No Further Action

The purpose of this blog post is to encourage social workers to consider how their use of language when writing about or referring to people can impact on practice. It explores some challenging ideas which reference the disability studies literature.

A Guest Social Worker Blog 

When I first qualified as a social worker I had an agency job at a hospital. I got on well with the nurses, I supported the discharge of many older people into care homes and on at least one occasion, it was against the woman’s wishes. She begged me to get her home but it was ok because I referred to ‘common law’ to justify my actions.  Her physical needs justified it and everyone (apart from her) agreed, so into a care home she went, the placement processed in less than an hour.

I jotted down little medical hieroglyphs on my handwritten notes and used medical jargon on the electronic recording systems. People were ‘patients’ or sometimes ‘service users.’ This language protected me from the reality of what I was doing to people caught in the system, lacking power and influence because of their age and disability, unable to square up to professionals like me with our clipboards and our own language. 

Social work with adults can be difficult when people are in crisis and experiencing loss, and they pour their pain into you because there is nothing else they can do.  And so I learnt that dehumanising people through my use of the language of the professional made it easier for me to cope. 

I stopped doing it, very quickly. There was another woman on the ward for whom I was the allocated social worker.  I had never met her but I phoned daily for a progress report. “How is she?” I asked the nurse. “Oh, she’s very poorly today, not fit for discharge,” said the nurse. On my notes, I wrote, “TC ward, Pt med” that is, “Telephone call to the ward, patient medical” (i.e. unwell, not able to be discharged). 

Next day the same call, the same note on her records. 

The third day I phoned, the nurse told me the woman had died during the night. I wrote “Pt RIP NFA”; that is, “Patient dead, no further action”. 

I stared at what I had written and the scales fell from my eyes. If I write about people in this manner, and think of them in this manner, I thought, then what is my treatment of them going to be? 

From then on, all my references to people use titles of respect – Mr, Mrs, whatever the person wants. I am not comfortable with the use of initials or ‘P’ in legal proceedings but the need for confidentiality justifies that I suppose. 

The words in the image above are words many of us professionals use and have used. You will find some of them in guidance from respected health and social care bodies. For example, ‘service user’ is a very common term most people reading this will have used at some point. Is it bad? Not necessarily. But why use the term at all? Or any other term which separates ‘them’ from ‘us’? 

Whatever our opinion, dehumanising people is contrary to the European Convention on Human Rights which is grounded in the basic right of every person to be treated with dignity. The Convention rights, incorporated into UK law with the Human Rights Act, were written after WWII, to prevent the horrors of Nazism from happening again.

I am absolutely not comparing myself or colleagues to officials working for fascists. But we must remain vigilant. The echoes of the call to the special path can be heard when we use language to dehumanise and other people. Unchecked, language can take us towards social extremes. Us and them. We are always superior to them. This is one reason why human rights should be at the heart of social work practice and education.  

After watching the recent Charlottesville riots in the USA, I found myself reading a story I found about a German railway clerk in 1944 who did not consider himself complicit as he wrote in his ledger not of people, but of how many Stücke (literally; ‘pieces’) he had processed through his station for special treatment that day (i.e. how many people crammed into cattle trucks without water or sanitation he arranged to be transported to a concentration camp). In “A Holocaust Reader” (1976) Lucy S Dawidowicz refers to bureaucratic language as “a language that concealed more than it communicated, its very structure and vocabulary buffering speaker and listener from reality.”

This may feel, and hopefully is, a thousand times removed from our use of language in health and social care. However, if a person is described in terms of being a thing (a Downs, a service user, a bed number) rather than a person, is it easier for us to cope with the emotional and physical pain the person is going through and possibly our failure to be able to do anything about it? Does it enable us to sleep at night like the railway clerk. I failed to listen to the woman begging me to let her go home who I processed into a care home; I saw her as a collection of things that had gone wrong and needing to be put right, and discharge to a care home was my solution. 

How we think about people and refer to them can become manifest in our practice.  I once saw someone working in a care home use a cloth to wipe down a table after lunch and then – without a word or any eye contact with this person – she used the same cloth to wipe the face of a woman still sat at the table who had just finished her lunch and had some food on her chin! That worker could only do that if she did not consider the woman to be equal to her, to be a fellow human being. And how many steps is it from treating a person like that, to neglecting her personal care needs, to hitting her, to stealing from her? Because she is no longer a human, she is a thing. But the care worker would probably never have thought of herself as doing anything mean or bad or hurtful.

As a social worker, I am privileged that the state trusts me to do the job I do. Anti-oppressive practice is central to good social work practice but just because we have a professional qualification, it doesn’t mean that we are immune. Far from it, the need to continually critically reflect on our practice and be open to the observations of others, in particular those “others” who we purport to serve, is an essential part of the job. 

The language we use is important because it can very easily be used as a tool to dehumanise people and yet it is also easy to fix. Looking at what we write about people and asking: “would I be happy to read this if written by another social worker about me or one of my relatives?” is a good place to start. 

Suggested reading:

Becoming dishuman: thinking about the human through dis/ability

http://www.tandfonline.com/doi/abs/10.1080/01596306.2014.930021