The Cassel Years

During this period I moved jobs after a long and generally fertile time at St Bernards, following the development of psychiatry, and trying all the time to inspire an interest in the experiences of the people we cared for. Or it was not so much inspiring an interest, but in trying to help sustain that interest in the majority of the staff who had gone into the work precisely because they were concerned and sensitive to the suffering of their charges. The job I moved to after St Bernard’s Hospital, in 1993, was an experiment on my part – to see how I would fare in a management role in the heart of bureaucracy, which had always been the kind of thing I’d carefully kept to the margins of. I became Clinical Director of the Cassel Hospital, a prestigious position. By 1997, I had got the result of my experiment, and left, to become an academic. In fact it gave me an opportunity to reflect on a lot of issues and themes that I had puzzled over during my period in British psychiatry. I considered anew, and from a different perspective, notions of authority, and the dynamics of therapeutic communities, and institutions. There were colleagues at the Cassel with experience and a high calibre of thinking about therapeutic communities, and they were the real stimulus of the work – whilst the managerial chores became… well, just chores.

2001 (with Peter Griffiths) Enquiry into a culture of enquiry.
In Lesley Day and Pamela Pringle (eds) Reflective Enquiry into Therapeutic Institutions. London: Karnac.
In some ways the Cassel Hospital was a living fossil, since the average lifespan of a therapeutic community may be around 10-15 years. It had been regenerated by Tom Main in 1946, on the basis of therapuetic community experiments in Military psychiatry, at Northfield Hospital in Birmingham.  At the same time it appeared to me to be at the sharp-end, forefronting the thinking that needs to be done on how an institution can in itself be, and remain, therapeutic. Perhaps constant enquiry means constant rejuvenation in terms of an organisation.

1998 (with Angel Santos) The use at the Cassel of the organisational dynamics to enhance the therapeutic work.
Therapeutic Communities 19 29-39
I learned many things at the Cassel Hosital. One of which is the importance of applying the notions of intra-staff dynamics in the clinical cut-and-thrust of everyday work in a caring institution. The ability for staff to enact the inner world of patients who they become involved with is quite extraordinary when we have the chance to focus on it and think about it. But that chance is only given by the institution itself, and individuals cannot take it for themselves individually.

2000 How Foulkesian was Bion?
Group Analysis 32 469-488.
I was very honoured indeed to be asked to give the annual Foulkes lecture, and I put a lot into researching it. It was an honour partly because I had tended to grow up, professional, along the guide-wires of Bion rather than Foulkes. The similarities in the background assumptions of the two schools of British group dynamics has always impressed me – notably the profound influence of gestalt psychology on both – via Kurt Goldstein and Kurt Lewin. Indeed it is the dissimilarities which need explanation.

1998 Groups, paranoia, enquiry.
In Joseph Berke, Stella Pierides, Andrea Sabbadini and Stanley Schneider (eds) Even Paranoids have enemies. (London: Routledge).
I was keen to contribute to this celebratory book from the Arbours Association, as it is a rare accomplishment to provide an alternative provision for the seriously disturbed without the back-up of the statutory public services. Here I wrote a little on the impressive paradox that groups are both the most creative of human achievmenets as well as the most massively destructive.

1999 False memory, false therapy.
Australian Journal of Psychotherapy> 18 41-58.
What actually is trauma? It is the most obvious of words, and yet how can a mind be damaged in a way analogous to a body? And in particular how can a trauma be falsified to the point of creating all the effects of an actual trauma, such that it becomes so difficult to distinguish whether someone has been actually traumatised or not – even in a court of law.

1998 Psychoanalysis and therapeutic communities – The Cassel heritage and the culture of enquiry.
In Penny Campling and Rex Haigh (eds) Therapeutic Communities- Past, Present and Future.(London: Jessica Kingsley).
When Penny Campling and Rex Haigh decided to do a ‘re-make’ of the book Nick Manning and I did in 1979, they commissioned a whole new series of Chapters nearly 20 years on. I was pleased to reflect on how the relations of psychoanalysis to the therapeutic community had evolved. Arising directly within the central thinking of psychoanalysis, therapeutic communities had emerged as a much more activist form of intervention than the purely reflective one psychoanalysis is. And it is of course appropriate that a community which is involved in all its self-sustaining activities should be more activist. It seemed however that a new investigation of how reflection and enquiry might need to connect with activity.

1998 (with Wilhelm Skogstad) The hospital in the mind: the setting and the internal world.
In Julia Pestallozi (ed) Psychoanalytic Psychotherapy in Institutional Settings. London: Karnac (in press).  [German translation submitted]
Again reflections on the Cassel Hospital, this time with a colleague there, attempted to explore the important dynamics around the prioritising the inner world within the pre-occupations and politics of an organisation.

1998 Creatures of each other – some historical considerations of responsibility and care and some present undercurrents.
In Angela Foster and Vega Roberts (eds) Managing Mental Health in the Community – Chaos and Containment in Community Care. London: Routledge.
Finally in this flurry of papers stimulated by revisiting all the stress and strain of working in an organisation that had set me off 30 years before to puzzle about MH institutions, I responded enthusiastically to this invitation to write about community care as the attempt to thrust beyond the institutional care of the large mental hospital. Whist thoroughly supporting the whole move to the community, I was concerned that not enough had been learned about the dynamics of care to avoid a similar defensiveness creeping into the new forms of care out there.