The Mental Health Service as Conspirator Thomas Gladwin, Ph.D.
ABSTRACT: Mental health cannot offer substantial help to persons trapped by poverty and discrimination without working for change in the system that has trapped them. Traditionally mental health has considered the hurts of its clients to be private, shielded by confidentiality. However, mental health is part of the establishment. "Confidentiality" seems to the client to mean the worker will do nothing about the rest of the establishment that the poor person sees as the real source of his troubles: teachers, welfare workers, police and housing authorities. Too often this is true. Helping poor people with their most crippling problems means using mental health insights to help other agencies be more humane, effective, and compassionate. The mental health professions, like many others, are bending their efforts increasingly toward work with poor people, usually members of minority groups. In doing so they know they will be facing problems of communication. The proposition that middle-class people do not know how to talk to lower-class people has been repeated so often over the years that it has become almost an axiom. However, this criticism seldom moves on to a more constructive phase in which ways of talking to lower-class people are described. Perhaps the reason for this difficulty in specifying how to talk to lower-class people is that there is a prior problem. Before deciding how to talk to anyone it is necessary first to decide what to talk about. Before that, furthermore, it is necessary to decide what there is that needs to be done which therefore needs to be talked about. This succession of logical steps backward points finally to the central issue in mental health services for the lower class, the issue of what mental health has to offer to poor people. Must it really be only a middle-class luxury, as some would insist? Put the other way around, what are the real needs of poor people that mental health can meet, and how must the role of the mental health professional be changed in order to meet them? Without pretending to answer these questions fully, this account is an attempt to examine some of the implications of the way mental health services are Dr. Gladwin, an anthropologist, is a consultant on poverty and social problems, lo9~ 3 Mariner Drive, Oxon Hill Maryland. Community Mental Health Journal, Vol. 4 (6), 1968
475
476
Community Mental Health Journal
offered to poor people, and to suggest some of the things to which mental health professionals should be willing to commit themselves if they are to embark seriously upon mental health services for the poor. INTO THE GHETTO A mental health clinic for children in a good-sized city is preparing to shift both its clientele and its physical location into a Negro slum area. What follows here would be equally true if it were written about a clinic working with poor Puerto Ricans or Mexicans, or perhaps some other minority. However, this is a real story so we will stay with its real subjects. The clinic is directed by a full-time psychiatrist of considerable wisdom, experience, and courage. It has a staff of a dozen or so professionals in the usual array of disciplines, most of them fully trained with the appropriate credentials, the rest with special kinds of useful experience and background. They represent, in other words, the kind of staff most community clinics can only dream about having. They are also almost all white. They work now in a building near city hall but are preparing to rent an old store building in the ghetto. They are changing their clientele simply by confining intake to the new population and letting the old more middle-class caseload diminish by attrition. They seek with 'excitement and perhaps some anxiety to discover through their new patients the shape of their own futures. How should they present themselves, and how are they likely to be perceived? What is offered here is no more than a note in partial answer to the latter question, one example of how the clinic is likely to be perceived by its clients and by the larger community of black slum dwellers who are its potential clients. Already the staff are hearing over and over about punitive welfare workers, heartless housing authorities, literally brutal policemen, and rigid teachers. They are distressed and angered, but not really surprised. We have all read about these things and, alas, no city seems to be free of tarnish. However, it is obvious that the actions of these other agencies, though funded by different echelons of local government, present the clinic staff with several dilemmas. One of the most pressing is that if they are to be of any help to their clients, many of whose presenting problems stem directly from the nature of their relationship with the other agencies, the clinic must obtain from the dient information that, if passed along, could be very damaging to him. Therefore, although both the clinic and the other agencies are tax-supported, the staff began very early to reassure their new clients, starting with the initial interview, that the clinic was in no way related or responsible to the others. Nothing that might be said in the clinic or to a clinic worker would go beyond its walls. The clinic and its work were entirely separate from the other activities, and would remain so. The staff are absolutely sincere in making this promise. They are, after all, doing nothing more than restating the guarantee of confidentiality that
Thomas Gladw|n
477
