Official proceedings of the annual meeting: 1923

SOCIAL CASE METHOD IN HEALTH WORK-THORNTON

25

It can be shown that some work of case-method nature underlies the foundations
of mass operations, but it is generally agreed that mass operation as such is performed
with a technique different from case technique. Yet the two must be often combined,
and it would be of real importance to case-method exposition to show that campaigns
and crusades and broadcasting are more effective when followed by case work with
individuals and with situations in which individuals are interlocked. It is, however,
in the field of health work which deals primarily with the individual; that is, in medical
practice proper, that a special case technique is needed. The phrase "co-operative
participation by the patient in the care of his own health" has been employed to picture
headline fashion a need which is forcing radical changes in medical practice.
Think just a moment of a few of the attributes which present-day medicine
requires of the patient. I fancy even fifty years ago, before anesthetics and trained
nursing were developed, that the attributes a patient needed most were courage and
endurance. Today intelligence and perseverance can, I believe, be put at the head of
the list. The prescription of a moder practitioner for the care and management of
conditions like rickets, gonorrhea, or diseased joints, requires a fairly high level of
intelligence, not only on the part of the patient, but also of his family. A very high
degree of perseverance is also required in many kinds of maladies where long, tedious
treatments are called for-the correction of posture, the correction of any habit, whether
of our muscles, glands, or nerves. Syphilis is typical of certain conditions which require
both perseverance and intelligence on the part of the patient; treatment is unpleasant
and often shows little result, is long drawn out and frequent, and all the while the
patient may feel no pain or disablement. These problems cited are old in medicine,
but the part which the patient is asked to play in present-day treatment of these old
problems is becoming far greater and more rigorous. Wherever medicine is practiced,
more and more participation is being demanded of the patient. At the same time,
also, this patient is being individualized and studied as he never has been before.
Two facts are recognized simultaneously: that each applicant presents a unique problem, and, to a far greater extent than had been thought, there resides within the applicant the means for solution of his problem.
A case technique is used to seek the factors, especially those in the client's thought,
his view of his own plight and of the people and things connected with him, and of
previous events and actions that have induced his present state. Furthermore, a
case technique is used to perform certain parts of treatment, explicitly and mainly
those parts modifying and regulating habits and those controlling the things and people
associated with the client. In major aspects the technique used for suchstudy and
treatment appears to me identical with that being learned and used in what we are
calling "social case method," which is that of standard social work.
It seems then to follow from the argument thus far that the use of the so-called
"social case method" in medicine is hardly to be described as supplementary to the
skill of another profession. The method seems necessary for the performance of component and integral, rather than of supplementary, parts of the service. That is to
say, the physician-the practitioner-as distinguished from the sanitarian, has always
practiced case method. Case method emphasizes what is unique, singular, special
among individuals, while mass method emphasizes what is common to many and
general. Each patient comes out of a different background and presents a condition
peculiar to himself. He may resemble many, but the best medical tradition regards
him as individual and unique. The more he is thus regarded, the more his ability as a