The Emotional Dog and its Rational ‘Tale’? Nurturing Wisdom and Humaneness in Professional Practice

1. The Emotional Dog and its Rational ‘Tale’? Nurturing Wisdom and Humaneness in Professional Practice Sue White Professor in Social Work University of Lancaster

2. Practically Popper? Formal Knowledge and Professional Practice • in current policy initiatives knowledge is often presented as an 'off the shelf' commodity • there is an assumption that, scientific knowledge, research findings or theory can deliver certainty in a professional environment characterised by uncertainty • Sound professional judgements should properly be arrived at through a rigorous process of falsification • ‘Ways to Stray’ Deficit models

3. Domains of uncertainty? • There may be competing versions and interpretations of events/symptoms • We depend on, often unreliable, testimony of various partial witnesses • Sometimes forensic and conventionally scientific evidence is unavailable • Whilst there will be some instances in which the ‘right’ answer is clear, there will be many others where a number of different actions could plausibly be followed • The ‘rightness’ of these may only be retrospectively obvious

4. Using this description of practice, we may assume that the further professional activity moves away from scientific domains the greater levels of uncertainty practitioners will have to tolerate in their practice and decision making Is this the case? Surprises from ethnographic research…

5. Modalities in Making Science: Fleck • Laboratory/Journal Science • Vade-mecum (handbook) Science: knowledge ‘to go’ • Popular knowledge and the exoteric domain

6. The Emotional Dog?

7. Moral Judgement in clinical work has a bad press, but…. • Descartes’ error • Social Intuitionist Model • Sentimental Rules • Intelligence of the Emotions

8. I suggest only that certain aspects of the process of emotion and feeling are indispensable for rationality. At their best, feelings point us in the proper direction, take us to the appropriate place in a decision-making space, where we may put the instruments of logic to good use. We are faced by uncertainty when we have to make a moral judgement.....Emotion and feeling, along with the covert physiological machinery underlying them, assist us with the daunting task of predicting an uncertain future and planning our actions accordingly. (Damasio, 1994: xiv-xv)

9. The Emotional Dog Social Intuitionist Model -Moral reasoning follows moral judgement (Haidt) e.g. abortion is wrong – life begins at conception NOT life begins at conception therefore abortion is wrong

10. Haidt’s hypothesis is not a crude evolutionary position which posits that our emotions are functional, naturally selected products of our biology (Printz, 2007), • Nor a leap back into unreconstructed cognitivism asserting that all that is meaningful is formed de novo inside the individual’s head. • Rather, morals are often the product of ‘moralising’ - cultural (group or organizational) storytelling.

11. Because moral positions always have an affective component to them, it is hypothesised that reasoned persuasion works not by providing logically compelling arguments, but by triggering new affectively valenced intuitions in the listener….. Because people are highly attuned to the emergence of group norms, the model proposes that the mere fact that friends, allies and acquaintances have made a moral judgement exerts a direct influence on others, even if no reasoned persuasion is used (Haidt, 2001: 819)

12. TL. ..... One that Deborah’s been out on today with Bev, and Deborah and Sally are going to finish it off this afternoon was a family called [name] where there’s a sort of marital conflict and where father’s made allegations about mother’s treatment of the children which does appear to be over the top OTHERS:uuuuurgh laughter. TLI know, I know..... There are four children in the family and there’s been a marital dispute, mother left and dad said the children had made allegations which sound a bit over the top so that’s one that may be coming back to us I suspect, but at the moment we’re trying to deal with it very clearly as a one off and getting them to get legal advice.

13. If Emotion and Moral Judgement are Inevitable and Necessary, but are Constructed as Murky Contaminants to Reason then…. At least 3 potential problems: • Emotional responses bracketed out by technological vocabularies, procedure, habit, rule and routine (Extract 3 • Affective/moral judgement justified using other warrants (e.g. theory) – therefore concealed and not debated (Extract 4) • Conventional violations transformed into ‘moral violations’ by normative understandings e.g. views on mothering, privilege given to some accounts over others

14. We may well hope our actions carry no moral ambiguity, but pretending that is the case when it isn’t doesn’t lead to greater clarity about right and wrong; it more likely leads to unconscious cruelty masked by inflated righteousness (Hyde, 1998: 11).

