Conflict Situations Between Clients and Case Workers
Stuart A. Queen
Associate Director, Detroit Community Union
I. BACKGROUNDS OF THE STUDY
IN its development family case work has sometimes been described as passing through four stages: indiscriminate relief, niggardly relief, relief with a plan, and personal service to which relief is secondary. The first stage is well illustrated by the "dealing days" of medieval noblemen and the "allowance system" of England one hundred years ago. The second is seen at its best in the hard conditions set by the English Poor Law of 1834 with its principle of "less eligibility" and the "workhouse test." The third, "relief with a plan," involves budget-making, vocational training and placement. In all three emphasis is on poverty, destitution, and pauperism. But along with economic difficulties, moral problems receive more or less attention. Thus the Society of St. Vincent de Paul is known for its "alms of good advice" as well as for its material relief. The fourth stage, therefore, arose out of interest in the client's conduct as well as in his financial status. To many people this means an evaluation of conduct in terms of approval or condemnation and an effort to modify "undesirable" traits by persuasion or coercion. To others it means the understanding and control of habit formation as a natural process. Both groups speak freely of habits, attitudes, personalities, and situations, but between them lies a great gulf.
To the first group habits are of only one kind, namely, "bad." On the "face sheet" used in most family welfare societies is a space marked "habits," in which it is expected that the visitor will enter such items as "drinking," "gambling," "drug addiction," "immorality," and "lying." The second
( 209) group uses the term "habit" in a more general sense. Influenced by the psychologists, it uses the word "to express that kind of human activity which is influenced by prior activity and in that sense acquired; which contains within itself a certain ordering or systematization of minor elements of action; which is projective, dynamic in quality, ready for overt manifestation; and which is operative in some subdued subordinate form even when not obviously dominating activity." The first group regards its clients as in trouble because of their own fault, and it exhorts them to lift themselves by their own bootstraps, that is, by an arbitrary act of will. The second group assumes that the conduct of its clients has resulted from a series of events which may be discovered and diverted "indirectly by modifying conditions, by an intelligent selecting and weighting of the objects which engage attention and which influence the fulfilment of desires." 
In recent years both social workers and students of human relations have talked less about habits and more about attitudes, although the two words have been used in much the same way. Thus the moralists have spoken of "good attitudes" and "bad attitudes," employing such adjectives as "co÷perative" and "reasonable," or "anti-social" and "obstinate." In general, the term "attitude" has been used loosely and without definition, but since the appearance of Thomas and Znaniecki's, The Polish Peasant in Europe and America, there has been a series of attempts at greater precision.
Thomas and Znaniecki used two correlative terms, value and attitude. By value they meant "any datum having empirical content accessible to the members of some social group and a meaning with regard to which it is or may be an object of activity." By attitude they meant "a process of individual consciousness which determines real or possible activity of the individual in the social world . . . . The attitude is thus the individual counterpart of the social value; activity, in whatever form, is the bond between them."  In accounting for these they held that "the cause of a value or of an attitude is never an attitude or a value alone, but always a combination of an
(210) attitude and a value." This general position has since been restated by Reuter  and by Park and Burgess. They variously define an attitude as "the tendency of the person to react positively or negatively to the total situation," as the "mobilization and organization of the wishes with reference to a definite situation," and as "the expression of a desire for status." The last interpretation is developed further by Reuter in these words:
Society provides the code of behavior, a definition of the situation that covers all phases of life and has become fixed as a result of experience, and from this social code, rather than from original nature, the individual values and attitudes have their rise . . . . The importance of the attitude lies in the fact that it determines the behavior of the person and provides the mechanism of social control. It is by definition a tendency toward activity. Toward any value in the society there are, possible or actual, a variety of attitudes. The actual attitude always represents an effort on the part of the individual to get some sort of recognition in the group organization. Life organization demands membership in a group and the attitudes are the expression of a desire for status.
Another phase of the matter was presented by Park and Burgess when they stated that "attitudes are, for the purposes of sociology, elementary . . . because, being tendencies to act, they are expressive and communicable." This lead was followed up by Faris with the statement that "an attitude may variously be designated as a gesture, an incomplete act, or a tendency to act."  Bernard carried the idea still further:
An attitude is essentially an incompleted or potential adjustment behavior process. It is the set of the organism toward the object or situation to which an adjustment is called for. When the adjustment is made the attitude disappears, except in so far as it is retained in memory or in the habitual set of the organism. . . Attitudes arise only in an adjustment situation and they may be
( 211) regarded primarily as preparation for the adjustment which is in its initial stages and is to be completed . . . .
Attitudes serve as conditioning stimuli as well as conditioned responses, and vice versa. In their simplest form they are symbolized overtly merely by emotional expressions and rudimentary gesture and vocal language. But in their more developed forms they constitute our conscious desires, valuations, and ideals . . . .
In the article previously cited Faris criticized some of Thomas' theory and terminology. He urged use of the word "object" instead of "value." He insisted that "attitudes are just as social as objects and that objects are just as individual as attitudes." Moreover, "new objects do not arise merely as effects of social values and preceding attitudes, but as a result of conflict, crisis, and reintegration." Faris also objected to the statement that wishes are related to attitudes as parts to wholes.
A wish is obviously an incomplete act, a forward-looking movement, with a future satisfaction as an essential characteristic. An attitude is, on the other hand, the result of organization, the residuum of activity, coming at the end of the satisfaction of some wishes and remaining to initiate other wishes, but not related to wishes as whole to parts. 
