Community Life for the Mentally Ill: An Alternative to Institutional Care

369 Pages·2008·23.835 MB·English

by  George W. Fairweather, David H. Sanders, David L. Cressler, Hugo Maynard

community life
for the
^
mentally ill

community life
for the
^
mentally ill
an alternative to institutional care
George W. Fairweather
David H. Sanders
David L Cressler
Hugo Maynard
SJ Routledge
Taylor & Francis Croup
LONDON AND NEW YORK
First published 1969 by Transaction Publishers
Published 2017 by Routledge
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Copyright © 1969 by Taylor & Francis.
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Library of Congress Catalog Number: 2008005495
Library of Congress Cataloging-in-Publication Data
Community life for the mentally ill : an alternative to institutional care /
George W. Fairweather ... [et al.].
p. cm.
Originally published: Chicago, Aldine Pub. Co. [1969].
Includes bibliographical references and index.
ISBN 978-0-202-36213-7 (alk. paper)
1. Mentally ill—Rehabilitation. 2. Community mental health services.
I. Fairweather, George William, 1921-
RC576.C58 2008
362.196'89--dc22 2008005495
ISBN 13: 978-0-202-36213-7 (pbk)
Preface
This book presents a social innovative experiment aimed at providing new
and more participating social positions in American society for mental
patients. It presents the events that occurred when a courageous group of
former chronic mental patients abruptly left the hospital and established
their own autonomous subsociety in a large, metropolitan area. The book
continues into the community setting the activities of such patient groups
first described in our Social Psychology in Treating Mental Illness: An
Experimental Approach. From an experimental point of view, it follows
the research procedures presented in a recent book, Methods for Experi­
mental Social Innovation, by one of the authors.
In order to complete this experiment, it was essential to create a small
society in the community where discharged patients could live and work.
The problems involved in establishing such a society and its history are
described in detail. It was equally important to evaluate the effects of the
newly created society upon the behavior and perceptions of its members.
Such an evaluation is also presented here. Both the descriptive and com­
parative aspects of this study are presented as they occurred in real life.
For that reason the book is concerned with the medical, economic, sociolog­
ical, and psychological facets of these former patients' daily lives. Finally,
the effects of this small society upon the neighborhood and city in which
it was located, as well as its effects upon professional persons, are ex­
plored.
v
vi PREFACE
All research material has been edited to preserve anonymity. Fictitious
names are used throughout, and identifying dates have been altered. Every
attempt has been made to disguise the names of the patients. Any name
given a patient which is the same as that of any individual in this study is
purely fortuitous. The names of professional persons have likewise been
changed.
Through the order in which the material is presented, the authors have
deliberately attempted to provide readers with the "flavor" of the research
activity from its beginning to its completion. However, for those who are
not interested in reading the entire work sequentially to capture this
"flavor," chapter 1 presents a brief description of the study and a sum­
mary of its findings. In this chapter the reader may also find a descriptive
account of the contents of subsequent chapters. It is hoped that both the
humanitarian and experimental goals of the authors have been communi­
cated effectively in the pages subsequent to this introduction.
No experiment of this magnitude could be accomplished without the
involvement of a large number of people. We cannot name all of those
who have made a significant contribution to this study, nor can we ade­
quately recognize those who have made such contributions. But to all of
them we are deeply indebted. Some persons contributed so much to the
total project that—despite the injustice imposed by the brevity of the
recognition—their names deserve special mention. First, a debt of grati­
tude is owed to Dr. John J. Prusmack, the Director of the Veterans
Administration (VA) Hospital at Palo Alto, California, where this study
was initiated, and to Drs. Thomas W. Kennelly, and John H. Vitale, Director
and Assistant Director, respectively, of the Psychology Services there.
The aid that they gave the project from its outset to completion was exceed­
ingly important to all of us who worked daily in it. We are also indebted
to the heads of all the departments at the VA Hospital, Palo Alto, Cali­
fornia, and to the many other individuals there who contributed in one
way or another to the completion of this project. And for providing us
with information about the rehabilitative programs at their institutions we
are grateful to Ladd McDonald, Chief of Vocational Services at Fort Logan
Mental Health Center, Denver, Colorado, and Dr. Charles Yohe and Mrs.
Billie Larch at Arkansas State Hospital, Benton, Arkansas.
Of course, the work of those who operated the psychiatric ward in the
hospital from which all persons participating in the research project came
