Therapeutic community and recovery: Old and new concepts of radical self-determination

In this paper I will begin by reviewing the history of treatments for psychosis which take place in, and consciously utilize milieu or group settings. There is a rich legacy of recognizing and enhancing the effects of being in... [ view full abstract ]

In this paper I will begin by reviewing the history of treatments for psychosis which take place in, and consciously utilize milieu or group settings. There is a rich legacy of recognizing and enhancing the effects of being in a community of people as an important treatment in itself, going back to at least the World War II era. This has been called therapeutic community or milieu therapy, and was once in such ascendancy that almost every psychiatric hospital unit or day program called itself a therapeutic community regardless of whether the actual principles were really embraced. This is similar to the way the word “recovery” is used so ubiquitously (and often in a much watered-down fashion) in our present climate.

This leads to the second part of the paper - an exploration of how therapeutic community and recovery are fruitful old and new concepts and practices for people with psychosis, involving radical self-determination and a critical learning approach to the communities in which we find ourselves, whether neighborhood or main-stream mental health treatment setting, whether we are “staff” or “patients/consumers/users/participants.” Both concepts question the hierarchical status quo, and posit that health only happens when people are given/take responsibility for their own lives.