The Good, the Bad and the Ugly of Social Work

By Marvin Ross

Social workers can and do play a significant role in helping the mentally ill to recover when they work with psychiatrists, nurses and occupational therapists. In my personal life, I’ve just witnessed how a knowledgeable and caring social worker can impact recovery from psychosis in an inpatient setting.

Sadly, the training that many social work students (and others like psychologists and counsellors) receive from some institutions does not aid in that role. Susan Inman, the author of After Her Brain Broke, Helping My Daughter Recover Her Sanity, has long complained about the lack of science and medical training for many of these professionals. She said:

Many credentialed mental health clinicians have never received science-based curriculum on severe mental illnesses. Too many are still being trained in the parent blaming theories which contemporary psychiatric approaches to schizophrenia have long since left behind.”

For a number of reasons, I had occasion to look at the mental illness course being taught at McMaster University in Hamilton Ontario and it confirms all that Susan had to say. The course is called “Critical Issues in Mental Health & Addiction: Mad & Critical Disability Studies Perspectives for SW”. Part of the course objective is to:

“explore contributions from critical disability studies, mad studies and the historical influences of sanism and eugenics on contemporary mental health practice. Addiction will also be briefly explored within these contexts.”

Then, this is added

“Throughout the course guest speakers may be invited to share experiences and analyses on course themes from ex-patient, survivor, consumer, service-user, and mad perspectives.”

Nowhere do I see anyone coming who can provide the medical perspective which would include the physiology and treatment of mental illness. Given that McMaster has a world-class medical school and one if its teaching hospitals is a psychiatric facility, this is very troubling. It would be so easy to find a psychiatrist to talk to the class or to take a field trip to the local psychiatric hospital.

One of the readings in the first week is Geppert, C. (2004). The Anti-Psychiatry Movement Is Alive and Well. Psychiatric Times 21(3), 21. Retrieved December 4, 2009”. This article is no longer on the Psychiatric Times website that I could find and the professor referenced it in 2009. It would be nice if the professor asked his students to read something like Psychiatry and Anti-Psychiatry by Dr Allen Frances. There are many comparisons of these two approaches in that article and students should have an opportunity to see both sides.

Another set of readings for this course is by Geoffrey Reaume who is a professor of disability studies at York University in Toronto. His view of Mad Studies can be summed up by a quote he gave to an article on Mad Studies in University Affairs in 2015. He stated that “People with PhDs had oppressed mad people throughout history. I wanted to help liberate this history from the shackles of the medical model.”

Dr Frances had this to say in the article I cited above (for psychologist also read social worker):

Psychiatry is far from perfect, but it remains the most patient-centered and humanistic of all medical specialties and has the lowest rate of malpractice among all specialties.

Psychologists criticize psychiatry for its reliance on a medical model, its terminology, its bio-reductionism, and its excessive use of medication. All of these are legitimate concerns, but psychologists often go equally overboard in the exact opposite direction—espousing an extreme psychosocial reductionism that denies any biological causation or any role for medication, even in the treatment of people with severe mental illness. Psychologists tend to treat milder problems, for which a narrow psychosocial approach makes perfect sense and meds are unnecessary. Their error is to generalize from their experience with the almost well to the needs of the really sick.”

And he added:

For people with severe mental illness (eg, chronic schizophrenia or bipolar disorder), a broad biopsychosocial model is necessary to understand etiology—and medication is usually necessary as part of treatment. Biological reductionism and psychosocial reductionism are at perpetual war with one another and also with simple common sense.”

Another author used quite a bit in this course is Bonnie Burstow of the Ontario Institute for Studies in Education (OISE) at the University of Toronto. Dr Burstow is the creator of a scholarship in Anti-Psychiatry Studies. I’ve done two Huffington Post blogs about Dr Burstow. The first was entitled The Truth Behind U Of T’s Anti-Psychiatry Scholarship and the second was Time For U Of T To Rein In Its Anti-Psychiatry Activist It is worth noting that OISE is a post graduate school on teaching, learning and research. Nothing to do with science or medicine.

In my second Huffington Post blog, I had this to say about Dr Burstow:

Burstow does not believe that the brain is capable of becoming ill, and that therefore mental illness cannot exist. Her doctoral thesis, according to the media spokesperson at her institution, was entitled “Authentic Human Existence: Its Nature, Its Opposite, Its Meaning for Therapy: A Rendering of and a Response to the Position of Jean-Paul Sartre” in 1982 at the University of Toronto.

Dr Burstow is the author of a book called Psychiatry and the Business of Madness which is not one of the readings for this course but exemplifies her position. Blogger, Mark Roseman wrote a very lengthy and detailed critique of this book which is well worth reading.

Roseman defines anti-psychiatry as:

a position that psychiatry is 100% flawed, has no redeeming features, is built on a stack of lies, necessarily does harm to all who encounter it, and must be abolished in its entirety. Moreover, the real proponents of antipsychiatry do not want to seriously engage in discussion with the broader community. They are not interested in critique, or divergent opinions, but only discouraging those seeking treatment, and attracting new followers to their movement.

The course does discuss medication but this is the description of that:

The Biological Mind: What are some of the critiques of the role of medication and the psychopharmaceutical industrial complex? How does neoliberalism matter in mental health? How do we think critically about suicide and self-harm?”

Here is the recommended reading:

Cohen, D. (2009). Needed: Critical thinking about psychiatric medications. Social Work in Mental Health, 7(1-3), 42-61.

