To Save Tomorrow; 3; Spruce House

Now, in Spruce House, we've had three or four Christs, and our first approach to this has been to ignore all talk about being Christ. If we don't ignore it, we may actually criticize it. Person may say, peace on you, brother, and we may say, shut up. I don't want to hear that kind of crazy talk. Now, this sounds like a harsh, unsympathetic way of viewing the mentally ill. I would assert that it is really the most sympathetic and the most loving attitude to take.

When a man bends to fetus squirrel in written house square, he is immediately rewarded by the squirrel and by the smiles of pastors by. If a patient in a traditional mental hospital who has been walking about gesturing bizarrely, stoops to fetus squirrel, all that the hospital staff are likely to respond to is the gesturing, not the feeding. John Henderson contends that traditional mental hospitals are no place for people in trouble to go. The way people behave, he believes, is the result of the ways they've been responded to. If they've been loved for working hard, they work hard. If they behave in crazy ways, it is because people have paid a lot of attention to them when they were acting crazy. The person whom we call mentally ill is someone who has gotten a great deal more attention, more reward from acting crazily than from acting normally. In traditional mental hospitals, placed far from people's homes, where they treat mental

illnesses as a disease, the staff tends to pay a great deal of attention to patients when they're acting crazy and to ignore them when they do things like feeding squirrels and working and talking to each other. The staff's own behavior, John, says, unintentionally generates more of the craziness they believe they are treating. In those hospitals, acting crazy is rewarding, acting normally is not. So when John accepted the directorship of Spruce House, he did so because it was located in Center City, in Philadelphia, because it was intended to intercept people who were going to state hospitals and because he could design a program he thought would be really helpful. So at Spruce House, we're taught to ignore crazy behavior and reward immediately any behavior that is normal. And since normal people for John are those who can socialize comfortably with each other and work effectively, all of the programs of Spruce House are built to reward success and working and socializing. Spruce House is quite intimately involved in the city.

One can look out the windows and see the rush hour traffic not moving in the street below. An ordinary family lives four to eight inches away on the other side of the wall. There are 19 people on the staff. Our capacity and patience, and we call them residents, is 20. 19 staff for 20 patients is a very advantageous relationship. Each case is reviewed in a general staff meeting once a week. We had a part-time psychiatrist, a full-time social worker, Mr. Skolls, who is a program supervisor, a full-time nurse in Scully, a licensed practical nurse, and nine counselors. These are young men, many of them undergraduates in college, and they bring to bear a kind of

youthful exuberance and dedication and intensity that you hardly ever find in a paid employee anywhere. They're not there for the money, they're there for the hell of it, they're there because it's fun, and because it swings, and because they think it's worth doing, and one of the big advantages for me is having an opportunity to work with these people who run me ragged and keep me young. A day bonus, because it's only tomorrow on June and Swim Day, and we haven't been any day this week, but I explain to them that on those days, unless he goes to the June and Swim, he can't get, you know, a day boss. He's very interested in bonuses. No, he will go now, I think, because it will come in short, and it will become apparent that he can't earn anything if he says, he costs him five to go, but when he gets there,

he can earn all kinds of ripples, so I think this will be effective. One talk about the bill now, right? Everybody happy with the pattern? They're looks. Yeah. Oh, I want to know what we're thinking about, this economy here, we're rather big stuff about whether we call our currency grants for ripples, and so right now we're calling them both, just sort of bridging the gap back from grants to ripples, because we're going to call them ripples again. The token economy, of course, tries to parallel a money economy, and if a resident works, he can afford food, he can get better accommodations, he can afford to go on various social functions. Much as if I work, I can get my food, by work hard, I can afford better accommodations, I can afford various social functions.

You can earn grants, as you all know, there's two main ways of earning grants, by dancing and by talking to the girls, I think you do. But the way it works is that for every dance that you dance, a complete dance that you dance, you receive one grant, and if you do ten or more, you receive a bonus. For every conversation of about five minutes, that's appropriate. No silly talk, nothing like that. You'll receive a grant, and if you talk for more than five minutes, you'll receive a bonus. On Monday evenings, the Coet Club meets an evening in which young ladies of the community come in to dance and socialize with our residents. They're also permitted to invite their wives or sweethearts, but not at the same time. We have a man who asks the girl to dance and she says no.

What he doesn't give up, he comes back again because he has been reinforced for doing so. Well, social programs try to accomplish two major goals. One is to produce coherent speech. The second is appropriate social interaction. We try to motivate the volunteers to ask residents, do you have a cigarette? Yeah.

