The Practical Application of Psychology in Social Service Work
By Marguerite Lazard, Graduate Student, University of Pennsylvania.
Wherever we undertake the task of ministering not only to the body but to the mind, our working basis must be psychology. In social work this psychology must be more particularly social psychology, for we are dealing with human beings as members of society. We are considering the physical welfare of individuals merely as a contributory factor to their social welfare. All social work, then, should be grounded on a social psychology which does not, of course, preclude the apparent necessity of the constant application of an individual psychology; for every human being is different from every other human being, in spite of the fact that there are a good many underlying principles which apply to whole classes of individuals. As Edward A. Ross puts it, “No two persons have just the same endowment. Looking at their heredity, we should expect people to be far more dissimilar and individual than we actually find them to be. The aligning power of association triumphs over diversity of temperament and experience. There ought to be as many religious creeds as there are human beings; but we find people ranged under a few great religions. It is the same in respect to dress, diet, pastimes, or moral ideas. The individuality each has received from the hand of nature is largely effaced, and we find people gathered into great planes of uniformity.”
The task of the social worker, then, is to obtain as far as possible a sound knowledge of the inter-relations of mind and body. She works with a class of individuals who, as a whole, are likely to have a poor mental equipment and few social or educational opportunities. By virtue of her education, her professional training, and her social environment, she is in a position to act as guide to less fortunate individuals. It is undoubtedly true that, as education progresses superstition decreases in an individual or in a community. Once let an individual appreciate the difference between science and quackery, and his superstition begins to crumble away. One of the largest tasks of the social worker is to teach truths, and in hospital work?to cite one example?this often takes the form of teaching the superiority of a real medical science as against a system of patent medicines. The worker assumes this position of teacher as a result of her knowledge of the principles of hygiene, psychology, and sociology. Says Ross under the caption “How to become crank-proof,” “Hygiene, psychology, and sociology, can ward off more folly than astronomy, physics, or geology. For body, mind, and society are storm-centers of faddism, the breeding grounds of manias. To be folly-proof here is to be fortified against ninetenths of the higher foolishness. * * * The most desired things in the world (are)?immunity from disease, from sin, and from poverty.”
Now, taking it for granted that social work should be based on a number of sciences, let us examine some of the principles of psychology, in which we are particularly interested. As I am most familiar with hospital social service work, my paper will discuss the principles underlying that particular branch, with the understanding, however, that these principles are more or less applicable to all types of social work.
To the hospital dispensaries and wards come those who are unable to pay for medical care. There are many with fair education, training, and social advantages. Others are below the poverty line and have never known life except as a struggle for sustenance. Success or failure is often entirely determined by the worker’s knowledge and understanding of the various classes of people and of their habits of thought. You cannot approach one who has been used to the good things of life, who has not until the present known real want, who has had a fair education, in the same way you approach a chronically poverty-stricken person, to whom life is nothing more than three meals or less a day, and a bed on which to lie at night,? a person who through necessity has been forced to abandon all social or spiritual ideals, and demands merely a certain degree of bodily comfort.
The worker seldom needs to “draw out” this latter type of patient; rather is it better to suppress the oft-told tale of woe. A family consisting of such persons usually gives itself over to the social worker and expects to be helped or even entirely reinstated without any effort on its own part. It is too tired, too disheartened, too worn out with the struggle of life to make a fight any longer. In this case the simpler problems of proper hygienic home conditions, medical attention, sufficient and nourishing food, proper working conditions?so far as this is possible?for the bread-winners of the family, constitute in most cases all that can be done.
The mental attitude of a member of a family of this type is such that it is often detrimental to allow him to recite his woes at length. They increase in size, number, and intensity as the recital goes on. He should be held down as far as possible to facts, and should be discouraged from exaggerating his hardships or brooding over them.
Mary F. came to me four months ago. She was apathetic, only fairly intelligent, and ill. For twenty minutes I listened to a story of poverty and woe, but as conditions seemed to become worse and worse in Mary’s mind as the story proceeded, I thought it well to stop the recital, and put Mary into the proper hands for investigation and home relief. A week later she returned, ready to give a second story of woe far worse than the first. For about two months this incident repeated itself, yet all that time the family was being given very definite relief, and much effort was being put forth in procuring work for the bread-winner. I found that it was really detrimental to Mary to allow her to recite her past woes, and that she left the hospital in much better condition if we could turn her thoughts towards definite ways in which she could work with us for a more hopeful future.
