Managing Vulnerability: The Underlying Dynamics of Systems of Care

Author(s) : Tim Dartington

Part of The Tavistock Clinic series - more in this series

Managing Vulnerability: The Underlying Dynamics of Systems of Care

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Clinicians, managers and researchers - as well as politicians and religious leaders - are worrying about a lack of compassion and humanity in the care of vulnerable people in society.

In this book Tim Dartington explores the dynamics of care. He argues that we know how to do it, but somehow we seem to keep getting it wrong. Poor care in hospitals and care homes is well documented, and yet it continues. Care for people in their own homes is seen as an ideal, but the reality can be cruel and isolating. Tim describes research over forty years in thinking why institutional and community care are both subject to processes of denial and fear of dependency.

His examples include children in hospital, people with disabilities living in the community, and the care of older people and those with dementia. He asks why there has been such splitting between health and social care and what underlying purpose this split may have in a societal response to vulnerability and long-term dependency. He also explores the implications of such dynamics of care in a vivid case study, drawn from his own experience, of the care as it developed over six years around a vulnerable person living and dying at home.

Reviews and Endorsements

There has been considerable progress in the last forty years in the delivery of care services, for example in the field of disability - to a great extent through the efforts of people with disabilities themselves. Institutional care, where it still exists, is subject to continuing review - while 'care in the community' has gone through a succession of policy transformations, with increasing emphasis on person-centred care and now individual budgets and personalisation of services. Even Alzheimer's disease, the most recalcitrant of illnesses to modern medical science, is receiving much greater attention than before, with media interest, celebrity involvement and the UK government publication of a dementia care strategy.

At the same time, the author argues that there are significant ways that the world has got tougher for the most vulnerable in our society. A culture of enterprise and opportunity, put to good use by the disabled people's movement, does have a downside - a wide-ranging lack of respect for dependency, even where this is necessary and appropriate, in human relationships. The culture of targets and audit in the delivery of public services - a distortion of organizational theory developed in other sectors - has made the effective delivery of humane and responsive care more difficult to achieve and maintain.

This book addresses the questions facing the survival of the vulnerable in society at a time of continuing uncertainties in local and global economic and political life.

'A unique, intelligent and passionate text about the many ways we - as individuals and as society - try to evade, actually hate, facing the facts of helplessness. Public services designed to provide rapid positive outcomes become clumsy when dealing with deterioration, yet that is where our humanity is tested. And we will be there ourselves, one day. Tim Dartington reveals the wisdom of decades of experience as a Tavistock social scientist, with painful examples from his consultancy practice of life at the front line, then gives a brilliant account of his attempts to get coherent help for his wife, Anna, as she became demented in middle age. With comments from Anna herself, this is very moving. A learned account of defences against vulnerability laced with deadpan irony creates irresistible and instructive reading for all who use or provide public services.'
- Dr Sebastian Kraemer, Consultant Psychiatrist, Whittington Hospital, London

'Original, absorbing, unsettling and beautifully written, Managing Vulnerability is an important book for anyone dealing seriously with the predicaments of caring institutions or who is concerned with renewing the capacity of society to address profound human need. Tim Dartington brings to light the social and psychological matrix that shapes our systems of care and how today's cultural context, which so often de-values dependence, creates debilitating cross currents for leaders and managers of organizations providing care. This book provides a penetrating account of how emotions associated with the work of caring find their way into the structure, informal processes, and functioning of modern caring institutions.'
- James Krantz, PhD, Principal, Worklab Consulting, NYC; Past President, International Society for the Psychoanalytic Study of Organizations (ISPSO)

'The writing is elegant and passionate, and I recommend this book to anyone who is managing care and wants to work at a deeper level than quality assurance, procedures and standards.'
- John Burton, Caring Times

I Individual survival and organizational life
II The survival of the unfittest
III The personal and the professional
IV Conclusions

About the Author(s)

Tim Dartington was a researcher at the Tavistock Institute of Human Relations in the 1970s and worked there with Eric Miller and Isabel Menzies Lyth. He has continued to carry out consultancy and research in health and social care from a systems psychodynamic perspective and has written on the organisational issues in the delivery of care.

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