15. Certainty and psychological theory • high degree of interpretive flexibility attached to psychological theory which forms part of the core professional education for many practitioners • Making judgements about relationships and character is a fundamental part of human interaction and therefore often relies on a culturally shared common-sense repertoire.

16. Without a Trace of Irony…. …theories help to organize what we know. Theories also provide an economy of effort. They allow conceptual short-cuts to be taken. If the theory is powerful one, it might only take a few observations to locate a particular phenomenon as an example of a class of objects or behaviours…. Hypotheses help to guide future observations, the results of which aid practitioners in further testing and refining their initial assessments and observations (Howe et al, 1999 p. 228)

17. First take our innate equipment for making emotional judgements • Add this to our tendencies as information processors towards seeking to confirm initial hypotheses • Shake in some group norms • Stir in supple theory – Attachment Theory is a particular favourite and is available everywhere in all seasons Result: An intoxicating concoction rendering us dizzy and drunk on our own convictions

18. ‘Yes, I know, absolutely, mother was very inappropriate…’ The cocktail is all the more sweet and heady when supped in the company of like-minded friends!

19. The Case so far…. • The moral dimensions of clinical work are an important and under-explored area. • Professionals are moral agents. The performance of a moral self is central to clinical competence. • Case formulations are often a product at least in part of professional identities which are in turn reinforced by moral tales • This has both positive and negative consequences which are likely to be local and contingent

20. The Case so Far… When transcripts of talk and similar materials are looked at in detail, it becomes possible to render explicit taken-for-granted aspects of professional moral orders. In so doing, the so-called tacit dimension is opened up for scrutiny and debate by professionals themselves.

21. Practicalities of practice

22. Modernization and Metrics • Social workers in the UK have been widely blamed for their handling of cases when children have died or been harmed, as a result of child abuse or neglect – death of Victoria Climbie. • Within the everyday work of child welfare services, concern about potential culpability for preventable harm to children known to services is a pre-occupation for practitioners and managers and forms part of the institutional talk of the agencies • As a result of New Labour's modernization agenda, key indicators of performance in relation to child welfare have been set supported by systems of regulation, proceduralization and metrics creating new sources of accountability and blame

23. Not a remedy for Climbie Errors! • E.G. Victoria became defined through the locally rational, but ultimately dysfunctional gatekeeping practices in Brent Social Services. • Actions to safeguard Victoria were road-blocked, by institutional practices that were excessively rigid and formalized. • Social services operated with institutional categories completely opaque to the doctors making the referrals. • Had to be a 47 to get a response!

25. Investigating error and blame • Multi-method ethnography • 5 sites • Micro-world simulation informed by ethnography

26. Negotiating Access • Our first findings related to the difficulties in negotiating access in this high risk, high blame environment • Impact of JARs • Worries about performance targets

27. Classification in Restructured Services Temporal dimension to teams – shift away from generic, locality-based work CRM - e-Government • Is it a contact or a referral? • Is it a ’47’? • Is it an Initial or a Core? • Does it need longer term work?

28. Fieldnotes from the front line… 28.11.2007- telephone call to Felicity French to confirm that I will meet with her at 10am tomorrow. Felicity French a bit cagey - said that she needed to let me know what was going on in the Referral and Assessment Team. She said that they had all been called into a meeting that morning with the manager. The manager, Deborah Davies was very annoyed and giving them all a bit of a ‘dressing down’ about the state of affairs in the team. They have missed the performance indicator this week for the % of Initial Assessments being done within 7 days and missed it by a lot. There’s no way of recouping the situation, once the % has been recorded. Deborah Davies is very annoyed, she has been on sick leave herself for two weeks and has come back to find that workers have been slacking behind her back. Felicity French added, that the problem is that part of Deborah’s annoyance is directed at ‘inappropriate chatting’ ... ‘social chatting’ and people not getting on with the job and that this included ‘chatting with Jane Jackson the researcher’.

