Social Work; Essays on the Meeting Ground of Doctor and Social Worker

Much as I hate the fault of never going beyond the fact that we see before us, I hate just as much the opposite error of not getting the full vision of the foreground. We ought always to be able to feel, at the end of any single home visit, that we have done something, accomplished something. Well: one of the things that we must make every effort to accomplish, and to feel ourselves a failure if we have not accomplished, is to find and to give pleasure, to enjoy ourselves, and if possible to give a little courage. The little embellishments of our work, the smile, the tone of voice, the jokes and courtesies of our fleeting contacts with individual patients, should be just as precious to us as any of our far-reaching plans and deep-plunging attempts to study into cases. How poignantly, how intensely Christ put this to us in saying that inasmuch as we did any good thing unto the least of his brethren we did it unto Him! I believe that He meant this not only of human beings, but of days, of moments. The least of these opportunities is infinitely precious and we are making a grievous mistake if we do not take it so.

I have known a few social assistants who make each little deed and each little moment a perfect work of art in itself. Art at its best this work is. It was my greatest single experience in 1917-18 to admire the French art for finding joy in little things, and of making beauty in little things. I asked recently a group of Americans what they had found the most admirable in their contact with the French people. Everybody present had had the experience of finding in his own hotel or pension, a femme de chambre or some other domestic who, though starting to work at five o'clock in the morning and working until late at night, nevertheless always kept joy or the appearance of joy in her work. On the first night that I was in Paris I went with a friend to dine at a restaurant very late. There was but one waitress, who had nearly finished serving an enormous number of people. She ought to have been near the end of her day's work, which our arrival prolonged still more. But I never can forget the welcoming look and tone with which she said to us, "Now I shall have the pleasure of serving you."

We need the artistic spirit, the spirit of beauty in social work. It is not opposed to, but surely very different from, the spirit of science which I have been emphasizing in the earlier chapters of this book. I must confess my impression that, on the whole, thus far, social work has been ugly. Social workers have not kept beauty and the sense of beauty in the foreground of their work. Beauty and joy always tend to drop out in social work, but this must not be. There is an old story of an inspired social assistant in Boston who had been working for a long time with a needy family who were at that time much discouraged. One day she had an idea: "What that woman needs is a blue dress. She is extraordinarily fond of that color. She has not had a new dress for a long time." And it was true. She was given a blue dress, and the history of that family afterwards began to show signs of the sort of change and upward constructive effort which had long been lacking. We cannot neglect that sort of thing, slight or sentimental though it may seem.

I remember another family in which flowers, and money spent on giving the children a chance to grow flowers, played a beneficent rôle; and still another discouraged family in which a canary bird seemed an essential element in the social work done.

There is something certainly very divine about the present moment. We shall never have it again. We are apt to think that next year we shall do something great. Then, we think, at last we shall gather up all the forces of our soul and do something worthy. But I do not believe we can tell ourselves too often in social work that now is the time, and that the opportunity of the present moment is priceless.

Hence, after trying to exemplify the backgrounds which we ought to seek out when a fellow being comes to us in trouble, I must now correct that overemphasis by paying homage to that state of mind which sees foregrounds. What we want is presence of mind– a very familiar and hackneyed phrase, but one which may grow precious to us after analysis. My complaint against the preoccupied, solemn look in the social worker's face is that the person's mind is not there with his fellow beings; it is aloof with his own troubles. He is not "in it," not all there on the spot. The necessity of joy in one's work, and the necessity of seeing the momentary and infinitely precious opportunities, come to the same thing. If you are "in it," you get your chance. To have sufficient presence of mind to seize one's chance is surely the crucial act in social work or anywhere else, for that chance does not recur.

But presence of mind connects itself with an interesting fact in our grammar about the present tense. The present tense, in contrast with past and future tenses, expresses presence of mind, attention to the wonder of the moment, the opportunity of the moment. But it also expresses a wholly different thing, namely, the eternal. Some languages have an eternal tense and use it about facts that are not present or past or future. We use the present tense for the eternal. Two and two make four. When? Well, not of course at ten minutes before twelve on the 11th of November, 1918, more than at any other time. We might just as well use the future tense. Two and two always will make four. But by a peculiar accident we have hitched on to one tense the whole body of eternal truth. Why did we hitch the eternal to the present rather than to the past or to the future? Because anything that we really grasp now, as truth or as joy or as beauty, anything that we really comprehend, can be eternally ours. In the physical sense it is so. The electric light that I am now looking at and which might be turned off at any moment, is eternal, for its vibrations are travelling off through space and always will be. The fact that those vibrations are going off through the ether is ever the same.

