JOURNAL ARTICLES
R.D. Hinshelwood (1994) The relevance of psychotherapy, Psychoanalytic Psychotherapy 8: 283-294.
Psychotherapy can relevantly address the unconscious aspects of the staff members in mental health institution as well as the inmates and clients.
have such an unconscious as well as patients/clients. These roles can become rigid and appear schismatic. In this case a schism between an emotionally distanced scientific attitude, amongst the biological psychiatrists and nurses, while a sentimentalised empathy was held by the therapeutically oriented staff – the psychotherapists, music therapists, art therapists. This offers an
understand the seeming irrelevance of therapies in such institutions.
R.D. Hinshelwood (1999) The difficult patient: The role of ‘scientific psychiatry’ in understanding patients with chronic schizophrenia or severe personality disorder. British Journal of Psychiatry 174: 187-190.
Mental heath services in the public domain are the last resort from society to manage – in care or custody – the most difficult persons. The difficulty that such people arouse in society with those most willing to help, even in the family, is not understood at depth. This paper considers that in severe personality disorders the early history of neglect or worse has left the person unable to distinguish help from abuse, and in the case of psychosis, reality is equally confused as for example in Bateson’s description of the double-bind.
R.D. Hinshelwood (2000) Alienation: social relations and therapeutic relations. Psychoanalytic Studies 2: 21-30.
The alienation of those who are psychotically disturbed and removed to psychiatric hospitals and wards are subjected to a process of alienation, which is often accepted as it fits with their own repudiation of reality. The conscious solutions to these problems were simplistic; they were to large therefore create small ones, too far from family and local communities, therefore institute community, too much a medical model and therefore reorganise the structures of authority, and so on. However all these miss the unconscious dynamic that we all fear insanity and must keep ‘it’ (in the form of mad humans) at a distance.
Gary Winship, Bray, Joy, Repper, Julia and Hinshelwood Robert (2009) Collective biography and the legacy of Hildegard Peplau, Annie Altschul and Eileen Skellern; The origins of mental health nursing and its relevance to the current crisis in psychiatry. Journal of Research in Nursing 14: 505-517.
This paper records the long tradition of nursing at the Casel Hospital informed by the psychoanalytic understanding of pre-verbal acting out, that involve th ‘use of self’ and of ‘working alongside. This was established by teams of nurses over several decades under the leadership of Peplau, Altschul and Skellerm, with the supervisory inspiration of T.F. Main.
R.D. Hinshelwood (2014) Bion’s paper on arrogance. Reading his personal disaster. Funzione Gamma 33; https://www.funzionegamma.it/wp-content/uploads/ing-hinshel-1.pdf
This paper speculates about the triad of arrogance, stupidity and curiosity which Bion postulated during the 1950s, whe working with psycbotic states. The speculation is that it is a state of mind he discovered in himself during his own analysis in the 1940s. It could be thought of as his state of mind resulting from the intractable problem of and curiosity about his intolerable war trauma in 1917-1918. Such a left-over PTSD could be a factor in his style of writing which provokes curiosity but which is often opaque to the reader’s comprehension.
R.D. Hinshelwood (2016) Is community care a success? In Argo https://www.argo-onlus.it/is-community-care-a-success/
British mental health Services progressively moved from the large mental hospitals towards community care during 1960-1980. The ossification and the unconscious dynamics underlying it resting on social defences systems to protect staff from the impact of insanity, appeared to make those hospitals seem uncaring and unhealthy. The solution was to close them. However how much were the underlying dynamics and the stress and unconscious defences really change by ork in the community?
R.D. Hinshelwood and Skogstad, Wilhelm (2002) Irradiated by distress: observing psychic pain in health-care organizations. Psychoanalytic Psychotherapy 16: 110-124.
A colleague and I presented some ideas about the social defence systems of mental health care in a workshop in Germany. The attempt was to expose the unconscious undercurrents that transposed the devoted attention to care for the unfortunate in mental health services into ossified, depersonalised and often down-right indifference. It seems that it is not the individuals but the cuture of the institution that pressures the individual into mechanical care roles.
CHAPTERS IN EDITED BOOKS
R.D. Hinshelwood (1998) Creatures of each other: some historical considerations of responsibility and care and some present undercurrents. In Angela Foster and Vega Roberts (eds) Managing Mental Health in the Community: Chaos and Containment in Community Care. London: Routledge.
