On being an authoritarian, from personal experience: Lessons from the psychiatric unit


au·thor·i·tar·i·an
əˌTHôrəˈterēən/
adjective
adjective: authoritarian
1.
 favoring or enforcing strict obedience to authority, especially that of the government, at the expense of personal freedom.

From one authoritarian to another...

Full disclosure: I'm an authoritarian. Not usually, but every once in awhile. I'm a nurse on a psychiatric unit, and it makes you that way. The psychiatric unit is a microcosmic culture where freedoms are given and taken away on a daily basis, and when I work as a charge nurse, I (along with my professional peers), am the authority that sometimes chooses to take away personal freedom, and demand obedience.

A different way to put it is that, on a regular basis, I have to make the choice to force people to do things against their will. It is both the nature of my job and the most morally challenging aspect of it.

When a patient comes into the emergency department in psychiatric crisis, it's been my role to decide whether they need to be admitted for inpatient hospitalization. At times, they disagree with my assessment. I currently work in pediatrics, so sometimes this means we get parents consent and admit forcefully that way. Other times, when the parents disagree as well, we pursue legal force through the Involuntary Treatment Act.

Once patients are on our unit, there are a variety of ways that we take away personal freedoms, from disallowing personal electronics use, to physically moving patients from one area to another, to placing feeding tubes for eating disordered patients, to injecting legally compelled medications for patients who are psychotic and unwilling to take medication on their own.

When do you feel okay about it?

Instinctively, I'm not an authoritarian, so I never feel good about doing anything against someones will. But I can tell you that the way a morally conscious person can continue to do this kind of work is to recognize that at times, authoritarian action is the least bad option.

For example, you can only pursue an involuntary admission if you feel that the patient will not be safe if discharged from the hospital. And you can only feel justified in forcefully placing a feeding tube in the nose of a crying young girl if you believe that they are actually killing themselves with their eating disorder. Or to hold down a psychotic patient and inject them with a medication with real side effects: you have to believe that their life is at risk, either in the short or long term, if their symptoms aren't addressed.

In other words, in order to feel that it is morally acceptable to take away another person's freedom, most of us have be feel at least a little bit of fear. For their own safety, or for another person's safety.

As a nurse, it is my responsibility, in fact, to only use force when I believe it is the least bad option. To question doctors and peers when I disagree with their decisions to use force. And to stop using force when it is no longer essential - to release an aggressive patient from restraints as early as possible, and to remove the feeding tube as early as is safely possible.

And there are types of force that are never seen as acceptable. It's never okay to lie to a patient to get them to do what I want, for instance, because it is counter productive. Believe it or not, a person will be less likely to trust you in the future if you lie to them in order to get them to take a medication than if you force them to physically, and less likely to work with you in the future.

Lying is an authoritarian act because it takes away an individual's honest choice, while also undermining their sense of security in their environment - their ability to trust what they hear and see as reliable.

We also don't use force for our own convenience. We don't physically move patients because they are being annoying, or because they're being insulting towards staff. We only do it when it becomes a risk to staff, or other patients.

Most people have to feel that there is strong moral justification in order to use authoritarian force. And on the flip side, people who have force used against them will only be able to learn from it if they too come to understand it as justified: that it was better than what would have happened otherwise.

Society and Authoritarianism

You might see where I'm going with this. There are some important social lessons in all of this for America in 2017. Working on the psychiatric unit has taught me that:

1) Most people who generally feel that it is not okay to take away individual freedom will agree that it is acceptable when they feel safety is at risk. That is, when they are afraid.

2) Lying is never an acceptable way to persuade because it undermines trust in relationships where power is varied and cooperation is essential.

3) Most people will come to conclude that authoritarian action is unjustified when they believe that less forceful options exist.

We can extrapolate these principles out, and recognize that they're the foundation of the rule of government in society: we trust government to the extent that we feel it only removes freedom to an extent that is necessary. We stop trusting government when we feel we are being lied to. We resist forceful action by government when we believe better options exist.

Authoritarianism as a leadership strategy

We can also recognize that these principles are manipulated by leaders whose instinct is towards Authoritarianism with a capital 'A' - the bullies and mean girls and bad bosses and dictators that exist, in relatively small percentage, at all levels of society. People whose instinct is to demand obedience and use force to get what they want, even when it harms the general public.

For the Authoritarian in government:

1) Fear is an important quality to cultivate in a population when government wants to remove rights or reduce freedom, because it leads the majority of the population to feel that such actions are morally justifiable.

2) Lying is an authoritarian action. It can be used as a shortcut to manipulate some situations, but will ultimately result in widespread distrust of government. (See WMD in Iraq.)

3) Resistance is driven by the principle that authoritarian action is unjustified: either the fears driving the actions are baseless, or there is a less authoritarian way to meet the same goals.

And to introduce another lesson from the psych unit:

4) The more power given to an authoritarian, the more dangerous they become, because their followers also are pressured to become authoritarian. Another time when I, as a nurse, use authoritarian action? When the boss says so. When the courts order a patient to receive compelled anti-psychotics, for instance, my decision becomes "give the med or potentially lose my job and license". Resistance comes with a higher cost than when I was making the call on my own. Government employees under a person who is willing to use force unjustifiably for convenience or personal gain are forced to choose between their livelihood and the correct moral decision.

