SOCIAL POLICY, Vol. 7 (2), 28-40, Sept./Oct., 1976.

Self-Help and Mental Health By Alan Gartner

THE ANONYMOUS GROUPS. does share with many of them an In many ways it is appropriate additional set of to begin a description of self- characteristics including a help groups with Alcoholics high degree of authoritarianism Anonymous (AA). Founded in (4), a form of blaming the 1935, AA is the oldest of victim, acceptance of societal groups currently in existence stigmatization (5) and of the (1). It is also the largest need for behavior reform by the self-help organization – one individual, and “acceptance of study estimated 18,612 AA the prevailing, dominant groups in 1972 and AA itself cultural and social values” reported 26,967 groups in 1975 (6). In the past few years, (2); and it is the group most while maintaining its basic written about – in 1973, a 63- position, AA seems to be page annotated bibliography on reaching out more to the AA was issued (3). Further, it broader community, as has been both the model of illustrated by the publication self-help for many and the of pamphlets such as AA: A spawning ground for at least a Community Resource for Coping with a dozen other groups, e.g., National Health Problem, with a 1975 Gamblers Anonymous, Narcotics print run of 100,000; If You Are a Anonymous, Neurotics Anonymous, Parents Anonymous, the newly Professional, AA Wants to Work with You, founded (1976) Prison Families with a 1973 print run of Anonymous, as well as AA 150,000; and Alcoholism Is a auxiliary groups such as Al- Management Problem, with a 1974 Anon and Alateen. print run of 125,000. And it is the most vivid Speaking of a variety of expression of one set of self-help groups, including AA, characteristics of self-help Caplan notes that they are groups : the focus upon behavior, the attention to explicitly authoritarian.Members are symptoms, the importance of the expected to adhere to a strict code role of the group and the value of conduct, centring of course on of the knowledge and experience drug abstinence. They are kept under of the “old-timers,” and the careful surveillance and they are viewing of the problem of severely judged for backsliding, alcoholism as chronic, with the which is punished by public alcoholic never being cured. condemnation and shaming. Although its distinguishing To me, they also resemble features are by no means common religious orders in their social to all self-help groups, AA

structure and controls. All of these don’t go in the bars to get people to institutions have in common a well- join AA. It doesn’t keep membership defined mission to train members and records or case histories. It doesn ‘ t support them in a disciplined new engage in sponsored research. It style of life. They combine an doesn’t offer spiritual or religious authoritarian hierarchy with an open- services. There is no attempt to ended mobility system that balances control its members. It does not punitive sanctions for nonconformity engage in education or propaganda with the very tangible rewards of about alcohol. It does not provide unlimited promotion for merit (7). housing, food, clothing, jobs, money, or other social services. It does not The growth of AA is a accept any money for its services or tribute to its effectiveness. any contributions from non-AA One observer noted a rise in sources. They don’t ask you to sign membership between 1939 and anything when you first come in. They 1947 from 100 members to more don’t ask you what social position than 40,000 (8). Since 1947, you have. They don’t ask what the number of AA groups has intellectual ability you have. They increased by about 3 per cent a just stretch out their hand and say, year, growing from 1,664 groups “Please come back.” Thank You (10). to the 1975 total of 26,967 with 578,007 members. In a sense, three pairs of The AA format has remained seeming contradictions stable over its 40-plus years. characterize AA. First, the The individual, whose anonymity participant is told that he is is preserved, is held helpless to overcome responsible for his (75 per alcoholism; yet he must take cent of the members are men) responsibility for his actions. conduct, while he invests faith Second, the individual is told in the group’s power to help that he is free; yet the Twelve achieve day-by-day abstinence. Steps prescribe a philosophy The Twelve Steps of AA (see and a set of behavior. And, box) provide a guideline for third, while responsibility is individual behavior, focused upon the individual, it maintaining that “although the is the group which provides the individual is powerless over central vehicle for AA’s work. alcohol, he can overcome his Perhaps this combination of problemthroughself-appraisal, allowing the individual to see disclosure and responsible himself as helpless while at behavior” (9). the same time seeing AA as Not surprisingly, AA has having the way to energize him been the self-help group most to cope with his alcoholism is critically examined. Its a feature which makes AA members are sensitive to the effective. various charges that have been A quite similar set of levelled against it, as is procedures is part of Gamblers illustrated by the following Anonymous, established in 1957 presentation made by an AA by AA members. Here, too, the leader at a self-help group plays an important role, conference. anonymity is preserved, there is an official credo with a I would like to comment on what delineation of a member ‘ s Alcoholics Anonymous is not. It does responsibility for his gambling not solicit members from bars. We (again the bulk of the members

are men), and a variant of the are different now since I ‘ve joined AA Twelve Steps. As with AA GA. I’m not out of hock yet, but I meetings, those of Gamblers can see that silver lining up there Anonymous follow a simple and in all those clouds. I don’t know generally unvarying format. The what it is, maybe it’s just coming to credo is read aloud and members these meetings, maybe it’s some comment on it; each member is higher power, but I ‘m getting called upon to give what is serenity, some peace of mind now. called a “weather report”; Like Harry G. says, “Progress is our there is a brief prayer; and most important product,” and I’m the formal meeting ends, often progressing all the time. Just followed by an informal lately, after an absence of many, discussion session. It is the many years, my wife and I rejoined weather report which provides the church of our faith. When I the most distinctive feature of joined GA, I didn’t even come on my the meeting. An example own, I had to square a beef with my follows: wife, I admit it, but I decided she was right. I looked in the mirror one I’m Jack R., compulsive gambler. I’m morning and I said to myself, a compulsive loser too, but I don’t “Schmuck, what are you doing with lose no more because I don’t gamble your life?” I know I’m still a no more. I want to tell you that six compulsive gambler, if I start months ago when I first walked staying away from here, I’ll be right through that door, I had reached the back where I started from. But I take depths of degradation. To give you an it one day at a time, I haven’t example of how low I was, my wife was gambled in the last 24 hours and in the hospital having a baby, and I tomorrow’s another day. That’s my was holed up in some stinkin’ petty weather report” (11). larceny joint over in Emeryville playing low-ball. I was in hock up to Many of the features of my ears, I had lost all my self- the weather report are common respect, I couldn’t look anybody in to all of the anonymous groups the face, I was the kind of guy that (12): the participant having if you had a sawbuck to your name, hit bottom, the self- I ‘ d figure a way of conning you out degradation, the lack of of $9.98. I was always trying for the alternatives, the value of the big score, and later I was trying group and its “way” being both just to get even and the harder I affirmed for the speaker and tried, the more I kept getting in other old-timers as well as for deeper and deeper. And what the hell the benefit of newcomers, the was this big score anyway? I made it inability of the individual to a couple of times, so what did I do behave adequately without the with the money? I blew it, I had to group. These commonalities are blow it, it wasn’t real money, it was no accident, for Gamblers Mexican money, strictly counterfeit. Anonymous, and Neurotics My wife never got a dress or a pair Anonymous were all founded by of shoes out of it. I mean, I was in AA members and have adopted the bad shape. I was writing lousy Twelve Steps and the Twelve checks, thank God I was able to cover Traditions (13). Indeed, the them in time, but for the Grace of first lines of the Neurotics God, I’d be in durance vile right Anonymous basic brochure now. But you know the routine as well states, “Neurotics Anonymous as I do, we’re all the same, we’ve does for the mentally and all gone the same route. But things emotionally disturbed

