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CERTAIN ASPEcts of Social WORK

By Margaret Moffit, Chief of Social Service,
Psychopathic Hospital, Iowa City, Iowa.

Modern social work may be considered as a product of two factors.

One of these, mutual aid, is the principle of cooperation upon which our civilization is founded-the principle that has been recognized as superior to the survival of the fittest. Only as individuals have learned to work together has civilization and culture been possible. In the primitive situation the process of mutual aid worked perfectly-no one in the tribe ate unless all were supplied-but in our modern civil society-highly complex and dynamicthis neighborly function has broken down, and we find the principle of mutal aid non-operative.

The second factor of which social work is a product, possibly growing out of the first, is our realization of the fact that the good things of life are unequally dstributed. The poverty that we have today is of a type different from that which existed before the industrial revolution. The poverty due to lack of production which prevailed in that era has given place to a poverty which takes its rise in errors of distribution. The standard of living of the majority has risen and yet sixty-five per cent-the basis of this great pyramid-own only their clothing and personal effects. This state of affairs does not correspond with our sense of social justice. From religious philanthropy, in which good to the giver as a basis for salvation was emphasized, up through the repressive measures of public poor relief, our modern conception of social work has been developed.

Social work has not yet attained the dignity of some of the other professions, but it does have certain features in common with them, for example, a body of knowledge which has been arrived at through discussion and experimentation, and a code of ethics. Standards for training and practice are also being established. The test of any profession is not what is done but how it is done and so, in social work certain procedure has been developed through the principles of sociology and social psychology. The oldest and best defined of these techniques is social case work. With its processes of investigation, diagnosis and treatment it aims to control certain factors in the environment in such manner as to get the desired responses from the individual.

Social work originally consisted of treatment for the problems

of poverty. These problems, it was soon found, could not be solved by relief alone. However, social case work is no longer limited to this narrow field and each day we are seeing its wider application as a method of social treatment.

Case work with families, the art of adjusting relationships in the home so that a normal family life may be possible; case work with children, such as child placing and adoptions; case work with delinquents-probation and protective work-and agencies for the dispensing of poor relief have been forerunners of medical social work.

Forward looking physicians discovered that a knowledge of the patient's social environment strengthened their diagnosis; and social adjustments, their therapy. It is the province of the social worker because of her training in the science of human relationships to supply this knowledge and to act as interpreter between the patient and the physician.

As an outgrowth of medical social work, case work with mental patients developed. This received a decided stimulus from the world war.

However in 1912 the Boston Psychopathic Hospital, with social service as an integral part of its machinery, opened. This was the first institution to systematize this work, to define its principles, to establish standards of training and to give it a name-psychiatric social work.

The psychiatric social worker is essentially a mental hygiene specialist. It is her work to promote mental vigor in her patients, to help prevent the milder difficulties of the mind, such as, worry, prejudice, irritability, and to aid in the care of the mentally sick.

Psychiatry, the study of nervous and mental diseases, relies upon psychiatric social work in diagnosis, treatment, research. As mental disease often shows itself in the form of a social disorder, the social worker is particularly needed to assist the psychiatrist. Many mental diseases cannot be properly diagnosed without a careful history of the patient such as the social worker is trained to obtain.

The social service department in the Psychopathic Hospital at Iowa City aims to secure as complete a history as possible on every case admitted. Very often the patient is accompanied by a relative whose information to us is put into orderly form for the use of the psychiatrist. This history is a complete personality picture of the patient. For additional information it is often necessary to communicate with other members of the family, employers, teachers, hospitals and physicians, and to make personal visits to the patient's community. An illustration in point:

A man, age 60, married, Catholic, upon admission to our hospital told a story of jealousy concerning his wife and his brother ten years younger than himself. He stated that his wife had been committing adultery with his brother for the past thirty years but

only lately had he taken any notice of it. He held to his attitude tenaciously and cited much evidence.

As the psychiatrist was not certain whether or not the man was suffering from persecutory delusions he requested that an investigation be made in the patient's community. The evidence gathered from interviewing the patient's wife, patient's brothers, the president and cashier of his bank, his priest and friends, was that the conduct of the woman was irreproachable and that they all had cbserved a change in the patient occurring during the last few months. This evidence presented to the psychiatrist cleared the question in his mind and a diagnosis of paranoid psychosis was made.

