Tag: empowerment

  • The discovery of freedom inside limitation: a story of an older adults mental health ward.

    There are things we simply cannot do.  There are things that simply are so.  I find it helpful to call these things ‘limits’.  You might also call them ‘reality’.   I want to offer the paradoxical idea that it is through the necessarily painful discovery of these limits that we find ‘freedom’.   

    On the locked mental health ward where I work this painful discovery of limits that we all come to know over the course of our lives repeats itself in miniature during a patient’s stay.   Many on the ward – their arrival is termed an ‘admission’ as if it involved being given access to something desirable like a rock concert – are held against their will under the Mental Health Act.   The price of ‘admission’ is a loss of a certain type of freedom – the freedom to move freely without visible restraint.   Once ‘admitted’, they cannot leave until their gaolers, the multi-disciplinary team of mental health professionals, determine that they no longer constitute a risk to themselves or to others.   They are deemed at this moment in time to be incompetent to make this judgement for themselves.  Prior to their admission, they were apparently free to float about in the community as they chose, like the rest of us (we will return to this apparent experience of freedom).   During the admission, the locked doors of the ward constitute a limit beyond which, without some special dispensation, they cannot go.    

    Many struggle to accept this new limitation.   They rail against the injustice of it and become so focussed on their lack of freedom to leave the ward that they cannot see much else.  They begin to believe and to say, ‘there’s nothing we can do’ and to give up on all but the most basic activities.   They sit unseeingly in front of the television set, barely talking to each other.   They take their meals at the allotted time.    They take their pills.    They wait for a decision, like a prisoner on death row waiting for the electric chair.  They can’t leave the ward.   They are not free.   So why bother trying to do anything?   A sense of powerlessness and lethargy takes hold, the only signs of life arising when they protest against doctor’s orders, against the rules, the things they are instructed to do within the artificial ward environment: medication non-compliance, complaints about the quality of the food, attempts to ‘abscond’, all efforts to break the metaphorical chains that bind them.    It is an entirely human reaction.   Ever since Prometheus stole fire from the gods, humanity has been unable to resist the temptation to try to push back the limits of what can be done, often at great cost to ourselves.  ‘Hubris’, the word given to this heroic overreaching, is a concept that points to the impossibility of escaping the iron laws of nature, and to the painful punishment that will be meted out to any who attempt this.   Prometheus’ crime was punished by Zeus who had him bound to a rock and sent an eagle to eat his liver which would then regenerate so that the eagle could be eat it again the following day; this punishment was to continue for all eternity and would have if Hercules had not eventually set him free.   

    For as long as things persist in this way, the situation appears entirely binary.   Either I can leave the ward and am free, or I cannot leave and I am a prisoner.   The choice is a choice between resentful submission – silently watching the TV, complying with doctors’ orders, being a good inmate and hoping for an early release for good behaviour – or rebellion, hiding the pills under your tongue and spitting them out after the nurse has gone, making a break for freedom when you get the chance.   But this binary is arguably more specious that real.   There is always an infinite number of things that the human beings on the ward are free to do and a finite number of things that are prohibited.    They are free to: talk to each other, to form friendships, to play games, to see visitors, to attend or not to attend therapeutic groups, to write poetry, to create art, to sing, to dance, to daydream, the list is (must be) literally endless.    And there is often a point at which a patient will begin to realise this and to ‘make the best of things’.   They begin to talk to their fellow ward residents, to show some curiosity about each other’s lives, to attend groups in a more than perfunctory way.   In short, they start to explore some of the potentialities of the world they are currently inhabiting rather than merely focussing resentfully on its limits.    They begin to feel somewhat free.   Not infrequently this process of adaptation goes so far that patients begin to associate this feeling of freedom with the artificial rules that they had previously so resented.   They begin to believe that their sense of freedom derives from the fact that they are being protected from the dangerous world outside the ward.    It feels safe in here but out there anything could happen.    They begin to fear the genuine freedom that only moments before they were so desperate to regain.    Maybe they begin also to remember that the freedom available out there did not feel quite so free after all.   It is not ‘really’ free in here.   But perhaps this is as good as it gets.   This somewhat non-binary response to limitation seems like an advance but still feels pretty disempowered.   It could be characterised as making the best of it while you wait for those with power to decide your fate.   

