Philadelphia Association households

1. Introduction

Version followed: the Philadelphia Association (PA) community houses as the PA currently describes them (PA website pages "Community Houses" and "How the houses work", and the PA houses leaflet, 2020s), read alongside the PA's own retrospective writing (Davenport 2005 occasional paper; PA 60th-anniversary publication, c.2025). Kingsley Hall (1965–1970) and the 1970s network are used only for history and the harm account [source: PA Community Houses; PA houses leaflet; Davenport 2005; PA 60th Anniversary; Chapman 2021].

This is not a manualised therapy. It is a named institution's residential practice: small shared houses in North London where people in serious emotional distress live together, run the house themselves, meet several times a week with non-resident house therapists, and are each in individual psychotherapy. The PA was founded in 1965 by R. D. Laing with David Cooper, Aaron Esterson, Joseph Berke and others; it began with Kingsley Hall in East London (1965–1970), and the PA reports having run more than twenty houses since, with two operating today [source: PA Community Houses; Wikipedia: Philadelphia Association; Chapman 2021].

Core idea of change: a crisis lived through in ordinary shared life, with others' attention and without being managed as an illness, can be transformed. The PA describes the houses as offering "asylum and hospitality to people in distress"; a founding statement calls the treatment "attention to each other, for attentiveness is therapy"; a later phrase for the aim is to "replace hospital with hospitality". Residents use the house to look at how they relate to others; the conflicts of daily living, often repeating family patterns, become the material of the meetings [source: PA Community Houses; PA 60th Anniversary; PA houses leaflet; Davenport 2005]. The intellectual frame is phenomenological and existential (Laing; later Heidegger, Merleau-Ponty, Bachelard on dwelling, especially via Robin Cooper), with a later psychoanalytic emphasis on containment and transference [source: PA 60th Anniversary; Davenport 2005].

What a practising therapist can use: (a) referring a client to a PA house; (b) working as the individual therapist of a resident; (c) training as or acting as a house therapist; (d) borrowing the model for a supported-living or crisis-house setting [synthesis]. The PA's fullest account of current practice is Paul Gordon's book An Uneasy Dwelling (2010), which is drawn on only through the publisher's description and contents; detail below that goes beyond those pages is marked [synthesis] or [uncertain].

2. Framework

The PA does not describe formal phases. The stages below are the sequence its pages and papers describe for one resident's stay; labels are mine [synthesis; content source: PA houses leaflet; How the houses work; Davenport 2005].

Stage A: Enquiry and application

Goal: decide whether a house is the right place for this person now, and whether the person wants it.
Format: self-referral or referral by someone else, by phone or email to the PA office; the office puts the applicant in touch with a house therapist, who explains the process and talks with them by phone or in person; there is an application form [source: PA Community Houses; PA houses leaflet].
Who it suits: adults of any age, including people with psychiatric diagnoses or past admissions. Usually unsuitable: current or recent drug or alcohol addiction, or a history of violence [source: PA houses leaflet].
Practical conditions: the person needs to pay rent or be eligible for Housing Benefit plus a personal contribution to service charges; houses need no statutory funding; there is no move-on or permanent housing [source: PA houses leaflet].

Stage B: Visiting and joint decision

Goal: mutual trial; the existing household helps decide.
Format: the applicant may attend a few house meetings before a decision. In the 2005 account, applicants came to a Thursday meeting and then visited several times, and the group reached "yes", "no" or "come back next week" [source: PA houses leaflet; Davenport 2005]. Whether the final decision rests with residents, therapists or both today is not stated [uncertain].
Criterion to move on: the household and house therapists agree, and the person accepts the conditions (meetings, own therapy, rent).

Stage C: Living in the house

Goal: live through the difficulty at one's own pace; examine one's ways of relating in the shared life and the meetings.
Format: own room; residents run the house day to day; three house meetings a week at fixed times with the house therapists; individual psychotherapy outside the house throughout (the PA can help find low-cost therapy); therapists available between meetings as needed [source: PA houses leaflet; How the houses work].
Typical course: Davenport describes an early "honeymoon" giving way to conflicts over daily living [source: Davenport 2005].
Length: open-ended; depends on individual circumstances and on commitment to the work of the house; the PA advises it is not worth considering a stay of under a year [source: PA houses leaflet; How the houses work].