is crucial to almost any psychologically therapeutic relationship, and that all mental health workers observe scrupulously. This they owe to all clients whatever their color or circumstances. Yet while the staff are pronouncing the words that are their solemn promise of confidentiality, their Negro clients are hearing them say something entirely different. What they are hearing instead is to them a self-evident lie, an announcement of yet another betrayal, another facet of the white conspiracy. THE WHITE GAME These black people have already seen the row of neat bureaucratic offices. In each there is a desk and behind each desk there is a white face, smiling in smug assurance (the staff member means it as a smile of welcome and reassurance). The bla& mother with her little black child in tow has indeed seen all this before. It is painfully familiar. Teachers sit in identical offices behind identical desks and scold her for not teaching her child more respect. If they are not white, their bosses are. The welfare worker, the police, and now these people, she knows they are all in the same game, a white man's game. This then is where the white mental health worker starts. What can he say that will persuade a black mother that she is in a different kind of a place, and that he really wants to help her and can help her? At least she is listening. What does she hear? He says he understands I have a problem with my son. Well, he is right there. Actually, Jimmy is pretty good at home, no worse than any other kid in the building, but the teachers are complaining all the time and every time something happens in our neighborhood the cops come and ask for him. This white man says he wants to help us. Good, we can certainly use some help, maybe even get some of those other people off our backs for a while. Who knows, maybe he cart even teach them something about the problems we black people have with being poor in their world. But now what is he saying? He is saying he has nothing to do with those other people. He says he knows they are bad and all that, but he is not going to say anything to them. He is sitting there behind this desk with his white face and his government job, working for city hall or something, and saying he has nothing to do with those other whites in their city hall jobs. What kind of problems does he think we have? Doesn't he kalow that our problems start and end with those other people? What kind of help can he be? Is this white man going to expect me to believe all his other lies when he starts out telling me that maybe those other whites are bad but he has no control over them? If he can't do anything about them, what does he expect a poor black woman like me to do? I don't know what his game is, but he has already said he can't help me. The best thing I can do is watch my words and try to keep us out of any more trouble. Am I having any trouble with any of nay other children? (I already told him that with this one it's the teachers and the cops who are having the trouble, not me.) No they are all just fine, thank you. Can you talk alone with Jimmy? (My God,
478
Community Mental Health Journal
is he going to rough him up like the cops did that time?) Yes, sir. Yes, I'll wait outside. So goes the dialogue. Words of trust are heard as words of betrayal. The white person says, "I'll keep your secret." The black person hears, "I'll stand aside while the other whites do whatever they want with you." Assuredly this is no way to start building a therapeutic relationship. What should the clinic do? Abandon confidentiality, or at least not mention it? Obviously not. If ever there is to be trust, confidentiality must be a part of it, and it cannot come in as an afterthought. Put more black professional faces behind the desks by recruiting more Negroes? This would doubdess help, but it is not enough and it is easier said than done. More to the point, it would not change the essential role of the clinic. In the eyes of its clients, unless the clinic serves the needs which they feel, the black faces would simply become the faces of Uncle Toms, come to do the white man's work in the ghetto. Either way, an agency coming to the black slums is suspect; white faces just make it more so. Because of that, if confidentiality does not trigger a misunderstanding, something else will. The clinic is an official agency and is therefore immediately suspected of being there to keep the black man in line, by fair means or foul. Closely related to this suspicion, however, there is another--not a suspicion, indeed, but a certainty--that no matter what the whites in other agencies do from behind their desks or in their cars, these new whites or their black Toms will just sit right where they are behind their own desks and do nothing to stop them. The terrible thing about this is that it is probably true. From the governmental (or professional, or white middle-class) point of view there are separate lines of administrative jurisdiction and communication whose separateness assures to each agency the autonomy necessary for the development of coherent policy and programs. From the lower-class Negro point of view this is just whitey talking to himself. The reality behind all these words as far as the black man is concerned is that every single organ of the larger society (the "establishment") that has power over him, whether public or private, corporate, or individual, is in a position to harass him, with impunity, and most of the time does just that, No wonder the black leaders say the white establishment is a conspiracy, and no wonder when the whites insist it is not a conspiracy the blacks say they are sick a term they borrowed from mental healthers, meaning in part that they have a faulty perception of reality. This is a confrontation fraught with ironies, but even more with tragedy. BAND-AIDS Again the question, what should the clinic staff do? Clearly, they must dissociate themselves from being part of the middleclass conspiracy. But how? It will require more than introducing every other sentence with " M a n , . . " or using "Support Your Local Police" as a sarcastic epithet. It is not enough to opt out, identifying with the victims of the es-