Struggling to understand the stresses and strains of working in an organisation over 30 odd years before, I responded enthusiastically to this invitation from Angela Foster to write about community care as the attempt to thrust beyond the institutional care of the large mental hospital. . The apparent meaninglessness, the projections into carers and others, and the social attitudes to mental disturbance make for a days shift on a ward to be a taxing emotional task. Whist thoroughly supporting the whole move to the community, I was concerned that not enough had been learned about the dynamics of care to avoid a similar defensiveness creeping into the new forms of care out there.
R.D. Hinshelwood (2013) Suffering the impact: Psychosis and the professional care-giver. In Gumley, A., Gillham, A., Taylor, K. & Schwannauer, M. Psychosis and Emotion: The Role of Emotions in Understanding Psychosis, Therapy and Recovery. London: Routledge
The impact of psychosis on the doctors, nurses and te professional and family caregivers is an important dynamic for everyone. And not least is the fact that the impact and how it is dealt with feeds back into the psychotic state of the person struggling to cope with the reality of their connections with others. Those who care suffer the impact of being misperceived in reality, and the cared-for suffer from their suffering. The distancing that ensues takes away the possible sunshine moments when the reality of two concerned and caring people can meet realistically.
R.D. Hinshelwood (2013) Schizophrenia, meaninglessness and personal stress. In David Bell and Aleksandra Novakovic Living on the Border: Psychotic Processes in the Individual, The Couple, and the Group. London: Karnac.
This is a book from the psychodynamic work of the Tavistock Cinic with persons suffering psychotic states. Though I never worked closely with the Tavistock staff, I was pleased to contribute my viewpoint. This was the interaction between staff and those they care for over making meaning from the apparent meaninglessness of a schizophrenic person’s psychotic episodes. My particular angle was the need for both to reach some sense of meaning while the patient also attempts to disrupt it. This Chapter homes in on the problems for carers of living with meaninglessness, and the destruction of meaning. The human mind abhors meaninglessness as’nature abhors a vacuum’.
Wilhelm Skogstad and R.D. Hinshelwood (2002) The hospital in the mind: the setting and the internal world. In Serge Frisch (ed) Psychoanalytic Psychotherapy in Institutional Settings. London: Karnac.
This was a further joint venture with Wilhelm Skogstad and his work with colleagues in Germany. The again paper again reviews he interaction at the powerful level of emotional stress, between patients, psychodynamic staff and the continuing institution. The particular contribution that Skogstad adds, is the dynamic introjection of the institutional culter that determines the roles of both carers and the cared0for by becoming an internalised object, functioning somewhat like a super-ego, but being an institutional culture determined also by the needs of staff for reief from the stress of meaningless not knowing.
Psychoanalysis and the Therapeutic Communities
BOOKS EDITED
R D Hinshelwood and Nick Manning (eds) 1979 Therapeutic Communities: Reflections and Progress (London: Routledge and Kegan Paul).
This very early contribution was my first book and drawn from colleagues I had made and worked with in the Therapeutic Community between 1969 and 1976. In that time we founded under David Clark’s inspiration the national Association of Therapeutic Communities. This book is contributions from this new association to celebrate the development over 30 years of one creative strand from the Northfield Hospital during wartime.
R.D. Hinshelwood and Luca Mingarelli (eds.) (2022) Learning from Action: Working with the Non-Verbal. London: Karnac.
Much later than that first book, this is a set of contributions from people attending a series of conferences run according the group relations form experiential learning. It was set up with a colleague in Italy and ran every tear or two for a long weekend to study non-verbal communication in the institution of the conference. It was for people working in mental health to begin to understand the way communications are acted (or acted-out). It was based on the proposition that enactments are much more common as form of expression and communication than are language and symbolic communication amongst the mental disturbed and therefore in the institutions and services that attempt to care for them.
JOURNAL ARTICLES
R.D. Hinshelwood (1972) A community treatment model. Bulletin of the Association of Therapeutic Communities No 6
This was a sort of manifest,o originally for discussion by staff in the Therapeutic Community I was part of at the time. It was basically a set of bullet points that characterised what a therapeutic community is, including the attempt to include all persons as part of a mutually respecting community. It was an attempt to put those principles into psychoanalytic terms, but especially in the terms used to apply psychoanalysis to organisations. It relied heavily on Elliott Jaques.
