This book is well written and well
researched.  The author, Helen Spandler, is a research fellow in the Department
of Social Work at the University of Central Lancashire, Preston in the UK.  She
studied on the innovative MA course in "Psychiatry, Philosophy and
Society" at the Centre for Psychotherapeutic Studies in Sheffield.  Before
her PhD she was employed by ‘Having a Voice’, a user run advocacy project in
Manchester.  She has been a leading support to Asylum, a magazine for
democratic psychiatry.

These credentials mean that she has
a sympathetic understanding of the origins and significance of the Paddington
Day Hospital, an important therapeutic community in London during the 1970s.  Her
analysis is not only informed by an appreciation of the perspective of mental
health service users, but also based on an academically sound, sensitive and
rigorous methodology.  She interviewed various key players who were involved in
the story she describes in the book.

Paddington Day Hospital was one of
the first non-residential therapeutic communities in Britain from 1962 to 1979.
 The threat of transfer to a more traditional acute psychiatry service was
thwarted by a protest involving patients in 1971-2. The spirit and success of
the protest led to the formation of the Mental Patients Union, a significant organization
in the origin of the British mental health survivor movement.

Patients’ complaints accumulated
over time about lack of involvement in decision‑making in the day
hospital, in particular about the perceived over-reliance on psychoanalytic
interpretations rather than support for their immediate social problems. An
official inquiry recommended change in the way of working, but the medical
director, Julian Goodburn, proposed that patients should choose from two
different types of therapy: one which complied with the inquiry’s
recommendations; the other which continued to try to develop an open
psychoanalytic approach without interference or material provisions.  When
Goodburn failed to go along with the Area Health Authority’s demand that all
the inquiry recommendations be met he was suspended and eventually dismissed.  Goodburn
took his case for constructive dismissal to an industrial tribunal and to
appeal.  The Area Health Authority closed the Day Hospital.

The dominant account of the
Paddington Day Hospital has been Claire Baron’s (1987) Asylum to Anarchy.
 It records, from its perspective, how a radical experiment in mental health
democracy and liberty turned into anarchy, chaos and tyranny.  Helen Spandler,
in her book, describes how the reputation of the Day Hospital was pathologized
because of its challenge to conventional psychiatric and psychotherapeutic
practice.  Paddington was seen as having crossed the boundaries of what was
deemed proper and acceptable in psychiatry.

Unfortunately Julian Goodburn died
unexpectedly during the course of Helen Spandler’s research.  Goodburn was
influenced by the work of Henry Ezriel and the positive side of his contribution
to the therapeutic community movement and psychoanalysis needs to be
remembered.

Goodburn was always clear that
exploration of the events at Paddington was only justified if it contributed to
present understanding.  This viewpoint and his untimely death may have meant
that Spandler was unable to explore fully the implications of the Paddington
controversy.  For example, she mentions the inquiry into the patients’
complaints and the subsequent inquiry following Goodburn’s suspension, but does
not mention his pursuit of the issues through an industrial tribunal and
appeal.  I think this would have been helpful to understand his perspective
more completely.  Nonetheless, Spandler has righted the bias of Claire Baron’s
account.

I also think that it is important
that Paddington’s challenge to mainstream psychiatry is not "left for
dead".  This is the sense in which Julian Goodburn’s wish, that the
Paddington experience could contribute to present understanding, may be
fulfilled.  For example, the influence of so-called
"anti-psychiatry", associated with psychiatrists such as R.D. Laing,
has been marginalized by conventional psychiatry.  Paddington is relevant here,
as evidenced in the account by Claire Baron where Goodburn (called Adrian in
the book) is depicted as a Laing-like figure. The demise of Paddington
parallels the condemnation of "anti-psychiatry".

Over recent years critical
psychiatry has attempted to redefine a psychosocial perspective in psychiatry
in opposition to the dominant biomedical model.  It should expect a similar
attempt to discredit its position as that experienced by Paddington Day
Hospital.  I am not saying that critical psychiatry wishes to promote a
psychoanalytic therapeutic community approach; nor that critical psychiatry
does not recognize the excesses of "anti-psychiatry".  Yet the threat
to biomedical orthodoxy in psychiatry seems to encourage a primitive
defensiveness of projecting onto the challenge the label of a risky and
unworthy venture.  Critical psychiatry should expect the same opprobrium as was cast at the Paddington Day Hospital. What critical psychiatry needs to do is
weather the storm and not be deflected from its aim of changing psychiatric
practice.  If successful it will truly have learnt from the Paddington experience
in Goodburn’s terms and Spandler’s book may well contribute to this end.

© 2006 Duncan
Double

Duncan
Double, Consultant Psychiatrist and Honorary Senior Lecturer, Norfolk Mental
Health Care Trust and University of East Anglia, UK; Website Editor, Critical Psychiatry Network.

Categories: Philosophical, General