When I moved into my five-foot-wide New York City bedroom, the walls were riddled with dark stains and loose tape that followed no pattern except chaos.
For two years, I did not clean or decorate it. Instead, every day I stayed on my mattress for up to 24 hours: acute depression, screen addictions, PTSD. My bedroom’s inch-thin walls were padded with soundproofing cushions and covered by white cloth. One day, I realized that my room resembled a padded cell.
In the second year, I signed up for a ketamine study for depression at the New York State Psychiatric Institute. Although the ketamine infusion seemed to lift my depression entirely, its effects wore off in a week. Each week for six months, the study psychiatrist and a social worker met up with me to take steps toward my recovery. Responding to my financial poverty, they helped me sign up for programs like food stamps. Responding to my depressive fatigue, they helped me sign up for Access-A-Ride, a taxi service for the disabled. I accepted these humbling forms of support without resistance. However, one recommendation I consistently resisted. Each meeting, and he asked nearly every meeting, I would say no when my psychiatrist asked, “Have you given the nice people at Fountain House a try?”
The face of Fountain House is its clubhouse, a five-story building two blocks from Times Square. It is exclusively for people with serious mental illness. A psychiatrist’s referral attesting to no recent history of violent behavior is the ticket for admission at Fountain House. There are 1200 active members; according to Kevin Rice, Director of Research at Fountain House, 37.9% of members who joined in 2019 self-reported a history of homelessness. While many members have diagnoses like depression and schizophrenia, it is the loneliness due to their mental illness that unites them. Like a second home, membership at Fountain House is free and forever.
The organization’s model is called “social practice”, a way of designing an environment to support those who are withdrawn to discover the power of belonging. Among one of its uses is mental health treatment.
Referring to social practice, Elliott Madison, the Executive Director of Fountain House, explained, “being involved is the practice.” When folks with mental illness who are withdrawn become involved in a community, they reap the many benefits of feeling welcomed to something larger than themselves, which can abide the symptoms of their illness.
Fountain House, founded by former patients who had been institutionalized and wealthy patrons in 1948, has viewed itself through the lens of multiple models over the years, its most well-known being the “clubhouse model of psychosocial rehabilitation.” Fountain House is the type specimen that inspired the creation of over 300 mental-health-focused clubhouses around the world under the consortium Clubhouse International. A systematic review of the clubhouse model suggests that, despite the varied approaches of previous studies and thus the challenge to summarize their results as a whole, folks with mental illness consistently exhibited overall improvements in their quality of life after becoming clubhouse members.
However, current and former staff including Madison and Alan Doyle, a retired Fountain House social practitioner and author of Fountain House, suggest that social practice is Fountain House’s essence. This is because, although the clubhouse is a convenient place to create a community centered on well-being, it is possible – and even necessary, Madison suggests – to bring social practice to places like high schools and hospitals to make mass mental health a norm. It is not the architecture that matters, but the intention behind the design. Alongside its clubhouse, Fountain House has a farm in New Jersey, which is where Alan Doyle actually believes the strongest transformations in members occur.
When folks with mental illness who are withdrawn become involved in a community, they reap the many benefits of feeling welcomed to something larger than themselves, which can abide the symptoms of their illness.
It is crucial, Doyle believes, to see beyond the clubhouse model of Fountain House. As he clarified to me in an email, “Fountain House is a place, a place for people, a ‘bridge’ for them to meet and reestablish their social connections (e.g. friends, family, schooling, working) destroyed by an insidious societal illness: prejudice.”
When I went into Fountain House, I did not feel that I belonged.
Not at all. One of the first things I saw was an old man in bedraggled jeans walking around with toilet paper stuck to his worn-out shoe. The middle-aged woman who toured me around the building talked without pause on a scattershot of hard-to-follow subjects for the hour I was with her, saliva encircling her lips. On my second tour, a fellow member was mute from an acute throat infection and coughed openly beside me.
