On violent states and creative states

Violent States and Creative States – From the Global to the Individual

John Adlam, Tilman Kluttig and Bandy X Lee (eds) – Jessica Kingsley Publishers (2018)

https://www.jkp.com/uk/violent-states-and-creative-states-2-volume-set-1.html/

Violence often feels like it comes ‘out of the blue’. This contention might almost be intrinsic to any account of the experience of any individual who finds themselves ‘on the receiving end’ of an act of violence. Repeated violence, almost by its very nature, risks ceasing to be perceived or experienced as violence at all – think of patterns of domestic violence or self-injuring practices – or the tweets of the President of the United States – or the newspaper columns of the United Kingdom’s recently-resigned Foreign Secretary.

And yet: human behavioural violence is not random. It involves an agent – the doer of the violent deed. In turn, the violence of this agent emerges out of the self state, the state of mind, of the agent: an act of violence is the external expression of an internal state of mind. James Gilligan, who contributed the epilogue to these volumes, has argued that all interpersonal human violence comes down to feelings of shame and humiliation and feeling disrespected.

From a psychodynamic perspective we might characterise such states of mind as unstable states in which a ‘bad object-relation’, a node or nexus of tension and aggression and ambivalence, experienced as intruding upon the self, has to be evacuated in pursuit of the unconsciously hoped-for restoration of equilibrium. Put (much!) more simply: I feel shamed or ‘dissed’ – there’s then a relationship in my mind between ‘me-who-is-dissed’ and ‘he-who-dissed-me’ – the feelings associated with this are increasingly difficult to tolerate – eventually I lash out at someone else ‘out of the blue’ – at least momentarily, I am powerful and someone else has the bloody nose or the black eye – the feelings associated with ‘me-who-was-dissed’ are no longer available, they belong now to the person I have humiliated in turn.

It was ‘out of the blue’, for me, when, working a cold weather shelter one winter’s night (if the reader will accept testimony from my own experience), I was suddenly attacked from behind and thrown to the ground by a homeless man who had taken refuge there. But it wasn’t ‘out of the blue’ for my assailant – I suspect his violent state of mind had been building and bubbling a while – and so might mine have been, if I had been out and about that freezing night on the streets of South London.

What finally did it for him (I have many times since reflected) was probably when I happened to turn my back towards him (in order to go fetch something, as I recall). His violent act emerged out of his violent state and was ignited by his experience of the violent, humiliating or shaming disregard that I (inadvertently) performed for him. And then we must imagine the kind of life experiences that had led this man into this particular predicament – and reflect upon the violent State that might be understood to obtain, when the sixth largest economy on the planet can’t quite manage to meet the basic housing and social care needs of its vulnerable populations.

This two-volume set of essays on violence and creativity has at its centre the observation that even individual or behavioural violence occurs within an ecology that encompasses not just immediate family and community but society as a whole. We hope to show that, just as an individual can be in a violent state of mind, societal structures can take on ‘violent states’ – not only in the political construct of the ‘rogue state’, but in the sense that anti-Semitism or Islamophobia or misogyny or neo-liberalism or biosphere destruction might be understood as ‘violent states’ that effect harm to the body politic (and also give rise to individual violence).

Those who lost their lives in the Grenfell fire, on this view, died not ‘simply’ of smoke inhalation ‘out of the blue’; they died of an ongoing slow-boiling ‘structural violence’ – just as the victims of Hurricane Katrina in New Orleans did not die of drowning, so much as they were killed by structural violence at Federal and State level: by the failure to repair the Mississippi levees and by racial segregation pursued in public policy by covert means (which latter factor is explored in the first contributor chapter in these books, on the violent State of racial segregation in the housing policy of Baltimore).

Throughout the thirty-two chapters of these two volumes, we invite the reader to position herself in the liminal spaces between two pairs of concepts: in the interplay between violent states of mind and violent States of society; and across the subtle distinctions or the mysterious fine line that may separate a violent state, of mind or society, from a creative one.

Violence begets only violence. This book project is first and foremost an activist project: we are looking to contribute to violence reduction, not only to the theory of violence reduction. We also hope that our authors may have helped to shed light on the wellsprings of human creativity: how a destructive death impulse and the healthy, creative life impulse, may be inter-related; how to divert the flow of human destructiveness into more creative channels, at the level of the nation State and the global community as well as in individual states of mind.

In a creative state of mind, unbearable experience can be integrated into the psyche instead of needing to be got rid of; likewise in a creative State, the feared or hated ‘other’ is not expelled, be it an idea or an individual or a people – the ‘other’ instead is received, engaged with, respected, accepted, even celebrated. In these dark times, that’s not just a project and a book worth launching – that’s more like an urgent and overriding imperative.

Violent States & Creative States Freud Museum authors group photo

Book Launch at the Freud Museum, 6 July 2018

(Some of the authors – from left to right: Gina Donoso; Wayne Martin; Tilman Kluttig; David Jones; Sarita Bose; Lucy Neal; Alex Maguire; Maggie MacAlister; John Adlam; Gerard Drennan; Anna Motz; Estela Welldon; Tamsin Cottis)

 

On the occasion of the tenth anniversary of the closure of Henderson Hospital Democratic Therapeutic Community

Alexander     Dost thou not know that I am able to give thee a kingdom?

Diogenes      I know thou art able, if I had one, to take it from me; and I shall never place any value on that which such as thou art can deprive me of. …

Alexander     … for which purpose thou hast forsworn society, and art retired to preach to trees and stones.

Diogenes      I have left society, because I cannot endure the evils I see and detest in it.

From “A Dialogue between Alexander the Great, and Diogenes the Cynic” by Henry Fielding (1743)

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On 23 April 2008 at 2.00pm, a certain NHS Mental Health Trust closed the Henderson Hospital Democratic Therapeutic Community on a ‘temporary’ basis – pleading or otherwise peddling the usual piddling managerialist alibis and nostrums.

Even if you weren’t there, you can guess the sort of thing they said. What’s a fellow to do, we were – and are still – invited to consider, when he runs a big business and he can’t secure his cash flow? Our hands are tied. It’s no longer financially viable … and so forth … (if you can bear to look, some of it is laid out in the southwark.gov weblink listed at the bottom here). It’s been the same old song, for many years now, and it never lets up (or lets on) (or lets anyone off) and at some point you just know you’re going to hear those two dread words – ‘luxury flats’ – and another expanse of the Attlee/Bevan post-WW2 welfare settlement will have gone down with all hands on deck and the officers in the lifeboat, to the sound of cash tills singing ‘ker-ching!’ and developers popping corks – and also, somewhere at the edge of audibility, the continuing suffering of the marginalised and traumatised and dispossessed and excluded …

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I was there. A bit player: not one of the residents, or the residential team; not one of the potential candidates for admission suddenly denied an opening – but I was there through the death-throes of the community and I was there the day it was finally evacuated and boarded up. I was working for the Henderson Outreach Service team: it was my first NHS job. I started there in April 2001 and was there for seven eye-opening, humbling, almost overwhelming years that educated and moulded me as a person, as a citizen, as a mental health practitioner and as a psychotherapist. I then joined the massed ranks of the redeployed – an ongoing upheaval still playing out its consequences a decade down the line, in a minor but nonetheless sharply-pointed echo of and parallel process to the upheaval endured by those residents and candidates.

This is not all about me – but I do want to say how vividly I remember my first contact with the Democratic Therapeutic Community (DTC). As part of the interview process I was invited to attend the 9.15 community meeting. I was intensely anxious. Staff and residents congregated in this long rectangular space, dark in my memory but lit by windows and glass doors all along the long side facing the garden and full of assorted faded and shabby but snug and inviting furniture and fittings of the sort that nowadays would have the corporate drones diving for their alarm buttons on about 57 grounds of violation of health and safety edicts (NB this and other photos in this blog were taken the day the hospital closed, by the way) …

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Visitors were participant observers in the community meeting but active verbal participation was strictly limited to stating one’s name and business when asked and otherwise to remain silent. It’s an old cliché of the DTC, but it was not an easy matter – and why should it have been? – to distinguish staff from residents by any visual cues, and this is one of the things I remember so well: the disorienting (transformative) almost visceral experience of stepping out of the world of vertical hierarchy and rigid structure and into a liminal space where everything seemed to be up for negotiation in a flattened (not entirely flat, but flattened) hierarchy. And the other memory I retain is how excluded I felt: I was wrong, somehow, wrong to the very core of me; I did not understand, there was a language and vocabulary whose key I did not possess; I felt received but not welcomed.

