A Working Definition of Empowerment ▼

spring 1997—Volume 20 Number 4

A WORKING DEFINITION OF EMPOWERMENT ▼

JUDI CHAMBERLIN

Judi Chamberlin is a psychiatric survivor and a long-time activist for patients’ rights. She is the author of On Our Own: Patient Controlled Alternatives to the Mental “Empowerment” has become a popular term in mental Health System, as well as numerous articles on the topics of self-help health programs, yet it has lacked a clear definition. In a research project and alternatives. She is affiliated with the Center for Psychiatric designed to measure empowerment in programs run by and for mental Rehabilitation, Boston University, health service users, we first undertook to come up with a working defini- and with the National Empowerment Center, tion. Key elements of empowerment were identified, including access to Lawrence, Massachusetts. information, ability to make choices, assertiveness, and self-esteem. Empowerment has both an individual and a group dimension. Details of the For information contact the definition are provided, along with a discussion of the implications of em- author at the Center for Psychiatric Rehabilitation, 930 powerment for psychiatric rehabilitation programs. Commonwealth Avenue, Boston, MA 02215, U.S.A. any inherent meaning at all. Some INTRODUCTION conservative U.S. politicians have pro- moted welfare “reform,” for example, “Empowerment” is a term that has by claiming that cutting off benefits will become very popular in mental health “empower” recipients (who would services (at least in the United States). thus, presumably, become self-suffi- Nearly every kind of mental health pro- cient)! Such usages make it difficult to gram claims to “empower” its clients, claim that “empowerment” is a mean- yet in practice there have been few op- ingful concept. erational definitions of the term, and it is far from clear that programs that use The problem of using the term meaning- the term are in any measurable way dif- fully becomes even more problematic in ferent from those that do not. other countries and other languages. When I have spoken abroad, I find that Still lacking a definition, the word has the word is usually not translated; the become common political rhetoric, translator merely repeats “empower- with a flexibility of meaning so broad ment,” in English, perhaps hoping that that it seems to be in danger of losing the listeners will be able to draw some

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43 Psychiatric Rehabilitation Journal A Working Definition of Empowerment meaning from the context. Nonetheless, ing the conditioning; seeing things opening discussion as to whether “em- I believe that the term can have real differently; e.g., powerment” is a meaningful term that meaning, and that the first step in mak- describes a discrete mechanism used by a) Learning to redefine who we are ing it meaningful is to define it. members of the self-help groups in our (speaking in our own voice). study. In fact, I have found that in pre- b) Learning to redefine what we senting the definition to various A WORKING DEFINITION can do. groups, it often does begin such a useful discussion, and I have been told by At the Center for Psychiatric Rehabilita- c) Learning to redefine our relation- non-English speakers that the definition tion, I directed a research project that ships to institutionalized power. has been useful in their attempts to studied participants in user-run self- 7. Learning about and expressing translate the word. help programs for people with psychi- anger. atric disabilities.1 At the beginning of 8. Not feeling alone; feeling part of the study, we found that many of these EMPOWERMENT: a group. groups included the term “empower- THE ELEMENTS ment” in their program definitions. It 9. Understanding that people have was clearly a key concept, making it rights. Returning to the definition, let us now necessary to define empowerment as look at each of the elements: part of the project. We therefore 10. Effecting change in one’s life and 1. Having decision-making power. brought together a group of a dozen one’s community. Clients of mental health programs leading U.S. consumer/survivor self- 11. Learning skills (e.g., communica- are often assumed by professionals help practitioners,2 who formed the tion) that the individual defines as to lack the ability to make decisions, Advisory Board of our project, and we important. or to make “correct” decisions. made our first task the formulation of a Therefore, many programs assume definition. Although we recognized that 12. Changing others’ perceptions of the paternalistic stance of limiting empowerment had elements in com- one’s competency and capacity the number or quality of decisions mon with such concepts as self-esteem to act. their clients may make. Clients may and self-efficacy, we also felt that these 13. Coming out of the closet. be able to decide on the dinner concepts did not fully capture what we menu, for example, but not on the saw as distinctive about empowerment. 14. Growth and change that is never overall course of their treatment. ending and self-initiated. After much discussion, we defined em- Yet, without practice in making deci- powerment as having a number of qual- 15. Increasing one’s positive self-image sions, clients are maintained in long- ities, as follows: and overcoming stigma. term dependency relationships. No one can become independent unless 1. Having decision-making power. We decided early in our discussions that he or she is given the opportunity to empowerment was a complex, multidi- 2. Having access to information and re- make important decisions about his mensional concept, and that it de- sources. or her life. scribed a process rather than an event. 3. Having a range of options from Therefore, we did not believe that an 2. Having access to information and re- which to make choices (not just individual had to display every quality sources. Decision-making shouldn’t yes/no, either/or). on the list in order to be considered happen in a vacuum. Decisions are “empowered.” best made when the individual has 4. Assertiveness. sufficient information to weigh the This definition is not necessarily a glob- possible consequences of various 5. A feeling that the individual can al one, but is linked specifically to the choices. Again, out of paternalism, make a difference (being hopeful). research project, and is offered as a many mental health professionals re- 6. Learning to think critically; unlearn- working definition for the purpose of

