Creating Constructive Cultures with Kids Version: 3.4 2/23/93 Michael S. Weiner, M.D. 1. INTRODUCTION: The Current Context of Futility and Fun At last year's meeting as a presenter began his paper, the man to my right said, "Oh, no, he's not going to read it!," to which his companion replied, "Yes, how I hate that." Well, I am going to read it -- because the subject matter requires cramming into one small space several unwieldy, non-linear springs of thought, padded with accounts of the most esoteric observations of my own clinical experience -- all tenuously tied together with a highly selected review of early pioneering work in group care for children. Whether or not I arouse your interest enough to re-read this paper, I hope you will use this presentation as an annotation to its bibliography and will look to the future by exploring further the relationships between these post-modern concepts of mind and culture and traditions of residential treatment. I first learned of the potentials of planfully creating constructive youth cultures while working with a neighborhood gang project in the late 1950's. (Weiner, 1973) Given current constraints on residential treatment, you may find a more rewarding future doing this kind of work on the streets. At first our difficult task seemed deceptively easy. I wanted only to relate some specific ways of managing groups of adolescents -- methods demonstrating magical efficiency in eliciting attitudes favorable for treatment and for ethical living together. The startling power of a facility's culture also impressed Bruno Bettelheim, the founder of AACRC who wrote: Both staff and patients of a total therapeutic milieu are exposed to its integrating influence from the moment they join it. I have seen some patients respond to it practically immediately.... (Bettelheim, 1974, 279) The readily described techniques had been easy for us to use and ought to be natural for others. However, as I confronted the requisite grounding circumstances for their application -- especially the attitudes and disposition of the adults, the required changes in ways of thinking -- I realized the improbability of more than a few today finding anything here they could really use. As Bettelheim (1974, 18) also said, "...most institutional settings render it not only difficult but impossible to do right by the patient." - 2 - Problems of the adults, not the kids, had been the greatest difficulty even before funding and length of stay limitations made long-term residential treatment almost impossible -- even before the crushing worry over liability (for everything) squelched approaching kids with the necessary creative sense of humor -- except for the foolhardy. Now we are in the same position as the TV comic Mark Russell who said, "Things are getting really serious, but I'm going to joke about it anyway. If I don't do my job, I could be sued for malpractice." Or, as E. T. Bazely writes of Homer Lane: He gambles with all the resources of his heart and head and life for the welfare of his boys and girls.... This is no safe way of life.... It is only possible for those who have attained complete and light-hearted disinterestedness, and who have identified themselves with the truth that has been revealed to them. (Bazely, 1928, 108) Of course, despite its outstanding results, Lane's Little Commonwealth closed after a 17 year old girl accused him of sexually molesting her, and Korczak, the great Polish pioneer of group care, had to sacrifice his life to continue caring for his children as they marched to the Holocaust (Lifton, 1988). Things might not be so much worse now after all, but I believe one cannot do good residential treatment without great courage -- perhaps cannot attain the necessary "light-hearted disinterestedness" without a vow of poverty. Even more important, for those who might identify themselves "with the truth that has been revealed to them," it really helps to be a little bit crazy -- or at least not entirely rational. Dr. Fritz Mayer, one of our organization's wisest founding members, led the Child Welfare League's extensive study of group care in America in 1975 just after his retirement from the directorship of Bellfaire and shortly before his death. I had an opportunity to ask him what he had learned about creating therapeutic milieu. After some time, he wrote me a cryptic letter emphasizing a finding that does not appear in the published report (Mayer, 1977). He wrote that the best group care seemed to occur in a "meta-rational context." That is, the driving motivations of the best care were not those usual in making money, practicing professions, or discharging social responsibilities toward children. Instead, the basis of the best care involved commitments to meta-rational spiritual, cultural, or neurotic ideals. Dr. Mayer explained no further. Subsequently at the 1977 annual meeting, Al Trieschman, - 3 - others, and I tried, unsuccessfully we later agreed, to explore this essence of therapeutic milieu, and I have been brooding about it ever since. The approaches which worked well for us have been reinvented and described previousy many times in detail and with enthusiasm. I urge you to read about Homer Lane and the Little Commonwealth (Bazeley, 1928), A. S. Neill and Summerhill (Neill, 1960), Korczak and the Warsaw Jewish Children's Home (Lifton, 1988), as well as Bettelheim and the Orthogenic School (Bettelheim, 1974). I will refer to these men and others like them as "The Great Pioneers" of group care culture -- purposefully highlighting similarities between them while ignoring the differences less relevant to our task. Some of you may even be Great Pioneers yourselves -- but may be too embarrassed to talk openly here, as I was early on, about what you really do. Because the four Great Pioneers created their impressive milieus, each apparently de novo, in widely different times and places, the awesome similarities of philosophy, personal style, staffing structure and especially of the Director's temperament and role provide an education in the essentials of residential treatment.[1] Let's take the lesson of history first. Despite the recognized quality of these programs, their inspiration of many workers, and the recurring attempts to recreate them, their method has never become solidly established as standard care. Even in somewhat recent times when enough money existed to engender the proliferation of residential centers, the principles of Lane, Neill, Korczak and Bettelheim were more widely read and respected than practiced. When practiced, such programs always have the quality of being new, unique, and unconventional -- requiring constant rejustification and unusually indulgent licensing workers in the face of hostile regulatory standards. Even once well-established, such programs typically grow away from their meta-rational, pioneering principles toward more normative forms. At any rate, just as you would assume the Orthogenic School continued to evolve after Bettelheim left and will do so after Jackie's departure, please do not burden the currently sane management of Meridell Achievement Center with the outrageous descriptions here of my own work there which ended two years ago. In blacker moments, I thought to focus this presentation around the question: Why is it so difficult to do good residential treatment? However, since I anticipated others at this meeting would adequately cover - 4 - that sad subject, I wish to focus on just one basic obstacle, not forced upon us from the outside, but promoted and cherished within. We are just too rational. Although we now see great shifts of interest from centrally planned to market economies and from centrally administered public education to models offering variety and choice, top-down, rule-based, policy and procedure models unfortunately prevail among designers and administrators of residential treatment programs. These models, built from careful definitions, clear distinctions and precise rules, use strategies which have led to some spectacular human accomplishments in logical science and in the creation of special social organizations. However, we are just beginning to appreciate that most of the action in our minds, cultures, and commercial enterprises is better described by other models with names such as "connectionist", "parallel distributed process" (Clark, 1991; Dennent 1991), "interpretive" (Geertz, 1973), and "chaotic" (Peters, 1987). These newer models more adequately characterize the systems of creative pandemonium fostering survival by their abilities to make rapid, best approximate, common sense choices in the face of inadequate, erroneous, or unanticipated data -- circumstances in which top-down, rule-based systems notoriously fail. Because psychoanalysis has revealed its limitations as a science of the mind, I turn instead for our theoretical foundation to some attempts by modern philosophers to exploit recent advances in the neurophysiology of the brain and computerized artificial intelligence.* __________ * As our subsequent discussion will suggest, these new models may rationalize better than psychoanalytic theory itself the importance of some of its fundamental clinical approaches -- especially the following of associations (connected contexts), the analysis of resistances (background assumptions), and the centrality of "conflict" (between competing excitation and inhibition) in all mental processes as well as such less basic ideas as Ives Hendicks' "instinctual anxiety" (anxiety engendered by the push of an instinct itself, which could be either learned or hard-wired). - 5 - NOTES 1. Actually, Lane drew on models originating in the United States. Korczak likely knew of Lane; Neill certainly did. Bettelheim may have known of Korczak even before coming to this country. 2. BASIC THEORY: Microcognition and Consciousness In his book Microcognition, the M.I.T. philosopher Andy Clark (1991) contrasts what he calls Von Neuman style manipulation (what I call the top-down, policy and procedure, rule-based model; see Figure 1) with models interchangeably called "parallel distributed process" or "connectionist." We tend to think our minds work in the top-down, bureaucratic, Von Neuman style, but mostly they don't. Most ordinary computers do function in this rigid, rule-following way and can be programmed to reproduce some of the highest level, supposedly uniquely human activities, such as playing chess, performing logical scientific and mathematical operations, and doing the work of highly specialized experts. Given a patient's signs and symptoms and the right expert system program, a desktop computer of rather modest capacities can out- perform most psychiatrists at psychiatric diagnosis. However, even vastly more powerful machines of the Von Neuman style have proven incapable of the common sense discrimination possessed by a four year old child -- or even a healthy dog. Because of their brittle collapse in the face of incomplete or inconsistent data, rule-based Von Neuman mechanisms are unlikely to have been helpful to us or other animals during the long course of evolution. Putting forward a more appropriate model of cognitive organization, Clark says: Parallel distributed processing (or connectionism) is an attempt to provide slightly more biologically realistic models of the mind. Such models, though hardly accurate biologically, are at least inspired by the structure of the brain. Moreover, they are tailored...to evolutionarily basic problem-solving needs, like perceptual pattern completion. (Clark, 1991, 83) Clark further suggests that the highly logical, rule- following Von Neuman process is only a relatively recent, specialized, and limited elaboration of the older, more - 6 - evolutionarily basic connectionist, pattern-recognizing capacities (see Figure 2).[2] Very grossly, the conscious (secondary process) of psychoanalysis is a Von Neumanesque virtual machine (i. e. a program that mimics a type of computer) running on the mind's underlying unconscious (primary process) connectionist, massively parallel cognitive architecture. At any rate, most mammals and the kids we treat are much better at recognizing, completing, and reproducing patterns than following rules. Unless you delight in careful philosophical reasoning, the book Microcognition, (though well, even wittily, written) may be hard going. However, Clark's Chapter 5 offers a more satisfying description of parallel distributed process than I provide here. I do hope you can imagine at least vaguely how information could be represented in networks of connected cells or simple processors (see Figure 3). By firing more or less frequently, groups of such cells or processors selectively stimulate or inhibit other connected cells to fire more or less frequently. Working in this manner, sets of processors respond to certain patterns by creating contexts predisposing other sets of processors to respond to other specific patterns. Crucially, while many of the connections are predetermined, such a system can learn to recognize new unanticipated patterns when trends toward correct identification result in relative strengthing of the appropriate connections. If this brief description of parallel distributed process fails to enlighten you, as well it might, read Clark's Chapter 5 (Clark, 1991, 83- 105). For now, you need to keep in mind only four great strengths of these connectionist mechanisms: o+ Sensible action when given partial or inconsistent data, o+ A capacity to deal with unanticipated situations (i.e. to generalize along unexpected dimensions), o+ Rule-describable behavior without explicit, fixed rules, o+ The capacity to shade meanings according to context.... (Clark, 184) Using a similar approach in his wonderful book Consciousness Explained, Daniel Dennent investigates how the microcognitive components of the brain might function together. Dennent attacks the central assumption of most traditional attempts to explain brain function. He calls it the fallacy of the Cartesian theater (see Figure 4). According to Dennent, the problem revolves around the idea - 7 - that information generated by brain substructures is referred to higher and higher centers until some ultimate higher center interprets the data -- always begging the question of just how interpretation occurs. According to Dennent, these models all end up invoking something like a little man, similar to the homunculus that used to reside in sperm cells, sitting in the highest center and watching a projection screen -- thus the "Cartesian theater". Of course the little man interprets the projected information with his brain which, you guessed it, contains a little homunculus in its highest center. This fallacy also infects models of residential treatment center organization (see Figure 5). Instead, Dennent proposes a model elaborating the same mechanisms of pattern recognition found in Clark's Microcognition. In Dennent's "Multiple Drafts Model", various substructures of the brain (each with its own limited version of reality) specialize in recognizing particular patterns, make definitive decisions about them, and make this information available to other interested (connected) structures as context for their own tasks. Figures 6-11 illustrate this multiple drafts process as three blind men pool their progressively changing impressions as they explore first an elephant and then a tree.)[3] Similarly, for processes of mind effecting action, Dennent attacks the usual notion of top-down planning which he calls the model of "Bureaucracy" (see Figure 12). In this erroneous model of the mind, higher centers determine appropriate action and call upon specialized lower level centers to effect it. Dennent proposes instead the model of "Pandemonium" -- a process of wild competition by sub-processes to put forward components of which the most useful are selected by pattern matching processes and shaped (settling into the best fit) into eventual behavior (see Figure 13).