Harriette C. Johnson

Violence and Biology: A Review of the Literature

Experts agree that the origins of violence are multifactorial, involving the complex interactions of macro-, meso-, and micro-system factors. The roles of cultural, economic, and family factors have been noted extensively in the social work literature, but the contributions of biological factors to violence have been overlooked. The author reviews evidence pertaining to the role of biology in interaction with the myriad other forces that converge in acts of violence. Social work administrators as well as direct practitioners need such knowledge to make informed judgments about the role of social work in violent situations. Implications for practice are discussed.

Strengthening the “Bio” in the Biopsychosocial Paradigm

Abstract Although for some time social work has paid lip service to the notion of “biopsychosocial” as a core concept for practice-relevant behavioral science, the literature suggests that the “bio” component is often neglected in social work curricula. This articles provides evidence of the need for biological content, considers obstacles to infusing biological material into existing curricula, and suggests alternative models for integrating biological knowledge into masters level social work programs.

Professional Beliefs about Parents of Children with Mental and Emotional Disabilities: A Cross-Discipline Comparison:

The views of social workers, child psychiatrists, and psychologists about parents of children with mental, emotional, and behavioral disorders were compared in this study. The Providers’ Beliefs About Parents questionnaire was used to measure views about parents’ competence, parents’ pathology, parents’ credibility, parents’ role in the etiology of childrens problems, information sharing with parents, giving explicit directives to parents about how to help their children, and related child mental health issues such as use of psychotropic medication with children and adolescents and perceived importance of research-based knowledge about child and adolescent psychopathology. Variables most associated with parent-friendly beliefs and attitudes were endorsement of a neuropsychological orientation and familiarity with parent support groups. Views of respondents did not differ by ethnicity, gender, or parental status. Child psychiatrists were most in agreement with parent-friendly attitudes and beliefs, clinical social workers were least in agreement, and psychologists were midway between the other two groups.

Neuroscience in Social Work Practice and Education

Abstract In the past two decades, advances in neuroscience research have revolutionized the scientific communitys understanding of branehavior connections. Social work is now taking note of this trend. Specialists in substance abuse, addiction, and co-occurring diagnoses are beginning to relinquish long-held beliefs in mind-body dualism in favor of a truly integrated biopsychosocial understanding. This article identifies challenges related to social work and argues that neurobiological knowledge is essential for a biopsychosocial understanding of substance abuse and addiction, other mental disorders, co-occurring conditions, and human behavior. It gives examples of drawing on neurobiological knowledge for practice applications. These include educating users, families, and providers about neurobiological aspects of substance abuse (psychoeducation); using neuroscience research on mental illness and addiction to develop integrated approaches for dually diagnosed persons; and considering a range of medication options to alleviate cravings and reduce relapse.

WHERE IS THE BORDER? CURRENT ISSUES IN THE DIAGNOSIS AND TREATMENT OF THE BORDERLINE

Differential diagnosis of subtypes of individuals meeting criteria for borderline personality disorder has received only limited attention in the recent social work literature on the borderline. Whether the borderline disturbance is moderate or severe, the condition may overlap with several “borders,” suggesting that borderline personality disorders are a heterogeneous group of conditions. Discrimination between different subtypes is necessary in order to help clients obtain the optimum combination of treatments.

The Disruptive Child: Problems of Definition

CURRENTLY LITTLE AGREEMENT exists among professionals on how to differentiate between various kinds of disruptive behavior in children. Is a child’s troublesome behavior evidence of antisocial character or attention deficit and hyperactivity, or is it simply oppositional? While awaiting definitions that can be widely agreed upon, social workers must continue to refer children for evaluation and treatment, coordinate a child’s treatment plan in the capacity of case manager, treat the child, and work with the child’s family. Differences of opinion about the nature of various problem behaviors, combined with the proliferation of evaluative methods and tools during the past decade, have made it extremely difficult to decide what the problem is, where to refer for evaluation, and what treatments are needed. Accurate diagnosis is important because different interventions are helpful, depending on the nature of the problem behavior. The literature on the damage that can result from inaccurate diagnosis is extensive.’ Questions of etiology, assessment techniques, and treatment choice have also been reviewed in the litera-

