than a social diagnosis that was not subject to review in the light of further facts. How do these suggestions apply to the Ames case? The following summary attempts to embody the criticisms and review of that case already given in this chapter: DIAGNOSTIC SUMMARY May 19, 1909 Ames, Thomas (38) and Jane (28), two girls, 6 and 2, and Mrs. Ames' mother DIFFICULTIES DEFINED: Illness of breadwinner from tuberculosis, no savings. Ames unwilling to take needed sanatorium treatment, wife seconds him. Mrs. Ames described as “frail” (competent report needed).1 Older child “not bright” in school (mental examination needed?). CAUSAL FACTORS: Of the tuberculosis, not definitely known. (Family history? Housing? Conditions of man's work?) Of the refusal of sanatorium care, Mrs. Ames' failure to realize man's condition, and her fears that home may be broken up. Of Alice's school record, not known. ASSETS AND LIABILITIES: Assets-(1) Man's temperate habits and affection for family. (2) Excellent home standards of family. (3) Dispensary's willingness to co-operate in persuading Ames to go away. (4) Miss Delancey's interest. (5) Mrs. Freeman, the wife's sister, and Joseph Ames are able to help with relief; other relief resources are Caldwell's and the church. Liabilities—(1) Man not a skilled worker, highest weekly earnings $12. (2) Needing immediate attention-Mrs. Ames' opposition to sanatorium care as above. 3. The Time Element. The omissions in the Ames record that are indicated in the foregoing diagnostic summary could have been accounted for, probably, by pressure of other work. Those who know most about the well-nigh intolerable conditions under which case work is done-conditions, that is, of too many clients and of continual hurry-will make large allowance for shortcomings. Even in normal seasons the demand for good social case work is so fitful that it cannot assure the conditions essential to good work. In periods of industrial depression, of war, of epidemic, or of other abnormal pressure, standards that have been established laboriously are not only battered down by the stress of the time but remain down long after the occasion has passed. This is owing in part to the tendency to carry over into ordinary times habits of work created by emergent periods. In spite of these discouragements the case worker who depresses 1 Entries in parenthesis indicate omissions in the inquiry. himself and others by an attitude of skepticism toward progress forgets that he is not alone in facing difficulties. Most of the world's advances in skill have been made under pressure. They have been made by the exceptional man or woman who has developed judgment in eliminating matters of lesser importance from the work before him through sheer strength of desire to work out his ideas. The exceptional teacher, physician, social worker has repeatedly established and advanced standards in this way. And one need not be unusually gifted to try two experiments in connection with his own work which will have a steadying influence upon standards. The first experiment has just been suggested; namely, that as soon as a period of special pressure is passed the worker should set himself to overcome those lax methods and mental habits which emergency conditions have forced upon him. The second experiment is suggested by Dr. Adolf Meyer, professor of psychiatry at Johns Hopkins. Dr. Meyer teaches students specializing in mental diseases that there is a subjective reaction toward better work in all their cases if they are careful to get a complete picture in a minority of them. In social work, also, experiment shows that the habit of covering the ground with especial thoroughness in a few cases affects a worker's standards with all. He may not be able to give any more time to the majority of his clients after this tonic exercise than before, but his judgments about them will be more penetrating. This result is so beneficent and far-reaching that every case worker should contrive to secure at some time during his crowded days a few undisturbed hours, a little center of quiet into which he may bring selected tasks to be worked out studiously, and, if possible, to a successful issue. Such concentrated attention produces another reaction which extends beyond the worker himself and his own achievement. Good work creates a demand for more work of the same grade, thus exerting an influence which tends, as it spreads, to change for the better the conditions under which social work is done. Boards of directors become awakened to the fact that thorough work means results, and are then ready to do their part toward supplying enough workers to maintain standards. An after-care worker for a girls' reformatory found that the reformatory authorities were satisfied with meager reports of the girls' previous histories. In special instances at first-instances in which the authorities could see at a glance the significance of a fuller history-she began to supply written data. The result was that gradually the management came to demand and to make provision for obtaining more detail for all inmates. By assuring a better understanding of each girl's individual problems not only the after-care work but the treatment of inmates of the institution was reshaped. 