Community as Doctor

Community as Doctor

Community as Doctor

Community as Doctor

Excerpt

The concept of a therapeutic community has tended to be used in so many ways that its meaning has become vague and confused. Nevertheless it is becoming increasingly clear that the social environment of psychiatric patients whether in hospital or in the outside community can have a profound effect on their readjustment and eventual recovery. To study these social forces and apply them in therapeutically desirable ways calls for the closest collaboration between the psychiatric team and their social-science colleagues. It was in this context that we sought the help that was so generously afforded us by the Nuffield Foundation and the Medical Research Council.

Dr Rapoport spent four years in all (1953 to 1957) working with the staff of the Social Rehabilitation Unit at Belmont (now Henderson) Hospital. During the first year of his stay Dr Rapoport was on his own without other research assistance. He spent this year in familiarizing himself with the whole structure and functioning of the Social Rehabilitation Unit. In particular he made close contact with hospital patients, getting to know them more informally than most staff members are able to do. He also sought to view the staff as objectively as possible. It was during this time that Stanton and Schwartz's book appeared, which emphasized the importance of staff interrelationships as affecting the treatment of patients. As the work developed, it was decided to add additional research staff to enlarge the Unit's understanding of its action experiment with treating personality disorders in a therapeutic community. Dr Rapoport worked in collaboration with his research colleagues for the two years that followed. This book draws on the findings of individuals in this group, though much of their work is published separately or is being developed in subsequent research in other organizations to which they have gone.

In order to place this research in perspective, a brief historical sketch of the Unit may be useful. The staff at the Social Rehabilitation Unit had long been interested in the problems of social psychiatry; the . . .

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