I was terrified. My psychiatrist insisted I come here. This was just the beginning. Bigger than coughing without covering my mouth or walking around while unaware of toilet paper stuck to my shoe, was I naive to where I fit in society?
Before my illness became severe, I volunteered as a research assistant for cognitive neuroscience labs at Northwestern University and New York University; I was building my resume to apply to their Ph.D. programs. Given the severity of poverty and debilitation I saw at Fountain House, I could not accept the idea that, out of anywhere, I belonged here, a place where I felt more likely to provide a compassionate service than be the recipient of one.
“You’re worried that you’re one of them,” my social worker from the ketamine trial told me. “The people who need the clubhouse the most are going to stand out the most. Give it some time.”
At Fountain House, there are several “Units” that house activities such as gardening, cooking, journalism, open mic performances, and even oil painting, the products of which can be showcased and sold in Fountain House’s art gallery. Members – emphatically not called patients, because everything is voluntary and free – begin their time at Fountain House by choosing the Unit that they like best.
Members are assigned a staff worker from the Unit who becomes their soft mentor, their accountability buddy, their personal social worker, and peer – for many members, staff workers are like friends; sometimes staff and members go out for drinks together after the House closes. These staff workers can, like my ketamine trial social worker, help them with anything fundamentally important to their well-being: finding a home, signing up for food stamps, walking them home from the hospital after they have undergone surgery.
Everything is built around agency in a place founded by people whose choices were made against their will in a padded cell. But in his book, Doyle explains that for a community of people who have experienced relationship failure – job losses, crumbled friendships, rejection from their family, the reality is that most people need more than just an attractive house full of people and activities to feel like they belong in the world. Through their patient and encouraging presence, the staff workers are there to guide the members, subtly, back into the trust that they have the power to stand on their own and yet fit into society.
To inspire that trust takes discipline and a lot of effort; it is not the magical offshoot of believing that someone with mental illness will heal themselves if you bring them to a clubhouse or farm, Doyle said. Trust requires evidence, and cultivating self-evident belonging requires social activities to which the person can direct their bravery. As John Beard, the first executive director of Fountain House discovered, supporting self-empowerment is an art form; the result of the art form – someone taking a risk, on their own, to grow – can seem uninfluenced or random, but it is a consequence of close and compassionate attention to an individual and their environment.
Before John Beard joined Fountain House as executive director in 1955, he was a therapist at Eloise Hospital, then the United States’ largest psychiatric asylum; the need was so great for mental health, that the hospital had its own zip code. The staff at Eloise pioneered techniques like lobotomies, electroshock therapy, and sensory deprivation to treat mental illness. But John Beard’s patients inspired him to invent a non-clinical intervention he called “activity group therapy,” the main idea he would bring to Fountain House.
One of Beard’s patients hallucinated, saved his feces in his pockets, and spoke unintelligibly (“I’ll cut out your eyes and put them in advertising; you were founded on the heel of an orange…”) But one day, the patient strolled into a room and announced with eloquence that he would like to draw a picture on the blackboard; before his illness, he was a talented artist. Another patient, normally mute and defiant, mirrored this transformation when a therapist went to the library and noticed them staring at an algebra textbook, captivated. What if, Beard thought, instead of trying to eliminate his patients’ illnesses – blunting whatever emerged like his medical colleagues at Eloise did, he furnished spaces to nourish what wanted to burst from his patients; their existing interests, their passions? Could these be their seeds of stability, the seeds that, if allowed to grow and take root, would support their transition back into society?
One month, Beard experimented with this idea. He invited four of his patients to a room for an hour each week to engage in group activities. But Beard developed this protocol with one patient in mind: a patient named John.
According to Beard’s account, when John was admitted to Eloise, he burned himself with cigarettes and rarely spoke, but Beard suspected he actually did want to talk to people; he was just incredibly nervous. (When, on a walk outside with Beard, John muttered the words “I gotta piss,” Beard acknowledged his effort to speak by encouraging him to pull down his pants and urinate right on the sidewalk.)
