Demolition

It feels like news about our neighbourhood over the last few weeks has been dominated by the theme of demolition.

Some of these projects ultimately link back to SoHo’s Community Improvement Plan and the Old Victoria Hospital Secondary Area Plan, while other buildings are going down in what feels like a perfect storm of random timing — as if someone mysteriously synchronized the wrecking balls across otherwise unrelated development initiatives. Perhaps it is this apparently random simultaneity that makes the present moment feel somewhat jarring.

Add discussions regarding the Thames Valley Corridor Improvements and the Civic Space: SoHo project at Colborne and South to the above, and you have a neighbourhood that is undergoing a significant number of changes.

This afternoon, Sean Irvine from CTV News asked me what the SoHo Neighbourhood Association collectively feels about this rather ‘sudden’ jolt of changes to the landscape of the community. His question reminded me how of just how diverse the ‘we’ of a neighbourhood is. Times of change, such as this moment, highlight a perennial feature of neighbourhoods: we are an intersection of very different people. We sometimes have wildly different ideas about the future, the importance of heritage and the past, the aesthetics of beauty, and the meaning and value of sustainability.

In times of change and uncertainty, little more is more important than listening to one another.

Social Timelines: Life Lost on the Curated Projections of Other People’s Lives?

Time spent reading social timelines is time lost. Scrolling through a timeline is time consumed by the curated projections of other people’s lives, which are absorbed wholly and only at the cost of living your own.

Or, to put it another way: time spent on timelines amounts to time spent not living your life.

Spending your time on a timeline is valuable only to the extent you define value in your life by the amount of your life spent reading about the lives of others.

Time spent on a timeline is not time paused, it is life extracted. On average, then, time spent reading timelines is irredeemable and wasted.

If the most immediate ‘value’ we derive from timelines is that they distract us from ourselves — from the lives we are living, here and now — how much value should ascribe to them?

Let’s repurpose simpleton

I think we should repurpose the word ‘simpleton’ into something that isn’t so pejorative. There’s something to be said for circumventing the needlessly complicated. And to consider oneself a simpleton reflects a healthy sense of skepticism about the comprehensiveness of one’s knowledge.

Besides, what’s the opposite of a simpleton? A ‘complicaton’? Who’d want to hang out with one of those?

241 Simcoe Street

There is a lively debate in my city over the proposed locations for a supervised drug injection facility. One city-endorsed location is 241 Simcoe Street — a public housing complex just outside of the downtown core.

I am a diehard supporter and advocate for harm reduction and I think a supervised injection site would greatly benefit our neighbourhood. (Full disclosure: yes, I live in the neighbourhood, too.)

However, although I was initially enthusiastic for the 241 Simcoe Street proposal, I have grown skeptical of the specific location choice over the past two months. What changed my mind? Talking to the residents of 241 Simcoe Street.

Let’s peel away all the layers of campaigning, protesting, and pontificating. What is at the heart of the debate? Imposing a supervised consumption facility in a subsidized housing complex. Let’s unpack this from a socioeconomic and class perspective.

What is the message you’d take away if you were told your apartment building was going to be assigned a safe injection facility on the premises? And what if you don’t get a say beyond the obligatory (and mostly symbolic feeling) ‘consultation’ process? No, the experts know best. They know.

After a few conversations, I can appreciate how this proposal feels like salt in an open wound for some people who are already survivors of the social stigma associated with living in a rent-geared-to-income complex. (And it ironically comes at the hands of a sector who fancies declaring itself as advocates for the underprivileged.)

In a sense, this debate seems like (yet another) example of further stigmatizing people under the pretence of ‘helping’ them. You know, addressing ‘the needs’ of ‘this population’ as a categorical monolith.

Notice the way the story is framed in the media: it is the building’s residents pitted against a swath of community agencies, faith communities, and other organizations. It doesn’t take much imagination to suppose how patronizing this might feel if it were your house or condominium in question.

What seems lost in the discussion is the simple appreciation that 241 Simcoe Street is someone’s home. Just because someone qualifies for subsidized housing, should this status mean they lose their say about what happens in their building?

Let’s use our imaginations for a minute.

Across the tracks from 241 Simcoe Street is The Renaissance, a new swanky condominium tower. Imagine if public health officials proposed a zoning change to allow a supervised drug consumption facility in the basement of The Renaissance. All hell would be summoned forth. And lawyers. There would be lawsuits everywhere — the residents, the builders, the city, the province.

Of course, one will interject, how much sense does it make to compare a snazzy, private condo tower to a publicly subsidized apartment building? Are they not legally different animals altogether? Well, yes, exactly. I think this is precisely the point. This controversy ultimately boils down to class: at the end of the day, money buys you the power to exert some degree of influence over what goes on in the basement of your apartment.

