Invitation

I astonish peopleYesterday, I asked a question to a group of about 40 people from all walks of life, gathered under a hand-constructed hut providing afternoon respite from the hot Tamil Nadu sun. Sitting, standing, listening intently, are men, women and children, mostly south Indian, from this rural part of Tamil Nadu.  People from the surrounding villages, people connected in some manner to this fledgling but beautiful effort in the district of Villipuram to bring together people with and without disability in communion, community and relationship.  All of these people care about restoring the plot of land they have to fruitfulness, and restoring themselves and others to the notion of community that, for many of them, has rejected them so profoundly. Some young people in the group are volunteers from Spain, France, the Netherlands, and Germany, here for a few months or weeks to try to move the world forward a bit. Most, though, are from right here in Tamil Nadu, and have stories of brutality and rejection to tell that would make your hair stand on end. They are people who grew up in orphanages, or were abandoned in hospitals, or had stones thrown at them, or were told, quite literally, that there is no place for them in the world. There are also families and those who have been caught up in the vision that this little place holds for us to learn how to be together.

It’s a question which seems unaskable, when standing in front such a group.  It’s rude. It seems an affront, an impossibly personal question when one considers the truth about what we as humans have perpetrated on such people and their families. I steeled myself, and asked what their vision was for their lives and for the future. Seems a hard thing to ask someone who is in a small lake of calm after a sea of trouble. It’s a lot to ask. And the answers came flowing.  Many people even stood up, came to the front of the room to be heard by all of us. Such dreams we humans have. Such robustness. And here is one of the statements that caused a small shift inside me.  One that I believe made an impact on each of us in that gathering in shelter from the harsh Tamil sun.

“I want to be invited to come back”

What a bold and powerful assertion for this South Indian man to make.  He has been so profoundly rejected, this man.  And yet resolute that it is not enough for us, in these enlighted days, to allow him a seat at the community table.  To afford him some sort of job. To allow him the right to marry. To make sure his children and all others are allowed into what he calls ‘normal schools’, to not ask for his father’s name but to call him by his very own name.

Does he recognize what he is really asking?  Much more than simply a pathway back to typical Indian life, or permission to enter.  That is not enough, not by a long shot. He understands that after such rejection and brutality, he wants to be issued an invitation.  A request.  One that allows him to decide whether such a community should be graced with his investment, his presence, his gift. It seems to me only fair.

His final vision is that he will “astonish people”. That his children and grandchildren will sit all around him in respect, and look to him for wisdom.  Again, it is only fair.

Make a little room

 

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It is tempting to think of big sweeping changes as we consider our work of helping a society learn to make space for everyone.  Big plans for our initiative were explored and crafted out of our hearts and minds 9 months ago in New Delhi as we imagined ideas towards inclusiveness would spread across India, policy would shape itself around such ideas, and we would be a part of the change movement that is a part of India in so many diverse areas. Indeed, it is an exciting time to be doing this work, in this place and at this time. As we re-gather with our planning group nearly a year later, I am reflecting on all of the work that has been done, and discerning which is of biggest import.

We know that for ideas to take root and change to happen, work must be done on all 4 levels – societal, community, family, and individual. It is a bit of a  rush to think about the impact one’s work may have on the very fabric of society, and indeed, the change agentry work being done  alongside The Hans Foundation may have just such an impact. However, the impact of a good idea that has the capacity to change the lives of an entire group of people must resonate in the lives of individual people and their families for us to grasp the tender core at the heart of the matter. For, in the long run, and also in the short run, the experience and impacts of having a disability in Indian society is experienced by individual people.

A few months ago,  a young man of 21 years of age gathered with a small group of people who care deeply for him to think about his future.  He is a man who speaks little, and many would say he is impacted by autism in significant ways.  He was accompanied by his parents, his teachers, and a number of others interested in beginning to explore and create a positive and possible future alongside him.  A number of commitments were made, as we imagined this young man developing a network of friendships which will expand his resources, and help him transition into the role of an adult son, with his own relationships. A vision of a young man who is has a bit of an adventurous spirit – who we can see as a hiker, a trekker, a music lover with an awesome set of headphones and an eclectic playlist.  A man who has friends and relationships with people outside of his family, and has a bit of a life outside their warm and strong family foundation.