Read Bain has recently criticized current uses of the concept "attitude," maintaining that "it is all things to all men; it is seldom used consistently by any one writer; it is normative, valuative, subjective; it refers to verbal responses, opinions; habits, vegetative processes, tendencies to act, impulses to act, inhibitive impulses, feelings, wishes, values, motor sets, and various combinations of these." Paraphrasing a famous question he asked, "Are attitudes data or hypotheses?", and taking a rigidly behavioristic viewpoint Bain insisted that "we can= not speak of the existence of attitudes or wishes or sentiments or any other phenomena of consciousness except as they are manifested in overt behavior." He decided, however, to retain the word, re-defining it as "the relatively stable overt behavior of a person which affects his status."
To this Faris made answer  that "the attempt to discard all consideration of the subjective experience neglects the middle or mediating part of the act, which is equally important with the objective and observable . . . . The attitude is in part the residual effect of the act, but it remains as a predisposition to certain forms of subsequent activity . . . . As used in this article, an attitude is a tendency to act. The term designates a certain proclivity, or bent, a bias or predisposition, an aptitude or inclination to a certain type of activity. As so used, an attitude cannot be an act, though it may be the beginning of an act." To Bain's specific thesis that it is futile to study anything except overt behavior, Faris replied that "behavior is important, and what men do is vital; but we are also interested in what they are about to do, in what they can be induced to do."
So stands the attitude controversy today. Social workers and sociologists are talking about attitudes, but they have yet to agree upon a common meaning for this term. In the midst of this unsettled state of affairs some of us have decided to proceed for the present as follows: We will use the word "habit" in describing those relatively stable forms of overt behavior to which Read Bain refers; and we will be particularly concerned with those habits which immediately involve one's relations to other persons. We will employ the word "attitude" in referring to those tendencies to act which are indicated mainly by "gestures," as Mead uses the term. Because we identify habits through the recurrence of specific activities, we designate them by such terms as "talking glibly," "frequently changing jobs," "keeping house in good order" and "refusing assistance." But the terms by which we designate attitudes are more general, because they represent summaries of our inferences drawn from many truncated and completed acts. Samples of these are "proud of children," "evading responsibility," "maintaining good front," "sensitive about deformity," etc.
Another concept which is widely and carelessly used today is "personality." Social workers say they are "developing
( 213) personality" through the "modification of attitudes,"  implying that the latter have no independent existence, but are integral parts of that more inclusive and complex whole which we call personality. To Miss Richmond this term "signifies not only all that is native and individual to a man but all that comes to him by way of education, experience, and human intercourse." By implication, at least, this definition includes both habits and attitudes along with ideas, feelings and, in fact, all that we are. The same is true of Park and Burgess' definition to the effect that personality is "the sum and organization of those traits which determine the r˘le of the individual in the group." These traits include, physical characteristics, temperament, character (defined as the sum and integration of habits), social expression (gesture, manner, speech), prestige, and the individual's conception of his role.  The assumption underlying both these definitions is that while personality rests on an organic base, it develops through social interaction. This directs our attention to the need of studying the processes through which personalities develop and the situations in which attitudes appear.
Perhaps it is to the Gestalt psychologists that we owe a renewed interest in seeing things whole and interpreting total situations as well as the elements which they contain. But without arguing the question of priority we note two significant expressions of this viewpoint. At the twenty-fifth anniversary of the Cook County (Chicago) Juvenile Court Dr. Healy presented a paper entitled "The Psychology of the Situation" in which he said: "The whole picture is meant, the actor and the setting, including both things and other people. `The situation' is the particular environment of the given mem- ber of society [the person of the sociologists] considered together with him as active in it." 
In his presidential address before the American Sociological
( 214) Society in 1927 Thomas emphasized the importance of this approach to an understanding of human behavior
In approaching problems of behavior it is possible to emphasize -to have in the focus of attention for working purposes-either the attitude, the value, or the situation. The attitude is the tendency to act, representing the drive, the affective states, the wishes. The value represents the object or goal desired and the situation represents the configuration of the factors conditioning the behavior reaction. It is also possible to work from the standpoint of adaptation-that is, how are attitudes and values modified according to the demands of given situations.
Any one of these standpoints will involve all the others, since they together constitute a process. But I wish to speak at present of the situational procedure as having certain experimental, objective and comparative possibilities and as deserving of further attention and elaboration. As I have said, the emphasis of this standpoint by no means obscures the other factors; on the contrary, it reveals them. The situations which the individual encounters, into which he is forced, or which he creates, disclose the character of his adaptive strivings, positive or negative, progressive or regressive, his claims, attainments, renunciations, and compromises. For the human personality also the most important content of situations is the attitudes and values of other persons with which his own come into conflict and co÷peration, and I have thus in mind the study of types of situations which reveal the r˘le of attitudes and values in the process of behavior adaptation.
2. A STUDY OF SOCIAL CASE RECORDS
With this general background I have been studying situations in which social case workers find their clients "uncooperative." At the outset my problem was to determine whether the attitudes of these difficult clients are always substantially the same or whether they may be classified into a number of types. As the study proceeded it became clear that they differ greatly. Indeed in any given case it was necessary to consider several different attitudes rather than any single one of non-co÷peration. Moreover, in the effort to be objective it was found best to identify habits first, and then to list
(215) the attitudes which it seemed legitimate to infer. Still the data were inadequate, because it was obvious that the traits displayed at any given time are, in part, reactions to the present social environment (especially other people) and, in part, the product of past experiences. Attention was, therefore, directed upon the conduct of the social worker as well as that of the client, and an effort was made to determine the sequence of significant events. Hence, when I came to classification this developed quite naturally in terms of total situations. The results of the study are, therefore, a tentative classification of conflict situations involving the relations between a social case worker and his clients.
