Editorial

Citation

Winship, G. (2020), "Editorial", Therapeutic Communities: The International Journal of Therapeutic Communities, Vol. 41 No. 1, pp. 1-4. https://doi.org/10.1108/TC-04-2020-047

Therapeutic communities and initial responses to COVID-19

What comes to mind at the moment is Bion’s idea of thinking under fire, combined with the sense of nameless dread that he also spoke about. With a view to keeping dialogue alive and learning from experience in light of the present challenge of COVID-19, I invited a few colleagues to share their thoughts. I’m grateful for their input. Dr Richard Shuker, Head of Clinical Services, HMP Grendon, shared the following: “During the last few months we’ve encountered something we could never have foreseen or anticipated. The impact has been far as reaching and indiscriminating as it has been ruthless. Communities have had to adjust to new social arrangements in ways with were, until several weeks ago, unimaginable and which in many ways forced people into separation and division. We’ve seen the different responses to this which have emerged. The images of queues of shoppers stretching round supermarket car parks at first light and fights over tinned fish and toilet paper have certainly been very visible. But we’ve also seen something else emerge which should neither shock or surprise us. With all the social distancing which is now becoming a global reality we’ve seen communities galvanised to find ways of coming together and connect. The stories of acts of kindness and generosity, coordinated volunteer groups emerging, collective and shared creativity, have also had equal if not more visibility. When talking to the residents in my community I observed an enactment of what we know will always routinely happen where we have a set of shared values which bring people together. The need to collaborate is acutely evident. Ideas for findings ways to provide support, plan activities and events, and continue to create a safe therapeutic space were very much at the centre of discussion. The need and desire to find ways to work together doesn’t seem to want to go away. Therapeutic Communities continue do what they do best in sustaining hope and meaning in the relationships which tie people together. So it’s not the division and separation which are becoming evident; it’s the need to collaborate, work together and collectively and creatively respond to fear and anxiety. Perhaps, more significantly, it’s becoming apparent that even in these difficult times, any communities, well beyond the world of TCs, are coming together. It was recently noted by the UK Prime Minister that in closing public spaces that this went against an inalienable and freeborn right of people. He may be right. However, what we’re seeing also is the inalienable drive to connect, and the hope this brings to our communities. The threat of a drift towards intolerance has an equally strong counterpart seen in the need to support, connect and belong”.

Shuker’s rallying cry perhaps needs to be set against the some of the stark circumstances that our colleagues are already seeing in Italy where the pandemic has taken hold. Dr Simone Bruschetta, psychologist from Rome and Director of the Italian quality accreditation Democratic Therapeutic Community programme reports the following: “At this time in some Italian TCs attitudes and practices adopted in the pre-asylum era are re-emerging (as before the Basaglia reform - Law 180/1978). All users are coercively detained within the confines of TC, confined in rigid spaces and with pharmacological sedation to avoid agitation crises. Operators are frightened by contact with users, they just monitor them and never share the same living environments or the same life-sharing activities. Meals are prepared by specialized external companies and arrive pre-packaged as in hospitals. I’m afraid that the medicocentrism and sanitation that are strengthening in this period in the Italian TCs will hardly be able to decrease after the end of the epidemic crisis. The limitations on individual freedoms and the imposition of public order are internally eroding the therapeutic and social factors of Democracy, not only in TCs but also throughout society. The deleterious effect of the panic of fear is that of the loss of confidence in oneself and in humanity. It is true that the virus attacks the organism of people who are more vulnerable, and it is equally true that the virus attacks more easily organizations where people are vulnerable and suffering. Bion (1968) states that there is a natural system where there is an overlap between physical and mental phenomena which he calls “proto-mental”. It is a matrix from which spring a potential not yet addressed. It is from this matrix that the emotional states of a basic assumption originate which strengthen and, in some occasions, dominate the mental life of the groups. When a feeling of anguish originates from this level, it can manifest itself both in physical and psychological form. TCs therefore have the task, already during this crisis, but especially afterwards, to guarantee the care of the group psyche, providing the necessary care also to individual organisms and at the same time to social organizations”.

