Monday, 27 April 2015

The four staplers of the apocalypse: Bureaucracy and people with learning disabilities

[Warning: this is one of those over-enthusiastic “I’ve just read this totes amazeballs book” essay-length posts, so if you don’t want to read credulous speculation look away now]

Long-suffering Regular readers of this blog will know there are a number of things I worry away at, without getting anywhere near the heart of the matter, such as: how and why agencies supposedly there to support people with learning disabilities and their families do the opposite of this in ways that are so malign; why there are such inequities in access to decent services and support; how and why bureaucratic processes are so regularly ‘weaponised’ against people with learning disabilities and their families with apparent impunity when breaking any regulation or law you care to name.
Sometimes you read something at the right time that helps you see things from a different perspective. I’ve just finished reading “The Utopia of Rules” by David Graeber (an anarchist anthropologist, or is it an anthropologist anarchist?), a set of essays that together offers a way of thinking about bureaucracy that made a lot of ‘care’ services’ behaviour make sense to me. In my usual fashion, I’ll quote/paraphrase extensively, then try to say why I think it’s relevant to the ways people with learning disabilities and their families are so often (mis)treated. This post is organised according to three of the maxims set out in the book.

Maxim 1: “The Iron Law of Liberalism states that any market reform, any government initiative intended to reduce red tape and promote market forces will have the ultimate effect of increasing the total number of regulations, the total amount of paperwork, and the total number of bureaucrats the government employs.”

David Graeber adopts a very broad historical context, but from this come a few starting points that help to describe some of the growth in (and characteristics of) modern bureaucracies. Bureaucratic corporate culture, applied in the name of ‘efficiency’, has been designed to extract more wealth in the form of short-term profit, with the following consequences:
1)      The executive class within public and private sectors (now indistinguishable in terms of corporate culture), previously aligned with the workers who actually made things or did things, have now become realigned ‘upwards’ to the interests of ‘owners’/financiers.
2)      ‘Shiny’ language: “It was a cultural transformation. And it set the stage for the process whereby the bureaucratic techniques (performance reviews, focus groups, time allocation surveys…) developed in financial and corporate circles came to invade the rest of society – education, science, government – and eventually, to pervade almost every aspect of everyday life. One can best trace this process, perhaps, by following its language. There is a peculiar idiom that first emerged in such circles, full of bright, empty terms like vision, quality, stakeholder, leadership, excellence, innovation, strategic goals or best practice.”
3)      Bullshit jobs: “This helps a phenomenon I have written about elsewhere: the continual growth, in recent decades, of apparently meaningless, make-work, ‘bullshit jobs’ – strategic vision coordinators, human resources consultants, legal analysts, and the like  - despite the fact that even those who hold positions are half the time secretly convinced they contribute nothing to the enterprise.”
4)      The increasingly bureaucratic ‘credentialisation’ of jobs in society: “One could repeat the story in field after field, from nurses to art teachers, physical therapists to foreign policy consultants . Almost every endeavour that used to be considered an art (best learned through doing) now requires formal professional training and a certificate of completion, and this seems to be happening, equally, in both the private and public sectors...In theory they are meritocracies. In fact everyone knows the system is compromised in a thousand different ways”.
5)      Audit culture: “The basic idea behind audit culture is that in the absence of clear, ‘transparent’ criteria to understand how people are going about their jobs, academia simply becomes a feudal system based on arbitrary authority” [this is a discussion of Marilyn Strathern’s analysis of audit culture in an academic department] “…Such reforms may aim to eliminate arbitrary personal authority, but of course they never actually do. Personal authority just jumps up a level, and becomes the ability to set the rules aside in specific cases.”

Any of this sound familiar in health, social care, education? Including:
·        The shiny, corporatized language (gotta get a website, a logo, a hashtag: the NHS Improving Quality (NHS IQ, geddit?) funded School for Health and Social Care Radicals, hashtag #TheEdge, motto “Rock the boat and stay in it”, springs to mind) that bears no relation to the realities of people using these services.
·        The transmutation of useful jobs (social worker, nurse) into accretions of ever longer and more meaningless bullshit job titles (fancy being a Senior Business Devlopment [sic] Consultant/Manager – Social Care anyone? It‘s a current vacancy in Community Care).
·        Audits designed to show the organisation to best advantage rather than gain honest ideas for how the organisation can do things better (sorry, #innovate and #exnovate) – the NHS Friends and Family Test, for example, compared to the honest feedback collected via Patient Opinion designed to start a conversation.
·        The increased ‘outsourcing’ of bureaucracy to people getting support, which at the same time requires ever more intrusive bureaucratic structures of surveillance (the way that many organisations ‘do personalisation’ is a prime example, with more and more bureaucratic responsibility placed on people and families, yet accompanied by a heftier apparatus of ‘monitoring’ and ‘audit’).
·        Within such ‘totalizing’ or ‘predatory’ bureaucracies (David Graeber’s terms), the increasing difficulty that care and support workers, social workers and nurses have in doing their jobs ‘on the side of’ people and families wanting support, rather than feeding the bureaucracy (and colleagues further up the organisational hierarchy).

