Inside Jim's Pod

Paddy McAloon - Meet the New Mozart

2010-03-22T05:11:00.001-07:00

The transitions are a bit ropey - naff, even, but it was about time I knocked up a video for Paddy 'Prefab Sprout' McAloon's 'Meet the New Mozart':

The 10 Best Films About Mental Illness

2010-03-18T16:04:00.000-07:00

1: Spider
2: Family Life
3: Clean, Shaven
4: An Angel at My Table
5: Van Gogh
6: The Madness of King George
7: Keane
8: Shine
9: Repulsion
10:Images

Fifty Sprouts and a Desert Island

2010-03-17T03:26:00.000-07:00

All The World Loves Lovers
Andromeda Heights
Angel Of Love
Appetite
Bonny
Cars And Girls
Cornfield Ablaze
Couldn’t Bear To Be Special
Cowboy Dreams
Cruel
Dandy of The Danube
Desire As (Acoustic)
Donna Summer
Don’t Sing
Doo Wop In Harlem
Dragons
Dublin
Earth: The Story So Far
Electric Guitars
Goodbye Lucille #1
Faron Young
Girl, I’m Here
Green Isaac
Here On The Eerie
If You Don’t Love Me (String Driven Thing)
I’m 49
I Never Play Basketball Now
I Remember That
I Trawl The Megahertz
Jesse James Bolero
Jordan: The Comeback
Last Of The Great Romantics
Life Of Surprises
Lions In My Own Garden
Meet The New Mozart
Moondog
Moving The River
Music Is A Princess
Nightingales
Pearly Gates
Rebel Land
Sleeping Rough
Sweet Gospel Music
Technique
The Ice Maiden
The Venus of The Soup Kitchen
‘Til The Cows Come Home
We Let The Stars Go
When Love Breaks Down
Wild Horses

www.vinylrecords.co.uk: CD SOUND: A CLOSER LOOK AT THE TRUTH

2010-03-10T14:29:00.000-08:00

www.vinylrecords.co.uk: CD SOUND: A CLOSER LOOK AT THE TRUTH

New Waits DVD

2010-03-10T02:51:00.000-08:00

http://www.amazon.co.uk/Tom-Waits-Under-Influence-DVD/dp/B00376AWE8/ref=sr_1_5?ie=UTF8&s=dvd&qid=1268218039&sr=1-5

Documentary examines Waits' legendary genius through exclusive interviews, rare and often previously unseen footage and contributions from many of his fellow musicians, historians and critics.

This documentary film examines, dissects and all but lobotomises the wealth of music, literature, theatre and film that have assisted in creating Waits' legendary genius and, results in hand, reviews the life and career of Tom Waits from this fascinating and rarely identified viewpoint. With exclusive interviews, rare and often previously unseen footage and contributions from; Tom's legendary producer Bones Howe; Moris Tepper and John French from Captain Beefheart's Magic Band; and occasional TW collaborator, Ken Nordine; Harry Partch associates David Dunn and Dean Drummond; BBC's head of music Chris Ingham; Beat-era scholar John Tytell plus Tom Waits historians, music academics, and respected writers. Also features numerous seldom seen photographs, much archive film and a host of other features which all at once make for an educational, inspiring and joyous celebration of Tom Waits and those he holds close to his heart.

Bonus Materials

Illustrated contributor biographies
'John French spills the beans'; 'The World of Ken Nordine'; 'The Other Lord Buckley Live In Paris'
Beyond DVD gallery and more

'Appetite' - Spangle Call Lilli line

2010-03-05T06:06:00.000-08:00

'Los Bastardos': Andrew Cox's brilliant response to my "Reflections on Beckettian 'Buddy Narratives'"

2010-03-05T04:53:00.000-08:00

Amat Escalante's 'Los Bastardos' (2008), which I had the pleasure of seeing at the Tate Modern in December 2009, also fits into the existential ‘buddy narrative’ of films/plays like ‘Rosencrantz and Guildenstern are Dead’ and Samuel Beckett’s ‘Waiting for Godot’. The long opening shot is of a desolate urban landscape on the outskirts of Los Angeles, and shows two wandering figures in the far background. Escalante sets the scene for the film and introduces us to the broader social predicaments of the characters, who are illegal Mexican labourers in the United States.

'Los Bastardos' opens slowly and the two main protagonists, Jesus and Fausto, don't come to the fore till at least halfway into the film. They have been contracted to kill an American woman. The woman's life is portrayed as rather drab. She lives with an uncommunicative and awkward adolescent son, with whom she can barely hold a conversation, and she seeks solace in drugs.

When Jesus and Fausto break into the woman’s home is where the narrative begins to unfold. ‘Los Bastardos’ is very similar, stylistically, to the German director, Michael Haneke’s ‘Funny Games’ (1989) - Jesus demands food from the woman and she is constantly watched over with a shotgun. Whilst Haneke’s film is very much a modern, dystopian fairy tale, with a nice family being tortured and imprisoned by two sadistic sociopaths from no particular place, Escalante portrays believable characters in Jesus and Fausto.

Jesus and Fausto are not ‘natural’ friends – Jesus is in his 30s, while Fausto is an awkward and reticent teenager. They are two people thrown together by their own social and economic deracination – neither of them can speak English; they are illegal aliens; and the very thing that has driven them to cross the US border – namely, money – is something they can only acquire in any substantial amount through killing another human being, whom they know nothing about.

The incarceration of the woman is gruesome and harrowing to follow. Though the two Mexicans are not brutal to the woman, she is still their prisoner and when she is told to strip down to her underwear to go swimming with the two Mexicans, she takes on a clown-like character and adds an ‘absurdist’ element to the drama. The woman cannot speak enough Spanish to plead or bargain with her kidnappers, and they take advantage of the woman’s home comforts such as food, swimming pool and TV while they are holding her. Escalante could be mocking passivity and consumerism when showing the kidnappers aimlessly lounging around in their victim’s home indifferent to her basic humanity, but on the other hand they could be seen as taking advantage of what little comfort is available to them both in America and their home country.

The narrative of ‘Los Bastardos’ in many ways becomes larger than the sum of its parts. Whilst a writer like Samuel Beckett was seen as hinting at the existential, philosophical alienation and deracination of post-war Europe in ‘Waiting for Godot’, Escalante’s film opens up channels of discussion about the very real human and existential void created by irrational preoccupations in the Western world with issues such as illegal immigration and the notion of the ‘economic migrant’. The United States is so determined to keep Latinos out that it is prepared to spend hundreds of millions of dollars on border security and perimeter walls. The inhuman consequences of these policies result in Latin Americans seeking even more dangerous routes, such as through desert, to get across the border leading to tragic consequences for those who perish at the cruel hands of nature.

There is no proper debate about immigration in America or Europe. The real human issues are ignored and immigration is reduced to a merely economic and technical problem – albeit, a very expensive one in terms of the social and financial expenditure required to contain it. The ingenuity of Escalante’s film is that makes us think about what is happening in front of us. He avoids endowing the film with an explicit social message, but you can’t watch and fully appreciate a film like ‘Los Bastardos’ if it doesn’t make you question why these things happen to people, and why it is wrong.

Quote of the Day

2010-03-05T04:49:00.001-08:00

Anvil drummer Rob Reiner's response to a British lawyer who asks why heavy metal stalwarts Anvil aren't playing in front of at least 1000 punters each night: "I could answer that in one word.. two words.. three words: we haven't got good management." Priceless.

'Withnail and I' et al.: Reflections on Beckettian 'Buddy Narratives'

2010-03-05T01:37:00.000-08:00

Two peripheral characters ponder and wander aimlessly, for want of a purposeful existence. This would be my one-line synopsis for Stoppard's wonderful Rosencrantz and Guildenstern are Dead, but it seems to me that it might just as well describe some other cast-iron favourites of mine, whether it's Withnail and I (Withnail and Marwood), Sideways (Miles and Jack), or (with rather less wandering about), Waiting for Godot (Vladimir and Estragon).

I could wax lyrical about the sublime Sideways, and, among friends, strangers and 'friends-to-be', casual references to W & I are a kind of communicative currency, a reminder that we're all comedy fans 'in the know'. But it's the pathos and poignancy of these stories that resonates most of all. The 'not-quite-friendships' of many of my favourite narratives seem to reproduce the unresolved struggles of the world in the fraught realm between the love and resentment we feel towards the people we find ourselves drawn to, inexorably, and wherein, at the same time, the reality of our frustrated ambitions seems to be amplified.

And, for me, the comic catharthis and emotional punch of Withnail and I and Sideways act as a kind of imaginative bridge to and from Beckett's and Stoppard's plays and the weightier philosophical questions they embody.

Finally, not least because Rik Mayall and Adrian Edmondson co-starred in the 1991 West End production of Waiting for Godot, surely Bottom's Richard Richard and Eddie Hitler deserve a mention too? Then again, perhaps not.

PS 125i Vid

2010-03-04T10:22:00.000-08:00

Let’s reclaim the C-word | spiked

2010-03-03T06:31:00.001-08:00

Let’s reclaim the C-word | spiked

Posted using ShareThis

Honda PS 125i - mine, all mine

2010-03-03T04:21:00.000-08:00

Dear Employer...

2010-03-02T15:25:00.000-08:00

I am a recently qualified mental health nurse eager to pursue a career as a psychological therapist. My clinical training has provided me with the communication, assessment, teamwork and therapeutic skills vital to effective mental health interventions. Empathic, motivated and adaptable I want to enhance my strengths by gaining expertise in non-pharmacological, psychological therapies. As such, I am confident that this new, challenging career opportunity will allow me to build on my proven aptitude for establishing therapeutic relationships with clients experiencing depression, anxiety and other mental health problems.

I have experienced a variety of mental health treatment settings, including community psychiatric nursing (adult and elderly), older people’s assessment, substance misuse, neuropsychiatry, acute admissions/assessment, psychiatric triage and a mental health resource centre. Throughout my training, I worked with representatives from a range of other disciplines, professions and agencies, including social workers, occupational therapists, psychologists, general practitioners, police officers, and others.

In all of these environments I have sought to ensure that my understanding of the role of comprehensive mental health and risk assessments, research methods, evidence-based practice and the administration of psychotropic drugs have been applied in a critically reflective and self-reflective manner. A combination of clinical supervision and academic study has also given me a solid grounding on which to properly integrate theory and practice.

My training has provided me with a very good understanding of depression and anxiety, and I have also gained insights from wide-ranging work and personal experience, including: teaching in adult and higher education, working with adults with physical and learning disabilities, support work in the voluntary mental health sector, and providing long-term support to a close friend with mental health needs.

I have a good understanding of the Mental Health Act (1983), the National Service Framework for Mental Health, and the Care Programme Approach, and have paid close attention to modifications and amendments to the standards and legislation they represent. I assisted, for example, the North Staffordshire Combined Healthcare NHS Trust’s Assertive Outreach Team in its first use of a community treatment order.

During my training, as well as acquiring first-hand knowledge of psychotropic medication, I became increasingly aware of the importance of advocacy, the recovery model and psychological therapies, and am committed to incorporating these techniques and approaches into my work as a mental health practitioner.

I have acquired a working knowledge of the applications of cognitive behavioural therapy, and have taken into consideration the impact of work on mental health (in relation to low job control; understanding of employee role; organisational culture; and workplace relationships) and the need for evidence-based practice (in relation to overcoming the research-practice gap; supporting the justification for current working practices; meeting the demand for accountability; and cost-effectiveness). I look forward to further demonstrating my commitment to ongoing training and development in this field.

For my final placement I elected to be placed with the Single Point of Access nurse and social worker-led psychiatric triage team in Stoke-on-Trent. Because it provides the central point of access to mental wellbeing/psychological services in the area SPA afforded me the opportunity to gain invaluable experience in assessing people’s mental health needs, in anticipation of a career as a psychological therapist.

One example of a guided self-help CBT-type intervention I employed involved a socially isolated, self-harming young woman, with whom I developed a strong therapeutic rapport through initial and generic assessments and follow-up phone calls. The client agreed to keep a Dysfunctional Thoughts Diary, in which to record her feelings about, and reactions to, self-harming thoughts and anxiety-inducing situations. She acknowledged that my support helped her to attain the confidence to apply for voluntary work and to take part in a ‘Changes Young People 16-25 Years’ mutual help group.

Working in multidisciplinary environments has also helped me to obtain a greater practical understanding of the different pressures faced by primary and secondary healthcare services, and the need to maintain and develop links between the two. At the Single Point of Access service, for example, I was ideally placed to gain an appreciation of how depression and anxiety can present in Primary Care. Regular contact with general practitioners confirmed, in particular, that patients with depression or anxiety frequently present with physical or somatic symptoms, which can obscure a psychiatric diagnosis.

During this placement I took the opportunity to manage my own caseload, which was a responsibility I carried out with both enthusiasm and effective use of my time management skills. I also demonstrated my ability to work on my own initiative by identifying appropriate referrals, levels of assessment and suitable points of contact within other agencies.

I also enjoy and appreciate the importance of team-working, which I have found to be mutually beneficial in ensuring that essential tasks are completed effectively. I am comfortable ‘taking the lead’ when working with distressed and difficult clients, but am very much aware that effective communication between colleagues will help to ensure appropriate interventions.

I am strongly aware of the importance of client confidentiality and informed consent, and have sought to uphold NMC guidelines in this and other areas relating to standards of conduct, performance and ethics.

My clear and confident interaction with nursing and medical staff, patients, families, students and tutors, together with my record keeping and academic achievements, testify to my exemplary oral and written communication skills. These skills also ensured that I was entrusted with submitting a report regarding a professional dispute between a colleague and a member of another clinical team. Senior staff and the management team praised the report for its clear and balanced tone and used it as evidence in their attempt to settle the dispute.

I am proficient in the use of Word, PowerPoint, E-mail and the Internet. Furthermore, as well as being the Student Representative for my Diploma cohort I was selected by Keele University to attend the Florence Nightingale Foundation’s Students’ Day at St Thomas’ Hospital, in May, due to my ‘outstanding academic scores’. My postgraduate studies, which focused on debates about cultural differences and equal opportunities, together with my support for third world development charities and anti-racist campaigns, also reflect my sensitivity towards the needs and values of individuals and groups from diverse backgrounds. This is a quality that I believe could be of great benefit to your service.

Being trained in partnership with North Staffordshire Combined Healthcare NHS Trust, whose reorganisation in 2002 was driven largely by service improvement and clinical governance targets, has made me very much aware of the need to achieve tangible results in alleviating the enormous personal, social and economic costs of mental illness. And I feel strongly that my special interest in working with people suffering from depression and/or anxiety would be best served through assisting in the delivery of IAPT services.

I believe I am well-suited and well prepared to support your organisation deliver on its commitment to extending the availability of psychological therapies. I hope that therefore you will be able to look favourably upon my application.

I very much look forward to hearing from you.

So, what was that about Marx, Dr Pod?

2010-03-02T15:16:00.000-08:00

I am a radical humanist, libertarian Marxist and anti-imperialist through and through, and yet I recognise that today's 'anti-capitalist' and environmentalist movements are backward ideological expressions of production in retreat ("Stop the World! I Wanna Get Off!"). On close inspection, the current world recession reveals the subjective retreat of the capitalist class from industrial growth*. It is therefore essential today to emphasise the need for continued economic growth, while holding to neither the sectionalism of capitalism nor the relativism of the left.

While I'm of 'Marxist extraction' I consider it a disservice to Marxism to call oneself a 'communist' or a 'socialist' today. It's axiomatic in the revolutionary Marxist tradition that communists cannot create a working class movement of their own volition. Rather it was their role was to give it conscious direction. At the present conjuncture, where the working class exists sociologically, but not politically, there is no concrete movement in society that can give expression to the abstract idea of 'social revolution' (indeed the very idea invites blank incomprehension).

Marx sought to liberate capitalism's progressive trends towards economic growth from the restrictions it places on that growth. It is because 'left', 'right' and 'centre' today are preoccupied with the destructiveness of capitalism that production (the well-spring of our humanity) and progress have been demonised, pushing social change off the agenda. The goal of surpassing capitalism has been passed over for retreating from it. Thus, to be 'radical' today is to believe that capitalism has gone 'too far', when, in reality, capitalism is unable to go 'far enough'.

The world needs development, not 'sustainable development'. The former is the pre-condition for human liberation, the latter a recipe for ensuring that majority of the world's population remains 'closer to nature' (i.e closer to death).

http://www.metamute.org/en/print/13124

(James Heartfield, 'A crisis of under-accumulation')*

Revisiting Pod v. Squeeth, in 'the Mike Leigh debate'

2010-03-02T15:11:00.000-08:00

http://www.imdb.com/name/nm0005139/board/flat/74586739?p=3&d=148181207#148181207

Communal self sacrifice

2009-09-25T02:54:00.000-07:00

Revisiting James Heartfield's 1996 essay, which reminded us what 'the 1980s' were really all about:

The greatest claim of the market system has always been the premium it placed on the freedom of the individual. Yet society today seems uniquely hostile to assertive individualism.

James Heartfield looks into who killed the capitalist spirit of the aggressive, self-assured individual - and why that demise is a problem for those of us who want to change society
Individualism today is in bad odour. Self-interest, self-assertion and self-reliance were once the official values of the 'free world'. Today, any expression of such values is more likely to be denounced as mere selfishness. Once, rich capitalists were the object of envy and emulation. Today they are likely to be denounced as greedy fat cats taking insensitive pay rises. There is without doubt a marked shift in the mood not just in Britain, but throughout the West.

You can judge a society's values by the kind of heroes it embraces. In the eighties the mood of triumphal individualism was caught by the revival of the forties comic book hero Superman. When Joe Shuster and Jerry Seigel first drew Superman comics he was a nerdy guy with glasses called Clark Kent. But once he stepped into a phone booth he tore open his shirt and pulled off his glasses to reveal the man of steel. In retrospect, it is difficult not to see the transformation as one from Jewish immigrant to all-American hero, as if Woody Allen had turned himself into Charles Atlas. His name translates into German as übermensch but, unlike the Nazi fantasy, this was a hero who stood up against injustice to defend the weak. When the Superman films were made, the choice of the strapping, chisel-jawed Christopher Reeve to play the part suited the American mood of standing tall in the world.

In recent months Christopher Reeve has once again become a symbol for his times. This time, however, he presents a very different kind of transformation than that from Clark Kent to Superman. Tragically, Reeve was paralysed from the neck down in a riding accident that snapped his vertebrae and damaged his spinal chord. He speaks with the aid of a microphone and a tracheotomy. He is strapped into a wheelchair. But still, remarkably, he has become a new kind of hero, for a different kind of age. Reeve was the star speaker at the opening of the Democratic Party Convention in the United States, before the president of the world's most powerful nation opened his re-election campaign. Thousands of party delegates cheered Reeve in an extraordinary outpouring of feeling for the wheelchair-bound star.

You do not have to be a cynic to ask why were they cheering? Of course, Reeve's decision to campaign for healthcare for people in his position is laudable, but it is hardly at the centre of the Democratic Party's policy agenda. Indeed, this is a party that has just committed itself to cutting back welfare benefits for single mothers. How does that sit with Reeve's crowd-pleasing claim that America does not turn its back on its needy? The truth is that the convention was cheering Reeve the symbol, not Reeve the man.

Christopher Reeve is a symbol of the values of our age. He represents the disaster that can strike us all. He represents the trans-formation of a Superman into a wheelchair-bound survivor. What the delegates cheered was somebody who had learned the hard way about his own limitations and his own fragility. He is a hero in reverse, of the kind that is all too characteristic of our times. Christopher Reeve has made the transition from the hero-worship of Ronald Reagan's America to the victim-cult of Bill Clinton's USA. Hollywood too reflects the cult of the victim as protagonist. Films of recent years feature lead characters who are autistic (Rain Man), retarded (Forrest Gump), feral (Nell) or disabled (Edward Scissorhands). Even traditional heroes are presented ironically, like Arnold Schwarzenegger's Last Action Hero.

The values that are expressed in Christopher Reeve's reception at the Demo-cratic Party Convention are quite different from the values of self-reliance and assertive individual freedom that were, until quite recently, the official ideology. Today, standing on your own two feet and insisting that you do not need to be protected or counselled is not likely to be celebrated. That is more likely to be seen as a sign of emotional illiteracy and an unwillingness to expose your weaknesses to others.

