heterodox: the blog
Social Work Needs Heterodoxy
As recently as November of last year, I considered myself a progressive, left-leaning liberal. I picked up Jonathan Haidt’s book The Righteous Mindwhile trying to make sense of the recent protests at Yale University. I had read about the overwrought response to Dr. Erika Christakis’ Halloween email, and was horrified by the video footage of the student screaming profanities at Dr. Nicholas Christakis. If I had ever behaved that way towards a professor, my parents would have refused to speak to me until I wrote a letter of apology, and read it aloud in front of the entire school. Naively, I assumed that all right-thinking people would agree with me that the student’s behavior was unacceptable, and the whole situation ridiculous. Then I got into a few debates with liberal friends, and found that they sided with the student. I was accused of not caring about racism, and even of wanting to allow Klan hoods and blackface on the Yale campus. It was surreal, finding myself standing to the right in a political argument for the first time since high school.
The Righteous Mind outlines a number of competing values which people hold. While my liberal friends and I have values that we share, I now notice differences in the ways that we weigh and prioritize them: Naturally, a person who places the moral foundation of Care/harm above all other values would side with students who “want to talk about [their] pain,” as one Yale student so memorably put it, and reject the idea of respecting authority. Perhaps it’s the influence of my immigrant family background (Greek and Indian) that causes me to value Loyalty, Authority, and Sanctity more than other (I’m also religious, which complicates things further). I am slowly beginning to doubt that I ever was a real progressive in the first place. Right up until college, I was more of a moderate, even conservative one some issues. When I went to New York University my views took a hard shift to the Left (most likely influenced by interactions with my peers and the political climate during the second Bush administration). This is where they stayed until late last year.
I became a social worker. In Social Work, you have to lean Left. By far, the highest moral value in Social Work is Care, especially care for perceived victim groups. Social workers value Fairness and Liberty as well, but Care predominates. The impulse to place care for victim groups above everything else can harming those same victim groups, whenever the fear of hurting victims’ feelings gets in the way of effective help.
A biopsychosocial understanding of clients is supposed to be fundamental to Social Work – I have written hundreds of such assessments over the years. But as Maynard, Boutwell, Vaughn, Naeger, & Dell write in their article “Biosocial Research in Social Work Journals: A Systematic Review,” there is not much emphasis on the “bio” part in the field (2015). The authors suggest that fear plays a role: Fear of biological determinism and fear of biosocial research being used for unethical purposes (Boutwell, Maynard et al., 2015). I witnessed this several times as a Social Work student. Discussions of biological differences between men and women were fraught (if they happened at all), because such differences could be used as a justification for discrimination against women. The avoidance of biology is driven by ideology.
I vividly remember an incident that occurred during a class discussion on obesity. One of the students was a self-declared “fat activist” whose goal was to end discrimination against and mistreatment of overweight people in society. That in itself is a perfectly fine goal, but she took it much farther than that. This student declared any discussion of the health-damaging effects of obesity to be “irrelevant” and therefore off-limits for discussion. When I tried to note that the health effects of obesity can indeed have a profound effect on people’s lives, no one even bothered to reply to my point. The student activist only replied that my use of the word “obese” was prejudiced (to this day, I am still not sure why), and to please use the word “fat” instead. The discussion was over. Later that day, the student sent an email to the entire class with “FAT FAT FAT FAT FAT” in the subject line, in case any of us had missed her point. The email contained a link to her personal blog and other fat activist websites.
This student’s views may be dismissed as a bit of college extremism, but they can cause real harm once the student graduates and starts working in the real world. What are the consequences of ignoring biology, as at least one professor encouraged us to do? My first job out of graduate school was in a hospital’s Maternity and Neonatal Intensive Care Units. The risk of developing life-threatening complications during pregnancy and childbirth are far greater for a clinically obese woman than for one of normal weight. In such a setting, the social worker quickly learns that biology is indeed very relevant. What could be more relevant than the risk of a mother dying in childbirth, or a baby suffering brain damage from shoulder dystocia during birth? Social Work ignores biology at its own peril.
The problems go beyond biology. When a profession makes the care of victims its most important value, it will eventually have to rank its victims in order of need. No one can help everyone all of the time, so some groups are ignored, and others are given priority. In a class on Family Practice, the professor led a discussion on domestic violence which was framed as an issue exclusively affecting women. A student briefly brought up the possibility that men might also be victims of abuse, only to be told by the professor that male victims were so rare that we didn’t need to focus attention on them. The facts do not bear out this assertion: Statistics vary, but a 2010 report from the CDC found that 40% of victims of severe intimate partner violence are men. Male victims are common enough that a social worker is likely to encounter at least one, probably several, in her career, but very little research has been done on them. Men who have sought help have reported being ridiculed and turned away from hotlines and agencies that only serve women. Sometimes they are accused of being batterers themselves. Attitudes like my Family Practice professor’s, which categorize men as victimizers and women as their victims, contribute to these problems. Ideology can blind us to the suffering of those who do not fit into predetermined groups; in a social worker such blindness seriously affects the help she gives.
My classmates could talk all day long about race, gender, sexual orientation, and gender identity, but when the topic of social class (or as we call it: “socioeconomic status”) came up, they became hesitant and quiet. Perhaps this is because most of them came from middle- to upper middle class backgrounds. The professors in my Social Work Policy courses tried valiantly to get their students interested in economic inequality, which is one of the most pressing challenges facing our country today, but the students were always more comfortable turning the discussion back to race, gender, and sexuality. One of our professors spoke about health care reform when a student began bombarding him with questions about the policy’s implications for same-sex couples. He answered these questions, and attempted to continue speaking, but the student kept accusing him of ignoring gay and lesbian people. Finally the professor had had enough of being interrupted, and said “We’re not talking about that right now. We’re talking about health care policy.” The student jumped up and ran from the room, and I did not see her in that class again.
As a social worker, she must have realized by now that poverty and all its attendant problems – including lack of access to health care, poor housing or homelessness, and hunger – loom very large in the lives of her clients. Will she regret having discounted them?
If social workers want to more effectively improve the lives of their clients, they will have to get better at understanding their clients’ particular challenges. To do so, Social Work must expand its political and ideological horizons. Social Work will always lean left. But the field would greatly benefit if more professors and students dared to challenge the ideologies currently in place: Ideologies that declare biology to be irrelevant, victims who do not fall into expected categories to be unworthy of attention, and economic inequality to be a mere corollary of racial and gender oppression. In the end, good social work (just like pastoral or medical care) depends on listening, without reservations, to the problems as they exist even when they are inconvenient.
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