excerpt

Democracy and Distress

If democratic/co-operative organisational forms were made and made use of, clients would be members and members would be expected to volunteer for the organisations which they are members of. The management committee would be, for the most part, made up of members elected by other members and the chairperson would also be a member elected by other members. These organisations would employ paid staff when required and members would each have the opportunity to vote on matters regarding their operation. Generally, in housing co-operatives employees are not allowed to vote because the fact that they are paid is deemed to lead to a conflict of interests. Employee rates of pay are set by members and the admission of new members is decided upon by current members. It is members who will be most affected by incoming residents and so it makes sense for them to decide who to admit. Housing co-ops are typically, although not exclusively, intended for people in dire housing need and the housing that they offer is sometimes short life and sometimes permanent. Perhaps democratic organization could help with the isolation and dis-empowerment that often goes along with or plays a part in generating distress. 'When it comes to rights over the homes we live in, our nation is a divided nation – divided between the two thirds who own their own home or are buying it on a mortgage and who are totally responsible for its financing, repair and maintenance and the one third who rent their homes and whose responsibility stops at the wallpaper. They are tenants dependent for services on the paternalism of their feudal landlord over whom they exercise little influence or control, however benevolent that landlord may be. In a modern democratic society, the issue of who controls rented housing is central to housing policy.'(David Rodgers)

As far as I can tell, no extra resources are required to implement democratic process. The difference between organisational forms such as these and the forms in place in most of the mental health sector is stark in terms of ‘empowerment’, involvement and democracy. In these latter organisations, 'clients' often have next to no say in terms of who they live with and so if, say, ’alcoholics’ and ‘criminals’ (to use less than helpful and somewhat stigmatizing tabloid examples) are moved into their flats there isn't much they can do about it. People in psychological distress are often already dis-empowered and so the dis-empowerment and the bureaucratic runaround that goes along with the kind of democratic deficit mentioned might hit them particularly hard. This deficit, Carol Bacchi suggests, is connected to a mania for such things as monitoring, performance measurement, strategic planning, best practice and risk management etc. which are, in turn, connected to, and come under the rubric of evidence-based policy: ‘…There is a further assumption that policy-making is a rational decision-making process. Parsons (2002: 45) describes evidence-based policy as a ‘return to the old time religion: better policy-making was policy-making predicated on improvements to instrumental rationality’, ‘a return to the quest for a positivist brick road’. He sees links between evidence-based policy and the popularity of auditing, monitoring, performance measurement, strategic planning, best practice, risk management and quality management systems, all buzzwords of our time. The emphasis, as Parsons says, is on professionalization (of public service) with an accompanying decrease of commitment to democratisation.’ See, also, the work of economist William Easterly et al. Steiners broad-view notion of social threefolding and the Christian democratic notions of subsidiarity and sphere sovereignty might also be apt. At the macro level, policy is predicated on improvements to instrumental rationality as Bacchi indicates and at the micro, procedure etc. is (in a scattergun manner) predicated on the same; visceral/personal phenomena are also very much implicated.

Bachi’s work is, itself, influenced by post-positivism. (Put very simply: post-positivism is a kind of humble positivism that incorporates ambiguity, hermeneutics and constructivism but which is, nevertheless, primarily empirical and rational in the positivist mode).

I see no reason to suggest that decision making shouldn't, where possible, be informed by evidence but what's at stake here seems to be the danger of a kind of technocratic rule; where, ironically, the demos is ill-informed when it comes to evidence. Sure, evidence filters down; diluted knowledge does filter down and as it does, sometimes it transforms into the kinds of things that Bacchi and Parsons list. Or, it goes hand in hand with them – with monitoring, performance measurement and all the rest - e.g. a fixation on evidence leads to a fixation on data and so implies monitoring in order to gather it. We go with the inescapable flow of whatever rolls down from headwaters high up in the mountains. When we talk about evidence we could ask whose evidence (or intellectual property) it is or why anyone would attempt inform themselves if they are unlikely to be understood in any non-trivial sense, less still, to see that understanding acted upon in any non-trivial sense. (As one survivor put it: “…I try to communicate and they still brush it off, then I end up exploding”). And we could ask whether or not there is a tendency to shoe-horn evidence into what we’ve already got.