With the elevation of suffering and victim status comes a denigration of individualistic values in favour of something called 'the community'. Self-centred individualism is decried as something that belongs in the past, as a disease of the eighties. Amitai Etzioni, champion of the community and one-time speech-writer for president Clinton, puts it like this:

'The eighties was a decade in which "I" was writ large, in which the celebration of the self became a virtue. Now is the time to push back the pendulum. The times call for a reconstruction, in which we put a new emphasis on "we", on the values we share, on the spirit of community.' (The Spirit of Community, 1993, p25)

Public service is an exemplar of the spirit of community that Etzioni is hoping to rekindle. Early in his presidency Clinton delivered a speech, written by Etzioni, in which he set out his appeal to America's students to do voluntary work--as 'teachers, law enforcement officers, healthcare workers or peer counsellors'--in exchange for loans to go to college.

'There are those among us who do not believe that young Americans will answer the call to action, who believe that our young people now measure their success merely in the accumulation of material things. They believe this call to service will be unanswered but I believe they are dead wrong. The American Dream will be kept alive if you will answer the call to service.' (3 March 1993)

In fact the nay-sayers appear to have been correct. Not many people did respond to Clinton's call to service. But, as it happens, that was never really the point. The speech is a revision of the values of the American Dream. Once that meant that everyone could make it by their own efforts--by the 'accumulation of material things', in fact. Instead, today the values that politicians and commentators look for are not acquisitiveness, pride, individualism and looking after your own so much as care, duty, selflessness, diligence and modesty.

The backdrop to this kind of appeal is the premise that people have become too selfish. This has become the stock-in-trade of today's gloom-mongers. The terrible inheritance of the greedy eighties, they say, continues to haunt us. It appears that people are pursuing their self-interest at the expense of every other value in society. Love of family, care for the community, neighbourliness and civic duty all appear to have been sacrificed to selfish concerns.

Every event, from juvenile crime to boardroom pay-outs, is taken as confirmation of the same interpretation--that love of self takes precedence over any wider loyalty or altruistic concern. But, like a reflected image in a mirror, this picture is the reverse of the real movement.

What looks to many like an elevation of the individual over the interests of the community today is really something quite different. It is not that individualism has come to the fore, but that all forms of basic social solidarity have been diminished. It is not that people have turned their backs on society in wilful pursuit of their selfish concerns, only that the old collective organisations and institutions hold so little appeal that they cannot garner support and loyalty. What looks like individual self-assertiveness is in reality a disillusionment with collective organisation and a withdrawal from contemporary forms of public life.

There is a real problem here, but it is quite different from the one that is bemoaned by commentators. People have been squeezed out of public life--the diminishing numbers of people participating in political parties, trade unions, churches and all kinds of cultural organisations demonstrates as much. People's lives have as a consequence become much more individuated and privatised. But that does not mean that individuals' sense of themselves has been strengthened. Rather, individuals have become less assertive about their own interests, and have retreated defensively into private life. It would be more accurate to say that today's individualism is a weakened sense of self that is more cautious, vulnerable and self-effacing than before. But that is not the way things are generally seen today.

In Britain, as in America, the changed attitude towards individualism is expressed above all in a retrospective criticism of the excesses of the eighties. Commentators elevate the concerns of community against the foil of the 'greedy eighties', when, it is claimed, Thatcherism and Reaganism swung the pendulum too far in the direction of individual avarice. This caricature of the eighties is so enduring that it is worth briefly looking back to ask whether this really was a time when individualism was let off the leash.

In the eighties, the Conservative govern-ment's stated aim was to set the individual free from the constraints of collectivism. They saw collectivist institutions as the great plague of modern society. Trade unions, the welfare state and comprehensive schools were all bodies that were found guilty of putting the collective above the individual. Higher taxes to pay for welfare, and higher wages won by unions were all supposed to be barriers to individual entrepreneurialism. Welfare provision only led to a dependency culture, undermining individual self-reliance, they said. Collectivism, according to the Tories was choking individual freedom. The obvious remedy was to roll back the welfare state and to smash the trade unions. If that was done then the individual would be set free. At any rate that was the theory. The practice proved to be rather different.

Under Margaret Thatcher the Conservative government did attack the trade unions and their supporters. They cut state subsidies to the docks and to the steel, motor and coal industries leading to massive redundancies. They held down benefit entitlements and cut back on local authority spending. They deregulated the City of London and sold off council houses and public utilities in a programme that came to be known as popular capitalism. On the face of things they did everything they could to reduce people's dependency on the state and persuade them to stand on their own feet.

But what was the consequence of these reforms? Instead of liberating people from state regulation, the Conservatives oversaw the greatest extension of state power since 1945. State expenditure rose in real terms from £217 billion in 1979, when Margaret Thatcher was elected, to £289 billion in 1994 (adjusted to 1994 money). Regulation of industry has not decreased with privatisation, but has, if anything, increased, as once-public utilities have come under new regulatory bodies like Ofwat and Ofgas. Subsidies to local industry were not suspended, but merely redirected, as money was channelled through unelected quangos and Urban Development Corporations instead of local councils. Clientelism, rather than free enterprise, is the driving force of industry today.

The numbers of individuals dependent on state benefits rose, with millions of people in receipt of welfare payments to supplement their wages. Some five million families are currently dependent on welfare for part of their income. On top of the official unemployed figure of just over 2m must be counted a considerable proportion of the 1.5m in receipt of invalidity benefit, and the thousands studying at colleges and new universities who would have been competing for jobs but for the exponential expansion of higher education.

Any objective assessment of the 17 years of Conservative rule would have to note that the effects of the Thatcherite revolution were seriously at odds with its claims. The Tories have not liberated individuals from the constraints of welfare dependency and state regulation. On the contrary, they have comprehensively undermined people's capacity to organise their own lives and further their own interests. How could this be?

It was always an absurdity to think that it would be possible just to 'roll back' the state and reveal millions of go-getting entrepreneurs underneath. The opportunities for making something of yourself are dependent on a society that is going forward. The great advantage that capitalism used to have over its rivals was its ability to repackage the goals of amassing profits as the goals of individuals seeking their own betterment. But that strategy can only work in a dynamic society with a growing economy. A slump economy has the opposite effect, putting many people's interests more clearly at odds with the market system. Mass unemployment, degrading rates of benefit and conditions of entitlement, and shabby services are hardly the basis of a muscular individualism. More profoundly, tearing up people's collective organisations, their trade unions, their mass political parties and forcing them out of the public sphere of political engagement was a recipe for disillusionment and despair, rather than a growth of the entrepreneurial spirit. The humiliation of the working class move-ment in the eighties was bound to be a degrading experience that would undermine personal self-reliance instead of building it up.

The Conservatives' mistake was to imagine that collectivities were at the opposite end of the scale from self-reliance. They imagined, like a see-saw, that you only had to lower one end to raise the other: you only had to restrain collectivism to set the individual free. The left's view, and the view of the critics of the greedy eighties, is the mirror image of the same Tory prejudice. They too think that community and individual freedom are at odds, only they want to curtail the latter in favour of the former. In fact, the two things are much more directly related. Self-reliance, independence of purpose and organisation are not the opposite of collective organisation, but its complement. The impact of the Conservative revolution was to undermine the basic social solidarities of neighbourhood, workplace and industry. Without these simple elements of collectivity, it is inconceivable that people will be able to stand on their own two feet. Collective experience and purpose is part and parcel of self-reliance and self-assertion, not its opposite.

This is the real story of the eighties. The defeat of collective organisation and the disaggregation of basic social solidarities did not give rise to a new individualism: it was at the same time the defeat of individual self-assertion and independent organisation. In the absence of the basics of social organisation, real individuality could never flourish. Individualism and collectivism were not alternatives in the way that things are usually seen. Rather, individual initiative and self-reliance could only hope to take off in the context of a widespread sense that some sort of social solidarities were in place.

In practice the Conservatives have promoted the market at the expense of the freedom of the individual. The association of markets and freedom that is so central to Conservative ideology is false. Karl Marx made this point 150 years ago:

'Gentlemen! Do not allow yourselves to be deluded by the abstract word freedom. Whose freedom? It is not the freedom of one individual in relation to another, but the freedom of capital to crush the worker.' ('Speech on the question of free trade', 1848, Marx and Engels Collected Works, Vol6, p463)

The only freedom that the Conservatives have truly supported is the freedom of capital to crush the worker. From that standpoint, it made perfect sense to smash working class organisation and put millions out of work. The Tory champions of the capitalist class could not be expected to tell the difference between freedom and the market. In their minds the two things are synonymous. More problematic is the fact that their opponents took this propagandistic account at face value. The critics have read the eighties as a period in which there was too much freedom granted, rather than one in which freedom was aggressively curtailed in the name of the market.

The lessons of the Thatcher experiment ought to have been that the market is hostile to real freedom. The obvious conclusion would be that it is the market that we should get rid of, the better to realise true self-government. Instead the conclusion drawn today is that individuality is suspect and that freedom itself is dangerous. In these circumstances, it seems that it is the goal of individual freedom that we are being told must be sacrificed to the greater good of society and of the community. But what society and whose community are they talking about? Why should anybody subordinate the aspiration to take charge of their own destiny to the interests of a capitalist society?

Once seen in this light, the current unease over 'excessive individualism' becomes clearer. It is less the 'individual' half of the couplet 'individual freedom' that offends nineties sensibilities, but the aspiration to freedom itself. All of the denunciations of excessive individualism are not directed at people's disengagement from society, so much as at their recalcitrant belief that they have the right to decide things for themselves.

This orientation explains one of the more absurd misreadings of contemporary society--that there are too many assertive individuals around. This is far from being the case. In fact the sense of individual self-assertiveness is more precarious today than it has been for 60 years. Today's culture celebrates caution and lowered expectations rather than a brash acquisitiveness. It would be true to say that people are more individuated today, but not that they are acting more as self-confident individuals. This is not a strong sense of individuality, but rather a weak one, through which people are encouraged to see themselves as frail and in need of protection from wider society. The difference turns on the role of subjectivity envisaged.

What is meant by subjectivity is the active sense of self-government, the idea that people should aspire to decide their own fates and control their own circumstances. At the heart of the current anti-individualistic mood is a decline in the idea that subjectivity is a virtue. It is noticeable that self-obsession is seen as laudable today, so long as it is inward-looking and 'sensitive' rather than outward looking and assertive. Healthy individuals are taken to be those who invest time and energy in self-discovery, tending to their physical and psychic well-being. That individuated outlook is celebrated whereas a more aggressive expression of individual interest is frowned upon.

It should be clear that the real debate is not about the relative merits of the individual as against those of the community at all. The 'individual' is just a fall-guy. The real target is subjectivity--the aspiration to take control of affairs and try to determine your own destiny. As it happens, the 'freedom of the individual' was always a peculiarly limited concept of freedom. We were granted a moderate degree of freedom in our private lives on the basis that we foreswore any collective interest in the way that capitalist society was organised. But the present mood of anti-individualism is aimed at disparaging even that modest degree of individual autonomy.

The current climate is not a reversal of the Thatcherite project, but its extension. In the eighties collective forms of organisation were attacked for over-aggressive assertion of people's selfish interests; trade unionists were attacked for their 'I'm all-right Jack' attitude. The trade-off was supposed to be that in return for abandoning trade unions and welfare provision, people would get greater control over their personal lives, through greater property-ownership, like home-ownership and share investments. But now even that deal, one-sided as it proved to be, is being reneged upon.

Basic civil liberties, like the right to raise your family as you see fit or to drive your car where you want, are now seen as dangerously individualistic. Core conservative ideas like 'an Englishman's home is his castle' now strike prying welfare agencies as an unwarranted degree of freedom and a license for abuse within the home. Having been chased off the streets we are now being hunted down in the home as well. The individual is a target because of the lingering belief that his private life is his own, even if autonomous collective organisation is off the agenda.

Today's popular causes, like environmental protection or the anti-roads campaign, make a virtue of austerity and self-limitation. Their message is directed less against the powers that be, than against other people. Their demands are not for more resources from the authorities, but for a restriction of people's excessive consumption habits. Challenged to show where anti-roads protests had succeeded one campaigner boasted that the government's road programme had been radically slashed. This kind of protest the government can live with. They must be wishing that campaigners would lobby to reduce other areas of public expenditure as well. Why not a campaign to reduce family sizes, taking the strain off Child Benefit payments, or for that matter, another against high wages? But, then again, a demand for us all to settle for less is the logical conclusion of the protests against fat cat salaries.

More sophisticated champions of the anti-roads and anti-car protests claim that their target is not any one particular stretch of motorway, but the 'car-culture' itself. Instead of favouring the self-contained bubble of the car we should embrace public transport. The car culture, according to this argument is inherently aggressive and individualistic, while buses and trains are communal and cooperative, as well as being friendlier to the environment. The advantage of this argument is that it makes it clear that the real target of the anti-roads protests is not roads or cars as such, but a way of living, the 'car culture'. And what is offensive about this way of life is that it is, within the confines of the road network, relatively free. Theirs is a point of view that prefers timetables and queues to cruising. The idea that somebody should just go out for a drive is inconceivable to this kind of austerity politics.

The principal intellectual expression of the climate of self-effacement and limitation is the cult of 'the Other' in academic life. In literature, sociology and even law the project of 'de-centring the self' is at the top of the agenda. According to this theory the traditional Western viewpoint privileges the self over 'the Other'--no longer a Carry On film euphemism for sex, but a catch-all term for any excluded section of society, whether it be women or people of colour, or those in the post-colonial world. The very promiscuity with which the term 'Other' is applied indicates that it is not a particular grievance that is being aired. Instead, any standpoint which offers a critical vantage-point on the despised 'self' of Western discourse recommends itself in the cult of the Other.

It is pointed that these theorists do not aim to grant the excluded Other the status of equality with 'the self', but to knock the individual off of his privileged position in the dominant ideology. The goal of mutual recognition of other people as persons in their own right is an anathema to the cult of 'the Other' because that would only reproduce the centrality of the self. These theorists aim instead to 'de-centre the self', so that we all become 'the Other'. This is the project that literary critic Paul Ricouer announces in his book Oneself as Another. Last year the late Emmanual Levinas published his rewrite of the Universal Declaration of the Rights of Man, as 'The Universal Declaration of the Rights of the Other' (see Outside the Subject, 1995). The compelling thing about these various attempts to rationalise the climate of self-effacement is their implicitly religious message: that we should subordinate ourselves to an essentially unknowable force outside of us, the Other. You could not ask for a more perfect expression of the alienated condition of modern society than that we are now all to think of ourselves as 'Others' instead of people in our own right, with our own concerns and interests.

The real tragedy of the climate of self-effacement is that it is the principle barrier to building any kind of collective solution to our problems today. For all the talk of community, nothing could be better designed to frustrate collective solutions than the prejudice that we should hold self-interest in such low esteem. It is not possible to make a commun-ity out of people without a sense of self and self-respect. Acquisitiveness, ambition and combativity will prove to be preconditions of any forceful assertion of collective interests in the future.

Any movement for social change will not come through self-effacement, but through self-assertion. It is futile to think that you could make a collective force out of individuals who were not prepared to stand on their own two feet and stick up for what they believe in. Before we can talk about the New Jerusalem to come, we need aggressive individuals in the here and now. Modesty in aspiration does not make for social harmony, but for a withdrawal from society and an increasingly privatised outlook. Agency, not self-effacement, is the basis of an association of equals. Rejecting the anti-individualism of today's moralising critics in favour of a confident sense of self is the precondition for an enduring fraternity.

Reproduced from Living Marxism issue 94, October 1996

America under Obama | spiked

2008-11-18T15:11:00.000-08:00

America under Obama | spiked

Ferraris for all

2008-11-17T09:19:00.000-08:00

Ferraris for all

Philip Hammond | Antiwar Radio with Scott Horton and Charles Goyette

2008-11-17T09:18:00.000-08:00

Philip Hammond | Antiwar Radio with Scott Horton and Charles Goyette

Vertigo: Kim Novak's breasts, the suspension of disbelief, and other pressing matters

2008-10-06T08:25:00.000-07:00

'glen-14', at imdb's forum for Hitchcock's 'Vertigo' says: "I hate these so called smart ass tricks. Anyone who has ever studied writing will know that everything you say in a book has to have a point, it has to drive or elucidate the action in some way. Yes, I know this is a movie, but the same rules should still apply."

Glen wants to apply strict rules to storytelling, but thank god so many novelists and filmmakers disagree! As has been said, the hotel scene serves as a motif for the mysterious, the inexplicable; and it anticipates those very qualities in Scottie's obsession with Madeleine.

On the other hand, it can be read in a more literal sense: the hotel manager is 'in on it'.

Watching it again, it strikes me that the only time the film really requires you to suspend disbelief is when Madeleine/Judy opens the Empire Hotel room door to Scottie and behaves as if she's looking at a stranger. The man she loves, the man who's at the heart of her terrible guilt, dread and longing appears to her as a common or garden creep. Yeah, right. Spotting him through the window before he ascended to her room would've solved that one; she could've prepared herself for the appropriate acting. I dunno, maybe she did. After all, we viewers are invited to fill in the gaps. (Novak has insisted that she set out in this scene to convey the ambivalence of Madeleine/Judy's emotions. Well, she didn't succeed.)

Whatever, we are suitably distracted from Judy's truly hideous green outfit by unfettered tits (a look Novak cultivated elsewhere to devastating effect). I seem to have lowered the tone. I only do so as a homage to Hitchcock, naturally.

Amazon.co.uk: My Wish List

2008-10-02T06:07:00.000-07:00

Amazon.co.uk: Your Wish List

Facebook | Jim Williams

2008-10-02T06:06:00.000-07:00

Facebook | Jim Williams

YouTube - StonefieldJim4's Channel

2008-10-02T06:05:00.000-07:00

YouTube - StonefieldJim4's Channel

IMDb :: Boards :: Profile for podwilliams

2008-10-02T06:04:00.000-07:00

IMDb :: Boards :: Profile for podwilliams

Sproutnet Community

2008-10-02T06:03:00.000-07:00

Sproutnet Community

Financial crisis | spiked

2008-10-02T06:02:00.000-07:00

Financial crisis | spiked

Essays and Assignments from the Pen of a Student Psychiatric Nurse 3

2008-05-14T07:50:00.000-07:00

Drawing upon recent clinical practice experiences and relevant literature, discuss the following statement: ‘The modern mental health nurse is guided in clinical practice by the concepts of recovery and service-user involvement.’

This essay seeks to explore some of the contentious, and often complex, issues associated with contemporary trends in mental health nursing, and to relate them, as far as is possible, to the author’s experiences as a student nurse in clinical practice. In particular, it addresses current (and anticipated) relationships between mental health nursing, the recovery approach and service-user involvement. To that end, as psychiatric rehabilitation begins to ‘redefine itself’ for the twenty-first century, it will be necessary to disentangle the various conceptual threads that run through the discussions surrounding the meaning and scope of ‘recovery’ for both nurses and people with mental health needs (Shepherd et al. 2008: 3).

In the first instance, as ‘a concept whose philosophical boundaries and practical implications are still contested’ the semantic, definitional problems linked to ‘recovery’ could prove vital to understanding the implications of the recovery approach for mental healthcare (Wallcraft 2005: 127). The Sainsbury Centre for Mental Health (SCMH) notes that ‘recovery’ is ‘something of a contested term’ (Shepherd et al. 2008: 1). Repper (2005), too, acknowledges that, among the principal ‘difficulties’ associated with the concept of ‘recovery’ is the fact that it ‘lends itself to so many different interpretations.’ Elsewhere, it has been suggested that ‘recovery may well be so deeply personal that it defies definition’ (Buchanan-Barker and Barker 2008: 94). Nonetheless, despites its status as an ‘elusive concept with multiple definitions’, it is important to recognise that the intangible quality attributed to ‘recovery’ has come to be seen by many of its adherents as a virtue (Higgins and McBennett 2007: 852).

According to Long (2005), the tendency towards diverse and wide-ranging interpretations of said concept only serves to ‘highlight the subjective experience of recovery [my emphasis].’ By looking more closely at this emphasis on the subjective experience of mental illness we will be able to shed some light on the goals and philosophy of the recovery approach, assess its theoretical strengths and weaknesses, and evaluate its potential as a practicable approach to mental healthcare, in terms of both service-user involvement and mental health nursing.

Despite spending a substantial amount of their training in clinical placement, where service-users are encountered on a daily basis, it is ironic, if unsurprising, that student nurses’ understanding and interpretation of ‘client-centred’ mental healthcare should be mediated, for the most part, through official sources. Recommendations and policy guidance on ‘recovery-oriented services’ are a case in point, and in discussions concerning government-sponsored proposals to implement the recovery approach the following supporting literature is frequently cited: the Department of Health’s Ten essential shared capabilities: a framework for the whole of the mental health workforce (DoH 2004); the National Institute for Mental Health in England's Guiding statement on recovery (NIMHE 2005); and the Sainsbury Centre for Mental Health’s Making recovery a reality (Shepherd et al. 2008). Nevertheless, notwithstanding reservations about the effectiveness of – and motivation behind – `top-down' policies towards recovery in mental health, these documents encapsulate most of the major and longstanding themes of the recovery approach (Clay 1999; Fitzpatrick 2001; Neuberger 2005).

