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Assistencialism vs. Liberation

Assistencialism vs. Liberation
Tina Minkowitz - Mon Oct 25, 2010 @ 05:45AM
Comments: 106

Colleagues in the Latin American disability movement have been quick to point out when something looks to them like "assistencialism". I looked this up and found several references, including one in Paulo Freire's Education for Critical Consciousness, that associate "assistencialism" with colonialism, treating the person as a passive recipient of aid rather than an active transformer of his or her environment.

Assistencialism is a good concept to use to critique projects that are being developed in relation to the CRPD. Is this a project that people with disabilities in the country where the project takes place control? Are there hierarchies among people with disabilities in the project that mean some of them are relegated to the position of passive recipients of the project formula, of the terms of reference, etc., that someone else has designed for them?

Assistencialism can be contrasted to the kind of support that we envision in relation to CRPD Article 12, and the exercise of legal capacity. We assume that everyone has an equal right to make decisions - an equal right and an equal ability, respective to one's own circumstances, to exercise self-determination, to be the transformative power in one's own life, to be the filtering consciousness and the choice of where to put energy, to act on choices and not be acted on by others in one's act of choosing. This right is violated when the law does not respect a particular person's right to make decisions, and also when the law does not protect a person against economic and social circumstances that narrow the possible choices to an intolerable oppression. Everyone's choices are limited by the choices and rights of others, but poverty, discrimination, corruption, systemic violence and other such conditions can effectively deprive a person of the right to exercise self-determination even if she or he has not been deprived of legal capacity in a formal sense. The right to self-determination and legal capacity can also be violated when a person does not have access to support that she or he needs, given the particular individual circumstances, to make choices that are meaningful to him/herself.

Article 12 support is not euphemistic "support" that assumes a person can't do it for him/herself but needs to have his/her ego propped up by being formally in charge. It is support that is obligated to play a secondary role not only by keeping offstage but by placing the other person's needs and wishes at the center, to the extent of defining what kind of support the supporter will give. It is not about feeding lines to the actor, but finding out what the person wants to say and do and helping him/her to say it and do it.

Support could be turned into assistencialism if it gets lazy, if it is only about how something is characterized in an official report, or if it is pretextual from the beginning (e.g. if the supporter really wants to maintain control over the other person). In the same way, projects that offer support should be critiqued by communities - and communities should either find a way to avoid donor funding, or donor funding will itself have to change to internalize the principles of support and reject assistencialism. Much of the funding going to projects related to the CRPD qualifies as assistencialism rather than support, putting resources to technocrats rather than communities, and manifesting disrespect for communities. This can happen at many levels, from decisions about the scale of projects to the question of whether an organization is run by its members or by unaccountable and assistencialist staff.

Another manifestation of assistencialism is in mental health reforms, both reforms of "mental health law" and "de-institutionalization". Any reforms that maintain the lawfulness of detention in psychiatric institutions, under any circumstances, maintain the assistencialist paradigm - treating people in psychic distress or crisis as "mental patients" rather than as people undergoing a transformation who remain active through this transformation. The same is true of de-institutionalization that transfers people to smaller group homes outside the large institutions, but still supervised by mental health workers. Defining people as patients deprives them of the need and opportunity to take responsibility for their choices beyond the limits prescribed to them by the mental health system. While some people may want group living and even a certain kind of supervision (as in monasteries), this should be treated as a choice and not as social policy.

For Freire and other writers on assistencialism, responsibility is inextricable from subjectivity and subject-hood. Freire talks about transitive consciousness, consciousness of one's environment that is necessary to transform it. Consciousness does not have to begin in any particular place or with any particular scope, it could start with the forest or with any tree. Support, like education, needs to meet the person at the point where his/her consciousness begins, and feed the continuing expansion without force-feeding.

The concept of assistencialism and its contrast to the kind of support we envision for Article 12 (and in general) should be incorporated into our analysis in the international disability community. I would also be especially interested to hear more from Latin America about how they use the concept and whether it can help to make a bridge of understanding with other human rights constituencies.