individual (neurotic) what was a cofounder (with Jolly K. ) Alcoholics Anonymous does for of PA and is now national the alcoholic. It operates administrator. Four of the 10 exactly as does AA” (14). officers and members of the Although it shares the board of directors are doctors anonymous name with AA and or social workers, and there is incorporates some of its a 13 person advisory council, notions, Parents Anonymous is all but one of whom is an M.D. in many ways different from the or Ph.D. ; the lone nondoctor is other anonymous groups. It was a member of the family which launched in 1969 when Jolly K., initially funded PA and is one then a 29 year old mother of of only two women on the two who was receiving mental council. health counseling from Leonard Beyond their leadership L. Lieber, met with another role at the national level, abusing parent from Leiber’s professionals are intimately caseload (15). Slowly this involved in the local PA group grew, and by 1970 it had groups. According to PSIS 70 chapters. Then, in June elaborately precise and 1974, PA received a grant from directive Chapter Development the Office of Child Development Manual, each chapter must have a (OCD), Department of Health, sponsor who “should be a Education and Welfare. Two professional person in the years later there were 450 mental health field who has a chapters with over 4,000 profound respect for the selfparents attending weekly help concept” (18). meetings (16). With the support Making a careful of the OCD grant some 10,000 distinction, the Ahnual notes a letters were answered, a 24- preference for licensed social hour toll-free WATS line workers over those who hold installed, an impressive MSWs (Masters’ of Social Work) newsletter (Frontiers) only. Sponsors attend the published with a mailing list weekly PA meeting, advise the of over 18,000, additional chairperson (who is a member of pamphlets and brochures produced, public service PA; the Manual (p.5) describes promotion spots developed. And the relationship between like other organizations which chairperson and sponsor as that have been funded externally, PA of “an active parent-with-ais now looking “to new funding supportivegrandparent…I1) and sources, including advise members during the corporations, foundations and meetings and through phone individuals…Small donors, big contact between meetings. donors, donors of special Like the other anonymous projects (17). Here, of . . . I 1 groups, PA members acknowledge course, is one of the major the presence of the child-abuse differences between AA and PA: problem and the need for help; AA refuses any support from plan to take one step, one day nonalcoholics (and limits the at a time; agree not to divulge contributions of alcoholics, as the names of other members; and well). take responsibility for their Another difference is the own behavior (19). role of professionals. Leiber, Parents Anonymous, then, a psychiatric social worker, may be considered a “mixed”

organization in that it controversial (21). combines many of the features Founded in 1958 by Charles of the other anonymous groups Dederich, an ex-alcoholic who with characteristics abhorrent while an AA member rejected its to them – namely, outside God-directed basis, Synanon funding . and integral incorporates many features of involvement of professionals. AA. Here, again, the It will be interesting to participants have reached observe PA’s progress after bottom, they can expect no June 1977 when its OCD grant cure, they must take expires to see whether its responsibility for their own momentum and, more importantly, behavior, the group (and here its apparent success continue. the whole Synanon community) offers the way to acceptable SYNANON AND I T S behavior. The use of taped OFFSHOOTS speeches by Dederich and other Many of the characteristics of oldtimers serves much the same the anonymous groups also purpose as the recital of AA’s typify several of the drug Twelve Steps, while the Synanon addiction programs. Caplan game builds upon GA’s weather describes some of these shared report. The game, however, is a features: group exercise. Characterized by wuthering personal Organizations that help their members confrontations designed to break a noxious habit – alcoholism, force all participants to be drug abuse, smoking, or overeating – totally honest about their offer not only individual and group previous behavior and, thus, to counselling in dealing with the take responsibility for their problems involved and particularly present and future actions, the anticipatory guidance fromold-timers game serves the same purpose as in preparing for expectable the self-declarations of the difficulties, but they also extend anonymous groups. Even more individual ego strength by group than the anonymous groups, sharing of the miseries and synanon with its organized discomforts of withdrawal symptoms. communities has found In addition, they provide a community continuing roles for oldin which friendships can develop to timers. The emphasis is on provide a new meaning to life; also, continued involvement, which social and recreational activities provides not only successful can take place that offer a role models for newcomers, but distraction from unsatisfied cravings also continuing reinforcement (20) for the old-timers (22). Indeed, Synanon now views Just as AA is the itself as a “secular religion” prototypical anonymous where ongoing participation is organization, so Synanon is the appropriate. Killilea compares prototype of the alternative it to such intentional community program in the drug communities as the Bruderhof field. It is not large presently there are some 1,500 (23) – Although AA’s founder, residents at five California Bill W. , was much revered and locations – but it is the most his ideas treated as gospel, written about of such the role of Dederich is even organizations, and the most

more central to Synanon. In s(he) necessarily understand part, this is a function of its it. This focus upon learning smaller size and geographic how to behave in a new role cohesiveness. But Dederich’s characterizes all of the selfrole goes beyond the Synanon help groups described here. centres themselves. For Indeed, role theory is a example, Daytop Village, a New central explanatory factor in York City drug program which understanding the effect of can be considered Synanon’s self-help groups. East Coast counterpart, was Following Synanon’s game, established in 1963 after its the thrice weekly encounter founders paid a visit to session is Daytop Is key group Dederich’s Santa Monica centre therapeutic technique. David (24) Deitch, Daytop’s director (and Daytop rejects treating a Synanon graduate) describes the addict as a sick person the encounter as “a gut-level needing medical treatment or as teaching device that speeds up a criminal needing jail or as a personality alteration, just as victim needing sympathy. a pressure cooker speeds up the Rather, according to the Daytop preparation of food” ( 2 7 ) . philosophy, the “addict is an Speaking of the decision to adult acting like a baby: expand Daytop Village from its childish, immature, full of initial group of 30 men, Deitch demands, empty of offerings” said, “The junkie needs new (25). In essence the addict is faces on whom to try out his seen as a psychopathic recently acquired skills. It is personality, always taking, necessary to create a community unable to give, and refusing to of men, women, and children who take responsibility for his/her live and work and love together actions or to recognize that if our people are to grow into the fault is his/hers. Taking mature responsible citizens” the posture that the addict is (28). While the newcomers both a reluctant enrollee (who provide the opportunity for the views therapy and change as old-timers to try out their only a lesser evil than jail or newly acquired skills (a good continuing on the street) and a illustration of the helpercon artist. Daytop’s initial therapy principle, according to attitude is both standoffish which the helper benefits most and questioning. The addict from the helping process), the must prove his/her desire to be old timers provide peer models in the program, and must do so for the newer members. in the face of severe Participants are supposed to be questioning from old-timers. responsible for both their own For the moment the addict must behavior and that of the others behave as if (s)he were members in the group. Here, in responsible, “must act as f you a total living situation, the understand, act as i f you are a peer-based method “powerfully reinforces more adaptive man, act as i f you want to do the right thing, act as i f you care behavior” (29)- Another offshoot of Synanon is San about people, act as i f you are a Francisco’s Delancy Street mature human being” (26). The (30). Like Charles Dederich, addict is asked to play a new who had found the constraints role without requiring that of AA too binding and thus

