Tag Archives: us and them

Privileged Glimpses 1: There is no ‘us and them’

mental health, social care, , , , ,

I am a manThis series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

In spite of having had my own issues in the past I began my nurse training with a very superficial mindset. I believed, without even thinking about it, that there were essentially two types of people in the world. There were ‘the mentally healthy’ and then there were ‘the mentally unhealthy’.

As a student nurse I believed myself (very arrogantly, I might add) to be one of ‘the mentally healthy’. I thought that people were born to mental health or to mental ill health and that the work of mental health services was to protect ‘the mentally unhealthy’ from themselves either by medication or by more social methods.

I’m embarrassed to acknowledge that my training did little to challenge that idea. There were a couple of outstanding exceptions but in the main the discriminatory attitude went relatively unopposed. Fortunately things have moved on and continue to do so but the student nurse training of 20 years ago was very definitely saturated by an ‘us and them’ ideology.

Of course, nobody ever came out and said it quite so bluntly, so starkly as I just did but there were plenty of references to ‘chronic illness’ and ‘irrecoverable’ conditions to illustrate the point just as clearly. Nowhere was this more obvious than during placements on the wards where people were described as ‘revolving door’ or ‘long stay material’ as though their very essence was illness and nothing more. I’m ashamed to say that for my first few years after qualifying I bought into this mindset completely along with all its negative (and essentially false) assumptions about incurable psychotic illnesses and irredeemable personality disorders.

I was glad to be one of ‘us’.

Then an interesting thing happened. I moved away from my first job on an acute psychiatric ward serving a large, deprived inner city area to my home town and began to meet up with old friends – many of whom I hadn’t seen for years. Around half a dozen of us met up for a meal in a local pub one night – it was a way to reintroduce myself to my old mates. And we had a good time swapping stories of our schooldays and catching up on the events of the intervening years. That was when it first began to become clear to me that there really is no ‘us and them’.

Of the six of us sat around that pub table five were taking anti-depressants. Every single one of my old friends had been prescribed pills to make them feel better. But they were my old mates. They were my best friends. They definitely weren’t to be considered as ‘them’.

That was the beginning of a mental journey that led me to rethink my old assumptions about mental health and illness. I needed to work out what was different between my old school friends and me. It surely wasn’t simple biology as I’d been taught. They couldn’t all have ‘the depression gene’ (whatever that is).

Finally it dawned on me – Sally had had a point. The difference isn’t just biology, although that can have a part to play. Biology is not the complete answer. It’s not the complete answer by a very long way. Attitude, social situation, environment and general coping style are just as important – arguably very much more so. This matters.

Once we acknowledge the impact of social skills, environment, opportunity, coping methods and psychological style we begin to see that given the right life chances people can be far more than they might appear. Our own assumptions about ‘them’ keep people from overcoming their problems by limiting those opportunities. It’s truly amazing what people can do when we treat them like ‘us’.

There really is no such thing as ‘us and them’.

Why I hate ‘staff mugs’

duty of care, social care, , , ,

I hate ‘staff mugs’!

Yes, I know… Many perfectly caring and compassionate care workers have no problem at all with this sort of seperation. They use crockery reserved only for staff because that’s what they’ve always done. And they never give the practice a second thought. It’s just a cultural ‘norm’ in many care organisations. But I hate it. I hate it with a passion. Not because I particularly care about the type of drinking vessel anyone uses but rather because I couldn’t give a fig about it. But I do care about culture. I do care about perception and I do care about discrimination.

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Of course care workers who defend the use of staff mugs don’t talk about discrimination – they talk about hygiene. They talk about infection control and they talk about good practice and cleanliness. And so they should.

Obviously hygiene is important and clean crockery is an important part of the whole infection control system. That’s why we wash cups and mugs in the first place, isn’t it? But if we’re washing them properly does it really matter who’s drunk from a particular mug before? The whole hygiene argument for staff mugs makes no sense at all to me unless we have no faith in our own kitchen processes.

So are our cups and mugs clean or aren’t they?

If they are then we shouldn’t need to indulge in cultural discrimination. If they’re not then how can we possibly countenance sharing dirty crockery among service-users in our care? And how can we seperate ourselves from such a practice and then talk about hygiene?

Can we really justify giving our service-users mugs that aren’t clean enough for us to use ourselves?

Of course it’s not really about hygiene at all. The whole cleanliness argument is just a big red herring that generations of care workers accept uncritically because that’s what human beings do. We accept the status quo, especially if it seems trivial and move on to other considerations. But this isn’t trivia. This is a significant, long-standing cultural artefact of discrimination.

Care workers seperate mugs because the culture seperates people. Staff mugs are a vestige of the ‘us and them’ culture that devalues and disempowers service-users. We may talk about equality and shared care but our most fundamental values tell a different story.

So yes – I’m irritated by staff mugs. In fact I’m outraged by them. They may not be the most pressing issue in social care but given how little effort it would take to remove them they are inexplicably common.

And worst of all – nobody actually intends to discriminate against anyone by using them. But still they do.