At the conclusion of our work together, his mother spoke movingly of how it was a risk  thinking about her son having a real future, and how hope had stirred again inside her.    A month or so ago,  she sent me a quick email because she could not wait to share the news until our next planning circle meeting. Her son had spent 30 minutes visiting with a neighbor without either of his parents present.  A first in many, many years. A small thing, but not so small either. It speaks to the potential for the world to shift just a bit to make some space for this young man.

I will hold this gem of an idea with me over the next few days of high-order planning and trying to work on a systemic level.  It only matters if we can get the world to move a bit.

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Ghost in the Machine

Institutions have been on my mind.  Their definitions, their characteristics, their meaning, their impacts.  Hard and wrenching images and scenes from the hellish large institutions I have seen too many of here in India vie with the images of hope and possibility of families who want good lives for and with their children- both keep me up at night. I had an illuminating talk with a colleague who reminded me of the problem of being dogmatic about issues like institutionalization in a society which you do not, and will never, fully understand. Fair enough. Upon my return to the US, I opened up the latest issue of the SRV Journal, and there before my eyes was Martin Elks’ article about institutions and their features, especially comparing the ‘new’, bright and shiny institutional models being pedaled in the United States with the monstrosities of the Willowbrook and Pennhursts which blight our history. Dr. Elks has proposed that institutions are a ‘meme’ running rampant through our society, spread across time and space, and re-occurring, seemingly spontaneously. He reminds us that Sarason (1969) warned us that “the beginning context is fateful for what comes later”, and Dr. Wolfensberger likened this to the ways that institutions, organization, and settings have ‘ghosts’ within them that will repeat certain ways of thinking and doing things (Wolfensberger, 1989) , a bit like there is a driver in the driver’s seat who no one sees or acknowledges.

One of the beautiful and terrible things about applying ideas, especially those ideas which center on people and their relations, constructs, and categoricals in a different culture is that you often get it wrong, and are forced to re-think and re-organize your assumptions.  Reading Elks’ article, and having several rich conversations with trusted colleagues have helped me struggle with this issue. So I am, as I often find myself,still confused, but hopefully on a higher level and about more important things.

In western societies, the term ‘institution’ and ‘institutionalization’ have a generally understood common meaning when used in the context of disability to mean a facility where people with disability are congregated together, often isolated from typical society, and are subjected to uniform procedures, and treatment which tend to be controlling, authoritarian, and de-individualizing.   Large residential facilities, nursing homes, psychiatric hospitals, and, often, boarding schools are considered to be such institutions.

In India, there is not a current consensus on the use of the word, or the concept, of institution. First of all, the word institution tends to be used in the broader sense, as “an established organization or corporation (as a bank or university) especially of a public character”  (Merriam Webster, 2016). In general, the value judgement inherent in the western use of the word in disability circles does not exist in the same manner.  Unlike most western countries,India has not (yet) experienced the large-scale, eugenics-based institutionalization of its disabled citizens, and the associated movement towards liberation from such places. Therefore, the work ‘institution’  is generally not laden with an association with abuse, neglect, oppression, and control as it is in other places.    One often hears that institutionalization has not been a significant factor in India’s societal  treatment of people with disability, and the word institution is used frequently to refer to any service organization.

However, it must be stated that there are indeed institutions in India, which fully fit the western notion of such places. Government psychiatric hospitals, hostels for both children and adults (and both together, sometimes) and beggar homes  exist in all population centers.  In a place where different kinds of disability are often poorly differentiated, people with mental disorders, physical disabilities, developmental disabilities, and autism are often lumped together in such places, and simply identified as ‘mad’.

If one decides to take a stand against such congregated service types, that no doubt have served a life-saving function (and may also serve a death-causing function at the same time)  there are implications. First, that person must realize that even such traditional institutions may well be, for many people, an alternative to almost certain brutalization, starvation, and death on the streets. This reality is one that advocates for alternatives to institutions must reckon with and come to terms with.