[4] Of course individual units and substructures can participate as components of several other substructures -- just as your participation as a member of AACRC, your family, church, neighborhood, and nation involve interpenetrating functions in maintaining our society. To better appreciate Dennent's model, let us consider an illustration of similar parallel distributed process drawn from a group meeting of all fifty or so residents of a treatment center for adolescents who reside in separate groups of about nine boys each (see Figure 14): As long as anyone could remember, it had been a custom in our treatment center to keep a complicated picture puzzle on an unused table at the back of the - 8 - dining room where idle hands could enjoy fitting in some pieces until the picture was complete -- a process sometimes taking several weeks. Actually, Janet Lippold, who with her husband Wayne founded Meridell Achievement Center and taught me much about making culture, had started this custom after reading one of Bettelheim's books. During those early days, she had no one to donate the very expensive chandeliers and murals Bettelheim used to convey to the children at Orthogenic School that the outside world respected their ability to respect their environment. Besides, such decorations would have been out of place in our culturally different rustic Texas setting and would have led the residents to feel more weird than respected. Instead of saying, "We can't because...," Janet creatively decided she could project the same message -- and promote more self- esteem for her buck -- with a big picture puzzle. At any rate, over the years kids looking for something to do often worked unsupervised on the puzzles, but seldom disturbed them. Many months prior to the community meeting described here, a previous such meeting had assigned a nine member living group (who had chosen to call themselves the Achievers) responsibility to buy the next puzzle from their group's activity funds as restitution for some event involving their disrespecting common property.[5] The Achievers had indeed supplied an attractive puzzle which people had enjoyed assembling for several weeks. However, the Achievers had recently noticed part of the puzzle disassembled and, even worse, some pieces might be missing. This problem was brought up first in the Achievers' own living group meeting which recurs each Monday, Wednesday and Friday. They deemed it of sufficient general community interest to raise in the larger community meeting which convenes each Tuesday and Thursday.[6] In the current meeting, after some unsuccessful requests for the offending parties to help out by taking responsibility for the puzzle problem, the tone of discussion becomes apathetic. However, after a few other problems with unattended property come to light, worried comments are made by the kids and adults: "If we can't leave a puzzle around, what will be safe?" "It could be your watch next." In fact, kids often left their watches, walkmans, and gameboys unattended in the dining room. This was not considered irresponsible "because someone will surely steal it," - 9 - but instead represented a sign of the community's health. Always looking for a chance to make some tacky comment at the expense of staff, I said, "We had better get this handled before the adults get it into their heads to lock everything up and then we will have a police state around here."[7] The Achievers, remembering they had had to take responsibility for their own previous disrespect of property, are indignant. It is now their puzzle that has been violated, and they add to the sense of crisis about the threat to our quality of life. They suggest, and many others second, that the community schedule a special additional meeting on Thursday afternoon to further investigate the puzzle problem. Standing in the middle of the circle, the Clinical Director who leads the meeting reads a consensus and is about to proclaim the decision when some younger children sitting on the floor in front of him signal by pointing to some others who are sitting quietly behind the leader with raised hands. When he turns to call on them, these turn out to be members of the baseball team who say they have a game on Thursday afternoon. Consequently, the meeting considers another day instead. A visitor might wonder why the baseball boys had not shouted out; and why the meeting appears so quiet despite the leader's doing little to enforce order except possibly saying something like, "Monitors, please go to work." At the meeting's very end, signaling its close, the leader calls, "Monitors, hands up!" Six boys scattered around the room raise their hands, and each when acknowledged in turn lists some names or says, "No one." The names are repeated and entered by the scribe into the minutes of the meeting, which immediately adjourns into pandemonium involving energetic further processing of various business as well as spirited playing around. Only later does the visitor learn the monitors list boys who they have seen disturbing the meeting and that these boys must do extra work on the weekend. Any rare complaints about a monitor's fairness would go to the meeting of the living group who appointed him. We can see in this description the wide distribution of functions into parallel, overlapping, connected processes. (Note the similarity of the processes illustrated by Figures 13 and 14.) Baseball team members best know their schedule and make this available to others as needed. Even administrative tasks, ordinarily ascribed - 10 - to the leader, of ensuring decorum and directing attention depend on elected monitors (whom everyone then monitors through other meetings) and on the alert younger boys who, functioning as his auxiliary eyes, lead the leader where he must next focus the group's attention.* Because of their experience regularly working together, this group of fifty emotionally disturbed children and their staff could process more business in a shorter time and certainly with more humor than either the Executive Committee of AACRC or the Professional and Technical Advisory Committee of the Joint Commission on Accreditation of Healthcare Organizations. Success of the community group process depends, as does microcognition, on bringing a multitude of processors together and selectively strengthening (through mirroring (Kohut, 1971)) connections recognizing relevant patterns and effecting action consistent with the group's goals and values. The Great Pioneers relied heavily on similar community meetings to create the quality of their milieus.[8] Except for Bettelheim, they gave the community meeting more importance than any separate meeting of staff.[9] The meeting proceeds from the assumption that while all are interested in the program's strength, kids living in the milieu have the greatest interest in preserving its quality of life. Furthermore, while adults can keep the program running when they have to, only the kids can make sure it runs really well. This idea according to Bettelheim was the theme of Korczak's life work.** __________ * The monitor process also depended on staff follow through aided for many years by an elaborate system of computer information processing to track the extra weekend work assignments. Mark Bradley, who became Clinical Director shortly before my leaving, tells me that in more recent times the computer became unavailable for such program applications. However, assigning one of the kids to keep track of the "monitors list" actually worked better -- not only for the processing of the information, but in terms of staff follow through. In this small detail, the confused reader can find the point (more grandly stated in the next footnote) of this paper. ** "Janusz Korczak's lifework shows that, without the help of children, adults will not be able to create a better world for all of us. His messages is that - 11 - Histories of human societies and current events around the world clearly display a reality that holds even for our own nation. Every group, be it living group, therapeutic community, or great civilization, must handle its own business or someone will come in from the outside and handle it for them -- usually with a heavy hand and lack of consideration for the former privileges of its members. When a living group cannot manage to run its own meetings via its elected president, the adults will take over. If the group continues to dysfunction, the Clinical or Psychiatric Director may take over and institute a group restriction -- raising levels of supervision and limiting privileges until the group can better handle its own business. __________________________________________________________ it is high time we free ourselves of the conceit that adults alone can create a better world, because in order to reform society [or a residential treatment center --M.S.W] we need the help which the honesty, directness, and spontaneity of children can bring to the task." (Bettelheim, "Introduction" to Korczak, 1986) - 12 - NOTES 2. These ideas are greatly expanded by Dennent (1991, Chap. 7). 3. Dennent's argument in support of the "Multiple Drafts Model" begins with several interesting neuro- perceptual experiments which lead to the amazing conclusion that what you think you perceived (which, depending on your epistimological persuasion, may be exactly the same thing as your perception) is determined by subsequent context. Following Dennent's similar example, suppose I send out a draft copy of this paper to Jones and Smith, but not to Schultz as there are some offensive references to Schultz which I plan to change. In a later revision, I modify the offensive references so they are more complimentary to Schultz and send him a copy. In the meantime I get some feedback from a third party that Schultz said he "wasn't very thrilled with the paper." On this basis I decide Shultz is not sophisticated enough to appreciate my work -- nor very capable in his own. I make a new revision with even more offensive references to him and start spreading some nasty half-true rumors about him. Then I learn from Jones that he had shared his copy with Schultz and I wonder whether Shultz really doesn't like the whole paper or just the offensive reference he may have read in Jones early version. Subsequently Smith confirms the latter alternative when he tells me that Schultz got the copy I had sent and really likes the paper. In this process over time, Schultz has changed his opinion about the paper; I have changed my opinion about Schultz (twice); and Jones and Smith have opposite ideas of what Schultz thinks about my paper. Clark (on the micro level) and Dennent give good descriptions of how the cognitive system settles over time into a best fit representation of the available exogenous and endogenous information. Clark (p. 92) stresses these "emergent schemata" are not "things" prepared in advance but emerge fresh, as needed from the interaction of large numbers of simpler processors working together. Social workers, using the term in the best sense, refer to similar "process" in social systems. Managers in residential treatment centers are familiar with the kinds of confusion of drafts which can lead to the nasty rumors I wish I hadn't started about Shultz. They also know that processing - 13 - systems function better when the processors are more immediately and directly connected (eg. face to face meetings of all interested parties) and worse when there are delays, blockages (secrets), and partial blockages (distortions originating in power struggles) in transmission. 4. In this process inhibition plays as much a role in action as stimulation. At any rate, conflict is at the core of the mental process. The success of Dennent's explanation of consciousness does not strictly require a description of the mechanisms for making the selection and controlling the wild process. However, his failure to supply this weakens his argument and will certainly bother the bureaucratic reader -- especially when I extend his model of "Pandemonium" to residential treatment. Careful study of the Great Pioneers' methods of controlling their little societies suggests a model of process regulating not by rules, but by opportunistically recognizing the most fortuitous patterns and reinforcing their connections. Better understanding of that process (curiously similar to the evolutionary process of selection operating upon the energetic proliferation of different genes) in the external world of social structure may then suggest a more precise description of the process by which psychic structures arise from the "internalizations" of object relations theory. (Dennent deals with some angles of this when he discusses his "memes".) For those who can't resist the Cartesian fallacy and feel that some center in the brain (or someone in a treatment center) must be in control according to some big picture, the essential point is that, while some mental centers play an important role in "controlling" through selecting from patterns of input presented to them, there is no need to assume that these patterns in any way comprise "the big picture." In fact, the "controller" (gate-keeping selector) has less real data about what is really going on than the rest of the system, it/he/she just needs to know how to weight the final result produced by each specialized input from its/his/her particular special sector of information. That is the way Dennent describes the mind's working, and that is the way I would describe the way I directed a treatment center. [Just before the release of this paper, Edelman (1992) became available. More biologically than philosophically oriented, this amazing book struggles - 14 - with the same basic issues as Dennent's. Despite their differences, Dennent and Edelman agree on the points essential to this paper. Most gratifying given my attempt in preceeding lines to grope around the problem of what controls the pandemonium via an understanding of how it works in residential treatment, Edelman clearly states the principles of "No supervisor," "Selection, not instruction," and "selection by value" as he draws a clear parallel between Darwinian evolution and the development of the mental apparatus. Except for hard-bitten philosophers, I would now recommend Edelman's book before Dennent's for further exploring the parallel distributed model.] 5. The living groups earn their activity money (which they must decide to spend as a group) based on the quality of their group cleanup of their cabin and its area. Thus there is a interpenetration of the issues of "we feel better about ourselves when we take good care of where we live," daily routines, activity planning, activity funds, and group process. 6. Both types of meeting had a long tradition and at least until 1991 still ran along the same lines as the videotaped examples I showed at the annual meetings in 1978 and 1982. 7. Bettelheim has described how crazy the adults can get about locks from motives that have little to do with the children. 