Stage D: Leaving

Goal: move to independent living with what has been worked through.
The PA notes rehousing after a stay has become hard and that houses provide no move-on [source: PA houses leaflet; PA 60th Anniversary]. How endings are worked with in meetings is not described in the sources used [uncertain]; see 4.10 [synthesis].

Staffing: house therapists do not live in; the PA settled on a team of two therapists per house (2005 account); recent named house therapists include Paul Gordon and others at Freegrove Road [source: PA houses leaflet; Davenport 2005; PA 60th Anniversary]. Supervision and the PA training/Study Programme sit behind the work; the programme describes its path as phenomenological [source: PA 60th Anniversary].

3. Guiding principles

Hospitality, not hospital. Offer a home and a place, not a ward. Practical: treat the resident as a member of a household, not a patient on a caseload [source: PA Community Houses; PA 60th Anniversary].
Attentiveness is the treatment. Practical: the main tool is careful attention to each person, in meetings and in passing, rather than techniques [source: PA 60th Anniversary].
Letting be (not indifference). Hugh Crawford's teaching as recalled by the PA: let people be, but this is not neglect. Practical: do not rush to fix, diagnose or medicate; stay interested and present [source: PA 60th Anniversary].
Living through, at one's own pace. People may "live through what they must, without jeopardy". Practical: allow distress, regression or withdrawal its time, while keeping the person and others safe [source: PA 60th Anniversary; PCCS description of Gordon 2010].
Structure emerges from members' concerns. Robin Cooper: a house's structure is "shaped or opened" by its members' concerns. Practical: few imposed rules; rules and arrangements are worked out in meetings [source: PA Community Houses].
Residents run the house. Practical: shopping, cleaning, rota, money, visitors are residents' responsibility; therapists facilitate, they do not manage [source: PA houses leaflet].
Everyday life is the therapeutic material. Practical: disputes about dishes, noise or rooms are taken to the meeting as relational material, often echoing family patterns [source: Davenport 2005; PA houses leaflet].
Containment. In the later PA, holding and containing distress came to take priority over free expression. Practical: meetings at fixed times, two therapists, and an individual therapist give a frame strong enough to hold crises [source: Davenport 2005].
Phenomenological understanding. Practical: try to understand what an experience means to the person rather than classify it [source: PA 60th Anniversary; Chapman 2021].
Scepticism about psychiatric labels and admission. Practical: diagnosis does not exclude anyone, and hospital is not the automatic answer to crisis, but houses now increasingly use psychiatric services for crises they cannot hold [source: PA houses leaflet; Davenport 2005; PA 60th Anniversary].
Commitment and reciprocity. Staying depends on commitment to the house's work. Practical: attendance at meetings and in one's own therapy is a condition, not an option [source: PA houses leaflet; How the houses work].
Privacy of household life. One PA contributor holds that what happens between people living together should stay private. Practical: protect confidentiality of house life within agreed safety and legal limits [source: PA 60th Anniversary; limits are synthesis].

4. Intervention inventory

The PA publishes no technique list. These are the concrete practices its own pages and papers describe. Where the sources give the practice but not the steps, the steps are my operational reading, marked [synthesis]. All example language is illustrative and mine, not PA wording.

4.1 First contact and screening by a house therapist

Purpose: give the applicant a real picture of house life; screen out situations the house cannot hold. Use at every enquiry [source: PA Community Houses; PA houses leaflet].
Steps: (1) The office passes the enquiry (self or other referral) to a house therapist. (2) The therapist talks with the applicant by phone or in person. (3) Explain the conditions: own room, residents run the house, three weekly meetings, being in individual therapy, rent or Housing Benefit plus service-charge contribution, open-ended stay of usually at least a year, no move-on housing. (4) Explore the stated exclusions: current or recent addiction, history of violence. (5) Ask what the person hopes the house will offer and what is happening in their life now. (6) Give the application form and invite them to meetings [source: PA houses leaflet for content; order and step 5 synthesis].
Example language (illustrative): "The house isn't a hospital and nobody lives in as staff. You'd be sharing a home with a few others who are also going through hard times. We meet three times a week, and everyone has their own therapist outside. What draws you to that?"
Watch for: a referrer seeking a placement rather than the person seeking it; need for 24-hour staffed care, detox or medical supervision; current violence. Working: the applicant asks questions about daily life and wants to visit [synthesis].

