TOWARD A DEFINITION OF THE THERAPEUTIC COMMUNITY

The therapeutic community concept is only one of many new approaches to the problem of the mentally ill. But it is a hopeful method, and one that can lead, I believe, to the improvement of our mental hospitals. How much its success depends upon the enthusiasm, optimism, and enhanced interest and activity of the staff is difficult to evaluate. The immediate task facing those of us who believe in its efficacy is, as I see it one of making the intangible atmosphere tangible—descriptively, statistically, and graphically—so that the failures and successes with the therapeutic community approach can be analyzed and the procedures perfected. We need to work toward a clearer understanding of what this method is, psychologically, psychoanalytically, and psychiatrically; to identify, define, and study significant elements of the therapeutic milieu as objectively and critically as possible. We need work like the paper of Ackner, Harris, and Oldham(1) in which scrupulous controls are established in the evaluation of treatment programs with proper consideration of therapy and socio-environmental factors with elimination of staff attitude from the final judgments.

The therapeutic community here described represents an effort at the understanding of patient management. It is my impression that it is also therapy but this has not been proved. The "traditional role of the patient is to be sick" but in this ward the role of the patient is to exhibit normal behavior as nearly as he possibly can. Management of the acute psychiatric patient was based on the expectation of self-control rather than the traditional staff attitudes that patients were "dangerous" and would momentarily go out of control. With a sharing of responsibility and participation in the over-all program (within the limitations of the military hospital structure) according to the capabilities of the patients the expectations were now based on actual happenings rather than projected fears. This type of management opens up the possibilities of therapy through social interaction with the staff-patient involvement affording potentialities for social development and identification with the group. It also focuses attention on treatment at the beginning of hospitalization (in an admission ward) which is a necessary parallel to studies of therapy and patient management, resocialization and rehabilitation of the long-term patient. It is also, in a sense, part of the same problem and could ameliorate the magnitude of the enduring hospital problems in patient management.