Social fields,battle fields and Northfield: The legacy of the ‘Northfield Experiments’

Introduction

If Bion, Foulkes, (Bridger) and Main had created a feast of new ideas at Northfield, it was Jones that sat down and produced a recipe that others could follow. (Kennard and Roberts, 1983: 5) ¹

The psycho-social treatments employed during the ‘Northfield Experiments’ are legendary. They are widely referred to both in the professional press as well as in literary works ² . However despite this fame there has been little attention paid to how they actually impacted on subsequent psychiatric practice (Harrison, 2000) ³ . This article aims to begin to address this by tracing a few threads of the complex weave of ideas and practice that were developed there and which subsequently influenced the therapeutic community movement in the United Kingdom. The aim is to set the scene for subsequent papers by Bob Hinshelwood, Diana Menzies and Dieter Nitzgen which expand on this preliminary survey (Hinshelwood, 2018; Menzies, 2018; Nitzgen, 2018).

Before identifying some of the ‘feast of ideas’ that found their way into British therapeutic community movement it is necessary to briefly describe the task that faced the staff at Northfield Military Hospital. After outlining a number of innovations some of the ways in which they were incorporated into post-war practice are then delineated. Finally the work of Harold Bridger will be referred to as representing one perspective, amongst others, on therapeutic community practice which has been overlooked in the United Kingdom.

Northfield Military Hospital

To understand the work of the staff at Northfield Military Hospital it has to be remembered that for those who were part of the ‘Invisible College’ it was a minor part of their activities throughout the British Army (Ahrenfeldt, 1958; Shephard, 2000). This phrase was applied to members who were either members of the Tavistock Clinic, or who became attached to it after the war. Of those who worked at Northfield It included Harold Bridger, Tom Main, Wilfred Bion and John Rickman. Significantly their commanding officer Ronald Hargreaves was also part of this coterie. The work that they were involved in outside of the hospital included the War Office Selection Boards that identified men suitable to be promoted to being officers, military training, the management of morale, broader issues of psychiatry throughout the army and the Civilian Resettlement Units which were used to rehabilitate returning prisoners of war from Germany and the Far East (Ahrenfeldt, 1958; Shephard, 2000: 188–195). It has to be said that the Tavistock group were not always easily understood by their colleagues. Dr Charles Lewsen recalled that Bion and Rickman were seen as being rather insular and arrogant to the other doctors (Lewsen, 1993). They could even be somewhat opaque to each other. Jock Sutherland recalled how he and John Rickman were not entirely on Bion’s wave-length in a ‘trial study group’ (Sutherland, 1985: 52) and Eric Trist was ‘completely at sea’ in an early psychotherapy group that Bion conducted in the late 1940s (Trist, 1985: 31).

This contrasts with others working there such as S.H. Foulkes and Joshua Bierer for whom doing therapy was the primary task. Reading the former’s articles it is evident that he, along with many other psychiatrists, saw the war as an inconvenient interruption to his study of group therapy. Indeed he was observed by two of his colleagues to open a session by stating ‘I want you to look on me as you would the doctor in a white coat and not as someone in uniform’ (Bridger, 1982: 240).

The arguments between these two points of view at Northfield were heated. Ronald Markillie recalled that relationships were ‘racked with personal conflicts and rivalries of intensely well-meaning psychiatrists and psychotherapists’ (Markillie 1990: 6). As an example Tom Main in a letter to John Rickman described Foulkes as a cult leader with his disciples and asked ‘whether Christ was as phony as he seemed’ (Main 1945). He expanded on this theme some 40 years later in an interview with this author: ‘They wanted to go on treating people, but it was inappropriate in a time of war. They wanted to pursue this selfish interest of theirs when there were bloody great issues to be resolved’ (Main, 1984).

Task and practice at Northfield

It is important to recognize who were being treated. The soldiers were young men, many were teenagers, who had either found the exigencies of military life obnoxious, or overwhelming, or who had been over-exposed to the violence of the battle field. They were ordinary conscripts, a number of whom had won medals for bravery including the Victoria and Military Crosses, who had been pushed beyond the limits of their endurance. The task at Northfield was, as Wilfred Bion put it, ‘to produce self-respecting men socially adjusted to the community and therefore willing to accept its responsibilities whether in peace or war’ (Bion and Rickman, 1943: 678). This demand appears to contradict the wishes of therapists to care for and protect their charges and resolving this dilemma was an essential part of work of the hospital staff. It placed the military requirement to maximise effective manpower over and above the longer term health of its personnel. The needs of the individual were subjected to the necessities of the group ³ .

