Wednesday, 11 February 2009

Serving Two Masters

Matt 6:24 "No one can serve two masters; for a slave will either hate the one and love the other, or be devoted to the one and despise the other. You cannot serve God and wealth.

Putting to one side the business about slaves Matthew has a point. Institutions, particularly caring institutions like hospitals, are notorious for their numbing effects where everything would work very well if only the ‘service user’ would go away. There’re a myriad of issues here: why people are attracted to caring in the first place, what purposes caring institutions actually fulfil, the deep seated (even if rebelled against) needs for leadership, control, hierarchy, personal responsibility and accountability, and who we are accountable to.

The first analysis is straightforward. As a chaplain I am accountable first and foremost to the Goddess, one percentage point above the person I’m visiting, and the institution comes somewhere further down the line. In my opinion, when this is not the case this is what can happen.

Mrs Waller and her husband Richard, 35, claim they contacted the hospital on several occasion but were refused permission to bring their daughter back in and instead referred to a child psychologist who told them 'not to worry'. She became so thin she could not walk on her own and was found dead in bed on December 2, 2005 - two weeks after leaving the hospital. She weighed less than four stone.

The parents hoped that the hospital would do something and felt powerless to act. The psychologist knew best. The nurse who rang to tell the parents not to come in took no responsibility and wasn’t expected to. No one felt responsible for anything and a child needlessly died. Now an inquest has begun and various policies will be tiddled with . . . you know the story, we heard it as soon as we became aware of the media and we’ll continue to hear it for as long as we live. A terrible inversion of purpose occurs again and again, the intent of the job is actually to tick boxes, fulfil policy and protect oneself and ones employer not just from litigation but also from adverse publicity. And yet anyone who’s ever spent more than a couple of days near a hospital knows that abuses of power, unkindness and thoughtless behaviours (as well as good practice) are fairly standard. Don’t pretend it’s not so! The very basis of institutions is the wielding of power.

I used to work in a psychiatric hospital in the 1950s. After having studied philosophy, I wanted to see what madness was: I was free to move from the patients to the attendants, for I had no precise role. It was the time of the blooming of neurosurgery, the beginning of psychopharmology, the reign of the traditional institution. At first I accepted things as necessary, but then after three months (I am slow-minded!), I asked, "What is the necessity of these things?" After three years I left the job and went to Sweden in great personal discomfort and started to write a history of these practices [Madness and Civilization]. It was perceived as a psychiatricide, but it was a description from history. You know the difference between a real science and a pseudoscience? A real science recognizes and accepts its own history without feeling attacked. When you tell a psychiatrist his mental institution came from the lazar house, he becomes infuriated.
Truth, Power, Self: An Interview with Michel Foucault - October 25th, 1982.

From: Martin, L.H. et al (1988) Technologies of the Self: A Seminar with Michel Foucault. London: Tavistock. pp.9-15.

(Practices have changed in hospitals, psychiatry and even in prisons yet their basis’ remains the same, it cannot help but do so: if they were to change they couldn’t continue to exist. In turn those practices are founded on basic human impulses, including yours and mine, which also remain the same. The classic demonstration of this is the Stanford Experiment

where a group of students were randomly allocated 'prisoner' and 'guard' roles. You can guess the rest. I've often wondered how life would be if our police, prison guards and traffic wardens uniforms were a light pink and they had to wear flower wreaths rather than caps.)

So. I am personally responsible for not reporting the abuses of power I may witness, from terminally disinterested staff to 4 large adults piling on top of a frail childs body. If I was to report everything I’ve seen in the decades I’ve been involved in hospitals I’d be admitted to psychiatric care myself. I don’t report everything because weighing up the benefits and detriments of doing so I’ve concluded that more often than not it will cause more trouble than it’s actually worth. I take responsibility for that which means not only that I trust I will stand in court and admit my failure if needs be, but also try to remain alert to the likelihood that I am losing interest in giving a damn.

I have the luxury of not being a member of staff employed by an institution and so am less institutionalised. As a visiting chaplain I’m very clear that beyond answering to managers or following policies I’m ultimately answerable to the Goddess. For me, the Charge is the first written source I look to for guidance, stressing freedom, love and balance and particularly personal responsibility.

Let there be beauty and strength,
power and compassion,
honour and humility,
mirth and reverence within you.
And you who seek to know me,
know that the seeking and yearning
will avail you not,
unless you know the Mystery:
for if that which you seek,
you find not within yourself,
you will never find it without.

But it's not always easy to be certain who benefits from my seeking for balance . . . my life is easier all round if I ignore bad practice on the ground that nothing will be done in any case, or that staff will learn not to trust me and so make access to patients less straightforward, or that patients may use me to manipulate a situation. We just try to do the genuine best we can. Knowing what's genuine is harder than it seems.

Image of Hekate by Robin M. Weare, 1995.

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