Making recovery a reality (Shepherd et al. 2008), for instance, distinguishes ‘clinical recovery’, whereby ‘the person has been restored to previous levels of functioning, from ‘the unique journey’ of ‘social recovery’ embarked upon by someone who has invested their hopes in a recovery approach to coping with their mental illness (Shepherd et al. 2008: 2; Higgins and McBennett 2007: 852).’ Accordingly, and as is consistent with comparable appraisals, recovery is here understood, not as simply ‘recovering from illness’, but as recovering a sense of human agency from a life that has been dramatically interrupted and re-shaped my mental illness. Thereafter, Making recovery a reality sets out to expound upon the government’s strategy for ‘promoting recovery’, previously outlined in The Department of Health’s Ten essential shared capabilities (DoH 2004: 3) as follows: ‘Working in partnership to provide care and treatment that enables service users and carers to tackle mental health problems with hope and optimism and to work towards a valued lifestyle within and beyond the limits of any mental health problem.’

This incorporation, or mainstreaming, of the recovery model in the United Kingdom owes its theoretical foundations to an extensive and expansive body of recovery literature (Ralph 2000; Bonney and Stickley 2008). To highlight one example, the aforementioned summary of the recovery approach by the Department of Health recalls the work of Anthony (1993), a significant figure in the emergence of the recovery approach, for whom recovery ‘is a way of living a satisfying, hopeful and contributing life, even with limitations caused by mental illness [my emphasis].’ Anthony, who is widely credited with having articulated the most satisfactory contemporary working definition of recovery (contra claims that it is beyond definition), maintains that recovery ‘involves the development of new meaning and purpose in one’s life, as one grows beyond the catastrophic effects of mental illness’ (cited in Anthony and Spaniol 1994: 527; Roberts and Wolfson 2004: 39).

Anthony’s interpretation of recovery reflects a wider struggle, embodied in the recovery approach as a whole, to resist the reduction of people with mental illness to their symptoms. That is to say, the recovery approach seeks to transcend the paradigm of chronicity that has long been entrenched in mental healthcare, largely as a consequence of the dominance, for the greater part of the twentieth century, of biological psychiatry. Separating out the person from his or her illness is thus a guiding principle for a recovery-oriented approach to mental health (Roberts and Wolfson 2004: 39). The relevance and the validity of establishing recovery-oriented mental health services, however, hinges, to a large extent, on the question of whether or not nurses can (or should) act as ‘advocates’ for their clients.

The veracity of the claim that mental health nurses are guided by the concepts of recovery and service-user involvement depends upon the extent to which the philosophy of advocacy is, or can be, translated into practice as a person-centred process of enablement and social inclusion. The conceptualisation of the mental health nurse as paternalistic and custodial, and concerned with little more than symptom management, has given way to a vision of the nurse as a partner in their patients’ strengths-based recovery and empowerment, and a coach in their resistance to learned helplessness (Roberts and Wolfson 2004: 40; Barker and Buchanan-Barker 2005; DoH 2007; Buchanan-Barker and Barker 2008: 95; Shepherd et al. 2008: 3). By investigating the basis upon which the parameters of advocacy have been determined, the author’s own recent experiences can be evaluated against the criteria for combining advocacy and the recovery approach that have come to exert a decisive influence on current thinking in mental health practice.

According to Gadow (1983: 45), advocacy demands ‘that individuals be assisted by nursing to authentically exercise their freedom of self-determination.’ Kohnke (1982: 2) argues: ‘The role of the advocate is to inform the client and then to support him in whatever decision he makes’. Though a little more circumspect, Shepherd et al. (2008: 3-4) have reiterated these positions more recently, suggesting that professional advocates exist ‘to provide [the client] with the resources – information, skills, networks and support – to manage their own condition as far as is possible’. They also add that ‘there is an intrinsic value in supporting people in trying to achieve the goals they set for themselves, even if [their advocates] think these goals are not ‘realistic’.’ Early criticism of this perspective suggested that it was rare for either party in the nurse-patient relationship to conceive of their roles in terms of ‘advocacy’ or ‘recovery’ (Melia 1987; Fowler 1989). My research and observations in practice confirm, not only that this is still the case, but also that attempting to elide the distinction between nursing and advocacy could have unforeseen, and potentially negative, consequences for the therapeutic relationship between nurses and their clients.

One might argue that my recent clinical placement with EMI (Elderly Mentally Ill) CPNs (Community Psychiatric Nurses) must necessarily have restricted my insights into the recovery approach, the average age of the client base seemingly situating this area of mental healthcare outside of the, purportedly, more fully implemented project of recovery-oriented practice in adult services. Yet, such an assumption would suggest both a patronising view of the elderly and a misleading view of elderly mental healthcare. It is true that many older mental health service-users retain traditional views about doctor-patient and nurse-patient relationships, which tend to reflect the kind of deference towards the medical profession that was established in the middle of the last century (Fitzpatrick 2001). Yet, by the same token, just as received wisdom tells us that the recovery approach ‘can be applied to anyone who experiences a significant mental health problem at any age’, I would stress that the values and expertise of modern mental health nursing (much of which, though not immediately distinguishable as the ‘recovery approach’, would satisfy champions of the latter) are, arguably, having as positive an effect in this field as they are in any other (Shepherd et al. 2008: 20).

Depression is the most common mental health problem for older people. Furthermore, together with psychotic disorders, organic mental illness is exacting a heavy burden on an ageing population (Beirne 2000; Chew-Graham et al. 2007: 364; McCabe 2008). With this in mind, one would expect the paucity of research into how to develop the recovery approach for the benefit of older people with mental illness to be a cause of alarm to those for whom the transformation of mental health services along client-centred lines is imperative. For instance, a study conducted into the characteristics of ‘psychosocial transition’ in the event of a stroke (a major predictor of organic mental illness), expressed concerns about ‘the need to review the meaning and experience of the term “adjustment to stroke” and the everyday terms “recover” and “recovery”’ (Dowswell et al. 2000: 513). The recovery model has been linked to various projects involving older patients with dementia (Buchanan-Barker 2008: 94). However, despite ‘the growth of a strong and effective user and carer movement for dementia’ it has been argued that ‘additional evidence is required to explore, test and evaluate’ claims for ‘the applicability of the recovery approach to dementia care nursing’ (Banerjee and Chan 2008: 52; Keady 2008: 72).

These concerns aside, in so far as I would defend a recovery approach, and identify it as a guiding principle for mental health nurses, it is because intrinsically patient-centred therapeutic interventions and principles are practised by mental health nurses irrespective of the Department of Health’s ambitions to effect a radical transformation of mental healthcare. It is striking, for example, that the much-trumpeted ‘Tidal Model’ of recovery, which is often held up as something approaching a qualitative shift in nursing philosophy, fails to distinguish itself, not only from the recovery approach per se, but from the axiomatic principles of therapeutic optimism that have long applied to mental health nursing (Roberts and Wolfson 2004: 39; Berger 2006; Buchanan-Barker and Barker 2005, 2008).

For instance, there is an emphasis in the literature on the need for mental health professionals to: ‘recognize the humanity of the people they work with’; ‘value their versions of events’; ‘appreciate the devastating impact of mental health problems’; and ‘believe that everyone can grow within and beyond the limits of their problems’ (Higgins and McBennett 2007: 854-845). Buchanan-Barker and Barker (2008: 93, 98), accepting that the prevailing view among mental health nurses is that ‘people should participate in, if not actually lead, their own recovery’, concede that, in as much as the Tidal Model of recovery has been endorsed it amounts to nurses ‘reclaiming their original caring vocation.’

None of this is meant to suggest that the recovery approach has not influenced or guided the principles of modern mental health nursing practice. Rather it is meant to suggest that it has not replaced them. That is to say, the ‘compassionate caring and genuine ‘nursing’’ that Buchanan-Barker and Barker (2008: 95) insist the recovery approach (‘Tidal’ or otherwise) requires of contemporary mental healthcare is readily evident in the everyday practice of mental health nurses. Such everyday practice, however, also highlights the problematic nature of ‘advocacy’ – not least because it is assumed to be co-extensive with ‘recovery’.

During my recent clinical placement, the one agent of ‘recovery’ notable by his/her absence from Community Care Assessments was the nominated patient advocate. In keeping with a recovery approach the role of religious, cultural and personal fulfilment are highlighted in the relevant documents produced for the purposes of specialist contributions to the assessment. Yet it is recognised that, just as assessing the care needs of clients should remain the preserve of social and healthcare professionals, the role of the advocate is to uphold the best interests of the client, regardless of whether those (ideally) self-determined interests coincide or conflict with the therapeutic relationship between nurses and clients or, crucially, a nurse’s specific responsibilities under the Mental Health Act (Clark and Bowers 2000; Edwards et al. 2000; Marriott et al. 2001; Hurley and Linsley 2006). This reveals the tension between nursing and advocacy, on the one hand, and recovery and service-user involvement on the other.

Because of the person-centred nature of their profession, modern mental health nurses are, by nature perhaps, advocates for – and partners in the recovery of – their clients. Nonetheless, adopting advocacy in the fullest sense entails recognising it as an essentially ‘socio-political activity’ (Mitty 1988). In that sense, for nurses to act as advocates beyond the duty of care demanded of them they must act independently of a profession that has been further compromised by the compulsion to extend its role in implementing new and draconian amendments to mental health legislation. Indeed resisting the trend to push mental health professionals into a more authoritarian role may be the prerequisite for the principles of recovery and service-user involvement to be given greater scope for development.

To conclude, I would argue that there is much evidence to support the claim that contemporary mental health nursing is guided by both the recovery approach and service-user involvement, but that attempts by the Department of Health and others to exploit or usurp the momentum underpinning these trends represents an unwarranted intrusion into mental healthcare that may well neutralise or weaken its more dynamic, independent initiatives. As it stands, official interpretations of a recovery-oriented approach to mental healthcare are, at best, innocuous and philosophically immature, and, at worst, disingenuous – even to the point of disguising an authoritarian agenda.

Word count: 2403

References:

Anthony, W.A. (1993). Recovery from mental illness: the guiding vision of the mental health system in the 1990s. Psychosocial Rehabilitation Journal. 16, 11-23.

Anthony, W.A. and Spaniol, L. (1994). Readings in psychiatric rehabilitation. Boston, MA: Center for Psychiatric Rehabilitation

Armstrong, E. (1998). Mental health and physical illness in older people. British Journal of Community Nursing. 3(10), 501-506

Banerjee, S. and Chan, J. (2008). Organization of old age psychiatric services. Psychiatry. 7(2), 49-54

Barker, P.J and Buchanan-Barker P. (2005). The Tidal Model: a guide for mental health professionals. London: Brunner-Routledge

Beirne, T. (2000). Community-based NHS nursing homes for older people with mental illness. Nursing Older People. 12(9), 14-15

Berger, J. L. (2006). Incorporation of the tidal model into the interdisciplinary plan of care – a program quality improvement project. Journal of Psychiatric and Mental Health Nursing. 13(4), 464-467

Bonney, S. and Stickley, T. (2008). Recovery and mental health: a review of the British Literature. Journal of Psychiatric and Mental Health Nursing. 15(2), 140-153

Buchanan-Barker, P. and Barker, P.J. (2008). The Tidal Commitments: extending the value base of mental health recovery. Journal of Psychiatric and Mental Health Nursing. 15(2), 93-100

Chew-Graham, C.A. et al. (2007). A randomised controlled trial to test the feasibility of a collaborative care model for the management of depression in older people. British Journal of General Practice. 57(538), 364-370

Clark, N. and Bowers, L. (2000). Psychiatric nursing and compulsory psychiatric care. Journal of Advanced Nursing. 31(2), 389-394

Clay, S. (2005). A view from the USA [foreword]. In Buchanan-Barker, P. and Barker, P.J. The Tidal Model: a guide for mental health professionals. London: Brunner-Routledge

Collier, E. (2006). Mental health and functional mental disorder in older adults. Nursing Older People. 18(9), 25-32

Department of Health (2001). The journey to recovery: the government’s vision for mental health care. London: HMSO

Department of Health (2004). Ten essential shared capabilities: a framework for the whole of the mental health workforce. London: HMSO

Department of Health (2007). Consultation on guidance on ‘finding a shared vision of how people’s mental health problems should be understood’. London: HMSO

Dowswell, G. et al. (2000). Investigating recovery from stroke: a qualitative study. Journal of Clinical Nursing. 9, 507-15

Edwards, D. et al. (2000). Stress and burnout in community mental health nursing: a review of the literature. Journal of Psychiatric and Mental Health Nursing. 7(1), 7-14

Fitzpatrick, M. (2001). The tyranny of health: doctors and the regulation of lifestyle. London: Harper Collins

Fowler, M.D.M. (1989). Ethical decision making in clinical practice. Nursing Clinics of North America. 24(4), 955-965

Gadow, S. (1983). Existential advocacy: philosophical foundation of nursing. In Murphy, C. and Hunter, H., eds. Ethical problems in the nurse-patient relationship. Boston: Allyn & Bacon

Hedelin, B. and Svensson, P.G. (1999). Psychiatric nursing for promotion of mental health and prevention of depression in the elderly: a case study. Journal of Psychiatric and Mental Health Nursing. 6(2), 115-124

Hilton, C. (2002). Religious beliefs and practices in acute mental health patients.

Nursing Standard. 16(38), 33-36

Higgins, A. and McBennett, P. (2007). The petals of recovery in a mental health context. British Journal of Nursing. 16(14), 852-856

Hurley, J. and Linsley, P. (2006). Proposed changes to the Mental Health Act of England and Wales: research indicating future educational and training needs for mental health nurses. Journal of Psychiatric and Mental Health Nursing. 13(1), 48-54

Keady, J. (2008). The role of the community psychiatric nurse. Psychiatry. 7(2), 70-72

Kohnke, M.F. (1982). Advocacy: Risk & Reality. St Louis: Mosby

Long, C. (2005). What is recovery? Naidex [online]. Available from: http://www.naidex.co.uk/ [Accessed 1 May 2008]

Malone, M. et al. (2003). Health visiting at the crossroads: which way to the 21^st century? British Journal of Community Nursing. 8(4), 160 - 165

Marriott, S. et al. (2001). Research into the Mental Health Act: a qualitative study of the views of those using or affected by it. Journal of Mental Health. 10(1), 33-39

McCabe, M. et al. (2008). Knowledge and skills of professional carers working with older people with depression. Aging and Mental Health. 12(2), 228-235

Melia, K. (1987). Everyday ethics – whose side are you on? Nursing Times. 83(29), 46-48

Mitty, E.L. (1988). The nurse as advocate: issues in LTC. Nursing and Health Care. 12(10), 520-523.

National Institute for Mental Health in England (2005). Guiding statement on recovery. London: NIMHE

Neuberger, J. (2005). The moral state we’re in: a manifesto for a 21st century society. London: Harper Collins

Ralph, R. (2000). A synthesis of a sample of recovery literature. Alexandria, VA: NASMHPD

Repper, J. (2005). Beyond diagnosis. In Mind annual conference and exhibition. Harrogate, United Kingdom, 15 to 17 March 2005.

Roberts, G. and Wolfson, P. (2004). The rediscovery of recovery: open to all. Advances in Psychiatric Treatment. 10, 37-49

Russell, A., Cutcliffe, J. and Collier, E. (2002). An examination of the last 10 years of mental health nursing. British Journal of Nursing. 11(7), 503-505

Shepherd, G., Boardman, J. and Slade, M. (2008). Making recovery a reality. London: Sainsbury Centre for Mental Health

Stansfeld, S.A. (1998). Social psychiatry research and the elderly with chronic mental illness. Aging and Mental Health. 2(3), 165-166

Wallcraft, J. (2005). The place of recovery. In Ramon, S. and Williams, eds. Mental health at the crossroads: the promise of the psychosocial approach. Aldershot: Ashgate Publishing

Whitwell, D. (1999). The myth of recovery from mental illness. Psychiatric Bulletin. 23, 621-622

Essays and Assignments from the Pen of a Student Psychiatric Nurse 2

2008-03-20T06:28:00.000-07:00

In order to ensure that health care delivery is of the highest possible standard, the U.K. Government (DH 2003) has highlighted a number of fundamental aspects of care, including 'Privacy and dignity'. With reference to relevant literature and clinical placement experiences in your own branch and at least one other practice setting, explore how nursing contributes to the achievement of best practice in this aspect of care.

This essay will address the perspectives and aims of the ‘privacy and dignity’ benchmark, as outlined in the Department of Health’s Essence of Care (2001b, 2003) document, taking into account its strengths, shortcomings and implications for ‘best practice’. First, the content of the benchmark factors themselves will be examined, both in relation to other key benchmarks and in light of my own experiences on clinical placement. Second, some of the problems associated with the definition of the concepts of ‘privacy’ and ‘dignity’ will be considered, with a view to clarifying their vital importance for the nursing profession.

Of the eight areas of care featured in the first edition of the Essence of Care (2001) the ‘privacy and dignity’ benchmark stands in marked contrast to most others (e.g. ‘pressure ulcers’ and ‘continence and bladder and bowel care’), because it is relatively vague. Moreover, although ‘privacy’ and ‘dignity’ are, broadly speaking, ‘taken-for-granted’ ideas there is little doubt that such terms can have little explanatory power when isolated as abstract concepts. Nonetheless, the Department of Health’s ‘toolkit for benchmarking the fundamentals of care’ aims to go some way towards indicating how these important principles can be made concrete in the delivery of healthcare.The Essence of Care benchmark for privacy and dignity is constructed around seven key factors and benchmarks of best practice, which can be summarised as follows: personal identity; personal boundaries; communication; confidentiality; availability of private areas; and attitudes and behaviour (of staff). The nebulous quality of some of the preliminary indicators of ‘best practice’ seem to reinforce the impression that, at the point of publication, privacy and dignity policies were underdeveloped. For instance, regarding the ‘attitudes and behaviours’ (of staff) the benchmark of best practice announces that ‘patients [should] feel that they matter all of the time’. It is surely easy to see how such an imperative might be considered glib and patronising. Research shows (and this author’s experience confirms) that, just as patients ‘expose themselves to hospital staff, and possibly other patients, to a degree that would not be acceptable in normal life’, they also accept that there is, necessarily, a system of priorities in healthcare that dictates that some cases ‘matter’ more than others at certain times (Malcolm 2005: 12; Scott et al. 2000: 566).

These doubts aside, of the remaining introductory summaries the majority of the benchmarks appear, on first reading at least, to be placed on surer foundations. Thus, in relation to ‘privacy of patient-confidentiality of client information’ (a topic to which this essay will return) the benchmark demands that ‘patient information is shared to enable care, with their consent.’ Similarly, the guidelines insist that ‘patients’ care actively promotes their privacy and dignity, and protects their modesty.’ In addition, together with the making available of ‘an area for complete privacy’, the above advice on ‘privacy, dignity and modesty’ is linked to the question of ‘personal boundaries and space.’ Here, in between uncontentious references to personal contact/touch and disturbing/interrupting patients, attention is drawn to the question of segregated/single-sex facilities. However, this author’s experience on placement, in conjunction with literature on the subject, confirms that there is a notable mismatch between many of the ideals promoted in Department of Health’s official guidelines ‘and the soft messy ground of practice’ (Manthey 2001: 5).

In addition to addressing the conflict between patient dignity and staff safety in the moving and handling of patients, Scott (1997, 2004) has highlighted the practical (not to mention financial) problems of implementing single-sex bays in hospitals. She points out, for instance, that ‘a partition designed to restrict patients’ view will restrict nurses’ view and may impede the delivery of safe patient care’. Unfortunately, the Essence of Care privacy and dignity benchmark does not properly tackle this tension between privacy and dignity, on the one hand, and safety, on the other. An attempt to confront the problem is made in the benchmark ‘safety of clients with mental health needs’ (specifically, in terms of ‘balancing observation and privacy in a safe environment’). Yet, perhaps surprisingly, it is an earlier publication, Safety, privacy and dignity in mental health units: guidance on mixed sex accommodation for mental health services (NHS 2000), that provides a more detailed and honest appraisal of the relationship between privacy and safety; and it is one that matches this author’s experiences and observations during clinical placement at an EMI (Elderly Mental Illness) ward.

