Policymakers across many modern democracies are oriented towards quick wins and short-to-medium term planning. Big bold infrastructure needs flashy 3D renders and visible milestones to demonstrate ‘progress’. Cutting the ribbon of a new hospital is a political win for politicians but then there is a tendency to ignore the needs to properly staff, maintain and improve these facilities to meet patient needs.
New big spends in specific areas like youth suicide prevention or mens mental health are badly needed reforms across the Western world. These are often co-opted by bureaucrats to manage impressions of their government ministries or departments. Then the spin comes in to create moral panics about the underlying problems and selectively choose metrics to report on apparent successes of each project.
The ghosts of Reagan and Thatcher still haunt the USA and UK respectively while their aggressive market reforms have long been imitated and pushed to new extremes throughout the Western World and into other cultures. Like memes that are quickly spread and slightly modified in a way that transcends many cultures, neoliberalism spread like a virus that still lingers. The modern asylum is built on neoliberal foundations that are market-based with a focus on economic outputs rather than protecting human rights.
With the focus on free market capitalism, neoliberalism is often a catchall by the left to criticise the many problems in healthcare, education, welfare and elsewhere. Rightly or wrongly, neoliberalism is an enemy of the past that seems to reappear across sectors that are meant to be about public good.
From the policy and funding agency, neoliberalism trickles down to hospitals and their staff like a toxic poison. At the highest levels of the madness in the modern asylum are the senior executive staff of hospitals, health districts, corporate HQ, or health trusts and the boards of directors that govern them. These people tend not to be toxic in nature but toxic by circumstance. They are following the structures and tainted traditions of the institutions the aim to serve these organisations to save or improve the lives of patients.
Neoliberalism and corporate orientations maintain hold of the organisations that run psych wards as a dangerous legacy reinforced by continued professional norms. Medical school, medical registration requirements, doctor training and organisational policy focus all promote and enforce paternalistic approaches to patient care. The ‘doctor knows best’ approach continues to be upheld through the training, ego and reverence given to doctors even in the frequent citation where the patient knows their past symptoms better than anyone and knows what treatments work best.
Nursing education and practice remains hierarchical, militaristic and highly masculine despite the extremely high ratio of females to males. Apparent feminine qualities of being gentle, caring and empathetic are subsumed by a tall and steep pyramid leadership structure dominated by nursing staff. The phrase ‘nurses eat their young’ is played out through the justification of mistreatment of junior nurses as senior nurses ‘helping’ them to toughen up. The most empathetic nurses leave the profession or burnout and breakdown.
Those with a hero complex are built up by tropes and media portrayals of doctors and nurses quickly saving someone in an emergency. These life rescues deserve ongoing recognition and celebration but so do the long rehabilitation journeys supported by allied health staff, countless hours of care from friends and family, and the personal resilience of each patient. By celebrating the lives saved, we also demonise those who allow lives to be lost with investigations, litigation and safety meetings that often miss the true root cause of a tragic accident or negligent action.
Those at the very highest level of organisations in control of the most people often climbed up there from graduate roles as a doctor or nurse. Some climbed up for money, some have climbed up to control all those workers and very few have sought leadership to help the most people possible.
Most public hospital systems and large corporations responsible for the modern asylums move at a snail’s pace. Major changes in the demographics or needs of patients or new treatments are bogged down both in the appropriate checks and balances and the immense red tape of bureaucratic command-and-control systems.
I am not of the opinion that senior executives are often sociopaths or psychopaths but there are some concerning traits at the top. Most health system leaders appear to understand and attempt to apply moral principles of what’s right and wrong and are capable of understanding the feelings of the staff and patients they encounter. They are however often disconnected with staff and patients so do not encounter them. Many executives are taken on tours of their own facilities with their minders and like health inspectors mostly see the facades they reinforce.
Next Madness Post: The Façade with the Revolving Door
