division of labour has outsourced your mind (Marmaduke Dando, If This Is Civilisation, 2010)
The Luddites, those groups 200 years ago who donned masks and stormed mills to smash the machinery within, fascinate me. The reason for this is partly that they are most widely remembered as a term of insult. To take actions against technology is seen as laughable and is rarely given any serious analysis. In this post I want to make a case for a “Luddite nursing” and suggest this as a health promotion activity.
In a previous post on this blog I described a research project that I recently completed exploring mental distress, modernity and geography. Here I am expanding on this in a more personal and reflective way as a means to chart a possible direction for a radical critical mental health nursing. The often conflicted meeting point of my activist leanings as an anarchist and my professional identity as a nurse brings me to search for such a radical path that could inform a more ‘sane’ existence.
As a mental health nurse I find myself at a certain nexus of regimes of knowledge, institutional practices and subjective experiences of mental distress. These forces shape who we are in our working lives and how we approach people experiencing mental distress. The things we focus on, the preoccupations of our practices and the techniques we employ are extremely contentious, as can be seen from numerous posts by others on this blog. The core of our practice, however, remains untouched by the many criticisms levelled at it (eg, Fanon, Laing, Cooper, Basaglia, Szasz, ‘Bifo’, Bentall, Moncrieff, etc, etc). The reason for this is that we are blinded to the necessary systemic critique by technocratic structures within which we are embedded. As numerous philosophers have suggested, we are operating within an iron cage (Weber) in a disenchanted culture in which our lifeworld has become colonised (Habermas) and technology has ‘enframed’ (Heidegger) the normal, the reasonable and the possible.
Thus as bio-medical psychiatry has come to the fore, under the cover of a narrow definition of “Evidence Based Practice”, we find that we are stuck delivering standardised interventions to people reduced to numeric codes from diagnostic manuals. Distress in a particular person, in a particular culture, in a particular time and in a particular place is reduced to a problem of individual mental hygiene abstracted from its context. Care in the modern world has been characterised as moving from “the sanctuary to the laboratory” (Peacock and Nolan 2000), and this is what we see in mental distress that is no longer an aesthetic and existential crisis, but a technical problem of neuro-chemistry and genes.
This is not only a problem for those using mental health services, it also means an alienating working life (Marx’s alienated labour) for nurses and our colleagues. We take pride in giving of ourselves to help others (the therapeutic relationship), and this is the appeal of the profession to many at the outset. The entanglements of the medico-legal bureaucratic machinery of paperwork, protocols, shift patterns, clock-in machines, et al, soon ensnare us however and it becomes almost impossible to give anything genuine, immanent and satisfying. This brings us back to the Luddite rebellions, which were at a basic level a reaction to alienating working lives wrought by the introduction of new mechanised processes. Their expression of rage was a significant threat over a number of years (leading to the allocation of more troops than were sent to fight Napoleon) and targeted machines that were fundamentally changing daily lived experience and relationships for the worse. What could it mean, I wonder, for a nurse to radically face up to the machinery of alienation?
This focus upon the machinery as more than just ‘neutral tools’ is key to an understanding of how technologies come to redefine human existence (David Kidner’s work is excellent on this subject). Deleuze and Guattari suggest that our desires become part of the current infrastructure and are not ahistorical universal ‘human nature.’ Thus when problems arise with these technological approaches it is not the logics of such a system that come in for criticism or analysis, but the individual technological device in isolation. Following this logic technological solutions come to be seen as the only way to solve technological problems: a process akin to digging a new hole to fill in the previous problematic hole. This applies directly to mental health nursing with the constraints of techniques such as the Mental Health Act, record keeping and medication protocols, but the constraints are also wider than our professional domain. Jacques Ellul describes the modern western world as a “Technological Society” in which a narrow rationality comes to enforce its logic across all activities. This systemic analysis allows us to see that a totalising rationality of this type is the genesis of much mental distress as well as being the apparatus that then captures this distress in technocratic definitions, institutions and treatments.
So to conclude, what could be the implications for a critical mental health nursing? Firstly it must be acknowledged that the systems we are enmeshed within demand a narrow division of labour in the same fashion as a ‘Fordist’ factory. The task of nursing is just such a specialisation. To function in such a discipline, according to the anthropologist Tim Ingold (2000), the person is drawn from the centre to the periphery of the activity. The technology then takes the place in the centre, with the nurse simply operating the device from the periphery with no meaningful agency in the task at hand. The nurse in such a system is simply a bored operative putting in a shift in the psych-factory.
To reclaim some autonomy, satisfaction, meaning and helping efficacy I suggest the radical critical mental health nurse can take on the Luddite mantle. Are we going to join in the frantic digging of new holes to fill in the problematic old holes, or are we going to don masks in the dead of night, feel the rage and sabotage the digging machinery?
Can we challenge the paranoid technics of metric reductionist interventions/outcomes and forge an imminent art and craft of care that is responsive to a holistic promotion of mental health?
human life needs reframing, redrafting, reweaving: a surrogate, virtual, second life, sacrificed on the altar of the technological gods, is no substitute for a life of immersion in rich, storied objects and relationships. (Dark Mountain book 8, Introduction, 2015)
Ingold, T. (2000). The Perception of the Environment: Essays in livelihood, dwelling and skill. (London; Routledge).
Peacock, J W and Nolan, P W. (2000). “Care under threat in the modern world”, Journal of Advance Nursing. 2000, 32:5, 1066-1070.