Edwin M. Lemert: Paranoja in dinamika izključevanja – uvod (1)

Uvodna opomba: Na skupščini o reorganizaciji CSD na kongresu socialnega dela, 16. oktobra, 2019, smo se pogovarjali o težkih preizkušnjah, ki jih doživljajo nekateri kolegi na centrih. V tem, pa tudi prejšnjih pogovorih, je veliko kolegov govorilo o šikaniranju in ustvarjanju koalicij proti njim. Kar so povedali me je močno spominjalo na tale klasični članek, ki govori prav o tem, kako ljudje – ne zaradi svojega »geštela« temveč tega, kar in kako se dogaja okoli njih postanejo »paranoični«, še več dobijo tako nalepko in so na tak način izključeni.

Seveda pa gre tudi za klasiko socialnega pogleda na norost. Ne le, da pokaže, da imajo duševno stiske družbene določnice nastanka, temveč pokaže, da je situacija tista, v kateri norost nastane, pa tudi da take situacije niso le stvar zasebnega in osebnega prostora, nasprotno značilne so za delovno mesto. Kot tak je članek paradigmatske vrednosti za razumevanje duševne stiske in norosti.

Prevod članka bom v nekaj zaporednih blogih objavil. V prvem delu uvodno pasažo, v kateri Lemert postavi tezo, da paranoja in paranoidne ideje niso le namišljena zadeva, le stvar posameznika temveč posledica vzajemnega delovanja človeka, ki dobi to nalepko, in ljudi, ki mu jo dajo.

Edwin M. Lemert: Paranoja in dinamika izključevanja[1] 

Ena od redkih posplošitev glede psihotičnega vedenja, ki so jo sociologi lahko naredili s kančkom soglasja in gotovosti je, da je tovrstno vedenje posledica ali manifestacija komunikacijske[*] motnje med posameznikom in družbo. Taka posplošitev je, seveda, velikanska, in medtem ko jo zlahka ponazorimo z gradivom zgodovin primerov, pa je potreba po tem, da bi konceptualno izpilili in podrobno opisali proces, ki zmoti komunikacijo v dinamiki duševne motnje, očitna že dalj časa. Med skrbno utemeljene spopade s tem problemom sodi Cameronova formulacija paranoidne psevdo-skupnosti (Cameron 1943).

V osnovnih potezah lahko paranoidno[†] psevdo-skupnost orišemo takole:[2]

Paranoični ljudje so tisti, ki jih njihovo neustrezno socialno učenje v situacijah nenavadnega stresa usmerja v nekompetentne socialne odzive. Iz fragmentov socialnega vedenja drugih lahko paranoičen človek simbolično organizira psevdo-skupnost, njene funkcije pa zaznavna kakor, da so osredotočene nanj. Njegove reakcije na táko predpostavljeno skupnost odziva, ki jo vidi kot polnega groženj do njega samega, ga pripeljejo v odprt spor z dejansko skupnostjo in vodijo do tega, da ga ta začasno ali trajno izloči iz svojih zadev. »Resnična« skupnost, ki ne more sprejeti njegovih stališč in reakcij, ukrepa s prisiljujočim omejevanjem ali povračilom potem, ko paranoičen človek »plane v obrambno ali maščevalno dejavnost« (Cameron 1943).

Da je skupnost, na katero se paranoidni odziva »psevdo« oziroma brez eksistencialne stvarnosti, je nedvoumno, ko Cameron pravi:

»Ko (paranoični človek) začne pripisovati drugim stališča, ki jih ima do sebe samega, nenameravano organizira te druge v funkcionalno skupnost, skupino, ki jo poenotijo njihovi predpostavljeni odzivi, stališča in načrti v zvezi z njim. Na ta način organizira ljudi, med katerimi so nekateri dejanski ljudje, o drugih pa zgolj sklepa ali pa si jih domišlja, v celoto, ki vsaj začasno zadovolji njegovo neposredno potrebo, da si zadeve pojasni, a mu ne prinaša gotovosti, in mu navadno povzroča naraščajočo napetost. Skupnost, ki jo oblikuje, ne ustreza nikakršni organizaciji, ki bi jo drugi imeli, temveč dejansko nasprotuje takemu soglasju. Še več, dejanja, ki jih prisuje njenim članom, ti dejansko ne izvajajo ali opravljajo; niso združeni v nikakršnem skupnem početju proti njemu« (Cameron 1943) (poudarek E. L.).

