Advocates and Professionals

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Advocates ,
Professionals & Social Work

The Caring Professions

Critical Notes On...

The Advocate. The professional advocate is positioned to 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 agents empowered by it. Self-advocates may 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 origins of social work are contested, but the profession's earlier roles 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 are uncontested. How do these troubled pasts square with the intentions of the helping professions? The tradition of individual, "scientific," or statistical case work in social work presented itself as a rational alternative, but how much can it truly affect the length or intensity of suffering of their client base when it does not address the system of capitalism that perpetually reproduces the conditions that cause that suffering? These questions are by no means easy to ask, since as Chris Chapman and A.J. Withers have pointed out, most social workers, unlike cops, and including those participating in acts we now consider reactionary, have played important roles in social reproduction and therefore 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. What is the role of the social worker today? What problems does it profess to tackle and how?

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 transhistorical or natural categories of people. They are statistical entities and conceptual short hands that conceal the historical evolution of the necessary suffering of a capitalist economy and the cruelty of the state in responding to it. 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.

We must further consider the ethics of imposing various business and statistical models into care work when 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, alternative concepts and models developed by patient movements like self-advocacy, recovery, and empowerment are formalized and turned into points on a checklist that assure the public of their legitimacy and efficacy. What counts is the movement of statistical entities from bad categories into good ones; the human being in question gets lost somewhere along the way. If the suffering management industry joins the search for radical solutions, they are committing themselves to a horizon in which they might disappear.

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 asks us to 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 structure: 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 and perpetual management. The possibilities of questioning, of collectively imagining possibilities, of examining the history are excluded from the start.