founded Synanon, John Maher, a toward personal growth and learning; former drug user, objected to a highly authoritian, member certain features of Synanon and controlled social structure founded Delancey Street in constantly evolving from within the 1968. membership; and periodic group confrontation sessions with strict Maher incorporated those concepts rules including energetic verbal which had worked for Synanon: no confrontation of each member drugs or violence, the game, the need regarding self-destructive behavior to locate in rich neighbourhoods, a admixed with warmth and empathy of a return to the early American work “super-family.” These five ethic to end the individual’s characteristics, working together, dependence on welfare, federal appear specifically to counteract and grants, corporate and foundation contain the severe authority funds. He rejected the ideas of conflicts, dependency, underlying Synanon that he felt were proven hostility, and profound narcissism failures: Synanon had withdrawn to an with certain patients classified as isolated, utopian community that had having character defects (33). no contact with current social … movements Synanon took no part in A follow up of some 200 politics; Delancey Street’spolitical graduates found that about half clubs would get out the vote for of those who entered the supportive candidates and would lobby program were . significantly to change laws. Synanon discouraged benefited (34). its people from leaving the commune to live and work on the outside; RECOVERY A N D OTHER Delancy Street would aim to put the EX-PATIENT GROUPS ex-addict back with society as a productive member with strong The groups described in the economic and emotional ties to the article can be thought of as community (31). aligned along a continuum. (Actually, a broad-band Also borrowing heavily spectrum may be a more from Synanon is a “peer appropriate metaphor, in that confrontation” program at Palo there is a set of Alto (California) Veterans characteristics around which we Administration Hospital. The can cluster the groups; but for participants are male in- now let us look at the patients on an open psychiatric continuum. ) The groups at one ward “seeking help with end, such as AA and the other alcoholism, drug dependence, anonymous groups, Synanon and gambling, sexual deviation, Daytop, see their participants repeated conflicts with the as persons with chronic law, and other self-defeating conditions who have hit bottom life styles” (32). The key and are incapable of helping characteristics of the program themselves; the activities of are: the program, whether or not it is residential, becomes central An individualized negotiated to the participants and “the treatment contract between each way” of the group is viewed as potential participant member and his the only solution for the peers; a 24-hour-a-day live-in individual; and the groups are setting …a supportive drug and entirely led by lay people medication-free environment oriented (except Parents Anonymous and

Daytop, which was founded by In addition, two studies, a professionals). Groups which decade apart, found that about will be discussed later in this half of Recovery’s members have article, such as the Widow-to- not been hospitalized, and a Widow program in Boston and the quarter have not had any national Parents Without psychiatric treatment (36). Partners, have participants There is a Recovery “way,” a whose conditions are not text, a revered leader, chronic (although they may although none of these features continue for a long period) and apply to some of the other exwho are not viewed (nor do they patient groups. And Recovery, view themselves) as having hit but not some of the other exbottom or being helpless patient groups I was (although, of course, they need professionally founded and sees help). Further, while the itself as an adjunct to latter group are important to professional care. their members, they are not the The largest of the exlocus of the individual ‘s life, patient groups, a 1973 study nor do they have a formal reported 850 Recovery groups philosophy and exegesis which with 15,000 members. All other are to be religiously followed. ex-patient organizations Often, professionals are combined were reported to have involved on an ongoing basis; fewer than 400 groups and less and there is no glorification than 3,000 members (37). In of a leader or founder. 1975, the executive director of Recovery, Inc. and the Recovery reported 1,045 groups other groups to which I will in the United States, Canada, turn now fall somewhere in the and Puerto Rico (38). middle between these two sets Founded in 1937 by Chicago of groups. Described by its Psychiatrist Dr. Abraham A Low, executive director, Robert Recovery was “designed to Farwell, as “a lay run, self- encourage his patients to carry help, after-care, group meeting out a self-help program that organization designed by a would permit them to control Chicago psychiatrist to prevent their symptoms.” It operates on relapses in former mental the principle that while patients and chronic symptoms patients returning from in nervous patients, (35) psychiatric hospitals are Recovery views its members as greatly improved, they still in need of long-term have “residual symptoms” (39). participation, but recognizes Dr. Low described the returning that one can (eventually) get patients as “mostly afraid better. The group is important of …terrifying sensations, to its members, but it is threatening impulses, obsessing neither residential (like thoughts and depressing Synanon and Daytop) nor are feelings, that is, their own meetings as frequent as those inner experience” (40). of AA. If the participants have In sharp contrast to the hit bottom, that level of the groups described earlier, problem was dealt with while Recovery members’ close working the individual was hospitalized relationships with and, thus, when participants professionals were a central arrive at Recovery they are feature from the outset. Since capable of helping themselves. 1969, a session on Recovery has

been included in the convention Recovery lingo, with program of the American psychiatric terms forbidden. Psychiatric Association, and in The reason given for this is 1975, the Psychiatric that it keeps inexperienced Speciality Boards included a people from straying into areas question about Recovery (41). about which they are ignorant, However, like the other “but it also serves to keep the groups, the weekly meetings are group’s attention on those rigidly structured. They begin things they can do to exercise with an introduction of members the self-help concept” (43). Of by their first names (as in course, it also serves to build AA), followed by readings from the sense of the group as Dr. Low’s book, Mental Health special with its own unique Through Will Training. (Akin to language. AA and GA readings of their Byprovidingunderstanding Twelve Steps and like Synanon’s and support, the group serves use of tapes by Dederich, some as an instrument for combatting recovery groups use recordings loneliness and isolation felt of Dr. Low’s comments.) Then by the ex-patient. In addition, members present examples of the Recovery group provides an their behavior and “spot” on advantageous element of the examples. The central competition. Recovery technique of spotting requires that members identify Patients consciously or unconsciously particular aspects to compete with one another to see who Recovery’s concepts for can improve most completely and maintaining mental health quickly and thereby win the approval (42).(this is similar to AA’s of the rest of the group. In turn, personal testimonials and GA’s the actual demonstration of ob jective weather reports, but there is improvement from week to week is a no formal group interaction to source of great encouragement and match Synanon’s game.) Unlike inspiration to the others. Part of the other groups described, the program for each is the support Recovery meetings close with a and reclamation of other patients. free-will offering of money, The spirit of working together toward and questions from newcomers a common goal cannot be are answered. Group socializing overemphasized. In union there is is not encouraged, nor is strength. Helping others is one of extensive out-of-meeting the surest ways to help one’s self. contact. These truths have been known through In addition to spotting on the ages. In Recovery they are behavior, Recoveryparticipants brought into sharp focus where are trained in “self- patients can actually observe them in endorsement,” which means that practice (44). they must give themselves praise every time they make an This mix of both effort to use Recovery methods. cooperativeness andcompetition Although spotting and self- is not the only dualism in the endorsement are methods to be Recovery design. There is also used outside of the group, the the tension between whether the Recovery participant learns patients will truly get better them and tries them out in a or whether they will always group setting. Such discussions continue in the ex-patient are conducted using a special role. Further, there is a

