A gilded cage is still a cage

'Clinical' is a word that is part of the framework and the furniture of my job as a Speech and Language Therapist (SLT). It trips off the tongue of colleagues without question and populates documents, policies and procedures. Yet, I wonder, in all its commonplace and everyday presence, do people ever really stand back to think about what that word actually implies?

Here are two definitions from the Cambridge English Online Dictionary

clinical adjective 

• used to refer to medical work or teaching that relates to the examination and treatment of ill people
• expressing no emotion or feelings; showing no character and warmth

In reading these definitions I feel like I want to scream loudly and break free from those words, that box that contains my working life. For all the talk of care, closeness and individual support by my professional body, the term clinical remains a gilded cage. A cage because these are the words and meanings that frame my day-to-day work, holding it in place so that it fits in neatly with the rest of the medical model to which my profession aligns. Gilded because it advertises itself as 'safe', 'trusted' and 'familiar'. 'Clinical' lulls too many into passivity and a lack of curiosity, content in the unawareness of anything that may lie beyond. A reliance on the security of the term 'clinical' is in short a form of disciplinary power that holds people in stasis, compliant to the capitalist structures that fuel our modern systems of care, cold to the reality of human diversity. 

In the fields of 'clinical' practice, there is little space to roam freely, to explore and to expand practice into more humanistic ways. Too often, centering lived experiences, valuing people's journeys and respecting their input as equals are seen as additional extras, not the core of therapeutic work. Worse still, these ideas may be even given as headlines, but the principles that underpin them remains wholly and defiantly part of the clinical machine. Those headlines then become 'lite' and 'tokenistic', floating in pretty places on websites, or in blurbs, worn as symbols of trust, but offering only false safety. The deep, reflective and ongoing work needed to really bring about change is not where investment lies. 

In the intrinsically intertwined world of capitalism and medical model ideology, knowledge is to be collected, gathered and harvested, and then to be regurgitated in definitive 'how to' guides and therapeutic plans. This objectification of knowledge means it is easy to be counted, measured and compared. Those neat 'decoded' parcels all ready to sell an idea and profit from its enactment. Herein,  humans who don't fit, are classified as being 'ill', a faulty outcome on the production line of being human. Human diversity becomes an 'object' to be shaped, sculpted and moulded to fit an expected 'norm' with other humans at the helm. The hierarchical trajectory is clear. There are those who are better and who know better than others, with clinical knowledge being as much a form of control as any physical structure.

I wonder too if my profession's stalwart stand behind the wall of 'clinical' practice is what prevents many from looking beyond their privilege and daring to see the harm that the extremes of hierarchy and supremacy enact upon innocent people elsewhere in the world. In focusing only on what is 'clinically' wrong, we coral ourselves behind closed doors, believing that wider issues affecting humanity are somehow beyond our scope of practice.  In an ever more globally intimate world, we bury ourselves ever deeper behind the barriers of our clinical knowledge. In this act, we fail to see that true care must extend beyond the narrow focus of our training. The connections, human to human, and human to the animate and inanimate, are the bonds that wrap, enfold and weave us into being in the world. These threads ultimately hold each of us in place, and as they begin to snap and break, we are all affected, no matter how secure we feel the locks are on the cage, no matter how much those in power reassure us that they remain in control.

To be truly free of the gilded cage, we must first recognise and name it, know its history, its boundaries and its weaknesses. As a species we have not always lived in this cage, and there are those who are also free of its confines. Many communities are already reclaiming the spaces beyond, offering freely their stories, their narratives, and finding the beauty of care in shared 'human' interactions, beyond the prescriptions of the 'educated expert'. 

Let's start by being curious, recognising the humanity in our own journeys, seeing the humans that we are, no better than any other human, all equal. These are simple, yet disruptive acts, that break the doors to the cage and throw into disarray the old order of how things have always been done. It is from this place of humility, that we can begin to journey in different directions, away from and outside of the cage; walking with, not doing to; learning with and alongside, instead of succumbing to the societal fabrication of only one way is best. Only outside of the cage can we begin to imagine a wholly different and authentic future for therapeutic practice. 

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