Bruschetta’s report makes for sobering reflection. I’m reminded of discussions with Carolyn Mears, who wrote about the life of the school and the local community in the aftermath of the Columbine shootings (Mears, 2012). In the early days after the shootings there was unification and solidarity, but later there emerged a divisive atmosphere of anger and recrimination. In terms of the impact of trauma, we might wonder what particular impact there is when it is biological virus that carries the threat. I asked Carolyn if she thought there was a different response to a trauma when it is the result of human hand, rather than a consequence of natural disaster. She thought there probably was, she told me, “There is a difference when the tragedy is human-caused. I think one factor has to do with the sense of community, when there is a natural disaster a sense of community builds, and when it human-caused it may more easily decrease. After a natural disaster, people come together to respond to a common tragedy, one that strikes the community as a whole. Even people who aren’t directly affected can identify with those who are. While there will be some conflict and disagreement, the overarching fact is that it was a natural act and no one’s to blame. With an act of rage or violence, any sense of community or coming together in the immediate aftermath quickly fades. People tend to take sides, ‘us against them’. There is a culprit (and his/her family) that can be singled out for blame. Levels of victimization further separate people. After the Sandy Hook tragedy, parents of some of the children who were killed didn’t want any of the public donations to go to the children who survived – they said that there wouldn’t have been any donations had their children not been killed. In many cases, victims are blamed for causing the rage that triggered the event. As a result, that texture of response and recovery can become hostile instead of healing for a while”.

So when we have floods or viruses, is our trauma different? COVID-19 will prompt us to re-model trauma at a personal, social and cultural level. Of course, a distinction between natural disaster and “human hand trauma” is confounded by circumstances where there is an overlap. There are some events which meld between natural and man-made, for instance the Aberfan disaster in 1966 when after three weeks of rain, there was a terrible slippage of colliery spoil tips which hit the village below. Two farm cottages and its occupants were killed as the spoil made its way down the hill (travelling at some 10–20 miles per hour), and the main building that was hit was Pantglas Junior School, where lessons had just begun; 5 teachers and 109 children were killed in the school. In the end, the National Coal Board were held to account. We might say that the event was subject to the considerable forces of nature and industry, both of which can be unpredictable and devastating. I think as we go forward with increasing awareness of the impact of climate change, there will be an increasingly overlap between the idea of natural and man-made disaster (the fires in Australia come to mind). So herein another level of new trauma classification which we might think of as a sort of “eco-trauma”.

COVID-19 may be a case in point. It is experienced as the external enemy, perhaps we will see some of the solidarity that Shuker talks about, but how much COVID-19 is nature and how much it is hand of man is probably subject to debate. Illich (1976) draws our attention to medical iatrogenesis, in this case our overuse of antibiotics has arguably led to the creation of a super-bug. There may be worse to come in the future. Caroline Mears talks about the need for communities to prepare for trauma and not simply just respond – prepare for the worst, hope for the best. This is the local challenge for therapeutic communities, to try and rally the sort resolve and solidarity that Shuker talks about. Therapeutic Communities will suffer; some will survive and some will close. In Hinshelwood’s (2012) paper where he considers the “seeds of disaster” in the process of a TC being closed, he points to the interplay between external threat and the divisive internal forces within the organisation. Hinshelwood’s nine-point plan for sustainability is focused on what it is that staff can do, and it is worth re-considering a summary here:

• Close personal relationships forged in the fires and passions of a developing ideal cannot be replaced by formal working patterns imposed at a later stage.

• Achieved leadership seems has an invincible advantage over appointed leadership.

• Grassroots initiatives and responsibilities are highly durable.

• Demoralisation, decline, resentments and jealousies are threats.