The ward in question, a mixed-sex ward with single sex corridors, conforms to the guidelines on privacy and safety outlined in the aforementioned NHS document. Consequently, while the single rooms on the ward ensure a degree of privacy, a ‘fail safe system for entry into rooms if staff are concerned about patients’ security’ is also in operation (NHS Executive 2000). Similarly, assessments of the patients’ susceptibility to self-harm (or suicide) are undertaken prior to the allocation of individual rooms; and the ward layout guarantees access to segregated toilet and bathroom facilities, without members of one sex having to pass through areas designated for the opposite sex.

In this author’s view, despite the conditions under which patients can be sectioned under the Mental Health Act (HMG 1983), and notwithstanding the way in which the above account of NHS policy and clinical practice highlights the manner in which patients are sometimes monitored in mental health facilities, there is no good reason to believe that principles of privacy and dignity are not generally adhered to. The point to emphasise is that, rather than being absolute, the principle of dignity is open to adaptation, especially where the issue of individual safety arises. Indeed, paradoxically perhaps, such modification may even provide a fuller scope to the exercise of dignity, because it is predicated on the well-being of the individual or individuals concerned.

To return to the Essence of Care guidelines, the document includes a range of other benchmarks and factors that relate closely, and appropriately, to privacy and dignity. Among these are: ‘assistance to eat and drink’ (‘food and nutrition’); ‘a physical and social environment conducive to continence and a healthy bladder and bowel’ (‘continence and bladder and bowel care’); and ‘environment within which oral and personal hygiene needs are met’ (‘personal and oral hygiene’). But it is the benchmark ‘communication between patients, carers and health care personnel’ – first included in the second edition of Essence of Care (DH 2003) – that is of particular relevance here, largely because much of it dovetails with an indispensable factor within the privacy and dignity benchmark: ‘privacy of patient-confidentiality of client information’.

With this in mind, this essay now turns to an opportunity this author had to reflect upon the implementation of confidentiality policy, at a local level, during time spent on a general adult nursing placement. Whilst on the ward in question, the policy document Information and Technology: Information Security and Confidentiality Policy (UHNS 2000) was made available to me. Emphasising the security of information in patient-care areas, the document stresses that the ‘[d]isclosure of patient-identifiable information [name, age, gender, address, patient’s diagnosis, current state of health etc.]… is a breach of confidentiality and can have serious consequences for the Trust’ (UHNS 2000). Notwithstanding the short duration of the placement, it was possible to evaluate routine practice on the ward against the recommendations of the policy. What was impressive was the continuity between the professional guidelines and the nature of nursing practice on the unit. Indeed great emphasis was placed on the fundamental importance of following the protocols laid out in official confidentiality policies.

The procedures pertaining to ‘telephone enquiries from patients’ relatives and friends (UHNS 2000)’ were among those singled out by the staff for consideration. The advice given was in accordance with the confidentiality directive, which states that ‘information should not be given unless the staff member is certain of the caller’s identity (UHNS 2000)’. Further attention was drawn to matters of confidentiality when staff nurses explained the importance of using password-protected electronic record-keeping in patient-care areas. They noted in particular that, when unattended, computer screens should be kept clear of sensitive information. Significantly, however, important qualifications were highlighted in relation to confidentiality, qualifications that are consistent with the BMA’s advice that, just as unrestricted access to patient-identifiable data by health professionals should be prevented, ‘[p]atients should be made aware that health teams need to share essential, relevant information in order to ensure that the safety and effectiveness of treatment are maximised’ (BMA 1999).

Despite research that has found standards in the NHS wanting (not least in relation to the privacy and dignity benchmark) experiences of clinical placements, so far, have given this author little cause to doubt the commitment of nursing professionals to matters of confidentiality in particular (Woogara 2004). Nonetheless, to enable a clearer understanding of the issues at stake in the discussion surrounding privacy and dignity it will be helpful to clarify some of the concepts underpinning (and the relationships between) both terms. As Woogara (2005: 34) observes, ‘the terms ‘privacy of the person’ and ‘dignity’ are interrelated’, in so far as dignity implies ‘respect for the person, privacy of the body, privacy of one’s space and territory, and having control and choice of one’s surroundings.’ Similarly, the multidimensional character of privacy (physical, psychological, social, informational) also implies (as does dignity) autonomy, or self-government (Scott et al. 2003; Burgoon 1982). And the desire to cultivate a climate of autonomous decision-making is of course especially pertinent to the modern healthcare environment, where the right to privacy is broadly recognised to be essential to maintaining patients’ independence (DH 2005).

Others, notably Wainwright (1995, cited in Scott et al. 2000), have sought to condense the idea ‘privacy’ into simply ‘two types’, one pertaining to personal information, the other to the physical aspect of the person. Meanwhile, Westin (1967: 31, cited in Woogara 2001) provides a more compelling, philosophical account of privacy, wherein he identifies (in advanced capitalist societies) four distinctive elements: solitude, intimacy, anonymity, reserve. Taken in turn, the composite aspects of Westin’s explanatory scheme make clear the importance of clarifying the meaning of privacy for the healthcare environment. Thus, ‘solitude’ implies a state in which an individual is separate and free from the observation of others. ‘Intimacy’ points to an individual’s facility to participate in family or friendship units. A third element, ‘anonymity’, arises when an individual is in a public place but wishes to be free from the scrutiny of others. Finally, ‘reserve’ describes an individual’s construction of ‘mental distance’ as part of ‘a psychological barrier against unwanted intrusions’ (Woogara 2001: 239).

If defining ‘privacy’ and its parameters has preoccupied the minds of many contributors to medical, nursing and healthcare journals, then establishing the salience and meaning of ‘dignity’ has proved to been an even more vexed question. In the first instance, however, it should be said that one need not agree with either Macklin’s claim that ‘dignity’ is so vague an idea as to be ‘useless’ or Beckworth’s assertion that dignity is a ‘right’ to recognise the significance of dignity, not least for nurses and their patients (Macklin 2003, cited in Gallagher 2004: 590; Beckworth 2006).

Bradshaw (2000) cites Stuart and Cuff’s Practical Nursing (1899) as an early example of a text emphasising ‘gentleness and dignity’ as an essential characteristic of nursing care. Similarly, at the Florence Nightingale commemoration service in May 2006, no less than the Archbishop of Canterbury reminded us that the founder of modern nursing viewed professionalism as ‘whatever served not only the physical health but the dignity of those being cared for’ (Beckworth 2006). It is clear, then, that dignity has long been deemed been a ‘core value’ for nursing practice. Nonetheless, despite the much-trumpeted claim that modern healthcare is moving away from medical paternalism towards to patient-centredness, dignity remains an under-defined concept in both nursing literature and Department of Health publications (Walsh and Kowanko 2002).

Haddock (1996, cited in Frankin et al. 2006) describes dignity as the quality of feeling valuable in relation to others, and being treated as such when that dignity is threatened. Elsewhere, Gallagher (2004) cites several attempts to define dignity. Mairis, for example, echoing Woogara (2005: 34), states: ‘Dignity exists when an individual is capable of exerting control over his or her behaviour, surroundings and the way in which he or she is treated by others’ (Mairis 1994, cited in Gallagher 2004: 589). No less useful is Shotton and Seedshouse’s ‘negative’ definition (1998, cited in Gallagher 2004: 589). Hence they suggest that ‘we lack [my emphasis] dignity when we find ourselves in inappropriate circumstances, when we are in situations when we feel foolish, incompetent, inadequate or unusually vulnerable.’ But perhaps the most important insight to be gained from the literature on dignity is that derived, in part, from Spiegelberg’s (1970) distinction between ‘intrinsic’ and ‘extrinsic’ dignity.

Dignity is the state or quality of being worthy of esteem and respect; and we earn or expect esteem and respect on the basis of common human values. Consequently, to treat a patient with dignity is to treat him or her with respect, and in the interests of his or her self-esteem. What Spiegelberg did was to distinguish between, on the one hand, our estimation of our own worth (intrinsic dignity) and, on the other, that conferred on us by others (extrinsic dignity). Therefore, where one is said to be able to have dignity, treat (or be treated) with dignity, or bestow dignity what is at stake is self-respect, in as much as valuing the dignity of others ‘requires an appraisal and recognition of one’s own value and worth, both as a human and as a professional’ (Gallagher 2004: 591). It is this acknowledgment of the two-fold character of dignity (respect for ourselves and others) that is conspicuous by its absence from both Department of Health literature and that of the Nursing and Midwifery Council (DH 2001b, 2003; NMC 2004).

As is consistent with reflective practice, where they are able to recognise the multi-faceted nature of privacy and dignity it should be incumbent upon student and registered nurses to adopt a properly critical perspective towards the health policies that they are expected to both implement and comply with. As part of a profession that is, in many respects, subordinate to government diktat, taking issue with, for example, some of the shortcomings of official guidelines is not a straightforward task for nurses to undertake. And yet, as this essay has sought to illustrate, ‘best practice’ will indeed be at its best when nurses set out to achieve it armed with the dignity and respect they owe to themselves and, above all, their patients.

References

Beckworth, S. (2006). Dignity is a core value. Practice Nursing. 17(6), 266

Bradshaw, A. (2000). Competence and British nursing: a view from history. Journal of Clinical Nursing. 9(3), 321-9

Burgoon, J. K. (1982). Privacy and communication. Communication Yearbook. 6, 206-249

Department of Health (2001). The NHS Plan: a plan for investment, a plan for reform. London: DH

Department of Health (2001b). Essence of Care: Patient-focused benchmarking for health care practitioners. London: DH

Department of Health (2003). Essence of Care: Patient-focused benchmarks for clinical governance. London: DH

Department of Health (2005). Independence, well-being and choice. London: DH

Department of Health (2006). A new ambition for old age: next steps in implementing the National Service Framework for Older People. London: DH

Franklin, L-L., Ternestedt, B-M and Nordenfelt, L. (2006). Views on dignity of elderly nursing home residents. Nursing Ethics. 13(2), 130-146

Gallagher, A. (2004). Dignity and respect for dignity – two key health professional values: implications for nursing practice. Nursing Ethics. 11(6), 587-99

Haddock, J. (1996). Towards further clarification of the concept ‘dignity’. Journal of Advanced Nursing. 5(24), 924-931

HM Government (1983). Mental Health Act. London: HMSO

Macklin, R. (2003). Dignity is a useless concept: it means no more than respect for persons or their autonomy. British Medical Journal. 327, 1419-1420

Magill-Cuerden, J. (2006). The curtain: for privacy or safety? British Journal of Midwifery. 14 (12), 723

Mairis, E. D. (1994). Concept clarification in professional practice: dignity. Journal of Advanced Nursing. 5(19), 947-953

Malcolm, H. A. (2005). Does privacy matter? Former patients discuss their perceptions of privacy in shared hospital rooms. Nursing Ethics. 12(2), 156-166

Manthey, M. (2001). Reflective Practice. Creative Nursing. 7(2), 3-4

NHS Executive (2000). Safety, privacy and dignity in mental health units: guidance on mixed sex accommodation for mental health services. London: NHS Executive

Nursing and Midwifery Council (2004). The NMC code of professional conduct: standards for conduct, performance and ethics. London: NMC

Scott, H. (1997). Can the NHS afford patient dignity and privacy? British Journal of Nursing. 6(3), 132

Scott, H. (2004). Should patient dignity prevail over nurses’ risk of injury? British Journal of Nursing. 13(8), 437

Scott, P.A., Välimäki, M., Leino-Kilpi et al. (2000). Autonomy and clinical practice 2: patient privacy and nursing practice. British Journal of Nursing. 9(9), 566-569

Scott, P.A., Välimäki, M., Leino-Kilpi et al. (2003). Autonomy, privacy and informed consent 1: concepts and definitions. British Journal of Nursing. 12(1), 43-47

Shepherd, E. (2006). Continence care must respect patients’ dignity. Nursing Times. 102 (47), 39

Spiegelberg, H. (1970). Human dignity: a challenge to contemporary philosophy. In: Gotesky, R. and Laszlo, E. (eds). Human dignity – this century and the next. New York: Gordon and Breach, 39-64

Taylor, J. (2007). Has dignity gone out of care? Nursing Times. 103(4), 18-20

University Hospital North Staffordshire (2000). Information and Technology: Information Security and Confidentiality Policy. UHNS

Walsh, K. and Kowanko, I. (2002). Nurses’ and patients’ perceptions of dignity. International Journal of Nursing Practice. 8(3), 143-151

Westin, A. F. (1967). Privacy and freedom. New York: Atheneum

White, C. (2006). Putting dignity at the heart of care. Nursing Times. 102(47), 8-9

Woogara, J. (2001). Human rights and patients’ privacy in UK hospitals. Nursing Ethics. 8(3), 234-246

Woogara, J. (2005). Patients’ rights to privacy and dignity in the NHS. Nursing Standard. 19(18), 33-37

Essays and Assignments from the Pen of a Student Psychiatric Nurse

2008-03-20T06:17:00.000-07:00

“Individuals’ choices about how they live their lives make a major contribution to their own and in some cases other people’s health” (Ewles 2005).

Choose and alter an aspect of your behaviour that may help you to improve your present health status. Follow the assignment guidelines and also discuss how your behaviour change could in fact influence other people’s health.

This assignment will document and reflect upon my attempts to reduce the extent of my smoking habit, and will consider the relationship between my behaviour and the health of others, smokers and non-smokers alike. In addition to outlining the strategy adopted to effect changes in my behaviour I will also address, briefly, the political climate surrounding debates about passive smoking and the banning of smoking in public places (Forest 2004; Benison 2006; Bailey 2007; Percival 2007). My justification for introducing this second dimension to the assignment stems from a recognition of the newly significant (and, in my view, authoritarian) role that health policy has come to occupy in the government’s relationship with the public, as expressed in the concerted effort to transform popular attitudes towards health and personal responsibility (Fitzpatrick 1996, 1998, 2006).

Initially, my commitment to reducing the amount of cigarettes I smoke was less than total. This was certainly due, in part, to my stubborn aversion to the nature of government-backed anti-smoking campaigns, and to my opposition to the smoking ban in England (which came into force on 1st July). These are issues to which I will return later. At this stage, it is important to stress that, just as I regard as wrongheaded any claim for smoking as a uniquely ‘disobedient’ act, it is no less obvious to me that the decision to reduce or stop smoking is an unquestionably sensible one.

It is not necessary here to detail the key factors supporting the link between smoking and premature death from lung cancer. It is enough to say that this correlation was first established in 1954 by the epidemiologists Richard Doll and Austin Bradford Hill (Doll and Hill 1954; Doll et al. 2004). Of course, for smokers, the risk that their nicotine habit poses to their health is not usually the first thing on their mind each time they ‘light up’. I am no exception. Nonetheless, in identifying smoking as an aspect of my behaviour susceptible to modification I have surprised myself by the degree to which I have been forced to face up to the dangers of a routine practice that, previously, I had done little to alter.

I chose the first day of the smoking ban in England to be the first day of my endeavour to cut down on my smoking. I also opted to keep a video diary as a system of recording the progress of my behavioural change (and as a way of highlighting some of the critical observations raised in this assignment). From the very earliest stages of this project, notwithstanding my broader ‘political’ scepticism, I was also mindful of the importance of exploring theoretical perspectives on behavioural change, and of gauging how successfully they might be incorporated into my own strategy for change. To this end, I consulted Prochaska and DiClemente’s transtheoretical stages of change model (Prochaska and DiClemente 1982, 1983, 1984, 1986).

Prochaska and DiClemente’s psychological model of change identifies five stages of behavioural change: precontemplation, contemplation, preparation, action and maintenance. The essential components of the model provide a useful way of identifying the stage reached by an individual contemplating change, and helped to clarify some of my own feelings towards giving up smoking. Prochaska and DiClemente characterise ‘precontemplation’ as the prelude or precursor to change, during which time the subject is not seriously considering change, perhaps because he or she is unaware of (or uninformed about) the possible consequences of their habit, is unconvinced that the immediate advantages of behaviour change will outweigh the disadvantages, or, more plausibly, because he or she has become demoralised by failed attempts to change in the past.

Especially pertinent to my circumstances, however, is the subsequent ‘contemplation’ stage, the features of which underscore the situation in which I found myself at the onset of this assignment. Prochaska and DiClemente draw attention to the way in which this stage implies ambivalence towards change (1983, 1984). Strictly speaking, to be ‘ambivalent’ means to be torn equally between two opposite courses of action (in this case, continuing or discontinuing a smoking habit), but Prochaska and DiClemente’s model does allow for a more general emphasis on the various contradictory and conflicting attitudes towards the kind of alterations in behaviour that individuals have, by this stage, already come to recognise as desirable and/or necessary. Moreover, it quickly became apparent to me that that the key problem that the model as a whole identifies is also the one that I myself am most guilty of: procrastination.

These observations aside, I have been able to achieve some success in executing the third step in the change agenda: ‘preparation’. It can be gleaned from the literature on the subject that, while cutting down on smoking (my initial goal) should not readily be classed as an example of ‘action’ (the fourth stage in the model of change) it can nevertheless still be seen as a positive shift towards ‘more decisive action’ (Harvard Women’s Health Watch 2007; Zimmerman et al. 2000). My first achievement in this respect was, arguably, a symbolic one. Setting out to purchase forty cigarettes I made a conscious decision to buy twenty instead, with a view to testing my ability to manage a fifty per cent reduction in nicotine during an unchanged time period of three days.

After conducting a randomised population-based intervention study in Denmark Pisinger et al. (2005) noted that, because ‘there is no evidence that a ‘minimum 5 g’ [five cigarettes] reduction has any health benefit’, the decision was made to set ‘a ‘minimum 50%’ reduction’ over a six month period, in order to be able to measure any significant changes in health. With this is mind, while my symbolic gesture was certainly made in the spirit of ‘starting as I mean to go on’, I was all too aware that my early achievement was, in reality, a mere 20 g reduction in tobacco smoked over sixty hours. Nonetheless, my video diary does record some success in maintaining my commitment to reducing the number of cigarettes I would ordinarily smoke in work and domestic settings.

By the close of day one I estimated that I had smoked five fewer cigarettes than usual: where I would normally smoke between ten and fifteen cigarettes I managed to reduce that figure to seven. By the evening of day three my cigarette supplies were diminishing, not least because I had given away as many cigarettes as I had smoked. I chose not to buy any more that night. Day four, which involved a busy six-hour shift at my clinical placement (a private nursing home), did not afford me a great many opportunities to smoke. This explains, in part, the dramatic reduction in the amount of cigarettes I had smoked by three o’clock: one. Nevertheless, having turned down the offer of a cigarette break, and having been responsible for the hourly allocation of cigarettes to approximately ten clients, I did feel that my resisting temptation was a positive sign of things to come.

This self-confidence led me, with perhaps undue haste, to suspend my daily video diary entries for several weeks. Instead, I decided that reporting back after a month of ‘testing the waters’ would be, apropos Prochaska and DiClemente’s model of behavioural change, an appropriate way to comment on whether or not I had identified areas of ‘social support’, and to provide confirmation of my ‘underlying skills for behaviour change’ (Telford 2000; UCLA date unknown). However, before drawing any conclusions about my own progress I want to consider the question of not only how my behaviour might impact upon – or be interpreted by – others, but also the extent to which the moralisation and ‘politicisation’ of smoking dovetails with official medical opinion and advice.

Being a mental health student nurse, a smoker and the close friend of someone with severe mental health problems (and an excessive smoking habit) put me, potentially, in a position to bring some unique insights to this assignment. In so far as I succeeded in doing so, this was due largely to the relatively informal, filmed interview I conducted with the aforementioned friend (and which is included in my video diary).

Having spent considerable periods of his adult life as a patient in mental health institutions (as a consequence of being subject to bi-polar disorder) ‘Danny’ claims that smoking has given him a substantial degree of respite from depression and anxiety. Familiar with the fact that smoking is especially common among people with severe mental illnesses ‘Danny’ is also aware of the link between smoking, mental health and excess mortality (Glassman 1993; Brown et al. 2000, cited in Allen et al. 2004: 356). Despite this, he sees no prospect of moving past – to use Prochaska and DiClemente’s terminology – the ‘pre-contemplation stage’ of behaviour change. Discussing these matters further we could also foresee areas of both common interest and potential conflict.

