Prikaz objav z oznako harm reduction. Pokaži vse objave
Prikaz objav z oznako harm reduction. Pokaži vse objave

sreda, 4. marec 2020

Operation B: Risk avoidance as a labelling and scapegoating (operations 6, risk 2)



Notion of risk is very often used to disqualify a particular person, a group or whole segment of society. To label someone as “presenting risk behaviour” and even ascribing this to his or her “personality”, i.e. seeing it as a personal property, a trait imbedded in his or her proper person (be it by psychological make-up, upbringing or by biological, “neuro-scientific” constitution), does not only mean to take the behaviour and personality out of its context, transfer the risk from a situation to a person, but means also to evoke, sometimes massive, mechanisms of control and consequently depriving the person or a group of their basic human rights, oust them from social participation and put them in some form of social custody.

Labelling and scapegoating

Labelling is a property of social interaction by which a specific behaviour or personality trait is stereotyped in a way that it overshadows other properties of the person. While stereotyping in its benign form can be useful shortcut or shorthand in interaction (if we label someone as “shop assistant” we know what to expect and how to relate to the person in a situation of shopping). Even if someone is given a label that is so dominant so it extends from the situation (a doctor, policemen, professor), in which he or she performs the pertaining role, it may do some injustice but not much harm. However there are such labels that discredit the bearer, spoil his or her identity, produce stigma (Goffman 1963) and therefore construct, sometimes unsurmountable, obstacle for social participation and rob him or her off contractual power. By the deprivation of valid means of interaction and social roles and his acts being read and judged on the account of the discrediting label, the labelling becomes a self-fulfilling prophecy, since a person in such situation is given a “license to deviate” and has little else to do.

Often people labelled by disqualifying labels serve as scapegoats for a certain group, sometimes the whole society. They are ousted as culprits for all the troubles and misery of the group, become a conductor for pent-up frustration, grief and anger of the group. For the leaders of such persecution (sometime termed “moral crusade” (Becker 1963) or “moral panic” (Cohen 1980)) having a scapegoat means increase in their power and obedience of the group.

The source of labelling, stigmatising and scapegoating the risk behaviour and personality is the uncertainty inherent in the “risk society”. It is the way of fending off the fears of what might happen, of unpredictability and precariousness of existence.[1] Risk avoidance is the other side of risk society or the imperative of risk. It is a leading principle of many public agencies concerned with public safety (police, sanitary inspection, etc.) – partly by concern for safe environment, partly by concern individual human beings might present. Latter being done by surveillance, constraint, in many cases also by restraint and confinement.

Although social work is not immune of such operations, these operations must be seen as unacceptable for social work. The mandate of social work is to support in coping with risks brought by society, its mode of production and organisation, however on the micro level of individuals and groups, it has to maintain the perspective that risk is the property of situation not a person, and apply the user perspective of risk taking as a means of benefiting and leave aside the custodian and guardian perspective of risk avoidance and thus impoverishment of one’s life and opportunities.

Harm reduction

Social work is not interested in what is right or wrong but what works or doesn’t.

We do not consider whether the use of drugs is right or wrong, or whether a parent should stay with their children or not, whether one should not talk to oneself, or kill oneself, should have a home, drive a car, wear socks of the same colour etc. We know that a drug can have destructive but also creative effects, that parents are a major resource, but can also pose a major threat to their children, we know that inner voices can be equally encouraging or demanding, etc. it is not a question of relativism, it is a question of what kind of machine is at work.

The criteria for the construction of the machine should be that the arrangements ensure maximum gain minimum loss to all participants; not only in economic terms - damage and improvement could be also bodily, emotional, sensual: pain, disgust, hurt and joy, pleasure, beauty; satisfaction to some degree.

The reduction of harm and increase of benefit; the pragmatics escape the binary division of the grammatical rules. It is not about a choice between health or illness, right/wrong, success/failure, black/white –we want the picture to be at least black and white, but preferably in colour.

What is specific in this construction, is the mandate of social work to observe the stakes of the weakest participants. Social work is there with the purpose of being a guardian or an advocate, to safeguard the interests of the weak who cannot do this for themselves; and to advocate on the behalf of those who do not have enough power to be heard on their own.

