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): 315–328.

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.

Operacija A: Kako se izogniti pastem pri raziskovanju življenjskega sveta in omogočanju dostopa do sredstev (operacije 4, življenjski svet 3)

Omogočati! Ne pa onemogočati

Medtem ko je bilo omogočanje dostopa do sredstev ena od glavnih nalog socialnega dela v razmerah obilja socialne države, pa so pod vplivom ideologije in režima zategovanja pasu socialne delavke in delavci potisnjeni v vlogo »varuha javnih sredstev«, psa čuvaja javne porabe, omejevanja, če že ne odrekanja dostopa do dajatev blaginje. Socialni delavci in delavke imajo več načinov, kako se upreti tovrstnim pritiskom kakor tudi kako se prilagoditi novim razmeram, ne da bi bistveno redefinirali svoje poslanstvo.

Predvsem pa ne smemo videti mobilizacije neaktivnih sredstev v nekogaršnjem življenjskem svetu kot varčevanje javnih sredstev, temveč vrednost sama po sebi. Skupnostni odgovori so navadno bolj ustrezni, uporaba skupnostnih virov krepi sodelovanje, mobilizacija skupnostnih virov je lahko prispevek (navadno obrobnih članov) skupnemu dobru. Mobilizacija lastnih sredstev, njihovo ponovno prilaščanje in ustvarjanje skupnih temeljev tudi poveča avtonomnost ljudi do oblasti in zmanjša odvisnost of javni, a odtujenih virov.

 

Spodbujanje želja, ne obkljukanje postavk

Ta operacija je dialektična celota, ki sestavlja dva precej raznorodna dela – enega zelo človeškega, dejanskega, drugega abstraktnega, mehaničnega. Umetnost je, ne le kako ju povezati, ne da bi pri tem robustnejši in močnejši kolonializiral bolj prefinjene in subjektivne dejanskosti, ampak tudi kako ne zanemariti enega na račun drugega. V socialnem delu se zna zgoditi, da se delavec ali delavka usmeri na raziskovanje življenjskega sveta, ob tem pa zanemarja dostop do sredstev drugod. Raziskovanje življenjskega sveta, ne da bi uporabili pri tem pridobljena spoznanja za uveljavljanje pravic ni le voajersko, temveč je tudi neproduktivno, jalovo (četudi morda zanimivo). V resnici tak spregled prikrajša človeka za njegove pravice, hkrati pa vzdržuje nadzorne mehanizme psihološke vrste. Na drugi strani, poudarek na zgolj postopkovnih, birokratskih operacijah, odreka ljudem subjektivnost, njihovo dejansko življenje, še več, je sredstvo njegove kolonializacije.

Uporaba ček list in obkljukanje kvadratkov po vnaprej določenih kategorijah ni raziskovanje življenjskega sveta, ampak je vsiljevanje zunanje (birokratske) logike in tujih idej (o tem, kaj človek potrebuje, kaj so osnove potrebe itd.) določenemu življenjskemu svetu, in torej ubijanje pomenov, ki so mu lastna, osebnih in skupinskih prioritet in hierarhij želja.

Podobno, vnaprej postavljene kategorije dajatev lahko določijo želje in cilje zgolj s tem, da jih močno ponujamo. »Logiko frižiderja«, pa kateri si želimo jesti prav tisto, kar je v hladilniku, lahko (in moramo) preseči s tem, da željo trdno usidramo v življenjskem svetu in šele potem pogledamo, kaj je na voljo, kako se sklada z željo in če se ne, da ustvarimo odgovore po osebni meri, tudi z uporabo virov zunaj življenjskega sveta, če je treba.

