The Role of the M e n t a l Health Executive in Conflict Resolution by James M. Hunt, M.P.H. Hospital Executive Vermont State Hospital Richard M. Daum, B.A. Formerly Hospital-Community Liaison Officer Officer of the Hospital Executive Vermont State Hospital Currently Graduate Student Program in Health Policy and Management Harvard University School of Public Health Over the last decade, the non-medical administrator in the mental health organization has increasingly been afforded the opportunity to function in the broader, more demanding role of organizational executive. The lay administrator is a manager of support services, charged with responsibility of implementing the decisions of clinical superiors, while the mental health executive manages both support and direct-care services. Consequently, he functions as a superior of the clinically-trained, mental health professional. A great deal of controversy, surrounds the issue of the medical (or clinical) versus the lay, executive. This controversy stems from the recent turmoil over the appropriateness of the medical model for the mental health care delivery system. However, due to a lack of time, the need for discretion, this issue must be left for other times and other groups to resolve. The intent of this article is to deal with specific sources of conflict in the mental health organization, and to offer both our experiences and suggestions in resolving them. Somewhat akin to the Chinese symbol for crisis, organizational conflict involves both "danger and opportunity".1 While such conflict often means prolonged and painful struggle, its successful resolution can provide the stimulus for improved organizational functioning and constructive change. Conflict is as much a part of the fabric of mental health organization as it is part of the personal lives of those served by the profession. Though mental health professionals generally regard themselves as experts in resolving the conflicts which plague their patients, they are consistently unable to avoid those which occur in their professional lives. The following discussion examines some of the sources of conflict in the mental health agency, and the role of the executive in resolving them. 46
One of the major sources of conflict in a mental health organization stems from the very nature of its goals. In his essay entitled The Sociology of Organizations, David Mechanic discusses the ambiguity and diversity of these goals: The goals of such organizations - whether they be hospital, mental health center, rehabilitation center, out-patient clinic, or some combination of these - are usually multifaceted and ambiguous. They normally encompass some concept of treatment, rehabilitation, and consultation. They frequently combine such functions as providing services to clients, training of professionals and other personnel, and some research. In addition, they are ordinarily expected to perform various tasl~s for the community, such as detention and evaluation of persons disruptive to the community, consultation with the courts and other community agenices, and a variety of other functions. Moreover, the organization may become involved in efforts directed toward community education, prevention, and social amelioration. 2 The vagueness and complexity of these goals result in organizational conflict when it becomes necessary to define goal-attainment success, or attempt to formulate priorities. As any student of behavioral science is aware, the effectiveness of "treatment" in mental health resists even the most noble attempts at quantitative or qualitative analysis. In a fiscal crisis when budgets are threatened, which goals are most important? Are research and training sacrificed in order to maintain a satisfactory level of treatment? If so, argue research and training professionals, the agency is doomed to stagnation, the incentive for advancement gone. Can community education be eliminated? Social and outreach workers would claim such measures to be a sacrifice of the valuable concept of prevention. An approach to the resolution of the above-mentioned type of conflict, was attempted at Vermont State Hospital in the fall of 1974. A combination of gasoline shortages and inadequate snowfall during the previous winter had substantially reduced the expected tourist revenues for the State of Vermont. Faced with a sharp drop in revenues and increasing inflationary cost for services, the Agency of Administration ordered a $9.000,000 reduction in State expenditures. Each State agency was instructed to prepare a revised budget reflecting the impact of the proposed budget cut. It was the decision of the hospital's administration to obtain as much organizational input as possible, in the budget reduction process. In accomplishing this difficult task, each major department head was assigned the responsibility of determining priorties for each department within the agency. (In other words, we asked each department head to create their version of a potential "doomsday plan".) Upon receiving the priority lists, the Administration ranked each department by the 47
frequency of supportive responses. The results were surprising for two reasons. First, they were remarkably similar to the administration's own disaster plan. Second, with few exceptions, the priorities of the department heads were quite similar to each other. This approach was valuable since it significantly diffused the harmful competition which might have arisen had budget decisions been made by administrative fiat. Based upon the recommendation of the hospital staff, department budgets were cut and positions eliminated with a minimum of internal conflict. 9Another source of organizational conflict can be attributed to the nature and variety of professional staff employed by the organization. Modern mental health professionals have a great deal of training, holding graduate degress in social work, nursing, psychology, psychiatry, etc. As H.G. Whittington points out, "The mental health agency at times seems to be very much like the Italian navy: There are more Admirals than ships. The professional staff members have a highly developed need for status, independence, and autonomy." 