During Coet Club, you can purchase things according to our monetary system, which are grants. Girls do not ask patients to dance like at the state hospital. The group of nurses might go to a social affair and they would look for the most disturbed person to ask him to dance, which is kind of dehumanizing. At 9 o'clock, the activity ends and the counselor at that time awards the grants for the activity. Okay, fellas, now I'm going to pay you for what you've done tonight in the dance. Sam, you got eight grants. I think that without the token economy, some of the residents would never make any efforts to interact at all. If they were getting everything that they wanted from the work program, there would be no reason for some of them to interact.

Some of them would be very happy being normal patients in a normal mental institution. This would satisfy every image that they have of them. I love it. You and Frank did the best of anyone. During myself, anyway, I really did. Thank you. What about my club? Am I going to get a pair of pins, tie and suit jacket? Four grants. Four grants? Oh, boy, that's cheap. A man who starts out in the toy factory where they make blocks for children at the Yale and Institute. These blocks are sent to them. The toy factory doesn't entail much work, but it's the first step and it is a big step. If a man can learn to produce there, then he can also produce in other areas. Most of my duties in the workshop center around to making sure that the men know what their job is and know how much they are going to be paid for doing the job.

What I think the tokens make a fellow get into the working situation, that you're really not going to work out your problems by sitting off in the corner. But as Bruce Housen tends to be two or three days and all this malachia bell, I can't do this. I have a headache. I'm sick. Seems to disappear and he's at his job because he wants to eat. He wants to go out on the pass. He wants to go down some. When he starts earning a certain amount of grants within a given time, then he is given another job somewhere else in the house. Maybe on domestic things. It may be in the kitchen where he has more freedom, where he has to decide a lot of things for himself, where he has to even work harder. But at the same time he even earns more and he can be able to buy more things. For many of our people, smiles and handshakes and hugs are not intrinsically reinforcing.

But by associating these social behaviors with chits and in turn with primary reinforcers, such things as a handshake or a wink become established as reinforcing in themselves so that when the person goes out into the real world, his behavior is maintained by a smile or a handshake. One of the criticisms that's leveled at us is that we are coercive. I can't really reply to that, perhaps we are. Our defense perhaps is that desperate ills, if you will, sometimes call for desperate measures. Work is available, no one is required to work. Neither is anyone required to be paid.

Say John, when you get a chance, guys, I'm going to make a big being tonight. Tonight at PsychoDrama, there will be two payments. There will be payments for appropriate coherent comments and appropriate participation in the scenes. Dr. Lowe would ask people if they want to get involved in a scene. You know what I would be satisfied if my family would at least call me once a week. See, they have a phone and I used to be able to call them and today got an unlisted telephone number. That really did that me upset and I put my mother when she refused to take me out on a discharge, you know, taking me out for a vacation light. I was thinking, once you know, I need the hospital, I got to try to leave it and leave it for good. See, because since I was 16 or 15, 14, I've been on medication and I will stay in now, 21.

Since I've been here, it's been practically about maybe my first time since I've been off medicine and I like to try staying off medication. When I go to bed at night, I just should not get this one. I want to hear from my aunt because I really miss my aunt because she's been like a mother to me and she's been better than my mother. I want to know how your family feels about you or at least how you think they feel about you. Does anybody expecting visitors with whom they might have a little difficulty and for whom it might be helpful just to rehearse? How, what do I say, how are you? I'm a sister, very up, I brought along Jill. I'm expecting to take me home, so I need to bring them back. So, why don't we start in a little way by rehearsing Mary, Jill's sister and Jill?

And Jill and Jill and Joker people? Yeah, better than while coming to visit you on Saturday. Seeing this Saturday after you know him, he knocked again. Me time for rest for the night, I talked to him and he was moving around. And there's a knock at the door at a concert. My camera is flashing. Let's go. How's the door at the door? How are you doing? How are you doing? All right, how are you? I'm doing this Jill. Jill is doing this. I know. And we don't know something. I just started with a little sister. No, no. No, no, no. Bill, you have a visitor here? Yeah. Hi, Bill. How are you? Pleased to meet you. Oh, nice day. How are you doing? Okay, Jill. Good.