1. Copies of the project materials and results are available from the author. 2. A list of the Advisory Board members is available from the author.

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44 spring 1997—Volume 20 Number 4

strict such information, believing re- psychiatric diagnosis and treatment, everything, and riding off into the striction to be in the client’s “best in- clients have had their lives, their per- sunset” to be synonymous with our terest.” This can become a sonal stories, transformed into “case definition! self-fulfilling prophecy, since, lacking histories.” Therefore, part of the em- 9. Understanding that people have adequate information, clients may powerment process is a reclaiming rights. The self-help movement make impulsive choices that confirm process for these life stories. among psychiatric survivors is part professionals’ beliefs in their inade- Similarly, the empowerment process of a broader movement to establish quacy. includes a reclaiming of one’s sense basic legal rights. We see powerful of competence, and a recognition of 3. Having a range of options from parallels between our movement the often-hidden power relation- which to make choices. Meaningful and other movements of oppressed ships inherent in the treatment situ- choice is not merely a matter of and disadvantaged people, including ation. In the early stages of “hamburgers or hot dogs” or “bowl- racial and ethnic minorities, women, participation in self-help groups, for ing or swimming.” If you prefer gays and lesbians, and people with example, it is very common for salad, or the library, you’re out of disabilities. Part of all of these libera- members to tell one another their luck! tion movements has been the strug- stories; both the act of telling and gle for equal rights. Through 4. Assertiveness. Non-diagnosed peo- that of being listened to are impor- understanding our rights, we in- ple are rewarded for this quality; in tant events for group members. crease our sense of strength and mental health clients, on the other 7. Learning about and expressing self-confidence. hand, it is often labeled “manipula- anger. Clients who express anger tiveness.” This is an example of how 10. Effecting change in one’s life and are often considered by profession- a psychiatric label results in positive one’s community. Empowerment is als to be “decompensating” or “out qualities being redefined negatively. about more than a “feeling” or a of control.” This is true even when Assertiveness—being able to clearly “sense;” we see such feelings as pre- the anger is legitimate and would be state one’s wishes and to stand up cursors to action. When a person considered so when expressed by a for oneself—helps an individual to brings about actual change, he or “normal” person, and is yet another get what he or she wants. she increases feelings of mastery and example of the way in which a posi- control. This, in turn, leads to fur- 5. A feeling that the individual can tive quality becomes a negative once ther and more effective change. make a difference. Hope is an essen- a person is diagnosed. Because the Again, we emphasized that this is tial element in our definition. A per- expression of anger has often been not merely personal change, but has son who is hopeful believes in the so restricted, it is common for a group dimension. possibility of future change and im- clients to fear their own anger and provement; without hope, it can overestimate its destructive power. 11. Learning skills that the individual seem pointless to make an effort. Yet Clients need opportunities to learn defines as important. Mental health mental health professionals who about anger, to express it safely, and professionals often complain that label their clients “incurable” or to recognize its limits. their clients have poor skills and “chronic” seem at the same time to cannot seem to learn new ones. At 8. Not feeling alone; feeling part of a expect them to be motivated to take the same time, the skills that profes- group. An important element in our action and make changes in their sionals define as important are often definition is its group dimension. We lives, despite the overall hopeless- not the ones that clients themselves believe that it is necessary to recog- ness such labels convey. find interesting or important (e.g., nize that empowerment does not daily bed making). When clients are 6. Learning to think critically; un- occur to the individual alone, but given the opportunity to learn things learning the conditioning; seeing has to do with experiencing a sense that they want to learn, they often things differently. This part of the of connectedness with other people. surprise professionals (and some- definition created the most discus- As was brought up numerous times times themselves) by being able to sion within our group, and we were during our discussion, we did not learn them well. unable to come up with a single want to leave the impression that we phrase that encapsulated it. We be- considered the image of “John lieved that as part of the process of Wayne coming into town, fixing