No money. No power.

And if you don’t have money, you find yourself beholden to all the bureaucrats and officials who — while insisting they serve your best interests — act in direct contravention of your stated desires. And they most probably will move against your pleadings because all the other potential venues in the city are economically walled gardens protected by the deepest pockets of the caste. At the end of the day, a) your building is the cheapest real estate for the project, b) your neighbours fit the stereotype, and 3) moving in comes with the least political fallout.

Setting aside the importance of harm reduction (in general) and safe consumption (in particular), there still remains the critical necessity of determining an appropriate, equitable location for services. As it stands, 241 Simcoe represents the imposition of a program in people’s homes. If you wouldn’t put it in the basement of The Renaissance based on the rights and privilege of those residents, you probably shouldn’t put it in the basement of 241 Simcoe Street either. How is this equitable?

How much autonomy and right to self-advocacy should a person lose if they rent their apartment from a housing corporation instead of owning a mortgage? Everyone loves to blame everyone else for NIMBYism, living in a subsidized housing unit seems to mean you can’t even advocate for Not In My Basement.

At risk of belabouring the point: I am 100% in favour of supervised consumption sites. Heck, build a facility on my block. But please don’t put it in the homes of people who don’t have a choice.

The biggest irony to me is that choice is a long established pillar of harm reduction theory, but choice is precisely the one thing that the residents of 241 Simcoe Street are not being given.

The System Made Me Do It

I somehow found myself thinking about a passage from Hannah Arendt’s 1951 landmark Origins of Totalitarianism while I was at the Thames Valley Family Health Team conference a few weeks ago. (I posted more about the conference earlier.) The event was about delivering primary health care, and Arendt’s book is about totalitarian regimes, which makes following connection feel somewhat spurious at best. But there’s the kernel of an idea here that I need to flush out.

In the panel discussion, we briefly touched on the systemic stresses and pressures felt by healthcare providers. For instance, if your caregiver is rude, impatient, or insensitive, the ‘system’ might try to excuse the behaviour based on ‘bigger’ issues such as underfunding, understaffing, etc. But one of the panelists, my friend Bharati Sethi, called this justification into question. Is there ever a point where work-related stress legitimizes treating other people without basic human decency and dignity? Where else in society do we expect this equation to fly?

Case in point. Later that week I was in a bustling, understaffed pub with some friends. The immediate and multitude ‘job stressors’ at hand did not impede our server from treating us kindly and taking a personal interest in us. Paying attention to us was their job.

In the healthcare sector, there is a lot more at stake than getting the right pints to the right customers (as crucial as this is). Primary care often represents the front lines for responding to significant physical and psychological crisis. Decisions are critical. A server at the pub who pays close, friendly attention to the needs of their customers is a good employee. The doctor who brushes me off or doesn’t care enough to listen to my symptoms and the subtext of my story might be bordering on malignant practice.

This is where Origins of Totalitarianism comes in. (I should emphasize that my intent here is not to compare healthcare to totalitarianism in any general sense, but to interrogate a specific feature of bureaucracies at scale.) In explaining the logic of totalitarian regimes, Arendt points out that “before the court” of terror, everyone who carries out the brutal decrees of a totalitarian government is “subjectively innocent.” The murderers aren’t really murderers; they are just obeying orders from the next level up. Likewise, the ‘next level up’ are just intermediaries and themselves not even lifting a finger to inflict any harm. At the very top, it is not so much an individual in charge as some dictator executing “historical or natural laws” — “suprahuman forces” — that are made all the more self-evident by their execution. To carry out their atrocities regimes need to figure out a way to make everyone find a way to believe themselves innocent. (See Origins of Totalitarianism, page 465.)

I hope it is evident that I am not trying to make a one-to-one comparison here. The point is much more subtle. The idea that an individual caregiver in the healthcare system might blame their lack of empathy, compassion, or patience on ‘the system’ itself echoes a similar kind of systemic scapegoating. It is simply replacing ‘The devil made me do it,’ with ‘The system made me do it.’ This is a perennial issue with huge bureaucracies in general: the organization, the institution, the structure itself becomes an ‘it’ that is itself inscrutable and above punishment. Once ‘it’ is to blame, all recourses to social accountability are made null and void.

I don’t mean to belittle the importance of leadership and workplace environments. If you stress your staff, you shouldn’t expect to deploy a team of relaxed, sensitive, listeners onto the floor or into the clinic. But the problem, at every level of the equation, is the temptation to excuse poor human-to-human experiences on some ‘thing’ that we call ‘the system’ that is patently beyond any single individual’s control. If it is ‘the system’ that makes you maltreat people, you have caught a tiny glimpse, according to Arendt, of how totalitarianism gets away with evil.

