Monday, June 27, 2011

The "Remember not to dismiss your clients" Lecture

So there I was sitting in the more analytical of my summer classes, listening to the subject of somatic disorders.  I had enjoyed the readings, especially since the one on hypochondriasis had explained how information-driven temporary hypochondriasis (aka Medical Student's Syndrome) worked, and was looking forward to the lecture.  My heart sank when the professor started the class reading from a list of unresearchable anecdotes including things like using acupuncture as a local anesthetic for some sort of major surgery, but I said nothing and waited for the class to move on to more concrete topics.  It did, and soon my hand was cramping from taking pages and pages of notes at high speed.  Then, just before the break, the entire class started shouting out "miracle" anecdotes.  Things like:
  • A relative was given three weeks to live by doctors because of his fast growing cancer, but he was convinced he'd live to see his daughter's graduation.  He did - ten years later!
  • A friend of a friend went to a psychic even though she didn't really believe in them, and he told her she should go to the doctor.  She did, they found a lump and removed it, and now she's okay!
  • A boss was told they'd never walk again after a car accident, and now they run marathons!
There were more, but I can't remember all of them, partly because I spent most of this time attempting to keep myself from saying anything.  I am not a fan of the "those silly doctors think their science can solve everything, but the mystical proves them wrong" tale, and that's what this litany was fast becoming for me.  I wanted to drill down into every anecdote, find out the truth and what had gotten tweaked in the search of a good story.  I wanted to reasonably note that science doesn't explain everything - it's not a group of answers but a reliabe way to find them.  And to point out that medical science is a lot farther along than it used to be but is still growing all the time.  Of course doctors get things wrong!  They're not psychic!

Instead I mumbled to myself about anecdotes and data.  Just loud enough for my professor to hear me and ask me to speak up.  I took a breath, squared my shoulders, and said that the anecdotes we just shared are very interesting, but they're not data.  Repeated studies have explained some of them, and hopefully further ones will explain the others so we can know how someone beats back deadly diseases so we can help others do the same.  My professor thanked me for voicing my "scientific viewpoint".

The class was silent.

My heart was beating fast.  I'm a killjoy.

And then one of my classmates talked about how we can't discount the client's viewpoint, so if they say they see a bird with the face of their dead mother, we need to believe them and not tell them they're wrong.

I said of course, I'm not talking about disrespecting clients.  I would never do that.

The class moved on to more note taking.

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This often happens: a class is talking about data practice or policy, anecdotes get shared, someone mentions data vs anecdotes, and another person reminds them not to disrespect clients.  It's so out of left field for me, but it's a pattern and I'm trying to understand it.  Was my classmate saying she felt I was disrespecting her but filtering it through the less confrontational lens of clients?  Does she think I'm unable to compartmentalize?  Does a social worker caring about data in a data context mean others feel they're unfit to work in the field?  I am defensive about this?  The answer to the last question is yes.

Every time I mention data, a classmate jokes about how I'm going to be getting a PhD in a few years.  When I took research most of my classmates were pretty vocal about how they felt they didn't need to do it.  Should research replace empathy and personal skills with clients?  Of course not.  They should be used in tandem, combined to help clinicians figure out what might best serve the client, and then to lay those choices out in front of the client and let them decide.  I use myself and my ability to connect with clients constantly - I have to as I work largely with mandated teens - but that doesn'y mean that I check my knowledge at the door.  And I don't think my classmates do either.

So how do I talk with them about that?

Wednesday, June 15, 2011

What I mean by "skeptical social work"

When I say I'm skeptical about something, I mean it as a positive thing.  I mean that I'm interested by it, by thinking about it, and that I want to know more.  I mean it in the sense that I don't have answer or an explanation I'm satisfied with.  For example, if I'm skeptical about little lights in my backyard at night, it means I'm not sure what's causing them and I'd like to find out.  Is it fireflies?  Dust motes reflecting the beam of my flashlight?  The reflection on the back of a cat's retina?  I don't know!  But I want to know, and I'm going to do some reading, and hands on research, and talking to people to find out.

I try to approach everything this way, which is probably why I did so well as a History major in undergrad.  I love learning new things, and want to do that in the most respectful way possible.  I also love teaching new things to others, and am hoping to experience this back and forth more often.

I also love social theories, and would like to talk about them even more than I already do in class.  Which is a lot.  I am a fan of social action, and yes, I call my representatives and go to rallies and volunteer with organizations who do things I care about.  I also think part of social action is talking with other people, hearing their perspectives, and thinking about all that.  It isn't the end all be all, but any time someone tells me to "stop talking about it and do something productive" I hear some derailing behind that sentiment.

So, when I say I want to practice "skeptical social work", I mean I want to bring these things to my current and future practice of social work.  I want to always be learning new things, because there will never be a time I know it all.  I want to keep an open mind just as much as I want to keep known facts in that open mind.  I want to keep my privledge in mind, try not to trip over it, and to apologize honestly and learn from the times I do.  I want to build my love of social justice into my practice, and always give a little bit of agency to my clients while addressing the other things they want me to address.  And hopefully somewhere in there get a little better at self care.

This is how I think, and how I feel, so it's going to end up being how I practice even if I don't intend it to be.  I'd prefer it to be intentional.