ECONOMIC INVESTIGATION BY THE SOCIAL ASSISTANT
It should be clear from what I have said already that the work of the
social assistant _may_ have nothing to do with poverty. Her only
business in visiting a family may be to assist the doctor in his
diagnosis and treatment by bringing him additional facts about the
nature, seriousness, or cause of the disease and about the means by
which it may be combated.
But in many, perhaps most, of the families whom the social assistant
attempts to befriend, there is a call for relief, for financial
assistance, for money, food, coal, and clothes. This appeal like most
medical appeals is apt to take the _form of an emergency_. Help (we are
told over the telephone) is needed at once, or disaster will follow. The
family is eager for immediate relief, not for a slow and painstaking
investigation of the causes which have led up to the present state of
things, or of the exact nature of their present troubles. They are like
the sick in this respect. Prompt relief from pain is what the sick
demand, not the tedious processes of questioning and examination. They
want a remedy, a pain-killer, morphine or its equivalent.
But we all know the dangers of giving morphine for the relief of pain.
It never cures a disease; it only stifles a symptom. It gives delicious
ease; but the need for its use soon recurs. Hence there is always
danger that before long the patient will have to fight, not only the
disease which originally caused him pain and made him call for morphine,
but the morphine habit in addition. This is all familiar. But not every
one realizes that the giving of money in case of poverty is as dangerous
as the giving of morphine in sickness. Money like morphine satisfies an
immediate need and hence is eagerly welcomed by the sufferer. But of
money as of morphine it is true that a single dose soon makes the
patient call for another, and often a larger dose; that it soon makes
the patient dependent on this sort of relief, and so forms a dangerous
habit. With the rarest exceptions, to give money or to give morphine
does not cure. The state of things which produced the pain or the
poverty is sure to recur. For (as I have said above) the patient's
belief that his present troubles are an unforeseeable accident, a sudden
catastrophe, is almost never true. The truth is that his pain or his
poverty are but the last chapters in a long story produced by causes
which can usually be traced out, and whose future action can often be
foreseen. By giving money we are covering up a smouldering fire, not
quenching it.
For economic bankruptcy or breakdown, like physical bankruptcy or
breakdown, is generally the result of _faulty organization_ in the
system of income and expenditure. Physically a person breaks down
because he has been spending more energy than he can recoup by rest,
food, and recreation. Economically he breaks down because his scale of
expenses exceeds his regular income. Hence it gives but temporary relief
to pay the bankrupt's debts, to cancel the sufferer's pain. The
operation will soon have to be done over again unless some constructive
plan for increasing his income or decreasing his expenditure can be
worked out. _Giving creates dependence_ because it atrophies industrial
and moral initiative, just as a crutch or a splint causes muscles to
waste. Powers unused atrophy. If we support a person, except
temporarily, he will soon lose the power of self-support.
But the point of view impressed upon us by the sufferer himself is apt
to be quite the opposite. What he wants is something immediate and
temporary for the relief of something accidental. The beggar who meets
us in the street has "accidentally" lost his purse and asks of us a
small sum of money to reach his home. Often I have said to such an
applicant, "Meet me at the railroad station half an hour before the
train leaves for your home. I will buy you a ticket and see you on
board." _He never comes._ This is an extreme instance and involves
almost always a deliberate attempt to deceive us. In home visiting it is
not like this. The sufferer does not usually intend to deceive.
Nevertheless his misfortunes are pictured by him as accidental and
temporary catastrophes, maiming a life which needs no general
reconstruction. He is so sure of this that he is apt to force the idea
upon us unless we are alert, bracing ourselves to question it and to
make sure that it is true. But actual experience has shown me and
hundreds of others that this point of view is almost never true.
It is not chance that the family is just now poor. It is no emergency
which we are summoned to meet. It could have been foreseen long before
and it will certainly recur unless we can trace out its causes and
prevent their acting as they have hitherto. Hence the detailed,
prolonged, individual study of the family's economic state is necessary.
One must find out, first of all, all the details of income and outgo.
The family is likely to forget some of these, so that one must be ready
to assist their memory.