Perhaps thinking about Arendt in the context of a complex healthcare environment offers us some ideas about contributing factors to inequitable and unequal treatment.

Later, in her 1963 book, Eichmann in Jerusalem, Arendt proposes the concept of the “banality of evil.” By ‘banality’ Arendt supposes that it doesn’t necessarily require a deranged sociopath to commit horrendous acts, just a simpleton who gets caught up in a narrative and executes a job description without thinking critically for themselves. In a healthcare context — where patients are often treated like widgets on a conveyor belt — perhaps we come to expect a kind of ‘banality of rudeness’ or ‘banality of impatience’ as staple features of bureaucracies. Perhaps this narrative about the nature of organizations is precisely the story we need to reimagine.

Everybody’s advertising Facebook

Every time a company or business implores its customers or clients to ‘Like us on Facebook’ or ‘Follow us on Twitter’ they provide free advertising for Facebook and Twitter. Subsequently, in seeking likes and followers, businesses entrust communications with their customers and clients to a third party, a corporate intermediary — an intermediary that is in the business of monetizing people’s attention for its own growth.

Somehow, this logic won the day a core assumption in just about every marketing strategy that exists at the moment. It truly boggles the mind. Everybody’s advertising Facebook.

Meditation of a Poll Official

On Thursday I worked as a poll supervisor for Elections Ontario. I have joined election teams for the last couple provincial and federal elections. I cannot fully explain my enthusiasm for working election days. The days are long and mentally exhausting, and yet strangely rewarding and enlightening.

To be a poll official is to spend a day devoted to serving your neighbours — and a day focused on the technical challenges that arise when serving so many fellow citizens in a friendly and efficient way.

Elections are political. The act of voting tends to stir convictions with cortisol. When my focus is on my ballot, my attention is wrapped up with ‘my side’ winning the election. But the work of elections staff is very different: it is all about neutrality, accountability, and customer service. Assuming this role makes for an entirely different way to experience and participate in an election. ‘Winning,’ for a poll official, means making democratic participation as accessible as it can be for as many people as possible.

I think everyone who lives in a democracy should try serving their compatriots at the polls. Try it at least once in your lifetime. The concern for elections staff is executing the practical logistical requirements of a functioning democracy, and in this context you find yourself working alongside people of every political ‘colour’ who come together and set everything aside to get a job done.

The Insidious Side of the ‘Housing First’ Model?

I have great respect and appreciation for the Housing First model. The proposition of Housing First, overly abbreviated, is as follows: the most effective way to constructively help a person address complex health and psychological challenges requires providing a stable and safe place to live. Until this safety and stability are in place, all the interventions in the world — medical, financial, psychological, etc. — are likely to fail in the long run. This logic makes intuitive sense to me, and from what I can tell, there is a significant and growing body of research to back it up.

While I support Housing First in principle, I also wonder if there is an unintentional yet insidious dark side to the model. The dark side happens at the level of unconscious bias: when we preach housing as the critical first step for health and stability, we might also be positioning and normalizing an economic standard of accommodation as a prerequisite for participating in mainline society. From this perspective, one might imagine scenarios wherein Housing First unintentionally reiterates the stigma of homelessness itself.

Put it another way: a great many people like me who advocate for Housing First also happen to have homes ourselves. It doesn’t take rocket science to hypothesize how we might have some assumptions about the relationship between housing and a ‘normal role’ in ‘respectable society.’ What am I trying to get at here? Underlying class assumptions. Housing First indirectly reinforces an idea that ‘success’ in society involves living in a house. Get every person in a house — whose metric of success is this? ‘Housing as solution’ is an assumption that, in a perverted, roundabout way, potentially exacerbates prejudice against ‘the homeless’ — the very people that Housing First wants to help.

If your health and ability to participate in your society is so wholly dependent on living in a house, should we blame you, the absence of a roof, or the caste that excludes people without steady accommodation? And if by giving you a shelter we then grant you access to the privileges of the housed, have we changed anything about the structure of exclusion that privileges us folks with roofs? Does upgrading you into my caste solve any of the underlying inequities?

This post is only one critique of Housing First, which is promising in many more ways than encapsulated here. The volume of research that ties health and overall well-being to secure housing seems reasonably indisputable, at least so far as I can tell as a non-expert in the field. I’m confident to say this constitutes a fact: it is healthier to have a dry, warm, and safe place to live than nowhere to live. On these grounds, I will advocate for housing unabashedly. And yet, at the very same time, I hold this conflict: I’m aware of the normative class assumptions lurking in the shadows, no less in the shadows of my well-intentioned advocacy.

