This is a next part of a longitudinal action research project studying the effects of forms of managerialism introduced into the lives of people such as the Outcomes Star, what has become a proprietary instrument used to provision organisational funding often to support vulnerable people. This work problematises this culture.

 

You can read the previous section of this project ‘Action Research: Collaboration as Reciprocal Relationships’ by clicking HERE.

 

This article explores the importance of equity in relationships in relation to the problem which is being understood and responded to. It examines formulations of participatory action research holding in mind the different ways which the knowledge that people have are valued – often it is the person receiving money which become dominant in structuring meaning making processes and people who live with the problems who become subordinates in nominally identified ‘participatory practices’.

 

As a result the notion of equity is highlighted in an idea of accounting from the ground up bringing into view the work of Dorothy E. Smith’s Institutional Ethnography as a means of mapping junctures of agency within an institutional/industrial context.

 

This part of the study looks at the quality of reciprocity in relationships as a necessary dynamic and problematises the introduction of bureaucracy into relationships as obstructive.  It introduces some critical analyses from the field of historiography that is useful in disengaging from the burden of the sometimes cult-like enthusiasm for generating paperwork and management processes.

 

Management is less often scrutinised as a factor in producing the failures it purports to be addressing and accounts are produced which draw silence over the real world experience of the least advantaged in organised line managed systems. Examples of correlated relationships within a nursing home context which take place between the frontline staff and the residents are noted.

 

The article finishes by examining the role bureaucracies play in the support/need juncture citing paperworks as having the effect of what the author coins as ‘downsourcing’; that is, the managerial practice of creating extraneous workloads placed on workers in the industrial complex but ultimately land on in some form on the ‘client’.  This produces a culture where people seeking critical support are set into a never ending cycle of speaking to the bureaucracies – however inaccurate or inappropriate they are – by sharing and repeating performative stories, form filling, and reiteration of information not shared across disparate administrative systems.

 

Preamble

This project, as an action research project, has been about documenting and articulating what do not get represented in the bureaucratic and administrative systems that come to bear in people’s lives who are drawn through need to seek formal help for some reason or another. It stems from the frustration and harms of having to deal with systems of organising support which are dysfunctional, and as a result cause forms of trauma which get put down to the idea that the individual is dysfunctional.

 

For anyone who has had to live or work in and under the industrial complex which configures the social practices that are involved in getting or giving support to an individual in need, it is obvious that there are whole universes which do not get voiced in the boardrooms, in the conferences, the annual reports, key performance indicators and accounting of society.  The interstitial spaces are where the breaking of these fertive silences takes place; ‘around the water cooler’, in the pub after work, informally over dinners, coffees and in private civilian spaces the unprivileged truths of the state of affairs get chewed over by individual people.

 

Every now and again a new language of policy is introduced with the new buzzwords intended to change practice for the better – according to one view or another.  Glossy pdfs and brochures are produced, a whole new echelons of businesses emerge speaking of continuing professional development, enthusiastic quick adopters endlessly drop the new language of aspiration and funders reward those who are using the new language with pots of funding (after a gauntlet which has pitted colleague against colleague).

 

The spread of ‘scientific management’ driven by the proliferation of business schools from the United States across the world has touched almost every part of the living world. As eyes become more fixated on the financial bottom lines and technologies (of which bureaucracy is regarded as one here) create more and more vertical hierarchical operational structures, the wages at the top continue to inflate whilst the wages at the bottom dwindle. The further to the bottom of the organisations, the more precarious the working conditions become, increasingly setting previously secure workers into precarious contexts to do life-vital tasks for people who have become little more than a product in a ledger.

 

The notion of ‘efficiency wages’ (efficiency wages are a level of wages paid to workers above the minimum wage in order to retain a skilled and efficient workforce) has been increasingly side stepped in favour of uncertain, low paid contracts which offer few – if any – benefits designed to ensure sufficiency for the worker (i.e. sick pay, holiday pay, maternity/paternity pay, etc).

