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 SPECIAL SECTION 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 use- ful 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. SPECIAL SECTION 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.