29. Preliminary Findings: Taking Referrals and Assessing Risk • Social work managers operate in morally precarious territory, where cases are packaged as ‘high risk’ by referrers but the service must be heavily rationed. • There are several improvisational devices which operate to translate enforced delay (“there is nobody to see this case”) into the institutionally legitimate rationality of strategic deferment (for example, “I will seek more information”)

30. Monday Morning in Erewhon

31. Example of ‘Risk Assessment’ used in Erewhon OfficeFigure 3: Example of ‘Risk Assessment’ used in Erewhon Office

32. Risk Scores and Organizational Practices • Cases can only be risk scored as 1, 2 , 3, 4, 6 or 9, • Only those receiving a score of 6 or 9 would routinely be accepted as referrals, with the latter triggering an immediate response. • 9 gets an immediate response

33. Decisions made quickly, often based upon limited information. • Likely to involve substantial amounts of lay reasoning and tacit knowledge and to involve the exercise of moral judgement about normality and deviance. • Leads to an ‘early categorisation’ e.g. ‘this is a non-familial assault’ or ‘this is a behaviour support issue’, and these are associated with plans about what we do in ‘these sorts of cases’. • Referral Team Manager explained she undertook the risk assessment score ‘in her head’, and then filled in the form to evidence her decision. • Suggests an ex post facto rationalisation for a decision taken on intuitive grounds

34. Remember! Affective judgements based on group norms are seldom questioned!

35. Decision-making about cases is contextually bounded by the availability of scarce resources. • This is in tension with the scientific rationalities posed by the Risk Assessment scoring process which intersects with other institutional categories • For example some types of cases were more likely to be offered a service than others. • Factors such as age appear to shape approaches to the assessment of ‘risk’ and ‘need’, with on the whole older children less likely to receive services than younger children and babies.

36. ‘Adolescents are difficult because they do not always get the service they deserve. ….if they are breathing, fed, clothed, got money in their pockets and a B and B, I will say, “that’s it, see you in another life”. …. Really these cases need more care…. The life skills they would have got from their parents. But I can’t do that. I’ve got a baby in a crack house. I’ve got to deal with that. But I know this is something we should be able to provide a service to. This is my next generation of parents’.

37. The moral dilemma facing the social worker is evident, as clearly both types of cases would benefit from a service. • Social work has its rhetorical ‘trump cards’ cf Argyris’ notion of ‘defensive routines’, which sustain established patterns and are usually so taken–for-granted they are difficult to spot. • The florid categorisation of a ‘baby in a crack house’ is potent and compelling, removing at a stroke any ambiguity about social work priorities • This kind of graphic descriptive phrasing is a common feature of case-talk in social services settings

38. Stories and Local Cultures: The Iron Fist… e.g. Three children, Mo has a recent partner who is violent - children have witnessed scenes of DV- 8 year old says 'I love my mummy and do not want to go into care' - social worker and team leader are pushing for the 'iron fist'- reason- mum failing to follow through with advice to prosecute partner and take an injunction. Rationale: 'iron fist' better than facing a serious case review/child death – ‘baby in the canal’ worker described the impact of 'taking a chance'- mother drunk dropped baby in canal – was not predicted and the grandmother was 'trusted' not to let anything serious happen - passer by rescued baby

39. Reasoning Institutional Context • Morally laden domain of child welfare - constructions of risk are ubiquitous, yet must in some way be prioritised and accounted for. • Very rapid judgements based on affect and cultural norms are ex post facto given a scientific and bureaucratic gloss through the various weighting and scoring systems. • Rationalities are embedded in software and disappear • Institutional life is not insulated from other times and spaces - including the individual lifeworlds of the families with (on) whom social workers work. • Case-talk - characterisations and moral attributions brought back by the social workers from the face to face encounter with the children and families intersects with the scientific bureaucratic rationality of management. • Performance framework is itself imbued with moral imperatives, through the language of ‘quality’.

40. Over to you…. What is to be done?

41. Social workers know how to inscribe everyday or mundane occasions as proper instances into institutional categories. Such inscriptive work quiets the tumultuous noise of drunken shouting between husband and wife. It cools out a child’s hot tears. It manages the welts from a beating. Simply put, it modulates the noise, multiple dimensions and uncertainties of an immediately experienced reality. It substitutes regulated tonal symmetries provided through professional categories and texts for the noise of daily life (de Montigny, 1995: 28)

42. If the booming noise of Victoria Climbie’s life had not been so efficiently quieted, she would almost certainly not have died. ‘BRING ON THE NOISE!’

43. ‘the human mind must make a great and laborious effort to understand itself, just as the eye sees all external objects, but needs a mirror to see itself’ (Vico, ScienzaNuovo, 1744, p. 120)