I quickly came to perceive that in this way some fragment of the experience of the residents had been located in me, or I had identified with, as though this community had a sign above the door that said “do not abandon hope, all ye who enter here, but check your privilege, interrogate the quality of your own hospitality and get your head around what it’s like to feel excluded and outcast, and that right speedily, because this is the emotional work we do here and it matters very much” – or something like that, and I’m sure that anyone who lived there for the allotted year would be able to come up with something decidedly more pithy and concise…

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This is not about me and it is also not about recording a formal history of the unit: plenty of other places where that can be researched. But in case you don’t know what all this is about, I’d want to include you in! The Henderson DTC was in its sixty-first year of existence when it was closed. It therefore just pre-dated the inception of the National Health Service. It opened in 1947 essentially as a trauma unit, for ‘shell-shocked’ soldiers struggling to reintegrate back into civilian life after the end of World War Two. It went through changes of identity and changes of location over the years – and changes of funding, especially in the wake of the advent of the ‘internal market’ but if you want to know what people remember and mourn, when the Henderson DTC model is evoked, it is this:

  • Staff had no control over admission and discharge of residents inside the maximum stay of one year
  • Admission was by majority vote of a group of nine residents and three staff members – early departure from treatment depended on the vote of the whole community (in which residents always outnumbered staff)
  • There was no use of psychotropic medication permitted or prescribed
  • There was no coercive psychiatry or medico-legal technologies involved – no use of the Mental Health Act (or Probation Orders or conditions of residence or restriction orders of any kind) – no curfews, no restraints – as far as is possible to sustain in the UK of the late twentieth and very early twenty-first centuries, residents entered and stayed of their own free will
  • There were no ‘one to one’ psychological therapies available but a range of therapy groups, work groups and community meetings, which latter could be called at any time, day or night, if an issue affecting the whole community demanded the community’s whole attention

The American social anthropologist Robert Rapoport studied the Henderson Hospital in the 50s and in 1960 reported that four key characteristics defined the therapeutic milieu of the then twelve-bedded unit (when I joined in 2001, there were 27 beds as well as two other ‘replicated’ communities of similar size, in Crewe (Webb House) and in Birmingham (Main House)). These four characteristics Rapoport identified as democratisation, communalism, permissiveness, and reality confrontation. Transposed to the late period Henderson DTC model, these four ideas relate to major decisions all being taken by majority vote; to the ethos (‘communalism’) of staff and residents sharing with one another all the tasks and processes of daily living in a flattened hierarchy, with conventional roles consciously blurred; to the principle (‘permissiveness’) that there were no transgressions but only enactments, in that there were plenty of ‘house rules’ prohibiting all kinds of violence but it was understood that residents were not expected immediately or magically to relinquish safety practices (such as practices of self-injuring) that had got them to the door; and finally (‘reality confrontation’), to the principle that permissiveness did not preclude challenging the individual to understand that within the communal frame his or her actions had an impact on the rest of the community – and that by engaging in a given safety practice (slamming a door in frustration, for example) it was understood that distress had been expressed but that the individual had still placed themselves thereby outside the (conceptual) boundary of the community and would need to ask the community’s blessing to ‘come back in from the cold’ and to continue their emotional work (again, others may be able to put this into words better than can I who worked mostly at the edge of this system).

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Elsewhere, I have written in perhaps more moderate and balanced tones about the demise of Henderson Hospital and looked at some of the ways in which the DTC  in its defiant persistence may ultimately have contributed to its own dénouement:

“The Henderson DTC … not only represented an affront as well as a reproach to the over-use and abuse of medico-legal technologies deployed by the conventional psychiatric services for trauma and social exclusion that surrounded it: it also rather enjoyed actively poking its thumb in that system’s eye and should not perhaps have been so surprised when it eventually got thumped for its pains.” (Adlam, article in preparation)

“The Henderson’s own fraught relationship with the system of care … perhaps meant that it found itself too closely identified and ‘damned by association’ with the troubled, anti-social outsiders and misfits who were its client group.” (Adlam and Scanlon, 2013)

But what is a blog for, if not for engaging in familiar safety practices – which, in my case, right now, may well mean slamming a door, or even breaking a window or two? In the permissive culture of the therapeutic milieu, it’s understood one can’t be, would not want to be ‘reasonable’ all the time. Confront me, o reader, with reality – but not just yet, if that’s okay … because it’s ten years since Henderson was closed, and I am still influenced and shaped and inspired by my experience then and in the aftermath of its closure and I’m still mourning its loss but most of all at this the tenth anniversary (give or take a week or two of assembling my thoughts) I am really very deeply furious that it was shut down. I read through contemporaneous accounts of the closure process (some of which weblinks I’ve included as references below) and it still makes me furious. And I’m furious to feel that, provocative, even Diogenesque, though we may have been, nonetheless, some of the Alexanders of the field (not those many allies who stood alongside us, but those arbiters and authorities who stood by) did not come to our aid, or came too late, or came with weasel words, when eventually they rocked up outside our barrel…

Most of all, I’m angry because I keep encountering people who I feel would have found hope in the idea of the availability of the Henderson Hospital Democratic Therapeutic Community as a national specialist resource for traumatised and dislocated souls – and for whom that hope has simply not been available. That door has closed – like so many other doors.

People have died.

Who knows if they would still be alive, if they’d made it into the DTC? No-one can know this. And not everyone who did spend time at Henderson felt helped by it. But austerity and managerialism are violent and mendacious discourses and so let’s not get confused. Of course we could afford to keep the Henderson open. We could then and we could now. Spare me all that crap about cross-subsidies. The annual budget of the Henderson was about a third the cost of a Challenger tank (well, I’m approximating this detail off the top of my head, but that’s the joy of a blog, and you get the point I’m making).

In 2001 the Taliban dynamited the Buddhas of Bamiyan in central Afghanistan. They felt, so it seems to me, that the Buddhas constituted the wrong sort of evidence base and they hated how much those giant artefacts were revered by those whose hearts and minds they were determined to dominate. The closure of the Henderson was, on a much smaller scale, an analogous act of irrevocable cultural vandalism. I sympathise then with Fielding’s Diogenes, who forswears society because he cannot abide the evils he perceives in it.

We can’t just start up a campaign to re-open the Henderson. It’s gone. It leaves a hole in the fabric of the body politic that can never be repaired.