8. See the work of Maxwell Jones and his collaborators for another whole line of development of such community meetings in shaping therapeutic communities. (Jones, 1953) 9. Bettelheim used staff gatherings extensively to acculturate staff and compel them to respect the humanity and capacity for healthy growth in his group of very ill children. Although Bettelheim disparages patient community meetings as "parlimentary palavering" (1974, 303) saying that the staff, not the very ill patients, should form the community, he does describe (1975, 283-5) meetings of all patients and staff which sometimes the patients ran. - 15 - 3. MORE THEORY: Culture as Context for Cognition Before further considering particular values and assumptions underlying specific group care cultures, we need to understand better the general difficulty of creating cultures. An essential obstacle rests in the paradox central to the very idea of "creating culture" (see Figure 15). Comparative study of residential treatment programs, like the study of differing cultures in general, helps overcome our limited imagination of what is possible. As we realize the enormous differences in what similar settings, treating similar kids, accept as normative and learn to discount the justifications for these differences ("Our kids are like this!" "Our kids are like that!"), we come to see the essential arbitrariness of what each place takes as given. Actually, the children, who seem so different from facility to facility because of program culture, often share the same presenting characteristics. This awareness of shared fantasy as the basis of so much "reality" empowers us to choose fantasies creating more favorable realities for our mission. To be successful in creating residential treatment cultures, you must have the feeling you can make it up as you go along! Ignore the question, "Is such and such notion about the way things are 'true'?" Ask instead, "Does the idea promote the cultural milieu we want to foster growth and treatment?" As important, can the staff sufficiently agree on whatever it is to make it real? For we must also confront the other side of the paradox: However arbitrary cultures appear when compared, the power of a culture by itself depends on a fundamental quality of inevitable "given- ness" -- the quality of "of course-ness." Indeed, we do not establish and strengthen a piece of culture by describing, arguing, or persuading -- all of which weaken it, calling it into question. As every psychoanalyst and schoolboy knows, the pattern of repeating something more than twice signals the opposite is more likely true (or at least that the assertion is not the whole truth). Instead, we best convey a piece of culture as given, implied context -- by acting as though we (and everyone else) assume it to be true -- more precisely, by trading in symbols (behaviors as symbols) most efficiently interpreted within the context being reinforced. In conveying culture, deep conviction is the name of the game. As a simple example, when setting important limits on adolescent behavior, don't say "No"; say "Hell No!" When calling a group's clearly out of bounds behavior into question, better than beginning, "I don't think you should do such and such," you should say, "I can't believe it; I - 16 - just can't believe you did that."[10] These necessities may explain the style of obnoxious and endearing dogmatism so common to leaders of programs for adolescents. In creating positive cultures, before the challenge of communicating comes the challenge of our own conversion.* __________ * These same considerations of conviction and assumed context apparently apply to other species as well -- at least to canines who co-evolved along with children in the web of human pack culture. Koehler's (1962) classic manual on dog training describes techniques the trainer should use on himself in the dog's first lesson to develop enough conviction about the assumed context to convince the dog: Regardless of your dog's attitude, your action will be the same:... Start walking....Resolve to head for a tree, a stone, or anything that marks a definite spot...and keep going until you arrive. It is important for both you and the dog to feel you have a purpose in your movement. Aimless floating can destroy confidence. Quit that -- don't look back to see whether the dog is aware of your going...or whether he is sniffing or looking in another direction. Don't cluck, chortle, or ask him if you can leave -- just leave. Most important, give no silly little invitational tugs that are no more than requests for the dog's permission to move; and refrain from argumentative arm jerks that will change your reasonable decision to walk into an emotional-charged bone of contention as to whether you have a right to move without the dog's approval. The [leash] locked in your hands, ignoring the dog, just walk. (p. 31) Yakking, backward glances and coaxing gestures would merely postpone the lesson that your dog must ultimately learn -- that he must sometimes do things that he doesn't want to do. [italics sic] So if you love your dog, let him learn this inescapable fact early and in the simplest way. Whether it goes against your teddy bear instincts or not, it's the truth. (pp. 44-47) For the open-minded, the first five chapters of Koehler's book (pp. 1-69) make great child care worker training. and would be even better for teaching sophisticated clinicians what really good child care - 17 - Again, the key question is: Can the staff agree enough to make it real? The key adults need to develop a culture among themselves based on a conviction that they can make almost any bad plan work well if they join together in supporting it, but they can bring a good plan to disaster by focusing on subtle doubts and disagreements. (See Figures 16-18 for an analagous illustration.) I cannot stress enough that your effectiveness creating positive cultures will be limited less by the children's characteristics than the adults' difficulties developing the necessary shared convictions. For this purpose also, rules, policies and procedures about staff's behavior work poorly; you must control their attitudes, assumptions and convictions about reality. Here lie the advantages of a small, tightly knit staff and of shared meta-rational belief. If you really want to create a positive culture and can't convert the staff -- especially if they carry on a culture of disagreeing about what is important and valuing fine debate about what to do -- you will have to massively reorganize as Bettelheim did until you have "an almost entirely new staff deeply committed to the new philosophy" (Bettelheim, 1974, 216-7), or get rid of a whole profession as Korczak did when they began to change his culture in ways he didn't like (vide infra). However, before discussing similarities of the Great Pioneers' approach to staffing, we need to share a clearer understanding of the essential nature of culture. __________________________________________________________ workers know in their bones, but can't always explain.[11] Compare Bettelheim's almost exactly similar view that conviction is more important than accuracy in shaping realities for fostering self-esteem (and safe behavior): Instead, the therapeutic task is to hold the patient in such high esteem that the expectation is that he will always act like a decent human being. The knowledge that lapses may occur mustn't change this conviction, but has to come from one's inner attitude and not from the realization that it will reduce attacks [italics mine]. Few dogs and no mental patients are fooled by nonchalance when one is really afraid of what they may do. (Bettelheim, 1974, 56) - 18 - In a typically accepted definition (Gordon, 1973 in Whittaker, 1989, 148), "Culture consists of prescribed ways of behaving or norms of conduct, beliefs, values, and skills." Clifford Geertz, author of the important book, The Interpretation of Culture, argues against such a definition and provides another more in line with the post-modern style of analysis and vastly more useful for our culture creating goals. In the first chapter entitled "Thick Description," Geertz states his thesis: "...culture is not a power, something to which social events, behaviors, institutions, or processes can be causally attributed; it is a context, something within which which they can be intelligibly -- that is thickly -- described. (Geertz, 1973, 14) Geertz's emphasis on culture as a context for interpretation of behavior and on behavior as mainly symbolic -- intelligible only within a context -- fits well with Clark's and Dennent's notions of cognition based on internal structures designed to learn and represent contexts for the purpose of pattern recognition. (Figure 3 could be used to illustrate both Geertz's concept of the process of culture and the parallel distributed processes discussed by Clark and Dennent.) Further, Geertz's culture, like Clark's cognition, shows "rule-describable behavior without explicit, fixed rules."[12] His book is long and difficult, but Parts I and II (Geertz, 1973, 1- 83) will help bring together Clark's and Dennent's connectionist model of mind with issues of culture. To better understand Geertz's emphasis on the primarily symbolic nature of behavior and on culture as context for the interpretation of behavior, let me condense into my own words the example, well-known to anthropologists, of "thick description" he takes from the philosopher Ryle. (Geertz, 1973, 6) Consider, he says, a twitch of the right eyelid. It could be a simple, involuntary muscular twitch or a wink, the kind of wink with which a child might signal a conspiracy of the kind, "I don't mean what I say, I mean something else." Now another child could maliciously, with forced clumsiness, parody the wink to make fun of the original winker. Further wanting to perfect his ridicule, the child could rehearse the parody in front of a mirror. In each case the behavior as recorded by a camera would be the same muscular contraction, but the differences in meaning between a simple tic, conspiratorial wink, ridicule of the conspirator, and rehearsal of the ridicule would be vast. The differences in meaning are determined - 19 - not by the behavior, which is the same contraction of the eyelid, but by its context -- the patterns within which the behavior is imbedded. Complexities are possible almost without end. If the original wink had been a fake wink to mislead outsiders that there was a conspiracy when there wasn't, then the description of what the parodist was parodying and the rehearser rehearsing would shift accordingly. Thus, the same behavior, a contraction of the eyelid, could be a simple muscular twitch or a rehearsal of a parody of a fake wink. Because our minds evolved mainly around pattern recognition rather than the more recent, slower running, logical processes (as shown in Figure 2), a deprived 10 year old in the inner city can more quickly perform such complex transformations intuitively than we can logically think about them here. Let's examine some "thick" description of a piece of residential treatment culture from an example closer to home which demonstrates the symbolic nature of behavior and some uses of ritual. During the banquet at AACRC's 1989 meeting in Phoenix, I sat at the head table as a past officer while Steve Clark, then Clinical Director at Meridell Achievment Center, sat several tables away into the hall. During dessert, exercising my conventioneer's license, I caught his eye, and quickly and unobtrusively shot him the finger (as in Figure 19). I think Ed Millard was the only one to see me, but, having no context within which accurately to interpret my behavior, he thought I was just waving at someone. This was the first time Steve had actually seen me do this. Of course the big joke was that I often "flew the bird," as they put it, with the kids back at our treatment center, especially during the important twice weekly community meetings led by Steve. The kids would usually try to return the favor -- an ordinarily obscene, hostile gesture, transformed by its context into a ritual of affectionate greeting. During after dinner conversation in Phoenix, my exhibitionism did get me in trouble when I targeted Jackie Sanders to shock with an account of this practice. I was right about her assumed cultural contexts; she could not suppress a horrified gasp. Then, recovering herself she said, "Oh, Mike, it's been so long since you presented at a meeting, why don't you give a paper next year," -- the seeds of her soon forthcoming discussion having been planted then in her desire to expose such shinanigans. But the whole thing was much worse than even she could have - 20 - imagined. You see, if Steve Clark caught a kid giving me the finger, he would give him a work restriction. Further, the kid knew that complaining about my giving him the finger first would be met by Steve's definitely knowing denial, "I know Doc wouldn't do that; I've never seen him." Therefore, not getting caught was the main part of the fun. I was especially careful to avoid getting caught by Steve in order not to ruin the credibility of his disbelief that I would do such a thing -- he had never seen it. Of course, at one time or another, everyone except Steve had seen it -- so the ritual parodies know-it-all adult authority taking the position that "the staff are always right." The joke shows our awareness that the kids are often the ones who are "really in the know." The joyful collusion with the children works to undermine the stability of the "kids against the staff" conflict that too often in treatment centers solidifies into an accepted context of relationships. Stories of the Great Pioneers sparkle with similar playful collusion with kids. Korczak even led an escapade to runaway and picnic on potatoes stolen from the pantry at three o'clock on morning. He establishes a similar tone of playful collusion in the preface to his novel King Matt (1986) quoted on this paper's cover sheet -- collusion which somehow avoids the destructiveness that occurs when doctors without humor really do countermand the limits of staff working directly with kids. For the finger joke to succeed, however, the kids must also know that at another level, Steve and I are in collusion together against them. The collusion, though denied, is more openly honest -- after all the kids are all there to see it for themselves -- than the widely admitted therapeutic conspiracy of behind the back planning practiced in staffings which exclude children. Since Steve and I can only play this game with our signals very straight, my deception of him is really the parody of a deception signaling our deep trust and basic agreement. Simultaneously, we advertise our readiness to differ constructively in the complex interests of the children. Thus, the finger flying ritual shatters old culture and creates new assumptions by demonstrating behavior unintelligible in the contexts of stereotyped roles of kids versus adults. The behavior is more intelligible instead within the new context I sought to create of attachment, playfulness, and a complex dance of relationships. The finger game also highlighted my most important task in the community meetings -- one taken by the Great Pioneers -- of using the Director's ultimate - 21 - authority to defend the rights of all against the narrow interests of delinquents and staff. I employed the finger ritual most usefully, however, to dispel by ridicule (by displaying behavior intelligible only within the new cultural context I sought to create) unacculturated adults' silly worries that they must maintain the most leaden, explicit consistency to communicate with children without confusing them. How can one hope to raise children's self-esteem while always talking down to them -- while tip-toeing around them as though they were helplessly fragile? Instead, the finger game reinforced self-esteem by communicating a context of assumptions showing respect for the children's abilities to handle such complexities -- as the rest of the story shows: In the first community meeting after Steve and I returned from Phoenix, the kids asked about our trip. Of course I couldn't wait to tell them about my giving Steve the finger just like I did them -- but to openly admit this in front of Steve in their presence would ruin the game. So I said instead, "You guys will never guess what happened at the banquet. I was sitting at the head table minding my own business, and then from across the room, I couldn't believe it, Steve Clark gave me the finger." "Oh no, Dr. Weiner!" many voices exclaimed, drowning me out with delighted accusation. "Steve wouldn't do that; we know you were the one who did it to him." How little confused the sweet little dears were, how readily they reversed the pattern I presented and performed all the other tortuous transformations. Note especially the complex implicit messages, economically communicated and powerfully reinforced in the background -- in opposition to the explicit nonsense in the foreground.