Destroying Sanctuary The Crisis in Human Service Delivery Systems

ISBN-10: 0199977917
ISBN-13: 9780199977918
Edition: 2013
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Description: For the last thirty years, the nation's mental health and social service systems have been under relentless assault, with dramatically rising costs and the fragmentation of service delivery rendering them incapable of ensuring the safety, security,  More...

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Book details

List price: $36.95
Copyright year: 2013
Publisher: Oxford University Press, Incorporated
Publication date: 2/12/2013
Binding: Paperback
Pages: 442
Size: 6.25" wide x 9.25" long x 1.00" tall
Weight: 1.540
Language: English

For the last thirty years, the nation's mental health and social service systems have been under relentless assault, with dramatically rising costs and the fragmentation of service delivery rendering them incapable of ensuring the safety, security, and recovery of their clients. The resulting organizational trauma both mirrors and magnifies the trauma-related problems their clients seek relief from. Just as the lives of people exposed to chronic trauma and abuse become organized around the traumatic experience, so too have our social service systems become organized around the recurrent stress of trying to do more under greater pressure: they become crisis-oriented, authoritarian, disempowered, and demoralized, often living in the present moment, haunted by the past, and unable to plan for the future.Complex interactions among traumatized clients, stressed staff, pressured organizations, and a social and economic climate that is often hostile to recovery efforts recreate the very experiences that have proven so toxic to clients in the first place. Healing is possible for these clients if they enter helping, protective environments, yet toxic stress has destroyed the sanctuary that our systems are designed to provide.This thoughtful, impassioned critique of business as usual begins to outline a vision for transforming our mental health and social service systems. Linking trauma theory to organizational function, Destroying Sanctuary provides a framework for creating truly trauma-informed services. The organizational change method that has become known as the Sanctuary Model lays the groundwork for establishing safe havens for individual and organizational recovery. The goals are practical: improve clinical outcomes, increase staff satisfaction and health, increase leadership competence, and develop a technology for creating and sustaining healthier systems. Only in this way can our mental health and social service systems become empowered to make a more effective contribution to the overall health of the nation.Destroying Sanctuary is a stirring call for reform and recovery, required reading for anyone concerned with removing the formidable barriers to mental health and social services, from clinicians and administrators to consumer advocates.

