Dunemeister
Well-Known Member
The following discussion is derived from an article "Community and Its Counterfeits" from a book called Ideas, itself based on a CBC radio show.
Iatrogenesis is a medical concept. Literally, it means "physician-caused harm." According to oral medical tradition, around 1910, medical practices advanced to the point where one could expect one's visit to the doctor to do more good than harm. Before that, if you visited your doctor, you could almost count on coming out the worse for the encounter. After that, it was more likely that the doctor would help you than hurt you.
As a result, medicine has always been acutely aware of such things as side effects of drugs. Every doctor has the Physician's Desk Reference, which lists all the side effects of every drug available to her. There's a cost associated with every benefit. Eli Lilly, in the 1800s, put "A drug with no side effects is no drug at all" on the labels of all the drugs his company made back in the 1800s.
However, the idea that the helper might, through the application of his helping techniques, actually do some harm to the recipient of help, is utterly absent from other helping services. There is no systemic understanding (or popular passive thought) that a social worker's, a psychologists's, or a psychiatrist's interventions have necessary side effects. If you ask a social worker, "What studies are there on the negative side effects of the interventions you perform?" you'll receive a blank stare and perhaps the puzzled accusation that you've made some sort of category mistake.
John McKnight, a Canadian researcher, has taken up that question for helping interventions generally (not just social workers) and has found that, although individual cases vary, you can count on the following four side effects of any helping intervention from a social service agency or person:
1. The interventionist focusses on the deficiencies, rather than the capacities and strengths, of the person whose situation/life is receiving the intervention. This has several negative effects. There is a kind of degradation of a person's self conception that occurs when he is told, by word or implication, that what's important about him is what's wrong with him. So the helper brings messages of deficiency, wrongness, brokenness, and need, which erode a person's awareness of capacities and strengths. The implication is that the helper is needed because of the inherent incapacity of the recipient of help.
2. The second effect is economic. A service intervention involves diverting money from the recipient person or community to the service provider. The diverted money may include income for people whose primary problem is lack of income. On a societal level, this means for example that we have taken all public investments in the poor and given them to non-poor people whom we call "servicers." This perpetuates poverty rather than alleviates it.
3. Each time we decide in a local community that we need more services, agencies, programs, outreach, or systems, we are deciding that the neighborhood's indigenous associations, leadership, and capacities are inadequate to solve the problem. In this tradeoff, we always diminish the community's powers by investing in the system rather than the community.
4. It's possible that a particular intervention has more benefit than cost. However, that does not mean that six other interventions, each of which might seem to work on their own, will give you a seven-times-more-powerful intervention when you put them together. The aggregation of services almost always negates the positive benefits that the individual services provide. Think of this metaphor. Perhaps you live in an area that has a few trees. If I asked you if you lived in a forest, you'd say no. "But you have trees" I say. "Yes, but I don't live in a forest" you reply. A forest is a place where the there are enough trees that they define the environment. The density of the trees creates a different ecology such that it warrants naming the environment differently as "forest." So it is with services. You can have a single service, but when you get enough services intervening in a person's life, you create a forest of services. Such service aggregation creates new environments that encourage and even guarantee deviant behavior by the people who receive the services, even though any one of those services may look justified in an of itself.
As a result of these four harms, people become known by their deficiencies, not their gifts. Money is put at the discretion of those providing services, not those defined as "in need." Active citizenship retreats in the face of professional expertise. And services aggregate to form total environments. Hence social services inevitably replace local community capacities. Knowledge vested in professionals disappears from communities; confidence withers in the face of professional mystique; eventually communities lose the vital functions that sustain them as communities.
Take the example of emergency grief intervention. There's been a school shooting. The community's immediate reaction is for parents to rush to the school to comfort their kids and to take comfort. Friends and family rally around those who have lost children. Priests and ministers of all kinds facilitate this and provide their own services. The community begins to grieve and process the event. Then, the school brings in grief counsellors. Suddenly, the grieving process, begun spontaneously by the community, gets bypassed. Families who once cried and cursed God and otherwise processed the event no longer do so. Obviously, there's something wrong with their grieving because someone brought in these professionals who will make sure we do it right. Subtly, the message sent is that the community is not properly equipped to grieve the death of children. Besides, money that would have been spent on buying each other coffee or having get-togethers gets replaced with fees to the grief counsellors. Thus we see that, although motivated by good intentions, the grief counsellors actually undermine the community they service.