3 As a rule, the mental health professional has subordinated the profit motive to a strong service ideal in which the clients interest served are believed to the the most important. In addition, the mental health professional believes that he, alone, can judge the validity of his decisions. 4 Professional tasks, for clinical staff, are frequently non-specific. Moreover, as alluded to earlier, it is often difficult to evaluate whether outcomes achieved are successes or failures. Thus, mental health professionals have the freedom to form alliances and initiate goals of their own. Such organizational sub-goals orgininate for a varity of reasons. Most significantly, "The participant's desire to achieve status, recognition, or other rewards by working through his own professional framework in conforming to the values of his own professional group."5 Mechanic illustrates this phenomenon with the following examples.: Many psychiatrists are reluctant to depart too drastically from what they perceive among their own peer groups as the valued forms of treatment in treatment organization. Similarly, social workers may resist the establishment of a lay therapist program or other organizational modifications because it challenges their status position and presumption of expert skills. 6 A potential conflict between professional groups is posed by a professional of lower status and salary being given a position of greater responsibility than other professionals of higher status and salary. 7 An example of this situation exits when a psychiatric social worker becomes the clinical director of a psychiatric unit. The psychiatrist, by definition, is expected to make diganoses and prescribe treatment, making admission studies and prescribing courses of therapy including occupational, recreational, or other 48
treatment procedures. The duties of the traditional social worker, on the other hand, are to work with individuals and families with social problems such as: chlildren with learning handicaps, physical or emotional handicaps, neglected or abused children, as well as a variety of social-psychological problems within the family itself. As a solution to this problem, H. G. Whittington recommends establishing "a formal management and control hierarchy that allows each of the disciplines to attain senior administrative rank by virtue of demonstrated competence."8 In dealing with conflicts of this type the mental health executive must clarify position guidelines, while upholding state and federal statutes which still require that "medical responsibility for each patient be vested in a physician." In addition, the executive must maintain a close vigil of the unit and attempt to mediate potential conflicts before they become destructive and inhibit the ability of the staff to function as a cohesive team. However, the reality remains that until social conventions and legal requirements are rectified, this type of conflict will continue to exist. The role of the mental health executive is, indeed, a sensitive one. As mentioned earlier, the traditional function of the lay executive was to manage support service departments. These departments were strictly structured, and rarely became embroiled in disputes over territorial boundaries. In addition, they were staffed by non-professionals for whom the opportunity for recognition and advancement was directly tied to the achievement of tangible organizational goals such as productivity and efficiency. The mental health executive is faced with an entirely different set of problems. Although usually having received graduate training in health services administration, or a related field, the executive's orientation is influenced by the "business model," i.e. increased productivity through increased efficiency (the truth of this statement is exemplified by the Iogos of: Better Management = Better Program). This model is nearly strained to the breaking point when transposed onto the mental health organization. What, exactly, is productivity or efficiency in mental health? Can it ever be stated, with a measure of certainty, that one form of psychotherapy is effective, let alone efficient? As the well known family therapist, J. Haley, has pointed out, patients may have a better rate of success with their problems, if they are never treated by mental health professionals at all. 9 While recognizing the "Achilles Heel" of the mental health profession, the executive must promote an organizational environment which encourages creativity and innovation. The wise executive recognizes that firm, but broad guidelines and an atmosphere in which new ideas are encouraged, are necessary ingredients for true "progress" in the mental health field. The executive must be sensitive to the personal and professional needs of the system, creating a spark where charge is needed. At no time, however, should the executive become the prime "power supply" for his system. 49
The classical argument most often posed against the lay executive's legitimacy is resolving professional conflict is that "They do not have the clinical background to make equitable judgements." It can be maintained, though, that this lack of clinical background is perhaps, a great asset. For unlike their clinically trained predecessors, they cannot be accused of professional favoritism. Earlier in this discussion, the conflict was mentioned that occurs when a superordinate agency establishes policies which directly affect the functioning of the mental health organization. An excellent example of this type of conflict occurred when the Vermont Department of Mental Health decided to accelerate the pace of deinstitutionalization in February 1975. While deinstitutionalization had been progressing successfully at a gradual rate for about 20 years,10Department officials felt that the pace of deinstitutionalization could be accelerated, despite the difficult fiscal