Good Intentions Overruled: A Critique of Empowerment in the Routine Organization of Mental
Health Services. By Elizabeth Townsend. Toronto, ON.: University of Toronto Press, 1998. Pp. 217.
$50.00 (cloth); $16.95 (paper).
Historians, sociologists, policy analysts, legal scholars, and academic professionals often
represent human service practitioners as self-interested state functionaries, as unconscious
minions, regulating, policing, and controlling behavior. Others look for agency, resistance,
discretion, autonomy, and empowerment. Post-modern theorists represent helping professionals as the
product of pervasive and dispersed systems of policy, organization, and discursive power. In short,
the criticism and study of helping professionals fluctuates around two poles, where one is
dominating and the other is empowering. (1)
Townsend's ethnographic study of occupational therapists identifies dominating and empowering
practitioners. The former produces "dependent caregiving" and the latter "enabling participation."
She studies the policy and practice effects of deinstitutionalization. The natural setting for her
ethnography is an adult partial-hospital (in-patient) and community support service (out-patient)
program. At great length, Townsend argues that therapists "objectify" service recipients through
case management and disease model techniques and practices. Her thesis is that a mental health
organization, a policy of deinstitutionalization, a case recording technique, a funding
prerequisite, and specific objectifying practices overrule practitioners good intentions to
encourage independent, self-reflexive, power-assertive clients. Though this is not a new thesis,
the method and data she marshals is freshly presented. The book's aim, however, is offset by an
uncritical use and exploration of the concepts power and empowerment. In short, the strengths of
Good Intentions Overruled are to be found in its methodology, its data, and its persuasive argument
about the relationships among policy, organization, and practice; the book's limitations are to be
found in its pre-loading the practitioner with idealized-as opposed to empirically
grounded-assumptions of shared power, or empowerment.
Townsend's study depends heavily upon Dorothy Smith's institutional ethnography, method, and
theory (Dorothy Smith, The Everyday World as Problematic: A Feminist Sociology Boston: Northeastern
University Press, 1987). Smith provides a strong methodological foundation for Townsend's main
argument. In order to derive conclusions about the normative effects of professional knowledge
schemes, recent studies, for example, examine practitioner texts. Townsend, in contrast, is fervent
about studying actual and everyday practices. In their natural setting, she observes how therapists
keep the mentally ill living in communities and out of hospitals. To study practitioners' enabling
(independent producing) and caregiving (dependent producing) tendencies, she effectively juxtaposes
actual (everyday) with normative work activities. Because most historical and sociological analyses
of helping practitioners tend to examine only written traces, she accomplishes a rarely studied
phenomenon: the practitioner-in-action. And for better or worse, scholars have neither appreciated,
nor studied, how practitioners use strategic (or situated) methods and actions to resolve the
indeterminate situations that practice invariably serves up. The everyday is problematic;
therefore, occupational therapists constantly confront an indeterminate ground between the
hoped-for effects of policy, organization, and theory and its actual or real effects. Ethnography
is uniquely situated to capture the tension between theory and action. Large pieces of practice are
not recorded in case records, progress notes, and other related materials. Thus it is that oral
narratives are crucial to our understanding of the dominating and empowering practices of
professional helpers. Institutional ethnography is capable of placing the oral and written together
in a policy, organizational, and professional context. In using ethnography, Townsend produces a
critical and significant examination of the practitioner-in-environment.
Though institutional ethnography yields productive results for Townsend, her "ruling apparatus"
theory is unproductive. The idea, borrowed from Dorothy Smith, is that professionals reproduce
(ruling) power relations by the use of "objectifying practices," the deployment of hierarchical
decision-making structures, and the writing of "textual" cases; the latter, in particular, acts to
transform mental health clients into diagnostic categories. These three "ruling" practices
privilege the professional side of the helper\recipient, binary relation. Occupational therapists,
Townsend posits, have a "bifurcated consciousness," where one side believes and acts in empowering
ways and the other side supports the dominating methods of the ruling apparatus. Though I do not
find her "bifurcated" thesis untenable, the argument is undermined by a lopsided theory of
power.
The "ruling apparatus" theory is so prominent in this study that it absorbs all the strategic,
personal, and creative sensibilities of occupational therapists. Townsend's dominating and ruling
elite theory obliterates practitioners' situated power; that is, I think situated power is the
everyday knowledge and action that makes up the difference between the ruling elite's desired
effects and the actual or real effects. Her eagerness to show that practitioners don't empower
clients is consistent with the idea that ruling power is top-down, hierarchical, and totalizing in
its effects. Research methods and theory need to move us away from the binaries that see either
dominating or empowering practitioners (Sharon Berlin, "Dichotomous and Complex Thinking," Social
Service Review, March 1990: 46-59). We need instead to see how professionals find a thirdspace, a
practice space between privileged ruling powers and non-privileged shared power. Townsend leaves us
only with a theory of ruling or disciplinary power. She does not provide a set of theoretical
concepts that would enable us to see practical work as an outcome of both ruling elite and
practitioner power. Thus, her ethnography fails to show us how therapists' intentions may be
overruled by their uncritical and everyday situated power; instead, "dependent caregiving"
practices are an outcome of the "ruling apparatus," or disciplinary theory alone.