Splošnemu vpogledu Cameronove analize ni mogoče ugovarjati in uporabnosti nekaterih njegovih pojmov zlahka pritrdimo. Hkrati pa je treba resno postaviti vprašanje, utemeljeno na empiričnem poizvedovanju, ali so v dejanskosti zavratne značilnosti skupnosti, na katere se paranoik odziva, psevdo oziroma simbolična fabrikacija. Obstaja alternativen pogled, ki je težišče tega članka, in sicer, da, medtem ko se paranoični človek odziva diferencialno na svoje socialno okolje, velja tudi da se »drugi« odzivajo nanj in da taka reakcija navadno, če že ne tipično, vključuje prikrito organizirano akcijo in zarotniško vedenje v zelo resničnem pomenu. Naslednji podaljšek naše teze je, da take diferencialne reakcije potekajo vzajemno ene z drugimi, so prepletene in verižne v vsaki in vseh fazah procesa izključevanja, ki nastopi v posebni zvrsti odnosov. Iluzije in z njimi povezano vedenje moramo razumeti v kontekstu izključevanja, ki odtujuje tak odnos in prekinja komunikacijo.

Če torej premaknemo klinični fokus stran od posameznika, k odnosu in procesu, naredimo ekspliciten prelom od pojmovanja paranoje kot bolezni, stanja, ali sindroma simptomov. Še več, ugotavljamo, da je nepotrebno postulirati travmo zgodnjega otroštva ali zaustavljenega psihoseksualnega razvoja, da bi pojasnili glavne poteze paranoje – četudi se strinjamo, da lahko taki ali drugačni dejavniki pogojujejo njen izraz.

Tako pojmovanje paranoje ni ne preprosta apriorna teorija ne lastniški proizvod sociologije. Obstaja znaten korpus besedil in empiričnega raziskovanja v psihiatriji in psihologiji, ki postavlja pod vprašaj zadostnost posameznika kot primarnega vira za raziskovanje paranoje. Tyhurst (1957), na primer, sklepa iz svojega pregleda literature, da je bilo zanašanje na notranje psihične mehanizme in »izoliran organizem« med glavnimi ovirami za plodna odkritja o tej motnji. Pomembno je, kot pokaže Milner (1949), da bolj kot je popolno raziskovanje primerov, bolj pogosto se prikažejo nevzdržne zunanje okoliščine. Bolj natančno, več študij se je končalo s sklepi, da zunanje okoliščine – spremembe v normah in vrednotah, premestitev, tuja okolja, izolacija, jezikovna ločenost – lahko ustvarijo paranoično dispozicijo ob odsotnosti kakršnekoli posebne značajske strukture (Pederson 1946). Prepoznavanje paranoičnih reakcij pri starih ljudeh, alkoholikih in pri gluhih dodaja k podatkom, ki so na splošno skladni z našo tezo. Ugotovitev, da so preseljeni ljudje, ki so prenašali visoko stopnjo stresa med vojno in v ujetništvu, razvili paranoične odzive, ko so bili izolirani v tujem okolju, zahteva posebno pozornost med podatki, ki zahtevajo drugačno pojasnilo od organskega ali psihodinamičnega (Kine 1951, Listivan 1956).

Glede na to, kar smo do tu zapisali, mora biti jasno, da se naša formulacija in analiza ukvarja predvsem s tem, kar Tyhurst (1957) imenuje paranoični obrazci vedenja, ne pa s klinično entiteto v klasičnem Kraepelinovem smislu. Paranoične reakcije, paranoična stanja, paranoične osebnostne motnje, kakor tudi redko diagnosticirana »resnična paranoja«, ki jih najdemo nacepljene ali povezane s širokim spektrom posameznih vedenj ali »simptomov«, nam priskrbijo korpus podatkov za preučevanje, v kolikor v smiselni družbeni interakciji dobijo prednost pred drugimi oblikami vedenja. Elemente vedenja, na katerih utemeljujejo paranoidne diagnoze – iluzije, sovražnost, napadalnost, sumničavost, zavist, trma, ljubosumje in nanašalne misli – lahko drugi neposredno razumejo do neke mere kot družbene reakcije, v nasprotju z bizarnim, manerističnim vedenjem shizofrenije ali s spremembami tempa in razpoloženja pri manično-depresivnih diagnozah. Iz tega ozira paranoja ponuja, bolj kot katerakoli druga oblika duševne motnje, možnost plodne sociološke analize.