In Beard’s room was a table with four chairs around it, and then another chair ten feet away – a chair Beard placed with John in mind. For the first three weeks, Beard and his three other patients took a seat at the table; John watched ten feet away in his sequestered chair. Neither Beard nor the other patients ever prompted John to come over; everyone was on the same page with what to do in the room: no pressure, all ease. But upon the fourth week, John changed. John walked casually past his chair and sat in the empty fourth seat – the seat at the table that was always there for him. Beard designed two options for John: the comfort and the risk. Eventually, developing trust with what he saw and how he was treated, John took his personal risk by choice. He grew beyond one of his core symptoms. He just needed someone to meet him where he was and hold a seat for him at the table.
This, to Doyle, is quintessential Fountain House. Those who are struggling could use a hand, at least to get them started. After becoming involved, the model of activity group therapy – and social practice – goes, the person who took the helping hand is likely to want to stay involved, and over time they will develop not only a sense of self-efficacy with the skills they learn but a trust that they can navigate the world even with a mental illness. Fountain House, with its Units and its farm, is an organization of options, of seats at the table created by staff workers who acknowledge the realities of mental illness.
It is a focused flexibility that is difficult to capture, even for researchers. In 1971, a group of researchers came to Fountain House to survey its program. They concluded in their report that the effectiveness of the Fountain House model might all be chalked up to the compassion of its staff. The sources of this story suggest that compassion is indeed a part of it; the spirit of the helping hand is an essential part of supporting anyone experiencing hardship.
“I believe that the reason for the array of metaphors used to answer this question is because Fountain House is not finished; it is still trying to figure itself out, what it is in society. It is still a verb, and not yet a noun; it is inventing ‘practice’ and evolving into its own species.” -- Alan Doyle, retired Fountain House social practitioner, author of Fountain House
But what seems to define Fountain House and its social practice is where that compassion is directed. “There are so many little small things that are just intentional, it frustrates a lot of people” who seek to understand Fountain House, said Samene Reid, the lead social practitioner of its Communications Unit. Instead of being directed solely at the person in hardship like a therapist might, the compassionate energy is directed additionally into the space between them: into doing activities in the shared environment.
John Beard, arriving at Fountain House, declared that even the bronze slats at the bottom of Fountain House’s entrance doors would have a purpose. They would not merely make it easier to hold the doors open but would become someone’s opportunity for identity formation. At Fountain House, there are no janitors, security guards, or any insignia that indicates whether someone is a member or a staff worker (you can only know by asking), supports that one might expect in an organization for the vulnerable. In such an environment, nothing inspires focus on a member’s diagnosis; instead, people will know that member as the talented woman who can polish bronze slats.
From the basement kitchen to the top-floor gymnasium and across the farm with its hungry goats and cats and hens, the natural thing to do at Fountain House’s locales is to respond to the needs of the environment together. Identities beyond illness emerge, identities that have released themselves from the shackles of prejudice and joined the nonclinical walks of life.
Despite my terror, I trusted my ketamine psychiatrist and social worker.
Upon the two-year anniversary of my first tour, I had spent what I estimate to be over one thousand hours at Fountain House. I rarely participated in Unit activities, instead opting to be in the mailroom and library, working on freelance journalism assignments alone. But the reason I kept going was that Fountain House impacted my well-being and my work. At home, even after becoming sober of my addictions, writing a two-paragraph email could take me hours, even days. At Fountain House, after chatting with people for one half-hour, I could write that email in a few minutes. Social anxiety was one of my symptoms; being in a place where bumping into people was inevitable had consistently eliminated it.