R.D. Hinshelwood and Sheena Grunberg (1975) The large group syndrome. Group-Analysis 8: 99-101. Republished in R D Hinshelwood and Nick Manning (eds) 1979 Therapeutic Communities: Reflections and Progress (London: Routledge and Kegan Paul) p. 245-248.
In these early days, the method of group therapy was also being developed from Northfield Hospital, and known as Group analysis. In the 1970s, there was a lot of interest in therapeutic work in large groups – maybe more then say, 30 people. Issues of inclusion, exclusion and identity become important and often painful for the individuals. This was relevant to the large community meetings of a therapeutic community, even if its task was not purely therapy but included community work
R.D. Hinshelwood (1982) Two community time scales. International Journal of Therapeutic Communities 3: 3-6.
Living in a therapeutic community involves daily experiences of of ork and relationships from which longer-term learning can develop. The long-term outcomes have some important connections with the day to day experiences. The daily attempts to cope and find relieve can however conflict with and exist in tension with the overall learning and insight intended in the outcome.
R.D. Hinshelwood (1982) Complaints about the community meeting. International Journal of Therapeutic Communities 3: 88-94.
The experience of large community meetings is often painful for members who will complain about having to attend. It is important to recognise that so much of what someone in a therapeutic community needs to express about their experience of themselves cannot, yet, be put into words. Instead enactments and complaints about compulsory attendance area form of communication about the in ability to use only words.
R.D. Hinshelwood (1989) The therapeutic community in a changing social and cultural environment. International Journal of Therapeutic Communities 10:63-69. Republished in the Italian online journal, Psychomedia. https://www.psychomedia.it/pm/thercomm/tcmh/hinshel.htm
The community spirit fostered in and after the Second World War was ideal for the development of therapeutic communities focused on the individual in his social context of others. However later at a time when I became involved, the historical transition to a more individualised consumerism had developed, leaving the therapeutic community somewhat isolated and alien within society and within psychiatric provision.
R.D. Hinshelwood (1992) Psycho-analysis and the therapeutic community: comments on Maxwell Jones. International Journal of Therapeutic Communities 12: 109-115.
Maxwell Jones was a significant figure in the development of therapeutic communities having conducted his own experiments in wartime at the Mill Hill Hospital. He had a brief analysis with Melanie Klein but turned quickly to more social measures, the influence of the culture of the treatment unit, and its context in wider society. The relation between therapeutic communities and psychoanalysis has been very varied, exemplified by Maxwell Jones hesitation over his own analysis..
R.D. Hinshelwood (1996) Communities and their health. Therapeutic Communities 17: 173-182.
This is a summary of the main features, conscious and unconscious, of the culture and working of a Therapeutic Community. It covers especially how the stress of the patients and the tensions of the staff can divert the community from the goals it aims for.
Enrico Pedriali, R.D. Hinshelwood and Louisa Brunner (2010) Action as a vehicle of learning. Organisational and Social Dynamics 10: 22-39.
Growiing out of the work with therapeutic communities, I visited several Italian units, including Il Porto. I also met Enrico Pedriali with whom I developed the Learning from Action workshops (see the book with Luca Mingarelli, 2022) which have run for 20 years despite Enrico dying suddenly in 2012). The aim was experiential learning opportunity for ths working in communities and services where communication in words failed with pre-verbal experiences and were enacted instead.
R.D. Hinshelwood (2011) Manual or matrix: How can we know our outcomes? Therapeutic Communities 31: 328-337.
With the increasingly managerial approaches in health care organisations, there has been the pressure to reduce therapeutic community principles to protocols )or manuals for performance. This reduces the personal learning of community members, staff as well as those they care for. The attitude to mistakes, tensions, conflicts and enactments had been slowly changing to judgements of performance and ultimately of spreadsheet analysis. Evaluating learning from the individual-community relationship slips between two demands; one for a measurable outcome ‘quantities’, and the other the felt capacity to exist within social matrix of others. Protocols or manuals pervaded by ‘should’ distract from an individual’s initiative to social ‘be’
R.D. Hinshelwood (2020) Leading from below? Decisions, responsibility and creativity as a group dynamic. International Journal of Therapeutic Communities 41: 47-55.
The observance of protocols has been a compelling pressure, partly at least, because it removes responsibility for professional thinking which can instead be directed by the protocols. One of the principles most compromised was that community members take responsibility for their own experiences and actions. They accept their thoughts and actions derive from themselves, and the way the community develops is in part the interactive product of all member, cared-for and carers.
