Viewpoint: A Therapeutic Alliance With Business

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This article is adapted from Dr. MacLeod’s speech to the Canadian Mental Health Association in London, Ontario on September 20, 1989.

Introduction

During most of this century, we have seen a clear division and even opposition between the world of business and the world of social concern. The sixties marked a high point of concern for making the world good and beautiful even though many of us now admit that the beautiful idealism of the sixties didn’t bring about the expected results.

Today there is a fascinating convergence taking place. All kinds of people in business are talking and writing about how to make business socially responsible through participation in areas of social concern such as environmental projects. On the other side, people in the world of social concern are experimenting with new and experimental community businesses.

In the field of mental health this new convergence has opened up new possibilities for those who are seeking ways in which former psychiatric patients may be integrated successfully into everyday society.

My fundamental thesis is that business structures determine the shape and quality of our society; the main agents of social change in this century are business corporations. If we want to be agents of real social change, we must, therefore, become part of the world of business corporations.

Defining the Problem

The conventional view would be that the psychiatric patient is out of kilter with the society, i.e., that the patient is the one with the problem. At the other extreme are those who hold that, on the contrary, the patient is okay and the society is out of kilter.

Charles Foucault, the French historian, points out in his book The History of Foolishness that in earlier centuries, a person who acted out of kilter with society was often called “a child of God”. Society tolerated and adapted to such people and they had a recognized role in society. Foucault points out that today the same kind of person is called “insane” and locked up in an institution. He also claims that if you took anybody off the street and locked him or her up in a mental institution for six months then he or she would automatically become “insane”.

The fact that the patient is a patient has many causes. I suspect that usually part of the problem is with the patient but, more often, the greater part of the problem lies in society. And it is complex. Part of the reason could lie with the educational system, part with the family, part with the media, the economic system, the health system, or the religious system.

Ifthe problem is rooted in many causes, then the solution of the problem will have to come from many sources. It will be multi-dimensional. We will have to stop thinking about “curing” the patient and concentrate instead on making it possible for the patient to find a role in society, i.e., a place where he or she can “belong”.

The Role of the Patient First, we must start with the ex-patient He or she is never perfect. He or she has to want to “belong” and that takes some adapting and compromise. Since none of us ever gets everything we want, the ex-patient is going to have to admit that even if the society is not the way he or she would like it to be, nevertheless he or she is willing to give in a bit. Not to give in completely, of course, but to be somewhat flexible so as to fit into the real world.

On the other hand, society has a responsibility to adapt and welcome the ex-patient to full participation. This responsibility is not only the family’s, or the health professional’s, or the voluntary sector’s. None of these can solve the problem alone; real partnership is required. It must involve the housing system, the family, employment, the recreation system, the religious system. It is not simply a psychological problem, it is an economic problem, a social problem, a spiritual problem, and indeed, a mix of them all.

What is important is that we recognize the responsibility and the necessity of involving every sector of society. The actual nuts and bolts of such a collaboration will depend upon each place. The way it works out in a small village will be quite different from the way it works out in a large city.

Success in solving social problems is always a question of imagination as well as of a will. I believe that we are more like plants than machines. Machines can be identical in a way plants cannot be. That being so, every ex-patient is unique . . . as all of us are. . . and every local society is different. In the plant world, one type of flower may flourish in a certain type of soil and a certain type of climate, yet another plant may not. It may wither and die in the same garden. We must always be sensitive to the differences when we deal with human beings.

An Innovative Example

An example from my own experience may stimulate your imagination.

When I was involved in New Dawn Enterprises, a community-based business group, I was also on the board of the local Mental Health Association. This was in the early 1970s and at a time when leaders of the mental health movement wanted to move patients out of the hospital into the community. The Association had been trying for years to raise enough money to buy a house but progress was slow and discouraging. Speaking from our experience in New Dawn, we suggested that the project be viewed as a business, and that it should adopt a business-like corporate approach.

New Dawn searched out a number of houses and asked the community which one it liked best. When the decision was made, New Dawn simply took out a mortgage and bought the house, as it had done for its other properties. Then the mental health committee signed a lease and rented it For New Dawn it was a business deal. There was a mortgage to pay along with maintenance etc., and the group had to pay enough to cover that, but all decisions were taken in consultation with the health care professionals. For their part, the professionals in the hospital had to decide which patients could best fit into the new situation. The project also required collaboration with the provincial government so it could receive a licence and per diem allowances.

