Mental Health and the TC. Chapter 5
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DOCUMENT RESUME ED 274 906 CG 019 410 AUTHOR Acampora, Alfonso P., Ed.; Nebelkopf,Ethan, Ed. TITLE Mental Health and the TC. Chapter5. PUB DATE 86 NOTE 73p.; In: Bridging Services:Drug Abuse, Human Services and the Therapeutic Community;see CG 019 406. PUB TYPE Speeches/Conference Papers (150) EDRS PRICE MF01/PC03 Plus Postage. DESCRIPTORS *Counseling Techniques; *DrugAddiction; *Drug Rehabilitation; International Organizations;Mental Health; *Mental Health Programs;*Psychiatry IDENTIFIERS *Therapeutic Communities ABSTRACT This document contains 19papers from the ninth World Conference of Therapeutic Communities(TCs) that deal with the interface between the mental healthestablishments and the TC. Papers include: (1) "Psychiatry and theTC" (Jerome Jaffe); (2) "The Chemical Brain" (Sidney Cohen); (3)"Where Does the TC Fail?" (Ab Roster); (4) "Psychiatric Severityand Response to Treatment ina TC" (Sherry Holland); (5) "PsychiatricDisorder in TC Admissions" (Nancy Jainchill and George De Leon);(6) "Diagnosis & Treatment ofthe Dual Diagnosis Client" (H. L. Wilder andChristopher Dawson); (7) "TheUse of Psychiatric Medications ina Drug Free TC" (Joe Lamberti and Anne Blyth); (8) "A Multi-Modality Approachto Treatment in a TC" (Robert Vaughn Frye); (9) "Working withMinorities in the TC" (Arnold Abbott); (10) "The Group Processwithin the Context of the TC" (Eugene Adler); (11) "AddictRage: A Therapeutic Dilemma" (Evan Garelle); (12) "Leaving theTC: Fantasies and Emotions" (EliseoM. Gonzalez Regadas); (13) "The Roleof Art as a Therapeutic Tool" (Sue Ann Rizzo); (14) "Towardsan Ethics of the TC Model in the Approach to the Addicted Patient" (DanielA. Campagna); (15) "A Rehabilitation Program in Brazil" (Haroldo J. Rehm); (16)"Reflections on Gradiva TC in Argentina" (Juan Alberto Yaria);(17) "The Sopimusvuori Society:A System of Rehabilitation in Finland" (MArkuuOjanen); (18) "A.R.E.B.A.-Casriel Institute: A DifferentTC" (Pietro Ceriana); and (19) "Applications of GestaltTherapy in the TC" (Joan Zweben). (NB) *********************************************************************** * Reproductions supplied by EDRS * * are the best that can be made from the original document. * *********************************************************************** -a CHAPTER 5 "PERMISSION TO REPRODUCE THIS U.S. DEPARTMENT OF EDUCATION Office ot Educational Research and Improvement MATERIAL HAS BEEN GRANTED BY ED ATIONAL RESOURCES INFORMATION MENTAL HEALTH AND THE TC CENTER (ERIC) s en lP'This document has been reproduced as A4A1/42/ received from the person or organization originating it 0 Minor changes have been made to improve PSYCHEATItY & THE TC reproduction quality TO THE EDUCATIONAL RESOURCES Points of view or opinions stated in this docu- Jerome Jaffe M.D. ment do not necessarily represent official INFORMATION CENTER (ERIC)." OERI position or policy National Institute of Drug Abuse Rockville, Maryland 44aC) I can't recall a time when I wrote a speech for someone else to present. I have difficulty imagininghow these words will sound coming from someone else's lips.If, at times, the words sound overly sentimental- ai forgive the speaker it is the writer who has stepped over the bounds of formality to speakto old friends and to express regret at missing an opportunity to meet the new generation of leaders in the world of T.C.s. I wanted very much to be with you at this meeting, because therewere so many old friendships that I CV wanted to renew and so many faces that I wanted to see again. I knew that there would beat this meeting old I=1 comrades from the early battles to establish the validity of the T.C.as an effective intervention, not only for problems of addiction, but also for problems of character and behavior unrelated to drug abuse. I L.1.1 have many vivid memories of those early struggles, and I must admit they grow fonder with theyears. It has been more then 20 years since I first visited Synanon and Daytop Village and becameaware of a remarkable and innovative concept that was certain to havean profound impact not only on the treatment of addiction, but on the fields of psychiatry, criminal justice, and sociology,as well. At the time, I was a junior faculty member in psychiatry at a medical school in New York. Unlikesome of you who Lave grown up with the therapeutic community movement, I have hada number of very different roles over the intervening twenty years. They have at various times involved research and teaching at medical schools, consulting with government and private industry, and developing and running programs related to drug addictionat both State and National levels. From time to lime, some of the titles of the positionswere far more impressive than would have wanted. I have never felt comfortable with titles and formality. Perhaps that is why I feltat home in therapeutic communities where, in the early days,you knew that last week's new entry could be next v......year's facility director. The quality resided in the