Thomas Gladwin
479
tablishment and perhaps suffering vicariously with them a little, but not really changing anything. The clinic is part of the establishment. As long as the establishment inspires hate the clinic will inspire hate, open or more likely concealed. The only avenue open is to try for change. Maybe not succeed but try, really try. If the clinic is content to put band-aids on the wounds inflicted by teachers or policemen or other bureaucrats without doing anything to stop them from inflicting these wounds, it will remain an indivisible part of the establishment, a partner in the conspiracy, like it or not. The staff can see individuals, help with their anxieties, build their strengths, and develop their social competence. They can also be of real help in treating more flagrant psychopathology. This is fine, as far as it goes. But it does not go far enough. Poor people know and--to be honest --most somewhat richer people know too that the white establishment is a lot bigger than any poor black man. The clinic does the walking wounded of the Negro community no favor by patching them up and sending them back into battle against a system everyone knows they cannot beat. Viewed in another way, however, seeing individuals--which is the work mental healthers traditionally know best--can be invaluable, the essential starting point for a strategy of change. Out of sensitive clinical interviews with poor people can come understanding of their hurts: how they hurt, why they hurt, and where the hurt comes from. This is of course what is called insight. Armed with the priceless tool of insight, plus some humility and courage and a lot of wisdom, the clinic can become a uniquely gifted spokesman for its black clients. Being a spokesman does not necessarily mean being a challenger or a public finder of public faults. A mental health worker has no mandate to be a muckraker. Yet as he comes to understand the hurts of poor people, he frequently finds they are inflicted by people who have power but have used their power clumsily. When he looks in turn at these people of power, he finds they often started out wanting to be wise and gentle and helpful. Caught up, however, in systems devised by persons far from the scene to meet needs long since outmoded, and caught up too in their own untutored ineptitude in the application of power, they soon begin to inflict hurts. Feeling guilty perhaps, certainly hated, they withdraw behind their defenses: the callousness of far too many welfare workers, the rigidity of frightened teachers, the angry retaliation of baffled police. Ideally the systems should be changed. Occasionally the opportunity arises for wise insight to combine with eloquent advocacy and a propitious moment in history. Then startling changes can be made. But a local clinic can seldom aspire to such moments. Instead they must work with local people who work within the systems, good or bad as they may be. Even here some changes are possible. There are always some procedures under local control--a very few in welfare, more in the schools, often a good part in police work. At the same time, any system or policy can be made more or less humane by those who apply it. It is here that the mental health clinic
480
Community Mental Health Journal
can be at its best, communicating insights derived from one group of people directly to others who are intimately involved with the same people. Yet this can be very hard, too, calling for much disciplined skill. How can one, for example, spend the morning talking with mothers whose children have been marked, perhaps permanently, by the seemingly callous cruelty of a petty official, and then spend the afternoon working gently with that same official, nurturing his compassion and building the strength that compassion demands? THE POLICE Let us look for a moment at the police. A number of agencies would serve equally well as examples, but among all these the excesses of police are usually considered most notorious. In fact, any case of bad police work (and even some which at least police might consider good) is likely to receive the epithet of brutality. Granted it is hard not to be angered by what in fact too often seems wanton brutishness and harassment. Nevertheless denunciation will do no good aside from transitory satisfaction for the denouncer. We have already seen enough of the unhappy dialogue between police and their critics to know that, quite apart from the justice that may reside with one side or the other, the rising drumfire of criticism has served only to make the police more angry and thus more clumsy in their use of power. Yet it is rare to find a police department in which there are not at least a few, often many, who not only feel hurt and baffled but also will welcome advice. They do not understand what makes people, especially poor people, act the way they do, and they do not understand why it is that the things they do as police have such perverse and to them incomprehensible outcomes. However, their need for help does not mean they want a lecture on the nature of human nature or advice on how to do their job from people who do not understand what that job is. These, alas, are sins to which mental healthers are too likely to be prone. Police are proud. They are proud of their badge, and they are proud of the responsibility this badge symbolizes to maintain law and order, a responsibility that police put foremost. Many are proud too of many wise and kind things they have done, credit for which is swept away and forgotten (if indeed it was ever noted) once they blunder. This is where one begins; it is on this pride that one builds, returning to it again and again to validate a point. This can be difficult work if one is spending the rest of the day working with people who, with apparently very good cause, hate cops. Yet it is the only course because, until the systems change, it offers the only solution. Mental healthers who will do this job have furthermore to prepare themselves to understand more than their own emotional ambivalence. They have to understand how it feels to be a cop, what is good about it, and what is hard. The clinician has to be prepared for the probability that the policeman will be afraid of him, afraid that the head-shrinker will tell him he
