Dr Neville Yeomans

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Dr. Neville Yeomans Link to Sydney University Museum

One of the World’s Therapeutic Community Pioneers

Dr. Neville Yeomans (1928–2000) pioneered therapeutic community in Australia in 1959 as the founding director of Fraser House, a therapeutic community based psychiatric unit in North Ryde Psychiatric Hospital in Sydney, Australia. Dr. Yeomans also pioneered many social changes in Australian society.

The two major influences on Dr. Yeomans were firstly his early experience of personally receiving nurturing from Australian Aboriginal and Islander women, especially following two life threatening traumas. Dr. Yeomans described these women as ‘natural nurturers par excellence’. He recognised that for them, social cohesion was fundamental to wellbeing. The second influence on Dr. Yeomans was his father Percival A. Yeomans, who was recognised by the world famous English agriculturalist Lady Balfour in the 1970’s as the person making the greatest contribution to sustainable agriculture in the world in the past 250 years. Dr. Yeomans worked closely with his father and two brothers Allan and Ken on the family farms west of Sydney, Australia. The Yeomans family used nature as their guide in working with the farm environment as an inter-dependent self organising complex living system. P.A. Yeomans called the processes he developed with his sons ‘Keyline”. Keyline practice fosters nature’s tendency for thriving.

Dr. Yeomans became a biologist, psychiatrist, sociologist, psychologist, and barrister. Dr. Yeomans adapted Keyline as ‘Cultural Keyline’ in the social life realm. ‘Cultural Keyline’ is a model for the social sciences. It is also a way of perceiving, sense-making and engaging with ‘the whole of it’ in social contexts. As well, it is a way of working well with others in group contexts; a way of enabling system emergence, transition and evolution towards thriving. Just as the Yeomans family was guided by nature, Dr. Yeomans was continually scanning the social environment and social topography for what to do. The wisdom was in the social milieu. On the farms, the Yeomans had looked for the free energy in the system, and particularly for the free energy near blocked energy, that is, where there may be scope for ripple through effects. Dr. Yeomans used these understandings as his guide in Fraser House and later outreach.

Dr. Yeoman became a psychiatrist in the mid Fifties. In 1956, Yeomans initiated the first group psychotherapy program for schizophrenics in Australia in Gladesville Hospital in Sydney. Yeomans recognized that, with considerable upheaval and questioning in the area of mental health in New South Wales, and a Royal Commission being mooted into past practices, there was a small window of opportunity for innovation in the mental health area. Dr. Yeomans was aged thirty-one when he obtained the go-ahead from the New South Wales Health Department to take in male patients at Fraser House in September 1959.

Dr. Yeomans sustained Fraser House as a balanced community in a number of respects. Half the patients at any one time were from asylum back wards and half were from prisons. Half were male and half were female. Half were under-active and half were over-active. Half were under-controlled and half were over-controlled. Half were under-anxious and half were over-anxious. Having opposites sharing the same dorm was based on the principle that the presence of opposites creates a metaphorical normal position in the middle. Fraser house research showed that there was a tendency towards the mean, with the under-controlled becoming more controlled, and less active; the over-controlled becoming less controlled and more active.

The Fraser House 80 bed residential unit was purpose built by the NSW Health Department for Dr. Yeomans on the grounds of the North Ryde Psychiatric Hospital. At either end of the administration block there was a double story 39 bed ward, and there was a dining room at each end. There was a separate staff office in each ward. Most rooms were 4 bed dormitories. There were a few single rooms in each ward. The State system’s intention to have a division of sexes in separated wards would have been ‘shattering’ any chance of what Dr. Yeomans called ‘total community’, ‘transitional community’ and ‘balanced community’. Yeomans viewed the original Health Departments planned use of space as ‘schizoid’ - completely divisive, split - creating ‘them and us’ and ‘no go’ areas for both patients and staff. Yeomans saw this separation of the sexes with administration as a ‘wall’ between them, as isomorphic with dysfunctional community. The female ward opened in October 1960. Yeomans rearranged room allocation so there were no separate wards for males and females, although bedrooms remained same sex.

It is possible that in 1960 Fraser House was the only clinic in the World where alcoholics and neurotics mingled 50% and 50%. In 1960 the Unit was referred to as the Alcoholics and Neurotics Unit. The male Unit had both single and married men. In 1960 married men who were alcoholics could have their wives stay with them regardless of whether the wife was an alcoholic or not. The couple was the focus of change. This was the start of eight family suites. Whole families with two and three generations, from babes in arms to the elderly were involved in the suites. Yeomans pioneered family therapy and inter-generational therapy in Australia. In 1961, referrals were accepted from patients, and family and friends were admitted. In 1963 whole families were admitted. Desegregation of family units and single patients occurred in 1964.

