Social Work; Essays On The Meeting Ground Of Doctor And Social Worker - free ebook by Richard C. (Richard Clarke) Cabot

Books by Richard C. Cabot

Published by HOUGHTON MIFFLIN COMPANY A LAYMAN'S HANDBOOK OF MEDICINE. With Special Reference to Social Workers. WHAT MEN LIVE BY. SOCIAL WORK. Essays on the Meeting-Ground of Doctor and Social Worker. SOCIAL WORK...

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SOCIAL WORK

ESSAYS ON THE MEETING-GROUND OF DOCTOR AND SOCIAL WORKER BY RICHARD C. CABOT, M.D. BOSTON AND NEW YORK HOUGHTON MIFFLIN COMPANY The Riverside Press Cambridge 1919 COPYRIGHT, 1919, BY RICHARD C. CABOT All Rights Reserved TO MARY E. RICHMOND WHOSE ILLUMINATING BOOK ON "SOCIAL DIAGNOSIS" MARKS AN EPOCH IN THE DEVELOPMENT OF SOCIAL WORK...

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PREFACE

Most writers who disclaim thoroughness are prone to describe their work as an outline, a sketch, or an introduction. But the chapters of this book are more like spot-lights intended to make a few points clear and leaving many associated topics wholly in the dark. Possibly such isolated glimpses may serve better than a clear outline to suggest the interest of the whole topic. At any rate, that is my hope. Part of the same material has been used in lectures given at the Sorbonne in the early month

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I

The profession of the social worker, which is the subject of this book, has developed in the United States mostly within the past twenty-five years. Probably ten thousand persons are now so employed. It is known by various titles—social worker, school nurse, home and school visitor, welfare worker, hospital social worker, probation officer—varying according to the particular institution—the hospital, the court, the factory, the school—from which it has developed. But although the use of these vi

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II

But in the evolution of the particular type of social worker who is the subject of this book, the home visitor connected with a dispensary, there are other forces besides those described above, other motives besides that common to the rise of all the types of home visitors in all the other institutions named. For in the dispensary, not only has the number of applicants greatly increased, but it has increased because people realized that there was much more to be obtained by going to a dispensary

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III

It was at this very unfortunate and undignified stage in the development of our dispensary work in America that we received priceless help from France, help which I am all the more anxious to acknowledge to-day because it has not, I think, been fully appreciated in the past. We in America have not given to France the full expression of the gratitude which, for her services in the field of medicine, as in even more important phases of our national life, it is to-day particularly fitting that we s

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IV

I must speak at this point of another great French contribution towards the occupation which in its fully developed state we now call social work. I mean that which at present receives ordinarily the name of the "Œuvre Grancher." Grancher proceeded upon the same sound bacteriological foundations which guided Calmette. Since children are especially susceptible to tuberculous infection (though they rarely show alarming signs of it till later years), he planned the separation of children from the n

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V

As far back as 1895 the reforms introduced by Calmette and Grancher in the field of tuberculosis had begun to modify and improve the treatment given in our dispensaries, not only to tuberculosis but to all other diseases. Especially it had favored the growth of home visiting, at first for the specific ends for which it was designed by Calmette and Grancher, but later for the prosecution of various related purposes which the very process of visiting brought to light. Not only in tuberculosis, but

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PART I Medical-Social Diagnosis

I have said in the Introduction that home visiting may easily and properly spring up in connection with various institutions; for example, in connection with the schools, courts, or factories of the city as well as with the dispensaries. But it is essential in home visiting, no matter what institution it is connected with, that the social assistant should be distinctly recognized as part of the machinery of that institution, or, in other words, as one of the means by which that institution does

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Light on the severity of illness

I have said that it is essential to the success of a medical visitor's work that she should be part of the medical machine, acknowledged as the doctor's agent, concerned wholly with helping to carry out his plans. But we must ask now, what part ? And the answer is that the social worker is an assistant to the physician both in diagnosis and in treatment . I will begin with an account of what she is to do as his assistant in diagnosis. She is to discover, so far as she can, what the disease is, h

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Nests of contagious disease

So far I have been describing the work of the social worker as a process of finding out how much ails the patient and what his symptoms signify. But it is also a part of the social worker's duty to find how much disease is present not only in the individual who appears in the clinic, but in his immediate environment, to discover nests, foci or hotbeds of disease . In the case of a disease like smallpox, this is obvious. If a patient presented himself at a dispensary with the pustules of smallpox

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Hotbeds of industrial disease