References/weblinks

Adlam, J. & Scanlon, C. (2013) ‘On agoraphilia: a psychosocial account of the defence and negotiation of public/private spaces’, Forensische Psychiatrie und Psychotherapie, 20 (3), 209-227.

https://www.researchgate.net/publication/261759145_’On_agoraphilia_a_psychosocial_account_of_the_defence_and_negotiation_of_publicprivate_spaces’

https://en.wikisource.org/wiki/A_Dialogue_between_Alexander_the_Great,_and_Diogenes_the_Cynic

http://moderngov.southwark.gov.uk/Data/Health%20and%20Adult%20Care%20Scrutiny%20Sub-Committee/20080227/Agenda/Closure%20of%20HendersonHospital.pdf

https://www.independent.co.uk/life-style/health-and-families/health-news/mental-hospital-closure-plan-is-condemned-as-inhumane-765690.html

http://www.communitycare.co.uk/2008/05/27/henderson-hospital-staff-and-residents-fight-to-reverse-closure/

https://www.leighday.co.uk/News/Archive/2008/April-2008/Henderson-Hospital-closes-today—a-failure-by-the

http://news.bbc.co.uk/1/hi/health/7144686.stm

https://www.theguardian.com/society/2008/apr/16/mentalhealth

Henderson April 2008 007

On ‘consultation’

“It is too often forgotten that the gift of speech, so centrally employed, has been elaborated as much for the purpose of concealing thought by dissimulation and lying as for the purpose of elucidating or communicating thought” Wilfred Bion (1966)

“To know and not to know, to be conscious of complete truthfulness while telling carefully constructed lies…” (George Orwell, from 1984)

“…there is a ‘symbolic’ violence embedded in language and its forms, what Heidegger would call our ‘house of being’ … this violence is not only at work in the obvious – and extensively studied – cases of incitement and of the relations of social domination reproduced in our habitual speech forms: there is a more fundamental form of violence still that pertains to language as such, to its imposition of a certain universe of meaning.” Slavoj Žižek (2008)

“He lit a lamp in broad daylight and said, as he went about, ‘I am looking for a man’.” Diogenes Laërtius (early third century AD)

 

Recently Barrelman and his colleagues have found ourselves being (apparently) consulted. There was a ‘Service Review’ in Athens and when its findings were announced, the thing that was proclaimed to follow was a ‘thirty day consultation period’. And when that was done, we were all unceremoniously turfed out of our barrels.

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It all reminded us very strongly of the last time the elders of the city conducted a Service Review. On that occasion, it was to consider the possibility that Socrates, late of this parish, had been ‘corrupting the youth of Athens’. Instead of a consultation, there was a trial – as you may have heard; and at the end of the trial there was a cordial invitation to come by for a cup of something strong.

Socrates could have done a runner at this point, but he elected to drink the hemlock and of course it terminally disagreed with him. In this way, the outcome of the review came to pass exactly as it had been planned and intended when the review was begun – which makes us Cynical types wonder, naturally enough, what on earth was the point of all that window dressing in the first place?

So when the local bigwigs announced a Review, last Spring, our thoughts turned to all those dreary preparations that would eventually turn out to be necessary: like rolling our barrels over to some shady olive grove; finding someone to look after the dogs; writing our wills; that kind of thing. But they were very clear with us that it was not about, you know, ‘jobs’ and such, or clearing undesirables out of the city – and the summer was long and hot and there was plenty to be getting on with, so we just kind of let them get on with it really.

Conceive, if you will, of our discombobulation, when the findings of the Review were announced and they were exactly what had been predicted. It was indeed all about ‘jobs’; and those wandering undesirables (Barrelman in particular, it must be said) were indeed, after all, to be shunted off into the suburbs.

So much for the legendary hospitality of the agora towards the maverick and the marginal!

But it did raise a dilemma: because there was this thing called a ‘thirty day consultation period’. What could they possibly mean by this? If we were being consulted, did this mean what it said on the tin? Or was it something a bit more like ‘insulted’? Or ‘assaulted’, even?

Well, the Cynical response seemed clear: we’d question the ‘findings’, whether or not anyone was interested.

And of course, no-one was.

At least, none of the city elders were interested. Plenty of people in the demos had some very strong feelings about it, being somewhat partial to the itinerant philosopher community and having come to rely upon us for a good old-fashioned harangue when times were tough (which was pretty much always, as the city elders tended to keep all the good stuff for themselves and the people could go hang…)

Still, it left a bit of a puzzle all the same: what was meant by ‘consultation’?

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When in doubt about something like this, there’s worse moves to make than to go down to the library at the Metröon and look it up! And what we found is that ‘consultation’ derives from the word ‘consult’, meaning ‘seek information or advice from’ (someone who knows something). This in turn derives from the French verb ‘consulter’, from the Latin infinitive ‘consultare’; which in its turn derives from ‘consulere’, meaning ‘to take counsel’.

We also looked up ‘consultation’ and found that this is ‘the action/process of formally consulting/discussing’. Here is a definition that makes more sense if you are an Athenian elder – because if you take that definition and you stretch the word ‘formally’ just as far as it will go and then some; and if you then compress the term ‘consulting’ within that definition down to the smallest scrap or iota of meaning that you can manage; then you’re somewhere in range of what they meant when they said there’d be a ‘consultation’ period.

To put the matter succinctly: when you hear an ordinary human being, with a mind of their own and no tail, use the word ‘consult’, what’s going on is that someone doesn’t know something and is seeking counsel from someone who does (like consulting the oracle at Delphi, for example, a thing Barrelman once did, and never looked back…)

But when you hear the word ‘consultation’ being used, especially by officials of the Metropolitan City-State, what is meant is ‘the formal process of NOT seeking information or advice or enlightenment of any description from anyone at all …’.

To which one might add ‘… whilst nonetheless indulging in a piece of transparently cynical (with a small ‘c’) and spurious virtue-signalling to an imaginary constituency of people, presumably all born yesterday, who might be supposed to be capable of imagining or believing that a decision of such import had been taken with meaningful and dynamic and interactive reference to the views and experiences of those who knew something, from lived experience and expertise, about the processes being discussed’.

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So look – Barrelman is not one for special pleading. I don’t want you thinking he’s got a personal beef and he’s just using his platform to vent it. Not that much of a platform, let’s face it. But Barrelman did feel at home in his barrel in the agora and he loved his interactions with the townsfolk and passers-by and as far as he is concerned the Metropolitan City-State and all its works can shove it where the sun don’t shine.

That’s the thing about a barrel – you can always just up and roll it to some other parking place.

But there’s two things stick in his craw. The first is that he has a hunch that the good people of Athens, if asked, would have had other ideas. It’s not comfortable or pleasant to see people being trampled upon in the service of ideologies to which they are not subscribed. But I don’t want to say too much more about that here – not least, because those people are very well able to say it themselves and probably say it better than Barrelman ever could.

No: the main thing to say here is this: there’s a violence done to language in this use of the word ‘consultation’. It’s a symbolic violence but it’s no less lethal for not being a contact sport. Lies and doublethink begin with expedience and end in totalitarianism. ‘Consultation’ is a phenomenon of epidemic proportions, reach and spread, in these post-truth times.

Language is an infinitely versatile but also unwieldy technology. Fiddle with its very basis and you mess most dangerously with minds and souls and systems. This is why Barrelman carries a lamp even in broad daylight – hard to spot an honest man about the place…

To borrow from a joke that’s even older than Barrelman: that ‘consultation’ was no bacon tree – that was an ‘am-bush …

 

References

Bion, W.R. (1966) ‘Catastrophic change.’ Bulletin of the British Psychoanalytical Society, 1966, N°5.

Orwell, G. (1949) 1984. London: Penguin Modern Classics.

Žižek, S. (2008) Violence: Six Sideways Reflections. London: Profile.

Dariusz Galasinski writes beautifully about corruptions and collapses of language and communication in mental healthcare systems, including difficulties in psychiatric/clinical consultations – see his blog at http://dariuszgalasinski.com/blog/?stc_status=success&stc_hash=04835e4cdee77914d0112b0a133fe20e

Diogenes Laërtius’ account of the life of Diogenes is at https://en.wikisource.org/wiki/Lives_of_the_Eminent_Philosophers/Book_VI#Diogenes

Janeway’s dilemma: coercive treatment and human rights in ‘eating disorders’ inpatient units

In 2017 the UN Human Rights Council published the “Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”. The secretariat prefaces the report by observing the Rapporteur’s call “for a shift in the paradigm, based on the recurrence of human rights violations in mental health settings, all too often affecting persons with intellectual, cognitive and psychosocial disabilities” (p.1).

The report goes on to say that “Informed consent is a core element of the right to health, both as a freedom and an integral safeguard to its enjoyment” (p.14). The right to consent to treatment includes the right to refuse treatment but “the proliferation of paternalistic mental health legislation and lack of alternatives has made medical coercion commonplace” (p.14). Justifications for using coercion based on risk and dangerousness and medical necessity are subjective and “exclusive to psychiatrists, who work in systems that lack the clinical tools to try non-coercive options” (p.14).