Then there are a host of other complications.  The western service models of supported living and small community group homes seem at times like a dangerous pipe dream in a country where communal living is the norm, and where there are precious few services at all, much less systemic integrated services. There are a host of services using relatively large congregate residential models which are being planned, conceptualized, and built as I write this. This is the direction India is going in, and it is a familiar one, fraught with problems and yet also an understandable solution (often handed over by western consultants) to families who live in terror of what will happen to their sons and daughters with disability where long-standing expectations of extended family-based life care is eroding fast.

It seems possible on the one hand to encourage and promote truly integrated Indian models which are highly individualized, life-giving, and are based in crafting desirable futures and facilitating informal support networks.  I have no doubt that this “bottom-up”, one person at a time strategy will play a powerful role in giving strong families and people with disability the confidence and experience to reap the benefits of such person-centered action strategies.  On the other hand, such seed planting will hardly address the needs of a nation with 1.3 billion people and no coordinated infrastructure for services and supports for people with intellectual and psycho-social disability.

There is likely a justifiable rationale in working with the new and emerging congregate model to raise awareness about the problems inherent in institutions – problems which already are plaguing such services such as de-individualization, to stave off the poor treatment that invariably occurs when devalued people are all together, apart and away, to actively promote and engage typical citizens in the lives of people in such facilities, and to promote entrance and exit routes to and from the service for the people living there, and for the surrounding communities.  Perhaps the lessons of moral treatment era can be brought to bear – communities which are physically attractive and promote engagement, a focus on whole-person development rather than a medicalized “cure”, a restoration of identity and connection rather than a solution to perceived brokenness.  If nothing else, one can select organizations to support and work with who are up to and open to the task of raising their own consciousness, applying keen and sharp eyes to the signs and effects contained within the meme of the institutional approach, and committed to working in service first to people with disability, and second to the organization and themselves.

Elks, M (2016) New quasi-institutions as examples of human service unconsciousness. The SRV Journal, 11(1),30-40

Institution. (n.d.). Retrieved September 13, 2016, from http://www.merriam-webster.com/dictionary/institution

Sarason,S. (1969) The creation of settings. In Kugel, R.B. & Wolfensberger, W. (Eds.) (1969). Changing patterns in residential services for the mentally retarded. Washington, DC: President’s Committee on Mental Retardation, 341-357.

Wolfensberger, W. (1975). The origin and nature of our institutional models (rev.ed.). Syracuse, NY: Human Policy Press.

Curb our Enthusiasm

The new Mental Health Care Act, passed yesterday by the Indian parliament, has been winding its way slowly through the Indian legislature since 2013, and replaces the Mental Health Bill of 1987. On the one hand, advocates celebrate its passage, realizing that limiting the use of electro-convulsive therapy, addressing the immense shortage of mental health experts, decriminalizing suicide, increasing the legal autonomy of people experiencing mental health problems, and mandating that mental health services be affordable and available are parts of the picture.

The narrative that picture is embedded in is one that we should take a closer look at and consider.  It is the catchy narrative that explains mental disorders as a medical condition that requires specific address by treatment. A comforting and easy way to see mental illness, for those of us who like neat thought packages, as we tend to do. At its least nuanced, this creates a mental picture where we see a sickness, and see medication as the first answer, and confinement as a strategy while the medication is adjusted. Neat and clean.

Of course, simple solutions can mislead when the true problem is complex and hard to unravel, and, no doubt, the context in which mental disorders exist is truly complex.

If it is true that mental illness is inextricably linked to poverty, then this complicates the picture.  We know that people experiencing major mental illness are nearly always poor.  Do they become so because of the mental disorder, or does poverty “produce” mental disorder? The frustrating answer is, of course, yes to both.

If it is true that gender oppression is inextricably  linked to mental illness, the picture complicates further. Deeply devalued widows rejected by family and thrust out into poverty and homelessness, women subjected to brutality at the hands of family and strangers, and the picture blurs even more.

If it is true that performing jobs that are torturous for human beings to do, jobs that are reserved for the poorest of the poor, with little hope of relief, causes people to lose their bearings, retreat, and lose their clarity of thought and memory, again, the picture needs to be refocused.

