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Villa 21

UnderworldAnti-psychiatry: David Cooper and  the Villa 21 Experiment

Oisin Wall

The ‘Anti-Hospital
In 1962 David Cooper, the South African doctor who coined the term ‘anti-psychiatry’, established an experimental therapeutic community in Shenley Hospital, Hertfordshire. It built on the therapeutic community and asylum liberalisation movements that flourished in Britain in the post-war years. The community, which became known as Villa 21 or ‘the anti-hospital’, was an ‘ultra permissive’ experiment which sought to restore power and autonomy to patients by levelling staff-patient distinctions and giving them democratic control of the ward (Cooper, 1965; Laing, 1976). Over the four years of its existence the Villa 21 community would test the boundaries of what was possible, not only in the hospital but also in the therapeutic community and asylum liberalisation movements generally (Cooper, 1967).
This article will describe the origins and development of the ward, some of the people who inhabited it and the conflict that emerged between the community and the rest of the hospital. Ultimately it will discuss Cooper’s psychiatric, philosophical and political influences and how they shaped the Villa 21 experiment.

Focus on the patient not the ‘illness’
Between the 1940s and the 1960s the psychiatric world in Britain changed radically. The therapeutic community movement built on experiments with group therapy and therapeutic communities conducted during the Second World War and on the formation of the National Health Service in 1948. By the mid-1950s the therapeutic community had become one of the dominant models for both small group therapeutics and in large psychiatric hospitals (ECMH, 1953; Rees, 1957). On top of this, chlorpromazine, the first successful anti-psychotic medication, was released in 1952 (López Muñoz et al, 2005). These factors, along with wider social changes, made liberalisation the order of the day in psychiatry. Across the country wards were unlocked, patient social clubs and patient-run hostels were established, hospitals took down the railings or walls around their grounds, and the use of physical restraints and padded cells was increasingly discouraged.
Built in 1933 as a series of self-contained wards, or villas, Shenley Hospital was spread out over the former Porter’s Park estate in Hertfordshire. The hospital was originally meant to house 1000 psychiatric patients but that population doubled within thirty years. New wards had been built but not enough to keep pace with the steadily growing population. Moreover, few renovations had been carried out so by the early 1960s the hospital was cramped and its facilities were often decrepit (MHSC, 1963). The administration had been attempting to modernise the hospital. Money was tight so the physical renovation of the hospital was a slow process that began in the 1950s and continued well into the 1970s. However, the administration began to reform the running of the hospital and to modernise its practices. They also sponsored several experiments that would, they believed, show off the hospital as modern and forward-looking.

Psychiatry 1
In the early 1960s, David Cooper was a radical young senior registrar at Shenley. He had come to Britain from South Africa and, it is rumoured, could not return because he was known to the security services as a member of the South African Communist Party (Berke, 2015). In Britain he had befriended R.D. Laing and in the early 1960s was becoming increasingly involved in the new left and the counter-culture. In spite of his radical beliefs, Cooper’s life in the early 1960s was still, in the words of Joseph Berke, “excruciatingly bourgeois”. He was a soft spoken and ambitious young psychiatrist, eager to test out his psychiatric and social theories in the traditional setting of the hospital.
Cooper’s most senior ally at Shenley was a consultant psychiatrist called S.T. Hayward. Hayward was a firm believer in the need for hospital reform. In 1961 he published an article in The Lancet calling for a new type of ‘patients’ hospital’ (Hayward, 1961: 387). This hospital would focus on the patient rather than on the patient’s illness. The article warned against becoming fixated on a cure, arguing that the hospital must be “a place in which patients are allowed to be ill ¬– sometimes for a very long time” (Hayward, 1961: 387). Throughout the 1960s Hayward firmly aligned himself with those who called for a therapeutic community-style reform of the hospital, rather than deinstitutionalisation. In 1961 he and Cooper submitted a grant proposal to the Regional Hospital Board (CRSC, 1961). Although this proposal was refused the plan received the support of the hospital.