No, I still believed that I did not belong at Fountain House – I rarely did Unit work or attended events, opting instead to ask for help from social practitioners in times of distress as I would a therapist. I did make some friends and I appreciated the one-dollar meals while impoverished. But I kept thinking of the first thing my ketamine trial social worker said. I was not one of them. I was a Fountain House member who took advantage of its resources in a way that worked for me, but who still did not belong. I did not find anyone who used Fountain House quite like me because it did not feel made for someone like me. Among them, I found it more natural to be alone.
My social practitioners and friends cheered me on as I recovered from PTSD, and my addictions, and became one of Fountain House’s most dedicated members, attending the program from 9 am to 5 pm each weekday. But still, I saw myself become sequestered in a quiet room each day. If I was embodying John, sitting away from everyone else, and my psychiatrist believed it was here I belonged, where was my second seat, the risk that would promote my growth and healing?
One day, I was having lunch in the cafeteria with a social practitioner from the Home & Garden unit. He said that the young adult group (a cohort of members and staff aged 30 or younger) was going to High Point, the Fountain House farm, next week. Would I be interested? I had given most everything else at Fountain House at least one shot, so I said yes.
As Doyle would confirm retrospectively to me in our interview, it was there that multiple beliefs I held deeply had alchemized into beliefs more honest about myself and purer from prejudice.
Eleven of us, four staff workers and seven members including me, traveled together by van to High Point for a three-day stay. It was deep in rural New Jersey, 477 acres of slightly rolling farmland, a chalet with several bedrooms overlooking a pond several times its size. We would buy groceries on the way; our only responsibilities would be to cook for ourselves and tend to the animals in the mornings and afternoons.
But quickly, I saw myself make choices that led me to aloneness. While the others stayed up until midnight watching movies, I went to bed early and woke up at 5 am; I considered early morning exercise, meditation, and nature walks to be staples of my mental health regimen. When we hiked together, I lingered in the back, not speaking with the group but instead browsing the scenery around me.
I was feeling self-consciously alone when a member, Ken, came up to me and said, “Andrew, I like your lone wolf vibe.”
I opened my eyes a little wider. He liked my aloneness? Instead of a lingering symptom to treat, my aloneness could be a strength?
After the walk, I slipped out of my momentary clairvoyance and instead got stuck in an hour-long thought loop of wondering whether I should socialize, journal, or take a walk alone. I decided to sit down and chat outside with another member, Daniel, who I knew as someone I meditated with occasionally at the House but who I otherwise did not believe had much in common with me. I told him about my thought loop and he looked at me with sincerity, and I saw in him what I can only describe as the conviction of seeing someone you truly understand. “If it’s important, it’ll come back. You can let it go,” he said, and because I felt seen, I let it go.
He looked down through the porous metal grid of the patio table in front of him and thought for a long moment. “You know,” he said, looking back up at me, “what you have is rare. I think you’re ready. Unlike many of us, you’ve built your house. You meditate, you exercise, I see you at the House all the time. You could handle a job. You’ve built your house. All that’s left for you to do is the painting, which is what we all do for the rest of our lives once we’ve built our house.”
“Yeah,” he said. “You’re ready, man.”
When I first came into Fountain House, my jeans were torn and my glasses bent; I do not remember if I showered regularly. But I had changed: my jeans were tailored and my glasses new; I showered and had developed healthy habits for my body and mind. This was my first big group outing where I could see those changes through the mirror of others’ reassurance. I had underestimated Daniel, I had underestimated Fountain House, I had underestimated myself. Of course it is hard for me to notice how Fountain House supported me as I grew. That may be by design.
I know it sounds unbelievable, even cliche, but the way the sunlight shone on me and Daniel at that moment felt particularly bright, the silence pure, the wind aetherial; I felt, right then at High Point, in the presence of something godlike. Daniel and I had first bonded over meditation, but this felt like a real awakening.
I began to see it: my belonging.
When we would cook in the kitchen together, I would be there early and stay late, cooking extra food for everyone: alternatives for the vegetarians, and dessert for the member who was sad and wanted french toast. Meanwhile, the others were at the table in discussion of mental health stigma, something I was also interested to discuss. I missed most of it, which I could have felt awful about.
