Saturday, 14 July 2007

Tough Week

This has been a very tough week (hence the shortage of postings). I've not felt like doing much at all so it's been a week of dragging myself to therapy, arguing with my analyst, (who seems to have misunderstood everything I've said, probably a reflection of the confusion within me), and coming home and arguing with myself about what to eat, whether to eat, whether to escape into sleep, or whether to sit her pretending to be creative but playing "free cell" instead. The latter was usually the winner.

I did manage to get myself out for a walk while my home help was here cleaning on Tuesday. She comes once a week to do the cleaning tasks, (hoovering etc.) that I am "advised" not to undertake in the interest of forestalling the wheelchair.

I drove to one of my local hangouts, Bedfont Lakes Country Park, where, because my membership to the private nature reserve has lapsed, I walked the public areas. This was my first walk of any consequence since the fall so I took my walking stick rather than my dual purpose monopod and was glad I did as I needed to bear down on the handle in order to negotiate the uneven ground off the gravel footpath in the public reserve.

I was soon rewarded when this stoat ran across the mowed grass footpath about 20 feet in front of me:

this is the first stoat I have seen in the wild and I was surprised at how small it was, I hope you can get some idea by comparing it with the daisies on the left of the picture. As it stopped running at the edge of the undergrowth I stopped walking and held my breath as I gripped my walking stick between my knees and raised my camera.

As you can see it turned and looked straight at me, expecting it to run straight off I took this a bit quickly but I shouldn't have worried, he/she then looked back to where it had come from and I got another six shots, similar to the first one, before it vanished into the undergrowth after about 30 seconds.

Now, I would have settled for that but with the thrill of the stoat giving my mind respite from the physical pain in my ankle and back I decided to walk a bit further to one of the public bird hides. AS I reached the hide I was aware of a great deal of noise above me and looked up to see a Black Headed Gull harassing a Common Tern. I love catching the wonder of flight with my camera and as I already have several pics of Black Headed Gulls I focused on the Tern. This was the result.

This was one of several Terns being chased by the Gull while returning to the floating breeding platforms where Chicks were waiting to be fed. I spent about 20 minutes watching and photographing the activity on and above the breeding platform before, body and soul refreshed, I returned to my car in time to beat the "school run" traffic home.

Luv Brian.

Tuesday, 10 July 2007

A quick thought: 2

These machines in supermarkets that are labelled “Turn Your Coins into Cash” puzzle me. Now, perhaps I am stupid as well as mad, but I always thought that coins are cash.

I got a closer look at one of these machines yesterday and it seems that they mean they will count your coins and change them for notes or coins of higher amounts, and ONLY charge you 8 pence in every pound for doing so.

What will they think of next, cash dispensers that charge you for withdrawing your own money? Oh, seems they already have, I wish I was clever enough to think up money for nothing schemes like these.

Bomb Carrying Doctors! Why the Surprise?

I can never understand why the public are taken aback whenever a doctor commits a crime. The Doctors who carried out experiments on living Men, Women, and Children, for the Nazi’s in Second World War Concentration Camps had signed the Hippocratic Oath, Dr’s Crippen and Shipman had signed the Hippocratic Oath, GP’s who are struck off each year for sexually abusing female patients have signed the oath.

Why does the public expect Men and Women who carry out that profession to be somehow saintly and more above reproach than say a plasterer or a bus driver? Members of the Medical Professions are numerically over represented in national statistics regarding both Alcohol and Drug Abuse, not surprising given some of the things they see and hear, and possibly a sign that members of the profession are more prone to human failings than the rest of us.

During my own experience of working alongside Doctors as part of multi-agency teams for protecting children or the mentally ill I observed many things that proved just how “mortal” these “saints” actually are. I found:
1: That in a multi-disciplinary arena the “Doctor” always appointed him or her self as the leader.
2: Along with the above not being prepared to listen to any alternative to their own opinion.
3: Judging families (particularly within hospital) against a white, Christian, middle class norm.
4: GP’s prepared to pass concerns to Social Workers but playing those concerns down when on oath in court, or worse, denying that they were concerned at all.
5:Imposing his or her “ideals” on an unquestioning public, it seems that once a week now we are informed that some foodstuff or liquid that has been enjoyed across generations is bad for us.

This last point is well reflected in the way smoking and smokers have been persecuted over the past few years.

First, the revelation that smoking is dangerous, there is good evidence and those who want to give up or not start do so: next, the attack on passive smoking, the evidence of which has been greatly exaggerated, is used to alter our social life and our culture forever: and: finally: within two days of the new smoking law coming into being, we are hearing that they want to stop us smoking in our own cars. Now watch out sheep, if you let them win that they will be demanding the removal of radios, CD players, fluffy dice, and everything else that they can say “distracts”, until they have robbed us all of our individuality.

If you detect some anger creeping in here, you are right. The reason is a headline in the Observer newspaper yesterday. I will tell you what it was about in a second but first let me give some background.

Throughout my Social Work and lecturing roles, I was on multi-disciplinary teams looking at the ways the statutory agencies work together. An ever recurring question was the massive increase in the numbers of children, mainly boys, being diagnosed with “Aspurgers Syndrome” and Attention Deficit Disorder, both of which have been described as being on the Autistic Spectrum.

“Where have these things come from?” was the question from middle aged lay people like me to the medics, these things did not exist when we were kids.

Reasons from Poor Parenting to diet were presented by the medics who shouted down, often seeking to humiliate those like me who asked about the evidence from elsewhere linking these increases to the MMR injection. We were told this was rubbish by doctors who, not for the first or last time in my experience, set out to ridicule both the doctors who had collected the data, and those in the room seeking clarification.