 

The money has been drained from the bottom and driven to the top.  The result is that on paper we see greater and greater ‘efficiencies’ being claimed through the neurosis of KPI (Key Performance Indicators) and efficiency savings (cuts) whilst in their lives people working in roles are expected to do more and more tasks beyond what they were hired to do (i.e. ‘bring in money’, take on administrative burdens, adopt a range of cockamamie technologies built by designers who have no knowledge of the context they have designed for, ‘re-applying for their own jobs’, etc).

 

This kind of expropriative executive culture – especially Chief Executive Officers and senior executives who have inflated wage packets but who work away from the front lines and funding administrators who have inserted themselves as gatekeepers – has led to an exploitation of the client base; people have become the product in many situations and instrumentalised as a direct result of the way the systems of organisation have been configured.

 

One of the undiscussed outcomes is how a growing number of people do not seek help from support services or systems anymore because they know the psychological damages which will result; for example, those seeking Personal Independence Payments in the UK. Medicine and personal care has, for many, become so traumatic to try and get – and so rubric bound – that individuals choose to adapt their preferences downward (aka Adaptive Preference Formation) than attempt to deal with psychological, physical and dental issues which cause severe impediments.

 

Serene J. Khader describes the characteristics of Adaptive Preferences as:

(1) preferences inconsistent with basic flourishing

(2) that are formed under conditions nonconducive to basic flourishing and

(3) that we believe people might be persuaded to transform upon normative scrutiny of their preferences and exposure to conditions more conducive to flourishing.

 

(Khader S. J. (2011). Adaptive preferences and women’s empowerment. Oxford University Press. Retrieved November 12 2022 from http://site.ebrary.com/id/10521042. Page 42)

 

The performative tasks which ‘clients’ in support/need junctures are expected to engage in are subtle and varied, not uncommonly colonizing the lives of people imperceptibly so that they can meet the minimal requirements of sufficiency for a period before they have to go through the whole circus again.  Fatigue impacts the individual along with the pain of regurgitating the details of traumatic events and social realities often creating a depression for which they are not uncommonly medicated; the medication does not change the nature of the social reality but it often blunts the cognitive capacity as many psychiatric drugs are psychoactive drugs that afford the individual to dissociate for the duration of their action. A terrible positive feedback loop can then occur where the effects of the psychiatric drugs become mistaken as a ‘biochemical imbalance’ inherent as a flaw in the individual rather than the down stream effects of social trauma.

 

This unvirtuous circle commonly expresses itself as increase in demand for support services which often gets presented as the success of the service agency through depersonalised, decontextualised and dehumanized key performance indicators.  There emerge problems of the annual Potempkin Villages constructed for the annual tradeshow of getting more money based on what Prof John Seddon details as Failure Demand – an increase in demand for a service because the service is failing to resolve the problems it is there to deal with.

 

Lucy Costa et al do a service to illustrate some of the effects of instrumentalising the lives of psychiatric patients by mental health organisations.  In their paper ‘Recovering Our Stories; A Small Act of Resistance‘  they detail how individual’s stories as speaking to ideas of ‘disability tourism’ or ‘patient porn’. Here is the abstract to this paper and a link for it’s download:

 

“This paper describes a community event organized in response to the appropriation and overreliance on the psychiatric patient ‘personal story.’ The sharing of experiences through stories by individuals who self-identify as having ‘lived experience’ has been central to the history of organizing for change in and outside of the psychiatric system. However, in the last decade, personal stories have increasingly been used by the psychiatric system to bolster research, education, and fundraising interests. We explore how personal stories from consumer/survivors have been harnessed by mental health organizations to further their interests and in so doing have shifted these narrations from ‘agents of change’ towards one of ‘disability tourism’ or ‘patient porn.’ We mark the ethical dilemmas of narrative cooptation and consumption and query how stories of resistance can be reclaimed not as personal recovery narratives but rather as a tool for socio-political change.”