The report continues:

“Coercion in psychiatry perpetuates power imbalances in care relationships, causes mistrust, exacerbates stigma and discrimination and has made many turn away, fearful of seeking help within mainstream mental health services. Considering that the right to health is now understood within the framework of the Convention on the Rights of Persons with Disabilities [CRPD], immediate action is required to radically reduce medical coercion and facilitate the move towards an end to all forced psychiatric treatment and confinement. In that connection, States must not permit substitute decision-makers to provide consent on behalf of persons with disabilities on decisions that concern their physical or mental integrity; instead, support should be provided at all times for them to make decisions, including in emergency and crisis situations.” (p.15)

The report acknowledges the radical nature of these proposals and the concerns of stakeholders including medical practitioners and proceeds nonetheless to invite States to move towards an “absolute ban on all forms of non-consensual measures … Instead of using legal or ethical arguments to justify the status quo, concerted efforts are needed to abandon it. Failure to take immediate measures towards such a change is no longer acceptable” (p.15)

The implications of this report have been seized upon by service user and survivor groups (see for example Point 7 of the Executive Summary of the Kindred Minds BME Manifesto at https://www.nsun.org.uk/news/bme-mental-health-service-users-launch-manifesto) but mental health services are not perhaps falling over themselves in their haste to catch up.

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The reference to ‘psychosocial disabilities’ includes the contested diagnostic fields of ‘personality disorder’ and ‘eating disorder’ and my business in this blog is with the latter category. For more than fifteen years now I have been working as a psychotherapist on an inpatient ‘adult eating disorders’ unit and for the last seven or so of these years I’ve been leading the psychological therapies team there.

The ‘symptom’ being treated is starvation and the treatment being enforced is refeeding. Psychological therapies are understood to play a central role in supporting this process and/or in supporting the sufferer to undergo the intervention. In my role I am therefore unambiguously party to and implicated in this enforced treatment. This treatment is possibly often life-saving and life-restoring and yet is experienced as a terrifying intrusion, one to be resisted at times by any means possible, by many of the individuals who receive it – and now it has been proclaimed to be part of a widespread and endemic abuse of the human rights of those same individuals.

When I first arrived on that ward, more than fifteen years ago, coercive treatments under the Mental Health Act were very rare (I emphasise here that it is adults I am thinking of and the particular dynamics of adolescent units, although of course also covered by the Rapporteur’s findings, are outside my authority to comment upon). Adult patients in those days were on some psychological level ‘volunteering’ to undergo the intervention, in the hope of making a full medical recovery from malnutrition and from the distress that drove the troubled or troublesome food practices to begin with.

Nowadays 30-60% of patients at any one time are detained under MHA s.3 for compulsory treatment for their ‘disorder’ (specifically, anorexia nervosa, for other manifestations of eating distress are very rarely funded for this kind of unit). Coercion is therefore more explicitly medico-legal than it used to be, even though refeeding was always carried out across a power differential. And according to the Special Rapporteur, the coercive aspect of ‘eating disorder’ treatment is therefore more explicitly in contravention of international law.

In this blog I do not propose to argue for or against the findings and recommendations of the Special Rapporteur. I propose to treat them as a given and to look at the treatments I have been party to and the ethical issues they have always raised in this particular new light. Historic moments like the publication of the report to the Human Rights Council do and must give pause for thought and one question in particular has been niggling away at the back of my mind:

What can the fourth season of Star Trek: Voyager teach us about the ethical limits and excesses and the psychosocial dynamics of coercive treatment for ‘eating disorders’ on inpatient units?

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Well, I know you’ve been asking this very same question … and I don’t mean at all to be flippant about so deadly and deathly serious a subject. But sometimes material from literature and popular culture may serve as useful analogy or parable and I don’t want to blog about a ‘real life’ case study – for reasons I hope are self-evident.

So I hope you’ll bear with me, Trekkies and non-Trekkies alike, while we journey into the 24th century and the Delta Quadrant, 70,000 light years away from Earth, where we find the crew of the starship Voyager, under the command of the intrepid Captain Janeway, stranded far from home, making their way through unknown swathes of space and hostile predators, of whom the most significant for our purposes is The Borg, a hive of drone organisms who anthropophagically assimilate the technologies of alien species via enforced assimilation, turning enslaved individuals into cybernetically and surgically transformed fellow-drones within the Collective in pursuit of an idealised technological and socio-political perfection.

Now when I describe them thus, they don’t sound like a very sympathetic bunch, but you have to remember that the Borg drones have been subjected to coerced medical procedures in order to become Borg. They are already traumatised, colonised, subjected: made abject. They are victims-turned-predators, like a conscripted child army brainwashed into the massacre of alien villagers.

In their predatory and compassionless nature, they are very different indeed from the sufferers and survivors who pass through the door of the ward on which I work. But nonetheless I crave the reader’s indulgence not to be offended if I ask you (why? well, please bear with me a moment) to understand them not as the super-bad guys of the Star Trek mythology but as traumatised subjects with complex post-traumatic stress disorders; to imagine them as life forms with inalienable (although not conceptually individual) rights of their own – to see that they are fearfully perceived as ‘other’ in the sense of ‘belonging to an out-group’ – to see them as fiercely loyal to their sisterhood – in general to note that ‘their’ groupishness is different to ‘ours’ but that groupish they certainly are, chasing mirages of perfection together as one …

I ask you to allow, in short, for purposes of relating my parable, that this image might serve, in translation, as playful but respectful representation of the out-group in the Delta Quadrant of ‘severe and enduring’ eating distress …

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As our story begins, a drone has become isolated from the Borg Hive and taken into inpatient treatment in the Voyager Sickbay. The drone’s appellation is ‘Seven of Nine’. In our story there are no junior psychiatrists – but there is an Emergency Medical Hologram (EMH) (a long story!) and he is presenting a tricky case to the Captain/Consultant Janeway …

EMH: I’m afraid we have a decision to make. A difficult one. Her human immune system has reasserted itself with a vengeance. … Her life is in danger. I have little recourse but to remove the Borg technology.
JANEWAY: Which is the last thing Seven of Nine would want.
EMH: Hence the difficult decision. If a patient told me not to treat them, even if the situation were life-threatening, I would be ethically obligated to honour that request.
JANEWAY: This is no ordinary patient. She may have been raised by Borg, raised to think like a Borg, but she’s with us now. And underneath all that technology she is a human being, whether she’s ready to accept that or not. And until she is ready, someone has to make the decisions for her. Proceed with the surgery.

Here then is the central ethical dilemma. Seven of Nine is being held to ‘lack capacity’. Janeway is acting paternalistically, on behalf of the Federation, in what she feels is a construction of Seven of Nine’s best interests – even though the Voyager MDT is clear that Seven of Nine would not want this. Her junior doctor evokes the CRPD – ‘we must respect the wishes of the patient’ – but Janeway feels she has to ‘hold the hope’ of a full recovery for her captive/patient. Seven of Nine cannot be allowed to remain (cybernetically) disordered – she is at risk of organ failure – a radical intervention is mandated, whether or not in compliance with Intergalactic Law … [I hope by now it’s clearer why I pleaded with the reader to bear with me]

In post-operative recovery, Janeway does a bedside visit …

JANEWAY: I’ve met Borg who were freed from the Collective. It wasn’t easy for them to accept their individuality, but in time they did. You’re no different. Granted, you were assimilated at a very young age, and your transition may be more difficult, but it will happen.
SEVEN: If it does happen, we will become fully human?
JANEWAY: Yes, I hope so.
SEVEN: We will be autonomous. Independent.
JANEWAY: That’s what individuality is all about.
SEVEN: If at that time we choose to return to the Collective, will you permit it?
JANEWAY: I don’t think you’ll want to do that.
SEVEN: You would deny us the choice as you deny us now. You have imprisoned us in the name of humanity, yet you will not grant us your most cherished human right. To choose our own fate. You are hypocritical, manipulative. We do not want to be what you are. Return us to the Collective!
JANEWAY: You lost the capacity to make a rational choice the moment you were assimilated. They took that from you, and until I’m convinced you’ve gotten it back, I’m making the choice for you. You’re staying here.
SEVEN: Then you are no different than the Borg.