Instead, I kept doing what felt natural, which was to be alone in the presence of others. Ben walked into the kitchen and said, “Andrew, that smells [expletive] amazing.” The vegetarians thanked me. The sad member was touched by the surprise dessert. When I sat down to take a break and eat, there was a seat for me at the table. In taking that seat, I witnessed the strength of my introversion in their gratitude.
When I first came into Fountain House, my jeans were torn and my glasses bent; I do not remember if I showered regularly. But I had changed: my jeans were tailored and my glasses new; I showered and had developed healthy habits for my body and mind.
My memories began to correct themselves. On the first day of our arrival, I wanted to swim in the pond because I love to swim and wanted to exercise, but it was forty degrees outside and the pond was also freezing. To me, it sounded fun; to everyone else, they said they would watch. Before my awakening, I saw my swimming as another act of isolation; a depressive act of self-destruction. When I revisit that memory now, I hear more than cold water splashing; I hear my peers’ cheers.
On the night of my realization, we built a bonfire by the pond. I brought a notepad and pen to be inspired by our incandescent gathering and write a poem. Daniel suggested that for extra flair I should write a poem, toss it in the flames, and then recite it. But all night I was stumped; out of haste I started to write anything just to try, but Ken, sensing my vibe shift, said “Don’t force it.” Eventually, Daniel left to go to bed. I wrote something and tossed it in the flames. Everyone stopped talking and looked at me; my poem had become the night’s suspense. “What did you write?” they asked. I said I wrote, “Thank you, Daniel.”
Pools of water are magnets for life. Every ecosystem has pools of water: in a desert, an oasis; in a jungle, a basin; in a woodland, a pond. At a woodland pond like High Point’s, spritely mammals arrive out of thirst; the languid amphibians, eyes glazing over the water’s ripples, know this to be a place for deers and therefore flies; things that buzz and flutter land on flowers bloomed by the refuse of these passing animals. The pond is a place, a place for life, a bridge to belonging not because every being shares the common purpose of quenching thirst, but because the pond inspires reasons for them to gather, and in their gathering, they exude their shared purpose, which for both others and themselves is to exist.
The founders of Fountain House named it so because the 47th Street building they purchased had a fountain in the back. A place, place for people, a place for us they, in the effort to humanize themselves, might have thought. An oasis, a basin, a pond. In the concrete jungle of Manhattan, there is Fountain House. Is it merely a model of mental health treatment?
Doyle used a bridge to describe what Fountain House is; I used its fountain and the staff and members to whom I spoke all found it challenging to define Fountain House concisely. As Doyle explained to me in writing, “I believe that the reason for the array of metaphors used to answer this question is because Fountain House is not finished; it is still trying to figure itself out, what it is in society. It is still a verb, and not yet a noun; it is inventing ‘practice’ and evolving into its own species.”
After my realization at High Point, I have begun to recognize who has given me close and compassionate attention. It was not only the social practitioners who talked with me therapeutically. Early on at Fountain House, I made a friend who is a fine art photographer. I attended her Fountain House art gallery show to support her through my presence; she priced her photos taken around the world for thousands of dollars. I kept staring at one of her photos, captivated. In it, there was a man in yellow-feathered garb standing under a clean blue sky, eyes fixed ahead, looking like a sun god. One day my friend walked into Fountain House and surprised me with a big bag.
Over the years, I developed a fondness for nature, and so blanketed the whiteness of my room in scenes from woods and jungles. The tape is mostly gone (I seriously do not know how the previous tenant reached some of the places they reached), and gone is my mattress dented from sitting on it in despair for thousands of hours. Now, when I wake up each morning and light pools into my eyes, I see between the green life the reflections of a photo given to me by someone who noticed me at Fountain House.
This story is supported by a National Association of Science Writers Diversity Reporting Grant.