The hospital was a military enterprise. Uniforms and military discipline were obligatory. It acted as a sorting station as much as a brief therapy centre. The task was to re-engage as many as possible of the soldiers in useful work in the British Army, which almost certainly never involved returning them to the battle front. All psychiatrists joining the army had to recognize that their ‘preoccupation with the needs of the individual has to be modified . . . Time and military needs are pressing’ (Lewis, 1940: 399).

The later experiments were not carried out in an entirely uncomprehending or hostile environment. Group work was actively encouraged by senior officers within the British Army, particularly Ronald Hargreaves, and the lessons learnt were applied in the Civil Resettlement Units that offered rehabilitation to thousands of returning prisoners of war.

The army is a group enterprise. Each unit relies on the ability of those in it to work with each other, particularly in conditions of extreme stress. The use of groups was not merely a means of treating people economically, but an active process enabling the soldiers to gain transferrable skills in working together and regaining the self-respect that went with this.

The emphasis was on what the soldiers themselves could do to help themselves and each other and to gain insight into their interactions. A typical enterprise was the organizing of a welcoming committee of more experienced patients to introduce new arrivals to the hospital. This resulted in an introductory pamphlet called Introducing You to Northfield, by a patient. Other activities included creating theatre scenery and lighting and playing in the band (Foulkes, 1964: 191).

Innovations at Northfield

Whilst many of the activities at the hospital were entirely innovatory others applied previously considered concepts on a broader scale. At the heart of the Experiments was a shift in relationships between those receiving treatment and those offering it. Tom Main in particular emphasized the move from the patients being treated as the ‘passive children’ of the psychiatrist, ‘obedient in nursery like activities’ to being active participants in creating the milieu in which they were living with ‘sincere adult roles to play’ (Main, 1946: 67). John Rickman, echoed by Foulkes, emphasized the sense of ownership that this entails when he described how the soldiers always referred to the ward as ‘our ward’. (Bion and Rickman, 1943: 680; Foulkes, 1946: 86). Bridger explained that ‘the individual can only experience full freedom and satisfaction in a society that recognizes his worth, and gives him the opportunity to develop in a spirit of warm human relationships’ (Bridger, 1946: 86). To enable this he instructed his staff not to continue training men in particular skills, but to watch for, and respond to, initiatives that they themselves came up with (Bridger 1984: 65).

In order to effect this staff had to be encouraged to be equally open and understand the processes. As Bridger described the process at Northfield: ‘the therapeutic task now involved far greater inter-disciplinary practice of all kinds’ (Bridger, 1982: 246). Their traditional role of ‘looking after the sick’ had to evolve into one that jointly enabled the patients to take the initiative (Bridger, 1984: 67). Bridger, Rickman and Bion all worked in the War Office Selection Boards where they formed multidisciplinary teams with psychologists and regular army officers of different ranks. The outcome at Northfield was that, from having had distinct and separate tasks, the staff began to collaborate between ‘professional therapeutic staff and social practitioners’ (Bridger, 1984: 67). This idea of the multi-disciplinary team, with all members contributing their opinions equally, would appear to be innovatory and whilst central to the way that therapeutic communities operate it has taken a lot longer to penetrate traditional psychiatric practice.

A significant outcome of the Northfield Experiments was the importance of leading a group by appearing not to do so. Bion and Rickman allowed the group to develop in silence without introductions by the group leader ⁵ . Rickman had experience of Quaker meetings that both acted as a precedent and experience in taking this approach. He had previously written an article on this practice describing how the meeting would wait in silence ‘until the spirit moved’ (Rickman, 2003). Bion himself would have been aware of this practice through his friendship with a Quaker in the First World War and through his relationship with Rickman himself (Bion, 1982: 112, 116).

The second fundamental development by Bion and Rickman was the study of the ‘here and now’ interactions and relationships between the group members, rather than focussing on psycho-historical issues ⁶ . Bridger distinguishes between this and Foulkes’ approach in which the ‘individual could be observed and reflected upon by the others. It was a setting rather than having a dynamic life of its own’ (Bridger, 1982: 240).

Peer group discussions between the psychiatrists on how groups operated were also novel. These were held on a weekly basis for nearly a year and were an opportunity for all the doctors to openly discuss the dilemmas they were experiencing in running groups (Anon, 1945). Rank gave way to experience in group psychotherapy.