Commoner and not less important than the contagious diseases that I have just mentioned are industrial diseases, or diseases aggravated by the conditions of industry. A physician may serve for many months in a dispensary without seeing a case of smallpox, of trichiniasis, or of typhoid fever, or feeling it his duty to set in motion the forces that I have just mentioned for rooting out the sources of contagion and preventing their further spread. But he cannot serve a month in any well-attended d

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Medical outfit of the social worker

In order to carry out the particular procedures of diagnosis and treatment which belong within the province of the social worker, a certain amount of medical knowledge is needed. Because this is true, it has often been assumed that the social worker must be a trained nurse, prepared by months or years of experience in a hospital. But experience has shown that much of the knowledge possessed by nurses who have had this training cannot be used by the home visitor. On the other hand, the informatio

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Technical methods

There are some technical processes of diagnosis and treatment which are usually carried out by the visiting nurse, but which may well be performed after a brief training by the social worker who is not a nurse. Among these are: (1) The accurate reading of the patient's temperature, pulse, and respiration, which she must often teach the patient to do for himself and to record accurately and clearly. This is of especial importance in tuberculosis, for in suspected cases of this disease one often n

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History and catastrophe

In our attempts to be of use to people in their misfortunes, there are two very common and quite opposite points of view (roughly the right and the wrong), which I call ( a ) the "historic" and ( b ) the "catastrophic," the accidental, or the emergency point of view. Confronted with people's troubles, whether physical or mental or spiritual, we are tempted, and above all they are tempted to regard the sickness, the poverty, or the sorrow in the light of an emergency, an accident, and therefore a

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The network of events

But the particular event, the particular complaint for which the patient comes to us, is woven not merely into one chain of evidence, but into several. Let us carry out the metaphor of the chain. We must imagine many chains woven into one another like the chain-armor of the mediæval knight. Each link is a fact. But many chains of facts are interwoven in the history of one single patient. First there is the chain of medical evidence, the links (or symptoms) leading up to a diagnosis; second, the

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Listening and questioning

As the history-taker traces out the symptoms of the patient's illness after finding an answer to this first question, Why to-day? two opposite habits of mind must be employed, one passive, the other active. We must be sure that the patient shall feel that he has had a good listener, that his troubles have really been appreciated. But if we are constantly putting in questions, as we certainly must later, the patient does not feel that he has been listened to. We desire first of all to get his own

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Past history

After getting the patient's present symptoms, one should ask, "Were you ever sick previous to this illness ? If so, what troubles have you had?" That is of use in clearing up the limits or boundaries of the present illness. The sicknesses which the patient says he has had are not of very much use to us in diagnosis because we cannot get true answers. The patient's diagnoses or his doctor's are apt to be vague or meaningless. But the questions about the patient's past history tend to make him mor

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Housing

A part of the economic life of our patients, aside from the food and clothes for which they may most urgently ask our aid, is their housing. ( a ) Is it hygienic? ( b ) Is it as inexpensive as can be obtained with due consideration of health, decency, distance from work, from friends, from amusements? ( c ) Is it large enough to safeguard the decencies of family life? The last of these questions is the most important of all. It should be among the medical duties of the visitor to investigate the

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Working conditions

Work and the conditions of work are among the most important and the most difficult of the economic problems in which a social assistant may find herself inevitably involved. These concern the patient's trade, the physical and moral conditions under which he practises it, his fitness or unfitness for it, the wages he receives, the future possibilities of advancement in pay and type of work which it offers. In all of these problems the social worker can sometimes help a little because of her grea

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Mental diagnoses in social work

The idea that social work necessarily concerns the poor is wholly wrong. It concerns the sick; it concerns the tuberculous; some of the sick and some of the tuberculous are poor. Others are not. The State provides dispensaries for tuberculosis, and the people pay for them out of the taxes. Hence all the people feel that they have the right to go there and that they are not in any sense accepting charity in going there. But social work is done in all these dispensaries. Thus the connection betwee

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Shiftlessness

Another mental element in social diagnosis I call shiftlessness , in a particular sense that I want to define. Not shiftlessness in the sense of a general moral accusation, but as a failure of adjustment—maladjustment, due to shiftlessness in the sense of an inability to shift when there is a need for it. Professor Edouard Fuster [1] has spoken of social treatment as consisting almost entirely of helping people towards a better self-adjustment to their actual or attainable environment. People of

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Instability

The shiftless person, in the sense in which I define the words, is the person who does not move often enough, who rests too long on one particular set of habits so that he allows the world to move away from him while he is left high and dry. Or he allows himself to get fixed in one little set of habits and becomes a person with one idea. That is shiftlessness, the person who cannot accommodate or adapt himself. The opposite of this is instability —the defect of the person who shifts too often, w

