Abstract

The institution tends to organise the individual in standard ways. And individuals are vulnerable to being organised for the convenience of the institution. Probably psychiatric patients needing hospitalisation are especially vulnerable to this coercive influence.
This has for long been known as a ‘top-down’ authority. A smallish group or single leader at the top of the organisation’s hierarchy makes decisions for those lower down to follow. For 50 years or so from the 1940s, there was, in Western society, an attempt to reverse this structure with what is called ‘bottom-up’ authority. The therapeutic community was one such experiment, being it aimed at a different approach. Instead of the simplistic abolition of psychiatric institutions, it seemed worth experimenting with different kinds of structures, and cultures.

The TC appears today to have lost some of its clear vision of its origins and the impetus that drove those origins. This is a persisting risk. We are of course not helped by the ambient culture that prioritises top-down authority.  But nevertheless we must remember that the origins were in fact in the strongly top-down system of discipline in an army at war. We need leaders that restlessly enable new thought – especially about the old ways of practising.

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