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Residential Treatment
From Spiritual Competency Resource Center
© Dr. David Lukoff 1994, 2014


While support for persons experiencing spiritual crises is not well developed in Western culture, some residential treatment centers have attempted to provide therapy based on an alternative perspective that psychosis is potentially a "breakthrough rather than breakdown." Kingsley Hall in England was the first alternative nonmedical model residential treatment, and it inspired the development of several others that are described below.

R. D. Laing, MD, psychiatrist and author of numerous books on mental health, argued that mad people have lost their conventional social filters, and have regressed to a level of experience that precedes the acquisition of rudimentary distinctions between inner and outer, past and present, real and imaginary, good and bad, etc. But he argues that their anguish and confusion may herald an inner voyage — termed metanoia — which under optimal circumstances, can result in the emergence of a more authentic and integrated way of being-in-the-world. While in training as a psychoanalyst, Laing came across instances of spontaneous remission in which subjects were not merely restored to their premorbid condition, but emerged more integrated, insightful and grounded than before — at least by their own reckoning.

Based on numerous case histories and first person accounts, and on the reports of friends and former patients who had metanoia-type experiences, Laing concluded that in optimal circumstances, a psychotic episode can have a positive outcome. To wrestle a redemptive measure of freedom and insight from a psychotic interlude, and to prevent the dreaded decline into chronicity, the disordered person needs a safe, non-coercive environment and the supportive and non-intrusive presence of others who have also made this perilous inner journey, and can act as guides, facilitators and protectors. Laing's enthusiasm for the metanoia concept was such that during most of the 1960s, he proposed that most psychotic disturbances would follow this pattern, if the requisite conditions were provided. Accordingly, Laing was also categorically opposed to drugs, shock treatments, or any surgical interventions that might cause the metanoia process to abort or misfire — in short, to almost all of mainstream psychiatry.

    If the human race survives, future men will, I suspect, look back on our enlightened epoch as a veritable Age of Darkness. . . .They will see that what was considered 'schizophrenic' was one of the forms in which, often through quite ordinary people, the light began to break into our all-too-closed minds. (The Wing of Madness: The Life & Work of R.D.Laing)

Laing never claimed that the onset of acute psychosis always heralds a metanoic journey. He merely said that it usually would, or could. After 1969, however, Laing's attitude was decidedly more cautious. When asked about this in the 1970s, he estimated the odds of spontaneous recovery, even in optimal circumstances, were 50% or less.

In 1965, Laing, Esterson, Cooper and a small group of friends and supporters founded a charitable foundation for the creation of therapeutic communities for people suffering from mental and emotional crises. The Philadelphia Association was committed to the idea that a psychotic breakdown is an existential crisis, and therefore, potentially, an attempt to reconstitute the self in a more authentic and integrated way. Professional and patient roles, as implemented and understood in mainstream psychiatry, are not conducive to genuine cure. In fact, they often preclude a genuine understanding of the psychotic as a person, and tend to exacerbate patients' sense of powerlessness and isolation.

To remedy this situation, Laing and associates set up therapeutic households that provided those suffering acute distress and disorientation asylum from the world outside, free from the stigma of diagnosis and the traumas of involuntary treatment. The most famous of these households was Kingsley Hall, in London's East End, which ran from 1965 to 1970. As his first marriage disintegrated, Laing himself moved in there. He said about Kingsley Hall,

    One of the problems is this: as soon as we have "professionals" we have expectations that they should be "doing something." People didn't have to do anything. They were living under the same roof, and making a life together, on an ad hoc day-by-day basis. There were no formal duties. Simply sharing the same situation, sharing a kitchen, sharing the arrangements to buy food (The Wing of Madness: The Life & Work of R.D.Laing).

It closed in May of 1970 as a result of the neighbors reactions to behavioral disturbances and lack of maintenance of the facility, but is widely considered a noble experiment that spawned other attempts to create non-medical approaches to residential treatment of psychosis.

