Social work turf wars
Graduate school in social work is such a trip. On the one hand I am always fascinated to learn about theory, social activism, and international perspectives on social justice, which I missed as an undergraduate (where I majored in English and Alcoholism), as well as getting an insight into all the ways in which the field of social work is currently trying to “professionalize” itself. On the other hand, I have become about as sick of the micro/macro debate as I currently am of the Presidential race. You see, in social work practice there is apparently a division between “micro”practice, which is considered to be any kind of direct service work, interpersonal practice, therapy/counseling, or group/agency work on a small scale. “Macro” practice involves practice with a broader focus, such as non-profit administration, community organizing, policy evaluation and research, and global social work. Very generally speaking, micro practice is often considered less radical (but constitutes the bulk of social work jobs) than macro, because it often seeks to assist oppressed people on an individual basis rather than working to create changes to the systems that oppress them in the first place.
I was not aware there was a name for the micro/macro divide until I had already applied for graduate school. Yet when I began working at a battered women’s shelter in the town where I attended college, I was very aware that something like it existed, although I had a pretty simplistic view of the divide: those who administer programs and those who do the “real work” (stating my 20-year-old opinion only here, don’t judge me, please!). The beef that micro/macro practitioners have with each other is generally as follows:
1. MICRO: Macro people get paid better. They have the cushier jobs and don’t know what it’s like to work down in the trenches with people who often represent the most disadvantaged in our society. They are responsible for creating the policies that we are supposed to follow, yet they don’t take into consideration the nuance of working with these special populations. Plus, they don’t appreciate our work because we seek to enact change one person at a time. They don’t understand that you have to have clinical practitioners to help people adjust to life in this world. You have to have homeless shelters; you have to have rape crisis counselors, unless you can take a magic wand and make all the bad things that happen to people go away.
2. MACRO: Micro people are too narrow in their focus. In their work with individuals they do not question the broader forces at play on these peoples’ lives, such as racism and poverty. They don’t know how to read and implement the research we do. They often have no idea what goes on outside their immediate agency or community, much less the country or around the world.
I’m not sure how you can be JUST a micro person or JUST a macro person–everyone who knows me, knows that I am not much one for rigid binaries. Yet I have met quite a few people in the School of Social Work (including professors) who are simply one or the other. They may voice respect for the other point of view, but they largely feel comfortable in their own little box. Nowhere was this more evident than in one of my Social Policy classes last semester, where you could literally see things exploding in the micro peoples’ heads as they bitched endlessly about having to understand Medicaid. “I just want to do therapy with kids,” I remember someone whining. “I don’t think micro people necessarily need all this information.”
For the first time since I started working in the social service field, I have bumped up against co-workers who do fantastic individual work but are disappointingly unable to see the larger impact that stigma, racism, and poverty have on the lives of people diagnosed with severe and persistent mental illness (and generally, substance abuse disorders, called a co-occurring or dual diagnosis). Battered women’s shelters have a reputation, perhaps left over from the 1970s when they first appeared, for being pretty politicized places regardless of how flowers-and-lambs the agency is. My theory is that any female-only space, just as any Black-only or LGBT-only space is instantly considered “radical” and looked at with some suspicion on the basis of its retreat from the white hetero male paradigm that controls the rest of our society. Both shelters where I worked were operated by agencies that few would consider truly radical (although many radical folks worked there). My first social work job was at a large shelter in the Midwest, the only facility of its type offering comprehensive services for battered women for the surrounding seven (seven!) counties. The administrative staff and Board of Directors was largely Republican, white, Christian. In New York I worked for a well-known non-profit that took pride in modeling itself after an internationally recognized corporation (its initials are W-M but I’m not linking to their website because they suck). My boss in New York was radical and used the agency’s mandatory support group curriculum to talk to the women about racism, poverty, sex work, and misogyny, encouraging the residents to become vocal activists in their own communities against domestic violence after leaving shelter.
