THE CONCEPT OF A THERAPEUTIC COMMUNITY

Abstract

Applied to a psychiatric hospital the term “therapeutic community ” implies that the responsibility for treatment is not confined to the trained medical staff but is a concern also of the other community members, i.e., the patients. How far can patients usefully participate in the treatment of other patients and how will this participation affect them? How far can they in turn be helped by other patients? The importance of staff tensions as they affect treatment have long been recognized and the work of the Chestnut Lodge group has had a profound effect on the thinking and practice of psychiatric nursing and we hope of psychiatrists themselves. This subject has been ably discussed in the recent publication by Stanton and Schwartz ( i). Relatively less attention has been paid to the social life of patients when staff are not present and the therapeutic possibilities this social interaction may have. Attention has been drawn to this subject by the interesting experiences of Caudill, a social anthropologist, who was ad-mitted to a mental institution for 2 months as a patient in order to study the social situa-tion from the patients ’ point of view. He states (2) While the staff exercised control over the patients, they did not give recognition to the patient world as a social group, but rather, they interpreted the behavior of the patients almost solely in indi-vidual dynamic-historical terms. The patient group, thus lacking an adequate channel of communication to the staff, protected itself by turning inward, and by developing a social structure which was insulated as much as possible from friction with the hospital routine. Nevertheless, such friction did occur, and the subsequent frustration led to behavior on the part of the patients which, although it overtly re-sembled neurotic behavior arising from personal emotional conflicts, was, in fact, to a considerable extent due to factors in the immediate situation. 1 Read at the si ith annual meeting of The Ameri-

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