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Innovation in Social Policy – the Case of the Therapeutic Community*

Published online by Cambridge University Press:  20 January 2009

N. P. Manning
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Abstract

Students of social policy have studied in some depth the fate of new ideas when they came close to inclusion in new policies, and especially new legislation. Less attention has been paid to the process whereby new ideas are generated, and the impact of advocacy on the future of simultaneous but independent innovation. Here, the therapeutic community, developed during the last war in response to largely neurotic difficulties in military personnel, is examined as a case study of innovation, and of the fate of innovation as a result of official support, and enthusiastic proselytization by committed practitioners.

Type
Articles
Information
Journal of Social Policy , Volume 5 , Issue 3 , July 1976 , pp. 265 - 279
Copyright
Copyright © Cambridge University Press 1976

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References

1 See, for example, the excellent study by Mulkay, M. J., The Social Process of Innovation, London: Macmillan, 1972.CrossRefGoogle Scholar

2 Malleson, A., Need your doctor be so useless?, London: Allen & Unwin, 1973.Google Scholar

3 Mulkay, M. J., Functionalism, Exchange and Theoretical Strategy, London: Routledge & Kegan Paul, 1971.Google Scholar

4 Eckstein, H., Pressure Group Politics; The Case of the British Medical Association, London: Allen & Unwin, 1960.Google Scholar

5 Willcocks, A. J., The Creation of the National Health Service, London: Routledge & Kegan Paul, 1967.Google Scholar

6 George, V. and Wilding, P., Ideology and Social Welfare, London: Routledge & Kegan Paul, 1976.Google Scholar

7 See, for criticism, J. H. Goldthorpe, ‘The Development of Social Policy in England, 1800–1914’, in International Sociological Association, Transactions of the 5th World Congress of Sociology, vol. IV, 1962.Google Scholar

8 This is only ‘potentially’ because the sociological study of social policy innovation is still in its infancy. Indeed two recent collections of case studies in this area rely heavily on a political science analysis: Hall, Phoebe, Land, Hilary, Parker, R. A., Webb, Adrian, Change, Choice and Conflict in Social Policy, London: Heinemann, 1975Google Scholar; Donnison, David et al. , Social Policy and Administration Revisited, National Institute for Social Work Social Services Library, London: Allen & Unwin, 1975Google Scholar, although chapter 12 in the latter provide a more sociological view of social policy innovation (pp. 293–300).

9 See Clark, D. H., Social Therapy in Psychiatry, Harmondsworth: Pelican, 1974Google Scholar; Jones, M., Social Psychiatry, London: Tavistock, 1952Google Scholar; Jones, M., Social Psychiatry, London: Thomas, 1962.Google ScholarPubMed

10 See the next section.

11 Belknap, I., Human Problems of a State Mental Hospital, New York: McGraw-Hill, 1956Google Scholar; Stanton, A. and Schwartz, M., The Mental Hospital, New York: Basic Books, 1954.Google Scholar

12 Drawn from Rapoport, R. N., Community as Doctor, London: Tavistock, 1960.Google Scholar

13 Jones, , 1962, op. cit., p. 73.Google Scholar

14 Clark, D. H., ‘The developing concept of the therapeutic community’, Psychotherapy and Psychosomatics, 1965, 13, nos. 1–3.CrossRefGoogle ScholarPubMed

15 Crockett, R., ‘Authority and Permissiveness in the Psychotherapeutic Community: Theoretical Perspectives’, American Journal of Psychotherapy, 1966, 20, p. 669.CrossRefGoogle Scholar

16 See N. P. Manning, ‘Values and Practice in the therapeutic community’, Human Relations, forthcoming.

17 Much of this paragraph draws on Jones, K., A History of the Mental Health Services, London: Routledge & Kegan Paul, 1972.Google Scholar

18 This commission was sponsored by the Lancet as a fact-finding study of ‘The Care and Cure of the Insane’, under the direction of Dr Mortimer Granville. See Jones, K., op. cit., pp. 166–7.Google Scholar

19 Freud, S., Group Psychology and the Analysis of the Ego, London: Hogarth, 1922.CrossRefGoogle Scholar

20 Mead, G. H., Mind, Self and Society: From the Standpoint of a Social Behaviourist, Chicago: University of Chicago Press, 1934.Google Scholar

21 Sullivan, Harry Stack, Interpersonal theory of psychiatry, London: Tavistock, 1955, pp. 110–11.Google Scholar

22 Lewin, K. in Cartwright, D. (ed.), Field Theory in Social Science, New York: Harper, 1951.Google Scholar

23 Dicks, H. V., 50 years of the Tavistock Clinic, London: Routledge & Kegan Paul, 1970.Google Scholar

24 Lewin, Kurt, obituary, Human Relations, 1947, 1, 1.Google Scholar

25 Ahrenfeldt, R. H., Psychiatry in the. British Army in the Second World War, London: Routledge & Kegan Paul, 1958.Google Scholar

26 Clark, D. H., Administrative Therapy, London: Tavistock, 1964Google Scholar; reference is to Ackner, B., Harris, A. and Oldham, A. J., ‘Insulin Treatment of Schizophrenia – a Controlled Study’, Lancet, 1957, i, p. 607.CrossRefGoogle Scholar