Thomas Gladwin
481
has been driving people crazy, or perhaps worse that it is he, the policeman, who is crazy and not the poor people he is having trouble with. It is also essential to learn how the police department works, where the blockages and the vested interests lie, who is for change and who is opposed. All these things are manageable only if the police are friends. Yet the poor black people, who see all cops as enemies, must also be friends. This is the hard role, that of mediator who must somehow maintain the trust and respect of both camps if he is to succeed. It is a role so hard that few have taken it up. TO BREAK THE CONSPIRACY How much easier it is to work as a professional healer of wounds by day, and then later as a private citizen join the ranks of those who loudly support justice and oppose brutality. This course is easy and it carries with it a lot of satisfaction, both professior.al and personal. For a while it may even persuade poor black people that the professional is on their side. The only thing wrong with it is that by now it is clear it does not work. After all these years of civil rights, all the poor Negroes are every bit as poor as they ever were, and being poor and black is still no fun at all. This is the reason why more and more black leaders, who feel they have been left with the burden of making the white man's world live up to its own commitments, are disgusted with all whites, friend and foe alike. They cannot understand why their white friends are still ready to join in protests long after protests have proven futile. They see too that even those whites who have the skills seem unwilling to face the humble and often dirty jobs that must be done before the white man's world can be made a decent place for all the other people too. Too often poor people know, and we establishment people know too, what must be done, but it is not done. We use band-aids instead. Yet until these things that must be done are done we will be accused of a white conspiracy to keep for ourselves our middleclass comforts. Can we deny the charge?
ABSTRACT: Mental health cannot offer substantial help to persons trapped by poverty and discrimination without working for change in the system that has trapped them. Traditionally mental health has considered the hurts of its clients to be private, shielded by confidentiality. However, mental health is part of the establishment. "Confidentiality" seems to the client to mean the worker will do nothing about the rest of the establishment that the poor person sees as the real source of his troubles: teachers, welfare workers, police and housing authorities. Too often this is true. Helping poor people with their most crippling problems means using mental health insights to help other agencies be more humane, effective, and compassionate. The mental health professions, like many others, are bending their efforts increasingly toward work with poor people, usually members of minority groups. In doing so they know they will be facing problems of communication. The proposition that middle-class people do not know how to talk to lower-class people has been repeated so often over the years that it has become almost an axiom. However, this criticism seldom moves on to a more constructive phase in which ways of talking to lower-class people are described. Perhaps the reason for this difficulty in specifying how to talk to lower-class people is that there is a prior problem. Before deciding how to talk to anyone it is necessary first to decide what to talk about. Before that, furthermore, it is necessary to decide what there is that needs to be done which therefore needs to be talked about. This succession of logical steps backward points finally to the central issue in mental health services for the lower class, the issue of what mental health has to offer to poor people. Must it really be only a middle-class luxury, as some would insist? Put the other way around, what are the real needs of poor people that mental health can meet, and how must the role of the mental health professional be changed in order to meet them? Without pretending to answer these questions fully, this account is an attempt to examine some of the implications of the way mental health services are Dr. Gladwin, an anthropologist, is a consultant on poverty and social problems, lo9~ 3 Mariner Drive, Oxon Hill Maryland. Community Mental Health Journal, Vol. 4 (6), 1968
475
476
Community Mental Health Journal