Dr. Yeomans evolved Fraser House as a transitional community. Everything was in constant change and flow – staff, patients, outpatients, processes, policies, and procedures; like the water in motion in the whirlpool, in Fraser House, structure was process in action. Every aspect of Fraser House process supported the emergence and growth of functional communities of networks. Margaret Mead the anthropologist visited Fraser House in the early Sixties and described the totality of this ‘every aspect linked to a return to functional living in wider society’ as making Fraser House the most ‘total’ therapeutic community she had every visited.

Neville evolved Fraser House as a short term residential unit assuming a social basis of mental illness. Fraser House treatment was sociologically oriented. It was based upon a social model of mental dis-ease and a social model of change to ease and wellbeing. Regardless of conventional diagnosis, in Fraser House dysfunctional patients typically would have a dysfunctional inter-personal family friendship network. This networked dysfunctionality was the focus of change at Fraser House. Consistent with this, a prospective Fraser House patient had to attend Fraser House Big and Small groups twelve times along with members of his or her family/friend network, with all of them signing in as outpatients before admittance was considered. Admittance was also dependent on the network members undertaking to continue attending Fraser House groups as outpatients throughout a patient’s stay. During the 1960s Fraser House had around 13,000 outpatient visits per annum. Fraser House patients arrived at Fraser House typically with a small (less than six) dysfunctional family friendship network and left in twelve weeks (the maximum stay) with a functional network of around seventy people, most of whom lived in the same locality as the patient. Ex-patients could, by arrangement, return three times for further stays at Fraser House. These seventy-people networks would be linked into other Fraser House based networks in an extended network of networks.

In Fraser House, it was not just ‘therapeutic community’ in name. Community was the therapy. On weekdays around 180 staff, patients, outpatients and visitors gathered in Big Group each morning and evening. Big Group utilised both crowd and audience effects. A half hour break followed Big Group where staff reviewed the Big Group chairperson’s use of theme, and his or her modes of interacting with the attendees, as well as group mood and values. During this review other attendees of Big Group took refreshments in another room. After the half hour break staff and attendees were divided into many small groups where group membership was based on a revolving set of sociological categories. In both Big and Small Groups, interaction was based on themes that emerged from the audience. The themes chosen had the particular quality of being conducive to coherence.

As part of their rehabilitation, patients were effectively placed in charge of every aspect of Fraser House administration via a system of committees that mirrored every aspect of the Unit’s administration. The committee structure was called ‘governance therapy’. With one person one vote, and patients/outpatients out-numbering staff on all committees, patients effectively ran Fraser House policy. Dr. Yeomans, as director had a power of veto which he rarely used.

Linked to this involvement in Fraser House governance was the use of work as therapy. Progressively all staff roles were taken on by patients with support. The principle was give the job to those who can’t do it, with support so they learn to do it through experience. To provide refreshments between Big and Small Groups the patients sought and got permission from the North Ryde Hospital Director to set up, own and operate a canteen. Patients with low social skills were assigned by patients in the canteen committee to purchase stock for the canteen and sell goods. Patients lacking integrity were put in charge of the money to learn ethical behaviour. There was plenty of therapeutic strife. As another example of work as therapy, Fraser House patients tendered for a public contract to build an outdoor bowling green in the grounds of Fraser House. They won the tender and built the bowling green. It is still functional to this day.

Unlike jails and lunatic asylums where inmates are expected to be mad and/or bad, no badness or madness was tolerated at Fraser House. Both patients and outpatients knew that the very strong expectation within the Unit’s milieu was that, ‘here people change and return to wider society well’. The requirement that patients and outpatients get on with self and mutual healing and interrupt any mad or bad behaviour in self and others was reinforced with the mantra, ‘No mad or bad behaviour here’. The expectation of change was conveyed by, ‘You can only stay three months, so get on with your change.’ New arrivals would have a settling in period where their mad and bad behaviour would be pointed out to them. Increasingly, mad and bad behaviour would be interrupted. There were many continually repeated simple slogans reinforcing values based behaviours.

