Maxwell Jones, one of the greatest therapeutic pioneers of British post-war psychiatry, died on 19 August 1990 in Nova Scotia. He is remembered mostly as the creator of the first and most famous ‘therapeutic community’ the Social Rehabilitation Unit at Belmont Hospital, Surrey (now the Henderson Hospital). However, he made many other contributions to the revolutionary changes in British institutional psychiatry in the early days of the
National Health Service, which made British psychiatric hospitals for a brief period an example for all western psychiatry by virtue of their open doors, patient freedom and active rehabilitation.
Maxwell Jones
It was the 1939 war which gave him the opportunity to develop his revolutionary ideas. A research unit was set up at Mill Hill to investigate DAH (‘dis
ordered action of the heart’) which had got many men out of the trenches of World War I and was being diagnosed quite frequently in the conscripts of
World War II. The research (which later gained him a gold medal for his MD thesis) soon established that this was a psychosomatic fear reaction. But it was while talking with the demoralized and anxious conscripts that he first discovered the great power of group discussions to heal anxieties and the fact that many people will accept comments and interpretations from fellow sufferers that they reject when they come from powerful doctors.
He extended these ideas in work with returned prisoners of war at Dartford, when he encouraged these shamed and demoralized men to take responsibility for the running of the unit, as a preliminary to taking responsibility again for their own lives. After the war he began to work for the Ministry of Labour with the emotionally disturbed unemployable (labelled by psychiatrists, then, as ‘psychopaths’).
Thus developed the famous Belmont Unit. At that time the only models for psychiatric institutions were the large regimented, locked-up county asylums with their prison-like regimes administered by uniformed staff, or the small psychiatric units which attempted to mimic general hospital wards with white coats for doctors, starched uniforms for nurses, glittering instruments and surgical cleanliness. At Belmont there emerged a different model-a community devoted to exploring emotional and social difficulties and interactions where everyone, staff and patients, dressed alike, looked alike and interacted freely and equally. At the community meeting anyone, but especially the Director – “Max” as he was always called-was open to challenge, criticism and interpretation. It was a revelation to all in those days who were seeking better ways to organize psychiatric institutions. Belmont became a place of pilgrimage for pioneering spirits of all professions in British psychiatry and for social scientists from all over the world. Research, professional books, articles, films and TV programs poured from it. Max was awarded a CBE.
In 1959 Max went to Stanford University, California as Visiting Professor for a year (when the American Psychiatric Association awarded him their prestigious Isaac Ray Award) and then for three years to the State Hospital at Salem, Oregon (where the film ‘One Flew over the Cuckoo’s Nest’ was later made). He started many new projects there but was finally rejected by the political establishment of Oregon State.
In 1963 he came back home to Scotland as Medical Superintendent of Dingleton Hospital, Melrose already famous as the first (1949) Open Door Hospital in Britain. Critics had said that although the therapeutic community method worked at Belmont with psychopaths, it would not work with psychotics. At Dingleton Max showed that a therapeutic community could develop in a traditional mental hospital. After changing the inner structure of the hospital and considerably emptying it, he moved their work out into the Border towns with specialist multidisciplinary teams and set up a pattern of community care which still endures as a model. He continued to travel widely in Britain and the USA consulting at hospitals and clinics; his visits were always exciting, leaving the institution astir with argument, fury and delight.
In 1970 Max retired from the NHS and went back to North America – first to Denver, Colorado, to the Virgin Islands, to Phoenix, Arizona and finally to Nova Scotia. In each place he consulted with local mental health facilities, lecturing, cajoling, stimulating. At first he travelled continuously, back to Europe, across the States, calling himself a “social ecologist”. He worked in prisons and schools and rehabilitation services, constantly stressing the need to let the under-privileged – the prisoners, the patients, the school children-talk freely to one another and make their own discoveries. He was always an exciting contributor to any conference, challenging the pompous and self-assured, asking the unexpected questions.
In his later years a failing heart limited his excursions, but his mind remained as fresh as ever, always a new enthusiasm, always a fresh delight. He became interested in spiritual issues; while not conceding the rational skepticism of a Scots scientific upbringing, he began to speak of the need for our society to concern itself with spiritual values. Max used to speak of himself as a “change agent”; that he certainly was. He deployed charm, intelligence and erudition in every situation, challenging, questioning, teasing those he met. He changed the lives of many colleagues and patients, he changed several institutions permanently, and he made a major contribution to the permanent change in British mental hospitals. Thanks to him and a few others we shall never slide back into the prison-like asylums, with their locked doors, punitive attendants and patients forbidden to talk to one another.
Through his long career Max published steadily and leaves seven books which describe his social experiments, expound his beliefs and at times catch the flavor of the excitement he engendered and the magic of his personality.
Max leaves three daughters from his first marriage, Chris his third wife who helped him devotedly through the last 15 years, and a host of inspired and devoted friends in many professions.
David L. Cutler, MD