The second important service is that of aftercare or rehabilitation. Our entire modern structure of social work has been developed chiefly in connection with this phase of the work. In dealing with mental patients we attempt to do one of the following three things.

1. Adjust the environment to the individual.
2. Adjust the patient to the environment.

3. Adjust the patient to himself.

Because of the social worker's training in the technique of social work and her knowledge of social relationships gathered from her study of biology, economics and sociology to which she adds a certain knowledge of the psychology of normal and abnormal individuals she attempts this difficult task of adjustment between the environment and the individual. Not alone is the psychiatric social worker interested in the adjustment of abnormal people to normal environments but to help normal people out of abnormal environments. For example:

A college girl found that her fiance was engaged to another girl. In desperation she attempted suicide three times inside of a few months. She was brought to our hospital for observation. Her personality history showed that she was highly idealistic, previously normal in her reactions, her whole mental activity a series of intensified responses to other individuals. After observation she was found to be free from any mental disorder but with no dominating interest. Her entire college course had been arranged with reference to her domestic plans and when these were shattered she was left with no second line of defense. After several attempts to interest her in various types of work the social worker finally recommended her to a case work agency in a city away from all her old associations and the patient has made an excellent adjustment in the field of social work.

The service of the social worker in the field of research will depend largely upon her success in making the social investigation and observation necessary to aid in clearing up the obscure causes of many so-called nervous disorders and also in disclosing certain factors which are constantly functioning in delinquency. The

technique of social case work may be applied with advantage to other types of social disorders.

It is not perhaps an over-emphasis to conclude that psychiatric social work is one of the most important contributions to the field of social work. With it thorough study and readjustment of the in dividual comprising investigation, analysis and treatment, it aids the individual in making the best possible adaption. In its broader aspect, research, it not only assists in solving the problems of individuals but is equally applicable to the general field of sociology

INHERITED INSANITIES.

R. A. Stewart, M. D., Superintendent, Independence

State Hospital, Independence, Iowa.

In its historical aspect insanity forcibly illustrates the fact that theories have always governed the world, even as to its more practical relations. For ages the civil and social status as well as the manner of dealing with and of treating them were determined very largely, by religious and philosophic hypothesis.

The earliest record of a case of insanity is found in the Old Testament. Saul possessed of an evil spirit was solaced by the music of David's harp and became well again. Nebuchadnezzar was driven from men and did eat grass as oxen, and his body was wet with the dew of heaven, till his hairs were grown like eagles' feathers, and his nails like birds' claws, and at the end of six years (559 B. C.) he recovered and was re-established upon his throne.

In Egypt cases of insanity were sent to the temples to be cured by priests being regarded as afflicted by the gods or possessed by demons. A similar view prevailed until the time of Hippocrates (460 B. C.), the father of medicine, who taught that the brain was the organ of the mind, and that it was subject to physical laws and diseases, like other organs, and that insanity followed abnormal conditions of the brain. He described disorders of the mind that correspond, essentially, with mania, melancholia, and dementia and he divined the important relation of heredity and temperament. Caelius Aurelianus (100 A. D.) taught that insanity was brain discase, that there were mental and bodily causes, that all severe measures of restraint should be rejected, and that medical and dietetic measures of cure alone should be employed. Galen (160 A. D.) recognized mania, melancholia, dementia and imbecility and he distinguished between insanity and the delirium of fever.

With the downfall of the Roman Empire, ignorance and superstition again prevailed and the lot of the insane became more wretched than at any previous time. They were again thought to be possessed of the evil spirits and the most ingenious and horrible means of torture were employed. Thousands of them were executed and very few of them found protection and humane treatment in cloisters. Many of the 50,000 executed between 1400 and 1700 A. D. as witches were actually insane. Special buildings for their care were erected in Italy during the fourteenth century and in Spain in the fifteenth century but it may be said that the care the insane received was only custodial until the latter part of the eighteenth century.

Many ingenious classifications of insanity were made during the seventeenth and eighteenth centuries. Rival schools existed in almost every civilized country. Kraft Ebing in a compara

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