Ehs Nursing Care Plan

thank you so much for coming. we really have a distinguished lecturer for you today, so i'm glad that so many people have shown up. my name is david mitchell. i'm the executive director of the institute on disabilities here at temple university. i would like to just point out a couple things to you, right from the beginning. if anyone needs open captioning, or access to the open

captioning, please move over to this side of the room. that's where we're providing it, and feel free to do so. second thing is on your chairs, you'll find a small survey form, and we'd love it if everybody would fill it out at the end of the lecture, so that we can get all of your enthusiastic comments about dr. wolfensberger's lecture today, which is what i fully anticipate. this series, which we've been running for two years now, this is the last lecture in this academic year,

lecture series run, is entitled the geopolitics of disability, and our idea in this series was to feature new research coming out of the field regarding people with disabilities, the social predicaments that they find themselves within, and to keep our focus local and move back and forth between local contexts and examples, larger global picture of people with disabilities, to start thinking really about people with disabilities as a global population that experiences significant degrees

of social marginalization and devaluation, to understand how those systems work, where that stigma and marginalization comes from, how it's particular with respect to people with disabilities, i think, in many cases, and ways to effectively redress that. really, there's no better speaker to take on that huge mission on our behalf, so i just thank him from the beginning, other than to bring dr. wolfensberger here to speak, who's written on social role valorization, normalization.

really, he's been such a stalwart in the field, and someone who has helped us to push forward a concept of having to need to understand the dynamics of stigma and marginalization and devaluation of people with disabilities, and then even better, how to redress those conditions to one extent or other. and even his arguments about social role valorization are situated on kind of a neutral scientific framework, to be able to assess and diagnose the kind of situations

that people with disabilities find themselves within, within various social contexts. but that, in and of itself, seems to me to already be doing something. in other words, we can't effectively come up with interventions and plan more productive and positive ways forward, for thinking about people with disabilities, including their perspectives in our society, without understanding the nature of why those perspectives

are so absent, so neglected, so undervalued, and my expectation today is that he will come in and illuminate us further in these various ways. but i'm going to hand the microphone over to guy karuso. he's the director of our pittsburgh office. he's like one person who extends the institute's reach all the way to the west of the state, which is one of the few states where it takes longer than five hours to drive from one end to the other, so in some ways, pennsylvania, really,

it should be cut in two or three or something like that. but at any rate, let me give the mic to guy. thank you all for coming. thank you, dr. wolfensberger, and let's have an enlightening time together. (applause) well again, welcome to dr. wolfensberger, who's here with us today. i met wolf back in 1974.

i know i don't look that old, but it was back in 1974, as a graduate student, and it was a real awakening to me, about the concepts that he shared at that point in time, about devaluation and deviancy, and social devaluation. i must admit, i wasn't easily convinced until i had an opportunity that wolf provided me, to actually go work in an institution for awhile. and all the things he talked about that were so horrible, that would happen in the lives of people with disabilities

were in fact very true, and it just shook my world, changed my perspective, and to this day, i've been so influenced by wolf. he's been my mentor and friend over the years. he started back in the early '70s at syracuse university, the training institute for human service planning, leadership, and change agentry, meaning just that concept of really looking at, how do you plan for services, how do you provide leadership, develop leadership,

as well as really look at change. because you have to realize, back in those days, the institution was a primary model for service for people with disabilities, where they were hidden away in the communities, not seen by anybody. so his movement back then to get people thinking about this was quite a shift in the thinking, and not a very welcome shift by many people, and his classic book in 1972, the "principle of normalization, " really

pushed us all to look at the world in a very different light, and really opened our eyes in many ways to see what was possible in the lives of people with disabilities that hadn't been deemed possible at all, by anybody other than parents, to a great degree. and parents were very enthused by what wolf had to share. in nebraska, where he worked with n-core, created a whole system of services, from birth literally to old age, that was community-based.

again, a whole perspective that had never been really thought about in society. from his work on normalization, he also developed an evaluation tool called pass -- program analysis of service systems -- which again, allowed us to use these concepts, in a very critical way, an eye-opening way, go to services and actually interview people, see what was happening, and start to realize that what's often talked about and said is in fact the realities of what's

happening in people's lives. so he really raised my personal consciousness, sometimes very painfully so, because i've worked in human services many years, and had to step back and say, you know what, i'm equally devaluing people, i'm equally doing things that are harmful to people, even in the name of independence and residential services and all these other things, just really i think personally helped me step back and many of us in this room to really look at what are

we really doing, and does it lead to people having the good things in life, like anybody else? so there's a book table in the back that i'm sure wolf will talk about, with many, many books. he has written -- his works have been translated into 11 languages. he's been very prolific around getting the word out over the years. now from normalization he moved on to what david had said,

with social role valorization, which again was looking at a way to help people have valued roles in life like anybody else, not the devalued roles that have historically been so predominant in the institutional models. he also developed citizen advocacy, a concept that really brought people together on a one-to-one basis, both on an advocacy -- helping people do instrumental things in their lives -- as well as helping people just to have friends.