Preface
Prologue: October 1996
Sanctuary Retreat, October 25, 1996
Introduction: January 2010
Sanctuary
"Aha" Experiences for Health and Human Services
Systems in Crisis: The Impact of Biological Reductionism
System Degradation: Systems in Crisis
New Mental Models
Organization as Machine
Organization as Living Being
Thinking About Operating Systems: A Useful Metaphor
Hardware, Software, and Operating Systems
The Human Operating System and the Virus That Disrupts It
Organizational Culture: The Organizational Operating System
Organizational Stress, Parallel Process, and Trauma-Organized Systems
A Word About Vocabulary
Chapter Summaries
A Cautionary Note
Human Service Organizations: Dead or Alive?
The Case of the Separated Garbage
Mental Models Shape Our World
Organizations as Machines
Health Care as Commodity: The Failed Balancing Act of U.S. Health Care
Mental Models of the Healing Professions
Aesculapian Authority
Community Responsibility
Health Care and the Threat of Communist Enslavement
Privatization Rules
Managed Care and Ethical Conflicts
Mental Models for U.S. Capitalism
Lessons Learned?
Mental Health: An Example of a System Under Siege
System as Machine
Social Engineering Cannot Address Adaptive Problems
Interlocking Crises
What Happened to the Social Psychiatry?
The Personal Is Political
A Biopsychosocial Model and General Systems Theory
The System Bites Back
Reductionistic Behaviorism
Deinstitutionalization and Deregulation
And That Brings Us to Today
The Economic and Human Burden on the System
Managed Care and Inadequate Payment
Transinstitutionalization and Inappropriate Care
Just Don't Ask About Trauma
Systems in Crisis
Conclusion
"I Gotta Get Out of This Place": Workplace Stress as a Threat to Public Health
It's All about Stress
Kinds of Stress
Allostatic Load
Adverse Childhood Experiences: A Public Health Nightmare
Adverse Childhood Experiences and the Workforce Crisis
Trauma Touches Everyone
Workplace Stress: Definitions, Scope, and Costs
"Normal" Sources of Workplace Stress
Downsizing and Turnover
Workload and Job Complexity
Role Definitions
Relationships, Diversity, and Health Disparities
Inadequate Training and Career Development
Regulation, Paperwork, and Corporate Compliance
Professional Values, Ethical Conflicts, and Burnout
Disruption in the Organizational Operating System
Lack of Mission Clarity
Lack of Innovation and Stagnation
Conclusion
When Terror Becomes a Way of Life
Attachment: The Human Operating System
Mirror Neurons: Wired at Birth for Social Relationship
Attachment in Adults
Social Support
Attachment to the Group
Group Cohesiveness
Trauma Disrupts Attachment
The Young Brain Organizes Around Trauma
Attachment Trauma and Betrayal Trauma
Disrupted Group Attachment Threatens Survival
Deindividualization and Ostracism as Disrupted Attachment
Disrupted Attachment, Stress, and Trauma
The Human Stress Response: What Does Everyone Need to Know?
When Terror Becomes a Way of Life
Individualism, the Common Good, and Modern Day Stress
Loss of Basic Safety and Chronic Hyperarousal
Loss of Emotional Management
Difficulties With Learning Memory, and Decision Making
Miscommunication, Conflict, and Alexithymia
Authoritarianism and the Danger to Democracy
Learned Helplessness
Punishment, Revenge, and Injustice
Addiction to Trauma, Trauma-Bonding, and Traumatic Reenactment
Grief, Reenactment, and Decline
The Germ Theory of Trauma and Public Health
Time-Binding Animals
Existential Terror and Terror Management Theory
Social Problems are Preventable
Who Deserves Empathy?
Science: Enemy or Ally?
Conclusion
Parallel Processes and Trauma-Organized Systems
Organizations as Complex, Adaptive, Emergent Systems
The Concept of Groupmind
General Systems Theory
Living Systems Are Characterized by Emergence
Not Sick or Bad, But Injured
Living Systems With Visible and Invisible Groups
Group Stress Responses
Group Emergency Responses to Threat
When Threat Becomes a Way of Life: Parallel Processes Emerge
Sanctuary Trauma
Sanctuary Harm and Collective Trauma
Social Defense Systems
Bion and Basic Assumption Groups
Jung and Shadow Groups
Menzies and Social Defense
Institutional Uncertainty
Institutional Trauma and Breakthrough Anxiety
The Social Defense System Operating Today
Parallel Process: A Trauma-Informed Understanding of Social Defensive Structures
What Is Denied Comes Back to Haunt Us
When Tragedy Strikes: The Impact of Chronic Stress and Collective Trauma
Conclusion
Lack of Safety: Recurrent Stress and Organizational Hyperarousal
Crisis in Human Service Delivery
Six Stages of Crisis Management
Violence in the Human Service Workplace
Dangerous Professions
Workplace Aggression and Bullying
Adult Psychiatric Inpatient Suicide
Working With Traumatized Children: Child Protection Workers
Chronic Crisis Equals Chronic Hyperarousal
Loss of Social Immunity
Thwarting Basic Needs
Triggering Mistrust
The Betrayal of Trust
The Blame Culture
The Silencing Response