The creation of a commune and the relaxing of rules
In 1962 Cooper was given control of Villa 21. The building was the former insulin coma therapy ward, insulin therapy having been discontinued in the late 1950s. Here he set up his experiment. The unit was in a self-contained villa with private rooms, dormitories, dining room, living room and a staff office. Cooper believed that in hospital patients became “institutionally deformed” as they learned how to act like a patient from those around them and to internalise the rules of the hospital (Cooper, 1967: 83). In light of this he filled the unit’s nineteen beds with male patients, mainly in their late teens and twenties, on their first admission to hospital. They ranged in background from a down-and-out Irish labourer to a wealthy public schoolboy who ran away from the hospital to try and buy a yacht. Around two thirds of the patients that passed through the unit had been diagnosed with schizophrenia while one third “bore such labels as adolescent emotional crisis or personality disorder” (ibid: 85). Accompanying these patients in the ward were seven nurses chosen for their calm and relaxed attitude, an occupational therapist, a psychiatric social worker and three doctors.
Cooper sought to abolish all except the most legally necessary regulation, all official roles and to create a kind of commune in which patients and staff interacted on an equal footing. He soon realised that the unit could not immediately become the ‘ultra-permissive’ community that he wanted. A culture would first have to be established which could accept this lack of rules. In the first few months of the community’s life Cooper set about establishing the organisational structures that would support the community in its experimental phase. The staff office was turned into a room for regular community meetings and patients were given a greater voice in the way the unit was run. Staff stopped wearing uniforms and rules about staff-patient interactions were relaxed. This early phase was very much in line with therapeutic community reforms elsewhere.
In 1963 the community moved into its most permissive experimental phase. As one patient put it “they were allowed to do more or less whatever the hell [they] wanted” and all rules were abolished except those forbidding public nudity and masturbation (Adam, 2010). The only roles played by the nursing staff were to act as intermediaries between the ward and the hospital and to hold the keys to the drug cupboard (Cooper, 1967). Apart from these roles they became community members like any other, with no more power in the running of the community than the patients. Indeed they seem to have intentionally played with the staff patient distinction. In 1966 the Royal Medico-Psychological Association, the precursor to the Royal College of Psychiatrists, held a divisional meeting at Shenley at which they heard lectures on Villa 21. One of these lectures was given by ‘Mr. F.P. Atkin’. This is likely to be a reference to Frank Atkin, the head charge nurse at the Villa. However some notes on the meeting refer to Atkin as a patient (RMPA, 1966). It seems likely that Cooper and Atkin were intentionally keeping the staff/patient distinction as vague as possible.
Just like the staff, the patients did not have any obligation in the maintenance of the villa. As a result the building began to deteriorate. Broken windows went unmended, rubbish began to accumulate in the halls and the building smelled of ‘Dettol and pee.’ While Cooper was away on holiday in Eastern Europe the community decided to reassert some rules about eating, cleaning and weekend leave (Adam, 2010). These stabilised the community to a degree and from then on the unit continued reasonably uneventfully until 1966 when Cooper left and Michael Conran took over.

Psychiatry 2

Group Therapy, medication and self-management
The treatment regime at Villa 21 seems to have been particularly interesting but has been difficult to reconstruct. Cooper was hostile to individual therapy and believed in the power of group therapy. This meant that patients had regular group therapy sessions with the rest of the Villa 21 community, some of which would be attended by Cooper but others were run by the community members themselves. However occupational and other therapies were provided elsewhere in the hospital, and patients might undergo these therapies alone or with patients off other wards. However in Villa 21 itself individual therapy was rare (ibid).
It is a common misapprehension that Cooper and the British anti-psychiatrists were opposed to the use of psychiatric medication. It is true that they opposed the use of drugs as a repressive tool that could be used to silence a patient for the convenience of the staff and others around him. However, they did not oppose the use of drugs for therapeutic purposes with the patients informed agreement and they sometimes used drugs like LSD and Largactil in their practices. At Villa 21 patients could request sleeping pills or tranquilizers if they felt that they needed them. This policy posed a problem, however, when patients were not capable of making decisions for themselves. For instance, when one patient was found playing with live electric wires and a bucket of water, a community meeting was held to discuss his behaviour, it being regarded as a threat not only to the patient himself but to the community as a whole. The meeting collectively decided that he should be medicated for a time (ibid).