 

Download Paper: Recovering Our Stories

 

The hidden harms of the way things are done continue on after the acknowledgements by professional individuals and lay like a wet blanket over the living experience of those seeking support in societal contexts where billionaires are being given tax breaks (For more information see Mr Shaxson below).

 

Old wine gets put into new bottles when new aspirational policies are splashed about by new executives keen to make their mark on the job they have just job hopped into before they job hop on once they have gone round the houses.  This is poured onto the willing smiling faces of the ‘customer-survivors’ in another round of bureaucratic waterboarding.

 

 

Like dancing bears, people are trained to perform to a regime of bureaucracies which have become normalised because people enacting the way things are done cannot imagine how the world would work otherwise. People become traumatised to the punitive aspects of what happens when they do not ‘perform’ the story telling or behavioural fawning which is designed by the subtle behaviourist system of stick and carrot.  Like the dancing bears of Bulgaria, people are put on show with their ‘stories’, to recount their grief and torments in ways which are palatable to funders and bureaucrats – the expectations are built into the system.

 

If an individual is exposed to this kind of sociological environment for long enough then it creates in some behaviours which are known as ‘abnormal repetitive behaviours’ – trauma responses that have developed as a part of adaptive preference formation; conditioned reflexes they have learned through positive and negative enforcement which have afforded them to survive in the situation they inhabit – the situation ultimately comes to inhabit them.  When long term damage happens from such structural violence, it becomes a scar on their psychology which they re-enact in the presence of others because the expectations of others have dictated for so long that this is what you must do to survive.

 

 

Witold Szablowski is a journalist who wrote about when the state of Bulgaria banned the medieval practice of dancing bears.  In his book ‘Dancing Bears; True Stories of People Nostalgic for Life Under Tyranny‘ he compares how trauma conditioned bears once released into the wild would still get on their hind legs and dance in the presence of humans with cultures which had nostalgia for past political regimes that had behaved badly.

 

I ask here that we reality check the practices which have become normalised and like wall paper, unnoticed for their ubiquitous presence.  Like Kate Millett in her book ‘The Loony Bin Trip’ identifies that a means of survival in the face of psychiatry is to become a “professional patient”, many people get broken by dictates which are codified into administrative systems and long after their encounter they still dance on their hind legs when faced by a human who holds power over their existence.

 

What is plain for people at the bottom of the socio-economic hierarchy is that equity is a word bandied about in policy documents and that the accounts which are asked for are the ones which fit the policy landscape and outlook for wherever they are in the surreal circadian rhythms of roughly four year election cycles – (at least that used to be the cycle before the new tragi-comedy of 21st century politics in Britain). There is a selective desire for truths and clear avoidance of examining structural issues which manifest in the lives of people as violence.  Who would have thought a piece of freaking paper could be so damaging.

---

Equity in Relation to the Problem

When encouraged, included, and collated, a collaborative situation is generated which is capable of analyzing and approaching persistent problems – i.e. so called ‘wicked problems’ [90]. Equitable relationships enable humane and cooperative interactions based on honesty. In this context, “Subjective prejudices, rather than being viewed as a distortion of reality and thereby a threat to be guarded against, become the background from which all further understanding springs forth. As the research topic is engaged, the socio-historically embedded researcher interacts with the subject matter to co-create the interpretations derived. This implies a commitment to self-reflexivity, wherein the researcher’s position requires a vigilant self-critical reflection” [17].

 

 

This approach is in contrast with older hierarchical research perspectives in which ‘experts’ go to a community to ‘study’ their subjects and take their data away to write reports. This ‘extractive’ approach does not authentically engage with the situational knowledge or lived experience of the ‘subjects’ thus does not gain from the diagnostic and interpretive contributions of the disempowered client side of service provision.

 

It also usually fails to add any public value to the community as the theories and findings are not usually shared with, nor owned by, the community which helped create them and which need them the most; i.e. the people who acted as ‘data suppliers’ and hence as enablers of the creation of the information outcome are separated from their efforts and removed from the authentic possibilities of using the information in situ for a positive application attempting to tackle the problem studied.