many people with disabilities live in the professional world and never had a relationship with anybody else. so his concept again, brought people together, really as friends on a reciprocal basis, and these programs exist around the world. he also has pushed us into thinking about the horrible things that happen in the lives of people with disabilities. a book of his, "the new genocide of handicapped and afflicted people ", isn't something folks really are really wanting to

read, but if you look at some things that are happening, and you have to realize, a good friend of mine says -- he has a child with down's syndrome -- 90 percent of babies with down's syndrome are aborted in this country today. 90 percent -- and there's no outrage, there's no even acknowledgement that that happens. but wolf coined a whole term called death-making, that takes place in the very services that we do. and i could go on and on and you can see how impassioned i am by

what this gentleman has both taught me, and given me the opportunity to see. so with no further ado, i'd like to welcome wolf wolfensberger. well, students are usually looking forward to completing their schooling and then going out to do some good in the world, and most are also hoping to get a good paying job, and to have a career that will allow them to be, so to speak, well off. now those hopes are very natural,

but there's something about the kind of paid work that involves service to other human beings who are in need, that is very different from any other kind of paid work. we're going to examine some of these differences and the implications, and i should warn you that some of this is likely to make some of you uncomfortable, and perhaps unhappy. now you're probably familiar with the story of the man who was traveling by foot through a mountainless desert,

when he was attacked by robbers, who took everything he had, even his clothing, and beat him half to death and left him to die. and a while later, first one traveler and then a second one came by, saw what had happened, and traveled on without helping the man, even though both travelers were religious ministers. they were probably on their way to some important function and didn't want to be late.

now, then the third traveler came by on a donkey. he was a member of a despised religious and ethnic minority, namely the samaritans. when he saw the wounded man, he was moved to his very inmost being. he had with him some wine and some oil, and he used these to clean up and anoint the man's wounds, and then with great effort, he laid the man on his donkey and walked to the nearest inn, where he nursed him,

and the next day, he paid the innkeeper an appreciable amount of money and said, take care of him until i come back from my journey, and if you spend more than i gave you, i'll pay the difference. because of this good deed to a debilitated stranger, we know this benefactor as the good samaritan. now the story is told to answer two questions. one is, who is my neighbor? and the other one is, whose neighbor am i?

now relevant to us is that the samaritan did not run to get the help of a charitable organization or agency, or of government, but himself helped the wounded man, and using his own wine and oil, lifted the man's body onto his donkey, delayed his important trip, nursed the man himself, and then gave man of his own money for additional care by the innkeeper; all this with no expectation of being paid in return, or even of being thanked by the wounded man who belonged

to the valued majority that despised people like him. so that is what personal samaritanship is all about. now one awkward thing about one's neighbor is that one often cannot pick him or her, one can't pick one's neighbor, and instead, a person's neighborship is thrust upon one unexpectedly. and the neighbor could be any number of people who would not have freely picked to be one's neighbor. all this, both the samaritan and the wounded man discovered.

left to themselves, neither would have picked the other as their favorite neighbor, and not even as their non-favorite neighbor. what also complicates issues of charity, in the sense of love and good samaritanship to the neighbor, is that people often fail to distinguish justice from charity. this is why people with a strong sense of justice are often interpreted as altruistic, when in fact they may be

very deficient in personal samaritanship. so there are people who are involved in all sorts of social justice schemes, maybe even justice for mistreated people halfway across the globe, but who do not practice samaritanship in their personal lives. some people have referred to this phenomenon as distance love, or telescopic philanthropy, in contrast to love of a near one, the neighbor. now to help clarify this distinction,

let's recall social justice can be delivered by all sorts of societal structures -- by laws, courts, governmental regulations, by the efforts of organized lobbying, and on and on. private individuals can also practice justice by not taking what isn't theirs, by not exploiting their neighbors, by not lying about what somebody has done, and so on. in either case, justice can be practiced in the absence of neighborly love, or even in the absence of close contact

with a neighbor. even personal justice is not the same as personal samaritanship, where, out of deep compassion for the plight of this or that individual in one's life, one engages in acts of mercy to that individual, such as giving or sharing food with the hungry, giving some clothes to the ill-clad, maybe even some of one's own clothing, taking in the homeless, tending to a sick person, being company to a lonely person,

visiting or even springing an imprisoned person, consoling someone who is in the dumps, or who has lost a loved one, and so on. so a big point is that justice can be practiced cold-bloodedly without love of neighbor, and in contrast, if personal charity were universally practiced, most of the conditions that call for justice would be greatly lessened, or even disappear. one reason is that people are likely to extend justice to

those they love, and even more, love will often go far beyond justice, in seeking the good of the neighbor. but keeping these things in mind, let's now look at some big problems or dilemmas with getting paid to serve upon needy persons. one big dilemma is that so many people who feel specially called to service their neighbor end up as paid employees of formal organizations that identify service to neighbor as their mission, and thereby, they become more like the innkeeper

who got paid to nurse the wounded person, than the samaritan who did everything, not only unpaid, but at considerable cost to himself. the big problem with organizations whose mission it is to tend to the welfare of afflicted people, is that they evolve or work under bureaucratic rules that limit the scope of merciful actions their members can take, both the paid and unpaid members, but especially the paid ones.

