The Speed of Care
We live in an age of acceleration. Food comes to us fast, already prepared and delivered to our homes, or delivered and ready to prepare. We live in a fast food world, for sure, but we also live in a fast food production world: we don’t have to wait for the cherry trees to root, blossom, and produce: we have cherries and berries on demand, brought to us from places around the world we’ll never know or experience. When we were growing up on the prairies of Kansas, we waited for our food to grow, we watched our food grow, we smelled the ripening wheat and the decaying silage, and we felt the processing of our food; and on occasion we helped our mothers with the preparation of food. Our senses, all of them, were fully engaged with food and the environment around the culture of food. We were in nature and culture simultaneously. We were present.
Yet as young children we were on the edge of a transformation in agriculture: steadily small farms were replaced by megafarms run by computers and the chemical industry (see blogpost: photoessay on the mega-chemical farms). Jeff remembers the farm auctions. They were events, often each weekend. He stood alongside his father, listening to the banter of the auctioneer and watching the small farmer as they saw their livelihoods and histories swallowed up by the bigger farmers, who felt no remorse. Jerry’s father was a member of a dairy cooperative, selling only one or two, three-gallon milk cans daily. Very quickly (After 15 years—1963— of small family farming, Jerry’s parents quit when farms had to double in size to keep up with the speed of agriculture), producers of food were losing connections with consumers and farmers altogether abandoned their alliance with the local COOP, the landscape, the biome, and the culture of food. Slow food, in all of its aspects, was replaced by fast food. In 1970, when we were still in high school, Americans spent around $6 billion on fast food; by 2000, it had climbed to more than $110 billion (Schlosser, 2012). Talkspace, a large corporate teletherapy service provides service 24/7/365, is to small mental health practice what corporate farming was to the family farm (see our post on the COOPerative movement.)
And our sense of food has given way to the speed of all things (Virilio, 1977). Technology enables us to live a life marked by speed: in food production and consumption, in transportation, in war, in accessing and distributing knowledge, in entertainment and news, in social interactions and conversation, in love and sex, in politics and civil society. Few of us live in the places we’ve come from or close to our families. Even at the university, the speed of things dominates alongside a pecuniary meritocracy, where value is often measured not by the quality of knowledge produced but by the speed and volume of its production (Chambers, 2017). And often the rigor of method altogether replaces relevance and research is increasingly distant from the everyday worlds of practice and suffering (see our post, The Gap….). This partly explains the lack of public confidence in science and the frequent exposure of fraud in scientific research (see Chambers, 2017, Seven Deadly Sins of Psychology) and also why today we see many joining the anti-science movement, subscribing to a belief in a flat earth, or fake science (see very important book by O’Connor & Weatherall, 2019). What is most disturbing about the contemporary, neoliberal academy has been best described by Paul Verhaeghe in his 2014 Book, What About Me,
Within the span of a single generation, however, this situation changed dramatically, with the result that, nowadays, university staff, especially if they are young, feel that they have very little influence over their careers. Instead, they are compelled to dance to the music of an invisible administration. They work flat out, but don’t find their jobs satisfying. They no longer identify at all with the organisation, and solidarity among colleagues has largely disappeared. The reason lies in the evolution of what started out as a meritocracy but turned into a neo-liberal evaluation system. I call it neo-liberal because the emphasis is entirely on quantitative production.
There is no doubt that the pharmaceutical revolution, what the Irish psychiatrist David Healy described as Pharmageddon (2012), has contributed to our current fast mental health movement. However, the 15-minute medication check and powerful neurotoxins alone cannot begin to explain the reach and power of fast mental health. To the powerful influence of the chemical industry (in agricultural and mental health) must be added the growing power of surveillance and control of the insurance industry, the move to brain research and neuro-reductionism (Martin, 2004; Rose, 2006), and the privatization of public mental health services (see post by guest contributor, Joseph E Davis). The outcome for caring practices and clinical social work education is: manualization. We teach by the manual and we practice by the manual. All of this has led to a deskilling of the mental health workforce. Here in New Jersey, where we teach and practice, one large agency has just mandated that clinicians see their patients once monthly, for half an hour! And what are called call Behavior Analysts (and sometimes life coaches), unlicensed and unskilled workers, are now doing the work of clinical social workers. This is a problem for social work education; is it also an ethical problem.