    It’s at this point I want to revisit the idea that prior to their admissions patients felt free.   This is actually very rarely the case.    It is perhaps more accurate to say that after being locked on the ward patients feel even less free.    The experience of the majority of us living under capitalist consumerism (and so the experience the majority of patients prior to admission too) is, I would argue, pretty close to this experience of making the best of it while you wait for those with power to decide your fate.   There is a slightly fatalistic acceptance that the general course is set; we are caught up in a system whose primary function is to cultivate not the ability of each human being to achieve their unique potential but the accumulation of capital at no matter what cost.   ‘It is the only way’ – the motto of every tyrant.   Rachel Reeve, the Chancellor of the Exchequer of our incredibly cynical current United Kingdom Labour government, likes to make a virtue out of imposing austerity with regret.   ‘We wish we didn’t have to do this but it’s for your own good. It’s the only way. ’  It is different but only in the sense that it lacks the straightforward honesty of Margaret Thatcher’s famous ‘If it isn’t hurting, it isn’t working’.  It’s the only way.     If you’ve read some of my previous blog entries you might be feeling puzzled at this point because I have clearly articulated a deterministic position elsewhere and here it sounds as though I am challenging determinism; I seem to be saying there isn’t only one way.   But there is an important distinction.   According to my view of determinism we cannot know what the only way is because that would mean having a complete data set and this data set is necessarily infinite.   Thatcher and Reeves appear to believe that they know what ‘the only way’ is and to believe that they are in control, that their actions are the ultimate causes of what happens within their sphere of power.    They seem to believe that they could do otherwise but that this would be a bad idea for everyone.   For me quite apart from the obvious bad faith here – does anyone really believe that doing things this way is in the interests of anyone but a privileged elite? – this narrative of control is entirely delusory.  Reeve and Thatcher might think they were ultimate causes but they are no more in control than anyone else.   Their power is merely the result of their privileged positionality –  a particular history means that they find themselves with access to levers that in a very obvious way materially influence lots of human lives.   This history is not their achievement.   It is simply a matter of what is the case.  I think delusory narratives of control are probably born with the advent of language but its strength intensifies hugely with the development of industrial capitalism and British Imperialism, a period of history during which those with material wealth exploit other human beings and the planet with enormous confidence that what they are doing is morally right.   The imperialists seem to be carried along by a hubristic believe in their own god-like power, bringing civilisation and order to a previously chaotic world of savages.  Although there have always been cracks in this narrative of control my sense is that in the current phase of post-industrial capitalist consumerism these cracks are wider than they have ever been.   Not only can we look back on the adventure of colonialism and see the violence and savagery that underpin its every step but we are coming to see how incomplete and provisional are our own narratives.   Rachel Reeves and the others who occupy positions of material privilege are starting to look like marionettes spouting narratives of control without really believing them as no one in particular (because the ‘cause’ of anything is always the unfolding relationship between that thing and absolutely everything else (see pages on interbehaviorism for more on this)) pulls their strings.   It’s so clear that we are not in a situation of our choosing, that those who we thought were at the helm steering the ship turn out just to have been playing out a strange kind of game without being fully aware of the situation themselves.   If no one really knows where we are going, if no one has ultimate control doesn’t that mean that each of us is a part of one interdependent whole, that whatever I do, whatever you do, makes the same unique difference to it all as the actions of anyone else?  What would happen if we were all to step into that strange power?  It feels as though collectively our species is hesitating about whether to stick or to twist.   The hesitation is easy to understand.    Even though we know in our bones that making the best of it while we wait for those with power to decide our fate is a disempowered position that not only stifles our potential for growth and creativity but that accelerates the destruction of the natural world that supports life itself, there’s a part of us that shrinks from empowerment.   It’s a bit of a relief, in a way, to stay somewhat infantile instead of daring to step into our own power, to take responsibility for our responses.    And with this there’s the fear of giving up our creature comforts of sharing our resources equitably with others.   Of course, it’s not fair and of course my privilege is unearned, but maybe in the end I just want to bury my head in the sand for a bit longer.   My creature comforts are so, well, comfortable.  True freedom and true empowerment look a little frightening.   Things might really change and who knows exactly what this might mean for me and my creature comforts.    This is the phoney freedom that our current cultural system offers, privileged access to resources built upon the oppression of others and a story that we cling to in order to live with ourselves about it being unfortunate but just the way of things – the power and material privilege of the people in charge is unassailable.  There’s nothing we can do.    So, are we going to stick or twist?  Perhaps, it is too late.  Perhaps everything is hopeless.   But are we really just going to shrug our shoulders, bad mouth the captain and his poor judgement, and focus on rearranging deck chairs on the Titanic as it slowly sinks beneath the surface of the sea?

