ACEs and -isms part I: Neoliberalism
Neoliberalism, like ACEs, is an oft-used term that has taken on a variety of meanings, depending on who’s using it and why. Recognising that it is a multi-purpose, often contentious and somewhat elastic term, I offer my own interpretation of neoliberalism here as a starting point for the discussion. There’s an abundance of readily available material on neoliberalism and I’ve put together a reading list at the end of this post pointing to just a few of what I think are the more useful bits. As ever, I remain open to hearing other takes.
Defining neoliberalism
In short, neoliberalism refers to both the prevailing economic model in Western democracies and the ideas and assumptions — about the function and value of markets, and of people and the societies they live in — that underpin and serve that model.
Many of the assumptions underpinning the neoliberal conception of society are, in essence, myths presented as incontrovertible truths. The key underpinning myth of neoliberalism as economic model is that a marketplace with little or no regulation is the ideal system to meet every need of individuals, and the communities and nations in which they live. This is the basic idea that drives the privatisation and marketisation of public services. Marketisation is good, so the myth goes, because it encourages competition which has the effect of raising quality and lowering the cost to the end user. While this might work for tinned tomatoes and high street fashion (though often at considerable cost to the rights and welfare of those involved in manufacturing processes) it is a myth that these principles when applied to social and health care and associated policy yield similar results. Research by the IMF shows that neoliberalism has failed to deliver on its own terms. The net effect of neoliberalism in social and health care policy — despite some anomalous examples to the contrary and notwithstanding the valid concerns about whether the state has done or could do a better job — is to reduce choice and lower standards. In the social care and health sectors, end users suffer the consequences of the poor care they have no choice but to accept while conscientious, ethical staff and professionals in public service find themselves impotent in the face of abuse, neglect and injustice due to the atomisation of responsibility and accountability arising from the organisation of public services along the lines of profit margins and supply-demand curves. (Before anyone starts going on about not all marketised solutions being profit-making let’s just agree from the outset that all organisations, whether they be social enterprises, charities or ‘non-profits’, have to be ‘profitable’ in order to be sustainable and that, ultimately, someone is getting paid. . . All systems have their vested interests, somewhere).
But neoliberalism isn’t just another name for an arm of late phase capitalism. Neoliberalism is the way of looking at the world and the people in it that paves the way for such things as privatisation and marketisation of health and social support services. It is probably more useful to see neoliberalism as an ideological expression of late phase capitalism. This is what makes it so pervasive, and so dangerous.
Neoliberalism is, more than anything, a permeating worldview — a seductive set of ideas and reflexes, remarkably efficient at spreading, replicating and adapting itself to just about any context. The success of neoliberalism in becoming the dominant ideology in our society derives from its ability to enlist, co-opt and colonise other ideas in order to turn them to its own ends. Crucially, these include ideas that shape and inform public policy.
At its core, neoliberal ideology can be summed up thus: a) citizens are consumers and producers; b) the wellbeing of individual citizens is important only insofar as to the degree it impacts on their contribution (their productivity and their consumption of goods); c) individuals are, ultimately, responsible for their own wellbeing; and d) any support provided to ease suffering will be aimed at correcting deficits/defects within the individuals themselves. Once you start unpicking these components, you begin to see how the ideological component of neoliberalism operates to regulate and control the populace with the key aim of servicing the needs of those benefitting most from the neoliberal economic model.
The thing that speaks not its own name
Before we go any further, a note on a key problem in discussing neoliberalism. Not only is it a contested, mutable term, it’s one not generally used by those who practise, advance and promote it. Partly because it’s seen as a pejorative term, a kind of shorthand for ruthless pursuit of self-interest over responsibility toward others. I think this is rather simplistic. It’s certainly not what I mean when I use the term. While extremely sceptical and, yes, critical, of neoliberalism, I don’t use it as an insult or ad hom argument any more than I use the words communism or capitalism or utilitarianism or reductionism in those ways. I can use those words in the context of (even strong) criticism of the concepts behind them without meaning to insult the people who adhere to those viewpoints. In my view, it’s ok to say someone’s a ‘neoliberal’, yet people who subscribe to neoliberal concepts rarely appreciate this being made explicit. But I actually think the ‘neoliberal as insult’ trope is a red herring. I think the reasons people and organisations don’t describe themselves as ‘neoliberal’ or openly subscribe to a thing called ‘neoliberalism’ are quite complicated but is in no small part due to the fact that neoliberalism is so pervasive, so successful in extending into every facet of society that it’s just accepted, by and large, without too much question, as just the way things are. By taking part (and let’s face it, there’s little choice not to, unless you live in a cave on a remote island without any of the trappings of contemporary Western existence) we are all neoliberals to some extent, but either don’t realise it or don’t want to acknowledge it. The triumph of neoliberalism is to make us all complicit. And, judging by the fact that avowed neoliberals are rare beasts indeed, those who knowingly subscribe to neoliberal ideology are possibly wise to the fact that giving something a name opens it up to analysis, discussion, dissection, critique, challenge and, ultimately, replacement.