question of the extent to which reasons, are not currently the patients’ efforts are under psychiatric care (48). sufficient or whether Dr. Low’s But according to Dr. Stanley R. dicta are the essential factor. Dean, who proclaims himself Recovery’s official brochure “the first psychiatrist to states: promulgate” the Recovery program after Dr. Low ( 4 9 ) , The Recovery method consists of (1) studying Dr. Low’s book, Mental Does that (acceptance of patients not Health Through Will Training and presently under psychiatric care) other literature, plus records by Dr. pose a threat to private practice? Low; (2) regular attendance at Not at all. The present author can Recovery meetings; and (3) the affirm that a physician who refers practice of Recovery principles in selected patients to Recovery will one’s daily life (45). find that it is like bread cast upon the waters – in terms of cross- Another important aspect referrals, therapeutic progress, of Recovery, in addition to the prestige, and self-esteem (50). group ‘ s role and Recovery ‘ s “way,” is how it delegates the This is a far cry from AA’s leadership function: aggressive assertation that nobody makes money from AA. Groups are led by former patients who However, at least one report have been members for six months or finds Recovery much like AA, longer of Recovery, who have been calling it “a kind of cult, trained in the regular Recovery with highly ritualized and meetings and at monthly area leader formalized behavior, with a meetings and who are authorized from charismatic leader who expounds year to year as group leader (46). the Word, and with a dogma and exegesis” (51). The leaders are responsible for A study looked at Recovery two things: the leadership of not as a form of self-help but the weekly meetings (unlike AA as a type of voluntary and GA where leadership rotates communityorganization. Finding among the lay members), and, as that “the members of this Executive Director Farwell specialized group showed many states, “to follow the of the personal characteristics proscription that we do not attributed to members of advise, consult, diagnose, or voluntary community treat.” As he puts it, organizations, ” Wechsler concluded: It is lay run. We deal in what we refer to as trivialities. We do not, The members of the self-help if possible interfere with but rather organizations were found to differ cooperate with medical and from other residents in their home psychiatric and other counseling that communities in a number of ways which a person may be getting would be expected to exist between simultaneously or before (47). joiners and the general population. In addition, despite the fact that While Recovery ‘ s ” ideal the members were either former mental referral comes from a physician patients or persons who were or psychiatrist,” if the need encountering psychiatric arises it will accept members difficulties, they were found to be who, for economic or other relatively active in other voluntary

community organizations besides the professionals are involved as self-help group. A comparison of the coequal members rather than as self-help organization members who leaders or therapists. were inactive, moderately active, and very active revealed the same type of Special responsibilities, such as relationships between extent of Group Chairman or Council participation and selected personal Representative, revolve and the characteristics that had been obligation to give as well as receive obtained in general studies of help is widely diffused. Every voluntary community organizations therapist is also a patient (if one (52). wishes to use these terms), every student a teacher(55). Wechsler ‘ s study is unique in the field but perhaps However, Mowrer does see a because it was pathbreaking it special role for professionals is also 1imited, not in starting non-professional considering factors such as the mutual-help groups; indeed, he self-help organization’s has run graduate seminars at members in comparison with the University of Illinois to those of voluntary community train such persons. Mowrer organizations, nor of the distinguishes between the AAnature of the involvement and type peer group, in which all participation of the Recovery the persons have the same members in the other problem and there is no status organizations to which they distinction, and the integrity belong. However, it is clear group peer group which includes that one of the facets of the persons of diverse background self-help organizations which who are “equals, without status requires more attention is its or rank, except as special group function. functions may be temporarily Emphasis on the role of assigned to them – or in terms the group is also found in of informally recognized group Mowrer ‘ s “integrity groups” experience or competence” (56). concept ( 53 ) . Responding to the Thus, while the professional growing sense of alienation as may also give as well as get, traditional primary groups (s)he does have a special role weaken, Mowrer, a psychologist, to play in integrity groups. sees “the new small group Mowrer also suggests a movement (as representing)an broadening of the self-help attempt to create, not just a concept to emphasize mutual kind of ‘ therapy, ‘ but actually help “which implies give and a new primary social group, or take.” This combination of institution, which will self-reliance and mutual compensate for these basic support is expressed in the human loses”(54). integrity group motto: We alone Beginning in 1961, the can do it, but we cannot do it integrity groups grew out of alone (57). Mowrer’s efforts to fins a way Mowrer goes so far as to to establish a warmer relation- propose that everyone ought to ship with clients in his be in a mutual-help or peer clinical practice. Indeed, one group “(for the bearing and of the unique features of sharing of ‘ one another ‘ s integrity groups is that burdens’) not as ‘therapy’ but as a way of life…” ( 5 8 ) . The

characteristics of such groups, number and wide variety of no doubt, would closely other ex-patient groups. Some resemble the present integrity are run entirely by groups which feature: participants (20 per cent 1. A well-defined structure. according to a 1957 survey (61), such as a club for former 2. Goals that focus on each patients at Massachusetts members responsibility for Mental Health Center (62), changing him/herself. while others are professionally 3. Group intake, with modelling run (63). Some simply provide a procedures, demonstrated by place for ex-patients to go and experienced members. be, such as the Massachusetts 4. A contractual agreement to group, while others, following embrace the core values of Recovery, offer therapeutic honesty, responsibility, and activities. And in England, involvement. professionally led followup 5. A commitment to move beyond groups for discharged patients self-disclosure by translating are part of an integrated words into deeds. mental health service system 6. Leadership shared by (64) participants. “Halfway houses” and some “day hospitals” also share Finally, the integrity group characteristics of self-help. A concept includes: notable case is the Lodge Program organized by a Rapid movement into self-disclosure, California state mental confrontation, and support – all hospital where male patients aimed at behavioral change. who were ready to be discharged Participants develop a strong volunteered to live in a fellowship and are available for building in the community, emergency meetings if a member is in organized a janitorial business need. Although the emphasis is on ( and later a gardening encouraging responsibility for one’s service), managed and conducted own behavior, Integrity groups also it as well as the affairs of help members overcome their the lodge (65). Professional alienation by developing authentic services were not provided by interpersonal relationships with the hospital, although a rarely others (59). used veto power was held over decisions. “Compared to their While not properly matched control, a labelled an ex-patient group, significantly greater Neurotics Anonymous (NA) does proportion of the individuals include many ex-patients; in the lodge situation were indeed, its founder, Grover, able to remain out of the was both an alcoholic and hospital and resume employment” undergoing psychiatric (66). treatment. NA follows “the AA Regarding ex-patient Recovery Program as adapted for groups, the converse of neurotics” (60). As such, while Wechsler ‘s point that those who not hostile toward the join REcovery are much like professional mental health joiners of other community community, NA can be best voluntary organizations is that described as distanced from it. those who are less likely to be There are a considerable joiners in general will be less

