Social Diagnosis

Social Diagnosis

Mary E. Richmond's (1917) scholarly work, Social Diagnosis, is a 511 page comprehensive approach to social work at the beginning of the 20th century. This book provided a systematic framework for social work by formulating questionnaires concerning nearly every aspect of the profession to be used at the initiation of services. The author expressed the specific intent to provide common ground for all case workers so they could "develop a knowledge and mastery of those elements" (p. 5).

While a condensed version of the book is certainly beyond the scope of this paper, a brief summary is in order. Two appendices, a bibliography and a thorough index supplement the book's twenty-eight chapters. Richmond divided the book into three parts. Part one is concerned with the history of social work investigation and discusses how workers gather the information used to decide to whom services should be dispensed, part two discusses the process of interviewing applicants, gathering information from other sources, and how to think through the information gathered in these processes to reach conclusions about client eligibility and planning. It also begins to address the philosophical basis of social work. Richmond (1917) said:

Individual differences must be reckoned with in every field of endeavor, but the theory of the wider self, though it has of course other implications, seems to lie at the base of social casework. We have seen how slowly such work has abandoned its few general classifications and tried instead to consider the whole man. Even more slowly is it realizing that the mind of man (and in a very real sense the mind is the man) can be described as the sum of his social relationships. (p. 368)

In part three, questionnaires are introduced with discussions on their appropriate use. There are questionnaires and chapters for (a) families in general, (b) immigrant families, (c) deserted families, (d) neglected children, (e) single mothers, (f) people who are blind, (g) those who are homeless and alcoholic, and (h) people with mental illness and developmental disabilities. The last chapter and questionnaires are for supervisory reviewing of the caseworkers to make sure they met professional standards.

Several areas Richmond (1917) dealt with can be seen as predicting social policy issues of today. The author's discussions of mental illness issues and self-reliance issues are prime examples that, for the sake of brevity, this paper uses to illustrate current social policy controversy. Social work programs that stress teaching social workers to provide psychotherapy have been attacked (Specht & Courtney, 1993), and social policies aimed at self-sufficiency have been construed as blaming victims for their problems (Hawkins, 2005).

Richmond (1917) emphasized the social worker's responsibility to provide helpful services to people with mental illness and specifically ruled out using the questionnaire for this area as a tool for formulating a medical diagnosis. The author focused on taking a comprehensive history and stressed the importance of making decisions based on behavior as it occurs in the context of a person's life circumstances, rather than allowing decisions to be based on isolated incidents. Thus, while expressing a concern that the worker concentrate on being helpful as a way to counteract natural repulsion in the presence of pathology, the book challenged the worker to carefully note reports of variations in social interaction, mood, and cognitive functioning, especially as they were affected by time of day or other aspects of the daily routine, so that workers would be better able to accommodate related problems in their planning. There is no inkling of the concept of a social worker actually providing psychotherapy, an area Richmond clearly regarded as properly reserved for the attention of a physician, as indicated by the statement that "the diagnosis of mental disease and of mental defect must be regarded always as primarily medical" (p. 434), and the later statement that "it should be repeated here that nothing in the following questionnaire must be interpreted to mean that a social worker is ever able to make a medical diagnosis" (p. 436).

The question of whether social work has lost its bearings is closely related to the use of publicly-funded universities to train social workers who then use their training for much more lucrative occupations than those envisioned by Richmond and other pioneers in the field (Specht & Courtney, 1994). The authors said that, rather than focusing on providing services to people who are underprivileged, have severe disabilities, or otherwise need help learning to care for themselves, as many as 40% of social workers were in private practice offering psychotherapy to people with relatively minor neuroses.

Turner (1999) took the position regarding psychopathology that "accurate diagnosis is the essence of contemporary, skilled, and responsible social work" (p. 2). The author stated that social workers should expect to encounter people with mental illnesses of every variety and ought to have the knowledge and skills to provide effective assistance. The conclusion was that, because of societal changes, such as the movement to treat people with mental illnesses in the community rather than long-term inpatient care, it is now necessary for social workers to become much more heavily involved in diagnosing mental illness.

The use of a holistic approach is essential to diagnosis and development of a social work treatment plan (Wodarski, Rapp-Paglicci, Dulmus & Jongsma, 2001). Mirroring many of the areas addressed by Richmond's (1917) work, these authors have produced a treatment planner for the specific purpose of developing plans acceptable to government agencies, managed care companies, insurance agencies and other third-parties. They stated that