Imagine a world in which power is replaced by connected networks and caring institutions
In response to a Better Way discussion on sharing power, I started to dream about the absence of power in some imaginary future, the year 2030, and think about how it could be replaced by connected networks like Alcoholics Anonymous, where everyone is equal and cares for each other and we can all find a place of asylum, when we need it.
What the absence of power might look like
In this imaginary England of, say, 2030, the symbols that used to bestow power - Eton, Roedene, Oxbridge and ‘self-made’ are gone. Their exceptionalism removed in a staggering revolution of equalisation. The first three having been privileged in England as proxies for intelligence bordering on brilliance. The conflation of education and intelligence was the masterstroke that segued the aristocracy into the meritocracy. We replaced the right to rule due to blood with the right to rule due to exceptional education, despite the crude inadequacy of many pupils. We understand the intergenerational desire to retain wealth and power for our children or better our grandchildren to keep them safe but in 2030 everyone feels safe without having to be stronger, richer, better. Even the concept of better is anathema in a compassionate world.
In 2030 ‘self-made’ man/millionaire/billionaire – an accolade that was never remotely true but whose wealth or fame gave entry into the ruling elite – has been defused and replaced with an honest acknowledgement of the million helping hands that make every success possible.
Those sad studies that show we would rather have £5,000 when everyone else has £4,000 than £10,000 whenever one else has £15,000 will be shown to be, as philosophers say, a category error. The real question being am I happy and serene with what I have? Can I love and value myself? What do I need to give away to be truly happy – how much time, money and love?
Building a new form of power through networks
Is power even a meaningful concept in a society of genuine equals?
I have been a member of Alcoholics Anonymous for 45 years. It is an organisation without an internal power structure. You become a member if you declare yourself to be one. You can start a group of AA any time any place and, as long as one other person comes, it is an AA meeting. There are no rules but if the meeting doesn’t pay the rent it folds. Each group is self-supporting and self-organising and will not be helped by other groups. In a meeting the functioning is wholly democratic with all posts elected normally for a short time. It has served me well. I do not like masters (although references to God are translated in my heart to Group Of Drunks) and rail against rules. I want help. I want not to be judged and in this group of drunks and criminals and outcasts there is no-one qualified to judge me because we have all behaved very badly.
The starting point for recovery in 12 step fellowships is the idea that I am powerless. This refutation of personal responsibility is troubling to many professionals. But for me to feel that these behaviours are outside my responsibility - which happen despite my categorical decision to the contrary - gives me hope. The possibility exists that with the aid of a power outside myself - the power of a network - I can change. Dispersed power as a solution to powerlessness as a means of providing power when I need to avoid drink/drugs/sex/gambling/etc.
This is a useful model for society because it is based on the understanding that we are all failures and will all continue to fail (try, fail, try again, fail again, fail better: Beckett) but helping us to love and care for ourselves will lead to a community where the ruling ethos is non-judgemental positive regard or, dare I say it, love.
Johann Hari’s assertion that the opposite to addiction is connection is lived out in these connected networks. In Cassie Robinson’s words, ‘networked power differs from hierarchal power because it is about relevance and contribution’. As she also wrote, ‘The Network is important, so is being connected to yourself’.
My experience of competitiveness in the NHS was very different
I joined the NHS hoping to become a part of a caring community. My experience is that the level of competitiveness in the NHS dwarfs anything seen on Wall Street. The fight for resources between competing demands is vicious. Why wouldn’t it be when the price of failure is death in a children’s cancer ward versus increased suicide in a mental health facility. The attempts to defuse this brutal power struggle were dissipated across a wide range of power centres, with resource allocation made an arcane and remote battle fought on the territory of equity versus equality. A major courageous breakthrough is in NICE where the decision on whether to fund a drug is based on the additional quality years of life it offers. The price is £30,000 for a year for everyone.
But in my view the change in my imaginary 2030 would be to accept death as normal, desirable, welcome, to find ways to die well and not spend more on healthcare in the last six months of life than the whole of the rest of life.
Can experts by experience rebalance power?
In 1985 Ingrid Barker of MIND and I set up the first patient advocacy service in mental health in the UK. It was an attempt to put some small rebalance in the power dynamic where doctors can and do have patients locked up for years. Where nurses can and do lock patients in solitary confinement (seclusion). Where a chemical straight jacket is often at the discretion of nursing staff. The user movement was developed through the eighties and nineties to redefine the power relationship. It failed. The user movement (of which I claim membership both by my incarceration in a psychiatric ward and a diagnosis of bipolar – very fashionable – disorder) still thrives at the margins but no revolution is in sight. Even as the CEO of the service, when I became ill not only was I disabled by the illness but always conscious that my psychiatrist could detain me and that I was instantly marginalised. The movement relabelled ‘experts by experience’ was largely bought off. We will re-think the whole categorisation process of diagnosis and discover a new respect for the perspectives of people who see differently.
Worse and more powerless are the seriously ill who cannot get admitted to hospital, who cannot get an asylum, a refuge from the storm of life. Who end in A&E desperately buying themselves some time. No one chooses to be mentally ill but when did we cease to realise the need and value of asylum?
A place for asylum
Part of my imagining is to have access to asylums that are a place of quiet safety where connection to the peace of nature is recognised as a necessary healing for all of us. Good healthy food and quiet – not pampering or alternative therapies – just simplicity.
Putting the caring back into services
Today a baby born to a mum with addiction problems and mental illness is likely to have her baby removed at birth. She will not be given any mental health assistance as the state carries out this judicially sanctioned torture. It is as though some medieval religious court has decided she is a bad woman who should be made to suffer for her sins. In my imaginary 2030, we will not treat illness as a sign of moral decrepitude. (Why does it hurt more that it is women social workers, judges and lawyers who exercised these judgments – devoid of compassion?) By 2030, we will have developed caring services to build this family unit back up, knowing that it is our failure that one of our members needs to take drugs to cope. It is our failure that we distinguish between heroin prescribed for cancer and heroin taken for self-medication.
Who will be held to account? Who will do the holding? This is one role of the networks we all inhabit. The best will act with a readiness to laugh at human failings. The best will be able to modify and manage our actions so the guiding principles that lead to happiness will prevail.
Conclusion
2020 has seen a Covid nightmare where, in addition to mass deaths, illnesses and confinements, London ambulance crews have been dealing with another kind of epidemic. The number of suicides and attempted suicides attended by ambulance crews doubled compared to five years ago.
In my social dream of 2030 - in which power as we know it is absent and is reborn as connected networks, with caring services and places of genuine asylum when we need it - we have first to go through a revolution. The time has never been more right. We need to finally behead the Hydra of historic English power that lurks everywhere with its trailing snakes of corruption, inequality, unhappiness, squalor and poverty. Having done that through the 2020s we will be free to live our wild and precious lives in our wild and precious communities in the 2030s. Bring it on.
Lionel Joyce is a recovering alcoholic with a history of mental illness who became CEO of the Newcastle Mental Health NHS Trust (the lunatic who took over the asylum!) chair of Turning Point, a Legal Services Commissioner, Mental Health Act Commissioner, member of the Public Guardian Board and founder of Mental Health Concern, Friends of Summerhill and Road to Recovery Trust.