Janeway here is channeling Creon in Sophocles’ tragedy, seeking to persuade Antigone that she would be making the pro-social choice in choosing life and conformity over autonomy in death (I write about this a lot in other places). She tries to soothe Seven of Nine with the wisdom of her experience – she has seen others recover. Seven of Nine, from this particular perspective, is a serious case – the disorder took her over at a very young age – but in time she will learn that it’s worth coming in from the cold on Federation terms, even though she doesn’t see it that way right now.

But Seven of Nine, still using ‘we’ in her Borg identification with the Hive, has a perceptive question: if you get me better, so that I am then able to exercise my free will, will you allow me to return to the disordered out-group? Janeway is boxed in by the logic of her own position: she upholds the full recovery model and reasserts Seven of Nine’s lack of capacity. No change to the care plan, sorry, it’s all in your best interests, says Janeway … and Seven of Nine sees it clearly in the moment: I recognise you – you are my abuser.

A little later on, it’s time for Seven of Nine to start therapy – her body is restored somewhat towards a standard of normal functioning – her sense of panic has subsided – she is more compliant, although still held in seclusion – she has entered cautiously into a relationship with her treating team …

SEVEN: … I cannot function this way. Alone.
JANEWAY: You’re not alone. I’m willing to help you.
SEVEN: If that’s true, you won’t do this to me. Take me back to my own kind.
JANEWAY: You are with your own kind. Humans.
SEVEN: I don’t remember being human. I don’t know what it is to be human.
(Janeway picks up a [tablet] and lowers the forcefield.)
SEVEN: What are you doing?
JANEWAY: I’m coming in.
SEVEN: I’ll kill you.
JANEWAY: I don’t think you will.
(Janeway enters the cell, staying out of arm’s reach. She shows Seven the picture from the Personnel File [of Seven of Nine as a human girl] on the [tablet].)
JANEWAY:  Do you remember her? Her name was Annika Hansen … There’s still a lot we don’t know about her. Did she have any siblings? Who were her friends? Where did she go to school? What was her favourite colour?
(Seven looks at the picture for a while, then slaps it out of Janeway’s hand.)
SEVEN: Irrelevant! Take me back to the Borg.
JANEWAY: I can’t do that.
SEVEN: So quiet. One voice.
JANEWAY: One voice can be stronger than a thousand voices. Your mind is independent now, with its own unique identity.
SEVEN: You are forcing that identity upon me. It’s not mine.
JANEWAY: Oh yes, it is. I’m just giving you back what was stolen from you. The existence you were denied, the child who never had a chance. That life is yours to live now.

In a scene that seems to me to evoke forensic psychotherapy settings and seclusion facilities across many pathways, Janeway seeks, within a custodial frame, to engage Seven of Nine’s ambivalence and her repressed memories of her ‘pre-morbid’ condition before the trauma of assimilation by the Borg. Janeway is offering recovery but Seven of Nine not only can’t imagine what that might be like but is not at all sure there’s anything wrong with her that she needs to recover from. The emotional temperature goes up: Seven of Nine is aroused and agitated and distressed and confused but she can still clearly discern Janeway’s agenda, pressing upon her an identity that once was hers but with which she does not and cannot at present identify.

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There’s lots more where this comes from, as Seven of Nine’s ‘recovery journey’ continues and Janeway and her crew gradually increase her privileges and reward her progress with initially fearful and reluctant but gradually more trusting processes and mechanisms of social inclusion. As time goes on, Seven of Nine’s expertise by lived experience will come in handy, when Voyager comes across the Borg again …

But for now, it’s time to leave them to their travels and to come back to the Special Rapporteur and his recommendations. Where does this report leave the coercive framework for inpatient eating disorders treatment? The Rapporteur acknowledges the intense ‘stakeholder’ anxieties stirred by the prospect of radical change. Where would these units be, after all, without their medico-legal technologies?

I have seen people in Seven of Nine’s situation (by allegory and analogy) who, like her, came to feel grateful that their lives were saved by coercive interventions. I have seen others whose lives were saved in the strict (and short term) sense of the word but blighted at the emotional and existential level by the horror of the treatment they received ‘in their best interests’.

Obviously, I have no authority to make an ethical ruling here. The Rapporteur says that “instead of using legal or ethical arguments to justify the status quo, concerted efforts are needed to abandon it”. His position appeals to me and scares me in equal measure. But the point of this blog reduces to one question that inches its way into consciousness, in various different guises:

What if Janeway had wrestled a little deeper with the question of Seven of Nine’s fear of losing everything in treatment? Janeway makes a case for the ‘special patient’ – she pursues a justification for the excess of forced treatment by saying that Seven of Nine is ‘no ordinary patient’. But what if there are never ‘special’ reasons for using force? This is the axiom that we are being required here to accept.

The Rapporteur says we “lack the clinical tools to try non-coercive options”. What if the increasing power and potency and even sophistication of our medico-legal technologies (the Mental Health Act; the Mental Capacity Act; Community Treatment Orders; naso-gastric feeding; PEG feeding; pharmaceuticals and so forth) has deskilled us in some simpler forms of intervention? Suppose our coercive muscles are so well developed, that our engagement skills have become rather flaccid and feeble with disuse?

Suppose we invested in developing those skills in what Judith Herman called ‘existential engagement’, instead of falling back in relief, behind our coercive medico-legal redoubts, away from the stresses and strains of open debate? Suppose as many or even more lives might have been saved in creative ways, as have been lost to mishap or suicide under more coercive regimes?

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I don’t know; but I wonder …

 

References

Adlam, J. (2015) ‘Refusal and coercion in the treatment of severe Anorexia Nervosa: the Antigone paradigm’. Psychodynamic Practice, 21 (1), 19-35.                  https://www.researchgate.net/publication/265685587_Refusal_and_coercion_in_the_treatment_of_severe_Anorexia_Nervosa_The_Antigone_paradigm

Herman, J. (1997) Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror. New York: Basic Books.

‘Star Trek: Voyager’ screenplays from http://www.chakoteya.net/Voyager/401.htm

 

 

“Nothing about us without us” – notes towards a draft manifesto for survivor-led emancipatory research

“The only true commonwealth is that which is as wide as the universe. I am a citizen of the world” – Diogenes of Sinope

“Education either functions as an instrument which is used to facilitate integration of the younger generation into the logic of the present system and bring about conformity or it becomes the practice of freedom, the means by which men and women deal critically and creatively with reality and discover how to participate in the transformation of their world.” – Paulo Freire, Pedagogy of the Oppressed

 

On a damp and foggy Paris day in December 2017, a small group of two survivor researchers, a philosopher, and a mental health practitioner (that last one was me) attended #ConfCap2017 to discuss and debate issues around the civic and legal and human rights of persons living with disability in the face of societal attempts, in certain circumstances, to restrict their liberty and to force treatment upon them.

We were invited to participate in a seminar/symposium in which we were asked to speak to this theme: ‘Exercice des droits et participation: entre contraintes et accompagnement: Recherche émancipatoire’. We began by considering the implications of Clause (o) from the Preamble to the UN Convention on the Rights of Persons with Disabilities:

“(o) Considering that persons with disabilities should have the opportunity to be actively involved in decision-making processes about policies and programmes, including those directly concerning them,” …

Some of the philosophical territory was set out and then we spoke about different ways in which our paths as users and/or as providers of mental health services and as activists, writers, researchers and consultants had intersected – how our ‘given’ roles had been creatively blurred in practices of equality in the field of mental health – how ’emancipatory research’ might be an organising idea for some of those practices and what the UNCRPD preamble’s ‘actively involved’ might mean in practice.

It’s these ideas of ’emancipatory research’, which I must confess I only first came across when I received this invitation, and the possible meanings of ‘active involvement’, that I wanted to write about here.