Maxim 2: “Always remember it’s all ultimately about value (or: whenever you hear someone say that their greatest value is rationality, they are just saying that because they don’t want to admit to what their greatest value actually is)”

“We are speaking of a certain abstract ideal of how bureaucratic systems should work, not the way they actually do. In reality, bureaucracies are rarely neutral; they are almost always dominated by or favour certain privileged groups…over others; and they invariably end up giving administrators enormous individual personal power by producing rules so complex and contradictory that they cannot possibly be followed as they stand.”

“Such institutions always create a culture of complicity. It’s not just that some people get to break the rules – it’s that loyalty to the organization is to some degree measured by one’s willingness to pretend that this isn’t happening…What I am saying is that we are not just looking at a double standard, but a particular kind of double standard typical of bureaucratic systems everywhere. All bureaucracies are to a certain degree utopian, in the sense that they propose an abstract ideal that real human beings can never live up to.”

The human in ‘human services’ has been systematically exiled in the name of avowedly impersonal bureaucracies. This is because impersonal rules are fair, right, ensuring that inequalities wrought by all the ‘biases’ of human beings engaging with each other without these rules don’t happen? And workers are trained so such a high standard now that support for people is uniformly great? And all these professional standards and organisations sharing best practice means that bad stuff is extremely rare, spotted quickly and dealt with honestly with people with learning disabilities and families? Wrong, wrong and wrong. There are still shocking inequities in the access of people with learning disabilities and families to decent services and support. Highly trained staff who are there to ‘help’, can treat people appallingly, with the organisations they’re working in rarely held to any form of meaningful accountability (heads may rock a little, but they rarely roll out of the boat).

Bureaucracies perform an ongoing con trick on people who have to engage with them. They are explicitly designed to be inhuman, so that actual people engaging with these bureaucracies are set up to fail. And people administering bureaucracies still have as much arbitrary power as they ever did, except that it is now cloaked and not to be challenged (except within the nonsensical terms of the bureaucracy itself). And everyone knows this, including (especially) people administering these bureaucracies, but there is a collective complicity within bureaucracies that does not allow this fact to be spoken. This leads to the self-referential piles of mendacious bullshit that bureaucracies present to the world (and to each other) that bear no relation to reality. Surely it’s only in such totalizing inhuman systems that people have to be told to act with ‘candour’ or that we really need ‘empathy’ in the workforce – ironically the solutions to these ‘problems’ are themselves highly bureaucratic (more credentialized training, more leadership, more audits, more hashtags and award ceremonies), meaning that they are more than likely doomed to fail.

If you’re a person with learning disabilities or a family member, you’re presented with an invidious ‘choice’ – try to play the bureaucratic game which is stacked for you to fail (with any ‘win’ more or less temporary), or challenge the terms on which the game is played and face the consequences.

Maxim 3: “Do not underestimate the importance of sheer physical violence”

David Graeber makes what seems to me to be a fundamental point that, for them to ‘work’, bureaucracies need to be underpinned by the (threat of) physical violence towards those who try to operate outside the terms of the bureaucracy:

“Max Weber famously pointed out that a sovereign state’s institutional representatives maintain a monopoly on the right of violence within the state’s territory. Normally, this violence can only be exercised by certain duly authorized officials (soldiers, police, jailers), or those authorized by such officials (airport security, private guards…), and only in a manner explicitly designated by law. But ultimately, sovereign power really is, still, the right to brush such legalities aside, or to make them up as one goes along.”

“One of the central arguments of this essay so far is that structural violence creates lopsided structures of the imagination. Those on the bottom of the heap have to spend a great deal of imaginative energy trying to understand the social dynamics that surround them – including having to imagine the perspectives of those on top – while the latter can wander around largely oblivious to much of what is going on around them. That is, the powerless not only end up doing most of the actual, physical labor required to keep society running, they also do most of the interpretive labor as well.”

“Jim Cooper, a former LAPD officer turned sociologist, has observed that the overwhelming majority of those who end up getting beaten up or otherwise brutalized by police turn out to be innocent of any crime. ‘Cops don’t beat up burglars’, he writes. The reason, he explained, is simple: the one thing most guaranteed to provoke a violent reaction from police is a challenge to their right to, as he puts it, ‘define the situation’…It only makes sense then that bureaucratic violence should consist first and foremost of attacks on those who insist on alternative schemas or interpretations.”

