The Third Generation of Therapeutic Communities: the Early Development of the TC for Addictions in Europe
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Research Report European Addiction Eur Addict Res 2006;12:1–11 Research DOI: 10.1159/000088577 The Third Generation of Therapeutic Communities: The Early Development of the TC for Addictions in Europe a a a b Eric Broekaert Stijn Vandevelde Veerle Soyez Rowdy Yates c Anthony Slater a b Department of Orthopedagogics, Ghent University, Ghent , Belgium; Department of Applied Social Science, c University of Stirling , Scotland; Phoenix House Haga, Mysen , Norway Key Words communities were established in Belgium, Finland, Ger- Therapeutic community Substance abuse many, Greece, Ireland, Italy, Norway, Spain, Sweden and Development of therapeutic community Switzerland as well. These communities were closely- knit and interconnected in their reaction against psychi- atric and methadone treatment. The European TCs de- Abstract veloped an own identity compared to the American ones. Aims: It is the goal of this study to investigate the fi rst Conclusions: The European TCs adapted the model of development of the drug-free therapeutic community their American predecessors to their own culture, infl u- (TC) in Europe. The paper aims at systemizing informa- enced more by milieu-therapy and social learning. In- tion, scattered all over Europe and is the fi rst stage in an stead of harsh behaviorism, more emphasis was placed ongoing study to record the development of the Euro- on dialogue and understanding. Professionals occupied pean TC movement and its infl uences. Design: After a a more pivotal role and took over the dominant position study of the grey (hidden) literature, TC pioneers and of ex-addicts. Research, executed by TC professionals experts per country were contacted to further elaborate gradually entered the TC. A generic network of TC con- the fi rst fi ndings. Subsequently, a preliminary summary nections, through which the development evolved, was of our fi ndings was published in the Newsletter of the uncovered, and clear regional trends can be observed. European Federation of Therapeutic Communities Copyright © 2006 S. Karger AG, Basel (EFTC), inviting additional information and corrections. The authors completed the results for this article with relevant fi rst-hand information, obtained through inter- Introduction views with European pioneers. Findings: The fi ndings are summarized under three topics: chronology, inter- The fi rst generation of therapeutic communities (TC) connections and European identity. It was found that was developed in Europe (United Kingdom) during the from 1968 until 1989, a new therapeutic approach arose Second World War, and was referred to as the psycho- all over Europe, modeled after Synanon, Daytop and analytical, milieu, environmental or democratic TC. Its Phoenix House, New York, through Phoenix House, Lon- origins can be traced back to the achievements of Wilfred don and Emiliehoeve in the Netherlands. Therapeutic Bion and John Rickman [1] (fi rst Northfi eld Experiment) © 2006 S. Karger AG, Basel Eric Broekaert, PhD 1022–6877/06/0121–0001$23.50/0 Ghent University, Department of Orthopedagogics (Special Education) Fax +41 61 306 12 34 H. Dunantlaan 2 E-Mail [email protected] Accessible online at: BE–9000 Ghent (Belgium) www.karger.com www.karger.com/ear Tel. +32 9 264 64 66/67, Fax +32 9 264 64 91, E-Mail [email protected] and Harold Bridger and Sigmund Heinrich Foulkes (sec- lution of Synanon into a cult [9] . Synanon eventually ond Northfi eld Experiment) [2] , who innovated psychia- found itself in the mired in controversy [16] and fi nally try in the treatment of soldiers suffering from neurosis, disbanded in 1991. Despite these diffi culties, the TC caused by traumatic war events. These pioneering psy- movement spread quickly throughout the United States, chiatrists based their interventions on group interaction, Europe and all over the world [17–19] . social setting, global approaches and the creation of a This paper aims to map out the development of the transitional space of experience, which allowed growth European TC: the third generation of therapeutic com- and development [3] . In 1938, Maxwell Jones began si- munities. The research study period is from the end of multaneously to innovate psychiatry both at the Effort the 1960s to the middle of the 1980s, when the last Euro- Syndrome Unit at the Mill Hill Public School and at the pean pioneers founded TCs in Finland and Greece. At Belmont Industrial Neurosis Unit: later, the Henderson that point, the third generation phase came to an end and Hospital [4] . He strived for less hierarchy, open commu- the TC began to mature and integrate with other treat- nication, decision-making by consensus, social learning ment modalities. The third generation has a specifi c place and testing the borders of social reality [5] . Jones [6, p. within the global context of substance abuse treatment in 24] described