I’ve been following a blog written by a victim of the sex trade, and I find her writings insightful, sad and incredibly brave. In one of her blogs, she talked about Biderman’s Chart of Coercion, and how it could be applied to sex workers. I’ve been reading about it, and thinking about it a lot with regard to aged care, and secure dementia units. All aspects of this chart can be identified with people in aged care who do become isolated, monopolised by the systems of the institutions they live in, who live with passive threats to comply with the times set for eating, toileting, activities and so on. The occasional outing or ‘special’ meal does provide the person in aged care to be more compliant, as they often have so little to look forward to. People living in aged care do feel degraded, they are forced into habits of existence and if they resist, then usually pharmacological or physical restraints are quickly put in place, even though they are technically against the law. I’m trying to write an article about the use of restraints in aged and dementia care, and Biderman’s Chart of Coercion has a lot to offer my thinking.
This is what enpsychopedia says;
Biderman’s Chart of Coercion: the process of abusive brainwashing
- Isolation: Deprives victim of all social support [necessary for the] ability to resist. Develops an intense concern with self. Makes victim dependent upon interrogator.
- Monopolization of Perception: Fixes attention upon immediate predicament; fosters introspection. Eliminates stimuli competing with those controlled by the captor. Frustrates all actions not consistent with compliance.
- Induced Debility & Exhaustion: Weakens mental and physical ability to resist.
- Threats: Cultivates anxiety and despair.
- Occasional Indulgences: Provides positive motivation for compliance.
- Demonstrating “Omnipotence”: Suggests futility of resistance.
- Enforcing Trivial Demands: Develops habit of compliance.
- Degradation: Makes cost of resistance appear more damaging to self-esteem than capitulation. Reduces prisoner [abuse victim] to “animal level” concerns.
As I talk to more and more people who live in residential aged care, or who are facing up to the possibility of having to live in aged care, many talk of the things listed above with fear and trepidation, and I have seen firsthand how people ‘give up’ especially when they are placed into high care. Being dragged out of bed at a time that suits staff, and eating at a time that suits the kitchens, and toileting regimes generally do not happen because too many of the staff have become dependent on the use of continence aids, rather than the other way around, all equate to feelings of anxiety and despair, loneliness, futility, and of feeling like a prisoner. Mostly aged care homes, and their staff are doing the best they can, with the best of intentions, but I am wondering if we started to think about the prospect of being in aged care from the minds of those living there, and the institutionalisation they face, if we might view it think differently.
I’ve been thinking some more about this, and how the coersion and compliance starts long before someone enters aged care. My father in laws entry into aged care, came about because everyone believed he was ‘no longer safe’ to live at home on his own, and because we believed we were not able to care for him in our home. And so it started with small degrees of coersion, followed up with coersion by the ACAT team, the community service providers, and the doctors who treated him. In the end, I suspect he ‘gave in’ to our well meaning ‘demands’ to shut us up. In reality, he tried to kill himself twice as he 1000% hated the idea of going into aged care, and spoke about how he wished he had succeeded once he was admitted into aged care. This was regardless of the fact the first facility he lived in was almost brand new, furnished with beautiful things, and appeared lovely with pleasant staff. He still felt like he was in prison, and had been coerced to go in. We visited him almost every day, sometimes twice a day, which was 1000% more often than when he lived at Goolwa, over an hour away from where we live, and he still hated it and felt trapped like a caged animal. My husband and I have said since he died, we will not let this happen to anyone else we love. I hope and pray we can fulfil this dream.
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I have worked in several nursing homes in SA and WA and they were all dreadful, although most looked up-to-date and appeared to be better than ok. I suspect it takes someone working there for 4+ hours at a time to see the way many homes function and some of the truly awful things that happen — and that includes some of the most expensive nursing homes. The old people I nursed loathed being forced out of bed very early in the morning to be showered hastily, given sub-standard food (in my mother’s case, she was served stone cold meals for three months, despite our protestations, because the new kitchen wasn’t functioning and the meals had to be carted long distances to the dining rooms), having someone else decide what they would wear, being parked at dining room tables with people who might be severely demented, people calling out for bed pans or toileting and being ignored for an hour or more, by which time they have wet themselves. And I haven’t even mentioned the cruelty, which at times was profoundly shocking: old people left standing naked on cold floors for up to 15 mins while the nurse got towels etc, an old darling dying of cancer and not receiving adequate pain relief for days, a nurse dragging a very elderly woman across the floor and over the springs of her bed — she suffered really severe lacerations and bruising. NONE of these incidents was acted upon although senior staff and the matron were quite aware what was going on. In fact the senior staff lied to the family about how this old woman came to be injured! I blew the whistle twice by alerting families to what was occuring (that was very effective as families were rightfull livid and took action) and I took the ‘nice’ nursing home my mother insisted on going to, to the SA Dept Health. You’ve seen the carelessness and casual cruelty Kate and in my experience, it will continue as nursing staff for the elderly are in such short supply, and proprietors and managers turn their faces to the wall rather than risk losing staff.
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Kate, your comparison is interesting. I can see some of the synergies about the social environment. Although I agree with Esther that there are also some excellent services out there. The problem drivers are POWER differentials combined with an underfunded system.
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Interesting thoughts…I’m only able to speak from an NZ perspective, but I do think that ‘mostly’ ( yes, sadly not always) that residential care is not as ‘bad’ as people might imagine it to be. Operators and caregivers are mostly doing a fantasic job. There are a number of studies too that show that many people feel great relief upon setting into a ‘new home’ (aka care facility), and many say that they’d have moved in earlier. Sadly media only focuses on the negatives of aged care (there’s no denying terrible, awful mistakes are made), rather than the life enhancing services and care many deliver. What makes me qualified to comment? I’ve visited probably 90% of all such services in NZ, often unannounced, and have seen this with my own eyes. I do believe though we should put a great amount of energy into ensure NOONE ever recieves substandard care.
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Hi Esther, I know there are some wonderful ones, and mostly the staff are amazing, but I do wonder if in all honesty the people living in them, in particular in high care, really feel that way, or if they have been passively ‘beaten’ into submission because there is no other option for them, and their families are usually the ones that ‘coerced’ them into going there in the first place? Just a thought. I did feel when I was in NZ that the service providers I met, and the ‘feel’ I got from everywhere I visited was that you are ahead of the pack with your person centred care, which might be why your experience and what you have seen with your own eyes is so different to mine. Keep up the good work. 🙂
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