How correct do you think this analysis is of the harms of social services? What are the implications? Do we give up on social services altogether? Or what?
Iatrogenesis is a medical concept. Literally, it means "physician-caused harm." According to oral medical tradition, around 1910, medical practices advanced to the point where one could expect one's visit to the doctor to do more good than harm. Before that, if you visited your doctor, you could almost count on coming out the worse for the encounter. After that, it was more likely that the doctor would help you than hurt you.
As a result, medicine has always been acutely aware of such things as side effects of drugs. Every doctor has the Physician's Desk Reference, which lists all the side effects of every drug available to her. There's a cost associated with every benefit. Eli Lilly, in the 1800s, put "A drug with no side effects is no drug at all" on the labels of all the drugs his company made back in the 1800s.
However, the idea that the helper might, through the application of his helping techniques, actually do some harm to the recipient of help, is utterly absent from other helping services. There is no systemic understanding (or popular passive thought) that a social worker's, a psychologists's, or a psychiatrist's interventions have necessary side effects. If you ask a social worker, "What studies are there on the negative side effects of the interventions you perform?" you'll receive a blank stare and perhaps the puzzled accusation that you've made some sort of category mistake.
John McKnight, a Canadian researcher, has taken up that question for helping interventions generally (not just social workers) and has found that, although individual cases vary, you can count on the following four side effects of any helping intervention from a social service agency or person:
1. The interventionist focusses on the deficiencies, rather than the capacities and strengths, of the person whose situation/life is receiving the intervention. This has several negative effects. There is a kind of degradation of a person's self conception that occurs when he is told, by word or implication, that what's important about him is what's wrong with him. So the helper brings messages of deficiency, wrongness, brokenness, and need, which erode a person's awareness of capacities and strengths. The implication is that the helper is needed because of the inherent incapacity of the recipient of help.
2. The second effect is economic. A service intervention involves diverting money from the recipient person or community to the service provider. The diverted money may include income for people whose primary problem is lack of income. On a societal level, this means for example that we have taken all public investments in the poor and given them to non-poor people whom we call "servicers." This perpetuates poverty rather than alleviates it.
3. Each time we decide in a local community that we need more services, agencies, programs, outreach, or systems, we are deciding that the neighborhood's indigenous associations, leadership, and capacities are inadequate to solve the problem. In this tradeoff, we always diminish the community's powers by investing in the system rather than the community.
4. It's possible that a particular intervention has more benefit than cost. However, that does not mean that six other interventions, each of which might seem to work on their own, will give you a seven-times-more-powerful intervention when you put them together. The aggregation of services almost always negates the positive benefits that the individual services provide. Think of this metaphor. Perhaps you live in an area that has a few trees. If I asked you if you lived in a forest, you'd say no. "But you have trees" I say. "Yes, but I don't live in a forest" you reply. A forest is a place where the there are enough trees that they define the environment. The density of the trees creates a different ecology such that it warrants naming the environment differently as "forest." So it is with services. You can have a single service, but when you get enough services intervening in a person's life, you create a forest of services. Such service aggregation creates new environments that encourage and even guarantee deviant behavior by the people who receive the services, even though any one of those services may look justified in an of itself.
As a result of these four harms, people become known by their deficiencies, not their gifts. Money is put at the discretion of those providing services, not those defined as "in need." Active citizenship retreats in the face of professional expertise. And services aggregate to form total environments. Hence social services inevitably replace local community capacities. Knowledge vested in professionals disappears from communities; confidence withers in the face of professional mystique; eventually communities lose the vital functions that sustain them as communities.
Take the example of emergency grief intervention. There's been a school shooting. The community's immediate reaction is for parents to rush to the school to comfort their kids and to take comfort. Friends and family rally around those who have lost children. Priests and ministers of all kinds facilitate this and provide their own services. The community begins to grieve and process the event. Then, the school brings in grief counsellors. Suddenly, the grieving process, begun spontaneously by the community, gets bypassed. Families who once cried and cursed God and otherwise processed the event no longer do so. Obviously, there's something wrong with their grieving because someone brought in these professionals who will make sure we do it right. Subtly, the message sent is that the community is not properly equipped to grieve the death of children. Besides, money that would have been spent on buying each other coffee or having get-togethers gets replaced with fees to the grief counsellors. Thus we see that, although motivated by good intentions, the grief counsellors actually undermine the community they service.
How correct do you think this analysis is of the harms of social services? What are the implications? Do we give up on social services altogether? Or what?