A Yale Medical School Student Research Project on Therapeutic Communities 55 Years Later

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

Do you ever wonder what happens to the results of a preliminary medical research project many years later? And how do you learn how to conduct and analyze research?

Some answers to both have traditionally taken place at Yale University School of Medicine, where there has long been a requirement to do a quality research project to graduate. I suppose that was offset for many years by not having any class grades!

Both Leonard Eisenfeld and myself had that experience from 1967-1971. Panicking as the time came, I was fortunate to do mine with the well-known depression researcher, Eugene Paykel, MD, FRCP, FRCPsych, FMedSci. It actually got published in the peer-reviewed and well-respected British Journal of Psychiatry in 1975.¹ Although I did not continue to focus on depression in medical in-patients or other settings, I did pursue an academic career.

Leonard Eisenfeld did an even more innovative research project about whether participating in Daytop, a relatively new residential therapeutic community for those with narcotic addiction. He wanted to examine any measurable change in personality characteristics, which had never been examined before. Lo and behold, there did seem to be change toward a greater sense of personal responsibility, mediated through peer feedback and modeling by ex-addicts in a structured hierarchy environment. Eisenfeld also went into a different field, becoming a renowned neonatologist.

We are both nearly 55 years post medical school and, not uncommonly, think back on our medical school years. Coming on the heels of the announcement for our 55th reunion, Eisenfeld has decided to try to formally publish his early findings that could provide some early evidence about what might work best with individuals with substance use disorder and subsequent therapeutic communities.

That goal seemed very worthwhile to me since over the years therapeutic communities in various psychiatric settings for various psychiatric disorders have had varying degrees of success. Led by Maxwell Jones,² therapeutic communities in psychiatric inpatient settings showed much promise, but have dissipated over time, in part because typical hospital stays have been drastically cut by the emergence of business control of medicine and psychiatry, leaving not enough time to establish a viable sense of community.³

In the area of addiction, various kinds of residential and inpatient facilities have emerged over the years, many of them now for-profit and for the very wealthy. The emerging sense that the therapeutic gains can slip at times after coming back into everyday society suggests the need for refresher reinforcement and settings that support the personality changes in order to make them more resistant to relapse.

Another kind of therapeutic community emerged with the Clubhouse movement, starting with Fountain House in New York. These are outpatient settings for members, not so-called patients, where a sense of community is established, skills learned, and hope flourishes.⁴ I once was President of the Board of the one in Milwaukee called Grand Avenue Club.

There seems to be important recommendations that come out of our mutual research experiences 55 years later. One is the value of doing research, not only to contribute to relevant knowledge, but to learn better how to analyze the voluminous research and other claims that come out nowadays online in almost overwhelming numbers. Secondly is the importance of therapeutic communities, not only for substance use disorder and other psychiatric disorders, but in everyday life, especially now with our loneliness epidemic as communities have broken down in so many ways. Even traditional religious communities have come to be under duress. In Brazil, the innovative development of community-based therapy has emerged.⁵

Society and psychiatry would do well to enhance to focus more on such powerful community therapeutic enhancements.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

Dr Eisenfeld is a neonatologist in Hartford, Connecticut and is affiliated with multiple hospitals in the area, including Connecticut Children's Medical Center and Hartford Hospital.

References

1. Moffic HS, Paykel ES. Depression in medical in-patients. Br J Psychiatry. 1975;126:346-353.

2. Fees C, Kennard D. Classic Text No. 133: ‘Maxwell Jones and Therapeutic Community’, by David Millard (1996). Hist Psychiatry. 2023;34(1):78-86.

3. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.

4. McKay C, Nugent KL, Johnsen M, et al. A systematic review of evidence for the Clubhouse Model of psychosocial rehabilitation. Adm Policy Ment Health. 2016;45(1):28-47.

5. Di Nicola V, Barreto A. Integrative community therapy in Brazil: an interview with Adalberto de Paula Barreto, MD, PhD - community psychiatry part II. Psychiatric Times. September 20, 2024. https://www.psychiatrictimes.com/view/integrative-community-therapy-in-brazil-an-interview-with-adalberto-de-paula-barreto-md-phd-community-psychiatry-part-ii