offered to poor people, and to suggest some of the things to which mental health professionals should be willing to commit themselves if they are to embark seriously upon mental health services for the poor. INTO THE GHETTO A mental health clinic for children in a good-sized city is preparing to shift both its clientele and its physical location into a Negro slum area. What follows here would be equally true if it were written about a clinic working with poor Puerto Ricans or Mexicans, or perhaps some other minority. However, this is a real story so we will stay with its real subjects. The clinic is directed by a full-time psychiatrist of considerable wisdom, experience, and courage. It has a staff of a dozen or so professionals in the usual array of disciplines, most of them fully trained with the appropriate credentials, the rest with special kinds of useful experience and background. They represent, in other words, the kind of staff most community clinics can only dream about having. They are also almost all white. They work now in a building near city hall but are preparing to rent an old store building in the ghetto. They are changing their clientele simply by confining intake to the new population and letting the old more middle-class caseload diminish by attrition. They seek with 'excitement and perhaps some anxiety to discover through their new patients the shape of their own futures. How should they present themselves, and how are they likely to be perceived? What is offered here is no more than a note in partial answer to the latter question, one example of how the clinic is likely to be perceived by its clients and by the larger community of black slum dwellers who are its potential clients. Already the staff are hearing over and over about punitive welfare workers, heartless housing authorities, literally brutal policemen, and rigid teachers. They are distressed and angered, but not really surprised. We have all read about these things and, alas, no city seems to be free of tarnish. However, it is obvious that the actions of these other agencies, though funded by different echelons of local government, present the clinic staff with several dilemmas. One of the most pressing is that if they are to be of any help to their clients, many of whose presenting problems stem directly from the nature of their relationship with the other agencies, the clinic must obtain from the dient information that, if passed along, could be very damaging to him. Therefore, although both the clinic and the other agencies are tax-supported, the staff began very early to reassure their new clients, starting with the initial interview, that the clinic was in no way related or responsible to the others. Nothing that might be said in the clinic or to a clinic worker would go beyond its walls. The clinic and its work were entirely separate from the other activities, and would remain so. The staff are absolutely sincere in making this promise. They are, after all, doing nothing more than restating the guarantee of confidentiality that
Thomas Gladw|n
477
is crucial to almost any psychologically therapeutic relationship, and that all mental health workers observe scrupulously. This they owe to all clients whatever their color or circumstances. Yet while the staff are pronouncing the words that are their solemn promise of confidentiality, their Negro clients are hearing them say something entirely different. What they are hearing instead is to them a self-evident lie, an announcement of yet another betrayal, another facet of the white conspiracy. THE WHITE GAME These black people have already seen the row of neat bureaucratic offices. In each there is a desk and behind each desk there is a white face, smiling in smug assurance (the staff member means it as a smile of welcome and reassurance). The bla& mother with her little black child in tow has indeed seen all this before. It is painfully familiar. Teachers sit in identical offices behind identical desks and scold her for not teaching her child more respect. If they are not white, their bosses are. The welfare worker, the police, and now these people, she knows they are all in the same game, a white man's game. This then is where the white mental health worker starts. What can he say that will persuade a black mother that she is in a different kind of a place, and that he really wants to help her and can help her? At least she is listening. What does she hear? He says he understands I have a problem with my son. Well, he is right there. Actually, Jimmy is pretty good at home, no worse than any other kid in the building, but the teachers are complaining all the time and every time something happens in our neighborhood the cops come and ask for him. This white man says he wants to help us. Good, we can certainly use some help, maybe even get some of those other people off our backs for a while. Who knows, maybe he cart even teach them something about the problems we black people have with being poor in their world. But now what is he saying? He is saying he has nothing to do with those other people. He says he knows they are bad and all that, but he is not going to say anything to them. He is sitting there behind this desk with his white face and his government job, working for city hall or something, and saying he has nothing to do with those other whites in their city hall jobs. What kind of problems does he think we have? Doesn't he kalow that our problems start and end with those other people? What kind of help can he be? Is this white man going to expect me to believe all his other lies when he starts out telling me that maybe those other whites are bad but he has no control over them? If he can't do anything about them, what does he expect a poor black woman like me to do? I don't know what his game is, but he has already said he can't help me. The best thing I can do is watch my words and try to keep us out of any more trouble. Am I having any trouble with any of nay other children? (I already told him that with this one it's the teachers and the cops who are having the trouble, not me.) No they are all just fine, thank you. Can you talk alone with Jimmy? (My God,
