Turning Troubles into Problems

Clientization in Human Services

Jaber F. Gubrium, Margaretha Järvinen, Jaber F. Gubrium, Margaretha Järvinen

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9781138960138
• eBook ISBN: 9781135123918
• Topic: Medicine
• Subtopic: Health Care Delivery

Human service professionals deal with a wide range of problems, from child abuse, parenting issues, and elderly care, to addictions, mental illness, sexual assault, unemployment, and criminality. These must be constructed as problems for professionals to appropriately respond to them. Human service provision starts from there. But in the everyday experience of service providers and users alike, there is a parallel world of ordinary troubles that remains professionally undefined but real, even when troubles are turned into problems.

This book brings into view the relationship between these worlds as it bears on the process of clientization—the transformation of people and troubles into clients and problems. Rather than taking the process for granted as many critics do, the book examines the instability of the process on several fronts and highlights its surprising local complexity. Foregrounding everyday life, the leading idea is that the transformation of troubles into problems is not straightforward and that problems are continually subject to alternative understandings. This poses new what, how, and where questions. What are ordinary troubles and how do they relate to the construction, maintenance, or undoing of serviceable problems? Where is social policy and how does that figure in the front-line work of service provision? The questions point to the challenges of clientization at the discretionary border of troubles and problems in everyday service relationships.

With chapters written by an international group of human service researchers, this book is an important contribution to the literature dealing with the construction of personal problems and will be useful to students and academics in sociology, human services, social work and policy, criminal justice, and health care.

1 Troubles, problems, and clientization

Jaber F. Gubrium and Margaretha Järvinen

Two seminal texts flag the title and the purpose of this anthology. One is Robert Emerson and Sheldon Messinger's (1977) article “The Micro-Politics of Trouble.” The other is Michael Lipsky's (1980) book Street-Level Bureaucracy: Dilemmas of the Individual in Public Services. The first is interactional and poses what and how questions: What are ordinary troubles and how do they relate to the construction of serviceable problems? These are important, especially for the idea of clienthood, because it critically approaches that as a product of the clientization process. The second is institutional and poses a where question: Where is social policy and how does that relate to service provision? It's also an important question, as it extends the location of policy formulation from legislation to front-line (“street-level”) service activities, in our case to everyday settings of the clientization process. The purpose of the anthology is to begin to view the complex challenges of that process at the discretionary border of troubles and problems (cf. Gubrium & Holstein 1997). The challenges stem from the inexorable interplay of troubles and problems in everyday life.

The world of troubles

Emerson and Messinger's article is about four decades old, but it remains relevant because it continues to affirm the fruitfulness of distinguishing troubles from the broadly shared and often professionally-defined problems that ail us. Emerson and Messinger begin by suggesting that it is quickly forgotten that whether what bothers us eventually becomes, say, psychological, medical, or criminal, it was once something else less formal and less well-formulated. At the time Emerson and Messenger wrote, the highly normative word “deviance” was commonly used for social problems in sociology.

Our argument assumes that any social setting generates a number of evanescent, ambiguous difficulties that may ultimately be—but are not immediately—identified as “deviant.” In many instances what is first recognized is a vague sense of “something wrong”—some “problem” or “trouble.”… This [article] will explore the processes whereby troubles are identified, defined, responded to, and sometimes transformed into a recognized form of deviance.

(Emerson & Messinger 1977, p. 121)

Vagueness and noticing

The inspiration for the argument appears immediately. We are introduced to the idea that there is a world of troubles that is distinct from the world of problems. As evanescence would have it, the world of troubles is murky, not as settled or as clear-cut as the world of problems. Troubles' key characteristic—vagueness—refers to something being wrong, but in that world it's not clear what that is or why it is so. As troubles are not part of the world of deviance or problems, they are formally out of sight in professional understanding. If troubles are given any attention, they are anecdotal, newsy perhaps, but undisciplined and removed from trained sensibilities.

Emerson and Messenger provide familiar examples of troublesome experiences. If the definition of problems begins with formal procedures such as psychological assessment, medical diagnosis, or adjudication, the onset of troubles starts with noticing that something is wrong. Noticing is the parallel by-word to problem assessment. Vague as troubles might be, they are enduringly present in life and bothersome on many fronts, from the troubles of bodies, behaviors, and minds, to troubling relationships and groups. The authors explain:

The perception of “something wrong” is often vague at the outset: a woman notices that she is gaining weight, or that she is frequently depressed; a husband realizes that his wife is drinking more than usual, or is beginning to stay out later after work; parents see their daughter getting overly interested in boys, or their son starting to hang out with a tough gang of friends.