The Jungian analyst John Perry, MD established a residential facility, Diabysis, in San Francisco in 1974 that serves as a model for the environment most therapeutic for spiritual emergencies, especially for persons in an acute psychotic crisis. Diabysis created a homelike atmosphere where diagnostic labels were not used, and staff members were selected who were comfortable with intensive inner processes. Training in the mental health professions was not a requirement for staff although many interns were used. Perry emphasized that when a person's psyche is energized and activated, what is needed isn't "treatment" but contact with a person who empathizes, who actively encourages the process, who provides a loving appreciation of the qualities emerging through the process, and who facilities the process rather than attempting to halt or interfere with the process. Medication, he believed, only inhibits a person's ability to concentrate on the inner work and it mutes the psychic energy needed to sustain the effort to move the process forward. Perry describes it as follows:

    What we did at Diabysis was specifically to set up what we hoped would be the most ideal, least toxic (smile), least damaging environment for a person in the visionary state. First off, this means a home. You need a place with friendly, sympathetic individuals who live there. These people have to be companions, have to be willing to listen and not be frightened and not be judgmental about it, and not try to do anything to anybody.
    One has to let the visionary process unfold itself spontaneously. Under such conditions, to our surprise, we found that our clients got into a clear space very quickly! We had started out with the notion that we would surely be in for a lot of bedlam with all this "madness" going on, but actually the opposite was true! People would come in just a crazy as could be on the first day or two, but they'd settle down very soon into a state of coherency and clarity. Often, when I would come in for a consultation at the end of the week, I would see someone who had been admitted in a completely freaked-out state just a few days before, sitting at the dinner-table indistinguishable from anybody else; sometimes I couldn't tell if this was a new member of the staff, or one of our clients. The calming effect of a supportive environment is truly amazing!

    It's a well-known fact that people can and do clear up in a benign setting. Actually, they can come down very quickly. But if some of our cases had gone to the mental hospital, they would have been given a very dire message: "You've had a mental breakdown. You're sick. You're into this for decades, maybe for the rest of your life!" and told "You need this medication to keep it all together." I am quite certain that if some of our clients had been sent to the mental hospital, they would have had a long, long fight with it. The outcome of their stay at Diabysis, however, was that their life after the episode was substantially more satisfying and fulfilling to them than it had been before!

    The acute hallucinatory phase, during which these contents go through the reordering process, usually lasts about six weeks. This, by the way, corresponds to the classical description of visionary experiences in various religious texts, such as the proverbial "forty days in the wilderness" often referred to in the Bible. (Interview: Mental Breakdown as a Healing Process)

Case Example from Diabysis

Soteria was another residential treatment program that existed in the 1970s in San Jose and provided a milieu that promoted expression rather than suppression of the contents of the patients' psychotic experiences. It was oriented toward a Laingian model with great respect for the psyche's own natural healing intentionality, but without delving into the archetypal/symbolic aspects of psychosis. This was the only alternative residential setting that conducted research on outcomes, and they were generally positive. This is a recent publication summarizing the positive long term results.

Mosher LR Soteria and other alternatives to acute psychiatric hospitalization: a personal and professional review. J Nerv Ment Dis 1999 Mar;187(3):142-9

Burch House was a residential, therapeutic community for up to eight client in a 19-room farmhouse on 13 acres of land in New Hampshire. Burch House worked with persons diagnosed with psychotic disorders since 1978. David Goldblatt, the co-founder and director, spent 4 years studying with R.D. Laing, and this profoundly influenced the clinical direction of Burch House. The program emphasized two principles. The first is community; all 8 residential clients share household tasks such as cooking, cleaning and gardening, and relationship building is encouraged. The second is "autorhythmia," meaning that clients are permitted to find their own pace and path within the community, free from prescribed schedules and expectations:

We give people room to be who they are, in whatever way they do it provided nobody gets seriously hurt in the process. We present a way for people to be with clients without trying to do anything to them or to structure their experiences, even if they're in the midst of a full-blown psychosis.

[The program is based on] a strong belief that people recovering from severe emotional and psychological distress are in a process that needs to be treated with humanity and dignity. And that given a place with time and safety individuals will be able to reach their own innate healing capacity that is lost through distress and traumas.

Wellspring Foundation
Located in the rolling hills of Western Connecticut, Wellspring's woodland setting with pastures, farm animals and stream provides a naturally healing environment. The highly structured but intimate programs are designed to treat persons with a wide range of behavioral and emotional problems, including affective, personality, attachment, eating, and traumatic stress disorders. Angelus House is the Residential Adult Treatment Program of The Wellspring Foundation for individuals ages 18 and over. The small community, with a maximum of 10 residents, creates a family environment that can serve as an often-needed step between hospital and home or independent living

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