For me, this might be getting close to the heart of how (why?) so many people with learning disabilities and their families (and other disabled people too) are treated so appallingly and with such violence by health and social care services supposedly there to help. This threat of violence isn’t symbolic, it’s real, and violence is exercised – forcibly removed from your home, killed by neglect, solitary confinement (sorry ‘seclusion’), physical violence (sorry ‘restraint’), forced administration of powerful tranquilising drugs, not to mention ways of keeping people in poverty and unemployed (sorry ‘benefit sanctions’). Again, within bureaucratic service systems this violence is never named for what it is, despite the obvious trauma experienced by people and families who have been subjected to it and the obvious fear of vengeance and reprisals at the hand of bureaucracies expressed by so many families thinking of questioning any aspect of their support.

And the interpretive labour that people with learning disabilities and families in particular have to engage in is prodigious and exhausting . One of my nieces is a teenager with learning disabilities with a line in quietly acerbic asides to accompany her general awesomeness. My sister spends an inordinate amount of time and intellectual/emotional energy engaged in exactly this interpretive labour with people in bureaucracies – how shall I present myself, my daughter and my family? Competent, with it, but not so much that people will say no support is needed? Wanting the best, but not pushy, demanding or unrealistic? Middle class enough to do business with, but not superior? Knowledgeable, but with due deference to professional expertise – and definitely not one of those internet mums? And of course, endlessly patient, as this interpretive labour only goes in one direction. Get to an appointment late as a parent and that can have serious repercussions; but if the bureaucracy forgets the appointment altogether you’ve got to suck it up, not complain, and try and reschedule.

And challenging the right of bureaucracies to define the situation, in any number of ways, can provoke the violence discussed earlier. Perhaps a person with learning disabilities does not show due deference (or simply doesn’t really care about) arbitrary and nonsensical rules and regulations? Perhaps a parent goes so far as to point out that somewhere in the bureaucratic machinery an error has been made and wants to complain or, even worse, wants it put right? These are the points at which bureaucratic vengeance or worse are likely to arise.

Can there be life outside bureaucracy?

As David Graeber points out, the increasing stranglehold of bureaucracy over all aspects of our lives has become almost total, such that any alternative to bureaucratic ways of organising society is literally impossible to imagine. Romantic appeals to a pre-bureaucratic era don’t cut much ice either, as this was hardly a golden age of equality for people with learning disabilities either. But I think there are a few grounds for hope.

The first is the JusticeforLB campaign, which among many other things is fiercely antibureaucratic and, in David Graeber’s words, has “the defiant insistence on acting as if one is already free”. The #JusticeforLB campaign is constantly exposing the shoddy, rigged, inhuman structures of structural violence that are bureaucracies, and insisting on the fundamental importance of a shared humanity rather than efficient rules as the foundation for the way we treat each other (I’m reminded of a couple of other dudes who were no respecters of bureaucracy, Bill & Ted, and their society-shaping maxim “Be excellent to each other”. Along with their other maxim, “And party on dudes!” that’s pretty much all you need, really).

The second might seem a bit weird, but it’s human rights, and the Human Rights Act in particular. The human rights contained within the Human Rights Act seem to me to come from a space outside bureaucracy, and are not themselves readily assimilable into bureaucratic algorithms for ‘correct’ behaviour. Most obviously, the structural violence of bureaucratic systems is off the agenda. It is also freely acknowledged that the basic principles of the human rights may, at times and for particular people, conflict with each other, acknowledging that lives are messy and not to be bound into any set of constraining rules. Sure, bureaucracies can and do grossly misdescribe what they’re doing in terms of adherence to human rights. However, perhaps it’s no accident that lawyers (no strangers to bureaucracy themselves, but trained in arguing from first principles and applying these basic principles to individual lives) have dealt some of the biggest blows to the violence enacted by bureaucracies towards people with learning disabilities and their families, using the principles in the Human Rights Act. The LBBill is coming from a similar place, compared to the much more limited ambitions of the “No voice unheard, no right ignored” consultation, which seems to me to be aiming to inject a little more rightsiness into existing bureaucratic structures rather than developing legal principles with which to challenge these structures.

Finally, I have hope in those professionals and organisations that are trying to reconnect to the human, based on human rights principles. Can organisations supporting people with learning disabilities and families operate by engaging people honestly, as human beings, without the threat of violence lurking behind inhuman rules that are impossible to fulfil? My hopeful answer is yes.


