Transcript Vad är vård?

Care
Johan Edman
Centre for Social Research on
Alcohol and Drugs, SoRAD
Stockholm University
[email protected]
Care and politics
Ideological visions
embedded in the
establishment and
development of
Swedish drug
treatment 1965–
2000
The study examines...
... the establishment and
development of Swedish voluntary
institutional drug care during the
years 1965–2000.
 ... the State’s management of this
process.
 ... the ideological visions embedded
in this process.

The empirical investigations
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Knowledge (official reports, bureaucratic
investigations and instructions, etc.)
Government policy (government bills,
committee reports, etc.)
Parliamentary debate (parliamentary
resolutions and records)
Bureaucratic management of granted and
rejected treatment programmes
(authorization and supervision
documents)
Government paradox
According to earlier research, the
State has not been interested in or
able to govern the actual treatment.
 On the other hand, the State has
occasionally been extremely active
in supporting or counteracting
certain treatment programmes.

Non-government thesis

Partly confirmed by the present study.
Discipline
Transactional analysis
House renovation
Therapeutic
community
Concentrative
movement
therapy
Role play
Confidence
exercises
Creating drama
Work
therapy
Group discussions
Physical
training
Large forum
Contact
training
12 step treatment
Psychotherapy
Object relation therapy
Medical rehabilitation
Christianity
Non-government thesis

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Partly confirmed by the present study.
At the same time, this treatment
eclecticism is described – by both
politicians and authorities – as
experimental and therefore as an
intentional outcome.
And also, some treatment programmes
were highly counteracted, as, for
instance...
Narconon
(vs. the National Board of Health and Welfare)
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Scientology is ”anti-medical, anti-political
and anti-democratic”.
Scientology is ”based on pronounced
economical interests”.
The treatment method is not based on
”science or well-tested experience”.
”The church of scientology and Narconon
originate from the USA”; the methods are
“not desirable in the Swedish society”.
The political dimension 1965–1981
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Consensus:
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Left-wing point of view:
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support for work and housing measures;
medical discourse criticized.
class conflict;
commercialism;
modernity.
Right-wing point of view:
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modernity;
social degeneration;
urbanism.
The communist party, 1979
“The children who were brought up in
poverty and discrimination, all the
workers that were excluded in the
name of the holy competition and
piecework, now they arrive – broken
down, deprived of their dignity,
distracted, addicted to drugs.”
The political dimension 1982–2000
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Consensus:
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Left-wing point of view:
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support for work, housing measures and
welfare;
commercialism;
urbanism;
modernity.
Right-wing point of view:
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familism;
subsidiarity;
reduced taxes.
The conservative party, 1984
“It is in the family that children get
the confidence and norms that give
them strength to resist when they are
offered drugs. Still, if addiction to
drugs arises, the family should be the
foremost support for the child.”
A contradictory problem
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National unity – strong support from every
party that this is the most serious problem
that should be solved with any means
(doxa).
Political conflict – therefore also an eminent
arena for playing out your own proposals
as superior to your opponents’ disastrous
politics.
Concrete suggestions on the drug problem
hardly diversified, ideological standpoints
more so.
The steering process
The drug problem primarily treated
as an ideological catalyst calls for
political steering.
 Actual management of treatment
programmes delegated to
bureaucratic authorities.
 Successful steering dependent on
the political activity of the
bureaucracy.

Bureaucracies as ideological
gatekeepers?
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The National Board of Health and
Welfare 1968–1981:
• management by variety;
• focus on non-profit organizations;
• distinct ideological line of policy (left-wing).
Bureaucracies as ideological
gatekeepers?
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The County Administrative Boards
1982–2000:
• passive (non-ideological) management
leading to a more narrow variety of
treatment methods (12 step treatment
increasingly dominant);
• passive management transfers the initiative
to treatment entrepreneurs and
(ideologically driven) municipalities;
• ideologically motivated shift from non-profit
organizations to private entrepreneurs.
To sum up…
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The problem as well as the proper method
remained vague, therefore it stayed a highly
politicized problem.
This shouldn’t surprise since all measures
aiming to adjust the livelihood of citizens to the
societal demands must remain ideological
questions.
If managing and bureaucratic authorities do not
have an ideological agenda of their own, they
will certainly make decisions out of somebody
else’s ideological agenda.
Ideology matters!
Care
THE END
Johan Edman
Centre for Social Research on
Alcohol and Drugs, SoRAD
Stockholm University
[email protected]