likely to join an ex-patient understanding and support to group. In addition, there is the afflicted person. the stigma still associated When the afflicted person with mental illness and is an adult, auxiliary groups patients’ desire to forget for spouses (e.g., Al-Anon and about their hospitalization Gam-Anon ) and children (67). Joining such a group (Alateen) have been means, in effect, accepting the established, or spouses are ex-patient role and, thus, welcomed to at least some of differentiating oneself from the activities of the self-help the general community. Many may group itself (e.g., Gamblers wish to “pass” as having never Anonymous, Recovery Inc,. been a patient (68). Moreover, Mended Hearts, Prison Families the absence of clear Anonymous, Huntington’s termination procedures (and the Disease). When the afflicted implication that one ‘ s person is a child, the family condition is chronic, as seems members, particularly parents, to be the case with REcovery) are required to play a more may lead to continued active role. Gussow and Tracy dependency. It is possible that have grouped self-help Mowrer’s notion of universal organizations into two participation in mutual-help categories: Type I includes groups might serve to those which provide “direct destigmatize it. On the other services to individuals and hand, similar to the process relatives in the form of described by Parsons as education, skills, “socialization into the patient encouragement, and other forms role,” (69) these groups may of support” (71), while Type I1 socialize ex-patients into a organizations are “more well role (70). foundation-oriented, promoting research, fund-raising, public “LIVING WITH” G R O U P S and professional education and legislative and lobbying All the groups described thus activities” (72). Caplan, far deal with people who, however, notes that “by depending upon one ‘ s campaigning politically for classification system and prior improvement of the community’s assumptions, are sick or handling of the needs of people patients or seem to be like themselves,” they are in inadequate in some way. The fact developing “cohesion and groups to be described in this some sense of mastery over section do not fit into these cruel fate. . . ” (73). In other categories. While these group words, the activities of what members have problems, the Gussow and tracy call Type I1 source of the problem is organizations have Type I someone with whom they live: effects upon the participants. spouse, child, parent. The range of such groups covers Essentially, the thrust of nearly all of the afflictions these efforts is to inform the from which children suffer: relative of the nature of the there are groups for parents of problem faced by his or her twins and multiple births, family member and to aid the retarded children, emotionally relative both in coping with disturbed, physically the problem and providing handicapped children, those who

face hospitalization, those announcements are not made. The with leukaemia, cystic parents lack knowledge of what fibrosis, congenital heart the child will look like, what disorders, Down’s Syndrome, (s)he can do and will need to rubella, spinal bifida, Tay- have done for her/him. And, Sachs, cleft palate and/or lip, very likely not knowing anyone cerebral palsy, hemophilia, with such a child, their grief brain injury, those who are is compounded by isolation. AT blind or deaf, as well as a group meetings, new members group for parents whose child tell about how they learned has died (74). about their child’s illness and The specific activities of how they responded, while old the individual group, of members tell of their own course, vary depending upon the experiences and changes over nature of the affliction. But time. Members practice (rolethe general functions and play) how to tell others and activities are quite similar. how to respond to them. Some were organized as a Information is shared on how to service activity of a large deal with children on a day-toorganization (e.g., United day basis, what to expect, and Cerebral Palsy), and others by what to do (75). the parents themselves (particularly those related to The group mitigates feelings of retarded children). Many were isolation and depression. Members organized by hospitals either could see how other children appeared as part of their program or as and acted. The discovery that other a response to parents’ desires parents had similar feelings and to get together with persons fears reassured them of their own like themselves. Other groups adequacy and sanity. Some parents simply grew out of parents served as role models to illustrate being together in a waiting that it is possible to survive such room of a special clinic an event (76). serving their children. Several examples may serve to For parents of children illustrate this type of self- with cystic fibrosis, the group help activity. performed a similar set of For parents of children functions. with Down’s Syndrome (and other similar diseases) what had been group meeting provided a sounding anticipated as a joyful board for parents to learn, to occasion becomes the opposite. devise, to consider, and to test new The medical staff often handle methods of coping as well as to their own disappointment by receive reinforcement for prior suggestinginstitutionalization satisfactory adjustments. Parents of the child, by exhortations repeatedly expressed a sense of to the parents to love the comfort in learning that their grief, child, or by avoiding the pain and everyday difficulties were parents. The parents, for their not unlike those of others (77). part, often react with an unwillingness to develop Parents of children who attachments to the child; are dying of leukaemia go friends and relatives are through a process of encouraged not to visit (or do anticipatorymourning following not on their own); birth stages not unlike those of

Down’s Syndrome parents: first, had died, the foundation now denial – including shopping has 43 chapters, while the around for alternative International Counci1 for diagnoses, then anger, Infant Survival, started in bargaining, depression, and 1964 by a couple whose 2-monthfinally, acceptance (78) old daughter died, has 23 Groups for these parents deal affiliates. with issues such as With parents of children disciplinary problems with the whose problem is serious but patient and siblings’ and not life threatening, a peers’ reactions to physical different set of activities changes in the patient, the takes place. For example, the patient’s own questions and Greater Omaha Association for fears, the relationship between Retarded Citizens not only the parents and their children. organizes groups of parents of In evaluating the retarded children, but pairs experience of the group, parents new to the groups with parents emphasize the value of long-time members (similar to realizing that they were not the AA and GA buddy system) to alone, that there was a place provide emotional support from where they could express their someone who has “already been actual feelings (at times not there,” facts about mental wanting to be with the child, retardation, information about being angry with him/her for services available, tips about being ill) without feeling ways to arrange things, and guilty, that they could introductions to other parents anticipate and learn how to of retarded children (81). A deal with problems and try out Yugoslav program for physically solutions, and for some parents handicapped children involves the group became the vehicle parents in discussion groups which enabled them to talk to about the children and their each other about their child’s problems, as well as engaging illness (79). them in helping with the Talking about their Children’s therapy (82). This feelings with someone who has is similar to the various shared similar ones is an programs in which parents learn overwhelming need for parents to provide early stimulation w h s s 17r\ungchildren have died, for their retarded children particularly those who are (83). victims of Sudden Infant Death Although not precisely a Syndrome (SIDS), formerly self-help activity as I have called “crib death.” As one been using the concept, it is mother said: “Whenever I get it worth noting the increasing on my mind and I can’t seem to number of programs that train function, I call someone in the parents as therapists to work Foundation (for Sudden Infant with there own children (84). Death). ‘Am I nuts? Am I going The Kendall Center (Chapel crazy?’ It’s comforting to her Hill, N.C.) incorporates into say, ‘No, I ‘ve been through its program of training parents this too. Everybody gets these as therapists a parents’ feelings. It’s part of the mutual-help group where they natural grieving process are able to share both their (80).Founded in 1962 by a experiences as parents of Connecticut couple whose baby retarded children and as