situation of the State. To accomplish that goal with limited resources, meant that funds for community programs had to come from Vermont State Hospital. The administration of the State Hospital prepared a planning guide in the hope of avoiding some of the problems encountered by other states undergoing dsinstitutionalization. The guide encompassed problems of staff morale during the period of transition (following the announcement of the proposed reduction in force at Vermont State Hospital), patient considerations, legal implications, as well as predictable problems which might occur in communities surrounding the State Hospital. The recommendations of the State Hospital administration went largely unheeded. A proposed reduction in force as announced by the Commissioner of Mental Health, and the morale Of the staff of the Vermont State Hospital plunged to an all time low point. Uncertain of their vocational security, staff members searched desperately for alternatives for employment. While only a moderate amount of "slow-down" occurred, it was fairly obvious to the administration that State Hospital staff spent an inordinate amount of time contemplating the fate of their jobs. The approach to the problem by the administration was two-fold: 1. The administration of the State Hospital instructed department heads that staff usage of patient-care time, for "doom and gloom" sessions, would not be tolerated. 2. Lines of communication from staff to administration and vice versa were kept as open as possible (the administration attempted to address as many questions and complaints as possible). In addition, the State Hospital brought a great deal of pressure to bear upon the Department of Mental Health, to insure that first preference for newly created jobs in community mental health agencies, would be made available to laid-off State Hospital staff. This action was taken in recognition of the Hospital Administration's responsibility of implementing the superordinate agency policy while 50
at the same time, recognizing the hospital's responsibility to its employees. As a consequence of these efforts, staff morale rallied and it was noted that hospital staff performed "above and beyond the call of duty" in preparing patients for community placement. At this point of this discussion, the role of the mental health executive in relation to specific sources of conflict has been examined. Now, examine this role in a more general perspective. The mental health executive, in order to maintain the balance and direction of an organization, must be able to function in many roles. As Whittington points out, "The leader is constantly caught between opposing g o a l s . . , he must reconcile the comfort goals of the staff, with the production goals of the community or funding a g e n c y . . . he is the man in the middle, a conflict-resolver and problem solver, continually compromising between the ideal and the feasible; continually espousing realism by living in the here and now while secretly harboring pessimism and cynical fears."11The executive, to accomplish a goal as conflict-resolver, must act at times as the arbitrator: one who settles a dispute by functioning as judge, jury and executioner; as the mediator: one who assists in the settlement of a dispute by acting as an intermediary agent between conflicting parties, and finally; as the moderator: one who regulates or controls the level of intensity of the conflict while allowing the conflicting parties the opportunities to settle their own dispute. The success of the mental health executive will depend on skill in functioning in each of these roles, and more importantly, on ability to determine which skill must be brought into play to settle the dispute at hand. As previously stated, organizational conflict does not necessarily represent an organizational evil. Conflict, in any organization, is a natural and generally healthy by-product of human organization. The organization, proudly described as "one big happy family", is probably a dead one. The executive who does not allow conflict to develop and attempts to maintain a "tight ship", has probably created an organization lacking creativity and immobilized with stagnation. Levinson states that in this type of organization, "Where conformity is the first rule of survival, initiative is likely to be found only in the dictionary on the secretary's desk."12 The executive must be capable of functioning as the watchdog of organizational conflict. A sense of timing and the ability to judge the intensity of a role in a particular conflict, is the fulcrum which balances the constructive or destructive effect on the conflict upon the organization. Both Levinson and Whittington describe the pressures placed on the man in the middle. Levinson states that the organizational executive " . . . often takes considerable psychological punishment in order to ease the difficulties of others." This function, generally unrecognized, " . . . i s both abrasive and draining . . ." he (the executive) must suppress his own feelings and serve as a cushion for those who seek his help. ''13 Whittington cautions that the eroding effect 51
of these stresses can " . . . contribute to the pathology of leadership, resulting in rigidity, paranoid distrust, over control, irrationality, and ineffectiveness." 14 To limit the damaging effects of this type of stress, the mental health executive must avoid the loss of objectivity in dealing with organizational stress. While able to empathize with conflicting groups, the executive may not enjoy the luxury of sympathizing with any group. If mental health executives lose objectivity in dealing with an organizational conflict, they will cease to function as a resolver, and become active participants in the conflict. Perhaps the best advice to be offered to the lay administrator assuming the new role of mental health executive, and faced with some of the problems discussed in this paper, is "ILLEGITIMI NON CARBORUNDUM", or loosely translated, "Don't Let the Bastards Get You Down".