Social reform in psychiatric practice after the Second World War

After the war it appears that the development of adult therapeutic communities in the 1950s and early 1960s occurred with little reference to the Northfield Experiments. Maxwell Jones famously never mentioned them, although he privately acknowledged a debt (Bridger, 1985: 100). Denis Martin (Martin, 1962: viii) at Claybury refers equally to Maxwell Jones and the Northfield Experiments and discussions he has had with a wide variety of people. Dr Stuart Whiteley (Whiteley, 1996: 132), the director of the Henderson Clinic after Maxwell Jones left, recalled going to a lecture given by Tom Main at Warlingham Hospital in the early 1960s. Almost certainly this was how the influence spread at this time through word of mouth rather than publications. With the early development of therapeutic communities in the 1950s and 1960s the protagonists were aware of each other and met during conferences, but largely went their own way, developing their work on an ad hoc basis.

David Clark (Clark, 1964: 28) at Fulbourn whilst mentioning Foulkes’ book and the articles by Bion refers to Maxwell Jones as being ‘one of the most significant figures’ during this period. In his history of Fulbourn (Clark, 1996) there is a real sense of ‘feeling his way’ and it was actually one of his junior doctors who initiated the first TC on a ward in 1958. In reviewing this Clark recalled conversations with Maxwell Jones a year earlier, and his visit to Belmont Hospital (Clark, 1996: 165–166). There is no reference to the Northfield Experiments. This sense of making it up as they went along is reflected in many of the stories and articles written about the early development of adult therapeutic communities in the 1950s. The full recognition of the work at the Northfield Experiments was possibly more a consequence of pioneers reflecting back on their achievements and giving weight to the papers that they authored later.

At the Ingrebourne Centre, Richard Crocket was in contact with his friend Jock Sutherland, a psycho-analyst and psychiatrist and leader of the Tavistock clinic who knew Bion, Bridger and Rickman well. Crocket was however a little uncertain what the latter was trying to tell him. His diary records in 1954 ‘Today had an interesting talk with J.D.S. He tends to be diffuse’ (Crocket, 1954). He appeared to have taken some note of the concept of intra-group tensions when speaking on the practice in his unit in 1959 (Crocket, 1959: 9), but this is an afterthought secondary to his acknowledgement of Maxwell Jones from whom he took a great deal of the fundamental philosophy.

This lack of recognition of Northfield is not surprising. Of the principles actors only Tom Main stayed in the therapeutic community field and wrote a few articles most notably The Ailment (Main, 1989) which he presented at the Medical Psychology section of the Royal Society of Medicine in 1957. Richard Crocket emphasized that this article drove his argument for openness and communication at the Ingebourne Centre (Crocket, 1959: 13–14).

Maxwell Jones and Sigmund Foulkes on the other hand were clearly more adept at publicizing their approaches. Foulkes (Foulkes, 1948) produced his account of the Northfield Experiments as part of An Introduction to Group-Analytic Therapy in 1948. His colleagues from the Tavistock play very minor roles in his account and indeed Tom Main gets as many mentions as that well known psychotherapist Admiral Lord Nelson! His later book Group Psychotherapy (Foulkes and Anthony, 1957) significantly influenced Dr St. Blaize-Moloney (Blaize-Moloney, 2011) who was instrumental in introducing a psychotherapeutic approach at Ingrebourne. In parallel Foulkes set up the Group Analytic Society in 1952 which was supported by his weekly seminars (Foulkes E, 1990: 16). But perhaps the most important impetus was the founding of the Institute of Group Analysis (IGA) in 1971 (Foulkes E, 1990: 16), which developed a formalized training in group therapy. However his influence immediately post-war was limited partly due to the resistance of the medical profession to psychotherapy and the public scepticism of talking treatments (Jones, 2004: 505).

At the Ingrebourne this became a central training plank. Anyone who wished to be a group therapist was encouraged to train at the IGA from about 1975. This included the nurses and an art therapist who went on to write a book on group analysis and art therapy (McNeilly, 2006). Diana Menzies article also refers to this happening at the Henderson Hospital (Menzies, 2018).

At Northfield Joshua Bierer is remembered as being rather unusual, introducing his wife to his ward where she sang opera to the men (Dewar, 1993). He lays claim (Bierer, 1948: 295; Bierer, 1959: 151) to having set up the first therapeutic community in the UK before the Second World War in which he carried out group therapy. However the apparent democracy of these social clubs is somewhat subverted by his description of covert therapy carried out by him and his assistants (Bierer, 1948: 304; Bierer, 1944: 14). Then in 1946 he went on to found the first day hospital in the UK, later named the Marlborough Day Hospital in 1954 (Farndale, 1961: 289). In the same year he brought Jakob Moreno to London for a Conference which did not go down well with Richard Crocket (Crocket, 1954) who recorded that he went ‘to hear J.L. Moreno—apostle of psychodrama. A dumpy little Viennese American, with plastic features, jerky delivery . . . I did not like him, nor did I like Joshua Bierer, who was too non-committal. A most revealing visit, and most disappointing one’. However later Crocket entered into a correspondence (Crocket: 1958) with Bierer about a scheme where patients spent nights at the hospital in times of crisis which the latter had instigated. Bierer had a much greater influence in other parts of the world than in the UK. In Yugoslavia for instance he was a significant factor in the development of day centres and group therapy through a number of psychiatrists who worked with him in London and then took his ideas back (Savelli, 2018).