However, before discussing these results it may be well to describe the procedure followed. This is one of a number of co÷perative studies carried on jointly by the Sociology Department of the University of Kansas and certain social agencies in Kansas City. The present study started from an analysis of 525 statistical cards in the files of one agency, representing most of the cases closed during an eight months' period. On exactly one-fifth of these cards was checked the item "lack of desire to co÷perate." Fifty of the 105, scattered throughout the alphabet, were selected for intensive study, and a few others were examined at the request of the social workers. As I read the records I summarized them in the following form
(1) general situation described in popular terms, ( 2 ) items on the statistical card, (3) habits and attitudes indicated, (4) sequence of significant events, (5) excerpts from the record, and (6) comments. After making these summaries I asked members of the agency's staff, including some of the original visitors, to make their own analyses and compare them with mine. We also discussed some of the cases in an informal seminar of which these workers were members. Out of it all five types of conflict situations seemed to emerge
A. Conflict between visitor and client with divergent personal schemes of life . . . . . . . . . . . . . . . . . . . . . . 16 cases
B. Conflict between visitor and client of divergent cultures . . . . . . . . . . . . . . . . . . . . . . . . . 2 cases
C. Conflict between visitor and personally disorganized client . . . . . . . . . . . . . . . . . . . . . . 17 cases
D. A mixed type combining elements of both A and C . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 cases
E. Conflict between visitor and psychopathic client with benevolent individuals intervening . . . 3 cases
F. Not classified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 cases
(a) Conflict Between Visitor and Client with Divergent Personal Schemes of Life. This type might well be called "pattern-of-life-tension," borrowing a phrase from Mowrer. Here the client has a fairly definite scheme of life, involving usually an unconventional way of making his living, which is interrupted by some economic crisis, frequently followed by humiliation. The social worker to whom he comes for assistance advises a program of action which is in conflict with the client's scheme of life. In several cases the visitor's plan promised security, but did not satisfy the client's desire for status. In others the pattern varied, but usually involved "moralizing" by the social -worker.
(A-1) Typical of this group is a Negro family, man 54, woman 27, and six children 3 months to 10 years, destitute in mid-winter. They were living in three basement rooms in an area of deterioration. The man was unemployed and professed inability to work.
Statistical card listed: unemployment, unskilled, venereal disease, lack of desire to co÷perate, unadjusted to customs, and unsatisfactory environment.
Habits indicated: boasting of being a self-made man, refusing regular work, making living by unconventional means, expressing pain at being misunderstood. Corresponding attitudes are: egocentrism, parasitism, and evasion. Visitor's tactics included: interpretation, suggestion, persuasion, and coercion.
The sequence of significant events follows
1. Southern Negro, without schooling, learned to read and write.
2. Selling .toilet articles and home-made patent medicines and playing violin among Negroes of rural South, succeeding by impressive line of talk in making a living without much work.
3. Death of wife; remarriage against children's wishes; loss of contact with them.
4. Decided to go West; stopped in city to get more money.
5. Health broke; resorted to odd jobs.
6. Injured at work; claimed to have three broken ribs; company physician; no compensation.
7. Tried selling farmers' produce in public market.
8. Brought suit for large sum of money; attorney (perhaps) advised him to deny ability to do any work.
9. Destitute in mid-winter, applied to agency and received material relief.
10. Agency secured medical examination at clinic; this showed no results of injury, but Wassermann four plus (syphilis).
11. Visitor explained medical findings; insisted that man go to work or return to peddling in the South; threatened to stop relief.
12. Man refused and took position that visitor did not understand.
13. Getting along by means not revealed to agency.
The thirteen items in this man's history may be reduced to seven stated in more general terms: handicapped for earning a living by ordinary means ( 1 ) ; he found an easy way of "getting by" (2) ; he met opposition by defiance ( 3 ) ; but his scheme of life was interrupted by hard work, broken health and injured pride (5, 6, 9) ; then followed a struggle to regain status ( 7, 8, 12, 13) ; visitor urged a program that promised greater security at the expense of ease and status ( 10, 11); but the client made an adjustment on his own terms (13) .
In the next case we have much less information, but the nature of the conflict between visitor and client seems quite clear.
(B-8) This is an American white family, man 23, woman 20, and two small children. The man is in a state reformatory for stealing an automobile; the woman is working irregularly and probably making most of her living through prostitution.
Statistical card lists: unemployment, unsatisfactory work record, immorality, lack of desire to co÷perate, imprisonment, no neighborhood ties, lack of church ties.
Habits indicated include: spending beyond income, frequently changing residence, jobs, and plans, accepting material aid but not advice. Corresponding attitudes are: extravagant, maintaining "front," and sensitive. The most significant attitude of the visitor was insistence upon economic security and respectability.