therapists in training. Of for the life-long feeling of particular value is the emptiness caused by having a child opportunity for “older” parents who will never develop to continue to report to the “newer” the chain of one’s life. But at least parents on changes in their the association with others in the children as a result of their same situation combats the social own role as therapists (85). isolation that would otherwise be the lot of those who feel themselves, PEOPLE ALONE and are perceived by others, to be deviant in ordinary society (86). Discussing various types of mutual-help community support Both the parent and groups, Caplan distinguishes “people alone” groups not only between those organizations provide emotional and social designed to help their members support “but they usually break a noxious habit, such as provide detailed information alcoholism, drug abuse, and specific guidance in smoking, or overeating, and increasing their members’ others which emphasize the understanding of the issues formation of a new community in involved in their predicament which members can immerse and of practical ways of themselves. Falling into the dealing with the expectable second category are parent day-to-day and long-term groups such as those just problems” (87). discussed and “people alone” Founded in 1957, Parents groups such as Parents Without Without Partners (PWP) is the Partners and widows largest group of single associations, to which I will parents, with more than 200 turn in this section. chapters and some 30,000 members, about three-quarters Most of these self-help groups have of whom are women (88). Unlike two-phase programs. The old-timers the anonymous and ex-patient help the newcomers to master the groups, membership in PWP is trauma of the acute crisis of the subject to considerable bereavement, the loss of bodily turnover: during its first 10 integrity, or the disappointment of years over 100,000 persons had parental hopes, by means of been members (89). individual and group counselling and Weiss makes a point by emotional support in expressing similar to Caplan’s, noting and mastering the shock and pain, as that for some PWP members, “the well as guidance in accepting and organization was responsive to coming to terms with the catastrophe. the marital loss itself” and But the characteristic feature of for others it was “responsive these organizations is their second- to the defects of life as a phase provision of long-term social single parent. “for the first contacts which serve as kind of group, more likely divorced (or psychosocial replacement for what has separated) than widowed, the been lost. This never really works – organization met individuals’ no amount of friendliness in meetings need “to be able to talk to of Parents Without Partners can understanding and sympathetic replace the intimacy of a marital listeners about their feelings, relationship, nor can collaborating their concerns, and their with other parents in bettering the plans. “For the second group, lot of the mentally retarded make up already having made the

transition from marriage to members with one (Nassau life on their own, PWP met County, N.Y. ) having over 7,000 their “relational deficits, members. Many of the groups are i.e., distressing absences of part of the new North American important relational Conference of Separated and provisions. “Weiss points to Divorced Catholics, although four “continuing sources of each club is autonomous (94). stress” to which PWP responds: The same issue of stigma (1) the absence of a sustaining arises in widow programs. community; (2) the absence of similarly placed friends; (3) Many women see widowhood as a social the absence of support for a stigma. They see themselves as marked sense of worth; and (4) the women, different from everyone else, absence of emotional attachment even carrying this so far as seeing (90). While it is this last themselves as defective, that’ factor that is addressed by the something must be wrong with them if charge that PWP is simply a they lost their husbands (95). dating service, the leaders of PWP play it down both because This sense of stigma felt by they wish to avoid the many of those involved in the pejorative implications of that groups I have discussed can be charge (and its attendant loss mitigated by the help of of attraction of “nice people”) someone with the same and because they see their work condition. The stigmatized as having a broader scope, as individual needs to feel that indeed it does. But this broader scope, he (or she) is human and essentially expressed in the normal in spite of appearances and in characterization of PWP by a spite of his own self-doubts…The professional adviser to its first set of sympathetic others is of national headquarters as “an course those who share his stigma. educational therapeutic Knowing from their own experience advisory organization,” (91) what it is like to have this presupposes an initial particular stigma, some of them can acceptance of the stigma of an provide the individual with inferior position; the belief instructions in the tricks of the is that ” ‘parents with trade and with a circle of lament to partners’ – in keeping with the which he can withdraw for normal prevailing social norm – are support and for the comfort of better” (92). Indeed, PWP’s feeling at home, at ease, accepted as recognition of this may be seen a person who really is like any other in the current discussion normal person (96). within PWP to change its name to Single Parents, This is precisely the function International (93). A different played by the widow aide in the type of stigma is faced by Widow-to-Widow program divorced Catholics given the established in 1967 by the doctrinal belief that a valid Laboratory of Community marriage is indissoluble in the Psychiatry, Harvard Medical eyes of God. It is no surprise, School (97). Both the formal then, that more than 150 groups auspices of this program and of formerly married Catholics the use of a paid worker (who, have sprung up in the past five in addition, shares widowhood years. Most have 100 to 150 with those served) make this

program different from those and to recognize and act upon discussed earlier. However, the the need to make new friends activities of the program are and be out among people (101). fully in the mode of self-help The widow aides, using their as it has been described here. own experience, help the widows The program was begun as an both to face the fact of experiment in preventing widowhood and then to learn how emotional problems in a to manage their own lives. bereaved group. “It was There are a large number of hypothesized that if another programs for widows, perhaps widow reached out to the new not as carefully organized as widow, she would be accepted as the Harvard program, but which a friend because she was involve other widows as someone who understood, since caregivers and recognize the she had been there herself” benefit gained by the caregiver (98). As one widow put it, as well (102). The extent of these program is not Since you are a widow too, when you surprising given the large said you understand I know you meant number s of widowed persons it and that was so important. I can’t 10 million in 1970, 85 per cent stand sympathy and that’s all anyone of whom were women (103). else could give me (99). Indeed, such groups sprout up quite independently – for While there are group example, in New Haven, Houston, meetings, most of the work of and Westchester County (N.Y.) the Harvard program is done (104). Some programs focus on through one -to-one contacts crisis intervention by between widow aides and the therapists, while others are widowed. Here, more self-help oriented; all see in the experience of the the aide is using her own experience widowed a resource for helping as a human being and as a widow to others like them. guide her encounter with the new Indeed, this may be the widow; she appreciates the real need single most important co~mon that exists but she never takes the denominator of the various widow’s initiative away from her t-ypes of self-help groups I (100). have looked at here – namely, that the role of the person who Beyond proving aid in coping has already lived through the with the trauma of becoming a experience is critical for widow – and, as Silverman helping others. For not only points out, this upset is not does that person know what the eased by an institutionalized experience is like, but (s)he rite de passage as engagement has learned how to play the eases the transition to required new role: the marriage – the widow aides help alcoholic who has stopped the widow adapt to the widow drinking or the mental patient role, which means accepting who is now well or the person that the spouse is dead and whose spouse has died and now that new life patterns must be accepts the state of widowhood. developed. The widow must now And to the extent that the learn to make decisions without condition continues (the person help and guidance from a remains a widow, for example), husband, to learn to be alone, the caregiver, too, is a