(Emerson & Messinger 1977, pp. 121–122)

Unlike formal procedures, noticing does not necessarily lead to assessment or intervention. A husband or a wife may notice something wrong with a family member, but keep it to themselves and do nothing about it. Or they may share it with each other. They might mention it to the subject of what is noticed. They may or may not bring it to professional attention. They might even dismiss and ignore what seemed to be wrong as insignificant and nothing to fuss about in the scheme of things. The important difference between troubles and problems on this front is that problem designations lead to a chain of relatively predictable responses that troubles commonly do not. Troubles are not driven by predesignated activities and formal missions. Troubles, of course, have a describable social organization, whose natural history can be studied. Problems, in contrast, are more formally organized today than ever, which, as we will see, has been the rub of many social critics.

The world of problems

Troubles are subject to the challenges of old, new, and dissenting problem categories and related social policies. Increasingly, institutions organize problem construction and manage the consequences (see Gubrium & Holstein 2000, 2001). Troubles are present across the life course; they are not the exclusive property of any stage of living. In contemporary society, troubles commonly are muddled and undefined until they are subjected to professional scrutiny. The “gaze” of experts transforms them into certifiable conditions, from specific diseases, disabilities, and dysfunctions, to particular crimes and transgressions (Järvinen & Mik-Meyer 2003). The idea of expertise itself is increasingly extending to the expert client and to expertly-informed laypersons in general (Järvinen & Mik-Meyer 2012).

Clarity and problematization

Human service professionals—counselors, schoolteachers, life coaches, nurses, doctors, physiotherapists, care assistants, social workers, psychologists, police officers, attorneys, judges, prison guards, and probation officers, among others—deal with a broad range of problems. Learning difficulties, child abuse, troubled youth, parenting issues, self-neglect and elderly care, sexual assault, mental illness, addiction, and unemployment abound in contemporary life. Troubling as these might be, they must be constructed as problems for professionals to appropriately respond to them. Human service provision starts from there. Still, in the everyday experience of those concerned, service providers and users alike, the related world of everyday troubles that is professionally undefined remains. It doesn't disappear when troubles are turned into problems. It is a world whose troubles persist at the border of the acceptable and the unacceptable, the insistently normal and potentially problematic, the well-recognized and the murky. It is a world enormously important to service provision, but outside the formal purview of professional practice. It is a world that is enduringly part of life, serving as the existential basis of the challenges of clientization.

If a key characteristic of troubles is vagueness, its counterpart for problems is clarity. This isn't to say that problems are clear from the start or that they are eventually completely clarified. Problems are continually subject to clarification, the paths of which are strewn with clarifying claims and counterclaims (see Spector & Kitsuse 1987, 1977; Schneider 1985; Best 2012). This is the stock-in-trade of social movements, from political and economic movements to newer identity movements. As far as clarity is concerned, the goal of social movements is to transform the vagueness of what is troublesome into what is clearly problematic. Whether troubles center on the body, behavior, the mind, relationships, or groups, the mission is two-pronged: to establish the taken-for-grantedness of a problem in what is otherwise vaguely understood, and to marshal proof for making that evident. As John McCarthy and Mayer Zald (1977) instructed years ago, clarification is not just cognitive, but entails organization, without which the clarification process would falter or fail. This reminds us that problem clarification is tied to its mode and relations of production.

Challenges to problem clarity also are the stock-in-trade of social movements. This is evident today especially in challenges to the taken-for-grantedness of human service problems. Efforts to deproblematize troubles have emerged on many fronts, from the goal of deproblematizing drug use, body weight, and alternative sexualities, to the aim of deproblematizing particular groups and relationships. These also are two-pronged. Whether it is being overweight, having a mental illness, being addicted, or undesirable peer influences, the aim on one front is to question the assumption that these are self-evident problems and on the other to provide factual proof of that. “Naturalization,” “normalization”, and “neutralization” are common terms of reference for this (see Sykes & Matza 1957; Foucault 1977; Costello 2000). Wayne Brekhus (1998) would refer to this as the process of “unmarking” problems so that what was marked as clear and evident becomes virtually unnoticed and, by virtue of that, “unremarkable.”