they involve rules as to what employees can and cannot do, and what they must do, and above all, these days, the very first thing they do is to make sure that the organization will not be successfully sued. many people are not even aware that these days, this is the often hidden purpose of the first thing that employees are asked to do when they have their first contact with a client, such as signing release forms. one thing i can tell you with near certainty:

if you are moved by the plight of one of your clients to the inmost of your being, as the good samaritan was, over time you'll be very likely to come in conflict with your employing agency. and, if you persist in putting the interest of your client above that of the agency, you will eventually be extruded from that agency -- and we will come back to that. one of the other great moral dilemmas of working in human services for pay, perhaps as a career even,

is rarely discussed. it is that the more people suffer and are afflicted and missable, and the larger the number of thusly missable and afflicted people there are, the more paid human service workers have to gain, both as individuals, as well as collectively. in other words, if the afflictions were less severe, or didn't exist at all, most human service workers would have no jobs, no income, no livelihood in human services.

people who might have been paid human service workers, would then have to pursue a different kind of livelihood. and in some economies, such as ours, that would be a chancy thing. in many western societies, we have seen over recent decades, an ever-increasing proportion of the workforce employed in human services. there may be a decline in some human service sectors during the present economic crunch, but even now, we're told that

the health service system alone will -- still needs millions of new workers... they never have enough. the health service system all by itself accounts for one-sixth of the american economy, and obviously has a big interest in the continuation of unhealthy lifestyles. at one time, most paid service workers were relatively poorly paid, even into the 1950s. the teacher's salary hardly survived to support a family. but then things changed...

now we find service workers at all pay grades. many still just barely earn a living, such as attendants in nursing homes and therapy aides, teacher assistants, custodial workers, kitchen helpers, and so on. but there's also a large group that earns enough for a middle-class lifestyle. that includes most of the professional and indirect service workers.

now, some people in human service can now even become outright wealthy. for instance, already by 1978, physicians in private office practice were in the top one percent of earnings in the u.s. population. more recently, administrators of large service organizations, and of hospitals, and especially of health insurance firms, may earn several hundred thousand dollars a year, maybe even millions.

our local health insurance giant in syracuse, new york, called -- it's one of the blue cross blue shield organizations -- paid 62 employees more than $200,000 a year, and the three top ones were above a million, the top one getting $2.73 million a year. even the school superintendents are paid scandalously high salaries, and ironically, the more money one makes, the less direct contact one is likely to have with afflicted and needy people, or even with any people to serve,

even if they're not terribly needy. i said earlier that there's a problem with people making a living off other people's misery, and especially when they become well-to-do thereby. but there's a second aspect to this problem in many service sectors, and that is that a huge proportion of service recipients are poor. they always have been poor, and they always will be poor. and even worse, their parents often were poor,

and their children are going to be poor as well. in fact, we're dealing with some families that have been poor for hundreds of years, and not only that, many service recipients are poorly educated, unemployed, even unemployable. they're dependent, their society devalued, they live in ghettos or in terrible public housing conditions, and with little opportunity to be mobile and to seek a better life elsewhere;

in societies that people have hardly any voice of power, and a lot of bad things get done to them. plus, they often do a lot of bad things to each other. also, there's a well-established relationship between poverty and poor health, and therefore, also ribbons poverty and shorter life expectancies. we've also found that the minds of many human service workers are so focused on the bodily or mental impairments of their service recipients, of the clinical diagnoses,

the clinical condition that they may have, that they do not give much thought to the fact that they're poor. so what they see is a physically handicapped person, a retarded person, a blind person, a deaf person, and they don't see a poor person. and that's the one thing that so many of the clients share. and they're not attuned to what this really means, and what it leads to.

yet further, the economic gulf between human service workers in certain sectors and their recipients has been growing bigger. as recently as 1940, physicians on the average did not even earn triple what their patients did. now the economic gulf means that there is now a big class gulf between many service workers and their recipients, and it may even be as multi-generational as the gulf was between the french nobility and the french proletariat

prior to the french revolution of 1789. the terms "exploitation " and "oppression " come to mind. after all, if a lot of people were made and kept poor, how could the rich people be rich? ask yourself, from where would a financial manager get an annual bonus of $500 million? where does this money come from? it must come from somebody, and from where would tens of thousands of financial managers get outrageous bonuses?

not to mention, just paying incomes. in my opinion, all this contributes -- correction -- it constitutes a great moral dilemma, even a scandal. and what makes it even yet worse is, if the paid workers reject their recipients and dislike them. and does this happen? absolutely. some fields are notorious for this. one is aging, as research has amply shown.