Further, one must inquire carefully into possible sources of help from
relations, friends, fellow members in some club or association, and so
forth. For next to self-help the help from those naturally bound up with
one is best. Compared with impersonal charity, it is less artificial. It
is less destructive to the natural family relationships which it is
always our ultimate ideal and our immediate job to maintain or to
restore so far as possible. Whatever disturbs or threatens them is
hostile to the social interests for which we labor.
Naturally one does not invoke the help even of family, friends, or
fellow club members, unless it seems impossible for the individual,
under the best plan that he and you can think out together, to get along
without outside help. But if we are convinced that, for the present at
any rate, this financial self-maintenance is impossible, it is to
securing help from those nearest to the sufferer that one should look
with least regret. Gifts or loans from members of his family or from
friends are more likely to be taken seriously by the recipient. He is
less likely to feel (as he does with an impersonal agency or charity
fund) that he can draw from a bottomless pit of money without making any
one else the poorer. Moreover, when he takes money from his brother or
the fellow member of some club, the pressure for regaining his economic
balance is likely to be exerted from without him as well as from within.
He feels the pressure of his debt and thereby is stimulated towards
regaining his independence.
The sufferer's "catastrophic" point of view, which tends to isolate the
present trouble from all its causes, to represent it as temporary and
accidental, is related to his tendency to state that he has no friends,
relations, or social connections through whom help could come to him.
Without any deliberate attempt to deceive us, he quite naturally forgets
some of his relations. He does not want to appeal to them. Hence they
fall into the background of his mind, and are not easily recovered. When
one finds them for him he is apt to say, "I did not think of him because
I am not on speaking terms with him"; or, "I would not on any account
take money from her, or allow you to ask her to help me." But such a
sufferer may very properly be asked, "Why is it that you are willing to
take money from me, a stranger, or from this impersonal charitable
agency, when you are not willing to call upon your own relations nor
even to let them know that you are in trouble? You are concealing it
from them, are you not? Is there really any good reason for this? Will
it not be easier for you, as well as for them, that they should know at
once? Are you not really storing up trouble for yourself, postponing the
evil day which, when it comes, will be worse than anything which you
would have to bear at present?"
Of course, in all such advice we intend to say nothing that we should
not wish to have said to ourselves. The social worker tries to treat
people always as she would wish to be treated. But one cannot always
avoid giving pain or even estrangement. Because such interviews are
necessarily difficult and may result in disaster to the relationship
that we are trying to establish, they should be postponed if possible
until we have already established in other ways a friendly
understanding, a structure of friendship which will bear the strain of
penetrating inquiries such as these economic matters necessarily entail.
I have said that the first guide to helpful economic relief is a
realization of its danger. The next is awareness of the advantages of
self-help and the truth that next to self-help, assistance from those
naturally and nearly related to one is best.
The third principle, by following which we may hope to do the greatest
good and run the least risk of harm in our giving, is this: never give
hastily except in extraordinarily rare emergencies such as acute hunger
or exposure to the elements. In all other cases give in accordance with
a plan worked out as carefully as may be, whereby we are confident that
our giving can be temporary. Sometimes we can arrange that it shall come
to an end automatically. That usually means that we arrange for a loan
rather than a gift, with repayment either by instalments or in lump sum
upon a definite date.
(_a_) _Loans._ It is in the hope of rendering service by these means
that there have been organized philanthropic loan associations which
lend money at low rates of interest and sometimes without interest or
upon security which the commercial loan companies would not accept. The
sufferer with whom we are dealing may know nothing of the existence of
such agencies. If so, to connect him with one of them, to help in
furnishing the security necessary to negotiate a loan, may perhaps be
the best way in which we can help. Or one may buy some rather expensive
article such as a piece of medical apparatus, with the clear
understanding that we are to be repaid in instalments or at weekly
intervals.
(_b_) _Tools of a trade._ Another example of the kind of giving which
comes to an end and does not tend to form a habit like the morphine
habit, is exemplified when we buy a man the necessary tools of his
trade, or the stock and furniture necessary to start a store. The belief
on which we rest in such cases is that after the initial act of
acceptance, after an initial period of dependence, the individual will
become self-supporting and independent.
