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Like many professionals, social workers
who treat the mentally ill sometimes find that the theories they
learn in the classroom don't help them in the situations they
encounter on the job. To bridge the gap, they often develop "situated
knowledge"-knowledge drawn from the practical experience of dealing
with clients. Such knowledge supplements the disciplinary, or
textbook, knowledge acquired in the classroom.
Jerry Floersch, assistant professor of social
work at CWRU's Mandel School of Applied Social Sciences, explores
the differences between situated and disciplinary knowledge and
their implications for the social work profession in his book
Meds, Money, and Manners: The Case Management of Severe Mental
Illness (Columbia University Press, 2002).
"In the social work literature, as in many
other professions, there's the idea that something exists called
practical wisdom, or intuition," says Floersch. "I was interested
in that piece of what the professional does and finding out if
there was a way we could actually study it."
A further motivation for the book were the
studies and histories of the social work profession published
in the last 10-15 years, most of which rely on written case records.
"I have been a practitioner and I knew
that much of our work is done in oral narratives, not written,
and I felt that it was in the oral narratives between the client
and practitioner, and between practitioners, that the practical
wisdom, or intuition, resided," he said.
Floersch researched his study by spending
a year at a mental health center in the midwest serving people
with severe mental illnesses, such as schizophrenia and manic
depression. The title of the book stems from the three main areas
in which the social work case managers helped their clients-managing
their medications, their money and their interactions with other
people.
The case managers were required under state
policy to treat clients using a method known as strengths case
management, which focuses on a client's strengths and desires,
rather than on his or her problems. But Floersch noticed that
the case managers frequently used the categories of "high need"
and "low need," for example, in talking about clients, terminology
that doesn't exist in the strengths case management theory.
"In that instance I make the argument that
the situated language of high and low need helps the case manager
to recover an older clinical language that used to help clinicians,"
Floersch said. "There was a need for language that would help
the social worker think about why one client can do tasks for
himself and another can't. Since strengths case management does
not supply that language, managers made up the language of high
need or low need, and that helped them categorize client needs."
Similarly, the social workers would use
the phrase "gets it" in describing clients, meaning that a client
understands the connection between taking medication and staying
out of the hospital.
"There's no theory in strengths case management
that helps the clinician understand why someone would just stop
taking their medicine, even if they knew they wanted to stay out
of the hospital," Floersch said. "So 'gets it' is a term they
invented to describe the reality they could see."
Floersch believes his book carries significant
implications for the practice of social work.
"I think it's important to make the practitioner
aware of situated knowledge," he said. "It's there, you have to
have it. And don't leave the university thinking that theory is
going to do all the work for you."
Nor is interest in Meds, Money and Manners
limited to the social work field. Among those to have "blurbed"
the book are Elizabeth Lunbeck, an historian at Princeton University,
and Philippe Bourgois, an anthropologist at the University of
California, San Francisco. Floersch is pleased that interest in
the book cuts across academic disciplines but not surprised. He
notes, for example, that most histories of the social work profession
are taken from practitioners' written case notes. But his findings
show that much of the practice takes place in oral communications.
"I wanted to demonstrate that you can't
write the history of social work practice just from case notes,"
he said. "You have to at least qualify, to the extent possible,
that much of social work is everyday, lived experience, and historians
often don't have access to that. The study of social work practice
requires both historical and ethnographic methods."
Finally, Floersch said, studying situated
knowledge often provides clues to shortcomings in social policy.
At the mental health center he studied, case managers were required
to use a theory of treatment that did not provide language for
the everyday situations they encountered.
"What you have to make up on the job is
often what the social policy restricts you from doing in the first
place," he added.
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