De hjälper oss till rätta: normaliseringsarbete, självbestämmande och människor med psykisk utvecklingsstörning

Sammanfattning: For people with learning disabilities care in institutions has been replaced by a life in community settings e.g. group homes, where a number of persons (4-5) are living with staff support. My case-studies cover three elderly and three more lately produced such units as well as a ward in a nursing home. Data were gathered through participant observations and semistructured interviews with staff and residents. The purpose was to describe and analyze group homes for people with learning disabilities as a practice of normalization. Special interest was paid to the understanding of how discretion was configured and used by staff and residents i.e. the issues of autonomy and independence in the residents everyday life. All units studied were human service organizations, loosely coupled with their superior levels, where daily activities were carried out by street-level bureaucrats with high auton-omy. Only concerning the basic personal decisions and the framework for col-lective decisions could some restrictions to this autonomy be seen. Two important factors limited the discretion: The wage-labor structure, with its progressive view of time, limited choices. The common uncertainty in hu-man service organizations concerning knowledge about clients and the ef-fects of used methods, resulted in used technologies and activities fol-lowing a process of imitation (mimetic isomorphism) where similar elements developed, e.g. contact days, kitchen weeks, etc. Successful methodologies became rationalized myths assuming the form of ceremonial procedures. A common feature was an organized bureaucratic control, but apart from that the control forms were disparate. In three units control was enforced before and after an activity, and then as a discrete (normative or ideologi-cal) control or as feedback. In the other three units, as well as in the nursing home, the control was more direct, e.g. intrusion, obstruction or avoidance i.e. during ongoing de-cision-making or actual activities. Although the weight of these forms of control must be judged in a particular context, the former tended to allow a larger degree of empowerment and development of adaptive behavior since it requires a form of communicative rationality. The latter run the risk of developing into strategic decision-making and objectifica-tion of the client. The two clus-ters of group homes did not differ in respect to age and sex distribution, nor substantially in the demand for care but markedly in three other respects. First, one cluster of units had fewer hierarchies and more close relations between staff and residents. Second, in the other cluster, medication using psychopharmacological drugs founded routines that strengthened an already existing time structure and created a gap be-tween staff and residents due to higher requests for control. Third, through contagious institutionalizing micro-level processes in the first cluster, the individualized practices of normalization used in one field, such as cleaning or shopping, spread to others such as cook-ing. The ambivalences frequently expressed by staff members had only a small or unclear correlation to how the degree of self-determination and inde-pendence were expressed. Instead they mainly reflected the basic ten-sion between instrumental-rational and everyday life modes of thinking