The Regimens of Regimes

I’ve noticed lately that, even on NPR, people often use the word regime when they mean regimen. They refer to “vitamin regimes” or “exercise regimes” or “treatment regimes.” This sounds odd to my ear and vaguely disturbing, so I turn to our trusty Concise Oxford English Dictionary (OED) for clarification. It says “The World’s Most Trusted Dictionaries” right there on the front cover.

A regime, according to the OED, is “a government, especially an authoritarian one.” And this is my understanding of the word. In everyday usage, when we say regime, we usually mean a tyrannical government that oppresses its people – that uses the threat of violence to impose its will on the citizenry. So we speak of “corrupt regimes” or “evil regimes” or “military regimes, and we topple governments to achieve “regime change.”

By contrast, the OED describes a regimen as “a therapeutic course of medical treatment, often including recommendations as to diet and exercise.” So we may devise a regimen of medication, vocational or social skills training, illness education, rehabilitation activities, etc. in order to help a person achieve his or her treatment or habilitation goals.

I’m not just channeling Andy Rooney. I have a point here.

In providing services to people with disabilities, we wield tremendous power – power so ubiquitous and pervasive, it fills us like the air we breathe. Like the air, this power eludes our awareness, is invisible to our consciousness. And power employed without mindfulness can be very destructive.

In mental health, developmental services, and educational settings throughout the country, professionals are often frustrated by what they describe as “treatment resistant” people. We say people are treatment resistant when they will not adopt the regimen we have developed for them, and seem unwilling or unable to make progress toward recovery or independence.

But what if through our unconsidered use of power, the person experiences, not a thoughtful and health-promoting regimen, as we imagine we are providing, but an oppressive regime? Then we engage, not treatment resistance, but a kind of political resistance, which family life advocate Mary Lewis describes as “acting out against a dominating power.” And that is a very different thing altogether. Political resistance serves a vital protective function. It preserves the person’s individuality, dignity, and essential freedoms.

In this context, the person’s resistance becomes more understandable, even admirable. One might argue that it is our duty as citizens in a free society to resist oppression. Is there anything quite so quintessentially American?

As service providers, we have an obligation to examine our practices, to challenge our own habits, customs, and superstitions in supporting people with disabilities. If we truly wish to eliminate coercive elements from our services, we have to confront them, and recognize the dynamics that lead to and maintain them. This recognition requires us to seek them, to root them out. Because our power is so pervasive, the elements of coercion will not always give themselves up to casual viewing. Elimination requires illumination.

Abraham Lincoln said, “Nearly all men can stand adversity, but if you want to test a person’s character, give him power.” As support professionals and service providers, our characters are tested everyday, each time we report to work.

-August 2005