52
Footnotes 1Minuchin, Salvadore, M.D. and Barcai, Avner, M.D. Therapeutically Induced Family Crisis, Sager, Clifford J. and Kaplan, Helen Singer, Editors, Progress inGroup and Family Therapy. 2Mechanic, David. The Sociology of Organizations. In Feldman, Saul, D.P.A., The Administration of Mental Health Services, Springfield, II1., Charles C. Thomas, 1973. 3 Whittington, H.G. People Make Programs. In Feldman, Saul, The Administration of Mental Health Programs. Springfield, II1., Charles C. Thomas, 1973. 4Dolgoff, Thomas, M.S.E. The Organization, the Administrator and the Mental Health Professional. Hospital and Community Psychiatry, February 1970, pp. 25-32. 5Mechanic, David, op. cit. 61bid,
7This trend is discussed in more detail in" 1. Burgess, John A., Who has the Administrative Skills in Mental Health? Public Administration Review, March/April 1974, pp. 164-167 2. Farberow, N., The Crisis is Chronic. The American Psychologist, Vol. 28, No. 5 (1973) pp. 388-394. 3.Fisher, W., et. al., Power, Greed, and Stupidity in the Mental Health Racket. The Westminster Press. 4. Szacz, Thomas, M.D., The Myth of Mental Illness. In Ideology and Insanity: The Psychiatric Dehumanization of Man. Doubleday and Co., Inc. Garden City, N.Y., 1970. 8Whittington, H.G., op. cit. 9Haley, J. The Power Tactics of Jesus Christ and Other Essays. Avon Books, New York, N.Y., 1969.
53
10Brooks, George W., M.D., Chittick, Rupert A., M.D. Irons, Francis S., Deane, William N., Ph.D. The Vermont Story. Rehabilitation of Chronic Schizophren/cs. Queen City Printers, Burlington, Vermont, 1961. 11Whittington, H.G., op. cit. 12Levinson, Harry. Executive Stress. Harper and Rowe, New York, N.Y., 1964. 13Levinson, Ibid. 14Whittington, H.G., op. cit.
54
One of the major sources of conflict in a mental health organization stems from the very nature of its goals. In his essay entitled The Sociology of Organizations, David Mechanic discusses the ambiguity and diversity of these goals: The goals of such organizations - whether they be hospital, mental health center, rehabilitation center, out-patient clinic, or some combination of these - are usually multifaceted and ambiguous. They normally encompass some concept of treatment, rehabilitation, and consultation. They frequently combine such functions as providing services to clients, training of professionals and other personnel, and some research. In addition, they are ordinarily expected to perform various tasl~s for the community, such as detention and evaluation of persons disruptive to the community, consultation with the courts and other community agenices, and a variety of other functions. Moreover, the organization may become involved in efforts directed toward community education, prevention, and social amelioration. 2 The vagueness and complexity of these goals result in organizational conflict when it becomes necessary to define goal-attainment success, or attempt to formulate priorities. As any student of behavioral science is aware, the effectiveness of "treatment" in mental health resists even the most noble attempts at quantitative or qualitative analysis. In a fiscal crisis when budgets are threatened, which goals are most important? Are research and training sacrificed in order to maintain a satisfactory level of treatment? If so, argue research and training professionals, the agency is doomed to stagnation, the incentive for advancement gone. Can community education be eliminated? Social and outreach workers would claim such measures to be a sacrifice of the valuable concept of prevention. An approach to the resolution of the above-mentioned type of conflict, was attempted at Vermont State Hospital in the fall of 1974. A combination of gasoline shortages and inadequate snowfall during the previous winter had substantially reduced the expected tourist revenues for the State of Vermont. Faced with a sharp drop in revenues and increasing inflationary cost for services, the Agency of Administration ordered a $9.000,000 reduction in State expenditures. Each State agency was instructed to prepare a revised budget reflecting the impact of the proposed budget cut. It was the decision of the hospital's administration to obtain as much organizational input as possible, in the budget reduction process. In accomplishing this difficult task, each major department head was assigned the responsibility of determining priorties for each department within the agency. (In other words, we asked each department head to create their version of a potential "doomsday plan".) Upon receiving the priority lists, the Administration ranked each department by the 47