Comments: 106

Comments

1. Hélène Grandbois   |   Wed Nov 17, 2010 @ 06:10AM

I want to know more and post this to a Bresilian friend who works in this field.

2. Tina Minkowitz   |   Wed Nov 17, 2010 @ 12:03PM

Hélène, Please feel free to share this with your Brazilian friend. I'm not sure what else to say, I wrote that post after a trip to Argentina and was reflecting on many things at once. I still want to understand more myself, about how the concept of "assistencialism" is used and whether people in Latin America would think my use of the term makes sense.

3. Jeff Kelly   |   Thu Dec 23, 2010 @ 06:21PM

The mental health system will NEVER---EVER--adopt a paradigm free of paternalism or the term used above--can't pronounce it easily and really find it hard to so much as spell it.
ALL--ie, the SUM TOTAL--of what the mental health system is all about---is defined by business interests--that of psychiatrists, ancillary health care workers, pharmaceutical companies, and hospitals and the county mental health centers that support them all--and the fear-mongering that the politicians, judges, and lawyers who gain from the system or who do not have the cajones to challenge it help keep.
I read a very very disturbing piece on the internet recently--wish I kept the URL but anyway--it is written in such a clever way so as to easily deceive the reader if one's consciousness gets lazy for a moment or the duration of the article--about how one type of mental patient is defined--the so called SPMI--or "Severe Persistent Mental Illness" patient. This is all circular reasoning of course--with all the circles therein flowing back in supporting already proven bankrupt ideas. The mental health system does not care--it perpetuates itself and that is its ONLY purpose. Once a person is labelled "SPMI"---it is much worse than being labelled with any other label the mental health system has invented---then logically the right is handed over to the mental health system to do whatever it wishes to anyone--mostly involving the old phrase "lock 'em up and throw away the key". It's frightening--but quite real. The business interests involved are just too strong and overpowering.
The only encouragement I find in all this is that almost any Jewish person can tell you what the Shul teaches about The Holocaust and the psychologic techniques used by Nazi Germany's authorities to perpetrate lies, bigotry, and hatred based on villification of a group of people that had no basis in truth and instead was cleverly manufactured entirely out of whole cloth. The techniques used by those in charge of the mental health system follow very similar patterns of thought---almost identifical as a matter of fact. The principles are very basic yet of potent effect: 1)Villify a group of people by accusations and labelling, no matter how inaccurate any of those activities may be; 2)Blame this group of people for some real or imagined ill that has befallen the whole of the society
3)Advocate for their physical removal from the rest of society;4)Argue that by virtue of their physical removal from society, this is "proof" this group of people is "bad";5)Exact torture and denial of basic human rights against such people as "punishment" for their being "bad"("Jude");6)Now deprive them of basic necessities like food, clothing, and shelter;7)Actively torture them and murder them;8)Conduct a distractive action(EG start WW II in Europe) that takes attention away from these human rights violations. That's pretty much how Hitler and his gang did things--and the fact that most of America fails to recognize what is going on in its mental health system only testifies to the continued potency and effecaciousness of the basic techniques used today by the mental health system to effect societal control which does in fact include torture and other abuses and holds no regard for any civil right imagined or real on the part of "participants" in the system.
"The proof is in the pudding": mental health system advocates year after year assert that more money, more power and control, more forced interventions, are the only way to "save" humanity. It's nonsense. The suicide rate is higher than it's ever been--which instead of using as a reason to think about changing the system as it is--is conversely(and illogically) used to argue for "more of the same". There is no argument on earth that would hold to such a trend except that more people are getting wealthy on this system than are getting more poor--and this is the real if not talked about societal norm--or societal stability point if you will--that keeps the system as it is:entrenched, unreformable, and unstoppably brutal and without any effective redress on those victimized by it. And moreover--no science at all is attached to this brutality. Psychologists study science and use science, but Psychiatrists only use coercion and the most poisonous drugs to supposedly effect great therapy upon people--a therapy and ostensibly humane attribute of "caring in this way"-- that we know to be nonexistent in truth.
