Book Review: Asylum to Action

I appreciated the opportunity to review this book, for having already enjoyed reading Claire Baron's memorable version of events at Paddington Day Hospital in the 1970's, Asylum to Anarchy (1987) I wondered what could be further added to such an interesting story – the story of the demise of a renowned therapeutic community which had been toasted as a radical overture of mental health democracy, with a controversial and charismatic medical director who had employed blanket use of psychoanalytic ideas.

According to Baron, Paddington Day Hospital had descended into anarchy, chaos and tyranny and was, indeed, after the dismissal of the medical director in 1977, eventually closed in 1979. With her main focus being on the therapeutic community movement, Helen Spandler, however, suggests that the fuller history of Paddington Day Hospital, a therapeutic community that was established in West London in the early 1960's and closed in the late 1970's, is less well known and her book is an attempt to remedy this, extending to both a celebration of the social action at Paddington and a critique of Asylum to Anarchy as a one-sided narrative. This book, in essence, attempts to understand how Paddington moved from being so strongly fought for, to being vilified and condemned.

The author methodically documents and explores the meaning of a number of significant events in the life of Paddington Day Hospital and in highlighting particular moments of innovation she recalls some of the radical aspirations of therapeutic communities. This book is comprehensively and impressively well researched; from the 'Chronology of Key Events at Paddington Day Hospital' which turned out to be an invaluable guide in helping to clarify what actually happened to whom and when, to interviews with several key people who were involved in the day hospital as a member of staff or patient. This included Julian Goodburn, the charismatic medical director, who had had a long association with the day hospital since being a junior doctor there in 1964 and who was responsible for introducing the more libertarian methods in 1970 after becoming locus medical director. In Goodburn's more libertarian method patients were not registered, and there were no clinical notes with patient history, no diagnosis and no treatment plan. A very different process and atmosphere to traditional psychiatry and having a strong resonance with the approach to patients adopted by R.D. Laing and members of the Philadelphia Association at Kingsley Hall during the same period.

In 1971, threats to reorganise local psychiatric services, which signalled the end of the day hospital, were met with organised and successful protest by staff and patients. And thus was the beginning of patient's activism. Spandler enthuses on the importance of this, the formation of the Mental Patients Union being the first overtly politicised psychiatric patients' group and precursor to survivors' and advocacy groups, which, she feels, is rarely figured in the numerous accounts of the crisis at Paddington and mentioned only briefly in Asylum to Anarchy. This newly formed politicisation and founding of the MPU the author recognises as collective action towards challenging fundamentally held belief systems about mental illness and psychiatry, and generating the notion of a common identity of oppression. Interestingly, such a perspective can also be linked to the idea of the foundation of the MPU providing a 'seedbed' (Baron 1984) for the patients' later complaint to the Area Health Authority in 1976, when they demanded an inquiry about the functioning of the day hospital and its lack of shared decision making. The patients, in this complaint, also expressed concern about over-reliance on psychoanalytic interpretation at the expense of support for their more immediate problems. The interrogations they received in response to their complaints led many to feel that they were not treated respectfully but with 'mockery and derision'.

Goodburn's suspension and later dismissal (and subsequent demise of Paddington Day Hospital) occurred after he had failed to meet in full the inquiry recommendations of the Area Health Authority, by proposing to offer two distinct categories of treatment in the day hospital – one which fully complied with the inquiry recommendations and the other which continued his method. Patients could choose to attend the method they preferred. Goodburn's proposal not only, in effect, challenged the authority of the Area Health Authority but also officially took Paddington Day Hospital beyond the notion of psychiatric acceptability, e.g. the lacking of any psychiatric assessments, note-taking, follow up and adequate referral procedures figured strongly in the official enquiries. His offer had also raised the fundamental question of what is the most appropriate social system for an institution devoted to psychotherapy?

If you don't play it by whatever rules, or by whatever codes of practice are seen as the usual way of doing things, or the established way of doing things... you're vulnerable... But, you know, fair enough. Because what's going to happen is that as the inquiry extends, it is going to be an inquiry into how authority functions.