frequency of supportive responses. The results were surprising for two reasons. First, they were remarkably similar to the administration's own disaster plan. Second, with few exceptions, the priorities of the department heads were quite similar to each other. This approach was valuable since it significantly diffused the harmful competition which might have arisen had budget decisions been made by administrative fiat. Based upon the recommendation of the hospital staff, department budgets were cut and positions eliminated with a minimum of internal conflict. 9Another source of organizational conflict can be attributed to the nature and variety of professional staff employed by the organization. Modern mental health professionals have a great deal of training, holding graduate degress in social work, nursing, psychology, psychiatry, etc. As H.G. Whittington points out, "The mental health agency at times seems to be very much like the Italian navy: There are more Admirals than ships. The professional staff members have a highly developed need for status, independence, and autonomy." 3 As a rule, the mental health professional has subordinated the profit motive to a strong service ideal in which the clients interest served are believed to the the most important. In addition, the mental health professional believes that he, alone, can judge the validity of his decisions. 4 Professional tasks, for clinical staff, are frequently non-specific. Moreover, as alluded to earlier, it is often difficult to evaluate whether outcomes achieved are successes or failures. Thus, mental health professionals have the freedom to form alliances and initiate goals of their own. Such organizational sub-goals orgininate for a varity of reasons. Most significantly, "The participant's desire to achieve status, recognition, or other rewards by working through his own professional framework in conforming to the values of his own professional group."5 Mechanic illustrates this phenomenon with the following examples.: Many psychiatrists are reluctant to depart too drastically from what they perceive among their own peer groups as the valued forms of treatment in treatment organization. Similarly, social workers may resist the establishment of a lay therapist program or other organizational modifications because it challenges their status position and presumption of expert skills. 6 A potential conflict between professional groups is posed by a professional of lower status and salary being given a position of greater responsibility than other professionals of higher status and salary. 7 An example of this situation exits when a psychiatric social worker becomes the clinical director of a psychiatric unit. The psychiatrist, by definition, is expected to make diganoses and prescribe treatment, making admission studies and prescribing courses of therapy including occupational, recreational, or other 48
treatment procedures. The duties of the traditional social worker, on the other hand, are to work with individuals and families with social problems such as: chlildren with learning handicaps, physical or emotional handicaps, neglected or abused children, as well as a variety of social-psychological problems within the family itself. As a solution to this problem, H. G. Whittington recommends establishing "a formal management and control hierarchy that allows each of the disciplines to attain senior administrative rank by virtue of demonstrated competence."8 In dealing with conflicts of this type the mental health executive must clarify position guidelines, while upholding state and federal statutes which still require that "medical responsibility for each patient be vested in a physician." In addition, the executive must maintain a close vigil of the unit and attempt to mediate potential conflicts before they become destructive and inhibit the ability of the staff to function as a cohesive team. However, the reality remains that until social conventions and legal requirements are rectified, this type of conflict will continue to exist. The role of the mental health executive is, indeed, a sensitive one. As mentioned earlier, the traditional function of the lay executive was to manage support service departments. These departments were strictly structured, and rarely became embroiled in disputes over territorial boundaries. In addition, they were staffed by non-professionals for whom the opportunity for recognition and advancement was directly tied to the achievement of tangible organizational goals such as productivity and efficiency. The mental health executive is faced with an entirely different set of problems. Although usually having received graduate training in health services administration, or a related field, the executive's orientation is influenced by the "business model," i.e. increased productivity through increased efficiency (the truth of this statement is exemplified by the Iogos of: Better Management = Better Program). This model is nearly strained to the breaking point when transposed onto the mental health organization. What, exactly, is