 

Izvirni članek

Lemert, E. (1962), Paranoia and the Dynamics of Exclusion. Sociometry 25, No. 1 (March 1962) , 1-20.

 

Navedeni viri

Cameron, N., (1943) »The Paranoid Pseudocommunity,« American Journal of Sociology, 46: 33–38.

Cameron, N., (1959) »The Paranoid Pseudocommunity Revisited,« American Journal of Sociology, 65: 52–58.

Kine, F.F., (1951) »Aliens' Paranoid Reaction,« Journal of Mental Science, 98: 589–594.

Listivan, L., (1956) »Paranoid States: Social and Cultural Aspects,« Medical Journal of Australia: 776–778.

Milner, K. O., (1949) »The Enviroment as a Factor in the Etiology of Criminal Paranoia«, journal of Mental Science, 95: 124–132.

Pederson, S., (1946) »Psychological Reactions to Extreme Social Displacement (Refugee Neuroses),« Psychoanalytic Review, 36: 344 –354.

Tyhurst, J.S., (1957) »Paranoid Patterns,« v A.H. Leighton, J.A. Clausen in R. Wilson (ur.) Exploration in Social Pychiatry, New York: Basic Books, 2. poglavje.

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[1] Raziskava za ta članek je bila deloma podprta s sredstvi Kalifornijskega državnega oddelka za mentalno higieno, s pomočjo dr. W. A. Oliverja, pridruženega predstojnika Državne bolnišnice v Napi, ki je tudi pomagal kot kritični svetovalec in omogočil vstop v bolnišnico.

[2] V naslednjem članku je Cameron (1959) modificiral svojo izvorno pojmovanje, a ne glede socialnih vidikov paranoje, ki je v središču našega zanimanja.

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[*] Čeprav besedo »komunikacija« nerad uporabljam zaradi njene prevelike splošnosti in amebnosti, jo v tem prevodu ohranjam kot tudi ne prevajam s slovenskim občim izrazom »občevanje«, pa tudi ne z bolj specifičnimi, kot so »sporočanje«, »sporazumevanje« ipd.

[†] »Paranoja« izvorno, v grščini pomeni »mimo« (para) »razuma« (nous). V zgodovini psihiatričnega izrazoslovja pa je dobila pomen »preganjavice«, torej občutka preganjanosti, zarote in nanašalnosti. Čeprav se je izraz »preganjavica« v slovenskem strokovnem jeziku precej uveljavil, pa zaradi zvestobe izvirniku in ker je izraz »paranoja, paranoičen …« tudi v pogovornem jeziku uveljavljen, v tem prevodu ostanemo pri »paranoji«. Angleški pridevnik »paranoid« izmenično, glede na kontekst, prevajamo s »paranoičen« in »paranoiden«, slednjega uporabimo za izvedena stanja iz paranoje.

The Breakthrough of the Social

 

Dubrovnik Manifesto 2019^[1][2]

 

The Necessity of the Social

In September 2019, over one hundred people active in social work praxis gathered in Dubrovnik to explore some of the most urgent current challenges and to reassert and reinstate social work. This manifesto, discussed before, during, and after the event, is our collective statement on the importance of social work praxis in the contemporary context.

Facing an increasing brutalisation of society that goes hand in hand with the destruction of welfare systems, encountering old and new forms of structural and concrete acts of violence, we set out to explore how we can contribute to re-emphasise and revive the critical tradition of social work, and reinforce solidarity with those who are oppressed, at-risk and vulnerable.