I was not prepared to walk away from this issue. As someone who lost a brother to whooping cough before the injections existed, and saw multi-disabled newborn affected by Rubella whilst I was working at the hospital, I always agreed with the need to protect children from these illnesses. I was not however prepared to back down and deny or omit my experience that the increase in conditions on the Autistic Spectrum was in direct proportion to the number “guilt” messages being laid on mothers who did not have their children injected, that is to say that as the number of injected Children grew, so did the instances of Autism.

In meetings, doctors ridiculed me, and as a teacher I was verbally “attacked” by teachers from medical backgrounds because I asked a class to research and consider this evidence from an ethical perspective.

Anyway, front page headline on yesterdays Observer “NEW HEALTH FEARS OVER BIG SURGE IN AUTISM: Experts “concerned by dramatic rise: Questions over triple jab for children.

I guess I do not need to tell you that I am not surprised.
Luv Bri.

Friday, 6 July 2007

Goffman's Concept of "Total Institution"

This is the essay I refer to in my "Self Help" posting. A bit academic in places but should be of interest to anyone who lives or works in a hospital or in Residential Care.
Discus Goffman’s concept of “Total Institution” and the implications of “Total Institution” for Social Work Practise.
Brian Barefield. CQSW Year 2 Dec. 1991

Goffman, ("Asylums" 1961 p17), perceived; "A basic social arrangement in modern society - (to be that) - the individual tends to sleep, play, and work in different places, with different co-participants, under different authorities, and without an overall rational plan.” The antithesis of this arrangement was the "total institution"; " - a place of residence and work where a large number of like situated individuals, cut off from the wider society for an appreciable period of time, together lead an enclosed, formally administered round of life.” (ibid p11).

Here Goffman's work will be placed in its historical and societal contexts before discussion of the actors passage into the habitat of total instit­ution leads to discussion of the concept of "total institution". Goffman's emphasis on psychiatric institutions will be duplicated here through reference to the writer's clients' experiences1. Discussion of the implications for social work within total institutions will lead into a broader examination of the implications of Goffman's work for the social worker, this examination based on current alter­natives to total institution and with reference to the observations of Szasz, the anti psychiatry movement, and what Pearson (1975) terms the "misfit" sociologists. This discussion implies a political role for the worker which will be discussed at the conclusion of the essay.

Total institutions provide a logical solution to problems of deviance as perceived by the functionalist paradigm which is historically and currently the dominant ideology of most capitalist societies. The Interactionist school, which began with Mead and rose to prominence in the 1960's, provided alternative theories of deviance and in so doing produced the "labelling" and "stigma" theorists such as Goffman who emulated Mead in challenging the positivist definitions of Durkhiem and Parsons. The interactionist’s purport that deviance is a socially constructed phenomenon that needs separating from "delinquency" if it is to be understood.

Specific to the relationship of deviance to psychiatric illness Aubrey Lewis2 calls for a distinction to be drawn between the two on the grounds that; " - mental illness and deviance - differ in their referents, - mind and behaviour respectively - ."
Distinction also needs to be drawn within mental illness definitions for, as Szasz pointed out, (Busfield 1986 p81), psychiatry may have a place in the treatment of psychotic disorders but the neurotic and the "managed" psychotic patient are abused by psychiatry's systems. One abuse of such patients is admission into total institutions via a path which is now discussed.

Goffman claimed that the career of the mental patient falls into three phases, those of the prepatient; the inpatient; and the expatient. In discuss­ion of the first and last of these he illustrated the power of total institutions to exert influence beyond their physical boundaries.
In the case of the prepatient this power manifests itself through the "betrayal funnel", a conspiracy of family, health professionals and other helping agencies to seduce him into the institution through a series of linked stages each of which " - tends to bring a sharp decrease in adult free status - ", ("Asylums" p131).

[An example of one component of the funnel was given to me by X. At his initial hospital interview his 15-minute interview preceded a 1-hour discuss­ion between his wife, who had her own reasons for wanting him "away", and HIS psychiatrist. X, who had been encouraged to attend the "preliminary" interview by all of the agents involved with his case, did not return home from it].

Illustration here of Goffman's contention (p136) that; "The last step in the prepatient's career can involve his realization - justified or not - that he has been deserted by society and turned out of relationships by those closest to him.". He is also left with a clear perception of the power of the total institution, the all-encompassing nature of which will now be discussed.

Jones and Fowles (1984 Ch1) claim that the reader of "Asylums" should remain aware of four points. First: Goffman's main focus was on the inhabit­ants of the institutions rather than the institutions' physical components. Second: his research centred on the patient rather than on the staff. Third: whilst he identified five types of total institution Goffman did not claim to present a list of features for all cases but a set of features which are present in most cases, and: Finally: that Goffman did not purport to provide a guide for action.

Goffman described four major facets of total institution living which are categorised by Jones and Fowles, (ibid), as "Batch Living"; the "Instit­utional Perspective"; "Binary Management"; which creates the divisions between the "staff world" and the final facet; the "Inmate World". Discussion of these facets will now be made commencing with the concept of "batch living".

Batch living implies that "each phase of the member's daily activity is carried out in the immediate company of a large batch of others, all of whom are treated alike, and required to do the same things together."3. It is characterised by a bureaucratic management whose rules and regulations mean a tight schedule with little free time and no choice of living companions for the inmate.

[X, a Moslem, was refused recognition of his cultural or dietary needs. His protestations were attributed to his psychiatric problems, (looping), by staff who encouraged him to concentrate on the "positive" attributes of the institution. To adopt the instit­utional perspective which is now discussed].

Through his adoption of the institutional perspective the inmate is socialised into the belief that the institution is a beneficial and nice place to be. Staff: who sanction "removal activities" such as sports days, and "ceremonies" such as Christmas parties: combine with relatives: who through their reluctance to receive the patient home, or who cannot face their own feelings of failing the patient, repeatedly tell him how much good the institution is doing him: in practises which Goffman perceived to be well suited to a Durkheimian analysis, ( p102), and which hold the divided society together.