another one is psychiatric services, where it's common for workers to hold low opinions of their recipients, and similarly, disdain for prisoners is widespread among prison personnel. in my archives, i have several stories of well-paid service workers, opposing the location in their neighborhoods of group homes for the very kind of people that they serve, because they don't want those people in their neighborhoods. aside from the objective hardship of many dependent

people, is their subjective misery. many are abandoned, and they feel this intensely. many have no one to talk to, no one to console them, no one to go to if they need help, no one who looks in on them to see if they're even still alive. and so when they die, it may take days or even weeks to discover, and no one may be at their funeral, or only people who get paid to be there, like maybe the clergy member on retainer from the welfare

department who never knew the person. we're not even done sketching the bad things connected to the gulf between workers and recipients. another one is that the quality of service rendered by the paid service, especially during publicly supported ones, is generally very low. the reasons are actually not as obscure, but overcoming them has been impossible. here are a few examples:

when i came to new york state in 1973, there were nursing scandals left and right, and there have continued to be ever since. every time there's a scandal, there's a kind of reform, and then the next scandal, on and on. despite all their money, the public schools seem incapable of teaching children even basic academic skills, as they once did. they once knew how.

they no longer know how, no longer do it. the single biggest service that people with mental troubles get is prescription mind clogging, with drugs that have very, very detrimental effects on their bodies and often debilitate their minds even more. but interestingly, the reasons for poor service quality have changed drastically, roughly since the early 1970s. before then, services often were bad because not much money was allocated to them.

a good example were the huge, overcrowded, underfunded snake pit institutions that were the stepchildren of the states. the federal role in service funding was then still in its infancy. however, an additional reason is that after about 1970, the economy became increasingly a so-called post-production one, in which service jobs replaced production jobs. soon, money started to flow to services in a waterfall,

and services proliferated. but they also began to become highly bureaucratic and to spend money frivolously and fruitlessly to this day. so at least one of the other major reasons for low service quality now is no mystery. if human services were effective, the entire economy would collapse. you got it? the economies of highly developed countries are

no longer based on productivity such as farming, fishing, mining, construction, and manufacturing as formerly, but they're based on services, and these economies literally need a large proportion of dependent people so as to create jobs in the human service sector, and not only in direct services, but in the construction of human service facilities, and supplying human services, energy and goods, in cleaning the facilities, providing food to the recipients, and on and on.

so the truth is that our post-production economy cannot afford to have too many healthy, well-adjusted, functional, productive, and employed people. they can't afford them, and therefore it has to create conditions that in turn create dependency, and hence, also, of course, create human service jobs. and it has to operate human services in a way that keeps them relatively ineffective. how is this accomplished?

well, by rules, laws, regulations, funding these incentives, and all sorts of other strategies that make for low service quality and that make for ineffectuality, but all of that of course is very disguised and hidden, the facade of benevolence, you see, and behind it are these systematic disincentives. there are some services that are not only ineffective, they actually do more harm than good. among these are much of juvenile correction,

many services to the elderly, many long-term institutions, and the entire...section. now there's all of this that's morally despicable, society hides it well behind the facade of generosity, of service probation, and funding, behind noble rhetoric, and behind the concealment of the amount of true unemployment. did you know that the long-term unemployed human service clientele is not even included in the official unemployment figures?

thus, when government releases unemployment figures, you have to multiply these by two, by three, by five or more, to get the real figures. or did you know that on the streets of all of our urban centers, you will see -- and you may see every day, some of you -- that there are many people who are poor, homeless, rejected, abandoned, wandering, hungry, in very poor health, but they've got a case manager, and they have at least one individual service plan.

(audience chuckling) what's wrong with that picture? you know, even people who are not homeless but are living under terrible conditions, may get services that are expensive but meaningless, such as case management and individual plans, but still nothing that would lift them out of service dependency. in syracuse, as elsewhere, various federal, state, and local governments have conspired to build -- and

businesses -- have conspired to build one segregated slum public housing project after another, and the federal department of housing and urban development is the worst. when after barely 30 years of use, such projects run down and they get abandoned, and that has happened with several of these projects in syracuse, then they get very expensively torn down, and very expensively rebuilt -- sometimes in the very same spot. each separate living unit of these projects is so expensive

to build that if residents were given the cash, they could have bought very nice existing housing dispersed throughout the community. unfortunately -- you do your own math, i'm not kidding you -- unfortunately, good houses in poorer neighborhoods are allowed to deteriorate until they become uninhabitable, and then much more expensive ones are often erected in the same spot with public monies, or by private non-profit efforts. there's a third big problem of paid services.

