Table Of ContentFlorida State University Libraries
Faculty Publications College of Social Work
1998
Coercion Justified?: Evaluating the
Training In Community Living Model — A
Conceptual and Empirical Critique
Tomi Gomory
Follow this and additional works at the FSU Digital Library. For more information, please contact
Coercion Justified? – Evaluating the Training In Community Living Model – A
Conceptual and Empirical Critique.
by
Tomi Gomory
B.S. (New York University) 1970
M.S.W. (New York University) 1986
A dissertation submitted in partial satisfaction of the
requirements for the degree of
Doctor of Philosophy
in
Social Welfare
in the
GRADUATE DIVISION
of the
UNIVERSITY OF CALIFORNIA, BERKELEY
Committee in charge:
Professor Eileen Gambrill, Chair
Professor Steven P. Segal
Professor Troy Duster
Spring 1998
The dissertation of Tomi Gomory is approved:
Chair Date
Date
Date
University of California, Berkeley
Spring 1998
1
Abstract
Coercion Justified? – Evaluating the Training In Community Living Model and It’s
Replications – A Conceptual and Empirical Critique
By
Tomi Gomory
Doctor of Philosophy in Social Welfare
University of California, Berkeley
Professor Eileen Gambrill, Chair
2
This dissertation examines the research and theory offered for Programs of
Assertive Community Treatment, the model that is supported by Institutional
Psychiatry as the most well validated and best model of intervention applicable to
the psychiatric population labeled the Severely and Persistently Mentally Ill.
Although this program has been researched for over 25 yrs. and the extensive
literature on this model claims to have established it’s efficacy on both the
systems and patient level, the findings of my critical review dispute these claims
based on the examination of the empirical evidence of all available randomized
controlled trials of this intervention as well as through a close conceptual analysis
of the theoretical framework and a situational analysis of the individuals who
invented this model.
I explicate the faulty view of science (Justification) which drives the findings,
by applying a view I argue is more correct ( K. Popper’s Fallibilism). My analysis
demonstrates that no superior efficacy can be associated with PACT
methodology when compared to no treatment or standard treatment control
groups. Further, any statistically significant impact putatively favoring PACT is
either a tautological outcome based on administrative rules differentially applied
to PACT and CONTROL groups, or are misattributions of worker activity as client
outcome, or are based only on data supporting various outcomes and the
ignoring or minimizing of negative results which contradict such claims, or are
based on manipulation of data to indicate significance for variables which are not
supported by the data (by for example collapsing various outcome variables
some of which are statistically significant, but are tautological, like number of
3
hospital stays, and some which are not statistically significant but empirically
important like less homelessness, or less time spent incarcerated, and
suggesting that the significance found (derived from the tautological components)
indicates treatment effectiveness for the non tautological components).
Finally the conceptual analysis of this model demonstrates that this model is
coercive and may lead to harm(excessive suicide among its treatment population
for example).
iii
To my life partner, Francine M. Gomory, without whom this dissertation could not
have been attempted much less completed.
iv
Contents:
Acknowledgements vi
Introduction
Chapter 1
Conceptual Critique of Mental Illness
Chapter 2
TCL treatment population and the meaning of Community Mental Health
Chapter 3
The Historical Roots of TCL or The Archeology of Coercion
Chapter 4
The Training In Community Living Model
Chapter 5
A Description and Critique of The Three TCL Studies
Chapter 6
The Replications: Programs of Assertive Community Treatment
Chapter 7
Concluding Comments
Appendix A
v
Appendix B
Appendix C
Appendix D
Bibliography
vi
Acknowledgements
An individual intellectual effort entails the complicity of many.
First, I owe an immeasurable debt of gratitude to my parents, Ilona and
Sandor, who had the foresight to emigrate and provide for their two children,
George and Tomi, so that they both could thrive.
Second, I would like to thank my dissertation committee for their support and
scholarly rigor.
Third, Dr. S. P. Segal has been a careful intellectual critic and a colleague,
holding me to standards that have forced me to think and question my most
closely held convictions and as a result immeasurably improve my work.
Fourth, to Dr. Eileen Gambrill, I want to say that I have received from her not
only the most selfless support for my work, but also found in her a role model of
what a truly ethical, deep thinking scholar and educator can be like, for that and
her friendship I am eternally grateful.
Last, I came to realize fairly late in my early adulthood that I possessed some
intellectual skill and critical acuity. This realization led to some individuals whose
work has made my scholarly life absolutely vibrant ever since. They are; K.
Popper, F. A. Hayek, E. Gellner, and A. Schopenhaur.
