Anti-Psychotic Drugs

Doctors are continuing to prescribe anti-psychotic drugs (such as olanzapine and risperidone) to control the behaviour of elderly and confused patients, especially in hospitals and care homes, despite strong guidelines indicating that they are inappropriate for this purpose and carry dangerous side-effects.

• BBC News: Doctors 'ignoring drugs warning'
• BBC File on 4: 'What did they give my mother?'

A typical pretext for prescribing these drugs is that the patient is agitated or upset - assertiveness framed as aggression. In other words, if an old person complains about the quality of care, the easiest way to fix the problem is to slip some olanzapine into the cocoa. If there is any psychosis here, it is in the system and not in the individual.

Drugs may be justified if they provide some therapeutic benefit for the patient, but not if their purpose is merely to compensate for the inadequate care offered to old people. The BBC has found cases where the patient's life appears to have been significantly degraded or shortened by these drugs, simply to make things easier for the carers. The use of these drugs for this purpose is deeply unethical.

Meanwhile, there is a much better and cheaper remedy for agitation among demented patients: drinking more water.

• BBC News: How care home keeps elderly healthy

Unfortunately, drinking water has a well-known side-effect, possibly resulting in more work for the care home staff, so we may see some resistance to this remedy among the less caring care homes. (Some schools also discourage water-drinking, to prevent the pupils needing to go during lessons.) When you are checking out a home for an elderly relative (or a school for a younger one), small details like the provision of water can provide good clues about the real purpose of the institution.

Surveillance and its Effects

Surveillance is a process of keeping people (such as customers and employees, as well as members of the public) under close supervision. What are the effects of surveillance? Here are two answers from an interesting blog (now called Into The Machine) whose main purpose seems to be to critique the authoritarian policies of the UK Home Secretary (past and present).

• All CCTV monitoring does is lock down the public face of our nation, allowing us in our public capacity to simply sweep aside all the factors that lead to the crime and attitude we're experiencing every day. (The Two Faces of CCTV)
• Surveillance will always produce nothing but underground revelry and a false sense of security. (The Ubiquity of Unnatural Surveillance)

[update: blog title and URLs changed, content looks the same]

It is clearly important to understand the effects on those being observed. But it is also interesting to note the effects on those doing (or relying upon) the observing.

Jeremy Bentham’s panopticon was originally a prison so designed that the warder could watch all the prisoners at the same time. By extension, this term is used to describe any technical or institutional arrangement to watch/ monitor large numbers of people. It forms part of Foucault's analysis of discipline, and provides a useful metaphor for various modern technologies

• CCTV
• workforce monitoring
• database systems such as customer relationship management (CRM)
• Google

The panopticon provides surveillance, and may result in a loss of privacy for the people being watched / monitored, but may also make people feel they are being looked after (better quality of service, safer). If you know you’re being watched, this may trigger various feelings – both positive and negative.

Besides the impact on the people being watched, the pantopticon often has an adverse effect on the watcher. The panopticon gives the illusion of transparency and completeness – so the watcher comes to believe three fallacies

• that everything visible is undistorted truth
• that everything visible is important
• that everything important is visible

This is one of the reasons why surveillance mechanisms often become dysfunctional even for those doing the surveillance. For example, instead of customer relationship management (CRM) promoting better relationships with the customer, it becomes a bureaucratic obsession with the content of the customer database.

See also Surveillance 2 (September 2005)