Early history for the hub proposal

Approaching problem situations

As indicated on the About page, I grew up in a paternalistic colonial society then lived in a town where the sentiments were pro-Nazi and the walls were adorned with swastika graffiti.  The horrors of the holocaust, were accompanied by the cruelty of the Japanese, and the horrors of Russian and Chinese communism.  I lived through the development of apartheid.  Since then we have had genocides in Europe and in Africa, the rise of fundamental Islam, the resurgence of fundamentalist Christianity in the USA and the advent of Donald Trump in that country.

My interest in belief systems and ideology ideology started early as I could never understand how such a large number of people even a whole country could become so deeply committed to irrational beliefs that they would kill millions of their own citizens and at other times themselves.  This could not be something done by isolated people.  It was a universal human problem that we all had.  So I became interested in what people believed in and have tried to see their actions within that context.  The great mistake we make is to call people evil or terrorists when in fact they believe implicitly in something and don't challenge those beliefs.  Most are caught up in it and believe that they are doing the right thing. Too often our problem is not villains but people who believe and have no doubts.

Furthermore, if you look around you see that every one of us, in our everyday lives, come to believe in things and we do the things we do in life because of them.  Many of them are irrational  even when they lead to good outcomes and not bad ones. Most are half truths or limited insights from a particular sphere of activity where they work that we then generalise.  We apply the ideas to everything we do.  These are the ideas that allow us to understand the world we live in and which give our lives meaning.  We cannot do without them so we are trapped. We have to learn to manage them and the evidence shows that we are singularly lacking in insight and do it very badly.

So we live by and through our beliefs and this extends from the small personal things we do, through a range of more complex beliefs to the great global ideologies of democracy, capitalism, communism, socialism and the perils of racism, sexism and ageism.  Many are beneficial and others are harmful, at least to some.   Most do not end up with piles of bloody bodies and mass graves, but there is a lot of suffering and dysfunction along the way.  While Nazi Germany and aged care may be worlds apart in what they wanted to achieve and in what they have done, they are both human activities.  Nazi Germany provides very important insights into how we humans behave when we believe in something and don't listen to what others who don't believe are saying. The aged care system we have today is a consequence of our beliefs and our not listening to the warnings made by critics.

You would think that by now we would all be acutely aware of the risks that our beliefs will get out of hand and critically examine any new ideas we have, listening carefully to our critics and proceed cautiously looking out for potential problems. But instead we seem to do the very opposite.  We form groups of true believers who reinforce each other.  We attack and discount our critics and their arguments.  We sell our ideas with rhetoric and catch phrases. We don’t collect information to resolve issues and when bad things happen we don’t see them, rationalise them away or angrily reject them.  And when we do these things we have no doubt that we are right. 

So with this background I don’t look around for someone to blame when things go wrong. Instead I look at what people who are doing these things believe to see what the relationship is.  I also look for the tell tale responses that true believers make to evidence of malfunction and to their critics. I look at their increasingly bizarre efforts to maintain their illusions, usually by developing more. The signs are unmistakable. Those often well intentioned but dysfunctional patterns of thinking that result in harm deserve a name. I have called them "culturopathies" or "culturopathic".

In analysing aged care, I look at what people are saying and doing to see what they believe.  In designing a solution, I look to creating a context where all of us can contribute, where many points of view have to be listened to and where criticisms have to be confronted.  I make sure that it has access to all of the information that is available and is close to the real experience being dealt with.  The intention is to ensure that true believers and certainty about what we are doing is confronted and that an element of uncertainty persist in whatever we do so that we are continuously reassessing and reconsidering our actions and respond when they don't work.  We cannot wait another 19 years to find out.  These ideas have been behind my proposal for a Community Aged Care Hub.

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Early thoughts about the Community Aged Care Hub

First attempts to find a solution: In October 2000, a little over 10 years after I first became worried about a US multinational's business practices in health care and started making enquiries, and 4 years after I started the Corporate Medicine website, I wrote a web page based on what I had discovered by then called Lessons for the Future. There is also a link on that page to the academic disciplines and some of the people whose writings influenced my approach to these problems.

Texas Senator Mike Moncrief, who had investigated some of these companies in Texas and whom I met in 1993, helped me by giving me access to the documents from his inquiry. He said that for him it was like peeling an onion. As each layer came off, the more pungent it became.

The web page I wrote in 2000, reflected my thoughts at the time, and my interest in addressing the problems by creating relationships between sectors with incompatible paradigms (patterns of thought). I had by then, stripped off the outer layers of the onion. I wanted to create ethical boundaries between sectors adopting different paradigms, that both sectors recognised and accepted.  Each sector could continue to function effectively.  Each sector would understand the differences in thinking of the other and recognise what was appropriate to each.

