Sunday, 26 August 2012

I have just been asked to write a foreword for a book by Father Hank Nunn, a Canadian Jesuit now aged 82, who set up Athma Shakti Vidyalaya - a therapeutic community in Bangalore.

This is a first draft, which describes something of my experience of ASV when I visited it in 2003. I hope it will help to promote the book, and the work of this remarkable therapeutic community.
The view from ASV, the road towards Bangalore city centre
 In about 1980 I remember being sent to a strange place. I was a medical student, and we were often sent to strange places -  from theatres where the surgeons wore space suits and do operations by remote control to rural GP surgeries with afternoon tea and linen table cloths; from rooms where babies are born to rooms where corpses are dismembered. This one was even more different, though.

I had been warned by previous students that this acute psychiatric admission ward, the Phoenix Unit in Oxford, was not somewhere to wear the normal jacket and tie. So I kitted myself out in a big red sweater and jeans, and I arrived there on a bicycle a couple of minutes after the suggested 8.30, and I was casually pointed in the direction of a large dilapidated room where I soon had to forget any ideas I had of hospital hygiene. I squeezed into the room to be confronted with a large circle of chairs - perhaps 40 people - where it wasn't possible to tell the consultant from the cleaner.  I had to find my own chair and pull it up next to a large restless man who just looked at me and laughed. "What's your diagnosis then, eh? You must be manic like me with a jumper like that." He trumpeted this at what felt like 120 decibels, and I just wanted the ground to swallow me up.  There was an excruciating silence (probably all of twenty seconds) before everybody introduced themselves.

After my initial culture shock of joining a therapeutic community, I went on to thoroughly enjoy it. I found something completely different about the way people were with each other - I learnt my psychiatry the same as other students who were on traditional wards, but I also got an inkling of something that is very hard to define or put in words. It was something about being allowed to be yourself, about playfulness, and creativity.  
That short experience set me on a quest and an adventure that I am still following, thirty-two years later. What is it that makes somewhere ‘feel’ safe? How do you set up places where staff enjoy working, and give their best? How do you run mental health services for love rather than for money?
I have tried to capture this essence in different ways since 1980 – not least by training as a psychiatrist, and soon realising that the elusive secret was not to be found in that territory. I was getting warmer when, training as a group analyst in 1994, I tried using my course dissertation to put the theory I had been taught into a developmental sequence called ‘the Quintessence of a Therapeutic Environment’. And perhaps even warmer when, as chair of the Association of Therapeutic Communities in 2002, I helped to instigate the ‘Community of Communities’ as a quality network to identify and set standards for therapeutic communities.

The entrance to ASV - created by the community, of course
One of the absolute highlights of that exciting time was a visit I made in November 2003, to a therapeutic community in Bangalore, that was hoping to join the project network. I knew that they used a reparenting (‘cathexis’) model of transactional analysis, for I had met people from their sister project in Birmingham. I knew cathexis had been controversial some years previously, in the United States and international transactional analysis organisation, as well as locally for the Birmingham therapeutic community. But my only intention was to go with an open mind, and see what I could find of this elusive ‘essence’ in a setting so different from all my previous experience of mental health services. As always, I was more interested in the ‘general therapeutic conditions’ than I was in the intricacies of a particular model of treatment.

Three memories stand out for me: I will call them ‘warmth of welcome’, ‘unlabelled living’ and ‘fight for survival and growth’.
The neighbours - mid monsoon season
The warmth of welcome was deeply moving, and I could tell from the moment I crossed the threshold that the intangible quality, which was so elusive and difficult to define, was present in abundance. I remember telling somebody when I got home that you could tell a therapeutic environment by ‘its smell’ – which didn’t exactly mean the physical aroma so much as the unconscious, primitive, limbic sensations that emanate from the social field your are joining. Within minutes, I remember playing backgammon with a community member and not having any worries about exactly where I was sleeping, what was on my timetable for the visit, or who was who. Several thousand miles from home, in a place where everybody was new to me, I felt I had arrived home.

The ‘unlabelled living’ was fascinating to me as a mainstream, though psychotherapeutically-minded, psychiatrist. The hard lines I had learned between psychosis and neurosis, between schizophrenia and personality disorder, and between traumatic and biological causes - dissolved into thin air. People were being treated as themselves, for themselves, each according to their own needs. Echoes of Laing, I wistfully remembered. But here, being done with compassionate meticulousness in a economic climate where the alternative was a social exclusion harsher than anything we know back home. To me, the therapeutic intention – and the palpable manifestation of it – was orders of magnitude more significant than any specific therapeutic techniques or methods.

The ‘fight for survival and growth’ was sadly familiar. Those of us who choose to work in these complex and indefinable ways always need to establish an ‘island of containment’ within which the work can continue. In the process of economic globalisation and market managerialism, the natural tendency will inevitably be towards instrumental rationality – with easily defined treatment processes and specified outcomes, which is of course antithetical to therapeutic community practice. I remember animated discussions with a parent, and being excited by plans to set up a similar unit elsewhere in India: ‘how could all this excellent work fail to be properly recognised?’, I thought. I was, and always will be, rather na├»ve about these things.

Father Hank Nunn, November 2003
But all these experiences now make me realise the enormous task of the leader of a therapeutic community, and the ever-increasing impossibility of the task of mere survival, never mind the possibility of growing and thriving. In ASV, one man has held this vision alive, through many years of surviving, thriving and carrying a flame through a hurricane, and this book is his account of that Herculean task. It tells Father Hank’s own story, laced with illuminations about the links with his Jesuit faith, his philosophy of compassion and the detailed methods he uses. It is a true and authentic account of what it means to love thy neighbour, profoundly understand another’s distress, and be human in the wilderness.