As I am in the process of leaving Buchanan, I find myself reflecting on many of the core principles of rehabilitation. In my reflections, I can’t help but evaluate how we, as a rehabilitative community, are doing – what is working well and what could work better. It is helpful for me to put my thoughts into some order and structure as a way of sorting them out. Perhaps some of you might find these reflections and thoughts on rehabilitation helpful, particularly as BRC has been going through such a process of change. We are struggling to address the rehabilitation needs of a very complex client group with multiple co-morbidities. It is both a strength and a weakness that we have multiple philosophies of treatment that we use – inpatient psychiatry, biomedical treatment, psychosocial rehabilitation and recovery. Depending on how we use these frameworks, they can end up competing with each other or complementing each other. It really depends on our choices, both the big choices as well as the little day-to-day choices that have so much strength in shaping our lives and actions.
For better or worse, I have decided to share my thoughts with you on a fortnightly basis.
Martin Luther King, Jr. said the following in the context of his human rights work to rehabilitate society:
“Power without love is reckless and abusive, and love without power is sentimental and anemic. Power at its best is love implementing the demands of justice, and justice at its best is power correcting everything that stands against love.” (This quote can be found in Power and Love: A Theory and Practice of Social Change, by Adam Kahane).
In a rehabilitation setting, we can consider power to be the aspects of our work in which we structure, contain and shape clients’ behaviour. We can also consider the structure of our systems and programmes as an aspect of power as we create these in order to shape our own work.
Love, in a rehabilitation setting can be considered to be compassion, empowerment and the desire to encourage the unfolding personal growth of clients.
We can see for ourselves in our work that an imbalance of power over love leads to behaviours that are “reckless and abusive,” and an imbalance of love over power leads to an environment that is “sentimental and anemic.”
So, what we are striving for is the right balance of power (structure, policy, constraint and paternalism) on the one hand and love (compassion, empowerment, the space to learn and grow and acceptance of the individuality of the client). This is a lot to balance, particularly since each client will need a different balance of power and love as they go through different stages of their rehabilitation. We, as mental health professionals who have taken on the stewardship of rehabilitation, must constantly strive to adjust ourselves and our service to the needs of the clients. We must do this while avoiding becoming “reckless and abusive” or “sentimental and anemic.” I see both of these temptations in myself during my daily work and I observe them in the behaviours and comments of BRC staff. We all have to struggle with these fundamental polarities in which the “right” action is a combination of both poles, rather than an either/or choice.
What each of us needs to strive for in our daily work (which is shaped by our beliefs, attitudes, comments and speech) is a balance of power and love, structure and openness, safety and empowerment. It is natural when human beings are under stress and systems are changing that we fall back on simple answers to complex problems. The simplest answer is to say that all we need is power or all we need is love (The Beatles non-withstanding). While choosing only power or only love might seem like it makes our lives and choices easier, this is not the truth. Our work in rehabilitation requires both power and love in appropriate balance and structure. This is my vision for Buchanan: that we create a place in which we use our power to create a structure that is safe for staff and clients while also creating the space and acceptance for clients to make mistakes, learn and grow.
I will continue to end these fortnightly thoughts with a poem:
It’s time to break out –
Time to punch our way out of
the dark winter prison.
Lilacs are doing it
in sudden explosions of soft purple,
And the jasmine vines, and ranunculus, too.
There is no jailer powerful enough
to hold Spring contained.
Let that be a lesson.
Stop holding back the blossoming!
Quit shutting eyes and gritting teeth,
curling your fingers into fists, hunching shoulders.
Lose your determination to remain unchanged.
All the forces of nature
want you to open,
Their gentle nudge carries behind it
the force of a flash flood.
Why make a cell of your home
when the door is unlocked
and the garden is waiting for you?