[13] Geertz's idea of culture as a context making possible the interpretation of behavior fits well with Clark's and Dennent's connectionist model of mind as a fluid process of creating from internal connections, contexts enabling recognition of various patterns. All of this bears down hard on our aspirations to create culture. In its essential nature, culture (context) resides in the background -- deriving its power from implicit, unquestioned assumptions -- on a myriad of unconscious, mental, parallel, distributed, processes ready to complete - 22 - patterns. Items in the foreground, which can be explicitly described, asserted, questioned, debated and changed -- derive their meaning from the more powerful, unexamined, apparently unchanging, context of the background. I am reminded of the Buddhist teaching that the illusion of suffering arises from our seeing things in the foreground as always changing (impermanent, suffering) against a background of unchanging, perfect harmony. Thus the trick of conveying culture, of installing the software of contextual patterns in another brain, depends on the same slight of hand as a magic show. The magician focuses all attention on some action in the foreground to distract from the really significant goings on in the background.[14] Because of the rich possibilities for communicating patterned context in the background while holding attention in the foreground, nothing -- except language itself -- rivals story-telling as the method of choice for communicating culture. Stories gain even more power when linked to rituals. Suppose I tell you, just as an example of an incidental part of some story, that "At Meridell, the kids have derived much pleasure, treatment progress, and improved self-esteem from playing football against the junior varsity teams of small rural high schools in the Central Texas area." Your parallel distributed processing, pattern completing neurons efficiently assume from these thirty words a great deal of information about the ages, sex, probable psychiatric diagnoses and lengths of stay of the clinical population (who you would be prepared to guess aren't usually called patients). You probably also can make some good guesses about the underlying treatment philosophy and cultural background of many of the staff.[15] Because this presentation, consisting largely of stories and accounts of rituals, designs to hold your attention in the foreground while communicating a host of controversial messages in the background, the program committee has assigned no less than four discussants to protect you from its implicit assumptions. The metaphor of magical trickery may mislead you to think that children's learning from background makes them easy to fool. I believe on the contrary that evolution has designed this mechanism to protect species from being taken off track by the occasional and incidental in the foreground -- focusing their learning instead on the more reliable patterns repeated in the background. Thus, children appropriately suspect what we say especially when we say it more than once, or clearly for their attention. Children learn instead much more from what we do when we think they are not paying attention. We influence them - 23 - much more by what we really are than by what we pretend. Here again we confront the need for meta-rational commitment. To convey a culture, you must believe it and live it. In fact, most of the time the would be magician fools himself. He thinks he's communicating an intended foreground message while unwittingly putting across something quite different and unintended in the background. Consider, for example, the rhetorical problem: "Why did the children put beans in their ears when the one thing we told the children not to do was put beans in their ears?" Clearly, the children ignored the foreground exhortation not to put beans in their ears, motivated instead by the background suggestion that other children had found this activity interesting enough to risk the dangers. - 24 - NOTES 10. Stephanie, a former Meridell Case Supervisor has pointed out to me that these statements themselves raise self-esteem by communicating our belief that the child is not defective and our expectation that the child has the capacity to live up to high standards -- and to withstand our bluntness. 11. Koehler understands a lot about culture. He starts his book with a long story and says (1962, 24) to start training with a long (at least 15 foot) leash which "will enable you, if you are slow, speedily to debunk some old fallacies and to learn one of the most important fundamentals of dog training." The point is not to drag the dog around on a short leash (lots of structure), but to give it the opportunity to make choices and learn from its mistakes by means of the consequent jolt. (He says (p. 51), "You can only agree that the cruelest correction is the ineffective correction, because it does nothing but encourage the dog's further resistance.") Thus the dog is not forced to hold the heeling position, but develops character by learning to do it on its own. 12. Geertz argues at length (1973, Chap. 3) that mind and culture co-evolved; that the development of each conditioned the other. Further, though Dennent denies such co-evolution, he details (1991, Chapter 7) the processes, (especially what he calls "autostimulation") by which it could have occurred. Dennent's processes also shed some light on the construction of internal psychic structures from external object relationships. 13. There are many other ways to collude with the kids and demonstrate their capacity to deal with contextual subleties. The Medical Director who succeeded me, Dr. Michele Toth, possibly finding "the finger" inappropriate and skilled enough to avoid just copying her predecessor's trademarks, quickly instigated (in a process likely abetted by some staff anxious to acculturate her) on-going squirt gun fights with the kids that lasted most of the summer. As an example of the difficulties keeping one's head on straight about the important lessons of this paper -- especially once one becomes distant from the kids -- after witnessing kids and staff carry on with - 25 - their squirt guns all through the big Fourth of July visitors' barbeque celebration, I asked the then Clinical Director, Mark Bradley, what complex set of rules made this spirited yet controlled play possible. Looking at me with grave disappointment as though I had forgotten everything I had taught him, he said (as any member of the culture could have), "Rules! There's only one rule: You can play at squirting people, but you have to do it respectfully." The kids can figure out who wants to play and who doesn't, and that saying "I don't want to play" and then squirting someone won't cut it. Of course, kids who demonstrate difficulties adapting their squirting behavior to the various complex contexts would loose the privilege of playing (and, possibly for some time, their squirt guns). In addition to inflexibilities of rule-based systems, rules too easily become a substitute for relationships. In our treatment culture, the impulse to make a rule to handle some problem became a signal to focus on the issues being avoided and the need for mutual respect so that we wouldn't need a rule. For this reason, we had a rule against rules. 14. Paradoxical therapy, "talking in opposites," is a special case, presenting the reversal nonsense in the foreground which implies the opposite real message in the background. 15. Here is a story about a story: Several months after I had left Meridell, Suzy Ludlow, who is the second former child care worker to become the Administrator of the Meridell North Campus, came to visit me. I wanted to hear how things were going and invited her to discuss some problems I had reason to know would emerge. Specifically, I asked how the little boys (who had recently been moved from the South Campus to the North Campus) were getting along. However, in our culture (thanks to Janet Lippold), complaining about how bad things are (especially about the management) and how therefore we can't help the children is strictly taboo. The correct way is to stress the positive. Suzy wanted to let me know that she and the culture were still healthy, and she knew that to convince me she would have to tell a story -- a story about the kids justifying our faith in their ability to sustain the culture. This is her story: Oh, the kids are doing a great job of bringing the little boys in right. Just the other day, the - 26 - little boys were having some trouble. They were raising hell in the lunch room, acting like mental patients and giving their staff a tough time. The Ranchhouse kids [oldest group] were real neat about it. Several of them went by the little kids and told them, "We don't act like that here," -- not in an angry or threatening way at all though. In fact, Doc, you'd have been real proud of Mike C. [one of the biggest and most respected boys]. He went right over to Jason L. who was acting like a real ding-bat and said, "I'm going out to play basketball now and I could teach you some tricks, but I won't play with you unless your staff tell me you've started treating them better. I wouldn't feel cool playing with someone who acts like a mental patient." Jason turned his behavior right around and later Mike really did spend some time showing Jason how to shoot baskets. The kids have been just great. Suzy also took care to support the charisma of the new Medical Director by talking about neat things she had done (such as getting into the middle of the squirt gun wars). These are the ways culture is established and maintained. 4. MAKING CULTURE: More Examples and Practical Tips Taking a less trivial problem than beans in their ears, why do the children threaten to kill themselves -- sometimes even really do kill themselves -- when that's what the adults take most responsibility to prevent with elaborate precautions. Most facilities, following the recommendations of expert child psychiatrists (working from an outpatient model), train their staff, "If the child looks upset, be sure to ask him if he feels like killing himself." I say, "In a residential setting, why ask?" If a child looks upset in a residential setting, immediately increase the supervision to safe levels.[16] Even more important to prevent suicide, always be ready to engage children with increased attention, supervision and relationship whenever they indicate the need, but don't take the initiative to focus this necessary attention on the contingency of suicide. Above all, I say don't so obviously take upon yourself responsibility to prevent suicide in a way that takes this responsibility from the child -- in a way that implies a kind of struggle and assumes the child is trying to defeat you. Such false assumptions invite fatal miscalculations. - 27 - As they learn the culture of your program, the children will learn the most reliable ways to engage your worry and attention. Because, as Geertz emphasizes, almost all behavior is symbolic, one behavior can be substituted for another to symbolize the same thing. Thus, as you make choices about shaping your culture, you can choose some behavioral battle grounds as preferable to others. For years, Bobbie Caviness, Clinical Director at the Meridell girls' campus, successfully chose to struggle over cigarettes rather than drugs. Meanwhile, at the boys' campus, drug-related activity, eventually, because of the hoopla we associated with it, just talking inappropriately about drug subculture became the ultimate antisocial, self-destructive behavior -- worse even than running away. However, the staff seldom talked about suicide except in relation to rare, clearly despairing youngsters. Instead of communicating concern that the kids might frequently be on the verge of killing themselves, we communicate our assumption -- which I deeply believe -- that for a teenager to kill himself is just too dumb for words. They may feel hopeless about their lives, but so much will change so quickly for them that they need to wait and see what happens (at least until they are fully grown) before definitively giving up. In addition, they need to realize the even greater stupidity of depending on us to keep them from killing themselves. They should be well aware of the likelihood that the adults will mess up; no matter how hard we might try because of our desire to keep them safe, we can never protect them from themselves as well as they can. Consequently, we never had a separate identifiable structure of supervision or restriction labeled suicide precautions. We wished no such ritual and certainly no associated stories, though we were quick to increase supervision whenever a child signaled any kind of distress. To further communicate our expectation that these adolescents were not about to kill themselves if given half a chance, we let residents have normal tools and personal hygiene equipment such as razors, cologne and deodorant labeled "Keep out of the reach of children." We then creatively used to our advantage the State's regulatory standards mandating that we lock up all such possibly lethal materials. We successfully requested a variance from the standards by certifying, on a living group by living group basis, that the members of each group were specifically assessed to - 28 - present no significant risk of suicidal behaviors. Then a youngster threatening to kill himself, holding a knife to her wrists, or hiding a blade under his pillow voided the grounds for our variance. For that living group, we were then obliged to lock up all razors, cologne, deodorant, and so on. Needless to say, the peer group developed a culture fostering suicidal threats about as much as publicly urinating in the middle of the dance floor during a co- educational activity. However, when we did occasionally encounter a genuinely suicidal child, we responded instead with the same kind of discrete, sensitive concern appropriate for other embarrassing misfortunes of adolescence, such as incest or AIDS. For example, as we made plans to protect such a child, we would ask if he wanted our help discussing the matter discretely with his close friends so they could lend support. During my 19 years at Meridell, we had only a small handful of suicidal threats, only very rare suicidal gestures, and no suicides. A combination of similar techniques and simple good luck also largely excluded from our culture firesetting, riots, and lawsuits. Certainly one wants to avoid creating contexts for distasteful eventualities. I have seen administrators, preoccupied with their own worries, actively create a culture of litigation by going around telling patients, staff, and families, "We do [this and that] so you won't sue us when things go wrong." I always felt people were more understanding when things went wrong if we had been sending messages that we did this and that because of our concern for their welfare and safety. The behaviors are almost identical, but the meaning -- and outcome -- may depend on your motives, on whether you are taking care to protect your clients or just covering your own butt. Here again, where culture is concerned, the meaning of behavior (like the wink) lies in its context. The meaning and effects of a policy or decision depend less on the actual action taken than on the values justifying it. What you do is less important than why you do it. The reasons you give will shape your culture and the significance of your actions more than what you actually do. You will often find it easier to change a behavior's meaning by changing its context than to