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Ada Eliot Sheffield.

The social case history : its construction and content online

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reach Mr. W. (her second husband) for she thinks he
would return to her, and she needs the additional
money. Says Mr. W. is a good man, has good prin-

166



THE NARRATIVE IN DETAIL

ciples, only Annie and Harry could not get along with
him. Thinks Jessie of different disposition and would
be happy with Mr. W. Harry could stay at Annie's
house if friction recurred.

Whereabouts of second husband Mr. W. was married
first time in Peoria, then went to Chicago; had six
children, five of whom died. When Mr. W. married
Mrs. W., his son, a boy of fourteen, was living with an
aunt and working at Rosenbaum's Department Store.
Thinks perhaps Mr. W. can be reached through this
information.

Health Jessie Nov. 20, '12 (M. A. V.) Telephoned
Farnsworth Hospital, Social Service Department.
Jessie is having every care and is contented. Should
have convalescent care after she leaves hospital, if
home conditions are not good. Suggesting Mountain
View House, family agency paying board.

Son-in-law, Finance, Health Nov. 20, '12 (M. A. V.)
Saw Mrs. Richards, who said Mr. R. had made out
application for compensation from the Government.
Mr. R. was examined at Consumptive Hospital and
told that he is in no condition to work. Has active tb.
and will go away if, after examination on the 25th, it
is considered necessary.

Health Jessie and Harry Mrs. R. says Jessie is having
splendid care at hospital and is contented and happy.
Harry has been examined at Van Zandt Dispensary,
has tonsillitis and is to return for further examination
on the 25th.

167



THE SOCIAL CASE HISTORY

Suggestions for clarifying them. In order to
clarify the treatment record by making the more
important of the various subjects of discourse
stand out from the less important, the writer
offers three suggestions:

First, that diagnostic summaries be made not
only when investigation is reasonably complete
but at the close of each episode or phase* of treat-
ment. Social workers recognize that when, as is
often the case, the client's need extends over
many months or even years, his situation is likely
to show a succession of phases, each calling for a
diagnosis somewhat different from the one pre-
vious. This brings it about that in a long-con-
tinued case problem, it is a question not of get-
ting at one ' 'constellation of meanings/ 1 or diag-
nosis, for good and all, but rather of modifying
the diagnostic summary from time to time. Not

* A "phase" may represent some one especially impor-
tant treatment act which alters the problem, like the re-
moval of children from their parents, or the getting a
patient into a hospital, or it may represent some signi-
ficant incident in the client's life which will change his
situation; e. g., the inheritance of a few hundred dollars,
the death of the wife and mother.

1 68



THE NARRATIVE IN DETAIL

only may the circumstances of the client change
in the course of events that goes without saying
but the action which the social case worker
follows in the first instance may become a causa-
tive factor in the succeeding phase. For example,
the first three phases in a successfully treated
family whose need lasted several years show the
following changes in diagnostic summary:

FACTORS IN ROBERTSON CASE

James 33 Margaret 9

Mary 30 Ethel 7

Garrett 4

I.

MAN. I.

A. Inconclusive Heredity: his father said (by sister-in-law)
to have died a hopeless drunkard.

B. Physical Development. No information.

C. Mental Development. Unstable? (No examination
a layman's query.)

II.

A. Family. Selfish and irresponsible husband and father:
extreme groundless jealousy of wife; threatens to take
children from her; talks coarsely before children at
times; has never supported family; dresses well when
children hungry on plea he must in order to get work;
children sometimes underfed and poorly clad; no
settled home.

169



THE SOCIAL CASE HISTORY

B. Sex. Irresponsible sex conduct. Marriage forced by
woman's family.

C. Occupation. Doubtful employ ability: suspicion of
dishonesty; overbearing disposition (wants to be boss,
can't take orders); laziness; can earn good money
"when he feels like it" (according to brother-in-law).

D. Recreation ?

E. Religion ?

F. Rehabilitation ?

WIFE. I.

A. Stable Heredity (so far as known); relatives all self-
respecting and self-supporting.

B. Physical Development normal: has good health.

C. Mental Development good: intelligent woman ac-
cording to former employers and social worker.

II.