The man's early history is unknown, but the more significant events in the woman's history seem to be these:
1. Reared in large, rural family, with poverty and little schooling (fourth grade).
2. Home broken by death of father and first step-father; earned own living from age 11.
3. Went to city; worked in stores, restaurants, and laundry.
4. Married man who worked irregularly, stole, and moved frequently.
5. Man sentenced to reformatory for theft of car.
6. Woman moved to escape stigma of husband's conviction.
7. Sent by neighbor to ask help of agency; decided to get along by self rather than give information and accept advice.
8. Crisis-new baby, no income, threatened eviction, relatives failed to help.
9. Agency provided relief; urged woman to go to relatives in another town; woman insisted on staying in city where man's reputation was not known.
10. Woman moved frequently, worked little, ceased asking for aid; source of income unknown; prostitution suspected.
There were two points of conflict both involving pride and security. The visitor urged return to relatives who were legally liable for her support, but the woman stayed in the city to escape stigma. The visitor inquired persistently into the woman's mode of life, but she concealed the essential facts and presently managed to get along without the agency's help. From childhood the woman seems to have had an unsatisfied desire for status. Whatever was achieved in her unconventional life was threatened by the plans and activities of the social workers; hence she took matters into her own hands and disappeared.
In a number of other cases of this general type the conflict between visitor and client has to do with sex. Thus a Negro widow, struggling to earn a living and make a home for her children openly accepted gifts in return for sex relations with one man. When the visitor urged their marriage, the woman flatly refused, saying that she did not love the man. In another instance the visitor both condemned the client's sex affairs and feared to visit her home. Hence the worker insisted upon office interviews as a condition of relief-giving. The tenseness of the situation is further suggested by the fact that the case was opened and closed three times in as many years.
A somewhat different situation involves the apparent transfer of a woman's dislike for her step-son to the social worker. One member of the agency's staff characterized this client as a "gold digger"
(P-5) An American white couple, man 65, woman 55, both previously married. Man a rather refined person, incapacitated by paralytic stroke, died within two months. Woman rather coarse, dodged bills, declined to accept jobs, or left them after a few days. Conflict between woman and man's only surviving son.
Statistical card listed: indebtedness, chronic illness, death, shiftlessness, bad housekeeping, lack of desire to co÷perate.
The man's habits included: meeting all obligations promptly, and letting his wife do most of the talking. His attitudes are described as straightforward, honest, and submissive. The woman's habits included: talking much, but withholding information, criticizing man's son, refusing to work, changing jobs frequently, quarreling with fellow workers. Her attitudes are described as:, domineering, jealous, parasitic, irritable.
Practically nothing is known of the woman's early history, but the most significant of the known events are these:
1. Since coming to the city 25 years ago man has worked most of the time steadily for one firm earning up to $5.5o per day, paying his bills, and bearing a good reputation.
2. Man's first wife died; later all but one of his children died.
3. Man advertised for a housekeeper; a divorcÚe answered; they married within two weeks.
4. Woman spent beyond their income; hence no savings.
5. Man's son and his step-mother criticized each other.
6. Man's health gradually failed; later he had two paralytic strokes, completely disabling him; hospital refused admission because his was a chronic condition.
7. Son helped financially and offered suggestions. Woman asked help of agency, concealing fact of son's existence as long as possible.
8. Man died; visitor found employment for woman; woman disappeared.
Two other variants of the pattern-of-life tension may be described briefly. One is the case of an old man, frail and lonely, long separated from all his relatives. He earned $2.00 a week as janitor and received small gratuities; but avoided contact with social agencies as long as possible, having a horror of the
(220) almshouse. The visitor attempted reconciliation with relatives, but the old man "refused to co÷perate." The other involves a family of six who had always worked hard and borne their own burdens without assistance. Even when a series of illnesses and an industrial accident forced them to ask for help, each declined or postponed medical and surgical care, especially hospitalization, saying that the family needed him or her to help at home. That is, the clients insisted on working hard to meet immediate financial needs, even though this was a serious menace to health, while the visitor urged medical and surgical care with a view to ultimate security.
In all these cases the conflict involved long-established habits and attitudes on both sides. The clients were accustomed to getting along by means not altogether conventional; the visitors undertook by suggestion, persuasion, or coercion to bring them into commonly accepted ways of living; the clients feared or resented interference; the visitors scolded or withdrew;  the clients persisted in their own schemes of life.
(b) Conflict Between Visitor and Client of Divergent Cultures. In the cases just described the social workers and their clients belonged to the same general cultural groups; there were no foreign families and Negroes were handled by members of their own race. The differences in life organization are, therefore, regarded as essentially personal. We come now to a type of situation in which the differences are more than personal; they represent a cultural conflict as well.
In contrast with many other American cities, Kansas City has a very small foreign-born population; the clients of social agencies are mostly native white Americans of native parents. It is natural, therefore, that we should find few cases of genuine cultural conflict. Curiously, however, the only ones we have discovered so far involve Mexicans, although the largest group of foreign clients is made up of Italians. In part this is because many of the Italians are old residents, while many of the Mexicans are newcomers; in part it is due to the Italian Council which mediates between maladjusted folk of that nationality and American agencies.
(L-2) This Mexican family consists of man, wife, and four children under 8. The man is alcoholic, promiscuous, and an occasional deserter, earning good wages, but giving little to his family. The woman is ignorant of English, afraid of her husband and of deportation.
Statistical card lists: intemperance, immorality, lack of desire to co÷perate, separation, bad housing, inability to speak English.
The man's habits include working regularly, drinking, running with other women. His attitudes may be described as independent and domineering. The woman's habits include staying at home, declining assistance, and refusing to prosecute her husband. Her attitudes may be described as submission to husband and fear of deportation.