Perspektiva uporabnika

Usmerjenost v življenjski svet, ko se ukvarjamo z vprašanji sredstev, pa tudi v drugih operacijah, uvaja to, kar pogosto poimenujemo »perspektiva uporabnika«. Treba je namreč videti situacijo in njeno spreminjanje z očmi človeka, ki mu je dejanje namenjeno. Aktivno in namenoma prevzeti pogled drugega je pomembno, saj bo v nasprotnem primeru storitev ali kakšna druga dajatev neustrezna in napačno razumljena na obeh straneh. Pogled izvajalca storitve je v temelju drugačen od prejemnikovega. Definicija situacije osebja v neki namestitveni ustanovi, ko streže kosilo stanovalcu, ki je priklenjen na posteljo, je sprazniti mizico, postreči obrok in pospraviti posodo z mizice. Postaviti stvari, ki jih stanovalec potrebuje nazaj na mizico, je preprosto onkraj take definicije situacije – kar lahko povzroči, da stanovalec ostane ure brez očal, pijače, telefona ali daljinskega upravljalca.

Refleksivnost in reflektivnost

V socialnem delu moramo ločiti med dvema podobnima a hkrati tudi povsem različnima načinoma delovanja – med »reflektivnimi« dejanji in »refleksivnimi« odgovori. Pri prvih gre za razmislek o tem, kar smo naredili oz. o tem, kar se je zgodilo, pri slednjih za to, da se odzivamo na življenjske situacije uporabnikov. Pri tem nam ni treba dogodkov in dejanj interpretirati, jih pa moramo videti kot celoto, v kontekstu in medsebojnih povezavah. Poleg odseva v zrcalu kontemplacije, nas zanima dejanski in dejaven odziv na dejanja in dogodke. Dejanja v povratni spregi kažejo na imanenco interakcije in ne odsevajo v nekakšnem transcendentalnem zrcalu. Socialno delo deluje v vsakdanjem, navadnem in banalnem. Večino človeških izmenjav ne ureja Pravo, božje zapovedi ali sanitarna pravila. Urejajo jih fleksibilna, samo vzpostavljajoča majhna pravila in načini upoštevanja, pogovora, dotikanja in vabljenja drug drugega, s pomočjo pravil, ki jih hkrati prinaša kultura in jih ustvarjamo na mestu dogodkov z ozirom na namene, smisle in nagnjenja ljudi, ki so v situacijah navzoči.

Tovrstna pravila in njim lastni pomeni so vezani na kontekst, v katerem se nekaj zgodi. Ker nimamo vedno na voljo natančnih zemljevidov za ta, stalno se spreminjajoča ozemlja, jih moramo skoraj vedno raziskovati v sodelovanju z drugimi sodelujočimi. S transcendentalnimi bližnjicami in aksiomatsko stenografijo vedno tvegamo nenatančnost in to da zgrešimo poanto.

Zgodbe kot zemljevidi

V socialnem delu slišimo mnogo zgodb. Čeprav vsakršen potek življenja lahko povemo kot »žalostno pripoved« (Goffman, 2019: 67, 148–160) ali pa »zgodbo o uspehu«, glede na to kako pripovedovalec poveže posamezne dogodke svojega življenja v pripovedno celoto, pa v socialnem delu prevladujejo žalostne zgodbe. Uporabniki socialnega dela se nagibajo pripovedovanju žalostnih zgodb, ne toliko zaradi velike količine žalostnih doživetij kot zaradi upravičevanja posega strokovnjakov in zahtevkov uporabnikov.

Ne glede na to, koliko so te zgodbe osebne, se opirajo na standardne pripovedne obrazce, ki jih prinaša popularna kultura. Nekatere zgodbe so prvič povedali že pred več sto leti in imajo trdne pripovedne obrazce in literarno strukturo, kot je na primer v »pripovedi džankija«, ki jo je pred dvesto leti (1821) zložil Thomas de Quincey in so jo, v številni variantah od Dostojevskega (Kockar) do Otrok s postaje ZOO, neštetokrat ponovili tako v literaturi, še večkrat pa v pisarnah socialnih in zdravstvenih delavcev po celem svetu. Pri tem pa ne gre za pomanjkanje domišljije ali plagiatorstvo, temveč le za način kako organizirati pripoved, način kako povedati zgodbo.