productivity or efficiency in mental health? Can it ever be stated, with a measure of certainty, that one form of psychotherapy is effective, let alone efficient? As the well known family therapist, J. Haley, has pointed out, patients may have a better rate of success with their problems, if they are never treated by mental health professionals at all. 9 While recognizing the "Achilles Heel" of the mental health profession, the executive must promote an organizational environment which encourages creativity and innovation. The wise executive recognizes that firm, but broad guidelines and an atmosphere in which new ideas are encouraged, are necessary ingredients for true "progress" in the mental health field. The executive must be sensitive to the personal and professional needs of the system, creating a spark where charge is needed. At no time, however, should the executive become the prime "power supply" for his system. 49
The classical argument most often posed against the lay executive's legitimacy is resolving professional conflict is that "They do not have the clinical background to make equitable judgements." It can be maintained, though, that this lack of clinical background is perhaps, a great asset. For unlike their clinically trained predecessors, they cannot be accused of professional favoritism. Earlier in this discussion, the conflict was mentioned that occurs when a superordinate agency establishes policies which directly affect the functioning of the mental health organization. An excellent example of this type of conflict occurred when the Vermont Department of Mental Health decided to accelerate the pace of deinstitutionalization in February 1975. While deinstitutionalization had been progressing successfully at a gradual rate for about 20 years,10Department officials felt that the pace of deinstitutionalization could be accelerated, despite the difficult fiscal situation of the State. To accomplish that goal with limited resources, meant that funds for community programs had to come from Vermont State Hospital. The administration of the State Hospital prepared a planning guide in the hope of avoiding some of the problems encountered by other states undergoing dsinstitutionalization. The guide encompassed problems of staff morale during the period of transition (following the announcement of the proposed reduction in force at Vermont State Hospital), patient considerations, legal implications, as well as predictable problems which might occur in communities surrounding the State Hospital. The recommendations of the State Hospital administration went largely unheeded. A proposed reduction in force as announced by the Commissioner of Mental Health, and the morale Of the staff of the Vermont State Hospital plunged to an all time low point. Uncertain of their vocational security, staff members searched desperately for alternatives for employment. While only a moderate amount of "slow-down" occurred, it was fairly obvious to the administration that State Hospital staff spent an inordinate amount of time contemplating the fate of their jobs. The approach to the problem by the administration was two-fold: 1. The administration of the State Hospital instructed department heads that staff usage of patient-care time, for "doom and gloom" sessions, would not be tolerated. 2. Lines of communication from staff to administration and vice versa were kept as open as possible (the administration attempted to address as many questions and complaints as possible). In addition, the State Hospital brought a great deal of pressure to bear upon the Department of Mental Health, to insure that first preference for newly created jobs in community mental health agencies, would be made available to laid-off State Hospital staff. This action was taken in recognition of the Hospital Administration's responsibility of implementing the superordinate agency policy while 50
at the same time, recognizing the hospital's responsibility to its employees. As a consequence of these efforts, staff morale rallied and it was noted that hospital staff performed "above and beyond the call of duty" in preparing patients for community placement. At this point of this discussion, the role of the mental health executive in relation to specific sources of conflict has been examined. Now, examine this role in a more general perspective. The mental health executive, in order to maintain the balance and direction of an organization, must be able to function in many roles. As Whittington points out, "The leader is constantly caught between opposing g o a l s . . , he must reconcile the comfort goals of the staff, with the production goals of the community or funding a g e n c y . . . he is the man in the middle, a conflict-resolver and problem solver, continually compromising between the ideal and the