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45 Psychiatric Rehabilitation Journal A Working Definition of Empowerment

take control of one’s life, demon- strating one’s essential similarity to EMPOWERMENT AND so called “normal” people, this per- REHABILITATION ❝ he desire to ception should begin to change. And T the client who recognizes that he or Within the research project, the defini- she is earning the respect of others tion was the starting point for the devel- protect (and to 3 increases in self-confidence, thus opment of a measurement instrument. Although our study was limited in be protected) is further changing outsiders’ perceptions. scope, we found that participants in the groups we studied displayed a fairly a strong one; 13. Coming out of the closet. This is a high level of empowerment.4 It is hoped term we have taken from the gay/ nonetheless, there that both the definition and the re- lesbian movement. People with de- search project will promote the further are genuine benefits valued social statuses who can hide study of the concept of empowerment that fact often (quite wisely) choose for people with psychiatric disabilities. to do so. However, this decision when clients begin to This concept is particularly important takes its toll in the form of decreased within psychiatric rehabilitation pro- self-esteem and fear of discovery. control their own grams, since these programs often claim Individuals who reach the point that they are promoting independence, where they can reveal their identity lives, and when autonomy, and other ideas related to are displaying self-confidence. empowerment. It would be extremely practitioners become 14. Growth and change that is never useful to find out, for example, whether ending and self-initiated. We want- rehabilitation practitioners believed guides and coaches in ed to emphasize in this element that their programs were promoting em- this process, rather empowerment is not a destination, powerment in their clients, and but a journey; that no one reaches a whether clients of those programs than assuming final stage in which further growth agreed. An increase in empowerment and change is unnecessary. scores following participation in a program would be a positive indicator the long-term, 15. Increasing one’s positive self-image about that program. If scores did not in- and overcoming stigma. As a person crease, practitioners (and program paternalistic role becomes more empowered, he or clients) should try to identify those pro- she begins to feel more confident of supervisors.” gram elements that interfere with and capable. This, in turn, leads to clients becoming empowered. increased ability to manage one’s life, resulting in a still more im- Operating an empowerment-oriented proved self-image. The negative program has risks, as does becoming identity of “mental patient” that has empowered. The desire to protect (and 12. Changing others’ perceptions of been internalized also begins to to be protected) is a strong one; one’s competency and capacity to change; the individual may discard nonetheless, there are genuine benefits act. If anything defines the public the label entirely, or may redefine it when clients begin to control their own (and professional) perception of to convey positive qualities. lives, and when practitioners become “mental patients,” it is incompeten- guides and coaches in this process, cy. People with psychiatric diagnoses rather than assuming the long-term, pa- are widely assumed to be unable to ternalistic role of supervisors. Such a know their own needs or to act on shift of roles and practices would make them. As one becomes better able to rehabilitation services truly transforma- tive in the lives of their clients.

3. Copies of the instrument, “Making Decisions,” are available from the author. 4. An article describing the instrument and the study result is currently in preparation.

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