What we need is an innovative logic model

What we need is an innovative logic model to quantify the baseline metrics for our impact assessment tool to analyze the efficacy of our evaluation design against the resource mobilization parameters as defined by the strategic plan…

We can’t calm the storm, but we can ignore it

[This is part four of a series reevaluating some propositions that I perceived as crucial and important in my early thirties.]

Proposition: I have about 112 hours of con­scious life to live each week: wis­dom dic­tates invest­ing at least one of these hours to med­i­tate on how I will use the remain­ing 111 hours.

First of all, why does getting eight hours of sleep a night seem to get harder with age? It might be time to recalculate my math here. But I digress…

Like most people, my commitment to grand declarations of personal self-discipline ebb and flow with time. Laser-focus intentionality is great: I just have a hard time controlling it consistently. As much as I like the idea that a calm mind — detached from the pressure points of deadlines and expectations — can transcend the temptation to feel overwhelmed, I fall victim to the tyranny of the urgent as much as the next person. Some weeks, devoting 1 full hour to contemplate the usage of 111 hours seems far more anxiety provoking than grounding.

However, in the fits and starts of life, I think I am slowly getting better at realizing that the feeling of pending implosion should be a trigger to slow down, not speed up. Thinking that I will alleviate the pressure by accomplishing more has proven, on many occasions, to be counterproductive. The days when the to-do list feels the least conducive to going for a walk or eating lunch in the park are the most important times to prioritize fresh air and clear headspace. Stress feeds its own momentum. The only way out is to break the cycle, not kick at it harder.

Leaving my laptop at the office and my phone in its home basket has done wonders for helping me appreciate that finding ‘the calm in the storm’ means leaving the storm behind, regardless of how loudly it is thrashing about. There is always a storm. Or at least an opportunity to fight a storm. Serenity only lives in parallel to the storm, not in place of it. The storm is only absent in some other magical realm, where divine management gurus receive book contracts to write about it the rest of us might imagine transcendence.

Those of us stuck in this dimension need to figure out how to strategically ignore the tornadoes trying to send us notifications.

I suppose the ‘problem’ with my initial proposition is that producing a week of organized calm is a lot to ask of one hour. Sure, I know that a weekly review of my projects, commitments, and calendar goes a long way to helping me make better decisions about how I leverage the hours at my disposal. This remains a valuable commitment to pursue, yes. But I also know those other 111 hours can throw plenty of curve balls of their own. Today, I think I’m less concerned with cleverly averting the tumultuousness of life in one fell swoop. There appears to be an infinite amount of chaos and only one me. The older I become, the more interested I am in learning how to just quit worrying about as much as I can altogether.

Humility is universally applicable

Yesterday I had the privilege of moderating a plenary panel discussion at the Thames Valley Family Health Team’s annual spring conference. The purpose of the panel was to share stories about patient experience. Four storytellers recounted personal moments when the healthcare system blossomed beautifully or failed miserably in response to an individual struggling with mental illness, addiction, depression, or post-traumatic stress.

I left the session with two salient points at front of mind. This post is a brief reflection on the first takeaway.

Listening to the panelist’s stories, it occurred to me that the concept of cultural humility has relevance beyond the domain and context of intercultural interactions. (Brief review: cultural humility is the idea that approaching an individual from another culture in a spirit of humble curiosity paves the way for a constructive therapeutic or clinical relationship. Now, juxtapose this approach of gentle inquiry with walking into the room thinking that you are aware of another person’s needs, beliefs, worldview, and convictions because you graduated from the ‘cultural competency’ course over the weekend.)

Conscientious, intentional, self-doubting humility is not only crucial in intercultural exchanges: the ethos transposes seamlessly when listening to individuals struggling with addiction or other psychological complexities. Assuming to know ‘the answer’ to another’s situation because you have a clinical category for their condition is something like ‘psychologicalism’ — similar to the way that a racist assumes to know particular facts about another person based on specific physical characteristics or ethnic appearances.

It is interesting to think about the ways that ‘cultural humility’ might be taken up as ‘clinical humility’ or in a broader sense. But creating more jargon is not the point: figuring out how we can inspire one another towards greater humility — and the curious, individual-centric inquisitiveness it fosters — is the bottom line.

It boils down to a question: as a healthcare system, how do we treat individual people as individual persons? The second takeaway from yesterday’s session follows from this question. It’s a reflection about the bottlenecks and potentials of bureaucracies. Will post shortly.