From the News: A police Inspector? was bailed for one violent offence. He murders the key witness to the offence. The Judge states he does not know why he gave him bail. Let’s speculate….
There are certainties about the Police. They know to murder is illegal. They understand about interfering with witnesses to criminal cases. The Judge makes a decision based on these predictions. It was wrong.
The Health Professions Order 2001 was put on the statue book to ‘safeguard the health and wellbeing’ of the population. The chief threat was Dr Shipman, a murderer, who was undetected because he was a very good doctor. HPO2001 is alleged to prevent the recurrence of uncertainty by regulation. It regulates every aspect: training, clinical decisions, fitness to practice, continuous professional development so that certainty is produced.
Evidence-based practice is one of the procedures for limiting the government’s financial liability. (Risk Analysis, appraisal, are some of the others) It takes the problem (let’s say anxiety) and measures how effective various practices are in erasing the symptom. The erasure is quite short-term – let’s say not recurring within 6 months. No account is taken of differences between those who apply the procedure. They are assumed not to affect the treatment’s efficacy. A uniformity is assumed about the initiating problem or symptom. The symptom is separated from the person and the meaning of their life and given a meaning. The result is always uniform. The uniformity of the process going from symptom through process to result measurement is possible. Which practice gives the result in the most cost-effective manner? Let’s compare the givers of the processes to see who is most effective. These ‘scientific measurements are operating within certainty. There is no room for difference in the problem, the procedure or its giver or the result. Any difference is blamed on maverick factors outside the certainty system.
Psychoanalysis allows difference in problem, the process used and the result mainly because it relies on relationship. Relationships do not register with evidence based practice. This is why psychoanalysis is associated with uncertainty.
Comments (2)
Hi Julia
I was fascinated by the resonances between your post and my own professional practice/area of interest.
In the context of services for children, young people and their families (in England) don't know whether you are aware of ContactPoint? On full implementation (mid 2009), ContactPoint will be a web-based universal database containing basic details about every child/young person (from 0 to 18) in England - and the public services working with them. ContactPoint will be accessible to any authorised practitioner (anyone who has undergone accredited training).
So how does this relate to your post? ContactPoint was created in response to findings from Lord Laming's Inquiry into the death of Victoria Climbie. It is intende to prevent the death of any more children because of action by their parent(s)/caregiver(s). As you point out, ContactPoint is intended to regulate uncertainity (the lives of children and young people and the services involved with them) by the introduction of machine like certainity and IT audit trails (an 'infallible' database in place of unregulated conversations between practitioners).
Such 'network centric practice' displaces the relationships between practitioners and groups into the certain (the domain of ContactPoint). I can imagine future Inquiries into child deaths focussed on why practitioners did not use ContactPoint correctly!
Thanks for the post - very thought provoking
David
Posted by David Hoyle | January 21, 2008 1:10 PM
Posted on January 21, 2008 13:10
Thank you for this comment.
My political analysis (This is when being a psychoanalyst comes into its own - if you are Right about something, you are not working as a psychoanalyst.): From 1998, Blair's government eliminated uncertainty from their decisions by suppressing discussion. Thus, Blair reduced Prime Ministers' question time, emasculated the Cabinet, refused civil servants access to meetings, and this certainty of decision was supported by a huge majority in the House of Commons and the 'Special Advisors' (yes-men and women) with whom he surrounded himself. This certainty was so concrete that Blair could make a decision to go to war, sat in a chair, isolated in the garden - I think, with his God as his witness. This government have used 'Orders' on many more occasions than any other government. These orders are certainties and enforced by the Privy Council.
I had not heard of Contact Point before and it now joins a growing list of where these certainties are being employed. Education, Local councillors, the legal professions - judges, barristers, etc, social work, (the recent Social Care and Welfare Bill goes this way and is criticised by the ft, Editorial 7th January), and the area of Health. I am involved in resisting the implementation of the Health Professions' Order 2001 and so on.
Zizek comments that the initial phase is to arouse fear in the population. The Inquisition used fear of hell, The Third Reich fear of those who are not the same as us. Stalin used fear of the capitalist machinery. This government uses extraordinary criminal acts. The Donaldson Report quotes 5, I think, Government investigations covering about 12 practitioners. These are all clearly criminal acts and over 100 years of the BMA has not stopped them.
Having aroused fear, the government then promises to protect or safeguard. It invents legislation which produces certainty. After Shipman, no doctor will murder their patients because the control procedures will prevent this - except last September, in the news, was a doctor who has murdered at least 11 patients. The legislation is blind to this. Factors outside this certain world are blamed for this. Unregistered talking therapists become charlatans and dangerous.
Behind the legislation is standards. The one true and certain way which will safeguard you from discontinuity or uncertainty.
What is foreclosed in all of this are relationships. Complaints, fitness-to-practice hearings and investigations into human error all overlook this. Read Dame Janet Smith's Shipman Enquiry.
This, psychoanalytically speaking, is a perverse system and maybe if I have time I will outline consequences of this imposition of certainty. A close reading of 'Tinker, Tailor, Soldier, Spy' is advised
Posted by Julia Evans | January 22, 2008 8:30 PM
Posted on January 22, 2008 20:30