Social Work and Elder Abuse: A Foucauldian Analysis
Jason L. Powell, University of Liverpool
The thesis pursued in this article is that an accelerating interest in elder abuse is central to understanding modern care policy as a social phenomenon. It will be argued that the 'discovery' of elder abuse legitimates practice in which the state monitors and co-ordinates but does not intervene. This has led to a social situation that has radically transformed social welfare of its traditional rationale as 'caregiver'. Simultaneously, informal care has become the centrepiece of social policy following the adoption of market forces to community care policies in the UK and elsewhere. One intended consequence of these policies has been to transfer the financial and emotional responsibilities for care to informal carers. The absence of a mechanism for formalising informal care is highly problematic. Such a social policy has found resolution through an emphasis on forms of abuse perpetrated by carers on older service users. This sudden concern for the safety and financial security of older people, who are service users, legitimates a role for welfare professionals within the bleak landscape constructed by community care policy. The price to be paid, however, is that the relationship between the state and older people has been reduced to one of surveillance and the enforcement of an oppressive notion of what community obligation might entail. As with other forms of tacit control, the surveillance role left to a residual local state evokes a 'surface' of reality as constructed as 'depth', whereby generic methods of surveillance are presented as 'concern' models. This act of observation confers a uniformity that emphasises the 'protective' role of the professional rather than the substantive requirements of older people at the centre of inspection.
This article will draw upon the theoretical work of Michel Foucault whose contribution to social theory is 'one of the most important events in thought of the twentieth century' (Veyne 1980: 22). Until now, there has been no serious Foucauldian study of 'elder abuse' in the U.K., although this is slowly developing (Powell and Chamberlain 2012). To utilise Michel Foucault's synthetic insights raises questions of power, of unintended consequences, of the impact of care managerial techniques that current health and social gerontological theories have yet to confront adequately, but which are the very stuff of recent social theory.
The specific focus of this paper will be to make out how the generic concerns of community care policy have legitimised generic surveillance practices. Simplistically, this idea can be presented as a mathematical metaphor of inspection minus intervention equals surveillance. It also serves to illuminate otherwise hidden facets affecting the practice of community services, which whilst based on foundational concerns can unwittingly serve more adverse purposes.
2 The Contemporary 'Discovery' of Elder Abuse
In the UK, formal recognition of this 'new' social problem has occurred with two policy initiatives: first, the implementation of the health policy under the then British Conservative administration under John Major (1992-1997). This included moves to enforce a privatised welfare economy, with emphasis on the centrality of informal care (Powell 2006). A residual role for the local state included monitoring and inspecting care purchased from the 'mixed economy'. Indeed, the development under 'New Labour' in the late 1990's of a 'third way' campaign that sought to reinforce startling continuities of the previous administration of a moral obligation to care by communities or families. Similarly, David Cameron, the current British Prime Minister has focused on the idea of a Big Society that has much in common with former UK Tony Blairs government: the common aim of these policy narratives would be to transfer financial and caring responsibility for dependent older people away from the collective and to individual families. In other words, the problem of elder abuse has reached professional salience at a time when the relationship between formal and informal care was being re-structured. The role of professional workers and the nature of informal care were both contested and in a state of considerable flux and uncertainty.
It will be argued that these two social policy initiatives have a number of common threads which establish a shift in older people's services away from care and support and toward the surveillance of informal care and those being cared for. The form that this shift has taken varies depending upon the site of interaction and subsequent power relations between professional workers and service users. For mental health services, surveillance is directly aimed at the nominated 'consumer' or 'patient'. It has led to the compulsory treatment of people in community settings and the instigation of community supervision orders.
It seems 'care' is not the primary concern of legislation, but it had to be supported because it served some greater purpose. The abuse of older people has been positioned by the Department of Health as a private problem within the domestic sphere. Here, the focus of surveillance is indirect, insofar as it is the informal carer of the nominated service-user who would be its object. Care management, the assessment and monitoring of support, has been identified as an appropriate response, for what is the largest group of informal carers (Powell 2006). In the absence of services that can directly engage with the often-painful circumstances pertaining to abusive relationships, such measures can do little more than supply a somewhat pretentious observation of distress.