A. Family. Conscientious wife: left man a year ago when
home had to be broken up and children placed because
of no support; returned in a few days because thought
it her duty. Responsible and anxious mother: appar-
ently now determined to separate from man for chil-
dren's sake; worried over his influence on children and
over his threats; children have good health and careful
training; woman worked occasionally to get food for
children. Cohesive family: relatives ready to help so
far as able.

B. Sex. Indiscretion: early marriage forced, in love
with man.

C. Occupation. Reliable, unskilled worker: wage-earner

170



THE NARRATIVE IN DETAIL

on leaving grammar school; cleaning- woman and
amateur dressmaker; upright and industrious (accord-
ing to employers and social worker). Kept as good a
home as uncertain income permitted.

D. Recreation ?

E. Religion. Loyal churchwoman. Careful about chil-
dren's religious training.

F. Rehabilitation. Treatment for long-continued and
aggravated non-support: church and relief agency in-
terested to assist ; no savings or income.

Plan: To further legal separation.

II.
WOMAN. I.

A. Heredity as above.

B. Physical Development unchanged.

C. Mental Development unchanged.

II.

A. Family

Broken yet secure home: LEGAL SEPARATION FROM MAN.
Responsible mother: man's imprisonment (for larceny)
relieving woman of worry lest he take children.

B. Sex ?

C. Occupation. Vocational handicap: slight education;
lack of vocational training; mere knack at dress-
making; scarcity of regular half -skilled or unskilled
work within hours allowing of care for children.

D. Recreation ?

E. Religion as above.

F. Rehabilitation. Treatment for dependent but reliable

171



THE SOCIAL CASE HISTORY

mother: continuing interest of church and relief agency ;
relatives unable to help further; no savings or income.
Plan: To raise an allowance.

III.
WOMAN. I.

A. Heredity as above.

B. Physical Development unchanged.

C. Mental Development unchanged.

II.

A. Family. Blameless partial neglect of children: ir-
regular or hurried feeding of children at times; in-
sufficient oversight (because of demands of work).

B. Sex ?

C. Occupation. Good vocational promise: ambition for
self-support; certified knack at dressmaking: dis-
couraged conviction she can never support children by
unskilled dressmaking or by cleaning, and anxiety over
uncertainty of income; scanty education due to
necessity for earning on leaving grammar school, to
lack of opportunity in native village, and to early
marriage.

D. Recreation ?

E. Religion unchanged.

F. Rehabilitation. Treatment for dependent mother in
need of vocational training: ALLOWANCE HAS PROVED

SUFFICIENT, WITH SOME EARNINGS, TO INSURE HEALTH
AND DECENCY BUT NOT TO PREVENT CONSTANT ANXIETY

IN A PROVIDENT WOMAN; interest of certain individuals
in giving woman opportunity of training; co-operation

172



THE NARRATIVE IN DETAIL

of public agency in placing children where mother could
visit them during training period.
Plan: To give woman training as dressmaker; children
to be boarded by public agency.

The capitalized passages in Diagnoses II and III
show in each instance the previous action of the
agency which has become a causative factor, here
phrased as a concept entering into its succeeding
diagnosis. In this family difficulty, the general
description of which is "non-support," the legal
separation furthered by the agency at the wo-
man's wish marked the end of the first phase of
treatment, and radically changed the nature of
the social problem. We are now dealing no longer
with a non-support problem, but with a depen-
dent mother one. This changes the main concepts
in the case from "selfish husband and father,"
"doubtful employability," "conscientious wife,"
"reliable unskilled worker," "treatment for ag-
gravated non-support," to "broken yet secure
home," "vocational handicap," and "treatment
for dependent and reliable mother." The situa-
tion now turns on the woman's qualifications as
breadwinner, instead of on the man's. In the
173



THE SOCIAL CASE HISTORY

third phase the woman asks for training, and the
concepts making up the diagnosis are "blameless
partial neglect of children," "vocational prom-
ise," and "treatment for dependent mother in
need of vocational training." One of the factors
which plays a part in her discouragement and her
desire for vocational opportunity is the amount
of the allowance secured by social agencies. The
two main treatment acts of the agency in charge
were then, first, to help the woman secure legal
separation; second, to raise an allowance for her
which she had to supplement with uncertain
earnings. It is evident that treatment in both in-
stances vitally affected the client's situation and
therefore affected the diagnosis.