in the case of some people, 100 percent of their lives are spent as recipients of paid services. they live in a serviced residence, they spend the day in a paid day service, or an agency-run vocation service. they get taken to recreation events by paid workers, plus, they may do all of this in the neverending company of other dependent and devalued service recipients. such people may be well taken care of,

but there's one thing they lack, and that is freely given relationships. there may not be one single person in their lives who relates to them without getting paid. imagine what the message of this is to such recipients... you are so different, and so despicable, that no one will choose you, will want to be with you, be your friend, and so on, unless they get paid for it. and there is the fact that so many lowly service recipients

have indeed been abandoned and rejected by just about everybody, including by the service workers who are getting paid to serve them. now this is why it's so important to try very hard to assure that people who are deeply embedded in the service system have relationships to people outside the service system. so on the one hand, there are many afflicted persons who are very much rejected, and yet on the other hand,

the moment people are offered good salaries for entering in service, then suddenly there are large numbers of them, proclaiming to have a vocation to feed the hungry, shelter the homeless, clothe the naked, console the broken-hearted, bind the wounds of the sick and wounded, and so on. just where were all these people before they were offered payment to do these things? could that many people really have had a calling

to what they end up doing for pay? after all, in north america alone, there are now about as many people living off human services as there are dependent or afflicted people at any given point in time. it's almost a one-to-one ratio now. true, at least some of them were service volunteers before they became employed human service workers, and others remain voluntary servants even thereafter,

but only some of them. now sorting out who has a service calling and to what, and who does not, is of course difficult. in fact, when paid servants do what paid servants do when their jobs disappear can be a strong retroactive sign, whether they had a calling or not. the ones that did will continue to serve as best they can, on an unpaid basis, and the others will disappear from the service scene.

they are human service workers who perceive the oppressive nature of many services, or service practices, but fewer who also perceive the exploitative element, and there are close to none who view themselves as among the oppressors and exploiters. and quite to the contrary, they see themselves as noble, unselfish, as giving more than they receive, as generous, and most definitely, as bringing benefits to the people for whom they work.

if they are professionals, they see themselves as deserving both relatively high social status that they receive, and the middle class income that goes with it. but that is not at all the way that the clients are apt to see them, or the way i see them, or necessarily the way it really is. to many clients, the human service worker is the enemy. an example would be the social worker who controls the poor family's income and takes their children away.

another example is the rehab counselor who hardly ever finds jobs for clients, but seems to string them along for years on end, or the psychologist who gives tests that lack ecological validity, or that lead to nothing, or the psychiatrist who brings havoc into the lives of patients, often by mindless mind clogging or other poor dispositions. now sadly, it is almost impossible now to get a paid job in human services that does not absolutely require that one

engage heavily in absurd and bureaucratic things, that at the very least waste one's own time and that of the service recipient's, but often also impairs service quality. now let's go back to what we said earlier about a service worker getting into conflict with his or her agency. imagine, if you work for an agency, the real function of which in society is to stimulate the economy and to maximize the number of dependent people in society.

when you try to liberate people from such an agency in societal dependency, how could you possibly not get into conflict with your employers, and avoid extrusion? today, to serve someone effectively and with high quality, almost requires that one do so outside of one's paid job, as part of one's way of living, and unpaid of course. people with more education are more likely to be able to find or create jobs outside the service sector, perhaps however also in other worthless employment sectors

like computer-dom. but that is much less the case with more lowly people who make up a large proportion of the direct service labor force. they're largely stuck in low paid service jobs, where they have to follow the instructions of the people from above. there are very few students of practicing human service workers, or all practicing human service workers, who have ever been told of the dilemmas that we've sketched

here, unless they've been taught by members of our teaching culture. and this tells us that there can be such a thing as systemic unconsciousness that can hold an entire field in its grip. there are other examples of this, for instance, the simple such unconsciousnesses about major issues in the mental field, in vocational rehab, in the mainstream of education, and so on.

a lot of you may be ready to shout out, but what is to be done about all this? let's face it, for many of these things, nothing will be done because these things serve too many powerful interests and societal functions. so a much more relevant question is, what am i going to do about all this? and here are a few possibilities... first is to acknowledge the realities that we've spelled out

here, because without a conviction that they're real, one is not likely to be motivated to take any relevant action. realities that are unpleasant tend to be denied and repressed. the best way to avoid all the problems that come with paid service is to keep people out of service clientage, or to get them out if they are already in it. now in the vocational sector, this could mean, for instance, trying to find employment for handicapped adults by using

informal avenues, like asking family, neighbors, friends, and so on, for work opportunities, trying to craft individual work niches for handicapped persons, maybe even of an entrepreneurial nature, and so on. amusingly, people's tendency these days is to instead do just the opposite, namely to get every effort, make every effort to get people enrolled in the service system, if they have some kind of a need. a major way of doing number two here is to meet people's needs

in informal, unpaid, voluntary ways, as for instance, by what has been called natural supports. there are many forms that this can take. this also implies that if one can afford not to work at all, it would be preferable to serve needy people on an unpaid basis. i've been emphasizing for years that for handicapped people, unpaid work that is contributive and that has a valued adult image may be preferable to paid work that may be segregated, that congregates devalued people together, as is typical

in service work, and so on, or that may only be work for a few hours per week, as is very common in so-called supported employment. and of course, doing productive, adult imaged, positively imaged, unpaid work is better than to do no work at all. by any account, by any criterion. and all of that is especially true for handicapped people who receive a government subsidy, as so many do, and who are not dependent on earned income.