The above inconvenient truths reveal that simple solutions to “bring people with mental disorders back on track” only address a part of the problem, and may create unanticipated problems, at least for affected people. If indeed, a society “manufactures” people with mental illness as a result  of poverty, oppression and associated brutal life conditions, at least in part, we need to keep that in our minds, and more importantly, our mindsets.

For me, it is helpful and important to remember and even embrace the complexity of the interplay between social and environmental factors.  The medical model of illness will never fully answer the question of how to address the big questions raised by the issues of mental disorders.

Meanwhile, people with mental illness languish in mental hospitals, beggar’s homes, and on the streets. We can celebrate a legal framework that offers people support, assistance, control, and recognition of their humanity and value.  There is something to be said for helping people to get “back on track”. Don’t think, however, that it will be enough.

 

 

 

 

Go Up

“When in doubt, go higher.”

Dr. Wolf Wolfensberger

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This was not advice about avoiding floods or choosing a hiking path. It was advice about our thinking.  When we are working with an idea, or a thought, or a phenomenon, or a struggle, we must strive to push our thinking to a higher level – to address universals rather than individual particularities. This was a great gift frequently offered by Dr. Wolfensberger to those he mentored and taught over his many years of change agentry around the plight of and possibilities for people with disabilities.  It has come into my mind many times this summer as we prepare to gather together a group of leaders in India to discuss, learn about, and push our own thinking about crafting a positive future by, with and for people with disability in India.

In just a few short weeks, a team from 3 countries will be introducing the core ideas of Social Role Valorization to India for the first time. A group or 40 or so leaders from across India will meet for three days to immerse themselves in the foundational ideas that have been so important to laying the groundwork for moving away from segregation and devaluation, and towards integration and full lives. In our preparations, the core trainers have been discussing SRV examples to illustrate the “big ideas”, such as the culturally valued analogue, role circularity, and the conservatism corollary.  Heady ideas, exciting, and ones that fit fairly “high” on the hierarchy of universals. They are also ones that we can easily illustrate and bring to life for Indian people from our years of work in the US, Australia, and the Republic of Moldova, respectively. In doing so, we risk the response earned by missing the nuances of Indian culture and society which will cause people to respond with “not here in India”. On the other hand, we can tailor our presentations to be specific only to India, and in doing so no doubt get it wrong in truly understanding what we are seeing and, perhaps “shoehorning” Indian experience into our own set of principles.

“Go Up”, we hear.  In this context, I think it means two things:  “Trust the Ideas”: Remember that the ideas we are teaching within Social Role Valorization are based on universal societal principles.  They matter and they apply wherever human beings live in community.  “Trust the People”: People have the capacity to interpret ideas, generalize them, adapt them and then make them specific to their own context when it makes sense to do so.  I look forward to what will be a potent mix of strong ideas, personalized illustrations, adaptations, and, I essence, all taking a leap of faith together. People matter, ideas matter, and, when we get stuck, we will “go up”.

 

Great Questions, Answers that Matter

Judith Snow

“A great question refuses to be answered; so it keeps leading us into deeper connections with each other & into deeper thinking.”

– Judith Snow

 

Change agent, activist and friend Judith Snow once said this, and it immediately captured my imagination at the time. Over the years, it has become a powerful tool of practice for me. A rich set of questions can yield immense wisdom when asked of many people, with a genuine curiosity at the core of the asking.

When we first began to think about the work that needs doing in India around disability and equity, and there came an opportunity to do a part of that work, it seemed wise to begin with some important questions that will add richness to the understanding of both the “asker” and the “asked”.

And so has our work begun, not with answers but with 4 simple questions. These questions are being asked in 45 participatory sessions being held across India, and they are being asked of families, people with lived experience of disability, professionals, and everyday Indian people who might be described as community members. The answers to the questions are respected, recorded, captured, and shared back. They also begin to fill out the tapestry before we can ask other questions, the very first questions of service design, “Who are the people?” and “What do they need?”