change the behavior itself. For instance: Some boys started wearing several colorful bandanas tied around their foreheads, arms, and legs symbolizing an anti-authority, anti-treatment - 29 - solidarity so subtle it begged us to look silly by attacking it. Consequently, I and several other key staff borrowed as many bandanas as we could -- some even from the boys in the negative sub-group -- and dressed ourselves similarly. We also bought some bandanas and gave them to some really uncool kids to wear. When the boys asked why we did this, we simply said, with knowing winks, (indicating our conspiracy which was a parody of the kids' conspiracy), that we wanted everyone to be cool. At any rate, the bandana thing faded away -- partly I think because the kids were embarrassed by how outlandish we looked. Here is another example of changing context by manipulating a ritual: In many children's institutional settings, a child's saying something about another's mother mandates a fight. I wouldn't want to repeat here the horrible things I habitually said about kids' mothers or the things they said about mine in order to change the context from one of confrontation to one of affectionate greeting -- usually accompanied by the finger (vide supra). [17] The more serious issue of children's choosing whether or not to attend school provided one of my favorite games for playing culture with the kids and jarring adults open to better realities (by trading in behavior intelligable only within the radically new cultural context). Because initially the staff were so hell bent on getting kids into school, I declared this a privilege which only I could grant. This set the stage for the following ritualized drama of my conversation with a new child:[18] Kid: I heard I have to get your permission to get into school. Doc: Forget it, the teachers are too mean and it's a waste of time anyway. Besides, you'll get your treatment off to a better start if you get to know the place by hanging around and get to know people -- that's more important than school. Maybe you can get a job in the kitchen and get to know the kitchen ladies. That's the most important thing to do in a residential center -- even if you're the Director. Then, at least you'll eat good. Kid: A job, great. (Two to ten days later) Kid: I've been working in the kitchen and the kitchen ladies are really nice, but I've gotten to know the place and it's getting boring and almost all the - 30 - other kids are in school. They say I'll like the school here. Can I go now? Doc: That's not much of a reason, besides school's too hard. Kid: The other kids warned me you'd give me a hard time. They said I should just keep after you and try to bribe you with a Skors bar. Is it true you take bribes? Doc: Only to let kids into school or to give them medicine -- mostly for kids who have been mean to me about it. I really like Skors bars, but since you seem like a friendly fellow, I won't make you pay a bribe this time. Kid: Why don't you want us to go to school anyway? Your supposed to make us go. Doc: You can't make me make you. Besides, I have my education, years and years as a matter of fact, so I know how bad it is. Why should I worry about you getting yours? Education is expensive. Kid: (Trying to suppress a smile) That's what the other kids said you'd say, but that the real reason is you're afraid one of us will get a good education and take over your job. Doc: They weren't supposed to tell. Kid: Well, I promise I won't take over your job so let me go to school. Doc: Look, you don't even know how bad it is. I'll tell you what, you get some other kid to take you down and introduce you to the teachers and you can sit in some classes and when you see how bad it is, that ought to be the end of it. (Next day) Kid: I got into school Doc: What! That's impossible; you can't get into school without my permission. The teachers must be manipulating again. I'll fix this; tell me exactly what happened. Kid: Well, George took me down to meet the teachers, and I sat in some classes and talked with the Principal, Ann, and she gave me a schedule and she said I can start as soon as you give the ok. Doc: Oh, well, you're not really in school then. At least I hope they gave you a decent schedule and didn't try to screw you around by putting you in the wrong grade. Kid: Well, actually they did move me back to the seventh grade, but Ann explained how that would work out better for me and I can get caught up. Doc: If you don't like it, it would be a good reason not to go. Kid: No, its ok. - 31 - Doc: At least I hope they had sense enough to adjust things for your learning disability, I don't want them throwing you into a school panic. You know what happens when you feel dumb. Kid: Yes, I have an extra reading class and I'm only starting with three classes to see how I do. So just say I can go. Besides, they told me that I can't keep my job in the kitchen after Wednesday, and if I'm not in school I'll have to go into the Alternative School Program and follow Linky around during school time and all he does is sweep and mow. Doc: That's not so bad. It would be dumb to go to school just to avoid that and you don't even really know what it's like. You don't even have to work; it's easier than school. Before I would consider giving you permission for school, you need to try hanging around with Linky for at least two days. Kid: Two days! That's a waste of time, I've already got my schedule. Doc: Well, it could save you time; if you did start going to school, you would know what the Alternative School Program was like and you wouldn't have to waste more time getting kicked out of school just to find out. Kid: You mean I can get kicked out of school. Doc: Sure, in fact the main reason I go through all this is to keep teacher-crankers out of the school. Kid: What's a teacher-cranker? Doc: Well, the teachers are mean enough, and then comes along a teacher-cranker provoking the teacher by acting like a clown and some poor dumb soul who really does want to learn his lessons asks a question and the teacher is so angry she goes off on the poor kid and tells him to figure it out for himself. So to protect the kids who want to learn in a hassle free place, I'm on a holy crusade to keep teacher-crankers away from the teachers. You aren't a teacher-cranker, are you? Kid: Oh no. (Pause) Doc: What about the time you pushed the Principal. Kid: That was two years ago; besides she made me mad. Doc: Well, our principal is sure to make you mad; she's an expert. And then you'll have to push her and end up kicked out. Kid: No, I can handle it. Besides she seems nice to me. Doc: She's putting on an act. Kid: You exaggerate too much! It'll work out. Doc: Well, time will tell, but first I'd like to see what you think of the Alternative School Program. - 32 - Maybe you'll push Linky. (Pause) Why are you rolling your eyes at me. Kid: You're too negative. Doc: Well, when I was your age, they didn't have treatment centers like this, and I couldn't get the help I needed....[19] Kid: Ok, ok, I'll go with Linky, but only for two days. (Later) Kid: I've been with Linky for two days and it's boring. Linky's a fun guy most of the time, but during school he's boring; he even says he likes being boring. Is it true that you used to make the Alternative School Kids watch TV? Doc: Yeah, daytime T.V. -- there's nothing worse. It was a get back against the staff because they wouldn't do things my way -- but the kids hated it too. They said I couldn't make them watch TV which was true, but I wasn't trying to make the kids watch TV; I didn't have anything against them -- just the staff -- and the kids do have to stay with the staff; that's the main Alternative School rule. Anyway, everyone complained so much I had to give it up. Kid: Why can't we play Nintendo during school? Doc: Then the whole world would know I'm crazy.[20] Uh... actually, the real reason is because school time is when the staff get to use the Nintendos -- that's all we do all day. If the kids used them then, the adults would stir up trouble. Kid: You are crazy, but stop trying to change the subject -- they said you would. I hung around with Linky for two days like you said. I helped some, but I don't like just following around and waiting while he does his work when I could be doing my own thing in school. Linky even said he'd come and tell you how good I did and that he thinks I'm ready for school. Doc: Well, come to think of it, you haven't even given me one good reason why you should go to school. Kid: My parents said they really want me to go too. Doc: That's the dumbest reason I could think of -- to do something that hard just to please them. I can fix it so they'll think it will help your treatment for you not to go to school. Kid: Oh no, I want to go for me; I need a high school diploma to get a job. Doc: That sounds better, but it's wrong. Long ago the great psychiatrist Elvin Semrad used to say you could get a job anywhere in the world without a diploma -- washing dishes. - 33 - Kid: That was then, this is now. Besides, I want a good job. I need an education for that. Doc: That sounds like a pretty good reason; I'll think about it. Kid: You'll think about it! Look, you have to let me go to school. I've been talking to people, and the law says I have a right to an education. Doc: My! You may be pretty smart after all. It's a good try but we've got that one covered -- that's why we call it the "Alternative School Program." It's even written into your Individualized Educational Plan. It's all legal. Kid: Well, I'm on to your reverse psychology anyway. Doc: It's not reversed; the rest of the world are the ones who are reversed. They think you have to make kids go to school; they think kids are too dumb to know what's good for them. They use reverse psychology and trick kids into not wanting to go by trying to make them. If you think it's a trick to make you want to go to school, just don't go. I mean I really do believe that if a kid is too dumb to go to school, it's a waste of time. Kid: Suppose I was? Doc: Great, I've been looking for someone to volunteer to be my example to prove I really am dumb enough to let a kid stay out of school for his whole treatment. My last example, Larry, was doing good, had been out of school for almost a whole year; then he screwed me around and got in. He even added insult to injury by starting to get A's right away -- but he was way behind. I've been looking more than a year for someone to be my new example. Please help me! Kid: No, I don't want to be be your example! I need my education. Please, let me go to school! Doc: Well, you have done a good job at everything I asked. You've even been pretty smart in keeping after me so I guess I'll have to say yes, even though I don't like it. Kid: Thank God! Doc: But don't blame me when the teachers get unreasonable. Just come see me, and I promise I can fix it so you can quit school. Kid: No thanks, you'd just try to get a Skors bar out of it for me to get back in. Doc: You are pretty smart; maybe you're too smart to go to school; maybe I should change my mind. Maybe... Kid: That's ok, bye. While the Great Pioneers turn over in their graves, we can laugh at the straw-person who says, "But how can you - 34 - let a 13 year old make such important decisions?!" Still, for the past 20 years I have been dividing AACRC presentations into two categories: By far the larger group, which I call Type X (or Dickensian), consists of papers based on assumptions that children don't know what is good for them, will resist unless forced, tricked or bribed to attend school and therapy, and otherwise endure their treatment. The smaller group consists of papers based on beliefs, which I call Type Y, shared by all the Great Pioneers. Bettelheim speaks for them: Milieu therapy consists of creating and maintaining an environment safe enough to free the patient's inherent maturational potential to achieve balance within his own psyche and realistic relations to the outer world.... Were it not for the innate developmental drive toward growth and normal functioning, no amount of tender loving care from the environment could bring about the vast changes we have observed in our patients. (Bettelheim, 1974, 372) Neither freedom, nor autonomy, nor self-esteem, nor a positive outlook on life or oneself, nor friendship, not to mention love, can be forced on a person. (Bettelheim, 1974, 51) But autonomy requires even more -- namely, the ability to choose for oneself not only how much, but what is wanted, and what isn't and the conditions under which it is received. (Bettelheim, 1974, 175- 6)* __________ * The requirement to write in advance detailed plans specifying where, when, and from whom the child will suffer exactly what treatments tends to encroach on the child's opportunity to make such autonomous choices. (See Weiner, 1973b, for some strategies of treatment planning which avoid this while providing accountability and managment by objectives.) Of course, faith in the childrens' making good decisions works only when linked through responsibility to some semblance of realistic consequences -- circumstances those using the Type X approach often avoid. - 35 - Remember the pointlessness of trying to choose whether the X or the Y assumptions are really true; instead choose which you will make the context of your work based on the advantageous interpretations conferred upon the behavior of children and staff. Type Y assumptions that the kids are doing the best they can to grow and be helpful clearly provide the best context for self-esteem enhancing interpretation of their behaviors. The temper tantrum provides an outstanding example of symbolic ritual behavior amenable to shaping by context. Although Trieschman, Whittaker, and Brendtro (Trieschman, 1969, Chap. VII) theoretically view the tantrum as a simple loss of ego control, their phenomenological description clearly shows tantrums are highly patterned by context. As they observe, the tantrum usually occurs in the context of a relationship with a trusted adult and often aborts from a sudden change in context -- as when strangers unexpectedly appear. We developed techniques of exploiting the great therapeutic potentials of the tantrum,[21] and explicitly expected children who "spazzed out" to make good use of the opportunity. However, with our population of adolescent boys turned athletes, safety required uncoupling the occasional usefulness of a tantrum from their macho aspirations, which we also encouraged. Our culture recognized that for big boys, tantrums, however therapeutic, were a luxury requiring their cooperation. The culture mandated that the stronger a boy, the more responsibility he bore to ensure the safety of his tantrums by directing these against the bigger staff. If he really wanted to look tough in a struggle, he needed to defer his tantrum until several gorillas were around, and even then he was responsible to see no one got hurt. For several years, until our licensing worker put an end to it, we had successfully and without significant injury expected the other boys to help staff restrain an out of control individual whenever safety required this.