R.D. Hinshelwood and Gary Winship (2022) Interview with RD Hinshelwood. Therapeutic Communities: The International Journal of Therapeutic Communities 43: 154-162. https://doi.org/10.1108/TC-07-2022-0010
The then Editor of the Journal interviewed interviewed me some 40 years after my first involvement with therapeutic communities. We covered my experiences, convictions and hopes as well as my devotion to communities as the natural human context.
CHAPTERS IN EDITED BOOKS
R.D. Hinshelwood (1979) Community as analyst. In R.D. Hinshelwood and Nick Manning (eds) Therapeutic Communities: Reflections and Progress (London: Routledge and Kegan Paul) pp. 103-112.
This is an early account of the way in which a therapeutic community might work therapeutically with its members. The community allows expression of unverbalizable experiences which cannot yet be thought. These expressions occur through the acted relations with the community and its other members.
R.D. Hinshelwood and Anna Christian (1979) Work groups. In R.D. Hinshelwood and Nick Manning (eds) 1979 Therapeutic Communities: Reflections and Progress (London: Routledge and Kegan Paul) pp. 173-180.
Part of life in a therapeutic community is th ordinary activities needed, cooking, cleaning, leisure activity. These activities allow expression of unconscious dynamics conflicts and difficulties, as well as keeping the life of the community going. With a senior experience occupational therapist,, Anna Christian, we attempted to log these kinds of events, their meaning and use.
R.D. Hinshelwood (1979) Supervision as an exchange system. In R.D. Hinshelwood and Nick Manning (eds) 1979 Therapeutic Communities: Reflections and Progress (London: Routledge and Kegan Paul) pp. 208-219.
The therapeutic community is a social configuration aimed at achieving individual change through insight into individual relationships in the community; it is psychosocial. It seemed, with Nick Manning’s encouragement to consider the social dynamics in sociological terms. That means there is a system involving the individual community member and the member of staff who attempts to understand and put into words the unspoken actions and communications.
R.D. Hinshelwood (1986) Britain and the psycho-analytic tradition in therapeutic communities. In James Zeigenfuss and George de Leon (eds) Therapeutic Communities and the Rehabilitation of Drug Abusers (Springfield: Thomas) pp. 43-53.
It became apparent to me through contacts with the authors of this book that in the USA, therapeutic communities are approached more as social systems, while in Britain the approach arises from the psychoanalytic understanding of the internal dynamics of the individual which require the community member to make some changes in how he manages his conflicts and anxieties. This invitation was an opportunity to reflect on how the psychoanalytic approach can contribute to the psychosocial situations in the community
R.D. Hinshelwood (2018) Psychoanalysis, social psychology and the therapeutic community. In Pereira, J., Goncalves, J. and Bizzari, V. (eds.) The Neurobiology-Psychotherapy-Pharmacology Intervention Triangle. Wilmington: Vernon Press.
This is a wide-ranging set of chapters from various perspectives on mental health interventions from many Portuguese and British authors. The multiple perspectives from which the therapeutic community can be approached make for a complex interaction with various influences over the course of its history. I attempted a review of this history and the stubborn need to keep in view the unconscious dynamics of groups as well as individuals
The Marlborough Day Hospital
JOURNAL ARTICLES
R.D. Hinshelwood (1980) Seeds of disaster. International Journal of Therapeutic Communities 1: 181-188.
I started work at the Marlborough Day Hospital in April 1969 a short whie after th founder Joshua Bierer had retired. There was a group of people left hanging without him. I joined with two others, Sheena Grunberg and Roger Hobdell, to form group with the intention of applying therapeutic community principles to people attending on a five-days-a-week basis. I left for personal reasons in November 1976, shortly after qualifying as a psychoanalyst. Concurrently, Hobdell qualified as an analytic psychologist (Jungian) and Grinberg moved to the Tavistock clinic. A little later the work there collapsed and this paper explores some of the social and individual dynamics that were involved. In particular, it examines a move from more communal decision making to top-down decisions.
R.D. Hinshelwood (1994) Integrity of the person and the day hospital: evidence from a therapeutic community. International Journal of Therapeutic Communities 15: 29-38.