It’s in the very nature of the term ’emancipatory research’ that it would be a very bad idea to attempt to claim or define the term or to appropriate, colonise or enclose the open spaces the term evokes and signposts. Here I just want to see if there’s part of the map that’s not yet been fully charted…

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I didn’t know a lot about the terrain and so I poked around a little and had a couple of pointers from survivor researcher colleagues. I probably missed a whole chunk but here is some of what I found …

In a book published in 2000 called ‘Research and Inequality’, co-editors Humphries, Merten and Truman reviewed arguments for an emancipatory research paradigm and traced some of the theories and discourses interwoven under this heading. They began with the Enlightenment as a movement located in optimism about emancipation (from scholasticism and the tyranny of superstition and religious dogma). They noted the importance and influence of Marxism, feminism, post-structuralism and other similar discourses and they identified research models such as ‘participatory action research’ (whose lineage goes back to Paolo Freire), ’empowerment research’ and ‘collaborative enquiry’ as examples of emancipatory research practice.

For Humphries et al., following Freire, emancipatory research is ‘research which has an explicit concern with ending inequality and taking the side of oppressed and marginalised groups…Knowledge is not just about finding out about the world but about changing it’ (Humphries et al, 2000: p.4.) And Humphries asks an important follow-up question (p. 186): “What does emancipatory research mean if researchers are inevitably implicated in power, so that our efforts to liberate perpetuate the very relations of dominance?”

‘Co-production’ was not so much of a buzzword at the turn of the century but that ethos also carries ’emancipatory’ connotations, at least in theory (instead of ‘us’ the experts by training producing knowledge for ‘them’ the experts by lived experience, let’s ‘we’ join to produce the knowledge ‘together’). Some other time I’ll share our co-produced critique of ‘co-production’ but for now let’s peg it as ’emancipatory lite’.

Jerry Tew (2003) shows how the conventional established discourses around the gold standard (an interestingly outdated term, this) in scientific/medical research paradigms are located in an excluding and objectifying value base and suggests emancipatory research would have as its task:

“To produce evidence and theory (concepts and frameworks) that can enable users and carers to:

  • have a greater awareness of their situation so that they can make informed decisions and choices;
  • have more control over their lives in areas where this may have been taken from them;
  • participate in areas of social, economic, and political life from which they may have been excluded;

and can enable communities and practitioners to:

  • challenge stigma, injustice, social exclusion…” (p. 24)

Emancipation, in any domain, is not a process of continuous progressive trajectory or a question of the quickest route from A to B. There are an increasing number of survivor researchers and experts by both training and lived experience who are making significant contributions in the field. The concept of ‘survivor researcher’ was news to the audience at Paris ConfCap, however, and as Diana Rose, Sarah Carr and Peter Beresford (2018) note: “service users, survivors and their organisations are pre-defined as consultants in research and knowledge-making and not positioned as leaders, knowledge-makers or researchers themselves. We do not appear to be permitted to enter the same terrain or space as ‘real’ researchers.”

There is some ‘active involvement’, in other words, within the possible meaning of the UNCRPD, but it’s the kind of involvement that mostly comes from being ‘included’ in someone else’s project…

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Here is possibly where the United Nations again comes in handy. Bear with me while I reproduce what they say a bit.

The ‘Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ (2017) proclaims (p. 6) that

“21. The promotion and protection of human rights in mental health is reliant upon a redistribution of power in the clinical, research and public policy settings.”

and goes on to recommend (p. 20):

“92. To address the imbalance of the biomedical approach in mental health services, the Special Rapporteur recommends that:

(a) States take immediate measures to establish inclusive and meaningful participatory frameworks in the design of and decision-making around public policy, to include, inter alia, psychologists, social workers, nurses, users of services, civil society and those living in poverty and in the most vulnerable situations;

(b) States and other relevant stakeholders, including academic institutions, recalibrate mental health research priorities to promote independent, qualitative and participatory social science research and research platforms, exploring alternative service models that are non-coercive;

(c) States partner with academic institutions to address the knowledge gap in rights-based and evidence-based mental health within medical education.”

So that’s a fairly clear rights-based mandate and indeed instruction to break up established monopolistic discourses determining research and knowledge production in the field of psychosocial disability (which term is broadly defined under the UNCRPD in a way that includes mental health issues and the contested domains of ‘personality disorder’, ‘eating disorder’, post-traumatic syndromes of various other kinds, etc).

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At ConfCap 2017 my colleagues and I looked back to the inspirational emancipatory pedagogy of Joseph Jacotot, concerning whom the contemporary French philosopher Jacques Rancière has written so eloquently. Jacotot, exiled to Flanders after the restoration of the French monarchy in 1815, discovered that he could teach French when speaking no Flemish even though his pupils spoke Flemish but knew no French.

Jacotot concluded from this experience that the role of the ‘master’ in relation to the ‘pupil’ needed to be entirely rethought and that “we are all equal in our intellect and common humanity”. Rancière critiques processes of social inclusion in which equality is constructed as a goal to be worked towards, arguing instead that we might simply assume equality from the outset and see how that changes our practice.

We also thought about the Democratic Therapeutic Community tradition in the UK since World War Two, beginning with a famous experiment in which Wilfred Bion, then an army psychiatrist in charge of the rehab wing of a military psychiatric hospital full of shell-shocked ‘soldiers who happen to be patients’, decided that his unit was in disarray and that the rehab task was hopeless unless the ailment could be displayed to the group as a group problem.

Bion formed an experimental therapeutic community centred around a daily parade ground meeting and invited the men to investigate their problems of discipline in wartime themselves, declining to exercise in any predictable way the medical or military authority vested in his role. The direct descendant of this approach was the Henderson Hospital Democratic Therapeutic Community, founded in 1947, which was the treatment centre in and around which, much later on, the paths of my colleagues and I converged.

At ConfCap 2017 we put the question whether this tradition of emancipatory practices of equality could be maintained and developed and we listed some of the ways in which we might be understood in different ways to have succeeded in producing knowledge together under this rubric and how this process has arguably become more emancipatory over time, at least in certain dimensions.

By this I particularly mean, that I was fairly clearly self-defining as project leader in my own early forays into research alongside survivors, whereas the roles have become gradually more ‘blurred’ (in therapeutic community terminology) to the point that recent and planned future ‘productions’ are either located in a practice of equality or may be understood as survivor-led.

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What then do I think I am doing, writing this blog and (for example) not even naming my colleagues? Well let me say first of all that I have not mentioned names because I am not assuming agreement with the train of thought I have set out here although I am very conscious of how strongly influenced it is by the collaborative work and I am not at all claiming thoughts as ‘mine’.

I also began by saying I was not going to make the mistake of staking out territory for myself or for my definitions of anything. Emancipatory research is a broad field and there might be something about this blog that justifies inclusion under that broad head, even if I am writing as expert by training.

What I want to do by way of conclusion is to jot down a few notes towards a manifesto or charter of some kind that might help to identify and mark ‘Survivor-led emancipatory research’ as an important and valued and differentiated subset of ’emancipatory research’ generally … and then see where it goes …

So – in that spirit – survivor-led emancipatory research is or might be understood:

(1) to be survivor led in design, implementation and publication
(2) to be embedded in flattened hierarchies and practices of equality that value expertise by lived experience
(3) to be concerned with, and to uphold a free and open and fearless culture of enquiry into, inequalities and dynamics of force within the system of care
(4) to renounce diagnostic models and categorisations that objectify the person in distress and not to objectify its own research subjects
(5) to place a value on deploying the self of the researcher
(6) to value communities of learning and to enlist experts by training in various fields as and when this may be helpful
(7) to value and privilege rainbow literature over grey literature

(8) to be understood as an anti-colonial practice and to resist and oppose discourses that would seek to ‘include’ it

(9) to be and to be recognised to be a form of knowledge production on equal terms with other such forms

(10)…..?

 

References

Paolo Freire ([1970] 1996) Pedagogy of the Oppressed. London: Penguin.

