Professionals & Social Work
Care work has always existed. The majority who do it have not been men, and are mostly working class. Most of the time, it is done at home and is uncompensated.
In the 19th century, a new group arose armed with an expert and scientific model of care drawn largely from a more homogeneously white and professional base.
These well-meaning expert care workers devoted their lives to the new fields of advocacy, social work, and professional case work. Their history proves that the desire to help can, at times, also slow the tide of radical change or morph into a project of normalization and surveillance.
The Caring Professionals of the State
Critical Notes On...
The Advocate. The professional advocate says that they speak for people deemed incapable of speaking for themselves. This arrangement reproduces the basic premise that the person in consideration still cannot be heard. In promotional videos, the voice of the patient may be included in short, inspirational snippets over soft, ambient music to serve as a deflection from criticism or as part of "anti-stigma" campaigns to attract new prospective clients to the same old treatment models. Is that actually listening? Is any room made for dissent, provocation, or alternative ideas? For whom is this kind of work really advocating? This isn't the only paradox of advocacy work: consider also that many advocates spend their time advocating for legal remedies to problems the law itself is historically responsible for. Advocacy organizations seek to produce strong, better laws and work with law enforcement to protect their mentally ill and disabled clients first and foremost from the law and legal agents. Self-advocates corrode this iron boundary, shifting the focus from solely what is said to the conditions under which one can speak, at times seeking forms of self-empowerment and legitimation outside of the law or standard treatment modalities.
The Social Worker. The tradition of social work exists within the same violent horizon as policing: the origins of social work are contested, but the profession's role in carrying out eugenics research that led to widespread sterilizations, separating (particularly Black) families in the child welfare system, and participating in cultural destruction in the residential school system for Native people is uncontested. The tradition of individual, "scientific," or statistical case work in social work has done little to affect the length or intensity of suffering of their client base for a simple reason: it does not address the structural factors and underlying system of capitalism that incite it. These critiques are by no means easy to make for, as Chris Chapman and A.J. Withers have pointed out, most social workers, unlike cops, and including those participating in acts we now consider racist or reactionary, tend to see themselves as progressive agents in society. Radical social work traditions have popped up, but problems persist even here. The most socially conscious social workers still hold the keys to needed resources and services, and can (or must, in some cases) call on mechanisms of punishment or coercive rehabilitation. Deep, trusting relationships are not possible under these conditions.
There is nothing natural about the categories of people who find themselves the objects of the caring professions.
The terms "homeless mentally ill" and "vulnerable adult" (among others) do not refer to objective, natural categories of people. They are statistical entities and conceptual short hands often used to pass the blame of the necessary suffering of a capitalist economy and the cruelty of the state in responding to it onto the marginalized by transforming the reactions to these horrors into individual pathology. The issue is not that toxic factories are placed in intentionally segregated Black neighborhoods, it's not the perpetual displacements of a settler-colonial state, nor is it the repeated traumas of police executions on the street; some people are just not fit for the modern world.
Worse: these nebulous categories shoulder the weight of myriad non-profit industries of their own, guaranteeing professionals a salary to just barely maintain the existence of the sick and isolated. In their hands, radical and alternative concepts and models developed by patient movements like self-advocacy, recovery, and empowerment are commodified and turned into checklists that assure the public of their legitimacy. The suffering management industry cannot join the search for radical solutions; they just might disappear in the process.
What is most sorely missing from both the traditions of social work and advocacy is a sense of imagination and striving for new possibilities. DJ Jaffe of the Treatment Advocacy Center and Mental Illness Policy once argued that the Souder v. Brennan case declaring institutional peonage (forced labor) unconstitutitonal was a mistake because the patients were afterwards idle. By asking us to choose one option in a truly terrible binary, Jaffe tries to make us accept that these two options (idleness or forced labor) are normal, and that there aren't any other possibilities for such hopeless people.
In many cases, these creative limitations are tied to their finances: the National Alliance on Mental Illness (NAMI), receives the majority of its funding from pharmaceutical companies and its base is not the "mentally ill," but the parents and family members of the mentally ill, most of whom would likely rescind their financial support if they advocated for anything outside the box or advocated for more patient control of treatment. Nor do such groups want to alienate the (also unimaginative) politicians they pander to.
Most of the debates around mental health policy have this character: do you want the mentally ill to suffer in prison or do you believe in early, preventative coercive care in congregate settings to prevent incarceration? Do you support forced treatment at the discretion of the psychiatrist or of the probate judge? In all these cases, we apparently already know who the mentally ill are, what constitutes treatment, who should make those calls, and much more, we just disagree about the details. "Let's be realistic" they say, as they advocate for your incarceration.
It is time to reject these stale binaries, and confront the advocacy groups with their own complacency and stilted lack of creativity and energy. The user and survivor movements are, in this light, counter-hegemonic forces that ask us to rethink not just this or that detail about mental health care, but its fundamental concepts and logic.