Specialness and difference
Both staff and patients at Villa 21 saw themselves as different from the rest of the hospital. Workers in the Villa often felt alienated from their colleagues in the rest of the hospital. Many people among the hospital staff opposed Villa 21 and both doctors and senior nursing personnel wanted to end the experiment. Some opposed it on theoretical grounds, arguing against the ideas of Cooper and Laing, his collaborator outside the hospital, while others saw it as unhygienic and dangerous. Even the ordinary nursing staff were quite contemptuous of the experiment (ibid).
By contrast with the egalitarian spirit within the Villa, patients saw what they considered to be abuses of power by some members of staff in other parts of the hospital. These included verbal abuse, racism and violence (Adam, 2010). This contributed to the feeling that the Villa and its patients were different. This sense of difference led to increasing self-confidence. The Villa 21 patients even rejected the exercise of what could be thought of as normal institutional power within the hospital. On one occasion a nurse decided to enforce a hospital rule and rouse the patients out of bed on a weekend morning. Incensed by this incursion into the community, the patients rioted and threw the nurse out. When Cooper arrived in on the following Monday they explained what had happened and the nurse was never allowed into Villa 21 again. However, this difference was not to everyone’s liking and at least one patient had himself transferred to another unit because he just wanted to be treated like a conventional psychiatric patient (ibid).
The sense of being separate and ‘a bit special’ was compounded by their awareness that the community was an experiment. Many optimistically believed that by participating in it they were helping to advance not only psychiatry but society as a whole. At various points in the unit’s history patients were brought before the media or learned societies like the Royal College of Psychiatrists (RMPA, 1966). One patient remembers that he was often brought out to speak to these groups because he was “a sort of star patient… [because he] never went completely nutty.” Cooper made sure that the patients did not feel exploited by this, but rather fostered a sense of complicity (Adam, 2010).
This complicity and feeling that they were ‘special’ affected the way that they related to others in the hospital. They did not generally socialise with the patients from the rest of the hospital and rarely went to the Alpha Club, the hospital’s patients’ social clubhouse. This was because they saw the patients from the rest of the hospital, who they believed spent “their days passively sitting in a lounge doing bugger all”, as institutionalised and depressing. Although there was a lot of boredom at Villa 21, the residents were also much more intellectually active, or believed themselves to be so, and would often get into intellectual debates about life, philosophy, and politics. Moreover, the patients also socialised with the staff. The patient I interviewed remembered visiting the staff social club with a nurse and trips to the pub in the local village with another nurse, who was eventually banned from the pub for sneaking a bottle of his own whiskey in and serving drinks under the table (Adam, 2010).

Conran and the return to the norm in Villa 21
In April 1966 the experiment came to an end. After four years of struggle the criticisms were still increasing. Not only were his colleagues attacking the Villa, but in 1965 a question was asked in parliament about the risks of liberalising psychiatry which referred directly to Cooper’s community. Reflecting on the end of the experiment Cooper wrote:
“The result was the establishment of the limits of institutional change, and these limits were drawn very close indeed – even in a progressive mental hospital. The conclusion is that if such a unit is to develop further, the development must take place outside the confines of a larger institution.” (Cooper, 1967: 104)

Psychiatry 3
Cooper found it very difficult to keep the ward afloat and to develop it. Moreover, he was being pulled in many different directions. During the mid-1960s Cooper became involved in a series of new and exciting counter-cultural projects: The Philadelphia Association (1964- ), the Kingsley Hall community (1965-1970), the Institute of Phenomenological Studies (1966-1970), and, later, the International Congress on the Dialectics of Liberation (1967) and the Anti-University of London (1968-1969). However, this was not the only reason that Cooper wanted to move on from Villa 21. Cooper’s radicalism had not made him less ambitious and he had become dissatisfied with his position as senior registrar at Shenley. Throughout 1965 and 1966 he applied unsuccessfully for consultancies in various psychiatric hospitals around London, including in Shenley Hospital itself. Ultimately he decided to move into full-time private practice and opened a consultancy at 39 Harley Street, to which R.D. Laing referred patients (Laing, 1966).
When Cooper left the ward, Hayward gave it to a young psychiatrist and psychoanalyst in training, Michael Conran. Conran transformed the community. He reasserted hospital rules, including uniforms and a system of locked doors. He also normalised staff-patient divisions. His biggest challenge, however, was breaking the resistance of the community which attempted to defend Cooper’s regime. In his thesis at the Institute of Psychoanalysis, Conran recalled that on one of his first days he was publicly told by a patient that “Freud has no place in Villa 21” (Conran, 1971: 28). Ultimately he identified the leader of the resistance:
“I instructed the nursing officers that he was to be transferred that day into another ward for which I had care. It was an open ward for very long-stay, chronic, docile, working schizophrenics. Whatever else he might seek to call himself in Villa 21, in Villa 19 he would be a patient. He discharged himself from the hospital forthwith.” (Conran, 1971: 30)
With the leader out of the community the resistance to Conran slowly petered out and patients stopped insisting on their equality with the staff. This was the end of the Villa 21 experiment as conceived by David Cooper.