Any present fact, then, so far as we realize its truth or its wonder, is eternally ours. Hence presence of mind is the quality needed in social work to balance the scientific habit which looks for past and future, for what is not present. Investigation and history-taking must always be completed by appreciation, the other half of our mental life, which is acutely conscious of the present and therefore can be conscious of eternity.

I hope I have not put the contrast of science and art in social work so sharply that it seems as if one must take one extreme or the other. I do not feel any such contradiction. I believe that we can get courage for the long, discouraging search for causes out of the present joy which we find in speaking and listening to a person now. On the other hand, these momentary contacts are thin, capricious, and insufficient if we are not also planning some solid progress which will give us something to show for it at the end of a day or a year. One of the dreary things in human beings' work is that sometimes, after a month or a year, they cannot see that they have accomplished anything. It is all a mass of details. I remember a very marvellous social worker saying to me, "I do not want to die thinking that I have never done anything but case work." Case work seems to me as great a thing as any one can do. One might as well say, "I have never done anything but miracles." But I know what she meant. She meant that through case work she wanted to feel that there was a thread of continuity which ought to be science or character or friendship, a thread whereon something accumulates. We ought each year to be able to say and to write what we have learned, or given.

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 twenty-five years, I should say that in most of my cases I have failed from the medical point of view. Yet in a great many of those failures I can see some redeeming feature because of the friendships that the patient and I built while I was failing in my medical job.

Such a blending of success and failure is the rule, not the exception. We make elaborate social plans, but we know that many of them are going to fail. It is humanly impossible that they should not fail. But they will not be flat failures if along the way we have tried to treat people, not as they deserve, but a great deal better.[4 - Polonius (showing out the wandering actors): – My Lord, I will use them according to their desert.Hamlet: Odd's bodikin, man, much better! Use every man after his desert and who shall 'scape whipping.]

But when we give pleasure we must try to provide that the stock shall go on. We want to try to build in and with the person some capacity to get that pleasure for himself after we have gone out of his life. This is just as true of course of Beauty which we surely want to try to bring into our patients' lives, and which is one of the things that redeems our failures on the other side of social work. Even people who are dying sometimes can get great enjoyment of beauty.

2. Money is, I suppose, on the whole, the thing we are asked for directly or indirectly most often in social work. If we are not doing direct medical work, if we are not giving a direct medical relief or trying to, we are more than likely to be asked for help in the way of money, clothes, food, or rent. Surely no one works long in social work who does not find the right place to give money. But I have to go back to the figure already used, the parallelism of money and morphine. A person comes to us with pain and begs for money or its equivalent – direct, immediate relief. What makes us hesitate in the one case is the same that makes us hesitate in the other. We may relieve, yes; but have we constructed? In the long run we must both construct and give, else our giving may be useless or harmful.

When can we give money without doing harm?

In a general way, when it is not going to lead to the repetition of the same demand. When are we perfectly sure that we may safely give morphine? In gall-stone colic. For it may be weeks, months, years, perhaps, before there will be another such attack of colic. We give morphine once only. The person gets over the attack, and does not want morphine again for months or years. But if the patient's pain is chronic or likely to recur soon and frequently, it is cruel to give morphine, because soon the patient will have all that pain again, and more —the pain which is produced by morphine after it has been taken a little while. We never can tell that the pain suffered is not wholly due to morphine. So the person's trouble after we have given money may be due to the money itself, ill used. We should be able to say, after a careful, though not care-worn study of the case, that we know the patient's pecuniary need is not going to recur, because we are not dealing with a chronic difficulty like extravagance or alcoholism, which will recur and cannot be checked by money.

3. On the whole, the safest form of giving that I know, that which is surest to perpetuate itself, to be planted like a seed and go on without our having to stand by it, is giving information– a cold-sounding thing, but sometimes very useful. One difference between the social worker and the person for whom she works ought to be that the social worker has had more education, more freedom, more friends, more opportunity to look around the world and see resources. Hence, when, for instance, she comes to find a job for a man, the social worker, because of the perfectly undeserved blessings that she happens to have, ought to be in a position to give information that is of value.

One of the most precious kinds of information is information how to secure more information. The difference between uneducated people and those whom we call educated, is not that the latter know very much, but that if they do not know something they know how to go to one who does. The uneducated person is helpless to improve his education. He does not know and cannot find out how to look up a subject.