Harm reduction is a leading notion replacing the guilt, the mistake, the lack.

References

Becker, H.S. (1963), Outsiders. New York: Free Press.
Cohen S. (1980), Folk Devils and Moral Panics, Oxford: Oxford University Press.
Goffman, E. (1963), Stigma - Notes on the management of Spoiled Identity.  Engelwood Cliffs: Prentice-Hall; (1968), Penguin edition.


[1] Although the risk taking is a leading and productive principle of the capitalist society and is sustaining the whole industry of risk (insurance, gambling, extreme sports etc.), its darker side is the risk avoidance, with whole apparatus of risk control (safety, security, etc.).

sobota, 29. februar 2020

Operation B: Risk analysis and harm reduction (operations 5, risk 1)



Social work is about change. It is either actively inducing change to improve one’s life or striving to contain the imminent change, i.e. conserving the person’s assets and benefits in coming perturbations (e.g. old age, illness). The change brings risks – with its benefits and dangers.

We live in a changing and risk society (Beck 1992) and we have to deal with it. Furthermore, macro-social risks, like pollution, natural catastrophes, climate change, political and military conflicts, economic crises and others strike the most the poorer, marginal and powerless segments of the society. Social work is the profession, which deals with “vulnerable groups”, i.e. the people who are exposed to societal stress to a greater degree or who, on the account of their life-situation, find themselves facing intense challenges that can result in massive distress.

Notwithstanding exposure to societal risk, ones produced by the “society”, there is a number of other instances where our life changes and presents risks to be taken. Various life events, passages, identity crises or even quite banal unexpected and unprecedented happening, no matter whether they are mishaps or just ‘haps’, occur in the life-course, affect daily routines.

Life events

Life events are highly stressful events that fundamentally change our Life-World. These events not only heighten the energy levels of functioning but also turn our notions of everyday life upside down, change the meanings, roles and alliances. This happens not only in adverse, undesired events like loss of a dear person, loss of employment, eviction, illness but also in the events that we deem positively, which we desire – like getting married, getting a child, a new job, new home etc. The research has shown that if few such events happen in a certain period (e.g. 6 months) some consequences to mental and physical well-being are very likely to happen (Holmes & Rahe 1967, Nastran Ule 1993, Gallagher 1995: 329–333, Lamovec 1998: 215–220).

Social work is very often (habitually) placed in a statutory position of a guardian whose role is to deal with hazards of people’s lives and to secure the best possible outcomes. It is an instance, to which people can turn to, when they see their own social, personal or financial capacities as insufficient to deal with the risk situation.  The task of social work is to assess the degree of risk and to provide response, provision that would diminish the risk to an acceptable measure. Risk is therefore often a measure of the entitlement to social or other provision. The assessment may be a rather simple one as in testing the means in the case of financial benefits or quite a complex one as in case of family violence and similar.

The risk taking is, however, constituent of person’s identity and self in the contemporary, capitalist society (and probably in post-capitalist too). People should be enabled to take risks (not just avoid them). The finality, the purpose of risk analysis is harm reduction, or better – the security of venture – being able to do things without exposing oneself to exaggerated, unnecessary or unwanted risks.

This is why the risk should be analysed and not just assessed. The main analytical tool is to distinguish in the risk situation the hazards, the dangers (harm) and the benefits (or even profits) of risk taking, and simultaneously consider the measures that would reduce the harm.

Distinguishing these elements of risk is necessary, since the circumstances that make a situation risky or hazardous, are in everyday life often confounded with the actual events that are dangerous. If one is psychotic, he or she is not necessarily dangerous. Statistically speaking on average not any more than any sane person, but psychotic behaviour introduces certain unpredictability of action. Hence, the assessment of the intensity (seriousness of the hazard) and the quality of psychotic situation must be done separately from assessment of the probability of a dangerous event (and combined into a risk formula only subsequently).

Moreover, the favourable events, the benefit of risk taking, and their probability must be taken into account, and be weighed against the odds of the situation. Benefits are the rationale of the risk taking behaviour. Finally, it would be unethical (and even stupid) to assess only the risks without considering the means of reducing the possible harm. It is not only the way of finding out the least harmful way of securing the benefits, but also about using the least constrictive measures to avoid harm.