Firstly, as a prospective nurse I am expected to place health promotion at the centre of my professional practice; and, as a smoker, modifying my behaviour is seen as a way to enhance my integrity as a care-giver and health advocate. In the relevant literature, varying degrees of emphasis have been placed on the effectiveness of smoking cessation services (Addington et al. 1998; Allen et al. 2004). Duncan (2006: 19) reminds us that, as part of the National Service Framework for Mental Health, ‘services in general practice should include advice to clients on changing life-style behaviours such as smoking, drinking alcohol and exercise’ – advice deemed applicable across all health specialties. Similarly, Furniss (2006) stresses the urgency of developing cessation programmes to tackle the huge health and social costs of smoking.

Secondly, when coupled with health promotion, the impact of my giving up smoking on other people’s health (specifically, mental health service users) can be looked at in two distinct ways. That is to say that, on the one hand, received wisdom would suggest that a non/ex-smoking nurse is in an ideal position to contribute positively to patient-centred anti-smoking health promotion and to enhance the general health of patients in his or her charge. On the other, research also indicates that a majority of mental health nurses are opposed to the proposed smoking ban in psychiatric units (July 2008), and to preventing staff from smoking with patients, on the grounds that it could have negative, anti-therapeutic consequences (Tarbuck 1996; Jochelson and Majrowski 2006).

In defending the second of these two perspectives it is tempting to counter those who argue that it is negligent to ‘pacify’ patients with cigarettes that they are ignoring ‘the soft messy ground of practice’ and the realities of mental illness (Lawn 2005; Manthey 2001: 5). Accordingly, my interviewee’s reaction to smoking cessation programmes was a sardonic one. Offer him a ‘bi-polar cessation programme’, he remarked, and he would sit up and take notice. Yet a re-evaluation of nurse-patient relations in mental health in particular is, arguably, also warranted on the basis that the alleged threat of ‘passive smoking’ has been wielded as much for moral and political reasons as it has for health and scientific ones.

It is ironic that Richard Doll, world-renowned epidemiologist and co-author of the first major study to make the link between smoking and lung cancer, should be a leading sceptic regarding evidence for passive smoking (Doll 1998; Fitzpatrick 2004; Lyons 2006). However, the spectre of second-hand smoke remains central to anti-smoking initiatives, as it does to the smoker’s consideration of the impact of his or her behaviour on the health of others. For writer and general practitioner Michael Fitzpatrick, this is an insidious trend borne of a social and political climate in which ‘the politics of behaviour’ has transformed health into a virtue, whereupon those who do not conform to, often questionable, health advice are effectively ‘in denial’ of the sins they are committing against themselves and others (Fitzpatrick 1998, 2004, 2006).

‘Once health is linked with virtue’, writes Fitzpatrick, ‘the regulation of lifestyle in the name of health becomes a mechanism for deterring vice and for disciplining society as a whole’ (1998). There is no doubt that this mood of critical scepticism has shaped my own outlook. Yet, notwithstanding the caveats, the virtue of Prochaska and DiClemente’s model – regardless of official policies on smoking and behaviour modification – is precisely that it stands on its own merits. It is for this reason that, despite having failed so far to progress towards the ‘action’ stage (wherein successful behaviour modification must be sustained for at least three months), I am confident that, rather than remain permanently ensconced in the ‘preparation’ stage, I will be able to overcome my smoking habit.

References

Addington, J., El-Guegaly, N., Campbell, W., Hodgins, D. and Addington, D. (1998). Smoking cessation treatment for patients with schizophrenia. American Journal of Psychiatry. 155(7), 974–976

Allen, D., Harvey, S., Marstin, P., Smith, S. and Wadhawa, S. (2004). Enduring mental illness and physical health care. Practice Nursing. 15(7), 356 - 360

Bailey, A. (2007). The ‘Big Ban’: a fresh start for smokers? British Journal of Nursing. 16(11), 641

Benison, L. (2006). English smoking ban. Practice Nursing. 17(3), 109

Brown, S., Inskip, H. and Barraclough, B. (2000). Causes of the excess mortality of schizophrenia. British Journal of Psychiatry. 177, 212–217

Doll, R. and Hill, A. B. (1954). The mortality of doctors in relation to their smoking habits: a preliminary report. British Medical Journal. 228, 1451-1455.

Doll, R. (1998). The first reports of smoking and lung cancer. In: Lock, S. et al. (eds.). Ashes to ashes: The history of smoking and health. Amsterdam: Rodopi, 130-140

Doll, R. et al. (2004). Mortality in relation to smoking: 50 years’ observations on male British doctors. British Medical Journal. 328, 1519-1533.

Duncan, D. (2006). Incentives for improving mental health care. Practice Nursing. 17(1), 18-21

Ewles, L., and Simnett, I. (1995). Promotion of Health: A Practical Guide. London: Balliere Tindall

Fitzpatrick, M. (1996). Warning: anti-tobacco crusades can damage your life. Living Marxism. 94, 16-18

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Forest (2004). Smoking in public places: an independent survey of public attitudes to smoking in pubs, bars and clubs. London: Forest

Furniss, L. (2006). Just nipping outside for a quick smoke. British Journal of Cardiac Nursing. 1(11), 508-509.

Glassman, A. H. (1993). Cigarette smoking: implications for psychiatric illness. American Journal of Psychiatry. 150, 546–53

Harvard Women’s Health Watch (2007). Why it’s hard to change unhealthy behavior – and why you should keep trying [online]. Available from http://www.health.harvard.edu/ [Accessed 5 August 2007].

Jenkins, I. (2007). Avoiding the burn of the smoking ban. Nursing & Residential Care. 9(8), 387-388

Jochelson, K. and Majrowski, B. (2006). Clearing the air: debating smoke-free policies in psychiatric units. London: King's Fund

Johnstone, J. R. (1991). Scientific fact or scientific self-delusion: passive smoking, exercise and the new puritanism. In: Peter Berger et al. Health, lifestyle and environment: countering the panic. London: Social Affairs Unit, 57-77

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Care co-ordination is a complex operation. With reference to relevant literature and legislation, discuss the process of co-ordinating care in your current placement area, and, using an example from this area, appraise the utility of this care package to that patient.

This essay will attempt to clarify the origins of the present system of ‘Care Co-ordination’ for mental health services, and examine some of the complexities in its development and application since its inception as the ‘Care Programme Approach’ (CPA) (DH 1990; 1999a). In addition, the role of care co-ordination in my current placement area (neuropsychiatry) will be considered through an evaluation of a specific care package, in terms of its efficacy in meeting both the principles set down by the Care Programme Approach and the needs of the client in question. In addition, in order to gain a fuller insight into current trends in care co-ordination the wider remit of the CPA/Care Co-ordination will be addressed, including some of the imperatives and principles underpinning its implementation.

Care Co-ordination and the CPA have their roots in the ‘care in the community’ policies of the 1980s and the shifting of service provision away from the older, long-stay mental hospitals towards community-based care (DHSS 1981; Parkinson 1981). And, for many, the following words from one of the key government policy documents of the time still ring true over a quarter of a century later: ‘Most people who need long-term care can and should be looked after in the community. That is what most of them want for themselves and what those responsible for their care believe to be best’ (DHSS 1981). Nevertheless, having long been linked (in the minds of the public and commentators alike) with the ‘abandonment’ of the seriously ill, as opposed to their care, the phrase ‘care in the community’, it is argued, has become ‘devalued’ (Dear and Wolch 1987; Court 1996: 532; Wheeler 2007). More recently, modified concepts, such as ‘spectrum of care’, have been put forward as alternative ways of characterising a mental healthcare system that is said to situate ‘the asylum at one end and the community at the other’ (DoH 1996; Carrier and Kendall 1998: 289).

The CPA was first proposed in the Conservative government’s 1989 White Paper, Caring for people, and was formally adopted and introduced in 1991, ‘to provide shape and coherence to what had often been haphazard, uncoordinated attempts to provide support in the community for people with severe mental illness’ (DH 1989; DH 1990; Simpson et al. 2003b: 490). Applicable to anyone aged 16 years or over in need of support from specialist psychiatric services (whether outpatient psychiatric services, in-patient psychiatric units or Community Mental Health Teams) the CPA also applies, in the case of the ‘Early Intervention Service’, to individuals below that age. Similarly, the elderly are entitled to treatment under the CPA, their needs determined through the Single Assessment Process (SAP) (DP NHS Trust 2006; MCIP 2006).

Notwithstanding the changes and modifications in the policies and practice of care co-ordination in the intervening years, the goal of effecting ‘systematic arrangements for assessing the health and social needs of people accepted into specialist mental health services’ remains unchanged (DH 1999a). As such, it is widely understood that the following, fundamental procedures are vital to the successful implementation of the CPA/Care Co-ordination: an assessment by a health and social care team, following referral to secondary, specialist psychiatric services; the development of a person-centred care plan, approved by a multi-professional team and (where appropriate and/or practicable) the client, advocate and informal carer; the allocation of a key worker/care co-ordinator to monitor the delivery of the care plan; and a regular review of the client’s care plan (DH 1990; 1999a; DCGN 2005).

In 1999, in accordance with the National Service Framework for Mental Health, the Department of Health acknowledged the need to update and streamline the existing model of care co-ordination for mental health service-users (DH 1999b). Setting out to transform the CPA into a ‘Whole Systems Approach’, the government sought to integrate the process with the screening and assessment procedures organised through Social Services ‘Care Management’. To signal this shift, the CPA would thereafter be referred to as ‘Care Co-ordination’ (DH 1999a, 1999b). The declared objective was the formation of ‘a unified health and social care assessment process’ and ‘a single care co-ordination approach for adults of working age with mental health problems’ (DH 1999a). In conjunction with the planned abolition of Supervision Registers (introduced in 1995 to address the problem of vulnerable patients ‘slipping through the net’ of psychiatric services), a rationalised, two-tier system of Care Co-ordination was introduced, built around ‘Standard’ and ‘Enhanced’ levels of care (DH 1999a).

In looking to refine the CPA, further provisions have also been put in place to ensure that a patient’s status under the Mental Health Act (MHA) be open to review at Care Co-ordination review meetings; and there has been a recognition of the need to monitor more closely the execution of the legal entitlement to after-care, as enshrined under Section 117 of the MHA (Wilkinson and Richards 1995; DH 2006). Arguably, however, the primary goal of Care Co-ordination continues to be that of bolstering the links between primary care, secondary care and the voluntary sector, on the basis that the synchronisation of care delivery is likely to be the most effective strategy for transforming the lives of people with mental illnesses (DH 1999a, 2001, 2002, 2006). With this in mind, and in order to test this claim, an example of Care Co-ordination implemented in my current placement area warrants consideration.

In 1998, the Health Advisory Service noted ‘the effectiveness of the complex care programmes (within the Care Programme Approach) that are being applied to patients with Huntington’s Disease when they are taken on by mental health services’ (SAC 1998). The Royal College of Psychiatrists has also endorsed the CPA/Care Co-ordination as good practice, not least in the neurobehavioural field (RCP 2004). The Department of Health and the NHS have continued to place great emphasis on the need for effective Care Co-ordination within neuropsychiatry. Moreover, this author’s experience provides strong evidence that the strategy can be put into practice with a high degree of efficiency and success (NHS 1997; DH 2005).

During my current clinical placement at a neuropsychiatric ward I observed and/or evaluated the assessments and multi-disciplinary output relating to a case of Care Co-ordination involving a 46 year-old patient with a history of depression, suicidal ideation, suicide attempts and self-harm. He was admitted to the ward in August 2007. Diagnosed with the genetic, degenerative brain condition Huntington’s disease in 2002, the patient was already known to neuropsychiatric services, having been admitted in 2004 following an overdose of sleeping tablets and attempted self-harm. (In the same year, as well as becoming divorced from his wife, the client was stabbed in the neck.) On this occasion, admitted as an informal patient for a 6 month mental health assessment, the client had presented with depression and suicidal ideation linked to loneliness and a stated inability to find a female partner.

After consulting the documentation relating to the patient’s Care Co-ordination it became clear that ward-based care planning, assessments and other nursing documentation represent a crucial aspect of the recovery-based, client-centred philosophy underpinning the CPA – whether applied within or without the hospital setting (Berger 2006). In this case, plans addressing ‘unmet needs’, ‘relapse prevention’ and ‘crisis intervention’ were drawn up. It is true that care plans can sometimes be perfunctory, with minimal consideration given to understanding wider social circumstances. What is more, limited time and resources can see care reduced to symptom management, treatment plans and compliance with medication. Yet the nursing process (assessment, planning, implementation, evaluation), of which it has been said (in its application to care planning) is ‘arguably the most important part of nursing care’, can still prove to be, as it did in this case, a key factor in the successful management of a patient’s needs (Wright 2005: 71).

In the first instance, risk assessments on admission to the ward formed an important part of the process of establishing the appropriate level of care provided for by the system of Care Co-ordination. After an initial assessment, a battery of detailed risk assessments was carried out, pertaining not only to the patient’s mental health, but their physical well-being aswell (e.g. the WHAMM Falls Risk Assessment). Of those assessments relating directly to mental state, a series of related risk factors were ‘scored’ according to their actual or potential applicability to the patient. Included within this standardised Care Co-ordination Risk Assessment documentation are: exploitation and harm by and/or to others; severe self-neglect; suicide; and deliberate self-harm. A further ‘Modular’ risk assessment evaluates the patient’s history against imminent and future potential for harm, in relation to, among others: overdose; self-mutilation; disability; chronic pain; feelings of hopelessness/lack of self-worth; relationship breakdown; impaired motivation and/or social functioning; and social isolation.

It should be stressed that this cursory summary of risk assessments need not imply that they have a merely quantitative character. On the contrary, while striving to be as objective as is possible, they are the building blocks of a qualitative, person-centred structure of care provision. To that end, the thorough, methodical nature of the initial, assessment-based stages of Care Co-ordination, in this instance at least, lent itself well to the Whole Systems Approach suggested by Care Co-ordination. And it is for this reason that they helped to facilitate relevant contributions and effective interventions from the multi-disciplinary team assigned to the patient’s clinical and social care.

The multi-professional entries in the aforementioned client’s notes drew on and complimented the knowledge already gained from his initial assessments. Alongside the consultant psychiatrist and the care co-ordinator (a senior nurse), the care team assembled for the patient’s Care Co-ordination included: a social worker; an occupational therapist; a speech and language therapist; a physiotherapist; an advocacy worker; the patient’s brother; and the patient/client/service user himself. The role of the care co-ordinator (who, prior to the modifications in the delivery of the CPA, was called the ‘keyworker) is to assume overall responsibility for the co-ordination of the care team, which includes making sure that the actions proposed in the client’s care plan are carried out, and that regular care plan reviews are arranged (DCGN 2005). Out of this multi-agency approach to evaluating the needs of the patient, ‘comprehensive assessments’ were produced by the professionals involved, all of which were returned to the service user’s social worker, and then transferred to the multi-professional documentation. The significance of assimilating the results of these investigations cannot be underestimated. For instance, the speech and language therapist’s report addressed factors such as oro-motor skills, expression, comprehension, reading comprehension and swallowing. Where a patient has a dual diagnosis of Huntington’s Disease and depression, the information derived from such an investigation can be of critical importance in gauging the impact that impairment in both communication and self-care skills can have on mental health (Guyon 2007; Zrínyi and Zékányné 2007).

Similarly, the ‘home assessment’ conducted by the occupational therapist, and observed by both myself and the patient’s social worker, proved to be decisive in determining the direction the Care Co-ordination was to take. To clarify, despite the patient’s wish to return home, grave concerns were raised about the risks posed by the combination of his unwillingness to confront the negative impact that Huntington’s Disease would have on the completion of everyday tasks and the damaging consequences that social isolation in his home environment could have on both his physical and mental health. The first Enhanced Care Co-ordination Review meeting, held a month after the patient’s admission, drew further attention to these problems, and yet, despite the misgivings aired by both his brother and the professionals present, the client persisted in his desire to return home.

As a result of the Care Co-ordination Review, two referrals were made. The first was to a Mental Capacity Advocate, with whom the social worker concurred that the client had the capacity to make the decision in question (MCIP 2006; Ross 2007). The second referral, made by myself, was to ASIST (Advocacy Services in Staffordshire), on the grounds that the service user may need the support and advice of a voluntary advocate, in order to address the possible options open to him, independent of (but with reference to) medical and legal imperatives. During this time, there was a marked decline in the client’s physical and mental health, which was instigated, in part, by his refusal to comply with medication (in protest at the decision made in the wake of his home assessment). This gave rise to complications, such as an intensification of the patient’s chorea, and further manifested itself in the form of an acutely aggravated and aggressive state.

The issue of the client’s discharge options remained a priority at subsequent ward rounds and Care Co-ordination Review meetings. In due course, perseverance and professional commitment reaped rewards for all concerned. The patient was persuaded of the seriousness of the situation and, paying close attention to the need for a client-centred approach to clinical and social care, he was asked to consider the possibility of moving to a nursing home, where care appropriate to his complex needs could be provided. As I write, the client is considering a range of options in this regard and, in recovering some of the pride and dignity he felt he had lost, is experiencing a marked improvement in his mental health.

Despite this very positive appraisal of Care Co-ordination in action, discussions (both formal and informal) centred around the CPA/Care Co-ordination are sometimes characterised by a narrowly instrumental focus on discharge and after-care, as opposed to a broader emphasis on the extensive view of care implied by a Whole Systems Approach. Undoubtedly, admission to hospital can sometimes run the risk of Care Co-ordination being suspended and continuity of care being interrupted. The Department of Health consultation document Reviewing the Care Programme Approach states: ‘The fact that a service user needs additional support in an in-patient or residential setting should prove no barrier to continuity of care planning.’ It continues: ‘For those on the CPA the responsibilities of the care co-ordinator will continue. For people not already on the CPA, a care co-ordinator should be appointed well in advance of discharge and arrangements made clear about future contact, risk and safety management and home care arrangements’ (DH 2006). In other words, accepting that the principal dynamic at work should be preparing the patient for his or her return home, admission to a psychiatric unit should, in itself, prompt the implementation of Care-Co-ordination.

This essay has not addressed the many, often stinging, criticisms of the CPA/Care Co-ordination. Yet one notable feature of much of the literature questioning the success of Care Co-ordination is that, in addressing the confusion, frustration and conflict surrounding the utility, or otherwise, of the approach, critics tend to focus more on the manner in which it has been implemented than on the content of the policy itself, a criticism which, unsurprisingly, its defenders are happy to concede (Sullivan 1997; Simpson et al. 2003, 2003b; Kingdon and Amanullah 2005). For this author, while this essay does not afford the scope to examine political questions too closely, there are certainly features of government policy that play a largely negative role in a whole host of health initiatives, not least the social engineering that, in my view, lies behind many of the government’s claims for ‘empowerment’ and ‘social inclusion’. Notwithstanding these reservations, however, and as the case study in this essay has made clear, whether because of or despite the manner of its implementation the health and social care professionals who are managing the care of the service-user in question have drawn out the most positive aspects of the present system of Care Co-ordination and put them into practice in such a way that the value of the client’s care package was never in doubt.

References

Berger, J. L. (2006). Incorporation of the tidal model into the interdisciplinary plan of care – a program quality improvement project. Journal of Psychiatric and Mental Health Nursing. 13, 464-467

Carrier, J. and Kendall, I. (1998). Health And The National Health Service. London: Athlone Press

Court, C. (1996). Government admits mental health service problems. British Medical Journal. 312, 531-532

Dear, M. and Wolch, J. (1987). Landscapes of despair: from deinstitutionalization to homelessness. Oxford: Polity

Department of Health and Social Security (1981). Care in the community: a consultative document on moving resources for care in England. London: HMSO

Department of Health (1989). Caring for people: community care in the next decade and beyond. London: HMSO

Department of Health (1990). The Care Programme Approach for people with a mental illness referred to the specialist psychiatric services. London: HMSO

Department of Health (1995). Building bridges: a guide to arrangements for inter-agency working for the care and protection of severely mentally ill people. London: HMSO

Department of Health (1996). The spectrum of care: local services for people with mental health problems. London: HMSO

Department of Health (1999a). Effective care co-ordination in mental health services: modernising the Care Programme Approach. London: HMSO

Department of Health (1999b). A National Service Framework for mental health: modern standards and service models for mental health. London: HMSO.