Neoliberalism and the new, big philanthropy
The rise of what has been called ‘philanthrocapitalism’ is directly linked to the emergence of neoliberalism as the dominant force shaping democratic societies today. This new, big philanthropy comprises the operations of global big money interests using philanthropic initiatives under the banner ‘corporate social responsibility’ to extend and consolidate their influence in the realms of public and social policy and health care. I highly recommend Anand Giridharadas’s book, Winner Takes All, which lays bare the workings and impact of global big money-led philanthrocapitalism. Domestically, one only has to look at current social reform initiatives to see how Wall Street transnational management consultancies, hedge funds, Swiss banks, ‘social entrepreneurs' and charities (I use the term only in its legal sense — these outfits have the pursuit self-interest at their core) move to influence social policy and practice through their ostensibly benevolent financial and pro bono support of fast track graduate social work, teaching, civil service, police and prison officer training schemes.
Neoliberalism and the ACEs movement
What has any of this to do with ACEs? We should never forget that the origin of the ACEs movement is in the US private health insurance system, namely the now-famous study in the 1990s by Kaiser Permanente, an ostensibly socially-responsible ‘non-profit’ healthcare insurer that had a net income of $3bn in the first quarter of this year. Kaiser Permanente is the epitome of the neoliberal socially benevolent business built on the idea that social inequality is best addressed by consolidating the wealth and power bases of the elite so they can decide who gets what, and how. Such enterprises are built on the myth that all that’s needed to address the world’s ills is ‘corporate social responsibility’. There is no requirement for businesses to take such responsibility, though there are tax incentives. That this big money philanthropy is fundamentally selective and therefore innately political/ideological, non-transparent, donor-led and unaccountable is by-the-by cos good intentions. But good intentions are not enough and they often hide ulterior motives.
ACEs ideology shares key common features with neoliberalism. Chief among them the individualised conception of social problems and the absence of any structural critique. The idea of the responsibilised individual who can be ‘empowered’ to address the complex social problems besetting them and theirs by recasting those problems as mental health issues (pathologisation) is at the heart of both neoliberalism and ACEs ideology. The discourse of resilience runs through both, undergirded by a saviour narrative that says 'the problem is in you and what you need is a wealthy benefactor/expert to modify your behaviour/change the way you think’. The neoliberal response to human suffering is to advance the view that individuals need to be more resilient. The most commonly espoused remedy for ACEs? Resilience. This is most often framed within the context of prevention rhetoric (thereby legitimising the focus on childhood as incubator of adult pathology). While this emphasis on behaviour- and thought-modification may appear benign (cos good intentions) it doesn’t take much looking past the eye-catching narratives of empowerment and transformation to see the motivations of big business in relation to preventive public health and social policy.
This article hosted by prominent ACEs website www.ACEsTooHigh.com sums up what motivates businesses to jump on the ACEs bandwagon: concerns about how human travails affect productivity. This slots neatly into the 'economics of human potential' narrative advanced by economist James Heckman. Among Heckman’s many gifts to neoliberalism is the 'Heckman equation’ which goes: investment in ‘birth-to-five early years education' of 'disadvantaged children' yields a 13% return on investment in terms of 'economic value’. This raises all sorts of questions about what this 'education' consists of, how it is regulated and what it implies about the parenting of the children targeted. Indeed, correcting defective parenting is the key aim of Heckman’s work in this area. Underpinning Heckman’s equation is the arithmetic of human potential: a person’s worth is the sum of their productivity minus the amount of assistance they need from the state. Hence, the discourse of burden in relation to the funding of social care and health services.