Most of the history is unknown, but the following events help us to understand this situation
1. Migration from Mexico to United States; man securing regular employment at good wages, learning American ways; woman remaining closely at home.
2. Man spending money for liquor and other women, giving his family little.
3. Woman asked help from agency; was advised to have man arrested; declined.
4. Family moved and could not be located.
5. School teacher reported family to agency; public department threatened man with arrest if he did not support his family.
6. New baby born; man disappeared.
7. Neighbor reported situation, though woman begged her not to; woman expressed fear of deportation [there had been numerous cases of this lately].
8. Man returned to home and job; visitor adjusted dispute with landlady.
This situation involves, therefore, fear of deportation, different rates of Americanization of man and woman, and especially a clash between the mores of the Mexican family and the American social workers. The Mexican mores include subordination of a wife to her husband; hence the visitor's threats of arrest and advice to prosecute must have been hard for the woman to understand.
Because my own series offers no striking case of cultural conflict, it seems worth while to call attention to a published
(222) narrative wherein this type of situation is clearly depicted. A Polish widow in an American city was struggling to make a living for her eight children and to finish paying for a little home. Visitors from various social agencies urged her to sell her equity, to place the children in orphanages, and to give up work in order to receive needed medical attention. All this clashed with her traditions of family solidarity, home ownership, self-support, and avoidance of institutions. She could not understand how anyone who pretended to be a friend and to want to help could ask her to act contrary to all her early teachings. The visitors on their part seemed to have no appreciation of the Polish scale of values; hence it was a long time before any common understanding was reached, and then only when a new visitor with a different point of view was introduced.
(c) Conflict Between Visitor and Personally Disorganized Client. More frequent than either the pattern-of-life tension or the cultural conflict is a type of situation in which the client displays erratic behavior not organized around any scheme of life. Hence the social worker has a very different situation to face, although his own participation in it frequently includes the same "moralizing," arguing, and coercion which we noted before. The symptom of personal disorganization in our cases may be classified into four groups: chronic personal friction with persons other than the visitor, contradictions in behavior, marked instability, and flight from reality. The chronic friction usually involves members of the immediate family, relatives, neighbors, fellow workers, and employers; the client seems to be "at outs" with everybody. Contradictions in behavior include: complaining of ill health, but refusing medical examination or treatment; asking for work, but declining it when offered; asking for material relief, but boasting of ability and wealth; insisting on plans that are mutually contradictory; alternately blaming others and self for one's predicament. By marked instability I mean such conduct as frequently changing plans, jobs, residence, marital relations, etc.; drifting aimlessly; striking out blindly; becoming excited easily and going into tantrums. Under flight from reality are included: con-
(223) -stantly blaming others, never admitting faults in self ; the imaginary invalid; extreme alcoholism or drug addiction; religious fanaticism. Some of these clients may be psychopathic, though none of them has been so diagnosed.
The break-down of life-organization and personality may center about marital conflict, chronic disease, unsuccessful pursuit of status, or isolation. It frequently involves a long series of unmet crises; rarely does it occur suddenly. Our first case centers about marital conflict, in which the man and the woman cannot decide definitely to live together or apart; they have no consistent plan, are always attempting the impossible, failing, and trying something else blindly. This case was opened and closed four times within five years and was handled by three different social workers.
(K-1) The changing situation of this family may be briefly indicated as follows:
October, 1923 ; man 32, Polish Catholic, employed by railroad at $t 5o per month; woman 28, German-American Protestant; four children. Man and woman often quarrel over money and sex; separate, placing children in orphanage, losing equity in house and furniture.
November, 1924; living together, heavily in debt, five children.
December, 1925; man seriously injured by auto, also cardiac and syphilitic; woman pregnant and hysterical.
August, 1926; much illness in family; appealing to Jewish agency, claiming to be part Jewish.
September, 1927; man proposed going on vacation to California, leaving family for agency to support.
The statistical card of 1925 listed: inadequate wage, physical disability, ignorance of customs, indebtedness, business tangles, mismanagement, lack of recreation. The card of 1927 listed: cardiac, venereal disease, mismanagement, lack of desire to cooperate.
The man habitually accused his wife of extravagance and infidelity, used the children to spy on her, and deserted intermittently with other women. His wife habitually complained about him and about the agency, and refused i0 accept medical and psychiatric examinations. Both were continually buying expensive articles on time, failing to pay debts, lying about their circumstances, demanding relief, and changing their plans. Their attitudes might be described as vacillating, fault-finding, and parasitic.
The sequence of significant events follows:1. Man born in Poland; came to America.; worked on farms; nominally a Catholic.
2. Woman reared on farm; parents German Protestant; woman worked hard; had little schooling.
3. Couple married on three weeks' acquaintance.
4. Within two years man deserted, presumably to live with another woman.
5. Man returned; couple lived together; moves to city.
6. Marital conflict renewed: man dressing flashily, giving little money to woman; she accusing him of spending money on another woman.
7. Man spent vacation with another woman.
8. Man having children watch woman and report to him.
9. Woman temporarily a prostitute.
10. First contact with agency: woman asking day nursery privilege in order to work and make payments on a player-piano; refused.
11. Man and woman separated after physical combat, placing children in orphanage, losing equity in house, selling furniture at loss.
12. Six weeks later man and woman living together again, buying expensive furniture on time, not paying children's board.
