Wednesday, June 23, 2010

It has occured to me that while responding to adult abuse and neglect falls within the domain of health care (at least in the province of BC), it is an uncomfortable fit at best. Situations of abuse and neglect are not acute or chronic medical conditions and therefore cannot be understood as such. Health care clinicians, for the most part, are driven in their assessment, understanding and actions of any given situation by an epistemological stance heavily influenced by a scientific, biomedical understanding of how things work - cause and effect, for example, and that for every problem there is a solution, and that the success of the fix is contingent on how the individual (body, mind, behaviour) responds to whatever solution is offered.

To be fair, abuse and neglect cases are prioritized and responded to swiftly like other crisis situations. This is where perhaps the fit between these issues and the health care system works. If an adult needs immediate safety, shelter and attention for medical conditions that threaten their health then the system is relatively well resourced to provide for these short-term, medically focused, interventions. But it is in the crafting of long-term, effective, appropriate solutions to these complex situations that challenge and expose the shortcomings of the health care system. Responding to situations of abuse and neglect extend well beyond the expertise of medicine; they are lived experiences born from multiple and intersecting social, cultural and historical factors - only some of which are manifested in the body and mind. Responding to these situations requires a different lens, a different language, a different orientation - a paradigm shift that allows and values an exploration of the whole: person, context, environment and the interpersonal relationships in and from which vulnerability, risk, abuse and neglect emerge.

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