    There is a final more truly empowered position that patients on the ward reach that is a kind of synthesis of ‘railing against injustice’ and ‘making the best of it’.  Here, instead of accommodating themselves to ‘making the best of it’ and letting go of their sense of injustice, patients extend ‘making the best of it’ into those moments where they encounter limitation, where things are not as they would wish them to be.  Instead of just bad mouthing the captain and blaming others, they step into their own power and assume responsibility.   With no certainty about the outcome, they begin to build a lifeboat.  They decide at least to try to make the actual system work better instead of meekly accepting the status quo.  They test the limits of the limits, discovering perhaps that it is possible for them to leave the ward for a certain period of time, that they can legally dispute the validity of the decisions that led to their admission, that they can ask for different food at a weekly community meeting;  some become radicalised by the experience of arbitrary rules, coming to see them as part of a wider system that oppresses both patients and staff.   Sometimes this insight is labelled as paranoia and lack of insight.   The patients see that staff are prevented from spending time with them by the bureaucratic demands of a paranoid organisation that is concerned less with providing excellent person-centred care and more with recording evidence of care so that it can defend itself, ‘should something go terribly wrong’.   (Is this so different from our system of representative democracy, with its focus groups and its crippling caution about doing anything to upset corporate power which it calls ‘being realistic’).  Instead of ‘us and them’, they begin to experience a sense of solidarity with everyone and to see their own fight for freedom as part of something that extends beyond the ward.   If they are lucky they may also begin to find a new kind of peace in relation to their existential situation.   Acceptance of limitation – ‘making the best of it’ – in this case is provisional in relation to the artificial limits imposed by human-made systems but absolute in relation to that which cannot be changed, that is to say what has already happened.   This might sound odd.   ‘Of course no one can change the past,’ you might mutter.   And it’s true that intellectually we all know this in the same way we all know that we must die but this kind of knowing is very different from the emotional acceptance that is only arrived at through a process of grieving.   If we could have written the story of our life, or of our species, from the beginning we would have written it differently.   But we cannot.   We could only have started where we started and, right now, we can only be exactly where we are.   We can only begin to move towards what we truly long for when we have let go of the impossible wish to have been born into a different life. 

    Most of us are born into a culture in which we are sold an ideology of individual freedom which, really, adds up to an ideology of individual licence, freedom without responsibility.   According to this ideology, if we accumulate enough capital we become free to do exactly what we want and to hell with everyone else, we gain absolute power over our lives and the lives of others.  But, as we have been finding, the briefest reflection reveals that this so-called freedom is no such thing.  Capital breeds more capital.   Money enables us to buy commodities and to purchase the labour of human beings who will do our bidding as long as we do not bid them to love us.  The human heart cannot submit to an external power.  Unless power and property is freely shared it breeds only resentment.   The miser dies alone next to their pile of gold.  If we are fortunate we learn to shake ourselves free of this ideology.   In the end all limitation dissolves, not just the artificial limitations that we have created, but the limited bodies we are born into.   Paradoxically freedom lies in accepting this limitation, accepting that we are born into living bodies not of our choosing, in which we move through a world not of our choosing, and that this life that we did not chose will be lived once and never again.    And maybe none of it could ever have been any other way.  Does that mean it isn’t worth doing?  Does it make it any less true that everything we do changes the world forever?  Shouldn’t we – mustn’t we? – at least do what we can do leave the world a better place than we found it?   Isn’t this, in the end, what we are here for even though it is a job we never asked for.  Isn’t this our destiny?  Stepping into this ‘truth’ is freedom with responsibilitybecause it is a freedom that entails an awareness of (and willingness to live in the blinding glare of) the fact that our every action permanently alters the universe and that we can never take it back.   If we hold onto the illusion of control this situation becomes completely paralysing.  If the stakes are this high how can I ever dare to do anything?   What if I harm someone?  What if I harm myself?  What if I get it ‘wrong’?  But for all the rules and advice we may encounter wherever we land, the truth is that none of it can tell us exactly what we need to ‘know’ because rules and advice are derived from the past experience of others and our former selves and they can never be the same unique event that each of us is right now.  This data set is infinite.   We cannot ‘know’ it all and in another sense – the sense of being directly in contact with it – we can’t not know it all.   If we are all radically honest with ourselves, isn’t it true that, even if we know we cannot ‘know’ we also know and have always known – in our bones – that it was going to turn out this way.   True freedom lies in the ability to ‘know’ all of this and still to choose to keep going with our heads not in the sand, diving into the impossible mystery of the unlimited sea of everything,  the unanswerable question as to why any of it should be at all.  We must have the courage to become exactly who we are and the humility to let others do the same: to live, to learn and to ‘make the best of it’.