(_c_) _Furniture._ Or, again, one may give or loan a cooking-stove, so
that the sufferer may no longer have to eat at restaurants, or some
furniture in order that he may get the benefit of the lower rent to be
had when one hires an unfurnished room. In all these cases the ideal
thing is to arrange for repayment in small instalments. Failing this we
try to think out a plan such that after the original expenditure the
sufferer will be able to go on independently.
(_d_) _Aid in illness._ A fourth example of temporary interference in
the form of financial aid, is a gift or loan of money to tide a person
over an illness, to make his convalescence complete or to rest him when
he is dangerously tired. Usually such aid can be rendered through
services or institutions (nurses, hospitals, convalescent homes) which
do not involve giving money outright.
(_e_) _Aid during unemployment._ A fifth good reason for giving money or
other forms of relief temporarily is to tide the sufferer over a period
of unemployment, during which he is actively looking for work or for
better work than he now has. Sometimes we can assist him in this search.
But there is danger in this. A man is less likely to keep a job that
some one else finds for him than one which he finds for himself. Still,
we may help him without harming him in case we can give him facts,
names, positions, employment agencies by means of which he may secure
employment, he himself taking the active part in securing the job.
_Information, which is what we here furnish, is one of the least
dangerous of gifts._
In all these cases the principle is like that whereby we do surgery.
Surgery is a temporary injury to the body done with the expectation of
ultimate good, a temporary interference of outside powers with the
natural self-maintenance of the organism, in order that those functions
may ultimately go on not only independently, but more satisfactorily
than before. The surgery may kill the patient, or leave him worse than
he was before. But our reasonable expectation is (in case our surgery is
good) that his health--that is, the capacity of his body to maintain
itself, or develop itself--will be improved. So in economic surgery we
foresee a speedy end to the need for aid. The person is to be put upon
his feet by our aid; our services can soon be dispensed with. The need
will not recur. It is not chronic. It was not his fault and therefore is
not likely to return upon him soon because of continuance of the same
defect.
Obviously one must try to make clear--or, still better, try to have it
clear without explanation, understood because of our previously
established relation of trust, confidence, and affection--that it is not
because of parsimony or close-fistedness that we are refusing to give
quickly, constantly, and without inquiry. Medical analogies must
constantly guide us and be in the minds of those whom we try to help.
We refuse money, as we refuse morphine, for the patient's good. We try
to make our giving of money temporary and self-checking, for the same
reason that we try never to begin giving morphine unless we can foresee
a speedy termination of it, a speedy cessation of the need for it, as we
do when we give it in gall-stone colic or acute diarrhea, or just before
a surgical operation. If morphine were a possession of the doctor's, as
money is a possession of the visitor or those whom she represents, then
the doctor might often seem stingy, cruel, selfish in his refusal to
give it. We must make it clear if we can that our hesitations,
limitations, or refusals in relation to money have no more connection
with our own control over that money, our own enjoyment of it, our own
sense that we have any right to it, than the doctor's refusal to give
morphine rests upon his desiring to take the morphine himself instead of
giving it.
All this is difficult to make clear, and it is chiefly for this reason
that I have repeatedly insisted that the financial approach, the
financial ground for an _entente cordiale_, should not be used early in
our dealings with the sufferer, but should if possible be postponed
until, through medical service and personal intimacy, something
approaching true friendship has been established.
It should be clear from what I have said that our judgments about giving
financial aid can be sound, can result in doing good without harm or (as
in surgery) good with a small element of harm, only in case they are
the fruit of detailed, prolonged, individual study. It cannot be a
wholesale matter. It cannot be done in exactly the same way in the case
of any two individuals.
Let us stop to realize for a moment how arduous, how bold a task we have
undertaken. We hope to construct a person's economic future better than
he can construct it himself. We hope to see what the individual himself,
despite the vividness and pressure of his immediate need, has not been
able to see for himself--namely, how he can get himself out of his
financial difficulties. We who do not wear the shoe are venturing to say
where it pinches and how the pressure may be relieved, and to know about
this better than the sufferer who feels the pressure in his own person
and longs for its relief as it is hardly possible for any one else to
desire it. It is almost as if we were trying to use his mind for him. It
must not be that. But if it is not to be that, we must be sure that our
aid is given through stimulating the individual to think for himself.