beneficiary via the helpertherapy principle. NOTES

l Bill W., Alcoholics Anonymous Comes l o Jack M., in Leonard 0.Borman, ed., of Age (New York: Harper and Brothers, Explorations in Self-Help and Mutual Aid. 1957); Robert Thomsen. Bill W. (New York: Proceedings of the Self-Help Workshop Harper and Row, 1975). Bill W. was in- held June 9-12, 1974, in Chicago, under volved in the Oxford Group, and others the auspices of the W. Clement and Jessie have traced AA’s antecedents to the early V. Stone Foundation (Evanston, Illinois: nineteenth century Washingtonians. See Center for Urban Affairs. Northwestern also Nathan Hurvitz, “Peer Self-Help University, 1975). p. 55. Psychotherapy Groups: Psychotherap Without Psychotherapists.” in Roman I? ” Alvin Scodel, “Inspirational Group Therapy: A Study of Gamblers Anony- Trice, ed., The Sociology of mous,” American Journal of Psychotherapy Psychotherapy (New York: Jason Aron- XVlll (January 1964). p. 117. son, 1973); Herbert Barish, “Self-Help j2 A 1973 study reported 28.000 Groups,” Encyclopedia of Social Work II, anonymous groups as part of 11 organiza- 16 (1971), p. 1164. tions. Zachary Gussow and George S. Zachary Gussow and George S. Tracy, Tracy, “Interim Status Report: Voluntary “The Role of Self-Help Clubs in Adaptation Self-Help Health Oraanizations-A Studv to Chronic Illness and Disability.” n.d.. in Human Support ~ystems.”septemb<r Table I. 1973, Tables I, Ill. 3 Julianne Phillips. Alcoholics Anonymous: An Annotated Bibliography, 1935- l 3 Narcotics Anonymous (Sun valley. 1972 (Cincinnati, Ohio: Central Ohio Pub- Calif.. NA World Service Organization. lishing Company. 1973). 1976); Charles Carner, “Now: Clubs for For an example of the disagreement Mutual Mental Health,” Today’s Health created by lumping together self-help XLVI, 3 (March 1968), p. 41. groups of differing value orientations, see l 4 Neurotics Anonymous: An Introduc- Alfred H. Katz, “Self-Help Groups,” Social tion (Washington. D.C.: Neurotics Work XVII, 6 (November 1972), pp. 120- Anonymous International Liaison, 1966); 121. p. 3. 5 Edward Sagarin, Odd Man In (Chicago, l 5 1 Am a Parents Anonymous Parent Ill.: Quadrangle Books, 1969). See also (Redondo Beach, Calif.: Parents Anony- Erving Goffman, Stigma: Notes on the mous, Inc., 1974), p. 6 ff. Management of Spoiled Identities (En- l 6 Leonard Lieber. “Parents Anonvglewood, New Jersey: Prentice Hall, 1963). mous,” Child Abuse and Neglect ~ e p o t k 6 Alfred H. Katz and Eugene I. Bender, (June 1976), p. 3. The Strength in Us: Self-Help Groups in “The Honevmoon Is Almost Over,” the Modern World (New York: New View- 1975). p. 1. Frontiers ( ~ i n t e i points, 1976), p. 39. Similar points are l 8 Parents Anonymous: Chapter Demade by Matthew P. Dumont, “Self-Help velopment Manual (Redondo Beach,

e Treatment Pro rams,” American Journal of Psychiatry XXXI, 6 (June 1974). pp. 631-635. Calif.: Parents Anonymous, Inc., 1974). p. 4. l 9 “Guidelines for Achievement.” IAm a Gerald Caplan, Support Systems and Parents Anonymous Parent, op cit., pp. 21 44 Community Mental Health (New York: Be- I I.

havioral Publications, 1974), p. 21. Caplan, op cit., pp.21-22. *O Oscar W. Ritchie, “A Sociohistorical Borman. op cit.. p. 58; see also Peter 2′ Analysis of Alcoholics Anonymous,” Ouar- Collier, “The Houses of Synanon,” Ramterly Journal of Studies on Alcohol IX parts VI, 3 (October 1967), pp. 93-100; (1948), p. 119. John 8. Enright. “Synanon: A Challenge to Anthony J. Vattano, “Power to the Middle-class Views of Mental Health.” in People: Self-Help Groups,” Social Work Daniel Adelson and Betty L. Kalis, eds.. XVII, 4 (July 1972), p. 10. See also Bill W., Community Psychology a n d Mental op cit. I Health: Perspectives and Challenges (Scranton, Pa.: Chandler Publishing Company, 1970), pp. 238-271 ; Lewis Yablonsky. Synanon: The Tunnel Back (Baltimore, Md.: Penguin Books, 1965).

22 Marshall S. Cherkes, “Synanon 38 Borman, op cit.. p. 53. Foundation-A Radical Approach to the Problem of Addiction,” American Journal j9 Donald T. Lee, “Therapeutic T y ~ e : of Psychiatry CXXI, 11 (May 1965): p. Recovery Inc.,” in Katz and Bender, op cit.. 1066. P. 43 23 Marie Killilea. “Mutual Help Organiza- A.A. Low. Mental Health Through Will tlons: Interpretations in the Literature,” In Training (Boston: The Christopher Publish- Gerald Caplan and Marie Killilea, eds. ing House, 1950.) Support Systems a n d Mutual Help: *l “Recoverv Comes of Aae.” Roche Multi-Disciplinary Explorations (New York: Reports: ~ront[ersof psychiat+ V, 16 (Oc- Grune 8 Stratton. 1976), p. 52. tober 1. 19751. 24 Following their 1961 visit to Synanon 42 stanley ‘R. Dean, “Self-Help Group at Santa Monica, Alexander Bassin, Her- Psychotherapy: Mental Patients Redisbert Bloch, Daniel Casriel, and Joseph A. cover Will Power,” International Journal of Shelly (then chief probation officer of the Social Psychiatry XVII, 1 (197l), p. 75. Brooklyn Supreme Court), made applica- l Lee, in Katz and Bender, op. cit.. tion to NlMH for a study program under the pp.4445. aegis of the court. A five-year NlMH study 44 Dean, op cit., p. 76. grant was received in April 1963. The ap- 45 Recovery: What It Is and How It Deplication for such funds would have been veloped (Chicago: Recovery, Inc., 1973). counter to AA policy, while Synanon itself p. 3. has failed in its efforts to receive NlMH 46 Borman, op cit., p. 53. funding. 47 Ibid., p. 54. 25 Alexander Bassin, “Davtop Villaqe.” Dean, op cit., pp,77, 74. Psychology Today II (December 1968), p. 49 Indeed, he offers as evidence a letter 48. (The author was one of the founders of from Dr. Low to that effect, ibid., p. 78, fn. Daytop.) 15. Apparently, Dr. Dean documents this 26 Ibid., p. 51. (emphasis in original). fact in each article he writes: see “The Role 27 lbid., p. 52. of Self-conducted Group Therapy in 28 Ibid., p. 68. Psychorehabilitation: A Look at Recovery, 29 Vattano, op cit., p. 10. Inc.,” American Journal of Ps chiatry , 3 0 Charles Hampden-Turner, Sane CXXW. 7 (January 1971), p. 937. &I. 4. As lum (San Francisco Book Co., 1976). so Dean. “Self-Help Group Grover Sales. John Maher of Delan- Ps chotherapy,” op cit., p. 77. cey Street (New York: W.W. Norton 1976), p. 60. l1 David Landy and Sari E. Singer. ‘*The Social Organization and Culture of a Club 32 William Van Stone and Robert Gilbert. of Former Mental Patients.” Human Rela- “Peer Confrontation Groups: What, Why, tions XIV. 1 (February 1961). p. 31. Whither,” American Journal of Psychiatry 52 Harry Wechsler, “Patterns of Mem- CXXIX, 5 (November 1972), p. 583. bership in a Self-Help Organization in Menj3 Ibid., p. 587. tal Health,” Mental Hygiene XLV, 4 (Ocj4 Ibid., p. 588. tober 1961), pp. 621-622. 35 Borman, op cit.. p. 53. 53 0. Hobart Mowrer, The New Group 36 Henry ~ e c h s k r , . ” ~ h e Ex-patient Or- Therapy (Princeton, New Jersey: D. Van ganization: A Survey,” Journal of Social Nostrand, 1974). See also his “Integrity Issues XVI, 2 (1960), . 50; Hanus J. P Grosz, Recovery, Inc., urvey (Chicago: Recovery, Inc., 1973), Tables 12, 14. Groups Today” (Urbana: University of IIlinois Press, 1969); “Conflict, Contract, Conscience, and Confession” (Urbana: j7 GUSSOW and Tracy, “Interim Status University of Illinois Press, 1971); “Peer Report: Voluntary Self-Help Oranizations,” Groups and Medication, The Best op cit.. Table Ill. Recovery has dominated ‘Therapy’ for Professionals and Laymen the field for the past 20 years. A 1957 study Alike,” Psychotherapy: Theory, Research, by the Joint Commission of Mental Illness and Practice VIII, 1 (Spring 1971), pp. and Health reported approximately 5,000 44-54. members in 42 organizations of mental patients, with an estimated 4,000 of them in 250 Recovery groups (Wechsler, op cit.. p. 50