After decades of a diminished social, in a neo-liberal conjuncture that has privileged the economic and neglected, marginalised, and thoroughly downgraded the social dimension as the basis of our existence, there is an urgent need for the breakthrough of a brand-new social, analogous to the one superseding classic liberalism at the end of the 19^th century in the Global North.

Social work has not only to be a part of this breakthrough, and would be strengthened by this emergence, enabled to survive as an essential feature of society –it also needs to play an active role in bringing it to fruition.

In order to do so we have to defy notions of ‘professional neutrality’, reclaim social work as a community-oriented, relationship-based activity that goes far beyond academia, and build strong coalitions of workers, academics, service users, movement activists, trades’ unionists and everybody else working towards social justice.

Radical Social Transformations

We are living through yet another great transformation. The transformation of the future will be radical – whether we give up and merely observe the collapse of civilisation, or if we try to bring about a more socially just world:  based on the common good and on the values of care; of living together with profound awareness of both our vulnerability and strengths as individuals and as a society. We need to actively preserve what is good, including the natural world and the eco-system, and radically change that which does not work.

Globalisation, digitalisation, forced migration, demographic changes, a changing division of labour, etc., have exposed us, in different ways, to unprecedented, and sometimes unseen, risks that are greatest for those who are excluded from privileges and experience exploitation, discrimination and poverty. The radical transformation has also created numerous new opportunities in terms of communications, mobility, diversity, productive capacities and culture. Yet we crave for security (both social and physical) and fear violence, which keeps emerging in new forms and with a growing intensity.

The natural and political dimensions of the catastrophe merge into one through global warming, caused by fossil capitalism and the rush to turn natural resources into profit. They are epitomised by migration, including migration forced as a result of conflicts, climate change and economic misery; by fear exploited by authoritarianism (fuelled by fundamentalisms of many different kinds), by increasing inequality created by neo-liberal regimes, and by the removal of liberties and freedom (gentrification for the rich – immobility for the poor), enforced hatred and discrimination towards all who do not conform to what is set as the male, white, heterosexual norm; growing exploitation through new forms of work in the so-called gig economy; and an expanded precariat, with deep psychological and social consequences, making human existence precarious indeed.

Yet, there have been important developments towards an inclusive society. The rights of people with disabilities and children have been clearly stated, enshrined in global Conventions, albeit with some hiccups and never fully implemented in practice. Deinstitutionalisation and long-term care have been introduced, albeit not without obstacles, contributing to a re-evaluation of old age (old is good), childhood, madness and disability.

New social movements keep arising desiring a better, more dignified, life connecting the grassroots and global scales. New, alternative, forms of economic relations are being developed and a new kind of urban revolution seems to be imminent, not least in the Fearless cities movements. Trades’ unions, including trades’ unions of social workers, need to be established where they do not exist and strengthened where they do, and to adapt to new forms of work and to advocate for measures to benefit the whole of society. New forms of fighting racism, sexism and other forms of discrimination and fighting the global, life-threatening, climate emergency are emerging, calling for no less than a radical system change!

Although the age of austerity seems to be waning, what post-austerity will look like is still under construction.

Wisdom of Social Work Interfaces

To steer the transformation toward human solutions, practical wisdom is needed. The role of social work is to do just that; furthermore, it has to safeguard and promote marginalised and disrespected local or indigenous knowledge so it withstands and has impact on the global rule of abstract schemes. Ordinary everyday life – the Life World – should become the basic and pragmatic criterion of policy change and adaptations – ensuring the sovereignty of people.

Besides the unalienable mandate of social work to provide the everyday, users’, perspective on life and the world, the strength of social work lies in bringing together unseemly combinations of knowledge and logics of action. The major sources of social work action syntheses are ethics, organisation and politics. There is the need to know what is the right thing to do, how to organise the transition and where to obtain the power to do it.

Social work’s Ethics of Inclusion and imperative of non-exclusion provide the humanist synthesis of the broken dialectics of Reason/ Unreason. To follow its ethical imperatives, forms of self-management (rather than social service management) should be sought. Social work engagement in politics needs to stem from popular activism and an intersectional understanding and way of working, mobilising and struggling together, acknowledging and seeking understanding of existing differences and constructively using them as a collective force for change.