[22] Except for the smallest boys, directing a tantrum against a woman resulted in a shameful public scandal -- branding the stigma that one must feel like a little boy to take such privileges. (Eventually this also became incorrect because of changes in the general culture.) Boys who insisted on demonstrating their physical manhood by dangerously challenging staff or bragging about how many it took to restrain them found this painfully counterproductive when they were excluded from participation in athletics and weight training. We refused to help them get stronger, and the other boys often refused to have - 36 - them on their teams, until they demonstrated they were not wimps who couldn't even control themselves. On the other hand, the sight of a large staff restraining a small child on the ground often upset newer boys, especially those who had themselves experienced physical abuse. We ritually handled this by asking the boys to fetch a pillow or jacket to place under the head of the restrained boy to relieve at least some of his discomfort. Often a restrained boy's friends would stay to lend emotional support and possibly participate in a subsequent life space interview. In addition to establishing a context of caring and avoiding kid vs. staff splits, these ritualized expectations expressed a basic element of our social contract: In any critical situation, the adult might well be in the wrong, might even be dismissed after calmer reflection. Certainly the kids could run things better through their own leadership and meetings. But when push came to shove, the kids had to take responsibility to support one another to let staff be in charge. Our motto was: Staff must be in charge, but staff can't be in control; only the kids can control themselves; kids need to control themselves enough to let staff be in charge. Safety required this and the kids stood to benefit as much as anyone. And no tip-toeing, if staff felt any doubt about being in charge, first things first required pressing the question (usually just before some wonderful activity) until clearly settled. "Are you going to let us be in charge? We can't go on until you do." Most things were negotiable, but this wasn't.[23] Most of you know that the cure of many traumatized youngsters depends upon the residential setting's ability to supply a holding environment strong enough to withstand their urges to break attachments. At last year's meeting, Ray Curtiss described precisely how to do this for pre- adolescent children. Later, Ray and I agreed that in order to cure similar problems of attachment in adolescence, the peer group had somehow to take over the crucial holding functions. Because of the developmental characteristics of adolescence, most teenagers who need to attach resist doing so -- at least until they can attach to a peer group supportive of relationships with adults. Moreover, given the capacities and skills of adolescence, only the peer group can generate enough energy to maintain a sufficiently strong holding environment for these youngsters. Consequently, we freely share with our kids the most basic premise of our therapeutic culture: Teenagers most in need of help can find it only if they - 37 - work together (with adult guidance) to create a culture which fosters this. If they care about themselves and each other, they cannot afford to leave making a favorable treatment culture to us. We just can't do it right without their help.** At least in our American culture, the older adolescents bear special responsibilities toward the younger teenagers, for the younger look to the older even more than to adults for cultural cues. As our family therapist, Weldon Ebling, taught us: Big brothers do not lead by setting limits -- that's the parents' job -- big brothers lead by example. In a gang delinquency project described elsewhere (Weiner, 1973) and illustrated in Figures 20-24, we found it too difficult to change the older adolescents, but we were able to modify how they interfaced with the mid-adolescents and even more the way those mid-adolescents influenced the early adolescents and pre-teens. From this youngest group, we planfully shaped a model gang who had first claim on our resources. By the time this model group reached late adolescence, it had induced a whole neighborhood of younger children into a much healthier youth culture than had previously prevailed. Efforts to change culture for the initial oldest group had required immense adult energy for only little change. However once the younger, model group matured and began replicating itself, the cultural improvement persisted for years after the adult workers disbanded. Your attempts to change culture will fall short until you get your oldest and highest prestige youngsters on the right track. In a residential treatment setting, this priority of establishing the right leadership justifies even cheating by draconian weeding and seeding: If done correctly, you will be able later to work more successfully with even very difficult youngsters; on the other hand, if you allow a non- therapeutic culture to persist, you are likely doing harm. Just as anthropologists know to introduce themselves into a culture through high status individuals, you must work through your high prestige kids to insert new culture. When introducing something like newly available psychotherapy or a new alcohol group therapy, make it available first as a scarce commodity (nothing sells to the elite like elitism) to some leaders "who will make __________ ** Here again appears Korczak's theme (Vide supra). - 38 - best use of it" rather than nerds "who need it the most." The practical tactics of making culture involve appeals to tradition: "We have never had to worry about...! We have always been able to expect...!" Fortunately, adolescents, especially cohorts moving through a treatment center, don't have much sense of history -- anything older than a year or two is an ancient tradition. If you don't have a tradition you need, create it -- with an atmosphere of crisis and drama (or at least use naturally occurring crises opportunistically). Then you can say, "Ever since the big crisis, we have done it such a way." Adolescents have a developmental need to be part of revolutionary improvements and love to participate in making new traditions. Directors of treatment programs would benefit from Mao Tse-Tung's and Janet Lippold's examples of periodically sweeping away the ossified bureaucracy of the Revolution in order to renew its values -- and to keep the new generation involved.[24] - 39 - NOTES 16. Of course, if reason existed for serious concern, a senior staff member or someone especially close to the child would explore this -- discretely. 17. Conversely, as an example of this paper's central point, policies (such as required by the Joint Commission and many states' standards) to insure respect of the patient's dignity, unless carefully handled, can backfire by communicating the background context that the patients are less than everyone else because one must take such care not to devalue them. If one can't kid around with them, the kids will feel different. And even though some licensing workers have trouble distinguishing, the children can easily tell the difference between respectful play and devaluing -- and humiliatingly special efforts to protect their assumed vulnerabilities. 18. Compare this ritual with those used by some other centers (e. g. Walker School) designed with extraordinary care to ease a new child's painful (it is assumed) entry into school. More importantly, the fact that learning involves strengthening connections (as a result of practicing and mirroring) rather than "digestion" of instruction, explains the superiority of the Socratic method of teaching. While not Socratic in the philosophical sense, the following dialogue illustrates the value of children's learning through active participation rather than passive acceptance. Here we may be stumbling also upon the value of the paradoxical approach (and a use of oppositional behavior). Since learning occurs best through active participation and engagement (through taking up one pole of a Socratic argument), the child naturally tends to take up an opposing position in order to explore the dimensions of a situation. (Perhaps certain learning disabilities specifically benefit from this compensatory strategy maximizing external manipulation.) If the adult asserts a socially acceptable position, we call the child oppositional when he disagrees; if the adult asserts a socially outrageous position, when the child disagrees we call the result paradoxical. - 40 - 19. "The message of this book will be lost on the reader who permits himself to think of 'patients' as one class of people and "therapists" as another. These two terms refer to people who are very much individuals, with their own life histories and personalities, but who are also in many respects very much like the rest of us, the author and the reader." (Bettelheim, 1974, 8) Korczak's preface to King Matt the First (vide supra) points to the same equivalence of children and adults. 20. This sentence (which is then immediately denied) is the first time in the conversation so far half explicitly acknowledging the (back-)grounding context that our culture does expect kids to go to school. 21. Children with Borderline Personality Organization use tantrums to integrate good and bad self-object representations -- especially if staff accept the gestures of restitution in the denouement. Schields (1971) described the use of tantrums in residential treatment well before Kernberg. 22. Stephanie, a former Meridel Case Supervisor for the oldest group, points out that usually safety didn't require the kids help and that the staff's politely declining their offer often helped reassure them that they didn't always have to be responsible (co- dependant) for everything. 23. Here is where the permissive/progressive movements (some stimulated by the Great Pioneers' work) went wrong. Kids need limits to grow. A structured milieu must ensure its residents are still able to experience that limits and consequences usually follow irresponsible behavior. Also, the childrens' attitudes and actions will determine the quality of the culture, but the adults still need to stand for something. In constructing a culture it makes sense to base the need for adults to be in charge (authority) on our desire to ensure the kids comfort and safety growing out of our concern for them. In fact, if the adults can't keep the kids safe from one another, how can the kids begin to trust them with other problematic issues. We had a handful of techniques for managing behavior; see Weiner (1978) for an elaborate - 41 - discussion. Importantly, the adults need channels for the constructive expression of their sadistic anger which the kids must provoke. (See Weiner, 1975, for Existential Psychiatry's criteria of the therapist's expressing anger when not to do so would increase distance in relationship to the patient.) Under extreme circumstances, when all else failed to prevent a child from successfully using physical violence over a period of time to abuse others to the point threatening our ability to help (N.B. this strict criteria), we were not above using non-behavioral methods -- usually medication in doses sufficient "to take control of his body as long as it takes" (usually one to four days) to interrupt the problematic behaviors. With regard to medication otherwise, my stated policy required that "all my customers must be satisfied" with their medication and dosage -- most of which were chosen by the patients with my guidance. A couple of exceptions to this practice involved paranoid psychotic children who not only refused offers of medication, but enlisted the support of their peers against my efforts. I learned to back off and take the position that I wouldn't give medication against the patient's wishes unless the peer group voted for this. As the patient got more frighteningly crazy, the peers rather actively sought medication for their friend. In one case where the group had attacked me for wanting to medicate a boy because they felt I was being unreasonable, they ended up begging me to medicate him on an emergency basis. I was then able to insist they give me reassurances that they didn't want him medicated just because he was annoying them, but because they sincerely believed this would help him. This process of involving the peer group really paid off when they later were crucial in helping the resistant boys accept the usefulness of medication for controlling their illness. 24. In the larger picture of culture change through human history (cultural evolution if you believe in Western "progress"), the adolescent developmental phase is the focal point of a society's movement (i.e. "social movements"). - 42 - 5. THE GREAT PIONEERS: A Rational Basis for Group Care Culture So far I have tried to focus on the general nature of culture and its transmission. However, we must now engage head on the issues of specific cultural content raised by the several preceding illustrative examples.[25] Fortunately, our shared mission of residential treatment saves us from the swamp of cultural relativity. Most of us recognize that successful therapy (of almost any type) provides a supportive context to stabilize self-esteem and safety to experiment with new adaptive strategies.[26] Among the many indicators of a destructive, counter- therapeutic culture, the clearest center around kids and adults not being comfortable around one another -- especially not feeling comfortable enough to be themselves, let alone to experiment with new adaptive strategies. In a bad place, everyone's self-esteem is always taking a beating. The kids feel uncomfortable openly engaging in positive, treatment relationships with the adults, and the adults avoid spending much time with the kids, especially informally or just for fun. In these milieus the adults prefer to deal with youngsters on a one to one basis rather than in groups -- for reasons of comfort, not efficacy. The best objective measures of progress at making culture result from carefully monitoring space and time boundaries separating kids and adults, and the amount and quality of mingling -- not counting staff who are specifically assigned to "cover" the children. Look especially in the kitchen (Do the kids feel at home there?) and in the dining room (Who eats with whom?). Be sure to ask: Where is the Director? The most important indicator is: How do the kids treat one another? In addition to the crucial issue of whether people are stabilizing or undermining each other's self-esteem, we are concerned here with improving distributed cultural processing by ensuring great interconnectedness (without blockages) among the individual components. Adequately shaping meetings of the small living groups and the whole community is necessary, but insufficient by itself. Bettelheim saw each child several times daily in informal circumstances with other children making it easy for them to let him know what was going on with them. Korczak most enjoyed putting his children to bed and telling them bedtime stories. The following description of Lane's Little Commonwealth applies also to Summerhill: All ate at the same table, did the same work, sat at the same hearth, enjoyed the same laughs, and shared each other's opinions. The thoughts of the grown up helper at the Commonwealth were as respected - 43 - as those of the boys and girls [sic]. (Bazeley, 1928, 54) The most time consuming but crucial practical work centers around aggressive limit-setting to eliminate the three main sources of blockage with the free flow of distributed processing -- all of which involve individuals attempting to stabilize their self-esteem by undermining the self-esteem of others.[27] o+ Intimidation in all forms -- both physical and subtle. o+ Secrets (another form of illegitimate power). o+ Power struggles of the adults (especially those inflamed by permitting either democracy or professionalism among the staff). Because the importance of controlling intimidation and secrets outweighs the space for their discussion here, some important technical tips will appear elsewhere.