Book Review: Austrian, S. G. (2005). Mental Disorders, Medications, and Clinical Social Work (3rd ed.). New York: Columbia University Press. (308 pp.,

In the third edition of her text Mental Disorders, Medications, and Clinical Social Work, Sonia Austrian has compiled psychiatric information “for social workers by a social worker.” She endorses the terms “exploration, assessment, and intervention,” the threephase terminology that has largely replaced the “study, diagnosis, and treatment” lingo from the 1950s adopted by social work from medicine and psychiatry. One of the chief purposes of interventions according to Austrian is to increase clients’ coping and mastery, again an objective widely accepted today in social work education. In her introduction, Austrian sharply criticizes the medical model as a basis for working with people with mental disorders. She deplores what she perceives as diminishment of personhood by a contemporary mental health focus almost exclusively on biological causality and treatments for mental illnesses/disorders. However, she mostly adheres to psychiatric diagnostic categories and language despite her condemnation of the medical model as she defines it. In contrast to her dismay with mental health practitioners’ inattention to “the whole person-in-environment” (the guilty include mental health specialists such as psychiatrists and psychologists), the approach of enlightened helpers (social workers) is extolled. She asserts that we amplify information on environments that influence mental health functioning, while practitioners in these other disciplines do not (pp. 12). To borrow from the libretto of the musical My Fair Lady based on Shaw’s Pygmalion, “Why can’t others be more like us?” Undoubtedly, a fair number of non-social-work mental health specialists do have the faults attributed to them by Austrian, and undoubtedly, the categorical approach to assessment can reinforce these faults. It is surprising, however, that she does not explicitly embrace the dimensional approach to assessment endorsed by so many in the disciplines she criticizes (psychiatry, psychology). A large cohort of psychiatrists for two decades have challenged the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) categorical approach in major publications and have advocated a dimensional approach instead. The challenge is hardly unique to social work. Austrian’s text is written in a clear, simple style and (apart from overuse of ego psychology jargon) reads easily. Chapters are devoted to groups of DSM-diagnosable disorders including anxiety, mood, somatoform/factitious, dissociative, schizophrenia, substance related, eating, personality, and delirium/dementia/amnesia. Using an easy-to-follow standard psychiatric convention, chapter format includes a brief introduction to each family of diagnosable disorders, definitions, epidemiology, etiology, assessment, differential diagnosis (despite her repudiation of the term “diagnosis”), clinical course, and intervention. The intervention sections in each chapter include some of the following: medication; psychotherapy; family and group sessions; and, sometimes, attempts to reduce environmental stressors. In addition, two chapters are written by others: a clinical psychologist (psychodiagnostic and psychoeducational testing) and a psychiatrist (medications). The text is targeted to social work students and beginning social workers. Austrian appears to succeed in conveying information at the beginner level. Perhaps the strongest feature of this book is its readability. By and large, the information is basic and introductory, heavily weighted to specific “practice wisdom” directives typical of the better social work introductory practice texts (my judgment here can be deconstructed as agreement with many of Austrian’s practice principles!). For example, she is to be commended for her emphasis on assessment of collaborating with clients in “determining what is the matter” (Meyer, 1993, as cited by Austrian), as contrasted with formulating a diagnostic opinion and planning interventive responses unilaterally on the basis of the worker’s “professional expertise.” A collaborative approach to assessment and problem formulation suggests not only that clients know a lot about the most troublesome issues they struggle with but also that their own views of these issues must be given credence and priority by workers and that workers must learn from clients as well as the converse. Several attributes of this book appear to limit its usefulness.