The division of staff from inmate, and the stereotypical imagery of each by the other that this facilitates, is characteristic of the "Binary Management" of total institutions. No matter how well the inmate is socialised into an institution's culture he will still encounter the social distance that exists between the two worlds. It is a distance which excludes him from decision taking and which keeps him ignorant of his own condition and fate. The ultimate achievement of his social­isation will be a movement between wards (Y related that status in the resident community is enhanced by the occupation of certain wards] but regardless of added status the inmate is still a puppet to the whims of the "staff world".)

This "staff world" is now explored.
Goffman highlighted a contradiction between what institutions say they do and what they actually do. Central to his observation was the fact that the staff who make policies are not the staff who implement them. It is lower echelon staff and not their managers who are the "tradition carriers" of the institution ( p107) as typified in a recent newspaper article 4 in which a Broadmoor hospital staff member of twenty years standing criticised a new, less militaristic uniform on the grounds that; "The old uniform was a symbol of authority.".

[Y perceived a dramatic change in personality when probationary staff changed from a yellow uniform to the blue one of a full staff member after 3 months].

It is such tradionalists who socialise new recruits into the role of the worker, a role which is more than just the "prescribed duties and reciprocal rights attached to a position.", (Goffman5).
Support for Goffman's [and Y's] observations of the detrimental effect on the inmate of the socialisation of the worker into role is implicit in Hudson's, (1982 p170), warning to hospital social workers not to become socialised into the institution's culture, that; " - being hospital based - carries the risk of losing some of the very qualities that make the social worker's contribution so valuable: awareness of things social, knowledge of ordinary life and resources in the community.".

Support for Goffman's "partial evidence" (Jones and Fowles p25) of these phenomenon is chronicled by Pearson, (ibid), and especially by Martin, (1984 pp.28/9), and Shepherd (1984 pp.85/91)6.

Goffman's assertion (p88) that some staff will suffer problems of conscience is typified in the previously mentioned newspaper article by a second officer who argues in favour of the new uniform that; "We are custodians of the mentally ill, not prison officers.". Evidence suggests however that this dilemma, which will be seen to be mirrored for the social worker, will not deter workers from affecting other's perception of the inmate through their subjective contributions to case conferences, to informal discussions about patients, and to patients' records.

They will use sanctioned violence against the inmates person and his will and they will employ the tactics of "looping", "tyranization" and "regiment­ation" to keep the inmate in his place and to preserve the social distance between inmates and themselves.

These tactics also play a crucial role in socialising the patient into the "Inmate World", the next facet of total institution to be discussed. Inmates are socialised into the inmate culture through a "mortifi­cation" process which comprises a series of systematic violations and degradations
[Y was strip searched and then forced to bathe while observed by three officers on her admittance to a "special" psychiatric provision]. Given names are replaced by staff or inmate attributed ones and "disculturation" is facilitated by "contaminative exposure", looping and a "privilege system" [going to the toilet unobserved was a "privilege" in Y's institution].

From within her world the inmate develops her "career line", establishes her place in the "underlife" hierarchy and develops her own "removal activities"
[Y would feign "intransigence" in order to receive an injection which "got my head out of there for three days" ].

The acquisition of the "institutional lingo" facilitates communication as the inmate proceeds through the four "secondary adjustments" which Goffman perceived to be developmental landmarks of her career. These adjustments, namely "withdrawal", "intransigence", "colonis­ation" and "conversion", further socialise the inmate into a way of being which is ultimately less acceptable to society than the "symptoms" of her original "illness" may have been; " - total institutions disrupt or defile precisely those actions that in civil society have the role of attesting to the actor and those in his presence that he has some command over his world.", ("Asylums" p47).

Support for Goffman's perception of the negative attributes of institutional care proliferate social work literature in guises such as "Institut­ional Neurosis"7, "Institutionalism"8, and "Social Breakdown Syndrome"9.

Such evidence would seem beg an end to institutional care, but, as Goffman (p124) observed, for some people, "entrance to the mental hospital can sometimes bring relief.". Shepherd (p10) relates that some inmates were identified by Mann and Cree to be "asylum seekers"; that is inmates who prefer the security of institutional life to the unpredictability of the outside world. These inmates accounted for 5% of psychiatric inmates in a sample taken in 1976. Additional support for the existence of total institution for some psychiatric patients is provided in Hudson's (p166) observation that; "some psychiatric patients need the surveillance, rest from stress and responsibilities, and intensive treatment that only an inpatient facility can provide".

After arguing that the major role of the social worker inside such institutions is to "contribute in helping to reduce the ill effects, and maximise the benefits of hospital care." Hudson provides insight into how this may be done, (pp.166/70). She also perceives a political role for the worker in effecting policy change (p170), and it is in this context that she issues the warning quoted earlier against the social worker becoming socialised into the institution and thus less effective in this role. A warning to the worker implied by Goffman's observations would be to take account of the consequences of the "deference" which the inmate will show to her position. ("Asylums" pp.107/8).

Here we reach the conclusion of discussion of the concept of "total institution" and the implications of that concept for social work practice within asylums.

Two areas of consequence emerge from the discussion, the first client orientated and the second worker orientated. Simply; the first requires the worker to adopt a political stance which argues for the patient’s rights and against stigmatisation from as early as is possible in the patient’s career. The second set of consequences beg social work to look to itself. In this second context social workers should remember that they too are members of an institution which " - captures something of the time and interest of its members and provides something of a world for them; (which) - has encompassing tendencies.", ("Asylums" p12). For this reason the following discussion of social works community role with the mentally ill, though alluding to casework practice, will concentrate on the less well defined roles which are implicated by the analysis of the concept of total institution and which have implications for social work practice during all three patient phases.

