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Self-Esteem, Empowerment and Social Action
Autobiographers, authors, philosophers, novelists, teachers, families and survivors, far too many to list here, have all noted the pervasive and disabling nature of the medical delivery system when it is driven by what is know as the "medical model."
Those who have experienced "serious medicine" have seen that model in action and experienced its effects on the mind and soul. It starts in white coats (uniforms of intimidation?), is driven by a faux expertise and believes that the worst thing that can happen is death. It steals dignity from customers by calling them "patients." Remember that Webster defines "patient" as: "one who is acted upon."
Usually a person is caught in the medical system from the emergency room until liberated from facility-based rehabilitation - all too frequently because "funds have run out." The issue has been and is - who has control. Professionals, consciously or unconsciously, work out of at least five belief/behavioral models. Behind their actions is one or more of the following notions:
It is this last model that is of interest here. The rehabilitation process has many failings. Perhaps the most destructive is the absence of a clear sense of integrated mission in regard to the individual customer. Starting, as it does, with a clear analysis and articulation of deficiency, it proceeds to a "set" of fragmented specialist-based physical, occupational, recreational, speech, social, neurological and medical interventions. Each of these specialists comes to the customer from a different educational background, a different technology and a different set of priorities and goals. This leads to staff behavior in the rehabilitation facility that results in what can only be described as extending from the ridiculous (nod once for "yes" in Physical Therapy, nod once for "no" in Occupational Therapy) through "Catch 22" (agree with us or you are crazy) to the sublime, ("if you don't do what we tell you to do, you won't get well and we will behavior mod you"). Throughout this process the dignity of risk and the right to be wrong are totally denied.
To simply state that a facility uses a "team approach," as all facility brochures do, is not enough. To behave as a team a group must have specific holistic agreed-upon outcomes which are developed with the cooperation of and concurred in by the customer. Restoration to pre-insult functioning is not sufficien even when such an outcome is realistic.
What is proposed here is that the concept of self-esteem and the process of building self-esteem be implemented as the first and primary step to empowerment and as the integrating conceptual framework for each individual rehabilitation plan. (Bush, 1990) One cannot approach, let alone achieve successful rehabilitation or empowerment with low self-esteem.
Stanley Coopersmith defines self-esteem as:"... the evaluation the individual makes and customarily maintains with regard to himself ... and indicates the extent to which the individual believes himself capable, significant, successful and worthy." (Coopersmith, 1967, p. 4-5)
Following a review of the writings of William James, G. H. Mead, Adler, Fromm, Rogers and extensive research, Coopersmith concluded that there are: "four sources of self-esteem: the ability to influence and control others (power); the acceptance, attention and affection of others (significance); adherence to moral and ethical standards (virtue); and successful performance in meeting demands for achievement (competence). (Coopersmith, 1967, p. 38)
What is required is some reflection on the rehabilitation process as currently delivered and funded and on the social context of prevailing attitudes about disability in contemporary society. Even the most casual observer must conclude that neither facilitates the development of strong self-esteem. What then is required is a facility-wide commitment to the development of self-esteem in both staff and customers. All medical and sub-medical specialties should study and reflect this commitment in their work.
A blueprint for developing self-esteem on a community-wide basis is presented in the "California Task Force to Promote Self-Esteem and Personal and Social Responsibility" report: Toward a State of Esteem. (California Task Force, 1990). That report argues that acceptance of self as we are, forgiveness of self and others, setting realistic goals in the context of being responsible for our own actions, risk taking, appreciation of our creativity and spirituality and affirming the worth and importance of others are the keys to healthy self-esteem. It further states that the development of these qualities should be done in an atmosphere of mutual respect and support for each other and in a context of negotiation, not abuse.
Empowerment, the facility to engage the process of having one's future under the consistent management and control of the self, is the next step. (Condeluci, 1991)
It is only after the development of self-esteem and gaining an appreciation for empowerment that we find ourselves free to define our needs. It is only at this point that we are free to no longer identify with our disability. It is only at this point that we are free to reject the diagnostic label for our disability. It is only at this point that we are free to network in all parts of our community, indeed - lead in our community, in the search for employment, housing, transportation, civil rights, access to medical services, social opportunity and quality of life. With strong self-esteem and empowerment the oppressive medical model of our problem can be rejected. We can join with all oppressed people and look forward to the day when we are all: "Free, Thank God, We Are Free At Last!"
Bush, Gerald W., "Self-Esteem: The First Step to Empowerment - A Working Paper," (Waltham, MA., The Heller School, Brandeis University, 1990)
California Task Force to Promote Self-Esteem and Personal and Social Responsibility: Toward a State of Esteem, (Sacramento, CA., California State Department of Education, Bureau of Publications, 1990) [P. O. Box 271, Sacramento CA 95802-2720, $4.00]
Condeluci, Al: "Empowerment, The Next Natural Step," The Perspectives Network, Vol. I, #1, p. 1-2, January 1991
Coopersmith, Stanley: The Antecedents of Self-Esteem, p. 4-5 and 38 (San Francisco, W. H. Freeman and Co., 1967)
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