Increased surveillance is often presented in official policy as a tactical response to crises at margins of community care policy, the accidental accretion of responses to unintended consequences. The argument pursued, here, however, will suggest that increased surveillance is part of a strategic agenda of wider questions of morality and control without which the technology surrounding community care fails to make sense to those employed to use and facilitate it.
It is not that community care has made more of an awareness of the fragmented variants of elder abuse, but that abuse gives meaning to community care and before its 'discovery', technologies such as care management were the welfare equivalent of a solution looking for a problem. Hence, it is precisely these 'marginal' activities that explain to us the flight of community care itself. Elder abuse, in particular, fills a vacuum at the centre of community care policy, giving it an ideological legitimisation function it had previously not had.
3 Foucault and Surveillance
As already hinted at, this paper will explore issues in a number of ways. First, the methodological 'box of tools' drawn from the work of Michel Foucault (1977) will be used to expand upon discontinuities between social policy and its consequences. Two themes will then be expanded, firstly, questions of morality to highlight change and the social policy technology available to execute it, namely, care management. Secondly, the relationship between overt concerns and covert consequences will be analysed in order to examine how benevolent intentions, without critical analysis, can result in negative outcomes for the recipients of state intervention.
Foucault's main interest is in the ways in which individuals are constructed as social subjects, knowable through disciplines and discourses. The aim of Foucault's work has been to 'create a history of the different modes by which, in our culture human beings are made subjects (1982: 208). In Madness and Civilisation (1965), Foucault traces changes in the ways in which physical and mental illness was spoken about. Foucault employs a distinctive methodology for these studies, archaeology, which aims to provide a 'history of statements that claim the status of truth' (Davidson 1986: 221). Foucault's later work, Discipline and Punish focuses on the techniques of power that operate within an institution and which simultaneously create 'a whole domain of knowledge and type of power' (Foucault 1977: 185). This work is characterised as genealogy and sets out to examine the 'political regime of the production of truth' (Davidson 1986: 224). Both archaeology and genealogy are concerned with the limits and conditions of discourses but the latter takes into account political and economic concerns relevant to community care policy.
Indeed, the work of Foucault has engendered an awareness that modern institutions operate according to logics that are often at excessive variance with the humanist visions embedded in policy analysis (Penna and O'Brien 1998: 51). In other words, the overt meanings given to a certain policy of activity may not correspond to their consequences. Whether these outcomes are intended or accidental was less important to Foucault than the analysis of power. As Smart (1985: 77) points out, Foucauldian analysis asks of power: 'how is it exercised; by what means?' and second, 'what are the effects of the exercise of power?' Within those strategies, investigation would need to be centred on the mechanisms, the 'technologies' employed and to the consequences of any social momentum for change.
An example of the discordance between social policy, the philosophy that overtly drove a certain initiative and its effects, comes from Foucault's (1977: 201) analysis of utilitarianism. Indeed, a pervasive theme of Foucault's (1977) work is the way in which the panopticon technique 'would make it possible for a single gaze to see everything perfectly' (1977: 173). Foucault describes how panopticism (based on the design of Jeremy Bentham) becomes a process whereby certain mechanisms permeate social systems beyond actual, physical institutions. Techniques are thus 'broken down into flexible methods of control, which may be transferred and adapted ... (as)... centres of observation disseminated throughout society' (1977: 211-2).
The mechanisms used to extend the reach of centres of power will vary depending upon the ground upon which they are required to operate. Their function is to evoke and sustain moral interpretations of particular social behaviours throughout intermittent observation such that their objects come to internalise their own surveillance.
One important facet of Foucauldian analysis is the author's preoccupation with historical periods in which conventional values are in flux as in the case of madness, discipline and sexuality (Foucault 1965, 1977 and 1978) and how the emergence of professional discourses interpenetrate the evolution of new commonsensical understandings of 'normality'. There are, in other words, periods in which particular sites of control, for example, institutional care, family relations, intimate relationships are subject to novel mechanisms and technologies in order to facilitate the transition from one state of affairs to another. These technologies may be overtly applied during periods of flux until moral relations have been accepted, and, during the process of their application they both modify and are modified by the professional groupings charged with their implementation. Whilst Foucault does not impose any sense of causality on the development of such discourses, it is possible to discern the need for both an explicit moral reason and a method of operation, shaped to whatever new contexts are appropriate. Government morality would act as a permissor for activities such as surveillance. A professional technology would provide a means of implementation depending upon the site (for example, in institutions of the state) of the targeted activity.