478
Community Mental Health Journal
is he going to rough him up like the cops did that time?) Yes, sir. Yes, I'll wait outside. So goes the dialogue. Words of trust are heard as words of betrayal. The white person says, "I'll keep your secret." The black person hears, "I'll stand aside while the other whites do whatever they want with you." Assuredly this is no way to start building a therapeutic relationship. What should the clinic do? Abandon confidentiality, or at least not mention it? Obviously not. If ever there is to be trust, confidentiality must be a part of it, and it cannot come in as an afterthought. Put more black professional faces behind the desks by recruiting more Negroes? This would doubdess help, but it is not enough and it is easier said than done. More to the point, it would not change the essential role of the clinic. In the eyes of its clients, unless the clinic serves the needs which they feel, the black faces would simply become the faces of Uncle Toms, come to do the white man's work in the ghetto. Either way, an agency coming to the black slums is suspect; white faces just make it more so. Because of that, if confidentiality does not trigger a misunderstanding, something else will. The clinic is an official agency and is therefore immediately suspected of being there to keep the black man in line, by fair means or foul. Closely related to this suspicion, however, there is another--not a suspicion, indeed, but a certainty--that no matter what the whites in other agencies do from behind their desks or in their cars, these new whites or their black Toms will just sit right where they are behind their own desks and do nothing to stop them. The terrible thing about this is that it is probably true. From the governmental (or professional, or white middle-class) point of view there are separate lines of administrative jurisdiction and communication whose separateness assures to each agency the autonomy necessary for the development of coherent policy and programs. From the lower-class Negro point of view this is just whitey talking to himself. The reality behind all these words as far as the black man is concerned is that every single organ of the larger society (the "establishment") that has power over him, whether public or private, corporate, or individual, is in a position to harass him, with impunity, and most of the time does just that, No wonder the black leaders say the white establishment is a conspiracy, and no wonder when the whites insist it is not a conspiracy the blacks say they are sick a term they borrowed from mental healthers, meaning in part that they have a faulty perception of reality. This is a confrontation fraught with ironies, but even more with tragedy. BAND-AIDS Again the question, what should the clinic staff do? Clearly, they must dissociate themselves from being part of the middleclass conspiracy. But how? It will require more than introducing every other sentence with " M a n , . . " or using "Support Your Local Police" as a sarcastic epithet. It is not enough to opt out, identifying with the victims of the es-
Thomas Gladwin
479
tablishment and perhaps suffering vicariously with them a little, but not really changing anything. The clinic is part of the establishment. As long as the establishment inspires hate the clinic will inspire hate, open or more likely concealed. The only avenue open is to try for change. Maybe not succeed but try, really try. If the clinic is content to put band-aids on the wounds inflicted by teachers or policemen or other bureaucrats without doing anything to stop them from inflicting these wounds, it will remain an indivisible part of the establishment, a partner in the conspiracy, like it or not. The staff can see individuals, help with their anxieties, build their strengths, and develop their social competence. They can also be of real help in treating more flagrant psychopathology. This is fine, as far as it goes. But it does not go far enough. Poor people know and--to be honest --most somewhat richer people know too that the white establishment is a lot bigger than any poor black man. The clinic does the walking wounded of the Negro community no favor by patching them up and sending them back into battle against a system everyone knows they cannot beat. Viewed in another way, however, seeing individuals--which is the work mental healthers traditionally know best--can be invaluable, the essential starting point for a strategy of change. Out of sensitive clinical interviews with poor people can come understanding of their hurts: how they hurt, why they hurt, and where the hurt comes from. This is of course what is called insight. Armed with the priceless tool of insight, plus some humility and courage and a lot of wisdom, the clinic can become a uniquely gifted spokesman for its black clients. Being a spokesman does not necessarily mean being a challenger or a public finder of public faults. A mental health worker has no mandate to be a muckraker. Yet as he comes to understand the hurts of poor people, he frequently finds they are inflicted by people who have power but have used their power clumsily. When he looks in turn at these people of power, he finds they often started out wanting to be wise and gentle and helpful. Caught up, however, in systems devised by persons far from the scene to meet needs long since outmoded, and caught up too in their own untutored ineptitude in the application of power, they soon begin to inflict hurts. Feeling guilty perhaps, certainly hated, they withdraw behind their defenses: the callousness of far too many welfare workers, the rigidity of frightened teachers, the angry retaliation of baffled police. Ideally the systems should be changed. Occasionally the opportunity arises for wise insight to combine with eloquent advocacy and a propitious moment in history. Then startling changes can be made. But a local clinic can seldom aspire to such moments. Instead they must work with local people who work within the systems, good or bad as they may be. Even here some changes are possible. There are always some procedures under local control--a very few in welfare, more in the schools, often a good part in police work. At the same time, any system or policy can be made more or less humane by those who apply it. It is here that the mental health clinic
