Friday, September 27, 2013

Link Mashup

For the last few years I've been doing a link blog called Three Good Links. I post short snippets from stuff I've been reading along with a link. Recently I've been feeling a little bit chatty, wanting to draw some connections and make observations about these links. But it doesn't really fit the format of the blog, so I thought to write here today.

1 Boring Old Man is a fascinating blog written by a retired psychiatrist.  Over the past few years he's written about the state of psychiatry today and reflections about the profession over his career.

I'll more or less follow my link format at my other blog, so here's a snippet from a recent post:

  • This falsely inflated market doesn’t have the steep lead-in of a financial bubble, and that graph up there just keeps on rising and taking a bigger and bigger piece of the pie. And back to Psycritic’s question, it doesn’t burst or pop like financial bubbles. It seems to grow unaffected by those usual market forces economists so love to talk about. What do you call a market like that – a falsely inflated market that is unopposed by any apparent forces to hold it in bounds? I personally think it’s called a Monopoly , and I don’t think we’ll be able to do anything about it until we come to grips with what that means. I wish it were a financial bubble, but it’s not. The medical analogy for an economic Monopoly is cancer – something that grows without restraint until it destroys its host. That’s a real possibility with the Healthcare Industry.
Mickey at 1 Boring Old Man. a bubble?

Ivan Illich wrote about radical monopoly. There's a pretty good chance that Mickey has read a bit of Ivan Illich's oeuvre, but I think he's making a point about monopolies in a more conventional sense.  In 1976 Illich wrote a book, Medical Nemesis. The book is no longer in print and rarely cited, nevertheless the critique is penetrating and Illich's observations are quite relevant if we locate the problem as monopoly. He writes:

Ordinary monopolies corner the market;9 radical monopolies disable people from doing or making things on their own.10 The commercial monopoly restricts the flow of commodities; the more insidious social monopoly paralyzes the output of nonmarketable use-values.11 Radical monopolies impinge still further on freedom and independence. They impose a society-wide substitution of commodities for use-values by reshaping the milieu and by "appropriating" those of its general characteristics which have enabled people so far to cope on their own. Intensive education turns autodidacts into unemployables, intensive agriculture destroys the subsistence farmer, and the deployment of police undermines the community's self-control. The malignant spread of medicine has comparable results: it turns mutual care and self-medication into misdemeanors or felonies. Just as clinical iatrogenesis becomes medically incurable when it reaches a critical intensity and then can be reversed only by a decline of the enterprise, so can social iatrogenesis be reversed only by political action that retrenches professional dominance. 
Ivan Illich in Medical Nemesis.

danah boyd has a post thoughtfully responding to the news about a California school district hiring a firm to monitor student's online behavior. She asks some pertinent questions:
  • So here’s the question that underlies any discussion of monitoring:  how do we leverage the visibility of online content to see and hear youth in a healthy way? How do we use the technologies that we have to protect them rather than focusing on punishing them? We shouldn’t ignore youth who are using social media to voice their pain in the hopes that someone who cares might stumble across their pleas.
danah boyd at apophenia.  eyes on the street or creepy surveillance?

This summer there was a FBI "rescue" of 105 sexually exploited children resulting in the arrests of 159 alleged pimps. I put scare quotes around  the word rescue because at least one of the minors in my state of Pennsylvania was charged with prostitution and jailed! This punitive approach is good example of what danah boyd urges we avoid.

I was heartened by a piece in Indian Country Today by a former FBI special agent, Walter Lamar:
Some states, like Minnesota, South Dakota and Oregon, are working to change that by knitting together networks of providers to help these exploited children. Minnesota’s Safe Harbor Initiative increases the opportunities for young people to walk in off the street, a method called “No Wrong Door.” Under new laws in these states, children who have been prostituted cannot be charged with juvenile delinquency and are instead treated as victims of a crime.
Walter Lamar in Indian Country TodayNative School Girls Should Not Be for Sale on the Street

I'm very much in favor of this approach, but I want to highlight Lamar's use of "knitting together networks" as a way of tying these varied links together.

Mickey points to monopoly as the cause of the steep increase in medical costs in the USA. The ordinary solution for monopoly is to introduce greater competition. Heaven's knows that policy makers have tried, but such policies haven't slowed the increases. Illich's construct of radical monopoly maybe one reason why not. Certainly the punitive approach helping kids in trouble is informed by radical monopoly too. 

Radical monopolies in psychiatry -and the healthcare industry more generally-- preclude, or at least make it difficult to incorporate networks of people outside the system in care.  A similar dynamic is involved when law enforcement charge sexually exploited children with crimes. There's an internal logic to it that makes no sense at all. 

Weaving networks together offers offers a more sensible approach, but radical monopolies are "radical" precisely because they exclude the competencies of ordinary people. Some worthwhile initiatives like Safe Harbor may emerge on the edges, but without the critique of radical monopoly, it's difficult for me to see such initiatives moving to the center.   


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