Moral Distress
Unrelenting Systemic Stress
Conclusion
Loss of Emotional Management
Emotional Intelligence and Trauma
Emotional Resonance and Contagion
Emotional Labor
Economic Invisibility and the Legacy of Gender Discrimination
Emotional Labor and Job Requirements
Training for Emotional Numbing
Dehumanizing Caregiving
All You Do Is Talk to People
Managers and Emotional Labor
Organizational Emotions
Emotions and Organizational Crisis
Groupthink
Conformity
The Abilene Paradox
Chronically Fear-Based Organizations
Conflict in the Workplace
The Nature of Conflict
Conflict and Emotional Intelligence
Different Kinds of Conflict
Conflict Management Strategies
Conflict Management Under Stress
Chronic Conflict and Organizational Learning
Conclusion
Organizational Learning Disabilities and Organizational Amnesia
Organizational Learning Disabilities
Chronic Stress Interferes With Learning and Adaptation
What Is the Increase in Value We Are Aiming for?
No Time for Process-Failure of Integration
Wisdom Walks out the Door and Is Not Replaced
Labeling That Prevents the Expansion of Knowledge
Self-Fulfilling Prophecies: Setting the Trap for Reenactment
Filtering out Trauma
Organizational Memory and Organizational Amnesia
Failures in Memory Storage
Downsizing Memory
Organizational Amnesia and the Mental Health System
Those Who Cannot Remember the Past…
Factors Contributing to Loss of Knowledge
Trauma and Organizational Memory
Compromised Decision Making
Absence of Participation in Decision Making
Decision Making Under Stress
Stress and Group Performance
The Destructive Aspects of Silencing Dissent
Group Polarization: Why It Must Be Safe to Dissent
Dissent Is Rarely Welcomed
Conclusion
Miscommunication, Conflict, and Organizational Alexithymia
Patterns of Organizational Miscommunication
Different Lenses, Different Points of View
Different Theories, Different Mental Models
Inadequate Information Systems
The Ease of Miscommunication
Miscommunication in Systems
And Then There Is E-mail, Texting, Cell Phones, Blackberries, Twittering…
Size Matters: Communication and Group Size
Communication Under Stress
Poisoning the Grapevine
The Undiscussables and Organizational Alexithymia
Collective Disturbance As Organizational Dissociation
The Natural History of a Collective Disturbance
Chronic Collective Disturbance
Dehumanization and Bureacracy
Conclusion
Authoritarianism, Disempowerment, and Learned Helplessness
Exerting Control: An Adaptive Evolutionary Response to Fear
Everyone Wants to Be Powerful
Learned Helplessness and the Lust for Power
When People Become Poison Containers, the Poison Leaks Out
Trauma Is Inescapable Shock Learned Helplessness
Learned Helplessness and Blaming Others
Our Systems Promote Learned Helplessness
The Parallel Process of Organizationally Induced Helplessness
Risky Risk Avoidance
Risk and Risk Avoidance in the Mental Health System
Chronic Crisis, Centralized Control, and Terror Management
Chronic Crisis and Authoritarian Behavior
The Inherent Problem of Authoritarianism
Authoritarianism in Human Services
Dangers of Authoritarianism Under Stress
Bullying in the Workplace
Toxic Leaders and Petty Tyrants
Barriers to Empowerment in the Workplace
Bogus Empowerment
Conclusion
Punishment, Revenge, and Organizational Injustice
The Problem of Revenge
Development, Trauma, and Revenge
When Good People Do Bad Things
Obedience to Authority
The Lucifer Effect
Sanctioned Perpetration
The Dynamics of Violence and the Bystander
Bystanders Beware
Why Organizational Injustice Matters
Types of Organizational Justice
When Organizations are Perceived as Unjust
Justice, Trust, and Emotions
Organizational Injustice and Health
Impact of Organizational Injustice on a Group
Organizational Retaliation
Punishment in the Workplace
Is Punishment Effective?
Punishing Unconscious Reenactment
Punishment to Change Behavior or as Revenge?
Punishment and Performance
Ethical Paradigms, Ethical Dilemmas
Moral Development and the Ethical Organization
Conclusion
Unresolved Grief, Reenactment, and Decline
Loss of Attachment in the Workplace
Complicated Mourning
Ambiguous Loss
Disenfranchised Grief
Traumatic Loss, Chronic Loss, and Organizational Change
Traumatic Reenactment: Never Having to Say Goodbye
Enactment in Our Evolutionary History
Collective Reenactments
Costs of Not Addressing Normal and Complicated Loss
Vicarious Trauma, Secondary Traumatic Stress, Compassion Fatigue, and Burnout
Burnout
Organizational Decline
Successful or Permanent Failure: Is This the Future We Want?
Conclusion: Chronic Disaster
Restoring Sanctuary: Organizations as Living, Complex Adaptive Social Systems
There Is So Much at Stake
Sanctuary Model: A New Operating System for Organizations
Universal Commitment
S.E.L.F.: A Nonlinear Organizing Framework
The Sanctuary Institute
The Sanctuary Network and Sanctuary Certification
References
Index

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