Need
 
What do users of mental health services need?  The response
depends on whom you ask.  It's very easy to start to answer
that question, to develop a polarized discussion while the
different speakers talk past each other.  
 
I want to look at the language of the question itself.
 
What do users of mental health services need in order to
what?  The goals are unstated, unexamined, unmeasurable and
unaccountable.  Where are the goals, and whose goals are
they? 
 
 
Policy makers use the language of higher power, authority,
and the passive voice to mandate needed services, needed
treatments.  The very language makes it sound as if the
result desired by the intervener is based in a natural
order, on natural law as compelling cause.  Using the
language of imperative distances the policy maker from
involvement with particular people and specific situations. 
Using a word like need as a basis for justifying action
hides that this is a personal judgment.  Need ignores that
there is an object, a value, a goal that is the
professional's goal (unstated) or society's goal (unstated),
but perhaps not the stated goal of the individual.
 
The need for service is not inevitable.  The requirement for
social action is optional.  Require has its roots in asking,
asking for, calling for as appropriate and suitable. 
Request has become demand, and the appropriate and suitable
has gotten lost.
 
The language of need is the language of paternalism.  It
makes room for beneficence and its cost is passivity and
dependency.  Instead, policy could use language that
develops agency and personal power that enables and
emancipates, language that minimizes medical and legal
paternalism.  Policy could look from the point of view of
the individual's own life plan and purpose to provide a
multiplicity of means for user productivity and user
community participation.
 
As Judi Chamberlin notes, "There is a vast difference
between the phrases 'I need ...' and 'you need.'" 
(Chamberlin, Judi.  (1994, Aug 20).  Re: Need.  NHCTEN
Discussion List [Online].  Available e-mail
nhcten@world.std.com.)
 
 
 
Copyright 1994 Sylvia Caras sylviac@netcom.com
 
 
 
 
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