Simon Duffy

Thoughts, Bemusements & Arguments

Month: September 2012

The Difference Between Prison and Institutions

Yes, because in prison at least you know where you stand. You have a sentence – till the whistle blows. Of course, they can always tack on another sentence, but they don’t have to, and in principle you know that sooner or later they’re going to let you out, right? Whereas in a mental institution you’re totally dependent on the will of the doctors…

Joseph Brodsky in conversation with Solomon Volkov

In the UK we remain totally complacent about the basic abuse of people’s human rights by the excessive use of institutions and hospitals. We seem immune to the fact that there is no evidence that these institutions work and only too much evidence that they fail: encouraging abuse, suicide, depression and increasing problems for their inmates.

I recently came across an honest assessment of the true problem from R D Laing:

It is not easy. What do we do when we don’t know what to do? I want that guy out of sight, out sound, out of mind… The situation keeps cropping up in our society, when no matter how liked, esteemed or loved, some people become insufferable to others. No one they know wants to live with them. They are not breaking the law, but they arouse in those around them such urgent feelings of pity, worry, fear, disgust, anger, exasperation, concern, that something has to be done. A social worker or psychiatrist is ‘brought in’.

This is honest, but also frightening. Is this really the best we can do?

My own experience is that there is much we can do to avoid the path to institutionalisation and much we can do to help people escape institutions. But the forces that keep these institutional arrangements in place are immense. A recent study showed that ‘out of area institutional placements’ were costing the NHS £175,000 per head. This is money that is being invested in abuse and wasted lives.

It is not the economics of rational commissioning that keep institutions going – it is the fear and anxiety that Laing describes. Professionals, families, sometimes even the individual themselves, all lose faith in the possibility of any sensible solution. The existing community care support offerings are woefully inadequate and for many people they quickly breakdown:

  • Day centres that lead nowhere and which are often boring and fruitless
  • Care homes that force people to live in groups they don’t choose
  • Domiciliary care that works to its own rules and its own time tables

In other words we force people to fit into systems that work to their own institutional logic, and then we blame the person for failing to fit in. When these ‘community care’ solutions fail we then send the person even further away to an institution that will fail even more dramatically – at greater expense – but at a ‘safer’ distance. The very fact that we spend so much money is perhaps partly a salve to the conscience: look we care – see how money we are prepared to spend!

Brodsky (who was forced to live in both prison and the institution for refusing to accept the justice of the USSR) rightly observes that with the institution there is no time limit to this madness – in the institution imprisonment can be endless.

The question then arises: Why could we not start by actually working with the individual, their family and their community, to provide what really does work? Instead of abandoning them we could work with them to find solutions that strengthen them and those that care about them.

Those of us who have worked in this way know that it works. What will it take to encourage the system to defend human rights and develop personalised support?

Action is the Pointer of the Balance

Action is the pointer of the balance. We must not touch the pointer but the weight.
Exactly the same rule applies to opinions.
If we fail to observe it there is either confusion or suffering.

Simone Weil from Gravity and Grace

This thought may seem hard to grasp, but I think its really important.

Weil understands that our actions or our opinions are the fruit of our will and our understanding.

If people do things that we think are wrong, or express views that we think are mistaken, then we can try to change those things directly:

  • We can ignore them, move our attention elsewhere, or
  • We can disadvantage them, make things more difficult for them, or
  • We can punish people, inflict pain upon them, or
  • We can create laws which threaten punishment

To put the matter like this is not to imply that any of these options is inherently wrong – systems of law and codes of behaviour are necessary frameworks for human beings. But all of these measures are acting on the action – they don’t touch the heart of the matter.

The same is even more obviously true with opinion. You can make it wrong, immoral or politically incorrect for me to say what I think; but you have not changed what I think. Moreover you risk twisting my unsayable thought into something worse. My unpalatable opinion may then become the means by which I confuse myself or the means by which I could lose faith in you.

My opinions, at least my honestly expressed opinions, are the fruit of my understanding. This is not just a matter of knowledge. My understanding is the picture I have the world in all its fullness. It is changed by logic, by knowledge and by the human will itself – that is by our heart’s awareness of things.

If we want to change someone else’s opinion then we must change their understanding; and if we are to do this then we must engage honestly in debate. We cannot expect to take the field by storm. We may find in fact that we must change – that we have something to learn – that our heart too has been misplaced.

Genuine change is inner change – and nobody should be in a position to dictate that change.

It is for this reason that I have always found the notion of ‘values training’, in all its forms, somewhat suspect. It is all too easy for it to slip into a kind of subtle bullying or an attempt to teach people a different language, a new kind of cynicism.

I remember spending several says running values training for leaders within Lennox Castle Hospital, a dreadful institution north of Glasgow. We offered people all sorts of ways of rethinking what they were doing; we tried to show them the way in which prejudice was generated, the injustice of institutionalisation and the many opportunities for positive community lives for people with intellectual disabilities in the community.

On the face of it the training was a success.

But some months later I returned to ‘The Castle’ to begin the process of helping people escape back to the community by means of the organisation I’d set up called Inclusion Glasgow. And so I met again many of the ward managers and staff that I’d met at the values training events.

Nothing in practice was different, except that now the staff were inoculated against the change. They knew the language and they had worked out how to rationalise what they were doing now inside the institution in a ‘new language’. Too often this is what happens when we only operate at the level of language and apparent values.

Partly this problem was made greater because the values training was completely disconnected with any real opportunities to live those values – to work differently and to see the fruit of that work. This is part of what makes for genuine and inner change.

As the great Dr Bill Schwab said: the treatment for attitude is experience

We must avoid trying to change attitudes by only attending to the surface of things. The weight is in the heart and the proper means to touch the heart is only with truth and love.

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