a democratic (‘old’ in his own words) TC that period. The TCs considered themselves as a legiti- as ‘… based on group therapy aimed at understanding mate reaction against the failing and disinterest of psy- group dynamics and effecting a progressive-learning pro- chiatric treatment for substance abusers [20] . Following cess’. In the course of time, this has become less psycho- in the wake of the American TCs, the European ones de- analytic in nature and based more on individual interac- fi ned their identity in terms of total abstinence from tion in a group setting – what has been termed ‘social drugs. They disagreed with Dole and Nyswander’s view learning’. The democratic TC infl uenced psychiatric hos- towards the heroin substitution approach [21] . They pitals in the United Kingdom, the rest of Europe and the shared Lennard et al.’s [22] opinion and saw methadone United States [7] . as an ‘ordinary street drug’ and methadone treatment as The second generation can be traced back to Synanon an illusion. They argued that methadone could be used (USA), which was initiated in 1958 [8] . From 1965, the in combination with other substances, could provoke model was taken up and further developed by ‘concept’ heavy withdrawal symptoms, and replace change by stag- TCs such as Daytop [9] , Phoenix House [10] , Odyssey nation [22] . In their reaction against psychiatric and House [11] and others. Synanon, a utopian community methadone treatment, they formed an inclusive closely in California, wanted to create a new way of living based knit network. They had problems to fully accept the con- of principles of honesty, creativity, openness and self-re- sequences of objective research as they did not like to liance [12] . Its charismatic leader, Charles (‘Chuck’) Ded- open their fi les to external researchers. Only in some cas- erich, was infl uenced by the romantic writings of Emer- es, research was carried out, mainly executed by TC mem- son, Skinner’s Walden II, by Christian-Judean values, bers with clinical experience. Only after the breakthrough Eastern philosophy, Moral Rearmament and the AA of the AIDS epidemic, the growing of methadone treat- movement [13] . Synanon’s social system and its treat- ment and the closing down of many TCs in Europe, they ment was based on the hierarchic structure of the move- accepted to adapt their reason of existence. ment (the triangle) alternated by the ‘Game’ (the circle) Whilst not ideal, the used time span is the most opti- – ‘an uninhibited conversation, an arena for discussing mal research period, since many of the fi rst-hand wit- all human feelings, community issues and the relation- nesses and pioneers are deceased, the scientifi c literature ships among people’ [13 , p. 8]. The concept TCs subse- is seldom available, and relevant grey literature is diffi cult quently adopted many of Synanon procedures and hired to locate and often not easily accessible. The authors did Synanon graduates to start their drug-free programmes only retain the TCs, pioneers and research fi ndings they [14] . found back in the grey and the scientifi c literature or in ‘A concept TC is a drug-free environment in which the additional information provided by the contacted ex- people with addictive (and other) problems live together perts. They do not intend to be conclusive, aiming rather in an organized and structured way in order to promote to give a fi rst impetus towards further research on this change and make possible a drug-free life in the outside matter. Since three of the authors (Eric Broekaert, An- society’ [15 , p. 51–62]. The concept TCs broke with Syn- thony Slater and Rowdy Yates) were personally involved anon because of the authoritarian leadership of Dederich, in the early development of the European TC, their view the commitment to a life-long membership and the evo- could be subjectively colored and prejudiced. However, 2 Eur Addict Res 2006;12:1–11 Broekaert/Vandevelde /Soyez /Yates /Slater since a transparent and detailed methodology was used, and to identify all existing therapeutic communities, the study was executed ‘sine ira et studio’ and aims at in- there has been chosen to include only the pioneering TCs viting comments, potential corrections and remarks from per country ( table 1 ). experts all over Europe and the rest of the world. On 10th June, 1968, Ian Christie founded a hospital- based community in St. James Hospital (Portsmouth, UK). This unit, originally called Pink Villa Huts, was Method briefl y styled like the Phoenix Unit then renamed the Al- pha Unit following objections from the original Phoenix The fi rst stage of the study comprised a literature review, using House, New York [29] . Later, the unit was re-established ‘grey’ conference papers and book chapters [20, 23–26] . From this, a brief letter concerning the origins and the further development of outside the hospital campus and re-launched as Alpha the TC was sent to various national experts, who were involved in House in June 1971.