480
Community Mental Health Journal
can be at its best, communicating insights derived from one group of people directly to others who are intimately involved with the same people. Yet this can be very hard, too, calling for much disciplined skill. How can one, for example, spend the morning talking with mothers whose children have been marked, perhaps permanently, by the seemingly callous cruelty of a petty official, and then spend the afternoon working gently with that same official, nurturing his compassion and building the strength that compassion demands? THE POLICE Let us look for a moment at the police. A number of agencies would serve equally well as examples, but among all these the excesses of police are usually considered most notorious. In fact, any case of bad police work (and even some which at least police might consider good) is likely to receive the epithet of brutality. Granted it is hard not to be angered by what in fact too often seems wanton brutishness and harassment. Nevertheless denunciation will do no good aside from transitory satisfaction for the denouncer. We have already seen enough of the unhappy dialogue between police and their critics to know that, quite apart from the justice that may reside with one side or the other, the rising drumfire of criticism has served only to make the police more angry and thus more clumsy in their use of power. Yet it is rare to find a police department in which there are not at least a few, often many, who not only feel hurt and baffled but also will welcome advice. They do not understand what makes people, especially poor people, act the way they do, and they do not understand why it is that the things they do as police have such perverse and to them incomprehensible outcomes. However, their need for help does not mean they want a lecture on the nature of human nature or advice on how to do their job from people who do not understand what that job is. These, alas, are sins to which mental healthers are too likely to be prone. Police are proud. They are proud of their badge, and they are proud of the responsibility this badge symbolizes to maintain law and order, a responsibility that police put foremost. Many are proud too of many wise and kind things they have done, credit for which is swept away and forgotten (if indeed it was ever noted) once they blunder. This is where one begins; it is on this pride that one builds, returning to it again and again to validate a point. This can be difficult work if one is spending the rest of the day working with people who, with apparently very good cause, hate cops. Yet it is the only course because, until the systems change, it offers the only solution. Mental healthers who will do this job have furthermore to prepare themselves to understand more than their own emotional ambivalence. They have to understand how it feels to be a cop, what is good about it, and what is hard. The clinician has to be prepared for the probability that the policeman will be afraid of him, afraid that the head-shrinker will tell him he
Thomas Gladwin
481
has been driving people crazy, or perhaps worse that it is he, the policeman, who is crazy and not the poor people he is having trouble with. It is also essential to learn how the police department works, where the blockages and the vested interests lie, who is for change and who is opposed. All these things are manageable only if the police are friends. Yet the poor black people, who see all cops as enemies, must also be friends. This is the hard role, that of mediator who must somehow maintain the trust and respect of both camps if he is to succeed. It is a role so hard that few have taken it up. TO BREAK THE CONSPIRACY How much easier it is to work as a professional healer of wounds by day, and then later as a private citizen join the ranks of those who loudly support justice and oppose brutality. This course is easy and it carries with it a lot of satisfaction, both professior.al and personal. For a while it may even persuade poor black people that the professional is on their side. The only thing wrong with it is that by now it is clear it does not work. After all these years of civil rights, all the poor Negroes are every bit as poor as they ever were, and being poor and black is still no fun at all. This is the reason why more and more black leaders, who feel they have been left with the burden of making the white man's world live up to its own commitments, are disgusted with all whites, friend and foe alike. They cannot understand why their white friends are still ready to join in protests long after protests have proven futile. They see too that even those whites who have the skills seem unwilling to face the humble and often dirty jobs that must be done before the white man's world can be made a decent place for all the other people too. Too often poor people know, and we establishment people know too, what must be done, but it is not done. We use band-aids instead. Yet until these things that must be done are done we will be accused of a white conspiracy to keep for ourselves our middleclass comforts. Can we deny the charge?
