I worked a few years at our state mental institution on a unit for people with chronic problems and especially problems of violence, escapism, and sexual predation. Most of these men were relatively low-functioning, and the longer they had been on the unit, typically the lower their level of function: years of isolation and drug treatment made them “safer.”
Sometimes we would get a patient as a transfer who did not quite fit the usual bill. We once received a young man apparently because he was large and Black. He never threatened us or tried to run, was compliant, recovered well from his break, and left us soon after his arrival. And sometimes we would get men who were just too smart for the system.
Our unit ran on timetables and rules, and compliance was the order of the day. And sometimes we would get a rare soul who wanted to question the need for all these rules and compliance. He would come into frequent and direct conflict with staff, trying to order the shift, encouraging other patients to stand up for themselves, asking us why we treated people the way we did, demanding others resist their medications.
We really did infantilize our patients in many ways. And these smarter, more rebellious, shorter-term patients could see it, and could not quite grasp that these things were necessary. Upon reflection, I sometimes catch myself wondering, too, and note here that I left this job partway through my graduate studies: the work did not sit well with my humanistic heart.
The best I could do for these young men was to take them aside and explain the facts of life to them. All the rules and demands for compliance had one main goal, really: to let the person demonstrate, through following the small rules of the unit, that they were capable of following the larger rules of society. If they could keep it together just for a week or two, they would quickly be on their way. It was their choice to keep pushing against the system and remain indefinitely, or buckle under, make a few mild concessions to good order and discipline, and get back to living a real life on the outside.
This approach often worked. The person would grudgingly obey and go away. I rarely saw such people twice.
I wonder even now if I really ever helped anyone.
Nowadays, I serve occasionally on a dissertation board. One of my students at my least favorite of the schools I do business with is having an especially hard time getting through the process (I have no actual relationship with the school and little insight into their processes). Her work is exemplary. Her scholarship is beyond reproach. But the school keeps adding steps in the process, and asking for more and more paperwork, more and more bureaucratic compliance. They keep sending her back for less and less meaningful reasons, and she is starting to feel persecuted.
Frank Herbert, the noted ecologist and science fiction writer, hated bureaucrats. He likened them to aristocrats, and suggested they meet their power needs through systems of byzantine rules and procedures with which the customer must comply. If one does not comply, they simply do not get their needs met, and can then encounter legal trouble.
I explained to my student that one reaches this point in one’s work when the study is done, the learning is done, the writing is done. All that remains is to get through the process: fill in the forms, check the boxes, put on the hood, and walk. In other words, all the meaningful parts of the experience are over, and one is simply navigating the bureaucracy. Small people exert power over you, for example a science reviewer with no background in psychology, an APA reviewer the school makes you pay for but who does not satisfactorily help you comply with APA style, the various top-floor people who lose your paperwork and hold up your graduation.
And after this is all done, if one wishes to obtain a license, one must run through another such gamut of heartless bureaucrats who care about nothing except your compliance with their byzantine procedures, including a licensing exam that has little relevance to the program you just graduated.
I told her the same story I just told you, about helping these young men find a reason for compliance, even a temporary and galling reason. This seemed to help (for today, at any rate). She is biting her tongue and biding her time, doing her best to conform so she can walk in October.
And I am left with this same bad taste in my mouth. Have I really helped anyone?
— Jason Dias