27 Dicks, , op. cit.Google Scholar

28 Rees, J. R.. ‘Three years of Military Psychiatry in the United Kingdom’, British Medical Journal, 1943, 1.CrossRefGoogle ScholarPubMed

29 Rees, J. R., The shaping of psychiatry by war, London: Chapman & Hall, 1945.Google Scholar

30 Taylor, F. Kräupl, ‘A history of group and administrative therapy in Britain’, British Journal of Medical Psychology, 1958, 31.Google ScholarPubMed

31 Main, T. F., ‘The hospital as a therapeutic institution’, Bulletin of the Menninger Clinic, 1946, 10.Google ScholarPubMed

32 Curle, A., ‘Transitional communities and social reconnection’, Human Relations, 1947, 1, 1.CrossRefGoogle Scholar

33 M. Jones claims in Social Psychiatry, 1952, op. cit.Google Scholar, that he did not meet A. T. M. Wilson, who ran the Tavistock-inspired Civil Resettlement Units, until 1946.

34 Jones, , 1952, op. cit., p. 1.Google Scholar

35 Difficulties surrounding this problem are discussed in N. P. Manning, ‘Evaluating the Therapeutic Community’, Social Science and Medicine, forthcoming.

36 For example, Medawar, P. B., Induction and Intuition in Scientific Thought, London: Methuen, 1969.Google Scholar

37 Merton, R. K., Social Theory and Social Structure, Glencoe, III.: The Free Press, 1968Google Scholar; Kuhn, T., The Structure of Scientific Revolutions, Chicago: University of Chicago Press, 1962.Google Scholar

38 Mulkay, , 1972, op cit.Google Scholar

39 This, as has been noted, included American connections. Interestingly the Americans did not develop the therapeutic community concept independently, which supports the interpretation that the catalytic impact of the war in Britain was an essential addition to an unsatisfactory hospital System and social science knowledge, both of which the Americans had. Indeed the Americans attempted hospital reforms after careful research, rather than innovating ‘on the run’, which resulted in more limited though broader changes.

40 Rees, (1945, op. cit.)Google Scholar records that initially there was considerable hostility to psychiatrists from other army personnel; but that success in tackling man-management problems earned the Army Psychiatric Services grudging acceptance.

41 See Banks, J. A., The Sociology of Social Movements, London: Macmillan, 1972, p. 31.CrossRefGoogle Scholar

42 See 2nd Report of the Standing Committee of the Rehabilitation and Resettlement of Disabled Persans, London: HMSO, 1949Google Scholar (Chainnan, Sir H. Wiles).

43 Op. cit.

44 Manning, Human Relations, op. cit.;Google ScholarCaine, T. M. and Smail, D. J., The Treatment of Mental Illness, New York: International Universities Press, 1969.Google Scholar

45 To separate. technique and values does not imply that technical development is valuefree, for the psychiatrist in attempting to normalize the abnormal immediately enters the realm of values, whatever his technique. Rather, to separate the technical from associated values merely means that the former shares the conventional wisdom of psychiatry.

46 Modified from Wilkinson, P., Social Movements, London: Pall Mall Press, 1971.CrossRefGoogle Scholar

47 Smelser, N. J., Theory of Collective Behaviour, London: Routledge & Kegan Paul, 1962.Google Scholar

48 Rapoport, op. cit.

49 Manning, in Social Science and Medicine, op. cit.

50 Festinger, L., Riecken, H. W. and Schachter, S., When Prophecy Fails, Minneapolis: University of Minnesota Press, 1956.CrossRefGoogle Scholar

51 Paddington Day Hospital.

52 Rapoport, R. N., ‘A new era in social psychiatry’, Social Science and Medicine, 1970, 3, p. 407.CrossRefGoogle Scholar

53 Weber, M., The Theory of Social and Economic Organization, London: Oxford University Press, 1948.Google Scholar

54 Banks, op. cit., p. 31.Google Scholar

55 A common feature noted by Smelser, , op. cit.Google Scholar

56 The Association of Therapeutic Communities. Differentiation of goals and the formation of an Association have again been noted by King, C. W., Social Movements in the United States, New York: Random House, 1965.Google Scholar

57 Smelser, , op. cit.Google Scholar; King, , op. cit.Google Scholar; Dawson, C. and Gettys, W. E., An Introduction to Sociology, New York: Ronald Press, 1948.Google Scholar

58 Except King, , op. cit.Google Scholar

59 From unpublished data on referrals to Henderson Hospital.

60 Since the National Health Service reorganization the Area Health Authority has been pressing for evidence which proves its efficacy, and justifies its high staff-patient ratio. However the evaluation of therapeutic community practice presents certain problems: it is multi-dimensional, and research is often designed to investigate single dimensions; it combines efforts at both intra-psychic and behavioural change; most previous studies in this area have focused on process rather than outcome; even then outcome success is only one goal amongst many which have been and continue to change. For these reasons orthodox experimental designs do not work, and a more eclectic, flexible approach must be pursued. See for example, Clarke, R. V. G. and Cornish, D. B., The Controlled Trial in Institutional Research, London: HMSO, 1972.Google Scholar It is no doubt of significance for the relative decline of the therapeutic community that this evaluative work has not yet been adequately tackled.

61 Gralnick, A., The Psychiatric Hospital as a Therapeutic Instrument, New York: Brunner/ Mazel, 1969, pp. 91–2.Google Scholar