4.2 Visiting meetings and the household's decision

Purpose: mutual choosing; the household has a stake in who joins [source: PA houses leaflet; Davenport 2005].
Steps: (1) Invite the applicant to a house meeting. (2) Let residents ask and answer questions directly. (3) Invite repeat visits; the 2005 account describes several visits. (4) Discuss the applicant in a meeting without them and reach a decision: yes, no, or "come back next week". (5) Tell the applicant and agree a move-in date [source: Davenport 2005; step 4 detail on who decides today uncertain].
Example language (illustrative): "We'd like you to come again next week. People here want a bit more time to get to know you, and you can see whether it feels like a place you could live."
Watch for: the group excluding someone because they evoke a disliked family figure; a lonely group admitting anyone; applicants feeling judged. Working: residents speak of the applicant as a possible housemate, not a case [synthesis].

4.3 The house meeting (three times a week)

Purpose: the central structure of the house. Residents meet the house therapists at fixed regular times to "talk about whatever is important" [source: PA houses leaflet; How the houses work].
Steps: (1) Keep the times fixed and start and end on time. (2) Do not set an agenda; let practical and personal matters come in together. (3) Notice who is absent, silent or in their room, and wonder about it aloud. (4) Take everyday disputes (food, noise, cleaning, guests, rent) seriously as practical problems and as ways people are relating, including echoes of family life. (5) Help residents speak to each other rather than through the therapists. (6) Leave decisions about how the house runs to the residents where possible; record agreements. (7) Name concerns about someone's safety openly and agree what the group will do [source: fixed regular meetings and open content from PA houses leaflet; family echoes from Davenport 2005; steps 3 and 5 to 7 synthesis].
Example language (illustrative): "The kitchen has come up three meetings running. I wonder whether it's only about the washing-up, or about who feels looked after here." / "Sam hasn't been at the last two meetings. Does anyone know how he is?"
Watch for: therapists running the house by default; meetings becoming only administration or only interpretation; scapegoating of one resident; one resident monopolising. Working: residents bring conflict to the meeting rather than acting it out, and meetings shift from complaint to reflection [synthesis].

4.4 Residents running the house

Purpose: ordinary living is the setting of change; responsibility for a shared home is itself therapeutic [source: PA houses leaflet; PA 60th Anniversary].
Steps: (1) Residents organise shopping, cooking, cleaning, bills and house money, and repairs reporting. (2) Arrangements (rota, shared meals, guests) are made and changed in meetings. (3) Therapists do not step in to do tasks; they help the group think about failures. (4) Use the house and garden as shared resources; PA writers note gardens have been neglected as places of healing [source: residents' responsibility from PA houses leaflet; gardens from PA 60th Anniversary; steps 2 and 3 synthesis].
Example language (illustrative): "The electricity bill is overdue. How do you want to sort it out between you?"
Watch for: a resident too unwell to do tasks being resented; one person carrying everything; everyone withdrawing to their rooms (a PA contributor recalls this). Working: residents adjust the load for someone in crisis and talk about it openly [source for withdrawal: PA 60th Anniversary; rest synthesis].

4.5 Individual psychotherapy alongside residence

Purpose: each resident has a private space outside the household; a condition of residence [source: PA houses leaflet; How the houses work].
Steps: (1) Confirm the person is in, or will start, individual therapy; the PA can help find low-cost therapy through its own service. (2) Agree with the resident what, if anything, the individual therapist and house therapists may share; in Davenport's account Hugh Crawford also saw residents individually. (3) If you are the individual therapist: expect house conflicts to be brought to you; help the person take them back to the meeting rather than resolving them for the house [source: steps 1 and 2 partly PA houses leaflet and Davenport 2005; consent and step 3 synthesis].
Example language (illustrative, individual therapist): "It sounds important that you tell the house what you've told me about how Thursday felt."
Watch for: splitting between individual and house therapists; therapy lapsing (a condition of residence); dual roles if a house therapist is also someone's individual therapist [synthesis].