So pa zgodbe tudi način, kako organizirati dejansko izkušnjo, scenarij, ki mu je slediti v dejanskem življenju, lahko celo trdimo, da se ljudje »ujamejo v svojih biografijah« (Grebenc, 2001). Socialno delo ima torej tri naloge: omogočiti ljudem, da povejo svoje lastne zgodbe, opogumiti jih, da si jih znova prilastijo, predvsem pa preoblikovati žalostne pripovedi v zgodbe o uspehu in izumiti načine, kako uiti biografijam, kako jih preoblikovati, kako jim spremeniti konec, jim dati boljša nadaljevanja. Dejanska življenja niso kot romani s njim lastnim zapletom, junaki (navadno tragičnimi), razpleti ipd. Človeška življenja so bolj kot niz povezanih novel, v katerih pogosto spregledamo obrate in zgrešimo povezavo z nečim, kar do zdaj še ni obstajalo. Spregledamo tudi to, da so človeška življenja bolj komična kot pa tragična.

Prečnost (transverzalnost)

Socialno delo povezuje mnogo niti v številne vozle. Pozna jezik in snov mnogih drugih disciplin, jih uporablja na svoj način, preči mnogo ravnin delovanja, jih povezuje v enkratna, singularna družbena dejanja in se ravna po številnih različnih ravninah človeške eksistence. V socialnem delu je torej nemogoče zvesti več različnih zvrsti pomenov in funkcij na eno dimenzijo, na homogen prostor redukcionistične stroke.

Ko starega človeka namestimo v dom za stare, vemo, da ne moremo tega dejanja namestitve pripisati samo enemu kriteriju, na primer: telesni oslabljenosti, ali njihovi osebni nezmožnosti, da bi poskrbeli zase. Na delu je več raznorodnih zgodb: gre tudi za to, da je nečak dobil novo službo, za mačko, ki bo ostala doma, odnose s sosedi itn. Seveda gre tudi za dostopnost in razpoložljivost storitev in kako posamezne službe delujejo – ali je na voljo oskrba na domu, ali ima na volj strokovnjake, ki bodo prisluhnili njegovim ali njenim hotenjem in potrebam, ali obstaja služba, ki lahko poveže formalne in neformalne vire podpore v skupno delovanje, kakšna so pravila porabe sredstev na voljo (npr. ali so sredstva namenjena za institucionalno oskrbo na voljo za oskrbo na domu) itd. Vse te sile in dogodki delujejo ena na drugo in ustvarijo vektorje in tenzorje, ki bodo potisnile starega človeka v oskrbo ali pa mu omogočile, da ostane doma.

Prečna akcija išče pomen in pomen, ki ga more najti še na drugi ravni, s tem, da se povezuje z drugostjo in ojačuje resonanco.

Socialno delo razume in uporablja dogodke, okoliščine in snovi tako, da jih povezuje z drugimi ravnmi. Prav tam je mogoče najti drug pomen, rabo ali funkcijo, tako, ki bo drugačna od tiste v čisti, homogeni coni bivanja (kot so, zdravje/ bolezen, prav/ narobe, pametno/ neumno itd.). Ravno s tem, da nekje drugje najde nekaj drugega, ali celo tretjega, nekaj, kar je radikalno različno od samega sebe, lahko ojači izhodiščno akcijo, ki takrat preči različne ravni.

Ponošena oblačila in zanemarjen videz »duševnega bolnika« so v okviru duševnega zdravja videti kot znamenja bolezni in poslabšanja; lahko pa to beremo kot znamenje tega, da človek nima veliko razlogov za vzdrževanje svojega videza ali kot znamenje izgube zanimanja za samopodobo, zaradi izključenosti iz vsakdanjega življenja. Ko se ta človek zaljubi, se lepo obleče, obrije in uredi. Ali je ne biti (za)ljubljen razlog za njegovo  stanje?