13. Quarreling again over money matters.
14. Moved, leaving no address, taking children from orphanage
15. Asked help because of heavy indebtedness.
16. Agency gave relief, moved family into cheaper quarters, urged free clinic instead of private physician, etc.
17. Agency and family agreed on budget, which included purchase of house on easy terms.
18. Continued poor management: endorsing another man's note, overdrawing bank account, buying expensive articles, etc.
19. Woman pregnant and hysterical, complaining, beating children, threatening suicide.
20. Man seriously injured by auto; received damages and insurance; quickly spent all but $200 ; also developed serious heart condition.
21. Agency advised using $200 to pay debts and living expenses, sending woman to relatives, children to orphanage, and man to hospital. Family objected to this plan, but did use money while man went to hospital.
22. Appealed to Jewish agency, claiming to be part Jewish. Much illness in the family.
23. Received large gifts from various sources at Christmas; told visitor they received nothing.
24. Quarreled with landlord over delayed payments on house and repairs; gave up house without informing visitor.
25. Found at new address with more extravagant purchases. "Mrs. K can see no reason why agency should interfere in her plans as the family is not asking anything from the agency. She realizes that Mr. K. may be ill again and that it will be necessary for them to have assistance, but they can get that from the Salvation Army or some other agency."
26. Changed mind and asked to get old house back; complained because agency did not help.
27. Man proposed to go to California for vacation leaving family for agency to support; agency advised concerning budget and postponement of vacation; man objected.
28. At Christmas time one of the children wrote a begging letter to a wealthy man.
29. Continuing to buy expensive articles, to run bills, and to ask agency to help them out.
The next case illustrates the personal disorganization that may accompany a chronic disease. Note that while the woman is practically demoralized, her husband keeps his head and is making a good adjustment. This might, therefore, be classified under Type D
(B-6) This is an American white family, man 45, woman 35, and two children. The man, whose work record is good, was laid off in slack time. The woman had tuberculosis.
Statistical card listed: unemployment, tuberculosis, lack of desire to co÷perate, broken home, lack of church ties, bad housing.
The woman was habitually accusing her husband of trying to get rid of her, spent money freely, alternately accepted and rejected sanitarium care. Her attitudes may be described as suspicious, extravagant, vacillating, and homesick. Her husband, on the contrary, worked regularly, spent his money carefully, and met each new trouble as it came. His attitudes may be described as independent, co÷perative, and calm.
The most important events in their history seem to be these:
1. Both had little schooling.
2. Woman spent money freely.
3. Man worked regularly and saved money.
4. Woman developed tuberculosis.
5. Man laid off from work.
6. Savings exhausted and debts accumulated.
7. Children sent to maternal grandparents.
8. Woman wished to go also; visiting nurse advised against this.
9. Visiting nurse repeatedly persuaded woman to go to sanitarium only to have her change her mind.
10. Woman's unwillingness to leave home complicated by loss of application, by having to make out third set of papers, and by having to wait for County to provide transportation.
11. Man co÷perated with agency in dealing with woman, also in matters affecting his brother's family.
12. Woman accused man of trying to get rid of her.
13. Agency advanced transportation to sanitarium when woman was in a mood to go; she spent eight weeks there, expressing satisfaction with care and begging forgiveness for being obstinate.
14. Woman returned home without being released.
15. Becoming worse, she went back to sanitarium.
16. Several times in and out of sanitarium.
The cases whose central feature is an unsuccessful pursuit of status also involve other important factors. In one situation we have a man worried and humiliated by ignorance of his parentage (reared in an orphanage and probably illegitimate) ; his wife suffering from a valvular heart disease (character said to have changed during second pregnancy) ; and marital conflict over money matters. The woman's disorganization was shown by her flying into tantrums, harsh and erratic handling of children, nagging at her husband, finding fault with everyone, boasting of her own virtues, refusing medical and dental care and recreational opportunities. In the man's case the significant habits were his constant search for the facts of his parentage, neglect of personal appearance, and staying away from home. The social worker found it impossible to "get anywhere" with this family.
Our most striking case of isolation also involves a chronic disease (diabetes). The client is a single man, native white, 56, living alone in a filthy shack which he owns. One foot has been amputated for gangrene. Neighbors and relatives have helped intermittently, but the man resents being cleaned up, objects to the prescribed diet, abuses everyone with whom he
(227) comes in contact, demands money from relatives and neighbors, accuses the agency of being high-handed, and boasts of getting his own way. For a long time this man has lived by himself, having no friendly relations with anyone, uncertain what he wants, and never satisfied with anything. Another case of isolation is P-I, classified under Type D (next section).
We have found only one situation in which there seems to have been a sudden break-down of life-organization followed promptly by personal disorganization. But more careful analysis shows that it too had been developing over a long period of years. Mr. A, an ignorant, unskilled man, had long depended upon political perquisites for his living. When he was 55 another political party came into power, and he was unable to find employment. He became very nervous and excitable. Both he and his wife were "set" on single, specific, usually impossible, and constantly changing "solutions" of their difficulties. On the surface this looks like a simple case of disorganization following an economic crisis. But we find that there had been a long series of conflicts with relatives, that the man and woman quarreled with each other, and that they were suffering from chronic ailments (kidney, heart, and venereal diseases). Thus, while the actual break-down did take place rather rapidly, factors contributing to it had been present for a long time.