4.6 Availability between meetings and being with someone in crisis

Purpose: house therapists do not live in but are available "as and when necessary" [source: PA houses leaflet].
Steps: (1) Give residents a clear way to reach a house therapist between meetings and say what to do if no one answers. (2) In a crisis, go and be with the person, or speak by phone; listen to what the experience is like for them. (3) Involve the household in who stays with the person and for how long. (4) Assess risk to self and others using standard practice; agree when the GP, crisis team or emergency services will be called. (5) Bring the crisis back to the next meeting [source: step 1 PA houses leaflet; steps 2 to 5 synthesis; current PA use of psychiatric services for crises from Davenport 2005].
Example language (illustrative): "I'm here now. You don't have to explain it properly. Tell me what it's like right now."
Watch for: residents left to hold acute risk alone overnight; burnout in residents who sit with others. Risk flag: the out-of-hours gap in a non-staffed house; see Harm account.

4.7 Allowing a person to live through an extreme state

Purpose: the founding idea that psychosis or breakdown may be lived through, without being medicated or restrained, as a possibly meaningful passage. Kingsley Hall residents lived through such states without medication, ECT or restraint; the PA says houses still let people go through experiences at their own pace [source: Chapman 2021; PCCS description of Gordon 2010; Davenport 2005].
Steps: (1) Agree beforehand, with the person when well, what they want if they become very disturbed: who to contact, medication wishes, when hospital is wanted. (2) During the state, keep someone available, keep the person fed, hydrated and physically safe, and keep the household informed. (3) Set clear thresholds (not eating or drinking, serious self-harm, danger to others, physical illness) at which medical or psychiatric help is called regardless. (4) Review in meetings what the household can and cannot hold [synthesis; the 2005 PA paper notes that psychotic crises are now feared and increasingly handled by psychiatric care].
Example language (illustrative): "We want to give you room to go through this. We also agreed with you that if you stopped eating we'd get the doctor in, and that's where we are."
Watch for: physical neglect, dehydration, self-harm, danger to housemates, a carer group overwhelmed. Risk flag: unmanaged prolonged regression and refusal of all treatment are where harm has been reported; see Harm account.

4.8 Working with conflict, aggression and asking someone to leave

Purpose: keep the house safe enough to live in while treating conflict as material [source: Ivimy 2017; Chapman 2021; PA houses leaflet].
Steps: (1) Bring the incident to a whole-house meeting quickly. (2) Hear from everyone affected, including the person who acted. (3) Reach an explicit agreement about the behaviour (at Kingsley Hall a resident who hit people made a verbal agreement in a whole-house meeting not to hit). (4) Review it at the following meetings. (5) If agreements fail or someone threatens safety, ask them to leave (Kingsley Hall required an aggressive, non-paying resident to leave). (6) Involve police or services when anyone is at risk [source: steps 1, 3, 5 Ivimy 2017 and Chapman 2021; steps 2, 4, 6 synthesis].
Example language (illustrative): "Several people are frightened after last night. We need to hear from everyone, including you, and agree what happens now."
Watch for: normalising violence as "part of the journey"; scapegoating; newcomers getting suspicion after a bad experience (reported after the Kingsley Hall exclusion). Working: agreements hold and the person stays engaged [source: Chapman 2021; rest synthesis].

4.9 Medication and psychiatric services: the resident's choice, with a safety net

Purpose: respect a resident's own decisions about medication and psychiatric contact while not leaving them unsafe. At Kingsley Hall residents chose whether to take prescribed drugs; former PA residents report using less medication and fewer services; the current PA houses accept people with psychiatric histories and now often use psychiatric care in crises [source: Ivimy 2017; PA houses leaflet; Davenport 2005].
Steps: (1) Record each resident's GP, any psychiatric team and current medication at entry. (2) Make clear that the house does not prescribe, stop or supervise medication; changes are made with the prescriber. (3) If a resident wants to reduce medication, encourage a planned, supervised reduction and tell the house so people know what to watch for. (4) Keep a working relationship with local crisis and community teams [synthesis].
Example language (illustrative): "Coming off it is your decision. I'd want you to do it with your doctor, slowly, and let the house know so people can look out for you."
Watch for: abrupt stopping of antipsychotics or other medication; group pressure against medication as "giving in"; a staff member giving a sedative informally (one Archway account describes a tranquiliser given to an overly affectionate resident). Risk flag: see Harm account [source: Chapman 2021; rest synthesis].