Leaving aside the question of expertise, the notion that individuals should have a say in decisions in proportion to the degree that they are affected by them seems to be relevant. Can any meaningful degree of accountability exist outside of something akin to the kinds of (relatively) socially mixed and democratic organisation discussed? Isn't a relatively enlightened membership important when it comes to things as complex and as widely misunderstood as ‘psychological’ injury? If ableism consists in ‘ideas, practices, institutions and social relations that presume abledness, and by so doing, construct persons with disabilities as marginalised…and largely invisible ‘others’(Chouinards) and if services consist in and promote ableism as much as, or more than, ideas, practices, institutions and social relations prevalent elsewhere then the existence or nonexistence of opportunities for enlightenment is a life and death question.

That the sufferer understands their injury or difference is also important; my mother told me an anecdote about a woman whose son had autism and who sometimes held a card with “My son has autism” written on it so that others would (or at least might) be more understanding. I don’t know whether this was the right thing to do but without knowledge, attempts at courtesy or accommodation would be impossible and misunderstanding more likely. So knowledge is necessary, and so is an understanding of how best to ‘perform’ or express that knowledge. This, in turn, touches on the question of self-authorship and it touches on the question of who has the authority to take part in authoring the world around them.

When a man had a psychotic break, injured himself and disappeared, his daughters mother gathered together friends and family to support her and she showed no, or relatively few, ill effects. (Later, the girl asked me why I hid when she came round). This is another illustration of the importance of emotional literacy and of social and emotional capital.

Organisational forms of the kind discussed have been implemented in sectors as diverse as banking, housing, colleges, retail and manufacturing. For better or worse, my interest in the design of organisations is more abstract than practical. As individuals we don’t necessarily have the wherewithal to help create such structures but knowledge has inherent value and if we understand what a well run organisation looks like then we will, perhaps, be better able to see damaging effects that poorly organised organisations and systems can have and to adjust conduct accordingly. How would we get the measure of things without rulers to compare them to? Drawing parallels with colonialism again, the following account, suggested remedy or alternative to the colonial method, works fairly well - convoluted as it is - as an alternative to current ways of dealing with biopsychosocial suffering: Either axial parts of the world recognise that the trouble at its borders are ‘…not a monstrosity grafted to its breast, a pathological 'after−effect' of underdevelopment…but rather an image…of its own history, and will undertake to confront it and resolve it and thus to put itself into question and transform itself. Or else it will refuse to come to face−to−face with itself and will continue to treat the problem as an exterior obstacle to be overcome through exterior means, including colonization.’(Étienne Balibar)

Also, I suppose it's more about looking for and finding instances that we can learn from, than viewing these examples as ready-made solutions that we simply need to join or re-create. To reiterate, my interest here is fairly abstract and non-commital. I could mention other extant examples of innovation in organizational structure – I could discuss companies like GrantTree, AES, Semco, Valve, Github, Zappos, MorningStar or Buurtzorg, however, as far as I know the status or role of their customers is, in essence, left unchanged whereas, in theory and sometimes in practice, the customer role would be transformed according to the democratic principles of organization sketched and in intentional communities, ecovillages etc. Rent, tax payer and debt strikes, crop-sharing
library economies, credit unions, free schools and community land trusts might also be worth mentioning, Alastair McIntosh likes and has been involved in creating land trusts, and he spoke about one of their benefits as follows: ‘…in as much as the wider problem is tied in with our industrialised mindset, restoration of links to the land is one of the antidotes obviously needed to make a people fitting for the the land’.