Heckman’s agenda fits sweetly with the emerging neoliberal paradigm of parenting as a public concern. Further, parenting in neoliberal society has been increasingly constructed as a public health issue. For examples of how such ideas (problematically) take root in public health and social policy, we need look no further than what is currently happening in Scotland, driven by the seductive power of ‘ACE awareness’.
Scotland: ACE-aware nation
Scotland. Place of my birth and early childhood, and the place where I picked up one or two ACEs myself. I was born in Dennistoun in the early 1970s and lived for the first few years of my life in Easterhouse, a conglomeration of housing schemes spread out on a gradually rising hill on the eastern outer flank of the Glasgow sprawl. Famed for all the wrong reasons, Easterhouse was to my young self a wonderland of kick-the-can, 'chappie' (knocking on doors and running away), the 'ask it' van (a mobile baker and grocer — there were hardly any shops, apart from a couple on Wardie Road where my mum and me got a flat and the only heating was a coal fire in my bedroom), and happening upon the family dog in neighbouring streets cos back then exercising your dog meant opening the back door and letting it out to roam the streets. But Easterhouse was also a place of crushing poverty and the problems that come with that. I will never forget the time the man next door came round and asked to borrow a tea bag because the priest was coming. In Scotland, tea is regarded a basic right.
I spent a lot of time with my gran, a foster carer, who lived a few streets away on Stepford Road, because my mum, young yet herself, was dealing with her own issues. My granda, a printer at the Daily Record and a union man, only came home two nights a week, for reasons I wasn’t fully aware of at the time. Many of the adults around me were quite heavy drinkers. My ‘uncle’ (a friend of the family really) once badly sprained my wrist through clumsy, drunken play. I got a 'stookie' (plaster cast) as a result, a badge of honour I brandished proudly.
I was aware of more deliberate violence too. Toward people. Toward animals (the horses in the field at the bottom of the hill got stoned and slashed more than once, I remember). I was only vaguely aware of the gangs. I moved away from Easterhouse (to Cumbernauld, a new town between Glasgow and Stirling) at a very young age and so escaped the gang culture that came to prominence in the Glasgow schemes in the 1960s and 70s, a culture which was itself rooted in the mass unemployment following the loss of industry in the British Empire’s second city. Wrecked lives, wrecked landscapes. These were the legacy of successive decades of social privation in the Glasgow schemes. Over the years, much of the housing stock has been demolished and that which survives renovated.
(Why am I saying all this? To be honest, I’m not sure, it just came out as I was writing. I feel fortunate and also guilty that I escaped the worst of what life in Easterhouse might have held in store for me. My life after that was hardly idyllic, and I didn’t escape the poverty that stalked the working classes in Thatcher’s Britain, but I have to wonder how my life might have been had I not moved away. I suppose I also want it to known that I’m not another academic with an intellectual objection to ACEs ideology. I’m not an academic at all. I’m a social worker from what might be called a poor working class background, a council estate professional who really doesn’t believe this ACEs thing is an adequate response to the myriad, complex factors contributing to childhood adversity and the problems that follow. There is, undoubtedly, value in being aware of the impact of childhood adversity and trauma across the life span. A key success of ACEs discourse is that it has popularised that awareness, but my strong view is we need to pull up for a while and consider where it’s all going… Hence this blog.)
But the problem of poverty persists in the schemes and there are places throughout Scotland with similar poverty-related problems. No wonder, then, the appeal of ACEs to an avowedly progressive, socially-liberal Scottish government looking for answers to big, complicated questions. ACEs present a seductive catch-all solution, something that can be held up as proof of what we’ve known all along: what happens to you when you’re a child stays with you, shapes you, affects your outcomes, even down to how long you live. ACEs go further. ACE doctrine makes explicit, causal links between particular adverse childhood experiences — many of which relate to parenting — and terrible things that happen to adults. Where before we understood the links as correlative, ACE ideology draws a clear causal line between how you were parented and, to give the most stark example, the likelihood of early death. The Scottish government, dealing with some of the lowest life expectancy figures in Western Europe, understandably laps this stuff up: its key ambition (save, perhaps, after independence) is to be the first ACE-aware nation.