Forced treatment is a highly lucrative means of keeping the business elements of the system flowing--the drugs coming in and being consumed and coming in more again--the "need" for such treatment established and re-established by so-called "Psychiatric histories which are long"--which the system only uses to order more of the same. It is in an overall societal context among the most brutal models of treatment of people ever devised by the human mind--and yet it continues unabated because so many people do not know--and would not believe--what goes in in mental wards at the hands of those who control the system and benefit by it.
There isn't one single branch of science--including mainstream medicine--that would look at things in this way, run things this way, and still with a straight face maintain that what is being practiced is "science." Thomas Szasz puts it succinctly in describing that in his training days, only three separate and distinct entities defined as mental illnesses existed, and since that time the number has exploded exponentially--to meet the demands of the drug industry, which necessitates the invention of more and ever more "mental illnesses" as defined.
The relatively easy way any person can become an involuntary hospital patient in America underscores the facts here. One can simply walk into a hospital and describe vague emotional symptoms, be involuntarily committed by a bogus interview process, and have their insurance bilked--especially if it is public health insurance because this is the biggest source today of insurance fraud and abuse. I know--I recently actually deliberately tested the system to see how easily this could be done. It's absolutely amazing to view this and to note that the lives of most people are not aware of the dark shadows of the human devisings that are reflected in this system. During my test, I learned of a legal technique used by this particular hospital to order drugging, and was told that process was initiated against me. Eventually the Psychiatrist himself became aware of my game and promptly got his ego in a bunch over my blatant attempts to screw with the system and ordered my release on what I believe was this ego-driven consternation--but not before I advised a couple patients on their legal rights under specific laws. (Prior to this I was involuntarily hospitalized in a sham incident that was very dramatic and terrible and reminded me of the involuntary commitment I was subjected to at age 11 for five weeks at Albany, NY-when they used Straighjackets, Solitary Confinements, Shooting Drugs in Buttocks, and the usual control techniques on me, while I watched others endure electroshock treatments and the like.
The mental health system, to summarize, has everything in common with the most repressive societal systems ever found in human history---including the fact that those once denied their rights will never--repeat NEVER--regain them as long as they remain in the system. PERIOD.
I can offer NO HOPE at all because there is none--Ralph Nader didn't become President and we still have self-deceived people out there that think that to be so militantly opposed to the mental health system means you have no heart for anyone. The reality is the exact opposite tends to be much truer if not wholly purely true. Man is by nature a ruinous creature and left to his own devices will always happily ruin someone else's life including and up to killing them--as long as there are grand benefits on this journey, and with the mental health system, there most certainly are grand and glorious financial benefits for those who run the system and those who benefit by it otherwise in the manufacture, sale, and distribution of drugs. Security guards regularly injure and kill people within the system and usually suffer no sanction for doing so and will usually return to their jobs at the hospital day after day and year after year. Simple. Sad. Frightening. And Unchangeable. The only thing that can be done that is efficacious is to remove as many people FROM that brutal system as humanly possible, to do so starting now and ending never, and to do as much of this as humanly possible to do.

4. Tina Minkowitz  |  my website   |   Sat May 21, 2011 @ 07:27AM

Jeff,

Thank you for your right-on comments. I don't have any hope that the mental health system will change of its own accord. But I do have hope that like other oppressive systems that have been defeated - e.g. the institution of chattel slavery in the U.S. (though slavery still goes on here & in other countries, it is not legal and the courts would not enforce any person's "ownership" of another person) and South African apartheid - I believe that forced psychiatry as an institution upheld by and through law, can be defeated.

Your comparison with the Nazi system is very apt, and a friend and activist, Louise Wahl, who has passed away due to the long-term effects of psychiatric drugs, used to say that the Nazis won, and I believe this is what she meant. Louise and her husband had been living in Paris and fled Europe to return to the U.S. (because of the Nazis). After the Nazis were defeated (militarily anyway) there was a trial of the judges, along with the other Nuremberg trials of war criminals. I need to go back and read the case again, but the premise seems to have been that judges could be held responsible for enforcing unjust laws when they shared the persecutory intent. It will be interesting to see if this can be applied to judges who enforce mental health laws.

Again thanks for your comments, and I hope to continue hearing from you.

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