Autonomy slips away when too many hands pull in different directions

The First Signals It began innocently. A girl with panic attacks. Her parents had brought her in. She was still in school and wanted to finish it. But at the care facility she was immediately given new learning goals: cleaning her room, cooking, washing, hobbies, activities. The municipality demanded progress. The learning goals had to remain measurable. She carried two burdens at once: school and treatment. At home, everything was falling apart, parents in conflict, a brother, a sister,
and a child who didn’t feel seen.

The panic attacks came quickly. Several times a day. The assigned caregiver got calls from the parents: “You’re not responding fast enough! It took ten minutes before anyone came!” And that’s where it began.

The Panic of the System
The panic of the system became greater than the panic of the girl herself. Every attack became an emergency. Every emergency another meeting. It all depended on which caregiver she got. One could calm her down in five minutes, the other kept talking for forty-five minutes. She cried, she screamed, and a moment later, she laughed again. The assistant caregiver, a man in his sixties, full of common sense and allergic to nonsense, was the first to understand. After ten minutes, he simply started acting silly. A little dance. A few funny faces. Or he’d say, “Come on, let’s take a short drive in my car.” And sure enough, she wanted to. Within ten minutes, the panic attack was over.

Later he said, “I don’t think this is panic. I think it’s just attention, the child was never seen” But he wasn’t allowed to say that. Not his role. Not professional. He didn’t have a degree. So officially, he wasn’t competent. Meanwhile, the panic above him kept growing. The parents wrote emails. The main caregiver ran from meeting to meeting. The girl sat in the middle of the storm and thrived on all the attention. Many months had passed. By now, panic had become procedural. A specialist had even come by with a PowerPoint presentation on panic attacks. We all sat there with our notepads. The assistant caregiver, the same man, sat with his arms folded. He’d had enough months ago.

One of the boys in the group said,
“That twenty-year-old intern is allowed to help her, but he’s not?” He kept pointing it out. Meeting after meeting. But no one listened. There was too much panic, too many meetings, too many words. The core stayed outside the room. The specialist explained everything: what panic attacks were, how they started, what we had to do. PowerPoints, definitions, step-by-step plans. We knew exactly what panic was, on paper. And still, nothing changed.

Then came the fatigue.
Slowly, quietly. After many months, the whole team was drained. The main caregiver held on a little longer, but the rest began saying it out loud: “I think it’s just attention.” The main caregiver had been so determined to meet the learning goals that she eventually had to quit school herself. She couldn’t take it anymore. Because now the girl didn’t just have school goals, she had treatment goals too. Double the load. Double Steering and then, slowly, the panic attacks disappeared. As quietly as they had arrived. The parents sent one last email to the team manager:
“The staff isn’t responding adequately.”

The team manager panicked. Complaints. More meetings. More pressure. The assistant caregiver shrugged. He said, “Guys, I’ve seen enough. I’m done.” Many months of panic. A team in crisis. A specialist, a protocol, a PowerPoint. And in the end, it turned out: the panic attacks had never been real. It was a cry for attention, a human being who simply wanted to be seen.

The Lesson of Panic:
everyone got exactly what they didn’t need.

The girl got panic.
The parents got control.
The staff got exhaustion.
And the system got yet another protocol.

No one got rest. No one got understanding. Only another document in the file. In the end, the girl was the only one without a disorder. The rest developed one, a collective anxiety disorder, officially confirmed by protocol. And so, it stayed quiet. No more panic, but no growth either. Only fatigue in human form. And no one truly looks at the history of the family, at what really happened. It isn’t discussed, acknowledged, or felt. Slowly, you become system-blind. What you see every day eventually starts to feel normal. And what you live among infects you little by little.

As Maslach and Leiter (2016) describe,
such organizations emerge when emotional strain,
lack of autonomy, and constant control begin to feed each other. Where exactly is the clinical logic in taking an overstimulated adolescent with, for example ADHD, autism (ASD) diagnosis and dropping them directly into a hyper-reactive institutional warehouse alongside 25+ severely traumatized, dysregulated youth? How would a child feel if their parents abandoned them? Maybe we can simply ask ourself a few questions before the child gets a new “fear disorder” in her file?

•⁠ ⁠Why does this appear to be such a fear-based institution?
•⁠ ⁠Why is the manager afraid to say, “This is how we work, and this is why?”
•⁠ ⁠Why is a complaint or a negative review from parents perceived as such a major threat?
•⁠ ⁠Is the organization driven more by fear than by reflection and learning?
•⁠ ⁠Why is the main caregiver afraid? Is it workload, accountability, organizational pressure, or something else?
•⁠ ⁠Are care workers expected to meet targets set by the municipality, or are they primarily expected to meet the needs of the child?
•⁠ ⁠Why does the child panic at the thought of being separated from their parents?
•⁠ ⁠Could attachment dynamics, uncertainty, or a lack of information contribute to panic attacks?
•⁠ ⁠Is there a hierarchical problem within the organization?
•⁠ ⁠Why does the assistant caregiver decide to leave? Were their concerns genuinely heard?
•⁠ ⁠Are the young people who witness these dynamics actually being listened to?
•⁠ ⁠Why does the rest of the team follow the main caregiver?
•⁠ ⁠Does the main caregiver hold more formal or informal influence than the others?
•⁠ ⁠Is authority outweighing critical thinking?

And what about the parents?

•⁠ ⁠Why do they keep talking about each other in the third person during conversations?
•⁠ ⁠Why is the focus always on what the other did wrong?
•⁠ ⁠What kind of relational dynamics unfolded behind closed doors before the care system became involved?
•⁠ ⁠How many unresolved conflicts, arguments, fears, and misunderstandings came before this situation?
•⁠ ⁠How much of the current conflict is rooted in the past rather than the present?
•⁠ ⁠Are we only examining today’s behavior, or are we also asking what happened before?
•⁠ ⁠And finally, are these individual failures, or are they symptoms of a system under pressure?