The practical power of social work lies in its transversal, inter-disciplinary, approach and inter-sectoral position. The Welfare State and Welfare Society needs to be reinvented on the grounds of a critical evaluation of the post-socialist (with post-austerity in mind) syntheses (South East European, Global East, and Global South) and social work’s role in the bottom-up construction of progressive social policies asserted.

Social work has to create productive links with other human disciplines and sectors. In education, social work can contribute to learning in action and provide the solutions to schooling problems (bullying, teacher protection, supporting teachers in building solidarity). In healthcare, constantly in relation to social work, it can bestow the importance of the user’s perspective, involvement and participation leading to an holistic approach to health and well-being, while still keeping existing specific needs in mind. In both challenging and strengthening the legal frame and combining it with social processes (in the law and administration), it can counter debasing practices and bureaucratisation with empowering practices and advocacy. 

Practical Utopias (Challenges for Social Work)

Social work is a practical, everyday Utopia; it is always about becoming, searching for a better place, more human and more social. It has to have a (utopian) sense of desire – be it about changing for the better or conserving what is good and it has to live up to the dictum that “action is the sole medium of expression for ethics”.  Throughout its history, social work has developed many productive tools, which need to be re-strengthened and re-loaded, with new alternatives sought and built. Social work’s classic tools and stories must be joined by new ones and governed by the notion of users’ emancipation and the emancipation of society as such.

Comparative social work should enable the transfer and translation of good practices, not only across diverse national and local contexts, but also over the life-cycle in working with children and youth, older people, families and groups facing multiple challenges, with people with diverse labels – poverty, delinquency, disability, challenging mental health concerns and so on. An intersectional approach should focus on the inter-relationship between gender, age, ‘race’, class, sexuality, and disability. It needs to focus on building solidarity and alliances with networks and self-organisation of marginalised groups such as LGBTQ-identified persons, refugees and migrants, homeless people, and initiatives and campaigns such as “Me too”, “Me two”, “blacklivesmatter” and many more.  

Deinstitutionalisation, which has, in recent decades, become a global platform, needs an overview and a context, an appreciation of its achievements, obstacles and traps and a vision how to handle it as a techne and an ethical imperative. Simultaneously, it has to be sensitive to, and in a polemical relation with, the remaining elements of oppression, detention, constraint, punishment and even torture in the care system and beyond. Long-term care, which aspires to become a universal provision, is a challenge per se and needs to be consistently and radically implemented as such, to connect with other types of existing provision in order to become universally available. Attention needs to be given to instances of increased power of service users (e.g. shared decision-making, co-managers, co-trainers and co-researchers) and more collaborative ways of working on the basis of self-determination and self-advocacy need to be realised.

There are new areas social work is entering into (such as green social work) and new means of performing social work (such as through social media and new technologies).  There is a constant struggle between social work and fragmenting governance and management. In the past decades social work has been under attack from ‘proceduralism’ and projectisation, even if social work has invented practical solutions to resolve the formal contradictions between protection (care) and freedom.

Increasing atomisation and individualisation of a practice based solely on individual social work, calls for a reinvention of community social work and action (also to challenge the rise of religious fundamentalisms and authoritarian neoliberalisms).

The challenge for social work today is to build a vision that will guide us through new areas, foster and preserve freedoms based on (social) security, dealing simultaneously and comprehensively with diverse adversity and enabling people (both professionals and users) to address life issues in a transversal and intersectional manner. In this way, social work will enable people to live together with minimum exclusion and maximum availability of support for personal and communal projects, without fearing the consequences of oppression and without becoming prey to authoritarian power.

Staying neutral is not an option. Working passionately and fearlessly towards turning our social utopias into the reality of a good life for all is what is needed today!

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^[1] The manifesto is based on ideas for the conference The Breakthrough of the Social: Practical Utopias, Wisdom and Radical Transformations – Social Work @IUC: Lessons Learned and Future Challenges; held at Inter-University Centre in Dubrovnik, 2–6 September 2019, organised by the IUC ‘School of Social Work Theory and Practice’.

^[2] This is the last version. Please ignore the previous.