For some, "halfway house" therapeutic communities offered an alternative to total institution. Goffman however perceived the limitations, and the potentially damaging effects of the communities which were set up within total institutions (p139) by exponents of this philosophy such as Maxwell Jones, (1968). The therapeutic communities which were set up in the wider community were also perceived to embody a social control function in which "contaminative exposure" and "the piston effect" are instigated in the name of "therapy" with greater frequency than would occur in "total institutions", (Sharp 1975).

Other community-based social work with psychiatric patients has evolved as a consequence of consecutive mental health acts since the 1950's. Martin (Ch.1), and Busfield (Ch.10), both perceive this evolution to have been facilitated by the discovery of the psychotropic drugs and to be driven by financial expediency rather than by any altruistic reasoning. Changes in legislation led to an end to compulsory admission of patients in most instances. The new legislation also facilitated a mass evacuation of long-term inmates into the community. With the implementation of each of the new acts new roles were designated for the social worker culminating in 1983 with the advent of the "approved" social worker and the acquisition by the profession of the ultimate responsibility for sanctioning the compulsory admittance of non-delinquent psychiatric patients. This legislation threw the "approved" social worker in at the deep end of the social control or social welfare dilemma.

Busfield (p8) locates the beginnings of this dilemma in the 1960's when; the problem was "less any inherent defects and deficiencies of medical practice than the application of medical ideas and techniques to this particular sphere:". She claims (p10) that Szasz, Laing, and Scheff; " - offered alternative ways of thinking about psychiatry and mental illness in which mental illness is generally viewed as a form of social deviance and psychiatry as a form of social control.". While Martin (p28) saw the implications of Goffman's work at this time to be separate from the arguments of Szasz and Laing, Busfield does not and the link from medical to interactionist philosophy is clear in her contention (p87) that; "While Szasz points to the social control that psychiatry effects in the name of care and cure, his objection is not to the control of behaviour as such, but to the fact that the control is hidden and unacknowledged, and is exercised by others rather than the individual. If there is to be social control - - then its real nature should be visible." Pearson (p126) sums up the dilemma for social work thus; "Very loosely, it is possible to say that social work is faced with the problem of whether it is an agency which enlarges human freedom or restricts it, - ".

The dilemmas posed in implementing community care are not only ethical ones however. When Martin (Ch.2), chronicles the progress of community provision for the mentally ill from the 1950's to the 1980's he perceives the social work contribution during this time to have been marred by workers and administrators who directed their talents and their finances respectively towards the more attract­ive client groups. He cites evidence. At the beginning of the 1960's only 25% of social workers in this field were trained and that figure had risen to only 50% by 1972. This apathetic approach was mirrored by administrators who by 1970 had employed only half of the perceived optimum number of workers, never neared the recommended number of community facilities, and concentrated financial resources in other, more visible, areas. [For example Berkshire Social Services allocate only 4% of their annual budget to this client group despite the fact that 1 in 7 of people in its area are potential clients10). This apathy continued throughout the 1970's (Martin Ch.3) alongside a recurring passion for self-analysis that continually altered the focus of social work with the consequence that; " - there developed among psychiatrists and many of their colleagues an almost universal impression that the mentally ill receive scant attention from the reorganized services - (due) - to the emergence of entirely different and unanticipated priorities." (op.cit. p38). Of the advent of the approved social worker following the 1983 mental health act Martin (p64) hopes for a political role for this worker but warns, in the light of previous experience "of the overloaded social worker" that one should "guard against over optimism here".

Ann Davies and Lynne Muir (1984) examine the perceived community role of the approved social worker. In a section of the book subtitled "Issues relating to the delivery of service" they outline the practice issues relating to the development of community services. In the light of the experience of X which was discussed earlier it is pleasing to note that Muir (Ch.14) perceives the social worker to have a particular role in educating multi-disciplinary teams in the needs of ethnic minorities. Martin is critical of social works ability to fulfil its functions claiming that as a consequence of its ill-defined role social work has little benefited the client group in question, (p96).

Other commentators are critical of social works ability and motiv­ation to deliver. They also criticise social work for its introspection; "Social work emphatically embraces human subjectivity and regards itself as a carrier of the humane tradition of compassion: it also sometimes behaves as if it were the only carrier of that tradition, and critics have taken social work to task for this." (Pearson p128). Busfield (pp.368/9) locates social workers amongst a group of "new mental health professionals" who are challenging the psychiatric stronghold but who she laments have already allowed themselves to be subordinated within a medical hierarchy. Hudson claims, (pp.172/4) that the profession leaves itself vulnerable to relegation to subordinate positions because of the reluctance of its workers to make detailed study of relevant research; "If we believe that it is part of our respon­sibility to seek change at any level, then it is a matter of professional ethics to keep up with research." (p173).

It can be seen that social work is perceived to be failing in its application of client targeted solutions to the implications of Goffman's observations. Discussion now follows of the political implications of those observations for social work practice.

From her critical analysis perspective Busfield sums up the argument of all the professions implicated here when she says; "The argument is that instead of directing all our resources and attention on to disturbed individuals, important though it is to ameliorate their situation, we need also to look beyond the individ­ual to forms and levels of intervention which would make mental disorders less likely for the population as a whole, or for particular groups within it." (p369). One strategy is implied through Pinkners (1971/6 p174) assertion on behalf of the stigmatised client that "Concepts like "the caring society" and the "welfare state" are subjectively meaningless to those who have not achieved citizenship in an authentic form. It may be that effecting changes in the consciousness of ordinary people is now becoming more important than further changes in the statute book.". Martin, however, exposes the futility of expecting public opinion or parliamentary intervention to assist in the fight, (p27), " - there is no particular reason to suppose that mental health issues ever assumed a burning importance for the majority of citizens, any more than they did for the majority of their parliamentary rep­resentatives.". Martin also argues (Ch.12) that successful political lobbying is best achieved by unified social groups. He is particularly critical of the political. indifference of social workers which sees only 40% of them in their own professional association, a fact which renders them politically impotent not only at the macro level but also at the micro level in discussion for patient rights with medicines professional bodies. The need for a unified approach by workers against the positiv­ist political and medical definitions of the problems of this client group, which are implicated by Goffman's examination of total institutions, is implicit in Busfield's (p370) contention that it is " - a political matter and requires debate and action in the political arena. It is political interests and political oppos­ition to more radical social interventions that maintains the curative approach.".