"What do you think," we must constantly be asking him, "is the best way
out of this our difficulty?" He must feel that we know it to be _our_
difficulty as well as his, that we are not looking on with the cold gaze
of an outsider, that we suffer in his suffering, and still that it is at
last his, and that with all our best efforts we can only contribute a
little to what must be for the most part his own reconstruction, a
reconstruction like that which the body performs when it heals a wound
which the surgeon or the physician can only encourage a little towards
its natural healing.
Without being impudent enough to attempt to use the sufferer's mind for
him, to force our wills upon him, to take his burdens off his shoulders,
to fill his place or to assume his responsibilities, we must try to help
him in all these respects, largely by the kind of sympathy which
stimulates, the kind of affection which encourages, the affection which
changes useless brooding, ineffectual worrying, destructive grieving,
into their opposites. We can help him to think by suggesting resources,
possibilities that he does not know or that he has forgotten, by
furnishing new material on which his mind may work, by helping to
generate the power, the hope, the concentration, the prolongation of
thought out of which new solutions may be born. He must really think of
something new. He must really invent something, if he is to get upon his
feet and become independent once more. Ordinarily necessity is the
mother of invention. We pull ourselves out of our difficulties when we
finally realize that we must because disaster is otherwise imminent. But
such pressure of necessity as would generate inventiveness in one
person, may generate only despair in another. It is to avoid this
tragedy, it is to make fruitful what were otherwise fruitless, that we
hope to warm the sufferer into better life. We hope to rouse in him, by
affection or by the stimulus of new facts (perhaps), the courage
necessary to see his situation afresh and to reshape it.
Because we are comfortable where he is suffering, because we have free
power of thought whereas his mind is numb and cramped, we may be able to
think of some possibilities, some changes, some sources of hopefulness
which he could not even imagine. He cannot take them from us ready-made.
If he does they will be useless to him. But if we have reached the
central fire of his life, if we have stimulated not this faculty or
that, but the centre of his personality, then by the grace of God we may
be able to do with him what he alone could not do.
_Housing_
A part of the economic life of our patients, aside from the food and
clothes for which they may most urgently ask our aid, is their housing.
(_a_) Is it hygienic?
(_b_) Is it as inexpensive as can be obtained with due
consideration of health, decency, distance from work, from friends,
from amusements?
(_c_) Is it large enough to safeguard the decencies of family life?
The last of these questions is the most important of all.
It should be among the medical duties of the visitor to investigate the
hygienic aspects of the home in order to explain them to the doctor, who
can then include them among the facts on which his diagnosis,
prognosis, and treatment are based. The social worker may then try to
carry out such improvements in housing as the combined judgment of the
doctor and the social worker suggests. More important than medicines,
often, is the provision for proper warmth and proper ventilation of the
patient's rooms during the day and especially at night. Darkness, dirt,
poor ventilation, favor the growth of germs, vermin, parasites of all
sorts. They also depress the vigor and power of the human organism to
resist disease. Doctors and social workers cannot hold Utopian views in
matters of housing, but must content themselves with trying to secure
something a little better than they find in the worst of the patient's
lodgings, especially when these lodgings represent conditions below the
family's own standard of living at some previous time. People adapt
themselves wonderfully to bad hygienic conditions, and once so adapted,
they may be able to preserve their health for a long period. But if then
a family is suddenly forced to crowd itself into smaller, darker,
dirtier, noisier quarters than it has been used to, or if a family group
increases its numbers within the same quarters, the adaptive powers of
the human organism may be overstrained and break down.
It is against these conditions especially that the social worker and the
doctor should labor. Housing problems are among the most difficult of
all that confront society. Yet we should pledge ourselves to attempt
some improvement, not disdaining slight gains because we are enamored of
distant Utopias.