it's also important to assist in sabotage, mindless and futile bureaucracy or bureaucratic rules, as much as one can do in one's paid service. in other words, i'm encouraging you to be in rebellion against your employer, in essence... (laughter) as much sabotage of the mindlessness that's going on as you can get away with. another strategy is to do everything one can,

that's under one's control, to keep people out of paid human services who are not having a calling for it, and who do it primarily for money. they're more apt to do harm than good. however, these days, keeping people who are unsuited as servers out of paid service positions -- as i said, there's a near impossibility, because paid services are available in the service industry, in service -- i shouldn't say industry,

in services -- in vast numbers, and in post-production economy, and so people flock to them regardless of their suitability for them. and secondly, it is widely assumed that in order to fill all sorts of human service positions, one does not need skills and qualifications. you can just see that the way people -- who gets hired and how do they get hired? and the people who cannot find a job anywhere else, then go and

apply in human services, and they're likely to get one there. and they can't get one anywhere else. to many people, human services is a pessimist, maybe even a business for profit. we have to resist that idea, and any idiom that suggests it, such as referring to service recipients as customers, and consumers; and the idea that the mission of service is to give recipients what they want, which is often said these days, much like business would do to keep a customer happy.

human services differ in absolutely essential ways and fundamental ways from purely economic enterprises. in business or industry, one largely works with objects and it's quite possible to manufacture objects that one detests. indeed, one can even abuse a great many physical objects if one feels frustrated or resentful towards them. you all know people who go around kicking tires. the problem is that one works with human beings,

especially wounded ones, one cannot kick them around, and one can't let one's frustrations and resentments stand between one's self and them, and relatedly, no amount of money can buy positive feelings or commitment from service workers. no one can pay one human being to love another... and in fact, it's even somewhat difficult to pay people to hate. one can get people to hate by indoctrinating them ideologically, or feeding them lies,

but no amount of money can get a person to like someone whom they don't like. money can only manage to give people motivation for hiding their feelings. what it boils down to, in essence, is that a sense of alienation, distentiation or non-identification with people when they're supposed to serve is one of the biggest contributors to violence and abuse in human services.

one can recite many examples of these problems, the current one being the nursing home field, which once again is being treated like a business, where many people are being hired to work with people who they do not like at all, and where abuses are rampant -- staff turnover in many has been 70 percent a year, 70 percent a year, at least in part a sign that people are working this field because it's a livelihood, and not because they feel a call to work with elderly people,

or because they love them or even like them. so a big point here is that many ways of serving others in need should be viewed as a calling, which can take a lot of forms, depending on one's gifts and talents. people in paid services are highly advised to engage in what we call validation of their paid work, namely, by doing certain things that make it clear that one is not in the work primarily for income, prestige, or comfortable lifestyle, and that one is not striving to

maximize one's material benefits from one's paid service. and one can think of four forms of such validation. one can find a place and a master that allow one to do the right thing, and in ways that are consistent with one's calling, even if one has to work at a significantly lower salary. actually, a lot of called service do that. in addition to serving for pay, one can also perform unpaid service, and best of all, outside of one's professional or occupational role, maybe in a completely unrelated

service role. for instance, a physician could take on a lowly and anonymous role as a server in a soup kitchen for the poor, or the service administrator could sit through the night by the hospital bed of a debilitated person as an unpaid companion and protector, and so on, rather than doing something that just is what they would do for pay, you know, ordinarily. outside of one's job, one can enter into so-called

life sharing with needy people, by establishing reciprocal and supportive relationships, joining in activities and celebrations together and so on, and best of all, one does this with people other than the ones whom one serves for pay. and such life sharing can take two major forms. one is to enter into the life sphere of the needy person, going to where they are, eating what they eat, living where they live, maybe living with them,

being treated the way they get treated, and the other one is bringing the needy person into one's own life sphere, just by involving them in one's own family activities, bringing them into one's home and so on. now, people who are not in paid services may also embrace this strategy in an effort to engage themselves in some kind of voluntary personal helping, and of course there are enumerable examples of people doing exactly these things, often through the natural infall, unpaid forms of serving others.

and several of these strategies point toward another strategy, namely, living in outright voluntary poverty, even when holding a paid service job, and thereby, one not only doesn't get much material benefit from one's paid work, but one also enters into solidarity and life sharing with and into the estate of so many of one's service recipients, who i said have always been poor and always will be poor. one can do this either by serving for much lower pay

than one could get, or by willingly giving away a good share of what one earns. i imagine if the insurance executive who is paid several millions were to give most of it away, live in a poverty level income, and thereby, not be able to afford private health insurance, not being able to -- thereby, having to make do with the same medical care that the poor have access to, that this of course is different from working in non-voluntary poverty, as many of the lowest

paid service workers are now doing. the lowest paid, the ones i talked to earlier, they get poverty wages. now some of these strategies can have the effect that one will be badly treated by one's privileged peers, or by society generally. they may begin to treat one the way they treat the people one serves, meaning badly, because one is becoming more like these people, at least in their eyes.