As Rouse (1994) has pointed out, an examination of the relationship between power and knowledge is central to interpret and understand social phenomena through a Foucauldian gaze. This is particularly apposite where there is an attempt of a disaggregation of a stated policy and its mechanisms in order to discover what is thereby hidden or obscured. One of the consequences of power and knowledge is that rather than the focus on the explicit use of a particular technique of knowledge by someone in power to cause a certain effect, attention is drawn to the reflexive relationship between both elements. There is a concern then:
'with the epistemic context within which those bodies of knowledge becomes intelligible and authoritative. How statements were organised thematically, which of those statements counted as serious, who was empowered to speak seriously, and what questions and procedures were relevant to assess the credibility of those statements that were taken seriously. ...The types of objects in their domains were not already demarcated, but came into existence only contemporaneous with the discursive formations that made it possible to talk about them' (Rouse 1994: 93).
So, just as knowledge shapes what action is possible, what power is exercised, those actions shape the creation of new knowledge and what is thereby given credence. Over time legitimate 'domains' are established which both define what is real and what can be done about it. Other possible interpretations are simultaneously discounted and delegitimised. The result is a self-contained commonsense world in which power and knowledge support each other. These domains, for example, not only sustain certain professional discourses, they mould what those professions might become. This analysis of power and knowledge emphasises their entwinement and the processes that occur as a particular domain takes shape. It also marks a distinction between what a method for obtaining knowledge produces and the relationship between the shaping of that product and the distribution of power.
Returning to an earlier theme, the process by which a particular domain is established may not be the same as the reasoning given to explain what events take place and their effects. Indeed, as his understanding of this relationship developed, Foucault (1982: 86) indicated that 'power is tolerable only on condition that it mask a substantial part of itself. Its success is proportional to its ability to hide its own mechanisms'.
Furthermore, in community care the open intention to 'empower' through allowing older people to live in their own communities and monitoring support, may have become a means of policing informal care and through that the conduct of older people. Throughout the past 15 years, community care policy has drawn upon a number of sources of flux to achieve momentum. These have included a concern over familial obligation to care and changing social work practices, from a traditional providing role to that of managing and purchasing of services.
Second, a model based on obligation does not fit well with what research is available on how third generational family relations work. Intergenerational family relations can be characterised as 'action at a distance' (Foucault 1991) a situation that would seem to have historical roots extending at least until the eighteenth century in U.K settings (Laslett 1977) and indicate that the current policy model may be more traditionalist than the traditional. Phillipson (1998) has reviewed contemporary family relationships in later life and claims that factors such as increases in geographical mobility, divorce and cohabitation have made intergenerational links increasingly complex. Further, families may not be cemented by 'fixed obligations' but rather, depend upon a variety of personal commitments that may change depending upon the circumstances of family members and quality of their relationships (Powell 2011).
It would seem from this review that whilst family bonds seem to be an enduring source of care, patterns of familial care are becoming increasingly diverse. Informal care may become more contingent upon personal ties than on formal relations, while, as Phillipson (1998) points out, older people may prefer formal services that preserve their independence from other family members. It is also apparent that demographic and workforce changes indicate a decline in the number of female carers as the demand, in terms of numbers of 'frail' older people arguably increases (Powell and Chamberlain 2012). However, the 'no-cost' option of a social policy reliant on informal care comes to look increasingly fragile. It is therefore in need of a shift to the moral ground of obligation into which the Cameron administration continually attempts to tap.
However, another complicating factor to an 'obligation' based social policy manifests from the idea that informal care is at root a voluntary activity. It is not, therefore, bound by any formal code of social practice, as would be the case for paid workers. Hence, there is no formal reason for intervention should a policy of informal care meet resistance. Thus, a social policy exists that contains fiscal policy and morality and makes informal care legitimate responsibility. The threat of 'elder abuse' provides the excuse for this invasion of the private sphere, a shift from 'consent' to 'coercion' and from 'support' to 'surveillance'. However, to be fully effective, a technology would also need to be found that would implement the logic of that policy.