4.10 Staying, endings and leaving

Purpose: an open-ended stay that ends well. Stays depend on circumstances and commitment; under a year is not advised; there is no move-on housing and rehousing has become hard [source: PA houses leaflet; PA 60th Anniversary].
Steps: (1) From admission, name that the house is a temporary home and that leaving is part of the work. (2) Raise in meetings when a resident has stopped attending or engaging, since staying depends on commitment. (3) Plan housing early, including housing applications and benefits. (4) Give leaving time in meetings so the household can mark it. (5) Allow former residents a clear, bounded way to stay in touch [source: "temporary home" from Davenport 2005; steps synthesis].
Example language (illustrative): "You've been here two years. It might be time to start thinking together about what comes after the house, given how long housing takes."
Watch for: residents staying because there is nowhere to go; abrupt departures, including families removing a resident (reported at Archway) [source: Ivimy 2017; rest synthesis].

4.11 The house-therapist team, supervision and "holding in mind"

Purpose: keep the therapists thoughtful and the frame steady. The PA moved from large therapist teams, linked by Davenport to alliances and power struggles, to two therapists per house; Hugh Crawford spoke of a "mycelium principle" linking households and those holding them in mind [source: Davenport 2005; PA 60th Anniversary].
Steps: (1) Two house therapists share each house and meet to think about it between meetings. (2) Take the house to regular supervision or a PA peer group. (3) Discuss your own reactions to residents, including rivalry or favouritism. (4) Agree between you who is available out of hours [source: steps 1 Davenport 2005; steps 2 to 4 synthesis].
Watch for: one therapist becoming the house's charismatic centre; splits between the pair played out in the house [synthesis].

4.12 Neighbours, landlords, funding and the local authority

Purpose: keep the house viable. Kingsley Hall met strong local hostility; later houses depended on local-authority funding or rent and Housing Benefit; Gordon's book covers dealing with neighbours and authorities [uncertain] [source: Chapman 2021; Davenport 2005; PCCS description of Gordon 2010].
Steps: (1) Keep an active landlord and maintenance relationship (the PA reports its houses undergoing refurbishment). (2) Have residents support each other with benefit and rent claims. (3) Respond quickly and politely to neighbour complaints and discuss them in the house meeting [source: step 1 PA 60th Anniversary; rest synthesis].

5. Handling problems

The PA sources say little about problem management. Items marked [synthesis] are guidance in the PA's spirit; specific reported problems are cited.