Medawar, C. & Hardon, A. (2004). Sedative hell. In Medicines Out of Control? Antidepressants and the Conspiracy of Goodwill (pp. 11-27). N.P., Netherlands: Aksant.

Whitaker, R. (2001). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Cambridge, Massachusetts: Perseus-p.3-19.

White, J., Marsh, I., Kral, M. J., & Morris, J. (Eds.). (2015). Critical Suicidology: Transforming Suicide Research and Prevention for the 21st Century. UBC Press. – Introduction

The titles give it all away. Whitaker, of course is an infamous anti-medication proponent and I have critiqued his views a number of times as have others more qualified that I am as in the debate between Whitaker and Dr Allen. The teaching of anti-psychiatry did not include anything pro-psychiatry and the discussion of medication contained no information on the benefits of medication. Should students not be given an opportunity to see the other side? McMaster and its teaching hospital has many first rate psychiatrists well versed in their specialties. I’ve observed the near miraculous results that properly prescribed medications can have on severe psychosis. Neoliberalism did not come up once.

The bottom line is that no one who graduates from this course will be capable of working in a psychiatric setting with patients. Hopefully, none of them will. The effective social worker I cited at the outset is a graduate of another university.

 

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9 thoughts on “The Good, the Bad and the Ugly of Social Work

  1. Thank you for this very enlightening albeit disturbing piece. There is no end of charlatans posing as academic, scientific, or medical experts. Without the willingness in the public or private sectors to comprehensively police or regulate such arenas, it is left to individuals like yourself to provide the public with a proper critical analysis of matters essential to managing our health on every level.

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  2. Psychiatrists are indispensable to a practising clinical social worker. Psychiatrists are indispensable in the treatment of many mental health disorders including serious axis I brain-based disorders. The fact that anyone would dispute this surprises me. I could not practice without psychiatric consult and backup, and many of my patients would not be living and functioning today were it not for psychiatric treatment and medication. Not acknowledging this is just dishonest. A person may choose to forgo medication. But the option to receive psychiatric care and medication should be available to everyone, and in the US it is not. 2 out of 3 mentally ill Americans receive inadequate psychiatric treatment due to lack of availability or affordability. This is the problem all mental health professionals should be focused on. Comprehensive treatment, including psychiatric care and psychotherapy, should be an option available for all.

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  3. It is terrifying to read that even now, in 2018, we are still not giving proper evidence-based training to social workers and even psychiatric nurses. I was on the receiving end of a blistering attack from a Professor of Psychiatric Nursing at a recognized university in Canada who wrote a letter to the editor of a major newspaper in response to an article I had written about problems facing the mentally ill. (https://bit.ly/2xWPPTR)

    She called me dogmatic, offensive, judgemental and disrespectful for stating that people with serious mental illness do benefit from anti psychotic medication. I shudder to think that she is teaching future PNs!

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    1. Anyone who has a professional status as a psychiatric nurse should be struck off the list if they believe that medication is not necessary for people who are afflicted with schizophrenia and allied disorders.

      A nurse who believed that it was unnecessary to treat a person who was afflicted with type ! diabetes sans insulin would be called on to the mat, and prevented from practicing as a registered nurse. One certainly would hope this to be the case. . Clearly some people are stuck in the dark ages. The flat earth people are clearly still among us.

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  4. Ross spells out the tenacity of the anti-psychiatry ‘brigade’ in spades.

    I have battled them for many decades and it is clear that they have held dangerous sway over our educational institutes , hospitals and voluntary agencies. They say they are advocates for the mentally! Sadly many of them are not. We witness the tragedies created by their false ideas on our streets everyday. The neglected , the untreated put out their begging bowls for mercy. The brigade shows no mercy for those in such plight.

    It is worth reading Marylin Baker’s article for which she received unwarranted criticism from an academic psychiatric nurse. Where does this person teach one wonders?

    Alas the Whittaker’s. Burstow’s , Raum’s and their followers have the high ground and they mercilessly peddle their myths to all that will be fooled by the their wares.

    SRN,RMN United Kingdom.

    I would be quite happy to sit on a panel and debate Marylyn Baker’s accuser.

    Anyone who has worked in a Psychiatric Hospital and has nursed patients who are totally trapped by psychoses, sees how only medicine has a chance of liberating them from their tyrant symptoms. They are like the anti measles vaccine brigade. They have no logical understanding . Flash back to 1950 before anti-psychotics or before polio injections etc.

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    1. Glad to see magic thinkers are alive and clear thinking. Forsdyke retains her understanding of the medical reality of chronic human brain diseases. Makes one wonder why others cling to unscientific explanations .like sociology does in garbling old social explanations of social assumptions that keeps the tribes accepting decades of never proven social theory by the old research guards who deny the science necessary for proving chronic diseases are in need of the intellectual scientific research that has found cures for many once-incurable diseases of human brains.

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  5. Severe mental illness such as schizophrenia, is so varied and complicated and has massive implications for the person with the illness, their family and community at large…to say the very least. In my opinion, medical students, social workers, psychologists and health care workers should spend time with ground care workers in Hospital ERs, community health care centers and street shelters to mention just a few, to see how complex this illness really is. Then I would challenge anyone to think these individuals could even have a fighting chance to live in this world without the help of medication and an entire team of caring people to help them through life. They truly suffer unimaginable pain. We treat our animals with more compassion. It is very important that universities get with the real world on severe mental health issues and do some time in the trenches where life really happens.

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