Graeber, D. (2015). The Utopia of Rules: On technology, stupidity, and the secret joys of bureaucracy. Brooklyn: Melville House.

Wednesday, 1 April 2015

Wordy Crappinghood

A weird thing happened to me yesterday (and yes, I’m blaming you #justiceforLB). Public health practitioners in North West England get together for an annual event, and to the organisers’ great credit they’d organised yesterday’s event in unconventional ways to get beyond the usual slow torture by powerpoint and do something different. Part of this was to have soapbox sessions, where you can sign up for 3-5 minutes of talking (no powerpoint!) about your ‘public health passion’ in a room full of people followed by 5-10 minutes of discussion.

So a month or two ago I signed up for a slot, and I’d put together my usual pitch of shocking/grim statistics and matchingly grim individual experiences about the health, living situations and health service treatment or otherwise of people with learning disabilities (gotta win that misery auction…). As I was last up, I was listening to persuasive, evidence-based and passionately expressed cases being made by public health practitioners about domestic violence, loneliness, plain English, high blood pressure and working with regulators, all based on the same premise – if you only knew more about Issue X, then of course you’d want to do something about it.

And I stood up to do my bit, and something went a bit wrong. Because when it comes to people with learning disabilities, I don’t think that professionals (including public health practitioners, but they’re by no means unusual) not knowing about the circumstances of people with learning disabilities is the main obstacle to them doing anything constructive to improve people’s lot. There are some brilliant public health people who use their unique professional position to see the whole picture and are trying to stitch together plans to really improve the lives of people with learning disabilities. But in many conversations I’ve had with public health practitioners ignorance of the evidence isn’t the issue – it’s (not to put too fine a point on it) discrimination. To caricature horribly, I hear things like:
·        People with learning disabilities aren’t really part of the ‘public’ in public health – they’re not part of communities and live in weird specialist services that we don’t have to think about.
·        The early death, poorer health and crap living situations of people with learning disabilities are kind of an inevitable function of their learning disability, so it’s not worth making too much of an effort to improve people’s health or people’s lives.
·        The proper function of public health when it comes to people with learning disabilities is to work to prevent such burdens on society existing in the first place.

And when I stood up, this is kind of what I said. Rude, certainly. Alienating, probably. Strategically, tactically wise? I don’t know what those words mean really. People listened politely and there was some good discussion and questions, but as a generally conflict avoidant person I felt a bit wobbly afterwards and had to go somewhere quiet. This seems to be happening to me more and more recently -  I’ve more and more had enough of spouting language that skirts or avoids the thing itself (this is something that I’m shamefully good at, by the way, and I’m sure if I looked I’d find it’s pervasive through what I write and what I say) and I find myself more and more wanting to talk about the thing itself.

Is this a good thing or a bad thing in trying to effect real change in the lives of people with learning disabilities? No idea. Why is my default position to talk and write in this euphemistic way, and why is just saying the thing itself so difficult for me? Well, for me a big part of the answer is habit, but the bigger part is fear (fear of losing my job, fear of alienating people, fear of looking unprofessional).

And of course, the statements above are what I hear/interpret from similarly euphemistic, ‘professional’ things that other people write and say. And this fog of ‘professional’ speak/write settles over everything, stifling any clarity, meaning or accountability. This is not just a question of jargon, but weaponised jargon, with hidden/unconscious purposes to deflect any challenge, retain power and avoid honest conversations.

George Orwell, in his essay ‘Politics and the English language’ (see here ) dissects these issues mercilessly, and rather than go on about it I’ll just pick out a few quotes:

“As soon as certain topics are raised, the concrete melts into the abstract and no one seems able to think of turns of speech that are not hackneyed: prose consists less and less of words chosen for the sake of their meaning, and more and more of phrases tacked together like the sections of a prefabricated henhouse.”

“Orthodoxy, of whatever color, seems to demand a lifeless, imitative style.”

“As I have tried to show, modern writing at its worst does not consist in picking out words for the sake of their meaning and inventing images in order to make the meaning clearer. It consists in gumming together long strips of words which have already been set in order by someone else, and making the results presentable by sheer humbug. The attraction of this way of writing is that it is easy. It is easier -- even quicker, once you have the habit -- to say In my opinion it is not an unjustifiable assumption that than to say I think.”

“The inflated style itself is a kind of euphemism… The great enemy of clear language is insincerity. When there is a gap between one's real and one's declared aims, one turns as it were instinctively to long words and exhausted idioms, like a cuttlefish spurting out ink.”

How much ‘official’ language within health, social care, education or any other system supposedly there to support people with learning disabilities and family members, is like this? Why? It’s time to talk about the thing itself.