Thursday, August 6, 2009

lack of philosophy in a nursing home

Institutions develop infrastructure of rules and regulations. Persons within and without institutions, if they are reputable, have expectations institutions will incorporate better rules and regulations rather than worse. But what is the mean between better and worse? It is usually taken to be whatever exists in the present. The penetration of the mean everywhere in an institution is the first principle of governance, whether public or private.

That being accepted, it is to be noted that persons within and without an institution, beyond expecting better rules and regulations, will cultivate certain bench markers to judge the state of the institution in its mean between better and worse. Rare or unknown is a philosophy of such bench markers. Consequently, judgment degenerates into an assortment of gross specifications which institutions, as a result, are expected to exhibit or run the risk of dissent, possibly venomous dissent. Foremost, for many people, of these specifications is that of consistency. It is foremost because it works in many cases, that is, it enables dissent to be informed by clear and simple illustration of why certain forms are better and certain forms are worse than the mean penetrating throughout the institution. Without this bench marker conditions would easily slip into incomprehensibility for even the most cogent of analytical observers, both within and without the institution.

But consistency is only a gross specification. It cannot accompany the mean everywhere. It is limited in breadth and depth of import throughout the footprint of an institution within itself and without itself. For breadth and depth of import everywhere, admittedly a distant standard for humanity, it is necessary to move in the direction of science, and for this civilization the result in both popular and professional orientation to passage upon the thoroughfares, into byways, and advancing upon frontiers, that has produced philosophy, whose primitive manifestations have included religion and folk tales, and whose recent improvements have led to the general availability of a liberal education. Application of philosophy to life is not easy but it certainly is better than religion and folk tales, and it tends to do better within and without institutions than mere gross specifications as a demand upon judgment of rules and regulations as being better or worse than the mean throughout the institution.

Science, in the ideal case being mathematically formulated natural philosophy, does not accompany men's judgment everywhere they go. For the best of men such accompaniment is limited to simple, non mathematical philosophy, and this structural foundation of civilization's advance has been pursued vigorously for hundreds, perhaps thousands of years, with occasional major advances by persons who have consequently acquired legendary status--persons such as Pythagoras, Buddha, and Fu Hsi. I am not so optimistic as this makes me sound. What of war? Poverty? Abuse of one or more persons by one or more persons whether its obscurity is found in small or large degrees of authority? These will only pass away when the accompaniment of men on all paths is science. Certainly the attainment of such a state is not guaranteed to any species, even homo sapiens in all his trust in his progress's inevitability and non reduction to a limiting sum of an infinite, or perhaps finite, series of species-wide steps.

Philosophy therefore being preferred over gross specification, it is to be considered greatly arguable whether a certain rule at the nursing home where I live is better or worse than the mean which penetrates throughout that home, that rule being that residents are to be always accompanied , supervised, assisted, and even stood in for, when getting hot water out of the hot water outlet on the food line, by staff. I think anyone who has read much of this blog will see how absurd this will be when it is applied to me, as it was this morning (August 5, 2009).

But is it a rule that is worse than the mean? Here is where the great argument will commence.

I have observed something else in the kitchen that also irritates me, and I see it practiced widely everywhere. Someone getting food in a group of equals gets his plate and then tells the server to give him more of one item than the server gave to him as his equal share with everyone else. The server accedes.

Now maybe the server first refuses, but the person gets more forceful. This may go back and forth at length, but eventually, more often than not, the server gives in and puts another spoonful on the person's plate. When I observe this happen I am always on the verge of bursting out, "You get more and the rest of us have to accept what we're given because we're not rude like you are. What justice is there in that?"

Anyone who does this would undoubtedly read this post with a different sense than anyone who sees what I'm talking about.

So while they are bending over backwards to stop me from pouring my own hot water, they are putting an extra helping on the plate of the guy ahead of me because he is rude enough to make a scene, and this in full view of others in line who will be met with less conformity if they should say, "Hey. You let him have more. Why can't I too?" It's the same employee who does both, literally.

So here is where most analysts would argue from consistency against the simultaneous execution of both practices.

But for me it is not so simple. Consistency, as I said, is not able to go everywhere in breadth and depth with rules and regulations. In this case, we could say that while here you are being strict, there you are being lenient, and that's not consistent.

But real consistency demands that two situations have a common framework or foundation, and this is not true here. In one case, there is a safety issue with special relevance because of the large number of functionally challenged residents living here. In the other, the issue is one of authority. Does the server have the authority to deviate from nominal equality? If he does, then I will have to accept it if he decides for his own reasons that he will honor a rude request. If he does not, then we have a roguery completely legitimized, merely by isolation of the point of service in the setting of the institution. This roguery is spread from the serving line to the server. But which is it? Does he have the authority to decide himself, or do regulations leave him no tolerance? One condition, the one where regulations leave the server no tolerance, requires a lengthy discussion between the philosophically endowed observer, who is also a paying resident, and the staff hierarchy. Most likely such hierarchy will not have the patience with a resident, none of whom are recognized as philosophers in any true sense, to reach a satisfactory conclusion with the resident who brings the matter up. The other condition, the one where the server has all the authority he needs to give out more food as he sees fit, may be poor organization, but it cannot be faulted on its command logic. My initial question to staff hierarchy will be simply whether servers have authority or do not have authority to give larger portions as they see fit.

Returning to the first case, of hot water pouring, the critical factor is to what extent is it practical for staff to become familiar enough with different residents that a decision of whom to stop from pouring hot water and whom not to can be made easily, which means without having to create a "no pour" list, and also faithful enough to residents' own view of their own functionality that arguments will not erupt over hot water.

As can be seen from these examples psychiatric nursing homes are fraught with delicate bureaucratic ensnarements, some commonly encountered and some particular to nursing homes.

What allows institutions to function is as much the frequency of philosophically adept observers in society as it is good rote analysts who usually make up the rules in the first place. It is the patience and continuing reflection of the first that gives the second time to eventually make the right decisions. Where the frequency of philosophers is low, thing tend to get mired or maybe just mediocre. Where fortune smiles and the frequency is high, much good will follow.