4 The Technologies of Care Management
The core technology by which community care can be implemented exists in the role of care management. It can be conceptualized as the co-ordination of services into a 'package of care' in order to maintain 'clients' in community settings. The managerial technology is indirect in three ways. First, the pivotal function of the care manager is seen as being the management of a package that draws on services made available through a 'mixed economy of welfare'. Second, there is a shift toward supporting informal carers rather than directly working with the nominated client. Third, there is the emphasis on assessment and monitoring of provision that is supplied by service providers.
This quality of indirectness 'makes sense' as a means of managing a 'mixed economy of welfare' which requires that those who purchase care, or their agents, are separated from those who provide it. Because of the intensification of marketisation, this limits the development of cartels, allows purchasers to choose between competing alternatives, thus placing them in the role of 'honest brokers' who assess need, supply information on the alternatives and then co-ordinate purchases. It does not, however, make sense in terms of direct care, intervention or interaction between older people and social workers other than as a sort of 'professional travel agency', advising clientele on the options, best deals and cash options. Care assessment and monitoring have now become an integral feature of social work practice and reflect a trend toward justifying welfare activities in terms of quality assurance (Powell 2006).
The Department of Health has commissioned research into demonstration projects, in order to monitor the implementation of care management. Unsurprisingly, this programme has generated scarce critical analysis of the role of this technology of care, focusing, instead, on the financial success achieved in its adoption. By replacing direct intervention with management systems, the technology fails to provide guiding theoretical principles for interpreting and acting on conflict in social relationships. Smith and Brown (1992: 685) compound this by arguing 'one of the reasons for confusion around community care is the lack of an ideology to guide and influence its implementation'. They suggest that normalisation may provide such a role once a perspective on the duality of power and powerlessness has been developed. 'Techniques of resistance' (Foucault 1977) by older people to managerial techniques was found by Powell (2006: 12) who claimed older people 'were particularly adamant that they did not want to be 'cases' and no-one needed to 'manage' their lives'.
However, despite this resistance, the introduction of the 'mixed economy of welfare' in the U.K has consequences for the surveillance of older people. The mixed economy reflects political rationalities and technologies of government. Welfare pluralism is used to mobilise the use of resources - and thereby embody power relations - and thereby supply an economic vocabulary to legitimise the allocation of those resources and associated schemes of inspection and surveillance of services for older people. Powell and Chamberlain (2012: 26) notes that 'social actors', such as care managers, try to translate values into their own terms, to provide standards for their own actions and in so doing, facilitate 'rule at a distance'. A mixed economy of welfare is a means of doing this, it fabricate representations of 'empowerment' for older people. As Chua (1995: 111-145) points out, not dissimilar to the social construction of health care accounting software, services become devices which transform real relations. In a sense, 'older people' become 'consumers', 'social workers' become 'managers', 'social service departments' become 'purchasers' all crystallised by the formation of community care policies. In this case, services provide schemas for the 'conduct of conduct' (Foucault 1991) dominated by power/knowledge and characterised by the discretionary autonomy of care managers. It is within this disciplinary matrix of policy, practice and autonomy that power operates on older people, ultimatley reinforcing the fragmentation that surveillance engenders in the psyches of older people at the centre of the professionals' gaze. This form of surveillance:
'clearly indicates the appearance of a new modality of power in which each individual receives as his status his own individuality, and in which he is linked by his status to the features, the measurements and gaps, the 'marks' that characterise...and make him a 'case' (Foucault 1977: 192).
Hence, the older client is marked out for perpetual surveillance throughout the remainder of his or her community care service. Carers and professionals also come under scrutiny as part of the continuous review of the client's needs. All are caught by a gaze which is 'always receptive' (Foucault 1977: 89) to older people and provides a further rationale for surveillance of the 'elderly population'.
5 The Panoptic Culture
Why is community care policy that is essentially empty of interpersonal meaning be 'legitimised' by the accretion of surveillance? The answer to this measure lies in the fact that it was not created as a philanthropic metaphor but as a mechanism for engineering the cost and structure of social welfare. Community care has been part of a strategy to reduce the costs of state welfare by adopting market principles (Hoyle and Le Grand 1991). Attempts at cost reduction have taken on two forms. First, there is the active encouragement of a private welfare economy in order to depress wages and related costs. Second, a hollowing out of the local state, through mechanisms such as care management and inspection, so that the primary role of social service departments has become that of monitoring and supporting direct care rather than provision itself. These trends may not simply reflect a flow through from market ideology but also wider pressure on the nation state as a consequence of globalization (Powell 2011).