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Fears and forgetfulness

It is not merely because of a doctor's mental habit that I speak of life in terms of diagnosis and treatment. For though those particular words are medical, any part of life can be thus conveniently summed up. One tries to find out the facts about some region of life in which one works or plays, fights, loves, or worships (diagnosis), and then one tries to do something about it (treatment). If one makes a friend one tries to find out something about him and then to treat him accordingly. If one

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Forgetfulness

There is a very eloquent passage in one of Mrs. Bernard Bosanquet's books [2] about social work, in which she describes the psychology of the poorer classes among whom she worked in London, and dwells especially on their characteristic forgetfulness. They cannot learn because they cannot remember. They cannot learn how to avoid mistakes in future because they cannot remember past mistakes. One well-known difference between a feeble-minded person and a person competent to manage the affairs of li

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Fatigue and rest

Fatigue is more important for medical-social workers to understand than any single matter in physiology or any aspect of the interworkings of the human body and soul, because it comes into almost every case from two sides: ( a ) from the workers' side because the quality of work that she puts into trying to help somebody else depends on how thoroughly she is rested, and how much she has to give; and ( b ) from the side of the patient, his physical, economic, and moral troubles, because fatigue i

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Tests of fatigue

The English tests of fatigue are nowhere near being applied yet in America or anywhere else as we hope some day they will be, to solve this tremendous problem of industrial fatigue and industrial disease. In some of the ammunition works in England [3] they took a body of people of approximately the same age and sex, living under the same conditions approximately, doing the same work. They changed the working hours of one set and left the other set unchanged as a "control." In any scientific test

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Industrial disease

Industrial disease is a phrase we have heard much in the last ten or fifteen years, meaning that diseases are caused—some of them—by the conditions to which people are exposed in industry. A great deal of indignation, some of it fruitful, much of it harmful, has been aroused against employers and against the whole system of industry—because we have now recognized the fact of industrial disease. Employers in the past have been more interested in their machinery than in their human help. That is n

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1. Order in social treatment

The principles of linkage embodied in the work of the home visitor, in her cooperation with doctors and other social workers, and in good history-taking which avoids the fallacies of the catastrophic point of view, take on a little more impressiveness when we consider what a widely general law that "linking-up" law is. It is the essence of science; indeed, it is the essence of things still wider, for it is the essence of order. There is an old phrase that "order is heaven's first law." It certai

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2. Presence of mind in social treatment

All our diagnostic duties, whether as doctor or social worker, are part of our search for truth, physical, economic, mental, and moral, as the basis for medical-social treatment. I have used again and again the figure of chains, each of them starting with the individual's present misfortune, need, or sorrow, as a central link, and radiating in different directions as we trace out the relevant physical and economic facts, the chain of the patient's relationships to family and friends, some of who

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3. How to give in social treatment

Social treatment is giving and constructing. We want to give Pleasure Beauty Money Information Education Courage and to help build the power to get more of each. 1. Pleasure. As we want to find pleasure in our work, we surely want to try, so far as our human capacities allow us, to give pleasure, to make people feel comfortable, to be always so polite to them and finally so fond of them, that they will enjoy the momentary contact no matter what it is about. As I look back over medical work of tw

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4. Creative listening in social treatment

One of the simple and yet honestly useful things that we can do in social work is to give a man a hearing. Often he will solve his own problems with the aid of a little information from one whom he trusts and has talked things out with. But this implies unusual powers of listening on the social worker's part. It implies what Mr. R. H. Schauffler calls creative listening . Some of the most delightful friendships are those one makes through a magazine. In the "Atlantic Monthly" some years ago I sa

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5. The case-worker's pyramid in social treatment

It might well be objected by any thoughtful reader that if a person carried out the physical, economic, mental, moral, spiritual investigations that I have suggested in this book, he could take care of no more than one patient at a time, and would need years to finish up the tasks suggested by the history of that one person. That is an objection that certainly deserves an answer. I will begin my answer by a comparison with medical work. A trained physician is supposed to know something of all th

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CHAPTER IX THE MOTIVE OF SOCIAL WORK

What is the motive of social work? Why do we do it? Why is it worth while? What will keep it going? To me it seems like a head of energy behind a faucet or behind a dam, a pressure that has to be explained; and as we use the word motive , we may well think of it in a literal sense as something that pushes, something that moves. Then what moves? Energy, which is the source of our work, is perhaps the most general term that there is in the world. Behind everything, we say, there is energy. Behind

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