This is one of many attempts to capture the systemic interactions between individuals and their social context. Individuality and its free-will does not mix with a social determinism of character and behaviour. Yet we all live our lives balanced on that threshold of individual freedom and social conformity. The thinking was based on the experiences and reflections from the time I spent involved with others in developing the therapeutic community at the Marlborough Day Hospital.
CHAPTER IN EDITED BOOKS
R.D. Hinshelwood and Angela Foster (1978) The Marlborough experiment: a short-term treatment programme for students’ summer vacation. In M.L.J. Abercrombie (ed) Students in Need (Guildford).
During the summer period, students have a three-month vacation. For many both the transition to academic study and the prolonged deprivation of colleagueship at university brings out unconscious stresses that many seek help for. Three months is a short period to make significant inner changes but we chose to consider if a full-time membership of a therapeutic community would speed the process. One the whole the experiment was positive in setting students off for their next study year with new insights and better understanding of how to struggle with their difficulties.
The Cassel Hospital
JOURNAL ARTICLES
Norton, Kingsley and Hinshelwood R.D. (1996) Severe personality disorder: treatment issues and selection for in-patient psychotherapy. British Journal of Psychiatry 168: 723-731. Republished 2009, in Adshead, Gwen and Jacob, Caroline Personality Disorder: The Definitive Reader. London: Jessica Kingsley Publications.
In 1993, I went to the Cassel Hopsital as clinical Director. I was stepping int the shoes of Tom Main one of the inspirational figures in the experiments at Northfield Hospital in wartime. He revamped the Cassel Hospital in 1946 as the first attempt at a public service therapeutic community, but had to retire in 1976 (retirement age then was 65). He became a psychoanalyst. This history was concurrent with the competing development of the Henderson Hospital based somewhat differently on group analytic lines. Th paper was a joint one with Kingsley Norton, at Director of the Henderson Hospital. So the paper compared the two slightly diverging approaches, one from individual psychoanalysis, and one from the group analytic social angle.
R.D. Hinshelwood (1998) Psychotherapy in an inpatient setting. Current Opinion in Psychiatry 1: 304-308.
The Cassel Hospital programme included an enlighted for of ‘social nursing in which the nurse ‘worked alongside’ the community member on daily tasks, and at the same time each member had their own twice-a-week individual psychotherapy sessions. This new Journal invited my account of this method of providing psychotherapy with a scrupulous attention to the context of the community I which it was taking place.
R.D. Hinshelwood and Santos, Angel (1998) The use at the Cassel of the organisational dynamics to enhance the therapeutic work. Therapeutic Communities 19: 29-39.
This paper, written jointly with one of the psychotherapists, Angel Santos, used a specific case to show how the context of the community allowed the patient member of the community to use unconscious splitting mechanisms in the context of the community. The private moments (psychotherapy sessions) were contrasted with the public space of the community as a transference of his phantasies about the conflicts and distance between his parents.
CHAPTERS IN EDITED BOOKS
R.D. Hinshelwood and Peter Griffiths(1998) Hall of mirrors. In [2001] Cassel Monograph No 2 Peter Griffiths and Pam Pringle (eds). London: Karnac.
During my time as Director, Peter Griffiths head of the nurse training course instituted with a colleague a series of Cassel Monographs. I was pleased to support this by writing the paper for one of the monographs. The aim of this paper was to convey the introspective mirroring of an individual in his own self-wareness and his roles and behaviours in the community setting.
R.D. Hinshelwood (1999) Psychoanalysis and therapeutic communities: The Cassel heritage and the culture of enquiry, in Penny Campling and Rex Haigh (eds) Therapeutic Communities: Past, Present and Future. (London: Jessica Kingsley).
Central to the culture of the Cassel Hospital was a culture that promoted enquiry, whether that was personal introspection or whether it was any of the social groupings that worked during the at all levels of the community including the staff meetings. This chapter was a description of the Cassel work in a volume intended to be a comprehensive survey of the therapeutic community approach in Britain at the time
R.D. Hinshelwood (1999) Psychoanalytic origins and today’s work: The Cassel heritage. In Campling, Penelope and High, Rex (eds) Therapeutic Communities: Past, Present and Future. London: Jessica Kingsley.
This chapter, like the preceding one, attempts a definitive overview of the place of psychoanalysis as background thinking for therapeutic communities from their origin in the 1940s. It would be somewhat isolated as, by this time, for various reasons practical, financia and ideological the more social perspective arising from group analysis had grown more to the fore.