are richly deserving of our thanks. They include Dr. Robert S. Mowry, Dr.
Roger D. Jennings, Mrs. Elizabeth A. Rankin, Mr. Keith Wilson, and
Mrs. Muriel Grey. Along with this professional staff, Mrs. Remalda
Fuentes, Mrs. Nettie Milton, Mr. Francis Norsby, Mr. David Dozier, Mr.
Clarence Henry, and Mr. E. Tescero also contributed their invaluable
aid. The assistance of this group was important since the maintenance and
PREFACE vii
stability of the ward small-group program on a daily basis was essential
to the completion of the project.
To Dr. W. Scott MacDonald we extend our gratitude. By spending the
first few difficult weeks with the hospital immigrants in this community
venture, he had a unique and important role in helping to create the
lodge society. Unfortunately, he accepted a position with another organi­
zation once these first few weeks had passed, but it is to his early efforts
that the members of this research group owe a great deal. The authors are
also indebted to Stanford University for its help in carrying out this proj­
ect. Particular gratitude is expressed to Sterling Silver, Cassius Kirk, Jr.,
Donald Price, and Lynn Comeski, who aided the establishment of the
lodge society in many ways. It is also important to recognize here the aid
of Mr. Cedric Kidder who was a janitorial consultant for those in the
lodge society. Finally, special recognition is due the National Institute of
Mental Health (NIMH), which provided the funds for this study (Grant
No. 3 Rll MH 01259 and No. 7 R01 MH 14690). A list of names of
those from the Institute who were helpful in this project is too lengthy to
present here, but special gratitude is expressed to the Applied Research
Branch and the San Francisco Regional Office.
The authors have had the particular good fortune to know and work
with several able collaborators of long standing in the current research
effort. Among them was Mrs. Helen J. Pearson who functioned as adminis­
trative assistant to the project. In this capacity, her major responsibilities
concerned administration on a day-to-day basis of the grant-supporting
project activities, especially those important functions of establishing and
maintaining relations with the sponsoring institutions of higher learning.
Another, Mrs. Betty J. Fairweather, assisted the project substantially by
typing transcripts of interviews and scoring data. Finally, aid in com­
pleting the cluster analyses of much of the research data was given by the
late Dr. Robert C. Tryon and his associates, particularly James Cameron.
There are others who made substantial contribution to the study. Dr.
Edward Custer played an exceedingly important role in establishing the
medical care for lodge members. We are grateful to Sharon Martin, Bar­
bara Hobbs, and Sharon Doolittle for help in preparing the manuscript.
We are also indebted to several publishers for their permission to reprint
material first published by them. They are: American Journal of Ortho­
psychiatry, Harper & Row, John Wiley & Sons, International Universities
Press, and Columbia University Press.
But we would be remiss if we did not recognize our lasting indebtedness
to those who established the community lodge. Whatever were the benefits
that this adventurous group of formerly hospitalized mental patients ob­
tained from this experiment, it was small in comparison to the benefits
gained by those of us who worked with them. The daily contacts with them
viii PREFACE
in their struggles to attain independence and to establish their own small
society were at times frustrating, unpredictable, and often inspiring, but
they were always very human.
G. W. F.
D. H. S.
H. M.
D. L. C.
About the Authors
At the beginning of the investigation reported in this book, GEORGE W.
FAIRWEATHER was chief of the Social-Clinical Research and Service Unit
of the Veterans Administration Hospital in Palo Alto, and an associate
consulting professor of psychology at Stanford University. Subsequently,
he moved the research project to Portland State University where he was
professor of psychology and director of a research institute. He is now
professor of psychology at Michigan State University and is planning an
institute to train researchers in the methods of experimental social inno­
vation.
The co-authors were all colleagues of Professor Fairweather during the
course of the project. DAVID H. SANDERS, HUGO MAYNARD, and DAVID L.
CRESSLER held positions as research associates both at Stanford University
and at Portland State University. David H. Sanders is presently associate
professor of psychology and psychiatry at Michigan State University; Hugo
Maynard and David L. Cressler remain at Portland State University.
Contents
PREFACE Vll
PART I. THE SOCIAL INNOVATIVE EXPERIMENT
1 Overview of the Experiment 3
2 Social Status and Mental Illness 9
3 Planning and Implementing the Project 22
PART II. EVOLUTION OF AN AUTONOMOUS SOCIETY IN THE
COMMUNITY
4 The Era of Maximum Professional Supervision 45
5 A Governing Body Emerges 70
6 The Attempt at Self-Government 88
1 Autonomy at Last 101
PART III. INTERCHANGE WITH THE SURROUNDING COMMUNITY
8 The Socioeconomic Environment of the Lodge 129
9 Social Exchange with the Community 149
10 Relations with the University 167
11 Medical Care for the Members 183