feasible; continually espousing realism by living in the here and now while secretly harboring pessimism and cynical fears."11The executive, to accomplish a goal as conflict-resolver, must act at times as the arbitrator: one who settles a dispute by functioning as judge, jury and executioner; as the mediator: one who assists in the settlement of a dispute by acting as an intermediary agent between conflicting parties, and finally; as the moderator: one who regulates or controls the level of intensity of the conflict while allowing the conflicting parties the opportunities to settle their own dispute. The success of the mental health executive will depend on skill in functioning in each of these roles, and more importantly, on ability to determine which skill must be brought into play to settle the dispute at hand. As previously stated, organizational conflict does not necessarily represent an organizational evil. Conflict, in any organization, is a natural and generally healthy by-product of human organization. The organization, proudly described as "one big happy family", is probably a dead one. The executive who does not allow conflict to develop and attempts to maintain a "tight ship", has probably created an organization lacking creativity and immobilized with stagnation. Levinson states that in this type of organization, "Where conformity is the first rule of survival, initiative is likely to be found only in the dictionary on the secretary's desk."12 The executive must be capable of functioning as the watchdog of organizational conflict. A sense of timing and the ability to judge the intensity of a role in a particular conflict, is the fulcrum which balances the constructive or destructive effect on the conflict upon the organization. Both Levinson and Whittington describe the pressures placed on the man in the middle. Levinson states that the organizational executive " . . . often takes considerable psychological punishment in order to ease the difficulties of others." This function, generally unrecognized, " . . . i s both abrasive and draining . . ." he (the executive) must suppress his own feelings and serve as a cushion for those who seek his help. ''13 Whittington cautions that the eroding effect 51
of these stresses can " . . . contribute to the pathology of leadership, resulting in rigidity, paranoid distrust, over control, irrationality, and ineffectiveness." 14 To limit the damaging effects of this type of stress, the mental health executive must avoid the loss of objectivity in dealing with organizational stress. While able to empathize with conflicting groups, the executive may not enjoy the luxury of sympathizing with any group. If mental health executives lose objectivity in dealing with an organizational conflict, they will cease to function as a resolver, and become active participants in the conflict. Perhaps the best advice to be offered to the lay administrator assuming the new role of mental health executive, and faced with some of the problems discussed in this paper, is "ILLEGITIMI NON CARBORUNDUM", or loosely translated, "Don't Let the Bastards Get You Down".
52
Footnotes 1Minuchin, Salvadore, M.D. and Barcai, Avner, M.D. Therapeutically Induced Family Crisis, Sager, Clifford J. and Kaplan, Helen Singer, Editors, Progress inGroup and Family Therapy. 2Mechanic, David. The Sociology of Organizations. In Feldman, Saul, D.P.A., The Administration of Mental Health Services, Springfield, II1., Charles C. Thomas, 1973. 3 Whittington, H.G. People Make Programs. In Feldman, Saul, The Administration of Mental Health Programs. Springfield, II1., Charles C. Thomas, 1973. 4Dolgoff, Thomas, M.S.E. The Organization, the Administrator and the Mental Health Professional. Hospital and Community Psychiatry, February 1970, pp. 25-32. 5Mechanic, David, op. cit. 61bid,
7This trend is discussed in more detail in" 1. Burgess, John A., Who has the Administrative Skills in Mental Health? Public Administration Review, March/April 1974, pp. 164-167 2. Farberow, N., The Crisis is Chronic. The American Psychologist, Vol. 28, No. 5 (1973) pp. 388-394. 3.Fisher, W., et. al., Power, Greed, and Stupidity in the Mental Health Racket. The Westminster Press. 4. Szacz, Thomas, M.D., The Myth of Mental Illness. In Ideology and Insanity: The Psychiatric Dehumanization of Man. Doubleday and Co., Inc. Garden City, N.Y., 1970. 8Whittington, H.G., op. cit. 9Haley, J. The Power Tactics of Jesus Christ and Other Essays. Avon Books, New York, N.Y., 1969.
53
10Brooks, George W., M.D., Chittick, Rupert A., M.D. Irons, Francis S., Deane, William N., Ph.D. The Vermont Story. Rehabilitation of Chronic Schizophren/cs. Queen City Printers, Burlington, Vermont, 1961. 11Whittington, H.G., op. cit. 12Levinson, Harry. Executive Stress. Harper and Rowe, New York, N.Y., 1964. 13Levinson, Ibid. 14Whittington, H.G., op. cit.
54
