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Most people remember their first day spent in a Therapeutic Community (TC): the upset, the overt conflict, the uncertainty about whether someone is a member of staff or a patient, the visibility of psychological disturbance in the scarred arms and strangle-marked necks, the terror of speaking up in the large group for the first time. I remember the daunting sense that I was being weighed up as the new doctor, together with the realisation that I would have to earn the members’ respect as a person and just another member of the group, and that there was precious little in my medical or psychiatric training that I could use to impress them or hide behind. But for me, beneath the stirring anxiety and excitement was a strong sense of calm and resonance, a sense of coming home, a sense of finding (at last) a place in psychiatry where I could be authentic, use my creativity and be the sort of doctor that I was meant to be.
What a tumultuous roller coaster of an experience it turned out to be! A living-learning experience that saw me through highs and lows, quite literally taking me to the edges of madness. And there was no road map of the sort that is provided by Steve Pearce and Rex Haigh in this invaluable book.
There was a sizable literature, including some very interesting academic theory and some extraordinary, honest and exposing personal accounts by staff – often of things going badly wrong. Those were the days when we were not only allowed to make mistakes, but write about them. It was the era of ‘watch one, do one, teach one’. (For younger readers, it is indeed true that medical students, after watching one, were encouraged to actually perform the second appendectomy.) Stuff happened and we muddled through as best we could; entrusted to act on our own initiative and for the most part conscientious and benign in our influence. But even by these standards, starting work in a TC was like being parachuted into an exciting but dangerous country, without knowing a word o