I have distinguished information from education. Information as such never changes character in my opinion. This subject has been discussed in recent years in connection with what some call quite falsely sex hygiene. Information biological, pathological, physiological, talks about health and disease, never kept any man or woman straight morally. It never changes character. So our public school education sometimes represents only information, only the facts, not the meaning, the interpretation, the use of those facts. Hence the public school is justly open to the criticism brought upon it by those who say that it does a child no lasting good to know facts. It may make him clever and so able (like German science in war) to do more harm than if he knew less.

But when we give education – for example, hygienic or economic education – we give something else than information. Education is that which, by reason of practice, by doing something again and again, and doing it if possible in the presence of a good model (living or dead, book or person), changes our character and our habits, as the use of a muscle changes the muscle. A person learns to write. That is not merely information – he has learned to do something. Learning to swim is not information. We learn it by practice, by doing it, and by the imitation of good models. How does one learn to think? By doing the thing, and if there is any model in sight, by trying to imitate that model.

4. Education is what social workers try to give most often, most consciously, over the longest time, and sometimes with the greatest results. We try to give people hygienic education. We try to give, not merely hygienic information, but motives fit to bring about a change in habits, a wholly different thing, and one which may be of signal value. We try to teach self-control, the control of sleep, the control of emotion, the control of appetite. It is hard, but it can be done by prolonged effort, under such influences as give us courage to work at it. We try to give economic education, the power of foreseeing what is going to happen by reason of what has happened before. People are extraordinarily prone to forget things which they do not want to remember. We may help people by economic education, to economic foresight, to economic organization of their resources by practice, and by going over with them the cases of other people who have won out in similar difficulties.

5. Anybody who does much talking is asked a good many times, "Won't you please come round this evening and just give us a little inspiration?" There is no request that I look on more sadly, more wistfully, than I do on that. I know how little good such "inspiration" usually is because it can be given the same way as money or morphine can be given. Inspiration or courage means emotion of some kind. Nobody believes in emotion more than I do. I believe the greatest life is the life that feels the most, enjoys the most, suffers the most. But emotion is one of the most transient and unreliable of states. One may be in a most exalted and courageous state of mind at the end of a lecture, and a few hours later be as weak as an invalid, because, though courage has come, it is courage which does not provide for its reënforcement, for a new supply. We never give people help that has any permanence except when we give them reality. We try at first to help people in their woes through our own personalities. But we are not strong enough to keep anybody else afloat. We have to transmit something greater than ourselves, if possible to bring people in touch with a life-preserver that will be there after we are gone.

I suppose that when we can teach people to work and give them something they can practise all their lives and get joy out of, when we teach people to play, to deal rightly with their affections, and to worship, we have given realities permanently buoyant.

Our social history cards at the Red Cross Refugees' Dispensary in Paris had a great many blanks on them, which represented the blanks in our knowledge of the patients and the defects of our social work. We rarely entered deeply into our patients' lives in relation to their education, family life, recreation, religion. In our work at that Dispensary we dealt chiefly with medical facts and economic facts. To go thus far and no farther cannot satisfy many nor remake lives. That Dispensary was open but a few months and within that time, of course, nobody could expect us to enter into intimate relations with a human being's life. But if we were to work in any Dispensary for years and still not one of those cards had any note about the patient's education, recreation, family relationships, and religion, I should feel that we had failed. I should feel not only that we had done superficial work (that is often inevitable), but that we had done nothing but superficial work, which is not satisfactory.

It is because we want to give people the best, not that we have but that the world contains, that we should have spaces on our social history card for notes about those things which we believe are fundamental in our own lives and which we want therefore to see constructed or increased in somebody else.

Social treatment, then, is chiefly, the giving and building of health, pleasure, money, beauty, information, education, courage. It is not because we have such a tremendous stock of those goods to give away, but because we know that we must somehow help a person to self-help in those directions or else be superficial, that I have phrased social treatment in those terms.