Therefore, I’m a little disheartened that my current agency, a community mental health organization, is staffed by people who are awesome (Larry thoughts, anyone?) yet really, really unconcerned with “macro” issues like the ones I have just mentioned. I’m surprised, too. Community mental health organizations came out of the 1960s, spearheaded by the Kennedy administration, responding to the rapid deinstitutionalization and closure of state hospitals and “lunatic”asylums for the mentally ill. The very nature of the work is radical. Often CMHOs are physically located in the worst parts of town and play host to, without a doubt, the most fascinating parade of individuals you will ever see grouped together under one roof. Psychiatrists, social workers, peer educators, substance abuse counselors, nurses, pharmacists, heavily medicated individuals, individuals in need of heavy medication, people coming off drugs, people coming to score drugs, all ages, all races. And everyone smokes at least two packs a day, including the staff–probably including the children.
Yesterday I was in supervision with my field educator, a youngish woman who is very nice to me and extremely good at her job. Admittedly, I was on a soapbox. My soapbox was the double stigma that mental illness introduces to individuals who are already disadvantaged by virtue of their race, gender, or class status. I was speaking in particular about a client of mine, a young working-class man who was diagnosed at AGE 10 with bipolar disorder and then at age 17 with schizoaffective disorder. This young man grew up poor, had horribly dysfunctional parents and a long history of sexual abuse, yet was slapped with this diagnosis on the basis of his “inattention” and schoolyard fights in elementary school. (It is common for sexually abused children, for obvious reasons, to feel sleepy or have trouble focusing in class, or to act out towards the end of the school day as they become increasingly anxious about returning home.) I was wondering aloud whether organizing the CMHO clients who had insight into their illness would be an effective lobbying tool when my supervisor politely interrupted.
“From a clinical standpoint, though, he’s saying those things because it’s a way of passing the blame for his actions and criminal activity. That’s very common in this type of disorder,” she said, her eyes a little glassed over. (I can be very long-winded on certain subjects.)
I don’t know. I know diagnoses are helpful, and there are hallmark signs of certain diagnoses, but I’m not comfortable with blindly disregarding everything a client says just because he or she might be “passing the blame” like “everyone with schizoaffective disorder does”. That’s just another form of discrimination, and the trademark paternalistic attitude that plagues the mental health field in my opinion. This young man has clear insight into his illness and understands that he will have to rely on psychotropic medication the rest of his life. Why can’t he question his diagnosis, or at least question the circumstances around which he received it? I think he’s right to do so. For lack of a better term, I think this is quite the sane thing to do.
But I digress. It is this division that frustrates me. I wish the CMHO could incorporate more social awareness into their work, especially since the people we see are directly affected by any policy or market changes in the public sector: Medicaid (which is under attack), housing, drug enforcement laws and statutes, etc. I don’t understand why some social workers appear to be willfully closed off to the large-scale implications of social policy, stigma, and good old American democracy on our work. I suspect apathy plays a large part in this; it’s hard to keep from becoming increasingly discouraged at the state of the world when you have a social work job. (I experience extreme apathy every election year and am currently abstaining from discussion of the Presidential nomination race. I tend to think, “Who cares/why does it even matter/nothing’s going to change anyway”.)
For what it’s worth, my two cents is still that the university overstates the division between micro and macro practice. What better place than the university to debate these issues and bridge the supposed divide, rather than entrenching it further among this generation of social work students and practitioners?
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February 25th, 2008 at 1:45 pm
I see, pretty much verbatim, much of the same in my own school. I do know that there are administrators who are aware of this though. the way they plan on combating the trend (which i have my doubts about the effectiveness of such a strategy) is by eliminating concentrations like “mental health” or “community social work” and instead letting you do much more picking and choosing of “practice areas.” Unfortunately, it just kind of seems like the practice areas are the same things as the concentrations with a new name and less integration.
February 29th, 2008 at 11:45 am
“Often CMHOs are physically located in the worst parts of town and play host to, without a doubt, the most fascinating parade of individuals you will ever see grouped together under one roof…And everyone smokes at least two packs a day, including the staff–probably including the children.”
I love you.
We so need to team up on this someday. I totally agree that I want to be both a macro and micro “social worker.” I think it is a counterintuitive to stick to one end or the other.
I can see when you are just starting out, as I am, you have to trim the leaves. But once you get some letters after your name, you have a responsibility to start digging at the roots.
March 12th, 2008 at 2:24 am
You are refreshing, as always.
Some of those cited: not so refreshing. But they’re out there. And we get to work with them. Fantástico. But I want more of your soapbox action. I suppose it’s the only way to put the smackdown on dichotomized bs distinctions.
Cheers to bridging the divide. Let’s go get drunk.