The four questions which are grounding our work include the past, the present, the future, and the action. Each has profound importance. One cannot know where one is going unless one knows where one has been. One cannot establish a vision without an acknowledgement of the present. One cannot formulate action without sensing a sharp tension between what is “now” and what “should be”.  A discomfort and even chafing at the conditions of today propels us towards a future in strong ways.

The answers are compelling, profound, diverse, and slowly painting a picture of life, hope, change, and possibility, while acknowledging the hard and faithful work that needs to be done.

When we have asked these questions 45 different times, among 45 diverse groups of people gathered in meeting rooms, offices, conference rooms, and wherever people can carve out a space, we will pull together these expressions of pain, knowledge, wisdom, hope, and, yes, direction, into a single snapshot which will boil down this work into one rich view. This informs the work of Keystone Institute India, can inform the work of many others, and will in some sense cause change simply by having asked elegant questions that echo in people’s minds and hearts for a long time.

“What is the HISTORY of people with disability – in your society, your neighborhood, your community, your family, your life?”

“How are things NOW?”

“What is the VISION for the future?”

“What ACTION must be taken to make that vision a reality?”

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One of the most profound moments came for me, as a facilitator, when 12 men and women, all currently institutionalized in government mental hospitals for decades, came to a session and told us of their realities. One man simply stated, “While we have been here for 15 years, the world has changed, but we have not changed at all”.  This observation brought a hush to the room, as all 35 strong of us realized that one of the profound impacts of segregation are the discontinuities with the outside world which get created. Everyone in the room- professionals, families, and others were immediately able to feel the visceral impact of what it means to be rendered an alien in your own culture through having been separated in a timeless, changeless world where you are frozen in time. If we want to do right by people, listening to their experiences of the past, present, and future matters a great deal. Listening is a part of the process, and it may be a part of the solution to the problems of discrimination, marginalization, and oppression as well.

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Who could have imagined?

Who could ever have imagined this moment, given the 50 year struggle to assist people with intellectual disability to take their place at the community table in the United States?

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It is May 7th, 2016, at the Millersville University’s graduation ceremony. It is time for the “Student Address”, delivered each year by a graduating student who exemplifies the university experience. Daniel Castellanos, university student, soon-to-be graduate, theater major, actor, campus activist, and now, commencement speaker, walks to the podium with an easy confidence. He is the very picture of a young man full of promise, and with just the kind of swagger reserved for the young on the exhilarating edge of anything-is-possible.

He begins his speech with a small joke, delivered easily and with charm, and loosens up his audience of regalia-clad faculty and classmates, and their families. He’s a natural.  Daniel delivers a powerful take-home message of exuberant joy and promise for the future. Just the thing to start out this ceremony, which marks a major life moment for each of the students who will take the stage and receive their graduation honors on this day. Cheers ring out – Daniel is one of their own, and stands with his classmates and proud faculty on the verge of possibility – the good things of life are not only possible, but probable and within reach for each of the students, and they know it. Indeed, Daniel is one of them.

Daniel spoke openly and honestly of his intellectual disability as a simple fact which makes up a part of his identity, but it is clearly only a part of who he is. In this company, it seems almost incidental. Hard to imagine that this man spent his elementary, middle, and high school years in segregated classrooms for at least a good part of the time. As for all the students, university success leads most students on a path that is different than they would otherwise have experienced. For Daniel, this is particularly poignant and meaningful.  For Daniel, university success may well mean a path away from ever being defined by his disability, a path away from lifelong client-hood and into lifelong citizenship. For those of us who get to bear witness to this small but exquisite moment, we can see the fruit of our hard and faithful work in some way.

For me, I take heart at the small, exquisite moments that are mostly unheralded but that signal the changes which are stirring within India as the promises made to India’s disabled citizens and their families begin to take root and grow.  I think of the men and women across India  in mental institutions looking with hope towards gaining their freedom, the families who are striving to create a secure future and a decent education  for their children, and the people themselves  struggling to find their own voice and be heard.  We must approach this work of building an inclusive community with pragmatism and grit, but also with unreasonable hope that the extraordinary will happen.  Thank you for this message, Daniel.