In the case of persons belonging to a family a few steps higher in the social scale, the problem of gaining their confidence is sometimes difficult. They have too much pride to wish to air their troubles, and too great fear of being misunderstood. With them, the utmost tact and care are needed, lest in her desire to help, the worker foil her own ends. In this connection the social worker will in all probability “lose her case” if she shows too much eagerness for information, as the patient is likely to think the worker inquisitive or possessed of some ulterior motive. In the majority of cases a sympathetic listener will win their confidence. During the year a middle-aged woman, very nicely dressed, intelligent, and of good address, came to the hospital for treatment. She was told by the physician that she must have an eye operation, but before this could be done she should go to the country to get in good physical condition. The physician referred her to me for direction in regard to entering a suitable country home. This was all she asked. An application was made out for such a place, a sympathetic interest shown in her personal welfare, and an offer made to communicate to her physician any messages she mightsend while away. The interview was quite impersonal up to this point, at least enough so to show that the worker’s attitude was an entirely disinterested one. No questions were asked the patient other than those necessary for filling out the blank, and those in connection with the condition of her eyes. When this had all been arranged, the woman made no motion to go but seemed to be struggling with some great doubt. Suddenly she began to pour out her troubles, stating that she was very anxious to enter the hospital directly from the convalescent home as she was most unhappy living with her son and his wife, the latter having been very unkind to her. It was with difficulty during this recital that she suppressed her tears. Then she seemed to come to herself with a start, exclaiming, “I don’t know why I should be telling you all this!” The reason was perfectly clear. She was unburdening her heart to a person who could not possibly be interested in her for personal reasons; who did not know her relatives and friends, and who had shown herself sympathetic and capable of understanding the physical conditions. Of course the woman did not analyze this, but it was the natural reaction. After the woman had gone to the country, she wrote in detail about herself and her family, stating that she considered this the only frank thing to do since the worker had offered her help. It was then simple enough to get in touch with the various members of the family and help effectively in adjusting affairs. I feel sure that in this case and others of a similar nature, no help of any kind would have been received had the worker shown over-much interest and asked too many questions in regard to the personal history.
In another respect we might divide persons into two classes. One is the type of person who is likely to become very friendly on first acquaintance?many foreigners might be put in this class. A certain amount of aloofness must be maintained, as too much familiarity is often fatal to influence. No man is a prophet in his own country. This is why an outsider may, with little effort, often accomplish what a member of the family has unsuccessfully striven for years to bring about. On the other hand, we have the type who is very much afraid of being presumptuous, or asking too much. This type needs to be drawn out and offered friendship. He must be made to feel that the worker has an understanding of his feelings, an appreciation of the things he has experienced, and a sympathetic interest in his welfare.
Then comes the question of fitting the individual to his environment or fitting the environment to the individual. To put it briefly, in most normal cases, an attempt should be made to fit a man to his surroundings; while in abnormal cases, the environment should be made to fit the man. This latter is the wherefore of institutions for the insane, feebleminded, tubercular, etc. These institutions are dealing with persons who are physically or mentally abnormal, and they are organized to meet the requirements of the particular abnormalities involved.
Here too, comes in the question of the care of the convalescent. Frequently, because of his weakened condition, it would be a risk to allow the patient to return to bad or uncongenial surroundings. Under these circumstances we often send the patient away to some place particularly favorable to a return to health, as for instance, a country home for convalescents.
In the case of a patient who is fairly normal in mind and body and whose life is likely to be spent in one type of place, it is very necessary for his happiness that he fit himself as well as possible to his surroundings, make the most of them, and realize that he can find happiness there if he only goes about it in the right way. There are many families who, we feel certain, will always remain at some fixed level of society even though conditions fluctuate. In such cases it is unjust and harmful to encourage hopes which are far beyond their probable realization. It is better for the welfare of these persons to help them become accustomed to those conditions which they are likely to meet throughout life.
No psychology should overlook the part that the church and religion play in the life of human beings. When the social worker meets a person whose religion is a definite help and guide, it is very necessary that she have enough insight into character to realize the importance of such a person’s religion in their life. The Protestant minister, the rabbi, the priest, may in many cases get a grip on a sorely perplexed soul where a layman may have no influence. Much seems doubtful until the priest has given his sanction; confession is balm to many souls?particularly true may this be of an adolescent who is in a very plastic state, yet in a confused and uncertain one. He needs someone in whom he has confidence to decide for him. The adolescent is likely to be deeply religious and this emotion should be directed into proper channels. The fact that it is through superstition rather than through a spiritual religion that a man may be guided by his minister, does not in the least affect the strength of the church’s influence. In encountering superstition and ritual observance, much can be accomplished with tact and understanding.