Bringing this into focus.

Authoritarians can exist on the right or left - socialism has had its dictators as had fascism. But let's be honest, we're talking about America here. And America is currently being led, at a federal level, by an administration with authoritarian instincts and aspirations, as evidenced by (among about a million other things):

1) The exaggeration of crimes committed by immigrants, and the risk posed by refugees from Muslim countries, while simultaneously trying to institute forceful bans and crackdowns on these immigrants and refugees.

2) A pattern of lying overtly, and by omission, publicly on Twitter and TV, and under oath during confirmation hearings, to achieve political ends.

3) A sowing of distrust of media that critiques leadership as an 'enemy of the state', while simultaneously barring that media from previous points of access to government.

4) A pattern of sowing distrust in political enemies by the propagation of conspiracy theories - such as the accusation that Barack Obama was not born in the United States, and more recently, that he has been responsible for stirring up the political dissent that has arisen against the administration.

5) The pitting of police against (particularly the black) population in "law and order" rhetoric.

6) Direct public attack and threats of legal action against private citizens, political rivals, and government employees that criticize the administration, and on judges that hold them legally accountable.

Fear and distrust are being actively promoted. Authoritarian action is being pushed by government leaders. the population is being lied to. A huge percentage of the population is willing to go along, either by active support, tacit support, or denial. A huge percentage of the population believes that liberals, blacks, Muslims, immigrants, the mainstream media, and the GLBT community, are enemies of the state. On the other side of the equation, of course, an equally large percentage of the population sees Republicans as the enemy of the communities listed in the last sentence.

The cycle of Authoritarianism


My colleagues know that one reason you don't resort to authoritarian measures unless you absolutely have to is that it creates a cycle. When someone forces something on you, you lose at least a little bit of trust. Or you get a little bit more willing to push back. On our unit, you know that going 'hands on' means that you're at a pretty high risk of getting kicked or punched. And you know that you're cementing a conflict with a patient that might not be easily resolved.

Which is, I believe, what's happening. The right didn't invent government overreach, and I'm not sure who started the fire. Lies by omission and 'spin' have been the standard operating procedure of government for years, for instance. We just call it politics, and it doesn't immediately infuriate people as much as overt lying, but it has contributed to the slow creep of fear, anger and disillusionment that got us here. The war in Iraq was sold to the general public in unjustifiable ways by both parties. The nature of American intervention internationally is consistently hidden from the general public by leadership on both the right and left under the guise of security. Executive action has been increasingly accepted as a legitimate means to make governmental change, and particularly authorize military intervention. Etc. etc. ad nauseum.

But I also believe that the political right in the U.S. has taken a step forward to a new level of unjustifiable authoritarianism, which has been building for years with federal level obstructionism (see the refusal to hold a vote on Garland as a Supreme Court nominee), and at a state level with gerrymandering and voter suppression efforts across much of the Midwest and South. Culturally, fear has been sold in a way that has been, at times, intentionally inflammatory. The Trump administration is a logical extension of the philosophy that force is an effective way for a political party to 'get what it wants' in a situation where massive public opposition exists. Public support for Trumpism is a signal that we've hit the point where people find throwing punches acceptable.

We've hit the point of escalating violence, and socially reinforced mutual fear, alongside gridlocked, corrupt, and counterproductive government.

And it's easy to see how this could continue to escalate in the near future: in response to the hard right shift in government, the left, if rights are taken, people are deported, Muslims are banned, police and government officials aren't held accountable for violence, will recognize a threat to their safety, and the safety of those they love. And they will respond with their own authoritarian actions, and will feel justified in doing so as a necessary step to maintain safety. When that happens, the right appears willing to rinse, wash, and repeat the same process.

How do we break it?

I don't know for sure. The center might hold in the US if enough voices on the right resist and condemn authoritarian strategies, and don't function as opportunists in response to Trumpian overreach. The center might hold if enough people on the left hold on to their moral authority, and don't overcompensate for unjust actions with injustice of their own. The left's vested interest is in demonstrating to the right that they're being lied to - that their fears don't merit an authoritarian response. And the right's vested interest is in not letting authoritarianism become synonymous with Republican by accepting it as normal. In both cases, it seems like breaking the cycle is going to mean dramatic reshaping of leadership and priorities in the political parties.

But I hope we break it, because the outcome of the cycle is violence and trauma, not progress. The arc of history doesn't bend toward justice on its own, as evidenced by the fact that we're bending it now towards injustice.








Comments

RYAN KNIGHT said…
Another risk in the cycle of authoritarianism is that the patient (or citizen as the case may be) loses a sense of responsibility for their own situation. If the only treatment the patient will accept is forced treatment then the person is unlikely to continue treatment once the court order is no longer in effect. If the person can realize the benefits of treatment and choose to accept it, either in the midst of crises or once a crises situation has subsided, then the patient and the authorities both win. I would like to tease out this idea of regaining autonomy after it's been taken away more as it has implications for politics and psychiatric treatment, but alas I have to get to my job at the psych ward soon!

Really appreciate the discussion. I also am a reluctant authoritarian charge nurse at work sometimes, making decisions that take away rights for the greater good.

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