Identification of this less obvious, but most important, political social work role brings to a conclusion discussion of Goffman's concept of "total institution" and a consideration of its implications for social work practice.

In the first part of the essay examination of Goffman's concept of "total institution" revealed an anti-social, potentially damaging environment which in addition to its damaging effects for the in-patient, also had the power to affect the quality of life of both the pre-patient, through a "betrayal funnel", and the ex-patient, through stigmatisation. It was clear that "Processes of secondary socialisation and remobilisation reinforce feelings of inferiority in so far as they have more time in which to take effect. Institutionalisation adds the dimension of intensity to that time.", (Pinker. ibid.).

As the implications of "total institutions" for social "casework" were discussed a perceived political role for the worker inside such institutions was highlighted. For, as Martin (p171) says; "The concerted action of a professional group, or at any rate of a significant and vocal fraction, may be a necessary precondition of change; and in the case of community mental health services, this commitment has been conspicuously lacking - ."

Discussion of the community role for the worker which is implicated as an alternative to "total institutions" also led to the identification of an informed political role for the social worker. Hudson (pp.173/4) argues; "Social work as a profession has a duty to add its contribution to the general store of knowledge that will sooner or later lead to more humane and more effective services." She argued that this contribution should stem from social work research obtained through a research function which should be added to the social work task.

Social work’s uninformed position was one aspect of criticism when reference was made to the views of anti-psychiatry, psychology, and "misfit" sociology. Examination revealed a universal cynicism of social works application to the implicated issues. A perceived impotence to serve the client effectively was seen to emanate from the apolitical culture of a fragmented profession.

In conclusion the major implication of the concept of "total institution" would appear to be a need for social work to agree its place in the social welfare, social control debate from which much of its practice emanates. If that agreement endorses the provision of community alternatives to "total institution" social work practice should encompass the role of politically motivated advocacy for its non assertive client group, not least because sociological evidence " - suggests that localities vary markedly in their capacity to meet their own inhabitant's social needs, and that the concept of the self supporting community is peculiarly fictional - " in some areas, (Martin p94).


1. The writer has worked with psychiatric patients during each of the three phases identified by Goffman in both the voluntary and the professional sector for the past sixteen years. Most recently this work took place in a therapeutic community which sought to rehab­ilitate psychiatric patients who had spent significant periods of time either in prison or in "special" psychiatric hospitals. X is a composite of the males who resided there and Y is a composite of the females.
2. Here quoted by Busfield (1986) pp.94/5.
3. Goffman, here quoted by Jones & Fowles (1984) pp.13/14.
4. "A Mail on Sunday reporter", "Broadmoor puts on the caring style." The Mail on Sunday, November 18th 1990. Page 29.
5. Goffman in "Where the action is" (1969) here quoted by Stephenson (1978)
6. Relates the research of Jack Tizzard who "operationalised" Goffman's ideas.
7. Russell Barton. Related by Jones & Fowles (1984) pp.71/77.
8. Attributed to Wing & Brown (1970) by Shepherd (1984) page 6.
9. Attributed to Gruenberg (1967) by Shepherd (1984) page 6.
10. Figures obtained during interview of the A.D.D. Mental Health, Reading Social Services, by the writer for his social policy project, C.Q.S.W. course, April 1990. The 1 in 7 ratio comes from figures supplied by MIND and relates to patients in all three patient phases across the country.

Busfield. J. "MANAGING MADNESS: Changing ideas and practice." Hutchinson & Co. London. 1986.
Davis. A. "Developing Comprehensive Local Services." Chapter 12 in Rolf Olsen. (1984)
Davis. A. "Working with other professions." Chapter 15 in Rolf Olsen. (1984).
Muir. L. "Working with volunteers and self help groups." Chapter 13 in Rolf Olsen. (1984).
Goffman E. "Asylums" Pelican Books. England. 1961/8
Hudson.B.L. "Social work with psychiatric patients." Macmillan Press. London. 1982.
Jones.M. "Beyond the therapeutic community." Yale. U.S.A. (1968).
Jones. K. & Fowles. A.J.
"Ideas on Institutions" Routledge & Kegan Paul. London. (1984).
Muir. L. "Teamwork" Chapter 14 in Rolf Olsen. (1984).
Pearson. G. "The Deviant Imagination: Social work and Social Change." Macmillan. London. 1975.
Pinkner. R. "Social Theory and Social Policy." Chapter 4. "Exchange and Stigma." Heinmann. London. 1971/6.
Rolf Olsen.M.(Ed) "SOCIAL WORK AND MENTAL HEALTH a guide for the approved social worker." Tavistock. London. (1984).
Sharp. V. "Social control in the Therapeutic Community." Saxton House. 1975.
Shepherd. G. "Institutional care and rehabilitation." Longman. England. 1984.
Stephenson. G. "Social Behaviour in Organizations" Chapter 13 in :
Tajfel. H. & Fraser. C. (Eds).
Martin. F.M. "BETWEEN THE ACTS. Community mental health services 1959-1983." Nuffield Provincial Hospitals Trust. London. 1984.

The reader may be interested in the backgrounds of the major authors (Goffman excepted) who are quoted in this text.
Joan Busfield is a trained clinical psychologist who now lectures in sociology. Barbara Hudson is an ex psychiatric social worker who now lectures in applied social studies.
F.M Martin is a professor of social administration
Geoffrey Pearson is an ex social worker who now lectures on Human Socialisation.

Self Help Books

Over the years I have been given these to read by well meaning friends and relations. I have just checked Amazon and they are all still available. These are my thoughts about them.