Department of Health (2001). The journey to recovery: the government’s

vision for mental health care. London: HMSO

Department of Health (2002). Community mental health teams: mental health policy implementation guide. London: HMSO

Department of Health (2005). Independence, well-being and choice: our vision for the future of social care for adults in England. London: HMSO

Devon Partnership NHS Trust (2006). Care programme approach operational policy. Devon: DP NHS Trust

Directorate of Clinical Governance and Nursing/North Staffordshire Combined Healthcare NHS Trust (DCGN) (2005). How can we help you? Information about Care Co-ordination for service users and their carers. Stoke-on-Trent: Combined Healthcare NHS Trust

Guyon, A. (2007). Assessments: speech and language therapy. Nursing & Residential Care. 9(10), 486-489

Kingdon, D. and Amanullah, S. (2005). Care programme approach: relapsing or recovering? Advances in Psychiatric Treatment. 11 [online]. Available from: http://apt.rcpsych.org/ [Accessed 10 December 2007]

Mental Capacity Implementation Programme (MCIP) (2006). Making decisions: a guide for people who work in health and social care. London: MCIP

NHS Health Advisory Service - Mental Health Services (1997). Heading for better care: commissioning and providing mental health services for people with Huntington’s disease, acquired brain injury and early onset dementia. London: NHS

Health Advisory Service

Parkinson, C. (1981). The right approach to mental health: a report based on the work of a Conservative policy group. London: Conservative Political Centre

Ross, C. (2007). The Mental Capacity Act: an overview. Nursing & Residential Care. 9(12), 556-561

Royal College of Psychiatrists (2004). Good Psychiatric Practice (2nd edn.). London: RCP

Scottish Affairs Committee (1998). Memorandum submitted by Scottish Huntington’s Association: Appendix 2 – Key issues relating to Huntington’s disease adapted from the HAS report. London: HMSO

Simpson, A., Miller, C. and Bowers, L. (2003). Case management models and the care programme approach: how to make the CPA effective and credible. Journal of Psychiatric and Mental Health Nursing. 10(4), 472-483

Simpson, A., Miller, C. and Bowers, L. (2003b). The history of the Care Programme Approach in England: Where did it go wrong? Journal of Mental Health. 12(5), 489-504

Sullivan, P. (1997). The care programme approach: a nursing perspective. British Journal of Nursing. 6(4), 208-214

Wheeler, M. (2007). Interview with Maggie Wheeler (chair of the Norfolk And Waveney Mental Health Trust) at BBC Norfollk [online]. Available from: http://www.bbc.co.uk/norfolk/ [Accessed 2 January 2008]

Wilkinson, E. and Richards, H. (1995). Aftercare under the 1983 Mental Health Act. Psychiatric Bulletin. 19, 158-60

Wright, K. (2005). Care planning: an easy guide for nurses. Nursing & Residential Care. 7(2), 71-73

Zrínyi, M. and Zékányné, R. I. (2007). Does self-care agency change between hospital admission and discharge? An Orem-based investigation. International Nursing Review. 54(3), 256-262

Define and explore how reflection can influence learning in clinical practice. Within this assignment, include reflection on your recent clinical experiences during Module 1, and recognise situations where you acknowledged the limitations of your own abilities and therefore required referral to a registered practitioner.

In this essay, I will examine some of the principal issues arising from the relationship between nursing and reflective practice, and, by drawing on my own experiences, I will further consider the extent to which theoretical models of reflection capture and compliment the essence of work-based learning.

Before setting out to demonstrate how reflection can play a key role in clinical practice I will first of all endeavour to outline the theoretical parameters of reflection itself. In recent years, reflective approaches to nursing, in the United Kingdom in particular, have evolved to support the broader goal of ensuring greater dynamism and effectiveness within the nursing profession (Manthey 2001; Sills and Tate 2004). It is against this background that a range of theoretical models of reflection have been applied, the hypotheses of which demand closer attention.

Of the various, more or less comparable, reflective models applied to work-based learning I will focus here on the approaches, or those aspects of them, that are especially pertinent to the early stages of training to be a mental health nurse. In the first instance, perhaps because of its simplicity and ‘user-friendliness’, the Gibbs Reflective Cycle (Gibbs 1988) is often highlighted as being especially useful to first-year student nurses faced with the prospect of engaging in critical reflection and reflective practice, often for the first time. For the same reason, it can be shown to be of general relevance to student nurses, irrespective of branch specialism.

The popularity of the Gibbs Reflective Cycle derives from its universal applicability, and for students evaluating their clinical practice and assessing the quality of their work-based learning it provides the most straightforward model for structured reflection. Firstly, it advocates that the student begins with a simple description of events. This should be followed by: an account of his/her feelings; an evaluation of the benefits and shortcomings of the experience; a broader analysis of the numerous situations, staff and patients constituting that experience; a conclusion drawn from insights gained from the previous stages in the cycle (including a retrospective critique of the student’s actions); and an action plan detailing how the student would anticipate confronting a similar situation in future.

Corresponding to the six stages in the Gibbs cycle (Description, Feelings, Evaluation, Analysis, Conclusion, Action Plan) are six exploratory questions: ‘What happened?’; ‘What were you thinking and feeling?’; ‘What was good and bad about the experience?’; ‘What sense can you make of the situation?’; ‘What else could you have done?’; ‘If it arose again, what would you do?’. A cursory glance at other models of reflection suggests that, rather than providing full-blown alternatives to Gibbs, they merely place differing degrees of emphasis on the same themes. At one level of course, this is clearly the case, as they all share the goal of identifying the most effective route to establishing a practicable approach to reflective practice.

Nonetheless, it is important to recognise the often subtle differences distinguishing one theoretical model from another, not least because this will help to clarify the strengths and weaknesses of many of the ideas underpinning reflective models per se.

Schön’s theory of reflection-in-action (1983, 1987) is a case in point. Schön has been described as a pivotal figure in the development of reflective practice, ‘on the high, hard ground of certainty in the academic ivory tower and the soft messy ground of practice’ (Vaughan, cited in Manthey 2001b: 5). A tripartite model, Schön’s theory of reflection is built around the inter-related concepts of ‘knowing-in-action’, ‘reflection-in-action’ and ‘reflection-on-action’. Thus, as Schön (1987: 29) contends, ‘In reflection-in-action, the rethinking of some part of our knowing-in-action leads to on-the-spot experiment and further thinking that affects what we do – in the situation at hand and perhaps also in others we shall see as similar to it.’ This configuration implies a transformative process, whereby reflective learning moves from the intuitive, familiar ‘know-how’ we apply to everyday working practices, through the ‘thinking on our feet’ associated with the improvised experiments we apply to unexpected workplace demands, to the intellectual deliberation we must engage in to facilitate a proper understanding (and if necessary, a refinement) of our ways of working.

Again, on first reading, Schön’s reading of the fundamentals of reflection appears to be similar, in essence, to Gibbs’. But if Schön’s approach to perfecting our understanding of reflection is examined in relation to further attempts to do the same we will be better placed to identify what are, arguably, qualitative differences between the philosophical assumptions underpinning, ostensibly, comparable theories of reflection. In this respect, Johns (2000) and Rolfe (2001) provide us with the opportunity to consider if the claims so often made for the advantages of ‘reflection‘ sometimes disguise the sort of introspection that is not necessarily beneficial to a professional environment (Kim 1999).

Like Schön, Johns’ interpretation of the role of reflection allows for a more complex, less reductive method than Gibbs. Where the Gibbs Reflective Cycle, in quantitative fashion, asks, ‘What needs to be added? What needs to be taken away?’, Johns’ Model of Structured Reflection invites the student to ask what he or she brought to the decision-making process in the first place. This question of influencing factors is a crucial one. Once the role of internalised and externalised ethics within reflection is acknowledged, the possibility of a more effective resolution of the challenges posed by professional practice suggests itself. Rolfe (2001), too, appreciates that the knowledge, assumptions and broader dynamics of reflection cannot be reduced to ‘learning from our mistakes’, and recognises that a synthesis of the subjective and the objective is required if reflection is to be anything more than the exploration of our innermost feelings.

While any formal, ‘technical’ model of reflection is bound to reveal its shortcomings when tested against the unpredictability of professional practice this need not imply that models of reflection cannot be used as general guides to action. Nevertheless, it is important to take on board the fact that it is not enough for ‘theory’ to merely describe and prescribe. Certainly, the role of theory is, in part, to logically reconstruct ‘reality’, but it must more do more than that – it must assimilate our experience of that reality, in order for us to be able to act on and shape our (working) environment with rigorous intent. If our subjective actions are rooted, simultaneously, in our working environment and the preconceptions we bring to that environment, then resolving the problems that confront us must surely demand of us a collective response.

For structured reflection to be effective it should be corroborated. Student nurses, for example, do not only need forums to exchange views, but also ample opportunities to support the development of a framework for establishing exactly what kind of framework for reflection they need. Rather than relying solely on ‘ready-made’ models of reflection the trainees’ commitment to mastering a professional approach to their work requires that they base their intellectual contemplation firmly in the concrete reality of their respective clinical environments (Kolb 1984). Without such a meeting of minds, mere introspection and abstract speculation could become the student nurses’ modus operandi.

Having considered, in some detail, the theoretical foundations of reflective practice I want to now to consider how my own experience on placement, in a Mental Health Resource Centre, has both inspired my thoughts on reflection and forced me to recognise the ‘mismatch’ between my stance on reflective practice and the reality of being a relatively inexperienced student nurse.

Prior to starting my training, I spent eight months working as a volunteer with the mental health charity MIND. Consequently, I began my first placement with the kind of knowledge, insights and skills that I was encouraged to believe were applicable to the role of a mental health nurse. And yet, since the beginning of my training, because my personal and professional development have been focused around adapting to the needs and demands of working with a multi-disciplinary team in a Combined Healthcare setting, my reflection has centred, initially, on the ways in which I tested my knowledge against the demands of working with nurses, social workers, occupational therapists and a mental health client base under the auspices of the NHS.

While matters such as promoting the dignity and interests of people of mental illnesses, recognising the wide range of social issues associated with mental illness, and understanding the importance of maintaining personal and professional boundaries are facets of my voluntary work that I confidently brought to bear on my placement experience, the ‘neutrality’ of voluntary work did not prepare me for the unique requirements of mental health nursing (Mid-Staffs Mind [date unknown]). That is to say, just as mental health charities are an important point of contact both for people with mental illnesses and overstretched statutory services, they are rarely equipped with the resources or the professional staff to fully address the short and long-term needs of people with serious mental illnesses. As such, the responsibilities I have begun to become acquainted with since working alongside qualified mental health nurses have further encouraged me to look more closely at the, sometimes fraught, relationship between the therapeutic and clinical aspects of psychiatric nursing.

While I would not want to question the efficacy of charitable organisations that often afford clients an enviable amount of therapeutic support, the principles of continuity of care are, as far as my experience tells me, implemented most effectively via qualified nursing professionals. Moreover, it is the question of record keeping in particular that, for my part, illustrates both the significance of upholding a duty of care to patients/clients and my own reflections on the limitations of my abilities at this early stage in my training.

Although not a requirement when working as a volunteer with Mind (as professional responsibilities were minimal), maintaining accurate and legible records is an essential and integral part of nursing practice, and I was made aware at an early stage during my clinical placement of the vital function that record-keeping plays in ensuring continuity of care. While on placement, in conjunction with completing admission procedures, and assisting with a range of assessments (Physical, Kitchen Risk, 3-Point Risk Assessment etc.), I was able to carry out other procedures essential to nursing, including: taking and recording blood pressure; measurement of body temperature; identifying nutritional needs; and administering medicine by intramuscular injection. And yet, as I have already intimated, record-keeping is perhaps the most appropriate focus for the purposes of this essay, because, concurrent with my reflections on the contrasts between professional and voluntary caring environments, it was this feature of clinical practice that led me to seek professional advice from registered practitioners.

Whereas working as a volunteer for Mind did not require record-keeping as a matter of course, on placement entries in patients’ notes were expected to be made whenever observations of changes in patients’ mood or behaviour, mental or physical health were deemed significant enough in themselves to be recorded. Furthermore, the significance of such changes was always to be judged on the basis of their bearing on holistic care plans. It was in this context that I sought clarification of clinical protocols, concerned as I was to keep accurate – and therefore, effective – records. The more sure I became of the relevant procedures in this regard the more proactive I became in taking responsibility for them, which, in practice, meant making entries in records whenever I considered it to be appropriate.

It is perhaps ironic that, despite the reservations I have expressed about the utility of oversimplified and reductive approaches to reflection (and my claim that reflection can only be truly effective if it is executed collectively), I should choose to close this essay by defending the Gibbs Reflective Cycle. Yet it is because of my limited experience at this point in the course that I am in a position to reflect soberly on the efficacy of attempting, at this point in time, to put into practice more ambitious modes of reflection. I do not believe there is any contradiction at work here. Instead, I have come to recognise that my limitations are due less to a lack of confidence about being able to fulfil the nursing role than an unreasonable expectation that this is possible at such an early stage in my training. In this respect, Gibbs’ question, ‘If [the situation] arose again, what would you do?’, is not a retreat from my argument that a more dynamic, collective approach to reflection is needed. Rather it is the first step towards critical reflection-on-action.

References

Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit, Oxford Brookes University

Grech, E. (2004) Hegel’s Dialectic and Reflective Practice – A Short Essay. International Journal of Psychosocial Rehabilitation. 8, 71-73

Johns, C. (2000) Becoming a Reflective Practitioner: A Reflective and Holistic Approach to Clinical Nursing. Practice Development and Clinical Supervision. Oxford: Blackwell

Johns, C. (2002) Guided Reflection: Advancing Practice. Oxford: Blackwell

Kim, H. S. (1999) Critical Reflective Enquiry for Knowledge Development in Nursing Practice. Journal of Advanced Nursing. 29, 5, 1205-1212

Kolb, D. A. (1984) Experiential Learning: Experience as the Source of Learning and Development. New Jersey: Prentice Hall

Manthey, M. (2001) Reflective Practice. Creative Nursing. 7, 2, 3-4

Manthey, M. (2001b) Reflective Practice in the UK. Creative Nursing. 7, 2, 5-6

Mid-Staffs Mind (date unknown) Volunteer Handbook and Personal Record

Rolfe G., et al. (2001) Critical Reflection in Nursing and the Helping Professions: A User’s Guide. Basingstoke: Palgrave Macmillan

Schön, D. A. (1983) The Reflective Practitioner: How Professionals Think in Action. London: Temple Smith

Schön, D. A. (1987) Educating the Reflective Practitioner: Toward a New Design for Teaching and. Learning In the Professions. San Francisco: Jossey-Bass

Sills M. and Tate S. eds. (2004) The Development of Critical Reflection in the Health Professions. Learning and Teaching Support Network/Centre for Health Sciences and Practice Occasional Paper, 4

Reflections on TV & Film

2008-03-20T05:13:00.000-07:00

Baise-Moi: The great thing about *beep* Me is that it serves to expose, say, Thelma and Louise for what it is: a 'feelgood' movie that conforms to Hollywood conventions by (admittedly, skillfully) pressing all the usual sentimental buttons, rather than being the thoughtful and insightful visual poem on women's oppression I probably thought it was in my early 20s. Baise-Moi goes on the offensive, subverting the genre and kicking against the pricks all the way. Refreshing.

Blackeyes: Seeing it again for the first time in 18 years what struck me most forcefully was how much better it is than my memory, and the programme's reputation, had led me to believe. We're familiar with the plot and the narrative and storytelling devices Potter used, but it's the use of sound that I find compelling: the way in which the various voices (whether in terms of ordinary speech, the music box as a signifier of childhood, or the sighs of sexual congress) are subtly interwoven with the (problematic) visual construction of the piece. It's the editing that lets it down - it's unnecessarily long. Together with the familiar question of how much the film itself objectifies women as sexual objects, these observations have convinced me that a shortened, audio version of Blackeyes would work brilliantly as a radio play or 'talking book'.

Day of the Woman/I Spit on Your Grave: Was the sex real? If I had a pound for every time that question was asked about movies... etc. The answer is invariably 'no', and to ask it of a film where there is rape after rape after rape is plain perverse. Think about it, if the 'sex' was real in this instance you may well be talking about a recording of actual violent assaults - something akin to the mythical 'snuff' movie. Whatever, I didn't even want to discuss the matter in the first place, until the sight of the dumb question compelled me to. No, I just wanted to say that, whatever the intentions, it's a peculiarly crass and prurient film (without absolutely no redeeming features whatsoever).

I did manage a giggle, though: in the bath scene, either the guy has a 12 to 15 inch cock or she's not reaching far enough. 'Realism', eh? Hmm.

Now, I shall do my best to forget about the whole experience.

Lipstick on Your Collar: I'm lucky enough to have both the series on VHS and the original soundtrack on cd. It was a wonderful drama, and the last near-great one from the pen of the mighty Dennis Potter. One thing it captures so well is that moment when the British ruling class had to face up to the fact that the loss of the Suez Canal meant, on the one hand, the decline of the British Empire and, on the other, the ascendancy of Pax-Americana. And yet, the stirrings of post-war optimism are also captured in the character of Mick Hopper. The casting is superb - Giles Thomas, Louise Germaine, Ewan McGregor, Douglas Henshall, Peter Jeffrey and Maggie Steed are all brilliant. Lipstick is far from being Potter's best work, but then he set a high benchmark with Pennies From Heaven and The Singing Detective (the best television drama ever made, bar none). It is, nonetheless, essential viewing, and alongside Blackeyes, should've been made available on DVD long ago.

Don't Drink the Water: To think of all those years that I spent wondering what this was like... and then, oh dear, along came the 1994 film version. It really is quite breathtakingly bad - an offensive, dumb, shrill, antiquated farce with absolutely no redeeming qualities. Why Allen chose to film this trash a quarter of a century after the original film and play is a mystery. It makes the woeful Everything You Always Wanted To Know About Sex look like a mature and sophisticated comedy classic.

I think I'll stick with my 10 Allen faves: Play It Again, Sam, Sleeper, Love And Death, Annie Hall, Manhattan, Stardust Memories, The Purple Rose of Cairo, Hannah And Her Sisters, Radio Days and Crimes and Misdemeanors.

Let Him Have It: 'Some ten years before the Bentley case, two men involved in the killing of a policeman were sentenced to death, helped by police testimony in which it was alleged that one of the men incited his accomplice using an almost identical phrase. In fact the phrase was so similar (with the exception of the name "Chris"), it has been alleged that this case was discussed by police officers who were on the rooftop the night P.C. Miles was killed as they prepared their reports, and that the similarity was more than a coincidence'.

Recent research is more emphatic. I think we can safely say that the phrase 'Let him have it' was indeed 'borrowed' from a previous case. Also, the policeman was shot by another policeman, not Craig. The only murder in this tale is that of Bentley, by the state. Nonetheless, while the film is not a properly factual account, it is truthful. That is to say, it makes it plain that the police, when they're determined to secure a conviction, can get away with anything. Anyone who thinks otherwise is either naive or a self-conscious apologist for British injustice.

Withnail & I: Two peripheral characters ponder and wander aimlessly, for want of a purposeful existence. This would be my one-line synopsis for Stoppard's wonderful Rosencrantz and Guildenstern are Dead, but it seems to me that it might just as well describe some other cast-iron favourites of mine, whether it's Withnail and I, Sideways (Miles and Jack), or (with rather less wandering about), Waiting for Godot (Vladimir and Estragon).

This probably isn't the place to wax lyrical about the sublime Sideways, but, as you all well know, amongst friends, strangers and 'friends-to-be' casual references to W & I are a kind of communicative currency, a reminder that we're all comedy fans 'in the know', but it's the pathos and poignancy of the story that resonates most of all. The 'not-quite-friendships' of many of my favourite narratives seem to reproduce the unresolved struggles of the world in the fraught realm between the love and resentment we feel towards those we find ourselves drawn to, and wherein the reality of our frustrated ambitions seems to be amplified.

And, for me, the comic catharthis and emotional punch of Withnail and I and Sideways act as a kind of imaginative bridge to and from Beckett and Stoppard's plays and the weightier philosophical questions they embody.

Why the Ladies Aren't As Fond of "W&I"

Any art worth its salt doesn't exclude anyone on the basis of their gender. Three of my favourite films, Desert Hearts, My Summer of Love and Fried Green Tomatoes have, in so many words, been written off by male friends of mine as 'chick' or 'dyke' flicks. That's their loss.

As I've said elsewhere, W & I deals with the 'fraught realm between the love and resentment we feel towards' the male counterparts 'we find ourselves drawn to, and wherein the reality of our frustrated ambitions seems to be amplified.' That only becomes a 'man thing' in so far it's about the qualities - or otherwise - peculiar to the kind of male friendships that Bruce Robinson proved to have a keen eye for; and he reflects on them with sensitivity and intelligence.

Because the semi-autobiographical dimension of the story implies a male-only world (Robinson says they were simply too poor to have girlfriends), perhaps we shouldn't be surprised to learn that W & I holds more appeal for a male audience. But methinks that what I've said would invite plenty of knowing nods from women.