A central policy plank of the ACE-aware Scotland agenda is the Getting It Right For Every Child (GIRFEC) initiative. Couched in the benign rhetoric of resilience and wellbeing, GIRFEC follows the neoliberal responsibilisation template by providing parents with a checklist of 'wellbeing indicators' known by the initialisation SHANARRI.
The Scottish government propose each child’s ‘wellbeing’ (thus constructed) to be compulsorily monitored by a government-appointed 'named person’ who can access confidential data about the family and speak to the child to assess their wellbeing against factors including whether they have any say in how their bedroom is decorated or have any choice in what they watch on TV. In 2016, the Supreme Court ruled the scheme breached ECHR Article 8 rights to private and family life. The Scottish government are pressing on with the scheme undeterred.
The implication that named persons may well have different ideas than parents about what’s right for children and, moreover, be able to take corrective action, raises the spectre of intrusive state regulation of parenting under the guise of 'early help’. In addition, the focus on a highly subjective, Westernised conception of 'wellbeing’ suggests families with diverse cultural needs may be more likely to attract the attention of ‘named persons’, compounding the pre-existing social risks and barriers they face. And we must never, ever lose sight of the fact that it is women who disproportionately bear the brunt of individualised narratives of poor parenting. Neoliberalism is the engine of patriarchy.
The Scottish government, as part of its public health approach to tackling childhood adversity, is piloting routine enquiry, which sees citizens routinely asked by health workers and representatives of other agencies, such as social care and the police, whether they’ve experienced childhood sexual abuse. Quite what the government proposes to do with this data is unclear, though it’s easy to see how such data could be (mis)used in the context of GIRFEC and the named person scheme.
Routine enquiry may well be underpinned by good intentions but in the era of Big Data, enabled by the increasing intertwinement of public services and private enterprise emerging as a result of decades of neoliberal economic and social policy, and advanced by governments and corporations seeking to use information gathered about us to predict and modify our behaviour, we should ask what this ACEs juggernaut heralds for our fundamental right and freedoms.
On a practical level, there’s concern that there simply aren’t enough high quality services in place to follow-up on disclosures of abuse following routine enquiry, which could lead to individuals and families being further harmed. Not to mention the risk of inexpert handling of difficult conversations that require time, sensitivity and knowledge, risking a tick-box approach that could trigger traumatic recall. This seems to me entirely at odds with the basic tenets of trauma-informed practice.
No matter how good the intentions, the framing of social problems as emanating from those most affected by them effectively casts politically-mandated inequalities as mental health problems. ACEs ideology slots neatly into neoliberal prevention and resilience discourse that says the problem is, literally, what and how we as individuals think and behave. It would be flatly wrong to deny the benefit of psychological and other personalised therapies in helping those who have experienced trauma, but at the same time we cannot think our way out of the material circumstances that very often contribute to our personal pain. We need public policy and support to tackle the deep rooted political problems that are the basis of widespread human suffering, not behavioural approaches that effectively teach people how to put up with their lots. There is a great deal at stake. What is happening to public policy in Scotland has implications beyond the ACEs agenda. The legacy of ACEs may well be that it provides a ready conduit for neoliberalism to continue to leverage good intentions, Big Data and pseudoscience to further assert its dominance as prevailing ideology of our time.
Further reading
Ball, S. J. (2016) ‘Subjectivity as a site of struggle: Refusing neoliberalism?’ British Journal of Sociology of Education, 2016, Vol. 37, №8, 1129–1146
Boas, T. C. & Gans-Morse, J. (2009) ’Neoliberalism: From New Liberal Philosophy to Anti-Liberal Slogan’ Studies in Comparative International development, June 2009, Volume 44, Issue 2, pp 137–161
Cahill et al (2018) The SAGE Handbook of Neoliberalism, SAGE: London
Mayor, C. (2018) ‘Whitewashing trauma: applying neoliberalism, governmentality, and whiteness theory to trauma training for teachers’, Whiteness and Education, 3:2, 198–216
Springer et al (2016) The Handbook of Neoliberalism, Routledge: Abingdon/New York