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 saw an article on playing string quartets by a man whom I had never heard of, Mr. Robert H. Schauffler. Mr. Schauffler's writings, which I came to know through this article, contain many interesting points, but nothing so valuable to me as the essay on "The Creative Listener."[5 - In the volume called The Musical Amateur. (Houghton Mifflin Co., Boston.)] It was founded upon an autobiographical incident. As a musical amateur he used to attend orchestral concerts in what was then his home city, Chicago. He used to go with a certain group of friends, his brother and others, who liked to sit together because they found that in this way they enjoyed the music more. Ordinarily they were very regular in their attendance. But one evening for some reason they had to miss the concert, and then it came to their knowledge that the orchestra had felt their absence very much, and really could not play their best without them. This is true. There are people whose attention makes us play or speak or act better than we could otherwise. We have known it in friendship We all know that some people when we talk with them, make us feel as if we really were worth something, had some ideas. Others are destructive listeners who make us feel as if we had no ideas; our personality seems destroyed.

I think it is perfectly within the province of any of us to make himself more of a creative listener than he has been before. For creative listening is due in part to the intensity of our sympathy, the whole-heartedness with which for the time being we give ourselves to the person we are with.

Under favorable conditions the power of the creative listener to enlarge and to remake a personality is not capable of limit. The people whom I most often help are the people for whom I do nothing. They tell their tale, spread it all out before me; then they see the solution themselves. Just to state our difficulties clearly to another person who will listen not merely sympathetically but creatively, and with resistance as well as furtherance, is of value. With certain people we run against a stone wall every now and then, even though they are only listening silently. This is right and helpful. The right kind of listening is sympathetic when it ought to be and dissenting when it ought to be.

We help people out of trouble in other ways also; often by bringing new facts. A person tells us about his difficulties at work. He sees it perhaps more clearly after he has talked about it. But he may not know some facts that we know, and therefore we may be able to help in some ways that go beyond creative listening. But in the end a person has to make his own decision, to find his own solution; and in many cases he will find it without any more active or physical help than this.

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 the organs in the body. Even a dentist or an oculist has had some training on all the bodily organs and not merely on the special ones he treats. Among the organs of the body, the medical profession is supposed to include the brain and all the functions of the brain. This implies that he is supposed to have at his finger-ends the ability to make an examination so complete that a whole day would be needed to finish it. Obviously if he attempted anything like that he would soon be overwhelmed. But on the other hand if he limits himself to the professional examination of a single organ, the one perhaps which the patient complains of, he does so at his peril. He is in danger of making a wholly wrong diagnosis. But that can be diminished only in proportion to his knowledge of all the other organs that he does not examine. A well-trained physician must and can safely do some superficial work. So a very well-trained social worker can and must do some superficial social work. In the practice of any doctor who counts up a month's patients we will say to one hundred, there will be about fifty that he has examined and treated very slightly. Then there may be twenty-five whom he knows a little more about, fifteen perhaps that he could give a full account of, and possibly ten whom he has had to study from all the points of view that his medical education has made possible for him. His professional life then is not wholly superficial yet does not attempt to deal exhaustively with every case.

As I see it, therefore, our work in the social or medical field ought to be something like a pyramid.

We should study and treat many cases superficially, a smaller number more intensively, and at the top of the pyramid which represents our case-work will come a few to which days or weeks of time are devoted. Such a distribution of time is not unsatisfactory or slipshod because not all the needs that come to our attention call for thorough study.

Such a pyramidal distribution of our energies is familiar and satisfactory in other fields of life, for instance in the field of friendship. Nobody wants only intimate personal relations. Everybody needs as a basis a host of acquaintances. Out of them all he makes a few friends whom he hopes to know as well as he can know any human being. Almost no one is satisfied to possess only acquaintances or only intimate friends. The properly balanced life has both.

Both among those for whom we attempt only slight study or slight service, and among those to whom we devote ourselves intensively, doctor and social assistant alike must count failures as well as successes. We do not try to balance failures and successes if we are wise. The Lord only knows which of our seeming failures are really successes and which of our successes are failures. Some of the people with whom we seem to have made total failures, a more complete knowledge might show to have been actually helped. All this we must face from the start. Then we shall not be disappointed because we have to touch a great many people superficially and to fail a great many times. That is all right so long as we are not always superficial and do not always fail.

Such a philosophy is my defence for so elaborate and extensive a scheme of social investigation and social treatment as I have tried to explain in this book. The experienced physician and the well-trained social assistant can judge with some accuracy which cases to select for thorough study and continued devotion. But such a judgment is impossible unless one keeps always ready in the background of one's mind the whole apparatus of social diagnosis and treatment as it might be applied in toto, if time and strength were unlimited.

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 the activities of our physical bodies there is energy to an extent that those who have not studied medicine or other physical sciences do not always recall.