“Self help for your nerves”: Claire Weeks.
Although I had experienced (and managed to keep hidden) two episodes of “Adult”* depression by then, during 1978 I suffered my first “Breakdown” requiring medical intervention. An Aunt who had herself experienced “Nervous Breakdown” sent me a copy of this book because she had found it helpful.

I guess this is where the difference between “Nervous Breakdown” and “Clinical Depression” showed. All the book did for me was to “prove” to me that I was, and always had been “Mad”, when, I skimmed the self-help suggestions because I was incapable of carrying out her suggestions, thus boosting my feelings of inadequacy, and focused on the section that outlined the symptoms of the various psychiatric illnesses.

I learned a valuable lesson here and throughout my “counselling” and “social work” roles always offered clients who I thought might benefit a list of books which they could dip into in the library before making their own choice about which was most beneficial to them. The “right” book, like the right therapy, is a very subjective thing, and I believe that, as with the latter, clients must feel comfortable with what is offered if they are to derive real benefit and growth.

* I distinguish the difference between my “Child” and “Adult” Depression as being the point at which I realised my fate was in my own hands and my “death wish” changed from “I wish I was dead” to “How can I kill myself”.

“The Power of Positive Thinking”: Norman Vincent Peale.
The Seventies and Early Eighties saw the rise of Behavioural and Cognitive therapies in the U.K. They were the only treatments available on the NHS because it was claimed that “outcomes” could be measured while the outcomes of “talking” therapies could not. (I disagree with both of these assertions, as you will see when I post my “Models of treatment” section).
The professionals I was referred to during this period kept dropping me the term “positive thinking” so when I saw this book I was drawn to it.

Written from a Christian perspective it, (in the way AA does with addiction), encourages the reader to replace their negative thoughts with religion.
Because of my alienation from organised religion I found many of the concepts and strategies in the book unpalatable, particularly as it seemed to advocate manipulating the Christian ethic for personal gain (see footnote). It did however give me two Mantra’s from scripture that I still use to boost my confidence during periods of stability.
These are: -
“I can do all things through Christ who strengtheneth me” and “If God be for me who can be against me”.

Footnote: Horses for courses.
I had a mature student, a very devout Christian who had internalised the “humility” aspects of the faith to an extent that was detrimental to him. To pay his way through the course he was allowing his willingness to please to be exploited by two unscrupulous employers and he would never promote himself forward in the classroom. This led some lecturers to define him as lazy and others to perceive him as timid and unlikely to pass the oral components of the course.
As a “tutorial” task I got him to prĂ©cis this book for me. As I had hoped he took on the message that being a good Christian does not mean being a doormat. It was wonderful to see him coming out from beneath “Christian” shell.

“I could not catch the bus today” David Lazell

Loaned to me by a friend during my agoraphobic period this book also advocates the application of Christianity as a solution to the problem.
All it did for me was to reinforce my feelings of inadequacy, as I was unable to effect the same changes in myself.

The books that have been most helpful to me in understanding both my illness and my behaviour are those I found in the College Library, when, following my period of intensive therapy in a psycho-dynamic therapeutic community, I got my self well enough to gain employment in professional social work and then to be sponsored for the Certificate of Qualification in Social Work (CQSW) course.

These are:
“On Becoming A Person”: Carl Rogers.
In addition to helping my self understanding (and self forgiveness) this book and the “Client Centred Therapy” that Rogers advocates in his counselling books, seemed to validate my self constructed Christian living model and provided me with a “Humanistic” philosophy on everyday living that I could utilise.

The Divided Self”: R.D.Laing.
Mainly an exploration of Schizophrenia, and much harder reading than the other books here, I took from this and Laing’s other writings the concept of Social Constructed mental illness. It offered me insight to those aspects of my personality that others were attributing to my illness but which I knew were just attributes of my own personality that were different to the accept norm.

“The Psychology of Personal Constructs”: George A Kelly.
The first cognitive based philosophy that made sense to me, mainly because it looks at the way people think without making tenuous links to the animal kingdom. Further understanding of some of my thought patterns to link with humanistic values I had acquired.

“Asylums”: Erving Goffman.
Insight to the way the system had abused me (confirmation that my illness was not responsible for some of my negative thoughts about “the system” as I had been encouraged to think by those perpetrating the abuse), and insight to the ways I had utilised the fear of my illness to abuse myself.
I became such a fan of Goffman that my Sociology tutor urged me to publish the essay I wrote applying his theories to my own professional and personal experiences.
As my lecturer, Prof. Clem Adleman, was a friend of his, and had discussed Goffman’s ideas with him first hand, this gave my confidence the greatest boost it had received since the days of Margot Theophilus (see Creative Writing 1).
I intend bringing the Essay up to date by including my experiences since 1990 but in the meantime I will post the original here (see Goffman) for any of you who might wish to read it.

“Mr God This Is Anna” Fynn.
I was given his amazing, delightful, wonderful book by a friend. It proved to me once and for all that there are many ways of enjoying the life of Christ and of putting his teaching into practice, without the dogma of organised religion. I return to it time and time again and find that the world it describes and the characters who come alive through the writers love and skill can make me laugh and cry each time with the same freshness as very the first reading.

Luv Bri

Thursday, 5 July 2007

I Wonder: 1

I wonder what birds think when they see people up trees.

I wonder how cats feel when they learn what those shiny things in the middle of the road are called.

I wonder how dogs react when people say "it's a dog's life" in a negative way.

I wonder why people let their dogs shit everywhere.