Sometimes people are living beyond their means, are accepting bad
quarters at high prices when they could get as good or better quarters
for less money in some less crowded and popular district. Human beings
have a strong tendency to stay wherever they find themselves, to settle
down by chance and resent any suggestion of change even for their own
greater comfort. After a few months any place soon comes to have the
attractions of home merely because we have been there. Hence we stick in
the same place, though we may know that it is chance and not choice or
necessity that has put us there. Under these conditions a social worker
may do real service by her greater knowledge of other lodgings at lower
prices, or (what is essentially the same thing) better lodgings for the
same price now paid. If the social worker is familiar, as she should be,
with the lodging conditions in the neighborhood in which she works, she
may be able to give a patient facts about lodgings which were either
unknown to him, or more probably unrealized, because he has never seen
them. Our mental horizon becomes restricted. Any one who enlarges it by
presenting new and helpful possibilities serves us well.
So far I have spoken of the housing question mostly from the standpoint
of health or cheapness, but, as I have already suggested, the moral
aspects of the problem are still more important. It is difficult, for
many impossible, to preserve personal decency and to keep family
morality at a proper level, when adults and grown-up children are forced
to sleep in the same room. Lifelong injuries to body and soul may be
forced upon innocent children in this way. Nothing can be more important
than this. We must remember, however, that custom and previous habits
play a vast part here. One race or one set of people may have so
adjusted themselves as to preserve decency under conditions impossible
for another. We cannot generalize. We must know the particular people
with whom we are dealing, and we must know their previous habits and
standards in case they have shifted their lodging or increased the
number of persons in a room within a short time, as is so frequently the
case.
_Working conditions_
Work and the conditions of work are among the most important and the
most difficult of the economic problems in which a social assistant may
find herself inevitably involved. These concern the patient's trade, the
physical and moral conditions under which he practises it, his fitness
or unfitness for it, the wages he receives, the future possibilities of
advancement in pay and type of work which it offers. In all of these
problems the social worker can sometimes help a little because of her
greater freedom of mobility, mental and physical. She is not tied to her
task as blindingly, as deafeningly, as the manual worker is. She may
know more or be able to find out more as to labor markets, as to other,
possibly better, positions, shops, employers. She may be able to see,
better than the worker himself, his fitness or unfitness for the work he
is doing. She may be able to realize better than he that his trade
presents an _impasse_, has in it no possibilities of development,
personal or financial. She may realize better than he the bad effects of
his work upon health or morality. In all these respects she may be able
to give the safest, and in some ways the most satisfactory, of all
help,--namely information.
I do not underestimate the difficulties of such help. It is not easy to
know more about a man's business than he does. Yet if the social
worker's education, her health, her circle of acquaintances, is greater
than that of the wage-worker, she may really be of some assistance to
him even in the field that is more specially his own and that she can
understand but superficially. It is for this reason among others that
the social worker cannot be too broadly educated, too fresh physically,
too vigorous in her powers of thought and observation, too widely
acquainted in her community.
Among the problems growing out of the basal economic needs of which I
have just spoken, are others with which I cannot here deal adequately.
Such are:
(_a_) The problem of industrial hygiene and industrial disease.
(_b_) The problems of school hygiene and school medicine, since school
life is the industrial life of the child, who even receives wages for
going to school in some communities.
(_c_) The industrial and psychological problems of those who are maimed
by accident, war, or disease.
(_d_) The problem of industrial insurance and health insurance.
All of these questions involve matters of State action, legislative
control, and economic reform with which I do not wish to deal. But I
wish to make it clear, in closing this chapter, that the social worker
as a citizen is as much interested in these hopes for radical economic
reforms as any one else can be, though she does not regard them as her
special business.
Preventive medicine and the daily fight against individual cases of
disease which we hope some day to prevent--these two activities go on
side by side, each helping the other. The social worker corresponds to
the private practitioner of medicine; the economic reformer and
discoverer corresponds to the laboratory student of preventive medicine
or to the public health official. In social work as in medicine the case
worker should bring to the inventor and reformer new facts and
illustrations suggestive of the evils to be reformed or possibly of the
ways of combating them. And in the difficult, often disappointing, task
of trying to help individuals, the case worker will also take part of
his inspiration from the hopes and ideals of a better economic order
sketched for him by the legislative reformer. The method and technique
of economic investigation is complex and difficult. For a masterly
treatment of this and all other aspects of social diagnosis Miss Mary E.
Richmond's epoch-making book on "Social Diagnosis" should be consulted.
(Published by the Survey Associates in New York City.)