Sadie Frost: 'Shopping', 'Final Cut', and 'Rancid Aluminium'. Ouch! Not exactly an enviable CV, is it? I mean, how many other people can claim to have starred in three of most appalling British films ever made? Maybe it's the curse of the Primrose set. Certainly, pretty much anything Sean Pertwee stars in should carry an 'approach with fear and trepidation' sticker on it, too. And, tellingly, the modestly talented pretty boy, Jude Law, only really showed signs of improvement after escaping their apparently stupefying influence.

Joanne Whalley: In reverse chronological order (and believe me, coming up with 10 was very difficult):

1. The Secret Rapture (1993)
2. The Big Man (1990)
3. Scandal (1989)
4. A TV Dante (1989)
5. Will You Love Me Tomorrow (1987)
6. The Singing Detective (1986)
7. The Good Father (1985)
8. Edge of Darkness (1985)
9. No Surrender (1985)
10. Dance with a Stranger (1985)

http://www.geocities.com/joannewhalley3/073.jpg

As central as she was to the U.K.'s little 80s golden age, it was - despite the odd moment - all downhill after 'Scandal'. I was lucky enough to be given a chance to soak up first class British films and tv drama in the mid 80s, when I was in my mid to late-teens. She'll always be a reminder for me of the excitement that gripped me when I first started to take film and drama seriously. And I'll be a happy man when the brilliant films 'No Surrender' and 'Will You Love Me Tomorrow' are finally released on dvd.

If someone can persuade me she's done anything of any interest in the last 10 years or so I'd be delighted to hear about it.

* Alternative title: the ONLY 10 films Whalley was in that are any good at all.

Capote: The film, whilst factual, sets out to condemn Capote, on the spurious grounds that he is culpable in the deaths of his new-found friend(s). It seems to me that that just lets everyone else off the hook; and the idea that Capote tumbled into a lifelong, guilt- and drink-ridden spiral thereafter, as a more or less direct consequence of his 'dastardly' actions, is a very dubious claim on Miller's part.

Dr Pod's 'Recommended Albums By His Bobness The Zimmerman'

2006-12-03T11:32:00.000-08:00

bob dylan (62)

the freewheelin’ bob dylan (63)

the times they are a-changin’ (64)

another side of bob dylan (64)

bringing it all back home (65)

highway 61 revisited (65)

blonde on blonde (66)

john wesley harding (68)

nashville skyline (69)

new morning (70)

pat garret & billy the kid (73)

planet waves (74)

blood on the tracks (75)

the basement tapes [67] (75)

desire (76)

hard rain (76)

street legal (78)

slow train coming (79)

at budokan (79)

saved (80)

biograph [62-81] (85)

oh mercy (89)

the bootleg series 1-3: rare and unreleased 61-91 (91)

good as i been to you (92)

world gone wrong (93)

time out of mind (97)

the bootleg series 4: live 66: the “royal albert hall concert” (98)

love and theft (2001)

the bootleg series 5: live 75: the rolling thunder revue (2002)

the bootleg series 6: live 64: concert at philharmonic hall (2004)

the bootleg series 7: no direction home soundtrack [59-66] (2005)

live at the gaslight 1962 (2005)

modern times (06)

30 Essential Zappa Collections: 1966 - 1996

2006-12-03T11:29:00.000-08:00

Jun 66 Freak Out! Mar 66
Jun 67 Absolutely Free Nov 66
Mar 68 We’re Only In It For The Money Feb - Oct 67
May 68 Lumpy Gravy c. 61 - Oct 67
Dec 68 Cruising With Ruben & The Jets Dec 67 – Feb 68
Apr 69 Uncle Meat Sep 67 - Jul 68
Oct 69 Hot Rats Jul - Aug 69
Feb 70 Burnt Weeny Sandwich Aug 67 - 69
Aug 70 Weasels Ripped My Flesh Dec 67 - 69
Aug 71 Fillmore East, June 71 Jun 71
Mar 72 Just Another Band From L.A. Aug 71
Jul 72 Waka/Jawaka Apr - May 72
Nov 72 The Grand Wazoo Apr - May 72
Sep 73 Over-Nite Sensation Mar - Jun 73
Mar 74 Apostrophe (’) Mar 70 - 74
Sep 74 Roxy & Elsewhere Dec 73/May 74
Jun 75 One Size Fits All Aug - Dec 74
Oct 75 Bongo Fury Jan - May 75
Sep 78 Studio Tan Dec 74 - 76
Mar 79 Sheik Yerbouti Oct 77- Feb 78
Sep/Nov 79 Joe’s Garage Acts I, II & III Mar - Jun 79
Sep 81 You Are What You Is Apr - Sep 80
May 88 You Can’t Do That On Stage Anymore Vol. 1 Feb 69 - Aug 84
Oct 88 You Can’t Do That On Stage Anymore Vol. 2:
The Helsinki Concert Sep 74
Oct 88 Broadway The Hard Way Feb - Jun 88
Jun 91 Make A Jazz Noise Here Feb - Jun 88
Apr 93 Ahead Of Their Time Oct 68
Nov 93 The Yellow Shark Sep 92
Dec 94 Civilization Phaze III 67/91/92
Feb 96 The Lost Episodes 58 - 74

The albums are listed in order of release. Dates on the right are recording dates.

Notes

2006-11-24T13:36:00.000-08:00

[i] ‘Modernism’ was the movement in the visual arts, literature, music and drama thatemerged at the turn of the twentieth century and which challenged broadly Victorian ideas about the production and meaning of art. ‘Modernity’ is often equated with ‘capitalism’. It can also be understood as the accumulation of capitalism’s social, cultural and technological forms. Alan Hudson suggests that ‘modernity is merely the phenomenal form of capitalist social relations embodying all the contradictions of that society.’ A. Hudson, ‘Introduction’, in F. Engels, Socialism: Utopian and Scientific, (London, Junius, 1995), p. xxxiii. For James Heartfield, meanwhile, ‘the idea of ‘modernity’… is hopelessly imprecise’:After all, which modernity are you talking about? The one with the bakelite fixtures and the telegraph wires, or the one with the formica and the mainframe? Modernity was always a useless category because it fixed not on social determinants, like the free market, but on technical features, like ‘heavy industry’. Being itself an imprecise category, qualifications like postmodernity are even less satisfactory, since we do not necessarily agree on what modernity is, let alone what comes after.J. Heartfield, ‘The Risk Zone’, Living Marxism, No. 80 (June 1995), p. 48. Broadly speaking, postmodernists use the terms ‘modern’, ‘modernism’ and ‘modernity’ interchangeably as the embodiment of the Rationalist and Enlightenment ideas of the 17th and 18th centuries, and their implementation throughout the 19th and 20th.[ii] See C. Jencks, What is Postmodernism?, (London, Academy Edition, 1986); E. Lucie-Smith, Movements in Art Since 1945, (London, Thames and Hudson, 1992)[iii] See H. Foster, Postmodern Culture, (London, Pluto, 1985); S. Connor, PostmodernistCulture: An Introduction to Theories of the Contemporary, (Oxford, Blackwell, 1989); D. Harvey, The Condition of Postmodernity: An Enquiry into the Origins of Cultural Change, (Oxford, Blackwell, 1989); F. Jameson, Postmodernism, or, The Cultural Logic of Late Capitalism, (London, Verso, 1991); M. Morris, The Pirate’s Fiancée: Feminism, Reading, Postmodernism, (London, Verso, 1988); R. Young (ed.), Untying the Text: A Post-Structuralist Reader, (London, Routledge, 1981); S. Sim (ed.), The Icon Critical Dictionary of Postmodern Thought, (Cambridge, Icon Books, 1998), especially S. Sim, ‘Postmodernism and Philosophy’, pp. 3-14; A. Easthope, ‘Postmodernism and Critical and Cultural Theory’, pp. 15-27; I. H. Grant, ‘Postmodernism and Politics’, pp. 28-40; D. Morgan, ‘Postmodernism and Architecture’, pp. 78-88; C. Trodd, ‘Postmodernism and Art’, pp. 89-100; M. O’Day, ‘Postmodernism and Television’, pp. 112-120; B. Lewis, ‘Postmodernism and Literature (or: Word Salad Days, 1960-90)’, pp. 121-133, D. Scott, ‘Postmodernism and Music’, pp. 134-146; L. Spencer, ‘Postmodernism, Modernity and the Tradition of Dissent’, pp. 158-169[iv] See J.-F. Lyotard, The Postmodern Condition: A Report on Knowledge, (Manchester,Manchester University Press, 1984); P. Dews, Logics of Disintegration: Post-Structuralist Thought and the Claims of Critical Theory, (London, Verso, 1987); M. Foucault, Power/Knowledge: Selected Interviews and Other Writings, 1972-1977, ed. C. Gordon, (Brighton, Harvester Press, 1980); J. Derrida, Between the Blinds: A Derrida Reader, ed. P. Kamuf, (London, Harvester Wheatsheaf, 1991)[v] J.-F. Lyotard, ibid., p. xxiv[vi] Ibid., p. xxiii[vii] Ibid., p. 81[viii] Ibid., p. xxiii[ix] M. Featherstone, ‘In Pursuit of the Postmodern: An Introduction’, Theory, Culture and Society, Vol. 5, No. 2/3 (June 1998), p. 198[x] R. Usher and R. Edwards, Postmodernism and Education, (London, Routledge, 1994),p. 2[xi] S. Grenz, A Primer on Postmodernism, (Grand Rapids, Eerdmans, 1996), p. 12[xii] J.-F Lyotard, op. cit., p. 79[xiii] Ibid., p. 79.[xiv] A. Callinicos, Against Postmodernism: A Marxist Critique, (Cambridge, Polity, 1989), p.18[xv] I say ‘ostensibly’ because it would be wrong to take modernism’s radical credentials forgranted. In 1992, the conservative critic, John Carey, upset the received wisdom of the liberal intelligentsia when, after exposing the explicitly anti-democratic credentials of many of modernism’s leading figures, he cast doubt on the presumed connection between modernism and progressive thought. J. Carey, The Intellectuals and the Masses: Pride and Prejudice Among the Literary Intelligentsia, 1880-1939, (London, Faber & Faber, 1992)[xvi] M. Berman, All that is Solid Melts into Air: The Experience of Modernity, (London, Verso, 1983), p. 345[xvii] Ibid., p. 346[xviii] M. Sarup, An Introductory Guide to Poststructuralism and Postmodernism, (London, Harvester Wheatsheaf, 1993), p. 133[xix] See D. Bell, The Coming of Postindustrial Society: A Venture in Social Forecasting,(New York, Basic Books, 1973); V. Mosco and J. Wasko (eds.), The Political Economy of Information, (The University of Wisconsin Press, 1988); A. Callinicos, op. cit., pp. 121-127[xx] A. Callinicos, ibid., p. 170

Chapter 1: The Contemporary Sources of Relativism: Lyotard

2006-11-19T16:08:00.000-08:00

1. Lyotard
Any critique of relativism in the current period must take into account the impact of postmodernism on social and political thought, and acknowledge the scope of its influence. Throughout this thesis, many of the major themes of postmodernism are apparent: the rejection of rational and universalising theories; the celebration of difference and diversity over common values; and the treatment of ‘reality’ as a discursive or conventional phenomenon. But understanding the extent to which postmodernism delimits these themes is problematic, not least in relation to the definitional imprecision of the terms ‘modernism’ and ‘postmodernism’, ‘modernity and ‘postmodernity’. Therefore, despite being well established in the lexicon of contemporary social theory, it is important to highlight the different ways in which these terms are applied to social, economic and cultural phenomena before we can clarify both the temper of current intellectual trends and the need to explore the wider sources of the epistemological relativism that undergird postmodernist thought.

Postmodernism has come to be associated with a variety of developments within aesthetics, literary theory, philosophy and social theory. The term was first applied in relation to innovations in art and architecture, music, film and literature. In these particular fields, postmodernism came to represent the rejection of much of the modernist agenda, including the idea that originality is the highest expression of artistic endeavour, best accomplished through experimentation with aesthetic forms. From the 1950s onwards, the move towards eclecticism, pluralism, irony and pastiche became the most recognisable features of a postmodern aesthetic. Wider concerns about the relationship between representation and originality, the status of the ‘author’ and the ‘mediatization’ of reality accorded with the influence of postmodernist social theory, which began to emerge as a more or less distinct body of thought by the 1970s.

The many tracts produced in its name suggest that ‘postmodernism’ does not imply a consistent method of analysis towards the aesthetic, philosophical, cultural and political themes that it denotes. But what we can say is that by rejecting broadly rationalist notions of society and progress, as well as the idea of an intelligible, objective reality, the leading figures of postmodernism accelerated a tendency towards relativism throughout the social sciences.
Postmodernist philosophers and social theorists justify their celebration of indeterminacy, in part, by claiming to have exposed the restrictions that humanism and universalism have placed on the analysis of identity, culture and ‘difference’. Later in this chapter, I address this question by focussing on some of the ways in which poststructuralism and deconstruction have provided the intellectual framework through which the universal human project commonly associated with the Enlightenment and its heritage has been challenged. At this stage, however, in order to clarify the use of the terms, ‘postmodern’, ‘postmodernism’ and ‘postmodernity’, I want to concentrate on the ideas of two authors in particular: Lyotard and Baudrillard. Lyotard and Baudrillard are both associated, to a greater or lesser degree, with poststructuralism, but what sets them apart from other leading contemporary figures associated with the emergence of postmodernism is that much of their work centres around the characterisation of the current conjuncture as an identifiable shift in social, economic and cultural life. Their conceptions of this new ‘reality’ differ in focus, but they both identify postmodernity as a more or less distinct historical phase in the evolution of capitalism, and share a concern to address the philosophical problems borne of this alleged transformation.

In his seminal work, The Postmodern Condition (1979), Lyotard sets out to clarify the intellectual orientation of postmodern thought: ‘Simplifying to the extreme, I define postmodern as incredulity toward metanarratives’. The ‘metanarratives’ against which Lyotard’s scepticism is directed can be characterised as any attempt to make sense of the human experience by relating it to general or determinate tendencies in social development. During the last two centuries, Lyotard argues, this has given rise to four more or less distinct discourses: ‘the dialectics of Spirit, the hermeneutics of meaning, the emancipation of the rational or working subject, [and] the creation of wealth.’ Each of these expressions of allegiance to ‘Progress’, he maintains, anticipates the gulag and the gas chambers. ‘The nineteenth and twentieth centuries have given us as much terror as we can take’, he remarks. It is therefore imperative that we abandon such ‘grand narratives’, insofar as they have been applied to legitimate science, politics and ‘the modern’.

All attempts at realising the Enlightenment project, Lyotard concludes, are ‘totally obsolete’. However, whilst distancing himself decisively from the ideological narratives of socialism and capitalism, and from the wider intellectual foundations of ‘modernity’, Lyotard does not read postmodernism simply in terms of the supercession of ‘modernism’. At the same time as identifying the exhaustion of ‘the modern’, Lyotard’s conceptualisation of the postmodern is also oriented towards realising the potential of many of modernism’s aesthetic concerns. In their own attempt to define postmodernism, Robin Usher and Richard Edwards write: ‘Perhaps it is best understood as a state of mind, a critical self-referential posture and style, a different way of seeing and working, rather than a fixed body of ideas’. But although his ideas are consistent with this interpretation of postmodernism as an ‘intellectual mood’, Lyotard offers a definition of postmodernism that proves to be altogether more revealing, especially in light of his concern to highlight its affinity with modernism. Hence postmodernism, Lyotard claims, ‘is not modernism at its end but in its nascent state’.

This celebration of postmodernism as an extension of a progressive dynamic within modernism can be read as an attempt to fully realise the potential suggested by the aesthetic experiments undertaken by the major figures of ‘high modernism’. In the case of literature, for example, the shift from the supposed objectivity provided by fixed, all-knowing third person narratives – the ‘God’s-eye view’ – to the notion of multiple, discontinuous narratives is, according to Lyotard, consistent with his own emphasis on the incoherence and fragmentation of meaning that he sees as constitutive of the postmodern condition. Indeed, for Lyotard, ‘the postmodern’

would be that which, in the modern, puts forward the unpresentable in presentation itself; that which denies itself the solace of good forms, the consensus of a taste which would make it possible to share collectively the nostalgia of the unattainable; that which searches for new presentations, not in order to enjoy them but in order to impart a stronger sense of the unpresentable. A postmodern artist or writer is in the position of a philosopher: the text he writes, the work he produces are not in principle governed by preestablished rules, and they cannot be judged according to a determining judgement, by applying familiar categories to the text or to the work…. Postmodern would have to be understood according to the paradox of the future (post) anterior (modo).

Presented in this way, Lyotard’s vision of postmodernism appears to coincide with the aesthetic ambitions of modernism, inasmuch as, for instance, the works of modernist authors – from dos Passos and Doblin, to Joyce, Eliot and Pound – capture ‘our inability to experience reality as an ordered and integrated totality’.

Nonetheless, whilst Lyotard’s postmodernist outlook rejects all universalist political ambitions as grand narratives that have outlived their usefulness, the fragmented view of both the Subject and ‘History’ associated with modernism did not preclude (at least, ostensibly) aspirations towards social change and emancipation. Similarly, modernism’s articulation of regret at the loss of certainty and meaning in the modern world was accompanied by a celebration of modern life’s thriving creativity. Like Marshall Berman’s vision of the archetypal modernist, the postmodernist, too, may find him or herself ‘at home in the maelstrom’ of a world ‘in perpetual disintegration and renewal, trouble and anguish, ambiguity and contradiction’. And yet Lyotard turns away from the kind of nostalgia for wholeness that saw modernists, despite the prominence that they gave to aesthetic innovation, obsess over a past they felt compelled to reconstruct. Instead, Lyotard identifies ‘the unpresentability of the whole’ and the fragmentation of history and subjectivity as primarily opportunities to promote a liberating social and political diversity in the present. Thus instead of the belated application of modernism’s most experimental ideas, postmodernism is a body of thought that welcomes and interprets the contingency and provisionality of social relations as an arena for the reconfiguration of radical thought.

This returns us to the second dimension of the postmodern. Lyotard presents the postmodern condition as a specific historical situation – ‘postmodernity’ – marked by distinct ideological, philosophical, social, cultural and technological trends. The disunity and fragmentation that Lyotard embraces in the modernist aesthetic finds its social and economic counterpart in a distinct stage in the development of late, ‘consumer’ capitalism. For Lyotard, ‘postmodernity’ represents the transformation of knowledge. The ‘computerisation of society’, he reasons, has ensured that the primary criterion of the social order, along with technology itself, is the statutory competition over information at a national and international level. From this perspective, ‘computerised knowledge’ has become ‘the principal force of production’, such that knowledge that cannot be transformed into computerised information is no longer applicable.

It is this alleged shift in the condition of knowledge that suggests parallels between Lyotard’s ideas and theories about the transition to a ‘postindustrial’ age. Later in this chapter, we will see that what concerns Lyotard above all is the question of whether or not knowledge, ‘scientific’ or otherwise, can be grounded in truth. What is clear however is that Lyotard’s approach to understanding the transition to a postmodern age confirms and complements a wider belief in the exhaustion of both ‘modernity’ (understood as the implementation of the Enlightenment project) and a Subject-centred society (through which the individual is understood to acquire self-knowledge through reason and rationality).

This question of the ‘decentred’ Subject is a key theme for philosophers and sociologists working within the orbit of postmodernism. Deriving principally from structuralist anti-humanism, it is of central importance, for instance, to radical interpretations of the political role and constitution of gender, race and ‘difference’ more generally. The idea of the decentred Subject takes on renewed significance for poststructuralists. The radical implications of this for social and political thought are touched upon in some detail later, in both this and subsequent chapters. What I want to stress here is how the relativist trajectory of poststructuralist and postmodernist ideas arose partly as a consequence of the breakdown of (structuralist) semiology. This is reflected in the work of Baudrillard, the second of postmodernism’s most prominent theorists to have provided ‘lengthy philosophical commentaries on the present’, and whose ideas about the ‘depthlessness’ of postmodern capitalism I now want to turn to.