s4 Mowrer (1971), op cit., p. 45 (emphasis in original). Leukemia,” Social Work XVIII, 4 (July 55 Ibid., p. 48. 1973), pp. 71-72. 79 Ibid., p. 74. s6 Ibid., p. 49 (emphasis added). 57 Ibid. 80 Marion Steinmann. “Crib Death: Too Ibid., p. 53 (emphasis in original). Many Clues?,” New York Times Magazine, s9 Vattano, op cit., p. 11. May 16. 1976, p. 41. 60 Neurotics Anonymous, op cit. 8′ Alfred H. Katz, “Self-Help,” in Joseph 61 Wechsler, “The Ex-Patient Organiza- Wortis, ed., Mental Retardation (New York: tion: A Survey,” p. 48. Brunner-Mazel, 1975), pp. 295-296. 82 A.H. Katz, “Self-Help and the Hand- 62 Landy and Singer, op cit., pp.33-37. Wechsler, op cit., p. 48. See also icapped,” New Society, April 10, 1975, p. Abraham Lurie and Harold Ron, “Self-Help 13.in an Aftercare Socialization Program” 83 Katz, in Wortis, ed., op cit., pp. 293- Mental Hygiene LV, 4 (October 1971), 294. pp.467-472. 84 Bernard Guerney, “Filial Therapy: Description and Rationale,” Journal of Consult- 64 Alfred H. Katz, “Application of Self- ing Psychology XXVlll (1964), pp.304- Help Concepts in Current Social Welfare,” 310; E. Schlo er and J. Loftin, “Thinking Social Work X. 3 (July 1965). p. 69. 65 David H. Sanders, “Patients-75; g Disorders in arents of Young Psychotic Children,” Journal of Abnormal Psychol- Professional-O: The Lodge Program in ogy LXXlV (1969), pp. 281-287; E. Community Rehabilitation,” in Katz and . Schloper and R.J. Reichler, “Parents as Bender, op cit., pp. 176-187. Cotherapists in the Treatment of Psychotic 66 Ibid., p. 182. Children,” Journal of Autism and Child- 67 Mary B. Palmer. “Social Rehabilitation for ~ e n t a l Patients.” Mental Hygiene LII. 1 (January 1968), pp. 24-28. . hood Schizophrenia 1 (1971), pp. 87-1 02; Brian Stabler, Frank W. Gibson, Jr., and D. , Scott Cutting, “Parents as Therapists: An i 68 Wechsler, op cit., p. 54 Innovative Community-Based Model,” Pro- i 69 Talcott Parsons, The Social System (Glencoe, Ill.: Free Press, 1951), pp. 428fessional Psychology IV, 4 (November 1973), pp. 3971402; R.G. Wahler, “Opposi- : 473; see also, Katz, o cit., p. 70. tional Children: A Quest for Parental Rein- 70 Donald T. Lee. “~ecovety,Inc.: A Well forcement Control,” Journal of Applied Role Model,” Mental Hygiene LV, 2 (April Behavior Analysis 11 (1969), pp. 159-1 70. 1971), pp. 194-198. Stabler et al., op cit., p. 399. 71 GUSSOW and Tracy, “The Role of Caplan, op cit., pp. 21-22. Self-Help Clubs,” op cit. 87 Ibid., p. 23. 72 Ibid. 88 Katz and Bender, op cit., p. 69. Re- 73 Caplan, op. cit., p. 23. garding the founding of PWP, see James 74 Each one of these groups operates in Egelson and Janet Frank Egelson, Parents Massachusetts. See “A Directory of Mutual Without Partners (New York: E.P. Dutton, Help Organizations in Massachusetts” 1961). (Boston: Blue Cross and Blue Shield of Massachusetts, 1974). 89 Ethel P. Gould, “Special Report: The 7s Ann Murphy, Siegfried M. Peuschel, Single Parent Family Benefits in Part *ts and Jane Schneider, “Group Work with Without Partners. Inc..” Journal of Mar- Parents of Children with Down’s Syn- riage and the Family XXX, 4 (November dromes,” Social Casework LIV, 2 (Feb- 1968), p. 667. ruary 1973), pp.114-119. 9 0 Weiss, op cit., p. 322. For a more 76 Ibid., p. 119. expansive treatment of these types of re- 77 Chancellor B. Driscoll and A. Harold lat~onships,see Robert S. Weiss, “The Lubin, “Conferences with Parents of Chil- Fund of Sociability,” Trans-action (July, dren with Cystic Fibrosis,” Social Work LIII, August 1969), pp. 36-43. 3 March 1973), p. 146. 9 ‘ Gould, op cit., p. 666. h Brenda S. Knapp and Howard Hansen “Helping the Parents of Children with 92 Katz and Bender, op cit. 93 Ibid., p. 69, fn. 3.

94 Paul Healy, “Divorced Catholics Find a New Life,” Daily News, April 12, 1976. 95 Phyllis Rolfe Silverman, “The Widow as a Caregiver in a Program of Preventive Intervention with Other Widows,” Menta Hygiene LIV. 4 (October 1970), pp. 545 546. 96 Goffman, op cit. 9′ Silverman, op cit., pp. 540-547. 98 Ibid., p. 540. 99 Cited in ibid., p. 542. ‘ 0 0 Ibid., pp. 542-543. 10’ Ibid., p. 101. ‘ 0 2 For an extensive analysis of the bene fits to those who staffed the Widow Service Line (a telephone hotline) see Ruby B Abrahams. “Mutual Helpin : Styles o P Caregiving in a Mutual Aid rograrn,” ir Captan and Killiba, op cit. 103 Phyllis R. Silverman. “Widowhoo, and Preventive Intervention,” Famil Coordinator XXI, 1 (January 1972), p. 95 1°4 “Bereavement Focus of Westchest. Program,” New York Times, December 1975.