Handbook of Social Work Practice with Vulnerable and Resilient Populations

Alex Gitterman

• Publisher: Columbia University Press
• Year: 2014
• ISBN:
  9780231537018
• Edition: 3
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

When community and family support systems are weak or unavailable, and when internal resources fail, populations that struggle with chronic, persistent, acute, and/or unexpected problems become vulnerable to physical, cognitive, emotional, and social deterioration. Yet despite numerous risk factors, a large number of vulnerable people do live happy and productive lives. This best-selling handbook examines not only risk and vulnerability factors in disadvantaged populations but also resilience and protective strategies for managing and overcoming adversity. This third edition reflects new demographic data, research findings, and theoretical developments and accounts for changing economic and political realities, including immigration and health care policy reforms. Contributors have expanded their essays to include practice with individuals, families, and groups, and new chapters consider working with military members and their families, victims and survivors of terrorism and torture, bullied children, and young men of color.

CHAPTER 1

Social Work Practice with Vulnerable and Resilient Populations

ALEX GITTERMAN AND LAMBRINE A. SIDERIADIS

Through our teaching and practice experiences, we have become distressed by the increasing degradation and distress faced by large sectors of the client population served by social workers. Students and professionals confront daily the crushing impact of such problems as mental illness, substance abuse, disability and death, teenage pregnancy, and child neglect and physical and sexual abuse. Clients suffer from the debilitating effects of such life circumstances as homelessness, violence, family disintegration, and unemployment. The miseries and human suffering encountered by social workers in the new millennium are different in degree and kind from those encountered in the 1960s, 1970s, 1980s, and 1990s. The dismantling of the welfare state, the consequences of welfare “reform,” and foreclosures are examples of newly devastating social phenomena.

Social workers in practice today deal with profoundly vulnerable populations, overwhelmed by oppressive lives, and circumstances and events they are powerless to control. The problems are often intractable because they are chronic and persistent, or acute and unexpected. When community and family supports are weak or unavailable and when internal resources are impaired, these populations are very vulnerable to physical, cognitive, emotional, and social deterioration. Yet, in spite of numerous risk factors and vulnerabilities, a surprisingly large number of children, for example, mature into normal, happy adults. Why do some people remain relatively unscathed and somehow, at times, miraculously manage their adversities? Why do some thrive and not simply survive in the face of life’s inhumanities and tragedies? To more fully understand the human experience, this book examines vulnerability and risk factors as well as resilience and protective factors.

Defining and Explaining Life Conditions, Circumstances, and Events

After a brief introduction about the respective population, contributors analyze the definitions of the life condition, circumstance, or event. What are the different political and theoretical definitions and explanations of the condition, circumstance, or event? What are the effects of the definitions and explanations on the larger community, service providers, and service users? With certain “personality conditions” such as chronic depression, schizophrenia, and borderline personality, and with certain addictions such as alcoholism, growing evidence suggests potent predisposing genetic, biochemical factors. Researchers’ studies have, for example, analyzed the life careers of identical twins separated at birth and have used other tracking designs to find significant genetic linkages to alcoholism (Cloninger, 1983, 1987; Doweiko, 2006; Palmer et al., 2012), bi-polar disorder (Gallitano, Tillman, Dinu, & Geller, 2012), depression (Pirooznia, Seifuddin, Judy, Mahon, Potash, & Zandi 2012), and schizophrenia (Gejman, Sanders, & Duan, 2010).

These conditions have in common certain genetic and neurochemical predispositions. With alcoholism, for example, serotonin and dopamine, major neurotransmitters used by the central nervous system, have been associated with depression. Research suggests that chronic alcohol use decreases the number of dopamine receptors in the brain and reduces serotonin turnover. Decreased levels of dopamine and serotonin have been linked to depression and increased risk of violent behaviors, such as suicide, among chronic alcohol users (Doweiko, 2006). The brain also manufactures natural substances that have painkilling properties. Kosten and George (2002) suggest that narcotic analgesics mimic the action of these natural substances resulting in a sensation of drug induced euphoria when the user is not experiencing pain. Thus, neurochemical imbalances appear to be associated with various life conditions.

With AIDS, our vulnerability to parasitic relations with microorganisms from within and without is ominous. AIDS continues to be one of the leading causes of death among all Americans aged 25 to 44. The biological reality of AIDS demonstrates how defenseless our immune systems can be to parasitic and toxic environments. With other life conditions such as anorexia and bulimia, the genetic linkages have not yet been discovered. Thus far, personality and family dynamic explanations are most frequently offered to explain these conditions. We should not, however, be surprised if in the near future genetic and biochemical predisposing conditions are discovered. With obesity, however, there is clear evidence of genetic influence (Garaulet, Ordovas, & Madrid, 2010; Spruijt-Metz, 2011).