Our idea was that the mental health committee should not have to worry about the business side. New Dawn was professionally equipped to look after that. The group home committee should look after the social and human dimensions of the project. One of the New Dawn affiliates was a handicraft centre, so it was a simple matter to arrange for some of the group home residents to take some handicraft courses. Also, New Dawn was involved in construction, so it was possible to provide some part-time work for some of the residents. Since they were paid they were able to pay board to the home.

Families also had to be involved and a compromise reached that met the objections of those who were afraid to let go of a “handicapped” member and, at the other extreme, those who wanted government or some other agency to relieve them of all responsibility for their “problem”. The aim was to create the normal situation in which a young person lives independently but maintains a connection to “home”.

I wish I could report the total success of this project but, in fact, it didn’t work out the way I thought it should. The government authorities in social services were not comfortable with a social project being tied into a business. Officially, if you get a grant from Health and Welfare it must be used for health and not business. If you get a grant from the Department of Industry Trade and Commerce, you must use it for business and not social projects. Eventually, the group home committee felt obliged to proceed with the project on their own and so the property was deeded to them, separating them from the New Dawn corporation. The group home is still working, and they have done a lot of good for a lot of people, but I feel that they did not reach their full potential. Among other things I wanted to see New Dawn reserve a few apartments which would have provided more options for the residents of the home. It is my conclusion that when the mental health group tries to set up and operate a project like this on its own, then it is much more difficult to fit the people it is designed to help back into the general society.

The Community-Oriented Corporation

Some people are a bit uncomfortable with the concept but I am inclined to use a corporate business model when dealing with certain social questions. It isn’t that I want to reduce social and psychological problems to purely economic ones. Rather, I insist that sound business practice can be socially sensitive. Sometimes, those involved in the fields of social service are paranoid about business methods and I consider that to be counter-productive.

Let me explain how a community-oriented corporation can work. In a conventional corporation we often see complex subdivisions. There may be a financial department, a construction department, a sales department, a personnel department, and so on. Also, we see that corporations develop subsidiaries for special purposes. A real estate development company may set up a subsidiary construction company. A food distribution company may buy some farms. What the corporation sector teaches us is that in a large conglomerate the different parts can help each other through their specialized functions.

When I talk about socializing the business corporation I am not coming up with something new. The idea of the corporation came from the Romans and the medieval church expanded it to create monasteries. Only during the last few hundred years has the corporate idea been applied solely to economic enterprises. The purposes of the medieval monasteries were certainly spiritual and social but they did not hesitate to develop revenue-generating functions. Some of their inventions were quiteingenious and profitable. (fwo of my favorite modem examples are the Benedictine liqueur produced by the Benedictine monks and the Trappist monks who make Oka cheese as a business venture.)

Many people in social service groups like the mental health associations automatically think of raising money through things like raffles and bazaars. These methods are inefficient and often frustrating and embarrassing. (I have seen topflight business people selling 50-cent tickets.) I would prefer to have talented business people using their time to figure out a business that would be a more stable and long-term way to finance group homes and to provide the jobs necessary if ex-patients are to fit into society.

My bottom-line suggestion is that the best structure for the partners who should be involved in the integration of the ex-patient into the community is the business corporation, a humanistic business corporation with the members of its board of directors using their talents, not for personal profit, but for the profit of both the ex-patient and the community in general. Ex-patients as well as supporting individuals and groups can become members of the corporation. The role of each will be different, but complementary, and making a contribution. In successful business corporations everyone is important, the president as well as the one who washes the windows. Everyone has something to contribute. As long as they work together in a common structure, all of the partners will benefit.

Since I was cautioned in my early years about the dangers of putting new wine in old bottles, I promote the establishment of new corporations. This does not mean that we should oppose the established corporations; they can help and collaborate. Indeed, I am requesting established corporations to participate in an executive-loan program, whereby large corporations would lend executives to fledgling community corporations.

I can envisage a community corporation producing furniture as competitively as any other but having a personnel department which administers a special training program for ex-psychiatric patients. I don’t believe that sheltered workshops can survive too long on their own when they are unifunctional; they are automatically handicapped in the marketplace.

Instead, I believe that the same goal can be attained in a larger multi­functional corporation.

The idea of a community corporation is not very mysterious. It should look a lot like any other business corporation except that it is owned and controlled by people who want to use the assets and power of their corporation to solve community problems. In places like Cape Breton the biggest problem may be unemployment. In places like Toronto or Halifax it may be mental illness or other social ills. A large part of solving any problem is keeping an open mind about it I have shown why the business corporation is not a type of organization that must be automatically unsuitable for the promotion of social causes. On the contrary, it has an enormous contribution to make. It is up to us to ensure that this contribution is realized.

 

GREGORY MacLEOD

Professor, University College of Cape Breton, Sydney, Nova Scotia