What's the event? Yeah, it's like a peanut. Okay, Mary. Yeah, what have you been doing? I've been working down in a hospital. I'm a pop boy down there. I watch pots and pans and I do darn good, but I cut. I'm doing darn good down there, but I need help. Dr. Little, of course, leaves and the counselor pays everyone and specifically tells them why they are being paid. Because throughout the whole program, residents have to know why they are being reinforced. Because we can't leave it up to their judgment as to why they're getting grants. John, you've got five for your coherent comments. You've got five comments. More than five. You've got five and you've participated in two scenes. The second social group, which is called the Conversation Club, meets one hour a week, where the counselor is the group leader.

The counselor has chits, which he awards to residents as they produce coherent, rational conversation. The conversation can range from bourbon and Bach to baseball and boxing. The third socialization group is conducted by our head nurse, Ms. Kelly. Now, the conversation should be about one's own problems. You know, anybody in my family, you know, they really need it. I give them, but given my mother the hair from my face, I won't. They actually do more for one another at this level than I do. They really can sit down and talk about the problems they've had. And just how are they going to start solving these particular problems?

I can tell you through my mistake, maybe you could cross the front, where it I made in the state, there was all those detrimental to me. That's why I say you should be able to get out, go find like an urgency, go find your own place, get out of face lights and have a man or face lights myself. You don't even move out of town or out of the city from your family. Get your place in your own, go buy a brand new show on the place. I don't have to stay with parents, where it's like you say you work and give us my dad's money, save up enough money. Well, I pass out chits not just simply for conversation, but I will pass out chits if someone actually begins to identify their problem, and then I pass out more chits when they begin to say, I think I can do something about it, and this is what I'm going to do. That's been my problem, and I'm scared to face you. I'm arrogant enough to lay my experience on the line against anybody else.

This is kind of a hutzpah, an arrogance that you need in this business. You need to be able to play God, not unthinkingly, I think you have to be aware that you can hurt people, and you have people's destinies in your hand, you ought to be mindful of it. But the alternative is also unacceptable. What the hell use am I to you if I'm not going to do anything for you? A person who gives you unconditional positive regard, what on earth is my use to you if I cannot influence you to change your behavior? Because your feelings and thoughts are getting you into trouble and messing up your life. So I think that issue has to be faced. If the therapist does not influence, I would argue he is useless, he should be discharged, he shouldn't pay him. The fourth therapeutic group meeting is very interesting in that the members of the group reward or reinforce each other.

The therapist happens to be myself, does not have any tokens in hand. Rather, each man has six tokens which are worthless until he gives them to someone else. And he is supposed to give them to someone else on the occasion of saying something that helps him to clarify his own problems in social living or his own symptomatic ways of behaving. I like to be about 36 and a half years old, but I wouldn't like to have all the anger, pen up, I do have pen up in time. So I can solve it easily for other people, I can easily do it for myself. I can tell him the easiest way to solve that problem about that letter. To help somebody, kitty, cat, eventually to help, drop in or something and tell them what.

I want you to do it yourself, thank you. The Lord gives me the Lord, he tells you in one breath that if you're in his way, he'll step on your dead body and then he likes your cigarette, an after friendship, and then he says, why don't you do it yourself? The total effect of this is to have Gary very much on the ropes. You very hung up on something, on a relationship between each other, and he probably has a lot to say about the relationships that each of you enters into, so that if you could ever work this out, this thing, whatever it is, it's between you, it might have tremendous implications for all the other relationships that each of you is involved. I've lived with less beings, homosexuals. I've lived with innocent children, two to three years old, boys and girls, and had the same kind of feelings for both the doth and kids, so it's not scary to me anymore, as long as I can talk about it.

What they're really doing is a kind of little dance around each other, which maintains a safe distance, and it illustrates the ambivalence that they feel, that there are approach tendencies, or they wouldn't be doing the little dance in the first place, but they're also profound fears, which keep them at a distance. So one of the things we're trying to do is to cut through all of this, and to say, let's define a relationship, let's reach out, let's take a chance, we won't die if we're rebuffed. So frequently, troubled people will make one tentative hesitant overture, and be rebuffed, perhaps unintentionally, and retreating to themselves and never come out again, so that we're trying to produce behavior of this sort that will persist in the face of no reinforcement. Is that how you say, I like you, and I think you're trying to cover me.

I never get a chance to get best a secretary of state with most men. I'm Tuesday and Thursday mornings, many residents go to the YMCA, the council informs each resident why he qualifies to go. And how he can earn grants going to the Y and coming back from the Y, and also participating in the activities at the Y. They can be paid for effectively following the rules and participating in the volleyball game or whatever the game is. And that's where the YMCA is located.