4. Full Diagnosis Not Always Possible. Last of all, full diagnosis-any correct diagnosis in fact-is not always possible, even when there is ample time. We are dealing with human factors and we too are human. We cannot hope that the processes here described will always bring the truth to light or reveal the possibilities of treatment. Try as we may, certain cases will remain obscure. When this happens we must trust in part to further acquaintance with our client and in part to temporary treatment of some kind which will itself become a form of investigation. Be it repeated, no diagnosis is final. Since later developments in a case may clarify the social practitioner's insight into its causal factors, there is a sense in which investigation continues as long as does treatment. SUMMARY OF THIS CHAPTER 1. First we collect our material, next we compare each part with all the other parts, and then we interpret it. This last is diagnosis. 2. Social diagnosis may be described as the attempt to make as exact a definition as possible of the situation and personality of a human being in some social needof his situation and personality, that is, in relation to the other human beings upon whom he in any way depends or who depend upon him, and in relation also to the social institutions of his community. 3. There has been too little relation, heretofore, between material gathered and its interpretation. This is due to neglect of the process of critical comparison. 4. Comparison of data should include review of each item with all the others in mind, and sometimes review of each with all other items deliberately excluded. It must guard against overemphasizing the fact established with difficulty, against hidden contradictions, and against overemphasizing first and last statements and hypotheses. It must retest carefully the inferences that have underlain the conduct of the inquiry so far. The questionnaire for Supervision and Review in Part III gives detailed suggestions for the comparison of data. 5. It is possible to make all these comparisons painstakingly and arrive nowhere. The "working machinery" of diagnosis does not assure results where imaginative insight is lacking. 1 6. A good social diagnosis is at once full and clear, with emphasis placed upon the features which indicate the social treatment to be followed. 7. The one-word diagnosis which is a mere classification is of little value, but a detailed diagnosis can also be valueless if it misses the very factors that are working most mischief in the case under consideration. 8. Not only must a social diagnosis define clearly the difficulty or difficulties; it must also bring together those elements in the situation which may become obstacles or aids in the treatment. 9. The form of diagnostic summary may have to be varied for different types of social case work, probably, but generally it will include (1) a definition of the difficulties, (2) a listing of the causal factors, so far as known, that enter into these difficulties, (3) an enumeration of the assets available and the liabilities to be reckoned with in treatment. 10. There are two experiments that may help to control, in part, the troublesome time element in diagnosis: (1) To watch for and check the tendency to carry over emergency period habits into times that are not emergent. (2) To cover the ground in a minority of cases with especial thoroughness. 11. Full diagnosis-any correct diagnosis in fact—is not always possible, and no diagnosis is final. CHAPTER XIX THE UNDERLYING PHILOSOPHY LTHOUGH mention has been made more than once in earlier chapters of the interdependence of individual and A mass betterment, it will not be amiss, in bringing this long discussion of the diagnostic process to a close, to re-enforce briefly the position already taken that social reform and social case work must of necessity progress together. We have seen, for example, that the diagnostic side of case work received a great impetus when the plans of reformers began to be realized, and that social work immediately had at its command more varied resources than it could apply without further knowledge of the differences between men. To understand these differences and adapt its working programs to them, account has had to be taken of men's social relationships. Less emphasis is placed in these pages upon the other side, upon the number of social reforms that have been direct outgrowths of case work, and the number that owe to this work either effective amendment or successful administration. There are few administrative tasks in the social field, in fact, which do not have to utilize some form of social diagnosis and treatment. A new piece of social legislation may give case work a new direction, it almost always modifies such work, and sometimes renders it unnecessary in a given field. This last eventuality, however, is predicted many times for once that it is realized. When, for example, the restriction of child labor was made possible, several new kinds of case work became necessary, one of them involving greater skill in sifting the various evidences of age, one involving the development of other family plans to take the place of children's earnings, etc. The methods of many agencies engaged in case work were modified by these child labor measures. In some states, on the other hand, data supplied by the agencies pointed the way for improvement in the new laws. Discussing this subject of the relation of case work to social reform at a recent 1 See p. 32. |