[28]. I must stress here only this: However permissive we were about the children's autonomy when it came to their personal issues such as therapy, education, nutrition and medication, we relentlessly prohibited interfering with others' self-esteem or the free flow of information through intimidation and destructive secrets. We must, however, use some of the very limited time remaining to discuss the problem of controlling staff -- especially their tendency to form subcultural gangs based on profession. None of the Great Pioneers would tolerate with the kinds of problems so many of us endure from prevailing staffing patterns. Frequently at AACRC we hear presentations about the introduction of new, and not so new, treatment modalities into a residential program. Typically, a third to half of the content of these papers struggles with adult's problems working through changes in their power structure. ("The clinicians felt threatened that the Child Care Workers....") One of the worst examples was a late 1970's report about the introduction of sex education on the Children's Unit of the Menniger Foundation. The presenters made clear that their paper never intended to deal with the content of the sex education nor its impact on the children, but only with the six to nine month period of working the idea through the various departmental hierarchies and preparing the unit staff. During the ensuing discussion, no one at that - 44 - meeting questioned possible inefficiencies in the Menninger staff structure. On reflection, I've decided the whole thing must have been a big joke, and I'm the only one who didn't get it and play along.* Bettelheim criticizes the over-application of medical structures to residential treatment.[29] ...features appropriate to the general medical and surgical institution are transferred and applied thoughtlessly -- and very expensively -- not because of any particular need but because the medical analogy bears down on the imagination of...the planners.... (1974, 22) Bettelheim says true professionalism "comes not from task or training for it, but staff's conviction about what is best for the patient" (1974, 238). He then attacks professionalism as a "protection against the worker's heart going out to the patient" and a "mutual protective society" (1974, 226-7) and claims that the way to unity is to outlaw all status structure (pp. 238).[30] However, Bettelheim's further attack on professional departmentalization best advances our purposes by also revealing the key content of his residential culture. The usual staff structure interferes with what he takes as the central goal of residential treatment: improving children's self-esteem by seeing them as the responsible agents of their own treatment (and, I would add, culture). An institution which is split into competing departments is ipso facto unable to give most of the credit to the patient, since the departments will clamor for credits to defend their vested interests and justify their importance. And if the entire staff do not feel they are together in the work, they will not implicitly give credit to the worker when he __________ * For an idea of the kind of problems resulting from such a staff structure, see Glenn's (1969) description of an attempt to remedy the kid culture using techniques of "gang work" on the wards at Menningers. For a related and much more powerful technique of helping kids in places with bad staff culture (whether medical or correctional) see Vorrath (1985), my first choice approach to culture building in a situation with limited options. - 45 - himself ascribes the achievement to the patient. So in a roundabout way, only a total therapeutic milieu can afford to give the patient the feeling he did it all by himself, or nearly so; and this is the most potent way to help him get better. (Bettelheim, 1974, 352) The other Great Pioneers, caring for less ill children and placing more emphasis on the childrens' central role of actualizing their culture, had even less tolerance than Bettleheim for professional staff games. Korczak's biographer describes his solution to some staff problems during the early work of establishing his Children's Home: The new staff also caused problems. A school had been organized in the home by the philanthropists, but the teachers they hired walked about like "aristocrats," creating an "abyss" between themselves and the cook, janitor and washerwoman, to whom they felt superior. Hating pedantry of any kind (he often said he would rather leave a child in the care of an old woman who had bred chickens for five years than with a newly graduated nurse), Korczak dismissed the teachers, who he truly did believe were less essential than the menial workers who kept the orphanage functioning. He sent the children off to schools in the area, retaining only one instructor to help with homework. (Lifton, 1988, 69) I do not suggest the immediate dismissal of all teachers and nurses solely because of their educational background. Individuals can make special contributions based on specialized training, and some nurses know a lot about raising chickens. Adults do have a crucial role to play if they can help realize the right kind of culture and can enter into self-esteem enhancing (i.e. real, human) relationships with the children. I do, however, suggest the usefulness of your publicly saying what Korczak said (which is also likely true): That you would rather leave your children in the care of an effective child care worker than an inexperienced clinician. I suggest also that (as the Lippolds did so well) you make fitting into your culture and getting on with the children requirements of continuing employment.[31] The Great Pioneers never hired staff primarily to supply specialized knowledge learned elsewhere, certainly not to fill rational professional roles. Prospective staff members sought out the Great Pioneers to learn their unusual and valued approach to children -- to learn a meta-rational way, to learn a culture. In the resulting - 46 - guru-disciple relationship, the Great Pioneers could be crushingly autocratic with adults about how not to treat children, but usually refused requests for direct advice about what to do (Bettelheim, 1974). They frequently responded with an "I don't know" (Lifton, 1988, 168) focusing the student back on his or her relationship with the children. The message was always: Learn for yourself, listen to the kids. Be aware how radical the Great Pioneers were about listening to children. Bettelheim acted on their input into staff hiring decisions.[32] Lane's older teens carried on with minimal staff; Neill dismissed staff when the kids really disliked them. Korczak went even further. A prospective staff member asked him, "But what if the children don't like me?" "We'll know soon enough," Korczak told him. "After three months the children vote on each new teacher. It's their decision who stays in the home." (Lifton, 1988, 152) Finally now, we have dug down to the cornerstone of the Great Pioneers' belief: All the Great Pioneers built their work on a meta-rational faith in the childrens' capacities. They[33] focused their energy not on staff, but on children -- especially on the self-esteem enhancing strengths children demonstrated by decisively contributing to their own growth and the creation of a positive group culture -- a culture focused around their mutually helping one another. James Whittaker describes the social support approach as a context for interpreting behavior so that individuals stabilize their self-esteem while promoting the self-esteem of others: It arises from a fundamental respect for human competence. It capitalizes upon human concern for fellow humans. It resonates with a positive view of human nature. It emphasizes the virtues of cooperation, interdependence, and responsibility. It presupposes an active, moral human community. It feels good spiritually, and calls for the best in us. (Whittaker, 1983, 407) Bettelheim gives grounds for believing that even very young children can participate in such social support from some observations he made of Isreali kibbutzniks: During this same toddler age, though, the peer group also comes to be a source of comfort in lieu of adults. It was charming, for example, to see a three-year-old come up to an age-mate who was upset about something, inviting him to play, cheering him up, leading him back to the group. (Bettelheim, 1968, - 47 - 91) Remember, however, justification for belief in the children's positive potentials depends not on the truth of this assumption, but on its usefulness in creating favorable contexts for residential work. If you agree with Bettelheim, as I so strongly do, that residential treatment's central task is "restoring [the patient] to a high degree of justified self-esteem,"[34] then relying on the childrens' positive contributions to maintain the quality of life will create the most favorable contexts for self-esteem enhancing interpretations of their behavior! The three great theorists, respectively, of the explanation of consciousness, The Analysis of the Self, and The Interpretation of Culture, (Dennent, Kohut (1971), and Geertz) all come together with the Great Pioneers in one deceptively simple statement: The self consists of internal pattern recognizing structures (strengthened neural connections) shaped (learned/selected) by the self-esteem enhancing (rewarding) mirroring (successful matching) of the patterned contexts of (body and) culture (as the real manifestations of natural and human phenomena).[35] - 48 - NOTES 25. For a more radical attempt to substitute the content of an entirely different (Native American) culture for our problematic Euro-American child care approach, see Brendtro (1990). 26. See Weiss (1990) for an elegant empirical effort to demonstrate this and to show in the arena of psychoanalytically oriented psychotherapy the superior efficacy of what above I call Type Y, over Type X, based approach. 27. A healthy residential culture respects and values its weakest members. The ability of the smallest, intellectually limited child to have his off-the-wall comment heard respectfully in a group meeting is an important indicator of cultural health. (This is also a property of parallel distributed process which depends upon generation of a tremendous variety of possibilities of which a few are selected on the basis of best fit, as opposed to top down communication of a solution known in advance.) The important point is that one cannot protect the rights of individuals unless the group is running well. 28. Forthcoming. 29. He was referring specifically to architectural arrangements, but I believe he would agree with the broader use of his comment. 30. "Thus any system of organization, even the most cohesive one, has its inherent disruptive forces. If all important tasks performed for a patient are unified by being entrusted to only a very few persons, among whom there is no status and, as far as the work is concerned, no professional differentiation -- then interprofessional jealousies are precluded but personal ones are not. The great merit of the therapeutic milieu, for patients and staff alike, is that all problems are put on an appropriate level: the personal one. Theoretical or professional disagreements cannot be used to cloak personal antagonisms, so they may be resolved. When personal animosity is hidden behind professional or theoretical disputes, no resolution of the professional controversy can cure the - 49 - problem, which is fed by the continuance of personal enmity." (Bettelheim, 1974, 257) 31. At Meridell, we followed the course of turning the more program-acculturated and intellectually inclined Child Care Workers into clinicians and administrators. Except for myself and my physician replacement, all Meridell staff mentioned in this paper spent their first two years at Meridell as child care workers. We often ignored the issue of whether they had the usually requisite academic degrees (often they got them along the way) until the outside world finally took a strong stand forcing the removal of a great many of the most skilled and experienced clinicians -- at which point I took up my conceptual toys and left. 32. "Thus while the patients did not make the final decision, they did influence the decision-making process; and this affected the way they felt about themselves, and about living in the institution. More than one patient changed his views about the School after he saw that the patients' negative evaluation led to a prospective staff member's not being employed." (Bettelheim, 1974, 175-6) 33. Bettelheim, was the only one with more than a handful of staff (the other three relied heavily on the older children giving them them great advantages in culture building). He did differ from the others in his investment in development and support of the adults. However, he concentrated on acculturating them and focusing them back on their relationships with the patients. From his book (1974), I can't imagine him tolerating problems of hierarchy, specialization or professionalism, which he attacked ruthlessly at their sources. Essentially he accomplished by brow beating what the others accomplished by keeping the adult group small and/or ignoring them. 34. "The absence of self-respect is a central issue in all functional disturbances. The most important task of therapy is not to have the patient gain insight into his unconscious, but to restore him to a high degree of justified self-esteem. Understanding one's unconscious can be a most important step toward this goal, because then one's "crazy" ideas come to make sense. But it is only a step in which we move...from the feeling that we have lost our mind to the conviction that we have - 50 - gained control over it." (Bettelheim, 1974, 18) Although we have mentioned self-esteem so far only in passing, we have mentioned it frequently and unavoidably. Self-esteem is the great central theme of residential treatment. If you are trying to reconcile milieus with equivalently appealing results but starkly opposite practices, keep your eye on self-esteem. Bettelheim refused for many days to let staff flush away one of his patient's stools until she was ready (because she was so valuable). At Meridell we sometimes made kids do "a really good job" cleaning toilets (because we expected so much from them). Staff at each place would be shocked to hear of the other's practices, but both are working hard (by taking extreme positions) to increase self-esteem. 