Villa 21 – a political and psychiatric experiment of its time
There are many ways that the community could be evaluated. The readmission rates that Cooper used in his collaborative article with R.D. Laing and Aaron Esterson, ‘Results of Family Orientated Therapy with Hospitalized Schizophrenics,’ were promising (Esterson et al, 1965). However, the conflation of Villa 21 and Esterson’s ward in Napsbury Hospital, and the fact that follow-up studies were not done after 1965 leave these figures incomplete. The positivity towards the community expressed by the former-patient of Villa 21 whom I interviewed is certainly an endorsement, but without finding more former patients we cannot assess the ward based on it. Conran argued that when he took over the staff had lost all sense of their professional worth and did not make any effort to care for their patients. In many ways Cooper’s own conclusion about the ward was the best. Villa 21 was ultimately overcome by organisational and inter-personal difficulties but its most important contribution was that it tested the possibilities of hospital reform and was a proving ground for ideas that would be influential in organisations like the Philadelphia Association and the Arbours Association.
Villa 21 was an experiment very much of its time. It developed in the heyday of the therapeutic community movement but was also influenced by Cooper’s radical views about psychiatry and society in general. Moreover, it used the all-powerful role that psychiatrists played on the ward in the 1960s to test the liberal boundaries of therapeutic community. Ultimately Villa 21 was a political experiment as well as a psychiatric one. It was intended to be a direct challenge to the power of the hospital as an institution of social control. Cooper wanted to prove that patients could recover if they were given space to explore their internalised oppression and discover their autonomy. He hoped to show that the power exercised by the hospital was not only therapeutically unnecessary, but was simply an exercise in disciplinary social control.

Oisín Wall is an Associate Curator of Medicine at the Science Museum, London. He is working on the new medicine galleries which are due to open in 2019. He is also working with Hackney Museum on a project about the British anti-psychiatrists’ Anti-University of London. He received his PhD on the history of the British anti-psychiatric group in the 1960s from King’s College London.

References
Conran, Michael The Family as a Model in an Application of Psychoanalysis to the Care and Treatment of Young Male Schizophrenics, Unpublished thesis (Doctor of Medicine), University of London.
Cooper, David (1965) The Anti-Hospital: An Experiment in Psychiatry, New Society, 3 May 1965: 11-16
Cooper, David (1967) Psychiatry and Anti-Psychiatry London: Tavistock Publications
CSRC (1961) Clinical Research Sub-CommitteeReport to the Planning and General Purposes Committee of the North West Regional Hospital Board (18 July 1961)London: Metropolitan Archives
ECMH (1953) Expert Committee on Mental Health, The Community Mental Hospital Geneva: World Health Organisation
Esterson, Aaron (1965) Results of Family Orientated Therapy with Hospitalized Schizophrenics, British Medical Journal2, 1462-1465
Hayward, S. T. (1961) The Doctor’s Place in the Patients’ Hospital, The Lancet, 18 February 1961: 387-89
Laing, R.D.(1966) Letter from R.D. Laing to David Cooper (7 February, 1966) Glasgow, University of Glasgow Special Collections, MS Laing GC114/14
Laing, R.D. (1976) The Politics of the Family and Other Essays Harmodsworth: Penguin Books
MHSC (1963) Mental Health Sub-Committee, Report to the Planning and General Purposes Committee of the North West Regional Hospital Board (20 May, 1963) London: Metropolitan Archives
Rees, T.P. (1957) Back to Moral Treatment and Community Care: The Preidential Address Delivered at the One Hundred and Fifteenth Annual Meeting held at Warlingham Park Hospital, British Journal of Psychiatry, 103: 302-13.
RMPA (1966) Royal Medico-Psychological Association South Eastern Division, Minutes of the South Eastern Division of the Royal Medico-Psychological Association (6 April, 1966) London: Royal College of Psychiatrists, College Archive
López Muñoz,F.  Alamo,C. Cuenca,E. Shen, W.W. Clervoy, P. Rubo, G (2005) History of the Discovery and Clinical Introduction of Chlorpromazine, Annals of Clinical Psychiatry,  (17) 3: 113-135.

Adam, Interview with Adam (Interviewer: Oisín Wall), 2010
Joseph Berke, Interview with Joseph Berke (Interviewer: Oisín Wall), 2015

Image: Surreal by Armin Tabari