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Good Intentions OverRuled

Good Intentions OverRuled: A Critique of Empowerment in the Routine Organization of Mental Health Services

Copyright Date: 1998
Pages: 240
  • Book Info
    Good Intentions OverRuled
    Book Description:

    Townsend illustrates how attempts by occupational therapists to enable empowerment in everyday practice are thwarted by the institutional processes of admission, accountability, decision making, budgeting, risk management, and discharge.

    eISBN: 978-1-4426-7541-4
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vii)
    (pp. viii-viii)
  4. Foreword
    (pp. ix-xii)

    More years ago than I care to think about I did the field research for my doctoral thesis in a large state mental hospital in California. Those residential warehouses for the mentally ill have now largely disappeared and among the otherwise displaced people in our society, we meet, as homeless people on the street, some at least of those who would in the past have been the inhabitants of what were called then ʹchronicʹ wards. It is true that the hospital provided food, shelter, and health care. At the same time it was a kind of institutionalized disaster. I remember...

  5. Preface
    (pp. xiii-2)
  6. 1 Exploring Empowerment
    (pp. 3-29)

    Jill¹ points to two fundamentally different ways of helping. One way involves people by enabling participation. Rather than give care to dependent recipients, we can facilitate, guide, coach, encourage, or support people to participate in helping themselves. Processes that enable participation can be described by adapting an old proverb:You can care for people for a day. But, if you educate people to become involved, you have helped them to care for themselves and others for a lifetime. Participation engages people as activists in shaping their own lives. In contrast to the one-way dependence that underlies caregiving, participation is enabled...

  7. 2 Objectifying Participants
    (pp. 30-46)

    Empowerment has been described as aparticipatoryprocess, meaning that it involves people as participants. We participate in life by activating mind, body, and spirit in the particular circumstances of our everyday lives. As long as we have breath to speak, muscles to move, or a spirit to express our beliefs, we can choose whether to participate in being disempowered or empowered. We cannot be empowered by others if we choose to be disempowered, nor will we participate actively if we choose to be passive or dependent. It follows that we involve others in empowerment by enabling their participation and...

  8. 3 Individualizing Action
    (pp. 47-67)

    Empowerment is a process that invites participation in individual and collective actions, as well as in the organization of society. If we intend to enable others to become empowered, then we need to ask how invisible organizational processes determine possibilities for individual and collective action. One answer to this question has already been laid out: mental health servicesindividualizeaction by assessing and admitting onlyindividual, medically categorized patients. Mental health services have no cases that are not individuals: no group cases exist as in government departments of agriculture, which work not only with individual farmers but also with groups...

  9. 4 Controlling Collaboration
    (pp. 68-88)

    Empowerment is a process of participating in individual and collective action so that power and resources can be shared equitably. Power is shared throughcollaboration, the process of working with others in interdependent relations characterized by reciprocity and mutuality: giving and taking, helping and receiving help. The interdependence of collaboration makes this a horizontal rather than a hierarchical relation.

    Identification of this third feature shows the complexity of empowerment: participation is important, but it needs to extend into collective as well as individual action; moreover, participation needs to occur in collaboration with others, rather than under their direction. We already...

  10. 5 Simulating Real Life
    (pp. 89-112)

    There is a popular expression thatknowledge is power. It follows that empowerment (taking on power) is a process of learning. Empowerment education, facilitates a participatory process of learning to critique and transform individual feelings, thoughts, and actions, as well as the organization of society. This type of education involves learners as partners in both individual and collective action, the aim being to learn how power and resources can be shared equitably. Education generates knowledge about power, whether or not we are aware of being educated.

    In recognizing that education can generate knowledge about power, I wanted to see what...

  11. 6 Risking Liability
    (pp. 113-128)

    Empowerment is a process of transformative change. Specifically, change is prompted through the participatory process of learning to critique and transform power. Participants engage in critique and transformation, changing not only their personal feelings, thoughts, and actions, but also the organization of major institutions in society. Such profound, transformative change is not without risks, especially since the process critiques and changes power in both the personal and social realms of life. When I recognized the magnitude of critique and transformation in empowerment, I decided to explore risk taking by asking how professionals support or limit risk taking by people who...

  12. 7 Promoting Marginal Inclusiveness
    (pp. 129-151)

    A host of stories, analyses, and statistics tell us that people with mental health problems are often excluded from ordinary employment, decent housing, and regular recreational and community events in modern Western society. Their exclusion points to the importance of promoting inclusiveness as a core feature of empowerment. Inclusiveness exists when all people are empoweredso that power and resources can be shared equitably, when democracy and social justice are embedded in everyday life. At a certain point in my study I found myself asking, How inclusive are such processes as diagnosis, case management, decision making, education, and risk management,...

  13. 8 Challenging the Routine Organization of Power
    (pp. 152-182)

    We have seen how everyday activities, from assessment to the use of petty cash, are acts of power. We have also seen how good intentions and real instances of empowerment are overruled: what seems like empowerment is narrowed, undermined, or otherwise distorted by anonymous but interconnected, routine organizational processes that govern what can and cannot be done. In mental health services, such processes overrule real attempts by mental health professionals to promote the empowerment of those who use mental health services. These people are transformed into medical objects, who are managed so that decision making and potentially transformative action are...

  14. Notes
    (pp. 183-188)
  15. References
    (pp. 189-212)
  16. Index
    (pp. 213-217)