Tuesday, 3 July 2007

Critics of Social Workers

Did you see the programme last night about the parents whose children were wrongly taken into care. I thought it was very sad, both for the parents and for the children, but I wondered why Social Workers were being called to account for their actions when it was perfectly clear that both Social Services and the Courts acted at the time on the basis of "expert" medical opinion that stated one of the children could not have been injured any way other than deliberately.
It was the same in 1989 when in the "Cleveland Report" Lady Butler Schloss (who chaired the enquiry) clearly stated that mis-diagnosis by a Paediatrician lay at the root of the problem. She shared responsibility for the way the mis-information was put into practice equally between the Police and Social Services but all of the Media criticism was aimed at the Social workers.
The Daily Mail is particularly vehement in it's persecution of Social Workers. I was interested to hear that last nights programme was co-funded by the Mail on Sunday. I smiled ironically because I know how damning of Social Workers the headlines of those papers would have been if the doctors had been right and Social Services had left the children at home and one of them had been injured more seriously, or killed.
I am no fan of Social Services, their treatment of me when I became disabled and was no longer able to do the work they employed me to do was outrageous, and included trying to discredit work of mine they had previously complimented, in an attempt to reduce the payment I was entitled to under the circumstances of my leaving.
They did not succeed but by putting me "under investigation" they removed any possibility of me receiving support from my work colleagues who are "advised" not to contact colleagues under those circumstances, and who did not feel able to contact me even after I had left, presumably because they did not want their own records to be contaminated.
So, I am no supporter of Social Services or sloppy Social Work. As a manager I came down very hard on Social Workers whose practise was not up to scratch.
However, I am a supporter of current child protection legislation and, knowing of the stresses on individual workers who implement that law, I know the job is tough enough without workers having to balance what the media might do to them if they make a mistake.
I know of circumstances where that threat caused my managers to err on the side of caution to an extent that workers relationships with clients were compromised because those managers, who never met the families, forced my staff, through me, to take a tougher line than the case merited.
There are even poachers turned gamekeepers, ex social workers who form agencies and take extortionate amounts of public money by "reviewing" difficult cases through paperwork exercises using files (always with mistakes because overloaded workers do not have the time to maintain then properly), to almost invariably find fault with the workers because that is the way they justify their existence and ensure getting further work.
The reality of Children and Families Social Work is that one experienced worker might be holding up to 30 "at risk" cases which means responsibility for may be 50 odd "at risk" children. They work in hostile, frequently violent environments in which many are injured each year. At the time I qualified older workers were lamenting changes in child care law that forced them to involve parents in the decision making process, not because it was a bad idea, but because there is not time to do that and to keep the needs of the child "paramount" as the law requires.
Ten years after retiring from Social Work I still have nightmares about things I saw, and things children told me, while I was doing "case work".
Social Workers are an easy Media target because codes of confidentiality designed to protect the clients prevent them, or their managers, from discussing the most relevant part of concerns about the work. You will not read in the Daily or the Sunday Mail of the high number of Social Workers who are attacked and injured, (and some murdered) while carrying out the role society asks them to fulfill.
If the Media want to attack someone, they should attack a society which, through the courts and sentencing, places a higher value on stolen mobile phones than it does on Children's innocence and on Children's lives: and the lamentably small amount of money that is given to Social Services by comparison to other "front line" public services. You are unlikely to read such things in the right wing Media who want to discredit wherever possible because they do not perceive there to be a need for such services in the first place.

Monday, 2 July 2007

Some pomes wot i rote

I think I’ve probably written creatively from the time I learned to form my letters.
As a young child I spent a lot of time in a world I had created in my head in order to escape the parts of the world I did not like. I guess it was a natural progression to get some of that world down on paper once I was able to and writing stories or “composition” was my favourite (that’s an understatement, it was probably the only thing I enjoyed) at both Infant and Junior School.

The first poem I can remember writing was for a school competition when I was 10. We had to write about Christmas and the winning poems were shown in schools all over the County (Oxfordshire). Anyway, mine was a winner, the only lines I can remember now are:
“The tree we decorate in our house
Came to us from Queen Victoria’s spouse”
(Not literally of course. Lol.)

The next one I remember was written about two years later for and about the girl next door who I adored with the childhood “love” and innocence that was lost soon afterwards (I suspect even earlier for kids today: sad.). Anyway, my Sisters came across this poem in the place where I had hidden it while I plucked up the courage to hand it on, the teasing was more than I could bear so I denied my love (coward) and destroyed the poem.

For various reasons school became a very difficult place for me to be for a couple of years and I truanted more often than I attended. Things might have been different, I passed my eleven-plus but my family could not afford the extra expense that attending the nearest Grammar School would incur. Some, including my Mum, have supposed that more stimulation at the Grammar School might have held my interest but I doubt that, I think my fear of school was part of a more generalised fear of the whole world and a symptom of the childhood depression that the medical profession refused to acknowledge until recently.

So, it was the original Secondary Modern school for me. A place where the girls were taught to be seamstresses, cooks, secretaries or hairdressers while boys learned how to make things from bricks, wood or metal. (I have never forgotten our end of school career interviews. We had to tell the whole class of our ambitions and were laughed at by the teachers if our dreams did not meet one of these “chosen” occupations).

At fourteen I decided I ought to do something about my attendance or I might not get a job when I left at fifteen. My saviours as I battled through the longest year of my life were “Maggsy” and “Stoner”, two companions with a sense of humour as daft as my own, and Mrs Margot Theophilus, my English teacher, an Australian and one of the few graduates among the teaching staff. As I write this, I remember that in each of my two most complete Secondary School years, the first (with Anthony Barham) and the last, I had English teachers who appreciated my work.

In Mrs Theophilus’ case, she admired the content rather than the appearance. Each of the poems I am about to copy here was awarded a “merit” by her and transferred to her special “honour” book but all of them also have a comment, in red ink, lamenting my poor handwriting skills. A typical example on the one in front of me which comes complete with inkblots, smudges and crossings out reads:

“Merit: Could be neater: You were to “rough” copy it at home not in class”. Oh well, I tried.
Anyway, the poems you are about to read are my longest survivors. I must have written them between September 1964 and February 1965, so I was aged 14 years and nine months and 15 years three months. I left school in April 1965 aged 15 years and 5 months. This (unabridged and unedited) is the sort of work Mrs Margot Theophilus was encouraging me to produce at that time.

