Are Institutions Evil? an Analysis, with a Review of (Re)Thinking Violence in Health Care Settings: A Critical Approach, Edited by Dave Holmes, Trudy Rudge, and Amélie Perron
Brickner, Philip W., Care Management Journals
A casual reader might assume from the title of this book that it concerns physical attacks of one person on another in the health care scene. However, the editors have a far grander scheme in view. The text can well be recognized as a cornucopia of remarkable material that deals, in varying degrees of success from chapter to chapter, with violence in very wide terms indeed as it affect the professional lives of nurses.
The 18 chapters that constitute this work are divided into three parts: institutional and managerial violence, horizontal violence, and patients' violence. However, this division is arbitrary, and the reader will identify unusual definitions of the word throughout the text, definitions that require an opening of the mind. Furthermore, there is a consistent tone, even though the chapters are written by 27 individuals, of distrust of institutions, with "distrust" defined in the broadest sense; and that institutions themselves are-by their very nature-abusive of the individuals who work within them. The following text from the Foreword indicates the overall emotional and spiritual drive behind the book itself:
This book addresses violence in all its forms, in the field of health care . . . for the past 25 years I have worked in psychiatry and forensic psychiatry, microcosms where organizational, managerial and horizontal violence are endemic . . . overwhelmingly, however, I experienced organizational violence, a despicable form of violence perpetrated by organizations or members of these organizations against those who are vulnerable: patients and nurses. This violence in health care settings, as well as its trickery . . . hides behind the rhetoric of treatment, care and welfare, making this form of violence the most perverse of all. (p. xxiii)
This tone of bitterness and anger (perhaps with a touch of paranoia) permeates the work; but nevertheless, a diligent reader will identify fascinating material regarding complex issues that nurses face. The subject matter is in part practical, theoretical, academic (and hyperacademic), and almost all of interest, even if not always convincing. Hyperacademic? Try this:
. . . the performative talk of staffand patients contribute to the cultural texturing of a masculine and sexist world in a way that marginalizes female nurses, mediates the otherness of inmates and contradicts therapeutic ideals. (p. 12)
Although this work is largely made up of heavy-duty subject matter, it is also a just criticism of the overall content and style that much of the material is arcane, pedantic, polemical, rhetorical, jargonized, navel-gazing, and perhaps intended for authors to one-up each other.
The first quote mentioned earlier defines the approach to institutional violence. What of horizontal violence? The term is defined as violence-but not actual physical abuse-between professional peers or from senior to junior nurses; bullying in the workplace and on the telephone; and (an outlier chapter) on written violence in an HIV/AIDS prevention campaign.
Part 3, Patient's Violence, derives its chapters from experience in the forensic settings of psychiatric hospitals, often for those who have committed crimes. This material is largely self-evident.
This review considers several chapters in some detail.
"The Violence of Tolerance in a Multicultural Workplace: Examples from Nursing" (Rudge et al.) considers the professional lives of skilled Black African migrant nurses at work in the Australian health care system. These foreign nurses are tolerated by the larger work pool of White nursing staff, turning the word tolerance, ordinarily considered a positive, into scorn. The authors consider that the tolerance offered to Black nurses in a White environment means the reproduction of racism and exclusion and its violent effects; it is an "attitudinal response" that "inflicts the violence of tolerance on those who experience racism and are racialized by their difference from the dominant group" (p. …