an example of -- is the white freedom riders of the 1960s, who in the u.s. south often got treated like blacks, even got beaten, and in some instances, killed. however, being treated the way one's recipients are is apt to make for strong identification with them, and hence for more devoted service to them. interestingly, the three big dilemmas that i sketched have been recognized in certain traditions of religious service. for example, into the middle ages in western europe,

and in some instances, even later, huge numbers of people served for free, either as unpaid members of serving orders, or of voluntary cofraternities, or just as part of their ordinary lives. and it was widely considered to be wrong, even a great sin, to accept money for charitable work. midwives especially considered it very sinful to accept payment for their services, and so did many wet nurses.

also, it was customary to treat the people one served with, with great -- one served -- with great deference, as if they were the so-called hidden christ. servers felt honored and grateful to have an opportunity to serve for free. commonly, a pilgrim or a sick person or a pauper who sought hospitality in one of the about 100,000 free hospices across europe would not only be provided with shelter, food, and medical attention,

but quite often would also be given clothing or better clothes, and upon departure, might be furnished not only with food for the journey, but also with actual cash in hand. and it was standard practice into the 20th century for physicians to serve the poor for free in hospitals. many went one step further and gave their poor patients money, recognizing that the poor needed money more than they needed the ministrations of the physician, because these ministrations were largely futile in those days anyway.

a similar tradition prevailed in the charitable installations of islam, at least during a small, flourishing period. some figures stand out in the history of medicine as selfless and dedicated. many of them saw themselves called to the tending of the sick, the way other people saw themselves called to the ministry or the religious life. they embraced voluntary poverty and sometimes led saintly lives of self-negation and without any sort of personal security,

and they risked their lives constantly in those days of contagion and infectious diseases, and so on. for example, one famous quaker physician in london during the late 1700s was john fothergill, who gave money to his poor patients, often slipping it discreetly into their clothes while examining them. he believed that practicing medicine for the sake of money was a vice comparable to drunkenness. he charged the rich only so that he could serve the poor.

he also opposed violence, injustice, and oppression in the larger society. and he was succeeded by another quaker, john coakley, who charged the rich fabulous fees in order to support countless charitable causes, and who believed that he could cure poor people more readily by giving them money than via his medical skills, and that's a sophistication many physicians have not retained to this day.

and william cullen, who practiced in edinburgh in the late 1700s was also very compassionate to the poor. what little money he had, he kept in an unlocked drawer in his office, and when he died penniless, the drawer was empty. such figures served as shining examples to younger colleagues. well, at the beginning of this lecture, i told you that you might not like to hear some of this, and this is a time when people are very anxious about their economic security, or if they are in high places,

they're very anxious about keeping their ill-gotten gains. however, truth is truth, and you should not be denied because of one's self-interests, and passions, because it is well-known that self-interests and passions are big obstacles to the apprehension of truth. i therefore hope that you will continue to think deeply and open-mindedly about the dilemmas that i have sketched, and not repress them or run away from this harsh truth. now, we're going to open the floor for discussion and if you

haven't noticed that we have a book table in the back there. questions, anyone? how much of this is a reflection of a capitalistic system? that's part of the question, but are there societies that have, or countries, social systems that have broken away from, are not engaged in what i guess farkle called a surplus, the need for a surplus population? well, the post-production economy has taken hold in many countries of the world, including some that have

very different political systems and ideologies. but the post-production economy has such strong dynamics that it tends to overwhelm whatever other systems that may have existed before it. also, we have to always keep in mind that there are no perfect systems, you know, that there are only least worst ones, that all the schemes and the systems and the ideologies and the plans and so on, they're all riddled with dysfunctionalities, and people think that they can exchange one dysfunctional

system for another one, and they find that they've bought a different set of dysfunctionalities. now even -- it is amazing that even the countries that were -- until recently, third-world countries are going through the same problem. one exception is that the chinese have deliberately decided they will not become a service economy, and that's not necessarily going to save them a lot of trouble, because they'll have a lot of other tremendous

difficulties to face. but at least they have been conscious about what that brings, and are trying to avoid this. other questions? yes...back here. what are your thoughts on -- since we have this dilemma with people getting paid to support individuals with disabilities, as far as loving them and really wanting to be with them, what are your thoughts on local government and providers not

supporting family members who would like to do this work and thus get paid for it, but there's rules and regulations that keep them -- there are barriers for them to get paid for this. what are your thoughts on it? if i understand you right, the problem's even bigger, because the paid service system is very much opposed to people providing services for free. there's some facade, of course, for hospitals having volunteers

and so on, but they're not really replacing any pay for workers. and so there's systematic disincentives against any kind of replacement of paid service workers with paying families, or even unpaid volunteers, and we see similar disincentives -- we can even say that generally, the less structured and often the less expensive form of service is disincentive -- it'd be the more expensive one, and the more structured one, and this is why the nursing home industry

has persistently been opposed against helping people in their own homes, home health services of various kinds. when service monies are cut, the home help services are often among the very first to be cut, which means more people get driven into much more expensive nursing homes, and there's good reason why this is happening, you know? there's a question over here. hi, thank you very much for coming, i appreciate it. i have a question, as a service provider,

that you would have a client who very desperately is feeling devalued and not part of the community, and they really want to get out of it. they have the desire to do it, and you, as a provider, want to do that for them, and give them the value, give them the abilities to make something of themselves and get into the good life. but by doing that, you as the service provider know that that person will lose all of their supports,

meaning, like their medical care and their financial support and things like that. how do you as a service provider want to help them better their life, but knowing that doing that is going to make it much worse? well, there is no doubt that certain barriers exist, but there are ways to get people out of the service system without them losing all of their supports, or their so-called entitlements, and so on.

