“for there is nothing either good or
bad, but thinking makes it so”
William Shakespeare, Hamlet, Act 2, Scene 2
With this simple line Shakespeare’s Hamlet summed up the basic notion behind psychological and emotional abuse. Eleanor Roosevelt said it rather differently three and a half centuries later when she pointed out that an insult only hurts if we agree with it. What both of these different expressions of the same principle have in common is this:
If I want to change the way you feel I must first change the way you think, either about yourself or about your situation.
Anything that causes distress or confusion or that misleads the other person causes psychological and or emotional harm. If the behaviour that causes that harm cannot be justified then it is also abusive.
The distinction between ‘harm’ and ‘abuse’ is as important here as anywhere. After all you can’t please all of the people all of the time and people do sometimes become upset for their own reasons even though no-one has done anything wrong. If a person becomes upset because you’re carrying out your legitimate duties then that’s not your fault.
For example the relative who chooses to become angry or distressed because the carer refuses to do what they demand is not being abused. They have no right to demand that they obey them – your duty is to the service-user, not the carer and so you are not being abusive by doing what you think is right, whatever the carer’s opinion might be.
However sometimes our dismissal of others opinions, wants and needs really is abusive. The service-user who becomes distressed when the carer insults or ridicules them is a victim of emotional and psychological abuse. We may not be able to please all of the people all of the time but that doesn’t excuse meanness.
Deliberately misleading, isolating or demeaning another person is likely to be psychological abuse as are intimidation, over use of criticism and hostility. If these things are done from a position of authority they may well also meet the European criteria for torture precisely because of the distressing impact they have on the victim. Repeatedly focussing upon distressing situations for no good reason such as constantly surprising dementia sufferers with the news of their parents’ death for example is a form of psychological/emotional abuse too.
Earlier we made the point that abuse is a violation of an individual’s rights. Rights are not only about the things we shouldn’t have to put up with – they’re also about our entitlements. For example service-users have the right to experience a stimulating environment (so long as they can cope with it). Endless hours of daytime television is not really appropriate psychological stimulation which is one reason why so many people in residential care or long term hospital placements become clinically depressed. What would happen to your mood if all you had to occupy your mind were chat shows relating to a world you no longer felt part of? Physical and environmental circumstances have psychological and emotional impact, for better or for worse.
Over-stimulation due to noise, overly bright lights or even simply too much frenetic activity can cause psychological harm. Critical, demeaning staff or dehumanising routines create difficulties too, particularly in relation to self-esteem. Consider the psychological impact of having someone else make your basic decisions such as what you wear or eat, what time you get up, when you bathe and even when you go to the toilet. Imagine someone else feeding you.
Of course it is undeniable that many people in our care need a great deal of support and assistance with all these things and more. However – when they are able to exercise choice about when and with whom for example they are much more likely to maintain a sense of independence and control than when they are simply factored into a routine that is decided ‘in the office’.
To the busy care worker these things are functional – they’re just routine and can become no more than ‘tasks’ to be performed in the minds of the staff. To the incapacitated patient or resident they may be the last aspect of independence supporting their self-esteem. Even routine can be a form of psychological abuse. We’ll explore this concept a little more when we cover Institutional abuse shortly.
As with so many aspects of abuse it’s always worth wondering how you would feel if you were in that situation. If you’d become distressed, depressed, angry or humiliated then there’s a good chance that the same will be true for your service-users.
The fact that they may not complain is no guarantee that they are satisfied. It is usually the most depressed and/or dehumanised people who complain the least because they have simply given up. That’s one reason why health and social care inspectors monitor complaints about a service. The service that has no complaints is often the service chosen for an inspection visit simply because it is impossible to please all of the people all of the time and so if nobody is complaining the inspectors often want to know why not.
About the Safeguarding series
This blog series first appeared on Stuart’s personal blog early in 2010. It has been reposted here as part of a process of ‘rationalisation’ in which work from several blogs has been removed and reposted on only two.