“Tall Men.”
Tall men in the field
Arms outstretched
Reaching, for nothing

Tied to each other
By thin, thin cable.
Bringing electric
To home, shop and stable.

Down it comes.
Dark and Grey.
But it goes just as quickly
It wafts far away.

“A Name”
What’s a name for?
Why can it be?
Not just to save being called
A, b, or c

“A Friend”
A friend is something everyone needs
But not all have.
When we are sad
Our feelings they save.

Are you still with me, good! I think there are signs in the last two of the isolation that was beginning to overwhelm me but perhaps I am being too analytical. If I remember rightly that lot was set as a homework task, we had to choose one but I enjoyed them so much I did that lot myself and then, for a small fee, wrote some more for some of my friends who also got merits lol. I had to be careful though, the school culture was not supportive of male poets and one or two of the more macho male members of staff made it very clear that they had learned of my “talent” and left me in no doubt of what they felt that said about me as a person.

While I have my doubts that the Grammar School (for different reasons) would have felt a more supportive environment, I sometimes wonder how different my life might have been if, during my last year, I had felt able to tell the teaching staff that I would have liked a job in journalism, one of my fantasies back then. I think Mrs Theophilus might have been very pleased. Here is another that made her “honour book”.

The leaves are scattered on the ground
Red and Golden all around:
As Golden leaves before us lie
Still more are falling (falling) from the sky
A carpet made of Gold-Red leaves
Which flutter to earth on a gentle breeze.

We wander through the leaves and peep
At the squirrels preparing for their long sleep.
They scurry around, to and fro,
Gathering nuts to make their stores grow.
The birds are migrating, going south
With exceptions like Robins, Blackbirds, and Grouse.

The babbling brooks are meandering slow,
Waiting ‘till ice diminishes flow.
The gentle light peeps through the branches
And on to streams where it gently dances.
The days are shorter
The nights more long
The trees now bare
For summer has gone.

I notice in the middle of the squirrel verse she has written, in red ink of course, “their X 20” because I had written “thier”, a mistake I would still make if my computer did not correct me because I internalised the “I before E except after C” rule too well.

This last one is dated Feb. 9th. That’s two weeks after Winston Churchill’s death on Jan 27th 1965. and just over a week since his funeral on Jan 30th.
I remember the latter well because it was a Saturday and I was doing my Saturday job as van boy for a travelling greengrocer. Although I was aware of Churchill’s greatness through my Gran (her bio to follow soon) I was amazed that every adult who answered the door that day was in tears. My interest was maintained because his final resting place at Bladon was in a village only about 30 miles from my own.
I recall at some point writing a much longer poem chronicling his entire life but this one I wrote with my memories from that Saturday still in my mind.

“Sir Winston Churchill - Departed in Spirit Only”
“Earth to Earth, Ashes to Ashes”
Slowly the coffin sinks from sight
But the memory of this great man,
Of the way he transformed wrong to right
Will never sink, and where ere It’s told
His story will bring thrills for young and memories for old.

A man with a flair for adventure
With nerve of solid steel
Has slipped from this world to the next:
A soul that surly must be blessed.
A man who did his very best has gone
But his memory will linger on.

So there you have it, the last poem I wrote for Margot Theophilus. It’s the one she commented might have been neater and when I see the beginning of a third verse crossed out on the page I have to agree with her, lol.
It must have been soon after writing this poem that I had a bad accident on my bike and, as a result, missed my fourth year exams. There seemed no point continuing at school, and Mum needed the money, so during the Easter holiday I got a job and never returned.
“Teen age” was just beginning in the mid sixties. I, and others like me, were expected to be school kids one day and adults the next. Without health and safety regulations in the workplace, and with the threat of Nuclear War an everyday concern, the world was quite a scary place. My poetry was never so innocent again and when I resumed writing at eighteen it was mostly about the darkness in my mind and a seemingly dark world outside it.
Luv Brian July 2 2007.

Sunday, 1 July 2007

where did the week go?

What a week. I think.
After I posted on Tuesday I began to feel really good but suddenly it’s Sunday and I don’t know where the week has gone.
I know I felt well the day after I started the anti-biotics but have since been very tired, almost in a daze.

The pain in the ankle was getting very wearing so it could have been the release from that, or perhaps it was my mind relaxing following the relief from the worry I have had for two years that I might loose my home, or maybe it’s been the depression again.
This is a problem I have recently discovered affects most of us with Mental Illness regardless of our diagnosis.

Chats in the smoking room or the kitchen at the day hospital often focused on the fact that we can often have other illnesses or complaints which both we and the medics can miss by putting the symptoms down to our “labelled” condition. Flue is a good example, early symptoms being a part of everyday life, particularly for depressives.

And then that “spaced out” feeling. Is it the medication? Is it the illness? Alternatively, am I just tired?
It was expected that once in a while someone would turn up at the hospital a couple of hours late saying “Well, I got up on time and sat on the edge of the bed and the next thing I knew it was two hours later”.

I’m a smoker and throughout my life people have given me a jolt by bringing me from my inner place to tell me the cigarette I lit some time before has completely burned away. I might have been trying to sift through the thoughts in my head or I might have found a moments respite from them but now I was sitting with a cigarette shaped ash balancing precariously on the filter tip.

Some days I am woken by my alarm but as I sit on the edge of my bed wondering whether to get washed, or make a cup of tea, or open the curtains, or what to have for breakfast, etc. I float off into some other place that is either incredibly troubled or wonderfully peaceful and I stay there for as long as it takes.

Since the diabetes this is more of a problem because the tiredness that comes when my blood sugar is up is like none I’ve experienced before. I can literally go to sleep anywhere when that happens, so much so that I have an almost permanent imprint of the toilet seat on my backside.