 

Reference

Grebenc, V. (2001) Ponesrečeni pobegi ujetnikov biografij. Socialno delo. letn. 40, št. 2-4, str. 151-158.

Goffman, E. (2019) Azili. Ljubljana: Založba /*cf.

Operation A: Alerts in investigating the Life-World and enabling the access to the resources (operations 4, life-world 3)

After outlining the basics of the operation of investigating the Life-World and enabling the access to the resources, we need to look what can go wrong – what are the traps and pitfalls we can encounter when performing this operation.

Enabling not restricting the access

While enabling access to resources was a prime task of social work in the abundance of welfare state, the social workers, under the ideology and regime of austerity, tend to be pushed into a role of “custodian of public resources”, a watchdog of public expenditure, their curtailing, if not denying, the access to welfare provision. Social workers have few ways available to withstand such pressures and to adapt to new circumstances without jeopardising the basic definition of their calling.

In this context especially, the mobilisation of the resources dormant in one’s Life-World, must not be seen as saving public money, but as a value in itself. The community response is usually more adequate, use of the community resources increases one’s participation, and mobilisation of community resources can be seen as a  contribution (by usually marginal members) to the common good. Mobilisation of own resources, reclaiming them and recovering the common ground also enhances people’s autonomy from the authority and diminishes the dependence on the public but alienated resources.

Eliciting the desires not “ticking boxes”

This operation is a dialectic whole, combining two highly heterogeneous parts – one very human, actual, the other abstract, mechanical. The art is not only how to fit them without the more robust and powerful colonializing the more fine and subjective actuality, but also not to lose one on the account of the other. It does happen in everyday social work practice that a practitioner would concentrate on the exploring the Life-World while neglecting the access to resources elsewhere. Exploring the Life-World without employing this knowledge in claiming the rights is not only voyeuristic but also not productive, sterile (even if interesting). Basically, this omission not only deprives a person of his or her rights, it perpetuates the control mechanisms of psychological kind. On the other hand, insistence on purely procedural, bureaucratic operation, denies people subjectivity, their actual life, even more it is a means of its colonialization.

Using check-lists and ticking boxes according to the presumed categories is not exploring Life-World, but imposing the extraneous logic (bureaucratic) and alien ideas (what is needed, what are basic needs etc.) onto it, thus killing the meanings inherent to the Life-World, personal and group priorities and hierarchies of desire.

Similarly, the pre-set provision might determine the desires and goals by their existence and strong offer. The “fridge logic”, which makes us wish to eat what is in the fridge, can (and must) be overcome by firmly grounding the desire in the Life-World. And only then look what there is on offer, how does it fit the desire, and if it does not, create a new tailor-made response, also by using external to Life-World funds, if needed.

User perspective

Life-World notion in approaching the issue of the resources, and also of great use in other operation introduces what is often called “user perspective”. The imperative is to see the situation and its change with the eyes of the person who is beneficiary of the action. To actively and purposely adopt the perspective of the other is important because otherwise service or other kind provision will be misplaced, misunderstood by both parties. Looking from the side of the provider is basically different to that from the recipient. Definition of the situation by the care personnel in a residential facility when serving lunch to a bed-ridden resident is to clean the table, serve the meal and clean the dishes off the table. Putting things that the resident needs to reach back on the bed-table, is simply beyond his or her definition – leaving the resident stranded for hours without spectacles, drink, mobile phone or a TV-channel control.

Reflective and reflexive

In social work, there is a need to distinguish between two similar but yet different modes of action – between the acts of “reflection” and “reflexive” responses. In the first, it is about contemplation, thinking about what has been done or what has happened, the latter it is about being responsive to the living situations of the users. Where there is action, there needs to be reflection. Not only do people involved in action have to think about what has happened, about what has been done, but also what has to be redone, amended, repaired. However, this needs not to be an interpretation of deeds and action, but seeing them as a whole, with the context and their inter-relatedness.