The same thing would be true in a child welfare
case in which the children were first removed
from neglectful parents and then were boarded
out. The removal from the parents becomes a
causative factor necessitating a substitute home,
and bringing to light other problems, such as that
of training a child with inherited peculiarities of
temperament. Does this not point out clearly
what we have all more or less recognized, that
174



THE NARRATIVE IN DETAIL

since an agency's action in a client's situation
operates in varying degrees actually to change
the nature of his problem, therefore, once having
interfered in his life, we are under an obligation
to see him through his troubles to the extent of
Durability?

These summaries, made at turning points in
the client's story, would not only supply a con-
necting link between the succession of events re-
corded, showing the purposefulness of treatment
that underlies their apparent disconnection, but
would, by revealing any lack ; in clear purpose,
tend to make a conscientious wiorker stop and do
the thinking she has neglected \to do before.

The second suggestion for clarifying the treat-
ment record is that in any entry the most impor-
tant matter be placed at the beginning of the
paragraph where it will catch the eye of the
reader most readily.* Whereas in ordinary writ-
ing the last sentence of a paragraph is equally
conspicuous with the first, in record writing,

* Needless to say, should all the facts to be entered from
one interview be of apparently equal importance this
suggestion would not apply.

175



THE SOCIAL CASE HISTORY

where the paragraphs begin with the date and
the source of information (facts which since they
affect all that follows the reader must look at
first anyway), the beginning of a paragraph is
more conspicuous than the end. Therefore, by
finding the most important fact in each para-
graph at the beginning, the reader will not only
get leading points more clearly, but should he
wish to recur to any special fact of importance,
he can run down the length of a page more
quickly.

The third suggestion is that marginal signs be
used to call attention to facts of special impor-
tance to the problem under care. Since the sig-
nificance of entries in a record is always a ques-
tion of degree, we can recognize certain ones even
among the important facts in any history as
making more difference to successful treatment
of the case in question than do others. The
worker could bring such facts into the foreground
by indicating in the margin those items in the
treatment record which show changes in or devel-
opment of the causal factors as given in the diag-
nostic summary. In the treatment following
Summary I, p. 169, the facts to be thus made to
176



THE NARRATIVE IN DETAIL

stand out would have been the mother's lack of
vocational training, knack at dressmaking, the
scarcity of work she was fitted for, and the ina-
bility of relatives to continue help; in the treat-
ment following Summary II the facts to be noted
would have been the woman's vocational dis-
couragement and the reason for it, her worry in
spite of the allowance, her partial neglect of the
children and its explanation.* These facts all
represent changes which have appeared in the
causal factors in the problem. In medical social
cases, although the treatment record would al-
ways emphasize health, there would be certain
social facts which might be marginally noted be-
cause so closely related to health as to carry equal
significance for successful dealing with the pa-
tient; e.g., anything in the patient's tempera-
ment or circumstances that stood in the way of
his carrying out the physician's directions.

*The interest of certain individuals in financing this
mother's training and the co-operation of the public
agency in placing the children, being parts of the treat-
ment process the importance of which, although great, is
temporary, should not be made conspicuous by any mar-
ginal sign.

12



THE SOCIAL CASE HISTORY

These important or significant facts noted in
the margin will often be one with evidence as to
the client's social relationships. Since these rela-
tionships are the special field of the social worker,
and since it is in these contacts that an individual
develops and reveals personality, emphasizing
facts of personality in the record would empha-
size that part of the social worker's function
which calls for most insight and skill. Concepts
indicating temperament, character, personality
will appear constantly among the causal factors
in the diagnosis of social case work problems.
Therefore the worker who wishes to give promi-
nence to the especially significant treatment
entries will often find herself putting a marginal
sign opposite facts which indicate personality*
This would be true in spite of the fact that our
work at present is primarily with income, with
the securing of hospital care, employment, voca-
tional guidance. As Mary C. Jarrett has re-
marked :

"So far social case work has dealt mainly with the ele-
mentary facts of social adjustment: income, employ-
ment, housing, housekeeping; and with the primary

