Making Life Work: Freedom and Disability in a Community Group Home

10. What Everybody Knows about Paul

Work at Driggs House is never done. It is endless because demand is endless, because human conduct is complex, unpredictable material, and because the goal of group home work is itself a process. One aspect of this endlessness is the nature of clinical work in the community: no longer contained within the unifying walls of the institutions , psychiatry and psychology had to adapt in order to function effectively outside the segregated settings that had been its province for so long. By the early 1970s, psy knowledge had already become integral to contemporary culture in many aspects of everyday life (Rose 1999a, 1994, 1998b). About psychiatry in particular, Rose (1998a, 1998b, 1996) argues that, in the context of deinstitutionalization, the field found itself accountable to the public and political concern about whether certain kinds of individuals were capable of freedom in terms of the risks they posed both to themselves and to the community. The assessment and administration of risk became one of the field’s central practices and transformed the nature of clinical work (Castel; Rose 1996, 1998). What occurred in community psychiatry also occurred in the implementation of community services for individuals with intellectual disability. In addition to the practices of accountability that emerged with deinstitutionalization, there was a new division of labor. In the community, the work of diagnosis and the work of treatment are not conducted by the same person or in the same place and, further, do not draw on the same kind of knowledge. For intellectual disability, which is not an illness, what constitutes treatment is not determined simply by the diagnostic classification. In their everyday work, professionals do not administer treatment so much as administer the techniques for 213 10 WHAT EVERYBODY KNOWS ABOUT PAUL assessing and monitoring risk. The ongoing cultivation of capacities that enable residents to govern themselves is about the shaping of conduct in ways that, ideally, allow individuals to manage and reduce the risks they pose to themselves. This is not an argument about an irreconcilable opposition between substantive clinical knowledge and the administration of services in the community. On the contrary, clinical knowledge was redefined by the problem of government as the practice of risk administration. This requires a different kind of clinical expertise, one that involves systematic attempts to shape conduct in relation to the ongoing assessment of the risks an individual poses to him- or herself and to others. The ideal of autonomy has made clinical work more than ever a general administrative practice rather than separate fields of expertise unique to intellectual disability, mental health, and other areas (Parton; Rose 1998b, 1996). Although Hughes described the risk of mistakes and failure as the burden of all work, the work of group home counselors and other community service professionals is uncertain and prone to failure by definition, because it is largely organized by the problem of risk. What interests me here is how the counselors’ work of risk administration creates a constantly transforming field of intervention in which the curtailment of a resident’s liberty is to be avoided wherever possible yet provides the one intervention that is seen to reduce risk with any certainty. In this chapter, I use the case of Paul to illustrate how what counselors know and do took practical shape in the endless process of calculating his risk. I describe how Paul’s riskiness was assessed and acted on over roughly a six-month period, from June to December. What sets this period apart is not that Paul raised particularly new problems but that counselors identified and acted on him as more at risk than usual. The counselors’ heightened concern over this period took shape in relation to the continuous assessment of Paul, and, with each intervention, counselors transformed the very conditions of risk they sought to manage. Paul When I began my research at Driggs House, I learned that Paul was already considered a risky individual. The counselors described him to me as full of life and energy but always somehow teetering on the edge of trouble, if not eagerly seeking it out. He was headstrong and 214 what everybody knows about paul intrepid in the pursuit of his daily pleasures, and this was an aspect of the warm and funny personality that counselors truly appreciated. But because a good deal of his preferred activities involved being out in the community on his own, he was, in principle...