person, not in the credentialsor the title.Today, I am temporarily wearing one of those formal hats again: Acting Director of the National Instituteon Drug Muse. I hope that you will not let your image of that role color what I plan tosay here - for I do not speak so much as the Acting Director of' NIDA, but as a long time observer of the field andas a long term friend of the therapeutic community concept. o I want to speak of old friendships, old tensions, and new challenges. fr-t OLD FRIENDSHIPS - because it is only upon trust and human relation ships that individual Cr organizations can thrive, and only when there are such relationships that different organizationscan work together effectively. CD OLD TENSIONS - because the therapeutic communities grew up in an atmosphere when theywere often 4C.) looked upon with skepticism by researchers and mental health professionals, and in which they, inturn, went to great lengths to criticize and often to exclude or minimize the ccntributions that such professionals and a research orientation could make. NEW CHALLENGES - because we must recognize that new findings about the co-existence of addictions and other forms of mental illness cannot be forever ignored and because a deadlynew virus - the AIDS virus - has emerged and is spreading rapidly among the drug abusers that the therapeutic communitieswere created to help. OLD FRIENDSHIPS: Some of my fondest memories of' the past 20years are of the times I spent at Gateway House in Chicago. It wasn't always known as Gateway- but that is a story for another time. Had Synanon been more willing to establish a facility in Chicago, Gateway might never havecome into existence. Nor was Daytop Village at the time, 1967, ready to open a facility that far from its home base. But in 1966, when the planning for treatment programs in Illinois began, I felt that a therapeutic community had to be part of that plan. Daytop was a key element in the establishment of Gateway. Patients I saw in Chicago in 1967 were sent to Daytop in New York with the hope that they could learn enough to develop a facility in 113 BEST COPY AVAILABLE Chapter 5 - Mental Health and the TC- Jaffe Blinois when they returned. (Some of those patients have sine:, goneon to graduate from professional schools and to enter government at high levels.) I remember, too, the problems we had in finding the resources and the location for sucha facility. Neighbors were wary; use of a house as a Therapeutic Community violated zoning laws. The Stateof Illinois would not let its funds bt used to purchase real estate, andno one would give a mortgage to the fledgling Gateway House Foundation which had no assets andno income. At one point, I became personally liable for the mortgage on one of Gateway's early facilities, much to the dismay ofmy family, who bad images of bank foreclosures and furniture on sidewalks. But, the return on the investment was greater than any I have made. While I lostsome money, I got to know the people who made the system work. My children,my wife, Faith, and I felt at home at Gateway; Gateway even adopted our kittens. By that time, there had been a chine in the organizational structure at Daytop in New York. Keystaff members left the organization, just at a time when Illinoiswas expanding its commitment to treatment, including therapeutic community. We were lucky. David Deitch, Carl Charnett, MichaelD'Arcy, Ellen Afterman, Jeanne Peake, Mickey McCallup, and several otherswere willing to come to Illinois to teach others and to help build the system. Those were days filled with the excitement ofa new enterprise. They were also days in which the rivalry between T.C.s and other treatment methodologies that seemedso strident and bitter on the East Coast were far less apparent in Blinois. Instead, therewas a willingness to see a role for a range of treatment efforts and for a range of skills including those of physicians, psychologists,and psychiatrists. Early in Gateway's history, a resident psychiatrist Iwas supervising spent part of his elective time living at the facility. Fortunately for me, my close friendships with leaders of anyone therapeutic community have never interfered (as far as I could tell) with my associations withmany of the other pioneers in this field - Monsignor O'Brien, Dan Casriel, Mitch Rosenthal, George DeLeon, Judianne Densen-Gerber- to name only a few. Most have forgiven me for continuing to see a usefui role for pharmacological approaches to treatment. OLD TENSIONS:- The antiprofessionalism- especially the anti- psychiatry bias - of the early years may already be part of the past. If it is, there isno need to dwell on that part of the past. If such feeling persist, however, it will become increasingly necessary to address them, for the challengesto the Therapeutic Communities, at least as I see them, are three-fold: First: How to deal with a health-care system that is increasingly concerned withcosts and is focusing ever more closely on the mental health, drug, and alcohol in-patient sector as an area where savingscan be achieved.