Indeed, her one-sided theory undermines the naturalistic method of studying actual empowering
and dominating activities. For Townsend, among helpers and recipients, empowerment is the act of
shared decision-making and shared resources. This theory of power is heavily dependent upon Steven
Luke's power-over thesis (Steven Lukes, Power: A Radical View London: Macmillan, 1974).(2) For
example, Townsend can't have contradictory forces (and a bifurcated conscious) unless she posits a
universal: the struggle to gain power-over a finite amount of power. To define empowerment as an
outcome of equal sharing requires that one know how much (total) power is available. Thus, her
theory requires the ontological assumption that a finite amount of power exists. The central
problem in this type of conceptualization is that power is so idealized that it can't be studied.
There are at least two reasons for this. First, though Townsend needs to show us the different
empirical amounts of power, she doesn't; and to do so is necessary to the argument. That is, to
know (epistemologically) when power is equally shared, we must first measure how much exists.
Second, by assuming equal parts of power, any apparent unequal distribution-in a teleological
fashion-requires participants to struggle, to claim, or to reclaim specific portions. Thus, her
practitioners have a bifurcated consciousness because they respond to conflicting (and
contradictory) power struggles over decision-making and resources. But, I argue, her power is so
rationally and abstractly constructed that it cannot be empirically grounded or discovered. In
other words, what she claims to have discovered-a bifurcated consciousness-is an outcome of her
theory, not her data. Townsend's one-sided, power-over theory offsets the productive use of
contrasting normative (disciplinary) and practitioner power (situated).
Moreover, in reversing her theory of power my criticism can be elaborated. Instead of
practitioners struggling with clients over finite amounts of power, what if power were pervasive?
What if power were always already present? What if there were an infinite amount of power? In other
words, by shifting attention away from power's finite character and its possible equal parts, we
may need instead to look toward the actual empirical effects of power. Studying the effects of
power doesn't require a utopian sensibility that power must be equally shared; at least by studying
the empirical effects of power, we have some way of establishing criteria for knowing it. I do not
think there is a way of knowing how much total power ever exists. Yet Townsend needs to do
otherwise; that is, in order to pre-load her practitioners with shared decision-making and
resources, she must identify how much power actually exists. And this Townsend does not accomplish.
Therefore a purely idealist notion of power undermines her thesis and drives it towards a moral
imperative: practitioners should share power. Her ethnography would have produced more significant
results had she shown us how occupational therapists actually use power to produce opposing
effects-dependent caregiving or enabling participation. Instead, we are given hypostatized examples
of empowering and disempowering practices.
Even with the epistemological and ontological problems in Townsend's theory of empowerment, her
study is a provocative work that students and scholars of helping professionals should read. It is
well written and a rare example of institutional ethnography applied to helping professionals.
Though she studied occupational therapists, as a social worker, I will return to it myself and I
will have my students read it. Townsend serves up to social work a very researchable but
under-researched question: how do practitioners use their own strategic power when working
alongside the powerful effects of organization, policy, and totalizing knowledge schemes?
Jerry Floersch, University of North Texas
Notes
1) See, for example: Leslie Margolin, Under the Cover of Kindness: The Invention of Social Work
(Charlottesville: University Press of Virginia, 1997). Harry Specht and Mark Courtney, Unfaithful
Angels: How Social Work Has Abandoned Its Mission (New York: The Free Press, 1994). Michael Lipsky,
Street Level Bureaucracy: Dilemmas of the Individual and Public Services (New York: Russell Sage
Foundation, 1980). Margaret Larson, The Rise of Professionalism (Berkeley: University of
California, 1977). Andrew Polsky, The Rise of the Therapeutic State (Princeton: Princeton
University Press, 1991). Andrew Scull, Decarceration: Community Treatment and the Deviant (New
York: Polity Press, 1984). Stanley Wenocur and Michael Reisch, From Charity to Enterprise: The
Development of American Social Work in a Market Economy ( Urbana: University of Illinois Press,
1989). Joel Handler, The Coercive Social Worker (Chicago: Rand McNally College Publishing., 1973).
Mary Odem, Delinquent Daughters: Protecting and Policing Adolescent Female Sexuality in the United
States, 1885-1920 (Chapel Hill: The University of North Carolina Press, 1995). Regina Kunzel,
Fallen Women, Problem Girls: Unmarried Mothers and the Professionalization of Social Work,
1890-1945 (New Haven: Yale University Press, 1993). Elizabeth Lunbeck, The Psychiatric Persuasion:
Knowledge, Gender, and Power in Modern America (Princeton: Princeton University Press, 1994).
Barbara Simon, The Empowerment Tradition in American Social Work (New York: Columbia University
Press, 1994).
2) For a critical view of the power-over thesis, see David Couzens Hoy, "Power, Repression,
Progress: Foucault, Lukes, and the Frankfurt School." In, Foucault: A Critical Reader, Editor,
David Couzens Hoy (Oxford: Blackwell, 1986).
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