(Goodburn, 2000:110)

Another important contributory factor in the downfall of Paddington was the use of psychoanalysis as the dominant framework of understanding dynamics in the community itself. Psychoanalysis tends to view people as isolated individuals rather than members of specific social and cultural practices and Spandler suggests that the continued absence of any alternate collective frameworks to psychoanalysis through which to understand community dynamics in therapeutic communities can contribute to irrevocable splits, polarisations and complaints. She goes to dismiss, however, the theory and practice of group analysis, despite its focus on the group, as it remains wedded to its psychoanalytic roots and she, therefore, calls for 'the necessity of developing alternative non-psychoanalytic and non-familial community and group frameworks and concepts.

My overall feeling after reading this book was that the story of Julian Goodburn and Paddington Day Hospital (for they are inseparable!) is primarily one of paradox and that this had been communicated fully and clearly in this book. Goodburn was criticised in the inquiry by the Area Health Authority for 'failing to carry out the duty of any consultant in the NHS' and his behaviour was considered remiss for having 'insufficient control over patients under his care', (Spandler 2006:109 quoting KCWAHA, 1976:20). This criticism articulated a deep confusion both within Paddington and in responses to it. On the one hand, Goodburn was chastised for maintaining 'rigid autocratic control' ([KCWAHA, 1976:]p25) over patients through manipulation, and yet on the other hand he was criticised for not assuming enough control over patients' behaviour (Spandler 2006:109). This paradox is symptomatic of the dilemma of how can psychoanalytic thinking be employed in a system devoted to the democratization process? Interestingly, Goodburn himself, was well aware of the limited context of psychoanalysis and later called for 'a theory capable of explaining all the facts' (Goodburn, 1986:58)

With the sheer volume of considerations in this book Helen Spandler reveals what an enormous commitment she has made toward the rethinking of events at Paddington Day Hospital. She puts forward the very interesting, and highly relevant idea of the need for 'paradoxical spaces' (Rose 1993) in which the tensions within and beyond the therapeutic community could be revealed, understood and acted upon. This would involve a radical shift from the need for premature and one-sided resolutions, that is normal in our society, toward strategies for engaging and working more creatively with paradoxes. An idea that will appeal to many of the existential therapists reading this journal.

The last word from this thought provoking story has to come from Julian Goodburn in his interview with the author when he reveals his more radical social constructivist if not existential leanings - toward the importance of the socio-cultural context:

How does one understand the transformations and the representations of the external situation in the dynamics of the one which is under immediate study? ....Somewhere or other there is a correlation between the contradiction, or disquiet that they're experiencing, and the contradiction or disquiet that everybody ought to be experiencing a propos some factor of society at large, which... .they are, though circumstances of their particular experience, the bearer of – the victim of, you might even say. [They] will subsequently manifest this as if it were solely going on in them, when in fact, it is going on in them... as a consequence of the fact that these issues are not resolved in the world at large... It just happens that they are the person standing on that particular corner at that particular time who has copped it, as it were.

(Goodburn , 2000:33)

The Interpreted World: An Introduction to Phenomenological Psychology. 2 edition.

Ernesto Spinelli. (2005). London: Sage Publications. Hardback. £60, Paperback £18.99.

I would be surprised if any reader of Existential Analysis is not already aware of Ernesto Spinelli's 'The Interpreted World; an introduction to phenomenological psychology', in many ways I feel that this book has become a classic of its time. But, of course, that could be a huge assumption, and within the spirit of the book itself, I need to bracket and set aside such assumptions, in accordance with the first step (Step 'A') of the phenomenological method as described by Spinelli.

So I will first of all introduce this 'introduction', and again, as proposed by Spinelli, attempt to do so in a descriptive rather than interpretational way. This is not an easy task, not least because I hold some considerable fondness for the first edition of the book.