Jacques Rancière ([1987] 1991) The Ignorant Schoolmaster: Five Lessons in Intellectual Emancipation. Stanford, CA: Stanford University Press.

Diana Rose, Sarah Carr & Peter Beresford (2018): ‘Widening cross-disciplinary research for mental health’: what is missing from the Research Councils UK mental health agenda?, Disability & Society. DOI: 10.1080/09687599.2018.1423907

Jerry Tew (2003) Emancipatory research in mental health, in “Where you stand affects your point of view. Emancipatory approaches to mental health research. Notes from Social Perspectives Network Study Day 12 June 2003” pp. 24-28

Carole Truman, Donna Mertens, Beth Humphries (eds) (2000). Research and Inequality. London: UCL.

Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (2017) UN General Assembly – A/HRC/35/21 https://documents-dds-ny.un.org/doc/UNDOC/GEN/G17/076/04/PDF/G1707604.pdf?OpenElement

UN Convention on the Rights of Persons with Disabilities (2006) https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html

 

The #PTMFramework debate – a Cynical view? By Barrelman

It’s been a busy old time for Barrelman in the agora, these last couple of weeks, I can tell you.

There’s all my daily challenges to grapple with: practising disappointment by begging from statues; waving my stick at people who don’t agree with me; trying to track down, by hook or by crook, one honest man hereabouts. Exhausting, questioning everything, you know. Not a lifestyle choice either, mind you – what’s a barrelman to do? it’s not about ‘good or bad’: it’s just the only place I can stand and still be me.

And now there’s all this tweeting and blogging and altogether just so many more things to Question. Take this latest example. All Athens is buzzing with this new philosophical manifesto – calls itself the Power Threat Meaning Framework. Aims to overthrow the Metropolitan Powers That Be. Especially the Medical ones. Sort of offering a Framework for a Meaning-full Threat to Power, if you follow me…

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Now you know me, I reckon. If there’s one thing I can’t abide, it’s the Metropolitan (Metropolis – City State – what it says on the tin, really) system of care. Whole point of me and my dogs being holed up in my barrel, here outside the Temple and just along the way from the olive grove (where Socrates used to hang out and make a very creditable nuisance of himself, few years back) is precisely that I do not and never shall recognise the authority of the Powers That Be to tell me what’s wrong with me or how I should live my life.

They might offer to relocate me, like the Emperor Alexander (no less!) did when he popped by for a bit of outreach work the other day. Cool guy, as it goes. We had a good chat and discovered we even had the same teacher back in the day (of which, more later!) – but notwithstanding, I sent him away with a flea in his ear (‘get out of my light’, I told him – you should have seen his face!). I’m not taking anything from that lot on the terms they’re offering it – which is always and invariably, that they could take it away again if the fancy took them. I’m just temperamentally incapable of ceding them that kind of power, no matter how cosy and structured a retirement plan they might have in mind to buy me off and shut me up with.

Who do they think they are, might I enquire, these great city-States: with their bigwigs and their elite in-groups and their excluded out-groups and their categorisations and their unexamined lives? Not to mention their disregard for animal life and the ecosphere and their colonial wars of aggression and the undeniable fact that their economic prosperity is built upon slave labour and Knowing One’s Place (and Minding One’s Own Business). The ‘Philosopher King’ says ‘The cobbler should stick to his last’ – I mean, please? Plato? Don’t make me laugh!

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So, anyway, not only am I well known to be ‘anti’ Metropolitan systems, but I’m also imagined to be pretty much ‘pro’ more ‘Cosmopolitan’ systems (which is what the ‘Framework’ is – bear with me!). I reckon this is because of one of my recent choice put-downs, when some practitioner or other asked me where I was from. Trying to get some narrative coherence out of me, no doubt. I drew myself up and I looked my haughtiest and I told him ‘I am a citizen of the cosmos, thanks very much’ … and before you know it, everyone and his uncle are wearing ‘Cosmopolitans do it ecosystemically’ badges and doing mindfulness courses in converted barns out towards Delphi way …

Well, I’ll come back to this point a bit later, about what I’m supposed to be ‘pro’ or ‘anti’, if I may – there being a rather significant and in fact total misunderstanding of my position bundled up in there somewhere. But when this ‘Framework’ comes along and is proclaimed in the main square and it’s avowedly Cosmopolitan and pokes its stick right in the eye of the Metropolitan system, speaking up for social justice, even asking some excluded people what they think about it all – well, you can see how people would figure I’d be like ‘yay!’ and gung-ho and putting out the bunting along with the rest of them.

Sure as I’m sitting here in a pile of my own dirty linen and not giving a damn, they got very cross very quickly when I started shouting at them too! Conceive, if you will, of their disappointment. But what I am urgently keen to understand is this: what on earth did they think they were thinking, imagining me as their cheerleader?

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To explain what I’m getting at here, the first thing to question, just to spell it out, is what exactly might be the difference between the Metropolitan and the Cosmopolitan systems. Might be obvious, might not be …

Now the Metropolitan system likes to think it’s not a system, not really and truly. ‘There’s no ideology hereabouts’, you’ll hear the in-group protest – ‘this is just how it is’ and ‘you can’t argue with science’ and all of that.

Okay, so this in fact is nonsense of the first water, because there’s a very clear ideology to the Metropolitan system – and that is that power rests at the centre and it’s up to the in-group to decide who gets invited in or not. Nice work if you can get it, of course (trust me, I’ve been there – or in fact, maybe DON’T trust me, because I’m tainted by association – well, either way…).

The small print of the Metropolitan kind of invitation is pretty damn specific and its special trick is that it excludes even when it looks like it’s including (note those active verbs, peeps!). If you look carefully, it says ‘Dear Barrelman (or whatever your name is, we don’t much care, so long as we know where you live) – Dear Barrelman, you too can be a Citizen of Athens, do please feel very welcome to come in from the cold, but only on the following terms (cue 426 pages of conditions, exclusions and penalties)’.

And right at the bottom, in slightly bigger font, just so we’re all clear, it reads ‘IF YOU DON’T ACCEPT THESE TERMS, WELL, TOUGH. We’ll either force you to come in, by means of what we call ‘medicalisation’ or ‘welfare benefit control’ or some other form of slavery – or we’ll leave you out there in the cold, and good riddance’.

So that’s the Metropolitan system of care, you see, and it’s kind of democratic, so long as you are not a slave or a homeless person – or a woman. Every so often someone says, okay, sod it, it’s bloody cold out here, and they accept the offer and the small print, even if they don’t read it or agree with it, and they get themselves some accommodation. Totally good luck to them, say I: I’m not knocking anything about that at all.

But there is a ‘but’. And the ‘but’ is that the Metropolitan system excludes faster than it includes, so the societal problem, if you get me, the problem of inequality and borders and privilege and force and generally trashing the place in pursuit of economic growth so we can go off and mash (or get mashed by) the Spartans or the Persians or whoever – the societal problem stays the same.

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So the Cosmopolitan ‘Framework’ has a much-hated system to go head to head against. And all credit to them: they go at it and set about it with much vim and gusto. Our Cosmopolitan friends pull no punches regarding the violence of the Metropolitan approach to sending out invitations. And then they argue ‘let’s not include or exclude by force across a boundary like those Metropolitans do’; instead, let’s include gradually, across a porous boundary so to speak (like the boundary of the agora, in fact, which is just a bunch of standing stones arranged in decorative poses at fairly wide intervals along the edge of the marketplace – nothing like your Long Walls down to Piraeus or anything). ‘Let’s see what develops’ and ‘why not come along for the ride’ – that’s their much more friendly and congenial idea of an invite.

According to the Cosmopolitans, we’re all citizens and we’re all linked to each other and the thing to do is to bring people in from the outer rings (starting with foreign peoples in distant lands, when we’re not enslaving them of course, and working inwards from there) towards the inner rings (community, family, the self, you get the gist) – by keeping the focus on what connects us all and not on what divides us.

So they’re for frameworks rather than fences and for descriptions that connect, rather than labels that divide. They have got various progressive moves towards equality on the go and they worry about the effect of the post-Peloponnesian War recession on the morale of the citizenry and, generally speaking, I hear you cry, what’s not to love?

