Recent history

The history of the modern therapeutic community begins during the Second World War, when the psychoanalyst Wilfred Bion was put in charge of the training wing at Northfield Military Hospital in Birmingham, England. His brief attempt in 1943 to establish a therapeutic community failed, but was soon followed by others who were more successful: Tom Main, S. H. Foulkes, and Harold Bridger at Northfield, and Maxwell Jones at Mill Hill Hospital, London. In dealing with psychiatric casualties among soldiers they developed a radical new approach which was first described in a series of papers in 1946. One of these coined the term 'therapeutic community'.(1.) Main and Jones continued to develop different versions of this new method after the war, Main as director of the Cassel Hospital and Jones at Belmont Hospital Industrial Neurosis Unit, which was renamed the Henderson Hospital in 1958.

The creation of the National Health Service in 1948 provided the stimulus to address the major problems of institutionalization revealed in a number of studies of large mental hospitals in the United Kingdom and United States.(8,,9.) In the 1950s and 1960s some of these hospitals developed what Clark (19 called the 'therapeutic community approach'. Their aim was to humanize the environment and resocialize the patient populations, bringing many long-term residents to the level of functioning where they could re-enter a society from which they had been excluded 20, 30, or more years ago. In the 1970s and 1980s concepts of collective responsibility fell from favour and individualism prevailed. There was a gradual decline in the therapeutic community movement as the large old mental hospitals closed and services were switched to the community, although specialized autonomous units remained active. The 1990s has seen a revival of interest in therapeutic communities within more specific contexts, including prisons, units for severe and borderline personality disorders, and the management of people with enduring mental illness in the community.

Alongside these developments two other types of therapeutic community have emerged. In 1958 a self-help organization in the United States called Synanon became the prototype for concept-based therapeutic communities for ex-addicts. These were user-run communities with a hierarchical structure, fierce encounter groups, and a simple explanatory model of addiction and its treatment (the concepts). Phoenix House and Daytop were two major programmes that grew from this, and today therapeutic communities modelled on them can be found in nearly 60 countries worldwide.(3) Another development grew out of the antipsychiatry movement in the 1960s. These were small therapeutic communities created to demonstrate that psychosis could be managed with intensive therapeutic support rather than medication. These communities have been tried in the United Kingdom, Switzerland, the United States, and elsewhere.

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