178



THE NARRATIVE IN DETAIL

social problems: how to find a job, to bring a deserting
husband from another state, to get milk for the baby,
convalescent care for the sick, to move a family to a better
house . . . We see case work about to pass into a
psychological phase . . . No one will be able to say
when or where factors of personality rather than factors
of environment began to be the dominant influence in
social case work. It is clear that environment prevails at
present. It is becoming evident that personality will
become the leading interest in the future." *

In thinking of personality as the center of con-
cern in social case work, does not Miss Jarrett
mean personality as identified by its response to
the complex social environment of modern life,
and as developed and expressed through its vari-
ous social contacts?

In any study of personality as identified by its
response to environment social workers must
necessarily follow behind the psychologists. Al-
though the latter have got but a short way on the
road toward a "science of character," social work-
ers could apply whatever knowledge is as yet
available. It would be a beginning toward this if

*" Psychiatric Social Work," p. 287, in Mental Hygiene,
April, 1918.

179



THE SOCIAL CASE HISTORY

we were to identify and report such ascertained
marks of personality as disclose themselves in
connection with the elementary facts of social
adjustment.

"Color" in the Record. It is mainly the de-
picting of a client's personality which workers
have in mind when they speak of putting ' 'color"
into records. By color they mean an individual-
izing of a client by recording such incidents about
him as will make him seem a living person and
not a marionette. Records in which the clients
might be interchanged without apparently alter-
ing the problem of either will occur to anyone
familiar with these social documents. Two de-
serted women may be distinguishable from each
other not by any hint as to their traits of char-
acter, but by the fact that one has five children
and the other three; one is robust, the other
fragile; one Polish, the other French Canadian.
Two husbands may differ only as to their age,
birthplace, and the names of their employers.
This may answer all practical requirements if
what the worker needs to do for these clients is
merely the raising of allowances for the women
1 80



THE NARRATIVE IN DETAIL

and the directing of the men to jobs. Having
satisfied herself that the women are respectable
and are reasonably good mothers and that the
men are honest and sober, she can pass on to
treatment.

Normal and abnormal traits. The social worker
has to deal right along with a certain number of
clients whose situations call for the use of only
"the elementary facts of social adjustment: in-
come, employment, housing, house-keeping."
These are fairly normal people whose problems
are not complicated by any pronounced inadapt-
ability of character. The adjusting of their diffi-
culties may not be easy, but it can often be done
satisfactorily with the extreme minimum of char-
acter insight. The moment the worker finds a
need of influencing the conduct or the decisions
of her clients, she must get at an understanding
of their inner life. At present, character study
which is sufficiently formulated to be reflected in
records is to be met with mainly in the case of
clients who are something other than what we
call normal. In this early stage of "characterol-
ogy" the observing of exaggerated and unorgan-
181



THE SOCIAL CASE HISTORY

ized traits is not only easier than the study of
"normal'* persons but it affords a fruitful method
for getting light upon normal human personality.*
Relevant and irrelevant "color." A method by
which social case workers sometimes attempt to
individualize a client is to give a short description
of his appearance; "a heavy-set man" ; "a short,
spare woman"; "she wears her hair in gray
puffs"; "little freckle-faced boy." In estimating
the value of such description we must bear in
mind that workers are writing their records not
for the entertainment of drama seekers, but to
further social case treatment. Any fact which
does not advance this purpose is out of place, in-
appropriate, drawing both the reader's and the
case worker's attention away from the problem.
Is treatment ordinarily furthered by the knowl-
edge that a woman is short? Should we do some-

*" Insane conditions have this advantage, that they
isolate special factors of the mental life, and enable us to
inspect them unmasked by their more usual surroundings.
They play the part in mental anatomy which the scalpel
and the microscope play in the anatomy of the body."
James, William: The Varieties of Religious Experience,
p. 22. Longmans, 1916.