Idealistically, I still believed that some sectors could be kept not-for-profit, and did not realise that the corporate lobby and the new market ideology was totally committed to dominating every sector of our lives. I was naive in not fully appreciating the nature of ideology, and its ruthlessness in achieving its objectives.

In the 14 years since I wrote that page, a lot has happened and, as layer after layer came off the onion (I did not realise how many there were), it has become ever more pungent - and the corporate medicine web site grew to over 550 web pages. I would not like to be held to the views I held in 2000, but the underlying analysis has been repeatedly reaffirmed. Much has changed. Hopefully I have gained more insight and a better understanding. Among its other functions, the proposed hub is intended to provide a forum, where some of the general processes I referred to in 2000 are included, and where the ethical barriers between sectors can be negotiated and managed.

Subsequent attempts: In a web page I wrote about the aged care accreditation system in 2006 I wrote:

I subsequently discussed how the community could be involved, with groups who were concerned about what has been happening.

In 2009 I made separate submissions to reviews into the Aged Care Complaints Scheme system and the accreditation of aged care homes system. I suggested that complaints handling, regular oversight, and monitoring of accreditation practices be situated in the community. They should be jointly supervised and administered by the community, government and the agency, with defined roles for each. I suggested ways in which this could be done.

In a further submission to the Productivity Commission's Inquiry (Caring for Older People) in 2010, I expanded on this and advocated for a community organisation or hub. Medical personnel would be included. This was to be responsible for coordinating and organising all aged care activities and was to act as customer for the services provided. Aged Care Crisis supported my ideas in their submissions.

The government would have been a joint partner in my proposals, providing training, supervision, and acting as mentor for staff working with the community group hub. The accreditation process would have worked with and through this group. There would have been a central national organization drawn from the communities to represent them in negotiations with government.

Current web pages: After the 2013 aged care scandals, I wrote the first three parts of the Solving Aged Care section on the Aged Care Crisis website and positioned them as additional components to Professor Maddock’s proposal for a Community Aged Care Hub and adopted his name for it.

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Theoretical Framework

My analysis of aged care can be seen as broadly situated within, but not constrained by, the constructionist approach to analysis (also called sociology of knowledge). It is a social theory about how we develop knowledge and use it. It has its origins in phenomenology and the theories of social construction first developed by Berger and Luckman in the late 1960s. It is well suited to an analysis of belief/knowledge systems and the relationship between individuals and their cultures in developing and maintaining these. 

I use it to analyse knowledge systems that don't work for mankind and cause harm, how they are created, why they are adopted and are applied in excess, how they are maintained and why they are so resistant to fact and logic. In proposing a solution I have suggested a social structure within which knowledge systems that serve society can be adopted and those that are harmful can be identified and either modified or resisted.

I chanced upon the following description in a recent article by Steven Anthony Quigley which I felt set out these ideas quite well.  I can't pretend that I have read any of the authors he references or the terms used.  The academic development of these ideas, which I became familiar with in the 1970's and applied in my own analyses of events, has progressed considerably since then.

Wikipedia has a longer article looking at the development of constructionism.  Because of my personal close involvement with several different cultures with very different views, I became interested in the work of Berger in sociology in the 1970s.  At the same time, I was learning a language and some basic linguistics. I also became superficially acquainted with some philosophy including some of Wittgensteins work on language. Because of my interest in medical education, I studied communication theory.  Constructionism was developing as a theory there too, but that word was I think coined much later.

My particular interest has become in patterns of thinking that don't work and are harmful. Often this is because they come from a different context and from a group that does not operate in the context where it is being applied but which imposes its ideas on it anyway.

The proposed hub: The proposed Community Aged Care Hub is an attempt to create integrated social units involving all those directly involved in aged care close to the coal face. Here they can interact and develop ideas that are relevant to what they are encountering in aged care. They should have the power to resist inappropriate ideas and then to promote their understandings of aged care in the wider community.

It is an attempt to create a context which encourages "openness to experience, open-mindedness, comfort with ambiguity, and cognitive complexity in terms of self and others". Within this sort of context it is difficult to get away with oversimplification, selective perception, knowing but not acknowledging, rationalising, compartmentalising, controlling information and the many other strategies used by culturopathies to maintain their legitimacy.

This can be contrasted with the narrow and over-simplistic rigid patterns of thinking that have been imposed by an ideology developed elsewhere that has little to do with actual care.

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