35. Among the many implications of this formulation, one of the simpler involves the notion discussed by earlier anthropologists as "cultural continuity" (across the life cycle). An individual's self-esteem depends on his or her ability to develop internal structures resulting in successful matching as defined and mirrored by the culture. Some cultures are more or less successful than others in helping individuals become the kind of people who can feel successful according to the culture's definitions. This helps explain the paradox that South Central Los Angeles has many people who feel degraded and dysfunctional because of their poverty who are in fact vastly better off materially than legions of the earth's peoples who have lived lives of great integrity and self-respect. They are certainly victims of a culture defining the value of one's life in terms of jobs and incomes to which they are deprived access -- as well of their more local culture's entraining them into behaviors for which (given contexts they accept from the more general culture) they cannot respect themselves. One might want to reframe this formulation in various ways depending on one's political view point, but whomever one wants to blame, it's still definitely somebodies' cultural problem. Of great personal interest to me, this line of thinking (and the integrating statement to which this note is referenced) points to the same view toward which, working from an entirely different theoretical (psychoanalytic) framework I had previously groped: I cannot propose any single, definitive technique for liberating acting out delinquents from their - 51 - passionate desire to live up to standards (of all kinds) -- even assuming we do want to cure them of what may be a useful and appealingly human virtue -- except that we first free therapists from the theoretical preconceptions which prevent them from recognizing this phenomena in their delinquent patients. The quickest way to establish therapeutic relationships with delinquents is to protect them against the pressure of their intense guilt and impracticable standards. This may be done any number of ways. One way is to have a particularly authoritative person or highly structured setting take over the job of defining and enforcing standards so that the child no longer has to depend on the inner mechanisms which insure failure and punish unmercifully.... Whether applied with psychoanalytic justifications or not, forgiveness is still the best therapy for sin. It is not so important that we forgive the sinner, which may even make his burden heavier, as it is for us to teach him to forgive himself. Ultimately, the cure and prevention of delinquency depend on our ability to substitute self-respect for self-hate as the basis of moral behavior. (Weiner, 1962, 98-99) 6. CONCLUSION: The Great Pioneers -------- A Meta----rational Basis Before we get carried away trying to integrate these concepts with the Grand Unified Theories of Physics, and in order to come to our conclusion, let's stay focused on the lessons for adult leaders seeking to create constructive cultures with kids. The Great Pioneers commitment to the grounding principle of their group-care cultures -- their dependence on children's capacity to help -- has much more meta-rational basis than the usefulness (great as this is) of the resulting contexts for improving kids' self-esteem. As we examine the nature of their so called charismatic leadership, each of the Great Pioneers complained that others were wrong to think his program's success depended on his own personality and skills. Each Great Pioneer insisted instead that success depended not on unique charisma, but on dedicated adherence to focusing on the children's inherent positive qualities and their necessary contribution to the group living process.[36] Generally, the Great Pioneers were considerably less charismatic, less alive, less assertive - 52 - when separated from their work with children. Lane is described by his biographer as passively unable to rise to his own defense while vigorously able to advocate for his children. Korczak apart from his work was shy, unsure of himself, and had difficulty making decisions or commitments. Yet while in contact with children and acting in their interest, these Pioneers were energized to heroic levels of activity. (Korczak went to the Gestapo's Warsaw headquarters to complain about their interference with his work.) Much of the time the Pioneers seem to have preferred the company of children to that of adults. At any rate, they worked very directly with the children, not only because this was so effective, but because they positively enjoyed it. I may be projecting too far to say the Great Pioneers suffered from developmental defects of narcissism (self-esteem regulation) such that they sought in the children positive qualities of selfhood they felt lacking in themselves as adults.[37] However, I do suggest that their energy and their charisma derived from their ability to enter into grandiose and mutual mirroring relationships with the children they so idealized.[38] Most importantly, note that within the milieu of the Great Pioneers, the flow of emotional energy and resources is not top-down as in Figiure 25, but distributed as in Figures 3 and 14. I wish to close now by briefly reiterating three practical benefits of the Great Pioneers' dependence on children and on child-like styles of thinking: o+ It freed them playfully to invent cultures rich in contexts for self-esteem reinforcing interpretations of children's behavior. o+ It led them to look away from themselves as "Cartesian" directors, away from an adult bureaucracy as the top-down organizing mechanism of their little communities and instead to take over the more important functions of freeing vast reservoirs of narcissistic energy of the children and staff and of integrating these with their own values and experience -- of participating in opportunistically stimulating, recognizing and selecting the most value satisfying patterns emerging from the parallel processes distributed among the kids and staff. o+ And finally, for those of you who have been wondering, "Where can we find the money?" (see Figure 26) it is cost effective (Figure 27). - 53 - By Bettelheim's standards, most of our staffing patterns are outrageously expensive. Summerhill ran on a shoestring; Lane's Little Commonwealth was nearly self- supporting even after most of the men and older boys who worked the farm had gone off to World War I; and Korczak's two hundred children showed more discipline and respect for one another while starving to death than residents in many costly treatment settings! Clearly the difference is not money but culture. Saying, "We don't have the resources to take proper care of them creates a context devaluing and victimizing the children with negative meanings for everything. So if you and your children are doing well, by all means keep up the good work. But, if in your current situation you feel unable to do right by your children, I empathize with the difficult decisions you face. I urge you to take our field's current crisis as a welcome collapse of inappropriate models and bad culture. Change your circumstances. Assume new contexts. If you can't do it where you are, move -- to where the lengths of stay are long enough -- to the surprisingly integrated (for the kids who hang together, not the adults divided among their agencies) milieu of neighborhoods, schools and juvenile justice facilities. There our youth, hungry for partnerships with adults and desperately trying to invent cultures supporting their self-esteem, can help you exploit their potential to create more constructive communities.[39] - 54 - NOTES 36. Bettelheim talks less about group process, but the reliance on the children's positive contributions (in this case to staffs' growth and to the treatment process) remains (and remains focused around implications for self-esteem): ...The patient will become convinced that he has indeed achieved full humanity-- at least in this one relationship -- if he begins to realize that, directly or indirectly, because he is important to the staff member, the staff member can and does change himself and enjoy life more; for example, by gaining the ability to view his body more positively. Since the patient has inspired such an important development in the life of this staff member to whom he has become attached, it turns him from somebody who was only the passive recipient of services into one who also can give significantly. More than anything else, this provides the conviction of his own human dignity. (Bettelheim, 1974, 221) 37. Bettelheim sees unconscious needs and efforts to cure oneself as the main and legitimate motive of working in residential treatment: The staff began to feel how my commitment to work, rational as were the courses of action that followed from it, had its mainspring in unconscious needs not to fail -- because failure here would imply a much deeper personal failing than a mere deficiency in a specific type of work. My commitment provided an example that specific "irrational" pressures need not be repressed as being all infantile, unhealthy, damaging, destructive; but that, to the contrary, they can be made to serve the most constructive endeavors. (Bettelheim, 1974, 11) Each generation has to wage anew the struggle against the darkness in our soul. Milieu therapy is not such a bad way of doing it, either for psychiatric patients, or for those of us who choose to join them as their helpers. (1974, 454) 38. The staff also play a part (via their own narcissistic aspirations and the guru-disciple relationships) in - 55 - making (even nerdy) Directors charismatic. However, as Bettelheim (1974, 250) points out, staff must learn to derive their satisfaction and status from their relationships with the children -- not from their profession or the Director's approval. Elsewhere (Weiner, 1975) I explore ramifications of such narcissitic transferences in residential treatment. 39. I have a meta-rational faith in the efficacy of residential treatment (when done well and with appropriate family work). Although residential placement may be a significantly restrictive alternative when compared to the small nuclear family, the small nuclear family (especially in a culture lacking kid-adult interfaces and consensual values) may be a highly unusual approach to socializing the young when compared to the ways of most of the world's peoples through history. I believe that for adolescents the crucial structure is more the community than the family (although obviously these are not mutually exclusive). For adolescents (not younger children) the idea that we must "get back to doing it in the family" may originate in a fantasy; it may not have been done very much that way at all. We need to look instead at other social structures which have become defunct. We need to look more carefully at institutions such as those by which young adolescents were traditionally rescued from their families by becoming squires, pages, apprentices or going away to sea or school. Most commonly among cultures, kids bunch in age-graded groups in whose acculturation certain specific adults of the community play a great role. This does work in our country when high schools and their communities are well integrated. Where it is failing, we need to reorganize educational, social, and juvenile justice services around naturally occuring adolescent groups and their age-graded hierarchies. That is the way culture is transmitted among adolescents. As a practical application, I would see targeting at-risk neighborhoods (as opposed to at-risk individuals) with an integrated in-neighborhood group-work approach and an away-from-neighbornood residential facility. I would use the residential facility, not primarily for the most at risk individuals, but to strategically juxtapose positive leaders and younger children while manipulating the age-graded hierarchy. Older youths who had been - 56 - through the program could periodically return for refresher "retreats" to function as models. Of course, in the context of a healthy helping culture, the facility would stand a good chance of accomplishing its secondary goal of helping disturbed individuals. The residential facilities would function primarily as a focus for the youth culture of a section of a city. Whole groups could return for weekends or parts of summers as only one part of the on-going group work with them in the community. If the juvenile justice system could cooperate, really negative leaders (who had also broken the law) could be removed from the streets temporarily to the usual storage facilities -- or made offers they couldn't refuse to use the residential program to realize their considerable potential as positive leaders. The schools also could play a crucial role. However, it's unlikely that either the juvenile justice system or the schools would cooperate. As Korczak says, "...they [grownups] won't listen to you, and you can't make them obey." Instead of stalling at "The kids can't, because the adult's won't," we should rejoice the established institutions won't participate -- they'd only mess it up. If anything is going to be accomplished, the young people, having the most compelling interest in the quality of the future, will have to take responsibility to press ahead -- with the help of some meta-rational admirers. Creating Constructive Cultures with Kids Version: 3.4 2/23/93 Michael S. Weiner, M.D. ABSTRACT ABSTRACT: This presentation at the 36th Annual Meeting of the American Association of Residential Centers for Children had multiple goals. The main objective was to teach clinicians to distinguish (a) residential treatment approaches focused on organizing adults to overcome children's anticipated resistance to therapy (Dickensian) from (b) approaches based on helping children organize to elicit more cooperative adult responses to their "innate developmental drive toward growth" (Korczakian). CONTENTS 1. INTRODUCTION: The Current Context of Futility and Fun............................................... 1 2. BASIC THEORY: Microcognition and Consciousness..................................... 5 3. MORE THEORY: Culture as Context for Cognition..... 15 4. MAKING CULTURE: More Examples and Practical Tips.............................................. 26 5. THE GREAT PIONEERS: A Rational Basis for Group Care Culture...................................... 42 6. CONCLUSION: The Great Pioneers -- A Meta-rational Basis............................................. 51 - i - - 57 - REFERENCES Bazeley, E. T.. 1928. Homer Lane and the Little Commonwealth. London. George Allen & Unwin. Bettelheim, B.. 1969. Childen of the Dream. London. Macmillan Co. Bettelheim. B.. 1974. A Home for the Heart. New York. Alfred A. Knopf. Brendtro, Larry K., Brokenleg, Martin, Van Brockern, Steve,. 1990. Reclaiming Youth At Risk. Bloomington, IN. National Education Service. Clark, Andy. 1991. Microcognition. Cambridge,Mass.. MIT Press. Curtiss, Ray. 1991. Presentation at AACRC Annual Mtg. Tape available from Buckeye Boy's Ranch. Dennentt. 1991. Consciousness Explained. Boston. Little Brown & Co. Edelman, Gerald M.. 1992. Bright Air, Brilliant Fire: On the Matter of the Mind. Geertz, Clifford. 1973. The Interpretations of Cultures. New York. Basic Books. - 58 - Glenn, Katherine. 1969. "Gang Work in a Psychiatric Hospital". Bulletin of the Menninger Foundation. p. 233. Humphrey, Nicholas. 1986. The Inner Eye. London. Faber & Faber. Jones, Maxwell. 1953. The Therapeutic Community: A New Treatment Method in Psychiatry. New York. Basic Books. Koehler, William R.. 1962. The Koehler Method of Dog Training. New York. Howell Book House (Macmillan Pub). Kohut, Heinz. 1971. The Analysis of the Self. New York. International Universities Press, Inc. Korczak, Janusz. 1986. King Matt The First. (Introduction by Bruno Bettelheim; Richard Lourie, translator). New York. The Noonday Press. Lifton, Betty Jean. 1988. The King of Children. New York. Farrar, Straus & Giroux. Mayer, M.F., Richman, L.H, and Balcerzak, E.A.. 1977. Group Care of Children. New York. Child Welfare League of America. - 59 - Neill, A. S.. 1960. Summerhill. New York. Hart Pub. Co. Peters, Tom. 1987. Thriving On Chaos. New York. Alfred A. Knopf. Schields, R.. 1971. A Cure of Delinquents. New York. International Universities Press. Trieschman, Albert E., James K Whittaker, and Larry K.Brendtro. 1969. The Other 23 Hours. Chicago. Aldine Pub. Co. Vorrath, H. & Brendtro,L.. 1985. Positive peer culture,. Second Edition. New York. Aldine DeGruyter. Weiner, Michael S.. 1962. The Psychology of Rebellion. presented to the Department of Social Relations in partial fulfillment of the requirements for the Degree of Bachelor of Arts with Honors. Harvard College, Cambridge, Mass. Unpublished. Weiner, Michael S.. 1973a. "Adolescent Group Life and the Transitional Community". Presented at 20th Annual Meeting. American Academy of Child and Adolescent Psychiatry. Unpublished. Weiner, Michael S.. 1973b. "Plans for Treatment in a Children's Residential Center". Presented at AACRC annual meeting October 11-13. Unpublished. - 60 - Weiner, Michael S.. 1975. "The Milieu of Real Relationships". Unpublished. Weiner, Michael S.. 1978. "Behavior Management In a Psychoanalytically Oriented Milieu". presented at AACRC Annual Meeting October. Unpublished. Weiss, Joseph. 1990. "Unconscious Mental Functioning". Scientific American. March, 1990, Vol. 262, No. 3, pp. 103-109. Whittaker, James K., Garbarino, James & Associates. 1983. Social Support Networks. New York. Aldine Publishing Co. Whittaker, James K., and Tracy, Elizabeth M.. 1989. Social Treatment, 2nd Edition. New York. Aldine de Gruyter.