Maxwell Jones pioneered techniques of great value in the treatment of those with mental illness or under stress. The main thrust of his work was as an innovator of therapeutic community techniques, but he extended his vision of change to community psychiatry and to education.
Jones’s early work was as part of the Maudsley Hospital team working in the Effort Syndrome Unit, which investigated the relationship between chest pains and stress in military personnel during the Second World War. Later his work was extended to the treatment of ex-prisoners of war at the Belmont Hospital, Sutton, and then into the setting up there of the Henderson Unit for those with psychopathic disorders.
The essence of this work involved his harnessing the forces within the peer group of those requiring help to produce emotional learning and behavioural change. Community meetings of patients and staff were used to work with those who, because of their emotional distress, their poor interpersonal relationships, their illness, were incapable of functioning effectively. Each was helped to become more aware of the thinking and feelings of others and more aware of the effect of their own contribution. Patterns of malfunctioning were identified with help towards change.
Jones continued his therapeutic community work in the United States as Visiting Professor at Stanford University, where he received the Isaac Ray Award of the American Psychiatric Association.
He returned to the UK as Physician Superintendent at Dingleton Hospital, Melrose, a psychiatric hospital dealing with the needs of the Scottish Borders population. Here he extended his work from the needs of specific smaller client groups to the treatment, management and change in a total psychiatric service. Therapeutic community principles were used to introduce change in a chronic as well as a more acutely ill population. They were also used to affect the whole administration structure of an institution so that those within it could participate in the better management of the institution and mental health service. Jones used living-learning situations to produce change (well described in his Painful Communication, published from Dingleton).
A further step which he initiated with his colleagues was the setting up of multidisciplinary Community Psychiatric Teams. A service where the traditional emphasis on in-patient treatment predominated was changed so that teams responded to the client needs in the community with both assessment and on-going treatment. Active dialogues were set up with families and other helping agencies such as general practitioners and social workers. The technique of learning from crises in the institution was extended into the community and a model of social psychiatry developed.
Change in an institution or service is never easy. Over the short span of seven years, Max Jones transformed a psychiatric service, using his communication techniques, his charisma and style. More than most leaders he was able to combine a vision and inspirational power with an ability to foster open two-way communication and to engage the potential of others. A highly effective communicator, the changes that he achieved were based not on this alone, but on many hours of hard work and a great respect for and engagement in efficient management.
This perception of his work is from the UK side of the Atlantic. In 1969 he returned to Fort Logan, then to the Virgin Isles, then to Halifax, Nova Scotia. While in these settings he extended his ideas into other areas such as education and old age, remaining active and taking on a variety of consultative roles.
It is perhaps noteworthy that the system he created has withstood the test of time, both by its continuation and development at Dingleton and by its gradual assimilation into the mainstream of psychiatry. Techniques that were perceived in some circles as worryingly unusual, are more and more being seen as both clinically and administratively desirable. This is especially so in the need for an effective model of community psychiatry and in the use of peer group techniques for monitoring service quality. These are both themes of vital importance in the delivery of mental health care.
Five years ago, writes Professor Terence Morris, when “Max” (as he was always known) was briefly back in England, Joy Tuxford arranged a reunion with a number of us who had worked in various capacities with him at what was originally known as the Social Rehabilitation Unit at Belmont Hospital.
After we had all exchanged our news – in some cases that of 30 years or more – we found ourselves sitting round in a group once more with Max as our leader encouraging us to talk about the problems we were facing in our contemporary work. It was like taking a step backwards in time: his charisma undiminished, he relentlessly pursued every contribution with the kind of eagerness that had characterised the morning staff meetings at Belmont when we assembled in his office with our mugs of coffee to discuss the events of the previous 24 hours.
What was extraordinary about Max was not probably related to his being a good doctor; he was one of those visionary innovators who, if they do not change the world, nevertheless manage to leave a massive mark on some part of it. He did not just develop his own brand of social psychiatry, important though that was, but he bridged the gulf between psychiatry and the penal system in ways that have left a lasting mark upon the whole edifice of the social control of deviant behaviour that attracts the attention of the law.
Thirty years ago, disturbed prisoners were still held pinioned in canvas suits although the new tranquillising drugs were just beginning to make a mark in mental hospitals. But the nurses in those hospitals were still trained in the Nightingale tradition and went about dressed like nuns. Max changed all that at Belmont with his policy of recruiting young Scandinavian and Dutch girls with backgrounds in sociology and social work who, though technically nurses, were always known as social therapists – “theraps” – for short.
Orthodox psychiatry was scandalised by the abandonment not only of nursing uniform but of the doctor’s white coat. “We don’t normally draw our patients’ blood, so we don’t need protective clothing,” Max was once heard to remark to a visitor troubled by all this. In that dreary old workhouse built in 1853, the grass growing through the paving joints in its deserted airing yard, he created one of the most successful of therapeutic communities; the daily meeting of staff and patients in which the behaviour of none was exempt from scrutiny had echoes of the healing examination of conscience and reconciliation of the monastic tradition, while the weekly psychodrama enabled patients to act out the experiences and emotions that had been so often the source of the inner torment that lay behind their socially unacceptable behaviour.
Max was an evangelist who was appalled at the inability of the penal system to treat those whose criminality was, whatever the sentencing judges and magistrates might think, something which stemmed from a disorder of personality. When it opened in the early 1960s – although it had been recommended by the East-Hubert Report as long ago as 1938 – the psychiatric prison at Grendon Underwood was able to draw directly from and build upon Max’s work at Belmont as have many other places and practitioners since.
He believed in there being “another way”, even with the most refractory. I recall one morning a sadly sullen young Borstal girl arriving on transfer from Holloway with a stern escort of two prison officers. Within minutes she had a tantrum and tried to push over a cupboard, but the noise she made was nothing to her subsequent silent amazement when she learned that she was not going to be shut away in a cell but only asked, by her fellow-patients, to explain herself and to say what was troubling her.
One will cherish many images of this man: his care for his staff and patients, his boyish delight in the company of pretty girls, whom he loved to transport in his white Ford Zephyr convertible, his dignified courage in the face of professional hostility and, now and again, local political abuse, but above all his lifelong commitment to treating those whom society had often literally “ cast out”.