Prisoners and systematic boxes


I am not sure what I would have to do to receive a three-month prison sentence.

Perhaps, steal a car, drive very (very) fast or accrue lots of parking tickets – I can’t quite think of anything else. I don’t know if that says more about me and my sheltered existence or the crimes described…

Nevertheless, to be honest, I really can’t think what I would have to do, particularly in the context of my having committed no obvious felony, to have my liberty deprived for such a period. Yet, I know many people, regular citizens, who are routinely subjected to these restrictions, usually, it has something to do with mental health – for example, an individual posing a risk of harm to themselves or another who is detained under a section of the mental health act; some people are even less fortunate and find themselves outside this framework – adrift in the complexities that are health and social care.

We have lots of systems – pathways and standards that are designed for the majority – those who represent the normal distribution of individuals seeking health or social care support; we do not have robust systems to support those who don’t fit neatly into such a box – a young person with dementia, for example; what do we do?

It is sort of alright if you are very old and have dementia – that is almost what is expected; even today, I discovered someone who was labeled as having ‘dementia’ – I am sure because they are old, have grey hair, are immobile in bed, unable to speak for themselves and apparently confused; (The same person might have assumed the author of The Diving Bell and the Butterfly, Jean-Dominique Bauby was demented, were he to turn-up on a routine medical on-call)

Dementia, particularly if you don’t fit in to a nice systematic category – i.e. you are too young, too aggressive, or, too at risk of falling, is a major problem for the system, with the outcome, often being that you are likely to spend significant periods of time transitioning between where you live and where you will live for the rest of your life.

That transitional time, often, in my experience, is usually, time spent in an acute hospital, not necessarily in a bed, as often the people aren’t bedbound, the system just doesn’t have anywhere else to place these people, to keep them out of harms way.

And I think this is a shame, this is a travesty, that those who are particularly vulnerable, happen to find themselves trapped, during the time that funding, care, treatment or support is identified in its various guises.

My poor patients are kept as patients, just as I am trying to undo the mythology of patients, trying to negate the harmful influences of care on people who have so much potential, so much to contribute, were it not for the, what I often perceive, as lack of imagination of our society and ability to think of solutions that are person-centred.

We treat people like diseases; we isolate, investigate, diagnose and manage, when sometimes, sitting, listening, handholding and thinking creatively, are what is needed.

Alan Paton wrote Cry the Beloved Country, I sometimes cry for the beloved, the forsaken who don’t fit into our systematic boxes.


Published by rodkersh1948

Trying to understand the world, one emotion at a time.

2 thoughts on “Prisoners and systematic boxes

  1. Thought provoking in so many ways. The systemic challenges of providing patient centred care are considerable and will not get easier. You are not alone in your passion for patient / person centred holistic care and if different parts of “the system” including people, families, voluntary organisations work together this can be achieved. It puts the focus on the importance of asset based community development for me. But your blog also made me think of the consequences of a diagnosis and what sociologists called labelling theory. On the one hand a diagnosis offers a relief and access to care and support and sometimes maybe a cure. But the dark side is labelling, dehumanisation and depersonalisation captured so vividly and painfully by Goffman in his book “Asylums” and in popular culture in the film “One flew over the cuckoos nest”.


    1. Thanks Ann – I appreciate your comments; I just wish I had some way to teach to train, to show the system – for, it isn’t the people, how to see the person, see beyond the technocracy, some more efficient way than chipping with a damaged chisel.


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