Power and the Social Service, Mental Health Professions

Until recently, in the cases of:children put in foster care, patients suffering from a form of dementia (Alzheimer disease can only be ascertained by autopsy) and people who were deprived of their liberty on the grounds that they were mentally ill and dangerous to themselves or others, were usually deprived of most of their civil rights as well. Once institutionalized, they were largely at the mercy of the institution and who ever ran it,which decided for them what privileges and duties they should have and what treatments., if any they should undergo. The abuses that could result from this system were suggested by a popular movie, One Flew Over the Cuckoo's Nest. Today, there is a strong trend toward guaranteeing patients certain basic rights, especially the right to treatment, the right to refuse certain types of treatment, and the right to decent living conditions. 

Unfortunately, in many cases and most respects, the thrust of many of the recent court and government decisions is to weaken family strength, limit  parents, and give power and control to Government , Social and Family Services. Fortunately, (in many, many but not all cases) the thrust has also been to limit the power of the mental health profession.. Yet despite these new restrictions, the power of psychological professionals is still immense. To begin with,it is the psychiatric profession that declares which among the countless variations of human behaviour are abnormal. This is a momentous decision--and one that psychiatrists, psychologists, social workers, have a very, very questionable right to make. Civil, First Nation, and human rights leaders have been fighting this for years. First Nations, Doukhobors, and other minority groups,  and those living in communes (communists)well remember the residential schools, the family, language, religious, and social barriers imposed by the government, because of decisions handed down by the psychiatric and mental health profession. Many Gays and Lesbians find it that in 1973 The U S Psychiatric Association (and the same thing happened in Canada)on the normality of their sexual preference.Presumably, if a condition were severe enough to be labelled abnormal, it should not require a vote. 

Whether or not psychiatrists and social workers are qualified to make such decisions, they do in fact make them, and the decisions carry tremendous weight. The very word "abnormal" as used in psychology, implies the need for change. Thus included in the power to decide what behaviour is abnormal is  the power to decide who and what needs changing in our society.Again, do social service workers and mental health professionals have the right to make this decision?Many people feel that the major cause of psychological disturbance in our society is not an individual's genes, or parent/child relationships; but the psychologists, psychiatrists, psychotherapists,and social service agencies.Many also feel, with the huge wage disparity in this country, that poverty is a major cause. What is the probability that mental health professionals, social workers--who are largely middle -class people of high income (much too high) will be especially sensitive to this problem?

Finally, as we have seen, these so called professionals are often the ones who determine whether children should be taken out of the family home and placed in foster care, people identified as mentally disturbed should be institutionalized, put on mandatory drug therapy, and whether those who are currently institutionalized should be released It is hard to imagine a one-to-one relationship in our society that involves greater power than this or, in many cases, a group that is more ill equipped to hold it. What situation in our society involves a greater loss of power than involuntary commitment?

Fortunately, the powers held by these groups are now being disputed. Numerous groups-- aboriginal, ethnic minorities, men,women, seniors, all the poor have asked why a professional class made up largely of affluent whites should be  given such broad authority. It has been argued that the mental health-social service professions suffer form a tradition of "Big Brother/Sister-Maternal/Paternalism, by a handful of self proclaimed "experts" can determine the fate of a large part of the rest of the population.Just as , the consumer movement demanded that cars be equipped with safety devices and of food manufactures that harmful chemicals be removed from packaged foods (true, these demands have gone largely unheeded by both our "government" and the manufactures), so a "consumer"movement has made demands on the mental health profession. In this case, the demands have been for sharing information between professionals and lay people, so that those who really need therapy--and only those who need it--can give it their informed consent. This implies , of course, the right to say no and the right to question the qualifications of the therapist.Patients for whom drugs are recommended should be told about side effects and given a choice of whether or not they are prescribed. Alternative treatments--and alternatives to treatment--should be discussed. When information is open ans shared in this way power is diffused and abuses are much less likely.