Resident withdraws to their room and stops coming to meetings. A PA contributor recalls most residents spending most of their time in their rooms [source: PA 60th Anniversary]. Response: name the absence in the meeting; a therapist or resident knocks and invites; check the person is eating and safe; if it persists, link it to the condition of commitment and review with their individual therapist [synthesis].
"Honeymoon" ends and household conflict escalates. Expected; often replays family dynamics [source: Davenport 2005]. Response: take each dispute to the meeting; separate the practical fix from what it stirs up; guard against one person becoming the scapegoat (a Kingsley Hall resident felt cast as a "sacrificial scapegoat") [source: Chapman 2021; response synthesis].
Aggression or violence. Response as 4.8: whole-house meeting, explicit agreement, exclusion if it fails, police if anyone is in danger. A history of violence is usually an exclusion criterion at entry [source: PA houses leaflet; Ivimy 2017; synthesis].
Acute psychotic crisis or suicide risk. The houses are not staffed overnight. Response: standard risk assessment; agreed thresholds for crisis team or emergency services; do not leave housemates holding acute risk; safety planning, including safer storage or removal of means, done with the person and their individual therapist; afterwards, process in the meeting [synthesis; PA now often uses psychiatric care in crises, Davenport 2005]. Risk flag: 4.6 and 4.7.
Refusing food, fluids or physical care during a regressed state. Response: physical health threshold for GP or emergency help regardless of philosophy [synthesis]. Risk flag: see Harm account (Mary Barnes was tube-fed in hospital before Kingsley Hall; prolonged regression there) [source: Chapman 2021].
Non-adherence: rent, tasks, own therapy lapsing. Response: raise it in the meeting; agree a plan; if commitment cannot be restored, discuss leaving, since staying depends on commitment [source: PA houses leaflet; response synthesis]. Kingsley Hall asked a non-paying, aggressive resident to leave [source: Chapman 2021].
Rupture with house therapists. Response: say it in the meeting; acknowledge the therapists' part; use the second therapist and supervision; individual therapist helps the resident bring it back [synthesis].
Group closing ranks against newcomers. Reported after an exclusion at Kingsley Hall [source: Chapman 2021]. Response: name it in the meeting before admission decisions [synthesis].
Families removing a resident. Reported at Archway [source: Ivimy 2017]. Response: an adult resident decides; offer a meeting with family if the resident wants; respect the decision and leave the door open [synthesis].
Medication stopped abruptly. Response: as 4.9; involve the prescriber; tell the house what to watch for [synthesis].
Substance use in the house. Current or recent addiction is usually excluded [source: PA houses leaflet]. Response if it emerges: meeting, explicit agreement, referral to specialist services, leaving if it endangers the house [synthesis]. Risk flag: drug use (LSD) was part of Kingsley Hall culture; see Harm account.
Charismatic therapist, boundary or power problems. Response: two-therapist structure, supervision, PA governance and complaints route; no sexual or financial relationships with residents [synthesis]. Risk flag: see Harm account.
Nowhere to move on to. The PA reports no easy rehousing [source: PA 60th Anniversary]. Response: plan housing from early in the stay (4.10) [synthesis].

Harm account

Scope: documented risks of unstructured therapeutic communities in the PA line. The sources used document conflict, violence, drug use, local hostility, power problems and one death of a patient associated with PA figures; they document no deaths, suicides or sexual abuse inside a PA household. Gordon (2010), the main history of the houses, is not drawn on here, so this account is thin and may be incomplete [uncertain].

What was actually done

Kingsley Hall, Bromley-by-Bow, East London, 1965–1970. Leased by the PA from the building's trustees; psychiatrists, helpers and people in psychotic states lived together, in theory as equals. There was no paid staff and no formal therapeutic programme or requirements; admission was usually through knowing someone in the network. Residents could live through disturbed states without medication, ECT or physical restraint [source: Chapman 2021; Wellcome record of Harris 2012; Ivimy 2017].
Regression. Mary Barnes, previously hospitalised and tube-fed for schizophrenia, "regressed to babyhood" at the Hall and went through about five years of extreme distress, with Joseph Berke as her main helper; her and Berke's joint book, Two Accounts of a Journey through Madness, describes it [source: Chapman 2021].
Drugs. A ground-floor room was known as the LSD room; residents and visitors report taking acid there; Laing is reported sometimes to have used LSD with patients [source: Chapman 2021; Ivimy 2017].
Confrontation and group pressure. Dinner-table exchanges were confrontational: Laing questioned residents about how they expected to die; one participant was drenched with wine and felt cast as a scapegoat; women were described as marginal and finding it hard to settle [source: Chapman 2021].
Violence and medication refusal. A resident who mostly refused antipsychotics hit other men, including Leon Redler; the house's response was a whole-house meeting and a verbal agreement. A hospital consultant charged Laing and Redler with negligence over this man's care (outcome not stated in the source) [source: Ivimy 2017].
Exclusion and local hostility. A local man who did not pay rent and became aggressive was made to leave. Neighbours were largely hostile; accounts describe a gang outside and the Hall "under attack". The trustees did not renew the lease in 1969 [source: Chapman 2021].
Archway Community (1970s). Filmed in Asylum (1972) in chaotic conditions; families removed two residents; one helper reports giving a tranquiliser to an overly affectionate resident [source: Ivimy 2017; Chapman 2021].
Wider PA practice. The PA experimented with practices including "rebirthing"; details of what was done are not in the sources used [source: Ivimy 2017; uncertain]. Davenport reports large early therapist teams marked by alliances and power struggles and a male-dominated team [source: Davenport 2005]. PA writers acknowledge tensions about Laing's personal conduct without detail in the source text [source: PA 60th Anniversary; uncertain].
A death. Ivimy reports that a woman, Anna, referred by Laing to Redler, had left hospital against advice refusing ECT and probably medication, then set herself on fire and died six weeks later. The source does not say she lived in a PA household [source: Ivimy 2017; setting uncertain].