As in agriculture and food consumption, in mental health caring we attend mostly to the speed of things. And it is also true in education. We attend less to the quality and depth of learning and scholarship and more to efficiencies and measurement (Verhaeghe, 2014). Few of our students have time to read and most confess they read very little. And the practice courses are seldom taught by full-time faculty and very fewer tenured faculty have ever practiced social work. What happens to practice wisdom when faculties are not invested or altogether lose their connection to it? Richard Sennett, in his book, The Craftsman (2008), writes about what happens to craft when the work of the hand and the work of the mind are disconnected. He writes,
“Skill is a trained practice; modern technology is abused when it deprives its users precisely of that repetitive, concrete, hands-on training. When the head and the hand are separated, the result is mental impairment” (p. 52).
For Sennett, the material world speaks back to us constantly, by its resistance, by its ambiguity, by the way it changes as circumstances change, and the enlightened are those able to enter into this dialogue and, by so doing, come to develop an “intelligent hand.” What happens to the head (mind) and the hand in caring practices when the practitioner and the teachers (and scholars) lose their connection to the human landscape? See also our blogpost, A Critical Social Work for a Caring Practice.
In 1986 (Rome Italy), McDonalds opened its first restaurant not far from the Spanish Steps. But not without protest. The Rome McDonald's was described as the biggest in the world with seating for 450. The owner, Jacques Bahbout, an Egyptian-born Frenchman, made the fast-food parlor out of a former coffee bar just a block away from the famous Spanish Steps. An Italian journalist, Carlo Petrini, gathered a small group to protest the opening, not by carrying placards, but by serving bowls of penne pasta to passersby. The slogan was: “We don’t want fast food… we want slow food!” In 1989 Petrini and representatives from 15 countries met in Paris for the signing of the Slow Food Manifesto, which spoke against what they described as a Fast Life. Today, they have more than 100,000 members in more than 130 countries where they have contributed significantly to debates on biodiversity and local food communities (Andrews, 2008). If there is a future for social work it is in joining ranks with the slow movement and in providing opportunities for students to engage with craftspeople (i.e., practitioners) who understand and can convey the connections among the hand, the heart, and the mind.
How can social work play a role in what might be called the slow caring movement? In three ways: 1) by re-introducing the case study, what Forrester (1996) calls, “thinking in cases” as the mainstay in social work education and practice; 2) by providing opportunities for members to write the case study, not just for publication but for learning and teaching; 3) by disseminating case study knowledge to schools of social work. The case study is for us, not unlike the slow food movement (and craft as described by Richard Sennett): it develops over time, sometimes long periods of time, it takes root deep in the complexities of human experience and suffering and in special ways of relating and its outcomes are often difficult if not impossible to capture with snapshot methods; and sometimes it may be impossible to measure effects. Foremost, the case study is more than a means of representing (i.e., writing about, disseminating, and publishing) the craft of therapy and psychoanalysis. It is a way of knowing, perhaps the only way of knowing, the depth of the human experience. A case study is like a small farm. It embodies the local, the N of 1, and seeks to see the client in their real actual context, not an abstracted one of statistical averages (see our post, N of 1).
For us the speed of things, manulization, and Big Data is as much a threat to small scale caring as the big farm was to the small farms of our youth. And we do not believe that private practice is the solution! (see our blog post on the COOPerative movement.) An ethical caring mental health practice should be available to everyone; and it should NOT be governed by marketplace dynamics. Social work must return to its deep roots in social caring, community-based caring, community-based mental health (not governed by fee for service) where practitioners and clients are not threatened by the limits of insurance, office rents, and the fees that put help out of reach for most people.
References
Andrews, G. (2008). The slow food story: Politics and pleasure. London: Pluto Press.
Chambers, C. (2017). The seven deadly sins of psychology: A manifesto for reforming the culture of scientific practice. Princeton University Press.
Forrester, J. (1996). If p, then what? Thinking in cases. History of the human sciences, 9(3), 1-25.
Healy, D. (2012). Pharmageddon. Los Angeles: University of California Press.
Martin, E. (2004). Talking back to neuro-reductionism. Cultural bodies: ethnography and theory, 190-211.
O'Connor, C., & Weatherall, J. O. (2019). The misinformation age: how false beliefs spread. Yale University Press.
Rose, S. P. R. (2006). The 21st century brain: Explaining, mending and manipulating the mind. New York: Random House.
Schlosser, E. (2012). Fast food nation: The dark side of the all-American meal. New York: Houghton Mifflin Harcourt.
Sennett, R. (2008). The craftsman. New Haven: Yale University Press.
Verhaeghe, P. (2014). What about me?: the struggle for identity in a market. Victoria, Australia, Scribe.
Virilio, P. (2006). Speed and politics. Los Angeles, CA: Semiotext(E)