With these ideas in mind 18 months ago I moved into a community of homeless
young people in south-west London. I intended to remain relatively value
free and role free and to avoid any suggestion of "doing good" or of
personal gain - though prepared to offer advice and skills when necessary.
Since I had few social ties and was not strongly career orientated within
medicine, I was able to squat rent free, and sustain myself financially on
occasional locums and agency work. I felt that an essential part of the
rapport I hoped to establish would stem from my non-specialization and
relative youth together with a desire to relate first as a person and later
as a doctor.
The core of about 50 permanent residents spent some time in creative pursuits, such as motor bicycle building and house repairs. There was a widespread interest in mythology, mysticism, popular eastern philosophy, and conservationism, which was cross-fertilized by exchange visits to country communities.
The community was good copy for the local press and a frequent target for the criticisms of local councillors, magistrates, and traditional residents. But fortunately there was little hostility from public utilities and social agencies: the relationship between squatters and police were best described as mutual tolerance.
My empathy with the group was obviously essential to the scheme though I soon became aware that my professional role included constraints (I needed to have a car to get to work, and had to keep drugs locked up) which hindered a totally free relationship.
Meetings of the resident community were held for a time in the hope that
some emotional exchange might develop, but in the event they served rather
as social gatherings and forums canvassing proposed social activities. At
one time I ran a "surgery" with a fixed location and time. This was in
reponse to a demand which was not backed up by consultations, which occurred
at any other time and place from that specified - a vindication of my
initial policy of offering low key advice. In the latter part of my stay
several "projects" emerged for entertainment and creative work. These were
developed organically and were generally well supported and smooth running,
in stirling contrast to projects conceived outside the community.
The ambience of psychiatric terminology in the community, with some
modified Laing concepts, was presumably a useful safety valve, though I felt
it might delay presentation of any overt psychiatric illness which could be
treated by extablished methods. Even so, the incidence of such overt illness
seemed to be low and such psychosocial disturbance as occurred could with
some mutual support be adequately handled within the community. Any
shortfall in mutual support was probably a function of both the
introspection of the community and the inadequacy of the welfare services
(such as nursery schooling and social activities) for this group. My most
useful contact was with the local probation officers, whose approach to the
multiple problems of the squatters seemed to be the most realistic. I also
made occasional contact with local social services, voluntary and community
groups, schools, police, and the prison medical service, but no working
relationship emerged, and interested individuals were more valuable than
There is obviously a need for community work with this group. Most medical and social agencies are not flexible enough to provide the low-key approach which would at least gain them a hearing. But it tends to be overlooked that this is a young adult group, some of whom have infant dependants, and that it is also probably getting bigger. Certainly the pressures that have caused young people to move towards this sort of community are increasing.
Patrick J. Day (British Medical Journal, 9 November 1974, p340)