Within eighteen months of Fraser House starting, the patients and the Unit’s staff had developed a body of community psychiatric practice, as well as psychiatric nursing, collective therapy (large group as crowd and audience) and psychiatric training that constantly evolved. It was commonly acknowledged that psychiatric patients became the most skilled in the emerging new field of community psychiatry – even ahead of the Fraser House psychiatric staff whose prior education and training had in no way prepared them for the Fraser House milieu. Patients who became experienced in community psychiatry were elected as members of the patient assessment committee. Patients and Outpatients who had been capacitated by their Fraser House experience wrote a handbook for Fraser House staff that included succinct sections firstly on the role of the psychiatric nurse at the Unit, and secondly, on the processes for leading Big and Small Groups at Fraser House.

Patients also began a domiciliary care unit for ex-patients with five patients (without staff) making home visits using a little red van purchased owned and operated by the patients from canteen profits. Three years after the Unit started, the Australian and New Zealand College of Psychiatry coopted Fraser House patients as trainers of trainee psychiatrists in the new area of community psychiatry. When Dr. Yeomans travelled overseas for nine months in 1963 the unit self organised and functioned very well during his absence even though they were without a replacement psychiatrist for a number of weeks.

Dr. Yeomans set up the Psychiatric Research Study Group which met monthly on the grounds of the North Ryde Hospital adjacent the Unit. The Group was a forum for the discussion and exploration of innovative healing ideas. Dr. Yeomans and the study group networked for, and attracted very talented people. Students of psychiatry, medicine, psychology, sociology, social work, criminology and education attended. The Psychiatric Research Study Group became a vibrant therapeutic community in its own right and had a strong relation with Fraser House. Anything raised in the Study Group that seemed to fit the milieu in Fraser House was immediately tested by Yeomans in Fraser House.

Yeomans left Fraser House in 1968 and devoted himself to extending the transformative ways evolved at Fraser House into wider society. It is one thing to evolve therapeutic community within an enclave; Yeomans wanted to action research processes for evolving mutual help processes in civil society. Yeomans wrote the job description and became the first NSW Director of Community Mental Health starting Australia’s first Community Mental Health Centre at Paddington in Sydney. Neville also started Paddington Bazaar, Sydney’s iconic Saturday community market to surround his first community mental health centre with a small village atmosphere. Paddington Bazaar continues to this day.

In the ensuing years Yeomans used his Cultural Keyline model in pioneering family therapy, suicide/crisis telephone services, counselling and family therapy within family law. Yeomans also evolved a number of psychosocial self-help groups, networks and a social movement that he called Laceweb. Another focus was multicultural festivals. Yeomans first was the Watsons Bay Festival in 1968 and then with others he energised a series of Festivals leading to the Aquarius Festival in 1973 in Nimbin, NSW.

Along with Australia’s Deputy Prime Minister Jim Cairns and others Yeomans evolved ConFest, an alternative lifestyle bushland campout conference festival that commenced in 1976 and continues twice yearly to this day. Yeomans explored celebratory artistry and alternative lifestyle gatherings and festivals as contexts for action researching the self organising emergence and strengthening of social networks among nurturers. The preparation of the festivals and gatherings created rich contexts laden with possibilities for community to emerge. Other processes Yeomans pioneered in Australia were cultural healing action, mediation and mediation therapy.

During 1971 to 1973 Yeomans supported the enabling of therapeutic community based networks among Australian Aboriginal and Islander nurturers, and from 1972 evolved a number of small therapeutic community houses in North Queensland in Mackay, Townsville, Cairns, and Yungaburra, and in the Darwin Top End. He also evolved what he termed an ‘International Normative Model Area’ or ‘INMA’ in Northern Australia that continues as a micro-model exploring linked local, regional and global governance as an aspect of epochal transition towards are more humane caring world respecting diversity and all life forms. In Fraser House, Dr. Yeomans was evolving a holistic bottom-up folk model for re-constituting collapsed societies. Patients and outpatients were evolving their lore and law in self governance. They were mutually supporting each other in re-constituting themselves as together they constituted their Fraser House social reality.

An outcome of Dr. Yeomans action research has been the emergence of an informal lace-web of networks amongst Indigenous and other intercultural natural nurturers in Northern Australia and in the East Asia-Oceania-Australasia Region. These networks, as self organising dispersed therapeutic communities are evolving and supporting self-help and mutual-help amongst Indigenous/Oppressed trauma survivors in the Region. Yeomans’ writings about his processes and action research are detailed in Dr. Les Spencer’s research on Dr. Yeomans life work (2006).


Reference

Spencer, L. 2006 Cultural Keyline - The Life Work of Dr Neville Yeomans. Internet Source – LaceWeb

Picture: Dr Neville Yeomans and a nurse at Fraser House in 1960

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