The book was first published in 1989 and I remember reading it as I sailed across the Mediterranean. At the time I was going through something of a crisis, having carried a keen interest in philosophy into my studies of psychotherapy, in the hope of finding within psychotherapy a way to a more 'grounded' and 'lived' philosophy. I was feeling particularly disenchanted with the unreflected assumptions and ungrounded presuppositions that seemed to underpin the generally theoretically driven orientations that I had been presented with up to that time. This disenchantment – I might even say distaste – had grown to such an extent that I was on the point of giving up the study of psychotherapy altogether until I came across Spinelli's book. The excitement and relief that I felt upon reading the book at that time is difficult to describe. I felt that here was much more at stake here than simply looking at another approach, it was, for me at least, the opening up of the possibility that there could be a therapy that was both humane and rigorous, rather than objectifying or fanciful, and that could be appropriately underpinned by a tradition that was able and willing to question its own philosophical foundations. I was not disappointed. Added to this that many of my fellow passengers seemed to be highly impressed to see someone apparently casually reading a book with 'Introduction to Phenomenological Psychology' in its title, so clearly visible on the cover as they sunbathed on the open deck (this was a source of some lively discussion with some, and of curiosity and even seduction, with others), the book carries all sorts of associations that I remember with some considerable fondness. I seem therefore to have quite a lot of prejudices to put aside. But what is interesting here, and perhaps needs to be emphasised, is that it is in no small part due to Spinelli's clarity of writing, his use of everyday examples, and his obvious command of the subject that allows him to bring examples readily to the fore, that even under the conditions that I was reading the book, the ideas and concepts that he presented were accessible and easily understandable.

I make this statement so that the reader understands that – despite my attempts to suspend my judgement – I do not claim to review this book from a dispassionate position and I would encourage the reader take this into account. But then, I'm a sort of Heideggerian and therefore passion is quite important to me.

So, step 'B': The Rule of Description. Given the limited space available perhaps I could just say that this book does exactly what it sets out to do; it introduces Phenomenological Psychology in an accessible and understandable way, which, as I have already alluded to, is one of the things that so impresses about the book. And yet, I would not only recommend this book to students of psychotherapy and psychology – I feel that it should be compulsory reading for any serious student in these fields – but I suggest that it would be of interest to anyone that has an interest in how it is that we engage with the world, which to some extent was demonstrated to me by the interest shown by those around me when I first read it.

Moving from a succinct overview of phenomenological theory, through a brief description of a basic Husserlian methodology, to questions of the perception of objects, others and self, Spinelli continues by giving a very brief summary of some of the major philosophers who he takes to be at the root of existential phenomenology; i.e. Heidegger, Sartre, and Buber. He does not, of course, claim that these are the only philosophers that are at the root of existential phenomenology. At no point does Spinelli claim that this summary is comprehensive and, as those who are familiar with any of his writing will already be aware, Spinelli is always careful with any claims that he does make. He then uses the Existential/Phenomenological approach to contrast and critique other major systems in psychology. For a more detailed account of the contents of the book I would refer the reader to a review of the first edition by Alec Duncan-Grant in Volume 2 of this journal.

For existential practitioners this book serves not just as an introduction, but as a constant source of reference, and I for one, have returned to it on a number of occasions. And it is here, I think, that Spinelli triumphs; he makes difficult and sometimes confusing concepts clear and understandable, without ever deliberately distorting them for the sake of simplicity.

It might be possible to criticize the first part of 'Chapter 2' on the 'Phenomenological Method' for an over-simplification of Husserl's method into what Spinelli describes as 'three distinguishable, though interrelated, steps' because it seems to me that the stage of verification that Husserl refers to in his later work is not made explicit in this chapter. However, this is somewhat rectified in the new and much welcomed chapter on phenomenological research that Spinelli has included. Here Spinelli once again gives a clear and considered summary of phenomenological research, beginning with a comparison between the Natural-Scientific approach and the Human Sciences moving on to a description of a phenomenological method as proposed by Paul Colaizzi, followed by a short example to give the reader a feel for how this method looks in practice. Once again, Spinelli does not yet lost in the details of comparing the many variations of differing phenomenological methods that have arisen from Husserl's original enterprise, but simply makes the reader aware that these exist, and this seems appropriate for a book that claims to be an introduction. Within the example of research given in this chapter we see the stage of verification included that is not explicitly mentioned in the earlier chapter on method as has been previously mentioned. This could have perhaps been more fully brought out in the book but seems to me to be a very minor point.

Similarly, Spinelli's humility comes across in his writing as when he claims only to have presented 'yet another "between the lines" interpretation of some of Heidegger's ideas'. There is some truth in this for all of us and, at times I would perhaps take a slightly different view from the one presented by Spinelli on what Heidegger might have been saying, particularly with regard to Spinelli's description of the ontic/ontological distinction and his understanding of Heidegger's use of the term Dasein. Nevertheless, at no time does Spinelli's interpretation misrepresent or distort these terms, but rather allows an introductory view to come to the fore.