitting at the dinner-table indistinguishable
from anybody else; sometimes I couldn't tell if this
was a new member of the staff, or one of our clients.
The calming effect of a supportive environment is truly
amazing!
It's a well-known fact that people can and do clear
up in a benign setting. Actually, they can come down
very quickly. But if some of our cases had gone to
the mental hospital, they would have been given a very
dire message: "You've had a mental breakdown.
You're sick. You're into this for decades, maybe for
the rest of your life!" and told "You need
this medication to keep it all together." I am
quite certain that if some of our clients had been
sent to the mental hospital, they would have had a
long, long fight with it. The outcome of their stay
at Diabysis, however, was that their life after the
episode was substantially more satisfying and fulfilling
to them than it had been before!
The acute hallucinatory phase, during which these
contents go through the reordering process, usually
lasts about six weeks. This, by the way, corresponds
to the classical description of visionary experiences
in various religious texts, such as the proverbial "forty
days in the wilderness" often referred to in the
Bible. (Interview:
Mental Breakdown as a Healing Process)
Case Example
from Diabysis
SOTERIA
Soteria was another residential treatment program that existed in the 1970s
in San Jose and provided a milieu that promoted expression rather than suppression
of the contents of the patients' psychotic experiences. It was oriented toward
a Laingian model with great respect for the psyche's own natural healing
intentionality, but without delving into the archetypal/symbolic aspects
of psychosis. This was the only alternative residential setting that conducted
research on outcomes, and they were generally positive. This is a recent
publication summarizing the positive long term results.
Mosher LR Soteria
and other alternatives to acute psychiatric hospitalization:
a personal and professional review. J Nerv
Ment Dis 1999 Mar;187(3):142-9
BURCH
HOUSE
Burch House was a residential, therapeutic community for up to eight client
in a 19-room farmhouse on 13 acres of land in New Hampshire. Burch House worked
with persons diagnosed with psychotic disorders since 1978. David Goldblatt,
the co-founder and director, spent 4 years studying with R.D. Laing, and this
profoundly influenced the clinical direction of Burch House. The program emphasized
two principles. The first is community; all 8 residential clients share household
tasks such as cooking, cleaning and gardening, and relationship building is
encouraged. The second is "autorhythmia," meaning that clients are
permitted to find their own pace and path within the community, free from prescribed
schedules and expectations:
We give people room to be who they are, in whatever
way they do it provided nobody gets seriously hurt
in the process. We present a way for people to be with
clients without trying to do anything to them or to
structure their experiences, even if they're in the
midst of a full-blown psychosis.
[The program is based on] a strong belief that people
recovering from severe emotional and psychological
distress are in a process that needs to be treated
with humanity and dignity. And that given a place with
time and safety individuals will be able to reach their
own innate healing capacity that is lost through distress
and traumas.
CURRENT PROGRAMS
Wellspring
Foundation
Located in the rolling hills of Western Connecticut, Wellspring's woodland
setting with pastures, farm animals and stream provides a naturally healing
environment. The highly structured but intimate programs are designed to treat
persons with a wide range of behavioral and emotional problems, including affective,
personality, attachment, eating, and traumatic stress disorders. Angelus House
is the Residential Adult Treatment Program of The Wellspring Foundation for
individuals ages 18 and over. The small community, with a maximum of 10 residents,
creates a family environment that can serve as an often-needed step between
hospital and home or independent living
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