Chronic physical illnesses and disabilities and learning and developmental disabilities reflect problematic physiological and neurological functions. Developmental disability often has genetic determinants (Butler & Meany, 2005). Similarly, possible genetic bases for the condition of Alzheimer’s disease (Kuller & Lopez, 2011) and cancer have also been identified (Hall, 2012). Even though many of the presented life conditions have genetic determinants, they may not be inherited. Certain toxic environmental agents can damage and disrupt normal genetic processes. A mother abusing alcohol, for example, may give birth to an infant with fetal alcohol syndrome, which is often characterized by developmental disability, facial deformity, etc. Radiation can cause infertility and birth defects (Cwikel, Gidron, & Quastel, 2010; Sabin et al., 2012). Whatever the cause, physiological and cognitive impairments severely curtail human activities. People with these life conditions often suffer for protracted and indefinite time periods. Their neurological and physiological disabilities create limitations and burdens of varying severity.

Genetics, biochemistry, neurological loading, and predisposition to a condition do not imply, however, that a person will necessarily acquire the condition or, if the person does acquire it, be debilitated by the condition. The resources and the limitations in the person’s environment, i.e., family, relatives, friends, workmates, neighbors, community, organizations, and spiritual life, all transact with individual constitutional resources and limits. On one end of the continuum, high genetic and organic loading may push certain people toward alcoholism, depression, borderline personality, or schizophrenia regardless of how protective and supportive the environment (although a supportive environment can certainly cushion its consequences). Similarly, a youngster born developmentally disabled or severely physically disabled has to function within the constraints of these neurophysiological impairments. Although supportive environments can provide essential instrumental and expressive resources, they cannot eliminate the disability itself. On the other end of the continuum, severely impoverished and invalidating environments may push certain people toward alcoholism or depression no matter how well they are constitutionally endowed. A youngster repeatedly exposed to malnourishment and physical and emotional abuse may succumb to these harsh environmental assaults with alcoholism or depression despite limited, or even no, genetic predisposition. Studies of psychiatric epidemiology have demonstrated that the lower the social class, the higher the rates of mental illness and the greater the severity of the mental illness (Mauksch, Reitz, Tucker, Hurd, Russo, & Katon, 2007; Sheperis & Sheperis, 2012).

Family, community, and society dysfunctions provide the most frequent theoretical explanations for the distressing life circumstances and events presented in this book. Unplanned pregnancies, for example, are associated with poverty, repeated academic failures, and pervasive lack of opportunities with consequent hopelessness and despair. Community and family norms reinforce or mitigate the personal impact of poverty. In intimate partner violence, the female as victim of her male partner is the principal problem. A pattern of control over the female maintained by physical, emotional, and sexual abuse is associated with violence and battering. On a more general level, sexism and sex-role socialization surely contribute to, if not induce, intimate partner violence. Boys observing their fathers abuse their mothers are more likely than otherwise to be violent toward their own wives (McClennan, 2010). Clearly, intimate partner violence is learned behavior that has to be unlearned.

No citizen, regardless of class or social status, is safe from crime. Women, children, and the elderly, especially those living in poor communities, are at highest risk of victimization by crime. They simply are easier prey! Perpetrators tend to be caught in a cycle of family poverty, illiteracy, drugs, racism, child abuse, and family violence. When they are incarcerated, they usually return to their community further damaged, hardened, and embittered. They often become socialized to a lifetime of crime and intermittent incarceration. In poor communities, both the victim and the perpetrator are trapped in the mire of despair. Similarly, the elimination of low-income housing, underemployment and unemployment, sharply curtailed and disappearing benefit programs, lack of health insurance, foreclosures, and deinstitutionalization have all conspired to create homelessness and an unconscionably large number of adults and children deprived of the basic human need for shelter.

The life event of being born black in the United States creates a trajectory with profound impact on education, employment, housing, health, and family life. For example, black Americans suffer higher death rates from most major causes. They receive less and poorer health care and die four to five years earlier than white Americans (National Vital Statistics, 2010). Moreover, major changes have taken place in the composition of black American families over the last several decades. In the 1950s, 78 percent of black families were composed of couples, compared with only 35 percent in 2010. During the same period, the presence of couples in white families witnessed a smaller decline, from 88 percent to 75 percent (U.S. Census Bureau, 2012).

When people find themselves in distressing life circumstances and dealing with stressful or traumatic life events, some become helpless, hopeless victims. They live on the margin struggling for day-to-day survival. Others somehow miraculously and astonishingly manage deeply adverse situations as survivors, not as victims. Various theories attempt to explain what differentiates a victim from a survivor. Unfortunately, most of our theories have focused on the deficits and negative aspects of individual and family life. Since many of our theoretical approaches are based on people who do not rebound well from life’s miseries, we know much less about those who do and how they do it. Rutter (1971) eloquently captures this pattern:

There is a most regrettable tendency to focus gloomily on the ills of mankind and on all that can and does go wrong. It is quite exceptional for anyone to study the development of those important individuals who overcome adversity, who survive stress and rise above disadvantage. (p. 7)

By developing knowledge about the positive as well as the negativ...