The Social Case Worker’s Task

Mary E. Richmond, Director, Charity Organization Department,

Russell Sage Foundation, New York

A Presentation at the 44th Meeting of the National Conference on Social Welfare,

Pittsburgh, PA, June 6-13, 1917 (pp.112-114)

First of all, it would seem necessary for the social case worker to stake out his claim to the word social, for I find that some members of this year’s Conference are inclined to dispute it. They assert, for instance, that a recent book of mine should be called Individual Diagnosis because it is not and does not pretend to be a diagnosis of the ills of society. Well, in medicine a diagnosis describes disease as it appears in the individual organism; in botany it describes not the genus but the combination of points which are characteristic of the individual plant. When, therefore, we describe the social difficulties of a human being, as we more completely understand them through a study of his social relationships, it would be tautological to call the description “an individual diagnosis.” But it may well be distinguished from physical diagnosis on the one hand and from mental diagnosis on the other by calling it social diagnosis. There may be other uses of these two words in combination, but the use now rapidly being adopted by social case workers is both literal and sound.

It is true that the word social has many meanings. As it has been adopted in the usage of this Conference and is now incorporated into the Conference title, it has a meaning at once more inclusive and more exclusive than some who glibly use the word seem to realize. The criterion of the social, its indispensable element always, is the influence of mind upon mind. This influence may be exercised in a small group, such as the family, the kindred, or the other personal contacts of a given subject, or it may be the result of a loose-jointed but vital international fellowship. Many things termed social lack this essential  element utterly because there is no mental interaction within the group. The dependent classes, about which we have heard so much in these conferences, are not a social group at all, nor is any other arbitrary grouping likely to become so. The approach to social questions is a varied one. One may be deeply interested in the manifestations of social relationships in the individual-realizing, indeed, that the individual is their product, that his central self is bounded “by his conscious interests and affections”; or one may instinctively begin at the other end and seek a better adjustment of social relationships by the manipulation of larger units, by what we call mass betterment. Social work includes both approaches; so closely do they interplay that it would be a topheavy and ineffective thing if either were neglected.

Dr. Cabot has just pointed out the folly of trying to treat a portion of the eye without knowing the whole eye. The social life of man is even more complicated than the mechanism of the eye-so complicated that this evening’s program might be taken as a partial demonstration of the need of combining many points of view and many explanations when we attempt to be social. The social case worker can hardly hope to effect the best possible adjustment in but one human life awry without seeking the special knowledge of others about occupations, recreations, government, or without seeking the aid of still others whose art is healing the body, and of others again who heal the mind. The social case worker has a specialty, too, however. His, too, is an artthe art (if I may venture a definition) of bringing about better adjustments in the social relationships of individual men, or women, or children. It matters not in what agency, public or private, this is achieved. If this chiefly is what we are doing-whether in a school, a courthouse, a hospital, or wherever-we are social case workers.

It should not have needed these three years, or nearly three, of war to convince us that such adjustments are going to have to be made and on a large scale. That they should be made not athwart the stream of mass progress but in closest sympathy with it, and in closest co-operation, too, with such professions as are represented on this platform tonight, should be self-evident also.

The attitude of some of the social reformers in this Conference toward the social case workers who make up the bulk. of its membership reminds me of an anecdote of the Spanish-American war. A young woman, approaching at that time a man in uniform, inquired, “Are you one of the nation’s heroes?” “No, ma’am,” he replied. “I’m just a regular.” We social case workers are not heroes and do not so regard ourselves, because there are so many of us. The study of men, however, and the advancement of their welfare through the study of their social relationships is no mean task.

We were all interested two years ago in Mr. Flexner’s analysis at Baltimore of our professional standing. We had to acknowledge that in so far as (under the name of social case work) we were merely matching folks and disabilities; in so far as we were tagging the one with the other and trying to call in the appropriate practitioner, we richly deserved his characterization of middlemen. Is that really all that we are doing? Too often it is. A reader of social case records sometimes gets the impression that the one who does such work has only to be a good shot. You drop your clients into one pigeon-hole or another, and there you are! The trouble is that there they are, too. But as we listened to Mr. Flexner we were more or less aware that quietly and behind his back, apparently, there was developing a skill quite different in method and in aim from the work that he described. We were not all behaving like the telephone girl at the switchboard who pulls out one plug and pushes in another; many of our social agencies were something better than animated clearing-houses, we felt. In fact, the distinguishing marks of their work were, first, skill in discovering the social relationships by which a given personality had been shaped; second, ability to get at the central core of difficulty in these relationships; and third, power to utilize the direct action of mind upon mind in their adjustment.