Awareness that the welfare state can be understood, not so much as a series of social service institutions and neo-liberal responses to social problems, but as an instrument of wider state power and governance is not new (Townsend 1986; Jessop 1994). What is perhaps striking is the extent to which the techniques used by welfare workers have been drained of creative and radical meaning concerning resistance with marginalised groups and had drawn workers into the day to day management of scarce resources (Phillipson 1998).
Until the advent of a panoptic culture, community care with older people lacked a convincing unifying metaphor for its activity. With its instigation, a previously inchoate accretion of initiatives around 'community care' achieves harmony and force. Once the vigilance advocated by the Department of Health's guidelines on elder abuse, are added to the indirect functioning of care management technology and the moral backdrop of obligation, the discourse of community care acquires a coherence of power/knowledge. It is, however, a power/knowledge to be deployed against older people's voices rather than for their emancipation.
Indeed, once older people are established as a socially significant object of power/knowledge, managerial techniques deem it necessary find the 'truth' about their care needs; to analyse, describe and to understand. The focus towards elder abuse takes place in a wider process in which attention is being directed towards individual bodies and control of 'ageing populations'. The individual is part of a machinery of power, a power that creates the body, isolates it, explores it, breaks it down and rearranges it. A knowledge of the body therefore requires a mechanism of discipline; that is, a machinery of power that is part of the managerial production of knowledge (Powell 1998). Discipline was the 'political anatomy of detail' (Armstrong 1983), that is to say older people become known and understood as a series of useable bodies which could be manipulated, trained, corrected, controlled and to legitimise the managerial profession. The outcome was to be a cumulation of increasingly detailed observations that simultaneously and inescapably produce knowledge of older people.
This paper has explored a disturbing constellation of factors in community care. It has been argued that the 'discovery' of elder abuse has lent coherence to a number of nascent tendencies in this policy that reinforce each other. These tendencies include an increased moralism toward informal care and a move toward indirect monitoring of the locative sites of such care. The development of a surveillance culture helps stabilise community care policy at a time of considerable underlying uncertainty. Such uncertainty has arisen from the changing structure of informal care and of specific services.
The neo-liberal strategy, to socialise care, has become an extension of the techniques of observation, monitoring and control into community settings. A new system for the surveillance of informal carers has replaced the idealistic dream of freedom with an extension of constraint.
Indeed, the shift in the focus of assessment contains a number of alignments. First, assessment decisions seem to be taking place within an existing discourse on abuse rather than user need. Whilst 'need' is given a recognition, the dominant decisions to be made would seem to concern risk of elder abuse. Second, the focus of monitoring seems to have moved from the performance of elements of the purchased package of care to the 'conduct of conduct' (Foucault 1991) of older people and informal carers. Third, parallels with child protection are clearly alluded to through at-risk registers and the value of records as evidence.
Following Foucault's (1977, 1991) analysis of the relationship between power and knowledge, this change can be seen as the development of a matrix in which to speak seriously about the support of informal care, the employment of discourses of surveillance and abuse would have to be entailed. It serves to reconfigure power relations during a period of flux and 'makes sense' of a previously disjointed policy formulation. Elder abuse has thus filled a vacuum at the centre of community care policy with potentially harmful consequences for the users of those services as support entails surveillance and consent contains the threat of coercion. The powerful language of surveillance offers a form of universalism to social policy, which as Williams (1992) has pointed out, has been subject to 'fragmentation, change and uncertainty and contradiction' (1992: 200). Rather than recognising patterns of social diversity all are now equal under the monitor of community care. Under such conditions, discourses such as 'care' and 'user' have worn out their analytical usefulness except as a rhetorical disguise for those with power.
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Dr Jason L. Powell
University of Liverpool
Department of Sociology, Social Policy & Criminology
Eleanor Rathbone Building
Bedford Street South
L69 7ZA - Liverpool