The world of problems extends beyond social movements to what is organizationally established and professionally relevant, the terrain with which this book is concerned. This part of that world has grown rapidly. Guiding texts, such as various editions of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association and the many versions of the Big Book of self-help addiction groups such as Alcoholics Anonymous and Narcotics Anonymous, are well-known and widely used. They concretely inform a huge public and a swath of service organizations of what is taken-for-granted as potentially problematic, not just troublesome, in our lives. DSM alone provides a problematizing system for virtually every conceivable form of conduct, quantitatively organized in terms of “too much” or “too little.” It is just one of a panoply of texts whose discursive conventions are well-established, offering formal guidance for how to problematize troubles by eclipsing their vagueness. More and more, problematization is textually-mediated, as Dorothy Smith (1987, 1990) would put it, institutionally and professionally organized not only to categorize, but to actually write and read problems into troubled lives.

Clientization

This brings us to those whose troubles are turned into problems in human services—the clients of service provision—and the clientization process. The term “clientization” was coined by Clifford Geertz (1978) to describe the peasant market relationship he was studying while doing fieldwork in Sefrou, a Moroccan town. As Geertz explains, the bazaar economy has few if any fixed prices, but like most markets the principle of selling high and buying low applies. Sellers want the highest price they can muster, and buyers want the lowest price they can get. But, as Geertz points out, this is vague and precarious, with few if any rules about what price level to begin bargaining. An effective solution to the problem comes in the form of clientization. In repeat transactions, there is a tendency to establish clear relationships between sellers and buyers about how high and how low bargaining is expected to transpire in particular cases. The result is that “clientization reduces search to manageable proportions and transforms a diffuse mob into a stable collection of familiar antagonists” (p. 30). Geertz states that this does not establish a dependency relationship, but merely provides for rationalized competition: “Clientship is symmetrical, equalitarian, and oppositional” (p. 30).

Globalized dependency and rationalization

The term as it's come to be used in human service does connote dependency, something closer to the idea of the role of a client or clienthood in relation to provider roles, which resonates patronage. Unlike bazaar economies, human service relationships and transactions operate within bureaucracies. As Smith (1987, 1990) would have it, these are relationships of ruling; they have built-in dependencies. The client of an attorney depends on the attorney for legal advice and adjudication, not the other way around. The client of a social worker depends on the worker for needs assessment and service intervention, not the other way around. The relationship is asymmetrical. If we combine this meaning with Geertz's, the outcome has an added value as far as problem clarification is concerned. Being a client or clienthood enhances both the clarity that reduces the murkiness of fleeting relationships and the directional clarity that hierarchical exchange provides. Put into action, the relationship is a one-way street that is well-signposted for all concerned to make their way. This describes the traditional bureaucratic model of the human service encounter.

According to prominent social critics, the world of troubles has been unwittingly flooded, if not displaced, by the world of problems. Some argue that the matter of turning troubles into problems has been unfolding for decades and is now complete. Denizens of the world of troubles have become “clientized” and, as a result, that world has disappeared. This has transpired before an unknowing public, who have been lulled into its naturalness, so it seems. Infused with rationalization and dependency, we have become the clients of a world we have been complicit in creating. The critique began in earnest after World War II with the rise of the welfare state and the rapid proliferation of human service professions. These observations are significant, as they alert us to the alleged global proportion of the trends.

On one side of the Atlantic and early on, David Riesman (1950) focused on the rapid displacement of an inwardly-driven American character by an outwardly-responsive one. Americans have become a nation of individuals attuned to the influence of others, Riesman argued, in particular the identity-defining agents who are increasingly prevalent in American life. As if to bring into view who these agents are, a decade later Erving Goffman (1961) featured the asylum-like characteristics of what he called “total institutions.” In focus were the organizational influences of displacement, much of these products of human services. “Totality” an...

Table of contents

• Cover
• Half Title
• Routledge Key Themes in Health and Society
• Title Page
• Copyright Page
• Table of Contents
• Notes on contributors
• 1 Troubles, problems, and clientization
• Part I Individual challenges
• Part II Collective challenges
• Part III Competing perspectives
• Part IV Contending clienthoods
• Index