A missing influence on British therapeutic community

Harold Bridger was influential in Europe, but had little impact in the United Kingdom therapeutic community work. This was largely due to his working in a consultancy capacity to industry following the Second World War. However in 1984 speaking at a conference of Italian therapeutic communities (Bridger, 1984) he explored the issues arising from maintaining ‘open systems’ in the face of an increasingly complex and intrusive external environment. This article is a significant contribution to conceptualizing the processes that maintain a successful therapeutic community. He reframes the approach as a transitional space-time experience derived from Donald Winnicott’s conception of the transitional object. He views it as an open system which has to find ‘a balance between maintaining an existing state, culture and structure while endeavouring to be creative in fulfilling its purpose, growth and development’. Here participants reflect on both the practical task confronting them and the emotional/unconscious processes that hinder progress in tackling it. This he describes the ‘double task’. At Northfield he viewed this as both dealing with the ‘hospital as a whole’ and its purpose, and working with the local (ward) leadership to develop a ‘readiness to perceive, reflect on and review the way that the group or part was working’ (Bridger, 1984: 64). This was carried out in the manner of a ‘“mini-scientific society” in which a collegiate climate was established to explore common problems and different ways of tackling them’ (Bridger, 1982: 240).

He unravels the spurious opposition of ‘democracy’ and hierarchy (Bridger, 1984: 56–57). The former is a way of life, whilst the latter is a structural issue. The opposite of democratic is not hierarchy but authoritarianism. Ignoring hierarchy results in confusion. This in turn leads to a consequent failure to address the necessary responsibilities incumbent on running such an organization. The ensuing conflict tends to be seen as ‘a clash of personalities’ rather than stemming from the underlying structural problems.

This failure to address the importance of leadership in running a counter-cultural organization, in a fluctuating and increasingly hostile environment, is a continuing problem in British therapeutic community thinking. The movement continues to rely on exceptional people taking such roles without due consideration being given to the complexity and responsibilities of the task. Bridger offers an alternative viewpoint from which to examine the opportunities the TC provides for reflection and testing that the participants experience as they struggle with the internal and external tensions that are exposed.

He argues that open systems were more appropriate in the rapidly changing modern world. Their strength lie in their ability to balance and optimize the resources from within and without, countered by an increased demand on inter-dependence and the management of complexity, conflict and uncertainty (Bridger, 1982: 246).

Conclusion

The forgoing outlines a few of the strands of intellectual influence that Northfield has exerted on the British adult therapeutic community movement. It is limited in a number of ways. In particular no reference is made to the deep history of young people’s therapeutic communities that have developed over the past century. Their influence is even more nebulous than that of Northfield, but on careful examination some threads can be traced through to those experiments via the Institute for the Study and Treatment of Juvenile Delinquency at the Tavistock Clinic. Both Bion and Dennis Carroll, commanding officer whilst Foulkes was starting his group work, were participants there.

Northfield was a cauldron of ideas bubbling up. The work of Sergeant (later Professor) Laurence Bradbury on Art Therapy and the role of employment placements in therapy are amongst the many that have been ignored here. Perhaps more interesting are the ideas that have subsequently been neglected in the UK. Harold Bridger’s conceptualization has been very briefly summarized, but others deserve further examination. The discussion meetings on group therapy threw up such interesting questions such as that which Tom Main (Anon, 1945: 12th September 1945) asked: ‘If a man is socially well adapted would you dare to say that his neurosis was?’. Wilfred Bion (Bion, 1946: 77) on the other hand examined the nature of leadership and concluded that an essential element was the individuals ‘capacity for maintaining personal relationships in a situation of strain’ where there was the temptation ‘to disregard the interests of his fellows for the sake of his own’. Neither of these concerns has been seriously addressed in the therapeutic community literature as far as this author is aware.

It is difficult to estimate the profound influence of the Northfield Experiments. They clearly contributed to a significant social change in how psychiatry could be practised. They suggested the possibility that therapy could be a community involvement with all participants offering their skills according to their abilities rather than remaining entrenched in the traditional doctor dominated discourse. The consequences of such a shift in power relationships were only beginning to be explored up until the onset of neo-liberal reaction in the late 1970s.