182



THE NARRATIVE IN DETAIL

thing different if she were tall? Are there any
conceivable circumstances in which gray puffs on
a woman's head or freckles on a child's face
would alter treatment? These facts do not point
to traits of character, they do not suggest per-
sonality. Even were we writing novels instead of
case records, a description which has no bearing
on the development of the plot would be out of
place. "Too frequently the amateur gives his
people an inventory of features merely for their
own sake a bright blue eye, or a mole on the
chin, a little nervous habit of tightening the neck-
tie, or a slight stammer in speech without ask-
ing if these are in any way characteristic features
. . . . The details that finally count for us
are those emphasizing the role the character
plays''* Or again, "If the appearance of the
actors (in a story) has absolutely nothing to do
with the reader's interest in them or in their ac-
tions, the least said about it the better."f The

* Campbell, O. J., Jr., and Rice, R. A.: A Book of Narra-
tives, p. 286. D. C. Heath, 1917. Italics not the au-
thors'.

t Albright, E. M.: Descriptive Writing, p. 97. Mac-
millan, 1911.

183



THE SOCIAL CASE HISTORY

social worker's interest and that of any persons
who read her records is either the practical one of
treatment or the scientific one of study. She
therefore should select her descriptive facts in
the light of this interest.

There is description, however, which is rele-
vant to social case work, which furthers its pur-
pose. Take these facts about a wayward girl :

Is medium height, very dark, complexion clear, black
hair, glittering eyes, bridge of nose somewhat flattened,
teeth good and have been taken care of, shows evidences
of negro blood. She laughs constantly and seems to be
in excellent spirits.

The evidence of negro blood with its bearing on
character would of course affect treatment, as
would also the girl's good spirits. Indeed, the
appearance face, figure, manner, dress of any
young girl or woman client in so far as it is a
factor in her attractiveness to men is always of
prime importance. In this instance the bearing
of the girl's height on treatment is not so clear.
If, however, she is a girl likely to run away, the
height would be relevant for police identification.
184



THE NARRATIVE IN DETAIL

The man, who is small, pale, and thin, said that he had
been working as a laborer.

The man in this instance was feeble-minded,
therefore his underdeveloped body was of impor-
tance both as part of an industrial handicap and
as one of the stigmata of defect.

Her dress, though patched and colorless, was clean.

Here is evidence of personal self-respect, an
important trait in the social worker's eyes.

Furniture old but in good condition, worn-out square
piano purchased for $5.00 years ago, elaborate silver
candelabra, a recent gift from maternal uncle Joseph.

This points to family self-respect, a struggling
for standards. They have taken care of their
furniture and cherish the symbols of cultivation.

A girl of seventeen, the oldest daughter among a large
family of children whose mother was feeble-minded and
erratic, came into the office of a social agency to discuss
the needs of her younger brothers and sisters. For
several years she had faithfully and unquestioningly
carried a premature responsibility in an ill-kept home.
She entered the office "dressed in a pale pink silk, high-
heeled slippers, her hair down over her ears (the extreme
of fashion so far as her small means would allow), and in

185



THE SOCIAL CASE HISTORY

the course of conversation she mentioned that she wanted
to become a manicurist."

For one who would influence this girl, such a
description is highly significant. The facts quoted
which, taken by themselves, suggest "flyness,"
looked at in the light of her devotion to her fam-
ily, indicate what are some of the better things
she values in life. Bred in slackness, her effort at
style and her wish to do manicuring represent a
reaching toward what to her seem higher stand-
ards.

The following succession of sentences taken
from the history of a fairly skilful artisan who had
got into heavy debt through his drinking habits,
seem to the writer to show facts that should be
made to stand out in the record as having espe-
cial character significance.

From the investigation record :

The men working at the X have a great many

good times together and seem to take debt as a matter of
course. Man is rather proud of the financial difficulties
which he has been through. (Interview with man.)

The men at the X are a sporting crowd inclined
to drink and many of them have to let their wives collect
their wages. (Interview with manager.)
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THE NARRATIVE IN DETAIL

He does not want to assign his wages to his wife as it
"seems a kiddish thing to do. " (Interview with man.)

He is very fond of his children and does not mean to
spoil their chances for an education. He loves his wife
and wishes that he might have work in the daytime so
that he could go out with her instead of his companions
at the X . (Interview with man.)

From the treatment record one month later:

Man is straightforward in admitting that the fault has


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Online LibraryAda Eliot SheffieldThe social case history : its construction and content → online text (page 9 of 12)