#democratic representation

Dr. Abrahams who works with us here in the Hall is someone to whom we are all very grateful for helping us solve our problems and finding out what brought us here. . . . Let us all pull together, and take our place in society together.

Others were less sure of the value of group therapy:

They [groups] are interesting, from the stand-point of applied therapeutics, but do they accomplish anything? . . . The main difficulty, as seen by Your Reporter, thus far, is that the Group seems to wander—they digress—and nothing seems to be done to correct this situation. Why?

And some were more directly critical:

Yet I was hostile to group therapy at first. It seemed to me a cut-rate modification of individual psychotherapy, an ersatz, prostituted, watered down system evolved out of necessity, embellished with a new name, and a few flourishes of theory to make it appear respectable.

Ward staff was another matter; nurses and attendants were more uniformly reticent to accept the changes. Once quiet wards were now more lively; one began to hear the “more normal sounds” of conversation on the wards. Some of the attendants, moreover, feared that leniency would lead to difficulties in maintaining control and might even provoke rioting. The facts that rioting did not happen, and that ward staff were either moved out of the hall or retrained in group psychotherapy, helped overcome, or at least contain, that friction.

Once assembled as a group, the Black patients would use the session to discuss problems on the ward—privileges, visiting hours, food preparation—in addition to their psychiatric maladies. One of the first patient requests was to the Red Cross for reading material and for opportunities for recreation. When these requests were granted, patients in the white wards took note and asked for group therapy in their section of Howard Hall.

Where in early 1946 there were virtually no therapeutic activities, now, by early 1947, the hall became host to recreational therapy, occupational therapy, and psychodrama, along with a variety of others. Patients noticed the change. One, for example, commented that

many old time patients of Howard Hall are saying that the Hall is a much better place to live in than it was a few years ago. Many improvements have been noticed in the last year [1947] or so.

...

The role of the psychiatrist in group sessions was to prevent epistemic closure. The consensus reality of the group included the psychiatrist, who stood in for an outside vision of reality. The physician’s presence in the group stood in for a reality that was authoritative but not definitive; his perspective was included in the deliberative process but didn’t determine the outcome. In this vision of community, the ambition of guardianship was to ensure the translatability of group decisions to both the hospital (administrators, psychiatrists, other patients) and, in principle, the wider (sane) public. The ambition was to make both madness and wider hospital needs and interests mutually recognizable—to turn private claims into appreciably public ones.

This kind of consensus building is a twist on the traditional image of able-minded dialogue partners that underpins most visions of collective deliberation. In Howard Hall, we have a vision of reason, of deliberation, without a traditional reasoner. Rationality (at least in theory) was an emergent property of patients working in concert, and deliberation was put in service of a shared, world-building project."

This post is a response to a question posed in its complete format: “Which type of party system is best for a country, one party system, two party system or multiple party system?” The more parties, the more broad the representation of the people. The more parties, the less polarized the people are by ideology. The more parties, the less gridlock on issues preventing progress on their…

"The mad are often taken to be irrational, dangerous, or even otherworldly; objects of pity, care, or concern, but not, in most accounts, the proper subjects of democratic institutions. But the reality of asylum life suggests a more complex picture. Patients can be sophisticated participants in the institutions tasked with their confinement and care.

The basic architecture of legal rights for patients committed to mental hospitals that we know today didn’t emerge until the 1960s and 1970s. Before that time, patients had little recourse to the courts to address intolerable hospital conditions or to protect their due process rights. For those found incompetent to stand trial, like many of the residents of Howard Hall described later, the situation was particularly bleak; even if patients were judged to be of sound mind, they would immediately face a criminal trial or plea deal, then be shuttled off to prison. Despite the inability to make a cognizable legal claim, and despite significant collective action problems—the ubiquitous potential for ward conflict, staff and patient predation, various and sundry illnesses—patients could, and did, collectively advocate for better ward conditions. How did “the mutterers, the masturbators, and the paranoid” of Howard Hall accomplish such a feat?

To become participants in the hospital order, patients required mechanisms to test reality, resolve conflict, and represent their interests. [There were] two sets of institutions that patients and staff devised for this purpose. The first set was an outgrowth of group psychotherapy. An early psychoanalytic experiment made possible the forms of collective action that later gave rise to patient administrative groups (PAGs) and a wider patient federation in the hospital. The second set concerns the place of PAGs in the wider organizational politics of the hospital. The struggle for representation provoked backlash. As wards challenged the authority of their custodians, their efforts were met with repression—not repression in the overt form of a Nurse Ratched, but with more subtle shifts in procedure and organization. Staff made strategic use of the traditional hallmarks of democratic governance—election, representation, deliberation, and constitution making—to contain and control wards."