Giiven the level of complexity involved in any system change, in even understanding the nature of a system like the mental health system or any organization within it, where do we start? We live within the embrace of the complex ecological system of the Earth, as a whole, self-regulating living system termed “Gaia” . If we employ an ecologically sound complexity theory to human service organizations it may help us find a way out of the multiple dilemmas and crises now facing all of these systems of care. We have a most advanced example of a complex system available to us all the time – the human body, including the human brain and we freely draw upon the example of the body to make analogies to the corporate body. A corollary of thinking about the organization as a living body not unlike our own, leads also to using the same parallels to think about the impact of adversity and trauma on the human organization, parallel thinking that can be served by our deepening understanding about the ways in which adversity impacts the human body, mind, and soul. In Sanctuary, we look at human service delivery organizations at the present time, as badly injured.
An injury model of understanding human systems – systems as small as one individual or very extended and comprising thousands of people – leads to very different kinds of thinking and behavior than a sickness model and reflects another significant change in mental models. Right now, there are basically three explanations for problematic human behavior: people are thought to be “sick” and if so they are usually sent to the mental health system; they are “bad” and they are relegated to the justice system; or they are both – and no one wants to deal with them, so they shuttle back and for the between the two systems. These dichotomous attitudes extend all the way to the microlevel of interactions between staff members and clients, including children who are in residential care. Enter the walls of a children’s program and attend a treatment conference and you are likely to hear children described as either “sick” or “bad” – although these terms may be disguised and embedded in the psychiatric terminology and labels, code words that staff members freely use with each other. In children’s services, such popular code words are “conduct disordered” and “oppositional”, while in adult services the most popular are “borderline” and “sociopath”. This is not to say that in the cases where these terms are used, they are always inappropriately or destructively applied – that is not true. But it is important to hear the meaning that is often embedded in the message that conveys to each other – “this kid (or adult) is just bad news”.
It has been difficult for individual clinicians and the system as a whole to have any kind of an integrated point of view about people who have significant problems – that people in the mental health system can do very bad things AND that people in the criminal justice system can have significant mental health problems. The attitude toward troubled staff members and dysfunctional organizations swings between those two polls as well. People within the organization often view each other and their system as “sick”, frequently irredeemably so, and people outside of the organization view it as “bad”, frequently irredeemably so. This is part of what makes the whole study of the complex biopsychosocial impact of adversity and trauma so very important – that it is all about injury, and that you can injure a human being – and human organizations – in an almost infinite variety of ways and it can look like everything from physical illness to moral corruption. The bottom line on changing this mental model of how we understand other human beings and ourselves is to reframe the fundamental question from "What's wrong with you?" to "What happened to you?" (2)
- Lovelock, J.E., Gaia: A New Look at Life on Earth. 1979, Oxford: Oxford University Press.
- Bloom, S.L., The Sanctuary Model: Developing Generic Inpatient Programs for the Treatment of Psychological Trauma, in Handbook of Post-Traumatic Therapy, A Practical Guide to Intervention, Treatment, and Research, M.B. Williams and J.F. Sommer, Editors. 1994, Greenwood Publishing. p. 474-49.