Notes:

A. Schutz, The Phenomenology of the Social World, trans. G. Walsh and F. Lehnert,
(London, Heineman, 1976); P. L. Berger and T. Luckmann, The Social Construction of Reality: A Treatise in the Sociology of Knowledge, (London, Penguin, 1967). Although its theoretical origins lie with Edmund Husserl, the dictum that ‘reality is a social construct’ is commonly attributed to the Austrian sociologist Alfred Schutz. It is also associated with the American sociologist Peter Berger, who, together with the German sociologist Thomas Luckmann, ‘moved American sociology irretrievably out of the positivist orbit with his phenomenologically inspired’ work. J. Heartfield, ‘American Pragmatists’, Intellectual
Currents of the Twentieth Century, (http://www.heartfield.pwp.blueyonder.co.uk/pragmatic.htm, July 1997)
‘Modernism’ was the movement in the visual arts, literature, music and drama that
emerged at the turn of the twentieth century and which challenged broadly Victorian ideas about the production and meaning of art. ‘Modernity’ is often equated with ‘capitalism’. It can also be understood as the accumulation of capitalism’s social, cultural and technological forms. Alan Hudson suggests that ‘modernity is merely the phenomenal form of capitalist social relations embodying all the contradictions of that society.’ A. Hudson, ‘Introduction’, in F. Engels, Socialism: Utopian and Scientific, (London, Junius, 1995), p. xxxiii. For James Heartfield, meanwhile, ‘the idea of ‘modernity’… is hopelessly imprecise’:

After all, which modernity are you talking about? The one with the bakelite fixtures and the telegraph wires, or the one with the formica and the mainframe? Modernity was always a useless category because it fixed not on social determinants, like the free market, but on technical features, like ‘heavy industry’. Being itself an imprecise category, qualifications like postmodernity are even less satisfactory, since we do not necessarily agree on what modernity is, let alone what comes after.

J. Heartfield, ‘The Risk Zone’, Living Marxism, No. 80 (June 1995), p. 48. Broadly speaking, postmodernists use the terms ‘modern’, ‘modernism’ and ‘modernity’ interchangeably as the embodiment of the Rationalist and Enlightenment ideas of the 17th and 18th centuries, and their implementation throughout the 19th and 20th.
See C. Jencks, What is Postmodernism?, (London, Academy Edition, 1986); E. Lucie-
Smith, Movements in Art Since 1945, (London, Thames and Hudson, 1992)
See H. Foster, Postmodern Culture, (London, Pluto, 1985); S. Connor, Postmodernist
Culture: An Introduction to Theories of the Contemporary, (Oxford, Blackwell, 1989); D. Harvey, The Condition of Postmodernity: An Enquiry into the Origins of Cultural Change, (Oxford, Blackwell, 1989); F. Jameson, Postmodernism, or, The Cultural Logic of Late Capitalism, (London, Verso, 1991); M. Morris, The Pirate’s Fiancée: Feminism, Reading, Postmodernism, (London, Verso, 1988); R. Young (ed.), Untying the Text: A Post-Structuralist Reader, (London, Routledge, 1981); S. Sim (ed.), The Icon Critical Dictionary of Postmodern Thought, (Cambridge, Icon Books, 1998), especially S. Sim, ‘Postmodernism and Philosophy’, pp. 3-14; A. Easthope, ‘Postmodernism and Critical and Cultural Theory’, pp. 15-27; I. H. Grant, ‘Postmodernism and Politics’, pp. 28-40; D. Morgan, ‘Postmodernism and Architecture’, pp. 78-88; C. Trodd, ‘Postmodernism and Art’, pp. 89-100; M. O’Day, ‘Postmodernism and Television’, pp. 112-120; B. Lewis, ‘Postmodernism and Literature (or: Word Salad Days, 1960-90)’, pp. 121-133, D. Scott, ‘Postmodernism and Music’, pp. 134-146; L. Spencer, ‘Postmodernism, Modernity and the Tradition of Dissent’, pp. 158-169
See J.-F. Lyotard, The Postmodern Condition: A Report on Knowledge, (Manchester,
Manchester University Press, 1984); P. Dews, Logics of Disintegration: Post-Structuralist Thought and the Claims of Critical Theory, (London, Verso, 1987); M. Foucault, Power/Knowledge: Selected Interviews and Other Writings, 1972-1977, ed. C. Gordon, (Brighton, Harvester Press, 1980); J. Derrida, Between the Blinds: A Derrida Reader, ed. P. Kamuf, (London, Harvester Wheatsheaf, 1991)
J.-F. Lyotard, ibid., p. xxiv
Ibid., p. xxiii
Ibid., p. 81
Ibid., p. xxiii
M. Featherstone, ‘In Pursuit of the Postmodern: An Introduction’, Theory, Culture and Society, Vol. 5, No. 2/3 (June 1998), p. 198
R. Usher and R. Edwards, Postmodernism and Education, (London, Routledge, 1994),
p. 2
S. Grenz, A Primer on Postmodernism, (Grand Rapids, Eerdmans, 1996), p. 12
J.-F Lyotard, op. cit., p. 79
Ibid., p. 79.
A. Callinicos, Against Postmodernism: A Marxist Critique, (Cambridge, Polity, 1989), p.
18
I say ‘ostensibly’ because it would be wrong to take modernism’s radical credentials for
granted. In 1992, the conservative critic, John Carey, upset the received wisdom of the liberal intelligentsia when, after exposing the explicitly anti-democratic credentials of many of modernism’s leading figures, he cast doubt on the presumed connection between modernism and progressive thought. J. Carey, The Intellectuals and the Masses: Pride and Prejudice Among the Literary Intelligentsia, 1880-1939, (London, Faber & Faber, 1992)
M. Berman, All that is Solid Melts into Air: The Experience of Modernity, (London, Verso, 1983), p. 345
Ibid., p. 346
M. Sarup, An Introductory Guide to Poststructuralism and Postmodernism, (London, Harvester Wheatsheaf, 1993), p. 133
See D. Bell, The Coming of Postindustrial Society: A Venture in Social Forecasting,
(New York, Basic Books, 1973); V. Mosco and J. Wasko (eds.), The Political Economy of Information, (The University of Wisconsin Press, 1988); A. Callinicos, op. cit., pp. 121-127
A. Callinicos, ibid., p. 170

Inroduction

2006-11-19T15:46:00.000-08:00

Introduction

This thesis explores several related themes linked to the tendency towards relativism and anti-humanism in social theory. Within the broader context of the influence of poststructuralism and postmodernism I seek to identify the main sources of social constructionist (conventionalist) theories of ‘the social’, and to clarify their relationship to the politics of ‘difference’. Paying particular attention to the impact of these trends on theories of gender and race I suggest the need to retrieve a humanist and historical materialist approach to understanding the relationship between the universal and the particular, difference and the Subject.
Much of the academic writing on questions of ‘identity’ and ‘difference’ expresses explicitly political concerns. This thesis is also concerned with the political questions raised by recent developments in social and cultural theory. However, my concern is to confront the conservative assumptions of postmodernist thought, by focussing on the ways in which the inter-dependence of relativist and anti-humanist ideas profoundly restricts the scope of progressive thought. Indeed, deriding and relativising traditional certainties, postmodernism denigrates the possibility of a society-wide political project of any kind. Beginning from the assumption that a universal worldview cannot be fashioned from the fragmentary nature of human experience postmodernists celebrate difference and its irreducibility to a single theory. My contention is that postmodernism and radical relativism, by celebrating marginality, make a virtue of powerlessness and inequality.

Central to postmodernist thought is a rejection of the humanist ideal of universal truth. Conflating objective reality with our interpretations of it postmodernists argue that ‘truth’ resides entirely within language, discourse and representation. It follows from this moreover that our means of making sense of the world are inextricably linked to cultural context. Hence science and logic, rationality and universalism are deemed to be no less culture-bound than other forms of human thought. The pessimistic and defeatist ideology of ‘difference’, I suggest, is rooted in this relativistic outlook.

The immediate pre-history of the trend towards relativism in radical social theory is to be found in the involution of French humanism. First, during the 1960s, French rule in Algeria became the focus for political and intellectual opposition to ‘French universalism’, which was widely judged to be a mask for European racism, and thus a justification for barbarism.[i] Second, precipitated by the failures of the French left, over Algeria and May 1968, a broad theoretical retreat from the Subject saw the focus of social change shift from the working class to the New Social Movements. It was through the New Left’s radical critique of universalism that the philosophy of ‘difference’ first took hold.

Theoretically, the gestation of postmodernist thought began with the deconstruction of the Marxist tradition, but culminated in the dismissal of all ‘grand narratives’. Lyotard and Baudrillard, both former Marxists, are crucial in this respect; and I consider their theories of the postmodern here.[ii] Lyotard in particular is pivotal to my examination of the main themes of postmodernist philosophy, as his work goes furthest in enlarging upon its political implications. The theoretical anti-humanism of postmodernism also owes much to Althusser’s structuralist interpretation of Marxism; and I examine his contention that the Subject is an effect of ideology mainly via its influence on the ‘identity’ theory of Hall and Butler. Althusser interprets Marx’s rejection of the ‘bourgeois’ Subject as hostility to humanism per se. Subsequently, through their challenge to the allegedly exclusive nature of traditional/modern notions of subjectivity, identity theorists have developed the idea of the socially limited Subject. This, I argue, is the starting point for the reciprocal relationship between relativism and anti-humanism.

Postmodernists argue, correctly, that women, black people, gay people, the mentally ill, and other marginalised persons and groups have been excluded from the status of Subject. Furthermore, because they argue that the Subject is subordinate to a narrowly ‘Eurocentric’ social order, they conclude that any struggle to be ‘included’ within a ‘universalist’ worldview will be counter-productive. Rather it is necessary, they claim, to establish different ways of articulating ‘identities’. Paradoxically, the perception that such an intellectual project risks being reduced to counterposing a ‘true’ Subject to a ‘false’ one also gives rise, ostensibly, to the tension between the particular and the universal in identity theory.

This problem of the meaning and scope of identity and difference is central to my overall thesis. For instance, I evaluate developments within feminist theory on the basis that its particularist theoretical trajectory explains both its failure to theorise women’s oppression and its disintegration as a body of thought. The particularism-universalism problematic within feminism, I argue, emerged in stages. First, radical feminism established a fundamental basis for unity between women: the capacity to bear children and a transhistorical system of male oppression (patriarchy). Second, socialist-feminism attempted to substitute a materialist explanation for women’s oppression for the biological essentialism of radical feminism, but remained attached to the ahistorical framework of patriarchy. Third, French poststructuralist feminism sought to explore, articulate and celebrate gender-specific differences, only to endorse an idealistic universalisation of femininity. Lastly, constructionist and postmodern feminisms have set out to deconstruct the abstract conceptualisations of the particular and the universal adopted by ‘identitarian’ feminisms, positing, in the process, an equally abstract ‘universalised difference’.

My criticisms of the failure of Butler to resolve the particularism-universalism problematic within feminism apply no less to Hall, despite some differences in his approach to theorising difference. Yet the question of ‘universalising difference’ necessarily has a much broader scope in my discussion of race and ethnicity. The historical and theoretical paths taken by cultural relativism are looked at in detail here, and I evaluate wide-ranging developments in the relationship between social constructionism/poststructuralism and theories of ethnicity. Despite its changing contours and different expressions there is a persistent emphasis within radical social theory on the different ways in which identities are said to be ‘constructed’. Similarly, ‘anti-foundationalist’ or ‘anti-essentialist’ arguments are frequently directed at what is widely considered to be the excessively restrictive nature of a politics built upon ‘universal’ allegiances: ‘woman’, ‘black’, ‘gay’.

Primarily, these theoretical disputes address the question of how to undermine the universal pretensions of the Subject without reproducing the ‘false universals’ of ‘interpellated’ Subjects. My evaluation of Hall’s and Butler’s approaches to resolving these tensions between the particular and the universal brings together elements of two broad theoretical themes that I explore throughout the thesis: structuralist/poststructuralist influences on theories of ‘difference’, and conventionalist (or social constructionist) theories of the social. Derrida is arguably the most important philosopher of poststructuralism, and many of the most important aspects of his work, and their influence on the politics of difference, are examined here. I argue that, to a great extent, poststructuralism’s anti-humanist approach to problems of identity radicalises rather then overthrows themes that are derived from structuralism.

Poststructuralism adopts the structuralist move of treating all discourses as analogous with language, only to allow for a greater emphasis on indeterminacy and difference by rejecting structuralism’s claims to be able to disclose society’s underlying signifying systems. Poststructuralist ideas are addressed here in relation to their role in enabling social and cultural theorists to theorise difference in terms of discursive practices.
Conventionalism is explored in terms of its reduction of the social to inter-subjectivity. Within identity theory, the tendency to fragment social relations into their immediate cultural context arises from the tendency to conflate the mediate social with the immediate intersubjective. The impact of anti-essentialism is considered in this context. Because of its opposition to the idea of a ‘social essence’ anti-essentialism obscures social determinants. This, I argue, is a central failing of much of postmodernist social theory.

Whilst I situate the problem of relativism and anti-humanism largely within the ‘postmodernist’ discourses of recent decades I also look to wider sources to explain some of the philosophical and methodological tendencies in contemporary thought. In this respect, I address three broad areas. First, I examine the roots of the conventionalist approach to theorising the social in Wittgenstein’s ‘second philosophy’, Kuhn’s philosophy of science and Husserl’s phenomenology. Second, I consider the importance of German anti-rationalist thought for contemporary social and cultural theory, focussing on the parallels between both Nietzsche’s and Heidegger’s ideas and the radical pessimism of postmodernism. And third, I look at the emergence of cultural relativism in the Romantic reaction to the Enlightenment, and its subsequent elaboration within social and cultural anthropology. Here, I pay particular attention to the work of the structuralist Lévi-Strauss, whose ideas form an important link to poststructuralist and postmodernist theories of culture and difference.

A final dimension to my critique is a consideration of the concept of the Other. I argue that the reconceptualisation of Hegel’s Master-Slave dialectic, which can be attributed to several sources (Kojeve, de Beauvoir, Sartre), and which has been applied in feminist and anti-racist thought (Irigaray, Cixous, Said, Hall), eternalises the opposition between Self and Other. As the mainstay of the project to decentre the Subject, the concept of the Other leaves ‘difference’ impossible to overcome.

Methodology
My methodology can be situated within the Marxist tradition. It owes much, for example, to the work of Lukács, especially his analysis of ideology, his concept of ‘totality’ and his defence of the ‘subjective factor’. I also draw on Guldberg’s defence of a ‘unitary’ theory of women’s oppression. Other important reference points for my work include Heartfield’s critique of post-materialism, Malik’s analysis of ‘race’ and Füredi’s critiques of academic Marxism. Recent Marxist scholarship has also been useful (Anderson, Callinicos, Palmer, Wood, Žižek).[iii]

The historical materialist approach that I adopt is also important in understanding the philosophical scope of this thesis. First, a major concern for me is the abandonment of Marxism by important theorists of the ‘postmodern condition’ (Lyotard et al.). As such, whilst there have been several attempts to defend the Subject against the effects of relativism (Rawls, Rorty, Taylor), my critique is motivated by the way in which the degradation of Marxist thought, especially in Althusser, continues to inform the idealism and impressionism of many of Marxism’s former adherents.[iv] Second, because I am concerned primarily with the impact of relativism and anti-humanism on social theory, the philosophical breadth of this thesis is somewhat limited. It is the specific impact of different strands of philosophical thought on the development of postmodernism and sociology that I am concerned with, not philosophy as such. My focus is on defending a materialist and ‘essentialist’ approach to grasping the character of social phenomena.

Terminology
The terminology associated with relativist thought can mystify more than it clarifies; and postmodernism can often make obfuscation a virtue. Nonetheless, terms like ‘relativism’, ‘particularism’ and ‘perspectivism’ should generally be treated as interchangeable here. By contrast, I have endeavoured to make clear that ‘conventionalism’, whilst it implies a relativist outlook, is not reducible to it. To avoid confusion, I understand conventionalism (or ‘social constructionism’) as the tendency to reduce determinate social relations to contingent, intersubjective relations.

Structure
The structure of this thesis is designed to explore these themes in relation to both established and growing trends in social thought, and the prospects for a credible challenge to them. Chapter 1 maps out some of the important contributions to, and influences upon, postmodernist and relativist thought. Chapters 2 and 3 look at the different ways in which ‘identity’ has become one of the principal concerns for radical thought. The two major areas of interest are ‘gender’ and ‘race’. Chapter 2 explores the most significant developments within feminist theory over recent decades, and relates these changes to the inherently particularist nature of feminist epistemology. Chapter 3 considers the ways in which notions of ‘difference’ have been developed in relation to theories of ‘race’ and ‘ethnicity’, and examines the implications of these ideas for anti-racist thought. Chapter 4 looks at Hall’s and Butler’s attempts to resolve the particularism-universalism problematic. It also tackles the specific limitations of identity theory and conventionalist theories of ‘the social’. Lastly, it addresses the current status of the Subject in radical thought. The conclusion considers, briefly, the retreat from engagement that the politics of difference represents; and highlights some strengths and weaknesses in recent Marxist writing on postmodernism and anti-humanism. Finally, it points towards some important critical developments.

[i] J.-P Sartre, ‘Preface’, in F. Fanon, The Wretched of the Earth, trans. C. Farrington,
(Harmondsworth, Penguin, 1967), pp. 7-26
[ii] J.-F. Lyotard, Libidinal Economy, trans. I. H. Grant, (London, Athlone, 1993); J.
Baudrillard, ‘The Mirror of Production’, in J. Baudrillard, Selected Writings, ed. M. Poster, (Cambridge, Polity, 1988), pp. 98-118
[iii] G. Lukács, History and Class Consciousness: Studies in Marxist Dialectics, trans. R.
Livingstone, (London, Merlin, 1971); G. Lukács, A Defence of ‘History and Class Consciousness’: Tailism and the Dialectic, trans. E. Leslie, (London, Verso, 2000); J. Heartfield, Need and Desire in the Post-Material Economy, (Sheffield, Sheffield Hallam University Press, 1998); F. Füredi, The Soviet Union Demystified: A Materialist Analysis, (London, Junius, 1987); F. Füredi, ‘Introduction’, in F. Jakubowski, Ideology and Superstructure in Historical Materialism, (London, Pluto, 1990), pp. vii-xxxiii; F. Füredi, Mythical Past, Elusive Future: History and Society in an Anxious Age, (London, Pluto, 1992), pp. 260-267; K. Guldberg, ‘Introduction’, in F. Engels, The Origin of the Family, Private Property and the State, (London, Junius, 1994), pp. ix-xxv; B. D. Palmer, Descent into Discourse: The Reification of Language and the Writing of Social History, (Philadelphia, Temple University Press, 1990); P. Anderson, The Origins of Postmodernity, (London, Verso, 1998); A. Callinicos, Against Postmodernism: A Marxist Critique, (Cambridge, Polity, 1989); E. M. Wood and J. B. Foster (eds.), In Defense of History: Marxism and the Postmodern Agenda, (New York, Monthly Review Press, 1997); S. Žižek, The Ticklish Subject: The Absent Centre of Political Ontology, (London, Verso, 1999)
[iv] J. Rawls, Political Liberalism, (New York, Columbia University Press, 1993); R. Rorty,
Objectivity, Relativism and Truth: Philosophical Papers, Vol. 1, (Cambridge, Cambridge University Press, 1991); C. Taylor, Sources of the Self: The Making of Modern Identity, (Cambridge, Cambridge University Press, 1989)

A Doctoral Thesis To Pass The Time With

2006-11-19T15:41:00.000-08:00

Abstract

This thesis explores several related themes linked to the tendency towards relativism and anti-humanism in radical social theory. Within the broader context of the influence of poststructuralism and postmodernism I seek to identify the main sources of social constructionist (conventionalist) theories of ‘the social’, and to clarify their relationship to the politics of ‘difference’. Paying particular attention to the impact of these trends on theories of gender and race I suggest the need to retrieve a humanist and historical materialist approach to understanding the relationship between the universal and the particular, difference and the Subject.
Chapter 1 maps out some of the important contributions to, and influences upon, postmodernist and relativist thought. Chapters 2 and 3 look at the different ways in which ‘identity’ has become one of the principal concerns for radical thought. Chapter 2 explores the most significant developments within feminist theory over recent decades, and relates these changes to the inherently particularist nature of feminist epistemology. Chapter 3 considers the ways in which notions of ‘difference’ have been developed in relation to theories of ‘race’ and ‘ethnicity’, and examines the implications of these ideas for anti-racist thought. Chapter 4 looks at Hall’s and Butler’s attempts to resolve the particularism-universalism problematic. It also tackles the specific limitations of identity theory and conventionalist theories of ‘the social’. Lastly, it addresses the current status of the Subject in radical thought. The conclusion considers, briefly, the retreat from engagement that the politics of difference represents, and highlights aspects of recent Marxist writing on postmodernism and anti-humanism. It also points towards some important critical developments.