There is a need to be reflective (in a mirroring contemplation) but also reflexive (in responsive action). Action points back to immanence of interaction and is not reflected in some kind of transcendental mirror. Social work operates in the everyday, ordinary, and banal. Most of human interaction is not ruled by rule of Law, God or hygienic regulations. It is ruled by the flexible, self-constituting little rules and ways of observing, talking, touching and inviting each other, by the rules that are both cultural and made on the spot regarding the intentions, purposes and inclinations of the people involved.

These rules and their immanent meanings are bound to the context, where events happen. Since we do not have good maps for these ever-moving territories, we almost always have to explore them, involving the people participating in them. By using transcendental shortcuts and axiomatic shorthand we will always risk imprecision and missing the point.

Stories as mapping

In social work, many stories are being told. Although any life-course can be narrated as “sad tale” (Goffman, 1961: 67, 151–162) or a “success story”, depending on how the storyteller links the singular events of his or her life into a narrative whole, in social work practice sad tales tend to dominate. Social work users tend to tell sad tales, not so much because of the massive sad experience as for the reason of legitimatising the intervention on the part of the practitioners and the claim from the users.

However personal such tales can be they rely on the standard narrative patterns present in popular culture. Some the stories, have  been told more than a hundred years ago, with a fixed narrative patterns and literary structure. Such is the “story of a junky”, which was told long ago by Thomas de Quincey (1821) and reiterated by Dostoyevsky’s Gambler, told by the Children of the Zoo Station, to be told again in the office of a social worker anywhere on this earth. It is not about the lack of imagination and plagiarism, if it was only a matter of organising the narration, the way of telling the story.

However, it is also a way of organising actual experience, a script to be followed in the actual life, and it could be claimed that people get caught in their biographies (Grebenc 2001). Social work has therefore three tasks: let people tell us their own stories, encourage and help them reappropriate them, transform the sad tales into stories of success and invent means of escaping the biographies, transforming them, giving them different endings, sequels. Actual lives are not like novels with plots, heroes (usually tragic), resolutions etc. Human lives are more like intertwining series of novellas, in which we often overlook the final twists and miss a connection to something that there has not been before. And we fail to see that human lives are more comic than tragic.

Transversality

Social work ties knots of many strands. It knows the language and the matter of many other disciplines, applies it in its own fashion, transverses many diverse planes of functioning, connects them in singular social doings and addresses many different planes of human existence. Therefore, it is unable to reduce the variety of meanings and functions to a single dimension, to the homogenous space of a reductionist profession.

When an old person is placed in an old people’s home, we know that we cannot attribute this placement to only one criterion, e.g. their bodily feebleness, or their personal inability to care for themselves. There may be many different stories involved: it is also about the job their nephew has, the cat that will be left behind, their relationship with neighbours, etc. Still it is also the issue of availability of services, and how they function. Is there a home help available, are there practitioners who will listen to his wants and needs, is there a service that would bring formal and informal support in unison action, what are the rules of how the funds are spent (i.e. can the money available for institutional care be spent to support the person at home), etc.? All these forces and events interact and produce vectors and tensors that will slide an old person into care or let them stay at home.

Transversal action is seeking meaning, which is to be sought on yet another plane, connecting to otherness and amplifying resonance.

Social work understands and employs the events, circumstances and materials, connecting them to other planes. There, a different meaning, use, and function can be found, other than the one in the clean, homogenous zone of existence (like illness/health, right/wrong, clever/stupid etc.). 

Shabby clothing and neglected, “mental patient” appearance, will be seen within the framework of mental health as a sign of the illness, and deterioration; it can be read as a sign of not having many reasons to keep up appearance, or as a loss of interest in self appearance on account of being secluded from the ordinary life, etc. When this person falls in love, he will be dressed well, shaved and trimmed. Was not being in love the reason for his miserable state?

References

Grebenc, V. (2001) Ponesrečeni pobegi ujetnikov biografij. Socialno delo. letn. 40, št. 2-4, str. 151-158.

Goffman, E. (1961), Asylums. New York: Doubleday & Co. (Pelican edition 1968).