Book Review: Asylum to Action: Paddington Day Hospital, Therapeutic Communities and Beyond
| Date | 01 March 2007 |
| Pages | 45-46 |
| Published date | 01 March 2007 |
| DOI | https://doi.org/10.1108/13619322200700011 |
| Author | Mark Freestone |
| Subject Matter | Health & social care |
tcould be argued that the last five
years have seen a profound change in the way that
social science approaches the study of mental health.
This change could further be expressed as an
epistemic shift in our understanding of the historical
narrative of mental health care in the UK and the
USA, as social scientists turn to libraries and the
surviving participants from the radical upheavals of
the 1960s in order to re-tell the story of the patients,
rather than the oppressive features of the institution
(Foucault, Goffman) or the overarching power of the
psychiatrist (Szasz, Laing). Part of this shift entails
the re-evaluation of classical texts and concepts
within the mental health field to incorporate the voice
of the service user,for so long merely a subaltern
account below the charismatic figure of the
psychiatrist or psychoanalyst. Thus Helen Spandler’s
book takes its name and subject matter from Claire
Baron’s influential but damning Asylum to Anarchy
(Baron, 1987), yet offers a fresh perspective on the
history of the Paddington Day Hospital therapeutic
community.
Paddington itself is a deeply ingrained partof the
history of the therapeutic community, a name up
therewith Penetanguishine, the American
community made famous for its use of LSD as a
‘treatment’, in its ability to inspiredespair,or
occasionally nostalgic fondness, from anyone
associated with this most misunderstood of treatment
models. Yet Spandler’s account of Paddington’s short
and highly eventful history is, unlike its predecessor,
sympathetic and non-judgmental, drawing on a
number of primary sources who were actually there,
including several patients and the late Dr Julian
Goodburn, who was the hospital’s clinical director
through both its highly successful campaign against
‘restructuring’ in 1972 to the inquiry in 1976 that led
eventually to its demise.
I
The Mental Health Review Volume 12 Issue 1 March 2007 ©Pavilion Jour nals (Brighton) Limited 2007 45
Book Review
Spandler’s treatment is at once a critique of what
she terms the ‘consumable pill of history’, the crisp
narrative account offered by Baron and others that
reifies a number of very heterogeneous events,
subjects and accounts into the present
‘governmentality’ of what is considered ‘risky’ or
‘unprofessional’; and also a re-affirmation of the
liberating and clinical potential of the unstructured,
democratic therapeutic community that has become so
subjugated by the dominant discourses of risk-aversion
and command-control bureaucracy. By systematically
unpicking the bonds that make up Baron’s, and indeed
the official NHS inquiry’s, pathologising of Paddington
as a latter-day Bedlam and Dr Goodburnas a
manipulative zealot from whom the patients had to be
‘protected’, Spandler brings to light the ultimately
human complexity of a treatment facility that was as
often inspired and singularly effective as it was
unstructured and insular. Popular therapeutic
community shibboleths, such as the ‘smearing of
faeces’ on the walls of the day hospital by patients, are
shown to be based on half-truths and wilful
misinterpretations of the facts that not only do a
disservice to the hospital’s staff but also mask a deeper,
morecomplex message that the patients were trying to
communicate through their actions at the time.
Indeed, it is not a bridge too far to read Asylum to
Action as a testament to Paddington’s phenomenal – if
clinically inexplicable – success as a treatment model.
For a group of severely psychotic patients to
successfully organise themselves into, initially, a
highly successfully campaign group and, subsequently,
ahighly influential union (the Mental Patients’ Union,
founded in 1972) and ultimately to possess the critical
faculties to sense that not everything was rose-
coloured in Paddington’sgarden in the late 1970s, and
to put this into effective political action, is quite an
achievement by any standard.
Asylum to Action: Paddington Day Hospital,
Therapeutic Communities and Beyond
By Helen Spandler
London: Jessica Kingsley (2006)
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