If not now, then very soon, the social case workers of this Conference are going to be recognized by the different professional groups that deal with human beings one by one-by the doctors, the jurists, the teachers, for example-as collaborators in a division of work among equals. We shall have a skill of our own, a point of view of our own, and shall act as middlemen to the extent that any professional worker who wants to do a good all-round job must so act, and no further. Nor will the fact that our skill was first developed and first practiced in certain charities damn us utterly, either. More than one of the other professions have worked out their technique under the same capacious mantle.

It seems natural enough to draw my only illustrations of this development, and of the line that I believe it must soon take, from the contacts of the social case worker with medicine. From none have we had more generous recognition of the things that we know how to do than from the best of the physicians.

I have told elsewhere of the first instance on record of seeking social case work advice for a well-to-do patient. The request came from a physician who knew what such skill had meant in his hospital practice and felt that he could not cure his private patient without it. Others have followed this lead in a number of places. Only a few weeks ago a fresh instance came to my attention from a part of our country in which medical-social work is unknown. I found that the secretary of a charity organization society in a town in the far south was often asked by local physicians to help them in pellagra cases which were not complicated by poverty. These doctors had learned to value the art of a social case worker who could discover and touch the hidden springs of interest in patients who were suffering from the horrible depression characteristic of one stage of that disease. They had learned that aggressive cheerfulness was worse than useless with pellagra patients, but that one who knew how to fill in social backgrounds and foregrounds could often find in them somewhere the one thing that would make life seem to the patient worth living.

It would be easy to cite other illustrations in fields far removed from the medical, but I must pass on to the one other point that there is time to make; namely, – to our great need of a deepened sense of professional solidarity and of professional standards. “Battles are not won by phrases” but by knowing every inch of the ground and by a% detailed working together, through methods which all have mastered, toward a common goal. The developments that point toward more social case work under public auspices will be a dismal failure unless we can work out standards and then achieve an enthusiasm for them which will assure their maintenance in our city and state departments.

I was impressed anew with the importance of bestirring ourselves about this after a recent visit from a surgeon who was interested in improving the clinical records of hospitals and dispensaries. He felt that they had been rendered worthless for medical study and progress in the past by the way in which they had been kept, and by the fact that the terminology used for disease had been whatever the private judgment of the different house officers happened to dictate. On the medical side he and his colleagues were making progress in remedying this, but, recognizing the importance of making social data a part of the medical record, he was seeking a terminology of social case work which could be placed beside a medical terminology already adopted in a number of the larger hospitals. It was impossible to tell him where such a terminology could be found because it does not exist. Evidently it will delay medical thinking in certain directions that our own thinking is still so inchoate. A terminology for the whole of social case work cannot be worked out by any one group of practitioners, any more than a medical terminology could be devised by the neurologists alone or by the surgeons alone. But is it not time that we got together and registered our differences, at least, as a preliminary to wearing them down to smaller proportions and building in their stead a common body of knowledge expressed in a language which is our common property?

I know that some leaders feel that this would be quite futile, that social case work as a separate discipline is soon to disappear, to be absorbed into medicine on the one hand and education’ on the other. Both of these are welcome to absorb all that they can contain, but there is going to remain a large field quite neglected unless we cultivate it. As democracy advances there can be neither freedom nor equality without that adaptation to native differences, without that intensive study and intensive use of social relationships for which social case work stands.

Source: National Conference on Social Welfare Proceedings On-Line

The web site for this resource is:  http://www.hti.umich.edu/n/ncosw/

The proceedings of annual meetings of the NCSW, 1874-1983, are available on the web thanks to a digitization project undertaken by the University of Michigan Library, with assistance from the Social Welfare History Archives at the University of Minnesota.  The web site for this resource is: http://www.hti.umich.edu/n/ncosw/