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Two things, actually (minor quibbles aside). Two things, and they’re quite closely connected.

The first is this: I hate systems. I just can’t be doing with them. People think I’m anti-Metropolitan because I’m ‘on the other side’. Me, I’m not interested in that kind of talk. I carry no torch for the Metropolitans; but I have a pretty strong hunch I’m none too keen on the Cosmopolitans, either – not if a system is what they are after.

I don’t think you can include by excluding. The Emperor Alexander can go boil his tail if he thinks I’m going to recognise his authority over me. But it’s no use the Cosmopolitans denying his authority. Question it – yes. Go for it. I’m all for that. But I’m pretty damn clear that most people figure he’s presently in charge. Ask the Corinthians, or the Persians, if you don’t believe me.

My saying Alexander should get out of my light is not the same as my saying he isn’t Emperor. He’s a bloodthirsty warmonger, make no mistake, but he’s the most powerful man on the planet and we may possibly never see his like again, IMHO. Him being Emperor doesn’t impress me in itself; but if I did want anything from anyone (which I don’t), I know it’s him (in effect) that I’d have to be asking. I’m not sure that the Cosmopolitans have quite worked out how to get round that one; but plenty of people around the marketplace seem to see this as a bit of a sticking point.

Be that as it may, I say again, it’s systems I don’t like. I’m a Cynic, you see? Now on account of me making myself a touch unpopular about the place (crapping myself in public, thwacking people who don’t agree with me, not bowing and scraping to the Macedonians, that sort of thing) people have taken to labelling me cynical with a small ‘c’, like I was being destructive or ‘doing it deliberately’ or something. “Get yourself a teaching job, Barrelman, instead of haranguing people all the time and being generally a menace to traffic – don’t you know there’s a war on?” – you know, the usual sort of thing. You’re either part of a hard-working family in this city, seems to me, or you’re out (or else you’re a Philosopher King, of course: in which case, you get other people to do the ‘hard-working’ bit and you live off of the proceeds) …

But there’s nothing ‘small-c’ cynical about me. I’m a Cynic – and Cynicism is not a System with a capital ‘S’ – it’s a practice (with a small ‘p’) and the practice is mainly around not being taken in by economic power, not identifying myself as a consumer and, above all, not taking anything as read EXCEPT that man and animal are all equal under the sun and let’s take it from there. I don’t concoct or proclaim ‘systems’. I don’t even usually write anything down at all. I made these notes for myself but I confidently expect none of my jottings will survive for Posterity and rightly so. You can’t enslave me with words: questioningly, that’s how I wander about the place.

This Cynical practice actually takes a lot of discipline, which is called askesis if you’re interested. Not bigging it up as a practice – just saying how it is. It involves another thing called parrhesis, which means speaking truth to power. Power comes along, like Alexander knocking on the hoops of my barrel in the agora – you speak Truth to it. Simple as. Fact that Power wouldn’t recognise Truth if you thwacked it amidships with it, needn’t deter us, right?

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The second thing ‘not to love’ is this: there’s a bit of an idea around that Cosmopolitanism is The Answer. You’re either Metro or Cosmo – no neutral ground allowed. But I’m here to say it’s not like that.

Once you have a system, on this scale, you’re including by excluding. It’s a binary. You’re ‘in’ or you are ‘not in’. Like I say, some systems have city walls with spikes attached; some systems just have waiting rooms with comfortable chairs and cute but informative signage in soothing colour schemes. But ultimately, the action of including leaves some people the other side of whatever line you draw, be it never so pleasing to the eye.

And once you have two rival systems, well, before you know it, they’re like an old married couple that have started to look like each other and the rest of the world just quietly drifts off, leaving them to bicker themselves away into oblivion.

And what’s more: these two systems already look a lot more like each other than at first meets the eye. Both the Metros and the Cosmos have a plan for including and both begin by including. They just have different ideas about who and how many to include.

The Metros don’t muck around much; abrupt is their middle name; they’ll bang you up or pewk you out, soon as look at you. The Cosmos, they’ve got gentle, ambient stuff going on so you don’t even notice you’ve crossed the line (or signed on the line, perhaps more to the point); gradualism is their game and someday all peoples of the earth will be connected to the centre. But the invitation to come along in is still being made. And by the way, I got to quibble this one quibble: the Cosmopolitans don’t actually seem to be very, well, you know, cosmopolitan, in the loose sense of diverse: not when it comes right down to it. Not so very different from the line-up of the ever-so-Metropolitan Academy across the way, unless you squint sideways…

Me, like I said, I don’t care for System but I set myself a practice and my practice is to be asking, right, well then, so wtf? Who gets to say where ‘in’ is – or where it ends and ‘out’ begins? If including is to be our business, then that’s no practice of equality. That’s some gradual working towards equality at some unspecified date – signalled to be sooner in the Cosmo camp, a whole lot later in the Metro camp, but not in anybody’s lifetime either way.

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I’m a Cynic and I may not have mentioned this before, but Cynic comes from kynikos, which means dog-like – or dogged, even, as in bloody persistent, not to say downright stubborn, in pursuit of a practice …

So now I got to run. Dogs to water, heads to bang. But here’s two last questions for you. You remember I mentioned that the Emperor and I turned out to have had the same teacher? Aristotle, was his name. Well, as you can imagine, I let him know in no uncertain terms, what I thought of his system. But some of his ideas did stick in my head. He says you need to have a clear shared idea of what the virtues are, if you want to have a clear shared sense of what a good, a good thing worth striving for, might look like.

Now I know this smacks a bit of Metropolitanism and telling other people how to be virtuous. Aristotle will come in for some stick on this point one of these fine days, and it will be well-deserved when it happens. But imagine it the other way – imagine a debate where each group in the debate has a different idea of what a virtue is and a different idea of what a good is. I hope it never comes to that, particularly if this city gets any bigger, but I tell you, it’d be chaos – and then we’d have to propose ourselves a new system – and then round and round and on and on it would go.

On the other hand, what would happen if we assumed equality was already the way of things, agreed our equality right from the outset, rather than shoring up the crumbling walls of our personal or collective discomfort about inequality by signing up to a direction of travel, feeling at best doubtful that we’d ever have to negotiate the tricky business of arriving? How would it be if we just decided there was no need for ‘in’ and ‘out’ anymore, so that there was nobody left to include?

Just asking …

Author’s note

Barrelman would like to be clear that he has written ‘Diogenesquely’ for literary effect and so as to inhabit and personify the points he would like to get across – but also so as not entirely to veil other parts of his (online and offline) identity (in anticipation of one set of objections, likely enough!).

If anyone identifies with any part of this analysis of the debate, or feels Barrelman’s lantern has chased away a shadow or two, that’d be fantastic. But this piece reflects Barrelman’s take on the #PTMFramework debate and is NOT intended as an attempt to ventriloquise anyone else’s voices. There are perhaps many contemporary Cynics and barrel-dwellers in our communities but they are fully able to speak for themselves and don’t need words put in their mouths by the likes of Barrelman.

A couple of historical notes to end with, if that’s okay, to anticipate one other set of objections. It must be conceded at once that the historical Diogenes, while doubtless a great questioner of societal morals and mores, was no respecter of women – in that, alas, he was a more ordinary man of his time – and so Barrelman’s critical observation about Athenian democracy represents an ahistorical hypocrisy, one from which this author would wish clearly to disassociate himself. Also, ‘Cosmopolitanism’ didn’t really exist as a philosophical system at the time Diogenes was creating havoc in the Athenian agora, so a certain liberty has also been taken on that score … a couple of other philosophical borrowings at the end, Barrelman likes to imagine, could have originated with Diogenes anyway, so there he craves your indulgence …

“The only true commonwealth is that which is as wide as the universe. I am a citizen of the world”

“I am Diogenes the Dog. I brown-nose those who give me alms, I yelp at those who refuse, and I set my teeth on those who are rascals”