 

In the participatory approach, the worker (researcher) and the service user (co-researcher) coalesce to create an assessment of the needs of the situation based on the knowledge and understanding of the individual circumstances. This approach equally combines ‘expertise’ from that of the frontline workers’ experience of engaging with others (observations and reflections which are external to the particular co-researcher/client/situation) along with the integral ‘expertise’ from that of the client on the encounters, problems, and difficulties they can articulate from their circumstance.

 

In this way, the assessment process is meant to emerge through dialogue between ‘expert’ and ‘lay person’, ‘service user’ and ‘worker’, principal and agent, which informs the perception of both parties while challenging the identity distinctions.

 

Accounting From The Ground Up

Taking a view of the Institutional Ethnography approach, Campbell works from the perspective that the power of subordinating local experiential knowing to the discursive is the basis of textually-mediated management, and of what Dorothy Smith refers to as “ruling”. An important consideration in fieldwork is to be attentive as to how the written word organizes what gets known and how it authorizes that version of ‘the facts’ [54].

 

These text mediated procedures are intrinsic features of study in the social organisation of knowledge methodology and institutional ethnography. Smith argues that they are conceptual reflections of actual relations and realities among people [54]. In this context bureaucracies determine the capabilities/opportunities which determine the social outcomes.

 

The researcher goes into the setting not to test a hypothesis but to examine the way that the social organisation is put together via the experiences of the people that encounter and inhabit the realm of action of the organisation. In this approach the researcher learns the standpoint and takes the perspective of those being ruled. The research explores and exposes how ruling affects people whose everyday lives come under the influence of specific ruling practices [54].

 

“One cannot know about their lives without their showing or telling it in one way or another. Thus the researcher’s attention to their voices”. In this respect there are strong common features with Action Research and Participatory Action Research, in that first hand experience provides the substance of knowing and primacy of understanding [54].

 

 

Diamond’s research included the perspectives of the residents in his study of nursing home care as they were also being ruled along with the frontline staff [54]. To carry out an inquiry, the researcher begins with the people involved actively in a social process, who can speak from their experience. Writing field notes is a located social practice rather than a remote professional one.

 

The informant’s account, and eventually the researcher’s, both rely on the located social process to discipline what is portrayed [54]. The informant is speaking with the terms and relevance’s of their own life and, they bring into the researcher’s presence the social organisation of that experience through their account [54]

 

Bureaucracy In Relation to the Subject

Joy MacKeith, author of the Outcomes Star theory and method states: “It could be said that the service user is seen as an Action Researcher in their own right, defining problems, taking actions and reflecting their consequences” [1].

 

 

Part of the role of the workers is to encourage and support this reflection and learning in the life of the individual. A problem with bureaucratic tools and paperworks is that they are in danger of becoming the sole form of expression and define the work which is engaged in.

 

Most vividly the client base in juncture with the services are effected with the taking on of the bureaucratic realities – what I refer to as ‘Downsourcing’, just as supermarkets are getting customers to scan and bag their goods, so profits can be extracted from ‘streamlining’ jobs – management levels are Downsourcing their administration creating more workload for people down the chain whilst withdrawing resources from them.

 

All the time this trend apparently inflates the wages at the top of structures widening the pay differentials between management and other ranks, instead of increasing the number of averagely paid workers, distributing onerous workloads and decreasing the wages at the top. People are ‘bought’ in to line manage sheer and vertical organisational structures that are not in the public interest.

 

Bibliography of References

[1] MacKeith, Joy (2011) “The development of the Outcomes Star: a participatory approach to assessment and outcome measurement”, Housing, Care and Support, Vol. 14 Iss: 3, pp.98 – 106

[17] Angen, Maureen Jane, Evaluating Interpretive Inquiry: Reviewing the Validity Debate and Opening the Dialogue, Qual Health Res May 01, 2000; 10: 378-395

[54] Marie L. Campbell, Institutional Ethnography and Experience as Data, Qualitative Sociology, March 1998, Volume 21, Issue 1, pp 55-73