These should be foreseen on various points of intervention: as means of preventing risk (not driving when drunk), as ways of accommodating the dangerous events (wearing a helmet) and modes of repairing the harm (insurance, making up). Various means of the harm reduction may be used: technical (smoke detectors, helmets, electronic devices), educational (informing, awareness raising, learning skills etc.), social (escorting, containing, mediating …), legal (written agreements, advance directives, court induced restrictions …).

In risk analysis we therefore: analyse the situation, pronounce the intensity of the risk, its acceptability and plan the risk reducing intervention. It is about securing the life situation and providing support in risk taking. 

Social work is producing change.
Social work is not needed to maintain what there is. Where routines are established, where forms have to be filled, where procedures are set and to be followed, Bill Jordan (1987) says, there is no need for social work. Social work is needed where change is necessary, where distress is so great that people cannot cope with it anymore, where change is happening and assistance is needed to fare better through the process, where a change has happened and we have to learn to live with it, or when there is a substantial possibility for a change to occur and we want to get ready for it; or prevent it. 

References:

Ulrich Beck (1992) Risk Society: Towards a New Modernity. New Delhi: Sage. (Translated from the German Risikogesellschaft) 1986.

Gallagher, B.,J. (1995) The Sociology of Mental Illness. Engelwood Cliffs: Prentice Hall.

Holmes, T. H., and Rahe, R. H. "The Social Readjustment Rating Scale." Journal of Psychosomatic Research 11 (1967): 315328.

Jordan, B. (1987), Counselling, Advocacy and Negotiation. British Journal of Social Work Vol. 17, N. 2 (April 1987): 135-146.

Lamovec T. (1998), Psihosocialna pomoč v duševni stiski, Ljubljana: Visoka šola za socialno delo.

Nastran-Ule, M. (1993), Psihologija vsakdanjega življenja. Ljubljana: Znanstveno in publicistično središče.


nedelja, 19. januar 2020

Four basic operations of social work (1 – introduction)




Perhaps the best way of presenting what social work does is by its basic operations. In order to have a better life, one has to change it, which brings about certain risks. To know what to change one needs to know what is there in one’s life, what are the resources that can be used and what needs to be imported from elsewhere. I order to induce change, but also to govern once life, one needs power to do so. A partnership or an alliance in a working relationship is needed in order to be not only supported but also increase the ability to reflect and perform. The key words of these four basic social work operations are therefore: relationship, power, change and resources introducing the operations that we choose to name: 1) work relationship or alliance, 2) empowerment, 3) risk analysis or harm reduction; and 4) investigation of the Life-World and enabling access to resources.

These four operations are defined by their purpose, which in turn presupposes their ways of doing them. The purpose of forming a work relationship or alliance is to gain an insight, a reflexion of the situation one is in, but also in a manner of dialogue to instigate  work, and change and is done mainly by speech and reflection, notwithstanding meaningful deeds and action. The purpose of empowerment is clear – to gain power – and this is mainly done by advocacy and negotiation in order to enhance one’s status – personal and social capital. The purpose of the risk analysis or harm reduction is security of venture (not so much risk avoidance) and is being done by analysing, securing and support in risk taking. The investigation of the Life-World and enabling access to resources has the purpose in being provided and equipped and is done by enabling access to resources and activation of own resources.

The purposes intrinsic to the operations as listed above are just instrumental to the personal finalities and are just tools to accomplish the latter. No matter how small and petty a specific personal goal may be, it has an overarching property regarding the purposes of the basic operations and the operation itself. The goal of an operation and its underlying desire is the basis of the operation and its purpose, finality and its “raison d’être”.

The social work basic operations are therefore not to be regarded as means of reaching some metaphysical or transcendental ends but means of reaching personal, group or even institutional desires usually articulated as goals, often as needs, sometimes in terms of necessities, sometimes in terms of wishes.[1]


[1] This blog is an introduction to a piece I am writing on the topic. There will be blogs following describing and analysing them in more detail.