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It was Maxwell Jones who most enthusiastically developed the concepts of the therapeutic community both in Britain and in the United States and attempted to spread those concepts to institutions outside of the formal psychiatric system. Another army psychiatrist, Jones first developed a program during the war to treat soldiers suffering from “effort syndrome,” a psychosomatic disorder that was related to combat fatigue. The approach was focused on education in a group setting which led to the development of a “group atmosphere”. Treatment was no longer confined to a therapeutic hour but became a continuous process operating throughout the waking life of the patient. To accomplish this, Jones had to reorder the hospital society and flatten the traditional hierarchical pyramid of authority to promote more interaction between patients, nurses, and doctors. Even before Moreno’s techniques about the use of dramatic techniques as a form of treatment had become well known, Jones was using drama as an effective technique of social therapy (Jones, 1953). The patient would write, direct, and act in his or her own personal play with the help of the entire community, as part of an intensive therapeutic experience. After the war, Jones developed a program for ex-prisoners of war and continued experimenting with the use of discussion groups, educational films, psychodrama, and discussions of community life. The results of the work impressed the government enough to ensure the development of a postwar program at Belmont Hospital to treat the chronically unemployed neurotic. Patients who were admitted were those considered unsuitable for either psychotherapy or physical methods of treatment such as electroshock, but excluded psychotic patients. He described the treatment population as "Inadequate and aggressive psychopaths, schizoid personalities, early schizophrenics, various drug addictions, sexual perversions, and the chronic forms of psychoneuroses. Our patients represent the 'failures' in society; they come largely from broken homes and are unemployed; inevitably they have developed antisocial attitudes in an attempt to defend themselves from what appears to them as a hostile environment; as often as not their marriages are in ruins and there is little or no attempt to keep up any of the more usual standards of behavior in their home life” (Jones 1953). These were not the worried well, but severely dysfunctional, but non-psychotic patients. These same kind of patients today may wind up in the mental health system but are just as likely to constitute a large proportion of our growing prison population. Jones and his colleagues performed follow-up studies and six months after leaving the hospital, two-thirds of the patients they traced had made a fair adjustment or better. Just over one-half had worked the full time since leaving. Patients generally stayed in the hospital for two to four months, but some patients stayed up to a year, while others stayed a much shorter time than two months. Jones based his work on the idea of “social learning, "The term social learning describes the little understood process of change which may result from the interpersonal interaction, when some conflict or crisis is analyzed in a group situation, using whatever psychodynamic skills are available. . Learning of this kind is complicated and painful: old learned patterns, adequate in previous situations, must be unlearned because they stand in the way of acquiring new and more adequate patterns of behavior." (Jones 1968b). To his way of thinking and working, every social interaction or crisis presented a “living-learning situation” which provided the grist for the therapeutic mill and the opportunity for changing and learning how to change. Excerpt from S. L. Bloom (1997) Creating Sanctuary: Toward the Evolution of Sane Societies. New York: Routledge In 2002, Dr. Sandra L. Bloom was honored to give the Maxwell Jones Memorial Lecture, for the Henderson Hospital. |
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