Facts and constructions

I wrote earlier about my impression that the field of ASP is delineated in current Scottish policy in ways that don’t make intuitive sense to many people without a grounding in the field. I also hinted at my view that there doesn’t exist one “intuitive” or “correct” way to define and draw boundaries around the issues and activities that Scottish professionals currently “box” together and call “ASP”. Instead, any given way of defining and drawing these boundaries needs to be understood as a product of its history and of its implicit assumptions: about society and the role of the state, for instance; and about care; and about vulnerability.

We see this in the way that the same issues are understood differently in different cultures and in different historical periods. For instance, some countries have separate policies for addressing the abuse of older people than they do for addressing the abuse of any other adult (7,8). They might define “abuse” and “old age” differently as well. Some might consider abuse within the family to be a distinctive enough phenomenon to legislate about collectively: this would include our concept of “domestic abuse”, many of the issues that we would class as “child protection” and a proportion of the issues that we would class as ASP (9). Others again might draw a different boundary between protection issues and political, cultural and economic issues. Highly prominent in a typology of elder abuse in Africa, for instance, is collectively-perpetrated violence against older women that stems directly from such factors as patrilineal inheritance laws and a belief in witchcraft (10). Some of these different ways of delineating issues might be because different problems face different societies at different points in time. But some are because we understand and group things differently. For instance, the persistent devaluing, even vilification, of people prevented by illness or disabling barriers from supporting themselves through paid work does not always count as an ASP issue in the contemporary UK context. Sometimes it passes for journalism. Sometimes it passes for welfare reform.

As well as the question of what counts as harm or abuse, there is the question of what counts as ASP. The leap to thoughts of allegations, investigations and risk assessments, case conferences and co-ordination of “packages” of intervention drawn from a mixed economy of care is not a leap that welfare professionals in every society and every period of time would make. On the contrary, what counts as an ASP activity here and now makes intuitive sense to us because of the political, cultural and service contexts in which we are immersed.

The idea that we can’t look at the facts about what is happening in our society in a way that is divorced from these contexts, in order to read off the “truth” about harm/abuse and the one “correct” way to design a service response has a lot of support in sociological theory. For instance, some sociologists argue that all social problems are constructed (11). This doesn’t mean that there is never a “real” problem, but it does mean that the particular ways we understand, define and respond to the issues that are accepted as problematic within our society are affected by a range of contingent factors. Often issues of definition, boundaries and approach are fought out in more or less explicitly political contexts. So what we are left with are constructions of problems that are never universally “correct”, though they may be more or less universally accepted as correct in particular cultures at particular points in time.

Similarly, there is a lot of reference in some fields of sociology to “discourses” (12,13). These can be thought of as bodies of ideas and practices that grow up in particular societies and are accorded the status of truth within those societies. They shape the ways that people think and act, the ideas that are accepted and those that are discounted. The power associated with certain societal roles helps to reinforce these discourses: for instance the power associated with being an ASP policy-maker, trainer or practitioner. It is currently accepted in these professional circles in Scotland, for example, that “harm” is a distinctive phenomenon that has something to do with “disability, mental disorder, illness or physical or mental infirmity” (14). It is also accepted that a key part of ASP is investigation. There are lots of forms, procedures and legislative provisions that govern when, how and by whom ASP investigation should be done. Some training to direct care and support workers begins from the premise that referring information on for investigation is the core role of these workers in countering harm. Voices wishing to challenge these truths carry less weight than voices subscribing to them, particularly in settings where ASP is practised, policy developed or training delivered.

So what does it mean for policy, practice and research, if we accept that “harm” and “ASP” are constructed in this sense, and connected in these ways with power? First, there are many things that it does not mean. It does not mean that our currently prevalent ideas about these concepts are “untrue”. The argument is rather that there is no single, underpinning “truth” of this kind, to measure our ideas against. It does not mean that power is necessarily being used oppressively; it pre-supposes instead that power and knowledge will always be linked. It does not mean that harm and abuse are not “real”. Some older people are undoubtedly raped; some people with mental health problems are undoubtedly stolen from; some people with learning difficulties undoubtedly lead diminished and fearful lives. The point is not to question the material reality of this pain and injustice, but to explore the ways we conceptualise certain phenomena as representative of certain kinds of problem, to be responded to in certain kinds of ways. To accept that “harm” and “ASP” are constructed also does not mean that any way of conceptualising and responding to these issues would be as good as any other. But it does mean that there will always be more than one way to understand them. And this means that “facts” alone are not enough to help societies and individuals judge which ways of understanding and responding might work best for them.

One concrete implication of this is for the evaluation of policy and legislative frameworks. To return to a previous example: we know that some national policy frameworks understand the abuse of older people to be a distinctive phenomenon, whilst others group it, or some aspects of it, underneath some broader heading: for instance “domestic violence” or “institutional abuse” or “harm towards adults at risk”. Perhaps none of these alternatives represents the “best” way because it is “true”. Perhaps we should ask instead what effects each grouping has (15). In the Scottish context, for example, what effect has subsuming the abuse of older people within the broader ASP agenda had on the priority that the protection of older people is accorded within the public consciousness? Within professional education and training? When resources are allocated on the ground? (16) There are plenty of other questions we could ask as well, about the effects of the broad shape and the underpinning premises of Scottish ASP policy. For instance, what are the effects of the division that ASP policy implicitly draws between those who are ASP workers and those who are providers of support and care? Do support and care workers perceive differences in their wider roles, and in their relationships with other services, since the implementation of the ASP legislation? Do people who use services perceive differences in the wider services they receive, for instance in the attitudes of their workers towards risk? There is a rich research agenda here, based on these and questions like them, the surface of which has barely been scratched up until now.