but yes, it is a dilemma, and may even be a hidden disincentive, you know, to prevent such, we call them liberations. i know that my individual case is that i personally would strive to assist them, to get into where they want to be, and try and find those supplemental systems, to allow them to continue to receive what they already are. but i know that in the person that i have in mind specifically, that should they do that,

the costs of going into an independent life is going to be so significant that they themselves, by coming out of it, will not generate enough income, and it's like frustrating. yeah, that's the reality, and the other -- one more part to it is if they do get out, and manage without those supports, and suddenly need them again, it may take forever for them to reestablish entitlement. what about the health care legislation? how should that look to reverse this process of

bureaucratization that you're talking about? well, tricky question, isn't it? for one thing, i don't think any of us really know how this is going to work out, and i wouldn't get my hopes up that you will encounter anything other than the same dynamics that we're seeing now -- different configurations and different sets of incentives, and disincentives and so on, but legislation is not going to reverse the major dilemmas that i have sketched.

hi, this is from carol marfisi. she asked, how would you suggest getting people who are used to having paid services out of the mentality of being obligated for unpaid assistance/relationships? say that again. how would you suggest getting people who are used to having paid services out of the mentality of being obligated for i'm a little hard of hearing. say it one more time so he can understand.

is it a feeling of obligation towards the caregiver? or service worker? if i understand you right, yes, we hear that all the time, that one is dependent on other people taking care of one, that one feels that one is obligated to them, and it's a two-edged sword, two-edged thing, you know? on one hand, it's real. it would be more real if the helper were unpaid, you know, than if the helper is paid.

then one would be even more obligated. and the other side of the coin is that there's been a mentality of an unhealthy sort of entitlement mentality, that if a service is paid, one should not have to feel grateful for it. this is a lawful entitlement, and so on. that's a little bit unnatural and against human nature, in my opinion. i think it is appropriate that if someone helps one,

and especially if the helping is not a completely impersonal thing, done only for money, let one be grateful that someone is willing to do that and can do that, and that one expresses and feels at least one's gratitude toward them. i can tell you that when i was in the hospital recently, i was filled with gratitude for the fact that my nurses who -- so paid to work -- were the soul of kindness to me. i said, oh my gosh, what would happen to me if they did not

have their hearts full of love, you know? it would be awful. one more question, anyone? yes. i agree with everything that you're saying, but i wonder if there isn't a kind of level of expertise that we have developed as being part of the system, and to not have a system with those professionals, wouldn't people be lacking for skilled help that they might

need to have more productive lives, or happier lives? well, you may know that this is very debated, you know, and there's much argument that this higher level of, in essence, amounts to technologization and so on, can be counterproductive. ivan ilych's work, for instance, speaks to that, and there's also much argument about to what degree the higher level of technology and things like healthcare has contributed to longevity.

a lot of people who would say that there's changes in life conditions that have increased longevity, rather than improvements in the medical care. so it's controverted. good, well, i'd like to thank dr. wolfensberger for being here today. one more question back there? want to grab the -- one more since we got it. you said that you came to this country in 1973,

and i was just wondering what your observations are of the differences in our country now, from 1973. well, the early '70s, late '60s were a watershed in many ways, and what i emphasized was, that's when the economy tipped over from a production oriented one to a post-production oriented one, and that changed everything, all about all these things that i talked about, and it's very debatable, you know. it is debated, where the people really are, so to speak,

leading more felicitous lives where they're really better off, where they're really happier than they were in a different, more production-oriented and simpler society than the current one. and in fact, in other contexts, we say a great deal about the current modernistic society actually heading towards collapse, massive collapse, unimaginably catastrophic collapses. okay, a nice round of applause for wolf.

okay, there is a book table in the back that has a lot of wolf's work on it that you're welcome to go to. also, please fill out your evaluation forms; you can just leave them at the end of your chairs if you would, we'd appreciate that. also, the institute -- in the back. there are some other books. we have a couple of events coming on. june 2nd is beyond inclusion: improving outcomes for

students with disabilities. if you're interested, you can grab a flier. there's also a flier for a summer institute, going july 26 through july 30, beyond inclusion: tools and strategies for including diverse learners. so again, both tables in the back of room, there's lots of materials to look at, so again, thank you very much, dr. wolfensberger.