In general, the cases listed as belonging to Type C differ rather sharply from those of Types A and B. The pattern-of-life tensions and the cultural conflicts center about a failure of the social worker and his client to reach a common understanding. In the cases we have just been describing the trouble is of much longer standing, and involves the visitor only incidentally. These clients would be hard for anyone to get along with and have become pretty well disorganized before they come to the attention of the agency. However, it is evident that the social workers do not have adequate facilities and techniques for dealing with these demoralized folk. Reference to the statistical table at the end of this paper will show that these cases are opened and closed more frequently, are handled by more different visitors, are followed through a longer period of time, and with no more success than any other type. An extreme example of social work futility is the case of an un-
(228) -married woman, mother of 11 children by several different men, who was constantly changing plans, residence, work, and paramours, complaining of illness and rejecting medical care, asking work and declining it when offered, fighting with her "husbands," and alcoholic. This case was handled by 8 different visitors, being opened and closed 11 times in as many years. She was given transportation and other material relief, arrangements were made for medical care, and employment was found. She was argued with, cajoled, exhorted, and threatened, all to no avail. At least 7 or 8 times the case was simply dropped. Doubtless the visitors were discouraged; we know they were very busy; but the absence of any consistent policy on their part must have contributed to the already advanced demoralization of their client.
(d) Intermediate Type. We found a number of cases which bear a resemblance both to Type A and to Type C. That is, there is evidence of personal disorganization, at least on the part of one member of the family (as in B-6 above), but at the same time there is rather shrewd and successful defiance of the social workers. We have, therefore, grouped them together as an intermediate type. The man in the first example has been characterized as a "rainbow chaser."
(B-1) An American white family, man and wife aged 40, seven children at home aged 2 to 15; unskilled and poor managers; saved money earlier, but became hopelessly involved in business tangles and debts after family became large.
Statistical card listed: unemployment, unsatisfactory work record, indebtedness, business tangles, maternity, begging tendency, shiftlessness, mismanagement, lack of desire to co÷perate, dishonesty, nomadic family, overcrowding.
Attitudes indicated: overwhelmed by large family and small income, vaguely hoping things would get straightened out, accepting material aid but resenting suggestions, persistently but vainly seeking recognition.
These items in the family history appear significant:
1. Man, a railroad laborer from age y, apparently got along; paying bills, and saving a little until family became large.
2. Started series of business ventures after birth of seventh child; failed in all, becoming hopelessly involved.
3. Church reported family to agency.
4. Man was insulted because visitor urged him to get a job instead of trying to be a contractor.
5. Church worker stressed danger of doing too much for family, and of relieving man of a sense of responsibility.
6. Man got series of short-time jobs; did not stick to any.
7. Man again tried business for himself, getting into new financial difficulties.
8. Man complained of visitor's youth and of agency's failure to help him when others were getting relief.
9. Family went in their car to another state, leaving house, furnishings, and debts.
Apparently a Malthusian problem has contributed to this man's partial disorganization. Yet he has a definite scheme of life; he wants to be a building contractor. Over against this the visitor insists that he should work for wages. Before the situation becomes more tense the family disappears.
In another situation we find apparent disorganization coupled with successful defiance of the social worker.
( P-1) Transient American white family, man 57, woman 44, two children of man and woman's sister (deceased former wife) aged 12 and 13, three small children. Living in filthy one-room shack in a hollow near railroad tracks on the edge of the city. New baby with running sores, other children dirty, ragged, and irregular at school. Man claiming illness as excuse for not working; woman selling patent medicine. Radio, auto, and dogs. Religious fanatics.
Statistical card enumerates sixteen items [omitted here].
Clients' habits: frequently moving, man letting fragile wife work while he stays at home, keeping several dogs "to protect them against scientific use," withholding information, refusing to speak to visitor on street, avoiding neighbors, talking excitedly when visitor offered suggestions, bragging of large earnings and rich relatives. Attitudes indicated: "shut in," "self-sufficient," boastful, fanatical, indolent.
Visitor's habits and attitudes: recoiling from dirt, odors, and confusion (disgusted), criticising failure to accept suggestions, (irritated), and despairing of accomplishing anything (discouraged).
The history of the family is very inadequate, but the following significant items have been gathered:
1. Woman's father was a travelling minister of the Church of God.
2. Woman had half of a college course, and business school training, following which she was an office worker and school teacher.
3. Man apparently had less education, but similar religious background.
4. Man married woman's older sister, who later died leaving two children.
5. Woman married the man (not verified), "to give her dead sister's orphans a home."
6. Moved frequently, living in at least 7 states in 8 years, and in 20 houses in one city in 3 years. Man claimed he was "forced to travel for his health."
7. Reported to agency by school nurse, when last baby was born. Woman willing to accept temporary financial assistance, but afraid this would involve accepting advice as well. Man "furious with the school for having reported him."
8. Neglecting children: letting them stay out of school, dirty, ragged, sores uncared for, sleeping on floor without bedding, etc.
9. Woman selling patent medicine, man staying at home claiming to be ill.
10. Case taken to juvenile Court; Judge advised choosing between dogs and children; no other action.
11. Family moved again; contact lost.
The man in this case seems to be constantly fleeing from reality. He consistently refuses to face the facts of the situation. Finding solace in an imaginative world, he resents intrusions from the outside. His wife has accepted the r˘le of martyr and has organized her life around her conception of duty to husband and children.
(e) Conflict Between Visitor and Psychopathic Client. It is quite likely that a psychiatrist would find the man in the last case to be suffering from some mental disorder. The same possibility exists with reference to several other cases of personal disorganization. But the basis of our classification is two-fold. first, in the cases we have listed as psychopathic the disorganization seems more complete, and, second, we have here a definite diagnosis of mental disease.