How it caused harm

No structure, no one responsible. With no staff roles, programme or entry criteria, risk sat with whoever was present; strain on the few psychiatrists holding things together helped end Kingsley Hall [source: Ivimy 2017; Chapman 2021]. Mechanism: diffusion of responsibility and burnout of informal carers [synthesis].
Untreated or prolonged extreme states. Refusal of all medication in severe psychosis left people violent, wandering and at risk of police pick-up and re-admission; one associated patient died [source: Ivimy 2017]. Prolonged regression can mean physical neglect and dependence; Barnes's recovery was long and arduous [source: Chapman 2021].
Drugs. LSD use among people in psychotic or near-psychotic states; Berke said no one was the worse for it, but no records were kept [source: Chapman 2021]. Whether harm resulted is not documented [uncertain].
Group dynamics. Confrontation, scapegoating, marginalisation of women and suspicion of newcomers [source: Chapman 2021]. Charismatic leadership and team power struggles [source: Davenport 2005; PA 60th Anniversary].
External threat. Neighbour hostility and attacks on the building [source: Chapman 2021].
Who was most at risk: people in acute psychosis without medication; residents subject to group confrontation; women; residents whose families could remove them; residents with nowhere to go after leaving [synthesis from the above].
Later PA response. The PA moved toward containment, two-therapist teams, required individual therapy, exclusion of current addiction and violence, and use of psychiatric care in crises [source: Davenport 2005; PA houses leaflet].

Recognising it today

Features to notice in a house, retreat or "healing community": no named person responsible; no entry criteria; "let them go through it" applied to someone not eating, drinking or sleeping; pressure against all medication; drug use (including psychedelics) framed as therapy outside licensed research; confrontational group sessions; a charismatic founder at the centre; no complaints route or governance [synthesis].
Phrases: "breakdown as breakthrough", "the journey must not be interrupted", "hospitals only harm", "no hierarchy here" used to deny anyone's responsibility [synthesis; the ideas are documented in Chapman 2021 and Davenport 2005, the phrasing is mine].
How the current PA houses differ: fixed meetings three times a week with two named therapists; individual therapy required; exclusion of current addiction and violence; a charity with trustees; use of psychiatric services when needed [source: PA houses leaflet; Davenport 2005; PA Community Houses]. Soteria-type houses descend from this line (Mosher modelled work on the Hall) [source: Chapman 2021].

What to do instead and how to help those harmed

Safer alternatives: current PA houses or other structured crisis houses and therapeutic communities with governance, a clear safety net and links to mental-health services; for first-episode psychosis, standard early-intervention care alongside psychological therapy [synthesis].
Assessing clients harmed in such settings: ask about what happened there in their own words; screen for trauma symptoms, shame, distrust of both psychiatry and alternative communities, drug-related effects, and loss of housing or family ties [synthesis].
Treatment: trauma-informed, collaborative work; validate both what helped and what harmed; rebuild links with GP and services at the person's pace [synthesis].
Duties: follow your professional body's code; report safeguarding concerns about adults at risk to the local authority; raise concerns about a practitioner with their registering or accrediting body and, for the PA, through its office and trustees; call emergency services where life is at risk [synthesis; PA is a registered charity, source: PA Community Houses].

Sources

Sources:

Further reading (not drawn on beyond descriptions):

Gordon, P. (2010). An Uneasy Dwelling: The Story of the Philadelphia Association Community Houses. PCCS Books.
Barnes, M. & Berke, J. (1971). Mary Barnes: Two Accounts of a Journey through Madness.
Cooper, R., Gans, S., Heaton, J. M., Oakley, H. & Zeal, P. (1989). Thresholds between Philosophy and Psychoanalysis: Papers from the Philadelphia Association. Free Association Books.
Laing, R. D. (1960). The Divided Self.

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