Rachel Levy, for instance, who has been ill, cannot go to the country for convalescence on a specified day because it is a Jewish religious holiday. Traveling at such a time is not permitted. To insist that under the circumstances traveling cannot possibly be a sin, and that it is mere superstition to keep a religious holiday, will not in the least affect Rachel; but, to insist that Rachel’s traveling is a necessity for her health, and not a pleasure, and that one does not sin in caring for one’s health, lends an entirely different aspect to the matter.
A worker is likely to encounter many of these problems in direct connection with her hospital work. Take, for example, the adolescent boy who has been brought by his mother to the dispensary for nervous diseases because he is beginning to brood overmuch. His mother fears that he is abnormal. His own society is beginning to be far more pleasant to him than the society of others. He is just at a stage where he can be easily influenced, where he will pattern his conduct after that of some older person whom he admires. The companionship of some man may mean more to him than anything else. If the worker realizes this, she can do much in helping the boy to pass safely through these rather critical years. Another phase of the work has to do with the moral problems involved. The social worker is constantly encountering these in both adult and child. She cannot effectively treat them without some knowledge of what constitutes morality, and the source of the various standards of morality. Often she must treat the minor problems without outside expert help. For this reason it is necessary to distinguish between real immorality and unconventionality. The worker interested in the patients coming to the maternity wards and dispensaries, has unusually difficult problems to handle. She must gain the confidence of the unmarried mother and the “unfortunate” girl. The hospital probably has as much hold on this type of woman as has any other agency with whom she comes in contact. The hospital social worker is able to deal with the physical problems involved and it is the physical side which at first is likely to drive home the real truth of the situation. The worker, then, must show the girl who has been brought up among people of loose morals, why it is detrimental to her to follow in their footsteps. It is not sufficient to tell her she is doing “wrong”. Nothing is wrong to her that spells pleasure. She must reckon her deeds by their consequences?usually their physical consequences?really to appreciate their meaning.
It is much the same with the boy to whom we too often attach the term “incorrigible” when by virtue of being a real boy he is merely energetic and acquisitive. Because of lack of proper training he has not yet been blessed with a sense of “mine and thine.” He is not fundamentally bad because he “collects” things which strictly do not belong to him. He is the result of his training. He must be shown the reason why he cannot appropriate all he sees. ?presupposing of course that he is not mentally defective or too young for reasoning. The son of a thief, who has been brought up according to the morals of a thief, knows only the standards of a thief. He may readily adopt our standards of morality if he is long enough in our environment to be shown the why and wherefore, but no boy is born with a sense of good and bad. He cannot be, for good and bad vary with different people and different places; it is often purely a matter of geography. The ignorant parent is not likely to recognize in the boy a good trait gone astray. To this parent the boy is thoroughly bad. However, this same parent can be reasoned with and the worker can show him that his boy’s nervous energy requires an outlet, and if not given proper channels for this energy, the boy may find improper ones for himself. The badly nourished boy is probably irritable, not bad; the nervous boy is destructive but not wilfully so; and the boy who is growing too fast is a gourmand and lazy.
Up to this point I have spoken of the personal relation of social worker to patient. In contrast to this, and indeed the real reason for this personal relation, is the impersonal relation of hospital to patient. This institution must be impersonal, otherwise it would lose in efficiency. Because of the large number of persons handled, routine is inevitable. Each person must be treated more as a “case” than as an individual; it is, in the main, the body, and not the personality, in which the doctor is interested. For medicine to be a science much sentiment must be held in abeyance. The doctor who treats the patient, having all the while in mind the pain, worry, and doubts of the patient, is very likely to overlook much that is medically necessary. It can clearly be seen however that something more than this impersonal attitude is needed, and it is here that social service steps in. The worker acts as interpreter whereby she presents to the institution a personality, and to the patient a reasonable institution:?in other words, she interprets patient to hospital and hospital to patient. This latter forms a very large part of a medical social worker’s tasks. She finds that she is constantly called upon to repeat, emphasize, and interpret the physician’s words, as well as to explain the real attitude and purpose of the hospital. Many have a blind fear of the very word hospital, but this fear is often groundless and when approached properly is found to be quite surmountable.
After all, social service work is based on common sense, plus an understanding of human beings, their wants and desires, and a realization that the same principles apply to others as to ourselves. It is true that many who come to us present particular problems which must be solved, but back of these problems we shall find lives not unlike those of most other human beings. To conclude, for the proper guidance of a man’s physical life, the worker must fall back on her knowledge of hygiene and medicine, and for the proper guidance of his psychical life, she must turn to her knowledge of psychology.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.