 

 

Leaky Roofs Matter: The Strength of a Metaphor

12 people from 3 different organizations – The Hans Foundation, Keystone Human Services International, and the Rural India Supporting Trust – joined together this month for several days to see how we could envision and describe an India where everyone belongs. When we say everyone, we mean everyone, and that includes people experiencing disability. This experience of capturing a possibility, or a guiding star, is the work of the heart, work which will soon require us to put our heads to our work, and then our hands to move towards that vision.

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As I find is often the situation with any creative process, we sometimes struggle with putting words and images to big ideas and complex, important notions. Sometimes, when this struggle to convey happens, someone can frame that idea into a metaphor of sorts. When this happens it is a wonderful and powerful gift to the process, and one which captures the essence of something to allow that ‘big idea’ to be harnessed over and over again to quickly and easily be recalled in all its nuances.

During our meetings, we had a discussion to discern our shared guiding values and beliefs about the work of helping Indian people with disabilities to experience full, rich meaningful life. General Surinder Mehta, the CEO of The Hans Foundation, offered a rich story to us to illustrate several critical points and realities about working with people who have often been betrayed and forgotten. It involved a family living in deep poverty who was visited by community workers who wanted to help. Instead of replying with great thanks and appreciation, the family responded by indicating that they had received many offers of assistance, and yet, their immediate concern was the roof which was leaking in their small, cramped quarters. It was the rainy season, and the wet was causing sickness and misery within their family. They noted that this situation had persisted for a very long time, while a host of well-meaning social workers and passionate charity organization representatives, government workers and politicians had come and gone, come and gone, come and gone again. All meaning well, all making promises of great changes to come, all good people. Promises from government programs, new initiatives and schemes have come and gone, and yet the leaky roof remains.

One of our planners gave this parable a name – “Leaky Roofs Matter”. It has become our working shorthand for a number of important and connected issues that relate to the work these three organizations are doing together.

The first issue has to do with the notion of “first things” – we often refer to this as “most pressing need”, and it is important guidance to any organization trying to make life better with and for people with disability. This means that some needs that people may have are more important that others, and it is fruitless to try to address other needs until that need has been met. A common example we often find in services to people with psychiatric disorders, or mental illness, is that the most pressing need people experience may be crushing poverty instead of the mental disorder they are said to have. As a result, this “fundamental attribution error” can cause us to waste people’s precious time and lives in all sorts of therapies and with all sorts of drugs when the condition may be intractable until the person is relieved from the some of the brutality and stress of living in poverty. Just an example, but one which is ubiquitous.

The second issue has to do with loyalty to the person impacted by the issue. As the good General noted, we simply cannot lose sight of the man or woman on the street – this means that whether a measure is focusing on the individual, community, or societal leave, we must not lose sight of the vulnerable person and their family. A program is only as good those working on its behalf see those it serves as much like themselves.Its leaders and workers must try continuously to see the world through the eyes of vulnerable people as much as is possible. Sometimes this means we have to make ourselves (and our associated organizations) small so the people we serve can be big.

Lastly, and perhaps most importantly, “Leaky Roofs Matter” implies that we must keep our promises. Vulnerable people have been promised change over and over. The charity mindset implies that the people who are being helped should be grateful for anything and everything that is given to them, whether it is what they need or not. The medical mindset implies that people will “become well” from treatments or service. Predominant service models of congregation and segregation imply that people will gain belonging and safety from being put apart and away from typical people and community. None of these widespread mindsets have consistently met people’s pressing needs, and yet they rage on in practice and theory. If we are to use a different mindset, one where we listen carefully to people with lived experience; one where we see individual people and families as unique, with a unique set of experiences, gifts; and one where we and stand by with and for vulnerable people, we are likely to chip away at the mistrust, suspicion, and weary sense of resignation that our biggest and best ideas are sometimes greeted with.  As our friends and colleagues Norman Kunc and Emma Vanderclift say in the Credo for Support with wisdom, “Do not work on me. Work with me.”

Thanks to this metaphor, all of the above issues, which might be powerful enough to build an organization on, or at least a  coherent service design, are now available to those of us working in concert within our initiative in India in nearly ‘total recall’ by saying three simple words, “Leaky Roofs Matter”. Those three words are now a strong safeguard and a potent builder of culture.