• Messianic expectations and hopes do not exist without extreme ambivalence, these need to be exposed.

• Support for the staff team insecurities is a delicate but highly important task.

• The support system must balance a focus on the personal concerns of the staff and the formal therapeutic relationships with clients.

• The support system should have particular regard for those working in the frontline.

• Benign mutuality between leadership and team, based on personal relationships that avoid any play on interpersonal insecurities, can bring about a high morale.

Hinshelwood’s recipe draws our attention to maintaining a sort of grounded formality, where grassroots engagement is necessary to quell idealism, and a frame where morale is drawn from formal support structures and benign relations between leaders and the team. Some might argue that there is not enough said about what clients can do, but I think Hinshelwood is concerned here primarily with the stoical responsibility of leadership. And sometimes we need strong leadership. In the early days of HIV/AIDS, when we really had no idea what was happening, there was a great deal of fear, and sadly, discriminatory practice. I was working on a psychiatric intensive care unit, but there was something equalising when the ward manager decided that we must treat everyone as if they were HIV positive, staff or patients, so being extra cautious about body fluids, blood spillages where possible. It was bold leadership, and the staff team concurred, some more reluctantly than others. But soon we realised that it was not a slur to treat someone as if they had the virus, and it became custom and practice. We are pressed again into this idea that we treat everyone “as if”, and so in the future, certainly for the foreseeable, we won’t shake hands, kiss or hug. We may keep a distance or even to wear a mask. In short, we might determine new modes of intimacy as Shuker suggests.

This is a different kind of war, but therapeutic communities do know about dealing with crises, thinking under fire, trying to remain cohesive against the odds. In a personal communication Dr Craig Fees, oral historian and founding archivist of the world’s leading therapeutic community archive and research library, argues that we need to understand the precedents Therapeutic Community offers in thinking about the future: “This time of international catastrophe will be of crucial interest to future historians. But it’s not just future historians that all this is crucial to – it’s the people in our therapeutic communities today and tomorrow, and the everyday communities we live in. The amount of experience available in therapeutic communities and their history is almost overwhelming. How do we marshal it, and bring the realism and optimism in therapeutic community history and practice to bear in envisioning the world beyond catastrophe? My mind goes to David Kennard’s “therapeutic community impulse”, the collective acts of kindness and generosity, the fundamental principle on which communities adhere. Or Mike Rigby and the virtual informal network of care set up in Cumbria (Rigby and Ashman, 2008). Dennie Briggs[1] had so much experience and insight into the possible in impossible situations. Perhaps, this is a time to consider his work, and also Harry Wilmer (Wilmer, 1957, 1968). Also the work of Lydia Tischler (Kennedy et al., 1987) and Elly Jansen (Jansen, 1980), who created so much from their personal experiences of the Second World War and the time of the “untouchables” in Europe; when to be different or Jewish or associated with Jews could be a death sentence; as it was for Janusz Korczak, the Polish pioneer in therapeutic community for children, who disappeared into Treblinka extermination camp with his children. What might come after the horrors and the disasters? This time may seem unimaginable, but what is unbearable and should be unimaginable is in fact native territory for therapeutic communities, as is its transformation. “Bearing the Unbearable” (Bradley, 2010) and “Metabolising Madness” are built into the being of Therapeutic Community [Planned Environment Therapy Archive (PETA), 2006]”.

Our thoughts go out to TC colleagues all over the world, and those key workers who are in the front line, battling to preserve some of the principles of TC practice, and at the same time refining others so they are fit for purpose. I really do hope colleagues can find the time and energy to write about their experience and publish in this journal. The social science of COVID-19, and its social impact, will linger on long after the vaccine has been found.

Note

1. Dennie Briggs, "Original Papers", a series edited by Elizabeth Beresford, http://www.pettrust.org.uk/index.php?option=com_content&view=category&id=237&Itemid=335. Dennie Briggs' personal and professional archives are in the Planned Environment Therapy Archive.