(A-3) An American white couple, man 52, woman 46, no children. Man has been a truck driver and packer; now works little
(231) because of alcoholism and injured foot. Woman mentally abnormal (menopause psychosis) and possibly drug addict. Agency proposes separate institutional care at which "sympathetic" persons are incensed.
Statistical card lists: unemployment, illness, need of surgical care, old age, mental disease, intemperance, shiftlessness, lack of desire to co÷perate, dishonesty, incompatibility within family, unsatisfactory community ties.
Habits: drinking excessively, quarreling with everyone, appealing to benevolent individuals for help, lying, crying, and screaming when excited. Attitudes: parasitic, quarrelsome, evasive, embittered, suspicious.
The precise origins of the woman's mental disorder and her husband's alcoholism are unknown; however, we do have some significant items from their history.
1. Man stopped school when nine years old; worked hard; early became alcoholic.
2. Man's first wife also alcoholic, said to have committed suicide.
3. Woman also early stopped school and went to work; had "spells" (no diagnosis) for years; married and divorced; had partial hysterectomy.
4. Marriage of this couple.
5. Man worked ii years for one transfer company, but was never given much responsibility.
6. Man's foot crushed in industrial accident; foot healed, but man used this as alibi for not working.
7. Woman became alcoholic and (perhaps) drug addict; also mentally disturbed, diagnosed first as pre-senile psychosis, later as menopause psychosis.
8. Man and woman quarreled much, especially after drinking.
9. Agency advised separate institutional care; clients objected strenuously.
10. Landlady evicted couple for non-payment of rent, drinking, and general nuisance.
11. "Benevolent individuals" intervened and complained to community chest; community chest criticized agency.
12. New visitor assigned ; new plan accepted by community chest as "eminently satisfactory," involved care of man and woman together, medical examination and employment.
13. Medical examination showed man able to work; agency tried to find him a job.
14. Couple disappeared.
The conflict situation here involves both the clients' personal disorganization, amounting with the woman to definite mental disorder, and the intervention of "sympathetic" but uninformed "uplifters." It is also significant that crowded institutions for the "insane," penurious local officials, and committing judges with crude notions of mental disease, made proper care of this couple practically impossible. Because of its seriousness we offer another example of the same type.
(B-9) American white family of Swedish extraction. At first contact man was 35, woman 31, child I. Two children were born later. Man clearly psychopathic; oldest child feebleminded and epileptic. Man and woman both untruthful, quarrelsome, and "spoiled" by unwise assistance.
Statistical card lists: unemployment, indebtedness, acute illness, begging tendency, shiftlessness, anti-social attitude, lack of desire to co÷perate, lack of moral responsibility, dishonesty, other behavior problems.
Habits: quarreling, begging, frequently changing jobs and residence, lying, flying into tantrums. Dominant attitude: "The world owes us a living."
Sequence of significant events:
I. Man's early history largely unknown, but appears to include a. "Fits" (possibly epileptic). b. Much wandering. c. Attempted suicide.
2. Woman's early history includes a. Reared in orphanage. b. Domestic service.
3. Man had industrial accident (knee), was offered settlement, but brought suit and recovered $650. While this was pending, first applied for relief.
4. Man did not get along well at work; was rated erratic, quarrelsome, and "not quite normal."
5. Frequent change of jobs and residence.
6. With various tales of woe man induced church, employers, fellow-workers, and other benevolent individuals to furnish considerable relief.
7. Series of difficulties with agency, e.g.:a.
Objected to suggestion that they move to house of cheaper rental.
b. Objected to sub-letting a room on the ground that they needed it for entertaining.
c. Objected to putting child in day nursery lest she acquire a contagious disease.
d. Refused medical examination to determine ability to work.
e. Indignant because asked to keep accounts.
f. Lied repeatedly about existence and whereabouts of relatives, own previous residence, use of money, treatment by medical and social agencies.
8. Unusually violent conduct, e.g.:
a. In one interview threw car tickets on floor and stamped out of office, cursing visitor.
b. Attacked visitor, throwing her on floor, choking, pulling hair, and gouging eyes.
c. With hatchet attacked agent who came to serve eviction notice.
9. Result of psychiatric examination: "neurasthenic but not committable."
From the foregoing it is clear that there is no single attitude of non-co÷peration. Instead there are several types of conflict situations each involving various combinations of habits and attitudes. Both causation and the indications for treatment differ from type to type. In types A and B the client has a definite scheme of life, more or less adapted to a given social environment; the social worker has an entirely different life organization; trouble arises when the two are involved in the same situation. Each fails to get the other's point of view; each assumes that he is right, and each criticizes the other. As a result conflict develops, and tension is relieved only by changing visitors, by closing the case, or by disappearance of the client.
In types C and E the client has no definite scheme of life end hardly knows what he wants. His erratic conduct may irritate the visitor and bring forth "moralizing," but he would be a difficult person to deal with in any case. His troubles usually reach back over a long period of time, whereas in types A and B they may be quite recent. In these situations little is
( 234) accomplished by changing visitors or closing the case. The trouble is almost certain to be recurrent. Hence it would seem wise to maintain contact even though this involve coercion, and even though it be an unhappy experience for both case worker and client. A really adequate program would probably involve institutionalization of many of these disorganized persons.
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